A TREATISE ON ASIATIC CHOLERA. INTRODUCTION. UNDER the common designation of Cholera we may properly include three diseases which, while presenting a striking similarity in regard to certain clinical phenomena, must yet be held to differ radically as to their origin and nature. These diseases are I. Epidemic or Asiatic Cholera; II. Simple or Sporadic Cholera, commonly called cholera morbus in England and our own country, and cholera Europæa or cholera nostras in continental Europe; and III. Cholera Infantum, or choleriform diarrhoea, which is popularly known in the United States as summer complaint. The three diseases named are all characterized by more or less vomiting, frequent watery discharges from the bowels, great prostration with a tendency to collapse, and usually a quick termination either in death or perfect recovery.' Indeed the clinical symptoms of these maladies may be so much alike that, during an outbreak of epidemic cholera, it may appear impossible to decide, in a given case, what particular one we are dealing with. Nevertheless such apparent likeness by no means constitutes an actual identity, especially from the standpoint of etiology. And the view, still entertained by some writers of the present day, and according to which these diseases are mere gradations of one and the same malady, must be discarded as utterly untenable. It is well known that cholera morbus may appear in any place and at any time, and that cholera infantum usually appears in larger towns during the hot season. But the history of Asiatic cholera demonstrates conclusively its specific, infectious, and epidemic character. Nor can the endemic presence of Asiatic cholera in some parts of India be construed into a valid argument against this view of its essential nature. The more protracted cases of Asiatic cholera often assume a form not unlike typhoid fever, death taking place by gradual asthenia, or convalescence being tedious and long delayed. The final outcome of recent pathological research, especially as regards the parasitic origin of many of our most formidable diseases, may result, as some suppose, in blurring the boundary lines that now separate them. But at the present writing, the tendency certainly is in a directly opposite direction. It would be out of place here to discuss what is known as the " germ theory" of disease. Nevertheless it may be said that the doctrine which assumes that each infectious disease has its particular and specific microbe, is more in accordance with known facts than any theory yet promulgated. It is not intended in this volume to describe the second and third varieties of cholera, the reader being referred to the standard text-books for an account of cholera morbus and cholera infantum. Nevertheless these diseases will incidentally receive some share of attention, especially in relation to diagnosis and differential diagnosis. Etymology. The etymology of the term cholera is somewhat doubtful. Most probably, however, it is derived from the Greek. By some it has been traced back to the Hebrew words, y, pronounced choli-ra (bad disease). But Laveran' says that competent Hebrew scholars have shown the real meaning of these words to have been erroneously interpreted, merely on account of the similarity of pronunciation between choli-ra and the Greek for cholera. xoxɛpa, xoxɛpn (Ionian) is certainly Greek. Hippocrates derived it from yoλn (bile) and pé (I flow), believing that the evacuations were caused by altered bile. Galen held that it was derived from xolades (viscera), as these organs were always first attacked in the disease. Celsus only admits the radical xol, meaning bile, and this is without doubt the true derivation of the word. The Greeks were in the habit of adding to the word cholera the further designation of vouoos (disease), and it is doubtless for this reason that we find the Latin translation often rendered as cholera morbus. This was retained in English, although at the present day cholera morbus is used to denote sporadic or simple cholera, while Asiatic is added to the term cholera to qualify the epidemic or malignant variety. Synonyms. The disease under consideration has been variously known as Asiatic or Indian cholera, serous cholera, spasmodic cholera, malignant cholera, cholera asphyxia, epidemic cholera, algid cholera, blue cholera or cholera morbus, cholera pestifera. But in English it is most commonly called Asiatic cholera; in French, choléra Asiatique; in German, Asiatische or Indische cholera; in Italian, coléra Asiatico; and in Spanish, colera Asiatico. Definition.-Asiatic cholera is a specific infectious disease which is endemic only in some parts of India. From there it may be conveyed all Article Cholera, in Dictionnaire Encyclopédique des Sciences Médicales. Paris, 1874, 1st series, vol. xvi. over the earth in the form of more or less malignant epidemics. An attack is, as a rule, characterized by premonitory diarrhoea, occasional nausea, muscular debility, faintness, and a sense of præcordial oppression. Next there arise the following symptoms: griping abdominal pains, frequent purging of a serous alkaline fluid resembling water in which rice has been washed or boiled, vomiting, a feeling of internal heat and actual external coldness. There also commonly occur suppression of urine, cold, clammy sweat, shriveling of the skin, pinching of the features, deep cyanosis, subnormal temperature, cold breath, intense thirst, a peculiarly husky voice, excessive restlessness, violent muscular cramps, and profound collapse, followed by speedy death or a reaction with or without fever. The British College of Physicians defines cholera as "an epidemic disease, characterized by vomiting and purging, with evacuations like rice-water, accompanied by cramps, and resulting in suppression of urine and collapse." |