164 THE ABORTIVE TREATMENT OF CHOLERA. 



cubation more or less prolonged ; a period in which, after the recep- 

 tion of the poison, into a system more or less suitable for its develope- 

 ment, catalytic changes are progressing ; changes which will, unless 

 arrested, end in confirmed cholera, whilst yet the more usually recog- 

 nized features of the disease are in complete abeyance. 



It is well known that a premonitory stage is very generally recog- 

 nized, and is spoken of as the stage of cholerine, of choleraic diarrhoea 

 or the premonitory diarrhoea. The writer believes that in temperate 

 climes, and in the European race this stage of cholerine is very gene- 

 rally present, though not constantly so is very certain ; yet among 

 the Asiatic races it is perhaps more frequently absent, and in the 

 latter it is common for a victim to fall down suddenly with the col- 

 lapse of cholera, the premonitory stages having passed by without 

 notice. 



In our own country we frequently find that a premonitory stage has 

 passed by unnoticed by the patient, or if feelings of illness or malaise 

 have been present, their connection ^ith cholera has been repudiated. 

 This is especially manifest when there is no diarrhoea present, nor any 

 uneasiness referrible to the abdomen. Under such circumstances even in- 

 telligent people deny that there is anything wrong with them, although, 

 on careful examination, it may be found that the tone of the system 

 is manifestly lowered. The poison is working, though not yet very 

 manifest. 



I would then divide the period between the reception of the poison 

 and its developement into what may be called the stage of invasion, 

 (i. e. the stage preceeding collapse) into two grades, the first of incu- 

 bation, and the second of premonition, the latter being a condition 

 usually recognized at any rate by the physician, but the former usual- 

 ly being overlooked. Nevertheless its existence may frequently be 

 detected, and as it may proceed to the period of invasion, without the 

 occurrence of usual premonitory diarrhoea, attention to the symptoms 

 that may denote it, is of great importance. An acute observer in the 

 East Indies observes that : — 



" The premonitory stage of Asiatic cholera is characterized by a 

 very peculiar appearance of the person about to be affected. The 

 countenance is said to wear the expression seen immediately before 

 the accession of the cold stage of intermittent fever, but I think it is 

 more like that of a person who has some vague, undefined, central im- 

 pression of the bowels being about to move. He seems involuntarily 

 to wish to be quiet, though he has no sick feeling, and does not com- 

 plain. 



