National Observer

Planeloads of medical supplies, doctors, and technicians flew into India last week to fight a cholera epidemic that has already killed almost 10,000 persons.

Most of the deaths so far have been among the 5,000,000 East Pakistani refugees who have pushed across the India-Pakistan border since civil war erupted there in March. The refugees entering an already overpopulated area and confined to makeshift camps are in ideal target for cholera - too many people and not enough sanitation.

While they waited for more medical help, Indian officials took drastic steps to slow the epidemic.

Police guarded waterways to prevent dead victims from being thrown into rivers and streams. A shortage of firewood made it practically impossible to cremate corpses in traditional Hindu fashion. Religious customs were also violated by burial of Hindu and Moslems together in mass graves holding as many as 500 bodies.

Officials were also trying, with limited success, to curb the flow of refugees from camps near the border to Calcutta, only 60 miles away. With 12,000,000 poverty- ridden people in the Calcutta area, officials were afraid the disease might spread too rapidly to be controlled.

LIMITS OF VACCINATION

Even though cholera is probably as old as man, successful treatment and prevention have lagged far behind that for other ancient ailments. For example, anti-cholera vaccination is goad for only six months, and even a vaccinated person can still carry the disease to others. Until three years ago the only known treatment for cholera required wholesale intravenous injections administered by a trained technician.

Too, cholera occurs only in areas and among people least able to handle it - where there is dense population, poor sanitation and general ignorance of simple health rules.

Most of the world has been relatively free of cholera for 60 years, but it has still been a problem in India and Southeast Asia. And about 10 years ago a new strain began spreading into Africa and the Western Pacific.

Aside from a few laboratory volunteers, there have been no known cases of cholera in the United States since 1910.

Anyone who has had dysentery or diarrhea has experienced in a mild form what a cholera victim goes through in a severe way. It is caused by small, comma-shaped bacteria that get into the system through contaminated water or food. After a short incubation period of one to five days, the bacteria make their victim violently ill.

The first stage lasts from 2 to 12 hours and consists of purging diarrhea and copious vomiting. This continues until the victim is so dehydrated that he suffers agonizing muscle cramps in the legs, arms, back, and abdomen. Then the skin becomes lax, wrinkled, cold, and clammy. A bluish tinge appears around the eyes and lips, and blood pressure falls.

But where the treatment starts in time, recovery is practically certain, says Dr. Robert S. Northrup, coordinator of cholera research at the National Institutes of Health (NIH) in Bethesda, Md. Without treatment the chances of recovery are about 50 per cent.

An NIH research team has studied 220,000 Pakistanis over the past few years, vaccinating, treating, and observing them. This team achieved a major break-through in treatment three years ago by developing a cholera treatment that could be taken orally rather than intravenously. Glucose is added to the solution of salts and soda used in the intra-venous treatment. The oral treatment is cheaper and easier to administer.

Research is in progress in several countries to develop a more effective vaccine. "Compared to other diseases, cholera vaccine is very poor," says Dr. H. Bruce Dull, assistant director of the U.S. Center for Disease Control in Atlanta. Researchers are working to develop a cholera toxoid similar to those now available for diphtheria and tetanus. This would mean longer immunization and elimination of the possibility that those vaccinated can be carriers.

Accounts of acute, epidemic diarrheal disease occur throughout history. Thucydides, the Greek historian, described something similar to cholera in Athens about 500 B.C. Similar descriptions came from India around A.D, 700.

The endemic center of the disease is the Ganges Delta in West Bengal, a state of northeastern India and scene of the current epidemic. There are good records of how cholera spread from the delta to other parts of India and then to other countries beginning in the Fifteenth Century. In 1438, for instance, an epidemic practically wiped out an Afghan army in western India, and another epidemic devastated the Netherlands East Indies in 1629.

According to Chinese historians, the disease entered their country about 1670. Medical historians identify seven general cholera epidemics in the world since 1817, and six of the seven began in the Ganges Delta.

HARDIER STRAIN

Properly termed pandemics, the first day these general epidemics began in 1817 and by 1823 had spread through personal carriers to China, Ceylon, the Philippines, Japan, East Africa, and Russia. Another started in 1826 and spread to include Europe, Great Britain, and eventually the United States, where it spread from New York and Boston to Chicago and down the Mississippi Valley. Subsequent pandemics occurred in 1840, 1863, 1879, 1891, and 1902.

What is now acknowledged to be a seventh pandemic started in the Celebes Island of Indonesia in 1961 and is still spreading, principally to the northern half of the African continent and to parts of the western Pacific.

This time it's caused by a new tougher and hardier strain of bacillus, named El Tor after the quarantine port in Iraq where it was first discovered. Last week an outbreak of cholera was reported spreading through Chad; the disease had already caused 400 deaths in that Central African nation. A lesser epidemic in northern Uganda has killed a dozen persons, and there are 171 cases under treatment. Doctors say there may be hundreds of unreported cases. Planeloads of medical supplies, doctors, and technicians flew into India last week to fight a cholera epidemic that has already killed almost 10,000 persons.

Most of the deaths so far have been among the 5,000,000 East Pakistani refugees who have pushed across the India-Pakistan border since civil war erupted there in March. The refugees entering an already overpopulated area and confined to makeshift camps are in ideal target for cholera - too many people and not enough sanitation.

While they waited for more medical help, Indian officials took drastic steps to slow the epidemic.

Police guarded waterways to prevent dead victims from being thrown into rivers and streams. A shortage of firewood made it practically impossible to cremate corpses in traditional Hindu fashion. Religious customs were also violated by burial of Hindu and Moslems together in mass graves holding as many as 500 bodies.

Officials were also trying, with limited success, to curb the flow of refugees from camps near the border to Calcutta, only 60 miles away. With 12,000,000 poverty- ridden people in the Calcutta area, officials were afraid the disease might spread too rapidly to be controlled.

LIMITS OF VACCINATION

Even though cholera is probably as old as man, successful treatment and prevention have lagged far behind that for other ancient ailments. For example, anti-cholera vaccination is goad for only six months, and even a vaccinated person can still carry the disease to others. Until three years ago the only known treatment for cholera required wholesale intravenous injections administered by a trained technician.

Too, cholera occurs only in areas and among people least able to handle it - where there is dense population, poor sanitation and general ignorance of simple health rules.

Most of the world has been relatively free of cholera for 60 years, but it has still been a problem in India and Southeast Asia. And about 10 years ago a new strain began spreading into Africa and the Western Pacific.

Aside from a few laboratory volunteers, there have been no known cases of cholera in the United States since 1910.

Anyone who has had dysentery or diarrhea has experienced in a mild form what a cholera victim goes through in a severe way. It is caused by small, comma-shaped bacteria that get into the system through contaminated water or food. After a short incubation period of one to five days, the bacteria make their victim violently ill.

The first stage lasts from 2 to 12 hours and consists of purging diarrhea and copious vomiting. This continues until the victim is so dehydrated that he suffers agonizing muscle cramps in the legs, arms, back, and abdomen. Then the skin becomes lax, wrinkled, cold, and clammy. A bluish tinge appears around the eyes and lips, and blood pressure falls.

But where the treatment starts in time, recovery is practically certain, says Dr. Robert S. Northrup, coordinator of cholera research at the National Institutes of Health (NIH) in Bethesda, Md. Without treatment the chances of recovery are about 50 per cent.

An NIH research team has studied 220,000 Pakistanis over the past few years, vaccinating, treating, and observing them. This team achieved a major break-through in treatment three years ago by developing a cholera treatment that could be taken orally rather than intravenously. Glucose is added to the solution of salts and soda used in the intra-venous treatment. The oral treatment is cheaper and easier to administer.

Research is in progress in several countries to develop a more effective vaccine. "Compared to other diseases, cholera vaccine is very poor," says Dr. H. Bruce Dull, assistant director of the U.S. Center for Disease Control in Atlanta. Researchers are working to develop a cholera toxoid similar to those now available for diphtheria and tetanus. This would mean longer immunization and elimination of the possibility that those vaccinated can be carriers.

Accounts of acute, epidemic diarrheal disease occur throughout history. Thucydides, the Greek historian, described something similar to cholera in Athens about 500 B.C. Similar descriptions came from India around A.D, 700.

The endemic center of the disease is the Ganges Delta in West Bengal, a state of northeastern India and scene of the current epidemic. There are good records of how cholera spread from the delta to other parts of India and then to other countries beginning in the Fifteenth Century. In 1438, for instance, an epidemic practically wiped out an Afghan army in western India, and another epidemic devastated the Netherlands East Indies in 1629.

According to Chinese historians, the disease entered their country about 1670. Medical historians identify seven general cholera epidemics in the world since 1817, and six of the seven began in the Ganges Delta.

HARDIER STRAIN

Properly termed pandemics, the first day these general epidemics began in 1817 and by 1823 had spread through personal carriers to China, Ceylon, the Philippines, Japan, East Africa, and Russia. Another started in 1826 and spread to include Europe, Great Britain, and eventually the United States, where it spread from New York and Boston to Chicago and down the Mississippi Valley. Subsequent pandemics occurred in 1840, 1863, 1879, 1891, and 1902.

What is now acknowledged to be a seventh pandemic started in the Celebes Island of Indonesia in 1961 and is still spreading, principally to the northern half of the African continent and to parts of the western Pacific.

This time it's caused by a new tougher and hardier strain of bacillus, named El Tor after the quarantine port in Iraq where it was first discovered. Last week an outbreak of cholera was reported spreading through Chad; the disease had already caused 400 deaths in that Central African nation. A lesser epidemic in northern Uganda has killed a dozen persons, and there are 171 cases under treatment. Doctors say there may be hundreds of unreported cases.