i8i8 



THE CHOLERAS 



rafts, for it must be remembered that cholera is very apt to be 

 introduced by persons travelHng along rivers. 



Any suspicious case must be detained for five days in quarantine 

 in suitable isolation hospitals erected near the frontiers, while the 

 sick must be tended in special hospitals with all the precautions to 

 be mentioned later. 



Merchandise does not, as a rule, require any disinfection, unless 

 there is reason to suspect that some of it has been fsecally con- 

 taminated from a case. 



When an epidemic begins, the first duty is to form a special 

 Cholera Board to deal with the outbreak, and this Board should be 

 composed of financial and legal authorities, as well as of doctors 

 and bacteriologists. This Board will form the central authority for 

 the control of the epidemic. All suspicious cases must be reported 

 to this central authority at once. 



Then central and outlying bacteriological stations must be pro- 

 vided, and special hospitals and isolation hospitals built, and, if 

 possible, nurses and medical men obtained who have some practical 

 knowledge of the disease. If time permits, it is as well to have 

 these vaccinated against the disease, but it should be remembered 

 that five days must elapse before the immunity is effective. 



Arrangements must then be made for the prompt bacteriological 

 diagnosis of cases, for the prompt treatment of all disorders, espe- 

 cially intestinal, and extra dispensaries must be opened, and the 

 public informed of the necessity of availing themselves of these 

 medical arrangements. If necessary, a house-to-house inspection 

 should be made, in order to find out if there are mild concealed 

 cases, and nobody should be buried without a proper medical 

 certificate. 



All patients must be removed to the hospitals, and the houses 

 disinfected with the Clayton gas apparatus, in order to kill not 

 merely the germs, but also the flies and ants. If this is not avail- 

 able, formalin sprays, together with burning sulphur, may be used. 

 Fomites should be carefully disinfected, and persons attending the 

 sick must avoid infection by careful disinfection of the hands and 

 by wearing overalls. 



The dejecta of patients should be carefully disinfected with cyllin 

 or carbolic acid, and no patient should be liberated from the hospital 

 until bacteriological examinations of his faeces on three successive 

 days are negative. This is a most necessary precaution, because 

 otherwise he may spread the germs broadcast for a period of about 

 six weeks at least. 



Care must be taken to disinfect and bury the dead with least 

 chance of the infection spreading. Cremation should be encouraged 

 in preference to burial. 



A systematic search must be made for the origin of the infection, 

 and drinking-water, well-water, etc., must be regularly examined 

 bacteriologically. Dangerous wells must be closed, and all wells 

 may be Hankenized — i.e., disinfected with permanganate of potash. 



