Coelius Aurelianus says, the name is derived from bile, and luo. It is called also diarrhoea cholerica, felliflua passio, and by some of the ancients, ho/era.
Hippocrates divides this disorder into the moist and dry; and there is a kind of cholera morbus which frequently happens to children from dentition. Dr. Cul-len names it cholera, and defines it a frequent vomiting and purging of a bilious humour, attended with anxiety, gripings, and spasms of the legs. He ranks it in the class neuroses, and order spasmi. He observes two spe-cies: 1 Cholera spontanea, which happens in hot seasons, and without any manifest cause: 2. Cholera accidentalis, which occurs from too acrid materials taken into the stomach.
The intermittent, inflammatory, arthritic, and vermi-nose cholera, are considered truly symptomatic. The true species is most frequent in autumn, and happens chiefly to young persons, and its seat seems to be the whole volume of the intestines, but more particularly the duodenum and biliary ducts, as appears by the vomiting and stools, which are bilious.
The cholera and bilious diarrhoea are incident to the bilious and dry constitutions; for those of a phlegmatic and sanguine habit are more frequently liable to a different discharge. Those who are subject to a scorbutic acrimony, or those of a passionate temper, are the commonly reputed victims of the disease. In sultry weather it is most frequent: hence it is said by Bontius and Thevenot to be endemic in India, Muritania, Arabia, and America.
The true cholera attacks often suddenly; sickness, pain, flatulency, and distention of the belly, are first perceived, and are soon followed by frequent vomiting and purging of bilious matter; the vomiting and purging come on together, and continue very frequent, with violent pain. The matters voided are at first the remains of the food; afterwards bilious fluids, more or less mixed with frothy mucus, of a yellow, green, and, at last often a black colour; sometimes bloody, like the washings of flesh, extremely acrid, and almost corrosive. The pulse is frequent, and sometimes small or unequal; heat, thirst, and anxiety, now attend; cold sweats presently appear, and spasmodic contractions affect the extremities. In greater degrees of this disorder, the muscles of the belly, and, indeed, the whole body, are seized with spasms: ineffectual strainings to vomit, with almost continual urging to stool, usher in an hiccough, lividness of the nails, convulsive contractions of the legs and arms, and death sometimes within twenty-four hours.
In the dry species, there is a considerable distention of the stomach and intestines by wind, which is plentifully discharged both upward and downward with extreme anxiety, but without either vomiting or purging the remote causes are various; as acrid poison taken into the stomach, active emetics or purgatives, acrid, fermenting, or putrescent, drinks or diet, and violent passions.
The immediate cause is the irritation of the nervous coat of the stomach and intestines, which is communicated to the biliary system, occasioning the violent pain and the discharge.
Hoffman says, that the dangerous vomiting and purging which infants are thrown into from the vehement anger of the nurse, and those which follow the exhibition of arsenic, some other poisons, and the virulent cathartics and emetics, seem to be no other than the true cholera.
The dry cholera proceeds from a collection of acrid and flatulent humours in the stomach, by which the adjacent nervous parts are irritated and distended.
The cholera morbus must be distinguished from a bilious looseness, a dysentery, and the dry cholera. It is distinguished from the first by its rapid attack, its violence, and short duration; from dysentery, by the absence of the violent forcing pains, and the ineffectual mucous evacuations; and from the dry cholera, by the nature of the discharge.
It is often fatal in hot climates, though seldom in temperate ones. The more corrosive the matter discharged, the more intense the heat and thirst, the greater is the danger. Hippocrates observes, that if black blood and black bile are voided together, death is certainly at hand; and an exorbitant discharge of a green fluid, both upward and downward, fainting, hiccough, convulsions, coldness of the extremities, cold sweats, a small intermitting pulse, and the continuance of the other symptoms, after the looseness and vomiting cease, are mortal signs: yet, in this country, all these may concur from a common bilious vomiting, without danger, if they do not continue long after the discharges cease. Danger is extreme, if what is vomited smells like the internal excrements. If the vomiting ceases, sleep succeeds, and the patient seems relieved, there are hopes; if the disease continues more than seven days, it is seldom dangerous; but the best sign is a free discharge of flatus downward.
The general indications of cure are: 1st, To correct the acrid matter, and, if necessary, to expel it by art.
2d, To check the violent commotions. 3d, To strengthen the weakened organs. Cholera, strictly speaking, arises from a discharge of superabundant acrid bile. It is the disease of hot climates, and of intemperately warm weather; but similar symptoms are sometimes produced by poisons, by anger, or fermenting food and drinks. In all these cases mild diluting liquors may be given, and the management as in real cholera adopted. The only difference in practice arises from the advantages of giving opiates sometimes earlier and more freely.
In the true cholera, Aretaeus long since commended frequent small draughts of tepid water, to evacuate the present contents of the stomach; and when bilious discharges, loathing, and restlessness, afterwards come on, a quarter of a pint of cold water, to check the purging, to cool the ardent heat of the stomach, and to abate the thirst, may be given: this he advises to be repeated as often as the patient throws up what he drinks: and if fainting,with other symptoms of weakness, appear, a little wine may, he thinks, be added to each draught of water. Many since Aretseus have extolled cold water, and the more so, as the climate, season, and constitution of the patient are warm; for it cools, blunts acrimony, and restores the tone of the parts. In this country it may be given safely, if large draughts at a time are avoided; but toast and water is perhaps safer.
Sydenham commends a similar practice. He orders, if called in at an early period of the disease, a chicken to be boiled for a short time in three gallons of water; of this the patient is to drink freely, and a part is to be injected as a clyster, until the whole is consumed: thus the offending matter will be diluted and evacuated both by vomit and stool. The clysters may be repeated as often as they return, at least until the pain abates.
Instead of chicken water, as advised by Sydenham, barley water may be used, or water impregnated with any insipid mucilage; butter milk, which some prefer above every liquid; gentle acid drinks; or a decoction of oat (or other) bread, that is first toasted, until it is brown as coffee, but not burnt, may be employed: as much of this toasted bread should be boiled in the water as will render the decoction of the colour of weak coffee. Edinburgh Med. Essays.
These liquors should be plentifully drank, until the contents of the bowels are sufficiently evacuated to render the exhibition of opium safe.
If the pain and sickness be violent, and the vomiting slight and ineffectual, from a quarter to half a grain of tart. emet. may be given in part of the drink, every three or four hours; or, if the discharge by stool be inefficient, such mild laxatives as the stomach will bear may be added. Manna is well adapted to this purpose, and may be given with tamarinds.
When the strength is reduced by the evacuations, and the primae viae cleared, the vomiting and purging may be checked with opiates. Sydenham directs the tinct. opii, from twelve to twenty drops, or more, in a little mint water, to be repeated two or three limes a day, or oftener, as the urgency of the pain or frequency of the evacuations require, and to be continued, at least night and morning, until the patient recovers sonic degree of strength. Opiates are often, however, in a moment rejected; and, in this case, a small pill of solid opium will elude the action of the stomach, and check the vomiting. This, too, sometimes is rejected; and we have then given with advantage, a teaspoonful of elixir paregoric frequently, which is lost about the fauces, but its effects are communicated by degrees to the stomach. •
If the disorder hath continued some hours, and the patient is already weakened, the opiates may be immediately given and continued, as already directed. If the symptoms of weakness are extreme, the pulse weak and intermitting, and convulsions approaching, twenty-five or thirty drops of the tincture of opium should be given in a large spoonful or two of strong cinnamon water, and after it a draught of whatever liquor the patient hath to drink, mixed with an equal quantity of wine.
The saline draughts given in the act of fermentation often allay the vomiting very soon: they may be repeated after each evacuation upwards, and to these some tincture of opium may be added.
A free use of the columbo root will be sometimes an adequate remedy against this dangerous disease. It is said rarely to require any means to be employed for promoting the discharge of bile, or to cleanse the primae viae, previous to its administration. As soon as assistance is demanded, from 3 ss to 3 ij. of this medicine, finely powdered, may be given in a glass of peppermint water, and repeated every three or four hours, according to the urgency of the symptoms. In hot climates this remedy is almost a specific: it soon abates the violent evacuations; and by continuing it a few days, every other symptom vanishes.
Hoffman observes, that in choleras and bilious diarrhoeas, especially such as are excited by passion, it is necessary to abstain from sudorifics and a sudorific regimen, particularly at the beginning; these being apt to bring on a violent rheumatic or arthritic affection.
The cholera morbus sometimes destroys the patient in twenty-four hours. If it is cured, the patient is much relieved in two or three days: it rarely continues a week, except it is the forerunner of some other disease. See Aretaeus, Coelius Aurelianus, Hoffman, Fordyce's Elem. p. 2. Edinb. Med. Ess. vol. v. Wallis's Sydenham. Cullen's First Lines, vol. iv. 39.
Cholera sicca. See Colica.