PATHOLOGY, 
160 
preceded by fpafms; fometimes the patient funk at once, 
after palling off a fmall quantity of colourlefs fluid, by 
vomiting and ftool. The matter vomited in the early 
ftages was, in molt cafes, colourlefs or milky; fometimes 
it was green. In like manner, the dejedfions were ufually 
watery and muddy; fometimes red and bloody ; and, in 
a few cafes, they confided of a greenifh pulp, like half- 
digefted vegetables. In no inftance was feculent matter 
palTed in the commencement of the difeafe. Thecramps 
ufually began in the extremities, and thence gradually 
crept to the trunk ; fometimes they were fimultaneous 
in both ; and fometimes the order of fucceffion was re- 
verfed ; the abdomen being firft affefted, and then the 
hands and feet. Thefe fpalms hardly amounted to ge¬ 
neral convullion. They feemed rather affections of in¬ 
dividual mufcles, and of particular fets of fibres of thofe 
mufcles, caufing thrilling and quivering in the affefted 
parts, like the fleflt of crimped falmon ; and firmly ftif- 
fening and contorting the toes and fingers. The patient 
always complained of pain acrofs the belly, which was 
generally painful to the touch, and fometimes hard and 
drawn back towards the fpine. The burning fenfation 
in the llomach and bowels was always prefent; and at 
times extended along the cardia and cefophagus to the 
throat. The powers of voluntary motion were, in every 
inftance, impaired ; and the mind obfcured. The patient 
ftaggered like a drunken man, or fell down like a helplefs 
child. Head-ach over one or both eyes fometimes, but 
rarely, occurred. The pulfe, when to be felt, was gene¬ 
rally regular, and extremely feeble, fometimes foft; not 
very quick ; ufually ranging from 80 to ioo. In a few 
inftances, it rofe to 140 or 150 fhortly before death. 
Then it was indiftinft, fmall, feeble, and irregular. Some¬ 
times very rapid, then flow for one or two beats. The 
mouth was hot and dry ; the tongue parched, and deeply 
furred, white, yellow, red, or brown. The urine at firft 
generally limpid, and freely palled ; fometimes fcanty, 
with fuch difficulty as almoft to amount to ftrangury; 
and fometimes hardly fecreted in any quantity, as if the 
kidneys had ceal'ed to perform their office. In a few cafes, 
the hands were tremulous; in others, the patient de¬ 
clared himfelf free from pain and uneafinefs, when want 
of pulfe, cold fkin, and anxiety of features, portended 
fpeedy death. The cramp was invariably increafed upon 
moving. 
“ Where the ftrength of the patient’s conftitution, or 
of the curative means adminiftered, were, although ina¬ 
dequate wholly to fubdue the difeafe, fufficient to refill: 
the violence of its onfet, nature made various efforts to 
rally ; and held out ftrong, but fallacious, promifes of 
returning health. In fuch cafes, the heat was fometimes 
wholly, at others partially, reftored ; the cheft and abdo¬ 
men in the latter cafe becoming warm, whilft the limbs 
kept deadly cold. The pulfe would return ; grow mo¬ 
derate and full; the vomiting and cramps difappear ; the 
naufea diminifh, and the ftools become green, pitchy, and 
even feculent; and with all thefe favourable appearances, 
the patient would fuddenly relapfe ; chills, hiccup, want 
of fleep and anxiety, would arife ; the vomiting, oppref- 
ilon, and infenfibiiity, return ; and in a few hours termi¬ 
nate in death. 
“When the diforder ran its full courfe, the following 
appearances prefented thernfelves. What may be termed 
the cold ftage, or the ftate of collapfe, ufually lafted from 
twenty-four to forty-eight hours, and was feldom of 
more than three complete days’ duration. Throughout 
the firft twenty-four hours, nearly all the fymptoms of 
deadly oppreflion, the cold Ikin, feeble pulfe, vomiting 
and purging, cramps, thirft, and anguiffi, continued un- 
diminilhed. When the fyftem Ihewed fymptoms of re¬ 
vival, the vital powers began to rally, the circulation and 
heat to be reftored; and the fpafms and ficknefs to be 
confiderably diminilhed. The warmth gradually re¬ 
turned ; the pulfe rofe in ftrength and fullnefs, and then 
became fliarp, and fometimes hard. The tongue grew 
more deeply furred 3 the thirft continued, with lefs nau- 
fea. The ftools were no longer like water; they became 
firft: brown and watery; then dark, black, and pitchy ; 
and the bowels, during many days, continued todifcharge 
immenfe loads of vitiated bile, until, with returning 
health, the fecretion of the liver and other vifcera gra¬ 
dually put on a natural appearance. The fever, which 
invariably attended this fecond ftage of the difeafe, may 
be coniidered to have been rather the refult of nature’s 
effort to recover herfelf from the rude fliock which fhe had 
fufcained, than as forming any integrant and neceffary 
part of the diforder itfelf. It partook much of the nature 
of the common bilious attacks prevalent in thefelatitudes. 
There was the hot dry ficin ; foul, deeply-furred, dry, 
tongue ; parched mouth ; fick ftomach ; depraved fecre- 
tions ; and quick variable pulfe ; fometimes with ftupor, 
delirium, and other marked affe&ions of the brain. When 
the diforder proved fatal after reaching this ftage, the 
tongue, from being cream-coloured, grew brown, and 
fometimes dark, hard, and more deeply furred ; the teeth 
and lips were covered with fordes ; the ftate of the fkin 
varied; chilis, alternating with fluffies of heat; the pulfe 
became weak and tremulous; catching of the breath; 
great reftleffnefs, and deep moaning, fucceeded ; and the 
patient foon funk, infenfible, under the debilitating ef¬ 
fects of frequent dark pitchy alvine difcharges. 
“ Of thole who died, it was believed, perhaps rather 
fancifully, that the bodies fooner underwent putrefac¬ 
tion than thofe of perfons dying under the ordinary cir- 
cumftances of mortality. The bodies of thofe who had 
funk in the earlier ftages of the malady, exhibited hardly 
any unhealthy appearance. Even in them, however, it was 
obferved, that the inteftines were paler, and more diften- 
ded with air, than ufual; and that the abdomen, upon 
being laid open,emitted a peculiar offenfive odour, wholly 
different from the ufual fmell of dead fubjefts. In the 
bodies of thofe who had lived fome time after the com¬ 
mencement of the attack, the ftomach was generally of 
natural appearance externally. The colour of the in¬ 
teftines varied from deep rofe to a dark hue, according as 
the increafed vafcular action had been arterial or venous. 
The ftomach, on being cut into, was found filled, fome¬ 
times with a tranfparent, a green, or dark, flaky, fluid. 
On removing this, its internal coats, in fome cafes, were 
perfectly healthy ; in others, and more generally, they 
were crofted by ftreaks of a deep red, interfperfed with 
fpots of inflammation, made up of tiffues of enlarged vef- 
fels. This appearance was frequently continued to the 
duodenum. In a very few cafes, the whole internal fur- 
face of the ftomach was covered with coagulable lymph ; 
on removing which, a bloody gelantine was found laid on 
the interior coat, in ridges or elevated ftreaks. The 
large inteftine was fometimes filled with muddy fluid, 
fometimes livid, with dark bile, like tar; juft as the indi¬ 
vidual had died in the earlier or later periods of the at¬ 
tack. In raoft cafes, the liver was enlarged, and gorged 
with blood. In a few, it was large, foft, light-coloured, 
with greyilh fpots, and not very turgid. In others again, 
it was collapfed and flaccid. The gall-bladder was, with¬ 
out exception, full of dark-green or black bile. The 
fpleen and thoracic vifcera were, in general, healthy. The 
great venous veflels were ufuaily gorged; and, in one 
cafe, the left ventricle of the heart w'as extremely turgid. 
The brain was generally of natural appearance. In one 
or two inftances, lymph was effufed between its mem¬ 
branes, near the coronal future, fo as to caufe extenfive 
adhefions; in other cafes, the finufes, and the veins lead¬ 
ing to them, were fluffed with very dark blood.” 
The treatment of cholera in each fpecies will be 
founded on the fame general principles; viz. to reftore 
to the llcin and external parts the balance of action by 
means of very-hot baths, diaphoretics, urtication, See. to 
remove the plethora of the fyftem, and efpecially of the 
portal fyftem, by aCtive bleeding; and to promote fecre¬ 
tion by mercurial remedies. The combating of particu¬ 
lar fymptoms, which is an indifpenfable talk, will require 
us to adminifter opium for the allaying of fpafm and 
nervous 
