800 



ZYMOTIC DISEASES. 



gress, as being highly important. The French 

 Congress further declared that the sanitation 

 of cities is the only efficacious means of stay- 

 ing the progress of the epidemic. 



The specific cause of cholera is said to be some 

 living organism, capable of multiplication and 

 propagation. Koch claims to have discovered 

 it, and found it to be a specific micro-organism 

 belonging to the vegetable kingdom, having 

 specific qualities that distinguish it from all 

 other known plants. His claim is essentially 

 fivefold : first, that a certain specific plant is 

 constantly to be found in the intestinal con- 

 tents of persons suffering with cholera; sec- 

 ond, that it is found in the intestinal contents 

 in no other disease ; third, that it has certain 

 vital characteristics, which readily distinguish 

 it from all other species yet known ; fourth, 

 that it has therefore a diagnostic value of the 

 greatest importance: fifth, that it alone has 

 the property of producing or exciting Asiatic 

 cholera, and that without its agency the dis- 

 ease can not exist. The views of Koch, while 

 not absolutely proved, have not as yet been 

 disproved. That the curved bacilli are found 

 only in cholera, and that without their agency 

 the disease can not exist, is a matter of much 

 dispute. Curved bacilli have been found by 

 some observers in the exudation of pneumonia, 

 in the intestinal discharges of diarrhoea, of ty- 

 phoid fever, and of dysentery, and Dr. Shake- 

 speare is inclined to the view that they exist 

 in the vaginal discharge of puerperal fever. 

 Emmerich, of Munich, claims the discovery of 

 a straight bacillus, upon which cholera is essen- 

 tially dependent, and which can produce a simi- 

 lar disease in the lower animals. He terms it 

 the Naples bacterium, and says it is only 

 found in the blood, in the tissues of organs, and 

 in the intestinal contents of cholera subjects. 

 Emmerich further claims that it is the only 

 bacillus always found in the subjects of chol- 

 era. During the past year Pettenkofer has 

 expressed the view that cholera morbus is but 

 a form of cholera. 



Cholera is not contagious, attacks persons 

 of any age or sex, and is most fatal among the 

 intemperate and those careless as to personal 

 cleanliness. The disease is most severe in hot, 

 moist climates, in low altitudes, and in the 

 warmer rather than in colder seasons of the 

 year. In nearly all places where a great dif- 

 ference exists between the summer and winter 

 temperature the disease has disappeared dur- 

 ing the cold season, and attained its greatest 

 intensity during the hot months. An excep- 

 tion to this is, that cholera has appeared in 

 some of the cities of Russia, Sweden, and Nor- 

 way in winter. There is no doubt that chol- 

 era is favored in its spread by poverty, crowd- 

 ing, filth, and intemperance ; but it is equally 

 certain that these agencies can not generate 

 the disease ; the presence of the active specific 

 ciuse is essential. All communicable infec- 

 tious diseases are favored in their spread by 



unfavorable sanitary conditions, but cholera in 

 an epidemic form does not prevail in a com- 

 munity unless its mysterious specific cause is 

 introduced. The special fomites of the chol- 

 era-poison are articles of clothing soiled with 

 the discharges from the sick and the emana- 

 tions from privies, sewers, and water-courses 

 into which the discharges have been cast. 

 Water that is contaminated by the discharges 

 of cholera-patients is the most rapid and effi- 

 cient agent in disseminating the disease. A 

 very small quantity of the cholera-matter is 

 capable of infecting the entire water-supply of 

 a city. There is no doubt that when cholera 

 suddenly becomes epidemic in a city or vil- 

 lage, it is by means of a contaminated water- 

 supply. When the germ is introduced in other 

 ways, it spreads slowly. 



During an epidemic of cholera the liability 

 to be attacked is greatest when the vital pow- 

 ers are depressed by mental or by physical 

 causes. Individuals should not become alarmed, 

 but lead a regular, quiet life, avoiding all ex- 

 cesses. The diet should not be changed sud- 

 denly, and, most important, all water for drink- 

 ing or cooking should be boiled. This should 

 also be done with milk. The house should 

 be put in order and thoroughly cleaned, and 

 cellars and privies disinfected with chloride of 

 lime or a solution of carbolic acid. Koch re- 

 gards this latter agent as the most effective of 

 all disinfectants. Cleanliness of person, and, if 

 possible, the avoidance of those infected with 

 the disease, is also important. All articles of 

 clothing, bedding, etc., that have been near 

 the sick, should be thoroughly disinfected, or, 

 better still, burned. After handling a sick 

 person, the hands should be washed in a five 

 per cent, solution of carbolic acid, and care 

 should be taken that no food is eaten by the 

 well in the sick-room. 



There is little doubt that, with proper treat- 

 ment in the earliest stages, the majority of 

 cholera cases recover. In the later stages of 

 the disease, treatment is not so satisfactory, 

 and there are certain sudden, violent cases, in 

 which any form of treatment is of little avail. 

 A treatment recommended during tne pnst 

 year consisted of small doses of corrosive sub- 

 limate. This was supposed to kill the bacteria, 

 but anti - bacteri.'d agents can not be relied 

 upon to cure cholera. It has been shown that 

 neither alcohol, camphor, laudanum, chloral, 

 mercury, nor carbolic acid, would kill the bac- 

 teria in the small quantity that could safely 

 be administered to the human being. The 

 greatest reliance must be placed in remedies 

 checking the diarrhoea of the early stage, in 

 stimulating remedies, in friction, warmth, and 

 certain remedies demanded by certain condi- 

 tions. A treatment highly recommended in 

 Spain, in 1885, was the rectal injection of 

 ether. A Spanish physician claimed to have 

 saved fourteen out of fifteen patients in the 

 second stage of cholera, by enemata of ether. 





