120 PRACTICE OF MEDICINE. 



fluid, with excessive and painful spasms of the abdominal and other 

 muscles ; the pulse is quick, small, and soon disappears altogether ; 

 the skin is cold ; the features collapsed ; the urine altogether sup- 

 pressed. As the vomiting and purging continue, the powers of life 

 quickly fail; the extremities become deadly cold, and of a bluish 

 colour ; the pulse ceases to be felt at the wrist ; the breathing is 

 laborious ; and the patient, who gets very restless, is generally car- 

 ried off within ten or twelve hours. 



Morbid appearances. — The blue colour of the extremities, which 

 are rigid, remains after death. The fingers are flexed and shrunk, 

 and the nails blue. The arterial system is empty ; the venous, and 

 particularly the right side of the heart, contains a quantity of dark, 

 grumous, and uncoagulable blood ; the latter fluid is deficient in salts 

 and serum. When death has taken place rapidly, the intestinal 

 canal is often pale throughout ; most frequently it presents an in- 

 jected appearance, either in spots or along continuous surfaces, from 

 congestion of the veins, or effusion of bloody serum underneath the 

 mucous coat ; there are no ulcerations or other signs of inflamma- 

 tion. The abdominal viscera are gorged with dark venous blood, 

 and the urinary bladder is empty, and contracted into a hard ball. 



Treatment. — A successful mode of treating Asiatic cholera still 

 remains to be discovered. Many of the Eastern physicians strongly 

 recommend bloodletting in the commencement of the disease, to be 

 followed up by calomel and opium. Others reject venesection, and 

 endeavour to allay the the most prominent symptoms — viz., the irri- 

 tability of the alimentary canal and the spasms, at the same time 

 such means as are best calculated to restore the circulation to the 

 surfaces of the body. This, perhaps, is the most rational mode of 

 treatment that can be adopted; but, unfortunately, medical men are 

 not agreed upon the means. Some prescribe nothing but ice-cold 

 water, as long as the vomiting continues ; others vaunt small and 

 frequent doses of calomel, or calomel and opium ; others advise the 

 administration of emetics ; and others again prefer stimulants, as 

 cajeput oil, brandy, &c. In order to determine the blood to the sur- 

 face, and allay spasm, the extremities should be assiduously rubbed 

 with warm anodyne embrocations; or when the vapour or hot air 

 bath can be obtained, these may be employed with advantage. Dr. 

 Stevens speaks highly of the saline treatment, which consists in the 

 administration of the salts of soda and potash in any appropriate 

 vehicle. In extreme cases, these salts have been injected into the 

 veins with apparent advantage in a few instances. When the 

 symptoms have subsided, and the patient survives, a stage of reac- 

 tion often succeeds, and is attended with symptoms of a typhoid 

 character. The treatment should then be directed by the principles 

 which have been laid down under the head of typhus fever. 



