Articles of diet on which the germs of cholera are usually found, such as fresh fruit, vegetables, and milk, should always be thoroughly boiled before being eaten, unless their source is free from suspicion. Water which has been contaminated by contact with the excreta from cholera patients is often the source of infection. For all household purposes, only such water should be used NVilidl conies from sources of supply known to be uncontami nated, and if there is any doubt, the best thing to do is to boil it before use. During the prevalence of cholera it is best to avoid houses in which the disease is known to be present, and also all public meetings and places of amusement where many people congregate. Neither is it wise to lodge persons in one's house who have come from infected localities ; and all articles which have been used by patients must not again be employed unless thoroughly disinfected. Public baths and toilets should be avoided. Absolutely no value attaches to the numerous proprietary prophylactic remedies which regularly appear during a cholera epidemic. They benefit no one but their manufacturers and sellers.
If, in spite of all these precautions, a member of the family is attacked by the disease, it is advisable to send the patient to a hospital. Aside from the experienced care and attention which is enjoyed, there is the additional advantage that all the infected clothing and the excreta can be properly disinfected, and that in this manner further contagion can be to a great extent avoided. If the patient remains in the house, it is necessary to isolate him completely, together with his nurse. Extreme cleanliness is one of the most essential things. The stools and soiled articles must be disinfected in the way prescribed by the physician. During the period of the disease nothing must be removed from the sick-chamber. The nurse must not be per mitted to take any food or drink while in the patient's room, and she must wash her hands thoroughly every time she has touched the sick person. In
case of death, the body should be removed from the house as soon as possible, placed in the casket without being washed, and buried with little or no public ceremony. After either recovery or death, the room should be thoroughly disinfected as described in the article on DISINFECTION.
it is necessary for the public authorities to consider every inmate of the house in which a case of cholera exists as capable of carrying infection ; and it is therefore necessary that they be subjected to certain rules and regulations.
Cholera in its severer forms begins in from twelve hours to five days after the reception of the contagion in the intestinal tract. The first symp tom may be an apparently harmless diarrhoea, gradually succeeded by all the other symptoms ; or the disease may be marked from the very begin ning by severe vomiting and diarrhoea. The evacuations become very numerous and resemble rice-water or pea-soup. In a few hours the patient may become rapidly exhausted from the resulting weakness. The skin is dry and cold, and when pinched into a fold it remains thus ; the face displays an expression of suffering ; the voice is dull ; a burning thirst is felt ; the quantity of urine steadily diminishes ; and painful cramps in the muscles, especially in the calf of the leg, torture the patient greatly. The weakness increases, and death ensues. Even when the symptoms improve and the patient appears to revive, a favourable prognosis is by no means certain. He often succumbs after days or weeks from the consequences of the attack. As has already been stated, not all cases of cholera run such a virulent course, and many much milder ones occur. Many of the very severe ones also end in recovery.
There are no specific remedies or methods of treatment with which recovery may be assured in the severe cases of cholera. Nevertheless, timely and appropriate medical care will do much to diminish the sufferings entailed by the disease, and also to sustain the strength of the patient.