Medical Officers of the Army of India.
19
solely on the action of alterations in the constitution of the intestinal contents
as an environment ; and, were epidemiological data to be set aside as of no
significance, we might be more or less justified in explaining the induction of the
choleraic condition as simply dependent on the access of certain vibrionic
organisms to the digestive tract. But, not only do epidemiological data not fit
in with any such assumption, not only is there an overpowering mass of evidence
to show that choleraic patients, apart from conditions of the locality into which
they are introduced, are not efficient causes for the establishment and diffusion
of the disease, but there is an absolute absence of any conclusive evidence
that choleraic vibrionic organisms, either as they issue from the bodies of the
sick, or as ordinarily artificially propagated in laboratories, are necessarily
capable of giving rise to the choleraic state on gaining access to the intestinal
tract. Actual experimental evidence on the effects of the ingestion of fresh
choleraic dejecta is naturally not ordinarily forthcoming, but when I first be-
came acquainted with the General Hospital in Calcutta, the old head-sweeper
there was always willing to earn a rupee by partaking of a dose, and certainly
appeared to suffer from no ill-effects from the treatment, and judging from the
habits of the class to which he belonged, there can be no reasonable question
that members of the latter must, during any period of prevalence of cholera, be
constantly liable to carry out similar experiments, casually and involuntarily,
with equal impunity. Numerous experiments on the ingestion of artificial cul-
tures of choleraic vibriones have, however, been deliberately undertaken, and, in
any laboratory in which such organisms are extensively cultivated, it may be
fairly assumed that innumerable involuntary experiments of like nature must
have taken place, and yet the record of unequivocal cases of so-called Laboratory
-cholera remains a minimal one.
The data are such that, in order to account for the seasonal fluctuations
and epidemic diffusion of cholera, we must assume the occurrence of coincident
seasonal fluctuations, and epidemic diffusion of certain predisposing conditions ;
and the only question is whether these are to be regarded as of a local or a per-
sonal origin. The question is :—are the phenomena of seasonal fluctuations and
epidemic diffusion of the disease to be ascribed to corresponding variations in
individual or local predisposition? If it be assumed that the real determinant
of the variations and the incidence of cholera lies in corresponding variations in
personal predisposition, it is clear that the vibrionic organisms are at once deposed
from their dominant position, and that, for all practical purposes, variations in
personal predisposition replace them as primary causes of the disease ; and, with
this, we are in fact driven to regard local conditions as all-powerful, since varia-
tions in personal predisposition can only be interpreted as due to the action of
the environment. Local conditions may, however, be conceived of as acting
in other ways than that of inducing personal predisposition. They may act
as affecting the capacities of growth and multiplication of pathogenic organisms,
D2