144 EDITORIAIi. 



Dr. Paul Clements, medical inspector, Bureau of Health, secretary 

 Philippine Islands Medical Association: I wish to say a word on the 

 mortality of cholera and on the factors which influence that mortality 

 in the provinces, where there are no hospital facilities, where the people 

 are not yet educated to the point of valuing the services of a physician, 

 and where the cholera patient is usually left to the care of his immediate 

 family and the mercies of the arholario (herb doctor). 



The mortality during the first two-thirds of an epidemic outbreak fre- 

 quently approaches 100 per cent. Probably 75 per cent die in from six 

 to ten hours, or a little longer, in the stage of collapse; the remaining 

 25 per cent die from three to seven days later, of uriEinia or from over- 

 feeding. Those who die in collapse are frequently not seen l^efore death, 

 by the health officer. The other cases are usually examined by him. 

 On account of the unwillingness of the family to accept medical advice, 

 even when offered gratis, it is rarely possible to do anything, even for 

 the remaining 25 per cent. Owing to the fact that many provincial 

 towns do not possess a drug store, and that the health officer as a cholera 

 campaigner can not carry very much with liim, attempts at medication 

 are seldom practicable even in the few cases which request advice. 



The advice which I have usually given in cases where a request has 

 been made is, to administer coffee, strong and hot, in as liberal a quantity 

 as the patient is able to take, to give the juice of native fruits of the 

 citrus family, and to insist upon complete abstinence from food for at 

 least three days. I have seen on many occasions a cholera patient, who 

 had survived the stage of collapse, whose kidneys had begun again to 

 secrete satisfactorily and who was apparently convalescent, die within a 

 few hours after taking nourishment. It may be possible, in a hospital 

 with a well-appointed diet kitchen and a well-trained nurse, to supervise 

 the administration of nourishment for such patients and to begin allowing 

 food twenty-four or thirty-six hours after the subsidence of the severe 

 symptoms. However, in the absence in the barrios of all such luxuries 

 greater precautions are necessary. The clamor of the patient himself 

 for food, when his appetite returns (as it frequently does within forty- 

 eight hours after the subsidence of the severe symptoms) the disposition 

 of the family to humor and encourage the desires of the patient and 

 their belief that if not fed he would soon starve, must all be guarded 

 against, otherwise a quickly fatal result may follow from indulgence in 

 food. In a few cases in which the patient or the members of his family 

 possessed sufficient knowledge to appreciate and follow the advice given, 

 encouraging results have followed. In fact, stating it broadly, I have 

 come to the conclusion that there should be no mortality in cholera 

 except from collapse or from uraemia. In the latter third of an outbreak, 

 a greater proportion of those affected survive the collapse stage, and the 

 disasters of overfeeding become even more apparent. Dr. Andrews men- 

 tioned in his paper that abortion of pregnant women attacked by cholera 



