CHOLERA 207 



Small intestine contains greyish grumous material, consisting of 

 food particles, epithelial cells, red and white corpuscles, and micro- 

 organisms. Mucosa hyper^emic and swollen, sometimes ecchymosis. 



Salivary and mesenteric glands enlarged. 



Liver congested, loaded with blood, ducts full of bile. 



Spleen shrivelled and small. 



Kidneys enlarged, tubules blocked with granular debris, cloudy 

 swelling. 



R. heart dilated. \"enous system congested with dark, thick, tarry 

 blood. 



L. heart empty. Arterial system empty. 



Lungs dry, anaemic and collapsed. 



Urinary bladder empty and contracted. 



The vibrios are usually confined to the intestines, but they have 

 been found in the liver, kidney and heart. 



SYMPTOMATOLOGY. 



Incubation three hours to six days. 



Typical form. 



Onset sudden as a rule; sometimes malaise precedes it. 



There are three stages. 



(i) Evacuation stage. 



Diarrhoea with or without colicky pains. Loose f^eculent motions, 

 followed quickly by the typical rice-water stools containing numerous 

 white flakes of mucus, epithelial cells and vibrios. 



Vomiting early, food first, then watery fluid with bile and some- 

 times blood, then rice-water material. 



(2) Algide stage. 



Always much thirst, sometimes hiccough, urine diminishes and 

 may cease. 



Subcutaneous tissues give up their fluid and the facies alter, e.g., 

 nose sharp, cheek-bones prominent, eves sunken, skin of fingers 

 wrinkled. 



B.P. falls, pulse weak and rapid, cyanosis, dyspncea, huskv voice. 



Painful muscular cramps, in calf, arm and abdomen especially. 



Reflexes diminish. Mind clear, patient apathetic between cramps. 



Skin cold, axillary temperature lowered, rectal raised. 



Pulse runs, heart weak and irregular, urine suppressed, tempera- 

 ture subnormal. 



Comatose and death in twelve to thirty-six hours. 



(3) Reaction stage. 



Improvement may commence at any stage. The symptoms 

 gradually disappear and indications of normal health return. 



