CHOLERA IN 1892. 



97 



of cholera has been frightful ; and, notwith- 

 standing I >etter hygiene, more perfect knowledge 

 of the m<'|e- <if prevention, and More rational 

 met hods of treatment, the percentage of deaths 

 to attacks is very little smaller now than it was 

 many years ago. It may safely be said that the 

 n\ erage mortality is from 80 to 40 per cent. In 

 some epidemics it has not been over 15 per cent., 

 wliile in others it has almost reached 90. It has 

 lieen noted that the ratio of fatal cases depends 

 much upon the rapidity of the spread of the dis- 

 ease. Where it travels rapidly the number of 

 deaths is great ; when it makes easy journeys the 

 havoc is not so frightful. Records of the epidemic 

 of 1885 show an average mortality of almost 

 80 per cent., but those of 1892 were much higher. 



Concerning this epidemic there are several 

 remarkable features, new departures from the 

 hitherto usual course of epidemics, the meaning 

 of which is yet to be explained. The disease 

 has marched westward with wonderful rapidity, 

 and its virulence is greater than that of most 

 other epidemics of the past. Heretofore it has 

 taken two years to travel the distance covered 

 by the epidemic of 1892 in six months. This may 

 be accounted for, to some extent, by the increased 

 facilities of travel and speed, but it is more prob- 

 ably due to the increased virulence of the poison. 



It has usually been held that one attack of chol- 

 era does not confer immunity from another; 

 but within the past few years several eminent au- 

 thorities have expressed the view that one attack 

 does confer an immunity, but not of very long 

 duration. A careful analysis of the epidemic 

 of 1885 led Koch to place cholera in the class of 

 general infectious diseases with variola and 

 scarlatina, as concerns immunity, although it 

 was much shorter and markedly less absolute. 

 Griesinger recently wrote " that, next to perfect 

 health and good hygienic surroundings, nothing 

 affords greater protection than recovery from an 

 attack of cholera." He also showed that when a 

 body of troops has suffered from cholera it enjoys, 

 fur some time, an insusceptibility. Pettenkofer 

 also has expressed the opinion that one attack of 

 the disease protects against a second. The few 

 American writers on the subject, within the past 

 ten years, incline to the opinion that no im- 

 mun'ity follows a first attack. But this view 

 is not based upon the extensive personal experi- 

 ence afforded observers abroad. Inquiries have 

 been started concerning this question, and a 

 tabulated record of cases showing a second at- 

 tack will be compiled. 



The beginning of the epidemic of 1892 was 

 about April 10, and its origin was in the Pun- 

 jab, India. It seems that at Hurdwar. a place 

 of pilgrimage, where, in spring, the largest fair 

 in India is held, more than 200,000 annually 

 LTJitli'T. and every twelfth year from 1,000,000 to 

 2,000.000. This was the twelfth year. Chol- 

 era suddenly appeared about April 10, and 

 iin leased with a singular rapiditv, the out- 

 break beiii.tr so virulent that the Punjab pil- 

 grims were forced to disband, thereby carrying 

 the seeds of the disease to various localities. By 

 the end of the month cholera was in Afghanis- 

 tan and Persia, and cases were reported in the 

 southern parts of Prance, but were termed chol- 

 erine. When May closed the epidemic existed 

 also in Harrar, Meshed, and Serinagur, where 

 VOL. xxxn. 7 A 



the deaths were over 500 a day. Early in June 

 the disease bad made such frightful headway 

 that business was completely suspended. The 

 Persian Government ordered a military cordon 

 placed around Teheran, the Russian Government 

 took active measures to prevent the spread of 

 cholera into Russia, English camps were re- 

 moved, and the movements of all pilgrims were 

 prevented by cordons. These stringent cautions 

 failed to check the disease, and by July 1, Tif- 

 lis, Baku, the west coast of the Caspian Sea, and 

 Asiatic Turkey were invaded. Shortly after- 

 ward it was in the suburbs of Paris, and was ad- 

 vancing toward Moscow. During July the dis- 

 ease spread in various directions throughout 

 Russia, no fewer than 9,000 deaths being re- 

 ported. In some localities the ratio of deaths to 

 cases was more than half. So many towns were 

 visited by the plague that on July 27 all the 

 schools under control of the Holy Synod were 

 ordered to be closed, not to reopen until cold 

 weather set in. In Paris 67 deaths from the 

 disease were reported during the month. At 

 Argenteuil, a suburb, there were over 40 deaths 

 from what was termed ''choleraic diarrhoea." 

 The French authorities seem to have made a 

 systematic effort to deceive the inhabitants of 

 Paris, as well as those outside their confines. 

 From the first the term "cholerine" was ap- 

 plied to cases that were unmistakably true Asi- 

 atic cholera. At no time had any such affection 

 producing so many deaths existed about Paris 

 and its environs. Prof. Peter, of the Necker 

 Hospital, in the earlv part of the month, de- 

 clared emphatically that the prevailing malady 

 was true Asiatic cholera. On the other hand, 

 several high medical authorities were equally 

 positive it was not. The same policy seems to 

 have been pursued at Hamburg when the first 

 suspicious cases were reported, and also by the 

 surgeons of a line of steamers sailing for the 

 United States from that port. Subsequent 

 events proved that what was called "cholerine" 

 was true Asiatic cholera, and should have been 

 recognized as such by any honest and competent 

 physician. 



With the beginning of August came the an- 

 nouncement that cholera had appeared in west- 

 ern Siberia, ten cases existing in the prison at 

 Tomsk. At Moscow there were over 60 deaths 

 in a few days, while in Russian Caucasus there 

 were over 4,000 deaths during the first week. So 

 rapidly was the disease spreading that the Min- 

 istry of Education, on Aug. 3, published an offi- 

 cial order that all schools be closed, and re- 

 quested that medical schools suspend lectures, so 

 that the students might assist in combating the 

 scourge in infected districts. Long before any 

 official announcement was made, quite a number 

 of fatal cases of cholera were known to have 

 occurred in St. Petersburg. Official announce- 

 ment was not made until Aug. 15. At that 

 time 154 cases, with 81 deaths, were reported. 



Toward the end of the month the disease was 

 announced in Austria, and the authorities of 

 Hamburg about this time admitted that what 

 they had regarded as a harmless choleraic diar- 

 rhoea was true Asiatic cholera. The disease was 

 chiefly prevalent in the Altstadt, or old portion of 

 the city, few cases occurring in the Neustadt. or 

 new portion. All precautions, it was claimed. 



