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Cholera

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CHOLERA ASIATICA.—An acute infectious disease, characterised by pain, excessive diarrhoea, rice-water discharges, and intense collapse. The disease is endemic in certain portions of India, where it rages most of the time, occasionally spreading to other parts of the globe. In the United States epidemics of cholera occurred at irregular intervals from 1832 to 1873. Since the beginning of the nineteenth century, when the disease became more completely recognised, Europe has had six cholera epidemics ; and local infections, transplanted through shipping, are of frequent occur rence. It is a subject of popular belief that a very hot summer, in which many people are suffering from diarrhceal troubles, has a tendency to bring with it an epidemic of cholera. This is, however, an error, as cholera neither develops of itself nor is due to other diseases or climatic influences.

It can develop only when the infectious materials are transported from India and spread about in other localities.

The germ which causes the disease is a microscopic organism belonging to the low group of plants known as bacteria. It was discovered by Robert Koch, and is called the comma-bacillus or Spiral= cholera-asiaticce. Cholera can be caused only by these germs gaining entrance into the intestinal canal ; either with the food or drink, or in any other accidental way. The germs multiply very fast, and produce toxic substances which are absorbed from the gut and give rise to disease-processes in various parts of the body. The cholera bacilli are thrown off from the body with the evacuations from the bowels ; and the patient's stools and everything else which either directly or indirectly comes in contact with him are therefore means of spreading the contagion. Dryness kills these germs very quickly, however, and they remain infectious only while lodged in or upon objects which furnish a sufficient supply of moisture. In addition to the patient himself, his clothing, wash, excrements, etc., it is well also to regard water, milk, fruit, and other foodstuffs as possible carriers of infection.

The more careful and thorough the study has been of the manner in which the disease has been distributed from its Indian home, the more evident it has become that this transmission has followed the lines of travel and transportation. The contagion is carried from place to place by

infected persons, and not by the wind or similar agencies. In order to protect a country against the invasion, it is necessary to direct the attention to individuals coming from an infected port. Formerly all intercourse was interrupted with localities in which cholera was raging, and travellers were isolated and kept under observation for several weeks before being admitted to free intercourse with others. As a matter of fact, however, it was found that even these stringent rules accomplished very little. Ways and means were usually found to escape the quarantine regulations if an individual was very desirous of doing so ; and the disadvantages and losses resulting from the restrictions placed on trade and intercourse were enormous. In later years the protracted quarantine of travellers has been somewhat modified. Persons coming from infected ports are now allowed to land, but their health is carefully watched, and especial care is taken that every suspicious case is at once reported to the proper authorities for further observation.

It must not be forgotten than an individual may swallow a certain number of cholera bacilli without becoming afflicted with a severe attack of the disease. Many persons thus infected suffer only a slight diarrhteal trouble. and others even less in the way of symptoms ; yet their stools may serve as a source of infection to numerous other more susceptible people. During the prevalence of a cholera epidemic, all cases of diarrhoea must be viewed and treated with suspicion.

The more important precautions to be observed during an epidemic are the following : In the first place one must beware of having too great a fear of becoming infected. It is an axiom of long experience that fear, as well as all other agitated states of the mind, increases the susceptibility of the body to the invasion of disease. Even if cholera breaks out in the locality where one lives, it is better to remain than to go away, because at home one is best able to continue without interruption the usual mode of life and alsa to avoid digestive disturbances, which greatly increase the liability to infection. An attack of diarrhoea, however slight, necessitates immediate recourse to medical advice.

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