pects 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.

Treatment.

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 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 Epi