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Specially compiled and prepared for public distribution, from latest authorities, up to February, 1893, by Edward Playter, M.D., Editor of the " Health Journal." author of "Elementary Physiolofry and HyKieno " (authorized by the Ontario Education Department), " Coiisuinptlon, its causes and prevention in Man and animals," " The Lungs and how to preserve and strengthen them," " Statistical Report on causes of Consumption," &c., &c. WHAT IS CHOLERA? Cholera has been defined by Mr. Ernest Hart, the very able and active editor of the British Medical Journal, and his definition is uni- versally endorsed, as " A filth disease, carried by dirty people to dirty places, " The germs of cholera, without which the disease cannot develop, are, like the germs of all the infectious epidemic diseases, living microscopic organisms, of the lowest or simplest type — thousands of them living unperceived in a drop of water, and which, it appears, develop and grow only on decaying organic matter. They are called vibrios, or, as more commonly referred to, the "coma bacillus" of Koch, who first definitely discovered and pointed them out a few years ago. They are now cultivated in the laboratoiy and their nature and habits are fairly well known. They exist in abundance in discharges from the stomach and bowels of those suffering from the disease, and may live and retain their virulence for some time in collections of filth. Hence, they doubtless often exift in dirty clothine:, by which they are commonly carried from place to place. They gain access into the body only by way of the mouth, it appears, and, although we may eat and drink them, we cannot "catch" them, or the disease, in the sense in which we catch scarlet fever, small-pox and the like. It must be remembered, however, that the cholera germ is but one factor in causing the disease, and that there is, as in the case of all the infectious diseases, a second equally essential factor, and with- out which the disease cannot develop. This second factor is the suit- able soil for the growth and multiplication of the germs — the receptive human body— the body not perfectly healthy, sound, vigorous, clean, in every respect, especially throughout the digestive canal (the stomach and bowels), from unhygienic habits of life anl surround- ings. Such receptive soil is, unfortunately, abundant everywhere. The home of cholera is in India, where, it appears, in many places the disease constantly prevails, owing to the filthy habits of the na- tives, who, contrary to their religion, drink from the tank in which they bathe their bodies and wash their clothes. From India the die- ease has always been brought to Europe alony its recent route, through Russia, or, by the Mecca pilgrims, to the sliores of the Red Sea, and thence to the Mediterranean, and brouglit along the lines of travel, by travellers, in their bodies or clotliing or merchandise, and. as Mr. Hart recently said in a lecture on "The Cholera," "wo may lay aside all pedantry and mystery — talk of ' epidemic constitution,' ' pandemic waves,' atmosplieric influences, and such like terms, with which ignorance has been cloaked, as in any way applicable to the cause of the spread of cholera. The disease stalks deliberately along from place to place as a mighty scavenger, lingering long, and with [terrible vengeance, in dirty places (" the soul that sinneth, it shall die,"), but passing by the clean. Dr. Max Von Pettenkofer, who has made a special study of the habits of this disease, says : " One of the established facts concerning epidemics of it, is the tendency of the disease to rage most where the greatest filth prevails." In epidemics not only is it always more prevalent and fatal in unsanitary localities, but it has been known, time and time again, to entirely pass by and around clean, well- drained places. Even in Calcutta, Madras and other cities of India, where the sanitary conditions have been made good, the disease is rare. So, where there is no dead, decomposing, fermenting, putrefy- ing organic matter, — no filth of any sort— in the air, water, soil, or in human bodies, — where all is absolutely clean, pure and sweet, there will be no cholera. OUR LINES OP defence: THE QUARANTINES AND PROVINCIAL BOARDS. These are two: One, the quarantines, for preventing as far as possible the entrance of the disease or its germs into the country. In Europe quarantines have been defined as an "elaoorate system of leakiness; im- possible if complete, because implying isolation and arrest of inter- course ; useless and dangerous if incomplete, because inviting a false reliance and offering a false security." Pettenkofer says : " Measures to prevent the spread of cholera by interfering with human intercourse are, for many reasons, impractic- able. If asked what good has resulted from sanitary cordo.MS, inspec- tion and quarantine, we ai'e bound to answer. None. All have failed because they simply treat the indi>idual, while the germs may be transmitted in the absence of the disease." In this country qua* rantines may doubtless be of much service, and should be efficiently maintainsd They may at least prevent a large proportion of the germs which cross the oceans from entering the country, and so serve as much purpose as the system of " customs" does against smuggling. The other or second line of defence consists of three inner lines. The Provincial or State boards, the Local or Municipal boards, and, as important as any, if not moreso, Individuq,l Action and Care, These J I i I — H te, through id Sea, and : travel, by nd. as Mr. may lay nstitution,' ike terms, plicable to eliberately ; long, and sinneth, it udy of the joncerning where the y^ays more en known, lean, well- s of India, e disease is g, putrefy- L soil, or in ?eet, there L BOARDS. as possible In Europe nness; im- of inter- ng a false lolera by mpractic- is, inspec- ive failed may be try qua- fflciintly n of the so serve uggling. ner lines, rds, and, e. These deal mainly with the second factor of the disease, the soil, the filth, the recflptive or fit body or individual person. The watchword, in these three inner lines, should be, in the words of Miss Nightingale, Scavenge ! Scavenge ! Scavenge I or. Scavenge, Disinfect, White- wash ; Clealiness, Purity, everywhere, around the bodies of the people and within them . As Mr. Hart says, (Brit. Med. Jr., Sept. 1892), " keep your houses, your cisterns (or well)), your stables, cowsheds, pigsties and slaughterhouies, your drains, yards, your clothing and YOURSELVES clean, and help your neighbors to do so . " Most of the provinces, if not all, now have each a Board of Health, or some form of organization, by which provincial authority can be brought to bear on the various municipalities, and by which a certain amount of local action will be secured, and we, may rest assured that in the t>vo principal and central provinces, and probably in all, every legitimate means will be put in operation for aiding, en- couraging and even enforcing municipal preventive effort. WHAT THE MUNICIPALniES SHOULD DO. It is, however, in and by the various cities, towns, villages and rural districts, even in the subdivisions of these — the separate wards and communities, that the practical work must be accomplished. Here, to every man, and woman too, must be " brought home " the necessity for prompt and energt^tic work ; here the watchwofds must be loudly and distinctly sounded, — cleanliness, purity, everywhere. There is even now abundance of time, with reasonable activity and push, to have every place made so perfectly clean and pure that the cholera germs, which will most likely find their way into many com- munities, could find no soil in which to take root and grow. Will you, reader, risk the consequences, the serious, perhaps terrible con- sequences, of apathy and inactivity ? But while every man should feel it incumbent upon him, for his own sake as well as that of others, to take a personal interest in all preventive measures, it must be remembered that in public health work as in everything else, what is everybody's business is apt to be regarded as nobody's buisness, and therefore a full and sufficient number of Health Officers— of pliysicians and inspectors— should be early appointed in every municipality whose sole business should bj to attend to sanitary work. All streets, lanes, vacant lots, and especially back yards, should be thoroughly cleaned ; sow grass seed of some sort plentifully whore- ever possible; and most particularly must those woict of all abomi- nations, the privy pits, be completely emptied and disinfected, or far— far better, entirely abolished, and earth closets substituted. Slaughterhouses, piggeries, stables, cow byres and certain kinds of manufacturing establishments must be looked after closely and all T ._4_ thoroughly renovated. Pools of Btagnant water must l)e made dry. All sewers should be freely and freciuently flushed and inspected in order that there shall be no pools of stagnant sewage in them, and all street gratings carefully cleaned and freely disinfected at repeated intervals. Inspectors should juake a most careful and close house to house inspection and see that all premises , even to the cellars, are well looked after, as above pointed out. If not done by the occupants, it!iust be done by the municipality, at the occupants' expense. In cities there are usually overcrowded, badly ventilated, filthy houses, which must bejespeoially set in order, as such places, in the event of an epidemic, are commonly the centres of outbreaks. The condi- tion of lake and river steamers, and of the " closets " of railroad Htations and cars, should be closely looked after. In most villages, towns and cities, old decaying wooden pavements are to be found, often saturated with moist fdth. These should be carted away and burned. All this cleaning should be done before the hot season sets in. In times of pestilence it is not well to disturb collections of filth. Better to disinfect the surface and cover with a layer of dry earth. The poor, in cities, must be looked after that they do not Buffer from want of cleanliness and proper food and lodging, and so become centres of outbreaks, and that they be provided with prompt medical attendance in case of illness from suspected cholera, or even diarrhoea . Drainage of the soil is very important . A damp eoil, especially when containing much organic matter, or any filth, is particularly favorable to the spread of cholera and all zymotic diseases. Deep open drains are much better than none. A good water supply is of great importance ; a bad supply has long been associated with great prevalence of cholera. Pettenkofer says : " All towns which have been provided with good drainage and water supply have lost their susceptibility to cholera." Bad water seems to be most active, of all agents, in the spread of this disease. Have public water supplies made as good as possible and all wells thoroughly cleaned; taking care that there can be no after contamin- ation of either. In times of cholera, all water should be well boiled first before use. No filter can be relied upon, but a filter may be used to improve the water, boiiin? it afterwards. Thorough boiling just before drinking it is the only means of making water absolutely safe. The food supply offered for sale in the markets and elsewhere requires frequent careful public inspection. This is especially im- portant in times of cholera. Every sort of food offered to the public should be sound and pure and of good quality. Butchers' meats must be fresh and free from any blemish, and all cured or canned meats, good and free from trace of taint. Fruits especially and many vege- table neei^close inspaction, that they shall ba entirely free from un- I — 5 soundness. Unripe as well aa decayed fruits should be interdicted. The quality of the milk supply, and especially the source of it, must be closely looked after. The ice supply too noods looking after, and ice never should be used in any food or drink and only near it for the purpose of cooling and preservation . INDIVIDUAL PREVENTIVE MKASURES. Upon individual or personal measures or habits, and individual health, purity and vitality, more, after all, than upon anything else, depends the extent to which the cholera (perhaps more than almost aay other disease) will develop and spread in any community when the disease has found its way in. If the body -the blooci and other fluidfi, and especially the digestive canal, be clean, pure and free from all worn out waste, or fermenting excremental substances of every sort, it is believed by the beat authorities that the germs of this disease (or of any of the other infectiouf? diseases) will not develop and multiply in the body, even should they be taken into it in any- way. It is thei-efore of the first importance that each and every indi- vidual attend well to the bodily condition. One cannot be in abso- lutely good health and have a pure body in the midst of unhygienic surroundings. But even with breathing a somewhat impure afrmo«- phere, as from neighboringfoul sources, perfectly good living in all other respects would moat likely secure immunitj'. One chief cause of waste fermenting impurities in the body is over-eating— eating more than the nutrient organs can digest, assimilate and dispose of— more than is needed for the due performance of the bodily functions; while ex- cesses of all sorts weaken the nutrient functions and render the organ- ism less able to throw off the waste of the body or other impurities. The United States Consul at Genoa, in a communication to the Home Government, during the time of cholera at Toulon and Marseilles a few years ago, states that the Sunday excesses among the laboring classes proved a pjowerful feeder of the epidemic. The strictest tem- perance in all things is therefore of the first importance. With a wisely judicious mod-'ration in eating, regularly, plain, digestible but nutritious, pure, sound, well cooked foods, with thorough mastica- tion, and the careful avoidance of all foods not fresh and pure : drinking pure water ; careful attention to the condition of the skin and bowels (by bathing and the use of flannel undferclothing)— keeping these organs free from waste fermenting substances, and with regular habits as to exercise anl sleep, and a tranquil, fearless mental condi- tion ; and in times when cholera is present, attention to the details given below, no one need have any fear of the cholera; — excepting fear for those who do not practice such habits. The above precautions, with such as follow below, may seem to many persons very hard to carry out. But with a little time .and care they are within reach and accomplishment of all. The cholera comes only after great sanitary transgressions ; it is a hard and cruel master ; often those who transgress little, suffer from it with those who transgress much . When cholera is present in any place —city, town or community of people, extra precautions must be ' racticed. It is indeed only by ATTENDING MOST CAREFULLY TO THii MINUTEST DETAIL in preventive measures that one can fairly expect to escape it, and by attending Btrictly to such details, one may be fairly assured of escape. Neglect (J — not therefore one point — one iota, of them respocting cleanliness, disinfection, diet, &c. The jjerms of the disoaso are always present in countloaa numbers in the dischar^tw from the stomach ana bowels of persons sick with cholera, even in mild cases which seem to be but simple diarrhcea, and if these discharges bo not iminodiately and thoroughly disinfected (or to a certain oxtont perhaps even with disinfection) certain of the germs get scattered and carried about in all sorts of ways, and settle on all sorts of tilings, — foo Is and other articles. Flies and other in- sects undoubtedly carry tliem. Tlie disease is then " taken " by these germs finding their way into the mouth and stomach of receptive persons, who provide the soil. Tlie germs may chance to get into the mouth therefore with any sort of food or drink, or from the fingers, from knives, forks, npoons, plates, cups, &c., or from pens, money and the like, if these tilings be put inside the lips. Hence, the great care which everj body should exercise. The following " dont's " and other suggestions are chiefly abbreviated from a sheet distributed by the New York City board of Health, and one by the Imperial Board of Health of Germany. Heat — thorough cooking, destroys the cholera germs ; therefore, don't eat raw or unc(Joked articles of any kind, nor drink unboiled milk or water. Don't eat or drink articles which are usually cooked unless they have been thoroughly and recently cooked, and the more recent, and the hotter they are, tlie safer. Sterilize bread by toasting. Don't eat or drink to excess. Don't employ utensils in eating or drinking unless they have been recently put in boiling water ; the more recent the safer. Don't eat or handle food or drink with un- washed hands, or ivcoivo it from the unwashed hands of others. Don't use the hands for any purpose when soiled with cholera discharges; thoroughly cleanse them at once. Thorough personal cleanliness, and cleanliness of the living and sleeping rooms and their contents, and thorough ventilation, should be rigidly enforced. Wash the hands frequently every day with pure water, soap, pumice stone and nail brusii, especially before eating. If the hands have touched any suspicious object, first wash them carefully with a solu- tion of four teaspoonfuls of good clear fluid carbolic acid to a quart of water (5 p.c. solution), then with the clean water, &c. Avoid over fatigue and exposure to damp and cold, and over-heating, often fol- lowed by chilliness ; jlso ice or iced food or drink, sudden changes in diet, and long fasting. Persons troubled with weak digestion or habitual diarrhoea should be doubly careful. A flannel bandage v/orn around the body would be useful in such cases. Should any person be taken ill with cholera, or suspected cholera, when the disease is prevalent, friends and neighbors, or even strangers, must not let cowardly fear prevent them giving proper attendance to the fellow creature in distress . With strict care, on the lines indi- cated herein, little or no fear need be experienced by any one attend- ing cases of cholera. Don't be frightened but do be careful. When the disease raged in Chili in 1886-7, no doctors, nurses or attendants in the many hospitals, sickened, it is stated, who adhered strictly to the rules laid down, and as herein given. Thei'e was great care exer- cised in washing and disinfecting the hands, the bread was all freshly toasted, and all dishes just before being used at meals were thoroughly heated by the flames of burning alcohol. Caps and long aprons, from chin to feet, were worn If one be taken ill on the street, he, or she, should be taken to the nearest drug store, dispensary, hospital or police station. In any % ■s; < — COSH, on tlio llrst syiiiptoins a plivHiciaii should bo sont for at oiico. Don't flolay a moment. If ono cannot Im soon obtained, a few oiKMmfuis of }.;ood brandy witii five to twenty drops of laudanum might well be given, and a little hot drink, as lenioiuuie, with warmth externally if there be chilliness, keeping (juiet till the doctor comes. In every such case all discharges from the stomach and bowels must be most thoroughly and carefully disinfected and everything which liad been soiled in tlie least degree with them— floors, furniture, clothing, etc., scrupulously cleaned- scalded, scrulibed and disin- fected — every spot and* speck being closely and most carefully looked after ; and the hands of all attendants or helpers well cleaned with the stron^j carbolic solution and warm water soap, brush and pumico stone, that the disease bo not communicated to any other person. Burn carefully everything of little value. Abunthmce of hot, boiling water is a good destroyer of disease germs, while a profusion of fresh air and sunlight soon destroys their virulence, should any es- cape the heat, carbolic acid, lime, &c., used. The physician will see that the patient is properly isolated in a suitable hospital or other place, with but little furniture and no car- pets, curtain, or the like, in tlie apartment, but permitting an unlim- ited supply of fresh air and Jsunlight ; and that all intercourse be prevented as fiir as possible between attendants or nurses and outside or healthy persons. He or the Medical health officer will see that all excreta, clothing, bedding, furniture, floors, etc., in all apartments occupied by the sick, are thoroughly and frequently disinfected dur- ing the progress of the disease ; that on recovery of patients all shall have their whole body and all clothing which had been recently worn by them well and carefully disinfected (in Chili the whole body of every convalescent before discharge was bathed in corrosive sublimate solution — 1 part to 1,000); that in case of death, the body be disin- fected before burial ; and the authorities should prohibit public funerals. DISINFECTION AND DISINFECTANTS. In disinfection —the destruction of disease germs — about the sick or in the apartments after recovery or death, no perfunctory or routine work by unreliable persons must be tolerated . All must be most thoroughly and carefully done . Abundance of pure out-door air and sunlight is universally put up as must essential in good disinfection ; thorough drying being most unfavorable to the life of all disease germs. Boiling hot water is a valuable and ready destroyer of germ life. Any clothing well boiled in water for half an hour will be safe to use again. Steam is, perhaps, best of all where there is a public disinfecting apparatus. Corrosive sublimate (bicloride of mercury), one p;jrt to 1000, is a very popular disinfectant in common use, but its value has been questioned by a few experimenters, and it is highly poisonous. Carbolic acid, one part to 20 or 30 of hot water or soap suds, is a valuable and safe one, in which to receive all excreta, and with which to wash almost any articles, floors, clothing, &c. Copperas (sulphate of iron), one t>) two pounds, at least, dissolved, to the gallon of water, is an inexpensive and effectual mixture for excreta, floors, &c. The free use of fresh slaked lime, where it can be used, is an excellent practice. For disinfecting rooms after use, with free washing and scrubbing, strong sulphur fumes are most highly recommended ; then, long and free exposure to air and sun- light ; while all articles which had been infected should be bo ex- posed before being used.