Chapter IV.]
CONCLUSIONS SUGGESTED BY THE STUDY OF THE CHOLERA OF 1875-76.
311
As seen by different observers and in other countries, cholera may present an aspect very
different from that familiar to us in India, and while this is not
recognised, the field remains open for controversy which is not
legitimate, and which must necessarily be unending.
When occurring in Russia, Germany, or America, cholera is
represented to us as a typhus, propagated by contagion and directly communicated from those
already affected; and we are asked to shape our conception of cholera as an epidemic to the
facts observed out of India. Cholera, which in India cannot prolong its existence for a week
beyond the date at which it is due to die, is represented as regardless of meteorological phe
-nomena, a circumstance possibly consistent with its natural history as a typhus, but which.
withdraws it from the category of malarious diseases.
I do not reply to such observation that, being inconsistent with observed facts in this
country, it is necessarily erroneous. No one has a right to
deny, unless for good and sound reasons, the conclusions of a
careful and truthful observer; and, therefore, on purely
scientific grounds, I do not dissent from the proposition that
epidemic cholera may be due to a malarious miasm in India, while beyond India it may from
time to time be propagated as a typhus,* or as a disease with some such natural alliance.
The failure to recognise this was probably the cause which led Copland to speak in terms of
disparagement of Jameson's conclusions, although based upon facts every one of which can be
verified at the present day. It is very interesting to find Copland writing of cholera under
two distinct heads—Cholera and Cholera Pestilence, which appear in entirely different sec
- t i o n s o f h i s d i c t i o n a r y . W h a t h e c o n s i d e r s c h o l e r a p r o p e r s e e m s t o h a v e c o m e u n d e r h i s o w n
observation in Africa in 1816-17 The clinical characteristics which he gives (page 321, vol. I)
are exactly those of true cholera, although he denies the identity; and he considers that it proceeds
from exposure "to a cold, raw, and moist atmosphere, or to the night air loaded with terrestrial
emanations, after the prevalence of warm weather, or exposure to a hot sun." His inference is,
that the different varieties of cholera which he describes (bilious, flatulent, and spasmodic), chiefly
differ in degree, the spasmodic variety arising "from the operation of causes of a more
intense grade than those which induce the former." If what Copland saw in Africa in 1816-17
was, as is possible, our true cholera of India invading, in the method of our modern parallels, we
must conclude that he erred in attributing to local causes merely the spasmodic cholera
which he saw. But the chief point of interest is, that he holds up to us as a disease of a
different aspect the cholera which came under his notice many years afterwards when England
was invaded.
From his own observation in England, he describes cholera as if it were a disease related to
typhus. "In two cases which I attended," be writes, "most extensive erysipelas complicated
the consecutive fever, and I agree with the observation of Drs. Baring and Russell, that persons
employed about cases in this typhoid stage are never attacked with ordinary fever, but with
a genuine cold, blue cholera (vol. III, p. 104)." Then be goes on (para. 36) to speak of the
points of difference between the characteristics of cholera as observed in India and in England,
—the period of incubation and the premonitory diarrhœa observed in Europe, the diminished
violence of the actual symptoms, the greater intensity of the typhoid state subsequently
developed, and the attacks of medical men or hospital attendants, describing even relapse as
common among those habitually in contact with the sick. Next he proceeds (para. 37) to ask
why this difference should occur if the disease be the same, and he comes to no satisfactory
conclusion.
Finally, he remarks (p. 109, para. 62), that before he had seen the disease in this country
he had not completely made up his mind on the subject of its infectious nature, but that
taking up the Indian reports he had convinced himself that cholera was contagious equally in
India and in Europe. What he quotes in support are the same general statements made in
the present day, which in certain cases are possibly founded on fact, but which, as the rule, will
not stand scientific investigation; and whether true or not, fall, one and all, to be considered
in relation and subordination to the great laws regulating the epidemic, and when so regarded
take up a very different position from that which the superficial observer or unphilosophic
narrator would assign to them.
All the reasoning which follows is founded on what may be an untrue basis—the identity
of the Indian with the European pestilence, and the inference that time arguments derived from
facts observed in the one are equally applicable to both. And it leads on to the con
- c l u s i o n , t h a t " t h e i n a c c u r a c y o f t h e o p i n i o n s w h i c h h a v e g o n e a b r o a d r e s p e c t i n g t h e b e h a v i o u r
of the disease in India have vitiated the doctrines and paralysed many of the preventive
measures which have been suggested in Europe."
These are the views which we find endorsed by the Surgeon General of the United States
Army, and recapitulated by him in an English journal a few months back. They coincide down
even to the personal experiences of Dr. Copland and Dr. McClellan. The former tells us
(Vol. III, page 121), how he had convinced himself that, without being himself affected, he
had personally propagated the cholera through the medium of his clothes, and gives cases
in illustration; the latter, how he carried infection by a coat, in which he had been visiting
It is quite possible that the aspect
of cholera is double; one aspect pre
- d o m i n a t i n g i n I n d i a , a n d t h e o t h e r
in countries beyond Hindostan.
If there be these two aspects of
cholera, criticism which does not
admit the possibility is likely to be
unsatisfactory.
* In relation to this the chapter of this Report on the connection between epidemic malaria and relapsing typhus
may be studied.