reference to the due recognition of the hygienic treatment of the

secondary centres, as well as primary centres.?keeping them of the most complete isolation

to

and their attendants in a state that may be compatible with circumstances. It is the fact that my hypothesis demands a more rigid regime which may induce the heads of the medical department and

sanitary authorities

to lend it a favorable countenance, and on it in future hygienic action. Additional arguments will be advanced in the present paper in support of an hypothesis which, I think, may be the means of saving many valuable lives, since experience has taught us that it is the robust young soldier just arrived from his native country who is most frequently the prey. I propose also to conclude with additional hj gienic principles, which a further consideration of the subject seems to elicit and to elucidate. One of the tendencies of medical in view of the bestow

some

attention

philosophy,

presence of intestinal lesion and intestinal symptomatology, has been to refer the origin of a choleraic seizure to the

contagion

virus introduced into the system per orem, and its operation on the mucous membrane of the alimentary tract directly, in much the same manner that the intestinal lesion of typhoid of

a

fever has been very

ON THE ETIOLOGY AND HYGIENE OF CHOLERA.?PART II.

By T. Oughton, Staff

Assistant

Surgeon, Neemucli.

However cliolera may be generated in the first instance exclusive of direct evidence of its importation into any given locality, it may be remembered that the doctrine, inculcated in my former paper 011 this subject, has explained its subsequent dissemination, as resulting from the radiation of a virus or caeozyme from one human centre to another, such radiating centres being either the subjects of the disease (primary centres),

persons in apparent good health

or suffering from diarrhoea slight indisposition (secondary centres). It was further advanced that the disease only manifests itself as such, when the virus happens to be engrafted on a suitable nidus, i.e., a weakly system wherein, it accumulates, in consequence of an incapacity for its due elimination, until it has become a vis morbi. And, lastly, that the virus inoculates the blood through the medium of the air vesicles of the lungs. The etiology of cholera, if not a very interesting subject, is the most important that can gain the attention of medical practitioners in this country especially. Definite ideas respecting the causation of a given disease, lead necessarily to a definite course of hygienic treatment, and these should not only be definite, but as nearly as possible correct in respect of an unrelenting malady which scores with regularity in India its annual tale of thousands of deaths. No hypothesis, with the

or

merely,

or

other

vides not

a

be

blame-worthy which proprobability, more stringent code of hygienic rules ; the existing code found to be sufficiently efficacious in its working : and can

least show of

being

confess that all the processes at present in vogue for the extermination of a choleraic invasion have been but partially successful in our experience. The new etiological theory, summarized in the preceding paragraph, does we

not

are

bound to

reduce the force of any recognized hygienic treatment very it establishes a basis whereby a more rigid of principles economy is enforced in respect

materially, whilst and indispensable

yet been recognized. Proper precautions heretofore, in regard to impure water, fatigue, defective ventilation, and drainage, &c., as tending to produce a bodily state that is equivalent to predisposition or susceptibility to attack, whilst the present hypothesis has more especial which have

not

must be taken,

as

as

properly attributed to drinking-water containing certain organic impurities. A more comprehensive view is now being taken however, touching the symptoms of cholera, and the lowered temperature with algide manifestations, the collapsed lungs with redundant aeration of the blood, the tendency to syncope in the heart and arteries, and the suppressed operation of the glandular physiologies generally,? these are regarded as constituting features of the disease equally with vomiting and purging. The modern pathologist consequently is disposed to regard the prejudicial influence of a peculiar blood cachexy on the sympathetic system of nerves, as the genuine cause of the morbid symptoms, both intestinal and general; whilst the intestinal lesion holds but a secondary rank in importance, and its presence has even been questioned by

several eminent authorities, among whom Dr. Parkes may be mentioned. The tendency of such views gaining the sanction of the profession, will be to transfer the locale of contagion from the alimentary mucous membrane to a vitiated transpiration of

impure exhalations through the vesicular lung-substance and subsequent blood poisoning. If a morbid agency operates prejudicially on the mucous membrane of the intestines, it must be clearly referable, either Certain arguments to impure diet or impure drinking-water. and evidence were offered in my former communication, which seem to disprove the active agency of drinking-water as an exciting cause, excepting perhaps in very exceptional cases, as when the disease springs up in an isolated locality after a protracted period of dormancy. It would seem that neither

arguments nor evidence can be adduced in favor of food operatI am not aware that as a vehicle for its propagation, and been advanced in this direction. Neither any theory has is it clear that any poisonous principle that is contained in

ing

food or water would not suffer disintegration and digestion in the stomach, since direct experiments have shown that no detriment has resulted from drinking rice-water stools. So by an exhaustive analysis, we are driven to the conclusion

that,

that the virus gains admission into the system through the portals of the lungs. A favorite surmise of certain propagandists is, that the epidemic resides in the atmosphere, and some maintain the influence of pandemic waves. Such opinions are clearly at varia still more favorite ance, however, with theory regarding the essential nature of cholera, and which has received very general acceptation, viz., that this disease, like the exanthemata, is due to a fermentative process resulting from the contact of a vitiated ferment with certain ingredients in the blood. It is evident that one of these hypothesis must fall to the or

otherwise there is

no

reason

wherefore every

one

ground, should

THE INDIAN MEDICAL GAZETTE.

150 not inhale the active aerial virus and mentation.

I have

already

contract the lethal fer-

Table I.

maintained that the

atmosphere, as a whole, is far too diluted with poisonous emanations, excepting in the immediate presence and close vicinity of centres, to be effective in generating the necessary blood cachexia.

showing

in several

[June 2,

1873.

the daily consecutive Admissions with Cholera Epidemics (from Army Medical Reports).

.Epidemic.

"We may now divert our attention to the arguments in favor of the views under present discussion, and I propose to ari-ange

?5.2

them under five

headings, as follows : 1 st.?It is well known that superstitious devotees and pilgrims travel great distances to concentrate at one or other of their

holy shrines; and further, contracting the disease somehow during their pedestrian marches through swamps and along dusty roads, they communicate the same to the different communities that may be unfortunately situated in the line of their route. Now, since a stricken pilgrim would certainly be unable to continue his journey, and would possibly be found dead on the

subsequently, it seems fair to assume that the infectious principle is extended to such communities through the medium of secondary centres or pilgrims in whom the incuroad-side

bative stage is in active although latent operation. II. One of the most striking incidents in the natural history

Neeinuck,

Malta,

1865.

1865

...

Ship "Renown,"

1

24 May 7 Sept. 14 Sept. 13 Oct. 20 J une 3 J lily*

! 4

"

i

10 Sept. 19 April 3 May 21 May Peshawur, Subathoo, 1867 28 J uly 2 Sept. Meerut, 1867 2 Sept. Malta, 1867 16 Dee. Belize, 1867 1869 ?9 'lkayetmyo, Alay 30 .Inly Neemucli, 1872 27 June

lS65t

Umballa,

1867...

'l867

...

...

...

cholera, notwithstanding that it seems to have been strangely overlooked, is the remarkable similarity in the numerical sequence of cases from day to day, and this whether the number

this table in which information

of seizures be less or greater. Table I. represents statement of the daily admissions which have been

been specifically afforded, so that the cases have not been selected to subserve the purpose of any particular theory. Table II.

of

Table II.

showing

the

Commencing 8th

daily

consecutive Deaths

recorded

a

extracted

from

Cholera

from the blue-books of the year 18G2 to 18G9. Every

during

the

Epidemic

at

Army Medical Department from the epidemic lias been introduced into

Constantinople,

Of course the tabulated facts in shown in the second column. relation to these deaths would be somewhat vitiated by the accidental circumstance that the ratio of deaths to admissions not have a constant value under different conditions of different treatment; but the error arising from such difference would probably be trifling, although it is to be regretted that the

might

number of actual admissions was not

published

in

place

of

the number of deaths.

It would be well if other epidemics could be quoted in which this pecularity is manifest, but the above tables, the several items of which have been utilized at random as they came to hand, seem to warrant the following important conclusions:

(not being sporadic but introduced) having community, there will be a second case on the next day, another case on the third day, none perhaps on the fourth, two cases on the fifth day, one on the sixth, and so on. 2nd. When a clear interval of three or four days lias elapsed without the further occurrence of any admissions, that there is a

case

a

a

the lancet).

30-1 11

indicates the same fact even where the initial number is so as 24, and the relation of the daily deaths to unity is

That

(from

53

high

ls

On the Etiology and Hygiene of Cholera. Part II.

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