70 ACUTE INFECTIOUS DISEASES. 



nective tissue and muscles are moister ; the blood is more fluid and 

 less dark. The cerebral membranes are usually injected ; not unfre- 

 quently there is a considerable amount of fluid in the meshes of 

 the pia mater and in the lateral ventricles ; the cerebral substance 

 itself is moister ; the right heart is usually overfilled, the endo- 

 cardium and lining membrane of the large vessels is greatly infil- 

 trated In this stage the lungs are no longer dry, but are vascular, 

 and are often the seat of extensive oedema and hypostasis, and not 

 unfrequently also of lobular or lobar pneumonia, or of hsemorrhagic 

 infarctions. The outer surface of the small intestine has lost its rosy 

 tint ; the contents are colored with bile. In some cases the epithelium 

 is replaced, and no disturbances of nutrition are discoverable in the 

 mucous membrane ; but it is often the seat of a typical diphtheritic 

 inflammation, which changes more or less extensive patches of the 

 mucous membrane into brown, dry sloughs. This secondary diphthe- 

 ritis occurs not only in the small intestine, but often extends to the 

 large intestine ; it may also attack the gall-bladder, vulva, and vagina. 

 The liver and spleen are not always changed, but are usually very 

 hyperaemic. Not unfrequently rupture of the spleen has been found. 

 The kidneys also are vascular, and often show the signs of acute 

 croupous inflammation. The bladder contains more or less urine, 

 which is usually albuminous. 



SYMPTOMS AND COURSE. Almost every one exposed to cholera 

 poison complains of light oppression in the praecordium, rumbling in 

 the bowels, and a feeling of impending diarrhoea. These symptoms of 

 slight indigestion, which unmistakably result from the action of the 

 poison, apparently only increase where the infection is rather intense, 

 or the organism inclined to a more or less severe disease. It has also 

 been attempted to refer the feelings of terror, the fainting-fits, cramps 

 in the legs, and other disturbances of innervation occurring during a 

 nholera epidemic, to the action of cholera poison ; and among the laity 

 the idea has become so firmly implanted, that the fear of cholera is 

 very dangerous, or is even the commencement of the disease, that 

 during a cholera season there are plenty of persons who dread having a 

 fear of the cholera (!). I regard this belief as groundless, and think that 

 the above symptoms are solely the result of the psychical impressions 

 induced in excitable persons, by the terrible disease, the accounts of 

 sickness, the numerous and unexpected cases of death. The same, or 

 very similar symptoms are experienced by the inhabitants of a bom- 

 barded town ; and, although timid persons show no immunity to chol- 

 era, they are not more frequently attacked than unterrified persons 

 are. According to my observation, cholera attacks never begin with 

 a feeling of terror, fainting, cramps in the legs, etc., although it often 



