CHOLERA, ASIATIC. 



165 



noticed that the attendants who removed the 

 excretions were attacked by the disease, and 

 covered the surface of the vessels used with oil, 

 and had a charge of chlorine gas passed at once 

 through each, and from that time no new cases 

 occurred among the attendants. As an illus- 

 tration of the virulence of the poison of cholera, 

 even when largely diluted, the following case, 

 related by Dr. Snow, may be given. In 1854, 

 there was a well in Broad Street, London, into 

 which the contents of a sewer had been perco- 

 lating for m'onths. Of this water hundreds of 

 persons had been drinking, and although cholera 

 was present in other parts of London, there 

 were no cases in this locality. At last a case 

 of cholera occurred, and by means of the sewer 

 the excretions of the patient were mingled 

 with the water of the well. Within three days, 

 more than five hundred persons, who used the 

 water from this particular well, were attacked 

 with the disease. Believing that the disease 

 was communicated by this water, Dr. Snow 

 removed the handle of the pump, and thus cut 

 off the use of the water, and no more new cases 

 appeared. 



This view of the portability of the disease 

 justifies the maintenance of a rigid quarantine, 

 to prevent its admission from foreign ports, and 

 indeed renders it imperative. If it once obtains 

 a foothold it will naturally prevail most in those 

 sections where filth, overcrowding, poor venti- 

 lation, and imperfect sewerage prevail ; and once 

 established there it will not be eradicated for 

 many months, nor without great difficulty. It 

 is. therefore, of the greatest importance that 

 special pains should be taken to maintain clean- 

 liness throughout our cities and towns, and to 

 avoid those evils which, if they do not engen- 

 der, at least aggravate disease. 



We turn next to consider the pathology of 

 the disease, or the portion of the human organ- 

 ism affected by it, and causing the symptoms 

 which are characteristic of it. 



We may, then, define Asiatic Cholera as a 

 specific poison introduced in some manner into 

 the system, and after a longer or shorter period 

 of incubation, acting either through the blood 

 primarily, or more probably through the ner- 

 vous system, and especially on the great sym- 

 pathetic nerve and its ganglia, producing at 

 first great excitement, but, speedily, still greater 

 depression of the vital powers causing a kind 

 of tetanic contraction of the capillary vessels 

 and arteries, and thus emptying all the blood- 

 vessels of the surface into the great central 

 veins, and preventing the oxygenation of the 

 blood by prohibiting its passage back to the 

 heart through the lungs. This driving back the 

 blood into the great central veins produces con- 

 gestion and oppression of the liver, heart, kid- 

 neys, and alimentary canal, and the effort of 

 Nature to relieve the system by violent purga- 

 tion and vomiting, only results in exudation of 

 the serous fluid of the blood, and secretions into 

 the stomach and bowels, causing a rapid ex- 

 haustion and collapse. From this condition 



unassisted Mature rarely rallies ; but in a few 

 and exceptional cases, a reaction takes place, 

 and a fever sets in, which usually proves fatal. 



The symptoms of the disease, from commence- 

 ment to termination, may, with propriety, be 

 detailed at some length, and in such a way as 

 to enable the non-professional reader to recog- 

 nize the disease without difficulty. Within a 

 longer or shorter period after the poison has 

 been absorbed by the system, usually only a 

 very .few hours, though in exceptional cases it 

 may be days, there is a vague feeling of uneasi- 

 ness in the stomach and bowels, accompanied 

 by a sense of heat and disorder, with some loose- 

 ness, a simple feculent diarrhoea, with little or 

 no griping, at first with but infrequent dis- 

 charges, three or four in a day, but increasing 

 by the second day to ten or twelve. Accom- 

 panying this diarrhoea there is soon occasional 

 nausea, with a constantly increasing lassitude 

 and languor. After purging, the patient is giddy 

 or dizzy, and very weak. There is an empty, 

 hollow feeling at the stomach, and soon some 

 vomiting, at first of no great amount, but a thin 

 watery fluid mixed with a little bile, and per- 

 haps some undigested food. By this time there 

 is a slight tendency to shivering, though no dis- 

 tinct chill. The stomach and bowels are dis- 

 tended, and the more frequent stools are no 

 longer feculent, but thin, whitish, having the 

 appearance of whey or rice water, with starchy 

 looking faeces floating in them, and, though 

 there may be once or twice traces of bile, it soon 

 disappears. There is a restlessness about the 

 patient, and he complains of ringing in his 

 ears, a tingling sensation in his hands and feet, 

 as if they were asleep, and slight cramps in his 

 feet. The pulse, at this stage, is somewhat 

 quicker and weaker than in health, the tongue 

 is moist and slightly furred, but the patient 

 complains of thirst. The features have an un- 

 natural sharpness, and the countenance an anx- 

 ious and apprehensive expression. 



If now the case is suffered to go on without 

 medical interference, or a further time elapses 

 before any thing is done for the patient, the purg- 

 ing becomes more frequent, abundant, and sud- 

 den, the discharges being violent, "shot out," 

 as the attendants will say, and always of the 

 rice or barley water character, with flaky or 

 starchy particles floating in them, and with 

 each purging there is a sinking of the pulse, 

 severe cramps in the feet and legs, and increased 

 helplessness and prostration. Vomiting accom- 

 panies the purging, and the matter ejected from 

 the stomach is similar in character to that which 

 comes from the bowels, with occasionally some 

 traces of bile ; but the vomiting is not so co- 

 pious as the purging, and after a time ceases. 

 As the patient grows weaker the purging ceases 

 also; but before this, spasms of a tetanic char- 

 acter have developed from the cramps which 

 at first affected the feet and legs ; the fingers 

 and toes thrill and tingle as if they were asleep ; 

 this is followed by a quivering rather strange 

 than painful feeling in the hands and feet; 



