96 



CHOLERA IN 1802. 



produce true cholera. The truth of Koch's 

 views has not been entirely proved, but they 

 stand the trial of experience, and find many 

 more supporters to-day than in 1885. 



Dr. Emmerich, of Munich, has laid claim to 

 the discovery of a, straight bacillus, which he 

 says is always present in Asiatic cholera, and 

 without which the disease can not exist. This 

 bacillus Emmerich has termed the Naples bacte- 

 rium. Without entering upon a discussion of 

 the subject, it can safely be asserted that the 

 presence of the curved bacillus of Koch is a 

 much more valuable diagnostic feature than is 

 the Naples bacillus. Asiatic cholera is now ac- 

 knowledged to be a specific disease, due to the 

 agency of a specific cause, which attacks the hu- 

 man being always by way of the alimentary 

 canal. The cause of the disease acts primarily 

 upon the epithelial lining of the mucous mem- 

 brane of the small intestines, which it has a 

 tendency to destroy, and, secondarily, upon the 

 blood and nervous system. Whatever this 

 cause may be, it is essentially of a living organic 

 nature, and, under favorable conditions, possesses 

 the power of multiplication and propagation 

 within the intestinal canal of the human being. 

 It is also known that it passes in a living, active 

 state by means of water, milk, food, or other 

 substances into the alimentary canal. That the 

 power of multiplication and propagation of this 

 specific cause is limited and destroyed by certain 

 not yet well-known, unfavorable conditions is 

 now a recognized fact. We find these unfavor- 

 able conditions existing over the entire world, 

 except, perhaps, in the very home of the dis- 

 ease. Investigations have discovered and point- 

 ed out the means by which an attack or an 

 epidemic of cholera may be avoided, and if the 

 proper course be pursued we shall cease hearing 

 of the travels of this fatal disease. 



Cholera is not contagious, attacks persons of 

 any age or either sex, and claims most victims 

 among the intemperate, those careless as to per- 

 sonal cleanliness, and among those living in 

 close quarters. It is most severe in hot, moist 

 climates and low altitudes, in the warmer rather 

 than in the colder seasons of the year. In those 

 localities where a great difference exists between 

 the summer and winter temperature the disease 

 is prone to disappear during the winter season 

 and break out afresh during the period of great- 

 est heat. We have an exception to this rule in 

 an epidemic that once visited Russia, Sweden, 

 and Norway. Here we have records of one of 

 the most severe epidemics the world has ever 

 seen, and in the midst of a most severe winter. 

 Such instances show that even now, with all the 

 experience of the past, the exact nature of the 

 malady is not entirely understood. Although 

 poverty, filth, and intemperance favor the 

 spread of cholera, it is quite certain that these 

 agencies can not generate the disease. 



This peculiar cause of the disease finds its 

 most ready vehicle in clothing, bedclothes, car- 

 pets, and other things soiled by the excreta and 

 vomit from the sick, also through privies, sewers, 

 and streams that have been Contaminated by dis- 

 charges from those suffering from the disease. 

 Nothing can carry and spread cholera so quickly 

 as water. When an epidemic appears suddenly 

 and spreads quickly in a city or town, it is 



through the medium of the water supply. When 

 the disease is introduced in other ways, it spreads 

 slowly. Fear, excesses of any kind, marked 

 changes of temperature, crowding, anything de- 

 ranging digestion, recent arrival in an infected 

 district, predispose an individual to an attack of 

 cholera. Attention should be paid to diet, but 

 most important of all is attention to the water 

 and milk consumed. These articles should al- 

 ways be recently boiled. In cities and towns the 

 streets should be cleaned, cellars whitewashed 

 and well aired, sewers flushed daily, privies dis- 

 infected with chloride of lime, or carbolic-acid 

 solution. Everything that has been near one 

 suffering from cholera should be thoroughly dis- 

 infected, or, better still, burned. The physician 

 and the nurse only should come in contact with 

 the sick, and the hands always should be washed 

 in a weak solution of carbolic acid, or corrosive 

 sublimate, after approaching a cholera patient. 

 The patient should have his own knife, fork, 

 spoon, and drinking cup, and the nurse should 

 never partake of food in the sick room. 



The first symptoms of cholera are feelings of 

 weariness, a diarrhoaa, soon followed l>y vomiting 

 and cramps in the abdomen, extending down the 

 limbs. The character of the discharges soon 

 change. They become more numerous, very 

 copious, often involuntary, colorless, and assume 

 the characteristic " rice-water " appearance. 

 Marked thirst is always associated with rice- 

 water stools, and this is an important diagnostic 

 sign. The secondary or algid symptoms are 

 marked by collapse. During the intervals be- 

 tween the cramps the patient will lie absolutely 

 motionless. The body temperature falls below 

 normal, sometimes going as low as 94 F. The 

 pulse becomes small, or very compressible, the 

 voice is husky and hollow, the breath is icy cold. 

 The features assume a dark hue. and the nose 

 becomes drawn and the cheeks hollow. The eye- 

 balls are congested, sunken, and quite hidden by 

 the half-closed lids. The legs and feet assume 

 a bluish tint, the skin becomes wrinkled and wet 

 with a cold sweat. A person who has once seen 

 a case of cholera at this stage recognizes it at a 

 glance. Cholera is a disease not of days but of 

 hours, and when this stage is reached we can 

 predict with almost certainty the prognosis of 

 the case. If the mind becomes inactive and 

 stupor appears, death is apt to follow. 



This second or algid stage may last from ten 

 to thirty hours ; in some cases only two to three 

 hours; but after six to twenty-four hours the 

 third train of symptoms should appear, and a 

 stage of reaction be looked for. The body tem- 

 perature gradually rises, the breathing becomes 

 natural, the pulse increases in volume, the sweat 

 is not clammy, the breach becomes warmer, the 

 secretions are re-established, and the patient 

 sleeps. At first the respirations are sighing, but 

 very soon perfectly natural. This is the critical 

 stage of the illness. Great care must be exer- 

 cised or we have a relapse in cholera cases. Com- 

 plications, such as suppression of urine, high 

 fever, congestion of the lungs, abscesses in vari- 

 ous parts of the body, or severe and fatal haem- 

 orrhage from the bowels, may ensue. 



The mortality of cholera varies much, being 

 influenced as to seasons, localities, and conditions 

 of the people attacked. At times the mortality 



