SYMPTOM A TOLOGY— VARIETIES 



of the circulation becomes more marked, the pulse almost disap- 

 pearing at the wrist, the heart becoming weak and irregular, the 

 respirations laboured, the skin cold and deeply cyanosed, the urine 

 suppressed, while the diarrhoea may or may not cease, and the 

 temperature falls far below normal. The first heart-sound becomes 

 impure, or a haemic systolic murmur may be present, and the second 

 may be faint, and friction-sounds maybe heard over both the peri- 

 cardium and pleura. The patient may now become comatose, and 

 death supervenes in from twelve to thirty-six hours after the onset 

 of the attack. If recovery is to take place, the diarrhoea diminishes, 

 the skin becomes warmer, the pulse and blood-pressure improve, 

 and after a time bile appears in the motions, and the skin fills out 

 with fluid again. 



Sometimes convalescence is rapid. In some a secondary febrile 

 condition ensues, which may last for several days, or even for a 

 couple of weeks. 



The patient may at times pass into a status typhosus, with 

 flushed face, raised temperature, dry brown tongue, low muttering 

 delirium, with subsultus and toxic trembhngs and toxic rashes, 

 which may be erythematous, papular, or hsemorrhagic. The urine 

 is diminished in quantity, has a high specific gravity, and contains 

 albumen and casts. The motions are somewhat like those of 

 typhoid, or may be bloody. 



Death may take place during this stage from complications, or 

 recovery may ensue after a long convalescence. The infection of 

 the convalescent may be said to have ceased when on three 

 separate days the bacteriological examination of the motions is 

 negative. 



The typical course of the disease, as described above, is often 

 arbitrarily subdivided into three stages: (i) The stage of eva'-jua- 

 tion; (2) the algide stage; and (3) the stage of reaction, when the 

 patient is about to recover. 



Varieties. — Cholera cases at times present many varied features; 

 which are usually classified into: — 



1. Ambulatory Cases. — There are cases in which, without any 

 signs of disease, the vibrio may be obtained from the fseces. These 

 people are genuine carriers of the disease, 



2. Choleraic Diarrhoea. — Choleraic diarrhoea is characterized by 

 severe purgation, associated with the passage of yellowish motions, 

 which contain the specific vibrio. This condition may be recovered 

 from, or may pass into a typical attack of the disease. 



3. Cholerine. — The patient is suddenly seized with abdominal 

 pains, and passes numerous faeculent motions, followed by typical 

 rice-water motions, which speedily cease, and the patient quickly 

 recovers without further symptoms. 



4. Cholera Gravis. — This is the typical form already described. 



5. Cholera Sicca. — In this type the patient becomes rapidly col- 

 lapsed, and dies before the typical symptoms of diarrhoea and 

 vomiting can appear. The post-mortem and the bacteriological 



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