PATHOLOGY 



1807 



The concentration of the blood causes a fall in the blood-pressure, 

 which is indicated by the feeble compressible pulse, but which, to 

 be studied properly, requires investigation by means of a Riva- 

 Rocci's instrument, as has been done by Rogers and Megaw, who 

 found that in typical collapse the blood-pressure might be only 

 60 to 50 millimetres of mercury, when the patient is markedly 

 cyanosed and restless. If the case is not so serious, the pressure 

 may be higher — 70 to 80 millimetres of mercury — and if the patient 

 is on the road to recovery it may reach to 90 millimetres. As a 

 result of this low blood-pressure, the urine may be suppressed or 

 scanty, with a high specific gravity, albumen, casts, and a large 

 quantity of indican. 



The body appears to react to the disease by the pouring out of 

 substances from the blood which are probably bactericidal, though 

 Edwards's attempt to prove this failed because of decomposition 

 and the admixture of other micro-organisms. Agglutinins are 

 absent in fatal cases, but, according to Greig, in non-fatal cases they 

 begin to rise after the sixth day, but drop after the twentieth day. 



When recovery is about to take place, the specific gravity of the 

 blood decreases, the blood-pressure rises, and the urine becomes 

 abundant. As convalescence continues, the great danger is 

 secondary infection of the body by other micro-organisms, which 

 may cause serious illness and even death. 



It is important to note that Greig has found the germ in the gall- 

 bladder (40-70 per €ent. of cases) — where it causes cholecystitis, 

 and in animals may give rise to gall-stones — in the lung, kidney, and 

 urine. According to Violle's researches, bile in vivo tends, however, 

 to hinder the development of the cholera vibrio. According to the 

 same author a small dose of cholera toxin excites the secretion of 

 bile while a large dose stops it. It is suggested that a septicaemia 

 takes place, but this has not been demonstrated. Manson suggests 

 that it may pass by the lymph channels. 



Danysz regards the disease as of anaphylactic origin. 



Morbid Anatomy. — Usually post-mortem rigidity is very well 

 marked, and the body keeps warm for some time after death. 

 On cutting into the tissues, it is noticed that they are very dry, 

 and that the blood is often thick and tarry. On opening the peri- 

 toneal cavity, the hand experiences a peculiar sticky sensation not 

 felt in any other disease with which we are acquainted. 



The stomach is usually empty, and the bowels are reddish in 

 appearance, with injected vessels. When a piece of small bowel is 

 opened, the contents are usually found to be whitish or greyish 

 grumous material; more rarely will the contents be blood-stained. 

 These contents consist of food particles, epithelial cells, red and 

 while corpuscles, and micro-organisms. When allowed to stand, 

 they separate into liquid and solid portions, the former containing 

 albumen, and having a specific gravity varying from 1005 to 10 15. 

 The mucosa of the stomach and bowels is hyperaemic and swollen, 

 and may be marked by ecchymoses. There is usually some enlarge- 



