Fight Against Cholera’s Resurgence

Press, Volume CIV, Issue 30945, 29 December 1965, Page 15

Fight Against Cholera’s Resurgence

(N Z P.A. Reuter)

GENEVA. War is being waged aaginst a resurgence of cholera which, until four years ago, was thought to be almost extinct.

But today the World Health Organisation is burbling what it says are “solid frontiers against the westward spread of the disease.” One means by which they are fighting the disease is by organising courses for medical men and women in affected areas. Cholera, which until the beginning of the century, took the lives of millions of people in Asia and Europe, had been restricted to India and Pakistan in recent decades. Even there the declining death toll seemed to indicate that the disease was disappearing spontaneously. In 1960, only 11,000 deaths from cholera were reported. Then, in 1961, a form of the disease, known as cholera El Tor, began to spread through many countries in the Western Pacific and South-east Asia, from which cholera had long disappeared. In four years, it had invaded 20 countries, including South Korea, Japan, Formosa, Hong Kong, Macao, the Philippines, Malaysia, Indonesia, South Vietnam, Cambodia, Thailand, Burma and Nepal. An epidemic broke out in Afghanistan, Iran .and Bahrein, and the disease entered Russia, appearing in Uzbekistan. Iran, which had been free of cholera since 1939, had 2704 cases by mid-October. 368 of them fatal. Most cases occurred in August and there were only five new cases in the week to October 23. As soon as Iranian health authorises informed the World Health Organisation of the outbreak, two epidemiologists were sent to help introduce rigid control measures. The Iranian Army was called in to help by establishing road blocks to cut off the east of the country from the west and so prevent the disease from spreading from four eastern provinces where it had appeared—Mazandaran, Khorasan, Baluvhestan and Sistan.

Between October 2 and 11, the regional office of the World Health Organisation in Teheran held an advanced training course in the latest methods of cholera detection and control for leading bacteriologists and cholera control workers from 10 countries in the Middle East. Two of the World Health Organisation officers went to Afghanistan to help isolate 218 cases which had occurred there by the end of August. Some 55 people died of the disease, but since August, Afghanistan has apparently been free of cholera.

The approach of winter in both Iran and Afghanistan will help the fight against the disease.

The outbreak is blamed on the absence of the fundamental pre-requisite for control basic sanitation. Cholera, according to a World Health Organisation official, can only occur as an epidemic in a hot, damp climate where people live in overcrowded conditions, in

poverty, dirt, undernourishment and ignorance. The El Tor form of cholera was for many years confined to a small area on Celebes (Sulawesi) island in the Pacific. It took its name from the El Tor quarantine camp, on the shores of the Red Sea, where, in 1905. a research worker isolated six peculiar strains from the bodies of pilgrims who had been to Mecca. Symptoms of this form of cholera are exactly similar to those of the cholera found in the stifling hot plains of the Ganges river, in eastern India.

In the days of Alexander the Great, cholera was described thus: “The lips blue, the face haggard, the eyes hollow, the stomach sunk in. the limbs contracted and crumpled as if by fire—those are the signs of the great illness, which, invoked by a malediction of the priests, comes to slay the brave.” Until the 19th century, the

disease was confined to Asia, and almost exclusively to India. In 1817, an epidemic of extraordinary virulence erupted in India and in successive waves attacked other parts of Asia, Europe and Africa carried by pilgrims, traders and soldiers. Then, from 1923 onwards, cholera receded to its traditional breeding ground and even there seemed to be diminishing. The only major outbreaks west of Afghanistan occurred in Iran, in 1939 and in Egypt, in 1947.

With increased travel facilities, cholera can be spread much more easily. But in countries where hygiene is highly developed, cholera cannot break out in the form of an epidemic and is generally confined to a single family or household, according to the World Health Organisation. With modern treatment, it is no longer a highly fatal disease. Its death rate is comparable to that of typhoid —about 3 per cent.