These spasms are accompanied by an increasing but not suffocative oppression of the chest, and tightness of breathing, increasing anxiety, vertigo, and principally a sudden collapse and excessive smallness of the pulse which frequently disappears entirely a long time before death, or is, at any rate, scarcely perceptible. The same statement applies to the beating of the heart. The sudden collapse of pulse is one of the most remarkable, and, at the same time, one of the most essential symptoms of this epidemic. This collapse of pulse appears to be dependent upon an arrest of the circulation rather than upon spasm.

Simultaneously with these symptoms, or before, the patient experiences a disagreeable, painful burning in the epigastric region, or in the region of the stomach down to the umbilicus. According to Annesley, this burning, which is sometimes experienced behind the sternum, and is one of the most constant, most distressing, and most alarming, symptoms, is so characteristic of cholera-that, whenever it exists in connexion with the anxious look, with sighing and anxious breathing, one may safely infer from it the existence of cholera. The burning remains frequently a long while after the vomiting has ceased, accompanied with a burning and tormenting thirst, the patient expressing a particular desire for cold water, which he swallows with great avidity, and throws up again immediately.

Simultaneously with the spasms, and sometimes a little before, the whole surface of the body becomes cold; first the lower limbs and then gradually the whole body. This coldness increases to a coldness as of a dead body (frigus marmoreum). . It resists the most persevering means of warming, and spreads over the face and lips, which become pale, blue and cold, and over the cheeks and eyelids; even the buccal cavity, the breath and tongue, become cold. The tongue is either little or not at all coated; more frequently it is dry, reddish or whitish, with brown edges; it becomes shrivelled when getting cold (this shrivelled appearance of the tongue is considered a particularly fatal symptom), without being insensible, and becomes entirely bloodless. The skin is covered with a cold, clammy sweat, which is frequently very profuse. The whole body becomes flaccid and sunken, and assumes a shrivelled appearance, especially on the hands, fingers and toes, as if these parts had been soaked in warm water, with a livid, bluish hue.

The face is excessively disfigured, sunken, pale or livid, cadaverous, with cold, bluish tip of the nose; cold sweat, the eyes having retreated deep into the orbits, half-closed, dim, having very often a reddish, and sometimes a blue, tinge, they are turned upward, and are surrounded with grey-brown margins. This expression of countenance is termed facies cholerica; it reflects anxiety and sadness; the patient has a staring and vacant look, and appears to be completely absorbed in reverie. The facies cholerica is one of the most striking characteristics of the higher degree of the disease, and is indeed a frightful and ghost-like appearance.

The peculiar alteration of the voice is likewise remarkable. The voice of a cholera patient is feeble, fine, somewhat hoarse, hollow, or without resonance; the patient, being extremely averse to talking, uses his voice only to complain of the burning in the pit of the stomach, and to ask for water.

The urine either ceases to flow from the very commencement, or the patient passes only occasionally a few drops of a turbid or brownish urine. This is not retention of urine, but the secretion of urine ceases entirely. This cessation of the functions of the bladder is a striking and constant symptom of the cholera. Not until the violence of the disease decreases, and the circulation becomes freer, is the urine secreted again, which may always be considered a favourable symptom.

The secretion of mucus is not changed, only less copious; the saliva is more viscid; the nasal mucus is generally wanting.

This stage lasts from two to three, up to eight, twelve, or twenty-four hours, sometimes two or three days.

The third stage cannot well be separated from the former, for this stage either passes into the highest degree of the disease, the stadium lethale, or into the stage of convalescence. The fatal stage is simply an aggravation of the symptoms which we have described as belonging to the second stage; sometimes vomiting, diarrhoea, spasms, abate shortly before death, the patient falls into a kind of sopor, the heart ceases to beat, the eyes become glassy, etc.

If an improvement set in, the pulse becomes fuller and more equal, the animal heat returns, and the spasms cease; the expression of countenance becomes more natural, cheerful, anxiety is no longer depicted in it; the look is firmer and more animated; there is a warm exhalation from the skin; the watery diarrhoea diminishes, the vomiting ceases, the alvine evacuations again assume a bilious, sometimes greenish tinge; the urine is secreted again.

§ 62. The prognosis is quite different from that of sporadic cholera; the course of the Asiatic cholera being extremely rapid. Generally the attack terminates in asphyxia after two or three hours; very seldom the disease lasts two or three days. If its course should be slow, and if the disease should pass into a typhoid fever, this may likewise be fatal. It is true the homoeopathic treatment of Asiatic cholera is much more favourable than that of allopathic physicians; nevertheless, the physician has to be constantly watchful lest he should overlook the dangerous moment. A chronic weakness of the nerves, and particularly of the digestive organs, frequently remains. According to Hahnemann, and several other physicians, the best remedy to prevent the complete development of the disease is Camphor. For this purpose one part of Camphor is dissolved in twenty parts of alcohol, and the patient should take one or two drops of the solution every two or five minutes upon a piece of sugar, or in a spoonful of water, according as the disease is more or less violent. As the symptoms abate, the Camphor is given at longer intervals, of course. According to some, Camphor simply palliates the symptoms, especially in those cases where the evacuations have existed for some time previous to the attack. The external application of Camphor-by fumigation, friction, and injection, is not only inexpedient, but positively injurious, inasmuch as Camphor would antidote almost all the vegetable medicines which the physician might have to use in case Camphor should not be sufficient.