CHOLERA ASIATICA. 709 



caused by the simple cholera diarrhoea is decidedly increased. This 

 torturing symptom hardly requires explanation, as it always follows 

 loss of water from the blood, whether induced in fevers by the increase 

 of insensible perspiration, by sweating, or by increased excretion of 

 urine. In cholerine the loss of water from the blood is greater, and 

 consequently the thirst is more intense than in cholera diarrhoea. The 

 characteristic evacuations, severe thirst, weariness, and depression, are 

 usually accompanied by a very annoying symptom, which it is difficult 

 to explain ; there are occasional spasmodic contractions of certain mus- 

 cles, especially of the calves of the legs, which last from half a minute 

 to a minute, and are very painful. These cramps are not pathognomo- 

 nic of Asiatic cholera, however, for they also occur in severe attacks 

 of cholera morbus. In favorable cases, the discharges gradually be- 

 come less frequent and copious ; the bile poured into the intestines 

 again suffices to color the passages. Finally, the diarrhoea ceases, and 

 the patient begins to recover ; but convalescence is always slow. In 

 other cases the disease relapses after it appeared to be doing well, and 

 then becomes dangerous. Lastly, in still other cases there is no im- 

 provement, the cholerine changes to cholera asphyxia. 



Cholera asphyxia depends on the highest development of the intes- 

 tinal affection. At least all its characteristic symptoms may be directly 

 referred to the severe and extensive disease of the intestinal mucous 

 membrane and to the copious exudations from the intestinal capil- 

 laries. The accounts of persons dying during cholera epidemics with 

 the symptoms of pulselessness, cold skin, cyanosis, etc., who had had 

 neither diarrhoea nor vomiting, and in whose intestines no characteristic 

 changes were found, have become more rare in late epidemics ; so that 

 at present almost all experienced physicians deny the occurrence of 

 " cholera sicca," which was generally considered as proved in the firs 4 

 cholera epidemics. But the case is different in regard to the views 

 about the dependence of the other symptoms of asphyctic cholera on 

 the intestinal disease. Many physicians, who consider the latter as 

 constant, do not refer the other symptoms of cholera to it, but think 

 that the intestinal disease in Asiatic cholera has no more effect on the 

 general appearance of the disease than the bowel lesion in abdominal 

 typhus has on the symptoms of that affection. We shall again refer 

 to the erroneousness of this view. In many cases asphyctic cholera 

 develops from a cholera diarrhoea or a cholerine that has existed for 

 several days ; but, fully as often, the symptoms to which this form owes 

 its name come on a few hours after the first cholera passage. By this 

 all the contents of the intestines seem to be evacuated ; the patients 

 are astonished that the vessel which they used is nearly filled, but do 

 not suspect that they are in great danger and neglect to seek aid for 



