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Cholera

quinine, sometimes, food, trouble, water, doses, dose, hours, diet and bark

CHOLERA MORBUS.—An acute affection of adults or adolescents, resulting from indiscretion in diet. It may be due to the quantity, but is more often due to the quality and kind of the food. The numerous component dishes of a single meal are often, when mixed together in the stomach, the means of generating a disturbance. In the summer there is more apt to be trouble from the food than in the winter, because many articles of diet are somewhat decomposed as the result of the heat, and contain toxic substances. Then, again, the body is frequently subjected to a sudden cooling by iced drinks. Sudden variations of outside temperature is an important factor in some people. Among the great variety of dishes which may produce these gastrointestinal disturbances may be mentioned fatty food, sausage, cheese, salmon, lobster, mushrooms, pickles, sour milk, and unripe fruit. Sometimes the first symptoms of the trouble may be noticed immediately after the meal, sometimes not for a few hours or not until night. They consist of severe gastric and abdominal pains, fever, sometimes chills, vomiting (first of blood ; later of mucus, water, and bile), and of diarrhcea which often persists until the stools become watery. The patient finally becomes weak and exhausted. The cause of these disturb ances is a slight inflammation of the stomach and intestines, which may last several clays, and then entirely disappear. If the condition is neglected, however, the catarrh becomes chronic, and results in many cases in more or less continual digestive disturbances. One of the noteworthy accom paniments of the trouble is extreme thirst, which is due to the marked loss of water from the body in the vomitus and stools. The appetite for solid food, on the other hand, seems to be entirely lost. The urine is also scanty in amount. A loss of several pounds in weight may result in a few days as a consequence of one of these attacks.

The elements of treatment are very simple : rest in bed, and the con tinued application of heat to the abdomen. The heat should preferably be dry, and may best be applied in the form of hot plates, sand-bags, or hot water bottles. The diet should be fluid and cold, and given in small quantities. The most suitable articles are iced milk and chocolate, tea, cracked ice to overcome the nausea, and cold gruels. It may benefit an adult patient to abstain entirely from food for twelve hours. It is advisable to administer a brisk cathartic at the very first signs of trouble, in order that the decomposing food which predisposes to the catarrhal conditions may be thoroughly evacuated from the intestinal tract. Castor-oil is usually effective. As soon as free evacuations have been secured, the physician may administer medicines to again quiet the digestive canal. A moderate and carefully chosen diet should then be adhered to for a few days more. CHOREA.—See ST. VITUS'S DANCE.

CHOROIDITIS.—See EYE, DISEASES OF.

CIMICIFUGA.—The root of the black snakeroot, or Citniciluga racemosa, a plant about six or seven feet in height, growing in damp, shady places. It is used most commonly for St. Vitus's dance in children, acting very satisfactorily, especially when given with some preparation of iron and laxatives. Brain-ache is a sign to discontinue its use. Too large closes cause dizziness, with severe headache and general prostration.

CINCHONA.—The bark of a number of trees growing naturally in the northern and western parts of South America. Several varieties of these trees are utilised, and are extensively cultivated in various parts of India, especially in the Himalaya Mountains and in Ceylon and Java. There

are numerous preparations of cinchona used in medicine, all having the same action because of the presence of the active alkaloid quinine.

Quinine sulphate, in which form the drug is generally used, is a white crystalline powder, having a very bitter taste. Its most important use is in the treatment of malaria, in which disease it has a direct curative effect. This is due to the fact that quinine, even in very dilute solutions, is poisonous to the germs which cause the disease by invading the patient's blood-cells. It is best to precede the administration of quinine by a close of calomel, and then, starting four hours 'before the expected chill, to give five grains of quinine every hour for four hours, so that a large amount has been taken before the chill would naturally occur. If the dose is large enough, there is no chill. This treatment is continued long enough to eradicate the germs from the blood, other drugs being required in the convalescent stages. In severe cases it is sometimes necessary to administer quinine by injections under the skin or by rectum. To prevent infection in a malarial district, about six grains a day should be taken. Quinine is used also to reduce fever in other conditions, but it is not as satisfactory as some other measures. In combination with other drugs it is often given as a tonic. A large dose of quinine will cause ringing in the ears and some deafness. Certain people are very susceptible to its influence, and notice this disturbance after a small dose. People who live in malarial countries, and who are accustomed to take the drug, sometimes take enormous doses without any unpleasant effect. Very large doses. are said to have caused temporary blindness or deafness, and various eruntions on the skin.

CINNAMON.—The inner bark of several species of Cinnamontunt, plants growing in China and in Ceylon. The bark contains tannic acid and a volatile oil which gives it its peculiar aromatic odour and taste. Its principal use in medicine is to disguise the taste of less agreeable remedies. Cinnamon has a stimulating effect on the stomach and intestine, and is sometimes used in watery diarrhceas or in relieving distention. It is occasionally of service in controlling bleeding from the womb. The form in which the drug is usually given is as the water of cinnamon, the dose being a Nvi neg 1 assf ul or less, or as oil of cinnamon in drop doses. Large doses are poisonous, largely because of the presence of a high percentage of a phenol (eitgenol) in the volatile oil.

CIRCULATION.—See INTRODUCTORY CHAPTERS (pp. 156-157).

CIRCUMCISION.—Term applied to the operation for partial removal of the foreskin of the penis. Among the Jews this forms part of a religious ceremony. Under ordinary circumstances the operation is done when the preputial opening is too small or has become contracted by inflammatory processes, thus constituting an obstruction to the ready exit of the normal or pathological secretions from the urethra. In small children the condition is often congenital. Circumcision is not dangerous' in children when conducted by a properly experienced person and with appropriate precau tions. The wound demands careful attention as regards cleanliness. After urination the surrounding parts should be washed, and the wound itself dressed with a salve or lotion, and covered with aseptic gauze. The application should never contain carbolic acid. See also FORESKIN,