ago so little was known of the causes which produced the disease, or of the means of hindering its distribution, that the doctors themselves not rarely became the innocent carriers of its poison. With its cause a mystery, and resistless apparently in its advance, it is no wonder that the frightful mortality attending it struck terror to the hearts of the people among whom it appeared. But, thanks to experience and the scientific investigation of many observers, all this has gradually been changed. It has been abundantly shown both here and in England that, with suitable sanitary precautions, such as are within the reach of every enlightened community, not only cholera but other diseases which tend to become epidemic can, if taken in time, be arrested in their progress and ultimately stamped out altogether by the prompt and energetic application of ordinary hygienic rules. This is now so well understood float epidemics of any kind, particularly in centers of population under municipal control, are justly regarded as evidence of official neglect or mismanagement.
In the case of cholera the work of the sanitary authorities is really very simple. It has long been attempted to exclude the disease from cities and towns by means of quarantine, the prohibition of immigration, and of the importation of certain classes of merchandise. These measures, however, seriously conflicting as they do with the self-interest of individuals and corporations, have always proved more or less ineffective, until it has become very plain that they can not be relied upon to keep out the scourge. In England this is now generally admitted in practice, as the authorities interfere far less with commerce than formerly, but give strict attention to the immigrant and the cargo after they are landed.
The real concern of the sanitarian, then, is with the conditions of living among the masses of the people in the district under his charge, and, if past experience is any guide, his chief duty will be to promote, and, if need be, enforce the virtue of cleanliness, interpreting that word in its widest meaning. Filth is a necessity to the very existence of cholera. It has been the one uniform condition present in all the epidemics of which we have any record, and is the usual vehicle for the transmission of the disease. On the other hand, purity and wholesomeness are its deadly enemies, and in proportion as these are secured will the danger of epidemics decrease. Medical authorities are generally agreed that cholera is propagated by a specific poison. It matters not whether we call this a virus, a germ, or a bacillus, the important point to observe is that whatever its nature it must gain a lodgment in the system before the disease can develop. So far as known this poison or germ is only produced by the disease. It is thrown off from the bodies of the sick in the discharges from the digestive tract, and, if not destroyed at once, is ready for its career of destruction. Through defective drains or other channels it may pass into a well or stream which furnishes the drinking-water to many families. This is one of the most common ways for the poison to gain an entrance into the bodies of the healthy. Dirty food and the use of articles soiled with choleraic discharges may also convey it, but most authorities assert that it is never carried through the medium of the air—that is, the disease is contagious, but, unlike scarlet fever and measles, is not infectious. Physicians and nurses work among it with impunity, even in its most virulent form, so long as rigid cleanliness of person and clothing is observed.
The only recorded death from the disease among the attendants in Russian hospitals during the present outbreak is that of a nurse who heedlessly swallowed the remains of a cholera patient's dinner. Drinking-water, however, is by far the most frequent vehicle of the
