Abstract
AT a recent meeting of the Abernethian Society of St. Bartholomew's Hospital, Dr. Klein briefly reviewed the accepted theories as to the ætiology of cholera, and stated the views concerning it which he had been led to adopt since his visit to India. His address is of importance as embodying the conclusions of the Indian Commission of Inquiry into this disease. Two main theories are held with regard to the cholera—the one, which is supported by a large section of the Indian medical staff, being that cholera is non-infectious and non-communicable; the other, which is upheld by European authorities, being that it is both infectious and communicable. In support of the former theory may be ouoted the numerous cases of sporadic cholera which occur, and the fact that when troops are attacked in a military cantonment and are at once marched out into camp, no new cases occur other than those which are already incubating. Lastly, in many places in India, in spite of all conditions favourable to a spread of cholera by the evacuations, it is rare for any but sporadic cases to occur. In support of its communicability and infectiousness it is unquestionable that when an outbreak of cholera has occurred, it has in most instances been introduced from a district where cholera was rife, as instanced by the late outbreak at Marseilles, which was shown to have been introduced from Egypt, Some have maintained that it may be conveyed by winds; against this may be adduced the fact that epidemics have occurred in Malta without any occurring at the same time in Gozo. Now, Gozo is nearer to Egypt than Malta, and yet no epidemic at Malta has ever been preceded by an epidemic at Gozo. The upholders of the theory of infectiveness are divided into two schools—the contagionists, who consider that the disease is directly communicable from the sick to the healthy, and that the virus is contained in the discharges from the alimentary canal; and the localists, who believe that the evacuations contain a germ which is capable of elaborating the virus under suitable conditions of climate and soil. Against the contagionists' view must be considered especially these facts—that it is very rare for attendants to be attacked early, and that, they only succumb at a late period of the epidemic; and that cholera patients are treated in the general wards of a large hospital in Calcutta, and yet no cases of contagion have occurred. Dr. Koch, in studying this disease, found that the lower parts of the small intestine of patients who died from cholera swarmed with peculiar bacilli (comma bacilli), which passed out with the evacuations, and which he considered were capable of manufacturing the cholera virus when introduced into the small intestine of an unhealthy patient. He also believes that this bacillus is destroyed by the acid secretion of the stomach of a healthy person, and, further, that this bacillus is destroyed by drying; and hence that this disease could not be propagated by soiled linen after this had been dried. The German Commission believes these bacilli to be the cause of the disease. Dr. Klein, by a series of experiments, has proved that these comma bacilli are not destroyed by an acid solution of the same strength as that of the gastric juice; but that, on the contrary, they thrive after having been immersed in such a solution. Further, that though these bacilli, in common with all germs (except spores of bacilli), are destroyed by thorough and scientific drying, still soiled linen never becomes thoroughly dry. Klein thinks that even the location of these bacilli in the lower part of the small intestine should of itself suggest suspicion, inasmuch as bacilli and micrococci in great numbers are contained in it even in health, and the more because this locality is not the exclusive seat of the disease. More conclusive evidence, however, was collected by him in India. For instance, three of the houses situate in a certain street in Calcutta contained in all eight cases of cholera. Leading out of the street was a narrow lane to a large water-tank, around which was built a squalid rookery. The water of this tank was used in the rookery for all purposes, and contained the comma-bacilli. Now, the houses in the street were not supplied with water from the tank, and yet eight cases of cholera occurred in the square, while none were found in the rookery, which was inhabited by about 200 families. The English Cholera Commission has also found a bacillus apparently similar with the cholera-bacillus in the intestines of children and adults suffering from diarrhœa. Dr. Lewis, of Netley, has found the same in the saliva of healthy persons. With regard to the evacuations containing the virus, Dr. Klein found that in India many of the public-built wells were contaminated by sewage, and that the water, though nominally not used for drinking purposes, for expediency was generally so used, and especially at night time. Again, at Benares a large sewer opens into the Ganges at a spot where the pilgrims and natives perform their religious ablutions, these including especially the washing out of the mouth with the river water. In spite of this only sporadic cases of cholera occur. Dr. Klein has been led to the conclusion with regard to the cholera—that Koch's bacillus cannot be the cholera germ.
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Dr. Klein on Cholera . Nature 31, 521 (1885). https://doi.org/10.1038/031521a0
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DOI: https://doi.org/10.1038/031521a0