208 



CHOLERA. 



the proportion of deaths in the cold stage, compared 

 with those in the hot, was liir u renter in India, ac- 

 cording to doctor Russell's experience, than here. 

 Fourthly, the number of medical men and hospital 

 attendants attacked with cholera during the present 

 epidemic, in proportion to the whole employed, and 

 to other classes of society, lias been beyond all com- 

 parison greater here than in India under similar cir- 

 cumstances." Doctor Keir, of Moscow, gives the 

 following description of the consecutive or secondary 

 morbid state : " A second ordeal now begins, some- 

 times as severe, and frequently not less fatal, though 

 more slowly so, than the first : this is probably the 

 effect of the morbid changes which liave been induced 

 (luring the first period of the disease. The appear- 

 ance of the complaint is now entirely changed, inso- 

 much that one who had not seen the patient during 

 the first period, or been told of the symptoms, could 

 not possibly know thut he was suffering from the 

 epidemic. 1 have observed the disease in this, its se- 

 cond period, to assume four forms : the first an in- 

 flammatory, or rather sub-inflammatory state of the 

 stomach and bowels, most frequently the latter, some- 

 times conjoined ; the second, inflammatory irritation 

 of the lungs, with pain of the chest, cough, viscid ex- 

 pectoration and fever, appearing as a critical metas- 

 tasis of the disease ; the third, bilious or bilio-nervous 

 fever, with suppuration of the parotid gland* in one 

 case, with auxiliary suppurating bubo, towards the 

 end of the fever, an inflammatory irritation of the 

 lungs took place, ending in vomica ; and the fourth, 

 a congestive sub-inflammatory state of the brain and 

 spinai chord. This last, as was natural to expect 

 from the nature and seat of the affection, proved by 

 far the most dangerous and most frequently fatal 

 form of the second period : it appeared generally to 

 supervene after the purging, vomiting, and cramps 

 had been relieved, and the external heat in some de- 

 gree restored ; the patient complained of pain in the 

 back, between the shoulder-blades, or in some other 

 part of the spine, sometimes along its whole tract : 

 he appeared sleepy to such a degree that at first I 

 was disposed to attribute this state, in part at least, 

 to the effects of the opium given hi the first period. 

 But I was soon convinced that the cause of this 

 symptom, and of another strongly characteristic of 

 this form of the disease, namely, the filling of the 

 vessels of the sclerotica with red blood, was a conges- 

 tive sub-inflammatory state of the brain and spinal 

 chord. This striking symptom at first began to show 

 itself in the inferior part of the globe of the eyes ; it 

 gradually increased, and, little by little, reached the 

 upper part, while the eyes turned upwards, exposing 

 the lower part gorged with blood. This state of the 

 patient generally ended in a complete coma, and 

 proved fatal a few hours afterwards." Besides the 

 various and appalling symptoms which indicate gene- 

 ral derangement of the action of the solids, there are 

 appearances in the blood drawn during the collapsed 

 stage, showing that the fluids feel the influence of 

 this formidable disease. These appearances are very 



prevailed in the different Indian presidencies, and like- 

 wise between that which existed in Hindostan and Cey. 

 Ion, perhaps as considerable as those now observed by these 

 intelligent physicians. In regard to what is stated in the 

 extract referred to, relative to the greater frequency at 

 Petersburg of the secondary " typhoid," or, as more com- 

 monly designated in India, " low biliary" symptoms, we 

 confess that we observe a discrepancy when we read a sub- 

 sequent part of the same Report, in which doctors Russell 

 and Barry state, " Convalescence from cholera has been 

 rapid and perfect here, as is proved by the following fact : 

 The minister of- the interior had given orders that all 

 convalescents, civil as well as military, at the general hos- 

 pital, should be detained fourteen days. We inspected 

 about two hundred of these dftcnus some days back, with Sir 

 J. Wylie, and found them in excellent health, -vithuut a 

 ingle morbid sequela." 



uniformly expressed by the terms ilni-k, Hack, or tarry, 

 in NgBM to colour, and by thick, ropy, sirupy, or 

 semi-coagulated, in respect to consistence. This 

 change in the condition of the circulating fluid is 

 fully proved to be in the ratio of the duration of the 

 disease ; the blood at the commencement seeinin to 

 be nearly or altogether natural, and more or less ra- 

 pidly assuming a morbid state as the malady advan- 

 ces. This condition was less conspicuous in <MM s 

 of cholera ushered in by symptoms of excitement, 

 than where the collapsed state of the system had oc- 

 curred early ; and in certain rare cases it was not. 

 observable at all, and the blood flowed readily from 

 the vein; but the reverse was the fact, both with 

 respect to its condition and the manner of its flowing 

 from the arm, in an immense majority of instance,. 

 In general, after a certain quantity of dark, thick 

 blood had been drawn, its colour became lighter, its 

 consistence less thick, and the circulation revived 

 such appearances always affording grounds for a pro. 

 portionably favourable prognosis. There is some 

 discrepancy in the accounts transmitted to us of the 

 mode in which this diseased blood coagulates. In 

 some instances, we learn, the coagulation is rapid, 

 whilst in others it is slow and imperfect. Reporters 

 are unanimous in declaring it deficient in serum, and 

 destitute of the buffy coat. The latter is occasionally 

 observed in cases attended with reaction, in which 

 the blood is not black and thick.* The discharges 

 from patients suffering under this disease were sub- 

 jected to experiment by doctor Christie. The secre- 

 tion consists of two substances, the one a transparent 

 serous fluid, the other an opaque, white coagulum ; 

 the former perfectly soluble in cold water, the latter 

 quite insoluble. These matters being submitted to 

 the action of reagents, the fluid part was found to be 

 pure serum, and the coagulated portion fibrin. The 

 secretion, therefore, as the author remarks, has a 

 composition similar to that of the blood deprived of 

 its colouring matter ; but the serum is in much larger 

 proportion to the fibrin. 



II. Character of the Epidemic as it appeared in 

 Britain. Were we to attempt a definition of epide- 

 mic cholera, as it appeared in Britain, the following, 

 would comprise its distinctive symptoms : After 

 watery diarrhosa, or other generally slight indisposi- 

 tion, vomiting and purging of a white or colourless 

 fluid, violent cramps, great prostration and collapse ,f 

 the last occurring simultaneously with the vomiting 

 and cramps, or shortly after them. Should the patien t 

 survive the last tram of symptoms, a state of excite- 

 ment and fever supervenes. We can convey a cor- 

 rect idea of the disease only by dividing it into three 

 stages, the incipient, the cold or choleric, and the 

 febrile : the division accords with the character of the 

 disease. 



I . Symptoms of the Incipient Stage. In an immense 

 majority of instances, diarrhoea was the prominent 

 symptom of this stage. Languor and lassitude, and 

 occasionally nausea and vertigo, coexisted with the 

 disorder of the bowels, and sometimes certain of 

 these symptoms may have appeared without it ; but 

 its occurrence was so common, that there were few 

 cases in which it had not preceded the more fonnid- 



Madras Report, p. 30, &c. 



t By collapse, in this definition, is meant the feebleness 

 or almost the arrest of the circulation ; the death-like ap- 

 pearance, the coldness, shrinking, and occasional blueness 

 of the surface, which may in other diseases be ob 

 after they have existed some time, and as the pow 

 life are passing away ; but which occur, in what w 

 call the cold or choleric stage of the epidemic, in a short 

 time after its commencement, as though they formed an es 

 sential part of it. The degree and early accession of thi 

 collapse, and the white discharge, are the only distinctive 

 marks that we are aware of between this stage of the epi- 

 demic and ordinary cholera. 



