210 



CHOLERA. 



4. Prognosit. The danger of the disease was, in 

 all cases, to be estimated from the degree of collapse 

 Attending the cold or choleric stage. In India, it 

 was remarked that the cases in which the spasms and 

 vomiting were the most violent were by no means 

 fraught with most peril, and the same held true in 

 many instances in Britain. Whether we are to dread 

 a fatal result in the cold or the excited stage, the in- 

 tcu-ity ami duration of the collapse in the former of 

 these stages, are the measure of the danger; for if 

 tile patient die in this stage, he dies of collapse ; and 

 if he survive it, and pass into the state of fever, the 

 character of this fever is malignant and dangerous in 

 proportion to the same collapse. 



5. Diagnosis. From ordinary cholera the cold 

 stage is to be distinguished, by the peculiar character 

 of the discliarges, and by the degree of collapse and 

 Its early occurrence. Cases have been adverted to, 

 which, at least in the choleric stage, could not be 

 discriminated from ordinary cholera, excepting, per- 

 haps, from their taking place at a season of the year 

 when ordinary cholera is never observed ; but it may 

 be remarked that no one would infer the existence 

 of the epidemic from such cases, though he might be 

 disposed to acknowledge that they belonged to it, if 

 cases less equivocal were simultaneously prevalent, 

 and especially if they originated under the circum- 

 stances mentioned in the preceding pages. Notice 

 has been taken of sporadic cases wnich occurred in 

 several parts of the kingdom. These cases were ge- 

 nerally fatal as cases of cholera, and, probably on this 

 account, attracted attention and were reported ; and 

 hence what we should consider the experimentum 

 cruets by which their essential alliance to the epide- 

 mic, as it manifested itself in this country, or differ- 

 ence from it, can alone be proved, the intervention, 

 or otherwise, of fever, between the cold stage and 

 recovery, is necessarily wanting. We have been 

 favoured, by a gentleman of high character and at- 

 tainments,* with a report of two cases, regarded, at 

 the time they occurred, as aggravated cases of the 

 ordinary disease : both took place in the interior, un- 

 der circumstances in which there was not the slight- 

 est ground to suspect contagion, and previously to 

 there being any suspicion of the existence of the epi- 

 demic in this country. In one, the symptoms bore, 

 unquestionably, a considerable resemblance to the 

 choleric stage of the epidemic ; but no fever super- 

 vened. The symptoms of the other shall be given 

 in the words of the writer : '' The total, or nearly 

 total suspension of the secretion by the kidneys ; the 

 watery vomiting and stools ; the severity of the 

 spasms ; the shrunk and corrugated state of the skin 

 on the hands and feet, and the olueness of his nails, 

 persuade me that his disease was of the true spasmodic 

 type. In him, moreover, a slow fever succeeded the 

 original symptoms, and long retarded his recovery." 

 We would not attempt to discriminate between such 

 a case as this and examples of the epidemic, believing 

 their character to be identical. This case occurred 

 in the beginning of July, 1831. There is a certain 

 form of the febrile stage, that which supervenes on 

 a choleric stage, attended with extreme collapse, 

 which the deficiency of the temperature and the cir- 

 culation, the congested state of the conjunctiva from 

 the very commencement of the fever, and the pecu- 

 liar torpor of the intellect, would enable the observer 

 to discriminate from any fever which we are in the 

 habit of witnessing in this country, provided he saw 

 the patient early and watched him throughout ; but 

 in the majority of instances, fte diagnosis can only 

 be correctly drawn by coupling the preceding history 



Doctor Fenwick, of Durham. 



of the case with the existence of fever and with its 

 character. 



6. Appearance* presented on Dissection. The ex- 

 ternal appearance of body closely reM'inbles that 

 which lias been noticed during lite: the solids are 

 shrunk, the surface is livid, the skin of the hands and 

 feet is corrugated, the nails are blue, and the fingers 

 often rigidly contracted. There is no evidence ot 

 any unwonted tendency to putrefaction, nor any cha- 

 racteristic foetorfrom the abdominal cavity. In the 

 head are found marks of congestion, and even occa- 

 sionally of extravasation. Such appearances were not 

 of uniform occurrence in the dissections performed 

 in Ilindostan; but they were found very constantly 

 in those made by Doctor Davy, in Ceylon ; and J Joe- 

 tor Keir, of Moscow, discovered in the Russian di- 

 c.i -c the blood-vessels of the brain and its membrane; 

 more or less turgid with blood, particularly towards 

 the base, with a fluid efoised into its convolutions, 

 and more or less of serum in the lateral ventricles. 

 In the thorax, the pleura and pericardium are found, 

 as the serous membranes generally are in this dis- 

 ease, perfectly healthy, with the exception, occasion 

 ally, of an unusual dryness. The lungs are some- 

 times in a natural state, but more frequently gorged 

 with dark-coloured blood, so as to resemble liver or 

 spleen ; or they have been found collapsed on each 

 side of the spine, leaving the thorax nearly empty. 

 This latter appearance Doctor Pollock, of the fifty- 

 third regiment, explained by supposing gas to be ex- 

 tricated within the cavity of the pleura ; but the 

 thorax having been opened in such cases under water, 

 and no air having been found, Mr Scot is disposed to 

 ascribe it to a contractile power exerted by the vis- 

 cus, sufficient to overcome the atmospheric pressure. 

 Both sides of the heart are in general distended with 

 dark blood, and the bronchi are frequently filled with 

 mucus. In the abdomen, the vessels of the liver are 

 often much congested, and pour forth blood copious- 

 ly when incisions are made into the organ ; but this 

 congestion is not uniformly found ; the gall-bladder 

 is turgid with black bile, and its ducts are sometimes 

 constricted and impermeable, though occasionally in 

 an opposite state. The peritoneum is often quite 

 healthy, but the portion investing the alimentary 

 canal lias frequently an inflamed appearance from the 

 exceedingly loaded state of its blood-vessels. This 

 congestion is sometimes so great as to give the ap- 

 pearance of gangrene ; but by drawing the finger 

 over the surface, innumerable small veins may be 

 found running in every direction, as in a preparation 

 nicely injected, and the texture is found to be resist- 

 ing and firm. This portion of the peritoneum, how- 

 ever, occasionally bears marks of actual inflammation, 

 especially if the patient has lingered long before 

 death. It then presents a thickened appearance ex- 

 ternally, and its colour varies from a pale vermilion, 

 through all the deeper shades, to a dark purplish hue ; 

 the former being chiefly remarkable on the surface 

 of the duodenum and jejunum, the latter on the ileum, 

 where it terminates in the caecum. At other times, 

 the whole alimentary tube, instead of this congested 

 state, presents a blanched appearance both internally 

 and externally. The omentum is sometimes healthy ; 

 at others, it presents the same appearance of extreme 

 vascularity as the peritoneal surface of the alimen- 

 tary canal. ---The following appearances are discover- 

 ed on laying open the stomach and intestinal tube. 

 A white, opaque, and viscid substance is found ad- 

 hering to the surface of some portions of the mucous 

 membrane ; and in many cases it is so abundant in 

 the intestines as completely to fill parts of them of a 

 greater or less extent. The stomach and portions of 

 the intestine are filled with a transparent or turbiii 

 serous fluid, and frequently the viscid matter men- 



