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Page 9 of Account of spasmodic cholera as it appeared in the city of Lexington in June 1833 / by Lunsford P. Yandell, M.D.

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YANDELL on Spasmodic Cholera. below the healthy standard; the countenance pale and anx- ious. But one of the most striking phenomena in the disease, was the natural appearance of the patient, and the unaltered state of many of the principal functions, there being often no complaint made of acute pain, except of cramps, and little indication of disease, except in the disturbance of the bowels. Where the suffering was most acute there was often least danger; and those were the most alarming cases where the patient complained only ot op- pression about the prwecordia, frequent watery discharges with- out pain, and rapidly declining strength. In negroes it was not uncommon, after a continuance of such discharges for five or six hours, without acute pain in any part, and without any previous indisposition, for spasms to come on suddenly, followed by cold sweats, shrivelled hands, and all the symptoms of collapse. It was less common among white persons. They generally made more complaint, and were oftener affected with nausea. In a word, whatever the cause may be, their sufferings in the disease seemed to be more acute. It was a mistake often fatal to patients, that, while their evacuations retained their fiecal character, however watery, they did not labor under cholera. From the nature of the case, the first discharges were filled with the contents of the bowels, and it was not until they were washed out that the peculiar rice water appearance was presented. By this time, the disease had made considerable progress. The strength had generally begun to sink, and the patient often fell into collapse before medicine could change the nature of the dis- charges. The issue, however, was often more favorable, for although when the rice water discharges had appeared, the disease was for the most part far advanced, the proper treat- ment at this period often arrested the complaint. It was always a stage of imminent danger, which might oftener have been prevented had people been aware how closely it fol- lowed the first intimation of diarrhoea. 9

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