203 



CHOLERA 



CHOPIN 



apathetic, except when tormented by cramps, which 

 are of frequent occurrence. The surface tempera- 

 ture of the body falls to 95 F., or even lower. 

 The pulse becomes almost imperceptible, and the 

 respirations are shallow and rapid, the air expired 

 being cold, and the voice a hollow, husky whisper. 

 The nervous system suffers severely, and muscular 

 prostration is well marked. The features assume 

 a leaden or livid hue ; they are pinched and 

 shrunken. The nose becomes sharp and pointed, 

 the cheeks hollow, and the eyeballs, which are 

 often bloodshot, sink in their sockets and are 

 nearly hidden by the half-closed lids. The surface 

 of the body, especially the extremities, is bluish, 

 wrinkled and shrivelled, and bathed in cold clammy 

 sweat. For a time the mind is clear but inactive ; 

 in fatal cases, however, stupor sets in, followed 

 by coma ; thirst is intense. In this stage assimi- 

 lation and secretion are in abeyance ; all the vital 

 processes in fact are brought almost to a standstill. 

 This stage may last from twelve to thirty -six hours, 

 when the third stage, that of reaction, gradually 

 commences. Heat returns to the surface of the 

 body, the breathing becomes regular and calm, the 

 secretions are re-established, the pulse improves, 

 and the patient will fall into a calm sleep. This 

 stage may terminate in speedy convalescence, but 

 such is not always the case, as a relapse may take 

 place and certain complications and sequelae follow. 

 The most dreaded of these are suppression of 

 urine, uremia, and fever, often closely resembling 

 typhoid, and constituting, at least in the temper- 

 ate zone, one of the chief dangers in the progress 

 of cholera. Disease of the kidneys, inflammation of 

 the lungs, ulceration of the cornea, abscesses all 

 over the body, and hemorrhage from the bowels 

 may also occur. The mortality varies very much : 

 it may be from one in four of those attacked to three 

 in four. In some epidemics in India it is not more 

 than 15 per cent, of those attacked ; in others as 

 high as 90 per cent. In 1885 it was announced that 

 of 233,546 persons attacked in Spain during the 

 recent visitation, 82,619 succumbed. One attack of 

 cholera does not confer protection against another. 



Treatment. With regard to treatment, medi- 

 cines are almost powerless, and many of the 

 vaunted remedies undoubtedly do far more harm 

 than good. It is, however, necessary to try to 

 check the premonitory diarrhoea, as by so doing in 

 many cases the disease may be cut short. The 

 slightest symptoms of diarrhoea should be attended 

 to ; the patient should be put to bed, a mustard 

 plaster should be applied to his abdomen, and 

 opium in some form or other should be admin- 

 istered. A favourite prescription is four grains of 

 acetate of lead with one of opium, which may be 

 given after each loose stool until three doses have 

 been taken ; or else thirty drops of laudanum in 

 half a glass of brandy in hot water. In the state 

 of collapse it is useless or even injurious to give 

 medicine, but soda-water and ice may be admin- 

 istered to relieve thirst. During collapse the 

 medicines could not be assimilated, and if given 

 then, during reaction they would be absorbed and 

 do hai'm. As soon as reaction occurs, thin water- 

 arrowroot should be given in small quantities, and 

 then iced milk, chicken-tea, and beef-tea, as the 

 stomach can stand it, and enemata of beef-tea 

 should be given every four hours. 



The true remedy against cholera is undoubtedly 

 prevention. The greatest care should be taken to 

 secure pure drinkivig- water, which should be boiled 

 before use, and uncontaminated food. Personal 

 cleanliness, free ventilation, and thorough disinfec- 

 tion of the drains should be enjoined. With regard 

 to quarantine, it is worse than useless in checking 

 the spread of cholera ; but all persons coming from 

 an infected area who have the slightest tendency to 



diarrhoea should be isolated and carefully watched. 

 It should be remembered with what ease cholera 

 can be conveyed by clothing, and therefore the im- 

 portation of all rags and old clothes should be pro- 

 hibited. Lastly, the destruction of the discharges 

 from cholera patients, and of the linen soiled by 

 them, is of the utmost importance. The dead 

 should be buried immediately, with due precau- 

 tions. A Spanish physician, Dr Ferran, employed 

 preventive inoculation in 1885 ; his methods, how- 

 ever, were discredited. But in 1893-95 Dr Haff- 

 kine, a Russian scientist, had performed in Bengal 

 alone 42,445 inoculations against cholera without 

 mishap and with great preventive efficiency. In the 

 Gangetic valley the home of cholera the comma 

 bacillus is a constant feature in the malady. 



Cholera Sicca is a rare form, in which symptoms 

 of collapse occur, with great coldness and blueness 

 of the surface, and death takes place in a few hours, 

 without any purging. 



Cholera Nostras is also called Simple Cholera, 

 Summer Cholera, British Cholera, Sporadic Cholera, 

 Choleraic Diarrhoea. This is an acute catarrhal 

 affection of the mucous membrane of the stomach 

 and small intestines, which usually occurs in late 

 summer or early autumn. It is attended by vomit- 

 ing and purging of bile, cramps and pain in the 

 bowels, the whole system being implicated on 

 account of the rapid loss of water from the body. 

 This disease, although severe, is usually only fatal 

 to young infants or to old or debilitated persons. 

 Simple cholera is treated like Diarrhoea (q.v.). 



Asiatic Cholera is regarded as distinctly a ' dirt 

 disease,' and the great religious pilgrimages of 

 the East have had much to do with conveying 

 the poison from places where it is endemic, and 

 distributing it widely. The sanitary measures 

 adopted at Hardwar on the Ganges have proved 

 as strikingly effective as those employed in England 

 to control the invasions of 1892 and 1893. But 

 though some attempts have been made to reduce 

 the risks attendant on the Mecca pilgrimages 

 (where the wells are a great source of infection), 

 effective measures have as yet proved impossible. 



See Pettenkofer's Cholera : How to Prevent and Resist 

 it (Eng. trans. 1884); Still's Cholera (Phila. 1885); 

 Bellew's History of the Cholera in India (1884); and 

 Macnamara's Asiatic Cholera (1892). 



Cholesterin, a fatty substance found in gall- 

 stones, yolk of egg, blood-corpuscles, milk, &c., as 

 also in peas, barley, &c. See ANIMAL CHEMISTRY. 



Cliolet, a French manufacturing town, dep. of 

 Maine-et-Loire, on the Maine, 32 miles SW. of 

 Angers by rail. Pop. 15,051. 



Cholu'la, a decayed town of the Mexican state 

 of Puebla, stands nearly 7000 feet above sea-level, 

 on the tableland of Anahuac, 55 miles ESE. of the 

 city of Mexico. Cortes found in it 40,000 houses 

 and 400 temples, including the great Teocalli (q.v.). 

 Now the place only contains 9000 inhabitants. It 

 was a great centre of the Aztec religion. 



Chondrin, the substance of cartilage, is akin 

 to the Proteids (q.v.). See ANIMAL CHEMISTRY. 



Cliondropterygii, one of the technical names 

 by which Cartilaginous Fishes (q.v.) are known. 



CllOUOS, a bare and sparsely peopled Chilian 

 archipelago off the west coast of Patagonia. 



Chopin (Fr.), an old English liquid measure 

 equal to half a pint. The Scotch chopin or chappin 

 was nearly an English quart. 



Chopin, FREDERIC, virtuoso and musical com- 

 poser, was born March 1, 1809, at Zelazova Vola, 

 a village near W r arsaw, in Poland, where his father, 

 a native of Lorraine, had settled and married. 

 Under the tuition of two professors at Warsaw, 

 notably Eisner, the director of the Conservatoire, 



