In 1894 no deaths from cholera were recorded in England, but on the continent it still prevailed over a wide area. In Russia over 30,000 persons died of it, in Germany about 500, but the most violent outbreak was in Galicia, where upwards of 8000 deaths were registered. In 1895 it still lingered, chiefly in Russia and Galicia, but with greatly diminished activity. In that year Egypt, Morocco and Japan were attacked, the last severely. The disease then remained in abeyance until the severe epidemic in India in 1900.
The great invasion just described was fruitful in lessons for the prevention of cholera. It proved that the one real and sufficient protection lies in a standing condition of good sanitation backed by an efficient and vigilant Prevention sanitary administration. The experience of Great Britain was a remarkable piece of evidence, but that of Berlin was perhaps even more striking, for Berlin lay in the centre of four fires, in direct and frequent communication with Hamburg, Russia, France and Austria, and without the advantage of a sea frontier. Cholera was repeatedly brought into Berlin, but never obtained a footing, and its successful repression was accomplished without any irksome interference with traffic or the ordinary business of life. The general success of Great Britain and Germany in keeping cholera in check by ordinary sanitary means completed the conversion of all enlightened nations to the policy laid down so far back as 1865 by Sir John Simon, and advocated by Great Britain at a series of international congresses—the policy of abandoning quarantine, which Great Britain did in 1873, and trusting to sanitary measures with medical inspection of persons arriving from infected places. This principle was formally adopted at the international conference ference held at Dresden in 1893, at which a convention was signed by the delegates of Germany, Austria, Belgium, France, Great Britain, Italy, Russia, Switzerland, Luxemburg, Montenegro and the Netherlands. Under this instrument the practice is broadly as follows, though the procedure varies a good deal in different countries:—Ships arriving from infected ports are inspected, and if healthy are not detained, but bilge-water and drinking-water are evacuated, and persons landing may be placed under medical supervision without detention; infected ships are detained only for purposes of disinfection; persons suffering from cholera are removed to hospital; other persons landing from an infected ship are placed under medical observation, which may mean detention for five days from the last case, or, as in Great Britain, supervision in their own homes, for which purpose they give their names and places of destination before landing. All goods are freed from restrictions, except rags and articles believed to be contaminated by cholera matters. By land, passengers from infected places are similarly inspected at the frontiers and their luggage “disinfected”—in all cases a pious ceremony of no practical value, involving a short but often a vexatious delay; only those found suffering from cholera can be detained. Each nation is pledged to notify the others of the existence within its own borders of a “foyer” of cholera, by which is meant a focus or centre of infection. The precise interpretation of the term is left to each government, and is treated in a rather elastic fashion by some, but it is generally understood to imply the occurrence of non-imported cases in such a manner as to point to the local presence of infection. The question of guarding Europe generally from the danger of diffusion by pilgrims through the Red Sea was settled at another conference held in Paris in 1894. The provisions agreed on included the inspection of pilgrims at ports of departure, detention of infected or suspected persons, and supervision of pilgrim ships and of pilgrims proceeding overland to Mecca.
The substitution of the procedure above described for the old measures of quarantine and other still more drastic interferences with traffic presupposes the existence of a sanitary service and fairly good sanitary conditions if cholera is to be effectually prevented. No doubt if sanitation were perfect in any place or country, cholera, along with many other diseases, might there be ignored, but sanitation is not perfect anywhere, and therefore it requires to be supplemented by a system of notification with prompt segregation of the sick and destruction of infective material. These things imply a regular organization, and it is to the public health service of Great Britain that the complete mastery of cholera has mainly been due in recent years, and particularly in 1893. Of sanitary conditions the most important is unquestionably the water-supply. So many irrefragable proofs of this fact were given during 1892-1893 that it is no longer necessary to refer to the time-honoured case of the Broad Street pump. At Samarkand three regiments were encamped side by side on a level plain close to a stream of water. The colonel of one regiment took extraordinary precautions, placing a guard over the river, and compelling his men to use boiled water even for washing. Not a single case of cholera occurred in that regiment, while the others, in which only ordinary precautions were taken, lost over 100 men. At Askabad the cholera had almost disappeared, when a banquet was given by the governor in honour of the tsar’s name-day. Of the guests one-half died within twenty-four hours; a military band, which was present, lost 40 men out of 50; and one regiment lost half its men and 9 officers. Within forty-eight hours 1300 persons died out of a total population of about 13,000. The water supply came from a small stream, and just before the banquet a heavy rain-storm had occurred, which swept into the stream all surface refuse from an infected village higher up and some distance from the banks. But the classical example was Hamburg. The water-supply is obtained from the Elbe, which became infected by some means not ascertained. The drainage from the town also runs into the river, and the movement of the tide was sufficient to carry the sewage matter up above the water-intake. The water itself, which is no cleaner than that of the Thames at London Bridge, underwent no purification whatever before distribution. It passed through a couple of ponds, supposed to act as settling tanks, but owing to the growth of the town and increased demand for water it was pumped through too rapidly to permit of any subsidence. Eels and other fish constantly found their way into the houses, while the mains were lined with vegetation and crustacea. The water-pipes of Hamburg had a peculiar and abundant fauna and flora of their own, and the water they delivered was commonly called Fleischbrühe, from its resemblance to thick soup. On the other hand, at Altona, which is continuous with Hamburg, the water was filtered through sand. In all other respects the conditions were identical, yet in Altona only 328 persons died, against 8605 in Hamburg. In some streets one side lies in Hamburg, the other in Altona, and cholera stopped at the dividing line, the Hamburg side being full of cases and the Altona side untouched. In the following year, when Hamburg had the new filtered supply, it enjoyed equal immunity, save for a short period when, as we have said, raw Elbe water accidentally entered the mains.
But water, though the most important condition, is not the only one affecting the incidence of cholera. The case of Grimsby furnished a striking lesson to the contrary. Here the disease obtained a decided hold, in spite of a pure water-supply, through the fouling of the soil by cesspits and defective drainage. At Havre also its prevalence was due to a similar cause. Further, it was conclusively proved at Grimsby that cholera can be spread by sewage-fed shell-fish. Several of the local outbreaks in England were traced to the ingestion of oysters obtained from the Grimsby beds. In short, it may be said that all insanitary conditions favour the prevalence of cholera in some degree. Preventive inoculation with an attenuated virus was introduced by W.M.W. Haffkine, and has been extensively used in India, with considerable appearance of success so far as the statistical evidence goes.
As already remarked, the latest manifestations of cholera show that it has lost none of its former virulence and fatality. The symptoms are now regarded as the effects of the toxic action of the poison formed by the micro-organisms Treatment. upon the tissues and especially upon the nervous system. But this theory has not led to any effective treatment. Drugs in great variety were tried in the continental hospitals in 1892, but without any distinct success. The old controversy between the aperient and the astringent treatment reappeared. In Russia the former, which aims at evacuating the poison, was more generally adopted; in Germany the latter, which tries to conserve strength by stopping the flux, found more favour. Two methods of treatment were invariably found to give great relief, if not to prolong life and promote recovery—the hot bath and the injection of normal saline solution into the veins or the subcutaneous tissue. These two should always be tried in the cold and collapsed stages of cholera.
See Local Government Board Reports, 1892-93-94-95; Clemow, The Cholera Epidemic of 1892 in the Russian Empire; Wall, Asiatic Cholera; Notter, Epidemiological Society’s Transactions, vol. xvii.; Emmerich and Gemünd,München. med. Wochenschr. (1904), pp. 1086-1157; Wherry, Department of the Interior Bureau of Government Laboratories, No. 19 (October 1904, Manila); Wherry and M’Dill, Ibid. No. 31 (May 1905, Manila).
CHOLET, a town of western France, capital of an arrondissement in the department of Maine-et-Loire, 41 m. S.E. of Nantes on the Ouest-État railway between that town and Poitiers. Pop. (1906) 16,554. Cholet stands on an eminence on the right bank of the Moine, which is crossed by a bridge of the 15th century. A public garden occupies the site of the old castle; the public buildings and churches, the finest of which is Notre-Dame, are modern. The public institutions include the sub-prefecture, a tribunal of first instance, a chamber of commerce, a board of trade-arbitrators, and a communal college. There are granite quarries in the vicinity of the town. The chief industry is the manufacture of linen and linen handkerchiefs, which is also carried on in the neighbouring communes on a large scale. Woollen and cotton fabrics are also produced, and bleaching and the manufacture of preserved foods are carried on. Cholet is the most important centre in France for the sale of fat cattle, sheep and pigs, for which Paris is the chief market. Megalithic monuments are numerous in the neighbourhood. The town owes the rise of its prosperity to the settlement of weavers there by Edouard Colbert, count of Maulévrier, a brother of the great Colbert. It suffered severely in the War of La Vendée of 1793, insomuch that for years afterwards it was almost without inhabitants.
CHOLON (“great market”), a town of French Indo-China, the largest commercial centre of Cochin China, 3½ m. S.W. of Saigon, with which it is united by railway, steam-tramway and canal. Cholon was founded by Chinese immigrants about 1780, and is situated on the Chinese arroyo at the junction of the Lo-Gom and a canal. Its waterways are frequented by innumerable boats and lined in some places with native dwellings built on piles, in others by quays and houses of French construction. Its population is almost entirely Asiatic, and has more than trebled since 1880. In that year it had only 45,000 inhabitants; in 1907 it numbered about 138,000. Of these, 42,000 were Chinese, 73,000 Annamese, and 155 French (exclusive of a garrison of 92); the remainder consisted of Cambodians and Asiatic foreigners. During the rice season the town is visited by a floating population of 21,000 persons. The Chinese are divided into congregations according to their place of origin. Cholon is administered by a municipal council, composed of French, Annamese and Chinese traders. An administrator of native affairs, nominated by the governor, fills the office of mayor. There are a fine municipal hospital and municipal schools for boys and girls. The principal thoroughfares are lighted by electric light. The rice trade, almost monopolized by the Chinese, is the leading industry, the rice being treated in large steam mills. Tanning, dyeing, copper-founding, glass, brick and pottery manufacture, stone working, timber-sawing and junk building are also included among the industries.