288 ITS BI-^ARING OX ilEDICAL PRACTICE. 



body temperature to 95'^ F. ; extreme prostration of strength; extremi- 

 ties pulseless ; and face liippocratic. 



Wlien death occurs during collapse, the following symptoms are usually 

 found on careful examination of the corpse : The temperature rises to 

 103° F. ; the mnscles give out their characteristic susurrus CCC, and 

 <ixhibit spontaneous movements; the whole train of symptoms prodncing 

 the effect of a ghastly attempt at resurrectiou.* 



In this disease we have phenomena respecting animal heat the very 

 reverse of those found in typhus fever; the body performing one vertical 

 mile short of its daily work, instead of one mile in excess. The prostra- 

 tion of strength resulting from this deficient combustion is so great that 

 death is often caused by bringing the patient to hospital in a cab instead 

 of upon a stretcher, by his walking up a dozen steps into his ward, and 

 sometimes even fatal results have followed a sudden effort to sit np in 

 bed to vomit. 



The rise of temperature after death, and the continuance of muscular 

 susurrus and motion, tend to prove that the impeded circulation, which 

 is the prominent symptom in cholera collapse, is due to constriction 

 (probably vasomotor-nervous) of the capillaries, in consequence of which 

 the muscles are deprived of their su})ply of freshly oxidized blood, the 

 result of which is necessarilj- contraction and cramp, which produces the 

 excessive agony that characterizes this disease. 



All authorities on cholera, whether their object be to "impede" or to 

 *' assist" nature, are agreed that medicines, whether astringent or i)ur- 

 gative, are not onlj' useless, but dangerous, in the stage of collapse. 



It is useless to give alcoholic fuel to restore the loss of animal heat, for 

 there is no circulation to cause the oxidation of the hydrocarbons. 



It is equally useless and more dangerous to give opium, to check the 

 remaining purging that exists; for if vomiting have ceased, your acetate 

 of lead and opium pills lie as if in the stomach of a corpse, and at the 

 termination of collapse, your patient enters upon the consecutive fever, 

 with perhaps a dozen grains of opium in his stomach, placed there like 

 an explosive shell by your ill-timed zeal, and rapidly jjasses into a coma- 

 tose condition, from which he never for a moment rallies. His death is 

 always accredited by the registrar to cholera morbus and not to opium. 



Purgatives and emeticst in cholera collapse effect the same object as 

 opium, but with greater rapidity. In the stage of blue collapse, the 

 chances of life and death are almost exactly equal, and the slightest 

 additional loss of force turns the wavering beam on the side of death. 

 The effects of a brisk purgative or emetic (if they act) upon a patient, 

 unable to (;limb a dozen steps, or sit np for a quarter of an hour, without 



* It is startling, on making a post-mortem examination of a cholera patient alone and 

 by candle-light, to witness, on the first free incision of the scalpel, the hand of the corpse 

 rise slowly from its side and placed quietly across its breast. 



t When mustard is used, its conservative effects as a stimulant sometimes counteract 

 its destructive effects as an emetic. 



