the algide or
asphyxial stage. As above mentioned, this is often preceded by the
premonitory diarrhoea, but not infrequently the phenomena attendant upon
this stage are the first to manifest themselves. They come on often
suddenly in the night with diarrhoea of the most violent character, the
matters discharged being of whey-like appearance, and commonly termed
the "rice-water" evacuations. They contain large quantities of
disintegrated epithelium from the mucous membrane of the intestines. The
discharge, which is at first unattended with pain, is soon succeeded by
copious vomiting of matters similar to those passed from the bowels,
accompanied with severe pain at the pit of the stomach, and with intense
thirst. The symptoms now advance with rapidity. Cramps of the legs,
feet, and muscles of the abdomen come on and occasion great agony, while
the signs of collapse make their appearance. The surface of the body
becomes cold and assumes a blue or purple hue, the skin is dry, sodden
and wrinkled, indicating the intense draining away of the fluids of the
body, the features are pinched and the eyes deeply sunken, the pulse at
the wrist is imperceptible, and the voice is reduced to a hoarse whisper
(the _vox cholerica_). There is complete suppression of the urine.

In this condition death often takes place in less than one day, but in
epidemics cases are frequently observed where the collapse is so sudden
and complete as to prove fatal in one or two hours even without any
great amount of previous purging or vomiting. In most instances the
mental faculties are comparatively unaffected, although in the later
stages there is in general more or less apathy.

Reaction, however, may take place, and this constitutes the third stage.
It consists in the arrest of the alarming symptoms characterizing the
second stage, and the gradual but evident improvement in the patient's
condition. The pulse returns, the surface assumes a natural hue, and the
bodily heat is restored. Before long the vomiting ceases, and although
diarrhoea may continue for a time, it is not of a very severe character
and soon subsides, as do also the cramps. The urine may remain
suppressed for some time, and on returning is often found to be
albuminous. Even in this stage, however, the danger is not past, for
relapses sometimes occur which speedily prove fatal, while again the
reaction may be of imperfect character, and there may succeed an
exhausting fever (the so-