of vegetables and certain classes of fruits may possibly come within the purview of intelligent public sanitation. The use of many of these articles should certainly be restricted if not wholly fordidden during the prevalence and presence of cholera.

Personal Sanitation.—The individual may do much for his own personal protection, even if the disease should encompass him round about as an epidemic. A careful observance of all the rules of health, regular hours, due care to the secreting and eliminating organs, abstinence from all causes which produce gastric or intestinal catarrh or digestive derangements, should be the rule. The stomach should be maintained in its integrity; it is the gateway to the intestines and the natural defense against those pathogenic germs which operate in the intestines.

Normal gastric juice is antagonistic to nearly all disease germs, especially those of cholera; and it must be a vitiated and abnormal stomach through which they can pass in reasonable quantities and retain their vitality. Then, to maintain the integrity of the digestive organs should constitute the most effective preventive treatment.

Vegetables, like lettuce, salads, and others eaten raw, are objectionable, because, by handling and otherwise, they are likely to become germ-carriers; besides they are not essential to digestive integrity. The same may be said of most fruits and berries; still these, if mature and above the possibility of infection, in reasonable quantities are not only harmless but probably conducive to normal digestion. Cooked vegetables, except in very small quantities, are objectionable, because many are intestinal irritants, and nearly all encourage alkalinity of bowels, the condition most favorable for germ development. Meats are preferable in that respect, as they encourage acidity. All that is eaten should be well cooked and consumed soon after cooking, or, if eaten cold, should be kept excluded from possible germ contact. The table ware and eating implements should be cleansed in hot water before being used. For precaution's sake all water should be boiled and filtered before using. If cooled by ice it should be done by placing the ice around and not in it, as freezing does not devitalize cholera bacilli, and the ice during cholera epidemics may contain the germs. Drinking vessels should be often scalded and, when not in use, kept under a screen.

Milk should be sterilized and cooled in cans or bottles. Butter, unless obtained from a locality above suspicion, should be discarded except when used in cooking. All alcoholic beverages, no matter upon what theories or in what quantities taken, are not only useless but harmful. The physician, especially while practicing in an epidemic, should wash his hands often in hot water, and, if his wardrobe will permit, change his clothing daily, sunning and airing those not in use. This will insure him against becoming an infection-carrier.

Therapeutic Preventives.-In persons of standard health and normal digestion, with the careful observance of the above suggestions, little or no danger from cholera need be apprehended, even in the midst of an epidemic. But probably the majority of people do not size up to standard digestive health or conform to orthodox prudence. Such will come to us for an ounce of that preventive which is said to be better than a pound of cure; and in this instance I think the cure estimate might be increased tenfold without changing the nature of the equation.

Many stomachs and intestines are found in the best possible condition for the reception and cultivation of cholera bacilli. Lowered vitality from any cause, unwholesome and indigestible foods, contaminated water, insanitary environments, alcoholic abuse, and many other causes contribute to bring about this widespread condition, favorable to cholera infection, and to furnish. the material upon which the disease principally preys. Can we by therapeutic measures overcome or correct these predisposing condition and protect the individual until the epidemic cloud blows over? I believe we can, in nearly all instances, where we can control the appetites and actions, of individuals. Persons with lowered dynamic forces and vitiated digestive powers should be advised to leave infected localities, but, when compelled to remain, then our efforts should be to restore as nearly as possible the gastric and intestinal functions to a normal standard. Foods of the character above suggested should be taken at regular times and in moderate quantities. Exposure to catarrh-producing influences should be avoided; also too intense heat, as this is one of the fruitful sources of our gastro-intestinal troubles. Loss of sleep and fatigue of body or mind should be abstained from, as these consume the vital energies which should be concentrated

on the digestive faculties. The fallacy of taking ardent spirits as a stimulant or preventive cannot be too emphatically condemned. Its effect in all quantities and at all times is to impair digestion. Artificial digests, simulating the natural, should be taken sufficiently often to insure their presence in the stomach at all times.

The action of the liver should receive especial care, as the bile is nature's antiseptic and germicide in the intestines, as is the gastric juice in the stomach. A mild cholagogue should be taken each day or two, if necessary. I know of nothing better for the purpose than a small pill of blue mass and hyoscyamus at bed-time. The bowels should be kept open, and daily evacuations insured with more than ordinary care. I would not attempt to fill the bowels with artificial and repulsive germicidal compounds, but would seek to insure an efficient amount of such as kind nature provides for that purpose. A compound of one of the pure pepsins-say 5 grains to the dose, with 10 drops of dilute muriatic acid, made up with a little glycerine and syrup and properly diluted, taken after meals and, in cases with bad digestion or chronic gastritis, between meals also-constitutes the best possible therapeutic preventive. In severe cases of chronic gastritis, when the stomach is lined with vitiated alkaline mucous, it will be well also to cleanse it once a day by means of tepid water and the stomach siphon.

Treatment. The stages of the disease, which call for treatment peculiar to each several condition, may be classed as the Prodromal or Cholerine, Choleraic Flux, Collapse, and Reaction.

The looseness of bowels, so common during epidemic cholera, has usually been thought to depend in some way upon the prevailing epidemic influence. Accepting the Koch theory, there can be but one way of accounting for it: upon the actual presence of cholera bacilli in the intestines, acting either mechanically or through their toxines upon the enteric nerve-endings. During this prodromal period, or cholerine, as it is usually called, and before the production of sufficient ptomaines to produce the more profound symptoms, nearly all cases can be arrested, and the evil effects which spring up later on, if neglected,, may be averted by proper treatment. The indications are to stop germ production in the intestines and to restrain bowel action within rea

sonable bounds, bearing in mind that most generally the free evacuation is the result of a conservative effort of nature to throw off offensive and deleterious matter; and further recollecting the well-established fact that cholera bacilli do not propagate or even maintain vitality in an acid medium, no matter how well adapted in other respects, the idea of a mineral acid treatment during this stage would naturally suggest itself. A prescription in which the standard and unvarying ingredient is dilute sulphuric acid should be employed in doses of 10 drops from three to six times a day, or oftener, if necessary. Sulph. of magnesia may be added in the event that freer or easier bowel action is desired, and laudanum in the event that a restrainant or analgesic is required. These ingredients should be made up with camphor water and given by the stomach, which, during this stage, retains its integrity. It is during this period that the almost universal and justly popular agent, calomel, does its best work. Later on, in the more advanced stages, it is questionable if it is absorbed or produces any effect until after reaction has set in. The effect of calomel at this stage is to arouse liver action, relieve portal engorgement, and promote the flow of bile into the intestines. I would not be willing to rely upon it alone and feel that I had given the sufferer the best possible treatment. Camphor is one of our best germicidal stimulants, and makes an excellent and popular combination with calomel, while capsicum acts well as a local stimulant. A capsule or powder, containing 1 gr. each of calomel and capsicum and 2 grs. pulverized camphor, should be given in connection with the acid compound sufficiently often to insure liver action. This treatment, with proper regard to diet, will arrest nearly all of the cases when commenced early enough to insure the action of the medicines before severer symptoms develop.

If seen too late, or after profuse choleraic flux has set in— showing that the system has become poisoned with toxines-then we may expect a growing demoralization of stomach as well as bowels, and an inability to retain or derive benefit from any therapeutic agent administered by mouth. Still it is customary, and probably allowable, to continue the employment of calomel, capsicum, and camphor in this stage, upon the ground that it can do no harm. In this condition absorption from the stomach

and bowels is arrested. There exists a reversed osmotic action. The fluids are all tending towards and being poured into the alimentary canal, consequently there can be but little utility in administering medicines by the stomach, as they will not likely be retained, and if retained not absorbed, at least not until after the alarming symptoms subside, when they will not be needed.

It is at this juncture that hypodermic medication comes to our relief. Opium has been and is still regarded as the sheet-anchor in the treatment of cholera at this stage. Its effect, probably, aside from its pain-relieving and spasm-controlling properties, is to obtund nerve impressibility and to cut off the reflex influence upon the intestinal vessels which is producing the extreme exosmotic action, and thus to arrest the spoliative flow until nature can rid herself of the toxine through her other eliminants. In this condition the hypodermic use of morphia and atropia should be resorted to until the desired effect is attained. Caffeine and digitaline may be administered here when a stimulant seems to be called for.

If not promptly arrested, the characteristic rice-water discharges may be looked for, with coldness of extremities, cramp in the limbs, failing strength, and threatening collapse. Heat should be imparted to the surface by wrapping in hot blankets, and the application by hot-water bottles around the body and limbs. Cramp should be treated by friction with spirits of camphor and chloroform. Vomiting may be palliated by the application of large sinapisms over the epigastrium, and the administration of 10-drop doses of chioroform in a little ice-water. The intense thirst, consequent upon the dehydrated blood, can only be met by allowing the patient to swallow small bits of crushed ice. Should profound collapse come on, which is but an exaggerated and legitimate outgrowth of the conditions just enumerated, largely the result of the exhausted blood, lack of oxygenation, and arrested innervation, growing in part, but not wholly, out of blood spoliation. These severe cases always have a strong element of ptomainic toxæmia acting upon and depressing the great nerve centers, also more or less uræmic toxæmia, resulting from defective kidney action. So, in this condition of profound collapse, the only and ever-hopeful indication does not consist in restoring water and salts to the blood, as many seem to think.