On the Channels through which Cholera is Communicable
Authors: J. Murray
Journal: BMJ (1873)

A,mONG the greatest obstacles to the study of cholera are the dis- similarity of the symptoms in the various stages of the disease, and the difficulty of connecting the mild symptoms at its commencement, with those that are so excruciating and virulent in its later stages.The recognition of this connectioni is of recent date, and until it was esta- blished our knowledge of the nature of the poison progressed slowly.The acknowledgment of this fact has materially assisted our investigations, as an early diagnosis of the presence of cholera is of the utmost importance.When this connection is allowed, it gives valuable aid in effecting measures for restraining the dissemination of the disease.In its milder stages, treatment can be emnployed which will prevent its advance to those later stages in which medicine is often powerless, and sometimes injurious; and in thus checking a simple case, the spread of the cholera poison is most effectually opposed.I consider cholera the most important medical question of the day, and it is to promote its elucidation, and in the hope of benefiting by the experience of the many celebrated and justly honoured memberr of our profession now assembled, that I submit my opinion on one branch of the inquiry, viz., the channels through which the disease can be communicated.I have selected this point as one of the greatest practical importance, leaving others for future investigation and more able observers.The history of the views of the medical profession on the contagious nature of cholera is very interesting.I find in the accounts of the disease in India previously to I817, that it was supposed to arise from a vitiated state of the humours and from putrid bile which had to be purged off.When the epidemic in 1817 commenced, it was considered an aggravated attack of an ordinary seasonable disease, which, like ague, prevailed during the rainy season in Bengal.The progress of the disease in the Upper Provinces, the severe attack in Lord Hastings's camp in Bundelcund in November, and its subsequent history when it attacked the troops on service in Central India and in Madras and Bombay in I8I8-I9, le(d some of the officers to consider it contagious.The official reports drawn up by the MIedical Boards of Calcutta and Madras, in i8I8, concluded that cholera was not contagious, though there were some dissentienit voices to this view.The Medical Board in Bombay, on the other hand, considered that it was contagious.In Paris, where I first saw the disease, in 1832 it was declared by the leading physicians to be noni-contagious.The same opinion prevailed in England in I848 and 1854.There were always individual exceptions, but officially and by the profession generally cholera was con- sidered non-contagious.The first departure from this view in any official report, occurs in one published in India in 1856, when the con- tagious nature of the disease was assigned as a reason for incurring the expense of removing the prisoners from the jail at Agra during a very severe epidemic.Again, in i86o, 6i, 62, and 63, the same reason was assigned for inicurrinig the expense of removing the European troops into camp during severe epidemics in those years.Similal views were supported by the Sanitary Commission in I862, and they have