Page:The American Cyclopædia (1879) Volume IV.djvu/525

CHOLERA 513 move the fetor of most animal discharges, either natural or the products of disease. They de- odorize sewage, and may be used for the disin- fection of rooms, and as a cleansing material for floors or furniture (2 ounces to a gallon of water). But, not being volatile, they must be aided by aerial and diffusible disinfectants, the best of which are chlorine, iodine, and car- bolic acid. The unpleasant odor of chloride of lime or soda may be overcome by the addi- tion of a small quantity of nitro-benzole. Iodine placed in saucers in different parts of the sick room evaporates spontaneously ; and if its odor can be detected, it is in sufficient quantity to disinfect the air. Or Ib. of carbolic acid may be mixed with 10 Ibs. of wet sand, placed in shallow vessels in various parts of the room, and renewed when its odor has disappeared. It will be seen that the attempt to obtain a disin- fectant of universal application, and capable of fulfilling every indication, will always be attend- ed with disappointment. Some, like the chlo- ride of soda and the sulphates of iron and zinc, prevent fermentation and putrefaction ; others, like iodine, chlorine, and carbolic acid, resolve the products of decay and decomposition into harmless substances. Although the first stage of cholera cannot be distinguished from a pro- fuse watery diarrhoea, the treatment is very simple. In the first place, it should be fully believed that nine tenths of all cases of diar- rhoea occurring in the summer season, even in cholera times, are not Asiatic cholera, and never will be. Even if the case be one of cholera, absolute repose in bed, between thin blankets, will cure at least one half of all cases without any medicine ; then one or two grains of sulphate of iron, with or without a quarter or half a grain of opium, every two or four hours, will cure a great many more. In the severest and most neglected cases no treat- ment is of any avail ; but from 5 to 20 per cent, of these will recover if not too much in- terfered with. The preventive measures are equally simple. As drinking cholera water is almost the only cause, a rather free use of salt and vinegar, which are the great domes- tic disinfectants, may be all that is essential. It is certainly unnecessary to abstain from ripe and good fruits and vegetables, while all sweet, fresh meats and farinaceous sub- stances are beneficial. Even of those per- sons who swallow water into which chol- era dejecta have found their way, all with healthy stomachs, containing healthy acid gas- tric juice, and food in the process of normal digestion, will escape. In some instances 15 out of 20 have escaped. But if cholera water be swallowed on an empty stomach some hours after taking food, then the cholera poison will set up its distinctive changes in the epithelium of the stomach, which speedily extend to that of the intestines, so that a robust, healthy, and otherwise prudent person may quickly succumb to the disease. Or, if more of such water be swallowed than the stomach will easily con- ! tain, some of it will at once pass to the small ! intestines, and their contents being alkaline, the specific action of cholera matter will at once take place. Hence persons with weak digestion, and those suffering from depression of the nervous force, whether following exces- sive fatigue or a debauch, are especially apt j to be attacked. Therefore the poor of large I towns, who are ill fed and suffer from want ! of a healthy acid secretion from the gastric ! walls, are especially liable to the disease, i Hard drinkers increase their risk by drinking large quantities of water after a debauch, to quench their unnatural thirst. But even all these will escape if they be fortunate enough not to drink foul cholera water. The pathol- ogy of the disease is eqilally simple. The cholera poison first produces a paralysis of the yaso-motor nerves and capillaries of the stom- ach and bowels, allowing the watery particles of the blood to exude as if from a relaxed and sweating skin. Next, the epithelium of the gastro-intestinal mucous membrane is shed in large quantities, leaving the latter bare and almost raw, red, and filled with blood. In this stage strong stimulants and irritants are very injurious, while a few teaspoonfuls of arrowroot with a little brandy, given very fre- quently, will prove quite beneficial ; and sweet oil and lime water is far better than castor oil, or other so-called eliminatives. As the dis- ease advances the blood is drained of much of its serum or water, becomes thick, and stag- nates in various places. It is no longer prop- erly oxygenated, and becomes dark, marking the third stage of the disease, followed by exhaustion and perfect collapse ; from which a small number may slowly rally, if care- fully supplied with drink and weak stimu- lants in small quantities, frequently repeated. Of these, some will pass into a typhoid state, through retention of effete materials in the blood, especially of urea, from complete in- action of the kidneys. Then diuretics, more particularly nitre, cantharides, digitalis, or nux vomica, will save a small proportion. The great point in the whole course of the disease is not to be too hurried or agitated, nor too anxious to do too much and too quickly. Ab- solute rest and warmth, the careful use of food and weak stimulants, aided by small quan- tities of astringents and opiates, especially vine- gar of opium, with an absence of all unmanly haste and fear, will save a large number who would fruitlessly rely upon vaunted specifies. Dr. Macpherson, who had seen and treated thou- sands of cases, when attacked himself at night, remained quietly in bed, took nothing but a little arrowroot and brandy with a few drops of laudanum, and occasional sips of carbonic acid water. In the morning he directed that an old and experienced medical friend should not be sent for until after he had finished his break- fast, and the usual time for going on his rounds had arrived. With these simple means, and the careful handling of an old and tried hospi-