Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    159/976 (page 139)
    Cholera does not spread uniformly over a large area or country; it seems rather to spread from certain centres first attacked, often passing over places in its apparent course, and perhaps suisequen y invading them. Some places indeed, although m the track, escape altogether. It has a tendency, even after long intervals to return to certain haunts in the same towns; thus, certain places which suffered greatly in 1832 were equally attacked in 1848-49, and some remarkable coincidences occurred in illustration. It has happened that the veiy first house invaded in 1832 gave the first cases in 1848. Protection by previous Attacks.—These do not appear to confer any immunity; there are numerous cases on record of persons who have had Cholera more than once. Some writers have speculated upon the susceptibility of individuals being diminished by long exposure to Cholera atmospheres without being attacked. The opinion does not seem to rest on any good foundations. Channels of Introduction into the System—-Being ignorant of the nature of the poison, we cannot well say how it enters the blood; it probably enters through the respiratory or intestinal surfaces. Incubation.—It seems that this may be very short for many cases ; perhaps two or three days, or even less. Of course if we include the Choleraic diarrhoeas and those cases which show other preliminary disturbances, mentioned hereafter, we must allow a much longer time. In the case reported by Dr. Barry, and referred to in the paragraphs on Contagion, the period of incubation does not seem to have exceeded forty hours. When Cholera breaks oat in ships at sea several days after leaving port, the attacks are probably due to freshly acting causes. Mortality to Populations.—This varies for different epidemics and in different districts. In 1848-49, in Dr. Baly’s report, we find that the deaths were 30 to every 10,000 living in England and Wales. This mortality was not evenly distributed : the inland districts giving 17 per 10,000, and the coast districts 50 per 10,000, and 404 districts 7 per 10,000, and 85 districts in which there were none. The denser the population to the square mile the greater the comparative mortality; thus a population of 915 to the square mile gave 65 deaths per 10,000, and 235 inhabitants, 7 per 10,000. In India among the European troops, according to Ewart, the deaths to strength of the men for 7 years was annually 070 per cent., or 70 per 10,000 ; of the officers, 042, or 12 per 10,000. It is not possible to ascertain what is the mortality of the native population of India from Cholera or any other disease. The susceptibility of populations is very difficult to ascertain, because a large number of attacks not fatal are never reported, and therefore, except in the case of troops, no reports are to be depended on. In India, Dr. Ewart places the liability of European troops to attack at 174 annually per 10,000 for the men, and 73 annually per 10,000 for officers. In India the percentage of attacks is much higher for European than for native troops. The Cholera Commission has shown that the native prisoners in gaols have a liability nearly the same as the European troops.