156 



CHOLERA. 



of the port, it was reported that they anticipated 

 Russian cruisers by only a few hours. Formal 

 protests were made by China and Japan, but 

 both powers were content to see the harbor in 

 British possession rather than have it fall into 

 the hands of Russia. The British Government 

 intended to fortify the harbor, but has as yet 

 taken no practical steps to do so. The naval 

 officers who examined the position reported 

 that the islands could not be adequately forti- 

 fied without an excessive outlay, and advised 

 the abandonment of the port. The British 

 have erected buildings for troops and war ma- 

 terials on the islands, and have laid a subma- 

 rine cable to Hong-Kong at a cost of 90,000, 

 but have not yet erected a coaling-depot there. 

 The fact that China does not acquiesce in the 

 occupation deters them from treating the islands 

 as definitely annexed to Great Britain. 



CHOLERA. Notwithstanding much time was 

 given to the study of cholera during the year 

 1886, the additions to our knowledge of the 

 disease have not been as satisfactory as was 

 hoped. Yet, as a result of the investigations 

 (some carried on in the very home of the dis- 

 ease), several mooted points have been de- 

 cided. By direction of the President of the 

 United States, Dr. E. O. Shakespeare, of Phil- 

 adelphia, visited Europe and Asia, as Gov- 

 ernment Commissioner, to investigate cholera 

 and report to Congress. He sailed from New 

 York in October, 1885, and returned in Sep- 

 tember, 1886, having visited the infected lo- 

 calities of France, Spain, Italy, and India. 

 Cholera is now recognized as a preventable 

 disease, and it is an accepted belief among 

 physicians that to Dr. Koch, of Berlin, be- 

 longs the credit of having first discovered and 

 described a peculiar curved bacillus in the 

 intestinal contents and dejecta of persons suf- 

 fering from cholera. He claims that this ba- 

 cillus is diagnostic of true Asiatic cholera. 

 The investigations carried on during the past 

 year have confirmed four of the five claims, 

 concerning this bacillus,, that Koch advanced 

 as the result of his investigations of the eti- 

 ology of cholera in 1884. His fifth claim, 

 that this curved bacillus not only constituted 

 a most valuable diagnostic sign of cholera, -but 

 was also the active cause of the disease, has not 

 been wholly substantiated; yet numerous in- 

 oculation experiments seem to show the cor- 

 rectness of his view. The recent investigations 

 and experiments of the American commissioner 

 are in accord with all but this latter claim. (For 

 an account of Koch's claims, see ZYMOTIC DIS- 

 EASES in the " Annual Cyclopaedia " for 1885.) 

 Emmerich's claim for the etiological power of 

 his Naples bacillus, in the production of cholera, 

 has not borne the test of even his own obser- 

 vations during the past year. Pettenkofer's 

 views, as to the unity of cholera morbus and 

 cholera, have been rejected by almost the en- 

 tire medical profession. The application of the, 

 exact knowledge that has been obtained, as a 

 result of the study of the epidemic of 1886, is 



of vast importance as concerns the selection of 

 hygienic and preventive measures. The dis- 

 covery of the comma-bacillus in the dejecta 

 of a suspected case, points to the existence of 

 Asiatic cholera ; and in the light of our pres- 

 ent knowledge the failure to apply this crucial 

 test would be little short of criminal negligence 

 on the part of health authorities. 



Although recent investigations and research 

 have brought to light hitherto unknown and 

 unconjectured facts, yet almost all the advance 

 has been made in the etiology of cholera, little 

 having been made in our knowledge of its 

 treatment. Experiences with the epidemics of 

 1884-'86 have not resulted in any improved 

 or more successful method of treatment, and 

 the ratio of deaths to persons attacked re- 

 mains about the same one third. That chol- 

 era is not directly contagious is now an ac- 

 cepted belief; and that an attack confers 

 a limited immunity is also very probable. 

 While pursuing his investigations in Spain, 

 Dr. Shakespeare made careful inquiries as 

 to the. question of immunity, and found that, 

 out of a large number of persons, who had 

 suffered from cholera previously, only a few 

 instances of second attacks were noted, and 

 in most of these there were good grounds 

 for believing that the subsequent attack had 

 been one of cholera morbus, and not true, gen- 

 uine Asiatic cholera. Communications were 

 sent to every village and town in Spain, where 

 cholera had existed, requesting a reply from 

 the physicians practicing in the towns, to a se- 

 ries of questions bearing upon the disease, the 

 question of immunity being one ; and the re- 

 plies showed that, in the experience of Span- 

 ish physicians, there were few instances of indi- 

 viduals having been attacked twice during the 

 same epidemic. Such has also been the ex- 

 perience of those in our own country who 

 have passed through epidemics, no instances 

 of an individual having cholera twice being 

 remembered. Medical men that have had ex- 

 perience with the disease have noticed, that 

 usually a weakened, irritable condition of the 

 intestines is left, often lasting through life ; 

 indiscretions in diet, sudden changes of tem- 

 perature, water, or prolonged muscular exer- 

 tion, would be followed by severe attacks of 

 diarrhoea or dysentery. It is undoubtedly true 

 that, with proper treatment in the earliest 

 stages of cholera, three fourths of those at- 

 tacked will recover ; and this fact sh.ould be 

 borne in mind, and advantage taken of prompt 

 treatment the instant suspicious cases are ob- 

 served in a community. After the disease has 

 passed into its second stage, treatment does 

 not yield such beneficial results, and in the 

 final stage it is very unsatisfactory. Certain 

 rapid, virulent cases occur, in the treatment of 

 which almost nothing can be done, the patient 

 being overwhelmed with the virulence of the 

 poison. More extended observations during 

 the past year have weakened the confidence 

 that some physicians had expressed in the use 



