Printed for Private Circulation. THE PREVENTION OF CHOLERA BY MEANS OF INTERNAL DISINFECTION. LONDON. 1884. ARMED FORCES MEDICAL LI3RAR\ WASHING! ON, D. C. Printed for Private Circulation. THE PREVENTION OF CHOLERA BY MEANS OF INTERNAL DISINFECTION. THE great calamity which has befallen France, which paralyzes the social and national life of her people, and threatens the rest of Europe, according to past experience, with a similar fate, demands that no means, however trivial and unpromising they might appear to the superficial inquirer, should be left untried to check the progress of the Cholera ; and I appeal for an unbiassed impartial investigation in favour of a remedial and prophylactic agent, which thirteen years of study and practical application has proved to be for the general well being of the human body a necessary food and the best tonic, and against diseases, with special relation to the infectious class of diseases, an effective prophylactic ; whilst I can point in support ot this, to the experience and writings of such men, famed in scientific research, as Boussingault, Liebig, Becquerel et Rodi6r, Lehmann and many others. In all endeavours to check the progress of the cholera, as of all other zymotic diseases, attention is chiefly directed to the disinfection of everything external to the human body ; to check the spread of the disease by killing the infecting disease-germ, with what result the history of cholera has shown ; whereas, the disinfection of the human system itself y to 2 prevent and destroy the predisposition of the individual human being, has been disregarded. Rules of diet and of modes of life are no doubt prescribed ; but the endeavour, to steel the system against the attack of the poison, is not included in the weapons to be used against this enemy of the human species. Now, without in any way deprecating those laudable measures which have been recommended and have been so assiduously employed in the attempt at checking the choler,a I contend that it is of the greatest, if not of the first, importance that the human body should be protected against infection by internal means ; by a liberal supply to the system ot that ingredient, which by its presence in the human body (in sufficient quantity) protects the various substances, of which the body is composed, against abnormal changes. This internal disinfectant is chloride of sodium — common salt. It is a well known fact, confirmed by historical evidence, that when salt (that is chloride of sodium, common salt, cooking salt) is studiously and rigorously withheld from the animal economy, first disease, and then, at last, death is the result ; that the presence of salt is a necessary condition for most functions to be performed in the organism ; that the blood cannot course through our arteries and veins without the presence of salt, and that even when death results in consequence of salt being withheld, the blood still contains about two portions of it in 1,000 (the normal amount being 0.45 per cent., that is, 4.5 parts of chloride of sodium in 1,000 blood). But it is also a fact, that in the face of this absolute necessity for the presence of it in the human body, salt is not taken by 3 the generality of mankind in sufficient quantity ; or, when so taken, it is supplied to the system in an improper manner, causing abnormal thirst and as a consequence, other bodilydisturbances. The indifference, with which salt is spoken of as a simple condiment, or a substance merely taken to excite our sense of taste, has produced a kind of contempt or at least disregard for this important element in our existence ; for it can be truly said that pure salt is of equal importance for the well-being of the human body as is wholesome food and an unvitiated atmosphere. In the history of the infectious diseases it is a striking phenomenon, that not everybody, who moves about and breathes in a contagious (for instance, cholera) atmosphere, is subjected to an attack ; although this may be incidentally owing to the disease germ not entering the system of every one exposed to such infection. Still, it is also a fact that the disease shows itself in varying degrees of violence and severity; and we are hence justified to assume, that different human beings have different degrees of susceptibility and predisposition for the disease. Hence the natural question : what is it, that causes this difference in the degree of susceptibility? I answer: the presence of sodium chloride in greater or lesser quantity in the human system— not only in the blood — but, also, if not chiefly, in the nervous substances ; because in /all] the contagious diseases, I maintain (as I have endeavoured to show in a pamphlet on Variola in 1871) that the disease*is above everything (if a sharp distinction and separation can be drawn) a disease affecting the constitution 4 of our nervous matter, leading, in fatal cases, to a chemical change, if not dissolution, of its component ingredients. Hence the suddenness with which an attack becomes fatal* And that chloride of sodium enters into the composition of our nerves is proved by the analysis of several physiologists ; among whom must be specially mentioned yon Bibra, who, according to Moleschott ("Physiology of Food," Table XXIX.) found two parts of salt in 1,000 of nerve matter. Physiological researches have established the fact, that the quantity of chloride of sodium in the blood varies from three to five per 1,000 ; but the quantity in the whole system greatly fluctuates, depending upon the diet — that is, the direct introduction of this substance into the stomach, and also its absorption through the skin by salt-water baths. The experiments on men and dogs show, that a considerably greater quantity can be absorbed into the system, than would account for the difference between the maximum and the minimum in the blood alone ; and this can be explained by the fact, that chloride of sodium has been discovered to be present in every part of the animal organism (except the enamel of the teeth). But not only is salt present in every part of the organism, it also enters largely, more or less direct, as an agent into the various processes going on in the animal economy,* whether the process is involved in the growth and development of the body during childhood, or in the nutrient changes or the secretion of used-up effete nitrogenous compounds by way of the kidneys ; which processes are constantly taking ¦mmon salt may be looked upon in relation to our bodily organism as g offices and agencies similarly performed by money in our social 5 place in the fully developed body during- life, and so cause a continuous loss to the system of common salt. Hence a diminution of its amount, unless a daily supply is kept up. The necessity not only for the presence of salt in the animal organism, but for its presence in sufficient quantity, is referred to by Lehmann (" Physiological Chemistry ") when he says : " Salt is the agent for the deposition of phosphate of 11 lime in the bones, for the development of cartilage, and the 14 growth of connective tissue and muscle ; it determines the "expulsion of effete matter through the kidneys, and attaches "itself to newly -deposited tissue, of whatever form in "the human economy;" and further on : " From the abun•' dance in which it exists, both in the saliva and the gastric "juice, we might be led to infer, that it essentially promotes " the solution of the food and its future changes, or at all " events, that it contributes to impede abnormal decompositions •* and metamorphoses of the food." On the same subject : the necessity of a sufficient quantity .of common salt in the system, and the antiseptic and prophylactic properties of sodium chloride, Liebig refers in his Letters on Chemistry 409) to Doussingault 's experiments on six oxen, in the following terms :—: — " In the oxen which only had as much salt as was contained " in their fodder, the quantity of salt was insufficient for their " secretory process. There was wanting the means of trans" port for a number of substances which out of the body excite " disgust ; their whole frame, the blood, flesh, and all the " juices were loaded with these ; for the external surface of " the skin (referred to in a previous part) is a mirror of the 6 " state of the interior. The other oxen which daily had salt ** added to their fodder, remained healthy, even in the mode ° of life to which they were confined, which corresponded but " little to their nature, and with excess of food and deficient " exercise. Their blood remained pure, and well fitted for all " the purposes of nutrition. In the salt they had a powerful " means of resistance to external causes of disturbance to healthy 11 which, in the actual circumstances was indispensable to " them. The body of the others was, in regard to disease, " like a fireplace, heaped with the most inflammable fuel, " which only requires a spark in order to burst into flame, 11 and to be consumed." That want of common salt in the human body predisposes the latter to various forms of disease, is confirmed by the researches of many physiologists, and is commented on by Lehmann (Physio. Chem.), who says ; Nasse and Scheerer found that there was a diminution of the chloride of sodium in inflammatory blood ; Nasse also observed it in the blood of diabetic patients ; Lecanu in cases of jaundice ; Jennings and Simon in chlorotic patients ; and O'Shannessy, Rayer and Mulder observed this strikingly in cholera. The remarks of Becquerel et Rodie'r (" Chimie Pathologique," p. 66) deserve special mention. When speaking about the quantity of salt in the blood the authors say :— "Sa diminution, au contraire, est un fait constant sous " Vinfluence de la diete. Ainsi, dans les maladies aigues, con-11 siderees dune maniere generate et en rassemblant tous les 11 fa its que nous avons recueillis, on a pour moyenne 2-5, et "pour variations 2-o et 3-0 comme minimum et maximum. Ces 7 "chiffres montrent que la diminution de cc principe est " assez considerable ; elle est tnanifestement due a V absence de " nourriture et au manque d' introduction dv chlorure de sodium lt dans I'organisme." 1 " Les recherches de M. Mialhe ont confirm^ compl&ement *' les notres, et ont d^montre la diminution de proportion dv * chlorure de sodium dans les maladies en general." , There is an important physical advantage connected with the presence of salt in the human body in sufficient quantity, which has a significant bearing on the disease-resisting power of the organism. When salt is dissolved in water, the temperature of the solution is lowered ; heat becomes latent, because the water, with the salt dissolved therein, has acquired a greater capacity for heat. So, also y the human system acquires by the presence of common salt greater capacity for heat ; and hence it can bear extremes of temperature better, than with a minimum or a diminished quantity of salt. The presence of salt has another and most vital effect on the blood, which stands in direct relation to one of the principal symptoms of cholera and allied diseases. When a drop of blood, in its normal condition, is observed under the microscope, each blood disc can be discerned (if Ie magnifying power is sufficiently great) as a flattened here with a cavity in the centre of each flattened surfacepon a drop of fresh water being added to the blood, the 3od cells or discs absorb the water, swell, assume a globular •m, and if the process is extended far enough, at last burst (as assured to me, in conversation, by Dr. Klein, one of 8 the leading experimental physiologists of the present day.) This would indicate the danger of the inordinate drinking of fresh water (so readily incited to during hot weather) as leading ultimately to a destruction of the red-blood corpuscles and its consequences. If, however, before this takes place, a little common salt is added to the mixture of blood and water, the blood-globules will give off their absorbed water, and assume their normal shape and size ; the chloride of sodium by its affinity fo water, and by a dialytic or osmosmic action deprives the blood -globules of the absorbed water, and reduces them again to their normal disc form. This fact is of so far-bearing a character and importance in the question of the circulation of the blood in health and disease * — from a simple " cold " and rheumatism to cholera and yellow fever, that much greater attention should be paid to it ; but here it must suffice to refer, in relation to it, to one of the most-marked symptoms in cholera. — Drs. Russell and Barry in a paper, drawn up by them and circulated by the General Board of Health, in December, 1831, say, speaking of the state of the blood in cholera patients : " The blood "ceases to circulate; its physical properties are altered; its " serous portion is suddenly thrown out upon the intestinal " mucous surface of the body ; the secretions are all arrested, "and animal heat is no longer produced," I think the enquiring mind will ask here the very pertinent question — " Do not all these symptoms indicate the cause to * How far this property of chloride of sodium can influence the circulation of the blood can be learnt by watching the flow of the blood through fine capillaries under a powerful microscope. 9 be : absence of sufficient chloride of sodium ? " but the scien. tific investigator, who desires his mental eye to discover more than the physical eye can show him, might well question whether the disintegration of the blood corpuscles may not be one of the principal phenomena accompanying, if not constituting, this direful disease.* Although we can give the animal economy too large a dose of salt at one time, we cannot surcharge the body by repeated small quantities. I believe it was Lehmann, who either experimented upon himself, or who reports experiments undertaken with the view of ascertaining, how far the human system would absorb the salt, or secrete it again. The salt was supplied in small doses at regular intervals, and the blood was analyzed every four hours, and, I believe, the urine at varying intervals. The result was that the quantity of salt in the blood never exceeded the normal proportion (about 4*5 per 1,000), whilst the quantity of secreted salt in the urine increased. The importance of the presence of salt in the body in sufficient quantity becomes, however, most evident when inquiry is directed to the way in which the disease-poison * The dangers of surcharging the system with fluid without a compensating supply of chloride of sodium during a cholera epidemic is signally illustrated by two cases reported from Toulon and Paris in The Times' telegraphic intelligence. The first case (July 25th) reads thus :—": — " Two youths, who made a bet, as to how much seltzer- water " they could swallow, have both died of cholera. One had drunk nine " syphons and the other eight." (The ordinary seltzer- water is but a carbonated water, or holding carbonate of soda and citric acid in solution.) The second case (July 28th) is reported from Paris: — " A man, having in" dulged in a bout of eight days' drinking, was attacked with cholen>ZŁ." (The existence of cholera i 3 not yet officially recognized in Paris.) 10 enters the human body. Various opinions have been upheld from time to time, but the theory, which has the greatest support in all the facts surrounding the phenomenon of infection is, that the disease germ is inhaled, mixed up with the saliva, and thus, swallowed with this, reaches the stomach ; there to try its strength of vitality against either the epithelial cells in the lining membrane of the stomach, or against the pepsine of the gastric juice, and the " struggle for existence " is decided by the survival of the strongest. I repeat here, what I wrote on this subject as long ago as May, 1871, when treating on the entry of the disease germ into our system in the case of the zymotic diseases generally. " When Liebig declared (Chem. as applied to Agriculture and Physiology, 3rd Ed., pp. 367 and 375) " that the poisonous " properties of the small-pox virus are ineffectual in the " stomach, because the free acid present, in the stomach, dcs" troys the action of the poison," he, no doubt, referred to hydrochloric acid, as the one secreted in the digestive organ of a healthy Jiuman being, and it is the nature of this acid to which we should direct our attention. Liebig, in his Animal Chemistry, further says (page 109) that " the " gastric juice, when separated, is found to contain a free mineral acid, the presence of which checks all further '• change," and at page 112, he continues, " the presence of "free muriatic acid in the gastric juice, first observed by *' Prout, has been confirmed by all those chemists who have " examined this fluid since." Yet it was for many years considered doubtful, whether lactic acid was not the normal ingredient of the gastric juice, instead of hydrochloric acid, so frequently and continuously is the former met with in the 11 stomach of even the apparently healthy. Funke fin his Physiology, fifth edition, page 173) declares that, under circumstances not yet properly understood, we can observe the formation of lactic and butyric acid in the stomach, the source of which is to be found in sugar, or the starch, from which the latter arises. This process, he intimates, is most probably abnormal, caused (according to F. Hoppe) by a want of acidity in the gastric secretion. We have, therefore, to bear in mind that the stability or vitality and disease -resisting power of the epithelial cells in the lining membrane of the stomach, as also of pepsine in the healthy gastric juice is owing to the presence of a mineral acid; but also that, when this is absent in the secreted fluid, an organic acid may take its place. Experiments have shown that lactic can replace the hydrochloric acid for the purpose of dissolving the food . . . . ; whether \ however^ the mineral acid can be replaced by an organic acid [a hydro-carbon) for the purpose of protecting the pepsine against a powerful disease -germ is highly doubtful, since the circumstances, under which lactic acid will easily undergo chemical decomposition or transformation, are not rare. That the stomach is the seat of infection, found, soon after I had written the above, confirmatory evidence from the labours of Mons. Chauveau in Lyon, who concludes that " the contagious principles are not floating in the atmosphere " in the shape of gas or vapour, but that they are always " adherent to some solid matter, which is taken up by the " gastric mucous membrane " It has now become an acknowledged fact, that the acid reaction of a healthy gastric juice is owing to the presence 12 of hydrochloric acid, which, as Liebig declares M is obviously «' derived from common salt," although, as Lehmann admits, it certainly remains a mystery for the present how this decomposition of the chloride of sodium is effected. There can, however, be little doubt that the presence of chloride of sodium is necessary for the production of hydrochloric acid, and that for want of salt in the system the gastric juice is deprived of its stability and disease-resisting power. On the whole, then, considering — that common salt enters as a necessary constituent in the various parts of the hnman body — that it is an indispensable agent in the various processes constantly going on in the animal organism — that total and rigorous abstinence from common salt produces disease and death — that it contributes to impede abnormal changes and decompositions — that it forms the means of transport for the excretion of effete used-up matter out of the system— that it is a " powerful means of resistance to external causes of '• disturbance to health " — that by its presence (that is, always in sufficient quantity) it gives the human body greater power to resist changes and extremes of temperature— that by its presence in normal quantity in the blood it protects this latter from changes in its physical and hence vital character and so prevents disease— that it counteracts the dangerous effects of a super-abundance of water in the human body by preventing the disintegration of the blood corpuscles and so protects us against many diseases— that its presence is necessary for the formation of hydrochloric acid in the gastric secretion and so supplies the most indispensable ingredient for giving the digestive principle its vitality and disease-resisting power ; and when remembering that the principal symptoms of 13 Cholera are, as stated above : The blood ceases to circulate ; its physical properties are altered ; its serous portion is suddenly thrown out upon the intestinal mucous surface of the body ; the secretions are all arrested and animal heat is no longer produced; when considering and weighing all these facts, are we not justified in declaring that : A Deficiency of Chloride of Sodium in the Human Body predisposfs this latter to Cholera and other contagious diseases. All the reasoning powers in the world, however, will not establish the efficiency of sodium chloride as a prophylactic ; to do this it requires a practical trial on a sufficiently large scale, carried out with method and forethought, that the result may be such as to leave no doubt upon the question With regard to the manner how to carry out such a trial and how to administer the salt, I beg to make the following suggestions, as based upon practical tests extending now over thirteen years. When salt is taken with food (especially by people who are sparse salt eaters j in greater quantities than is required for flavouring the food— making it "tasty,'' it will produce thirst in a greater or lesser degree, depending upon the amount so taken, and on the amount already in the system. The thirst will cause the drinking of inordinate quantities of water, the evil effects of which have already been referred to above (although not to the extent, that the importance of the subject deserves). When however the salt is dissolved in fresh cold water (or for stomachs sensitive to cold, with the chill taken off) in 14 such proportion (i salt to ioo water) that the salt can scarcely or be just tasted, it does not produce thirst.* This should be taken on an empty stomach, which insures its quick absorption into the circulation ; and the quantity for an adult at one draught should be about \\ gramme of salt dissolved in 15 centilitres of water ; this to be taken at least once during the day as a general supply under ordinary circumstances, up to three or four times a day, or whenever thirst demands it, during an epidemic. It would be, however, utterly useless to disseminate such knowledge about a prophylactic remedy in a random occasional manner, without aim and method. To achieve a signal success and so insure the general adoption of the remedy, it is absolutely necessary that, upon the authority of either Government or Municipality, the populace of a town or village should be appealed to by means of printed wall-bills, and the distribution of handbills, to adopt the proposed means for their own protection. These wall-bills should be posted about the town within the shortest space of time, and the handbills distributed from house to house within a few hours, so that the application of the remedy will take place at once, to enable the result to be marked and unmistakable, The information, to be conveyed by these bills, should be the following : — " Want of salt in the human system predisposes this latter "for the cholera and other infectious diseases. "Salt should be taken with all food to the extent ot 11 flavouring it well ; but, besides this, it is necessary that it *In fact when suffering from abnormal thirst (as, for instance, after salted fish) the only way to quench the craving for water is, to drink some salted water, mixed in the proportion as stated. 15 "should be taken independent of food in the following " manner : — " Take the best salt (chloride of sodium — cooking salt — table " salt), dry it well> pound it fine and keep it in a bottle, to " protect it from the moisture of the atmosphere. Take for one " draught about as much as will lie heaped up on a franc or a " shilling (by weight about i drachm =i °$ gramme), place it "in a tumbler and pour fresh cold water over it until the "tumbler is about half full (by weight about 5^ oz. =150 11 grammes, or by capacity =1 5 centilitre); when dissolved,drink 11 it. This should always be taken on an empty stomach ; and " should the mixture not be quite palatable, it can be made "so by either a little more or less water. The salt should " scarcely or be only slightly tasted. One draught should be 11 taken at least once a day ; but during an epidemic it should "be taken whenever thirst demands it. To prepare the 41 mixture so as to be constantly in readiness, put 10 "grammes of salt in a litre bottle and fill it up with fresh •'cold water (by preference from a filter). " Taking a draught of the salted water for the first "time may, when the stomach is out of order, occasion " sickness and vomiting, particularly when the mixture is " taken rather strong ; but if after the vomiting another less " strong draught is taken, the stomach will feel refreshed. 11 This is most markedly the case when suffering from bilious"ness; when nothing will have so signal an effect as a 11 repeated dose of the solution." "On the whole, the daily supply of salt to the human " system has such beneficial effect in promoting health and " preventing disease that every one is recommended to take 16 lt this simple solution of chloride ot sodium in water every v morning at least. It must be added that sea-water or any 11 of the natural mineral waters, all of which contain useless 11 and some of them hurtful ingredients, are a bad substitute ; " and the simple solution of common salt in water, parti" cularly when fresh prepared, is the best tonic, a most •*. necessary food for the body, and the most effective 'prophylactic *' to keep off disease." In addition to the distribution of the above walhand handbills, the municipality of a town might undertake the supply of the best salt obtainable, and arrange for a gratuitous supply of it to the very poor. But all such further considerations would suggest themselves readily, if but the importance of the subject be sufficiently acknowledged to lead to a practical trial, such as is referred to above; and here really lies the greatest difficulty, since most people, even those who understand, or whose education should enable them to understand the physical and physiological reasons, advanced here, are only too prone to look upon the recommendation of common salt as the outcome of a very common mind. May this soon be otherwise. London, C. G. G. July, 2gth, 1884. Thos. Pettitt & Co., Printers, &c, 23, Frith Street, Soho, W.