On the pathology and mode of communication of cholera / by John Snow.

  • Snow, John, 1813-1858.
Date:
[1849]
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology and mode of communication of cholera / by John Snow. Source: Wellcome Collection.

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    ON THE PATHOLOGY AND MODE OE COMMUNICATION OF CHOLEEA. By JOHN SNOW, M.D. [From the London Medical Gazette.] Reasons for considering cholera a local affection of the aliynentarif canal — •proofs of its communicability —diffi¬ culties in the way of the ordinary doctrine of contagioyi. Cholera poison is contained in the evacuations, and communicates the disease by being swallowed: illustrations of this in the houses of the working classes—in mining districts. Cholera communi¬ cated by drinking water : cases illus¬ trating this. Difference of elevation in London influences cholera only through the drinking vmter. Com¬ munication of 'cholera through the water in York, Exeter, Hull. Writers on cholera, however much they may have differed in their views concerning the nature of the disease, have generally considered it to be an affection of the whole body, and con¬ sequently due to some cause which acts either on the blood or the nervous sys¬ tem. The following are the reasons which have led me to entertain the opinion that cholera is, in the first in¬ stance at least, a local affection of the mucous membrane of the alimentary canal; an opinion which I thought almost peculiar to myself when I was first led to adopt it, but which, as I have since been informed, others were be¬ ginning to entertain. In those diseases in which there is reason to conclude that a morbid poi¬ son has entered the blood, there are symptoms of general illness, usually of a febrile character, before any local affection manifests itself; but so far as I have been able to observe or to learn from carefully recorded cases, it is not so in cholera. On the contrary, the disease begins with the affection of the bowels, which often proceeds with so little feeling of general illness, that the patient does not consider himself in danger, or apply for advice till the malady is far advanced. It is true that, in a few cases, there are dizziness and faintness before discharges from the bowels actually take place, but there can be no doubt that these symp¬ toms depend on the exudation from the mucous membrane, which is soon afterwards copiously evacuated. With respect to certain rare cases of cholera without purging, Dr. Watson has re¬ marked in his Lectures, that when the bodies of such patients have been opened, the characteristic fluid was found in the bowels. Another reason for looking on cholera as a local dis¬ ease is, that the affection of the stomach and bowels is sufficient to explain all the general symptoms. The evacua¬ tions, in the cases I have witnessed, have always appeared sufficient to ac¬ count for the collapse, when the sud¬ denness of the attack is considered, and the circumstance that absorption is probably suspended. The thickened state of the blood arising from the loss of fluid accounts for the symptoms of asphyxia, by the obstruction it must occasion in the pulmonary circulation.