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Annual Report of the Medical Officer of Health,—1893. 27
during the ten days preceding his death. On Friday, September 22nd, he ate some
liver and bacon. On Saturday, September 23rd, diarrhoea commenced. The next
day, feeling better, he partook of some beef-steak pudding, and the diarrhoea returned
during the evening. On Monday, September 25th, he commenced work, but at
10 a.m. complained of diarrhoea to his master, who told me "he looked pale." The
diarrhoea was allowed to remained unchecked and untreated up to this period, when
it became more severe and was accompanied by vomiting. The same evening he
was attended by Dr. Cooper, to whom I am indebted for the following clinical
account of the case:—
"The patient's face and finger nails were bluish, the hands were clenched and
sodden, and the voice husky. His breath was felt to be cold. The pulse was
frequent, small, and feeble, and the general condition was one of collapse. Pain in
the stomach was complained of, as well as cramp affecting the calves of the legs.
There was copious vomiting and purging of thin fluid, for the most part of a whitish
colour, like water in which rice has been boiled, and unmixed with bile. The
intellect was clear, and the patient was able to answer questions in a sensible
manner." In a word, all the clinical symptoms of Asiatic cholera were present.
At the post mortem examination, at which I was present, the intestines were
found injected throughout their whole length, and there was a little fluid in the
peritoneal cavity. Submucous hemorrhages were disclosed in the lower ileum and
the large intestine. This extravasation was extensive in the head of the caecum. A
portion of the lower ileum, with its contents, was taken to Dr. Klein.
Report by Dr. Klein :—" The mucous membrane was deeply congested, the Peyer's
patches and solitary follicles prominent and deeply congested; the contents of the
ileum a brownish fluid. On microscopical examination numerous epithelial flakes
could be distinguished. Crowds of different bacteria present, among them a fair
number of comma and S shaped forms. Peptone salt cultures yielded crops of
commas, giving markedly the cholera-red reaction. The peculiar character of these
commas was this, that, while in gelatine plate cultivations, the colonies were of the
general character of the choleraic commas, except that the liquefaction proceeded
very slowly, in gelatine stab cultures they did not produce liquefaction. In agar and
other media they did not differ from the typical cholera commas."
My own report completely corroborates that of Dr. Klein. Some of the contents
of the ileum, cultivated in broth, containing 1 per cent, of peptone and J per cent,
salt, gave positive evidence under the microscope of Koch's comma bacilli, which I
consider to be the specific cause of Asiatic cholera.
This same peptone-salt culture distinctly gave, on the addition of a single drop of
pure sulphuric acid, the characteristic rose-coloured tint called the cholera-red
reaction—thus confirming the former test.
On my first visit to the patient's workshop, which he occupied alone, I noted a
crate partially filled with sheet glass, lying open, on end, with its packing of
straw disturbed. This straw, I was told, the patient had handled the week preceding
his death. At the wholesale house from whence the crate came, I was told that 80
per cent, of the crates similar to the one I described came from Antwerp. On
returning to the workshop I found on examination the crate was marked with the
Antwerp stamp.
From this observation, coupled with the fact that Antwerp had been for some
time a cholera-infected port, it appears probable that the straw with which the glass
was packed had Koch's comma bacilli in it. The straw, handled by the patient,
might then easily have conveyed organisms, which later on reached his stomach, and
so gave rise to the fatal attack of cholera.
It should be added that every possible precaution was taken to prevent the spread
of the disease. The family was removed, all infected bedding and clothing destroyed,
the water-closet used by the deceased closed, and rooms disinfected.