CHOLKRA IN 1892. 



99 



classes, those who were careless in their eating 

 ami drinking, and who were sulTerers from 

 chronic bronchitis and indigestion. In Belgium 

 tin ic wore 1.135 cases of cholera and 503 deaths 

 from the disease between the appearance of the 

 first case. July 2$, and Oct. 1. The majority of 

 fhnlera ea-es, it' taken in the earliest stages and 

 properly treated, would undoubtedly recover. 

 In i he later stages, treatment is not so promising 

 m its results, and there are certain acute, violent 

 caso that do not yield to any form of treatment, 

 (tl nervations made in Hamburg during this 

 epidemic show a tendency to lengthen in the 

 duration of the cases, and, after the algid or 

 secondary stage abates, a tendency to typhoidal 

 conditions and sympathetic inflammation of the 

 kidneys. Some practitioners in that city have 

 xpre-sed the view that, as a rule, all cases that 

 lasted longer than five days manifested kidney 

 complications. It was also noted that some 

 patients passed through the acute stages in a 

 favorable manner and then expired suddenly 

 from heart failure. 



In the early stage of cholera the indications 

 demand prompt and decisive treatment of the 

 diarrhoea. For this, warmth must be applied to 

 the abdomen and extremities, and a full dose of 

 morphine must be given hypodermically. The 

 condition of the patient is such that little re- 

 liance can be placed on the prompt action of 

 medicines when administered by the mouth. It 

 is here that valuable time is lost. An injection 

 of one-fourth to one-half grain of morphineshould 

 be given, and it has been found that more prompt 

 results follow when the injection is made under 

 the skin covering the abdomen. In quite a 

 number of cases this treatment may be all that 

 is required. In severe cases, where no response 

 follows the injection it should be repeated within 

 two hours. Cholera calls for heroic treatment. 



The second indication is to destroy the germ, 

 and for this mercury has been widely recom- 

 mended. Large doses of calomel, corrosive sub- 

 limate, and carbolic acid have been administered 

 for this purpose, but antibacterial agents do 

 not yield very gratifying results. Sufficient 

 quantities to destroy the bacteria can not be ad- 

 ministered to the individual with safety. We 

 must place greatest reliance in remedies the ac- 

 tion of which will control the diarrhoea of the 

 early stage ; in stimulants, such as alcohol, cam- 

 phor, ether, and capsicum ; in friction, warmth, 

 and mustard applied to the abdomen and to the 

 extremities. 



During the epidemic of 1885 a treatment 

 highly recommended in Spain was the rectal in- 

 jection of ether; but this does not seem to have 

 been resorted to during the epidemic of 1892. 

 Bnteroolysis and hypodermoclysis promise the 

 bi-t results in the later stages of cholera. The 

 temperature of the water should be at least 101 

 P., and should contain a large quantity of 

 common salt. This should be injected into the 

 lower bowel after each operation, at least a quart 

 of the solution being used. When collapse 

 occurs, the solution should be boldly injected 

 into the breast or under the arms, a fountain 

 syringe armed with a cannula being used for the 

 purpose. Upon the withdrawal of the cannula. 

 the tumor arising should be well nibbed until 

 absorption has taken place. It is said that this 



is faci litated by plunging the patient into a hot 

 bath. During the recent epidemic in Hamburg 

 a new method of treatment by means of chlorine 

 water was tried and was reported to b- very 

 effective. The effect of the treatment was to 

 produce perspiration in cases that were most un- 

 promi.Mtig. During the epidemic of 1892 no at- 

 tempt seems to have been made to follow the 

 practice of Perran as to vaccination as a means 

 of prevention. Dr. Ferran recommended and 

 tried this procedure in Spain during the severe 

 epidemic of cholera in 1885, and some astonish- 

 ing claims were made for it. In 22 cities and vil- 

 lages, with an aggregate population of 136,000, 

 Perran vaccinated 30,500. Of these, only 12 in 

 1,000 were attacked, and 3 in 1,000 died, thus 

 reducing the mortality to 25 per cent. Of 

 the unvaccinated, 77 per 1,000 Were attacked 

 and the deaths were 33 per 1,000. These 

 experiments showed that the liability of those 

 who had submitted to the vaccination was at 

 least seven times less than that of those who had 

 not been vaccinated. The cholera commissioners 

 appointed by England, Belgium, Germany, and 

 France investigated this claim made by Ferran 

 after the epidemic had subsided, and did not ex- 

 tol his claims or recommend the adoption of his 

 practice. Shortly afterward the cholera com- 

 missioner from the United States investigated 

 the subject and thought the method worthy of a 

 trial. 



The most reliable method of security against 

 cholera in the United States is to be found in a 

 proper system of quarantine, and this can be the 

 most effectually established and maintained by a 

 system of National Quarantine. Instead of the 

 various States having a seaboard or port of 

 entry, maintaining a separate service, the General 

 Government should have the absolute control and 

 responsibility of inspection. Until such is the 

 case a perfect cordon can not be maintained. The 

 question of an international quarantine service 

 has been under consideration during the present 

 year, and several countries have already appoint- 

 ed commissioners to represent them at a meet- 

 ing to be held in 1893. As the cholera concerns 

 all civilized nations alike, it is but proper that 

 all of them should take part in the proper quar- 

 antining of the source of the plague. This is the 

 only feasible plan for the prevention of epi- 

 demics. International action means that the 

 civilized world will contribute scientists and 

 funds to aid in the extermination of the disease 

 in its home. 



The importance of International action is illus- 

 trated in the record of cholera in 1892. Nearly 

 three fourths of all the cases of cholera in south- 

 ern Russia, or in that vast region lying between 

 the Caspian and the Black Seas, 'have proved 

 fatal. In St. Petersburg, where a better sani- 

 tary condition prevails, over 50 per cent, of the 

 cases have had a fatal termination. In Ham- 

 burg the ratio of deaths in cholera cases has 

 been nearly half, while in northern Germany, in 

 Belgium, and in France, it has been about 83 

 per cent. In Persia the appalling record of 85 

 per cent, in mortality is given. It is said that a 

 quarter of a million Persians perished by the 

 Asiatic cholera in 1892. In addition to the great 

 loss of life, is the monetary loss occasioned by 

 the interruption to commerce. 



