NATURE 



629 



THE CHOLERA EPIDEMIC OF 1884 



THE reappearance of cholera in an epidemic form in 

 European countries after a comparatively long 

 absence is a matter of considerable concern, not only on 

 account of the severity of the existing epidemic but also 

 in connection with the prospects which are in view with 

 respect to the coming year. A great westward diffusion 

 of cholera in the Eastern Hemisphere began in 1863, it 

 was continued almost uninterruptedly to 1873, and the 

 disease not only clung with considerable tenacity to 

 certain towns and districts for two and three years at a 

 time, but in some cases after it had apparently subsided 

 for good, there came recrudescences of the disease after 

 long intervals. From 1873 t0 tne present year the 

 greatest danger which Europe has incurred as regards 

 cholera was during the Egyptian epidemic in 1883, but 

 there is no reason to believe that the outbreak which is 

 still prevailing in Southern Europe was in any way con- 

 nected with that epidemic. On the contrary the evidence 

 tends to show that it was imported by means of an imper- 

 fectly disinfected vessel, the Sarthe, on which cases of 

 cholera had occurred. 



Toulon was first infected about June 18, and from that date 

 up to the present time, when only occasional deaths take 

 place, nearly 8S0 fatal cases have been officially recorded 

 there. The first cholera deaths in Marseilles occurred on 

 June 27, the disease spread with great rapidity, reached 

 its most fatal stage about the middle of Jul}', and, includ- 

 ing the few deaths that are now and again still registered 

 there, the total mortality, according to official records, 

 has fallen but little short of 1700. During the third week 

 of July scattered cholera deaths occurred in a large num- 

 ber of the southern departments, in many localities the 

 disease spread widely, and even during the earlier part of 

 the present month, fresh deaths were still recorded from 

 the department of the Pyrenees Orientales. In all, the 

 French cholera mortality which has been recognised in 

 official publications has, during the present year, not 

 fallen far short of 3500. 



Towards the third week in July cholera had made its 

 appearance in Italy, and it spread with great rapidity 

 during the month of August through the north-western 

 part of the kingdom. Towards the end of the month 

 several places in the south, including Naples, became 

 infected. During September the diffusion in the north, 

 as also in and around Naples, greatly increased ; the mor- 

 tality in certain towns, such as Naples, Spezia, Busca, and 

 Genoa being very heavy. A general subsidence of the 

 disease has now set in, but the published mortality already 

 reaches nearly 10,300, over 6500 of the deaths having 

 taken place in the city of Naples. 



In Spain the epidemic was first officially recognised 

 during the first week of September ; it has been to a large 

 extent limited to the province of Alicante, which abuts 

 on the Mediterranean, and since the middle of October 

 no further cholera deaths have been recorded. Some 

 600 fatal attacks are, however, known of. But whether 

 it be Spain, Italy, or France that is in question, it is more 

 than doubtful whether the statistics hitherto published by 

 Vol. xxx. — No. 783 



any means include the total deaths that have occurred. 

 The French records are probably the most correct, but 

 these will have to be revised before they can be regarded 

 as in any way accurately representing the extent of the 

 epidemic. 



The very general subsidence of the epidemic which has 

 now set in suggests two questions which are of great 

 international importance. In the first place : — What 

 experience has the epidemic afforded as to the measures 

 which should properly be taken to stay the spread of 

 cholera ? The system of sanitary defence which has been 

 adopted by France, Italy, and Spain has been quarantine ; 

 the energies of all three countries have been engaged in 

 enforcing the system of land quarantine, with its sanitary 

 cordons, its lazarettos, and its fumigations ; and that 

 system has utterly broken down at all points. In France 

 the absolute impossibility of maintaining it and the use- 

 Iessness of adhering to it only in part led, early in the 

 course of the epidemic, to its abandonment, except 

 in so far as the maintenance of certain processes 

 of fumigation, in order to satisfy the public, are concerned. 

 But with Italy the matter was different. No advantage 

 had been taken of the lesson taught and bitterly enforced 

 during the previous Italian epidemics, as to the intimate 

 connection which exists between cholera and the reten- 

 tion about human dwellings of those conditions which 

 befoul both air and water ; filth abounded in by far the 

 majority of her cities, towns, and villages ; her only 

 chance was to trust in that which had failed her before, 

 and she clung to her cordons of troops and other allied 

 measures with a tenacity that could not well be exceeded. 

 But, as was pointed out by Mr. Simon many years ago, 

 quarantine is impracticable except when planned with the 

 precision of a scientific experiment and conducted with 

 extreme rigour, and even then it is not conceivable as a 

 system of national defence for the purposes of countries 

 communicating with each other by means of great high- 

 ways of traffic and of commerce. And so it has turned 

 out. Cholera took no heed of the lines of troops, whether 

 at the frontier or around the infected districts ; it diffused 

 itself along the lines of human intercourse as if without 

 let or hindrance, and the very cordons and lazarettos 

 assisted in the process of the spread ; for the fear of the 

 cordons led to the flight of an infected population before 

 the line of bayonets could be established, and the lazar- 

 ettos became, by the mere aggregation of sick and 

 healthy under conditions as unwholesome as can well be 

 conceived, fresh centres of infection. If it were not that 

 the prejudices of an ignorant public had to be taken into 

 account, land quarantine in Western Europe would pro- 

 bably never be heard of again. So far as measures of 

 sea quarantine are concerned, it suffices to say that, ac- 

 cording to the Revue d' Hygiene, Algeria became infected 

 early in October by means of its communications with 

 the southern ports of France, and that the diffusion of 

 the disease to Spain must be regarded as having taken 

 place by means of the sea-port of Alicante. In short, 

 everything that has occurred during the present epidemic, 

 including such occasional importations of choleraic cases 

 into our ports as occurred last month at Cardiff, has gone 

 to show that the substitution by this country of a system of 

 medical inspection and of isolation in the place of qua- 

 rantine has, both in its direct application and by the 



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