CHOLERA 205 



Austria, 39 different centres. 



Germany, 10 different centres. 



Turkey, 2 different centres. 



Persia and Arabia are seldom free from the scourge. 



In 1915 the Russians tool^ cholera to their Austrian guards and to 

 the civil population. There were then 30,000 cases with 16,000 deaths 

 in Austria, and 5,000 cases with 3,000 deaths in Hungary. 



During the same year there were 147,000 deaths in India, of which 

 68,000 were in Bengal. 



Tropical and South Africa, the Azores, the Pacific Islands have 

 not yet been infected. The principal endemic centre is lower Bengal. 



It always adopts channels of human inter-communication ; ships, 

 rivers, roads, railways, producing a widespread epidemic in places of 

 bad sanitation. 



iETIOLOGY. 



The existing cause is Koch's comma bacillus. 



),hi 



Cholera spirilla. (From Pitfield's " Bacteriology.") 



Predisposing causes are low-lying areas, contaminated soils, unripe 

 fruit, lowered vitality from any cause, as seen in gaols. 



Infection is by — 



(i) Direct contact. A medical man examined a patient suffering 

 from cholera, then had his lunch. Patient and doctor were both dead 

 in twenty-four hours. Care is required in performing autopsies. 



(2) Fomites form a common means of infection. 



(3) Water is the medium. 



The comma bacillus passes out with the faeces, and as it lives and 

 multiplies in water for 163 days or more, a place having a poor sanitary 

 system would have all the conditions favourable for an epidemic. 



Hampstead, a cholera-free place in 1854, was infected by a lady and 



