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Scientific Memoirs by
practically enforced would never afford any security against the importation
of the factors of the specific poison or against the rejuvenescence of any which
might happen to be already present, and would in any case be the cause
of great expenditure without any return save very problematical prevention
of cholera, but any improvements in local sanitation are a positive benefit, not
only as protectives against cholera, but as protectives against other forms of
disease, so that the expenditure which they involve can never be thrown away.
Both on theoretical and practical grounds, therefore, the only rational course to
follow in endeavouring to limit the epidemic diffusion of cholera is to abandon
quarantine, and to push on general sanitary improvements.
Whilst it is to local sanitary improvements, and not to quarantine restriction of
traffic, that we must look to limit the development of the specific cause of the initial
symptoms of cholera, and its access to the human organism in any locality ; it is
also possible that these may exert a further action on the disease. It is quite
possible that they may have an influence in determining the presence or absence
of secondary symptoms. It has already been pointed out that the occurrence of
these is probably due to the absorption of products attending the excessive
development of certain schizomycete organisms within the intestinal tract during
the period in which its contents have acquired abnormal qualities in consequence
of the establishment of the choleraic condition, and it is very possible that condi-
tions in the environment may affect the nature of the intestinal schizomycete
population to a greater or less extent. It is quite possible that general sanitary
improvements in any locality may affect the local prevalence of those forms of
schizomycetes which when they encounter a congenial environment in the con-
tents of the intestinal tract are capable of manufacturing toxic products there,
or may affect the chances of their gaining access to the intestinal tract. In so
far, therefore, as any hygienic measures serve to limit the local development of
such factors or their access to the human organism, they must tend to diminish
the probability of the appearance of secondary symptoms in any cases of cholera
which do occur, and it is thus possible that sanitary improvements of locality
may not merely limit the diffusion, but also modify the character of the disease,
so that we have additional grounds for advocating them in place of impos-
sible attempts at quarantine.
Another measure has recently been advocated and extensively practised in
this country as a protective against cholera. M. Haffkine believes that because
he can produce temporary protection against the morbid results following the
introduction of virulent comma-bacilli into the lymphatic and blood-vascular
system he has necessarily produced protection against cholera, and consequently
assumes that the universal adoption of his system of protective inoculations is
all that is necessary in order to secure the impossibility of the epidemic occur-
rence of cholera in any locality. This, of course, implies the previous assump-
tion that comma-bacilli are the specific factors of the poison which gives rise to