CHOLERA. 



CHOLIAMBIC. 



870 



drains or cesspools, during warm seasons, or wide and rapid changes of 

 temperature ; or when the thermometer rises high during the day, and 

 sinks low towards the night and morning." 



The presence of these miasmata as the cause of cholera accounts for 

 the much greater prevalence and severity of this disease, in this 

 country, in ancient than in modern times. The account given by 

 Sydenham, who wrote about the middle of the 17th century, of the 

 regular annual return of cholera and of its great fatality, may well make 

 us rejoice at the altered condition as to cleanliness of our streets, drains, 

 and houses, and at the different kind and better quality of our food. 



" This disease," says Sydenham, writing of cholera as it appeared in 

 London in the year 1699, "comes as certainly at the latter end of 

 eummer and at the approach of autumn as swallows at the beginning 

 of spring, and as cuckoos at the heat of the following season. That 

 disease which is occasioned by a surfeit comes at any time; the 

 symptoms are indeed alike and the cause the same, yet it is of another 

 kind. The cholera is easily known, for there are violent vomitings 

 and an evacuation of ill humours with great difficulty and trouble by 

 stool : there is a violent pain and inflammation of the belly ; a heart- 

 burning, thirst, a quick pulse with great anxiety, and often a small and 

 unequal pulse with great nausea and sometimes a colliquative sweat, 

 contractions of the arms and legs, fainting, a coldness of the extreme 

 parts, and such-like symptoms, which frighten the bye-standers and 

 kill the patient in twenty-four hours." 



The persons most liable to biUous cholera are either those whose 

 bowels are pretematurally irritable, and who are consequently subject 

 to diarrhoea, or those whose bowels are torpid, and who are con- 

 sequently subject to habitual constipation. In the latter case it is 

 probable that the biliary secretion is sometimes long retained in the 

 gall-bladder, where it becomes changed in nature, and acquires irrita- 

 ting properties. 



Bilious cholera is rarely fatal in this country, excepting at seasons 

 when the concurrence of circumstances is peculiarly favourable to the 

 production of a severe form of the disease, and when at such seasons 

 it attacks persons very much predisposed to it, and whose constitutions 

 have been previously enfeebled by other causes. Its ordinary dura- 

 tion is from twenty-four hours to three or four days, when it often 

 spontaneously disappears ; but in general medical aid is indispensable ; 

 and when the attack is severe, if such aid be not promptly afforded, 

 the danger of the disease and the difficulty of the cure are very seriously 

 increased. 



The milder forms of bilious cholera may pass away without the 

 occurrence of any degree of spasm ; but when the attack is severe, 

 spasm is as constantly present as vomiting or purging. And eases now 

 and then occur in which the spasm comes on so early and is so pro- 

 minent as to give its own name, spasmodic cholera, to the disease. 

 Spasmodic, by no means as frequent as bilious cholera, is on the other 

 hand a much more formidable malady. It is indeed the same in nature, 

 and arises from precisely the same causes, but its intensity and danger 

 are widely different. Its attack is often immediately preceded by a 

 sense of chilliness or a distinct [rigour ; the griping pains are more 

 severe than in bilious cholera ; the vomiting and purging are more 

 urgent ; the matter rejected consists of a watery or slimy fluid, and 

 very soon there come on painful and violent spasms, which attack the 

 muscles of the abdomen, thighs, legs, thorax, and lastly the arms and 

 hands. These symptoms are attended with a small, quick, and con- 

 tracted pulse, great thirst, and the immediate rejection of whatever is 

 taken into the stomach. " As the disease proceeds," says Dr. Copland, 

 who witnessed its progress in an intertropical climate, and who ex- 

 perienced it in his own person, "the pulse becomes weaker and 

 smaller ; the spasms more general ; the purging constant and painful, 

 generally with tenesmus ; the vomitings are renewed upon the inges- 

 tion of substances into the stomach ; and the powers of life rapidly fail. 

 During this time the fluids evacuated from the stomach and bowels 

 present no appearance of bile, although occasionally bile is seen in the 

 evacuations to a small extent. In the course of a few hours the 

 features shrink, the hands and feet become cold and clammy; the 

 exacerbation of the spasms forces out a cold clammy sweat on the 

 face and breast; the pulse is extremely small and weak, or nearly 

 disappears. In a case which came before me in Africa, in 1816, the 

 pulse could scarcely be felt four hours from the attack; and the 

 content* of the stomach are now, in the more dangerous cases, thrown 

 off without any effort of retching. Commonly during all this time the 

 fsecal matters and the biliary secretions are retained, apparently owing 

 to the extension of the spasms from the duodenum to the common 

 biliary duct, and to spastic constrictions of parts of the colon ; the 

 epigastrum and hypochondria being sore, tense, and tumid. When 

 the disease is treated with decision, the vomitings cease ; free evacua- 

 tions with a discharge of bile take place, and the patient soon recovers. 

 But if neglected, or improperly managed, the powers of life fail rapidly ; 

 the eyes sink, and are surrounded with a livid circle ; the countenance 

 assumes a remarkably anxious cast, or_is pale, wan, and shrunk ; and 

 the spawns extend to the very fingers. The breathing now becomes 

 extremely laborious ; the patient is restless, and at last is earned off, 

 sometimes in the space of ten or twelve hours." 



The pathological state constituting the disease seems to consist of 

 irritation of the mucous surface of the digestive tube, commencing in 

 the duodenum and extending in each direction to the stomach, small 



intestines, and along the common duct to the gall-bladder and liver, 

 with increased action of the muscular coats of these viscera and deter- 

 mination of the circulating fluid to them. This irritation or morbid 

 excitement, owing to the connexion of the organic nerves supplying 

 those parts, is propagated to the spinal nerves, by which the muscles 

 of the abdomen and extremities are affected by painful and violent 

 contractions ; and it is chiefly owing to the exhaustion of the vital 

 manifestations of the organic system of nerves, and to the frequent 

 and profuse discharges, that a fatal issue takes place : the circulating 

 organs, which are [actuated by this system, being in consequence in- 

 capable of performing their functions. 



In regard to the treatment, Sydenham recommends in the early 

 part of the attack the promotion of the discharge of the offending 

 matter by means of diluents, such as weak broths and soups; and 

 since his time this practice has been very generally followed. When 

 the discharge has continued some time opium is indispensable, which 

 is best given in the form of pill, in doses of from one to three grains, 

 repeated at short intervals. The muriate of morphia, in doses of from 

 half a grain to two grains, is also an excellent remedy. In some 

 cases the opium should be combined with calomel; and in the intense 

 forms of this disease, common in warm climates, twenty grains of 

 calomel combined with opium, repeated once or twice after an interval 

 of from three to six hours, is found by experience to be the most 

 effectual remedy. Under such circumstances these large and re- 

 peated doses of calomel do not salivate, partly because the whole of 

 the calomel is never retained, and partly because- the system is not 

 in a condition favourable for the absorption of what does remain in the 

 stomach. 



The malady, new to this climate, which has spread to so many 

 different nations of the globe, and which has swept away so many of 

 its inhabitants, commonly known under the name of pestilential, or 

 Asiatic cholera, is a different disease from that here treated of, and is 

 noticed under the article PESTILENCE. 



(For a minute account of the symptoms, and for the details of the 

 treatment of bilious and spasmodic cholera, see Sydenham's works ; 

 Dr. James Johnson On Diseases of Intertropical Climates ; Dr. Chis- 

 holm On Diseases of Tropical Climates; and Dr. Copland's Diet, of 

 Pratt. Med.) 



CHOLESTERIC ACID (C 1( ,H 10 10 ?), one of the final products of 

 the oxidation of either of the bile constituents with nitric acid. It is 

 most conveniently obtained by saturating the mother-liquor, from the 

 preparation of choloidauic acid, with ammonia, precipitating with 

 nitrate of silver, and re-dissolving the precipitate in boiling water. On 

 cooling, crystalline scales of Moresterate of silver separate, from which 

 the acid may be isolated by suspending them in water, decomposing 

 with sulphuretted hydrogen, filtering, and evaporating the solution to 

 dryness. 



Cholesteric acid is a yellowish, solid substance resembling cherry- 

 tree gum. Its taste is sour and bitter. It is very soluble in w.-iUr, 

 alcohol, and acids. It forms soluble non-crystalline salts with the 

 alkalies. 



CHOLESTEHILIN (C 52 H 4 ,,) is obtained in three isomeric modifi- 

 cations by the action of concentrated sulphuric acid on cholesterin : 

 a has an earthy appearance ; 6 occurs in spangles ; c is resinous and 

 non-crystalline. They all yield cholesteric acid by oxidation with 

 nitric acid. 



CHOLESTERIN (C 52 H 4 ,0 2 + 2 Aq.). This substance is a constant 

 constituent of bile, though in very small quantity. It is also found in 

 the blood, the brain, and in the yolk of egg. It frequently accumu- 

 lates in the gall-bladder, forming what are called gall-stones ; and it is 

 from this variety of calculus that it is most easily prepared. Powdered 

 and boiled with alcohol, the cholesterin dissolves, and crystallises out 

 on cooling. It is obtained quite pure by one or two re-crystallisations. 



Cholesterin is insoluble in water, slightly soluble in cold alcohol, very 

 much so in boiling alcohol, ether, or wood-spirit. It fuses at about 

 280 Fahr. into a colourless liquid, that again becomes crystalline on 

 cooling. Heated to near the boiling point of mercury, it volatilises 

 without decomposition, forming a snowy-white sublimate. In the open 

 air it burns with a smoky flame. The alkalies do not act upon it. 

 Strong acids convert it into cholesterilin or cholesteran. 



CHOLESTERON (C^H,,,), a solid hydrocarbon, somewhat similar 

 to cholesterilin. It is derived from cholesterin by the action of con- 

 centrated phosphoric acid. It crystallises in beautiful prisms or silky 

 needles. Cholesterou and cholesterilin have the same chemical compo- 

 sition, containing the elements of cholesterin less two equivalents of 

 water. 



Cholesterilm. 

 J^H^O,, = C 5S H., + 2HO 



Cholesterin. Cholesterol!. 



CHOLESTUOPHANE. [CAFFEINE.] 



CHO'LIAMBIC, the name of a kind of verse employed by Greek 

 and occasionally by Latin writers (e. y., Martial). It consisted of 

 six feet, and was regulated by the same general laws as the iambic 

 verse of tragedy. In two or three points it differed considerably : the 

 fifth foot was properly and generally an iambus, though a few 

 instances are found of a spondee in its place : the sixth foot was 

 always a spondee or trochee. From this circumstance the name 



