ACUTE INFECTIOUS DISEASES. 



gages become fewer and less copious, and the liquids taken into the 

 stomach are no longer vomited. The first signs of improvement, which 

 always introduce the change in the disease, are soon followed by symp- 

 toms which show that part of the liquid taken is absorbed, and that 

 the blood is consequently thinned. The capillary circulation is re- 

 stored, the pulse returns to the carotids, then to the radial arteries ; 

 the cyanosis disappears ; the skin resumes its color, and the face loses 

 its distorted appearance ; the disease passes from the algid stage to 

 that of reaction. Occasionally, this stage offers no peculiarities, and 

 forms the beginning of convalescence ; then, when the asphyctic symp- 

 toms have ceased, there are a few more copious passages, with dis- 

 tinctly fecal odor. Even on the second or third day there are pulpy 

 or formed stools, or else constipation. Every thing indicates that the 

 lost epithelium has been regenerated. We may compare these cases 

 to those where a superficial dermatitis from a blister has been entirely 

 removed in a few days by regeneration of the epidermis. When the 

 stage of reaction forms the commencement of convalescence, even the 

 stagnation in the capillaries during the algid stage has not led to any 

 considerable disturbance of nutrition in any organ ; only there is ex- 

 ceptionally albumen in the first urine evacuated, on account of the 

 stagnation in the veins that precedes the ree*stablishment of the nor- 

 mal circulation. In other cases, where the damage to the intestine is 

 less quickly and completely repaired, the violent evacuations cease dur- 

 ing the stage of reaction, but a moderate diarrhoea, with fluid, badly- 

 smelling greenish stools, continues ; the pulse remains small ; the tem- 

 perature of the extremities low, and the patients are in great danger 

 of dying from exhaustion on an exacerbation of the intestinal disease. 

 But there is not generally a return of the algid stage with disappear- 

 ance of the pulse, cyanosis and coldness of the body ; the incomplete 

 reaction is more apt to pass into the so-called typhoid stage of cholera, 

 but not unfrequently it ends in protracted convalescence, after the 

 diarrhoea has ceased. Sometimes after the algid stage the pulse not 

 only returns, but becomes unusually full and strong, the previously 

 sunken temperature rises above the normal height, the cheeks turn 

 dark red, the eyes are injected, and the signs of fluxionary hypersenw 

 to the brain and other organs appear. These violent reactive symp 

 toms are difficult to interpret. They most probably depend, at least 

 partly, on the abnormal quality of the blood, and the consequent im- 

 pediment to the capillary circulation. The symptoms of violent reac- 

 tion also pass imperceptibly into those of the typhoid stage, or into 

 convalescence. The opinion, which I advanced from my observations 

 of the first cholera epidemics, that the temperature was only dimin- 

 ished at the periphery while it was elevated within the body, has been 



