Vibrio cholerae

“ The virulence of the cholera vibrio can be exalted by passage through guinea pigs—successive culturing of the peritoneal exudate of intraperitoneally infected animals alternating with culture media growth inoculations. Such a fixed virus, the virulence of which cannot be exalted, is the material used by Haffkine in his cholera vaccine. The toxicity of cholera is supposed to be due to an endotoxin which is set free when the vibrios undergo disintegration when lying between the basement membrane and epithelial lining of Lieberkühn’s glands. ”

“ Definition.—Cholera is a disease caused by a spirillar type of bacterium, Spirillum cholerae asiaticae. The organism multiplies in the small intestines and, undergoing lysis, liberates an endotoxin, which is responsible for the desquamation of the epithelium of the mucosa and other manifestations of the disease. Cholera appears to be endemic in the delta of the Ganges and the various world-wide epidemics can generally be traced to that source. The rice-water stool of cholera teems with the spirilla, and infections of water or food supplies can be traced to such a contamination. ”

“ In the acute phase of cholera, the loss of water from the small intestine is greater than the reabsorption in the large intestine, resulting in a major loss of fluids. Approximately, five percent of people infected with V. cholerae may present a severe cholera disease, which is characterized by profuse watery diarrhea, vomiting, and leg cramps. ”

“ If the cholera vibrio be the germ of cholera, then such healthy, vibrio-bearing individuals may well suffice to start an epidemic. It is impossible, short of absolute and complete isolation, for any practicable system of quarantine to deal efficiently with such cases.
So far from ordinary quarantine proving a defence against cholera, it may actually increase the risk of an epidemic. This it does by fostering a false sense of security, and so leading to neglect of those well-proved guarantors of the public health— domestic, municipal, and personal cleanliness, and a pure water and food supply. ”

“ The inoculation of animals by cholera cultures tends to produce an immune serum which is remarkable for its high agglutinating power, the titre at times going as high as 1 to 20,000. For agglutination tests in proving spirilla isolated from stools to be true cholera ones we use a serum of at least 1 to 4000 for its specific vibrio. Such a serum should agglutinate any true cholera spirillum in a 1 to 500 or 1 to 1000 dilution. The occurrence of bacteriolysis, when a small loopful of the culture emulsified in 1 cc. ”

“ All facts in connection with the spread of cholera by land or water routes can be best explained by the cholera carrier; the individual who is excreting vibrios, while in apparent health, being far more dangerous than the one excreting such organisms in the rice-water stools of a well-recognized case of the disease. ”

“ I will not pretend to say, which is the first cause of Cholera, nor do I think we shall arrive at that knowledge till the analysis of the atmosphere is carried to infinitely greater perfection than it is at present; till we are able to separate the principles of small-pox, plague, and intermittent fever from the air we breathe, and bottle them up as we do oxygen, nitrogen, and carbonic acid gas. I consider cholera essentially a disease of secretion, of immoderate secretion of serum from the skin and the intestines. ”

“ Many considerations render it probable that a very small quantity of cholera matter may suffice to render infectious a very large quantity of liquid, and especially of matters in process of putrefactive fermentation, and that the gaseous or vaporous emanations from them become diffused in the atmosphere and infect all who imbibe them. But water contaminated by cholera discharges is the most rapid and efficient agent in disseminating the disease. ”

“ An objection that has repeatedly been made to the propagation of cholera through the medium of water, is, that 113every one who drinks of the water ought to have the disease at once. This objection arises from mistaking the department of science to which the communication of cholera belongs, and looking on it as a question of chemistry, instead of one of natural history, as it undoubtedly is. It cannot be supposed that a morbid poison, which has the property, under suitable circumstances, of reproducing its kind, should be capable of being diluted indefinitely in water, like a chemical salt ”

“ The modern writers, according to the more popular views, almost universally adopt the hypothesis that the remote or final cause of the Cholera is a specific poison; for at no period has a person in good health in this or any other country been known in a few minutes to be shriveled up, his face and extremities to turn purple, his whole body to become of an icy coldness, and with or without vomiting a peculiar fluid, like rice-water, to die in a few hours, except under the influence of poison. ”

“ First and foremost, Koch has been unable to find anything of this "comma-shaped" bacillus in the blood or tissues in any stage of cholera. Now, all experience on cholera teaches that, whatever its cause may be, the alimentary canal is not the only passage through which the cholera-poison enters the system, but that its entrance through the respiratory organs is also an established fact. For this reason it is necessary to assume that, as in other infectious diseases, it passes through the blood and system in the stage of incubation of the disease. ”

“ The England, and a few days later the Virginia, with crews and passengers all in perfect health, departing from a healthy port where no cases of cholera were known to exist, and after being out at sea six or eight days under the influence of a cool, invigorating atmosphere, were surprised by the sudden irruption of cholera on board. It breaks out among the steerage passengers who are crowded and packed together between decks like sheep for the slaughter, in a confined atmosphere, daily becoming more noisome, without the means of ventilation or disinfection. ”

“ The essential cause of cholera, and of other febrile endemics might be brought into existence, but without indulging in idle visions, it may be predicted that they would be comparatively harmless, in as much as they would be deprived of the concurrent, fostering agencies, from which they derive their prevalence, and chief instruments of destruction. And not only would cholera and other endemic diseases, whether prevailing epedemically, or occurring rarely, be checked and mitigated, but other forms of disease would be lessened, while constitutional health would be invigorated. ”

“ With Asiatic cholera, just as with typhoid fever, domestic animals are not susceptible to the disease, all cases of infection having a direct human origin. Drinking-water is the usual vehicle of cholera infection, and even in countries where the disease is endemic, food-borne outbreaks of this disease are far less common than those of typhoid fever. Occasional instances of Asiatic cholera due to milk supply and to contaminated fruits or lettuce are on record, but these are exceptional and cannot be regarded as exemplifying a common mode of spread of this disease. ”

“ Stronger and better evidence of the utility of a [p.188] prompt and diffusive stimulant, permanent in its character and influence, cannot be furnished; one that will act kindly, without violence and without any disturbance to any organ or tissue, to injure or delay the return of immediate and perfect health after the disease is subdued. Such we affirm to be the principle demanded in the successful treatment of the epidemic cholera. ”

“ But it would be a mistake to regard cholera as purely a water-borne disease, even locally. It may infect the soil in localities which have a perfectly pure water-supply, but have defective drainage or no drainage at all, and then it will be found more difficult to get rid of, though less formidable in its effects, than when the water alone is the source of mischief. In all these respects it has a great affinity to enteric fever. With regard to locality, no situation can be said to be free from attack if the disease is introduced and the sanitary conditions are bad ”

“ This is not unfrequently the case on board some of our emigrant ships, when hundreds of human [p.36] beings are stowed away between decks without the means of efficient ventilation, disinfection, or other mode of expelling the noxious principle. Though the germ of disease may be ever on board, it does not vegetate and come forth and rapidly acquire its activity, vigor and power, unless the localizing influence vivify, foster and nurture its development. This is fully confirmed by the recent arrival of two steamers with cholera on board. ”

“ Research has shown the importance of the cholera “carrier,” that is to say the person, usually a native, who harbours in his bowel the specific organism of the disease. He may be perfectly healthy and yet be able to transmit cholera to other people by infecting water or food. The rôle of flies, infected clothes and rags, and faulty conservancy methods must be kept in mind.
Symptoms.—Giddiness, faintness, persistent vomiting and diarrhœa, great prostration, feeble pulse, cold perspiration, colic, intense thirst, and constant desire to pass urine. ”

“ They not only afford a considerable degree of protection but lessen the risk of a fatal issue in the inoculated. Hence it is advisable to be vaccinated against cholera whenever there is risk of infection. The inoculation must be repeated after the lapse of four months if the epidemic still persists, as the protection afforded is only temporary. Persons travelling in regions where cholera is present in an endemic form should take a little lactic acid in tea, or add a little vinegar or thirty drops of dilute hydrochloric acid to every ounce of drinking water. ”

“ Nor can we shut our eyes to the probability, growing stronger every year, that the true meaning of the term "endemic area," in regard to cholera, is a district in which the customs of the people sanction the drinking of fecally polluted water, and in which from temperature, and perhaps from other causes incompletely known, the cholera germ or contagium can easily keep alive and propagate itself in soil or water in the interval between its exit from one host and its entry into another. ”

“ Those who see irresistible motives for dismissing all idea of contagion, look, on the contrary, for the production of cholera, to sources, admitted from remote times to have a powerful influence on our systems, though invisible—though not to be detected by the ingenuity of man, and though proved to exist only by their effects.
Many who do not believe that cholera can be propagated by contagion under ordinary circumstances, have still a strong impression that by crowding patients together, as in hospitals or in a ship, the disease may acquire contagious properties. ”

“ Can any sane man [p.37] say the disease—the cholera—was not here, on board these ships, generated and produced?
This is also confirmed by the occurrence of an isolated case on Ninety-third Street, near Third Avenue, the first case in this city this season. Though the cholera exists at Quarantine, the patient had not been in any way exposed to the disease, except to the exhalations from the overflowing and drainage of a privy and the foul atmosphere arising from the cellar of her own tenement. ”

“ Besides the facts above mentioned, which prove that cholera is communicated from person to person, there are others which show, first, that being present in the same room with a patient, and attending on him, do not necessarily expose a person to the morbid poison; and, secondly, that it is not always requisite that a person should be very near a cholera patient in order to take the disease, as the morbid matter producing it may be transmitted to a distance. ”

“ If it be true, as it is believed to be, that they are affected by cholera in a degree scarcely, if at all, exceeding that of persons in the same social condition otherwise employed, the fact would appear to furnish a strong general argument against the contagious nature of the disease. ”

“ It has often been observed there is no disease on which so many different modes of practice have prevailed, some purely experimental, others empirical—and all without discovering an antidote to the poison, or any efficient mode of relief. The cause, or the poison producing the disease, still remains undiscovered. The direct mode of suspending and removing it, or counteracting its power and neutralizing its effect, and subsequently eliminating it from the system, remains still in doubt. What course, then, should the epidemic cholera again prevail in our midst, shall we pursue? ”

“ There is no danger from aerial conveyance of infectious material other than the possibility of one’s coming within the danger zone of a vomiting patient. Therefore, for disinfection of a room occupied by a cholera patient we need not use formaldehyde gas but washing of floors and lower part of walls with 21⁄2% compound cresol solution is sufficient. The stock solution of chlorinated lime, 1 pound to 4 gallons, is suitable for mopping floors and walls.
Vaccination prophylaxis against cholera has been less used than has been the case with plague or typhoid fever. ”

“ Care must be taken by the authorities and by the community to take measures for the treatment of the sick. But the difficult point in the prevention of cholera is the predisposition in time and place. It is no use urging, as the contagionists do, that we can not change the nature of the soil. One of the established facts concerning epidemics of cholera is the tendency of the disease to rage in those quarters where the greatest filth prevails. All towns which have been provided with good drainage and water-supply have lost their susceptibility to cholera. ”