Cholera Asiatica: clinical observations on one hundred and twenty-five cases of the disease, with special reference to the beneficial effects obtained in its treatment by intravenous infusions of a normal (isotonic) saline solution

Abstract

The following observations were made by me while I was serving as a Captain in ihe R.A.M.C. with the Mesopotamia Expeditionary Force. Shortly after my arrival ill Mesopotamia, in May 1916, I was sent up River to Mmara, which is a town situated on the left bank of the River Tigris, about 76 miles up River from Basrah.During 1916, when the British Front Line was situated below Eut-el-Amara, Amara acted as advanced Base, and was, therefore, from a military point of view, of greater importance than during the following years, when it became merely a station along the long line of communication from Basrah to Baghdad.There I was attached to a small unit which was , in reality, a detached section of a British General Hospital - namely Section 'D' , E2nd British General Hospital. Its function, at that time, was confined to the care of British troops who were suffering from communicable diseases, such as Enteric Group infections, Dysentery, Diphtheria, and the like.Early in August 1916, our unit was detailed to take over the treatment of Cholera. This entailed the moving of the whole of the personnel and equipment to what was then known as - 'The Cholera Camp' , at the same time relieving the Field ambulance which had been in charge there.in addition to the care of all Cholera cases, we were to continue to receive all cases of communicable disease - except enteric group infections, and dysentery - occurring in or brought to the Amara area. Both British and Indian troops came under our charge, and accordingly our unit was renamed 'The Isolation Hospital'.The capacity of the Hospital was 250 beds, 125 beds being allotted to the British Section and 125 to the Indian.With the exception of four huts (50 beds in all) in the British Section, the whole Camp was composed of tents (E.P. ) each tent accommodating 6 beds fairly comfortably.The four huts in the British Section were far from ideal, from the point of view of the treatment of a disease such as Cholera.In the first place, they were mere shells of matting made locally, by the Arabs and known as 'chittai'. The roofs too, were composed of this, fragile material and consequently it was possible to spread only a thin layer of mud and straw - (Bhoosa) on top, providing but the slightest opportunity to keep the temperature lower than that of the outside air.it will be appreciated, therefore, under what adverse conditions those who suffered from high temperatures in the reaction stage of cholera, attempted to pass safely through that critical period c of the malady.As to the staff of the unit, there were at first (up to November 1916), three ITedical Officers, including the Commanding Officer, sixteen British (Nursing Orderlies, and some eighty Indians (Nursing Orderl ie s , hard Boys, etc. ).The nursing of all patients was carried out by men. This, I think, is as it should be, when one considers to what an extraordinary degree the nursing of cholera demands physical strength to move these helpless, collapsed patients.