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THURSDAY, JULY 19, 1883 



CHOLERA PROSPECTS 



THE early history of cholera is involved in a good deal 

 of obscurity, and it was not until 1817, when the 

 disease caused a terrible mortality amongst our troops in 

 India, and subsequently spread into different parts of the 

 Asiatic continent, that any noteworthy attention was 

 given to it by European observers. It is very possible 

 that even previous to the present century cholera had 

 made its way into Europe, but the first trustworthy record 

 of its course westwards was in 1831, when it travelled by 

 way of Russia and the Baltic, and, as far as we know, 

 made its appearance for the first time in England. In 

 the following year it became widely prevalent in this 

 country. In the years 1848-49, and again in 1853-54, 

 cholera travelled to Europe and England from the East, 

 taking much the same route as it did in 1831-32. The 

 last outbreak from which we have suffered was in 1 865-66, 

 the disease being imported into Southampton in 1S65, 

 and reappearing both in the metropolis and in several 

 other parts of the United Kingdom in the following year. 

 But on this occasion the infection for the first time 

 reached us through Egypt, having travelled there in the 

 track of the Mohammedan pilgrims, who were on their 

 return from Mecca, and being then distributed along the 

 lines of steamboat traffic which, starting from Alexandria 

 as a centre, radiate towards ports in the Mediterranean 

 and on our own shores. In 1866 the disease became 

 epidemic in the metropolis, and its special incidence in 

 the East End was shown to be in the main due to the 

 polluted character of the water delivered to that part of 

 London. 



The disease' is once more prevalent in Egypt; it has 

 already caused over 2000 deaths in a few towns in the 

 delta of the Nile, and the prospect of its spread to the 

 several ports of Europe is regarded with universal 

 concern. 



The etiology of cholera, in so far as relates to its influ- 

 ence in this country, does not admit of much doubt. The 

 infection must be actually imported into our midst ; it 

 has never yet been imported except through human 

 agency, and the poison appears to be all but, if not 

 entirely, limited to the discharges from the bowels and to 

 the matter vomited by the patients. Where these go the 

 poison goes ; hence sewers and drains receiving them 

 tend to become channels for conveying the disease ; soil 

 fouled by them may, by leading to the pollution of well 

 and other waters, as also by aerial emanations, favour its 

 diffusion ; and, to a less extent probably, the bed-linen 

 and personal clothing of the sick may become vehicles of 

 infection. In all essential respects the disease appears 

 to spread under much the same conditions as favour the 

 spread of enteric or typhoid fever, and, like that disease, 

 it has in this country mainly been associated with the 

 use of water supplies, which have been subjected to the 

 risk of receiving the specific infection. What that infec- 

 tion consists in is not yet known, but judging from 

 analogy it is a definite organism capable of reproducing 

 its own kind under those conditions of filth which we 

 have adverted to as being associated with the spread of 

 Vol. xxviii.— No. 716 



the disease. In the case of anthrax, which causes 

 the so called wool-sorter's disease in man, and in 

 the case of relapsing or famine fever, the microscope 

 has succeeded in showing the organisms which lead to 

 the production of tho-e specific affections ; but in the case 

 of cholera no such results have as yet been attained, and 

 this notwithstanding the laborious microscopic and other 

 researches which have been made in India and else- 

 where. 



Having regard to the fact that choltra is as yet confined 

 to Egypt, and that any spread may be expected to follow 

 on the lines of human intercourse, the most obvious 

 means of staying its spread to this country would at first 

 sight appear to consist in quarantine measures. Such 

 measures are already in force all along the Mediterranean, 

 and even on the Atlantic coasts of Portugal, Spain, and 

 France, but England has decided to adopt no such course, 

 and our Government have acted wisely in arriving at this 

 decision. Quarantine, in order to be efficient, must 

 exclude all the healthy as well as the sick who arrive in 

 our ports after having passed through the infected area, 

 and if there be really reason to believe that vessels so 

 arriving contain within them the germs of infection, and 

 that those on board are liable to contract cholera, the 

 result of detaining suspected fleets of merchant and 

 passenger ships at the entrance of our ports until the last 

 of those who are susceptible have suffered from the 

 disease can be more readily imagined than described. 

 In point of cruelty and selfishness such a practice could 

 probably not find its equal. But, as a matter of fact, 

 quarantine invariably fails to effect its intended purpose ; 

 those countries which practise it most rigidly are those 

 to which cholera has almost invariably spread, and 

 the line of loaded rifles and fixed bayonets by which 

 quarantine measures have surrounded Damietta and 

 Mansurah, the two first towns infected in Egypt, have 

 certainly not succeeded in preventing extension of the 

 disease along the lines of railway in the direction of Cairo 

 and of Alexandria. For some thirty years we in England 

 have trusted to a different system ;^and that system, which 

 is known as one of "medical inspection,'' has received 

 the formal assent of the delegates of the Cholera Con- 

 ference which met at Vienna in 1S66. In -tead of herding 

 the healthy together with the sick, we endeavour to deal 

 with the sick and their infected things in such a way as 

 to prevent the spread of infection to the healthy. To 

 take an example. A ship arrives from Port Said in the 

 Thames. Off Gravesend it is boarded by a Customs 

 officer, to whom written statements as to the health of all 

 present or previous passengers must be made. If any 

 case either of cholera or of suspicious diarrhcea has 

 occurred, the vessel is detained for a period sufficient to 

 allow of a medical examination of all passengers and the 

 crew by an official of the Port Sanitary Authority, who in 

 turn have power to remove to their hospital ship all infec- 

 tious patients, to detain for a period of probation all 

 suspicious cases of sickness, and to disinfect the vessel 

 and all infected articles. The really healthy are however 

 permitted to land, and the vessel itself is detained no 

 longer than is needed in the interests of health. 



So far as the importation of the disease is concerned, 

 our national system tends to greater security than a pro- 

 cess of rigid quarantine, which would certainly be evaded 



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