CHOLERA ASIATICA. 



rhoea energetically, should not have gone a step further, and recognized 

 the intestinal lesion as the starting-point of the other symptoms and 

 as the true source of danger. The rapidity with which the patients 

 changed, the great disturbance of all the functions, the pulselessness, 

 coldness, suppression of urine, vox cholerica, facies cholerica, lack of 

 contractility in the skin, and the fact that many patients were received 

 into the hospital in this state, who had no diarrhoea or vomiting after 

 their reception, and who did not always tell that they had previously 

 had violent evacuations, led to untenable hypotheses. It is true it was 

 acknowledged that cholera poison led to an affection of the intestinal 

 canal ; but at the same time it was accused of having a directly per- 

 nicious effect on the blood, nervous system, and more or less on all the 

 organs and tissues, the intestinal canal escaping altogether sometimes. 

 Cases where the algid stage develops in a few hours are certainly less 

 suited to explain the dependence of all the symptoms on the intestinal 

 affection than are those where it develops in the course of several days. 

 From the identity of the symptoms that finally result, however, we 

 cannot doubt that the rapid cases are to be explained in the same 

 way as the others. The immediate result of acute intestinal catarrh, 

 of the excessive transudation from the intestinal capillaries, and of the 

 diminished absorption of the fluid drank, is a thickening of the blood, 

 its sudden impoverishment in water and salts. As long as the disease 

 is moderate, it has no particular effect on the circulation and distribu- 

 tion of blood through the body ; only the thirst is increased and the 

 secretion of urine diminished. But, as a burn of the second order is 

 free from danger as long as it affects only a limited portion of the sur- 

 face, while it becomes very dangerous if widely extended, and as we 

 dare not deprive the entire surface of its epidermis by blisters, so an 

 extensive and intense choleraic affection of the intestines induces the 

 severe and threatening symptoms that characterize the algid stage. 

 The heart's action is palsied, the blood, deprived of its water, eagerly 

 takes the fluid from the interstices of all the tissues. Hence the tis- 

 sues all become dry and diminished in size ; the nose becomes pointed, 

 the cheeks hollow, the eyes sink into the orbit, the skin of the fingers 

 shrivels, and, when pinched up, stands in folds. Even pathological 

 collections of fluid, which had previously resisted all treatment, effu- 

 sions in the pleura, joints, etc., are absorbed. Moist eruptions and 

 ulcers acquire a parchment-like surface. In spite of the patient's 

 drinking constantly, the loss of fluid so far exceeds the supply that 

 he may lose one-fifth of his weight in a few hours. The thicken- 

 ing of the blood explains the drying up of all the secretions of the 

 saliva, tears, sweat and urine, just as well as it does the absorption of 

 the interstitial fluids ; the blcod actually does not contain the material 

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