NEW YORK, September 1, 1884.
_To the Editor of the New York Medical Journal_:
SIR: I have been exceedingly interested in Dr. Bartlett's suggestive
article in your issue of August 30. But a sufficient number of
well-established facts are known to account for all the peculiarities and
vagaries of cholera.
1. Cholera has existed in Hindostan for centuries. It was found there by
Vasco da Gama in 1496, and there is a perfectly authentic history of it
from that time down to the present.
2. It is never absent from India, from whence it has been conveyed
innumerable times to other countries. It has never become domiciled in any
other land, not even in China, parts of which lie in the same latitude;
nor in Arabia, to which country pilgrims go every year from India; nor in
Egypt, nor Persia, with which communication is so frequent; much less in
any other part of the world. Canton in China, Muscat and Mecca in Arabia,
lie nearly in the same degree of latitude as Calcutta, in which cholera is
always existent; yet these places only have cholera occasionally, and then
only after arrivals of it from Hindostan.
3. The arrival of cholera in other countries is often involved in some
easily removable obscurity, which is deepened only by the ignorance and
want of veracity of quarantine and other officials.
4. Cholera is almost always preceded by a premonitory diarrhoea, which
lasts from one or two to three or four or more days before urgent and
characteristic symptoms show themselves. Of 6,213 cases, no less than
5,786 had preceding diarrhoea. The sufferers from this sow the germs of
the disease in numerous, often distant and obscure, places, to which no
choleraic person is supposed to have come.
5. The discharges swarm with infective bacteria of various kinds, some of
which, especially Koch's comma bacilli, seem to be specific.
6. The disease has been reproduced in men and some few animals by their
swallowing the discharges.
7. The discharges, according to the experiments of Thiersch,
Burdon-Sanderson, and Macnamara, are not virulent and poisonous for the
first twenty-four hours; on the second day eleven per cent. of those who
swallow them will suffer; on the third day, thirty-six per cent.; on the
fourth day, ninety per cent.; on the fifth day, seventy-one per cent.; on
the sixth day, forty per cent.; and after that the discharges have no
effect--the bacteria die, and the poison becomes inert.
Professor Robin reproduced cholera in dogs, and the celebrated dog Juno
died of cholera in Egypt last year. Professor Botkin, of the University of
Dorpat, reproduced cholera in dogs by the subcutaneous injection of the
urine of cholera patients. Even if the comma bacilli are not found in the
urine, other bacteria are; and even Koch supposes that they secrete a
virulent poison similar to that of some insects, which may be absorbed
into the blood and escape from the kidneys.
8. Some of the manners and customs of the Hindoos are very peculiar. They
always defecate upon the open ground, and will not use privies or latrines
This is a matter of religious obligation with them. It is also obligatory
upon them to go to stool every morning; to use the left hand only in
wiping themselves; to wash their fundaments after stool; to wash their
whole persons and clothing every day; and, finally, also to rinse their
mouths with water, and this they often do after washing in foul tanks, or
still fouler pools of water. On steamships, where tubs of water were
provided for washing their fundaments after defecation, Surgeon-General De
Renzy saw many Hindoos rinse their mouth with the same water.
9. The population of Hindostan is nearly three hundred millions, and at
least one hundred million pounds of fæcal matter is deposited on the open
ground everyday, and has been for centuries.
10. Much of this foul matter is washed by rains into their tanks and pools
of water, which they use indiscriminately for washing, cooking, and
drinking purposes.
11. The poison of cholera has repeatedly been carried in soiled clothing
packed in trunks and boxes, and conveyed to great distances.
12. Articles of food, even bread and cake, as well as apples, plums, and
other fruit, handled by persons in the incipient stages of cholera, have
been known to convey the disease.
13. The number of epidemics produced by cholera discharges getting into
drinking water are almost innumerable, and those from contaminated milk
are not few.
14. The first case of cholera is generally counted from the first fatal
one, whereas this is almost always preceded by non-fatal ones, which have
escaped notice. And each subsequent fatal case is interwoven by one, or
several, or even many, non-fatal causes. If the string of a row of beads
is broken, and the beads scattered everywhere, it would be just as
improper to say that they had never been upon a string as to say that,
because all the fatal cases of cholera cannot be traced to equally fatal
ones, no connection ever existed between them.
These points are necessarily stated categorically, but every one can be
proved, if proof is called for. The numerous and very large pilgrimages of
the Hindoos must not be forgotten.
John C. Peters, M.D.