ACUTE INFECTIOUS DISEASES. 



is formed by those cases where violent vomiting accompanies the diar- 

 rhoea, where the discharges acquire the well-known "rice-water" ap- 

 pearance, but without the occurrence of the paresis of the heart and 

 thickening of the blood, which constitute the terrible symptoms of 

 cholera asphyxia. This still mild form, or, rather, these comparatively 

 low grades of the disease, which, however, often increase to the highest 

 grades, have been distinguished from cholera diarrhoea on the one hand, 

 and from cholera asphyxia on the other, by the names " erethitic chol- 

 era," or "cholerine." The discoloration of the dejections depends 

 chiefly, or entirely, on their excessive dilution by the quantities of 

 fluid transuded into the intestine ; hence the more copious the pas- 

 sages, and the more rapidly they succeed each other, the more com- 

 pletely and speedily they lose their brown color and fecal odor. Oc- 

 casionally all the contents of the intestine are passed at the first evac- 

 uation. In such cases, even after the second movement, the dejections 

 consist of an almost colorless and odorless fluid, holding in suspension 

 more or less white flocculi. We must not conclude, from the lack 

 of color in the passages, that the formation or excretion of bile has 

 ceased ; for even if the bile be produced in normal amount, and poured 

 into the intestines, it can have no great effect on the color of the large 

 quantity of liquid. Chemical and microscopical examinations of chol- 

 era stools have shown that the serum, transuded from the intestinal 

 capillaries, contains little albumen, but plenty of salts, especially of 

 chloride of sodium, and that the white flocculi floating in the serum 

 rarely consist of perfect cylindrical epithelium, but generally of its re- 

 mains, in the shape of fine, loose nuclei, with coarse and fine granular 

 masses embedded in a mucous basement substance, and of round, nu- 

 cleated, coarse, or finely-granulated cells (Uruberger). Cholera-stools 

 occasionally contain crystals of triple phosphate, remains of food, para- 

 sites, vibriones, and fungi. Lastly, the dejections sometimes contain 

 blood-corpuscles ; then the fluid is somewhat richer in albumen, which 

 has escaped from the capillaries along with the blood. These charac- 

 teristics of cholera-stools, which all authors consider pathognomonic, 

 fully explain the symptoms of cholera. We are justified in comparing 

 the effects induced in the bowels by cholera poison, with those pro- 

 duced on the skin by a blister. In both cases the protective covering 

 is removed, and there is an excessive transudation from the capillaries. 

 It only depends on the intensity, and particularly on the extent, of the 

 process, whether symptoms of paralysis of the heart develop, and 

 whether the loss of water from the blood shall prove dangerous. Cases 

 where the heart's action is but little weakened, and where the loss oi 

 water from the blood is to some extent replaced, correspond to chole- 

 rine. When the characteristic cholera stools begin, the thirst alreadv 



