I8l2 



-THE CHOLERAS 



9. Castellani's Method. — Inoculate peptone water tubes (it is of advantage 

 to use centrifuge tubes) with the faecal matter in the usual way, but before or 

 immediately after making the inoculation add to each tube 3 to 5 drops poly- 

 valent lactose fermenting faecal bacteria serum {B. coli, B. pseudo-coli, B. coli 

 tropicalis, etc.), or the respective mono-serums may be used; 3 to 5 drops 

 polyvalent non-lactose fermenting faecal bacteria serum [B. proteus group, etc.) ; 

 3 to 5 drops paratyphoid B serum. The addition of the last-named serum is 

 made with the object of agglutinating and delaying the growth of the bacilli 

 of the paratyphoid B and aertrycke type, which, in the tropics at least, are 

 not very rarely found in the intestinal fluid. Care should be taken, of course, 

 to use serums containing no coagglutinin for the cholera vibrio, or only in 

 very small amount. Or serums can be used from which the cholera coagglu- 

 tinin — which is always in very much smaller amount than the other coagglu- 

 tinins — has been removed by absorption. The tubes are placed in the incu- 

 bator, and the further steps in the investigation are carried out in exactly the 

 same manner as with the ordinary methods. For details see British Medical 

 Journal, October 13, 1917. 



A modification of the method consists in inoculating ordinary peptone-water 

 tubes with the faecal matter, and, after four to six hours, from the upper 

 portions of these tubes inoculations are made in peptone- water tubes containing 

 a few drops of intestinal bacteria polyserums. 



If material has to be sent to a central depot for bacteriological 

 examination, certain precautions must be carried out. The faeces 

 must be carefully collected, if possible into a bed-pan which has been 

 scalded or boiled, or a loop of small intestine carefully removed post 

 mortem. These specimens must be forwarded in a glass bottle, which, 

 as well as the cork, has been boiled. It is, perhaps, hardly necessary 

 to state that no antiseptic must be mixed with the specimens. 



Prognosis.— The prognosis is usually bad at the beginning of the 

 epidemic, but improves as the epidemic continues. The case- 

 mortality may be stated to be on the average about 50 per cent. 



Treatment. — The treatment of cholera must aim at the destruc- 

 tion and removal of the vibrios, the neutralization of the toxins, 

 the prevention of secondary infection through the damaged intes- 

 tinal mucosa, the healing of which must be assisted, and the relief 

 of symptoms. 



To promote these objects, the patient must at once be sent to 

 bed, no matter how slight the attack may seem to be. His room 

 should be airy, and he should not be allowed to leave the horizontal 

 position. The bed-pan and urine bottle must be used, and the 

 former should be slightly warmed. 



The best treatment is that devised by Rogers, which is as follows :• — 

 The patient is given as much calcium permanganate water (i to 6 

 grains to the pint) as he can drink, and permanganate pills every 

 quarter of an hour for two hours, and then one pill every half hour 

 (any pill rejected by vomiting being immediately replaced). These 

 pills are continued until the stools become green and less copious, 

 which may occur in twelve to twenty-four hours. At the beginning 

 of the second twenty-four hours eight pills are administered within 

 four hours, and in severe cases this is repeated at the beginning of 

 the third twenty-four hours. In mild cases after the first twenty- 

 four hours the pills are only administered every four hours. 



