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

The course of infantile diarrhœa is often appallingly rapid, so that all may be over with the little sufferer in a few hours, and on this account there should be no delay in obtaining medical assistance, even on the appearance of slight symptoms of the kind, wherever such help is at hand.

Plague.

Strictly speaking, this terrible scourge cannot be said to be in any sense a disease peculiar to warm climates, for the one climatic condition that appears to check the course of epidemics of this disease is extreme heat, which always moderates their virulence as long as it lasts. In reality, it is a disease of low civilisation; and appears to be practically incapable of attaining any serious spread amongst people of European habits. During the terrible recrudescence of this disease, which, for the last decade, has been ravaging the semicivilised world, although repeatedly introduced, it has never succeeded in seriously establishing itself in any European town. Even the admittedly backward sanitation of Spanish towns appears to be too advanced to admit of the spread of plague, and, what is more remarkable, the European portion of the population of plague-stricken Eastern towns has remained practically unscathed, while the indigenous population have been dying around them in their thousands. When first the disease invaded India there was naturally a good deal of alarm amongst the European population of Bombay, but nowadays the official, commercial, and social life of the European community goes on unmoved, even at times when the disease is doing its worst—and is so assured of its own immunity that timid ladies out for their evening airing will scarcely turn their head as the bodies of the plague-stricken are carried past them on the way to the burning ghaut. Perhaps this immunity may be to some small extent a question of race, but the main determining cause is undoubtedly difference of habits of life, as natives who have adopted European habits share in it.

The most important conditions favouring the spread of plague appear to be overcrowding and inadequacy of air space and ventilation in dwellings; and especially lack of light, as well as the want of domestic cleanliness, and the treasuring up or neglect to do away with dirty rags, dust and rubbish. A further reason in India is the sacredness of animal life, which leads to the unrestricted multiplication of rats and vermin of all sorts.

The germs of the disease are easily destroyed by moderate heat, strong light, and most disinfectants, but are apparently capable of preservation for long periods when protected from such agencies; and hence the disease is capable of being transported from place to place by the agency of dirty clothing, infected rags and such like, but the characteristic which most embarrasses our efforts to deal with the malady is the fact that plague is a disease not only of man, but also of many other animals; and that rodents in particular are specially liable to be affected by it, and are in fact generally seriously involved before an epidemic has attained any serious spread amongst human beings. Not infrequently, the first warning of an impending epidemic is the discovery of dead and dying rats in large numbers; and the best considered plans of dealing with the disease are necessarily constantly defeated by the impossibility of extending to these proverbially secretive and cunning animals the measures of isolation and disinfection that are indispensable to success. It is obviously to little purpose to disinfect the room in which a human patient has died, when in hollows in its walls, roof and floors are hidden whole families of rats in every stage of the disease; and it can avail little to isolate the comparatively few human patients, while hundreds of infected rats are left to wander about at will. Luckily, the infection of plague requires close contact to secure transmission, and there is practically no danger of contracting the disease in the ordinary open-air intercourse of life.

From what has been said, it will be seen that for Europeans resident in plague-stricken towns personal prophylaxis is a comparatively simple matter, as it is instinctively carried out as a matter of national habit. There is comparatively little danger in entering infected buildings during the day, or even in handling the sick, but unless it be a part of his duty to do so, it is better for the European to avoid passing through the infected portion of the town; to keep a keen eye on the health of his servants; and generally to restrict, as far as possible, association with the native community. The house should be kept freely open to air and light, avoiding the closing of doors and windows to exclude the heat, as in doing so we reproduce the domestic habits which cause the natives to suffer so severely. If the weather admit of it, it is better to sleep in the open; and should any mortality among rats be observed within the dwelling, there should be no waiting for any second hint, but the place should be vacated at once, and thoroughly disinfected; nor is it well to return to it for at least three weeks. Among the very small number of cases in which Europeans have fallen victims to the disease, neglect to take timely warning from the death of rodents within the house has occurred in more than one instance directly reported to the writer.

On the personal prophylaxis of plague no more need be said, but in out-of-the-way places, it not unfrequently devolves on the non-medical European to have to take measures for the protection of the indigenous community, in the absence of medical advice. To be effective, the little that can be done must be done at once, and therefore a few words on the general or public prophylaxis against the disease may not be out of place. One of the few redeeming features in the natural history of plague, is that it at first spreads very slowly. It is doubtful if, in any case, the bulk of the infections are from man to man, and it appears on the whole probable that, after the first introduction of the infection, time is usually required to admit of the thorough establishment of the disease amongst the rats before it can attain any formidable spread amongst men. During this early stage there is no great difficulty in dealing with the disease, and hence it is absolutely of the most vital importance to obtain information as to the occurrence of the first cases. In the case of these first attacks, whether imported or apparently of local origin, no measures of disinfection and isolation can be too rigorous; but the people should be made to clearly understand that except at their own express desire and by their own enforcement, compulsion in such matters will be at once relaxed should the disease unfortunately gain a firm footing in their midst. As a matter of fact it is unfortunately too true that there is really very little that can be done to any purpose, when once the disease has fairly fixed itself on the susceptible mass of an oriental urban population, and above all things it is worse than useless to attempt to enforce sanitary measures by compulsion, as it only leads to the concealment of extent and localisation of the disease, and to organised obstruction to all remedial measures attempted by those in authority.

It should be the duty of a civilised government to place at the disposal of the population every possible means of combating the disease which our superior knowledge and civilisation enables us to recommend, but it should be made absolutely clear that these benefits of civilisation are there to be simply taken or left, as they please. In the cases of measures particularly liable to be mistrusted, such as inoculation, it may even be well to charge a small fee for the operation, to be remitted of course in cases when the patient can show that he is really impecunious. The joy of getting to windward of the too credulous official by a pardonable understatement of finances, would be a temptation hard to resist by the average Oriental, and there is no harm in writing out such a receipt; for the folks who require Hibernian driving of this sort cannot read, and it was one of their countrymen who could not only read, but think very much to the purpose, who suggested the expedient to the writer.

I believe my good native friend was right, for I have actually seen ordinary vaccination eagerly sought for by Orientals over whom we had no shadow of political control, and who would have been up in arms at the idea of compulsion; through the simple stimulus of the nominal fee system.

As a matter of fact, there are few things that the Indian cannot be persuaded to do by a tactful European official who has been allowed to remain sufficiently long in a locality to become known and trusted by the people among whom he has to work; but the notion of utilising the personal factor in administration is, unfortunately, far from the Indian bureaucracy, and the theory of one man being as good as another for any purpose has been adopted to such an extent, that combatant magnates were actually selected to control the operations of the medical experts in dealing with plague. The attack on the plague bacilli with so tactless a weapon as the bayonet naturally failed, but we certainly secured a striking and no doubt valuable demonstration of “how not to do it.”