NATURE 



2 u 



THURSDAY, JULY 3, 18S4 



CHOLERA AT TOULOX 



THE doubt which existed as to whether the outbreak 

 in and about Toulon was true cholera or only the 

 sporadic type of the disease must be regarded as set at 

 rest ; indeed, from the date when the details of the out- 

 break first became public, it is probable that those who 

 declared the affection to be only of a local and sporadic 

 character were mainly influenced by political motives. 

 Dr. Fauvel apparently now stands alone in the determi- 

 nation not to admit that the epidemic is the same as that 

 which is known as Asiatic in type, and the fact that the 

 source of the infection cannot by any chance be attributed 

 to England is almost enough of itself to mould the views 

 of this able physician. The onset of the disease, the 

 sudden outbursts during its subsequent course, its diffusion 

 to other towns and places, and notably to Marseilles, and 

 the fatality attending it, all prove that we have not to do 

 with the disease which in this country goes by the name 

 of English cholera, and which when occurring in hotter 

 climates and under favouring conditions of filth is known 

 as sporadic, but with true cholera, such as was imported 

 into the south of France and into England from 

 Alexandria in 1865 and 1866. 



Of the future course of the epidemic it is at this stage 

 almost impossible to speak with any authority, but it is 

 very certain that occasional lulls in the number of attacks 

 — occurrences which are immediately reported as indi- 

 cating a subsidence in the outbreak— cannot be regarded 

 as having much significance in this respect ; for it is one 

 of the essential characteristics of cholera, especially in the 

 early stage of an epidemic, to exhibit periodic fluctuations 

 both in the number and in the intensity of attacks. So, 

 also, the hold which cholera acquires in any town or 

 district is largely dependent on the sanitary circum- 

 stances of the locality, and it is well known that in Toulon 

 the conditions of filth which so especially favour the 

 spread of that disease are exceptional in point of general 

 prevalence and intensity. Marseilles stands much higher 

 in this respect, but French towns which are regarded as 

 ranking among the most advanced in so far as their 

 sanitary circumstances are concerned stand but low in 

 the scale when compared with the healthy towns of 

 England. 



Another circumstance has rendered it well-nigh im- 

 possible to foretell events, and that is the flight of panic- 

 stricken persons to all parts of the country. Instead of 

 dealing with the outbreak in its early stage, the French 

 authorities made a secret of the matter, and by the time 

 that the Government which takes precedence of all others 

 in extolling the virtues of cordons sanitaires were prepared 

 to act, they found that their secret had oozed out, and 

 that thousands had fled beyond all cordons ; and so once 

 again the fear of restrictive measures such as quarantine 

 and its allied practices has defeated the very objects 

 which the advocates of that system so unhesitatingly 

 claim for them. 



Bringing the lesson of the epidemic home to ourselves, 

 it must be admitted that, with the constant communica- 

 Vol. xxx.— No. 766 



tion which exists between the various French and English 

 ports, we are not free from the risk of having cholera im- 

 ported. To prevent importation by imposing a lengthened 

 quarantine on the almost numberless vessels arriving in 

 England from the various French ports would be an im- 

 possibility ; and our Government, fortified by the decision 

 of the last European Conference held at Vienna, will un- 

 questionably trust, as heretofore, to a combined system of 

 inspection and isolation. For this purpose all the Orders 

 and Regulations which were re-issued during the preva- 

 lence of cholera in Egypt last autumn remain in force, as 

 also does the special provision that persons removed to 

 the hospitals of the Metropolitan Asylums Board are not 

 to be regarded as having become pauperised in conse- 

 quence of such removal. At our various ports vessels 

 arriving from infected places will be inspected, first by 

 the Customs Officers, and then by the Sanitary Officers 

 of the ports ; all cases of cholera or choleraic diarrhoea 

 will be at once removed to such hospitals as have been 

 provided for the purpose ; any doubtful cases will be de- 

 tained to undergo a short supervision ; the healthy will 

 be allowed to land ; and no detention of the ship or of 

 persons on board will exceed forty-eight hours, a period 

 regarded as ample in view of the short period of incuba- 

 tion in the case of cholera. 



Last year, when the question of the importation of cholera 

 from Egypt was so urgent, the Local Government Board 

 issued a special Memorandum to port, urban, and rural 

 sanitary authorities, urging them to observe the utmost 

 cleanliness in relation to all sources whence any pollution 

 of water drun'c or of air breathed could possibly emanate, 

 and a vast amount of valuable sanitary work was carried 

 out with the object of preserving water-sources from con- 

 tamination, of excluding sewer and drain air from dwell- 

 ings, and procuring the rapid and regular removal of all 

 sources of nuisance and offensiveness from premises. 

 We shall this year profit from so much of that work as 

 was of a permanent character ; but since it is essentially 

 on cleanliness of all our surroundings that we must rely, the 

 work of 1883 should be continued and renewed this year. 

 Such work is never wasted. Even should cholera die out 

 in the south of France, and never come nearer to us than 

 it has done already, progress in sanitary work will be 

 amply remunerative in the prevention of those diseases 

 which, in point of origin, so much resemble cholera, and 

 it will, in addition, tend to the moral and social improve- 

 ment of those who only cling to filthy surroundings 

 because the means of cleanliness have never been pro- 

 vided for them. 



We are glad to learn that Dr. Koch, the chief of the 

 recent German Cholera Commission to Egypt and India, 

 has left Berlin for Toulon. His journey is undertaken 

 partly at the wish of the French Government, who are 

 anxious to know more of the methods of investigating and 

 suppressing cholera which that gentleman has pursued 

 with such signal success. Dr. Koch is going to France 

 alone, although he had full permission to take with him 

 any of his recent colleagues in Egypt and India- 

 Moreover, the German Imperial Cholera Commission 

 has concluded its deliberations. The result has now 

 been submitted to the Government, and will be imme- 

 diately published. The Commission holds that the sani- 

 tary condition of Germany in general is not favourable 



