891

while, the Livornesi living in voluntary exile in the Tuscaninterior are content to abide by the maxim hic manebimusoptime," and to submit to expatriation until the malady hasbeen beaten off.Such being the status quo on the Tuscan seaboard, particu-

larly at its chief centre, Leghorn, I must ask you to accom-pany me to a part of Italy which has scarcely, if at all, figuredin official bulletins-th Abruzzi. That picturesque Neapolitandistrict, so dear to the artist and to the Anglo-Italian in questof summer coolness, has been sharply visited by the

disease, in circumstances, moreover, which cannot but

prove favourable to its severity and its diffusion. Byway of precaution a public fountain at Castel di Sangroof more than equivocal purity had been closed, andthis act was so resented by the populace that a

hostile demonstration sprang up before the town ball andthe houses of the magistrates, resulting, however, in littleelse than the smashing of window-panes and street lamps. Thedisturbance, however, sufficed to arrest further precautions ;precious time was thus lost, and when cholera did appearit caught the sanitary board napping. In twenty-four hours,out of a population of less than 6000 persons, seven personswere struck down of whom four are dead. In the nexttwenty-four hours six more were attacked, four fatally ; in all,thirteen cases and eight deaths. The worst feature of thesituation, however, is the panic of the people, who in suchbenighted regions always suspect their best friends-namely,the medical men ; and when they do not stone them or

attempt to take their lives, flee to the uplands and prefer to dieunder the hedges there rather than take the poison, " as theyinsist on calling the medicine proffered them. So seriousdid the aspect of affairs become on the part of thesemi-fatuous and wholly affrighted populace, that inaddition to the g1lardie of public security a body ofbersaglieri (troops of the line) had to be summonedfrom Sulmona, under whose protection the sanitary com-missioner, Dr. Gualdi, and the advocate Bacchetti, towhom the district owes its well-appointed lazaretto, are

working in concert with the municipality to take the neces-sary measures for isolating and treating the cases as theyoccur. The supply of pure water is another adjunct to thesedefensive operations, and disinfectant matériel, of whichDr. Gualdi found hardly more than "una quantita risibile "(a ridiculous handful), is now available in abundance. Thenuns of the neighbouring convent have also been pressed intothe nursing service, and the medical staff has been reinforcedboy Dr. Petrarca (who now directs the proceedings), Dr.Terenzio and a first-rate practical hygienist, Dr. Fiocca,trained in the laboratory of Professor Celli of Rome.As to the "conditions precedent" of this cholera

explosion in the Abruzzi the pollution of the drinking-supply is pronounced to be the chief by Dr. Gualdi andhis colleagues. Nature has been exceptionally lavish of herpure water springs in that "circondario," but rather thantake the trouble of drawing from these sources the in-habitants go on from generation to generation using waterfrom wells contaminated with dejecta. Sulmona, a leadingcentre of Abruzzese ’’ civilisation,’’ is described to me by alocal authority as non provvista affatto di fognatura "(absolutely unprovided with drainage) ; it has a slaughter-house in the worst possible state ; a cemetery quite too smallfor the requirements of sepulture, and the sanitation generallyis medieval in character. Naturally enough, the brief visitof the hygienic commissioners can only indicate the problemwhich the municipality has to solve ; but with the lack ofpatience, perseverance and, above all, money (Sulmona, likethe majority of Italian communes is deplorably poor) thesolution in question can come off only at the Greek Kalends.

Pescina, another town of the Abruzzi, where, in Heber’swords, " every prospect pleases and only man is vile, " isalso paying the penalty for defying Nature’s laws. Thedisease, according to Dr. Gualdi, up to the 20th inst. "si ediffaso rapidamente e violentissimo " (has spread withrapidity and the utmost violence). The "condizioni dellacittà sono, al solito, deplorevole " (the state of the town is,as usual, deplorable). One consolatory feature of the crisis,however, is this : the people have not, as at Castel di Sangro,lost their heads as a prelude to losing their lives, but arecooperating energetically and intelligently with the sanitarycommissioners to circumscribe the disease and to reduce itschances of spreading. It is fortunate, too, in its local medicalstaff, headed by Drs. Freda and Proja, and reinforced by theindefatigable officer of the Board of Health, Dr. Ambrogetti.hp to yesterday the number of cholera cases officially reportedis fifty-two, of which twenty-six have proved fatal.

Aquila, with its 19,000 inhabitants, is another town in theAbruzzi which has been severely visited ; but the last officialreport that has reached me announces a distinct and steadydiminution in the number of victims.

LATEST CHOLERA INTELLIGENCE.

I THERE have been no cases of cholera reported from Yar-mouth since the 29th ult. At Coton Mill Asylum two patientswere last week attacked with violent diarrhoea and died inthe course of three or four days with no antecedent illnessof a choleraic nature. Bacteriological examinations of the

evacuations were said to give distinct indications of true

cholera, the source of which has not yet been discovered.A case also occurred at Newcastle-on-Tyne on Oct. lst whichwas pronounced, bacteriologically, to be cholera. The patienthas improved. On the same date the port sanitary officerat Blyth reported a case of cholera on board a vessel whicharrived at that port. The patient was attacked at sea onSept. 30th. From this vessel a patient suffering from cholerawas also landed on Sept. 23rd at the Port Sanitary Asylum atDenton. The South Shields medical officer of health reportson Thursday, 5th inst., that a resident in that town

was attacked last Sunday and died after thirty hours ; Dr.Murray of Newcastle regards the case as one of Asiaticcholera. At Gloucester a fatal case was reported on the 3rdinst. by the medical officer of health. The examination of thecontents of the intestines has not yet been completed but theappearance is suggestive of true cholera. At North Bierleyit seems that a serious outbreak has been taking place forsome time past ; and the medical officer reports on the 4thinst. that an intensely virulent form of choleraic diarrhoea orEnglish cholera has been in progress at Low Moor ; of sixattacks five have proved fatal. Dr. Bulstrode has been des-

patched to investigate the outbreak. From Grimsby noauthentic information has been obtained. It seems, however,that a considerable outbreak of infective diarrhoea has been

prevalent amongst the ships in the Alexandra Dock and it isquestionable whether the authorities have been dealing withthese vessels as if they were infected with cholera; manycases presented symptoms which were extremely suggestiveof cholera.

PROFESSOR R. KOCH ON THE CHOLERAEPIDEMIC IN GERMANY DURING

THE WINTER OF 1892-93.

II.

WE had here to deal with the same conditions which in the

previous summer brought about the outbreak in the harbourof Hamburg. Then it was the barracks of the Russian

emigrants on the America Quay ; the drain of the quaycarried the infected fasces and dirty water from washingclothes into the harbour. The sewage matter from thesebarracks was by no means inconsiderable, for some hundredsof emigrants arrived daily and had to be kept till theycould be sent on. At the time of the outbreak of cholera the

average number of emigrants in the barracks was 1000, andmany of them took the opportunity which the break in theirjourney afforded to wash their dirty linen and clothes. The

theory that the Russian emigrants conveyed cholera to

Hamburg has been objected to on the ground that no casesoccurred amongst them before the town was infected. Severe,clinically unmistakable cases of cholera were, indeed, notobserved amongst the emigrants ; but that is no proof thatthere were no cholera germs in the bodies or clothing of theemigrants, who came for the most part from severely affecteddistricts. No one can deny the possibility that there may havebeen amongst these persons slight cases and convalescentswho would have cholera bacilli in their motions for two orthree weeks, or that amongst the masses of bedding and linenwhich the emigrants brought with them some may have beensoiled with the dejecta of cholera patients. Under the