OBSERVATIONS ON SOMEV INTERESTING AND PECULIAR SYMPTOMS OF CHOLERA AS OBSERVED IN FOUR EPIDEMICS AT PESHAWAR. By Assist.-Surgeou Chetan
Shah, Khan Bahadur, Officiating Surgeon, Jhang. While in charge of the Peshawar City Dispensary I had a great though sad opportunity of observing there four epidemics of cholera, viz., in 1867, 1869, 1872 and 1876. In each year I had a very large number of cholera cases under my care not only in the temporary cholera hospitals that were erected for the poor friendless people, but also in private circles which I had to visit from house Civil
to house.
When
this
on
duty
I took
to take brief
care
some
immediately under my own down some important facts of
notes of such cases as were to write
treatment, and others that I The will, I
saw
in consultation with the hakims. statement of facts recorded in my notes
following hope, interest
Medical Gazette
Comparative Statement showing peculiar characters of Cholera
some
of the readers of the Indian
:?
as
observed in four
epidemics.
Epidemics Particular characters. of 1867.
1. Cramps in nonclioleraic patients. 2,
Convulsions.
of 1872.
of 18G9.
Occurred in several cases.
Occurred in several
In 2 adult who were
patients healthy before, epileptic fits occurred at irregular
Occurred in several cases.
cases.
None.
None.
of 1876.
Only
one case
observed.
Convulsions occurred in cases in children suffering from cholera.
3
each fit followed by characteristic vomiting and purging.
intervals,
being
3.
Paralysis.
Recovery from
tial few
paralysis
par-
in
a
cases.
Paralysis occurred No motor paralysis : in 6 cases?in 2 of one case of anaeseither arm, in 3 of thesia. bladder, in one squinting ; in 2 cases anassthesia remained for some time after re-
No case of anaesthesia.
paralysis
or
covery. 4. Sensation of needles and pins during reaction.
5.
Head symptoms.
Did not
Not
noticed.
occur.
particularly
Did occur as a prominent symptom, especially in the skin covering the outer aspect of the arm. Not
noticed.
particularly
Not
a
symptom.
prominent
Predominated in children not only when urine was suppressed, but even when suppression had been overcome or
not
ced.
yet
commen-
Did not
occur
at all.
Out of my 101 cases delirium occurred in 9 and coma
and
drowsiness
very much more noticed in this year than in any former one. Head symptoms occurred not only as a result of uraemia, but they also supervened in some cases before the suppression of urine, and in several after it had been overcome. were
July 1,
1880.]
OBSERVATIONS ON CHOLERA.?BY ASST.-SURG. CHETAN SHAH.
igl
Epidemics Particular characters. of 1867.
6. Vomi*Jag followed by collapse and death without purg-
Occurred
in
some
cases.
Occurred in
some
Not observed.
cases.
ing.
7. Collapse followed by death without
Such
cases
did
occur.
of 1876.
of 1872.
of 1869.
Out of 101 cases that I treated in the city, one case of this sort occurred, though several other cases of this nature have also been reported.
None noticed.
No such
On account of chomensea ceased after an hour or two of their appearance.
No case seen.
No
In three pregnant this occurred long before they died.
No such
case seen.
No such
In some
cases.
None noticed.
case
occurred.
vomiting or purging; ordinary fsecal matter, not void of bile, being passed. 8. Flow of ceased.
menses
Not observed.
case seen.
lera
sounds 9. Foetal ceased before death.
Not observed.
10. Successive stagpassed much more rapidly than usual.
In
case
seen.
women
a
few
In
cases.
some
cases.
es
Death in nine actually known to have occurred within 3 hours of seizure. Three of these died within half an hour,?one of these occurred at the dispensary. Many died aft'er
unusually thus, one
long period,
after 16 days, after 12 days, and ono after 10 days, and four after 9 days.
one
11.
Time of pass-
ing urine and
its re-
Not noticed.
In
13.
Severity
of type.
Prsecordial op-
pression.
case
water
after 6 days without uraemia.
lation with ureemia.
12.
one
passed
Same in four Not particularly corded.
re-
epidemi
Common.
More marked than in
Less than in 1869.
previous epidemics.
14. Second attack after recovery from the first seizures.
Not noticed.
In 2
cases.
Statistics of 15. seizures with reference to age.
Not procurable.
Not
procurable.
16. Statistics with reference to caste.
Out of 101 cases that I Average of 72 cases, 72 hours after 6eizure took notice of 36 died in shortest 24 hours, collapse Or very imperfect reaction without passing longest 144 hours. urine ; in one time was not noticed ; in 6 urine was not suppressed; in remaining cases, in which urine was suppressed, it was passed at an average of 21*02 hours after seizure,?at shortest 8 hours after seizure, at longest 144 hours after seizure.
In none.
Proportionably more
children seized than in former epidemic.
In none,
Out of 330 cases 53 occurred under 5 years of age, 27 between 5 & 10. Hindus Christian
Mussulmans 17. Statistics with to males reference and females.
...
20 1 309
223 7
No. 32553
Female... 107 j
25877
Male
...
THE INDIAN MEDICAL GAZETTE.
182
[July 1,
1880.
Epidemics Particular characters.
18. Effect tion of milk.
19.
oil secre-
Profuse sweat-
ing.
Not noticed.
Occurred mon
as a com-
symptom.
of 1872.
of 18G9.
of 1867.
of 187G.
Not noticed.
Not noticed.
Noticed j'n 2 cases in which it did not stop.
Occurred
Less marked.
Only recorded in 3 cases out of 101 ; considering all the cases that I have
mon
as a com-
symptom.
seen, cold sweating was remarkably less this year.
Noticed.
20. Occurrence of several cases in one house.
Out of my 101 cases, in 9 places more than one occurred in the same house.
REMARKS. 1. We are accustomed to recognize the influence of cholera poison when it is sufficient to produce a number
of well-marked symptoms, but I have no doubt that all those who have had much experience of cholera epidemics in large towns will agree with me that as under the influence of different degrees of intensity of malaria and
cases cases
in 1867 might be due to the treatment of these by frictions with medicated oil containing ginger,
nutmegs and cloves.
to different length of the period of exposure and individual susceptibilities, &c., the poison produces different varieties of malarious fever,?from the fatal remittent to the mildest dumb ague or neuralgic and other periodic complaints?so also cholera poison under a variety of circumstances might produce a variety of symptoms that are not yet fully recognized. 2. The occurrence of cramps and twitching in men not suffering from the usual symptoms of cholera, and in whom no cause could be detected, and collapse without vomiting and purging might be taken as examples of
The sensation of needles and pins in the skin, reaction occurred as a prominent symptom when the season was hot, and the intensity of thirst also varied to a certain extent with the heat of the season. 7. Head symptoms in cholera may supervene long before entire suppression of urine,?most probably from the partial arrest of that excretion. Hence it is important to attend to the kidneys and derivation from the head at the outset. 8. The occurrence of a second nttack of cholera after complete recovery from the first during the same epidemic is worthy of note. 9. In two cases of women suckling their children secretion of milk was not arrested.
the effect of different degrees of the poison. As in severe fevers, convulsions simple or epileptic 3. may precede, or supervene on, an attack of cholera.
I hope facts similar to these, or others of greater interhave been observed by medical men in different parts of India, and I shall feel much obliged to them if they
according
4. Occurrence of so many cases of motor paralysis and anoesthesia in the epidemic of 1869 is remarkable, 5. The recoveries from partial paralysis in a few
6.
during
est,
will kindly publish the result of their this subject. 30th March 1880.
experience
on
Shah, Khan Bahadur, Officiating Surgeon, Jhang. While in charge of the Peshawar City Dispensary I had a great though sad opportunity of observing there four epidemics of cholera, viz., in 1867, 1869, 1872 and 1876. In each year I had a very large number of cholera cases under my care not only in the temporary cholera hospitals that were erected for the poor friendless people, but also in private circles which I had to visit from house Civil
to house.
When
this
on
duty
I took
to take brief
care
some
immediately under my own down some important facts of
notes of such cases as were to write
treatment, and others that I The will, I
saw
in consultation with the hakims. statement of facts recorded in my notes
following hope, interest
Medical Gazette
Comparative Statement showing peculiar characters of Cholera
some
of the readers of the Indian
:?
as
observed in four
epidemics.
Epidemics Particular characters. of 1867.
1. Cramps in nonclioleraic patients. 2,
Convulsions.
of 1872.
of 18G9.
Occurred in several cases.
Occurred in several
In 2 adult who were
patients healthy before, epileptic fits occurred at irregular
Occurred in several cases.
cases.
None.
None.
of 1876.
Only
one case
observed.
Convulsions occurred in cases in children suffering from cholera.
3
each fit followed by characteristic vomiting and purging.
intervals,
being
3.
Paralysis.
Recovery from
tial few
paralysis
par-
in
a
cases.
Paralysis occurred No motor paralysis : in 6 cases?in 2 of one case of anaeseither arm, in 3 of thesia. bladder, in one squinting ; in 2 cases anassthesia remained for some time after re-
No case of anaesthesia.
paralysis
or
covery. 4. Sensation of needles and pins during reaction.
5.
Head symptoms.
Did not
Not
noticed.
occur.
particularly
Did occur as a prominent symptom, especially in the skin covering the outer aspect of the arm. Not
noticed.
particularly
Not
a
symptom.
prominent
Predominated in children not only when urine was suppressed, but even when suppression had been overcome or
not
ced.
yet
commen-
Did not
occur
at all.
Out of my 101 cases delirium occurred in 9 and coma
and
drowsiness
very much more noticed in this year than in any former one. Head symptoms occurred not only as a result of uraemia, but they also supervened in some cases before the suppression of urine, and in several after it had been overcome. were
July 1,
1880.]
OBSERVATIONS ON CHOLERA.?BY ASST.-SURG. CHETAN SHAH.
igl
Epidemics Particular characters. of 1867.
6. Vomi*Jag followed by collapse and death without purg-
Occurred
in
some
cases.
Occurred in
some
Not observed.
cases.
ing.
7. Collapse followed by death without
Such
cases
did
occur.
of 1876.
of 1872.
of 1869.
Out of 101 cases that I treated in the city, one case of this sort occurred, though several other cases of this nature have also been reported.
None noticed.
No such
On account of chomensea ceased after an hour or two of their appearance.
No case seen.
No
In three pregnant this occurred long before they died.
No such
case seen.
No such
In some
cases.
None noticed.
case
occurred.
vomiting or purging; ordinary fsecal matter, not void of bile, being passed. 8. Flow of ceased.
menses
Not observed.
case seen.
lera
sounds 9. Foetal ceased before death.
Not observed.
10. Successive stagpassed much more rapidly than usual.
In
case
seen.
women
a
few
In
cases.
some
cases.
es
Death in nine actually known to have occurred within 3 hours of seizure. Three of these died within half an hour,?one of these occurred at the dispensary. Many died aft'er
unusually thus, one
long period,
after 16 days, after 12 days, and ono after 10 days, and four after 9 days.
one
11.
Time of pass-
ing urine and
its re-
Not noticed.
In
13.
Severity
of type.
Prsecordial op-
pression.
case
water
after 6 days without uraemia.
lation with ureemia.
12.
one
passed
Same in four Not particularly corded.
re-
epidemi
Common.
More marked than in
Less than in 1869.
previous epidemics.
14. Second attack after recovery from the first seizures.
Not noticed.
In 2
cases.
Statistics of 15. seizures with reference to age.
Not procurable.
Not
procurable.
16. Statistics with reference to caste.
Out of 101 cases that I Average of 72 cases, 72 hours after 6eizure took notice of 36 died in shortest 24 hours, collapse Or very imperfect reaction without passing longest 144 hours. urine ; in one time was not noticed ; in 6 urine was not suppressed; in remaining cases, in which urine was suppressed, it was passed at an average of 21*02 hours after seizure,?at shortest 8 hours after seizure, at longest 144 hours after seizure.
In none.
Proportionably more
children seized than in former epidemic.
In none,
Out of 330 cases 53 occurred under 5 years of age, 27 between 5 & 10. Hindus Christian
Mussulmans 17. Statistics with to males reference and females.
...
20 1 309
223 7
No. 32553
Female... 107 j
25877
Male
...
THE INDIAN MEDICAL GAZETTE.
182
[July 1,
1880.
Epidemics Particular characters.
18. Effect tion of milk.
19.
oil secre-
Profuse sweat-
ing.
Not noticed.
Occurred mon
as a com-
symptom.
of 1872.
of 18G9.
of 1867.
of 187G.
Not noticed.
Not noticed.
Noticed j'n 2 cases in which it did not stop.
Occurred
Less marked.
Only recorded in 3 cases out of 101 ; considering all the cases that I have
mon
as a com-
symptom.
seen, cold sweating was remarkably less this year.
Noticed.
20. Occurrence of several cases in one house.
Out of my 101 cases, in 9 places more than one occurred in the same house.
REMARKS. 1. We are accustomed to recognize the influence of cholera poison when it is sufficient to produce a number
of well-marked symptoms, but I have no doubt that all those who have had much experience of cholera epidemics in large towns will agree with me that as under the influence of different degrees of intensity of malaria and
cases cases
in 1867 might be due to the treatment of these by frictions with medicated oil containing ginger,
nutmegs and cloves.
to different length of the period of exposure and individual susceptibilities, &c., the poison produces different varieties of malarious fever,?from the fatal remittent to the mildest dumb ague or neuralgic and other periodic complaints?so also cholera poison under a variety of circumstances might produce a variety of symptoms that are not yet fully recognized. 2. The occurrence of cramps and twitching in men not suffering from the usual symptoms of cholera, and in whom no cause could be detected, and collapse without vomiting and purging might be taken as examples of
The sensation of needles and pins in the skin, reaction occurred as a prominent symptom when the season was hot, and the intensity of thirst also varied to a certain extent with the heat of the season. 7. Head symptoms in cholera may supervene long before entire suppression of urine,?most probably from the partial arrest of that excretion. Hence it is important to attend to the kidneys and derivation from the head at the outset. 8. The occurrence of a second nttack of cholera after complete recovery from the first during the same epidemic is worthy of note. 9. In two cases of women suckling their children secretion of milk was not arrested.
the effect of different degrees of the poison. As in severe fevers, convulsions simple or epileptic 3. may precede, or supervene on, an attack of cholera.
I hope facts similar to these, or others of greater interhave been observed by medical men in different parts of India, and I shall feel much obliged to them if they
according
4. Occurrence of so many cases of motor paralysis and anoesthesia in the epidemic of 1869 is remarkable, 5. The recoveries from partial paralysis in a few
6.
during
est,
will kindly publish the result of their this subject. 30th March 1880.
experience
on
