164 



CHOLERA, ASIATIC. 



spasm, collapse, and death. Their existence in 

 the highest degree of intensity in the bottom 

 lands of the Ganges, the Brahmaputra, the Irra- 

 wadi, or the Meinarn, may account for its 

 apparently spontaneous generation there. In 

 other countries, however, there has been needed 

 apparently a germ of the disease to fall into 

 these prepared seed-beds, to develop into the 

 formidable and deadly epidemic. It is well set- 

 tled that this germ is found in the discharges, 

 either by vomiting or purgation, of those who 

 are affected by it ; and these excreta, permitted 

 to flow into uncleansed gutters, privies, or 

 sewers, impart their deadly character to what- 

 ever of decayed animal or vegetable matter 

 may be brought in contact with them, and thus 

 the disease is communicated with fearful ra- 

 pidity through the poisoned air to hundreds, 

 and perhaps thousands. This may serve to 

 explain why the disease rages so frightfully in 

 the crowded and filthy tenement houses, and 

 the dirty and uncleansed back slums of our 

 great cities, and why when it has once obtained 

 a foothold there it is eradicated with such diffi- 

 culty. Every case furnishes the poison which 

 will be absorbed by scores or hundreds of per- 

 sons, who will, if they remain in the vicinity, 

 most surely be attacked by the disease, and if 

 they attempt to fly, will, in all probability, bear 

 it off with them. 



Contagiow, in the ordinary or in the medical 

 sense of that word, namely, as being communi- 

 cated by contact with the patients affected by 

 it or by inoculation of "the matter discharged, 

 cholera certainly is not, but that it is portable, 

 or capable of being transmitted by the carrying 

 of these germs, from one place to another, in 

 the excretions of persons who have already ab- 

 sorbed the poison, there can be no sort of doubt. 

 And it is not impossible that the deadly virus, 

 after having lain dormant for months, and per- 

 haps for years, may be quickened into new 

 vitality by some influences, climatic or other, 

 which only develop it in the presence or in the 

 approach of the pestilence. How otherwise 

 shall we explain satisfactorily its return with 

 such unerring certainty after an interval of 

 some years, not simply to the same neighbor- 

 hood, but to the same house, and the same room, 

 to commence anew its ravages ? This has oc- 

 curred too often in London, in Edinburgh, in 

 Glasgow, in Montreal, and in New York, to be 

 a mere matter of accident. 



The progress of the disease and the mode of 

 its transmission from one city and country to 

 another during the present epidemic, fully de- 

 monstrates its portable character: it has, in 

 every instance, from its first appearance at 

 Alexandria, on the llth of May, to its introduc- 

 tion into Guadaloupe, and its existence on the 

 Atalanta, been satisfactorily traced to emigrants, 

 pilgrims, or travellers who have come directly 

 from localities and dwellings where it existed. 

 The investigations of Dr. Snow, an eminent 

 physician and sanitarian of London, in the epi- 

 demic cholera of 1854-'56, fully confirm this 



view. His theory was: 1st, that cholera was 

 exclusively a disease of the alimentary canal ; 

 2d, that the primary change in the alimentary 

 canal is always induced by the induction therein 

 of a specific poison ; 3d, that the poison is ex- 

 clusively contained in the intestinal contents 

 of the infected person that is to say, in what 

 is purged from the bowels and vomited from 

 the stomach. There is nothing breathed from 

 the lungs, nothing thrown off from the skin 

 that will propagate the disease ; 4th, that the 

 poison is neither a gas nor a vaporous, but a 

 material substance, and exists either as a liquid 

 or a solid. It cannot, therefore, be carried far 

 by the atmosphere, and when dry must be at- 

 tached to clothing, or disseminated through 

 water, to be carried long distances. 



He believed that the dissemination of the 

 disease was accomplished in one of the follow- 

 ing ways: 1st. The moist concreta of cholera 

 on the clothes and bedding of infected persons 

 might be carried mechanically by the vapor of 

 water, and enter the mouth and nostrils in that 

 form, and so be swallowed. In this way laun- 

 dresses who washed the clothes of cholera pa- 

 tients often took the disease. 2d. The poison 

 might dry on infected clothing, and from such 

 clothing, on its being unfolded or moved, the 

 solid organic matter might escape in small sub- 

 stance, to be wafted in the air, and be absorbed 

 through the mouth by any one exposed to it. 

 The disease was introduced into Gandaloupe by 

 the clothing contained in a trunk belonging to a 

 person who died on the voyage thither from 

 Marseilles, where the cholera was then raging. 

 The laundress who washed the clothing died 

 of the cholera, and all her family. 3d. Persons 

 who lay out the dead, and others in attendance, 

 might actually carry the poison in their hands 

 and infect themselves by taking food when 

 their skin was not properly cleansed. Twenty- 

 seven physicians and medical assistants in Con- 

 stantinople were attacked and died during their 

 attendance on the disease, and in Paris and 

 Toulon similar results have followed. 4th. The 

 very utensils, such as basins and cups, used by 

 the sick, might convey the poison, as well as 

 the cloths on which these utensils, after an im- 

 perfect washing, have been dried. 



To these modes stated by Dr. Snow may be 

 added that the effluvia from basins, bed-pans, 

 etc., used by cholera patients, if suffered to re- 

 main, especially in small, close, or ill-ventilated 

 rooms, charge the atmosphere and the bedding 

 with the poison, which is often taken up by the 

 absorbents or being inhaled passes into the 

 stomachs of those in attendance. Further than 

 this, the excretions thus charged with poison, 

 if thrown into gutters, cesspools, privies, or 

 open sewers, will communicate their deadly 

 character to the vegetable and animal matters 

 with which they are brought in contact, and 

 the exhalations arising from these may be ab- 

 sorbed and induce the disease. Dr. Rich, who 

 had charge of the cholera lazaretto in Malta, 

 and afterwards in the Balearic Islands, in 1831, 



