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cholera spirillum is doomed to a somewhat early destruc- tion, whereas in pure water, and, above all, in that which has been sterilized, its life may be greatly prolonged. In cultures made along with other saprophytes, and espe- cially with B. prodigiosus, the growth of the spirillum was greatly retarded, but it was not killed (Babes). In the rice-water dejections growth is most active when first passed, but the propagation of the germ is speedily checked as the liquids evaporate and the material be- comes denser and more acid. The antagonism of other saprophytes is greatly lessened if the liquids are largely diluted, and under such conditions the spirillum may take precedence of all other bacteria and Prilosec Cheap form its characteris- tic wrinkled film on the surface (Gruber and Schottelius). The principal sources of water contamination are the bowel dejections, vomited matters, foul clothing, house slops, especially that produced by the washing of infected houses and infected bodies. The importance of the stools and vomit lies in the fact that in man the germ is only propagated in the intestine. It fails to live in the blood or tissues, and it is only what escapes from the bowel that is to be feared. But in severe cases the dis- charges are so profuse as to endanger everything in the room, and therefore nothing can be considered as be- yond suspicion, and nothing should be allowed to leave the room without thorough disinfection, unless it be clothing tied in a close Prilosec Buy bag to be subjected to dry heat or boiling without being opened. The house slops, if they cannot be boiled, should be made strongly acid, and left so for several hours before they are thrown out. Corpses should be burned, or wrapped in cloths wet with a mercuric-chloride solution, and buried at a safe dis- tance from any well or water-course. No prophylactic measure can be more important than the protection of water supplies. Artesian and deep-flowing wells are safe, but rivers, ponds, shallow wells, and such as are not safely cemented against all surface leakage, are ever to be suspected during a cholera epidemic' The rational plan is to boil all o:her water which is to be used for drinking, ' In the city of Pondicherry, Hindostan, which derives its water from artesian wells and a carefully enclosed and protected reservoir, epi- demics of cholera are unknown, though the surrounding country, from Madras southward, is being swept over by the plague. washing Buy Prilosec the mouth or teeth, the hands or the face, and for all household purposes. The predilection of the spirillum for water and dilute watery solutions has a very direct bearing on the mode of development of the disease, and on its prevention and early treatment. As if to secure a proper culture-medium the germ determines a profuse secretion from the intes- tinal mucosa, and it may fairly be inferred that, in the absence of this, the case is destined to prove a benignant one and the patient to recover. If, therefore, the pro- fuse secretion can be anticipated and prevented, the spi- rillum Prilosec 20 Mg is likely to be repressed by the density of the bowel contents and the antagonism of the saprophytes, and the ptomaines and toxines are never absorbed in dangerous amount. Here is a ground for the long es- tablished opium treatment, which does appear, in certain What Is Prilosec cases, to abort the malady when employed in the very ear- liest stages. Here, too, is a rational explanation of the apparent benefit of the early use of aromatic oils, and of Cantani's Coupon Prilosec exhibition of tannic acid by enteroclysis and by the mouth. Here, too, may be found a partial ex- planation of the beneficial operation of acids, aside alto- gether from their destructive action on the spirillum. But while opium has undoubtedly proved useful in the incipiency of the disease, its use is attended by a great danger, for if it is used after the secretion of the rice- water fluid has occurred, or if it fails to prevent such se- cretion, it checks the peristaltic movement of the bowels, locks up the infected culture fluid by checking peristalsis, and seals the doom of the patient. The action of opium in such a case is precisely that which Koch has availed himself of in securing the infection of the guinea-pig. Milk, like water, forms an excellent culture-medium, and watered milk is trebly dangerous, because the water may have been contaminated, and the diluted fluid is more favorable to the growth of the germ. The milk is liable to contamination from the hands of the Purchase Prilosec milker, the skin of the udder, or from dishes that have been rinsed out with cold, contaminated water, or wiped with towels that have been rinsed in such water. Where cholera ex- ists the only safe course is to raise the milk for ten min- utes to 130° F., or upward. Milk that has stood till sour is not thereby rendered safe, as the spirillum lives for two days even in milk that has soured. Another point is worthy of note. Milk which has been sterilized forms a better culture-medium than fresh milk, as it con- tains no antagonistic microbes, and it is prevented from turning acid, so that two influences inimical to the spiril- lum are eliminated. After sterilization, therefore, milk should be kept in a scalded vessel, well covered from any possible source of contamination. On milk or bouillon the cholera spirillum forms a characteristic, grayish, wrinkled, surface film, but the absence of such a film must not be taken as a guarantee of purity. As bearing on the influence of moisture in preserving the spirillum the following data are interesting : It lives one day on rye-bread drying in the open air, three days on bread wrapped in paper, and seven days on bread covered with a bell-jar. It lived four to six days on feebly acid butter, seven days on roast meat under a bell- jar, four days on smoked fish under a bell 20 Mg Prilosec jar, twenty to thirty hours on dried fruit, four days on fruit under a bell-jar, one to three days on fresh cauliflower, and seven- teen hours on the dried leaves of a book (Uffelmann). On apparently dry cloth it lived four to six days, while on moist cloth it lived twelve days and multiplied. It can thus find a temporary home and culture-medium on cloth as well as on the common food products, and thus the prompt Prilosec Otc sterilization of every article of soiled cloth- Order Prilosec ing becomes a pro])hylactic measure as vital as the main- tenance of the purity of the food. The growth of the cholera spirillum is always retarded by the presence of acids, and its death follows if these are in excess. Boer found that it was killed by a two hours' exposure to hydrochloric-acid solution, i to 1,350, or to Omeprazole Prilosec sulphuric-acid solution, i to 1,300. Acetic and citric acids, and consequently lemons, lemon-juice, and July 8, 1893] MEDICAL RECORD. 41 acid oranges, are to be accounted prophylactic. Lactic acid in excess will destroy the germ, yet, as we have seen, it will live for two days in souring milk. The organic acids are less reliable than the mineral acids, and if these are mild or dilute their presence may fail to check the growth. Thus the spirillum can accommodate itself to the acid developed on the cut surface of a raw potato. The free acid of the gastric juice (2 to 1,000) stands as nature's guardian for the protection Prilosec Mg of the bowel, and, during active, healthy digestion the jjerson is safe. Dur- ing abstinence, however, the stomach may be entirely empty, even of gastric juice, and the little mucus and Otc Prilosec sa- liva present are rather favorable than inimical to the germ. With this alkaline saliva, and, above all, with a draught of water or watery fluid, the germ may be washed on into the alkaline duodenum direct. Iced water, by actively stimulating the peristaltic movements of the stomach, is especially calculated to hasten this passage. Prolonged abstinence should therefore be avoided, and unboiled water, which may possibly have been contami- nated, should be especially refused between meals. Tea or coffee made with boiling water, acid lemonade, or other acid drinks are to be preferred. Whatever tends to derange digestion is to be avoided. The escape of the bowel — the one organ in which the spirillum can dangerously propagate itself — is contingent on the due acidity of the stomach, Prilosec Online which must be suffi- cient to destroy every cholera germ that enters it. If, therefore, the gastric secretion is impaired or arrested, or if from any cause the gastric contents are hurried through the pylorus without thorough permeation by the acid liquids, the infection of a susceptible subject is rendered possible. This accessory cause is subsidiary, it is true, to the primary and essential factor of the disease — the [iresence of the spirillum in Cheap Prilosec the food, drink, or saliva swallowed — yet in its place it is so essential to pathogene- sis that it must Online Prilosec be accorded a place in the front rank of all considerations looking toward prevention. It will not be superfluous, therefore, to identify some of the more common causes of the passage of undigested albuminoids through the stomach, and especially such as come under the direct control of the individual himself. Drinking of water or otherwise harmless liquids to ex- cess at meals acts injuriously in two ways : It favors the preservation and propagation of the spirillum by provid- ing it with its favorite dilute solution, and it hastens the passage of food into the duodenum before it has been sufficiently acted on by the peptic acid. Excess of iced water is still worse, as this stimulates the muscular coat to violent vermicular contraction, thereby adding to the force which impels undigested matters through the pylorus. Hot coffee, tea, chocolate, or lemonade in moderate amount, are safe substitutes. .\Prilosec 20 so that they dilute and weaken the gastric acids, furnish a favorable watery medium for the growth of the spirillum, and foster other fermentations, with evolution of gas, and hurry the undigested mass through the pylorus. Once present in the duodenum these join the spirillum in stimulating a free alkaline watery secretion, and thus producing a fruitful field for the culture of the germ. As a rule, lemons and other acid fruits are protective, but we must not forget the well-known action of green apples and other unripe fruits in Prilosec Purchase producing acute indi- gestions, which must be a prolific cause of the evasion by the germ of the gastric sentinel. Spoiled and stale fruits and vegetables add to the above dangers that of the injurious action of the ferments already in active process of reproduction, together with their more or less poisonous ptomaines and toxines. These are so notoriously injurious in cholera seasons that no effort should be spared to exclude from the market whatever has started on the road to decay. In this connection the proverbial indigestibility of certain salads deserves mention, and the injunction to confine the diet to cooked dishes is in order. The usual washing of vegetables is a possible source of infection which should always be counteracted by the sterilizing action of heat. Unwholesome food of all kinds is dangerous as causing the derangement of the gastric secretions and motions, and thepassagfe of undigested masses through the pylorus con- tributes to favor the escape of the germ. The poisonous ac- tion of many of the ferments and their chemical products demands that whenever food has started to decay it should be rigidly withheld. This applies to farinas, eggs, meats, and, above all fish, in which decay is so rapid and the products often highly injurious. Tough, fibrous, or otherwise indigestible meats are especially dangerous for invalid stomachs, as the more resistant pieces tend to pass on unchanged and carrying the still viable germs in their interior. Hurried eating and bolting the food unchewed and unsalivated introduces the Prilosec Omeprazole same danger, which is greatly enhanced in the case of vegetable food, consisting mainly of starch, which must pass through the stomach unchanged in the absence of saliva. Eating to excess so that the stomach cannot readily digest its load, tends similarly to the passage of undigested particles and of the spirillum if present. The general resort should be to eat moderately, at regular intervals, of your customary food, taking care that it is, easily digestible, well cooked, and thoroughly masticated and insalivated. If it is unavoidably tough and indigestible, cook until dis- integrated and tender. Avoid excessive exertion just after a meal. It arrests digestion, favors fermentation, and paves the way for the passage of the spirillum. Excessive fatigue lowers the tone of the whole system,

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