PRECAUTIONARY MEASURES.
5
the course of the disease over the world. A specific germ is required for the
production of a specific poison, though peculiar circumstances may render
it more or less prolific. In theory, protection from this specific disease is
simple, viz., to destroy, isolate, or exclude the generating source, and thus
prevent its spreading ; but in practice this cannot he carried out ; at least the
means hitherto employed have not been successful.
The rigid discipline available in jails and military cantonments has, doubt-
less, warded off attacks in many instances ; so also have precautions been taken
under quarantine rules in open countries ; but they have generally failed. The
experience of the world has proved that the cunning of individuals, or the
corruption of the guards, will always leave a weak point through which, like
the heel of Achilles, the fatal poison may enter. It will remain to be considered
how far present quarantine regulations could be extended to afford reason-
able hope of protection without intolerable restraint.
Though perfect immunity cannot be secured, much good may be done by
measures which ought not to be neglected, and which bear especially on the
subject of this report, of which one of the most important is the accommoda-
tion and comfort of the sick. They are a source of danger to those near them,
and it is not prudent to collect them in ordinary hospital wards with other
patients. Even special wards in ordinary hospitals would bring the disease
in dangerous proximity to the other sick. Special hospitals are very desirable,
and, as a general rule, tents are the most suitable. They can contain but few
inmates in each, and the ground can be left when vitiated. Wooden sheds or
straw huts may be made more comfortable for wet cold weather. Communica-
tion between the outside world and the inmates should be restricted to near
relations. The attendants should limit their intercourse outside as much as
possible. Perfect isolation is impracticable, but that should indicate the course
to be followed.
Having observed the injurious effects of neglected or defective sanitary
rules, the first object on the approach or appearance of cholera is to ascertain
if these have been efficiently carried out, and, if not, so far as practicable, to
have the defects or omissions rectified ; special attention being paid to those
points where the communicable peculiarity of the disease may come into
action. The water supply requires the most careful supervision to prevent its
contamination from the evacuations or emanations from cholera subjects. The
wells or springs from which drinking water is supplied should be protected
from contamination from the surface and from infiltration from cesspools or
sewers. In India the tanks in which the people bathe and procure drinking
water should be guarded, and travellers or pilgrims watched during epidemic
seasons.
There were two remarkable instances during the "Hurdwar epidemic" of
the inhabitants being attacked by cholera on the second day after the poison
had been communicated to the village tanks : in one instance from a pilgrim
suffering from cholera having bathed in it, and remained on the banks during
the day ; and in the other after the clothes of a man who had died from
cholera were washed in it.
The effect of boiling contaminated water is questionable. The trouble
and expense of the process is considerable. It concentrates the salts and
renders the water unpalatable, so that, on the whole, boiling is not advisable.
Public latrines are a source of great danger, unless most carefully super-
vised with strict attention to the reception and the speedy removal of the
contents and the free use of disinfectants. The dry-earth system is the best.
'The contents should be buried in trenches at some distance from the station.
Burning would more effectually destroy the poison ; but it requires more
complicated means and the process is less convenient (especially in camp) than
burying, and the latter has proved efficacious.
Overcrowding, assembling large numbers of men in the sanie room, and
imperfect ventilations are sources of the greatest danger, and require to be re-
medied by every practicable means ; more especially as the place or building
may form an active agent in disseminating the disease. The first indication
is to diminish the number of the occupants of the building, and to provide
accommodation for those removed, without endangering unaffected localities