CHOLERA. 185 



portion of a city inhabited by the poor and that in which 

 the better classes dwell." The habits of people, then, es- 

 pecially as regards their food, play a most important part 

 in the propagation or restriction of cholera. The organism 

 is almost invariably introduced by the mouth, so that in 

 addition to passing into the alimentary canal by con- 

 taminated water directly, it may also be introduced by 

 utensils, or food washed or sprinkled with such water, and 

 Koch gives an excellent example of this when he describes 

 the market women of Marseilles as being in the habit of 

 sprinkling the vegetables exposed for sale with water from 

 the street gutter, into which he proved that comma bacilli 

 were constantly making their way, so that any one partaking 

 of these vegetables uncooked, just as in the case of the 

 American sailor at Shanghai, was taking in an unknown 

 quantity, but a very appreciable and deadly dose, of the 

 cholera organism and its poisonous products. Not only do 

 these uncooked vegetables oflFer a nidus and an excellent sub- 

 stratum for the growth of cholera organisms, but they often 

 produce that condition of slight indigestion which along 

 with an overloaded stomach, is one of the most favourable 

 for the development of the comma bacillus in the human 

 alimentary canal. 



For the same reason feasts, fasts, Saturday night carousals 

 and Sunday dyspepsias, pilgrim festivals, arrivals in port, 

 and similar events are all predisposing causes of cholera, 

 as in all cases there is a disturbance of the digestive function 

 and a lowering of the system, due either to excess in 

 drinking or in eating, or to gastric disturbance and lowered 

 vitality resulting from abstinence from the use of food for 

 too long a period. It is found, too, that wherever people 

 assemTale in large numbers in excess of the ordinary popula- 

 tion, the strain on the sanitary arrangements is always 

 excessive, and further, is necessarily accompanied by care- 

 lessness in the selection and preparation of food. Cholera 

 depends for its existence, outside those places in which it is 

 endemic, on these fairs and pilgrimages, and only by 

 controlling them and by attending most thoroughly to the 

 sanitary conditions at the points where people are massed 

 together can there be any hope of preventing the outbreak 

 and spread of this insidious and deadly disease. 



It is not necessary here to do more than mention the pre- 



