174 THE ABORTIVE TREATMENT OF CHOLERA. 



watery-stools following the more foecal excretion, cramps of voluntary 

 muscles, chiefly of the clonic or permanent rind, pulse at first small, 

 weak and accelerated, becoming rapidly less perceptible, and finally lost 

 in the extremities, while there is yet strong pulsation of the cceliac 

 axis and abdominal aorta, coldness of the surface supervenes, the 

 bronzed flush of countenance and skin giving place to it, and a clam- 

 my cold sweat, often very profuse, is every where present. This state 

 of things, if not speedily arrested, ushers in the stage of collapse. 



Collapse may come on without any evacuation by the stool taking 

 place, though sometimes in such cases, the intestinal tube is filled with 

 the secretions peculiar to cholera. Cramps of voluntary muscles may 

 likewise not occur, and it is considered a sign of peculiar malignancy 

 when either of these is absent. During the cold stage the voice is 

 changed, the lips, the nails and skin become blue or livid, the surface 

 collapsed, the skin corrugated and sodden in appearance, and insen- 

 sible to the action of chemical agents ; the patient cold to the touch 

 and pulseless, yet complaining of heat ; demanding cold drinks and 

 rejecting them by vomiting, or at any rate not absorbing the liquid by 

 the stomach, and assuming a strikingly cadaverous aspect. No symp- 

 tom is so invariably present to the full extent as sinking of the circula- 

 tion, and no morbid post mortem phenomenon more constant than the 

 alteration of the blood in colour and consistence ; the darkness and 

 thickness being extreme, and observable in direct ratio with the dura- 

 tion of the disease and the quantity of gastro-intestinal discharge, 

 ^yhen death occurs in this stage, the venous system, the right side of 

 the heart and the pulmonary artery with its branches are found loaded 

 with dark thick blood, while the lungs are comparatively bloodless, 

 and the systemic arteries quite empty. This would indicate that 

 either from inspissation of the blood, from spasm of the pulmonary 

 arterial vessels, or from both these causes combined, the blood does 

 not reach the air-cells to get rid of its carbon and absorb the due 

 amount of oxygen. In natives of India where collapse often happens, 

 without intestinal discharges taking place, the blood is found to be 

 dark likewise. 



The experiments of Dr. John Davy and others, have demonstrated 

 that the respired air of cholera patients, contains a much smaller pro- 

 portion of carbon than is sufficient for the proper purification of the 

 blood ; respiration is apparently going on well, it is the vital changes 

 that are not performed, the exchange of carbonic acid gas for oxygen 



