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

A traveller draws water from an infected, but chemically practically pure well, and marches on, or it may be travels some hundred miles by train. Arrived at his next halting-place, he lowers his drinking vessel into the well he finds there. The amount of matter carried from the infected to the clean well is necessarily far too small to turn the most delicate balance ever constructed, but that same amount would suffice to infect not one, but an indefinite number of wells, so infinitely small are the individual germs concerned carrying the infection. Moreover, the drinking of infected water does not imply certain infection, as at certain stages of digestion the germs are destroyed in the stomachs of healthy people; and hence it is quite possible for the disease to be introduced by a person who has not himself suffered, though perhaps it is more common for it to be caused by mild cases; for it is a mistake to think that cholera is always a fatal or terribly serious disease, as in every epidemic large numbers of cases occur of slight upset of the digestive organs, but which we now know by microscopic examination to be really true cholera. These cases, however, are rarely recognised or recorded, and the really virulent form of the disease, which kills, roughly speaking, half of those it attacks, is alone referred to in ordinary statistics of attacks and deaths.

In India, and I suspect in most other semicivilised countries, the commonest method by which wells become infected is by the using of a vessel which has contained infected water to draw water from an uninfected well. The quantity of material required to start the fermentation in a still wholesome well is, as already remarked, infinitesimally minute, and a small drinking vessel and the string used for lowering it into the water, if carried by a traveller from an infected to a healthy place, is amply sufficient, and as the, chemically speaking, still pure water of an infected well is all that is required, it is obvious that no actual fouling of drinking water with the discharges from those stricken down by the disease is either necessary or common. The actual fouling of wells from contiguous latrines or cesspits does no doubt occasionally occur, but owing to the extremely primitive character of Oriental plans of conservancy, is rare.

From what has been said, it will be obvious that it is perfectly easy to suggest measures for the prevention of cholera which may be trusted to be perfectly effectual. The only difficulty lies in carrying them into practice. Practically, all that is required is to protect all supplies of drinking water by covering in wells and fitting them with pumps. But the mere expense of doing so is often beyond the means of the community, and when the pumps have been fitted, there is no one available to keep them in order; so that after a very short period they become useless, and the old infection-carrying bucket and string must needs be reverted to. Nor is it by any means easy to protect one’s own supply, as strangers have a free and easy way of making use of their neighbours’ wells, whether rich or poor. Nor can one’s native servants be trusted either to prevent this or to employ for drawing water a single vessel set apart for the purpose, for being unable to comprehend the reasons for such precautions, they naturally regard them as merely troublesome fads on the part of their employer, to be observed only when he chances to be looking on.

On this account the cardinal precaution of personal hygiene is to drink only water that has been boiled, and to see it boiled oneself. Every housewife knows that even European servants are often singularly obtuse, or neglectful, in recognising when water has actually come to the boil; and that to be certain of the perfection of the domestic cup of tea she must satisfy herself that the water is actually in a state of ebulition. Nor are such precautions onerous or troublesome. Orders should be given that the portable charcoal stove should be brought into the verandah and that the water should be boiling at the time of some meal, when the master of the house necessarily passes through on his way to table; preferably that of late dinner, so that the water may have all night to cool in, and so be ready for the next day’s consumption. The boiling water should be poured directly into the vessels, porous or otherwise, in which it is to stand, and put aside in some place sheltered from dust. They should not be filled too full, as after they have cooled it is desirable to shake the water violently so as to re-aerate it, and so remove the insipid taste which the water has acquired, owing to its dissolved air having been expelled during the boiling process. The still boiling water may generally be trusted to sufficiently sterilise the containers, but it is perhaps well, as an additional precaution, to boil them occasionally in a large cauldron. Above all, do not filter; but trust to settlement. Ordinary filters are perfect germ-traps, while all varieties of the Pasteur filter are slow in action and apt to get out of order. Added to this, their rubber connections may leak without our being aware of it, and even when in their most perfect condition, they afford a protection but little superior to that given by boiling, so that personally I would far prefer to put up even with a little turbidity in boiled water than put any trust even in the best of them. Remember that you can trust no one but oneself to attend to their cleanliness and efficiency, and that to do so implies the sacrifice of a good deal of time on a very irksome job. Drinking water that chances to be impregnated with lime necessarily becomes turbid on boiling, but the turbidity is perfectly harmless. If the deposit be so fine as to be very slow in settling, the process may be hastened by stirring it round a few times with a crystal of alum. These precautions should be, of course, routine ones at all times, but should be maintained with special vigilance at times when cholera is present in one’s place of residence. Aerated waters that have been kept in the house a week may also be drunk, but care should be taken to avoid any articles of food that are consumed raw, such as salads and fruits. Tomatoes may be dipped into boiling water and peeled without detracting from the pleasant, fresh acidity of their taste, but it is well to specially avoid during such periods lettuces and melons, as owing to the circumstances under which they are cultivated they are specially liable to have been wetted with infected water. Cucumbers may be dealt with in the same way as tomatoes, as from their shape it is very easy to sterilise their exterior by dipping them for a few seconds beyond the middle of their length in boiling water and changing end for end. This and the customary subsequent peeling really affords a sufficient practical security, and it must be remembered that the usual dressing of vinegar, “fortified” as this article of consumption usually is with sulphuric acid, affords an additional security, and does away with the necessity of submitting to what would be really a considerable deprivation at the time of the year when cholera is most common; for cholera and cucumbers flourish most at the same season of the year, a coincidence which has led to the not unnatural, but quite erroneous, popular idea that cholera may be caused by eating this vegetable. Of course, too liberal an indulgence in cucumber, like too much of any other rather indigestible good thing, may cause bowel disturbance, and an irritated bowel is especially liable to infection; but apart from superadded infection, no article of food is capable of causing the disease.

In dealing with drinking water on a large scale, such as the disinfection of wells and tanks, we have several available methods, for one or the other of which the materials are almost everywhere available. The most valuable of these agents is undoubtedly the permanganate of potash, and the suggestion of its use for the disinfection of drinking water from the germs of cholera is undoubtedly due to Mr. Hankin, our official bacteriologist at Agra. No doubt more than one medical officer had previously made experiments with this chemical for the purification of drinking water, but the credit of definitely proposing its use on a large scale in cholera epidemics, and of proving that it is lethal to the cholera germ, even when greatly diluted, is undoubtedly due to him alone.

The enormous practical importance of the discovery has, however, been but slowly realised, though its capabilities were put to the test of practical application by the writer immediately after Mr. Hankin published his suggestion, with the result that a severe epidemic in a town of over 10,000 inhabitants was brought to an abrupt termination within three or four days.

The method of disinfection of wells by means of this chemical has already been described on [page 47], et seq.

The addition of a few ounces of common sulphuric acid increases, I believe, the lethal effects of the permanganate on the cholera germ, but is certainly not necessary, and I have no personal experience in its employment, as the taste imparted is somewhat persistent; and in dealing with suspicious races such as those inhabiting our Indian possessions, it is desirable that all obvious change in the taste or appearance of the water should pass off as soon as possible.

The alternative agents are alum and quicklime, either of which is very fairly effectual, though by no means as trustworthy as permanganate. Their great advantage lies in the fact that they are obtainable almost everywhere, and that being familiar articles of daily life their use is less likely to give rise to misunderstandings in dealing with ignorant and suspicious populations, who regard with mistrust the treatment to their wells with a chemical so strange and striking as permanganate must appear to them. Nearly all races are, however, familiar with the cleansing powers of lime, and in the case of Indians, the wonderful powers of alum in clearing turbid water is a bit of household knowledge familiar to everyone. A pound or two of alum, or half a hundredweight of lime, are required for each well. If alum is employed, it should be roughly powdered.

To further avert all suspicion I find it a good plan to hand the necessary money to an inhabitant of the place and ask him to fetch me from the local shop the amount of alum or lime required. I then, if alum be chosen, tell him to pound it up with a brick and himself to throw it into the well, myself standing somewhat aloof. As everyone is familiar with the use of alum in purifying water, and there is obviously no possibility of the surreptitious introduction of anything else, with ordinary tact, no objection will ever be made. Of course, the person thus impressed into the service of sanitation should always be a man of good caste, preferably a Bhraman.