CHOLERA ASIATICA. 717 



Peculiar importance has been attached to the fact that, during the so- 

 called cholera typhoid, a maculated, papular, or erythematous exanthe- 

 ma has been observed ; and the " cholera-exanthema " has even been 

 compared to the " typhus-exanthema," and its occurrence regarded as 

 a proof of the similarity or relationship of cholera typhoid and typhus. 

 The exanthema is not, however, so constant a symptom of cholera ty- 

 phoid as to be pathognomonic, and according to my observation it oc- 

 curs chiefly in those cases where sinapisms have been applied repeat- 

 edly or continuously to the extremities during the algid stage, or where 

 the extremities have been rubbed energetically. The exanthema, which 

 chiefly affects the limbs, often extends to the trunk, hence its occur- 

 rence seems to me to be due to continued stagnation of the circulation, 

 and consequent interruption of the nutrition of the skin, and to be 

 favored by precedent irritation of the skin. Moreover, attention has 

 recently been called to the fact that the diagnostic importance of the 

 exanthema of typhoid fever has been overvalued, and that roseola 

 spots and erythema also occur in many other feverish diseases. 



TREATMENT. We shall not discuss the sanitary police regulations 

 by which we may hope to arrest the progress of cholera epidemics ; 

 and shall only call attention to the fact that, in the Mecklenburg epi- 

 demic of 1859, it was shown that the quarantining and locking up, 

 which, from the experience of previous epidemics, were declared to be 

 utterly useless, were found to afford full protection when energetically 

 and perseveringly followed out. Since a person, suffering from an ap- 

 parently simple and harmless diarrhoea, may carry the cholera-poison 

 to a previously healthy place and there induce a fatal epidemic, places 

 that would be protected must cut themselves off from all communica- 

 tion with the rest of the world. It would be very satisfactory if the 

 attempts to dry the soil of cities by drainage, and by improving the 

 erection of privies, should have the desired result of lessening the pre- 

 disposition of the affected places for extensive cholera epidemics. It 

 would also lead us too far, were we to treat fully of the police regula- 

 tions that physicians, in places where the cholera has appeared, must 

 require of the proper authorities, and here we can only make certain 

 suggestions. Since the privies, cess-pools, dirty gutters, etc., favor the 

 development of the cholera-poison, they should be energetically 

 cleaned and disinfected. Stools of cholera patients should never be 

 thrown into the common privy. One of my pupils, Dr. JKeich, while 

 btill a student at Greifswald, was cholera physician at Tribsees, a 

 small town on the Mecklenburg border, where he succeeded in urging 

 the police to empty all the privies and have a certain quantity of solu- 

 tion of sulphate of iron poured into them. Large tanks, filled with 

 this fluid, were placed before each house to facilitate this procedure, 



