THE PILGRIM PATH OF CHOLERA. 639 



I think it capable of proof that it is on the scarcity of water, 

 and on the habits and customs which have grown up during 

 centuries of suffering from that scarcity, that the existence even of 

 the " endemic area," the natural " home of cholera," depends. If 

 this be admitted and I think it can no longer be denied the fact 

 and necessary inferences from it are of vast and world-wide impor- 

 tance. The natives bathe and wash their utensils and clothes in 

 the tank, because it is the only available place in which to do so, 

 and they use the water of the tank, contaminated as it is in addi- 

 tion by soakage and sewage, for cooking and drinking, because it 

 is the only water supply available for domestic purposes. 



With these facts before us, and reading them in the light of 

 our European experience, it can no longer be doubted by thought- 

 ful and reasonable persons that the reason why, in India as in 

 other places, some classes escape and others suffer, is that some 

 drink pure water and others drink water contaminated with chol- 

 eraic discharges. 



Nor can we shut our eyes to the probability, growing stronger 

 every year, that the true meaning of the term " endemic area," in 

 regard to cholera, is a district in which the customs of the people 

 sanction the drinking of fecally polluted water, and in which 

 from temperature, and perhaps from other causes incompletely 

 known, the cholera germ or contagium can easily keep alive and 

 propagate itself in soil or water in the interval between its exit 

 from one host and its entry into another. 



Nothing seems more certain than that people can touch chol- 

 era patients, and rub them, handle them, and live with them, even 

 in the midst of an endemic area, and not catch the disease so long 

 as they take precautions not to swallow it. 



This is the key to the position, the horrid truth, the dirty fact, 

 that the bacillus, the contagium of cholera, lives two lives : one, 

 in the human body, causing the disease, multiplying within the 

 patient, and poured forth by him in abundance ; the other, outside 

 the body, waiting in damp ground, on soiled linen, in dirty water 

 waiting to be swallowed by some one else and to start again on 

 its destructive course. How, then, does it get round ? We know 

 well enough that the outside of a cholera patient is not infectious ; 

 the infection comes from within, with the discharges ; how, then, 

 does it get into the alimentary canal ? How can it get round 

 except in what we drink ? 



This is what I mean by speaking emphatically of cholera being 

 a water-borne disease. It is not that cholera is a disease of rivers 

 and watercourses alone, but that, whether it is a matter of rivers 

 or tanks or water supplies, or merely of wash-basins, jugs, and 

 water-bottles, the water which the patient drinks is the vehicle 

 by which the poison enters, and is the final step in the course of 



