274 SPASMODIC CHOLERA. 



feature of the disease. There is a sudden sinking of the 

 pulse, a diminution of the heat of the body, a pallor of the 

 countenance, suppression of the urinary discharge, and oc- 

 casional cramps in the limbs. As the malady advances, 

 the cramps and spasms increase in violence and frequency, 

 and the vomiting and purging are severe. The skin be- 

 comes deadly cold ; it is covered with a clammy moisture, 

 and is of a bluish colour about the face ; the extremities are 

 shrivelled, and the nails of the fingers of a purple hue. 

 The countenance is ghastly, and expressive of great anxiety. 

 The eyes are sunk in their sockets, and surrounded by a 

 dark hvid circle : there is a distressing thirst, with burning 

 heat and pain in the region of the stomach. If blood be 

 drawn from a vein, it is of an unusually dark colour and 

 thick consistence. Debility increases rapidly, — the patient 

 lies in a state of helpless exhaustion, — the spasms and vomit- 

 ing cease, — the breathing is oppressed or scarcely percep- 

 tible, — and under these unfavourable symptoms death closes 

 the scene, in many cases in the course of six or twelve 

 hours, generally within eighteen or twenty, from the com- 

 mencement of the attack. Under all these bodily sufferings 

 the mind remains collected and sensible to the last. 



A favourable issue of the case is denoted by the pulse 

 rising in strength, a return of heat to the surface, an incli- 

 nation to natural sleep, and a diminution or cessation of 

 vomiting, purging, and spasms, with the usual appearance 

 of bile in the excretions. Among the natives, in whom 

 there is little tendency to inflammatory disease, the recovery 

 is speedy and perfect, no symptoms of the attack remaining 

 after the lapse of a few days ; but in Europeans, in whom 

 there is a much greater propensity to inflannnation, the 

 recovery from cholera is by no means so rapid and complete ; 

 affections of the intestines,'lhe brain, liver, or stomach, are 

 often found to supervene. 



In India, persons exposed to great bodily fatigue, con- 

 fined to poor and scanty fare, or leading irregular lives, were 

 usually the victims of this dreadful disease. The Euro- 

 peans were comparatively less subject to it than the natives ; 

 and the higher classes of the latter were more exempted 

 from its effects than the lower. Females suffered more 

 rarely than men, and children in a less degree than either. 

 Of all the circumstances predisposing to an attack, great 



