The sodden shrivelled hands, as those of a washerwoman, are very characteristic. Thirst is intense.
The patient now falls into a listless, motionless state in which, however, the apathy is more apparent than real. The algidity may deepen and death ensue or the stage of reaction may set in. The algid stage may last from a few hours to two or three days.
Collapse and uraemia are the two most frequent causes of death.
Stage of Reaction.—The pulse returns, urine is again secreted and the duskiness and coldness of the skin give way to normal conditions and a favorable convalescence sets in. At other times, however, the rise of surface temperature and restoration of the circulation are not attended by urinary secretion.
In such cases a typhoid state ensues with accelerated respiration, dry, brown tongue and muttering delirium.
It is customary to divide the types of cholera cases into:
1. Cholera gravis. The type above described.
2. Cholerine. In this there is a more or less marked stage of evacuation with possibly the appearance of rice-water stools. The urine, however, does not become suppressed and the algid stage is not entered upon.
3. Cholera sicca. This type of the disease is more apt to be seen in old or debilitated people. The patient dies of collapse without showing symptoms of vomiting or diarrhoea. At the autopsy one may find the bowels distended with rice-water contents.
The so-called cholera ambulans is simply another designation for the more or less ill cholera carrier.