Alimentary System Infections

-JL g he face was sunken as if wasted by lingering consumption, perfectly angular, and rendered peculiarly ghastly by the complete removal of all the soft solids, in their places supplied by dark lead-colored lines. The hands and feet were bluish white, wrinkled as when long macerated in cold water; the eyes had fallen to the bottom of their orbes, and envinced a glaring vitality, but without mobility, and the surface of the body was cold."

This vivid description of cholera was written by Army surgeon S. B. Smith in 1832 when the disease first appeared in the United States. "Lingering consumption" refers to the marked wasting of the body seen with chronic tuberculosis.

Cholera is a very old disease and is thought to have originated in the Far East thousands of years ago. Sanskrit writings indicate that it existed endemically in India many centuries before Christianity. With the increased shipping of goods, and mobility of people during the nineteenth century, cholera spread from Asia to Europe and then to North America. Cholera was a major epidemic disease of the nineteenth century, appearing in almost every part of the world.

In 1854, John Snow, a London physician, demonstrated that cholera was transmitted by contaminated water. He observed that almost all people who contracted cholera got their water from a well on Broad Street. When the handle of the Broad Street pump was removed, people were forced to obtain their water elsewhere and the cholera epidemic in that area subsided. Snow's explanation was not generally accepted by other doctors, mostly because disease-causing "germs" had yet to be discovered. It was not until 1883 that Robert Koch isolated Vibrio cholerae, the bacterium that causes cholera.

In the United States, cholera epidemics occurred in 1832, 1849, and 1866. The disease seemed to infect poorer people, those unfortunate enough to be crowded together in cities where cleanliness was impossible to maintain. Many doctors were of the opinion that not only were the personal habits of these people "rash and excessive," but also that they insisted on taking the "wrong" medicines. By 1866, however, it was evident that where cholera appeared, the lack of sanitation was at fault. Public health agencies then played a major role in the elimination of epidemic cholera.

—A Glimpse of History

IN THE SPRING OF 1997, AN EPIDEMIC OF SEVERE diarrhea broke out among 90,000 sick and malnourished refugees in the Democratic Republic of Congo. More than 1,500 deaths occurred over a 3-week period. Volunteers from the medical relief organization Medecins Sans Frontieres rushed to set up medical

facilities, while people from the World Health Organization, Red Cross, and local health agencies worked to provide a filtered and chlorinated water source, construct latrines, and educate the people about sanitary measures. Treatments were started using oral and intravenous rehydration fluids. Unfortunately, at that point, the refugees were all scattered and driven away by unidentified soldiers.

Fear generated by a diarrhea epidemic, compounded by ignorance, can defeat efforts based on reason and understanding of disease.

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