HYGIENIC CONDITIONS IN CHILI. BY W. B. HOOVER, M.D., Iquique, Chili, S. A. (CORRESPONDENCE.) IQUIQUE, March 22, 1894. T. S. VERDI, M. D., WASHINGTON, D. C.: My Dear Doctor: I am very much surprised to find myself, after the lapse of four and one-half years, with a medical duty to perform. I am in receipt of your pleasant letter of February 10, 1891, and find myself, in spite of many other duties, in spite of conscious inability to lend any real service (not in spite of lack of inclination, for whatever is done by my colleagues in the great work of ameliorating human woe finds me full of attention and interest), obliged to pen you what little I can. I regret to say that in moving, in the beginning of February, your circular was mislaid, and I fear, destroyed, so I am dependent upon the hint you give in your last note for direction in the few remarks I shall make. I might actually dispose of the subject in hand, i.e., “The Public Treatment of Cholera in Chili," by saying, there is no public treatment of cholera in Chili, and I might allege as a reason that there is no cholera in Chili, but this would not necessarily be true, for the last-mentioned fact, though a fact, would not be the whole cause of the absence of a "Public Treatment" of that disease, as I shall presently show by using another disease as an illustration. A moment's explanation of the pleasant fact of the non-existence of cholera, non-existent at least within my experience here, since October, 1889. The strip of country called Chili extends through many degrees of latitude. The conditions necessary to the existence of that dread disease are not united in any one point. The north, or torrid extremity, has abundance of heat (though actually not the torrid heat prevalent in similar latitudes) but it is absolutely barren of of vegetation, being the great saltpetre deposit of the world, and entirely rainless. The southern extremity has variety and moderate luxuriance of vegetation, the luxuriance of the temperate, not of the torrid, zone, but the heat is not great and, moreover, the small rainfall occurs when the heat is least. Much of the vegetation is dependent upon irrigation, so you will readily see that the humidity which (I judge) is necessary to cholera is lacking. The subject of the presence of cholera is thus readily disposed of, that of its "Public Treatment," if it existed, may be inferred from the few remarks which I shall make, perhaps irrelevantly, on the subject of smallpox-which does exist, at times. Chili, both north and south, is subject to small-pox. An epidemic, virulent and long, raged in the years 1891 and 1892. It began with the beginning of the movement of troops and travellers incident upon the revolution of 1891, and continued long beyond it. As director of the Iquique English College at that time, I had ample opportunity to observe, and our school also passed through the sad experience of losing one of our teachers. There was, and continues always in Iquique (I shall be able only to speak of this city as my residence in South America has been confined to this one port), free public vaccination, and lymph is used which comes from Santiago, in glass tubes which must be broken to extract it, and each tube only contains sufficient for perhaps two punctures. It is said to be very carefully prepared. This step is excellent, but there is a prevalent idea that if one is vaccinated during an epidemic, he is more liable to take the disease! So they are in the very stupid and ridiculous position of the man whose shanty possessed a very leaky roof, i.e., when it was raining he could not mend it. In fair weather he did not need to-it was all right! During the epidemic we understood it was contrary to law to harbor patients in private houses-all should go to the pest-house or lazaretto, as it is called. There were constantly from forty to fifty cases in that place, but as a matter of fact there were many more scattered about through the city, and the authorities perfectly cognizant of it. I think there must have been hundreds of casesperhaps two or three hundreds at any one time during several. months. The place is said to have 15,000 to 20,000 inhabitants. The mass of the people live with a bedstead, chair, trunk and table, a whole family in a single room, floors rough, warped laurel boards guiltless of water. The whole city lives with but a wall between himself and his neighbor. The wall consists, on one side of a loose boarding up, perhaps an inch or two between the boards, always irregular and uncertain spaces, save in the rare cases where matched boards are used for a hall. Over this rough wall a coarse cloth like thin coffee sacking is used; this is called crudo (pronounced crutho); this crudo is the basis of a cheap, a very cheap paper. The neighbor on the other side may have a similar fitting up or he may have only the wrong side of your wall, as often happens. I have been thus explicit that you might realize your security (save the mark!) in case your next-door neighbor has the small-pox. No sign to warn you to be careful; no way of knowing how to avoid it. So our fated Miss Lanyoa, who was of Spanish mother (English father), and had declined to be vaccinated some weeks before, when I had urged it upon the household, walking through the streets one afternoon, breathed the contagion, and in three or five days was ill. We hired a room in the very outskirts of town, and gave her in charge of a Spanish woman, a warm and faithful friend of us all. An English physician had her case, but she died. The physician whose care and treatment most commended itself to my judgment was a native. He had his patient lie a half-hour or more daily in a quite warm bath. It kept the skin from crusting and left a minimum of pitting. As for precautions, it was enough to chill one's blood (till he became accustomed to it) to note the absolute indifference and obstinate insistence with which the natives generally (almost universally) went in and out among those sick with the disease. If one had been "apestado" (pested)—that is, had had the disease—that was considered reason enough why he should move with absolute freedom between the well and the sick, no matter to how many of his own or friend's children he might bring seeds of death. One day I passed along the street, and seeing an acquaintance in an open door, stepped in to chat a moment. A child sat at a table eating bread and milk, ten feet or less from that door. The eruption was just drying up. I exclaimed over it and stepped out. He called out to me that the child was getting better-in fact, was quite well—and no argument was sufficient to make him see that he was jeopardizing lives. A gentlemen of wealth and education-an Italian-had a son down with the disease. Kept him in his own house with other little ones and very indifferently isolated. Lost his boy; moved, with considerable upholstered furniture, opposite our college; lost two or three more. I notified the police of its proximity to a school, endangering public safety. A feint was made of doing something, but he remained. Fortunately he was to leeward. Bakers, butchers, travelling vendors of all kinds went from house to house as usual. The dirty water and closet barrels were carried about as usual, changed each time; anybody's barrel might be in our closet or by our kitchen door at any time. I could continue indefinitely. I was filled with horror at first. Then I saw the absolute futility of avoiding it; so I just left my case in the hands of my loving Father in Heaven and went serenely on my way. But, oh, they died like sheep! They thought it must be so, hence precautions were useless. P.S.-The people are really half-civilized. They have the gloss of a higher enlightenment, but are truly lacking in much that constitutes civilization. They have the telephone, electric light, etc., but no water-closets on their trains and none too many in the homes -men urinating in the middle of the street a common sight, sometimes stepping aside from a female companion for the purpose; unblacked shoes, or even dusty shoes, a great breach with many, who literally do not wash their feet or body from fall till spring. Vaccination perfect theoretically; isolation, common-sense-nil. COBRA VENOM IN CHOLERA. BY L. SALZER, M.D., CALCUTTA, INDIA. (CORRESPONDENCE.) Dr. T. S. Verdi, Chairman, etc.: CALCUTTA, 6 LOUDON STREET, My Dear Doctor: I owe you an apology for not having sent you my promised contribution. Illness of a malarial nature has prevented me for the last five to six months from devoting myself to any serious subject of study. At this very moment I am busy in making preparations for a change to the Himalaya Mountains. Meanwhile, I may be allowed to say that as my contribution was to deal with questions of sanitation in reference to cholera, the world has not lost much by my not having given out my opinions and observations on the subject. For the "Official Report on Cholera in Europe and India," published by order of the American Senate in the year 1890, fully contains all that possibly can be said on the subject. At the same time, I cannot help expressing my regret that Dr. Edward O. Shakespeare of Philadelphia, who was the officer in charge of the report just mentioned, has ignored Homœopathy altogether. The American Institute of Homœopathy should address an interpellation to the Senate on the subject, according to my humble opinion, if they have not already done so. From page 899 of the said report it can be seen that Dr. Shakespeare had been in Calcutta. He speaks of the "antidotal" treatment of cholera by cobra poison, as practiced by a certain Mr. Perroux. From a letter I addressed to one of the daily papers of Calcutta, The Statesman, a copy of which I have much pleasure in enclosing herein, it will be seen that the cobra plan of treatment may have a great deal in its favor, the same being essentially a Homoeopathic mode of treatment. I have just prepared a tincture of the ptomaines of a cobra victim, and I |