Medicine: A Potent Pandemic

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Cholera should exist only as a historical footnote. Modern sanitation can eliminate the primary causes of this highly infectious disease—waste-contaminated water supplies—and advanced medical techniques can effectively treat it. Yet cholera continues to kill. Confined for many years to the world's more primitive countries, mostly in the Far East, it has been moving westward with a new force. Last week it was threatening the already troubled Middle East, even causing concern in the technically advanced Soviet Union, and may well have surfaced in Africa.

The cholera pandemic is no sudden development. It started in Indonesia in 1935, was confined there for nearly three decades before jumping to the mainland in 1961. Then it spread rapidly across Southeast Asia and into Taiwan and Korea. By 1964, it was on the increase in Pakistan and India, moving into Afghanistan, Iran and Iraq. A year later it struck the Iranian town of Rasht on the South Shore of the Caspian Sea. From there, it jumped to Astrakhan, a Soviet city of 500,000. Now it has burst out in two more areas: Alexandria and Port Said and—after a visit by the Soviet fleet to the two Egyptian cities—the Soviet Black Sea port of Odessa.

Powerful Parasite. The classic disease is caused by Vibrio cholera bacteria, comma-shaped microbes that multiply in the intestine and thrive in contaminated water supplies. The bug responsible for the present pandemic, a strain first identified in 1906 at the Tor quarantine station in Egypt, is prolific and can quickly cause death if not treated promptly. It multiplies rapidly in the gut, producing millions of offspring in a matter of hours. The bacteria trigger a devastating diarrhea that can drain off as much as 15% of the body fluids in eight hours, depleting the body of water and essential salts. This depletion can be deadly. Lack of bicarbonate turns the blood more acid. Vomiting further dehydrates and weakens the victim; the dehydration shuts down the kidneys and allows toxic materials to accumulate in the body.

To treat the disease, physicians replace the body's lost fluids with intravenous infusions of water and salts. Antibiotics, such as tetracycline, may also be used. If administered in time, the treatment is almost 100% effective. But untreated, cholera kills more than half of its victims and spreads with lightning speed. Introduced into a water supply by poor sanitation, it can decimate an entire village in days. In one tiny Nepalese hamlet last week, 63 people came down with the disease; in three East Pakistan communities, 435 died when floods contaminated the water supplies.

Travel Restrictions. Recognizing the virulence of cholera, officials in many countries have moved quickly to stem its spread. Health authorities from Jordan, Syria and Lebanon met last week in the Lebanese town of Chtaura and agreed on regulations that make cholera vaccinations compulsory for travelers between the three countries. Israeli health officials began demanding that all persons crossing from Jordan into Israel be immunized prior to entry. The Soviets went even farther. Travel to Astrakhan and Odessa was restricted, cutting the cities off from the rest of the country, and all but essential trips to Black Sea vacation areas were curtailed. Soviet citizens were warned to take precautions with their food and water supplies.