Malignant Cholera, as the Asiatic form of the disease has been called, so far resembled the summer Cholera, or Cholera Morbus, that it was attended with profuse vomiting and purging, by extreme prostration of strength, and by cramps. But it differed remarkably in these respects; that the matters ejected from the stomach and bowels during the height of the disorder contained no bile; in the early appearance of the symptoms of collapse; and in the great mortality of the disorder.

"The amount of the fluid matters thrown up from the stomach and discharged from the bowels was really in many cases wonderful. At first, perhaps, the patient would have so copious a stool, a consistent dejection it might be, but so large in quantity, as to lead him to think that the whole contents of the intestines had been discharged at once. Yet soon afterwards a turbid whitish liquid would again and again pour from his bowels in streams, and be spouted from his mouth as from a pump; not in general with pain or much effort, but easily and abundantly. The matters thus discharged were thin, and for the most part of a whitish colour, like water in which rice has been boiled; having a very peculiar odour, but without fecal small; and containing small white albuminous flakes. There were some varieties in the evacuations, but the kind I have mentioned, resembling rice-water, was the most common and the most characteristic: and however else their sensible qualities might vary, this circumstance was universal, that they contained no bile.

"With all this there was early sinking, and collapse, as it was called. This term collapse expressed a general condition, made up of the following particulars: A remarkable change took place in the circulation, and a striking alteration in the appearance of the patient. The pulse became frequent, very small and feeble, and, at last, even for hours sometimes, extinct at the wrist. The surface of the body grew cold; and in most, or in many instances, blue as well as cold. The lips were purple, the tongue was of the colour of lead, and sensibly and unplesantly cold to one's touch, like a frog's belly; and the breath could be felt to be cold. With this coldness and blueness there was a manifest shrinking and diminution of the bulk of the body. The eyes appeared sunk deep in their sockets; the cheeks fallen; in short, the countenance became as withered and ghastly as that of a corpse. The cadaverous aspect that sometimes precedes death in long-standing diseases would come on in the course of an hour or two in this complaint. If the physician left his patient for half an hour, he found him visibly thinner on his return. The finger nails became blue; the hands and fingers shrivelled, white, corrugated, and sodden, like those of a washerwoman, after a long day's work. The skin was bathed in a cold sweet. The voice became husky and faint. So peculiar was this change that the sound was spoken of as the vox Cholerica (Cholera voice). These are the symptoms which the single word of collapse was meant to express.

"Another very striking feature of the disorder was the muscular cramp; affecting the muscles of the thighs and calves of the legs, rendering them as hard and rigid as wood; and drawing up into knots the muscles of the abdomen. These spasmodic contractions were attended with severe pain, and constituted the greater part of the patient's suffering. During the continuance of the symptoms, not a drop of urine was passed or secreted. One man who was under my own observation and care, and who recovered, did not void a drop of water from Sunday morning till the afternoon of the following Wednesday.

"Even in the extreme state of collapse the intellect remained quite clear; the patients would continue to talk rationally to the last moment of their lives; and, for the most part, they seemed singularly indifferent and apathetic about their condition.

"In the fatal cases, and a very fearful proportion of the whole number were fatal, death took place sometimes in the course of two or three hours; and it was seldom delayed beyond twelve or fifteen. In those that recovered, the favorable symptoms were the cessation of the purging, vomiting, and cramps; the return of the voice, of the pulse, and of warmth to the surface; the disappearance of the blueness of the skin, and of the ghastly appearance of the countenance, the reappearance of bile in the evacuations, and the return of the secretion of urine.

"The course of the symptoms varied a good deal in different persons. Sometimes the vomiting and purging soon ceased, and sometimes there was neither sickness nor diarrhoea at all, but rapid collapse and sinking. These were deemed to be the most formidable cases. A patient died of Cholera in the Middlesex Hospital without any vomiting or purging; but on examining the dead body we found the intestines quite full of the rice-water, serous fluid. Sometimes the cramps were not very troublesome. The cutaneous blueness was not universal. The patients were in general tormented by thirst; and when attempts were made to bleed them, the blood was found dark and thick, like treacle, and scarcely moving,if moving at all in the veins: in some cases it could not be made to flow out.

"Examination of the dead bodies threw no clear light upon the nature of this frightful disease. The alimentary canal generally was found to contain a white liquid, having whiter flakes in it; such as had previously issued from the bowels: and the mucous glands of the intestines were unusually large and conspicuous. The veins were loaded with thick, black, tar-like blood; and the urinary bladder was always found empty, and contracted into the size of a walnut. Even when the blue colour had existed in a marked degree during life, it often quickly disappeared after death. And another most singular phenomenon was occasionally remarked in the dead body. A quarter, or half an hour, or even longer, after the breathing had ceased, and all other signs of animation had departed, slight, tremulous, spasmodic twitchings and quiverings, and vermicular motions of the muscles would take place; and even distinct movements of the limbs, in consequence of these spasms.