710 ACUTE INFECTIOUS DISEASES. 



for these secretions. In the suppression of urine, however, the stag- 

 nation of the circulation also plays an important part. The feebleness 

 of the heart's action, which causes the weakness and indistinctness of 

 the impulse and tones of the heart, the diminution and disappearance 

 3f the pulse in the radial arteries, and even in the carotids, appear to 

 depend chiefly on the depressing influence that severe acute disease, 

 especially of the abdominal organs, has on the organic nervous system, 

 and particularly on the nerves of the heart. Immediately after the 

 perforation of an ulcer of the stomach I have often seen loss of pulsej 

 cyanosis and coldness of the extremities, and in one case, already men- 

 tioned, perforation of the duodenum, was diagnosed as cholera sicca. 

 Such cases, where there could not be the slightest suspicion of an in- 

 fection, show that the hypothesis that the cholera-poison poisons the 

 sympathetic, is untenable. On the other hand, it is not improbable 

 that the stagnation of blood in the capillaries of the heart's substance 

 has something to do with the paralysis of that organ. We know that 

 blood can only pass freely through the capillaries when the blood-cor- 

 puscles are separated from each other by a sufficient amount of inter- 

 cellular fluid. Hence a loss of water from the blood, such as occurs in 

 cholera, must hinder or even arrest the circulation in the capillaries ; 

 and, if the blood in the capillaries of the heart stagnate, according to 

 all physiological and pathological experience, paresis of the heart is 

 the inevitable result. The cyanosis that occurs in the algid stage of 

 cholera depends on the same cause as that occurring in other diseases, 

 on an abnormal distribution of the blood the arteries, which receive 

 no blood from the heart, contract and press their contents into the 

 capillaries and veins ; but the collection of the blood in these vessels 

 causes very great cyanosis in cholera, because the blood is so concen- 

 trated, and hence is relatively rich in colored corpuscles, and because, 

 from the retardation of the circulation, it has become so venous in 

 character, and consequently very dark. If an attempt be made to 

 bleed in the algid stage, as was often done in the first epidemics, a 

 thick, dark stream springs from the swollen vein, but no more blood 

 follows the first spirt, the stream soon ceases, and then it is difficult to 

 bring out even a few drops by pressure and rubbing. As the circula- 

 tion is reestablished, the cyanosis rapidly disappears, although the 

 blood still remains of a dark, huckleberry color. As early as 1848, in 

 my pamphlet, "Die Symptomatische Behandlung der Cholera," I 

 showed that the cyanosis and asphyxia did not depend exclusively on 

 the thickening of the blood, but was mostly due to the paralyzing 

 influence of the extensive intestinal disease on the sympathetic nerve. 

 The correctness of this view is supported by the frequently rapid dis- 

 appearance of the cyanosis, etc., by its ceasing before the thickening 



