for the cholera germ to multiply in. Besides diarrhœa, other prodromata, such as languor, depression of spirits, noises in the ears, etc., are sometimes noted.
When true cholera sets in, profuse watery stools, painless or associated with griping, and at first fæcal in character, pour, one after the other, from the patient. Quickly the stools lose their fæcal character, becoming colourless or, rather, like thin rice-water containing small white flocculi in suspension. Enormous quantities— pints— of this material are generally passed by the patient. Presently vomiting, also profuse, at first perhaps of food, but very soon of the same rice-water description, supervenes. Cramps of an agonizing character attack the extremities and abdomen; the implicated muscles stand out like rigid bars, or are thrown into lumps from the violence of the contractions. The patient may rapidly pass into a state of collapse. In consequence principally of the loss of fluid by the diarrhœa and vomiting, the soft parts shrink, the cheeks fall in, the nose becomes pinched and thin, the eyes sunken, and the skin of the fingers shrivelled like a washerwoman's. The surface of the body becomes cold, livid,and bedewed with a clammy sweat; the urine and bile are suppressed; respiration is rapid and shallow; the breath is cold and the voice is sunk to a whisper. The pulse soon becomes thready, weak, and rapid, and then, after coming and. going and feebly fluttering, may disappear entirely. The surface temperature sinks several degrees below normal to 93° or 94° F.; whilst that in the rectum may be several degrees above normal— 101° to 105° F. The patient is now restless, tossing about uneasily,' throwing his arms from side to side, feebly complaining of intense thirst and of a burning feeling in the chest, and racked with cramps. Although apathetic, the mind generally remains clear. In other instances the patient may wander or may pass into a comatose state.
This, the "algide stage" of cholera, may terminate in one of three ways— in death, in rapid convalescence, or in febrile reaction.
