502 DISEASES OF THE STOMACH. 



constantly becomes thicker ; the secretions, particularly that of urine, 

 are diminished, or cease entirely, for want of fluid to maintain them ; 

 the interstitial liquid is absorbed from all the tissues ; hence the skin 

 appears dry and shrivelled, the patient looks collapsed and disfigured, 

 the nose is pointed, the eyes are sunken, because the connective tissue 

 in the orbit has become dry, and has hence actually lost in volume. 

 While there is rarely pain in the abdomen, there are very painful con- 

 tractions of the muscles, especially of the calf of the leg. If these 

 occur, and the evacuations of the patient consist only of colorless fluid, 

 containing shreds of intestinal epithelium, so that they resemble rice, 

 water, or oat-meal gruel, the cholera morbus will very much resemble 

 Asiatic cholera ; nevertheless, it rarely goes on to the complete disap- 

 pearance of the heart-beat and the pulse, to the cyanotic hue, and rep- 

 tile temperature of the skin, which is seen in the so-called asphyxiated 

 stage of the Asiatic cholera. No matter how threatening the symp- 

 toms, how great the collapse and depression of the patient, how dis- 

 pirited he and his attendants may appear, the physician must not feel 

 discouraged if he is sure that epidemic cholera is not raging, for he 

 must know that a previously healthy adult very seldom dies of cholera 

 morbus. Usually, after a few hours, rarely not till the next day, the 

 vomiting and purging subside ; the skin becomes warm, and acquires 

 its fulness again, the exhausted patient falls asleep, and only suffers 

 from great depression. More rarely, the symptoms of gastric fever 

 join on to the cholera morbus. In the rarest cases, and only in sickly 

 ind weak persons, or in children or old persons, do we see a fatal ter- 

 mination ; then the bowels are paralyzed, the vomiting and purging 

 cease, while the transudation continues ; the pulse disappears, the move- 

 ments of the heart become weaker, the intellect cloudy, and the patient 

 dies of exhaustion. 



The acute gastric catarrh of children, during the first years of life, 

 presents certain peculiarities, which are due to the fact of such children 

 being almost exclusively nourished with mother's or cow's milk. Bed- 

 nar considers the fermentation of the ingesta as the sole cause of this 

 disturbance of digestion, and denies either a primary or secondary par- 

 ticipation of the walls of the stomach in the affection ; he designates 

 the milder forms of the affection as dyspepsia ; according to the classic 

 description of this author, the appearance of the child is little changed, 

 at most it only looks a little pale and has a slight ring around the 

 eyes. Almost always, shortly after nursing, there is vomiting, and the 

 milk evacuated is no longer curdled. This sort of vomiting is an im- 

 portant symptom ; even the nurses recognize it as such, and readily 

 distinguish it from the healthy evacuations of an overfilled stomach. 

 The curdling of the milk in the so-called " puking of children " does 



