CHOLERA, ASIATIC. 



109 



from which the generative principle of cholera may 



M.MI'.- :l, u-i.li-r tin; iiiilii.-iiee of favorable con- 

 dition^; ii follows, also, tli;it the origin of the elude 

 germ takes place very probably in tin- digestive canal, 

 to the e.\clu.-iiiu, perhaps, o! all other parts of tin: 



riiat in the open air the generative principle of 

 eholrr.i loses rapidly its morbific activity, and that 

 tlii-s is tin- rule; but that under certain particular 

 conditions of confinement, this activity muy be pre- 



I I'm- an unlimited period. 



. .ition shows that the duration of the 

 cholerine diarrhoea, called premonitory which must 

 not be roni'i.iiiuted with all the diarrhoeas which exist 

 during the time of cholera does not extend beyond 

 a f.-w days. 



ta cited as exceptional do not prove that the 

 cases of diarrhoea prolonged beyond that period be- 

 long to cholera, ana are susceptible of transmitting 

 the disease, when the individual affected has been 

 withdrawn from all cause of contamination. 



The British members of the conference, Doc- 

 tors Stuart, Goodroe, and Dickson, reported 

 from Constantinople to the Earl of Clarendon 

 (Foreign Minister of Great Britain), under date 

 of May 25th, and after giving a summary of the 

 preceding conclusions, proceeded to state the 

 following results, to which, after free con- 

 ference, they had come, on the important sub- 

 ject of quarantine results as applicable to the 

 United States as to Great Britain. It may be 

 possible that in the case of ships or passengers 

 arriving from infected neighboring ports, the 

 following measures might advantageously be 

 adopted : 



1. No person should be allowed to land previous 

 to efficient inspection by medical men appointed for 

 the duty. 



2. The healthy passengers should be removed from 

 the ship, and isolated for a period which need not 

 exceed five days; at the end of which time they 

 should be again inspected, and if found without 

 choleraic symptoms should receive pratique. 



3. All persons with cholera or diarrhoea at the 

 time of arrival, or at any period of the detention, 

 should be isolated from the rest, and removed to a 

 separate place. Cases of diarrhoea should be retained 

 under observation until the diarrhoea is cured, or until 

 the medical officer in charge is satisfied, from the fea- 

 tures of the disease, that it is not of choleraic nature. 



We think that the time of observation in such 

 cases of diarrhoea should not be less than eight days 

 from the commencement of seclusion. 



Persons having a medical certificate of being suf- 

 ferers from chronic or symptomatic diarrhoea should 

 follow the rule of the tieafthy, subject, however, to 

 the discretion of the medical officer in charge. 



As the time occupied in the voyage between Eng- 

 land and the neighboring ports is short, we have not 

 included it in the period of observation. 



\Ve further think that the complete disinfection of 

 the effects of persons coming from contaminated 

 places should be insisted on, and that the period of 

 isolation of the persons should be from the time 

 that they arc separated from their suspected prop- 

 erty. 



All persons (including medical officers) employed 

 .n the Quarantine Department, who in any way 

 come in contact with the ships, passengers, crews, 

 or effects, that have arrived from contaminated 

 places, should follow the same rules as the arrivals 

 themselves. 



With respect to persons detained in the sick de- 

 partments of the quarantine stations, the destruction 

 or disinfection of all articles used by them should be 

 imperative. 



Tin- application of chemical diinfuctftnU to the 

 discharges, tin: disposal of them- he-low the iurfnce of 

 the soil, if on shore, and beyond the possibility of 

 contaminating water used for drinking purpose*, are 

 indispensable. 



The above measures would require the following 

 conditions at each quarantine station: 



1. An establishment for the reception of the 

 healthy, capable of completely isolating successive 



- of arrivals in distinct classed, well separated 

 from each other. 



2. An establishment for the reception of the sick, 

 with an isolated convalescent establishment. 



Each of the above should be provided with lat- 

 rines, having moving receptacles, which should ho 

 daily emptied and purified. 



C. An establishment for the purification of effect*. 



The establishments required would certainly bo 

 large, but a small number of them placed on a few 

 points of the coast would suffice, if all the ships car- 

 rying passengers from infected ports were made to 

 pass through them before receiving free pratique. 



We consider that islands lying at some distance 

 from the coast would be the most desirable spots for 

 the institution of quarantine stations. On these 

 wooden or, still better, iron constructions mi^ht 

 be rapidly raised. In summer weather isolated 

 camps, with tents, might be formed, 



In the event of islands not being available, it 

 would be well to select some place on shore capable 

 of complete isolation, and at a considerable distance 

 from any inhabited quarter, or hulks moored at some 

 distance from the land, but never within rivers. It 

 will be observed that several ships at each station 

 would be necessary for. the efficient working of the 

 plans proposed. 



The principle of isolation, adapted to special cir- 

 cumstances, should, we think, be carried out within 

 the country when the disease has found a footing on 

 shore. We cannot too strongly urge the necessity 

 of excluding from workhouses and general hospitals 

 anv forms of choleraic disease. 



The sick poor should be cared for in special and 

 isolated institutions. 



We have based the suggestions which we have 

 taken the liberty of submitting to your lordship upon 

 the supposition that all the agents employed shall be 

 of an intelligent and upright class ; that they shall 

 be specially instructed to watch attentively, and 

 without exciting their suspicion, the persons placed 

 under observation, and report to the medical officers 

 every visit made by any one to the latrines. With- 

 out the aid of intelligent and trustworthy agents, it 

 would hardly be possible to limit safely the period 

 of observation to so short a time as above stated. 



While convinced that all personal effects should 

 be thoroughly disinfected, we do not think it neces- 

 sary to extend the measure to mails or to ordinary 

 merchandise. 



The epidemic, which in Europe committed 

 its ravages in the autumnal months of 1865, 

 reaching its period of greatest intensity in Paris 

 in October, and about the same time in most of 

 the cities and towns of Western Europe, hiber- 

 nated during the winter, only sporadic cases 

 occurring, but in the spring, summer, and au- 

 tumn of I860, it appeared in many of the Eu- 

 ropean states with great severity. It visited 

 Paris twice in that time once in the spring and 

 .again late in the summer; made great havoo 

 in London, where the deaths, in the week end- 

 ing July 28th, reached 2,600, and in that end- 

 ing August 4th, 2,661, and greatly increased the 

 mortality of the other cities of Great. Britain. 

 In Holland, during the summer, there were 

 6,446 cases and 3,866 deaths. In Hungary i* 



