membrane of cholera The reader is referred for the details of this disease to the Lancet, '2nd
sanitary authorities, that the alimentary mucous is the principal medium through which the factor enters
the system.
this very able hypothesis regarding December, 1871. It may be premised that my views in reference to the above malady coincide with those of Dr. Carpenter in regarding it The blood becomes loaded with as essentially a blood disease. the morbid virus more or less, and the air surrounding the
sick man is charged with it at every act of respiration, and it arises also as an exhalation from the rice-water stools, the morbid scretions of the skin, &c. In pursuing the present hypothesis further, I propose to introduce a series of interrogations in the order in which they have occurred to me, and to embody my views on the subjects of the etiology and hygienic treatment of I must be permitted to explain, cholera in my replies thereto. however, that these replies have been based partly on a review of a series of medical histories of the disease which have in the Medical Report of the Army from time to time,
appeared partly from a personal experience during two epidemics occurring at different periods in Africa and the West Indies. It will, perhaps, be as well to state the case of these epidemics before proceeding further; and they are. especially interesting,
and
inasmuch as the disease had never been known oil the "West Coast of Africa at any previous period, and I believe the same remark is applicable to the "West Indian epidemic. .Art invasion of cholera occurred at Kingston, in the island of Jamaica, during the year 1852, and its origin and progress may be recorded as follows. A sailor was brought on shore from a ship lying in the harbour, which had recently arrived from Halifax, where the -epidemic had been raging at the time of
ship's departure. The nature of his malady was unknown the time of his admission into the Kingston hospital, but it speedily revealed itself as a case of genuine Asiatic cholera;
the at
and the
authorities
exceedingly anxious that the. kept a secret. A few days subsequently, however, notwithstanding that the strictest secrecy had been adhered to on the subject, two or three choleraic seizures occurred in the lunatic asylum adjoining the hospital premises, and after a longer interval three or four cases were reported in the city of Kingston, rhese being the forerunners of an epidemic of considerable magnitude. The epidemic in Africa prevailed at Bathurst?a military station cause
on
hospital
of the
were
man's death should be
the river Gambia?during the middle of the year 1867. This was distinctly traceable from Senegal, whence it was
epidemic supposed
have been
imported by some pilgrims travelling in MacCarthy's Island in the first place, and from MacCarthy's Island to Bathurst. An exceedingly interesting feature in the extension of the disease between the two latter places consists in the fact that MacCarthy's Island is 250 miles eastward of Bathurst, and that the prevailing wind during that period of the year blew from the west. The abovementioned facts may tend to exemplify the replies to some of the following queries which I proposed to myself for solution. The etiology of cholera.? How does the specific poison of cholera gain admission into the system ? As a rule, by the breathing of a vitiated atmosphere. How does the atmosphere become vitiated in the first instance ? By exhalations from eholerous excreta long buried in the earth, these being disengaged by either mechanical of an unusually high temperature; exposure or the operation by exhalations from eholerous clothes long confined in boxes; by exhalations from eholerous grave-yards in excessively hot weathers, possibly accelerated by a previous rain-fall whereby the poison is dissolved and rendered portable. It may be noted with reference to the last-mentioned mode of causation?that the general grave-yard of Bathurst was situated to windward of to
caravans, to
ON THE ETIOLOGY AND HYGIENE OF CHOLERA.
By
T.
Oughton, Staff
Assistant
Surgeon,
Neemuch.
Dr. "W. B. Caepentee is probably the latest contributor to the numerous hypotheses, respecting the causation and intimate nature of this fearful scourge, which have been propagated by the acutest thinkers of our profession at various times. His theory is that a cholera-molecule?or "cacozyme," as it is termed by him?is introduced into the system in various ways, and that a peculiar fermentation is set up whenever this into contact with certain waste tissue its way into the blood; the full expression of such fermentation being exhibited in cases wherein there exists an excess of such organic debris in the circulating fluid,
vitiated molecule
that is ever
and
comes
finding
being coincident with the phenomena of a choleraic Moreover, he coincides with the opinion of most
eeizure.
" Station and Vicinity the town ; 2nd, in a report upon the of Neeinuck" with reference to an outbreak of cholera which
THE INDIAN MEDICAL GAZETTE.
176
occurred between May and October 18f5, to be found in the Army Medical Blue-Book for the year 1864, it is said that the thermometers indicated 110? in the shade at the commencement and that the wind had previously shifted to the of the
epidemic, southeast, "when
it would blow in a direct line from the These facts are not stated as proving very coincident circumstances merely.
cemetery. but
as
public much,
How does the first case of cholera oecur in a community ? Possibly by breathing air contaminated a3 described, the virus being introduced into the system by solution in the pulmonic air vesicles; possibly by drinking water in which the poison has been dissolved, when it would enter the circulatory system through the alimentary mucous membrane. Undoubted evidence refers its origin to importation by an individual recently
arrived from an infected district or seaport, and this constitutes the method by which its spread into a community is regulated in by far the greater proportion of cases. This explains the
migration of the disease from town to town, over a large tract of country such as India, importation into a Country where the disease
its dissemination and likewise its was
previously
a
Thus it traversed the continents of Asia and Europe in its route to England and America, and thus it was engrafted
stranger.
the Africans in the year 1867. the disease to break out in a town in India after two or three years of entire immunity, state the cause of the origin and progress of the disease in that town ? The first case owes its origin to one of the threefold modes of causaon
Supposing
tion
already ennumerated,
water.
viz.
The second and all
importation, foul air, or impure subsequent cases result from human
intercourse. How docs
man become the vehicle of communicating the disease to his neighbours ? Most insidiously, for it is propagated by individuals in a state of perfect health.
your views more fully on this point ? Each attenfirst case of genuine cholera becomes a focus of the disease, although he may be a healthy focus. He breathes the infected exhalations from the sick man, the poison is admitted into his system, and he vitiates the surrounding atmosphere by respiration wheresoever he goes.
Explain
dant
on a
How is it that such a man may exhibit no symptoms of the He is in an excellent state of health at the period
disease?
of exposure to the contagium, so that his lungs and organic secretions are enabled to withstand the lowering influence of the virus, and to remove it as fast as it becomes developed in his
system. What arguments can you produce in favour of such an hypothesis ? Firstly, there can be no reason why a healthy man should not imbibe an aerial poison through the medium of respiration as much as a susceptible man. Secondly, the general "malaise" that is experienced during a choleraic epidemic and with the prevalence of diarrhoea, indicate a cachectic state of blood. Dr. Martin states, in his report on the epidemic at Neemuch, that the general health was very unsatisfactory, diarrhoea, mild dysentery, and general debility being the prevailing diseases,?the men generally had a washed-out and delicate appearance. Thirdly, the incubative stage of zymotic diseases indicates that a specific poison may remain latent in the system. How long may such an attendant be considered a dangerous he eventually elimiperson ? For several days probably, but nates the poison in the same manner that alcohol and other
poisons
are
eliminated, viz. by respiration, urinary secretion, &c.
A smart attack of diarrhoea would aid these processes. Is the surrounding atmosphere as a whole, or the drinking of water from the same source by successive persons, to be blamed for the fostering of an epidemic ? No. The atmosphere is too diluted for the poison to be operative through its medium, and it is the air in the immediate persons
vicinity of infected or dangerous only which engrafts the deadly virus on another. As
[August 1,
regards water, cholera propagation
has
probably
1872.
been referred
cause, because persons drinking the same water usually associate very freely among themselves. On the other hand, the first three or four cases of cholera in a community
to it
are
as
a
frequently
found to have been
different sources. You state that the
atmosphere
drinking as
a
water from
quite
whole, by being
too
diluted, is incapable of infecting persons; what do you mean by this ? The atmosphere may be rendered innocuous by the dis-
of the cholera-germs, and their ready solution by it. probable supposition is that the choleraic molecules emanating from the lungs of a dangerous centre are diffused rapidly through the atmosphere, in the same manner that the smoke of a pipe or cigar becomes diffused, and analogously, that their presence as a materies niorbi become dissipated very speedily. Do you consider that the track of a cholera epidemic along a given country is dependent on winds as a directing element of causation ? Certainly not. First, the choleraic atmosphere cannot be sufficiently concentrated. Second, no evidence is wanting to substantiate the fact that an epidemic is never propagated in a direction immediately in the teeth of prevailing winds. The medical history of the outbreak in H.M.'s 18th Hussars at Secunderabad in 1871, as carefully detailed by Surgeon W. R. Cornish in the Indian Medical Gazette of January, would seem
integration The more
to indicate that the air acted as a carrier between a latrine made use of by the patients and three blocks of barrack buildings in
which the number and fatality of the seizures were unusually high. The close proximity of the cholera centre to these buildings must be considered, however (only a few yards) neither must it be ignored that the general health of the men living in these barracks may have been lowered previously, rendering them predisposed to the disease by such proximity. Have you any fact to produce, militating against the generally accepted opinion that the spread of cholera is due to the introduction of the specific poison by drinking-water? The c-ity of Kingston was watered, at the time of the epidemic of 1852, by means of pipes brought from two high cisterns which were placed at a distance of upwards of two miles from the town and at an elevation of 500 or 600 feet above its level. This, coupled with the fact that the outbreak was characterised by several cases originating in different parts of a city which had never probably been visited by the disease previously, or certainly not for several previous years, would seem to prove its propagation by human intercourse or some cause not referable to drinkingwater. Three
or four persons in different parts of a community may attacked, at first, within 24 hours of each other without any obvious inter-communicfftion; how is this to be explained on the above hypothesis ? A healthy person may become a dangerous but healthy centre by breathing cholerous air, drinking cholerons water, or, on arriving in a healthy town from a cholerous district, by having been exposed to the infection previously. The air escaping from him during the expiratory act infects several other persons, who in their turn become healthy foci. Each of these healthy foci infect several other persons at or about the same time, and, as a consequence, three or four cases of cholera burst out synchronously. How do you account for sporadic cases of cholera being confined in their attack ? Possibly, by the community being so healthy as to be able to carry the seeds of the disease about them, for the number of days that are essential to elimination, without manifesting the same by any outward or functional sign ; possibly, on account of the virus not being so concentrated and lethal; possibly, because the attendants have taken the precaution not to come too near to their patients, and have acted in accordance with the rules of good hygiene. How is an epidemic of cholera lighted up, and how is it limited ? "When three or four cases have occurred in different
be
August 1,
1872.]
A CASE OF ASIATIC CHOLERA.?BY C. MACNAMARA.
parts of a community and at short intervals of time, these have got about them the circumstances which tend almost inevitably An epidemic to a general outbreak by fostering infection. may be limited by the virus becoming weakened in its successive transmission, from man to man, (in the same manner that the vaccine virus becomes deteriorated by its passage through numerous human bodies,) by the adoption of suitable measures of sanitation, not unfrequently by the supervention of cold weather or heavy falls of rain, or, in the absence of these, by the disease weeding out all unhealthy and susceptible persons from the community. The Pathurst epidemic is an illustration of the latter statement, a population of somewhat less than 16.000 having furnished nearly 4.000 fatal cases in the short it is almost impossible to conceive space of two months; and of any place in which the elements of insanitation could be rife than in the native
town,?wells having a depth of three latrines, no removal of excreta, no dry-earth conservancy, and the inhabitants living in low and dirty hovels which were surrounded by a swamp on three sides. The 'suddenness, moreover, with which this cpidemic abated after the first tornado, (characterised by a violent wind-storm succeeded by a heavy rain and thunder-storm, the rain coming down in torrents,) was a noteworthy circumstance. What are the causes that operate in rendering an individual susceptible to an invasion of this disease ? Derangement of the general health or malaise," as evidenced by the very great readiness with which it is communicated by the doctor or attendants to patients in a hospital who are under treatment for more or
four feet,
no
drainage,
no
"
diseases. The lowering of their system, engendered by low diet, the medicines they are taking, want of exercise, confinement for long periods to their wards, or the nature of their diseases, may render them susceptible. This other
either
derangement of health in other members of
a community may be any such as would be engendered by violation of the ordinary hygienic principles of health?e.g., bad diet, excessive fatigue,
defective ventilation, impure water, &c. What is your candid opinion in reference to the theory that water operates as a vehicle for conveying the infection ? I cannot consider that water is the cause of the introduction of the specific poison of cholera into the system excepting in very exceptional cases, such as when an outbreak is introduced originally by some one drinking cholerous wrater. Neither is it clear that water holds the first place among the predisposing causes of cholera ; for example, the utmost vigilance in respect
of the quality of water was exercised during the Neemuch epidemic by Dr. Martin, sentries having been posted over the well which yielded the best drinking-water, which was moreover filtered, and subsequently both boiled and filtered, before use, and nevertheless his praiseworthy efforts in this direction were unrewarded by any abatement in the ravages of the plague. What do you consider to be the principal cause of susceptibility ? Bad diet. 1 opine that such is an explanation of the fact that officers usually escape during an epidemic among
troops, and that married families amongst soldiers
are sometimes attack than single men. During the very fatal epidemic in Bathurst not a single white man contracted the disease, and it must be remembered that the white community consisted entirely of officers, non-commissioned and more
liable to
an
merchants?that is, persons who were not ties of life. (To be continued.)
officers,
wanting
in the ameni-
j
177
sanitary authorities, that the alimentary mucous is the principal medium through which the factor enters
the system.
this very able hypothesis regarding December, 1871. It may be premised that my views in reference to the above malady coincide with those of Dr. Carpenter in regarding it The blood becomes loaded with as essentially a blood disease. the morbid virus more or less, and the air surrounding the
sick man is charged with it at every act of respiration, and it arises also as an exhalation from the rice-water stools, the morbid scretions of the skin, &c. In pursuing the present hypothesis further, I propose to introduce a series of interrogations in the order in which they have occurred to me, and to embody my views on the subjects of the etiology and hygienic treatment of I must be permitted to explain, cholera in my replies thereto. however, that these replies have been based partly on a review of a series of medical histories of the disease which have in the Medical Report of the Army from time to time,
appeared partly from a personal experience during two epidemics occurring at different periods in Africa and the West Indies. It will, perhaps, be as well to state the case of these epidemics before proceeding further; and they are. especially interesting,
and
inasmuch as the disease had never been known oil the "West Coast of Africa at any previous period, and I believe the same remark is applicable to the "West Indian epidemic. .Art invasion of cholera occurred at Kingston, in the island of Jamaica, during the year 1852, and its origin and progress may be recorded as follows. A sailor was brought on shore from a ship lying in the harbour, which had recently arrived from Halifax, where the -epidemic had been raging at the time of
ship's departure. The nature of his malady was unknown the time of his admission into the Kingston hospital, but it speedily revealed itself as a case of genuine Asiatic cholera;
the at
and the
authorities
exceedingly anxious that the. kept a secret. A few days subsequently, however, notwithstanding that the strictest secrecy had been adhered to on the subject, two or three choleraic seizures occurred in the lunatic asylum adjoining the hospital premises, and after a longer interval three or four cases were reported in the city of Kingston, rhese being the forerunners of an epidemic of considerable magnitude. The epidemic in Africa prevailed at Bathurst?a military station cause
on
hospital
of the
were
man's death should be
the river Gambia?during the middle of the year 1867. This was distinctly traceable from Senegal, whence it was
epidemic supposed
have been
imported by some pilgrims travelling in MacCarthy's Island in the first place, and from MacCarthy's Island to Bathurst. An exceedingly interesting feature in the extension of the disease between the two latter places consists in the fact that MacCarthy's Island is 250 miles eastward of Bathurst, and that the prevailing wind during that period of the year blew from the west. The abovementioned facts may tend to exemplify the replies to some of the following queries which I proposed to myself for solution. The etiology of cholera.? How does the specific poison of cholera gain admission into the system ? As a rule, by the breathing of a vitiated atmosphere. How does the atmosphere become vitiated in the first instance ? By exhalations from eholerous excreta long buried in the earth, these being disengaged by either mechanical of an unusually high temperature; exposure or the operation by exhalations from eholerous clothes long confined in boxes; by exhalations from eholerous grave-yards in excessively hot weathers, possibly accelerated by a previous rain-fall whereby the poison is dissolved and rendered portable. It may be noted with reference to the last-mentioned mode of causation?that the general grave-yard of Bathurst was situated to windward of to
caravans, to
ON THE ETIOLOGY AND HYGIENE OF CHOLERA.
By
T.
Oughton, Staff
Assistant
Surgeon,
Neemuch.
Dr. "W. B. Caepentee is probably the latest contributor to the numerous hypotheses, respecting the causation and intimate nature of this fearful scourge, which have been propagated by the acutest thinkers of our profession at various times. His theory is that a cholera-molecule?or "cacozyme," as it is termed by him?is introduced into the system in various ways, and that a peculiar fermentation is set up whenever this into contact with certain waste tissue its way into the blood; the full expression of such fermentation being exhibited in cases wherein there exists an excess of such organic debris in the circulating fluid,
vitiated molecule
that is ever
and
comes
finding
being coincident with the phenomena of a choleraic Moreover, he coincides with the opinion of most
eeizure.
" Station and Vicinity the town ; 2nd, in a report upon the of Neeinuck" with reference to an outbreak of cholera which
THE INDIAN MEDICAL GAZETTE.
176
occurred between May and October 18f5, to be found in the Army Medical Blue-Book for the year 1864, it is said that the thermometers indicated 110? in the shade at the commencement and that the wind had previously shifted to the of the
epidemic, southeast, "when
it would blow in a direct line from the These facts are not stated as proving very coincident circumstances merely.
cemetery. but
as
public much,
How does the first case of cholera oecur in a community ? Possibly by breathing air contaminated a3 described, the virus being introduced into the system by solution in the pulmonic air vesicles; possibly by drinking water in which the poison has been dissolved, when it would enter the circulatory system through the alimentary mucous membrane. Undoubted evidence refers its origin to importation by an individual recently
arrived from an infected district or seaport, and this constitutes the method by which its spread into a community is regulated in by far the greater proportion of cases. This explains the
migration of the disease from town to town, over a large tract of country such as India, importation into a Country where the disease
its dissemination and likewise its was
previously
a
Thus it traversed the continents of Asia and Europe in its route to England and America, and thus it was engrafted
stranger.
the Africans in the year 1867. the disease to break out in a town in India after two or three years of entire immunity, state the cause of the origin and progress of the disease in that town ? The first case owes its origin to one of the threefold modes of causaon
Supposing
tion
already ennumerated,
water.
viz.
The second and all
importation, foul air, or impure subsequent cases result from human
intercourse. How docs
man become the vehicle of communicating the disease to his neighbours ? Most insidiously, for it is propagated by individuals in a state of perfect health.
your views more fully on this point ? Each attenfirst case of genuine cholera becomes a focus of the disease, although he may be a healthy focus. He breathes the infected exhalations from the sick man, the poison is admitted into his system, and he vitiates the surrounding atmosphere by respiration wheresoever he goes.
Explain
dant
on a
How is it that such a man may exhibit no symptoms of the He is in an excellent state of health at the period
disease?
of exposure to the contagium, so that his lungs and organic secretions are enabled to withstand the lowering influence of the virus, and to remove it as fast as it becomes developed in his
system. What arguments can you produce in favour of such an hypothesis ? Firstly, there can be no reason why a healthy man should not imbibe an aerial poison through the medium of respiration as much as a susceptible man. Secondly, the general "malaise" that is experienced during a choleraic epidemic and with the prevalence of diarrhoea, indicate a cachectic state of blood. Dr. Martin states, in his report on the epidemic at Neemuch, that the general health was very unsatisfactory, diarrhoea, mild dysentery, and general debility being the prevailing diseases,?the men generally had a washed-out and delicate appearance. Thirdly, the incubative stage of zymotic diseases indicates that a specific poison may remain latent in the system. How long may such an attendant be considered a dangerous he eventually elimiperson ? For several days probably, but nates the poison in the same manner that alcohol and other
poisons
are
eliminated, viz. by respiration, urinary secretion, &c.
A smart attack of diarrhoea would aid these processes. Is the surrounding atmosphere as a whole, or the drinking of water from the same source by successive persons, to be blamed for the fostering of an epidemic ? No. The atmosphere is too diluted for the poison to be operative through its medium, and it is the air in the immediate persons
vicinity of infected or dangerous only which engrafts the deadly virus on another. As
[August 1,
regards water, cholera propagation
has
probably
1872.
been referred
cause, because persons drinking the same water usually associate very freely among themselves. On the other hand, the first three or four cases of cholera in a community
to it
are
as
a
frequently
found to have been
different sources. You state that the
atmosphere
drinking as
a
water from
quite
whole, by being
too
diluted, is incapable of infecting persons; what do you mean by this ? The atmosphere may be rendered innocuous by the dis-
of the cholera-germs, and their ready solution by it. probable supposition is that the choleraic molecules emanating from the lungs of a dangerous centre are diffused rapidly through the atmosphere, in the same manner that the smoke of a pipe or cigar becomes diffused, and analogously, that their presence as a materies niorbi become dissipated very speedily. Do you consider that the track of a cholera epidemic along a given country is dependent on winds as a directing element of causation ? Certainly not. First, the choleraic atmosphere cannot be sufficiently concentrated. Second, no evidence is wanting to substantiate the fact that an epidemic is never propagated in a direction immediately in the teeth of prevailing winds. The medical history of the outbreak in H.M.'s 18th Hussars at Secunderabad in 1871, as carefully detailed by Surgeon W. R. Cornish in the Indian Medical Gazette of January, would seem
integration The more
to indicate that the air acted as a carrier between a latrine made use of by the patients and three blocks of barrack buildings in
which the number and fatality of the seizures were unusually high. The close proximity of the cholera centre to these buildings must be considered, however (only a few yards) neither must it be ignored that the general health of the men living in these barracks may have been lowered previously, rendering them predisposed to the disease by such proximity. Have you any fact to produce, militating against the generally accepted opinion that the spread of cholera is due to the introduction of the specific poison by drinking-water? The c-ity of Kingston was watered, at the time of the epidemic of 1852, by means of pipes brought from two high cisterns which were placed at a distance of upwards of two miles from the town and at an elevation of 500 or 600 feet above its level. This, coupled with the fact that the outbreak was characterised by several cases originating in different parts of a city which had never probably been visited by the disease previously, or certainly not for several previous years, would seem to prove its propagation by human intercourse or some cause not referable to drinkingwater. Three
or four persons in different parts of a community may attacked, at first, within 24 hours of each other without any obvious inter-communicfftion; how is this to be explained on the above hypothesis ? A healthy person may become a dangerous but healthy centre by breathing cholerous air, drinking cholerons water, or, on arriving in a healthy town from a cholerous district, by having been exposed to the infection previously. The air escaping from him during the expiratory act infects several other persons, who in their turn become healthy foci. Each of these healthy foci infect several other persons at or about the same time, and, as a consequence, three or four cases of cholera burst out synchronously. How do you account for sporadic cases of cholera being confined in their attack ? Possibly, by the community being so healthy as to be able to carry the seeds of the disease about them, for the number of days that are essential to elimination, without manifesting the same by any outward or functional sign ; possibly, on account of the virus not being so concentrated and lethal; possibly, because the attendants have taken the precaution not to come too near to their patients, and have acted in accordance with the rules of good hygiene. How is an epidemic of cholera lighted up, and how is it limited ? "When three or four cases have occurred in different
be
August 1,
1872.]
A CASE OF ASIATIC CHOLERA.?BY C. MACNAMARA.
parts of a community and at short intervals of time, these have got about them the circumstances which tend almost inevitably An epidemic to a general outbreak by fostering infection. may be limited by the virus becoming weakened in its successive transmission, from man to man, (in the same manner that the vaccine virus becomes deteriorated by its passage through numerous human bodies,) by the adoption of suitable measures of sanitation, not unfrequently by the supervention of cold weather or heavy falls of rain, or, in the absence of these, by the disease weeding out all unhealthy and susceptible persons from the community. The Pathurst epidemic is an illustration of the latter statement, a population of somewhat less than 16.000 having furnished nearly 4.000 fatal cases in the short it is almost impossible to conceive space of two months; and of any place in which the elements of insanitation could be rife than in the native
town,?wells having a depth of three latrines, no removal of excreta, no dry-earth conservancy, and the inhabitants living in low and dirty hovels which were surrounded by a swamp on three sides. The 'suddenness, moreover, with which this cpidemic abated after the first tornado, (characterised by a violent wind-storm succeeded by a heavy rain and thunder-storm, the rain coming down in torrents,) was a noteworthy circumstance. What are the causes that operate in rendering an individual susceptible to an invasion of this disease ? Derangement of the general health or malaise," as evidenced by the very great readiness with which it is communicated by the doctor or attendants to patients in a hospital who are under treatment for more or
four feet,
no
drainage,
no
"
diseases. The lowering of their system, engendered by low diet, the medicines they are taking, want of exercise, confinement for long periods to their wards, or the nature of their diseases, may render them susceptible. This other
either
derangement of health in other members of
a community may be any such as would be engendered by violation of the ordinary hygienic principles of health?e.g., bad diet, excessive fatigue,
defective ventilation, impure water, &c. What is your candid opinion in reference to the theory that water operates as a vehicle for conveying the infection ? I cannot consider that water is the cause of the introduction of the specific poison of cholera into the system excepting in very exceptional cases, such as when an outbreak is introduced originally by some one drinking cholerous wrater. Neither is it clear that water holds the first place among the predisposing causes of cholera ; for example, the utmost vigilance in respect
of the quality of water was exercised during the Neemuch epidemic by Dr. Martin, sentries having been posted over the well which yielded the best drinking-water, which was moreover filtered, and subsequently both boiled and filtered, before use, and nevertheless his praiseworthy efforts in this direction were unrewarded by any abatement in the ravages of the plague. What do you consider to be the principal cause of susceptibility ? Bad diet. 1 opine that such is an explanation of the fact that officers usually escape during an epidemic among
troops, and that married families amongst soldiers
are sometimes attack than single men. During the very fatal epidemic in Bathurst not a single white man contracted the disease, and it must be remembered that the white community consisted entirely of officers, non-commissioned and more
liable to
an
merchants?that is, persons who were not ties of life. (To be continued.)
officers,
wanting
in the ameni-
j
177
