SANITARY MEASURES.
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of the writers state that medicine has no power in cholera. Others say that
the attention should be devoted to the prevention of the disease, as medicine
can do little in its cure. Though strong medicines have little power to do good
during one stage, they may, if improperly used, do much injury. The disease
may he prevented reaching that stage, and when that has passed, much may
often he clone to remove its effects and to restore health. All the resources
of medical science may he brought to bear on the treatment of this terrible
disease. The observations of European and American authors have not been
overlooked in forming the practical conclusions which I now with diffidence
beg to submit.
SANITARY MEASURES.
It is allowed by all that defects in the purity of the air and water,—over-
crowding,—improper food or clothing,—bad conservancy, and all sanitary defects
which act prejudicially on the general health, predispose to the action of the
cholera poison. These defects have existed, and still exist, in many parts of
the world without the appearance of cholera : still experience shows that in
this contaminated soil or atmosphere, the choleraic poison when imported
flourishes and spreads; whilst its progress or development is stunted or limited
where these sanitary defects do not exist. Overcrowding and imperfect ventila-
tion appear to be peculiarly favorable to the spread of the disease.
There have been numerous illustrations on this point on boardship,—in
jails and cantonments,—at holy places and fairs, where large crowds collect,
and at marriage and funeral feasts in India. In proportion as the conservancy
arrangements were defective, the attack was generally more violent and ex-
tensive ; but the most efficient arrangements will not always avert an attack.
The human body appears to be the chief medium of reproduction, or mul-
tiplication and dissemination of the poison. This is fully proved by the
history of the progress of the epidemic attacks in India, Europe, and America.
It is the opinion arrived at in the report of the International Congress at
Constantinople in 1866.
The history of the Hurdwar epidemic in 1867
showed that the disease radiated with the pilgrims from one focus in all
directions from 300 to 700 miles, advancing in strict conformity to their rate
of travelling, and being accelerated by the railway to Mooltan.
There are numerous well authenticated cases of the poison having been
mixed with the water of wells and tanks, those using the water being attacked
by the disease.
It appears to be propagated in and near drains or sewers. Decomposition
facilitates the dissemination and probably aids in the reproduction or ger-
mination of the poison.
There is abundant concurrent evidence that contact with the evacuations
from cholera patients, or with articles of clothing, &c., contaminated by them,
and using public latrines, have been followed by attacks of the disease.
In some instances the poison appears to have been inhaled from the
atmosphere into the lungs, from close approximation to the sick, or from residence
in close ill ventilated rooms, or barracks where many cholera patients were
confined. Visiting places recently occupied by choiera cases, as buildings and
camping grounds, has in many instances been followed by attacks of the disease.
The period during which the locality remains dangerous varies according to
circumstances. The shorter the interval, and the more confined the space,
the greater the danger. I am not aware of any instance in which it has
remained attached to the open ground so long as one year. Cholera camping
grounds, which had in the meantime been cultivated, were occupied at Αgra
the following year without injury. In several instances which have come
under my observation, the disease re-appeared, or was aggravated in hospitals
or buildings occupied by cholera patients the previous year at the same season.*
* The following report from Dr. Ricc, Assistant Surgeon of Jubbulpore, illustrales this point :—Three fatal cases I
cholera appeared in a gang of coolies working on the road 29 miles from Jubbulpore. They \ill\ to a place two
\ill\
where four more cases occurred within the next two days, also fatal. They then dispersed. Some ten days after, a party
of pilgrims, en route from Nagpore to the Ganges, encamped for a few hours at the latter spot to cook and can their
mid-day meal, and then came on to Juhhulpore. Two days after resting there, and just after their arrival, it appeared
amongst them and within the next 48 hours nine cases occurred, of which three proved fatal.
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