ESSENTIAL FACTOR IN THE TREATMENT OF PREGNANT 

 CHOLERA PATIENTS ^ 



By Paul McC. Lowell 

 {Philippine Health Service, Manila) 



Among the many incidents that a physician treating cholera 

 has to contend with none, perhaps, will cause him more anxiety 

 than the handling of the pregnant woman. The almost hopeless 

 condition of coma in some and delirium in others, so striking at 

 times, often causes him to give them less attention than they 

 deserve. For over a century men have written about cholera, 

 describing the clinical picture, and have often mentioned the 

 pregnant cases, comparing their chances for recovery with those 

 of the nonpregnant. However, the different workers contended 

 with unlike conditions, and their methods of treatment varied 

 greatly; consequently their results and deductions are so non- 

 uniform that considerable doubt is left in one's mind as to the 

 correct prognosis of these cases. It is evident that in order to 

 obtain satisfactory deductions one must treat a sufficient number 

 of these cases, of varying virulence, extending over a consider- 

 able period, and not be misled by the prognosis obtained in 

 small epidemics. 



In Manila we have had admissions of cholera to San Lazaro 

 Hospital almost continuously from September, 1913, to February, 

 1917, of a spasmodic virulence varying at times from a very 

 severe typical type to a more or less mild atypical one. The 

 cholera here is thought by some to be endemic, and the admis- 

 sions during this period numbered 1,588, all of which were 

 Filipinos residing in Manila or its near vicinity. Of these, 379 

 were females between the ages of 15 and 40, and 77 of this num- 

 ber were pregnant, which were distributed as follows: 4 cases 

 were pregnant for two months ; 13 for three months ; 4 for four 

 months; 13 for five months; 9 for six months; 14 for seven 

 months ; 11 for eight months ; and 9 for nine months. 



Sixty-six of these cases received the ordinary treatment of (1) 

 intravenous injections of a hypertonic salt solution containing 

 soda bicarbonate and (2) the usual symptomatic treatment when 



' Submitted as a thesis for the degree of Doctor of Public Health. Re- 

 ceived for publication April, 1917. 



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