Sequelae.—Following an attack of cholera we may have abscess of the parotid gland or gangrene of various parts of the body. There may be ulceration of the cornea. In pregnant women the disease almost invariably causes abortion. Post-choleraic pneumonias and renal inflammations are to be considered.
Symptoms in Detail
General Appearance.—A typical case of cholera, with its cyanosed, drawn, pinched face, cold, clammy skin and the eyes deeply sunken in the orbits, makes a picture rarely seen in other conditions. The washerwoman’s hands appearance should always be looked for.
Temperature Record.—The temperature of the skin surface is lowered from the normal while that of the rectum may be normal or even elevated. There may be a difference of 10° or more between rectal and surface temperature. In the stage of reaction the temperature may continue to rise to high fever points and this so-called hyperthermic type is very fatal.
Circulatory System.—The pulse is rapid and feeble in the stage of evacuation to become imperceptible in the algid stage. The circulation is practically at a standstill so that only a few drops of black tarry blood, which does not coagulate readily, flow from a wound of a vein when giving an intravenous injection. The blood is concentrated and has a specific gravity of 1072 to 1078. The systolic pressure falls greatly, even to 60 mm. of mercury in a severe, or 75 mm. in a less serious case. The red cell count is increased to 7 or 8 million red cells per c.mm. and the leucocyte count reaches 15,000 to 50,000.
Nervous System.—The mind is clear, even when the patient seems profoundly apathetic. The muscle cramps are characteristic of the disease.
Diagnosis
Clinical Diagnosis.—It is customary to state that cholera nostras and infections with virulent meat poisoning bacteria of the paratyphoid group show bile in the intestinal discharges and not the typical rice-water stools of true cholera. It must be remembered that these affections can at times show as marked muscular cramps, emaciation, cyanosis and weak voice as cholera so that only the bacteriological examination can differentiate.
Algid pernicious malaria generally shows a rather high axillary temperature and the stools are rarely so profuse as in cholera.