contact with
but it does not
clothes,
germinate
or
these circumstances.
develop
under
Do you consider that the atmosphere would operate as a nidus for its generation ? I do not think, neither has it been proved by experiment, that the presence of the three elements
decomposition, yiz., air, water, and increased temperature, either isolated or combined, would tend to the active developWere it air?or water?born or ment of the cholera-molecule. of
bred,
there would be
no
limit to its dissemination. been
germ in the blood, or the determined by microscopical
of any
experiment having
Has the existence of the nature of the
molecule,
research ? I
am not in this direction.
On the
hygiene of
broken out in of
aware
sanitation,
a
town
specific
been made
four cases having time, to what method you be disposed to resort
cholera.?Three or at or about the same
in each
instance,
would
in order to prevent a further spread of the disease ? The laws of the land forbid that the patients should be poisoned outright, and charity forbids that they should be unattended during I should be
disposed to place over each case one tried attendant?a courageous man, in thorough good health, whom I should assure previously that the chances of his contracting the disease were very remote, provided he sickness.
faithful and
ordinary precautions. Suitable medicines should be issued to him, with instructions as to their administration; and he should have the entire medical charge of the cas?. Lastly, both he and the sick man should be confined for several days, took
perfectly
ON THE ETIOLOGY AND HYGIENE OF CHOLERA.
J3y
T. Ouguton,
Staff
Assistant
Surgeon,
Neemuch.
(Continued from 'page 177.) How do you account for the fact that persons in rohust health sometimes seized and carried off? From their breathing air that is densely charged with the virus; for example, inare
spiring the very air that has just escaped from the lungs of a sick man, or remaining in a close and unventilated sick-chamber for long consecutive periods. Thus it is that healthy doctors are so peculiarly liable to be struck down at their post of duty epidemic of 1849 in London, I healthy young medical man, having a very extensive and rising practice in a populous thoroughfare, whose death was probably the result of visiting his poor neighbours who were lying stricken in small unventilated houses, where the air must have been surcharged with poisonous exhalations. How would you suppose the poison to operate in such cases ? Being admitted into the system in inordinate doses, either from long exposure to a less vitiated air or from short exposure to a very concentrated and poisonous atmosphere, it has the property of prostrating the vital powers at once, and of reducing the healthy man to a state of deranged healtli, that is synonymous with susceptibility, in which lie is unable to excrete the virus as rapidly as it becomes generated. Do j'ou believe that cholera is a zymotic disease ? The poison undoubtedly multiplies itself rapidly in the system, although this by
this pest.
remember the
the
During
case
of
a
fine and
cannot arise from fermentation of the blood, or otherwise every dangerous focus would inevitably exemplify the disease in himself. Such multiplication is very analogous to the development of the virus of vaccination molecule probably germinates by
or
small-pox,
and the cholera-
process of cytogenesis. What should you consider to be the nature of a choleragerm ? A morbid molecule consisting of debased animal organic a
matter, which finds its nidus probably only in the circulating fluid.
It may be dormant for a
long
time in the
earth,
or
iu
isolated in the
apartment
in which the case was
placed.
Would you not superintend the treatment of the case personally ? Not under the circumstances in consideration. The operation of every known medical appliance being so wholly
unsatisfactory, I should feel myself justified in absenting myself unless the epidemic had become generally established. What precautions would you enjoin on such attendant for his personal protection ? Most generous ventilation; not to remain in the vicinity of the patient excepting when compelled to do so in order to administer to his wants or to ease his pain; most carefully to avoid inspiring the patient's breath, and to keep his head averted from the sick person as much as possible when rubbing his cramped limbs, &c., to maintain the strictest cleanness of his hands and face, and occasionally to vrash himself all over; lastly, a generous diet?and, if a literary man, an amusing book to employ his mind. What precautions would you enjoin on him in order to prevent the extension of the disease talk to
no
one,
and
permit
110
one
to
others ?
to enter
That he should
the apartment; and
should fetch all food and other necessaries (previously provided him) himself; that all waters made use of for washing purposes should be thoroughly disinfected before being thrown for
away ; that the close stool should constantly be charged with a disinfecting solution, more of this being added whenever the patient vomited, or after every motion ; and that it should be frequently emptied into an adjoining isolated latrine; that the apartment should be thoroughly fumigated, by being exposed for several days to chlorine or sulphurous acid gas, on his leaving it with the patient when the term of their isolation had been
accomplished. In the contingency
of the
patient dying,
what
procedure
would you advise the attendant to adopt ? To undress the corpse and wash it thoroughly, placing it on a table ; to close the apertures of ventilation, and retire from the room after the necessary preparation for a gaseous disinfection; return in the course of three or four hours, and to re-ventilate the room for a like period of time; to admit the undertakers, no communication being held with them at the same time; to disinfect the room once more, and to place himself
making
to
a state of complete isolation for one week. Do you consider that persons would be liable to render themselves dangerous foci by contact with a cholera corpse f The
in
September 2,
TYPHOID FEVER IN DACCA.?BY JAMES "WISE.
1872.]
theory of be against
the emission of the poison by respiration would this view. Further, instances in which such corpses have been utilised for dissecting purposes prove them to be innocuous as agents of contagion. What
precautions
to take on
would you, as of cholera
a
medical man, bo disposed
being brought
under your It would behove me, for the sake of my other patients who might be susceptible, to use the utmost caution,?keeping at a distance from the patient, averting my head on feeling his pulse, obtaining his history from others, if possible, rather first
a
case
notice ?
than from himself, &c. Mention the sanitary precepts that you would enjoin on a community in case an epidemic of this disease was established as an outbreak ? The chief advice would be, not to stint themselves in of
diet, but to spare good, wholesome,
expense in procuring a generous supply and nutritious food,?in fact, to 3pend more
no
on their victuals than they have been in the habit of doing. Animal food being so essentially destitute of the normal amount of fatty principle in the tropics, I should be disposed to recommend the isssuc of cod-liver oil daily, as a possible prophylactic measure during the prevalence of an epidemic in a country like India. Secondly, that the members of the community should near each other during a colloquy, that they retired in their habits, and, in fact, that they should be less social and intimate than is their ordinary custom. This precaution is especially important among the members of a family circle in case the disease exists in the
not
approach
should be
too
more
house, and, under these circumstances, the family dinner-table should be enlarged, together with free ventilation of the dining-
an uncommon occurrence for a panic-stricken throng together in their churches and chapels for an unusual display of religious devotion ; and it may be affirmed that no more pernicious exciting c uise of cholera exists than this practice, since the iirtbiifiLog, or cholera-poison, is extremely likely to be present in a latent form among such assemblages, ready to make its assault on any duly susceptible individual. It is well known that the fumes of tobacco will hang about a closed smoking-room, and the aerial poison of cholera, in like manner, will accumulate by stagnancy in an unventilated church. The third important precaution would be, the avoidance of all unusual or unnecessary fatigue of mind or body, and to observe moderation even in the daily routine of one's ordinary avocations. Thorough ventilation and moderate exercise should be insisted on. Lastly, the most stringent attention room.
It is not
community
to
197
breaks, which seem to admit of an intelligent solution on the hypothesis of the present paper. ?? It would seem that during cholera periods the emigration of persons suffering from diarrhoea has been followed by outbreaks of cholera in places previously uninfected; and Professor Pettenkofer ascribes this fact to an influence [zymotic ?] exerted by the foeces of such diseased persons in the cesspools and adjoining soil of ill-conditioned places to which they go."* I do not know whether the word in crotchets in the abovo extract is original, or has been inserted by Professor Aitken. It is manifest, however, that such persons (on the preceding hypothesis) were foci of the disease. 2nd.?During an epidemic, " the proportion of deaths form3 a gradually decreasing series of five-sixths, three-fourths, onehalf, one-third, till, towards the close, a large proportion of those attacked recover. The uniformity of this law in every country affected with cholera, whether Europe, America, India, or China, is extremely remarkable."! Does not this fact point to a principle of propagation whereby the disease is communicated from person to person in successive generations, so that the poison becomes gradually weakened until ultimately exhausted ? 3rd.?Troops or pilgrims on a march universally suffer more than troops in quarters, or civilians in a town. Professor Aitken has made the following very pointed observation in reference to this fact. " This influence of long marches appears to indicate something more powerful than mere fatigue in bringing about the disease." Here is a large assemblage living in tents, and moving rapidly from place to place; it would be difficult to maintain that the specific poison is introduced into their systems by drinking-water. Is not the disease propagated and rendered more intense by the closer intimacy than ordinary of persons under such circumstances, by the aggregation of dangerous foci during the march, with a tendency to unusually frequent and prolonged tete-a-tete conversations, and, subsequently, by their being crowded together in tents ?
of the local authorities should be directed to every known of sanitation, in order to improve the public health and to remove all pre-disposing influences. measure
If a comparison be drawn between the above hypothesis on the nature of the communication of the cholera cacozyme from man to man and the hypothesis of Dr. Carpenter (previously alluded to) on the nature of the proximate causation of choleraic symptoms, it will be found that there is nothing inconsistent between the two theories. Let us consider, first, the of a healthy man; there must, invariably, be present a
case
certain amount of waste-tissue in the blood, even of the healthiest man. This constitutes the ferment which will render him a dangerous focus, provided he be exposed to the cholerous
contagium
;
nevertheless,
such waste-tissue is too
largely diluted
by the blood for the full expression of the disease to be manifested, and he presents the outward appearance of health or of only slight indisposition. But, in the case of a susceptible person, it is obvious that the fermentation would proceed to an extent only limited by the generation of a true seizure, whether fatal or otherwise. Indeed, the only apparent obstacle to the hypothesis of Dr. Carpenter would seem to present itself in the fact that healthy persons may develop the symptoms of cholera which may even proceed to Allusion may be and
hitherto
a
fatal issue.
made,
inexplicable
in conclusion, to certain remarkable facts in reference to choleraic out-
*
"The Science and
f Idem, page 655.
Practice of Medicine" (1863), by Dr. W. Aitken, p. 217.
but it does not
clothes,
germinate
or
these circumstances.
develop
under
Do you consider that the atmosphere would operate as a nidus for its generation ? I do not think, neither has it been proved by experiment, that the presence of the three elements
decomposition, yiz., air, water, and increased temperature, either isolated or combined, would tend to the active developWere it air?or water?born or ment of the cholera-molecule. of
bred,
there would be
no
limit to its dissemination. been
germ in the blood, or the determined by microscopical
of any
experiment having
Has the existence of the nature of the
molecule,
research ? I
am not in this direction.
On the
hygiene of
broken out in of
aware
sanitation,
a
town
specific
been made
four cases having time, to what method you be disposed to resort
cholera.?Three or at or about the same
in each
instance,
would
in order to prevent a further spread of the disease ? The laws of the land forbid that the patients should be poisoned outright, and charity forbids that they should be unattended during I should be
disposed to place over each case one tried attendant?a courageous man, in thorough good health, whom I should assure previously that the chances of his contracting the disease were very remote, provided he sickness.
faithful and
ordinary precautions. Suitable medicines should be issued to him, with instructions as to their administration; and he should have the entire medical charge of the cas?. Lastly, both he and the sick man should be confined for several days, took
perfectly
ON THE ETIOLOGY AND HYGIENE OF CHOLERA.
J3y
T. Ouguton,
Staff
Assistant
Surgeon,
Neemuch.
(Continued from 'page 177.) How do you account for the fact that persons in rohust health sometimes seized and carried off? From their breathing air that is densely charged with the virus; for example, inare
spiring the very air that has just escaped from the lungs of a sick man, or remaining in a close and unventilated sick-chamber for long consecutive periods. Thus it is that healthy doctors are so peculiarly liable to be struck down at their post of duty epidemic of 1849 in London, I healthy young medical man, having a very extensive and rising practice in a populous thoroughfare, whose death was probably the result of visiting his poor neighbours who were lying stricken in small unventilated houses, where the air must have been surcharged with poisonous exhalations. How would you suppose the poison to operate in such cases ? Being admitted into the system in inordinate doses, either from long exposure to a less vitiated air or from short exposure to a very concentrated and poisonous atmosphere, it has the property of prostrating the vital powers at once, and of reducing the healthy man to a state of deranged healtli, that is synonymous with susceptibility, in which lie is unable to excrete the virus as rapidly as it becomes generated. Do j'ou believe that cholera is a zymotic disease ? The poison undoubtedly multiplies itself rapidly in the system, although this by
this pest.
remember the
the
During
case
of
a
fine and
cannot arise from fermentation of the blood, or otherwise every dangerous focus would inevitably exemplify the disease in himself. Such multiplication is very analogous to the development of the virus of vaccination molecule probably germinates by
or
small-pox,
and the cholera-
process of cytogenesis. What should you consider to be the nature of a choleragerm ? A morbid molecule consisting of debased animal organic a
matter, which finds its nidus probably only in the circulating fluid.
It may be dormant for a
long
time in the
earth,
or
iu
isolated in the
apartment
in which the case was
placed.
Would you not superintend the treatment of the case personally ? Not under the circumstances in consideration. The operation of every known medical appliance being so wholly
unsatisfactory, I should feel myself justified in absenting myself unless the epidemic had become generally established. What precautions would you enjoin on such attendant for his personal protection ? Most generous ventilation; not to remain in the vicinity of the patient excepting when compelled to do so in order to administer to his wants or to ease his pain; most carefully to avoid inspiring the patient's breath, and to keep his head averted from the sick person as much as possible when rubbing his cramped limbs, &c., to maintain the strictest cleanness of his hands and face, and occasionally to vrash himself all over; lastly, a generous diet?and, if a literary man, an amusing book to employ his mind. What precautions would you enjoin on him in order to prevent the extension of the disease talk to
no
one,
and
permit
110
one
to
others ?
to enter
That he should
the apartment; and
should fetch all food and other necessaries (previously provided him) himself; that all waters made use of for washing purposes should be thoroughly disinfected before being thrown for
away ; that the close stool should constantly be charged with a disinfecting solution, more of this being added whenever the patient vomited, or after every motion ; and that it should be frequently emptied into an adjoining isolated latrine; that the apartment should be thoroughly fumigated, by being exposed for several days to chlorine or sulphurous acid gas, on his leaving it with the patient when the term of their isolation had been
accomplished. In the contingency
of the
patient dying,
what
procedure
would you advise the attendant to adopt ? To undress the corpse and wash it thoroughly, placing it on a table ; to close the apertures of ventilation, and retire from the room after the necessary preparation for a gaseous disinfection; return in the course of three or four hours, and to re-ventilate the room for a like period of time; to admit the undertakers, no communication being held with them at the same time; to disinfect the room once more, and to place himself
making
to
a state of complete isolation for one week. Do you consider that persons would be liable to render themselves dangerous foci by contact with a cholera corpse f The
in
September 2,
TYPHOID FEVER IN DACCA.?BY JAMES "WISE.
1872.]
theory of be against
the emission of the poison by respiration would this view. Further, instances in which such corpses have been utilised for dissecting purposes prove them to be innocuous as agents of contagion. What
precautions
to take on
would you, as of cholera
a
medical man, bo disposed
being brought
under your It would behove me, for the sake of my other patients who might be susceptible, to use the utmost caution,?keeping at a distance from the patient, averting my head on feeling his pulse, obtaining his history from others, if possible, rather first
a
case
notice ?
than from himself, &c. Mention the sanitary precepts that you would enjoin on a community in case an epidemic of this disease was established as an outbreak ? The chief advice would be, not to stint themselves in of
diet, but to spare good, wholesome,
expense in procuring a generous supply and nutritious food,?in fact, to 3pend more
no
on their victuals than they have been in the habit of doing. Animal food being so essentially destitute of the normal amount of fatty principle in the tropics, I should be disposed to recommend the isssuc of cod-liver oil daily, as a possible prophylactic measure during the prevalence of an epidemic in a country like India. Secondly, that the members of the community should near each other during a colloquy, that they retired in their habits, and, in fact, that they should be less social and intimate than is their ordinary custom. This precaution is especially important among the members of a family circle in case the disease exists in the
not
approach
should be
too
more
house, and, under these circumstances, the family dinner-table should be enlarged, together with free ventilation of the dining-
an uncommon occurrence for a panic-stricken throng together in their churches and chapels for an unusual display of religious devotion ; and it may be affirmed that no more pernicious exciting c uise of cholera exists than this practice, since the iirtbiifiLog, or cholera-poison, is extremely likely to be present in a latent form among such assemblages, ready to make its assault on any duly susceptible individual. It is well known that the fumes of tobacco will hang about a closed smoking-room, and the aerial poison of cholera, in like manner, will accumulate by stagnancy in an unventilated church. The third important precaution would be, the avoidance of all unusual or unnecessary fatigue of mind or body, and to observe moderation even in the daily routine of one's ordinary avocations. Thorough ventilation and moderate exercise should be insisted on. Lastly, the most stringent attention room.
It is not
community
to
197
breaks, which seem to admit of an intelligent solution on the hypothesis of the present paper. ?? It would seem that during cholera periods the emigration of persons suffering from diarrhoea has been followed by outbreaks of cholera in places previously uninfected; and Professor Pettenkofer ascribes this fact to an influence [zymotic ?] exerted by the foeces of such diseased persons in the cesspools and adjoining soil of ill-conditioned places to which they go."* I do not know whether the word in crotchets in the abovo extract is original, or has been inserted by Professor Aitken. It is manifest, however, that such persons (on the preceding hypothesis) were foci of the disease. 2nd.?During an epidemic, " the proportion of deaths form3 a gradually decreasing series of five-sixths, three-fourths, onehalf, one-third, till, towards the close, a large proportion of those attacked recover. The uniformity of this law in every country affected with cholera, whether Europe, America, India, or China, is extremely remarkable."! Does not this fact point to a principle of propagation whereby the disease is communicated from person to person in successive generations, so that the poison becomes gradually weakened until ultimately exhausted ? 3rd.?Troops or pilgrims on a march universally suffer more than troops in quarters, or civilians in a town. Professor Aitken has made the following very pointed observation in reference to this fact. " This influence of long marches appears to indicate something more powerful than mere fatigue in bringing about the disease." Here is a large assemblage living in tents, and moving rapidly from place to place; it would be difficult to maintain that the specific poison is introduced into their systems by drinking-water. Is not the disease propagated and rendered more intense by the closer intimacy than ordinary of persons under such circumstances, by the aggregation of dangerous foci during the march, with a tendency to unusually frequent and prolonged tete-a-tete conversations, and, subsequently, by their being crowded together in tents ?
of the local authorities should be directed to every known of sanitation, in order to improve the public health and to remove all pre-disposing influences. measure
If a comparison be drawn between the above hypothesis on the nature of the communication of the cholera cacozyme from man to man and the hypothesis of Dr. Carpenter (previously alluded to) on the nature of the proximate causation of choleraic symptoms, it will be found that there is nothing inconsistent between the two theories. Let us consider, first, the of a healthy man; there must, invariably, be present a
case
certain amount of waste-tissue in the blood, even of the healthiest man. This constitutes the ferment which will render him a dangerous focus, provided he be exposed to the cholerous
contagium
;
nevertheless,
such waste-tissue is too
largely diluted
by the blood for the full expression of the disease to be manifested, and he presents the outward appearance of health or of only slight indisposition. But, in the case of a susceptible person, it is obvious that the fermentation would proceed to an extent only limited by the generation of a true seizure, whether fatal or otherwise. Indeed, the only apparent obstacle to the hypothesis of Dr. Carpenter would seem to present itself in the fact that healthy persons may develop the symptoms of cholera which may even proceed to Allusion may be and
hitherto
a
fatal issue.
made,
inexplicable
in conclusion, to certain remarkable facts in reference to choleraic out-
*
"The Science and
f Idem, page 655.
Practice of Medicine" (1863), by Dr. W. Aitken, p. 217.
