CHOLERA ASIATICA, 707 



happens that these symptoms urge the patient to seek medical aid. 

 If we examine such cases carefully, we always find that they have 

 been preceded by diarrhoea, to which the patient paid no attention. 



Some observers estimate the period of incubation at from one to 

 three days ; others say from eight to fourteen. We rarely have the 

 opportunity of exactly determining the time between the action of 

 the poison and the outbreak of the disease. In a few cases that I 

 observed in Greifswald, in 1859, as well as in a number observed by 

 Dr. GrUttner^ then assistant physician in the Medical Polyclinic, in a 

 small town on the Mecklenburg boundary, where the limits of the in- 

 fection could be pretty accurately determined, the period of incubation 

 was certainly not less than thirty-six hours, and not more than three 

 days. 



The mildest form of cholera is a simple diarrhoea, which is not ac- 

 companied by colicky pains or tenesmus, and causes no constitutional 

 or other disturbance, except a moderate degree of depression and re- 

 laxation. The evacuations follow each other more or less closely; 

 they are very copious and watery, but have neither lost their odor nor 

 color. These cases do not appear on the official lists as cholera ; but, 

 although the police do not consider them as such, science should do so. 

 This is shown : 1. By the large number of cases of diarrhoea occurring 

 in cholera times, although almost all sensible people carefully avoid 

 errors of diet, catching cold, and other sources of injury. 2. The great 

 obstinacy of these diarrhoeas, and the slight efficacy of opium against 

 them. 3. The well-known transportation of cholera by persons suffer- 

 ing from these diarrhoeas. 4. But especially the numerous transfor- 

 mations of simple " cholera-diarrhoea " into the severest forms of the 

 disease. Many patients, especially of the poorer classes, worried by 

 a diarrhoea that would not give way to domestic remedies, go to the 

 doctor's house for a prescription at noon, and in the evening lie cold, 

 pulseless, and cyanotic, in an almost hopeless state. The investiga- 

 tions concerning cholera, made during the late epidemic, especially in 

 the hospitals, which are otherwise very serviceable and valuable, have 

 made some believers in the false views concerning the significance of 

 the intestinal affection in cholera, which I combated twenty years ago 

 It has again been forgotten that very many cholera patients, who do 

 not seek admission into hospital, have no symptoms but the profuse 

 diarrhoea. I consider it much more important to determine the fre- 

 quent occurrence of a gradual transformation from simple cholera diar- 

 rhoea to cholerine, and to malignant cholera, and to prove the iden- 

 tity of these three forms, than to seek for pathognomonic signs of epi- 

 lemic cholera. 



The transformation from the mildest forms of cholera to the severest 



