The sporadic or bilious cholera, known as Cholera Morbus, differs materially from that fearful pestilence Epidemic or Asiatic Cholera, notwithstanding there is something of a resemblance in appearance. It occurs principally in the summer and autumn, and is common in all parts of the country.

Diagnosis

The attack may be preceded by the ordinary symptoms of bilious derangement, such as, languor, nausea, oppression about the stomach, colicky pains, etc. More frequently, and as a general rule, it comes on suddenly, without any precursory symptoms. There is nausea, sudden and repeated vomiting, with a violent diarrhoea, first of faeces, then of a watery, bilious fermenting liquid, accompanied with tenesmus, violent burning, cutting, griping colic, particularly about the navel. The vomiting consists at first of the contents of the stomach, but at length a watery, slimy, or bilious fluid is discharged in larger or smaller quantities. Even after the vomiting has ceased, painful retching and gagging may continue. In violent cases, if the disease is not promptly checked, there may be a rapid prostration of strength, cold sweat, pale and haggard face, spasmodic and scarcely perceptible pulse and convulsions.

Causes

Taking cold suddenly in hot weather, intense heat long continued, violent emotions, unripe fruit, acrid, non-fermenting drinks, fat, rancid food, powerful cathartics, suppressed menstruation, gout or cutaneous eruptions.

Treatment.* - The principal remedies in the treatment of this disease are: Ipecac, Chamomilla, Arsenic, Colo-cynth, Veratrum, China, Dulcamara, Pulsatilla. The precursory symptoms, if there are any, will generally yield to one or two doses of Chamomilla. Should however nausea and vomiting with diarrhoea exist, a dose of Ipecac. repeated every hour or two, will be indicated. If these do not relieve in four or five hours, or the attack becomes fully developed, other remedies should be consulted, as Veratrum, Colocynth, etc.

Particular Indication.

Chamomilla

When the attack is occasioned by a chill or fit of passion, and where there is yellow-coated tongue, bilious diarrhoea, cramps in the calves of the legs, colic pains, or pressure about the navel.

Ipecac. is an important remedy, particularly in the commencement of the disease, when the vomiting seems to predominate.

Veratrum

If, notwithstanding the use of the preceding remedies the disease becomes fully developed, this is a most important remedy. The vomiting and diarrhoea are very violent, the countenance is pale and expressive of deep suffering, the abdomen is tender to the touch; excruciating pains in the region of the navel, cramps in the calves of the legs and fingers, coldness of the breath and extremities, and rapid prostration of strength. It alternates well with Ipecac.

* For general directions as to the administration of remedies, see page 12.

Colocynth is also an important remedy and is indicated by violent griping colic, bilious vomiting, green, bilious or watery diarrhoea.

Arsenic

Rapid prostration of strength, violent and painful vomiting, diarrhoea almost constant, small, weak, intermittent pulse, spasms in the fingers and toes, clammy perspiration, burning sensation in the region of the stomach, etc.

Dulcamara

Caused by changes of the temperature, iced drinks, &c; griping or cutting pain in the bowels, greenish diarrhoea and bilious vomiting.

Pulsatilla

In mild cases, where there is mucous diarrhoea, and where the attack was caused by indigestible food.

China

When the disease was occasioned by indigestible substances, unripe fruit, and where it occurs in marshy districts. There is prostration, vomiting, pressure about the abdomen, and brownish evacuations, containing indigestible food.

Dose

Three drops may be mixed in a tumbler of water, and a tablespoonful taken at a dose; or a powder or six globules may be taken on the tongue. In violent cases, a dose may be given every twenty or thirty minutes, until three or four doses have been taken, when, if indicated, other remedies may be selected, or those given in longer intervals, varying from one to three hours.

Diet And Regimen

The patient should be kept warm by means of blankets, bottles filled with warm water should also be applied to the feet, and in violent cases dry hot cloths, or a mustard poultice, may be applied over the stomach. The drink should consist of cold water, and the food of gruels.