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

Both these agents act, I believe, mechanically by coagulating certain forms of organic matter present in the water, and so carrying to the bottom, entangled with it, the germs present in the water, in which situation they perish on account of the free access of water containing their nourishment being impeded, and on this account at least two days should be allowed to elapse before the water is again taken into use, during which all disturbance of the water should be carefully avoided.

Neither of these agents is in any degree as trustworthy as permanganate, but their employment should not be neglected in cases where the latter is either unobtainable or objections are raised to its use. Of the two, lime is probably the better, but alum much the handier.

Whichever agent be adopted, it is well to treat as large a number of wells as possible. A certain number must needs, of course, be left untouched, for use during the time the treated wells must be left undisturbed, and these should be dotted about the town, so that the minimum of inconvenience may be inflicted on the townsfolk; but always leave as few as possible, as objections may be raised on your second visit, a couple of days after, to complete the process by disinfecting the remaining wells, and it may hence happen that you may have to rest content with what you have been able to effect on your first visit. Always, too, commence operations on the well you have reason to suspect is infected, or, in other words, that used by the people of the house in which the first local case has occurred.

Permanganate has now had a long trial in India. I have never known it fail, wherever it has been used in the manner above described, and the operation has been conducted by an European officer in person. The native medical officer, even when trained after our European methods, is seldom really convinced of its efficiency, and moreover he lacks the prestige of prophets hailing from abroad, and so may be really unable to carry out his instructions. An even commoner mistake is to go to work piecemeal, disinfecting a few suspected wells and leaving the rest till fresh cases spring up, as they necessarily must, as buckets infected from the first infected wells will inevitably be taken to other wells during the time that the former are unusable, and they can scarcely fail to infect them, and so start new foci of infection, if sufficient time be allowed for the germs to increase and multiply to a dangerous extent in their new location. Reports of failure I have received in plenty, but on investigation they have always proved to be due to some such cause as those indicated above. It is, of course, only rarely that a layman will find himself called upon to conduct such operations on a large scale; but the knowledge of how to do so may be of such great public benefit to the readers’ coloured fellow-subjects, that it is most desirable that every European should know how to proceed, and, at any rate, I would strongly advise my readers, should cholera appear in their neighbourhood, never to omit the precaution of disinfecting all wells under their own control, as it is a great protection to one’s servants and other native attendants. It is well, too, to repeat the process occasionally as long as the disease continues near one.

By the simple precautions as to food and drink described above, the danger of being attacked by cholera may be reduced to a very small contingency, even when it is raging around one, and there is no reason whatever for the almost superstitious fear with which the disease used to be regarded.

It remains to say a few words as to the treatment of cases should they arise in your household in places where medical aid is unobtainable.

In the first place, it should be remembered that the danger of handling and nursing patients is but small, for, as already remarked, you cannot “catch” cholera in the same way as you can small-pox or plague. To become infected by the germs you must eat or drink them. The discharges in cholera are, of course, intensely poisonous, and it is impossible to nurse a case without the hands, and perhaps one’s clothing, becoming fouled; but the germs are perfectly harmless applied to the skin, and with due precautions as to cleanliness and disinfection of the hands, there should be no danger of their gaining access to the nurse’s mouth. To avoid contamination of clothing, a washable overall should be worn, such as can be improvised from a sheet, with a hole for the head cut in the middle, secured round the waist with a cord, and the sleeves should be turned up well above the elbows. Care should be taken not to touch the lips or face with the hands while in attendance on the patient. On leaving him, the overall should be wrung out in sublimate lotion and spread out in the full blaze of the sun to dry, and the hands and arms should be thoroughly washed first with warm soap and water and then with sublimate lotion, care being taken not to eat or drink until these precautions have been complied with.

Medical science is absolutely at fault in the treatment of cholera, so that no treatment can be recommended beyond such measures as naturally suggest themselves to relieve the patient’s sufferings.

The symptoms of the disease consist of violent purging and vomiting, the discharged matter being watery and almost colourless, with small particles and shreds of whitish matter floating in it, being, in fact, to quote the usual simile, very like rice water. Very often the patient suffers from violent muscular cramps, which cause great suffering. This active onset is followed by a stage of collapse, in which the skin becomes cold and livid and the face and hands singularly pinched and blue. If the patient survive this stage, it will be found that the urine is suppressed, the functions of the kidneys being, for the time, absolutely suspended; and the patient can never be considered out of danger till this function has resumed its natural course.

Now as to treatment. It must be in the first place remembered that it is absolutely useless to worry the patient with attempts to administer medicines by the mouth, as the digestive and absorptive functions are for the time totally stopped, and it is quite as much to the purpose to put your remedies in the patient’s pocket as to force him to swallow them. To have any chance of acting, medicines must be administered by being injected beneath the skin by means of the hypodermic needle; and so powerless are all known drugs in this disease, that I should hesitate to recommend such medications to be attempted by amateur physicians. The only drug which has ever appeared to me to effect any good has been chloral hydrate dissolved in water and injected under the skin in 5-grain doses every few minutes until 30 or even 40 grains have been administered. There can be no doubt that this treatment controls the violence of the symptoms, and usually does away with the horrible suffering caused by the terrible cramps that are so common in the disease. I am even inclined to believe that a somewhat better percentage of cases recover under the treatment, though this is doubtful. Failing this, massage and frictions with the hands do much to relieve the cramps, and in the cold stage, every care should be taken to maintain the heat of the body by covering the patient with blankets and placing around him bricks heated in the fire and wrapped round with strips of wet blanket. During the reaction that follows on the cold stage, in favourable cases, attempts should be made to stimulate the kidneys by the application of mustard plasters to the loins. To attempt to give food during the acute stage is obviously worse than useless, but there is no harm in letting the patient suck small lumps of ice to assuage the terrible thirst of the disease. In the stage of collapse, stimulants naturally suggest themselves, but are seldom of any use when given internally. A few drops of ether inhaled from a handkerchief is, if available, perhaps the best method of stimulation, but the weakened kidneys have quite enough to do without having to deal with alcohol, so that it should be but sparingly resorted to, if at all. When the patient shows such signs of recovery that it appears likely that food can be tolerated, small quantities only of easily digestible food, such as milk, rendered mucilaginous by the addition of a little arrowroot, Brand’s extract, &c., should be given, but it can easily be understood that after so severe a shock to the digestive system, the greatest care will have to be exercised in the feeding of the patient. Finally, it should not be forgotten that all the discharges of the patient are virulently infective, and that they and everything soiled by them should at once be disinfected. When the supply of disinfectants is limited, a good plan is to place in the bed-pan and basins used a sufficiency of sawdust, and to at once burn the contents by emptying them on to a brisk fire.