Page:Tropical Diseases.djvu/514

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472
CHOLERA
[CHAP.

When death from collapse supervenes, it may do so at any time from two to thirty hours from the commencement of the seizure, usually in from ten to twelve. On the other hand, the gradual cessation of vomiting and purging, the reappearance of the pulse at the wrist, and the return of some warmth to the surface may herald convalescence. In such a case, after many hours' absence, the secretion of urine returns, and in a few days the patient may be practically well again. Usually, however, a condition, known as the " stage of reaction," gradually supervenes on the algide stage.

Reaction; cholera typhoid.— When the patient enters on this stage the surface of the body becomes warmer, the pulse returns, the face fills out, restlessness disappears, urine may be secreted, and the motions diminish in number and amount, becoming bilious at the same time. Coincidently with the subsidence of the more urgent symptoms of the algide stage and this general improvement in the appearance of the patient, a febrile condition of greater or less severity may develop. Minor degrees of this reaction generally subside in a few hours; but in more severe cases the febrile state becomes aggravated, and a condition in many respects closely resembling typhoid fever, " cholera typhoid," ensues. This febrile or possibly typhoid state may last from four or five days to perhaps a fortnight or even longer. In severe cases the face is flushed, the tongue brown and dry, and there may be delirium of a low typhoid character with tremor and subsultus; or the patient may sink into a peculiar torpid condition. The motions are now either greenish or like pea-soup, and may contain a larger or smaller amount of blood; at the same time they are very offensive. The reappearance of urine may be delayed from two to six days; at first scanty, high-coloured, cloudy, albuminous, and containing casts, it gradually becomes more profuse, paler, and with less albumin. Though at first the urine is very deficient in urea, in uric acid, and in salts, later the quantity of these substances may exceed for a time the normal