166 



CHOLERA, ASIATIC. 



then a sudden twitching, and stiffening, and 

 twisting of the toes and fingers, which greatly 

 alarms the patient, and often brings tears. Then 

 the calves of the legs, and the muscles of the 

 arms and thighs and loins are drawn up in 

 excruciating knots; the integuments of the ab- 

 domen are raised in irregular folds, the belly 

 itself drawn violently backward toward the 

 spine, the diaphragm upward and inward, and 

 toward the chest There is hardness and con- 

 stant pain in the region of the bowels, and the 

 flesh is sore to the touch. Agonizing, however, 

 as these spasms are, there is no convulsion, no 

 blunting of the intelligence, no unconsciousness. 

 In the interval of these spasms, the expression 

 of the countenance is bloodless and corpse-like ; 

 there are livid circles around the mouth, and 

 the dull, sunken eyes; the features are sharp 

 and contracted ; the expression helpless, wild, 

 and terror-stricken ; the lips blue ; the face and 

 neck have a leaden, brown, or purple hue, ac- 

 cording to the complexion of the patient or the 

 severity of the attack ; the hands are withered, 

 and the fingers wrinkled and sodden, resem- 

 bling those of the washerwoman when just 

 taken from her tub ; the large superficial veins 

 are very dark, almost black ; the respiration 

 is broken, labored, and irregular, inspiration 

 appearing to be effected by an immense effort 

 of the chest, while the nostrils, instead of ex- 

 panding, collapse, and stop the ingress of the air, 

 and the expiration is hurried and convulsive. 

 The breath is intensely cold, much colder than 

 the atmosphere ; the tongue, perhaps, white and 

 loaded, but always moist, flabby, and chilled, 

 having a feeling like the nose of a dog or a bit of 

 dead flesh. The feet, legs, thighs, and arms, and 

 soon the abdomen and chest, also have the dis- 

 coloration so marked in the dead body, and the 

 toes, like the fingers, are shrunken and withered. 

 The patient tosses incessantly from side to side, 

 laboring and struggling for breath ; his voice is a 

 hoarse, plaintive whisper, or occasionally a low 

 poignant wail or a weak whine ; he calls con- 

 stantly in piteous tones for "water, water, 

 water," to allay the all-consuming thirst, and in, 

 broken sentences, a word at a time, complains of 

 the weight and anguish at his heart, and the fire 

 in his stomach, bowels, and throat. His skin is 

 deadly cold, and wholly or nearly insensible to 

 the action of either mustard or blister, yet at times 

 he complains of feeling too warm, and endeav- 

 ors to throw off the bedclothes. The secretions 

 have all ceased; there is no urine, no bile, no 

 saliva, and no tears. There is no genuine per- 

 spiration, but a cold, clammy sweat, possessing 

 in a marked degree the death odor, exudes from 

 the relaxed pores of every portion of the body ; 

 the lips and cheeks puff out and flap in expira- 

 tion, with a white froth between them as in 

 apoplexy. The spasms have cramped the very 

 vitals; the pulse, which has been growing 

 feebler and feebler for hours, ceases, at the 

 wrist ; the broken heavings of the chest grow 

 fewer and fainter ; there is a quivering among 

 the tendons of the wrist ; a long, weary, con- 



vulsive sob, but . no rattle, and all is over, 

 Of course, all of these symptoms may not be 

 present in every case ; in rare and exceptional 

 instances, the preliminary diarrhoea has been ab- 

 sent, and an obstinate constipation has continued 

 up to the time when the explosive purgation and 

 cramps set in ; but in no case of genuine cholera 

 are the rice-water stools, the terrible cramps, 

 the tetanic spasms, the oppressed breathing, the 

 chilled breath, the dog-nose feel of the tongue, 

 the withered, sodden condition of the hands 

 and fingers, and the wild, haggard, pinched, and 

 anxious expression of the countenance absent. 

 The entire course of the disease which we have 

 thus endeavored to portray may he run in 

 twelve hours, or it may occupy three or even 

 four days. Spontaneous recovery, without 

 medication, when the attack is severe, is ex- 

 ceedingly rare. 



From the description given of the pathology 

 and characteristic symptoms of the disease, it 

 is not difficult to determine the indications to 

 be fulfilled in the treatment of the disease. 

 There may be a diversity of views as to the par- 

 ticular means by which the object is accom- 

 plished, but all would agree as to the principles 

 upon which the treatment ought to proceed. 

 In the first, or what some physicians would call 

 the preliminary step, but which is, nevertheless, 

 really cholera, the diarrhoea which precedes the 

 more violent purging, vomiting, and spasms, 

 the first indication is to check the diarrhoea 

 without inducing inflammation or undue excite- 

 ment of the system. It is to be understood and 

 remembered, that the purging is an effort of 

 nature to rid the system of the poison which it 

 has imbibed ; and though it is likely to be inef- 

 fectual, yet it should not be checked in such a 

 way as to leave the alimentary canal in a state 

 of violent irritation, but so far as possible the 

 highly excited nervous and vascular tissues of 

 the intestines must be soothed and quieted. 

 Those who have read carefully the statement 

 given of the pathology of the disease, will recol- 

 lect that one feature of it was, that the general 

 vascular system, the small blood-vessels which 

 approached the surface were greatly depressed 

 and constricted, and the blood thrown from 

 the surface inward upon the central veins and 

 the vital organs. Another indication, then, is to 

 restore the circulation upon the surface, to call 

 the blood back from the internal organs which 

 are becoming oppressed by it, to run its usual 

 course in the superficial veins and arteries. The 

 accomplishment of this will fulfil a third indi- 

 cation, that of restoring the secretions from the 

 liver, kidneys, salivary glands, &c., which have 

 been suppressedTby the overwhelming amount 

 of work thrown upon them, and the want 

 of vitalized or aerated blood to stimulate their 

 action. The circulation fully restored, and the 

 system relieved from the depressing influence 

 of the poison, the next indication will speedily 

 be fulfilled. The liver will again secrete, and 

 send forth the bile to restore healthy action in 

 the stomach and bowels, and the kidneys once 



