CHOLERA J09 



(3) Mix directly a drop of the stools with immune serum. 

 If agglutination suspect cholera vibrios (Dunbar). 

 This is useful only when the vibrios are very numerous. 



(4) Inoculate four tubes of peptone water with sample of stool 

 \ CO., h c.c, I c.c, 2 c.c, respectively. 



A scum on the surface of the medium in 8-10 hours is suspicious 

 of cholera. Examine scum for comma vibrio, inoculate plates 

 with the germs to confirm. Add to peptone water medium a 

 few drops of pure H2SO4. In true cholera the indol reaction 

 is present in 8-10 hours. 



(5) Inoculate the surface of three serum tubes with the sample and 

 incubate at 35°C. If no liquefaction in 16 hours, it excludes 

 cholera. 



If liquefaction in 16 hours, exclude cholera by plating out, &c. 

 If liquefaction then, the vibrio may be present, plate out and 

 further examine. 



(6) Inoculate a sedimentative tube of peptone water and immune 

 serum with the faecal sample. Incubate at 37° C. for three to 

 seven hours. 



If true cholera, numerous small flocculi of agglutinating 

 vibrios, at first suspended, sink to the bottom (Bandi). 



(7) Inoculate with fa?cal sample media of pure bile mixed with 3 

 per cent, of a 10 per cent, solution of XaoCOj. 



Incubate at 37°C. Plate and further examine. 

 In epidemics due to cholera nostras, mushroom poisoning, 

 bacterial food poisoning, trichinosis, pernicious malarial fever, all 

 have a low mortality as compared with cholera. If an epidemic has 

 over 50 per cent, mortality it is cholera. 



TREATMENT. 



The indications are : — 



To destroy and remove the vibrios. 



To neutralize the toxins. 



To prevent secondary infections. 



To relieve the symptoms. 

 B^d at once under the best hygienic conditions. 



Warmth essential. Water to drink in sips. Turpentine stupes to 

 abdomen. \o food during acute attack. Hot, strong cofifee, good. 

 Rogers' method. 



Calcium permanganate water (gr. i to vi to a pint) ad lib. 

 Permanganate pills : — 

 Potassium permanganate gr. ii. 



Kaolin and vaseline as recjuired. 

 To be taken every ^ hour for two hours, then one pill half-hourly. 



