OBSERVATIONS ON THE NATURE OF CHOLERA POISON. By G. C. Roy, M.D., F.R.C.S., London, Corresponding Member of the Olasgow Medico-Chirurgical Society.

The more wo trace an outbreak of cholera to its source, tlio clearer will stand the fact that, like specific poisons, it is a disease sui generis, that is capable of developing only its own kind. It pre-supposes for its existence the presence of a specific germ ; but how the ultimate particle was brought into activity is a mystery of medical science, which it is beyond our present power to solve. We aro as much in the dark as to the first appearance of small-pox and scarlatina as of cholera, but the fact cannot but bo gainsayed that they both dovelope only through contagion. To say that stnall-pox is the result of a dry or humid condition of atmosphere, betrays our ignorance of the etiology of disease. It is similarly absurd to maintain that cholera can bo produced through bad food doubt or through any external condition of the air. No

Mat 1,

1873.]

OBSERVATIONS ON THE CHOLERA POISON.?BY G. C. ROY.

atmospheric changes may bring into activity the potency poison, but the first presence of the germ of disease is an indispensable item. We know for certain that some diseases prevail in certain latitudes, which, although they have been imported into regions beyond their habitat, then cease to spread, or lose their virulence. Thus, yellow fever of the torrid zone has never found a footing in cold latitudes, nor have the symptoms of scarlatina been developed with equal It is, therefore, fair manifestations in hot as in cold climates. to suppose that some condition of the atmosphere, as temperature, electricity, &e., brings into light the poisonous agency of specific diseases, or feeds them, as it were, with principles withIt used to be out which they lie dormant. believed?probably from the first origin of cholera in tropical India?that it is a disease only of a tropical climate, and the belief gained countenance from the fact that in India it acquires special activity in the hot weather, when it rages as an epidemic, whilst in winter sporadic cases only are noticed. Now the prevalence of the disease in Russia midst snow and frost has negatived the assumption that fixed hot climates are its special habitat. In India it sometimes rages with as much frequency in cold as in hot weather; and in the instances now under observation, it will be seen that the places possessed immunity simply because the first germ of disease was wanting. When once that is supplied, it spreads like wild fire, and proves as destructive in the neighbourhood. How then is the fact of the greater prevalence certain

of the

of cholera in hot weather to be accounted for ?

ther, travellers

are

not

In hot

wea-

to the water with which Most of the shallow tanks on

particular

as

they slake their ardent thirst. wayside are polluted -with cholera discharges, either directly passed in to them or through filtration, and it is no wonder that drinking the same will render one a victim to it under such circumstances. The pilgrims generally carry the disease from one locality to another, but the agency of wind in wafting it across the land is a fanciful theory not borne out by actual facts, for more often it has been observed to spread contrary to the direction of the prevailing wind than along with it. These mere casual coincidences, which have no real bearing on are the propagation of cholera. The drinking of water from a previously-contaminated source is its only exciting cause. Food or milk, in like manner, might be rendered impure by adulteration, or the plates on winch the meal is taken might have been washed in impure water. It is not enough, therefore, to ensure that the drinking water is free from all corruption, the

b"t there

other collateral

circumstances must be attended to.

Yet

that baffle all

research, and the only history obtainable is, that either the patient took his meals at a place where cholera was lately raging, or drank water indiscriminately. I firmly believe and maintain that cholera is contagious, and that the contagion spreads not by pulmonary inhalation or personal contact, but by ingestion into the stomach. One can live and breathe in an atmosphere of cholera, and yet enjoy freedom from attack, if he takes precautions to keep his stomach free from are

cases

any unhallowed mixture. The evidence of Dr. Goodeve bears conclusively on the point, that in the Medical College Hospital of Calcutta, although the wards get crowded with cholera patients in the cholera season, it has never been contracted by

students who watch the cases, by the nurses, or by the sweepers who remove the vomit and the stool. Dr. Macpherson instances vost-mortem examination of cholera cases in which the hands

literally soaked in cholera discharge, and yet no ill consequence resulted. When in the face of such authorities I assert that cholera is contagious, I exclude from were

undoubtedly channels?the lungs

or the skin?which popular the usual channels of communication of all contagious diseases. There is one way by which it may prove contagious through our respiratory organs. The atomic particles in a close room float in the air surcharged with poison, and

estimation those

belief ascribes

as

121

may bo inhaled through the mouth and swallowed with the saliva. Thus, ultimately, the stomach becomes the channel o f absorption. From what has been said above, the following precautions should be observed in cholera districts for prevent-

the propagation of the disease. Too much attention cannot be paid to ensure the purity of drinking water. In cholera localities, since it is impossible to keep a constant surveillance, every -water should be thoroughly boiled before use. How far the inference is a correct one, I would not venture to dogmatize, but it seems plausible from inductive reasoning, that like other organic poisons the boiling temperature destroys the virulence of cholera morbus. If no sort of food-supply should be received from a cholera

ing

possible, quarter,

such

as

milk, sweets, &c. ; and if obtained, the precau-

boiling should always be resorted to. Cholera patients should be separated ; the vomit and stool immediately disintion of

fected, and not buried but burnt. The soiled clothes and bedding should be destroyed, as it is not practicable in all instances to pass them through a thorough process of disinfection. Above all, it is necessary, for the safety of the attendants, to allow free ventilation in the room where cholera patients are received, so that the air of the room may be changed constantand the organic particles not allowed to accumulate. In close room, saliva should be swallowed as little as possible, and the mouth should be well rinsed after leaving it. If these suggestions are carefully observed, I have no hesitation in

ly,

a

maintaining that atmosphere, would a

one,

And if along quarantine regulations

minimum.

enforce

to live and

having

move

in

a

cholera

the disease to with these it were possible to in India, we would soon be in a

reduce his chance of

catching

position to stamp out cholera from our list of social scourges. The places where cholera raged in my district in winter are numerous, and the mortality was everywhere heavy. Everywas limited to a few contiguous houses, whilst the rest of the village was entirely free. Some houses numbered their victim by twos, and, in some instances, the disease ceased with the annihilation of the family. Everywhere, and without any exception, the disease, unknown to the neighbourhood for many

where it

years,

was

first

imported by

an

unfortunate traveller

through

cholera-stricken locality, who brings with him the first germ and propagates it amongst, his neighbours. The habits of the

a

people are everywhere the same. Stools are passed on the mud-floor, and allowed to soak through. The only purification afterwards gone through is plastering the floor with cowdung. The soiled clothes are washed in a neighbouring tank which is always shallow and stagnant. This water is not used for drinking purposes, but, is used by the neighbourhood for washing clothes, the floor of the rooms, and the brass plates, off which they take their meals. The dirty, imperfectly-washed clothes are again made use of for ordinary wear. Such being the habit of the villagers, we can well understand how and why

the disease is so limited, and commits such dreadful havoc in In Calcutta, where the people the house where it once enters. are in a great measure free from such causes, only individual

are noticed in the family. The first outbreak of cholera was noticed at Buthungunge, where no such disease was in existence for eight years. It was in December, in the middle of winter, when the weather was

cases

pretty cold.

rliic first case

was

in

the person of

a

traveller

Calcutta, who caught the disease on the way. He reached home in a state of collapse, and died after two davs' lingering illness Several cases broke out immediately afterwards in the same house and three or four contiguous houses, from

within the extent of a biggah of land, all of whom were using the foul water for domestic consumption, in which the soiled colthes were washed.

Whilst cholera had nearly ceased at

people

from

Kissengunge,

a

village

Buthungunge,

about

a

some

mile and half dig-

THE INDIAN MEDICAL GAZETTE.

222

came to an invitation to one of their relative's, whose house situated in the midst, of the previous cholera centre. They dined for three days. On their return home on the fourth day,

tant, was

one ca?e

Several broke out amongst, them, which proved fatal. in their immediate neighbourhood. afterwards place

deaths took

The village The third observation I made was at Oochalun. was altogether free from cholera for some time, but the first case

supplied from amongst my own bearers. They had to through so many places where cholera existed, that it is impossible to ascertain where the disease was contracted. He died in a room in the midst of the chuttey, and I issued was

travel

immediate order that the room on no account be let until thoroughly cleaned and the floor scraped. A woman engaged

in

cleansing

more

than

From the

tlie first to carry the disease to her own house, distant, whilst the neighbourhood escaped. habits of that class of people 1 have no doubt

was

mile

a

dirty

that either she carried it in her

own

clothes,

or

she must have

of the soiled clothes of the deceased, which left unburnt. Though she did not confess

appropriated wrre injudiciously the act, she paid the penalty in the death of two of her children, and several others in her neighbourhood fell victims to cholera. Akloki being on the bank of the Dalkessur, a running stream that supplies pure water to the district, the first, case that oceured there was reported by the Sub-Assistant Surgeon as sporadic. some

Determined

to

get

at.

the truth I went in person, and

on

en-

quiry brought to light the fact that one of the villagers returned from Kytee in a dooley with cholera and died. All the cases date subsequent to that period, and only in a few adjoining houses, all of which were Mahomedan. Amongst Mahomedans I have seen it cling tenaciously till a great many in one No doubt it is the result of the unclean house are destroyed. ?

habits of the poor class of Mahometans. At

Digulgram the disease

was

imported from Xoire, and one family.

ceased with the entire annihilation of

At Kamarpookur the first victim of cholera returned from Goghaut, where cholera was raging, after which several cases occurred in their family with nearly wholesale mortality. Similar histories were obtained at Hajeepore, Inthas, Aknee, Milkee, Joshporo, &c., which are so exactly alike those previously mentioned, that, it would be mere repetition of facts if the details were entered into. All these villages are situated wide apart from each other?north, south, and west?without any apparent connection with the direction of wind. The succession in

infected also negatives altorelationship. All were infected bv independent centres and by individual communication ; but not through the agency of wind. Everywhere it committed cruel havoc in only a certain number of houses, whilst the rest were entirely healthy. The drinking water in a village is drawn generally from a pond on its extreme boundary. This is comparatively pure, and is used indiscriminately by all classes, whilst water for other domestic consumption is drawn from neighbou ring tanks. These tanks are numerous, each supplying a group of houses in its immediate vicinity, and sometimes one is used exclusivelv bv one family. Here the zenanas bathe them selves, the brass plates are washed, and the soiled clothes purified. Thus, if one house suffers, the neighbours sympathize also, and people wonder to learn why, the drinking source of the whole village being in most instances identical, the disease should be partial in its attack? Thus the correctness of the water th eory is brought to question, whilst the solution of the problem lies at the verv door. The improvement of the health of Calcutta, and the reduction of the rate of mortality from cholera since the new water-supplv, speaks conclusively in its favor. I am bold enough to say that the majority of those cases in whom cholera appears, notwithstanding the use of pipe water in Calcutta, are not exceptions ; but if their history be thoroughly investigated, they will prove that the sufferers

gether

any

which they supposition of

were

their

[Mat

1, 1873.

or other expose themselves to the contagion. way with which the inquiries used to be made by the clinical clerks in the Medical College Hospital is anything but satisfactory. A patient, is asked as to which water

did in

The

some

way

haphazard

lie is in the habit of

drinking, and the case is immediately put negativing the supposition of water contamination if lie gives his assurance that, he drank the pipe water. Now, in such instances, who would guarantee that he was free from all the possible sources of contagion that I have previously enumerated ? Did he.take anything fluid or solid that might have been possibly infected? All these investigations are impracticable to be carried out in a large town, but. can be traced with the utmost pre. cision in a village where every chance or probability is limited down

as

within

a small compass. To repeat then, cholera, like

diseases,

owns

a

specific poison,

generated in the air and

small-pox

and other

specific spontaneously by the wind, but

which is never

wafted

across

spreads through the medium of pilgrims and travellers who are infected by drinking water previously contaminated with cholera discharges. They are affected en route to their destination, and thus scatter widely the genus of disease, 'l'lie poison might get into the system through various ways, but it is the stomach that is the ultimate absorbing organ. Some seasons of the year might give it particular activity, but it is always potent of evil. The poison has a tendency to wear itself out as is shown in the greater number of cures amongst the last few cases in an epidemic than in those occurring at its very commencement. Hypercatharsis might simulate thejsymptoms of cholera, and even-end fatally with collapse, yet these are not geuuine cases, and I presume are not contagious. Buudwan, Voth March, 1873.

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