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the ]jhysicians of the commonwealth. Under such a re- gime we may expect that these officers of the State will order the affairs of the citizens so that no man shall live for private greed, but, as in ancient Sparta, each man shall conclude that he was born not for himself but for his country. And under all their labors to eradicate infectious dis- eases, to enlighten the people in sanitary living; their removal of the generic prevacid otc tuberculous, the asthmatic, the rheumatic to proper climates ; their modelling of tenements, in- spection of food, regulating of marriage, these graver minds will read those portions of our literature with amused contempt and pity, where learned societies waste their time in disclosures and debates as to the rival claims of this or that drug, or combination of drugs, in the cure or relief of yellow fever, diphtheria, scarlatina, typhoid and typhus fever, cholera, and such like diseases, instead of striking at the root of these scourges, and with an over- whelming dictum forcing the public conscience to the only sensible remedy — the banishing of them altogether from the face of the earth. Opium Consumers in Bnrmah. — A new law will shortly be put in execution in Burmah, according to the provisions of which habitual consumers of opium in that province must register their names, and the Treasury officers can issue the drug only to the people registered. Boils. — The external use of chloral is recommended very highly in the treatment of furuncles. The boil is to be kept covered with a compress soaked in a solution containing four drachms of chloral in one ounce each of water and glycerin. July 8, 1893] MEDICAL RECORD. 39 CHOLERA: SOME SUGGESTIONS FOR LOCAl AND PERSONAL PROPHYLAXIS." By JAMKS law, F.R.C.V.S., The germ of Asiatic cholera is the spirillum cholera; asiaticK, as demonstrated by Koch in the tlgyptian and Indian epidemics of 1884. Among other bacteria which have been advanced as the cause of the scourge it is only necessary to mention two or three. The spirillum prevacid savings card mets- chnikovi, while it resembles the true cholora germ in its morphology, biology, pathogenic qualities, and even in the color Reaction of its products prevacid otc 30mg with sulphuric acid, yet differs strikingly in that it has never been shown to produce cholera in the human being. It is exceedingly fatal in Asia to chickens, pigeons, and guinea-pigs, pro- ducing most diastrous epizootics among the birds, but no outbreak of cholera in man habitually coincides with such bird-pest, and conversely, no such plague among the birds appears simultaneously with the frequent extensions of cholera in the human being. Klem has claimed that the bacillus of Finkler and Prior, li. prodigiosus, B. coli commune, typhoid H., and proteus vulgaris, each pro- duces the same poison as does the spirillum of cholera, and that they render the system immune from Asiatic cholera. The fact that these bacteria are constantly with us, and that by themselves in non-cholera years they do not produce this affection, sufficiently disposes of any claim that they can generate true Asiatic cholera. Bloh- stein, of St. Petersburg, in his investigations in the epi- demic in Baku and Astrachan, found and prevacid discount card described two new bacteria which he considers essential factors, along with the cholera spirillum, in the causation of Asiatic cholera. He found that the cholera dejections, when in- oculated hypodermically prevacid for sale on animals produced all the symptoms of Asiatic cholera, while pure cultures of the spirillum cholerre asiaticte did not. The first objection which presents itself is, that neither in man nor in ani- mals have other observers found cholera ]3ropagated by endermic nor by hypodermic inoculation of the dejections ; that the germ does not propagate in the blood, nor, apart from the intestinal mucosa, in the tissues. Man may handle the dejections without fea"r, even though he may have skin abrasions, so long as he takes due precautions against the introduction of the germ into his mouth. So in all the experiments of Koch and others in transmitting cholera prevacid en espanol to guinea-pigs, no effect whatever is produced by hypodermic or intestinal inoculation, and success only follows the introduction of the virulent germ into the alkaline intestine. It would, however, be premature to condemn Dr. Blohstein's conclusions without further ex- perimental inquiry. The toxines of two otherwise harm- less bacteria may become deadly when combined, and conversely, the most poisonous toxines may act as anti- dotes to each other, so that both are thereby rendered harmless. As an prevacid sale example of the first is the bacillus of malignant oedema, or that of Rauschbrand, which is harm- less to an immune animal, but becomes deadly to the same animal when associated with the bacillus prodigi- osus (Roger). As an instance of the second may be named the bacillus anthracis, which though deadly to a susceptible animal may be rendered non-fatal by inoculat- ing at the same time with the germs or the chemical products of the pneumococcus of Friedliinder, the staphy- loccus pyogenus aureus, the streptococcus erysipelatos, the bacillus prodigiosus, or the bacillus pyocyaneus (l'!m merirh, Pawlowsky, Bouchard, P'reudenreich). As a still simpler example of the effect of chemical compounds we have the fact that an animal immune from either an- thrax or Rauschbrand is rendered dangerously susceptible by the addition of lactic acid. Such facts, which might be largely multiplied, should warn us against prevacid naprapac 500 too hurried or absolute conclusions as to the influence of additional or- ganisms and their products u|ion the pathogenic proper- ties of the cholera spirillum or other disease germ. It is not improbable, therefore, that other germs may contrili- ' Read before the Tompkins County Medical Society, May, 1893. ute to the pathogenic role of the cholera spirilhmi, ren- dering it specially deadly in given epidemics, or accord- ing as they may be present or absent from the alimentary canal, determining the susceptibility or unsusceptibility of the subject. Further experiment is necessary before we can confidently accept or reject Blohstein's results. Coming back to the spirillum cholerse asiaticje, which we must accept as the essential factor of the disease, we can now intelligently deduce from many known facts of its life-history how its pathogenic re.sults may be warded off. Morphology. — The cholera spirillum is a bent, twisted, mobile rod 0.8 to 2.0 micromillimetres in length and furnished with one terminal flagellum. If growth is re- tarded by cultivation in an unfavorable medium the dif- ferent elements fail to separate from each other and be- come prolonged in the form of a spiral. In old cultures the individual elements are liable to show involution forms, becoming swollen and distorted at points (the ar- throsporses of Huppe). The germ has, however, never been seen prevacid otc coupon to produce true spores, and therefore it is much more destructible and more easily controlled than are the spore-producing bacteria. The spirillum stains best in an aqueous solution of fuchsine, and is decolorized by iodine (Grave's solution). Biolog'y. — The cholera spirillum is aerobic and grows well in almost any neutral or alkaline nutritive medium. Hence it is to a great extent a filth disease, clinging to generic name for prevacid soils saturated with decomposing organic matter, and maintained in an alkaline condition by the constantly evolving ammoniacal gases. This holds true alike of the filth-laden street or hamlet, or the soil charged with the decomposing vegetation of the tropics, and, above all, of the river deltas (Ganges, Nile), which receive the accu- mulated organic debris of a large tropical area, and ex- pose it to the rays of an equatorial sun. This germ is, however, a facultative anaerobic organism, and can secure what oxygen it requires from the white of egg, the con- tents of the bowel, or, in some animals, from the blood. It is extremely sensitive to temperature. In culture media its growth ceases below 14° C. and above 42° coupons for prevacid 24 hour C. Its vitality is not prevacid generic equivalent destroyed, however, and on being re- stored to an intervening heat growth commences anew. It is killed in ten minutes by exposure to 52° C. (Stern- berg), so that it is always easily and safely destroyed by boiling or cheap prevacid online an equivalent dry heat. There can be no more effectual mode of sterilizing soiled clothing, vomit, or de- jections, than by exposing them to a boiling temperature. On the other hand. Babes has successfully cultivated the spirillum which free prevacid coupons had been exposed in the open air in a Berlin winter, so that the habitual disappearance of the disease in northern latitudes during cold weather must be explained otherwise than by the exposure to frost. Its ex- tinction under such circumstances is prevacid chewable tablets to be attributed rather to its unsuccessful struggle for life with other bacteria at a temperature unfavorable to its vitality and growth. In ice collected from infected ponds and rivers this antagon- ism is not met with, and the use of such ice is therefore a means of infection. Dried up in a thin film the spirillum dies in a few hours. There is, therefore, almost no danger from street dust, contrary to what is the case with the comparatively inde- structible germ of tubercle. These two germs indeed are respectively favored by antipodal conditions. The bacil- lus of tubercle reaches the air-passages of man and beast through the whirling clouds prevacid ac of street dust, while the spi- rillum of cholera is preserved only in the close, narrow, sunless, damp street, where the filth is protected against dessication. Dampness thus becomes a potent factor in the maintenance of cholera in the squalid and impover- ished areas of our cities, as dryness contributes to its dis- appearance from districts where the streets are broad, roomy, sunny, and dry. The influence of weather is to be largely explained on the same ground. .\ damp, foggy, or rainy period preserves the "germ against dessication and destruction, while a dry, prevacid 24hr coupon dusty time is often the signal for an abate- ment of its ravages. It has been noticed that during 40 MEDICAL RECORD. [July 8, 189: •some cholera epidemics a ' ■ blue fog ' ' hung over the sur- face of the ground, and that the disease abated when the fog cleared away and dry weather set in. In other terms, so long as objects on the surface of the ground were kept in a moist condition the cholera germ was preserved, whereas as soon as these were dried up it perished. In the same way may be explained the Pettenkoffer theory of the influence of a rise of the ground-water level. When the ground-water is low the surface is dried and the surface bacteria destroyed ; when, on the con- trary, the ground-water rises to the surface the germs sur- viving in the water are brought up with it and gain an entrance into wells and other sources of infection. As drinking-water is now recognized to be the most fre(juent channel of infection, it is well to note that the rapidity of multiplication of the cholera germ is to a large e.xtent in ratio with the dilution of the medium in which it grows. Thus it is propagated much more slowly prevacid 42 count in bouillon of the density commonly employed for the culture of other microbes than it is-when the mi.xture has been diluted with eight or ten times its bulk of water. Extreme dilution is rather favorable to it, and it retains its vitality for several months when added to well or river water which has been previously sterilized fWolffhiigel and Riedel). In still water at 17° C. to 24° C. it mul- tiplies in fifteen to sixteen hours. Growth is more active in pure well or sterilized water than in stagnant water charged with organic matter and bacterial ferments. This antagonism of dense nutritive solutions and of other saprophytic bacteria is strongly suggestive in several di- rections. The apparent purity of any well or river water which may by any chance have become contaminated is no guarantee of wholesomeness, but rather the oppo- site. In the impure, stagnant, and septic prevacid 24 hour coupon water the

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