Asiatic Cholera: A treatise on its origin, pathology, treatment, and cure

by Elijah Whitney; A. B. Whitney

A large body of evidence, however, has been exhibited, going to show that human intercourse has, at least, a share in the propagation of the disease, and that it, under some circumstances, is the most important, if not the sole means of effecting its diffusion. On the other hand, it is affirmed that though it may be communicated, in some cases, by the agency of human intercourse, it does not follow that the material cause spreads by true contagion, that is, by reproducing itself in the bodies of men, and there only.

The disease may be carried by healthy persons in their clothing, in their ships, and in their caravans. That instances of this kind have occurred there can be no question, for numerous records present some undoubted instances of the occasional communication of the cholera-poison through human intercourse; still it is no less certain that its general extension over the world cannot be accounted for on this principle alone. "Its propagation by this means seems to be the rare exception, its spread over the earth from other causes being the common rule."

Dr. Hamlin, writing from Constantinople, in reference to the recent irruption and prevalence of the cholera in that city, observes, "The idea of contagion should be abandoned. All the missionaries who have been most with the most malignant cases, day after day, are fully convinced of the non-contagiousness of the cholera. The incipient attacks which all have suffered from are to be attributed to great fatigue, making the constitution liable to an attack."

It is a very singular fact, that the medical profession in India, the birthplace and home of the cholera, almost universally reject the doctrine of contagion. If those most observant and familiar with its history, its prevalence, and its annual recurrence as an endemic disease, which they are called to treat in all its varied phases, have discovered no contagious character by which it can be propagated, it may be safely inferred that it is not contagious in the common acceptation of the term, and that its extension over the earth is governed by some other principle, and that the predisposing and localized causes which are always in operation in India exercise no small share in its diffusion, in directing its course, aggravating its severity, increasing or diminishing its fatality, and determining the duration of its prevalence in particular localities. When its infecting germs have gained a lodgment in any city, section, or country, they may be stimulated and become exceedingly active in the production of the disease through these influences.

As to its introduction into different countries, it is quite evident that the germ, or latent principle of the cholera-poison, exists in such a state as to be capable of transportation, and may in this way be diffused to almost any extent when the localizing influences are sufficient to develop its energies.

In this, as in all other zymotic diseases, some persons are more susceptible of an impression and more liable to an attack than others. Though no class can be considered exempt, yet there are some whose organization, or innate protective principle, seems to render them impervious to its influence. The cholera, however, is no respecter of persons, or rank, or condition. The anæmic and cowardly in all ranks and conditions are peculiarly liable, and are the most defenceless and unresisting when invaded. In Europe, the probable numbers attacked in that part of the world appear from statistics to be, in France, as 1 in 300; Russia, as 1 in 20; Austria, as 1 in 30; Poland, as 1 in 32; Holland, as 1 in 144; Germany, as 1 in 700. "The circumstance of one attack by no means protected the individual from a second in the same, or any subsequent year; still a repetition of the disease in the same person in the same year was rare."

CHAPTER II.

Section I.—Pathology.

The doctrine now universally accepted and prevailing regarding its Pathology is, that a poison, virulent, subtle, and unknown, has been absorbed, and primarily infects the blood, so that, after a longer or a shorter time, a primary disease of this vital fluid is produced, and that the poison undergoes an enormous process of multiplication in the living body of the cholera patient, as the direct result of this morbific process so established, and that changes are induced in the function of respiration directly consequent on this alteration of the blood.

This altered condition and rapid change in the life-sustaining principle of the blood, the loss of nerve-power, the impaired circulation and tendency to congestion, are the proper and distinguishing features of the disease; and the term "Algide," first used by the French Pathologists, very happily describes one of the most remarkable and constant symptoms, namely, the diminution of animal heat. The loss of temperature and its consequent effects upon the circulation, depressing and prostrating the nervous power, impairing and paralyzing the respiratory organs, suspending the functions of the liver and kidneys, enfeebling the action of the heart, and causing the capillary vessels of the mucous tissues to expand and pour off the serous fluid from the blood and every muscle and tissue of the system, with great rapidity, essentially constitute the phenomena of the Cholera. The constantly increasing augmentation of the poison and its intensified effects measure the malignity, the violence, and the rapidity of the disease.