CHoLKliA 



207 



Cholera (Kr. </// /^ if,/</^///.-i. Tin- 



word i-li<il'i-'< i connected witli i-Jiul?, ' bile, ' as U 

 also tin- Knjjish 'choler') was used ly l)tli !li|>|Hi 

 crate-, and (Vlsiis to de-crilie sporadic cholera (nee 

 In-low). The- ttTin i now rather loosely emuloved 



to denote v;uiolis forms of di.sease (suell as Chicken 

 eliolera, for which see I'uii.TKV). Ill this article 

 it i> n-ed as the designation for Asiatic, Oriental, 

 or Kpidemic Cliolera, otherwise called Cholera 

 Morlni- or 1'estileiitial Cholera. This disease 

 has been popularly l>elieved to he a new dis- 

 ease which made its first appearance in Bundel- 

 khand in IS17, when 5000 men died in five days; 

 hut there is no douht that it has a far more 

 ancient origin, and has visited Europe since 1500 

 A.D. Cholera is a specific disease characterised 

 l'\ violent vomiting and purging, with rice-water 

 c \ a. nations, cramps, and collapse; tending to run 

 a rapidly fatal course, and capable of being coin- 

 in n moated from person to person by means of the 

 dejecta of patients suffering from it. The mor- 

 tality of cholera varies in different epidemics ; it 

 is always greatest at the commencement of a fresh 

 outbreak ; at the lowest estimate one-half of the 

 persons attacked die. Cholera has been endemic 

 for centuries in certain parts of India, especially 

 in the valley of the Ganges, and in the 19th 

 century it has spread on various occasions almost 

 all over the civilised world. In 1817-23 cholera 

 spread rapidly throughout Bengal and other parts 

 or India, Ceylon, Burma, and China, slaying 

 thousands of victims. A second outbreak occurred 

 from 1826-37, and spread vid Central Asia and 

 Russia with frightful virulence throughout Europe 

 and America. From Riga it was imported to 

 Sunderland (26th October 1831); from Hamburg 

 to London (13th February 1832) ; and so it passed 

 on to Paris, Quebec, Chicago, New Orleans, &c. 

 In 1846-63 a third epidemic occurred, and Europe 

 and America were again visited ; 53,293 persons 

 dying in England and Wales in 1848-49, and 

 20,097 in 1854. A very extensive outbreak took 

 place in 1865-75 ; and in 1884-85 cholera reached 

 France (especially Toulon and Marseilles), Italy 

 (especially Naples), and Spain, but did not spread 

 farther. The outbursts of cholera are generally 

 sudden in their advent, hundreds of people being 

 attacked within a few days of its appearance in 

 any locality. It is a noteworthy fact that in each 

 outbreak of cholera, one or other of its various 

 symptoms is especially well marked. 



Certain factors determine the origin and pro- 

 mote the diffusion of cholera. Places having a 

 high altitude are prone to escape its ravages (at 

 anyrate for a long time ), whereas low-lying ground 

 favours its spread. During the general diffusion 

 of cholera in India in 1817-19, the hill-forts 

 remained exempt in a remarkable way, while the 

 disease was prevalent in the plains around. There 

 is no doubt too that cholera follows the rivers ; and 

 the more copious the saturation of the ground, and 

 the greater the amount of organic matter under- 

 going decomposition it contains, the more exten- 

 sive will be its spread. The drying of the soil 

 after it has been soaked is very favourable for the 

 development of cholera epidemics ; and they are 

 also favoured by certain physical characteristics 

 of the soil, such as permeability to water and air, 

 also by rocks that nave a capacity for retaining 

 moisture, and by organic detritus. But these are 

 not the only factors we have to take into account, 

 for climatic influences, such as heat and moisture, 

 also affect its epidemic spread. Heat aids its pro- 

 duction ; a marked fall in the temperature and 

 heavy rain stay its ravages, but rain after a pro- 

 longed drought often gives it impetus. 



As to the exact nature of the morbid poison 

 which causes cholera, authorities still differ, yet 



in all probability a genn found in 1883 by Koch 

 in (lie dejecta of cholera patient* in Egypt, 

 Calcutta, and Toulon, and named by him the 

 Comma' bacillus, constituted the morbific agent. 

 His observations were to some extent confirmed 

 by the researches of Klein and Gibta in Cal- 

 cutta and Bombay, and numbers of observers, 

 notably Dr Macleod and Mr Miller at Shanghai 

 in 1885, have since found the bacillus in the 

 stools of cholera patients (see BACTERIA, GERM 

 TIIKORY). The importance of this discovery can 

 be estimated by the following fact. An Italian 

 emigrant steamer arrived at New York in 1887, 

 having on t>oard a case of diarrluea, the symptoms 

 of which were suspicious but not perfectly typical 

 of Asiatic cholera. Cultivation experiments were 

 made at the Carnegie Laboratory of material dis- 

 charged by this patient, and in four days they 

 manifested the characteristic amiearances due to 

 the growth of the ' Comma ' bacillus ; and the 

 diagnosis was subsequently confirmed by the 

 occurrence of cases amongst the ship's passengers, 

 in which the unmistakable symptoms of Asiatic 

 cholera were present. It must, nowever, be said 

 that bacilli similar to these do occur in healthy 

 persons ; they do not, however, give rise to the 

 same appearance when cultivated by Koch's 

 method as do the bacilli found in cholera stools. 

 Further research is necessary to show in what way 

 these bacilli cause cholera. The dejecta of cholera 

 patients when perfectly fresh are innocuous, but 

 very soon- they develop the morbific agent, and 

 water, food, or clothing contaminated by them 

 will communicate the disease to healthy persons. 

 Numerous observations go to prove that the 

 wind also is capable of conveying the poison 

 from dried cholera stools, but how far it is im- 

 possible to say. Troops or pilgrims may carry 

 the infection and propagate it along their line 

 of march ; if healthy bodies of men meet with 

 infected troops or enter a tainted district, they 

 will almost certainly suffer; or if a body of men 

 encamp on a site recently occupied by cholera 



Eatients, they will become affected, if cholera 

 reaks out on board ship in mid-ocean, it will be 

 coincident with the exposure of some part of the 

 cargo from an affected place. 



Causes. (a) Predisposing. Fear or shock, ex- 

 posure to sudden changes of temperature, intem- 

 perance in labour, pleasure, or drink, and want 

 of proper clothing, as well as everything which 

 tends to derange the stomach, or the use of 

 strong purgatives, predispose a person to an 

 attack of cholera ; and fresh arrival into an in- 

 fected area renders a person extremely liable to 

 an attack, (b) Exciting. This is of course the 

 entrance into the body of the poison, which may 

 be introduced into the system either by drinking- 

 water, or by food contaminated with the discharge 

 of a cholera patient. It may also be inhaled as 

 dust, and enter the body through the lungs. There 

 can be no doubt that' polluted drinking-water is 

 by far th<> most common source of infection ; and 

 it has been noticed, as for instance in Calcutta, 

 that the improvement in the water-supply has 

 greatly diminished the prevalence of cholera. 



Symptvms. After some premonitory symptoms 

 characterised by malaise, depression, and slight 

 diarrhoja, eliolera commences by purging, to be 

 soon followed by vomiting and painful cramps in 

 the stomach and * limbs. These symptoms form the 

 first or evacuation stage. The discharges down- 

 wards are extremely copious, and they soon become 

 colourless and turbid, resembling water in which 

 rice has been boiled ; hence the expression, ' rice- 

 water ' evacuations. In the second stage, which is 

 called the ' algid ' stage, there is profound collapse. 

 In this condition the patient lies motionless and 



