PART I.] Coincident Conditions of Soil in Cholera and Malaria. 297 



vomited matters were a light-coloured watery fluid ; the countenance pinched, voice 

 hoarse and husky, tongue pale, and breath cold, the extremities of the fingers and toes 

 puckered, pulse not perceptible, and the surface of the body cold and clammy. The 

 patients suffered from cramps of the stomach and extremities, and had great thirst ; 

 respiration was much restrained, causing extreme anxiety and a presentiment of approach- 

 ing death; in most cases the urinary secretion was suspended. The only diagnostic 

 sign to distinguish the disease from cholera was the character of the stools, and they 

 sometimes approached the conjee-like character of choleraic evacuations." 



During a visit to the Andamans in 1872 one of us had an opportunity of witnessing 

 a case of this kind. In this instance the rice or conjee-water character of the evacua- 

 tions was very evident, together with every other characteristic symptom of cholera, 

 including suppression of urine. Dr. King, the Surgeon-Major in charge of the hospital, 

 had witnessed several such cases, but had hesitated to return them, whether fatal or 

 otherwise, as cholera, because there was no general diffusion of the disease among the 

 convicts. 



The importance of well-authenticated records of cases of this character can scarcely 

 be overrated in connection with the etiology of cholera. Questions of possible contagion 

 or of water-contamination by a specific material can hardly be seriously entertained 

 here; there can be no casual importation of cases among an isolated community of this 

 character, as the recent history of every person landed is accurately known. Somewhat 

 similar cases habitually occur in every city in India, as well as every summer in nearly 

 all the large cities of Europe. These, however, excite no special comment unless an 

 epidemic breaks out in any part of the country ; on this the previously ignored cases 

 are carefully collated and described as the starting points of the pestilence : it is not 

 the custom to look upon such cases then as due to a localised generation of the 

 disease. 



That, in the present state of our knowledge of the subject, it may appear difficult 

 or impossible to explain all the phenomena of the distribution of cholera by coincident 

 conditions of the soil must be at once allowed. But at the same time, when we come 

 to inquire into the point, we find that just as many difficulties present themselves in 

 reference to malarial affections.* Whilst generally associated with moisture of air and 

 soil, they also occur in certain localities which might have been regarded as quite 

 incapable of furnishing the conditions for their production. In some of these cases, 



* " Malaria sometimes breaks loose from its endemic haunts and shows itself in places where it has seldom or 

 never before appeared. It thus loses its endemic character and sweeps over considerable regions of country as an 

 epidemic or over vast sections of the globe as a pandemic. ... In view of what has been said before, it 

 does not seem probable that currents of air are capable of carrying the poison which is generated in the breeding 

 places of epidemic to a distance of any considerable number of miles. We believe rather that malarial poison is, 

 in the majority of cases, generated on the spot. ... It is a still more difficult matter to account for those 

 isolated areas of malarial poison which are often confined to a single street, or to one side of a street, or even to 

 single houses, unless, indeed, supposing them to arise from subterranean swamps and collections of waters, the 

 exhalations from which reach the surface through rifts in the ground." — H. Hertz on "Malarial Diseases "in 

 Zienssen's Cyclojjadia of Medicine, 1875, p. 578. 



