Dietetic Prophylaxis

Cholera is a zymotic disease, the germs of which can only enter the system by the mouth, and they are spread chiefly through the agency of contaminated water used for drinking or washing purposes. All raw foods and cooking utensils washed in such water are liable to become infected.

No raw food or drink of any kind whatsoever should be taken. In many cities it is customary for the local health boards to prohibit the sale of raw fruits while a cholera epidemic is in progress. It is a standard rule to cook all food and boil the drinking water.

Tea, coffee, chocolate, and cocoa should be made only with water previously sterilised by boiling. Sterilised water only should be used for cleansing the teeth. Water should not be cooled by direct contact with ice, or the latter should be newly made from distilled water. No beer, ale, soda water, or artificial mineral waters should be used if there is any chance of contaminated river or well water having entered into their manufacture. Milk may become infected from washing the milk cans in impure water.

Acid beverages should be freely drunk, for the cholera germs do not thrive in acid media, and if accidentally introduced into the stomach they may perish there if the gastric contents always have an acid reaction. Sour lemonade made with ten or fifteen drops of dilute sulphuric acid has an excellent reputation as a prophylactic against cholera. Vinegar, sour pickles, or lime juice may be taken for the same purpose.

Indigestion, perhaps because it promotes alkaline fermentation in the stomach, favours infection, and hence during the prevalence of an epidemic it is desirable to eat only plainly cooked, wholesome food, and to avoid all excesses in eating and drinking. All foods, such as pastry, fried dishes, etc., having the reputation of easily disagreeing should be eschewed.

During the prevalence of an epidemic of cholera it is highly important to avoid eating anything likely to produce diarrhoea, and all indigestible substances, such as meat, eggs, fish, or milk not strictly fresh, unripe or overripe fruit and vegetables, must be absolutely forbidden.

Symptoms

The symptoms of cholera are usually divided into four typical periods, which are those of -

1. The premonitory diarrhoea.

2. The period of profuse serous diarrhoea.

3. The algid stage, or that of collapse or asphyxia.

4. The reactionary stage.

The dietetic treatment varies with each of these stages of the disease. It is imperative that the patient be kept absolutely quiet in bed throughout all the active phase of the disease.

First Period

There is alkaline watery diarrhoea with frequent profuse stools, nausea and, usually, vomiting. The stomach is too irritable to retain food, and undigested broths and milk only furnish culture media for development of the cholera bacilli and production of toxins.

During this period only light fluid food in very small quantity should be eaten. Nothing can be worse than overeating. Whey, gruels, bouillon, or pancreatinised milk only are permissible.

The contents of the stomach should still be kept acid, and sour lemonade, lime juice, dilute acid phosphates, dilute vinegar, and dilute hydrochloric acid, twenty or thirty drops in a half tumblerful of water, or diluted aromatic sulphuric acid in similar dosage, are to be swallowed from time to time. The acids should be given through a glass tube to spare the teeth.

Hyperacidity of the stomach artificially produced favours the passage of a portion of the acid stomach contents into the small intestine, so that its normal alkalinity is, to some extent, neutralised.

The duodenum indeed may temporarily acquire an acid reaction, which is inimical to the development of cholera germs.