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SIMPLE ENTERITIS OR ENGLISH CHOLERA (?).
1058
cer-
mind my absolute matter and merely wetting, but not staining, the sheets. she had well passed the eighth There were no colicky pains. She suffered from constant month of pregnancy she had no faith in the treatment vomiting, and there were severe and constant cramps in the whatever, for it was her firm conviction that, after mis- calves and right forearm. Hot bricks were placed in bed around carrying three times, she would never go the full nine months. her. A few teaspoonfuls of weak brandy-and-water with a trace As will be seen the result was agreeably surprising to her. I of hydrocyanic acid were administered every two or three may mention that this treatment was suggested to me by minutes, as well as a teaspoonful of meat juice every ten Dr. Sutherland of South Shields, whose case is narrated first : minutes irrespectively of the vomiting. Brandy and meat. CASE 1.-A married woman consulted Dr. Sutherland at juice were also given hypodermically. The knees, ankles, the end of December, 1892, with regard to her condition, and toes were kept forcibly extended to relieve the cramps, she being then about two months pregnant. The history which were almost constant and very severe. From the time I saw her the patient began to improve steadily as regarded was that eleven years previously she had her last living child, but since his birth she had been prematurely delivered-in all her symptoms. The body heat began to return, and at the majority of cases at the sixth month-of nine stillborn noon the pulse could be counted. The vomiting and diarrhœa. children. She was at once ordered ten grains of chlorate of became steadily less severe, and by 4 P M. the patient could potassium three times a day, and she continued to take it, keep food in her stomach for an hour at a time. Thewith an interval of a fortnight in April, until the beginning cramps became less frequent, but caused considerable trouble of August of this year, when she, being then at full term, till about 8 P.M., when they began rapidly to subside, anc was delivered of a living child. There was a distinct history I was able to pronounce the patient out of immediate danger. From that time she made a steady recovery. of syphilis. Remarks.-I should be glad of an opinion on the above CASE 2.-A married woman came to see me on April 2nd of this year, telling me that she was about four months case. I believe it to have been an example of simple enteritis pregnant and that she had had three premature confine- or English cholera, which cases are not uncommon at that ments, but never one at full term. She was, however, time of the year and when fatal are, I believe, often certified ! most anxious to have a living child and was willing to do as Asiatic cholera. My reasons for the above opinion are anything or take anything if only her wish could be gratified. (1) the rapid and complete recovery of the patient ; (2) theI ascertained that during her first pregnancy she had had a intimate connexion of the attack with an attack of undoubted fall at about the eighth month, with the result that labour simple colic and diarrhcea ; and (3) the severity of the supervened and a child was born, which lived for two days. vomiting. On the other hand, the character of the motions, She again became pregnant, and at the eighth month, although with the absence of colic or abdominal pain, and the very she could find no cause for it, was again delivered of a marked severity of the cramps in the calves caused me child, which was in this instance stillborn. She became to be very suspicious of Asiatic cholera, and precautions pregnant a third time and went seven months only, were taken accordingly. the child being in this case, too, stillborn. After obtainNorton Woodseats, Sheffield. ing from her the above facts, and bearing in mind Dr. Sutherland’s case, I advised her to commence at once with the medicine I should give her and to continue it until labour set in. She expressed herself as being perfectly NOTES OF THE TWO SUSPICIOUS CASES OF CHOLERA AT THE COTON-HILL ASYLUM. willing to do so, so I commenced with ten grains of chlorate of in three times a her water at the same day, telling potassium BY HAROLD S. BEADLES, M.R.C.S., L.R.C.P. time to let me have a specimen of her urine each time the bottle was renewed. On May llth I found a distinct haze IN THE LANCET of Oct. 7th it is stated that two susof albumen present in the urine, so I stopped the chlorate of ordered her minims of and ten tincture of potassium per- picious cases of Asiatic cholera had occurred at the Cotonchloride of iron in water three times a day for about ten days. Hill Asylum, Stafford. As I was acting for the time being At the end of that time the albumen had completely disas medical officer at that institution, and personally attended appeared, so the chlorate of potassium was recommenced. the cases and made the post-mortem examinations, the followIn June I again found it necessary, for a similar reason, to not without interest. For permission to notes be the for a tincture of iron She the ing may preference fortnight. give then resumed her original medicine and took it constantly publish them I have to thank Mr. Hewson, the medical supertill Aug. llth, when labour commenced and she was safely intendent of the asylum. delivered of a strong and healthy living female child at full CASE 1.—The first case is that of a man aged fifty-two, term. She made an excellent recovery and the infant is all that she could wish. There was no history of syphilis in who had been thirty years in the asylum and was quite demented. At 5 30 A.M. on Sept. 28th the patient was. this case. seized with vomiting and continuous retching. Two hours Heaton-road, Newcastle.on-Tyne. later some diarrhoea occurred, the motions being soft but of a natural colour. He became very cold and passed into a condition of collapse, the pulse being almost imperceptible. SIMPLE ENTERITIS OR ENGLISH CHOLERA (?). Hot fomentations were applied to the abdomen and hot bottles to the feet. Bismuth and opium were given internally BY CHARLES ROLFE, M.B., B.C. CANTAB. and brandy at frequent intervals. At 11 A.M. vomiting again occurred, when he brought up undigested food with fluid of a ON Thursday morning, Sept. 7th, I was called to see a brown colour. The patient remained in a collapsed condition healthy married woman aged about fifty years. I found her during the whole of the day, and the radial pulse could not be to be suffering from a severe attack of colic and diarrhoea and felt. No further diarrhoea occurred, but at one time during confined to bed. She had no sickness and was passing i the course of the day a colourless watery discharge was found from the rectum. During the whole time he made no ordinary watery motions. I prescribed a mixture of compound running to speak, but in the course of the evening his legs were attempt tincture of camphor, aromatic sulphuric acid, and spirit of drawn up on several occasions and he clenched his teeth. At chloroform. On my next visit, which was on Saturday no time was there any indication of rallying, and he died at morning, I found her rather weak, but able to be up and 10.30 P.M., seventeen hours from the onset of the attack. about, the symptoms having ceased. She went to bed that At the necropsy, eighteen hours after death, old peritoneal were found. The intestines, both large and small, night in good health, but at 1 A. M. was suddenly seized with adhesions contained a thick, quite opaque, tenacious fluid, and the violent sickness, diarrhoea, and cramps in the calves, and I lining of the bowel was congested with localised areas of was sent for at 7 A.M. I then found her condition to be as greater intensity. Towards the cardiac end of the stomach follows : The temperature was below 95° F., the body and there was a similar area of large size. No ulceration existed. limbs feeling cold to the touch. The pulse at the wrist was There was nothing further to note beyond the fact that the imperceptible. The eyes were sunken as in severe cases of heart was exceedingly fatty but without valvular disease, peritonitis. The hands, feet, and face were of a bluish-white that the lungs were cedematous, and that the brain with its The tongue was quite clean, but membranes was congested. colour and very cold. The CASE 2.-Two days later the second patient was attacked. white. patient was conscious. Diarrhoea was nearly was a man aged fifty-six, who had been three years in constant, the motions containing no trace of bile or solid
trying
to
impress
tainty of
success,
on
the
patient’s
yet until
This
cer-
mind my absolute matter and merely wetting, but not staining, the sheets. she had well passed the eighth There were no colicky pains. She suffered from constant month of pregnancy she had no faith in the treatment vomiting, and there were severe and constant cramps in the whatever, for it was her firm conviction that, after mis- calves and right forearm. Hot bricks were placed in bed around carrying three times, she would never go the full nine months. her. A few teaspoonfuls of weak brandy-and-water with a trace As will be seen the result was agreeably surprising to her. I of hydrocyanic acid were administered every two or three may mention that this treatment was suggested to me by minutes, as well as a teaspoonful of meat juice every ten Dr. Sutherland of South Shields, whose case is narrated first : minutes irrespectively of the vomiting. Brandy and meat. CASE 1.-A married woman consulted Dr. Sutherland at juice were also given hypodermically. The knees, ankles, the end of December, 1892, with regard to her condition, and toes were kept forcibly extended to relieve the cramps, she being then about two months pregnant. The history which were almost constant and very severe. From the time I saw her the patient began to improve steadily as regarded was that eleven years previously she had her last living child, but since his birth she had been prematurely delivered-in all her symptoms. The body heat began to return, and at the majority of cases at the sixth month-of nine stillborn noon the pulse could be counted. The vomiting and diarrhœa. children. She was at once ordered ten grains of chlorate of became steadily less severe, and by 4 P M. the patient could potassium three times a day, and she continued to take it, keep food in her stomach for an hour at a time. Thewith an interval of a fortnight in April, until the beginning cramps became less frequent, but caused considerable trouble of August of this year, when she, being then at full term, till about 8 P.M., when they began rapidly to subside, anc was delivered of a living child. There was a distinct history I was able to pronounce the patient out of immediate danger. From that time she made a steady recovery. of syphilis. Remarks.-I should be glad of an opinion on the above CASE 2.-A married woman came to see me on April 2nd of this year, telling me that she was about four months case. I believe it to have been an example of simple enteritis pregnant and that she had had three premature confine- or English cholera, which cases are not uncommon at that ments, but never one at full term. She was, however, time of the year and when fatal are, I believe, often certified ! most anxious to have a living child and was willing to do as Asiatic cholera. My reasons for the above opinion are anything or take anything if only her wish could be gratified. (1) the rapid and complete recovery of the patient ; (2) theI ascertained that during her first pregnancy she had had a intimate connexion of the attack with an attack of undoubted fall at about the eighth month, with the result that labour simple colic and diarrhcea ; and (3) the severity of the supervened and a child was born, which lived for two days. vomiting. On the other hand, the character of the motions, She again became pregnant, and at the eighth month, although with the absence of colic or abdominal pain, and the very she could find no cause for it, was again delivered of a marked severity of the cramps in the calves caused me child, which was in this instance stillborn. She became to be very suspicious of Asiatic cholera, and precautions pregnant a third time and went seven months only, were taken accordingly. the child being in this case, too, stillborn. After obtainNorton Woodseats, Sheffield. ing from her the above facts, and bearing in mind Dr. Sutherland’s case, I advised her to commence at once with the medicine I should give her and to continue it until labour set in. She expressed herself as being perfectly NOTES OF THE TWO SUSPICIOUS CASES OF CHOLERA AT THE COTON-HILL ASYLUM. willing to do so, so I commenced with ten grains of chlorate of in three times a her water at the same day, telling potassium BY HAROLD S. BEADLES, M.R.C.S., L.R.C.P. time to let me have a specimen of her urine each time the bottle was renewed. On May llth I found a distinct haze IN THE LANCET of Oct. 7th it is stated that two susof albumen present in the urine, so I stopped the chlorate of ordered her minims of and ten tincture of potassium per- picious cases of Asiatic cholera had occurred at the Cotonchloride of iron in water three times a day for about ten days. Hill Asylum, Stafford. As I was acting for the time being At the end of that time the albumen had completely disas medical officer at that institution, and personally attended appeared, so the chlorate of potassium was recommenced. the cases and made the post-mortem examinations, the followIn June I again found it necessary, for a similar reason, to not without interest. For permission to notes be the for a tincture of iron She the ing may preference fortnight. give then resumed her original medicine and took it constantly publish them I have to thank Mr. Hewson, the medical supertill Aug. llth, when labour commenced and she was safely intendent of the asylum. delivered of a strong and healthy living female child at full CASE 1.—The first case is that of a man aged fifty-two, term. She made an excellent recovery and the infant is all that she could wish. There was no history of syphilis in who had been thirty years in the asylum and was quite demented. At 5 30 A.M. on Sept. 28th the patient was. this case. seized with vomiting and continuous retching. Two hours Heaton-road, Newcastle.on-Tyne. later some diarrhoea occurred, the motions being soft but of a natural colour. He became very cold and passed into a condition of collapse, the pulse being almost imperceptible. SIMPLE ENTERITIS OR ENGLISH CHOLERA (?). Hot fomentations were applied to the abdomen and hot bottles to the feet. Bismuth and opium were given internally BY CHARLES ROLFE, M.B., B.C. CANTAB. and brandy at frequent intervals. At 11 A.M. vomiting again occurred, when he brought up undigested food with fluid of a ON Thursday morning, Sept. 7th, I was called to see a brown colour. The patient remained in a collapsed condition healthy married woman aged about fifty years. I found her during the whole of the day, and the radial pulse could not be to be suffering from a severe attack of colic and diarrhoea and felt. No further diarrhoea occurred, but at one time during confined to bed. She had no sickness and was passing i the course of the day a colourless watery discharge was found from the rectum. During the whole time he made no ordinary watery motions. I prescribed a mixture of compound running to speak, but in the course of the evening his legs were attempt tincture of camphor, aromatic sulphuric acid, and spirit of drawn up on several occasions and he clenched his teeth. At chloroform. On my next visit, which was on Saturday no time was there any indication of rallying, and he died at morning, I found her rather weak, but able to be up and 10.30 P.M., seventeen hours from the onset of the attack. about, the symptoms having ceased. She went to bed that At the necropsy, eighteen hours after death, old peritoneal were found. The intestines, both large and small, night in good health, but at 1 A. M. was suddenly seized with adhesions contained a thick, quite opaque, tenacious fluid, and the violent sickness, diarrhoea, and cramps in the calves, and I lining of the bowel was congested with localised areas of was sent for at 7 A.M. I then found her condition to be as greater intensity. Towards the cardiac end of the stomach follows : The temperature was below 95° F., the body and there was a similar area of large size. No ulceration existed. limbs feeling cold to the touch. The pulse at the wrist was There was nothing further to note beyond the fact that the imperceptible. The eyes were sunken as in severe cases of heart was exceedingly fatty but without valvular disease, peritonitis. The hands, feet, and face were of a bluish-white that the lungs were cedematous, and that the brain with its The tongue was quite clean, but membranes was congested. colour and very cold. The CASE 2.-Two days later the second patient was attacked. white. patient was conscious. Diarrhoea was nearly was a man aged fifty-six, who had been three years in constant, the motions containing no trace of bile or solid
trying
to
impress
tainty of
success,
on
the
patient’s
yet until
This