CHOLERA, Wes-a, Asiatic, an acute, infectious disease, endemic in some localities and epidemic in others, characterized by vomit ing and purging of a peculiar rice-water-like fluid, and a stage of collapse.
It is usually ushered in by vomiting, purg ing and griping pains in the stomach, and death may follow in from 1 to 24 hours. If life is retained longer than this time the patient may possibly recover. The mortality is 30 to 80 per cent.
It originated in the East Indies and was not known to migrate for 1,000 years. The oldest Sanskrit writings show that it was known many hundred years before the birth of Christ. There are abundant proofs of epidemics in the 17th and 18th centuries, but it did not spread into Europe until 1830. The Russians took it from India through couriers and stage-coaches. Another peculiarity of this disease is that when it was in Marseilles it broke out in Paris, jump ing Lyons, the second largest city in France, notwithstanding the fact that quarantines were in full force.
It was first observed in the United States in 1832, having been brought by immigrants from Great Britain to Quebec whence it found its way across the border to New York. It was also epidemic in the United States in 1835 and 1836. In 1848 it was brought into the country by way of New Orleans, traveled up the Mis sissippi Valley and thence across the continent to California. Other years in which it pre vailed with greater or less severity were 1849, 1854, 1856, 1867, 1873, 1884, 1892, 1893.
Since 1873 it has had no positive foothold in the United States or Great Britain, but in the Philippine Islands it has prevailed since 1901 though it is now under control. It has prevailed in the Orient since 1901 and it was severe in Russia from 1907 to 1911. In 1911 it was prevalent in Italy, North Africa, Ma deira, Asia Minor, Arabia and Turkey. It still prevails in India where it is always endemic. Several cases were brought to the. United States on shipboard in 1911, and a number of so-called were detained until the evi dences of the disease disappeared. There was no extension of the disease from the port of entrance (New York).
Etiology.—The undoubted cause of the dis ease is the comma bacillus which was dis covered by Koch in 1884. It is about half as
large as the tubercle bacillus, but is some what thicker. Under high magnification it re sembles a bent rod, or a short spiral. It is about Mil of an inch in length. It will grow in water at ordinary temperatures, and was isolated from the water tanks at Hamburg during the epidemic of cholera which visited that city in 1892. It is said to live at temperatures ranging from 15° to 104° F. The bacteria are located chiefly in the intes tines, as, according to Dr. Koch, none have been found to exist in the blood or in any of the other organs. In the lower section of the lower in testines they are found in greatest abundance, also in the dejecta, but not often in the vomit. It is said that the bacilli cannot live in the stomach.
In post mortem the organisms were found by Koch in the intestines but not in other in ternal organs. They have often been found in the faces of persons who are apparently healthy, during an epidemic, such persons being the so called cholera-carriers.
The symptoms of the disease are apparently due to the absorption from the intestine of toxic material generated by the bacilli It is asserted that these comma bacilli de stroy the blood corpuscles within a pretty wide range, and it is fair to conclude that they also destroy more or less of the surrounding tissues.
Transmission.— The disease is contagious but not highly so. Those who wash the cloth ing and bedding of cholera patients often con tract the disease, and so do those who come in direct contact with the body, as undertakers, orderlies, etc., but such attacks are probably due to imperfect hygienic precautions on the part of the victims. Physicians and nurses suffer with comparative infrequency from cholera. Animals may be readily immunized to the disease by first injecting a suitable cul ture of the dead organisms and following it with the injection of a culture of living or ganisms. Many human beings have a natural immunity to it. It is demonstrable that it may be conveyed by vegetables, especially by raw ones, by milk and by other forms of food.