Cholera is a serious infection, involving the lower part of the small bowel. It is one of the most severe diseases of the intestines. It is a waterborne disease and is common during monsoon. The disease is predominant in children in endemic areas like India and other countries of South East and Mid East Asia. Its incidence is much higher in the age group between one and five years than in other age groups of children.

Cholera strikes suddenly and fills the intestinal canal with bacilli which die rapidly and leave the person alive or dead. It comes as an epidemic and creates havoc but subsides quickly in the locality. Those who are susceptible to it are carried away and those who are left alive become immuned to it. Thus after an epidemic in a non-endemic area, there is no revisitation by cholera in the locality for two or three years.

Symptoms

Cholera appears in three stages. In the first stage, the patient suffers from mild diarrhoea and vomiting, which worsens rapidly. The motions become watery, containing no faecal matter. The patient gets severe cramps in the muscles of the abdomen and limbs, resulting from lack of salts. The temperature rises but the skin is generally cold. Taking water to quench the thirst makes the cramps worse by diluting the body salts still further.

In the second stage, known as the stage of collapse, the body becomes colder, the skin dry, wrinkled and purple. Voice becomes weak and husky and the urine becomes dark and scanty or altogether absent. It is in this 'algid' stage that the patient may die, as early as 24 hours after the onset of symptoms.

In the third stage, recovery follows in favourable cases. All the changes seem to reverse themselves. The fluid loss decreases and there is a slight improvement in general condition. Even at this stage, the relapse may occur or the patient may sink into a condition resembling typhoid fever. The condition may deteriorate over a period of two or three weeks. During this stage of reaction, the temperature may rise, and the patient may be in danger from pneumonia.

Causes

Cholera is caused by a short curved, rod-shaped germ known as vibrio cholerate. This germ produces a powerful poison or endotoxin. It is spread by flies and water contaminated by the germs. The real cause of the disease, however, is the toxic and devitalised condition of the system brought about by incorrect feeding habits and faulty style of living. This condition facilitates invasion of cholera germs.

Treatment

Before the onset of dehydration, the treatment should aim at combating the loss of fluids and salts from the body. To allay thirst, water, soda water or green coconut water should be given for sipping, although these may be thrown out by vomiting, therefore, only small quantities of water should be given repeatedly, as these may remain for sometime within the stomach and a stay of every one minute means some absorption. Ice may be given for sucking. This will reduce internal temperature and restrict the tendency to vomit. Once the child is dehydrated, intravenous infusions of saline solution should be given to compensate for the loss of fluids and salts from the body. The child may require two litres or more a day. Care shoud , however, be taken to avoid waterlogging. Potassium may be added to the infused fluids, if there are signs of heavy potassium loss.

After the acute stage of cholera is over, the child may be given green coconut water and barley water in very thin consistency. When the stools begin to form, he should be given buttermilk. As he progresses towards recovery , rice cooked to semi-solid form, mixed with curd, may be given.

The child should not be given solid food till he has fully recovered. Liquid and bland foods are the best which he can ingest without endangering a reoccurance of the malady. Lemon, onion, green chillies, vinegar, and mint should be included in the daily diet during an epidemic of cholera.

Certain home remedies have been found beneficial in the treatment of cholera. The foremost among these is the use of lemon (bara nimbu). The juice of this fruit can kill cholera bacilli within a very short time. It is also a very effective and reliable preventive food item against cholera during the epidemic. It can be taken in the form of sweetened or salted beverages for this purpose. Taking of lemon with food as a daily routine can also prevent cholera.

The root bark of guava (amrud) is another valuable remedy. It is rich in tannins and can be successfully employed in the form of concentrated decoction in cholera. About 15 grams of the root bark should be used in 250 ml. of water to make the decoction. The water should be boiled till it is reduced by one-third in quantity. It can be taken twice daily. It will arrest vomiting and symptoms of diarrhoea.

According to Culpeper, an eminent nutritionist for children and young people, nothing is better to purge cholera than the leaves and flowers of peach(arhu). They should be taken in the form of syrup or conserve. The leaves of drumstick (sanjana) tree are also useful in this illness. Half a teaspoon of fresh leaf-juice, mixed with equal quantity of honey and half a glass of tender coconut water, can be given two or three times as a herbal medicine in the treatment of cholera.

Onion is very useful in cholera. About 15 grams of this vegetable and four black peppers should be finely pounded in a pestle and given to the child-patient. It allays thirst and restlessness and the patient feels better. The fresh juice of bitter bourd (karela) is another effective medicine in early stages of cholera. A teaspoon of this juice, mixed with equal quantity of white onion juice and half a teaspoon of lime juice, should be given.

The intense visceral congestion can be relieved by maintaining warmth and activity of the skin. This can be achieved by applying hot-blanket pack or by taking hot full-bath followed by vigorous cold rubbing with towel until surface is red. To check vomiting ice-bag should be applied over stomach,throat and spine. Cold compresses can also be applied over the abdomen with beneficial results. They should be changed every 15 or 20 minutes.

Cholera can be controlled only by rigid purification of water supplies and proper disposal of human wastes. In cases of slightest doubt about contamination of water, it must be boiled before use for drinking and cooking purposes. All foodstuffs must be kept covered and vegetables and fruits washed with a solution of potassium permaganate before consumption. Other precautions against this disease include avoiding all uncooked vegetables, through washing of hands by all who handle food, and the elimination of all contacts with the disease.