Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    170/976 (page 150)
    during Cholera epidemics, and, though some of the cases may he harm- less, many of them do ultimately pass into Cholera. The necessity of checking such discharges should he earnestly impressed upon the medical practitioner. Stage of Development.—Evacuation Stage.—It is a matter of com- mon observation that the attack commences with purging, very often early in the morning; vomiting seldom comes on till later/ The alvine evacuations are copious and fluid. The first stools, generally, consist of the ordinary contents of the intestines mixed with much liquid. The patient often describes them as rushing from him in a full stream. Often so great is the purging, that he sits sometimes on the close stool or privy, until several pints, or even quarts of fluid have passed from him. Generally the evacuations are repeated and frequent; they are soon attended with a feeling of exhaustion,' so that the patient is glad to get to his bed again. This excessive watery purging characterizes the onset of Cholera. It is frequently painless, but not always so; there- fore we should not suppose that a patient has not Cholera because he has griping and pain. So excessive are these evacuations, that in two or three hours, or less, an ordinary-sized stool-pan will be nearly filled. With the exception of those first passed, they are of a light straw or pale drab colour. The surgeon should not be thrown off his guard because the evacuations he sees in mass are somewhat coloured. There is often feecal matter enough in the first evacuations to colour the subsequent stools passed into the same unemptied vessel. The quantity and con- sistence of the discharge and the effect upon the pulse are of infinitely more importance than the shade of colour. The name of rice-water stool has been given to the genuine unmixed Cholera evacuation, and if collected separately, after the first two or three have been passed, the discharges do, indeed, resemble water in which rice has been boiled. It is a thin, pale, slightly opaque or slightly turbid fluid, depositing a sediment on standing, which is like fine, minute, flaky particles of rice broken down by long boiling. Occasionally in the evacuation stage, the fluid is whitish or somewhat milky, or of shades varying between this and the whey-like colour before mentioned. With purging, but generally beginning later than it, is combined vomiting. The fluid vomited, if unmixed with ingesta, is clear and watery, often in quantities of a pint or more, and generally ejected with force. The vomiting is less constant in its intensity than the purging, and some- times is very slight, occurs at irregular intervals, and is readily excited by • medicine or drink. When the rice-water evacuations appear, cramps generally set in, not often before this ; they are most frequent