90 NICHOLS AND ANDREWS. 



these cases proved fatal and the rash, although it caused a slight itching 

 sensation, which was relieved for the time being by sponging with a 

 solution of sodium bicarbonate, seemed of little importance. 



V. SPECIAL PROBLEMS. 



Among the many puzzling and worrying incidents that the physician 

 in a cholera epidemic has to contend with, none perhaps will cause him 

 more anxiety than the treatment of the children and pregnant women. 

 To stand by the bedside of the little ones and witness their intense 

 suffering without being able to bring relief is very distressing. Their 

 veins are so small that in their collapsed condition it is in many cases 

 impossible- to give an intravenous injection of saline solution. In such 

 cases subcutaneous injection of the solution is the only alternative but on 

 many occasions it seems to do little good. In addition to the attack of 

 cholera the native children here, are almost invariably infected with round 

 worms which for some reason seem to manifest an increased activity at 

 this time. Possibly the presence of the cholera toxin and the increased 

 intestinal peristalsis are accountable for this action, for certain it is 

 that they are frequently passed by the mouth as well as by the rectum. 

 As many as fifteen large worms were pulled from the throat of a child 

 at one time during an attack of cholera. At first small doses of calomel 

 and santonin were given for this condition, but owing to the great 

 depression produced by this treatment it was soon stopped and nothing 

 was done during the attack to expel the worms. Their annoyance to the 

 patient occasionally is great, sometimes almost choking him. Convul- 

 sions are not uncommon in children, and all of the cerebral symptoms 

 seem to be more prominent than in adults. 



With pregnant women, inasmuch as they almost always abort, one 

 asks one's self the question: Should abortion be produced as soon as 

 the patient enters the hospital or should the physician let nature take 

 its course ? We preferred not to interfere for the following reasons : 

 First, these patients, like ' the others, usually entered the hospital in 

 collapse; and, second, were never thought to be strong enough to with- 

 stand the shock of artificially produced abortion. While pregnancy 

 lessens the chances of the patient's recovery such cases do not necessarily 

 prove fatal. In our experience at San Lazaro we had several women who 

 recovered after abortion. The term of pregnancy ranged from three to 

 eight months. Other things being equal, the earlier the case is treated 

 the better the patient's chances are for recovery. 



A bacteriological diagnosis was made in nearly all cases within twenty- 

 four hours by Mr. Clegg of the Biological Laboratory of the Bureau of 

 Science. This was of much assistance in handling suspects. Two consec- 

 utive negative reports of the stools or contents of the rectum were 

 required before the patient was discharged from the hospital. 



