THE CHOLERAS 



opposed to it. With regard to the use of permanganate of potash in 

 cholera, it was recommended in 1866 by Everest, who treated seven- 

 teen cases with Condy's fluid, with only one death. Dr. Mackie in 

 the same year treated six cases similarly without a death. In 1884 

 J. W. Fry stated that the only thing he found of remedial use was 

 an enema of diluted Condy's fluid. In 1910 Rogers reported 

 favourably of the use of the permanganates given liberally in 

 cholera. In 1913 Castellani definitely separated the condition 

 which he called paracholera, from cholera. 



etiology — The Vibrio. — The cause of the disease is undoubtedly 

 Koch's vibrio (p. 962) ; still, this alone may not produce illness, 

 for, as Dunbar showed in 1892 in Hamburg, people who had never 

 suffered from the disease, and who were in good health, might still be 

 passing quantities of the virulent micro-organisms in their faeces. It 

 is evident, therefore, that these persons lacked some predisposing 

 condition, and, further, that they must have been a fruitful source 

 of infection. What this condition may be we do not definitely 

 know, but it would appear that such factors as mental worry, 

 underfeeding, and any slight disorder, but specially any derange- 

 ment of the alimentary canal producing diarrhoea, are predisposing 

 causes. With regard to these causes, it may be mentioned that 

 unripe fruit, and especially melons, are regarded with suspicion 

 in times of epidemics, probably because they cause diarrhoea, and 

 thus predispose to the disease. 



It may be that the vibrio merely lives in the lumen of the bowel 

 in the cases in which it causes no symptoms, and only gains access 

 to the epithelial cells and mucosa in cases of lowered vitality, and 

 perhaps is only toxic in this situation ; but if this is so it still remains 

 to be proved. 



This lowered vitality would explain the apparently extraordinary 

 cases which at times appear in gaols when the town is apparently 

 free. The reason may be that short-sentence prisoners are generally 

 on a very low diet, while long-sentence prisoners often have such 

 hard manual labour to perform that they are exhausted at night. 

 Therefore, if a carrier is introduced into a gaol, the disease may 

 easily start apparently de novo among incarcerated inmates. 



The disease is communicable directly from man to man by con- 

 tamination. As an example from our own experience, a medical 

 man examines a patient suffering from cholera, and then proceeds to 

 have his lunch, with the result that both patient and doctor were 

 dead within twenty-four hours of cholera. Again, there is the 

 chance of infection from dead bodies in performing autopsies, but 

 graveyards are not important means of dissemination of the disease, 

 because the germ rapidly disappears from the dead body. Fomites 

 may also spread the contamination, but these are not the usual 

 method of infection, which is generally by water. The vibrios 

 pass out with the fseces, in which they are capable of living a long 

 time (163 days); hence the great danger of faecally contaminated 

 fields, rubbish-heaps, gardens, etc.; for if there is a poor sanitary 



