History and treatment of the malignant cholera, as it prevailed at Vienna : from the 12th August, 1831, to the 15th February, 1832 / by John Freeland Fergus.

Date:
[1832?]
Catalogue details

Licence: Public Domain Mark

Credit: History and treatment of the malignant cholera, as it prevailed at Vienna : from the 12th August, 1831, to the 15th February, 1832 / by John Freeland Fergus. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    circulating systems predominant, who had just reached, or were a little past, their prime, were much predisposed. The gin- drinkers who had not carried their practices so far as materially to affect their consti- tutions, were often affected by it. Women above 40, in these circumstances, were sometimes seized with it. It became more seldom in proportion to the distance from the above-mentioned constitution. In general it occurred suddenly after some great excess. The patient felt a sud- den giddiness, and dropped down, or he felt a tremendous pain in the region of the stomach, or a sudden stoppage of his breath. In most cases there was one or two fits of vomiting or purging at the mo- ment of attack, or these were altogether wanting. In a few moments the severest tonicspasms attacked first the lower, then the upper extremities, and then the muscles of the abdomen, which were drawn in as Hat and hard as a plank,—these were accompanied with greatpain. Almost immediately the skin began to cool and to take on a blue colour, which speedily increased to an icy coldness and deep purple. The pulse, at first very irregular, became small, and then ceased, first at the wrist and then at the neck. The tongue was cold, and covered with a white crust. The voice became choleric in a high degree; the patient expressed the utmost longing for cold w-ater; the thirst was ex- cessive ; the difficulty of breathing so great as to cause him to gasp for breath, and throw himself from one side of the bed to the other. This spectacle of anxiety and torture was really horrible- Yet during all this time the understanding remained perfect, but rolled in upon itself, the patient taking little notice of what went on around, or even of his own condition, his present sufferings seeming to absorb his entire mind. Death takes place for the most part sud- denly, seemingly from the heart ceasing to act. It is almost impossible to obtain a drop of blood. Even if we open a vein at the very first, only about an ounce will flow. The stomach seems to be paralysed, as the strongest doses of ipecacuanha, even some drachms, with a large quantity of tartar eme- tic and other stimulants, produce no vomit- ing. It seldom lasts longer than from six to twelve hours. In cases of recovery, the reaction is very violent, and of an inflamma- tory character. | Second Form. This was generally preceded by a pro- drome, which came on with giddiness ; loss of appetite; troubled sleep ; convul- sive twitchings in the separate muscles of the extremities; rumbling in the bowels, like water rolled about in half-filled barrels. But the most characteristic symptom was a diarrhoea, or rather a looseness ; this was extremely constant, and might with more propriety than any of the other symptoms be called the prodrome of cholera. It often came suddenly after an exposure to cold, or error in diet; often without any obvious cause. It is never accompanied with pain or tenesmus. The ejected matter va- ries from a pultaceous consistence to a fluid nearly resembling that proper to cholera itself. It is seldom that a person has more than three or four stools in a day. In re- gard to duration, it lasts from an hour to many days ; it often ceases entirely, and begins afresh. When it lasts for many days, the person is very liable to be at- tacked with the third form of cholera. An immense number of persons were attacked with these symptoms, even several times, but by taking proper care, the further develop- ment of the disease was prevented. Copious vomiting, or purging of the pe- culiar clear fluid, mixed with flakes of a whitish substance, and accompanied with excessive faintness, marked the passagp of the above state into real cholera; in a very short time cramps came on in the feet and calves of the legs. The pulse diminished in strength and frequency; the respiration deep, and accompanied with much effort. The voice peculiarly altered ; the skin cold and blue; all the various secretions sup- pressed ; the thirst very violent. After these symptoms had continued a shorter or longer time, if the patient was strong and undebilitated, either the vomiting ceased suddenly, and he passed into the state de- scribed in the first form, or the vomiting continued, and became of a grass-green or yellow colour ; the pulse rose, became full and strong, and, often, active congestion* were formed to various organs. A tor- menting hiccup frequently followed or ac- companied the bilious vomiting. In patients of a weaker constitution, (women, youths, children, &c.) quite an- other order of symptoms succeeded,—the paralytic state. The cramps and evacua- tions qeased ; the patient lay quite still and powerless on the back; the consciousness was lost; the pupil dilated, or sometimes strongly contracted; the eyes half closed and turned up so as to show the white, which was often strongly injected on that part which was exposed to the air. The pulse rose a little, so as to be again felt at the wrist, but remained very weak. The respiration was performed at intervals by gasps ; the skin was cold, and generally covered with a cold, clammy sweat, which even exuded from the pores after death. Patients in this state generally sank in a few hours by the gradual cessation of the pulse, and then of the respiration, which at