THE TIMES" ON INDIAN CHOLERA. The Times of tlie 25th of
the
subject of cholera following:?
the
in
September has an article on India, from which we extract
"The recent outbreaks of cholera among European troops in India, to which we have directed attention, have called forth remarks from several correspondents who are more or less acquainted with the local conditions of the stations in which the disease has appeared. Their letters assign various causes, and suggest various remedies for the periodical recurrence of the most formidable and most demoralizing of epidemics. In the country itself an army sanitary commission has long been at work upon the question, at present with the sole result that its members have been overwhelmed by the number and variety of the views and statements submitted to them, and that they have been unable to educe even the form of order from such a chaos of material. The fact is, that the problems, relating to the origin and the diffusion of cholera, present themselves to the inquirer in India in forms absolutely too complicated for solution, and which seem to tend only to the production of bewilderment. Where the poison of the disease, whatever its nature, is so widely scattered and so frequently active, it becomes impossible to determine with even an approach to accuracy the share of any single condition in the production of the general result. When Mr. Simon and Professor Parkes announced, as the result of investigations carried on under more favourable, because less complex conditions, that contaminated drinking water would furnish a sufficient explanation of the spread of cholera, they reduced the whole question to a more simple form than any in which it, had previously appeared. If the value and importance of their work had been recognized in India, steps would immediately have been taken to guard the water-supply of military stations from pollution, and thus to exclude at least one element of danger. It is not probable that by this means cholera would have been entirely kept at bay, but its prevalence would have been diminished in the precise degree in which water is the channel of conveyance for its contagion. To this extent the ground would have been cleared for further inquiry, and other channels might, in like manner, have been discovered and stopped singly, and in succession, until, in course of time, almost complete security might have been obtained. Instead of following this reasonable course, Indian authorities have wholly misapprehended the real bearings of the question. They seem to believe that English inquirers have represented 'impure' water to be a cause of cholera, or even to be the only cause; and Dr. Muir, in the recently published 12th volume of the Reports of the Army Medical Department, speaks of the question of Indian water-supply as having been 'mixed up with theories of cholera and other epidemic diseases.' Dr. Muir and other observers in India often use the word ' theory' as if it were equivalent to ' hypothesisand they estamanifestly fail to apprehend what it is which has been blished here at home. The proposition is, not that ' impure' water is a cause of cholera, but that water contaminated by choleraic discharges will reproduce cholera in those who drink it; and this is no mere hypothesis, but a truth resting upon evidence which cannot be contravened. The distinction is of such grave practical bearing that it is worth while to give a typical illustration of the facts on which it is based."
Referring
to
the
Jheydon
Bois cholera of 1865, The Times
continues? "
Now, this case, which is supported by many others of like kind, but which, even if it stood alone, would be absolutely conclusive, presents the facts in the smallest possible compass. It shows that simply impure or dirty water may be more or less unpleasant or unwholesome, according to the nature of the dirt or the impurity, but .that it would not, therefore, be a cause of any defined or specific disease. When, however, the poison of cholera, or of typhoid fever, or perhaps of some other malady, is'added to the water, whether this was previously pure or impure, then, and then only, is the specific malady reproduced among those who drink it. The obvious corollary is that water for human consumption should not only be
December 2,
ADULTERATED MILK.
1872.]
obtained from the best accessible source, but that it should be secured on its way to the consumer against the possibility of receiving contamination from sick persons. The necessary security can only be afforded by the use of closed pipes as the channels of conveyance, and wherever closed pipes are not employed, the watercourse is liable to become a highway for the current contagions of the locality.
" It is this officers seem
simple proposition which
many Indian health understand, or which they neglect, ' while they are writing about theories' and compiling voluminous reports. Dr. Muir, in the document to which we have already referred, states that the water for the troops at Meean Meer is obtained from an adjoining canal, and proceeds unable
to
to declare that much has been accomplished of late to increase the purity of the supply. He admits that a good deal still remains to be done, 'such as the covering in of wells, the provision of pumps, the substitution of suitable vessels for the objectionable mussucks, and improvements in the mode of distributionbut he appears to regard all these as comparatively unimportant matters of detail, and not to see that, with the habits and customs of the natives, the open canal, the open well, and the filthy dipping vessels are so many totally unguarded inlets through which cholera, or any other epidemic disease, may at any time enter and be diffused abroad among the garrison. In all these wells the need for protection from choleraic discharges may be said to be totally neglected in practice ; and it is further asserted that in more than one instance foul water has been strained through filters, made from sand, which had itself been exposed to choleraic contagion. Such are the conditions against which we have to guard in the East; and they render the quality of the original source of water-supply a matter of less importance than the intercepting of accidental pollution between the source and the consumer. Water which was hard, or turbid, or brackish, or in other respects of bad quality, might, indeed, be unwholesome, but it would not be a cause of cholera; and no degree of original purity or excellence would avail if the supposed good water had been contaminated by cholera matter on its way. The protection against cholera, which may be gained from closed channels and reservoirs, is not, therefore, in any sense a matter of hypothesis. It is a matter of fact, like the pi'otection against rain which is afforded by an umbrella. Like that protection, also, it is possibly incomplete, and may leave some channels of access unguarded. But we do not discard umbrellas on the ground that they fail to keep the feet dry ; and we have no right to neglect precautions which would be, to a effectual on the that further precautions ground great extent, in to addition bo them. So as required might long the Indian authorities leave wells and watercourses exposed to innumerable chances of pollution, so long will they retain one efficient channel of cholera in their midst." We
heartily
concur
in
the sentiments
expressed
in this
The Times is wrong in supposing that the ' value and importance' of the fact that water is one of the media article ; but
which cholera is
disseminated, has remained unappreciated impossible to have written more frequently and more urgently than we have done on this subject. True, our efforts have been unavailing, for as we noticed in our issue of the 1st of April, 1872, on the authority of the Commander-inChief, that with reference to European troops the water-supply His Excellency remarks that "so long was still most defective. in mussucks from as the existing procedure of conveyance different sources, and the storage in numerous receptacles, at all times more or less open to pollution of dust or dirty vessels exist, so long is it fruitless to expect anything but comparatively foiled results;" consequently, this faulty condition of water supplied to our European troops existed at the close of last year, when the letter from which we have quoted was by
in India ; it is
written. It was in August, 18G2, that Sir J. Strachey, then Sanitary Commissioner of Bengal, remarked that " we can form no
opinion regarding
the extent to
which,
in this
country,
the
283
diffusion of cholera may be dependent upon tlio water, for facts almost
totally wanting." Cuningliam, the present Sanitary Commissioner with the Government of India, reiterates this opinion in 1870, as fol"The belief that the presence in water of a special poison, lows derived from a previous case is the great medium of spreading the disease (cholera), by no mean3 rests on such a sound basis This opinion was as that which Dr. Macnamara claims for it. advanced many years ago, but much more decisive proof must be given before it can be accepted as a fact. Dr. Macnamara, in his recent work on cholera, has adduced some instances in support of liis views; but details are very incomplete and unsatisfactory." Dr. Muir, writing at the same time, observes that drinking water is one of the media by which cholera is propagated, although a very good practical doctrine has never to my mind been satisfactorily demonstrated, and must bo considered at presonfc as a mere hypothesis, whatever Dr. Macnamara may aver to the contrary" (2nd August, 1870). "We can only hope that the epidemic of cholera through which this presidency has just passed, may be the last which will find any of our troops supplied with water in the manner above described by Lord Napier, because we hold with The Times, and have repeatedly asserted our conviction, that water contaminated by choleraic discharges will reproduce cholera in those who drink it; and that this is no mere hypothesis, but a truth resting on evidence which cannot be contravened."
are
Dr.
"
"
the
subject of cholera following:?
the
in
September has an article on India, from which we extract
"The recent outbreaks of cholera among European troops in India, to which we have directed attention, have called forth remarks from several correspondents who are more or less acquainted with the local conditions of the stations in which the disease has appeared. Their letters assign various causes, and suggest various remedies for the periodical recurrence of the most formidable and most demoralizing of epidemics. In the country itself an army sanitary commission has long been at work upon the question, at present with the sole result that its members have been overwhelmed by the number and variety of the views and statements submitted to them, and that they have been unable to educe even the form of order from such a chaos of material. The fact is, that the problems, relating to the origin and the diffusion of cholera, present themselves to the inquirer in India in forms absolutely too complicated for solution, and which seem to tend only to the production of bewilderment. Where the poison of the disease, whatever its nature, is so widely scattered and so frequently active, it becomes impossible to determine with even an approach to accuracy the share of any single condition in the production of the general result. When Mr. Simon and Professor Parkes announced, as the result of investigations carried on under more favourable, because less complex conditions, that contaminated drinking water would furnish a sufficient explanation of the spread of cholera, they reduced the whole question to a more simple form than any in which it, had previously appeared. If the value and importance of their work had been recognized in India, steps would immediately have been taken to guard the water-supply of military stations from pollution, and thus to exclude at least one element of danger. It is not probable that by this means cholera would have been entirely kept at bay, but its prevalence would have been diminished in the precise degree in which water is the channel of conveyance for its contagion. To this extent the ground would have been cleared for further inquiry, and other channels might, in like manner, have been discovered and stopped singly, and in succession, until, in course of time, almost complete security might have been obtained. Instead of following this reasonable course, Indian authorities have wholly misapprehended the real bearings of the question. They seem to believe that English inquirers have represented 'impure' water to be a cause of cholera, or even to be the only cause; and Dr. Muir, in the recently published 12th volume of the Reports of the Army Medical Department, speaks of the question of Indian water-supply as having been 'mixed up with theories of cholera and other epidemic diseases.' Dr. Muir and other observers in India often use the word ' theory' as if it were equivalent to ' hypothesisand they estamanifestly fail to apprehend what it is which has been blished here at home. The proposition is, not that ' impure' water is a cause of cholera, but that water contaminated by choleraic discharges will reproduce cholera in those who drink it; and this is no mere hypothesis, but a truth resting upon evidence which cannot be contravened. The distinction is of such grave practical bearing that it is worth while to give a typical illustration of the facts on which it is based."
Referring
to
the
Jheydon
Bois cholera of 1865, The Times
continues? "
Now, this case, which is supported by many others of like kind, but which, even if it stood alone, would be absolutely conclusive, presents the facts in the smallest possible compass. It shows that simply impure or dirty water may be more or less unpleasant or unwholesome, according to the nature of the dirt or the impurity, but .that it would not, therefore, be a cause of any defined or specific disease. When, however, the poison of cholera, or of typhoid fever, or perhaps of some other malady, is'added to the water, whether this was previously pure or impure, then, and then only, is the specific malady reproduced among those who drink it. The obvious corollary is that water for human consumption should not only be
December 2,
ADULTERATED MILK.
1872.]
obtained from the best accessible source, but that it should be secured on its way to the consumer against the possibility of receiving contamination from sick persons. The necessary security can only be afforded by the use of closed pipes as the channels of conveyance, and wherever closed pipes are not employed, the watercourse is liable to become a highway for the current contagions of the locality.
" It is this officers seem
simple proposition which
many Indian health understand, or which they neglect, ' while they are writing about theories' and compiling voluminous reports. Dr. Muir, in the document to which we have already referred, states that the water for the troops at Meean Meer is obtained from an adjoining canal, and proceeds unable
to
to declare that much has been accomplished of late to increase the purity of the supply. He admits that a good deal still remains to be done, 'such as the covering in of wells, the provision of pumps, the substitution of suitable vessels for the objectionable mussucks, and improvements in the mode of distributionbut he appears to regard all these as comparatively unimportant matters of detail, and not to see that, with the habits and customs of the natives, the open canal, the open well, and the filthy dipping vessels are so many totally unguarded inlets through which cholera, or any other epidemic disease, may at any time enter and be diffused abroad among the garrison. In all these wells the need for protection from choleraic discharges may be said to be totally neglected in practice ; and it is further asserted that in more than one instance foul water has been strained through filters, made from sand, which had itself been exposed to choleraic contagion. Such are the conditions against which we have to guard in the East; and they render the quality of the original source of water-supply a matter of less importance than the intercepting of accidental pollution between the source and the consumer. Water which was hard, or turbid, or brackish, or in other respects of bad quality, might, indeed, be unwholesome, but it would not be a cause of cholera; and no degree of original purity or excellence would avail if the supposed good water had been contaminated by cholera matter on its way. The protection against cholera, which may be gained from closed channels and reservoirs, is not, therefore, in any sense a matter of hypothesis. It is a matter of fact, like the pi'otection against rain which is afforded by an umbrella. Like that protection, also, it is possibly incomplete, and may leave some channels of access unguarded. But we do not discard umbrellas on the ground that they fail to keep the feet dry ; and we have no right to neglect precautions which would be, to a effectual on the that further precautions ground great extent, in to addition bo them. So as required might long the Indian authorities leave wells and watercourses exposed to innumerable chances of pollution, so long will they retain one efficient channel of cholera in their midst." We
heartily
concur
in
the sentiments
expressed
in this
The Times is wrong in supposing that the ' value and importance' of the fact that water is one of the media article ; but
which cholera is
disseminated, has remained unappreciated impossible to have written more frequently and more urgently than we have done on this subject. True, our efforts have been unavailing, for as we noticed in our issue of the 1st of April, 1872, on the authority of the Commander-inChief, that with reference to European troops the water-supply His Excellency remarks that "so long was still most defective. in mussucks from as the existing procedure of conveyance different sources, and the storage in numerous receptacles, at all times more or less open to pollution of dust or dirty vessels exist, so long is it fruitless to expect anything but comparatively foiled results;" consequently, this faulty condition of water supplied to our European troops existed at the close of last year, when the letter from which we have quoted was by
in India ; it is
written. It was in August, 18G2, that Sir J. Strachey, then Sanitary Commissioner of Bengal, remarked that " we can form no
opinion regarding
the extent to
which,
in this
country,
the
283
diffusion of cholera may be dependent upon tlio water, for facts almost
totally wanting." Cuningliam, the present Sanitary Commissioner with the Government of India, reiterates this opinion in 1870, as fol"The belief that the presence in water of a special poison, lows derived from a previous case is the great medium of spreading the disease (cholera), by no mean3 rests on such a sound basis This opinion was as that which Dr. Macnamara claims for it. advanced many years ago, but much more decisive proof must be given before it can be accepted as a fact. Dr. Macnamara, in his recent work on cholera, has adduced some instances in support of liis views; but details are very incomplete and unsatisfactory." Dr. Muir, writing at the same time, observes that drinking water is one of the media by which cholera is propagated, although a very good practical doctrine has never to my mind been satisfactorily demonstrated, and must bo considered at presonfc as a mere hypothesis, whatever Dr. Macnamara may aver to the contrary" (2nd August, 1870). "We can only hope that the epidemic of cholera through which this presidency has just passed, may be the last which will find any of our troops supplied with water in the manner above described by Lord Napier, because we hold with The Times, and have repeatedly asserted our conviction, that water contaminated by choleraic discharges will reproduce cholera in those who drink it; and that this is no mere hypothesis, but a truth resting on evidence which cannot be contravened."
are
Dr.
"
"
