On the value of the bacteriological diagnosis of asiatic cholera / by Sheridan Delépine.

  • Auguste Sheridan Delépine
Date:
[1894]
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Licence: Public Domain Mark

Credit: On the value of the bacteriological diagnosis of asiatic cholera / by Sheridan Delépine. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    Reprinted for the Author from the British Medical Journal, January 20th, 1894. ON THE VALUE OF THE BACTERIOLOGICAL DIAGNOSIS OF ASIATIC CHOLERA. By SHEEIDAN DELEPINE, M.B.Edin., Professor of Pathology, Owens College, Manchester. Bacteriologically indistinguishable from Asiatic cholera is an expression which, to some, will undoubtedly convey a feeling of doubt concerning the value of the bac- teriological diagnosis, whilst for those who believe that the spirillum cholerse Asiatics? is the cause of the disease, the same expression leaves absolutely no doubt as to the nature of the case; the presence of the comma bacillus consti- tuting an infallible diagnostic sign of the existence of the disease.1 The diagnosis of cholera is by all acknowledged to be based on evidences of four kinds (1) clinical, (2) anatomi- cal, (3) epidemiological, (4) bacteriological. Clinical Evidence. The clinical diagnosis presents serious difficulties, for (a) the symptoms, even of undoubted cases, vary much in in- tensity and in sequence, (b) Other illnesses may closely simulate Asiatic cholera: among them may be mentioned cholera nostras (English cholera, summer diarrhoea, infantile diarrhoea), perforation of the stomach and bowel, cold stage of remittent fever, poisoning by certain organic poisons (mus- carin, croton oil, food poisoning), poisoning by certain inor- ganic poisons (arsenic, nitrites—the latter according to Em- merich and Tsuboi).2 All the essential symptoms of Asiatic cholera—namely, (1) diarrhoea with rice-water stools, (2) vomit- ing, (3) cramps, (4) suppression of bile and urine, (5) pinched expression and lividity, (6) extreme prostration and collapse, (7) coldness of surface but not of rectum, (8) reaction or fever in cases not dying in the stage of collapse, (9) death in a certain proportion of cases—may be observed in severe cases of cholera nostras, in which, however, suppression of urine and bile are seldom seen Unfortunately for the diagnosis, sup- fZT.T °Tib- VT* uln-e may be absent in ^iGal epidemic +w h,S dlfficu.1]y 1S. 80 g^at, that Koch 3 himself has rnil f when an epidemic of cholera has reached its acme, Pnncli ^Ute dia!r 10ea.' with vomiting and cramps, may be f?T?f SV8nCh?ler?.\c, rthout bacteriological analysis. (°L dlfficulty is still further increased by the fact that some cases of alleged cholera, as diagnosed by the bacterio- logical method, show absolutely no symptoms Ufl10