2
SYMPTOMS.
In many instances there is an ineffective effort at re-action, when the
congee vomitting or purging returns with increased animation ; but only for a
short time. When the disease continues and re-action progresses favorably,
the restlessness subsides, the breathing becomes easier and more regular, the
burning pain in the stomach disappears, the pulse becomes stronger, the color
improves, the evacuations become colored and less frequent, and sleep ensues.
Bile and urine are secreted, the bowels become regular, the appetite returns,
and only slight debility remains. This is the regular uncomplicated course of
the disease.
In some cases the urine does not appear,—the bile is dark green,—the
vomitting or looseness continues,—the skin becomes hot and dry, and the head
painful, with tendency to delirium, or coma. As these sequelæ do not form
an essential part of the natural course of the disease, it is important, in regulat-
ing the treatment, to ascertain the cause of the complications, whether arising
from the retention of the effete portion of the blood during protracted
collapse,—from the partial retention of the poison,—from its injurious action on
the organs,—or from the action of the remedies employed during the previous
course of the disease.
In ordinary cases there is painless light colored diarrhoea for several
hours, or sometimes for several days, before the characteristic congee-like stools
appear, with suppression of urine; and the disease then progresses as previ-
ously described. When the collapse rapidly subsides, or when it does not
supervene, weakness alone remains, and the natural secretions of the liver and
kidneys are soon restored.
In the mildest form of the attack, there is a dull feeling of depression or
malaise with sinking in the epigastrium and want of appetite,—torpor of the
bowels, with a desire for stimulants. These symptoms are felt by almost all
who are in contact with cholera patients in severe epidemics. During this
period if the person be subjected to great exhaustion, from a long march, from
exposure, from watching or fear, or if a strong purgative be given, the usual
symptoms of cholera with collapse will generally supervene. Many such
instances have corne under my observation, and many more have been reported.
The poison was in the system, and brought into activity by the depressing or
exhausting influence superadded; instead of being quietly thrown off, as in
general, by the healthy natural secretions.
The action of the poison on the body is the same in character in all these
forms of the disease. The symptoms are merely modified by the intensity
of the poison, which induces diminished action of the sympathetic or involun-
tary nerves : amounting in the most intense form to total paralysis. The
voluntary nerves and mental energy remain unaffected in the earlier stages.
Whether the sudden accession of collapse which supervenes or the
diarrhoea arises from the natural development of the germ of the poison, or
whether the power of resistance being diminished, its action becomes more
powerful, or both these circumstances combine to produce it, is uncertain.
The disease may be cut short or arrested in the first or second stage this
has led to calling the second stage a distinct disease. Cases of diarrhœa
abound during cholera epidemics. When the evacuations become more watery
or congee-like, with cramps, the disease gets the name of choleraic diarrhoea.
These symptoms generally precede the congee stools with collapse, which are
considered to constitute cholera. The concealment of the real nature of the
disease, for fear of alarming the patient, is followed by hopeless despair when
collapse supervenes. There are numerous instances recorded, by the highest
and most reliable authorities, of intense attacks of epidemic cholera appearing
immediately after the arrival of people who were suffering from diarrhœa, who
came from places where cholera was raging. The symptoms in the original
cases sometimes subsided without advancing to collapse, though they more
generally proceeded to that stage. Choleraic diarrhœa is a stage of cholera
as much as collapse. The name should be discontinued, as liable to lead to the
neglect of the precautions required to prevent the spread of the disease.
A knowledge of the circumstances which predispose to the action, or
development of the disease, and the means by which it is disseminated, is
essential to its comprehensive treatment. In the reports submitted, some