620 Asiatic Cholera 



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in the coolies of the Assam-Burmah survey party, where, as far as I can gather 

 from my preliminary information, strong doses have been applied, the number of 

 deaths was reduced to one-seventh. This fact would justify the application 

 of the method independently of the question as to the exact length of time during 

 which the effect of this vaccination lasts. 



"3. In Lucknow, where the experiment was. made on small doses of weak 

 vaccines, a difference in cases and deaths was still noticeable in favor of the in- 

 oculated fourteen to fifteen months after vaccination in an epidemic of exceptional 

 virulence. This makes it probable that a protective effect could be obtained 

 even for long periods of time if larger doses of a stronger vaccine were used. 



"4. The best results seem to be obtained from application of middle doses of 

 both anticholera vaccines, the second one being kept at the highest possible 

 degree of virulence obtainable. 



"S- The most prolonged observations on the effect of middle doses were made 

 in Caljcutta, where the mortality from the eleventh up to the four hundred and 

 fifty-ninth day after vaccination was, among the inocvdated, 17.24 times smaller, 

 and the number of cases 19.27 times smaller than among the not inoculated." 



Serum Therapy. — Pawlowsky and others have found the dog 

 susceptible to cholera, and have utilized it in the preparation of an 

 antitoxic serum. The dogs were first immunized against attenuated 

 cultures, then against more and more virulent cultures, until a 

 serum was obtained whose value was estimated at i : 130,000 upon 

 experimental animals. 



Freymuth* and others have endeavored to secure favorable 

 results from the injection of blood-serum from convalescent patients 

 into the diseased. One recovery out of three cases treated is 

 recorded. 



In all these preliminaries the foreshadowing of a future thera- 

 peusis must be evident, but as yet nothing satisfactory has been 

 achieved. 



One of the chief errors made in the experimental preparation of 

 anticholera serums is that efforts have been directed toward endow- 

 ing the blood with the power of resisting and destroying the bacteria 

 that rarely, if ever, reach it. The two essentials to be aimed at are 

 an antitoxin to neutralize the depressing effects of the toxalbumin, 

 and some means of destroying the bacteria in the intestine. 



Sanitation. — The first appearance of cholera may depend upon the 

 introduction of the micro-organisms upon fomites, hence to avoid 

 epidemics it is necessary to disinfect all such coming from cholera- 

 infected locahties. 



So soon as cholera asserts itself, the chief danger lies in the prob- 

 able contamination of the water-supply. To prevent this the 

 utmost effort must be made to locate all cases and see that the de- 

 jecta are thoroughly disinfected, and as the micro-organisms persist 

 in the intestinal discharges for some weeks after convalescence, the 

 patients should not too soon be discharged from the hospital, but 

 should be retained until a bacteriologic examination shows no more 

 comma bacilli in the feces. During an epidemic the water consumed 

 should all be boiled, raw milk should be avoided, and no green or 

 uncooked vegetables or fruits eaten. Foods should be carefully 

 * "Deutsche med Wochenschrift," 1893, No. 43. 



