adequate protection of such people is a hopeless task, but there are always more or fewer white people in such countries who must also and with whom an appeal to reason is not apt to be disregarded.
In countries in which cholera is epidemic or endemi therefore, the areas in which water is collecte that is to say water sheds, must be protecte religious pilgrimages by which cholera is constantly carried from one country to another must be discouraged by government, and the milk supply, which is so easily con taminated by polluted water, by flies, and by other food, must undergo rigid public super vision.
Preventive measures on the part of local and general governments will also consist in keeping the public streets absolutely clean, in efficient drainage, in careful collection and dis posal of garbage and sewage, in fumigation and disinfection of public and private buildings and private property wherever such attention may be called for. Preventive measures on the part of individuals may consist in (1) Pre ventive inoculation. (2) Personal hygiene. (3) The treatment of all forms of diarrhoea and of bowel disorders in general.
1. Hafflcine's method of preventive inocula tion is as efficient as any which has yet been tried. It consists in the subcutaneous injection of a culture of living and virulent Cholera microbes. An injection of nine minims has been found sufficient as an average dose for an adult. The germs die shortly after their injection, and yield an antitoxin which gives protective immunity from cholera for a few weeks or months though it was not found that it had materially lessened the mortality from cholera in India.
2. As to personal hygiene those who are new arrivals in a cholera infested district are usually more susceptible to the disease than , those who are acclimated.
As far as possible, in the presence of cholera, fatigue, worry, the use of unripe fruits and uncooked vegetables must be avoided. Decomposed food, especially fish, must be avoided with religious care, also stale milk, unboiled or dirty water and alcohol in all forms. Food should he carefully screened from flies; flies should be kept out of the house and should not be allowed to breed in yards ' and stables. Milk and water should he boiled, the hands and vessels of all kinds should be kept scrupulously clean and if a water filter is required only one of some standard variety should be used.
3. In the preventive treatment of bowel disturbances salines and purgatives should be avoided and a choice may be made from the following astringents: chlorodyne, laudanum, catechu, kino, asafoetida, black pepper and opium, lead and opium, and chalk and opium.
If a person has diarrhoea, when cholera is epidemic it will be wise for him to go to bed . and remain there until his diarrhcea is relieved.
Treating during the disease varies accord ing as the stage is that of (1) invasion, (2)' collapse or (3) reaction.
1. In this stage it is essential that the patient be in bed, in the recumbent positionand ' that the bed he warm and the body The ' room should be darkened and kept at a tem perature not exceeding 70° F. The patient must be kept quiet, he must have litilie or no company and be given plenty of iced water, but not enough to provoke vomiting. For the relief of the cramps in the bowel he may in hale chloroform, or be rubbed with a suitable anodyne liniment, • or applications of turpen tine or mustard may be applied to the abdomen. Morphine may be given hypoder mically if necessary. The antitoxic sea have' been used in various countries in the treatment during this stage hut without very results. The Japanese are the only ones who speak with confidence of this method of treat ment.
2. In the stage of collapse it is necessary to stimulate the patient as vigorously as his strength will allow.' Alcohol in the form of brandy, whisky, or champagne may be given by mouth, also nitrite of amyl, nitro-glycerine,, and hypodermics of ether. A very efficient form of treatment consists in the intia-venous injection of a normal saline solution...A pint may be injected in the course of ten minutes and this may be given as many as three times' if the conditions warrant it.
3. In the stage of reaction the bladder and kidneys must be carefully attended to there is sometimes suppression of the urinary secretion or retention of urine within the bla der. In such cases heat may be applied over the kidneys, or wet or dry cupping be practised. The retained urine must be withdrawn with a catheter. If the diarrhcea continues hot injec tions of a suitable astringent may be slowly ad ministered, and bismuth may be given by mouth.
In all cases the food must be simple and easily digested, the stools disinfected, the clothing sterilized, and the hands of nurses and attendants sterilized.
Latham and English, 'A System of Treatment' (1912) ; Osler, 'Princi ples and Practice of Medicine' (1912); Mel ville,