From “The Annals of Hygitne” Phila. Vol. VII. Page 653. (ppvmfi/i'mentd ojf Sfcaml&on. Ih tlie Early Recognition of Cliolcra Asiatics Possible ? BY HUGH HAMILTON, M.Sc., M.D., ofHarrisburg, Pa. KVERYONE is much interested in this question. In a recent article, by an authority on cholera Asiatica, Dr. E. O. Shakespeare, read before the Philadelphia County Medical Society, on September 14, 1892, and published in the University Medical Magazine, Vol. V, No. 1, October, 1892, p. 75, says: We do not, at present, know how to recognize Asiatic cholera in time to safely guard the people against its deadly power} Exactly how much time must be used for such recognition is a matter of some importance. Dr. Shakespeare remarks further down the same page that “ There is reason to believe that the awful calamity which has befallen the city of Hamburg, Germany, is traceable to the criminal neglect of a single man.” Upon the cause of cholera Asiatica, we admit it to be due to a constant cause known as Koch’s Comma Bacillus. Its entrance into the body is solely by the intestinal tract, i. e., the nose and mouth by the hand; as the avenues of its recep- tion are limited, the prophylaxis is easily executed. Disinfect the hand. When we have the cholera Asiatica to deal with, its detection is of vital moment; no one questions these aforesaid facts. Never before did bacterio- logical art become science so successfully as in the demonstration readily of the comma bacillus. The proceedings of the Society of Physicians,2 of Hamburg, Germany, in extraordinary session of August 30, 1892, speaking upon the entrance of the plague into that city, Doctor Reinhard stated, respecting the death of a sus- picious case on the 17th of August, 1892, that it was thought not to be cholera Asiatica by both himself and Drs. Erman and Hahn—hence no bacteriological examination of the contents of the intestines was made. On the 18th of August, however, the first case of cholera Asiatica was brought to the hospital; on the 19th a post-mortem was made in the presence of Drs. Erman, Police Surgeon Wahucan, and also Hahn and Eiihrs; the latter undertook the bacteriological examination; but, owing to the extreme heat, were unable to secure good cultures upon gelatine capable of giving positive results (why did they not use a constantly cool chamber, say 37-38°C.); so that they were compelled to make their cultures upon potatoes, which took them until the 22d before the announcement was officially made to the authorities. Between these dates to the 22d there were 369 cases and 128 deaths from the disease.3 In Altona, near Hamburg, Regimental Surgeon Kosta stated that Surgeon Weisser had, on the 19th of August, in the morning, made a post-mortem of a ' The italics are in the University Medical Magazine. 2 Deutsch. Med. IVochenschrift, No. 37, p. 838-1892. sDeutsch. Med. IVochenschrift, September 15, 1892, No. 37, p. 839. 2 suspicious case of cholera Asiatica, and immediately commenced a bacteriological examination, and by the afternoon of the 20th of August had determined it was cholera Asiatica—about thirty-six hours. These cultures were confirmed by Prof. Koch as being cholera Asiatica. The histories here related of the ravages of the plague in Hamburg and the surrounding towns is most interesting, and, furthermore, prove most con- clusively that the comma bacillus was found in from 24 to 36 hours after post-mortem examination of the suspicious cases in pure cultures. Dr. Carl Lauenstein particularly deserves credit for receiving, on the 21st of August, in the Seaman’s Hospital, a suspicious case, and by the 22d had discovered the comma bacillus in the dejections, and on that day made his official report to the authorities. At the extra session of the Berl. Med. Gesellschft, on the 7th of September, 1892, Prof. R. Pfeiffer read an interesting paper upon the method to be pur- sued in bacteriological examinations for the diagnosis of cholera Asiatica, by gelatine plate cultures, in from 24 to 36 hours. All simple microscopical ex- aminations, not free from doubt, must be confirmed by the gelatine plate process, i. e., cultures, and it is the only method to certainly depend upon.1 Every suspicious case should, when possible, be subjected to this scrutiny. Under normal conditions the recognition of the comma bacillus, by gelatine cultures, may be perfectly made, and the diagnosis certainly declared in thirty- six hours at most. Upon this diagnosis depends the lives of our nation ; to neglect the means to recognize it, as early as possible, becomes criminal and invites fearful calamity. At numerous important centres bacteriological stations should be established with complete apparatus and competent persons to quickly and certainly inves- tigate suspicious cases at the expense of the State and Nation. Then we would have a sure method to determine what we had to do; to skillfully treat the patient and protect their families, other households and communities. Every proper and firm authority ought to enforce the most recent informa- tion to obviate its dissemination. Whenever found strict quarantine offers safety to other places. Isolation of the patient, complete antisepsis of the persons of the sick and his nurses; destruction by fire of the patient’s personal effects, and, in case of death, if possible, cremation of the body. So far all our health authorities have been alert, done well and successfully, but 1893 still stares us in the face, with diarrhoeas now a prominent factor in many diseases. Let us be prepared to know soon the presence of the plague, so that need- less alarm may not frighten us nor subject persons and places to unnecessary trouble and expense. The usefulness of proper and prompt bacteriological examinations would prove to be of inestimable value, although apparently quite expensive. We think that early recognition of this disease is possible 2 and singularly definite. 1 Deutsch. Med. Wochenschrifl, September 8, 1892, No. 36, p. 815. iDeutsch. Med. Wochenschrift, September 22, 1892, No. 38, p. 858.