Cholera1

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    IF anyone had undertaken, thirty years ago, to classify the communicable diseases according to whether they are easy or difficult of prevention, he would have doubtless placed cholera, the disease I have chosen for the subject of this lecture, in the front rank amongst the non-preventible, or, at any rate, amongst those diseases that are preventible with very great difficulty; while, if anyone were at the present time to revise this classification, he would find himself in the fortunate position of placing cholera in the front rank amongst those diseases that are easily prevented; in fact, he would be able to tell you that the prevention of the spread of cholera is beset with less difficulty than that of some of the communicable diseases which in towns we have almost constantly among us, as, for instance, pneumonia, diphtheria, measles, and scarlet fever. Nothing could more forcibly illustrate the great advance in practical sanitation than the comparative immunity from cholera in an epidemic form, which this country has enjoyed for the last twenty-five years. By saying “comparative immunity,” I am not forgetting that we have had cases of Asiatic cholera in this country during the last autumn, and it is precisely the remarkably limited character of this last outbreak which furnishes the best proof of our advance in sanitation, and gives satisfactory evidence of the correctness of the views on which the measures adopted for the prevention of the spread of cholera are based, and of the justification of placing cholera amongst the easily preventible diseases. To give you an idea of what sanitation has been able to do, and the complete success which attended the practice of good sanitation in preventing the spread of cholera, I will quote in illustration the following remarkable instance:2—A well known fact which has received, unfortunately, a great many illustrations, is this: that pilgrims in India carry the contagium of cholera from the fairs or festivals, to which the disease is brought from the endemic area, to localities which were previously free from cholera. One such fair is particularly notorious, and it has in the past always been a source of the utmost anxiety to the Government of India; this is the great religious festival or Kumbh fair of Hardwâr, a town on the Ganges, but situated outside the endemic area of cholera. This great Kumbh occurs once in twelve years, and it is attended by large numbers of pilgrims, a proportion of these coming from districts in which cholera is always endemic. It has thus frequently happened that this great concourse of pilgrims has been followed by a wide diffusion of the disease. The great Kumbh is principally a religious festival, and is looked upon by Hindus as one of peculiar sanctity, and the very aim and object of their pilgrimage is to bathe in the sacred Ganges, and drink of its holy waters. In 1891, when the last Kumbh fair was held, 800,000 to 1,000,000 pilgrims assembled in Hardwâr; and to get an approximate estimation of the enormous pollution to which the sacred Ganges at Hardwâr; is on this occasion subjected, and the great risk from cholera to which those who drink of its waters are exposed, I will mention what Dr. Simpson, the able health officer of Calcutta, states. In describing the scene at the “sacred pool” at Hardwâr;—somewhat retired from the rest of the river—to bathe in which and to drink whose waters the pilgrims gather together in such multitudes, Dr. Simpson states that as the bathing of the pilgrims went on the clear stream became a muddy one; that from April 8 to 12 there was always passing through the sacred waters a “seething mass of humanity” in constant motion, passing through the pool at the rate of 400 to 500 per minute. You can easily picture to yourself that a few cases of cholera introduced into such a multitude, living under such conditions, would easily cause not only an outbreak of cholera there and then, but would by the returning pilgrims be carried far and wide. Thus a sanitary commissioner says of the Kumbh, previous to 1867: ”Very little remains on record, but that little is a record of disease and death.” In 1867, and again in 1879, the festival was followed by an epidemic outbreak of cholera, which on the latter occasion rapidly extended to the western districts. Now, all through the winter of 1890-91 there was much cholera in the north-west provinces and along the pilgrim routes below the hills. So grave was the outlook, that the question of prohibiting the fair to be held in April, 1891, was seriously discussed, and the official opinion of a civil-surgeon, in conformity with that of many other officials of great experience, was to the effect that “the most complete sanitary arrangement will be powerless to prevent the spread of cholera should the contemplated fair at Hardwâr; be permitted to take place.” Now mark what Mr. Ernest Hart says:

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      This account is taken from Mr. Ernest Hart's description in the Daily Graphic, September, 1893.

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