NATURE 



73 



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Cholera Risks. 



RECENT Press telegrams emphasise Poland's 

 strug-gle to resist the tide of infection of 

 ! tjphus, small-pox, and cholera which is rolling 

 up from Russia, while the Times announces that 

 the Mecca pilgrimage has been declared free from 

 cholera, and the work of the Internatnonal Quaran- 

 tine Board, shortly to be absorbed into the Public 

 Health Department, is eulogised, and its possi- 

 bilities of co-operation to protect the world from 

 the Russian cholera danger are stated. 



The association of famine, like that of war, 

 with great outbreaks of epidemic disease is well 

 known. The exigencies of both war and famine 

 commonly mean the aggregation and a vastly en- 

 hanced movement of masses of people, thus 

 greatly increasing the likelihood of trans- 

 mission of infection at a time when the 

 possibility of precautionary measures is re- 

 duced to a minimum. This general problem 

 is of great interest both historically and in con- 

 nection with current events. 



The terrible ravages of typhus in Russia, 

 Poland, and Serbia during the war and since its 

 formal termination are well known, and its almost 

 complete absence from the ranks of the Western 

 belligerents is striking evidence of possibilities of 

 prevention when there is a background of civilian 

 behind the military sanitary- administration. 

 Small-pox similarly has been kept under control, 

 and sanitary measures and anti-typhoid inocula- 

 tions have made typhoid fever a shadow of its 

 former self. 



XO. 2707, VOL. 108] 



Against cholera a country in a most backward 

 condition as regards the elementary sanitation of 

 water supplies and sewerage is almost helpless, 

 and the chaos of practical anarchy adds to its 

 difficulties. It is this conjunction of events which 

 makes Russia a source of danger, not only to 

 Germany and Poland, its immediate neighbours, 

 but also to a less extent to Europe generally, and 

 even to America, so soon as frequent human inter- 

 communications are established. 



Assuming that no efficient action is likely to be 

 taken in Russia itself, the possibilities of prevent- 

 ing importation and of olQviating the spread of 

 imported infection of cholera vary according to 

 the country concerned. In a country like Poland, 

 recently reconstructed out of several nationalities 

 and with hastily improvised organisation, the diffi- 

 culties are exceptionally great. The history of 

 cholera in Poland this autumn, and still more next 

 summer, will depend chiefly on the extent to which 

 the water supplies of its towns and villages are 

 liable to specific contamination by human choleraic 

 discharges. It is not surprising to learn that in 

 Russian refugee camps mass inoculation against 

 cholera has been begun. This measure is still in 

 its infancy, and the personal immunity thus 

 secured is relatively short. We need not be sur- 

 prised, therefore, to learn, in the early future, of 

 attempts at land quarantine, which in the past has 

 never succeeded in preventing the importation of 

 infection. This has been shown both in European 

 and American experience; one American hygienist 

 compares attempts at inland quarantine to delirium 

 ferox in the scale of insanity. Such quarantine 

 has always been incoherent, uncertain in adminis- 

 tration, a source of friction and interference with 

 trade, without commensurate sanitary gain. It is 

 important, of course, to supervise the medical con- 

 dition of immigrants from infected localities and 

 to keep them under surveillance if their condition 

 is suspicious, but to take similar action for large 

 . masses of population or for a prolonged period is 

 foredoomed to failure. 



Similar remarks apply partially to efforts of 

 maritime quarantine. When rigidly enforced it 

 has embarrassed commerce, and has not suc- 

 ceeded. Even in the case of immigrants arriving 

 in American ports from Europe, the failures to 

 prevent the importation of cholera by rigid quaran- 

 tine at the port of arrival have been conspicuous. 

 In infected neighbourhoods in Manila 6 to 7 per 

 cent, of healthy individuals were found to be 

 "carriers" of cholera bacilli in their intestinal 

 contents, and when we note that these bacilli may 



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