EPIDEMIC DISEASES, SANITARY CONTEOL OF. 



tion of its vital statistics as reported to the 

 proper officer, week after week ; its cleanli- 

 ness or uncleanliness ; bearing in mind its his- 

 tory and the sources from which infection is 

 likely to be admitted. The natural influence of 

 locality favoring the propagation and spread 

 of certain diseases may be entirely changed by 

 perfect cleanliness. The experience of the 

 British in India, and the French in Africa, is 

 on this point quite conclusive. Cholera is a 

 disease believed to have originated in Asia (the 

 banks of the Ganges being, perhaps, its native 

 habitat, if, indeed, a place of nativity can be 

 assigned to it). It is called Asiatic cholera, in 

 recognition of the place of its nativity. Pro- 

 fessor Blanc (" Cholera, how to Avoid and 

 Treat it," London and Paris, 1873, p. 40) states: 

 " While I was on special duty in Abyssinia, 

 cholera gained the camp of the Emperor Theo- 

 dore, where it was brought by recruits from 

 Tigre, in May, 1866. This disease had been 

 making havoc in Tigr6. We were not sur- 

 prised, therefore, to hear that it had spread 

 over other provinces, and that several cases had 

 already broken out in Kourota, a town situated 

 on Lake Tana. The King's camp was pitched 

 in a very unhealthy situation, on low, swampy 

 ground. Fever, diarrhcea, and dysentery had 

 prevailed to a great extent. The Emperor, in 

 the hope of arresting the spread of the epi- 

 demic, moved his camp to the neighborhood 

 of Kourota. A worse place he could not have 

 selected. He first encamped on a low promon- 

 tory south of Kourota, but the cholera had by 

 this time broken out in the camp and hundreds 

 were dying daily. He again moved his camp, 

 this time to some high ground a mile or so 

 north of the town. The church was so com- 

 pletely choked up with dead bodies that no 

 more could be admitted, and the adjoining 

 streets offered the sad sight of countless 

 corpses, surrounded by the sorrowing rela- 

 tives, awaiting for days and nights the hal- 

 lowed grave in the now crowded cemetery. 

 At last the Emperor asked for my advice. I 

 told him to proceed at once by different routes 

 and follow the many small streams that flow 

 from the highland of Begemder ; to protect 

 from pollution the water used for drinking ; 

 and, once on the plateau, to break up his army 

 as far as possible, selecting a few healthy, iso- 

 lated localities, where every fresh case that 

 broke out should be sent. He acted upon this 

 advice, and before long had the satisfaction of 

 seeing the epidemic lose its virulence, and be- 

 fore many weeks disappear entirely." Dr. 

 Blanc shows by the above case how much 

 may be done by isolation and scattering into 

 camps, and separation of the sick from the 

 well, and, to indicate how much better the dis- 

 ease was managed in India, under sanitary con- 

 trol, cites the following instance : 



" Cholera had been raging during May and 

 June, 1872, in the Mahratta country, a well- 

 populated district, stretching from the eastern 

 slope of the Bombay Ghauts. The altitude of 

 VOL. xxn. 19 A 



this plateau averages 2,000 feet above the level 

 of the sea. It is mostly composed of laterites, 

 well cultivated, sparsely wooded, possessing a 

 few running streams, more or less dried up in 

 hot weather, and a moderate rain-fall for India. 

 We had learned from the reports of the police 

 and civil officers in charge of the districts that 

 the epidemic was of a most virulent type. 

 Some medical subordinates were sent to the 

 localities most infected, and they confirmed 

 the great extent and severe character of the 

 outbreak. I was at the time civil surgeon of 

 Sattara, a town of some 23,000 inhabitants. 

 . . . Informed of the progress of the epidemic 

 in the direction of Sattara, with the assistance 

 of the civil authorities, the following sanitary 

 measures were carried out : The whole town 

 was thoroughly inspected, filth and rubbish 

 were carted and burned to leeward of the town, 

 drains were flushed, houses were whitewashed, 

 gardens cleared out, and all excrementitious 

 matters removed to trenches dug for that pur- 

 pose near the city, and filled with earth. Po- 

 licemen were stationed at the different roads 

 leading to the city, provided with medicines to 

 distribute to persons suffering from diarrhoea, 

 and directed to accompany to a building set 

 apart for the purpose any case of cholera that 

 should be reported to them. The town fortu- 

 nately receives an excellent supply of drinking- 

 water from a small lake situated on a hill in 

 the vicinity of Sattara. Policemen were post- 

 ed at the reservoir which receives this water ; 

 the place around was kept clean and dry, and 

 no one was allowed to bathe or wash clothes 

 at it or in its vicinity. The inhabitants were 

 warned not to use the water of their wells for 

 drinking purposes, but to fetch it from the res- 

 ervoir. They were also told to apply for med- 

 icine on the first appearance of diarrhoea, and 

 that every case of cholera that declared itself 

 in the town should be taken to the hospital, 

 and that myself or my subordinates should be 

 informed of the occurrence, when some one 

 belonging to the hospital staff would visit the 

 patients. In the beginning of July a few cases 

 were admitted into the cholera hospital, one or 

 two a day, during some eight or ten days. 

 Every one of these cases had been contracted 

 in the villages south of Sattara, the district 

 where the cholera was at the time prevailing. 

 All the discharges of cholera-patients were at 

 once saturated with disinfectants, and buried 

 in trenches dug for the purpose, and the clothes 

 and bedding of all were destroyed. A good 

 ventilation, fires, and disinfectants were used 

 in and around the cholera- ward." Although 

 Sattara was surrounded by villages, and in all 

 of them the cholera raged for several weeks, 

 not a case broke out in the city while under 

 this management. About a mile from Sattara 

 there was a military cantonment, composed of 

 European civil and military troops. This can- 

 tonment had a strict quarantine enforced around 

 it as long as a single case of cholera remained 

 under treatment at the hospital, and for some 



