Cholera Old and New

have long been a concomitant of epidemic disease.Thus during the latest prolonged pandemic of cholera, health authorities in Asia, Africa and Europe repeatedly denied that the infection had reached their countries.When eventually they began appealing for outside help, cholera had become firmly entrenched.Typhoid has had a similar effect, as epitomized in the persecution of a zealous medical officer in Ibsen's 'An Enemy of the People', and more recently in the Zermatt epi- demic.But the demands upon politicians and medical officers are complex, and still must oc- casionally be met by irrational acts.For example, during the 1964 Aberdeen typhoid epidemic, the spraying of the streets with disinfectant solution evidently satisfied a deep need of the local popu- lation.Cholera has, however, elicited more than its fair share of public and medical obtuseness.The Boards of Health which investigated the early outbreaks were accused of inventing an imaginary disease so that members could obtain their daily fees.Moreover, miasmas and sewer gases were being invoked as etiological agents long after John Snow (1855) had elucidated the water-borne route of spread and his colleague Arthur Hassall (1855) had actually described and depicted the cholera vibrio -30 years before its 'discovery' by Koch.Nevertheless, for the wrong reasons the right things were done.Each wave of cholera as it swept through Britain stimulated valuable sanitary reforms and public health legislation, engineered by Chadwick, Southwood Smith, Farr, Simon and other indefatigable Victorians.In the international field, cholera led to cooperative effort and, in 1907, to the establishment of the Office of International Public Hygiene -ancestor of the World Health Organization.For medical science, too, cholera has proved a valuable catalyst.The work ofHaffkine in India led, in 1895, to the production of a prototype killed vaccine, while the clinical researches of Sir Leonard Rogers in India had, between 1907 and 1920, established the modern intravenous treatment of severe water and electrolyte loss.But very notable scientific work has also been stimulated by the current seventh pandemic.The El Tor vibrio, whose early history is described by Dr Bryceson, lost its hemolysin in 1961 but, paradoxically, at the