REVIEW — TEOPICAL MEDICINE, ETC. 31 



Cholera is in the majority of cases a water-horne disease, due to water having become Cholera- 

 contaminated with the cholera organism derived from some person suffering from the disease. cmitinued 



It is, therefore, usually conveyed by the drinking of water which has become polluted 

 by the excreta or discharges of an infected person, as such water may occur in the form 

 of ice, or may be found added to milk, or used for the washing of vegetables, etc. ; ice, raw 

 milk and uncooked vegetables, salads and fruit may also transmit infection. Flies also and 

 other insects, especially ants, may be to blame by carrying the infection from polluted 

 matter to food and drink, while these may be contaminated by the infected and dirty hands 

 of those engaged in their preparation. The organism is easily killed by boiling and drying, 

 hence the value of the following : — 



Pbeventive Mbasubes 



(i.) All water intended for personal use, viz., drinking, cooking, washing, and, wherever possible, bathing, 

 must be boiled. Drinking water is best boiled in a can provided with a cover and a tap. The boiled and 

 cooled water can then be drawn directly into the cup or tumbler. Care must be taken that an infected 

 drinking vessel is not used, as, after the boiled water has cooled, it can be re-infected. Water from zed's and 

 goulahs should be looked upon with suspicion unless these are carefully watched and cleaned. 



(ii.) All raw milk must be boiled. 



(ui.) Uncooked vegetables, raw salads and fresh fruits, especially melons, should be avoided. 



(iv.) Food stuffs should be carefully protected from flies, ants and other insects, and not stored anywhere 

 in the proximity of latrines or any collection of refuse. As far as possible all food should be cooked. Jellies 

 are liable to become contaminated and should be avoided. 



(v.) Personal cleanliness on the part of those engaged in preparing food and drink is most essential. 

 Care should be taken to see that cooks and other servants are cleanly in their habits and clothing, and are 

 careful to vi-ash their hands before handling food or dishes or vessels used for food or drink. 



(vi.) General cleanliness, especially in latrines and in kitchens and cook-houses is most necessary. All 

 dishes should be carefully cleaned with boiling water, and kitchen cloths should be well washed and dried in 

 the sun. Any cloths used for straining soups, sauces and the like should be washed in permanganate 

 solution (ride infra.). Brooms, brushes, or cloths used for cleaning out latrines must on no account be used in 

 kitchens or cook-houses. 



(vii.) In any case of cholera or disease like cholera, with diarrhoea, colic, vomiting or cramps in the arms, 

 legs or stomach, the vomit or stool should be kept covered up until seen by a Medical Oflicer. The latter 

 should at once be informed of the illness, and only those in actual attendance on the patient should be 

 permitted to stay in the room with him. 



Great care must be taken thoroughly to wash and disinfect the hands immediately after touching the 

 patient or the bed-clothes or any vessel containing his vomit or dejecta. 



The same care is necessary on the part of those dressing or burying the corpse of anyone dead of the disease. 



(viii.) Any symptoms like those occurring early in cholera, especially colic and diaiThoea, should at once be 

 treated. In order to enforce these precautions, and for the general information of the public, it is hereby notified : 



1. That no water will be allowed to be taken from the river bank. Anyone attempting to do so will be 

 liable to imprisonment or punishment. 



2. That no bathing or washing will be permitted from the river bank, nor will anyone be permitted to 

 foul the bank, or the river from the bank, in any way whatever under pain of punishment. 



3. Pure water may be obtained from such wells in the town as have been disinfected, and inhabitants are 

 warned again.st using water from any untreated well. Bathing and washing in the immediate vicinity of wells 

 is prohibited. 



It is hoped that a general supply of pure water will be distributed both in Khartoum and Khartoum North. 



4. The general public milk supply will be placed under sanitary control, and inhabitants are hereby 

 warned to obtain their milk only from one or other of the Municiiial MUk Depots. The site and arrangements 

 of these will be duly notified later. 



5. AU aerated water factories will be placed under sanitary control, and only such aerated waters as can 

 be drunk with safety will be issued. 



6. The ice factory will be placed under sanitary control, and only such ice as can be used with safety will 

 be issued. 



7. Disinfectants will be issued at cost price from the office of the Sanitary Inspector in the Mudiria. 

 Purchasers must bring their own bottles. Instructions for the disinfection of weUs, latrines and kitchen floors 

 will be issued separately. 



8. The use of weak tea and lemon drinks made with boiling water is hereby recommended, as is an 

 early application for preventive medicines in all cases of colic or diarrhoea. 



9. The inhabitants are informed th.at cholera is a complaint which is very easUy prevented and controlled 

 provided the necessary measures are taken, and they are invited to co-operate with the authorities and to assist 

 them to cope with the disease. 



Ants as carriers of infection were specially included, because in Khartoum they are more 

 in evidence than flies, and I am certain that from their crawling habits and scavenger 

 propensities they can play a considerable role in the infection of food and drinks. 



