GLYCOZONE. PREVENTS FERMENTATION OF FOOD IN THE STOMACH. DYSPEPSIA, GASTRITIS, ULCER OF THE STOMACH, HEART-BURN. Glycozone is sold only in 4-oz., 8-oz., and 16-oz. bottles. Never sold in bulk. CH. MARCHAND'S PEROXIDE OF HYDROGEN (MEDICINAL) H2O2 (ABSOLUTELY HARMLESS.) MOST POWERFUL BACTERICIDE AND PUS DESTROYER. UNIFORM IN STRENGTH, PURITY AND STABILITY. USED BY THE HOSPITALS OF THE U. S. ARMY. Ch. Marchand's Peroxide of Hydrogen (Medicinal) is sold only in 4-oz., 8-oz., and 16-oz. bottles, bearing a blue label, white letters, red and gold border, with his signature. Never sold in bulk. PHYSICIANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLES ON APPLICATION. BOTH OF THE ABOVE REMEDIES ARE PREPARED ONLY BY Mention this publication. Charles Marchand Chemist and Graduate of the "Ecole Centrale des Arts et Manufactures de Paris (France). SOLD BY LEADING DRUGGISTS. Laboratory, 28 Prince St., New York. NATURE, CAUSE, PREVENTION, AND TREATMENT OF ASIATIC CHOLERA.* BY J. S. CAIN, M. D., Professor of Principles and Practice of Medicine in the Medical Department University of Tennessee; and Professor of Principles and Practice of Medicine in Sewanee Medical College and Dean of the Faculty. The threatening attitude occupied by cholera at this time, and the very strong probability that it will visit our country during the coming summer, seem to call for a careful review of the disease and an inventory of the reliable stock of knowledge and means of defense at our command bearing upon the nature, cause, prevention, and treatment of this justly dreaded disease. Noting that no allusion to the disease appears upon the printed programme of our meeting, I have hurriedly and at the last *A paper read at the sixtieth annual meeting of the Tennessee State Medical Society, at Nashville, April, 1893, 2 moment prepared a brief and concise paper bearing upon these particular points alone, which I trust, if it sheds no light upon the subject, will at least provoke a discussion in the association and a comparison of views and experiences which may prove of value to the profession as well as to the public. I shall not attempt to deal in novelties or originalities, but shall seek to follow the beaten path of experience, as lighted by modern scientific research, and summarize the accepted views of the day; and in advance, I may say, that probably there is no other disease of the magnitude and importance of cholera concerning which there exists so much unanimity of opinion in the profession. This usually in medical subjects argues correct knowledge, Nature.-There can scarcely be said to exist a difference of opinion as to the nature of this disease. It is acute, epidemic, non-contagious, and infectious in its nature; produed by a toxic agent gaining access into the human economy and operating upon the nervous system; probably at times and stages principally upon the nerve-endings of the intestinal mucosa, or later on upon the great nerve centers, resulting in a train of symptoms and pathological phenomena dependent largely upon the amount of the toxine present, and upon the normal resistance of the individual attacked. If profound and overpowering in its nature and virulence, resistance may succumb at once from the shock to the nervous system. These are fulminating or explosive cases, for which there exists probably no remedy; they occur, but rarely, in nearly all cholera epidemics. The most common form is that in which the toxic influence is spent or reflected upon intestinal mucous membrane, and manifesting itself in profuse watery discharges of peculiar characteristics from the bowels, with persistent vomiting, rapidly depriving the blood of its serum by an exaggerated exosmotic action, and carrying off with it the albuminous and saline principles contained in this the larger element of the circulating fluid, thereby reducing its volume in the blood vessels to the minimum, and rendering the remaining portion so thick and tenacious as to impose a mechanical impediment to the circulation in the capillaries and smaller arteries and veins. Hence the lack of peripheral circulation; the algid, blanched, and shrunken surface; the defective oxygenation in the lung capillaries; and, in a word, all the prominent symptoms of the disease. This heavy drain upon the watery element of the system results in rapid shrinkage of tissue and manifestations of emaciation so conspicuous in cholera. The tenacious blood remaining in the system fails to bring innervative force to the secreting and eliminating organs, while it clogs up the avenues to normal function. The brain and great sympathetic centers fail to receive their required stimuli, while they are flooded with inert and defective blood. The liver is engorged and inactive; the uriniferous tubules become clogged up, and kidney function is almost suspended; the débris of the whole system remains as a menace to life and comfort; cramp in the muscles soon becomes a tormenting symptom, and, unless relief comes from treatment or from the recuperative powers of nature, collapse and coma soon close the scene with the sufferer. Cause. While there exists at this time a pretty general consensus of opinion as to the cause of this disease, there still exists in the profession a very reputable dissent from the dominant theory, and a feeling that it lacks demonstration. The theory first given definite shape by Dr. Robert Koch, of Berlin, and which bears his name, is very generally accepted by the profession. This theory, as is desirable in all medical theories, accounts in a general way for most of the phenomena and conditions of the disease. The Koch theory maintains that the disease is produced by the cholera or comma bacillus, more properly called spirillum or spirochete, coming neces sarily and alone, either directly or by propagation, from the evacuations of some precedent case of cholera, and gaining a lodgment in the intestines, where, under favorable conditions, they rapidly multiply, producing at first by their presence irritation and diarrhoea peculiar to, and almost universal during the prevalence of, an epidemic of this disease, and afterward, when accumulated in greater quantities, generating a ptomain or poison, which, being absorbed into the blood, finally produces by its toxic effect the specific disease cholera. The theory further maintains that the disease can only be transmitted and conveyed from place to place by persons having the disease, or upon clothing or things which have upon them the infection in the form of vitalized germs, and that it is never and under no circumstances susceptible of being conveyed by gases or atmospheric influences; consequently, it is a disease which may be definitely and sharply limited in its spread by nonintercourse and guarded alimentation. This theory further maintains that, while cholera bacilli or germs do enter the stomach and bowels of many persons who are not in a receptive condition without producing the disease, it is absolutely impossible for any person to contract it who does not receive the germs into the intestines, and that they must gain access through the mouth and stomach with foods or drinks. Therefore it follows, as a logical sequence, that if the bacilli of cholera are excluded from the intestines of an individual by rigid methods of sterilization and guarded precautions in everything which could convey these germs into the alimentary canal, such person would be absolutely immune from the disease, though dwelling in the midst of an epidemic. This theory further maintains that cholera bacilli are seldom found in vomited matter, but always in the excreta from the intestines; that when freshly voided the germs are wholly innocuous and incapable of producing the disease, until, after being exposed to some principle in the atmosphere, ground, soil or air, a change or zymosis imparts to them the power of infection and pathogenesis. Another logical conclusion from this theory is one which is largely supported by observation, and had gone into general acceptance before the scientific rationale was promulgated. If the clothing and bedding of the patient are preserved absolutely free from contact with the excreta, and if the evacuations are destroyed or rendered aseptic as soon as voided, there is no risk from contagion, and no possibility of a spread of the disease from a patient so managed. This theory further teaches that cholera bacilli flourish and multiply most vigorously at a temperature ranging from 85° to 104° Fahrenheit; that dry heat, and especially sunshine, very soon destroys their vitality; hence they can never be borne upon the winds, as the desiccation essential to such conveyance would render them harmless. They may be cultivated artificially in gelatine, milk, broths, potato, and almost any nutritive matter, provided it is alkaline in reaction. They have a peculiar and easily recognized morphology. Dampness and the alkaline media in which they escape from the bowels during cholera seem |