"Infectious nature of pestilential cholera"

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PFD from photocopy, courtesy of the Taubman Medical Library, University of Michigan.

The PDF is an extract from Copland's discussion of infection in part 10 of the Dictionary of Practical Medicine, introduced by two paragraphs from the Editors of the London Medical Gazette (LMG).

The editors write: "A common opinion among those who have had an opportunity of seeing this disease in India, is that it is not infectious; but Dr. Copland shows, and we think most successfully, that the facts accumulated by many of these gentlemen, in their official reports, are decidedly adverse to the inference which they have drawn" (517).

Copland offers the following summation before dissecting the "arguments of those who contend that the disease [cholera] is not infectious" (517):

"I verily believe . . . that this malady is infectious in a similar manner to measles and scarlet or typhus fever; that is, not by contact, but from the inhalation into the lungs, along with the air, of the morbid effluvium given out from the body or bodies of the affected. We know that the mere contact of persons suffering from the diseases just mentioned, will not communicate them even to the predisposed; whilst the presence in the air which is breathed, of a scanty portion of the effluvium given off during their progress from the affected, will often produce them; and such, I am convinced, is the case with the pestilential [Asiatic] cholera. We further know, that it is no easy to communicate these acknowledgedly infectious diseases by inoculation, when access of the morbid effluvium to the lungs is prevented. It, therefore, can be no matter of surprise to learn that M. Foy, and others of the young physicians who visited Warsaw, failed to propagate the malady [cholera] by inoculation, or by tasting the matters vomited by the affected; even although the tasting matters vomited, under any circumstances, might well have turned the stomachs of many. Indeed, though cautiously convinced of the existence of the infectious nature of pestilential cholera, I would have inferred that inoculation, or the introduction of the morbid secretions into the stomachs of healthy persons, even were they predisposed to an attach of the malady, would have failed, in accordance with the laws which infectious diseases observe, to communicate it, provided the effluvium proceeding from the bodies of the affected be prevented from passing into the lungs" (517).

[Here Dr. Copland mentions the three modes of communication that fell within the contagionist position as set forth in a previous article on contagion in the Lancet: the lungs (the mode specifically associated with the term, infection); skin (inoculation); and the stomach.]

[The concluding paragraphs in the extract are transcribed below:]

"The operation of the morbid effluvium or animal poison was violent in proportion to the concentration of it in the air respired [by the victim], and to the weakness of the person inspiring it, and to the grade of predisposition.

There is no evidence to account for the generation of the choleraic poison in the first instance, and there is as little of its reproduction de novo on subsequent occasions. It is also impossible to form a correct idea of the period during which the infectious miasm or seminium may be retained by clothes [fomites] closely shut up from the air, or by the dead and buried body, and be still capable of infecting the healthy" (521)