| THE PILGRIM PATH OF CHOLERA. |
By ERNEST HART, F. R. C. S.,
EDITOR OK THE BRITISH MEDICAL JOURNAL; CHAIRMAN OF THE ENGLISH HEALTH SOCIETY.
WITH cholera steadily creeping toward our shores, and all Europe standing armed against the invader, it becomes a matter of the extremest interest to inquire how the disease escapes from its home in India, under what influences it becomes able to break its bounds, invade the outer world, and carry death and devastation into countries where not only has it no natural home, but where it is so far an exotic that even after repeated attempts it fails to become acclimatized.
India is the endemic home of cholera, and from some parts of that great country it is seldom entirely absent. In 1881 there were in India 161,000 deaths from cholera; in 1887, 488,000; in 1888, 270,000. The heat, the moisture, the necessity of drinking stored water, and the habits of the people which make that water foul, all combine to plant firmly in the district a contagium like that of cholera. For the living infection, the contagium vivum of this disease, enters man's body in the water which he drinks, while in return it enters the water by means of the sick man's discharges. A vicious circle is thus set up. Given a temperature and perhaps a condition of water in which this contagium can retain its vitality outside man's body, and a state of society in which the fouling of the water and the drinking of it when foul are daily habits, and we have before us the essentials necessary to render the disease endemic.
Whether this living contagious matter be a bacillus or a spirochæte is almost beside the present question, and under what circumstances of water and soil it grows and propagates, or merely rests, is again for our present purpose not of much importance. What is certain and what is of extreme importance is that incontestably within the human body it grows enormously; that every individual sufferer from cholera is constantly discharging an untold multitude of contagious particles, which are capable of again setting up the disease afresh in any one by whom they are swallowed; and therefore that if these contagious particles are swept by rain showers into streams or wells, or if the water in which linen soiled by them is washed percolates into tanks or ponds, the water so fouled is specifically poisonous and will produce cholera in those who drink it, just as arsenic mixed in water will produce arsenical poisoning.
It is a matter of surprise to many, who have the proofs of this vicious circle nakedly before them, that the truth so long lay hidden, and that even yet men who have lived much among chol-
