14 JOURNAL OF THE [January, 



out in a fluid form, and the discharges soon become almost 

 colorless, like whey, or like water, in which rice has been boiled ; 

 so that they are commonly spoken of as " rice-water" evacua- 

 tions. On standing, this fluid deposits a loose, whitish gray 

 material, which consists of mucous flocculi, containing numer- 

 ous leucocytes, and immense numbers of granules, including 

 many bacteria. This flow is sometimes most profuse. The 

 specific gravity of this liquid is 1.006 to 1.013. It has a neutral 

 or slightly alkaline reaction, and contains chiefly sodium chloride 

 with a quantity of albumen. So profuse is the flow that several 

 pints or quarts may be voided in a few hours. When collected 

 in a vessel it may be of a light yellowish color at first, owing to 

 a slight admixture of bile. Sometimes a pinkish tinge is caused 

 by the admixture of blood. Often there is no pain in the bowels, 

 but sometimes patients complain of griping pains in the abdo- 

 men. After an interval vomiting sets in. The fluid rejected 

 from the stomach, unless mixed with food, is pale and watery, 

 being identical with the " rice-water " liquid. There are also 

 crampings of the muscles of the feet and calves of the legs, and 

 sometimes cramps of the thighs, hands, chest and abdomen are 

 among the early symptoms. In many cases they may be absent. 



These symptoms are usually followed, more or less rapidly, 

 by the development of a very remarkable condition known as 

 "collapse," sometimes described by some writers as the " algid 

 stage " of the disease. It usually occurs within six or seven 

 hours after the commencement of the purging, and often earlier. 

 Occasionally the patient dies collapsed, before there has been 

 any evacuation, the rice-water being found in the intestines after 

 death. This collapsed condition is due to the failure of the cir- 

 culation, beginning at the periphery, but afterwards affecting 

 parts nearer the heart. The pulse at the wrist becomes more 

 and more feeble and thread-like, until it is altogether imper- 

 ceptible. This condition of collapse frequently leads directly 

 to a fatal termination, which usually takes place between twelve 

 and twenty-four hours after the commencement of the attack ; 

 but sometimes earlier, and sometimes during the second day. 

 Reaction not infrequently, where collapse in extreme form has 

 existed, takes place in from twenty-four to forty-eight hours. 

 Improvement occurs slowly. 



Regarding the cause of Cholera much has been learned during 



