Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

Although the main essentials of domestic sanitation have already been dealt with at some length, and incidental mention has necessarily been made of their bearing on the avoidance of particular maladies, it appears desirable to devote a few pages to the separate consideration of the avoidance of some of the more common tropical diseases. Some apology may be necessary for the inclusion in the following remarks of some brief references to medical treatment, but it is difficult to keep absolutely distinct the subject of prevention and cure in a popular work, and while there is no desire to convert this little book into a treatise on family medicine, it is thought that a few words on the subject of remedial treatment may not be out of place, especially as most of the writers that treat of this subject popularly, from the tropical point of view, are hopelessly out of date.

It must be clearly understood that what little is said on this subject is in no way intended to supersede the necessity of medical advice, whenever that may be available; but in these out-lands, the number of doctors to the square yard is far smaller than it is in Europe, and even in comparatively settled regions, it is quite easy to place twenty miles or more between yourself and the nearest medical man.

It must be remembered that in tendering general advice of this sort the prescriber is considerably hampered by the necessity of recommending nothing that is likely to do harm should the amateur doctor’s diagnosis be faulty, and that he is thus debarred from suggesting many measures that would be perfectly appropriate were the case under competent supervision.

I do not of course refer merely to the question of poisons, as there are few drugs that are of any real use that are not capable of causing dangerous symptoms if administered in adequate doses—and many of the drugs recommended are as a matter of fact powerful poisons—but rather to the fact that even assuming reasonable care and intelligence in weighing and measuring, one must needs direct only such measures as will not be harmful in the by no means unlikely event of a mistaken diagnosis. In only too many of the scourges that devastate these latitudes, there is no time to wait for the arrival of a doctor living a day’s journey away, as the chances are that the fate of the patient will be no longer in the balance when at last he arrives; so that for anything to be of any use it must be done quickly.

This method of treating the subject necessarily involves occasional repetition, but in view of the importance of the details thus emphasised, this may not be entirely disadvantageous.

Cholera.

When the writer first went to India some quarter of a century ago, there was still a tendency to invest this disease and its propagation with certain mysterious attributes, and a certain pompous obscurantist who was then at the head of affairs invented the awe-inspiring term of “pandemic waves” to account for, or rather cover, ignorance as to its method of spread; nor was it altogether safe for his subordinates to record facts that appeared to indicate a more common-sense explanation. But even then, the theory that the disease was usually conveyed from man to man by infected water, was held practically by all whose opinions were worth having. Still we were very much in the dark as to the methods whereby it gained access to water, and had no means of distinguishing infected from harmless water; and our measures of prevention, being thus based on guess work, were uncertain and often ineffective. At the present day, thanks in the main to the labours of Koch and Hankin, there is no disease about which our knowledge is more definite. In dealing with semicivilised communities it is still, it is true, quite impossible to prevent or foresee outbreaks of the disease, but when it occurs our knowledge now enables us to bring an epidemic to a speedy termination, always provided we are permitted to do so by the population; and personal prophylaxis may almost be said to amount to security.

We now know that the germs of cholera can exist only in the human organisation, but that they are capable of living and also multiplying in water. In very impure water, they cannot long survive, as they soon get crowded out of existence, in such situations, by putrefactive and other germs that are most at home under such conditions. For their multiplication the presence of a certain amount of otherwise harmless organic and mineral matter is of course necessary, but if introduced into water containing this, they can survive some time in the purest natural waters, though they ultimately die out in such situations. Owing to these habits of life on the part of the germ, it follows that the taste and appearance of water are absolutely valueless as regards its safety, and that the chemical examination of water is an equally futile test. The disease is carried about from place to place by infected human beings; but in ninety-nine cases out of a hundred is conveyed from man to man not directly, but indirectly through the agency of drinking water. In the hundredth case the germs may be carried in food, and of course milk, being often intentionally or accidentally mixed with water, is a frequent vehicle.

Direct infection from man to man does probably occasionally occur, but the contingency is too remote an one to be worthy of consideration, as it implies close personal contact, and in fact is usually traceable to those in attendance on the sick getting their hands or clothing fouled with the discharges and neglecting due measures of disinfection before eating or drinking. Save in this way, there is practically no risk whatever in the proximity of, or of attendance on, cholera cases, and no one need shrink from nursing persons stricken down with the disease, provided they observe a few very obvious precautions.

Fortunately the cholera germ is rather a delicate sort of plant, and but for its sharing with man a preference for good drinking water it would be comparatively harmless, as it soon perishes elsewhere, and is very soon destroyed by drying or too great heat. It is needless to remark that it cannot stand boiling, for the germs that can stand that sort of treatment are few and far between; but it is also very sensitive to the action of most of the ordinary disinfectants, which destroy it in dilutions far weaker than is the case with the agents of most other diseases; and it is also killed by a sufficiently long exposure to the action of carbonic acid, from which fact there outcomes the useful bit of knowledge that it is quite safe, qua cholera, to drink aerated waters even of doubtfully careful preparation, provided that they have been kept a few days in the house before use. Owing to the fact that the cholera germ cannot only survive, but is also capable of multiplying, in drinking water of average purity, the amount of fouling of the water which is required to infect it may be very small indeed, and usually is infinitesimally small.