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.

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.

    185/974 (page 167)
    Diagnosis.—This is easy in marked cases. Purging, vomiting, anxious countenance, cramps, quick advent of collapse, and profuse sweating, are decisive enough of the presence of Cholera. There is some difficulty in deciding in the diarhoeal stage. Cholera may be mistaken for bilious diarrhoea, choleraic diarrhoea, purging produced by irritating drugs or poisons, and the onset of some fevers. We rely for diagnosis chiefly on the absence of any known cause for purging, the absence or slightness of pain or tormina, upon the liquidity and pale colour of the stools, and copious rush of fluid from the bowels, the early tendency to exhaustion, and the frequent beginning in the early morning. If the patient is passing brown feculent matter, not very liquid, and if there be griping and colic, and a probable cause in improper diet, we may be pretty easy, and the disease will pro- bably be common diarrhoea. But we should nevertheless watch the patient carefully for a few hours. Choleraic diarrhoea is less violent in its onset than Cholera, and the stools generally contain bile, even after the disease has lasted for days. There is seldom much or any pain in this. It should always be treated as Cholera in the beginning. Vomiting helps in the diagnosis, but it is sometimes absent for the first few hours, and is sometimes present in diarrhoea. The vomiting in Cholera is fluid and colourless generally; that of bilious diarrhoea often consists of undigested food or biliary matter. The diarrhoea in the beginning of fevers is often very exhausting, and at first it may be difficult to distinguish it from the commence- ment of cholera. Generally, however, there is less exhaustion, and though there may be a tendency to collapse, this is not deep, and in a few hours the pyrexial stage comes on. AU surgeons in charge of hospitals must be familiar with indica- tions afforded by the countenances of patients even in the earlier stages. Men are often seen looking somewhat anxious, with the face pointed, and perhaps somewhat shrunk and mottled or leaden coloured. On being questioned it will perhaps be found that the patient has watery purging on him; a close stool at his bed-side will, perhaps, be half or two-thirds full of the brownish or pale liquid, and he will be, indeed, in the first stage of Cholera, though ignorant of it, and making no complaint. A glance at a man's face will often save his life, and no man, when in or out of hospital, whose countenance shows this change, should be passed over in a routine way, however trivial his old complaint may be, or although he may be engaged, as sometimes happens, in his usual occupations. Cases of irritating poisoning often occur either from accident or design, and it is always well to be alive to such facts when called to cases supposed to be Cholera, and not take it for granted that all cases of vomiting and purging are those of Cholera. It cannot be too strongly impressed upon the young medical practi- tioner that in every case of diarrhoea which he attends, in seasons of Cholera, he should ask to see the evacuations at the very first visit. In India fortunately there are few privies or cesspools to private houses,