CHOLERA IN CHILDREN. 369 



Case 15. — L. S. — ^Age, 3 years. Brother of case 14. Taken sick on September 

 13 with vomiting and diarrhoea. Three to five movements per day. Stools were 

 faeculent and foetid. Thirst, no loss of voice, and no suppression of urine. Fever 

 first two days, but afterwards temperature normal. 



Necropsy by Doctor Andrews. 



Body well nourished, rigor mortis marked; nails blue; skin shriveled; eyes half 

 open and sunken. 



Suhcutaneous tissues moist, muscles dark. 



Peritoneum smooth and moist, few cubic centimeters of blood-colored fluid 

 present. Intestines distended with gas, slightly congested. 



Pericardial sac blood-stained, increase of fluid. Heart soft, flabby and blood- 

 stained. 



Lungs. — Increase of pleural fluid in both cavities. Lungs voluminous and 

 heavy. Cut section shows congestion and considerable frothy fluid present. 



Kidneys swollen, soft, capsule strips readily. Cut section dull gray color. 

 Striations partially obliterated. Intestines distended with gas. Lower part of 

 ileum .slightly congested, contents dark and watery; mucosa intact. 



Urinary Madder contains about 200 cubic centimeters of dark colored \irine. 



Examination of intestinal contents for cholera reported positive by the Bio- 

 logical Laboratory, Bureau of Science. 



It seemed probable at first glance tbat cases of cholera were being 

 concealed, or that typical s3'mptoms were carelessly overlooked, but I 

 have seen a number of cases in which a diagnosis of Asiatic cholera 

 would not liave been made from the clinical picture; and without the bac- 

 teriological investigation of the stools these cases would never have been 

 recognized as cholera. I am convinced that many of the diagnoses of 

 acute or chonic enteritis, acute dysentery, meningitis, etc., are made in 

 good faith by the Filipino doctors. They have erred in looking for a 

 typical picture of Asiatic cholera, and this picture is lacking in children 

 in many instances. The erroneous diagnosis of chronic and , acute 

 enteritis and of dysentery alone is often due to the actual presence of tliese 

 conditions, probably before infection with cholera occurred, and to the 

 absence of the classical symptoms of cliolera. 



The frequency of diagnosis of meningitis by native phycisians is due 

 to lack of or failure to observe tlie early symptoms of cholera, vomiting, 

 rice-water diarrha^a, muscular cramps, collapse and anuria, and to the 

 presence, late in the disease, of marked cerebral symptoms, due to a 

 profound toxaMiiia. Accurate diagnosis of cholera in these fatal cases 

 was only possible from the post-moi-tem findings and the isolation of 

 cholera vibrios from the intestines. 



In other cases, we have found tlie acute enteritis, acute parenchy- 

 matous nephritis, dryness of the. tissues and serous cavities, tarry appear- 

 ance of tlie blood on section of the lungs, dry appearance of tlie spleen 

 on cut section, and other pathological appearances of cholera, without 

 being able to demonstrate the presence of cholera vibrios in the intestines. 

 These cases were probably cholera in which the duration of the illness 

 was so long that the disappearance of the vibrios from tlie intestines 

 had occurred. 



