THE CHOLERA.
THE cholera has clearly effected a lodgment among us, and we must prepare our minds for outbursts which, in spite of the generally good sanitary condition of our cities, may in places be severe. Slums are not extinguished in London yet, perhaps never will be, the authorities in little towns shrink too much from annoying their neighbours, and a multitude of villages still remain in a disgraceful con- dition as regards water supply. The only objection to a well is that no practicable method of sinking one will wholly prevent its liability to the percolation of diseased water. The central authorities are, however, awake and active; the people have, we fancy, comprehended the first grand precaution, namely, that drinking-water should be boiled ; and the danger of panic is, as compared with that danger on the Continent, very slight. Something in the inner temper of our people, perhaps their trust in Providence, perhaps their habitual resignation under illness, seems to preserve them from the fury of rage which undoubtedly mingles on the Continent with the fear caused by epidemics. They would think themselves fools if they attacked the doctors as men do in Russia, Italy, and Spain ; or if they considered an epidemic an excuse for cruelty towards its victims, as Hungarian villagers have recently done. The journalists, too, for the most part treat the visitation in the true spirit—as a danger to be provided against, like scarlet fever or the influenza, and not to be regarded as a mysterious plague which may destroy whole communities. This is the more remarkable because many of them, probably from reading of old epidemics, appear to be under the impression that an outbreak of cholera seriously impairs the resources of the States it may affect. We have seen this very week certainly five serious articles, all penetrated with the thought that no State would go to war while cholera was raging. It would be too weak. That is surely nonsense. Cholera is a ghastly disease, owing to its method of slaughter, the pain it inflicts, the short interval it allows between seizure and death, and its tendency to localise, instead of spreading, the mortality it causes, which thus strikes painfully on the imagination. It is not, however, a pestilence which strikes a State down as one or two of the Middle Age pestilences are believed to have done, or as famine may do even in modern times. While we believe the frequent assertion that cholera does not affect the death-rate to be unfounded, it probably does not kill many more than scarlet fever, or yellow fever, or even the new form of influenza. In Russia, it is true, it is slaying perhaps 3,000 a day ; but in Russia whole classes have been weakened by famine, and predisposed towards sharp enteric disease by con- suming unwholesome or loathsome food. Russia, too, contains millions of Jews, who, for some reason to us unknown, do not appear to enjoy the comparative exemp- tion from the diseases of malaria attributed to their kinsfolk in many countries. They are too numerous, we suppose, for all families liable to attack to have been weeded-out, as life in the Ghettos seems in some places to have weeded- out the feeble. Russia, however, is a world, and will not be enfeebled by any probable alteration in the death-rate, even if the addition amounted to a million for the year. Even there, and certainly in most other countries, it is the social disorganisation produced by the deaths of the useful, feebleness among workers, and panic, which are to be dreaded, rather than the total destruction of population. If it were not so, the Indian Empire, the permanent home of cholera, would never be safe as a State, nor ever ready for any great enterprise. Cholera is no peacemaker, and, owing to the facility for movement away from infected localities enjoyed by soldiers, it rarely makes the terrible impression upon armies which has been repeatedly made by dysentery, typhus, and the Asiatic plague. There have been exceptions ; the very first recorded outburst on the grand scale having caused the dissolution of Lord Hastings's Army, then engaged in the Mahratta War; but this is, we conceive, the modern rule.
The precautions and palliatives adopted on the Con- tinent appear always to break down on two special points. The doctors understand the disease everywhere, and the authorities do not generally lose their heads, except in the way of insisting too much rather on the isolation of the patient than on the isolation of the tainted products of his disease. The neighbours of a cholera-hospital on the Continent are sometimes in more danger than its patients. Everywhere, however, there is too great a readiness to do, while the disease is raging, work which ought to have been done before, or to be left till the disease is abating. It cannot be wise to clean all the cesspools of a town just when the cholera-wards are full : and that seems to be the instinct of " authorities " ashamed of themselves for previous neglect. We bow to expert opinion in all such cases ; but to disinfect, rather than clean, while the death-wave is passing, seems to lay observers, as regards crowded places, a dictate of common-sense. The other failure is in the provision of hospitals. There seems to be no kind of idea in the municipalities that they can ever want temporary hospitals, and no kind of prearrange- ment for securing them. The consequence is, that when an epidemic breaks out existing buildings are crowded to suffocation, that patients with cholera and patients without it are huddled together pell-mell, and that the provisions for rapid and safe interment break down altogether. It is positively heart-breaking to read the accounts from Ham- burg, and recognise the amount of preventible misery; and those accounts are mere repetitions of what occurred in Naples during the last great outbreak, and what must be occurring—and concealed—in the feebler of the stricken cities of Russia. The patients choke the passages, the fetor of the crowd spreads disease, the doctors are paralysed with fatigue, and all attempts at nursing are abandoned as hope- less or impossible. The Army surgeons, with their immense experience of sudden demands, must surely be able to teach the authorities how to improvise hospitals, even on the grand scale ; nor do we see that the liability of women and children adds more than a manageable complication to the problem. Is it really an additional danger to camp the people out, as a regiment when attacked is camped out, on high ground with good natural drainage ? We doubt if Indian doctors would think so, and "fighting cholera" is their first business on earth. Nor do we see why per- manent provision for sudden epidemics should overtax the resources of great cities. Citizens cannot be ex- pected to ruin themselves with rates in order to guard against a danger recurrent at long intervals ; but all that seems to be necessary is a prepared camping-ground, with pod drainage and a water supply, and numbered•beams, Joists, and planks ready for the rapid erection of the needed sheds. If we were likely to want such arrangements for war, or for defence, we should have them speedily enough ; and we do not see why the cities should not provide them, and keep them ready as part of the permanent municipal plant. A whitewashed wooden marquee, with good drainage and carefully-arranged ventilation, is as healthy a temporary hospital as could be found—far more healthy than brick wards, crowded to suffocation, such as the doctors report to be existing in Hamburg, and such as we might see in London, if the disease broke out here in earnest. All the reports agree that if the disease really broke out in any strength in London, it is in accommodation that we should fail ; and certainly that is the evidence daily reported from the Continent.
By-the-way, the use of the telegraph-wire during this outbreak will probably destroy a superstition. The half-educated have all an idea—of which Eugene Sue availed himself in his " Wandering Jew "—that the cholera "marches ;" that is, pursues some definite and unaccountable path of its own, as a human traveller might. The accumulating telegraphic reports, however, show that it constantly breaks out in two or three places at once, and that in most instances it can be proved to follow the arrival of travellers from infected places with the disease already developed in them. The fugitives from Hamburg, for instance, are scattering the disease broadcast, as, we doubt not, we should find, if the Russian doctors were allowed to speak out, did also the fugitives from Baku and Astrachan. Certainly that is the way in which the disease has crossed. the Atlantic, from Hamburg in the Moravia.' The fact is important, not only as divesting the disease of a certain awe which has attached to it, and which has helped to develop panic, but as justifying the impression that it is rarely self-generated—to say it is never self- generated is to say it does not exist—and that, conse- quently, precautions taken at the ports are of the highest utility. The authorities seem to be taking them in all English harbours with sense and without cruelty, and they ought to be energetically supported by the whole body of shipowners, the only set of men whose interest, un- happily, lies the other way. They do their duty, usually, conscientiously enough ; but if they did it always, it would be much easier to do all we can hope to do : that is, limit the territorial area in which the pestilence is intense. It is vain to hope that we can keep it wholly out of Europe, but we may, by degrees, prevent its transmission entirely from country to country or from sea to sea.
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