CHOLERA. 29 



that the cases at Stuttgart and at Craponne must have been tended 

 and their linen washed. How was it that no further cases occurred, 

 and that an epidemic was not started ? The linen of the case from 

 Munich was poisonous, but not that from the cases at Stuttgart ! Must 

 we not also suppose that another factor is necessary to explain the fur- 

 ther spread of cases introduced from without ? And this local factor 

 was wanting at Craponne and Stuttgart. If a case from Munich 

 caused three at Stuttgart, then the latter ought to produce nine. In 

 places which enjoy immunity from epidemics it is conceivable that 

 sporadic cases may occur, but, the conditions which are necessary for 

 the production of an epidemic being wanting, no further development 

 can take place. The soiled linen appears to me to be infective not be- 

 cause it comes from cases of cholera, but on account of its arrival from 

 a locality where cholera prevails. Perhaps linen is a good vehicle for 

 transmitting the infective material produced in a locality under the 

 necessary circumstances of time and place. Man is the only creature 

 that wears linen, and perhaps he alone spreads cholera, and it is pos- 

 sible that whether he were clothed or naked he would spread it just 

 as much and no more. But, if we accept this doubtful solution of the 

 Gordian knot, still the views of the contagionists on the dejecta of 

 cholera and the soiled linen would not stand on a firmer basis, since we 

 see not only individual cases but actual epidemics arising without the 

 introduction of soiled linen. The infective material which produces 

 cholera may be transmitted at all events in other ways along the paths 

 of human intercourse. The germs of cholera may be brought from a 

 locality to a place where the necessary relations of time and place are 

 not favorable for the epidemic development of cholera, and they may 

 there slumber for a month before they develop. There is every chance 

 for the propagation of cholera in India, and yet cholera only shows 

 itself fitfully in districts lying outside the endemic area. If the inter- 

 course with India be reduced to the least possible, as it was in the last 

 century, yet cholera might still at times visit us. 



Finally, I shall ask myself what can be done to ward off cholera ? 

 The measures to be adopted will be very different according to the 

 theory adopted. According to the contagionists, the spread of epi- 

 demic cholera depends on personal and material intercourse, as well 

 as on conditions of time and space when the germs arrive at certain 

 localities. Moreover, the severity of the epidemic is supposed to de- 

 pend on the individual susceptibility. If one of these three factors be 

 wanting, an epidemic of cholera can not develop. Preventive meas- 

 ures against cholera may be devised in one of three directions : (1) 

 intercourse ; (2) disposition in time and place ; (3) individual predis- 

 position. Measures to prevent the spread of cholera by interfering 

 with human intercourse are, for many reasons, impracticable. If we 

 ask ourselves what good has resulted from sanitary cordons, inspection, 

 and quarantine, we are bound to answer, None. All these measures 



