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Background: The cholera epidemic which swept through the Eastern Bengali areas following the recent mass exodus from East Pakistan into the Nadir region of India is now reported to be under control. On Saturday (12 June) health authorities in Uganda reported that a hundred new cases had been confirmed -- bringing the total number to 370. Uganda's outbreak has been confined to the borders of the Karamoja district where rigorous movement checks are in force, and no one is allowed to leave or enter the area unless he can produce a vaccination certificate.

Cholera is a term that can be applied to a wide variety of acute diarrheal diseases of short duration and references to such epidemics are common in history. As early as the 5th century B.C. Thucydides described the occurrence of cholera in Athens. The earliest reports of cholera in India were in the 7th century A.D. in the delta of the Ganges river and in lower Bengal. With increasing travel facilities, cholera spread as far east as China and Japan, west to Europe, and north as far as Russia.

Cholera occurs regularly in India in epidemic form and with great loss of life (up until 1969, 200,000 deaths per year was the usual toll). In recent times, various outbreaks have been recorded in European countries but the disease has not made any serious threat to health since the early centuries.

It must be stressed that while the disease is readily controlled by sanitary measures, these are often not available under some primitive conditions. Should any preventative measures break down at any time, the rapidity of travel possible in the 20th century would enable the spread of cholera in pandemic proportions in a matter of a few weeks or months.

Under natural conditions cholera is a disease of man. The cholera bacteria, called a cholera vibrio, enters the body through the mouth -- usually in contaminated water or food -- and sets up an infection in the small intestine. The disease develops in three well-defined stages; the stage of evacuation, the stage of collapse, and the stage of reaction. The onset is usually abrupt and characterised by a purging diarrhea followed by copious vomiting. With the cumulative dehydration and loss of fixed base (caused by the vomiting and the diarrhea), agonizing cramps occur in the muscles and the sense of prostration is extreme.

The next stage, coming after 2 to 12 hours, brings lessened vomiting and total collapse. The appearance of the patient changes rapidly, and the skin becomes lax and clammy to the touch. The blood pressure falls, the pulse cannot be felt at the wrist and the urine is suppressed. If the treatment is delayed to this stage, death may occur from circulatory failure.

The treatment of cholera is both symptomatic and specific. The former is directed towards the replacement of the fluids lost in the dehydration -- achieved through intravenous administration of hypertonic alkaline salt solution.

A majority of cases of cholera, especially in an epidemic, are diagnosed on clinical grounds alone and during such as epidemic all suspected cases are treated as cholera and all contacts are potential cases. Ultimate control of the disease depends on the development of a higher standard of living in the underdeveloped parts of the far east, and under ideal conditions cholera could well be stamped out entirely.

This is an official film from the American health authorities in Pakistan, and was shot during 1970. It is important to note that it shows the treatment of cholera under ideal conditions, i.e. in a clean hospital with sufficient staff and requirements. It cannot be regarded as the methods or conditions under which the refugee aid teams are working in the camps of India at the present time.