Cholera in the perspective of 1966

Abstract

Cholera is a disease state caused by the Vibrio cholerae. The vibrios remain in the gut lumen, and the disease is atypically afebrile. The main symptom is a profuse isotonic diarrhea of rice-water character with an output rate of as much as 1 liter/hour. Early signs in the untreated patient are skeletal muscle cramps (presumably due to electrolyte loss) and vomiting. Mortality rate in untreated cases may be as high as 80%, and in treated cases, 20%. The U.S. Navy method of treating chlera has reduced the mortality rate to zero in the uncomplicated cases. U.S. Navy scientists have demonstrated that the cholera stool is remarkably constant from patient to patient and throughout the course of the disease. The simplicity of the Navy method for treating cholera makes it well suited for use in epidemics in populations with no experience in cholera. The method measures plasma specific gravity by the copper sulfate method. The Navy scientists found that there is a sodium transport inhibitor in cholera stools, and that there is decreased sodium transport from the gut lumen to plasma in the acute phase of cholera. Unlike other forms of shock, the mesenteric circulation in cholera must continue as there is a danger of loss of protein-free plasma, eventually leading to death. Tetracycline and other antibiotics have been shown to halve the course of the disease and fluid requirements for its therapy