Cholera

“ To those who have attended to the subject of cholera, nothing can be more absurd than to hear people say such or such a case cannot be the true cholera, or the Indian cholera, or the Russian cholera, because all the symptoms ever mentioned are not present: as if, in the epidemic cholera of India and other places, even some of the symptoms considered the most prominent (as spasms, and the disturbance of the stomach and bowels) were not often absent, and that too in some of the most rapidly, fatal cases! ”

“ 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. ”

“ British people would not desert their friends or relatives in illness, though they should incur danger by attending to them; but the truth is, that to look on cholera as a “catching” disease, which one may avoid by a few simple precautions, is a much less discouraging doctrine than that which supposes it to depend on some mysterious state of the atmosphere in which we are all of us immersed and obliged to breathe. ”

“ My grandfather was of opinion that in every instance an attack of cholera is preceded by a period of a few days (sometimes only of a few hours) of premonitory symptoms, which, since they are painless, escape notice; and that, unless a specially appointed medical visitor goes round to the houses of the less educated to inquire, and almost to cross-question, as to the existence of these symptoms, and to treat the disease at once, this stage rapidly passes on into developed cholera, when recovery becomes all but hopeless. ”

“ The poor little creature was on a bed, with her clothes on, supported on her weeping father’s arm—her countenance collapsed, and her hands characterized by all the signs of the second stage of cholera,—no indication of pulse—scarcely a sign of life—from all appearances, the disease had secured its prey. ”

“ 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. ”

“ Baker, of Staines, who attended two hundred and sixty cases of cholera and diarrhœa in 1849, chiefly among the poor, informed me, in a letter with which he favoured me in December of that year, that “when the patients passed their stools involuntarily the disease evidently spread.” It is amongst the poor, where a whole family live, sleep, cook, eat, and wash in a single room, that cholera has been found to spread when once introduced, and still more in those places termed common lodging-houses, in which several families were crowded into a single room. ”

“ The only effect of its communication in the pits would be, that the men and boys in a family would have the cholera a day or two earlier than the women and children; and if a special inquiry were made on this point, this would probably be found to be the case. It has often been said that, if cholera were a communicable disease, women ought to suffer in much greater numbers than the men, as they are employed in nursing the sick. ”

“ The cholera has prevailed to a considerable extent in the crowded habitations of the poor in Liverpool and some other towns, where the general supply of water was not in fault, but I know of no instance in which it has spread through all classes of the community, except where the general supply of water has been contaminated with the contents of the drains and sewers; and all the towns with which I am acquainted that have enjoyed an almost complete immunity from this disease, have a water supply quite free from any chance of contamination. ”

“ There are certain circumstances, however, connected with the progress of cholera, which may be stated in a general way. It travels along the great tracks of human intercourse, never going faster than people travel, and generally much more slowly. In extending to a fresh island or continent, it always appears first at a sea-port. It never attacks the crews of ships going from a country free from cholera, to one where the disease is prevailing, till they have entered a port, or had intercourse with the shore. ”

“ 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. ”

“ 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 ”

“ 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 ”

“ When the attack of cholera is of milder character in all its stages than that above described, it has been named Cholerine, but the term is an arbitrary one and the disease is essentially cholera.
The bodies of persons dying of cholera are found to remain long warm, and the temperature may even rise after death. Peculiar muscular contractions have been observed to take place after death, so that the position of the limbs may become altered. The soft textures of the body are found to be dry and hard, and the muscles of a dark brown appearance. ”

“ 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. ”

“ In epidemic cholera good signs are the arrest of vomiting and of rice-water discharges from the bowels, rapid movement of the blood in the veins after removal of momentary pressure, return of natural color and warmth to the skin, with filling up of the pulse at the wrist. Bad signs in cholera are shrinking of the cheeks and of the flesh upon the hands, deepening ashiness or blueness of the skin, coldness and clamminess to the touch, dyspnoea, loss of pulse, incessant vomiting and purging of rice-water stools, constant cramps of the limbs, and suppression of urine. ”

“ It was amongst the vagrant class, who lived in this crowded state, that cholera was most fatal in 1832; but the Act of Parliament for the regulation of common lodging-houses, has caused the disease to be much less fatal amongst these people in the late epidemics. When, on the other hand, cholera is introduced into the better kind of houses, as it often is, by means that will be afterwards pointed out, it hardly ever spreads from one member of the family to another. ”

“ The persons who suffered less from cholera than any other part of the male population, are footmen and men-servants; and it is impossible to conceive a class less exposed to the disease. They live in the best parts of London, and go from home much less than their masters. The low rate of mortality amongst medical men and undertakers is worthy of notice. If cholera were propagated by effluvia given off from the patient, or the dead body, as used to be the opinion of those who believed in its communicability ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Aretæus defines cholera to be a retrograde movement of the matters in the body upon the stomach and intestines, consisting of a discharge upwards and downwards of bile, which, if the disease proves fatal, becomes black; and, at the same time, the extremities are cold, with profuse sweats, pulse small and dense, constant straining to vomit, and tenesmus. He also makes mention, among the symptoms, of spasms and contractions of the muscles in the legs and arms, borborygmi, tormina, and syncope. ”

“ If the mortality in the workhouse had been equal to that in the streets immediately surrounding it on three sides, upwards of one hundred persons would have died.
There is a Brewery in Broad Street, near to the pump, and on perceiving that no brewer’s men were registered as having died of cholera, I called on Mr. Huggins, the proprietor. He informed me that there were above seventy workmen employed in the brewery, and that none of them had suffered from cholera,—at least in a severe form,—only two having been indisposed, and that not seriously, at the time the disease prevailed. ”

“ The consequence of this prudential arrangement has been, that hundreds, if not thousands of cases of the incipient disease, have been checked in the bud, which, had it been allowed to go on, would have ended in all the dreadful symptoms of genuine cholera. Would persons only be persuaded to attend to their bowels the instant they are affected with purging, so as to get this checked, the result would be, that there would not be a single death from cholera. ”

“ THE CHOLERA NEAR GOLDEN SQUARE. The most terrible outbreak of cholera which ever occurred in this kingdom, is probably that which took place in Broad Street, Golden Square, and the adjoining streets, a few weeks ago. Within two hundred and fifty yards of the spot where Cambridge Street joins Broad Street, there were upwards of five hundred fatal attacks of cholera in ten days. The mortality in this limited area probably equals any that was ever caused in this country, even by the plague; and it was much more sudden, as the greater number of cases terminated in a few hours. ”

“ 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. ”

“ I feel confident, however, that by attending to the above-mentioned precautions, which I consider to be based on a correct knowledge of the cause of cholera, this disease may be rendered extremely rare, if indeed it may not be altogether banished from civilized countries. And the diminution of mortality ought not to stop with cholera. The deaths registered under the name of typhus consist chiefly of the typhoid fever mentioned above. ”