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A HYPOTHESIS ACCOUNTING FOR THE ORIGIN OF PANDEMIC CHOLERA: A RETROGRADE ANALYSIS L. A. McNICOL* and R. N. DOETSCHi The cause of the epidemic that destroyed Sennacherib's army (710 b.c.), described in the Bible [1] and in Lord Byron's poem [2], is unknown . What disease "... smote in the camp of the Assyrians a hundred and fourscore and five thousand . . ." [3] in a single night? Other biblical disasters include a malignant epidemic that Moses brought down on the Egyptians characterized by "... a boil breaking forth with blains upon man, and upon beast . . ." [4]. Equally puzzling is the epidemic wherein "... there was a great cry in Egypt; for there was not a house where there was not one dead" [5]. The Philistines were visited by sudden disease for seizing the Ark [6], and chilling are the words, "So the Lord sent a pestilence upon Israel from morning even to the time appointed: and there died of the people from Dan unto Beersheba seventy thousand men" [7]. While we know the causes and modes of spread of such terrible epidemics as the Black Plague of the Middle Ages and the Spanish influenza that occurred early in this century, there is no proved cause for these biblical afflictions. So, too, are we still ignorant ofthe critical factors involved in the fearful appearance of "swetyng sykness" in England in 1485 [8] and in the irruption of syphilis at the end of the fifteenth century. As in so many retrospective forays into problems of historical impact involving infectious diseases, their origins and causes remain mysteries to which solutions ofvarious degrees ofprobability attend. In this paper, we speculate on the possible origin of pandemic cholera using a method of retrogressive induction, in which we begin at the end and proceed backward to the historical origins of the disease. To do this now is espe- * Assistant professor, Department of Microbiology, University of Maryland, College Park, Maryland 20742. t Professor, Department of Microbiology, University of Maryland, College Park, Maryland 20742.© 1983 by The University of Chicago. AU rights reserved. 003 1 -5982/83/2604-0352$01 .00 Perspectives in Biology and Medicine, 26, 4 ¦ Summer 1983 | 547 daily propitious since a vast number of clinical, epidemiological, and immunological data are available that may be used to advantage. Indeed, Holmgren's recent review recalls once again that, while a great deal is known regarding the structure and action of cholera toxin, virtually nothing has been written concerning the origin of this disease [9]. Cholera is considered by some [10, 1 1] to be an ancient human affliction , and its striking symptomatology and explosive epidemic onslaught are believed to be depicted in early Arabian, Chinese, Greek, Hindu, and Roman medical writings [12-15]. But there are no compelling reasons for these assumptions. Two grossly observable manifestations ofcholera are a profuse, watery diarrhea and vomiting, and therein lies a curious fact. "Cholera" is derived from Hippocratic humoral pathology, originating from ????, bile, and pécv, to flow. For 2,500 years this word was used to describe diarrhea and vomiting from any cause whatsoever. It has been noted that "... the name was a blunderbuss epithet for almost all acute gastrointestinal disturbances except the one that we now call cholera" [16]. The pandemic cholera that is clinically recognized today emerged in India around 1817 [17]. Thirteen years later it appeared in Europe, and contemporary writers were divided as to whether this "Asiatic malady" was an entirely new disease or an altered form of the disease of the ancients [18, 19]. For the past 164 years, this issue has remained unresolved. It is proposed here that the cholera which arose in early nineteenth-century India was, in fact, a new disease and represents an instance of a hitherto unknown affliction suddenly smiting a vulnerable population. An examination of the ecology of Vibrio cholerae reveals interesting facts. This organism is not ordinarily a component of the human intestinal flora. It is found to be indigenous to estuarine waters when appropriate cultural techniques are used. And its physiologic properties equip it to survive more in the estuarine environment than in the human gut [20]. Its presence in natural waters is not correlated with the...


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