504 DISEASES OF THE STOMACH. 



more normal, the collapse disappears, the temperature becomes more 

 even, the child improves and convalesces, but a great tendency to re- 

 lapse remains. 



If the symptoms above described appear very rapidly, and the evac- 

 uations come one right after the other, if decided collapse occurs in a 

 few hours, with great depression of the bodily temperature, and signs 

 of thickening of the blood, before emaciation has resulted, we call it 

 cholera infantum. The thickening of the blood is shown by the un- 

 quenchable thirst ; older children follow the glass of water with eager 

 eyes, and when it is offered to them seize it with both hands and hold 

 it tightly till it is emptied ; it further betrays itself by the increasing 

 cyanosis, and by a peculiar dyspnoea, in which the thorax and dia- 

 phragm make extensive movements, without there being any apparent 

 obstruction to the breathing, except the difficulty of the thickened 

 blood passing through the capillaries of the lungs. The patients may 

 die in a few hours of cholera infantum, with the above symptoms ; 

 hi other cases, the cholera proper passes off, and a milder form of the 

 disease remains ; and finally, in other cases, rapid and complete re- 

 covery take place from conditions which are apparently utterly hope- 

 less. 



DIAGNOSIS. In Chapter X. of this section we shall speak of the 

 distinction between gastric catarrhs, occurring as the status gastricus^ 

 and other disturbances of digestion. 



During an epidemic of Asiatic cholera it is impossible to distinguish 

 (*ises of cholera morbus from those caused by the cholera miasm, for 

 the symptoms are not only similar, but are absolutely the same as those 

 of the milder cases of Asiatic cholera. The chief difference is, that of 

 those attacked with Asiatic cholera about half the patients die, while 

 almost all recover from cholera morbus. The disease may much more 

 readily be mistaken for poisoning; but cholera morbus is rarely accom- 

 panied by such severe pain as poisoning with acids and metallic salts 

 induce, and they seldom cause such copious evacuations as characterize 

 nholera morbus. If the disease lasts unusually long, or if its course 

 shows any other peculiarity, we should carefully examine every circum- 

 stance that could indicate the presence of poison. 



Acute gastric catarrh of children in the first years of life and 

 the diarrhoea of children cannot easily be mistaken for other dis- 

 eases. 



PROGNOSIS. The prognosis is evident from the description we have 

 just given of the course. Previously healthy adults rarely die of this 

 disease ; but chronic catarrh may result from repeated attacks, weakly 

 and decrepit persons may die of gastric fever, or still more readily of 

 jatarrhal fever (see this disease). In children, acute gastric catarrh, 



