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. The importance of the cholera carrier has been thoroughly demonstrated from the time of the Hamburg epidemic of 1892. The clinical course of the disease is divided into a stage of evacuation, in which we have diarrhoeal discharges of rice-water character along with very painful cramps of the muscles. Following increasing cyanosis we have almost a cessation of circulation often associated with anuria, the algid stage. With the return of activity of circulation and urinary secretion we have the stage of reaction.
Synonyms.—Cholera Asiatica.
History and Geographical Distribution
History.—Although the word χολέρα, meaning flow of bile, is found in the writings of Hippocrates, it certainly does not refer to the disease we now recognize as cholera. The older writers noted the characteristics of bilious discharges in the disease they termed cholera, which could not apply to the bile-free rice-water discharges of what we now term cholera. Koch rather doubted the antiquity of cholera but Susruta, in India, in the 7th century A. D., described a disease in which there were diarrhoea and vomiting, stabbing pains, cyanosed lips and nails, with sinking in of the eyes and weak voice.
Detailed accounts of the presence of cholera in India were published from the 16th to 18th centuries when the Portuguese, English and French were carrying on their wars of conquest in India. These wars naturally spread the disease all over India.
It is thought that true cholera did not exist in China until 1669 when it was carried there from India. It is first described from Japan in 1821 although an epidemic which devastated Tokyo in 1718 may have been cholera.
A great pandemic of cholera started in India, in 1817, extending over Asia but not invading Europe. The second great pandemic is of importance as being the first to invade Europe. It started in India in 1826 and advancing slowly reached Persia in 1829, going thence by way of Astrakhan to Russia, Sweden, Northern Europe and England. By 1832 it had spread over the whole of Europe.
In the same year, 1832, it reached Canada and thence spread to Fort Dearborn where it infected the soldiers who subsequently carried the disease down the Mississippi valley. It was also introduced into New York and spread thence South and West so that by 1836 cholera was present all over the U. S., not disappearing until 1838. It disappeared from Europe in 1839.
The next European outbreak or third pandemic lasted from 1846 to 1862 and was traced to India by way of land and sea, that by land following the caravan route by way of Persia and Russia and that by sea from Indian pilgrims going to Mecca and there causing the infection of Mahommedan pilgrims from Egypt and European Turkey. This pandemic reached the U. S. in 1848, starting at New Orleans and going up the Mississippi valley. Central and South America and the West Indies were also invaded by the third pandemic.