CHOLERA ASIATICA. 



of the blood could possibly be remedied by the absorption of liquid. 

 The stagnation of blood in the capillaries of the lungs, induced by the 

 paralysis of the heart and thickening of the blood, explains one symp- 

 tom, for which I could give no explanation in 1848, that is, the feeling 

 of anxiety and oppression, which is rarely absent in the algid stage. 

 The change of the blood in the pulmonary capillaries is just as neces- 

 sary for the respiratory act as the change of air in the air-cells ; and 

 stagnation of the circulation induces the feeling of want of air and 

 oppression, just as is done by obstructions in the bronchi and alveoli, 

 which impede the entrance and exit of air. The very slight amount 

 of carbonic acid in the air expired by cholera patients shows that, in 

 spite of the extensive movements of the chest and the unimpeded en- 

 trance of air to the air-cells, respiration is imperfectly performed. 

 Lastly, the complete arrest of the secretion of urine in the algid stage, 

 and its diminution even in cholerine and cholera diarrhoea, are easily 

 explained. We know that the amount of urine secreted depends chiefly 

 on the amount of lateral pressure in the glomeruli of the Malpighian 

 capsule ; we have already explained, that in heart and lung diseases, 

 which induce imperfect filling of the heart and arteries, the secretion 

 of urine is diminished ; hence it is not strange that the urine should 

 be suppressed in the algid stage of cholera, where the heart's action is 

 reduced to a minimum, and the pulse cannot be felt even in the large 

 arteries. The low temperature of the periphery of the body appears 

 partly due to the diminished production of warmth, partly to the 

 diminished supply of warm blood to the skin (from the weakened ac- 

 tion of the heart). 



Cholera asphyxia runs a very acute course. Many patients die in 

 six, twelve, or twenty-four hours. The algid stage rarely lasts longer 

 than two days. The evacuations often cease some time before death, 

 and we must be careful about regarding this as a favorable sign, as it 

 is not due to cessation of the transudation, but to paralysis of the in- 

 testinal muscles. On the contrary, patients in whom the evacuations 

 continue for a long time recover more frequently than those in whom 

 they cease suddenly. It would be wrong to decide from this fact that 

 an excessive and long-continued transudation into the intestine had a 

 favorable influence on the course of the disease, or was at least unim- 

 portant. It would be much more correct to interpret the fact thus : 

 In cholera, the occurrence of paralysis of the intestines is one of the 

 most unfavorable symptoms, and the continuance of the evacuations 

 shows that the intestines are not yet paralyzed, and so justifies a more 

 favorable prognosis. The death of the patient is a gradual " going 

 out ; " the rattling in the throat especially, which takes place shortly 

 before death in most diseases, is absent. In favorable cases the pas- 



