CHOLERA. 



207- 



low, hoarse, and interrupted. The eyes were sunk 

 in their orbits ; the corneae flaccid, the. conjunctivas 

 frequently suffused with blood ; the features of the 

 face collapsed ; and the whole countenance wore a 

 cadaverous aspect. The secretions (those of the skin 

 and intestines excepted) were generally suspended. 

 The functions of the mind were undisturbed almost 

 to the very last moment of existence. The approach 

 of recovery was denoted by the rising of the pulse, 

 the return of heat to the surface, inclination to natu- 

 ral sleep, diminution or cessation of vomiting, purg- 

 ing, and spasms, and, after an interval, the reappear- 

 ance of bilious stools, urine, and saliva.* Regarding 

 the above as a picture of the general type of a disease 

 rather variable in character, we shall proceed to re- 

 late the more striking deviations from the ordinary 

 form which were observed in India, f Instead of the 

 exceedingly sunk state, there was a marked excite- 

 ment, with a hot and dry skin, and a pulse of con- 

 siderable force, in several instances throughout great 

 part of the course of the disease. J This, in some cases, 

 arose from the early exhibition of stimulants ; but in 

 others it appeared to be an essential part of the dis- 

 order. These cases yielded most certainly and readi- 

 ly to treatment ; and hence many of them having 

 been subdued without the occurrence of sinking or 

 debility, it was a matter of doubt whether this de- 

 scription of disorder really belonged to the epidemic ; 

 but that it did so was placed beyond all question by 

 some of the more protracted cases degenerating into 

 the ordinary low form. The most fetal variety of the 

 disease was denoted by the slightness of the commo- 

 tion in the system : there was no vomiting ; hardly 

 any purging ; perhaps there were only one or two 

 stools, with no perceptible spasm ; no pain of any 

 kind ; a mortal coldness, with arrest of the circula- 

 tion coming on from the beginning, and the patient 

 dying without a struggle within three or four hours. 

 Several instances were heard of, at Hoobly and other 

 places, of natives being struck with the disease 

 whilst walking in the open air, and who, having 

 fallen down, retched a little, complained of ver- 

 tigo, deafness, and blindness, and expired in a 

 few minutes. Mr Scott informs us that this most 

 deadly form of the disease frequently manifested 

 itself in local epidemic visitations, which were often 

 observed in India, all the cases occurring at the same 

 time in a given district partaking of the same pecu- 

 liarity of character. The collapsed form of disease, 

 first described, is that which has been most frequent- 

 ly observed. In fatal cases, its duration varies from 

 four to eight hours ; whilst in those which terminate 

 favourably (a result often apparently due to early 

 medical assistance), the patient may be restored to 

 perfect convalescence in a period rangingfrom twenty- 

 four to twenty-eight hours. But, in many cases, 

 considerable disturbance of the system intervenes be- 

 tween the period of collapse and restoration to health ; 

 or this disturbance may itself cause death. The In- 

 dian reporters mention two forms of this disorder. 

 In the one, with some excitement in the system, the 

 bowels continue to discharge, for many days, first 

 brown and watery, then dark^black, and pitchy stools, 

 sometimes with blood, and with peculiar pains in the 

 bowels, particularly in the rectum. The other, a 

 distinct febrile form, we shall describe in the language 

 of the Bengal Report : " The fever, which almost 



* Scott's Reports on the Epidemic Cholera; Anderson on 

 Cholera (E. M. and S. Journal, vol. xv, p. 325) ; Christie on 

 Cholera and the Pathology of Mucous Membranes ; Annes- 

 ley's Sketch of the Diseases of India, &c- 



t For much that is valuable in this article, we are indebt- 

 ed to the Cyclopedia of Practical Medicine, Lon. IS32; the 

 Englishman's Mag., No 1; and the Westmin. Review, No30. 



} Madras Reports p. 25 



invariably attended this second stage of the disease 

 (in Europeans), partook much of the nature of Un- 

 common bilious attacks of these latitudes. There 

 was a hot, dry skin, a foul, deeply furred tongue, 

 parched mouth, thirst, sick stomach, restlessness, 

 watchfulness, and quick, variable pulse, sometimes 

 with delirium and stupor, and other marked affections 

 of the brain. Generally, when the disorder proved 

 fatal in this stage, the tongue, from being cream- 

 coloured, became brown, and sometimes black, hard, 

 and more deeply furred ; the teeth and lips were 

 covered with sordes ; the state of the skin varied, 

 chills alternately with heats ; the pulse became ex- 

 tremely quick, weak, and tremulous ; hiccough, 

 catching of the breath, great restlessness and deep 

 moaning succeeded ; ana the patient soon sunk, in- 

 coherent and insensible, under the debilitating effects 

 of low nervous fever, and frequent, dark, tarry, al- 

 vine discharges." A consecutive fever, similar to this, 

 we learn from doctors Russell and Barry, is of more 

 frequent occurrence in Russia than in India. The fol- 

 lowing description of it we owe to these gentlemen : 

 " After the blue, cold period lias lasted from twelve 

 to twenty-four hours, seldom to forty-eight hours or 

 upwards, the pulse and external heat begin gradually 

 to return ; headache is complained of, with noise in 

 the ears ; the tongue becomes more loaded, redder 

 at the tip and edges, and also drier. High-coloured 

 urine is passed with pain and in small quantities ; the 

 pupil is often dilated ; soreness is felt on pressure 

 over the liver, stomach, and belly ; bleeding by the 

 lancet or leeches is required. Ice to the head gives 

 great relief. In short, the patient is labouring under 

 a continued fever, not to be distinguished from or- 

 dinary fever. A profuse critical perspiration may 

 come on from the second or third day, and leave the 

 sufferer convalescent ; but much more frequently the 

 quickness of pulse and heat of skin continue ; the 

 tongue becomes brown and parched; the eyes are 

 suffused and drowsy ; there is a dull flush, with stu- 

 por and heaviness, about the countenance, much re- 

 sembling typhus ; dark sordes collect about the lips 

 and teeth ; sometimes the patient is pale, squalid, 

 and low, with the pulse and heat below natural ; but, 

 with the typhus stupor, delirium supervenes, and 

 death takes place from the fourth to the eighth day, 

 or even later, in the very individual, too, whom the 

 most assiduous attention had barely saved in the first 

 or cold stage. To give a notion of the importance 

 and danger of cholera fever, a most intelligent phy- 

 sician, doctor Reimer, of the merchant hospital, in- 

 forms us, that of twenty cases treated under his own 

 eye, who fell victims to the disease, seven died in the 

 cold stage, and thirteen in the consecutive fever."* 

 The same gentlemen state, as the result of their ob- 

 servations, that the following are the points of differ- 

 ence between the European epidemic and that of In- 

 dia: " First, the evacuations, both upwards and 

 downwards, seem to have been much more profuse 

 and ungovernable in the Indian than in the present 

 cholera, though the characters of the evacuations are 

 precisely the same. Secondly, restoration to health 

 from the cold stage, without passing through conse- 

 cutive fever of any kind, was by far more frequent in 

 India than here (St Petersburg) ; nor did the conse- 

 cutive fever there assume a typhoid type, f Thirdly, 



* Report of doctors Russell and Barry to C. C. Greville, 

 esquire, published, among other papers, by authority of his 

 majesty's most honourable privy council. 



t If we compare the symptoms attributed to this consecu- 

 tive fever by doctors Russell and Barry, with those quot- 

 ed from the Bengal Reports, the difference between this 

 stage of the respective epidemics does not appear very 

 striking: the epithet typhoid seems almost equally applica- 

 ble to both. Varieties were observed in the disease as it 



