CHOLERA I NDICA, or ASIATIC CHOLERA. This is an infectious di-ease caused by drinking %rater contaminated by the fa(ces of other cholera pa tients, and containing the Spirillum cholera'. It is probably never communicated by contagion, that is, through the breath, perspiration, or other emanation from the patient. The disease originated in India, where it is endemic. Its per manent home is Calcutta and the southern part of Bengal. It has existed since 1817 in endemic form, and epidemics of it antedate the Christian era. Cholera first appeared in China in Is20; in Arabia, Persia, and Mesopotamia in 1821: in Syria, Palestine, and on the shores of the Cas pian in 1823. The second epidemic, starting from the Ganges in 1826, passed through Persia and Astrakhan to Russia in 1830, and to Poland in 1831. Meanwhile it extended through Mesopo tamia, Arabia, Palestine, and Egypt, and from Russia it passed into Germany. After invading Austria, Ilungary, Wallachia, and Turkey, it reached England in 1831. Brought by Irish im migrants to Quebec in 1832, it entered the United States by way of Detroit, Mich., and thence it spread through the West to the Pacific Coast and south to New Orleans. Subsequent epi demics occurred in 1841, 1863, 1871, 1883. 1891. and 1893. The disease prevailed in America in 181S and 1852, and from 1865 to 1865. It ap peared in New Orleans and the valley of the Mississippi River in 1873, and in 1892 a few cases came to the port of New York from ham burg, Germany. In 1899 it was found by the United States troops in the Philippine Islands, where it has probably been often prevalent.
Most eases of cholera begin with nausea, rest lessness. and chilly sensations, followed by vio lent and frequently recurring diarrhost, with vomiting and vertigo. In from one to six hours buzzing in the ears, palpitation of the heart, pressure over the stomach, an anxious, gray face, and blueness of the whole surface supervene. The bowels are emptied, painlessly, of discharges re sembling rice-water. Pain in the stomach and in the region of the heart is often severe, and cramps occur in the calves and arms. The pa tient suffers continually from thirst. The tem perature remains about 95° F., and the pulse rarely exceeds 100, while the respiration is usually increased to 30 or 40. Urine may be
suppressed. The patient may sink into a somno lent and then a comatose condition and die, or else he may suddenly improve, and then either go on to convalescence or sink into fatal coma in a few clays. Of the mild cases, about 50 per cent. die; while of those with subnormal tem perature, cyanosis, and coma, 90 per cent, die. A mild form of true Asiatic cholera. known as cholcrine, is rarely fatal, but is dangerously in fectious. Lobar or lobular pnomnonia, enteritis, nephritis, and neurasthenia may follow cholera.
Asiatic cholera is due to a slightly curved ha _ .
cillus which, from its shape, is called the comma bacillus (Spirillum cholera' Asiatica). The ba cillus, discovered by Koch in 1883, is a short mo tile rod from one to two micromillimeters long. A number of such bacilli are often found clinging to one another at their ends, and thus forming spirals of various lengths. The bacillus grows in the presence of oxygen, and does not produce spores, the temperature best adapted to its growth being about that of the human body. It is, however, quite resistant to cold. though it is readily destroyed by drying or boiling. Its defi nite biological characteristics usually enable an expert to determine its pressure or absence in intestinal evaeuation even at the earliest stages of the disease. The bacilli are usually confined to the intestines, dad during the active stages of the disease may be present in enormous numbers. The systemic effects seem to be due to absorption of toxins produced by the bacilli and are of the nature of a taxa-1111a. There are no pathological changes which are characteristic of the disease, and an autopsy shows those degenerative changes which usually accompany acute infection. In the small intestines, where the bacteria are usually present in the largest numbers, there are apt to be hemorrhages into the mucous membrane and a more or less intense congestion. The lymph follicles of the intestines are apt to be swollen and congested. The contents of the intestines may either consist of the characteristic rice water fluid, or else may he dark-colored and bloody.