The Express.
London, England, 1853-09-21 00:00:00

THE CHOLERA.

GENERAL BOARD OF IIEALTIL—NOTIFICATION.
(FrAs 164 Night's Gasete.)

General Board of Health, Whitehall,
So ember 20, 1353.
_ _ _

It is the painful duty of the General Board of
Health to notify a third visitation of epidemic cholera.
This disease, again first breaking out in Persia, has ex-
tended within the present year over a large portion of Rus-
sia, stretching as far northwards as Archangel, on the
shores of the Arctic Ocean. It has ravaged Denmark,
Norway, and Sweden, and then developing itself in the
north of G,rmany, it has attacked Stettin, Berlin, Itotter-
d►m, and 11 ,mburg ; and subsequently it boa appeared in
England, again breaking out on its north-east coast, in the
near neighbourhood of the town in which it made its first
appearance in this country in 1831.

In this wide-spread course it hu everywhere overleaped
the barriers which quarantine boa erected to stay its pro-
gress ; and where this mesas of protection has been melt
rigidly enforced, it has not only disappointed the ezpeLta-
tau of those who have relied upon it as a safeguard, often
to the neglect and exclusion of the most important priciu-
ties', but has aggrarited the evils of the pestilence, and
added disastrous consequences of its own.

The eel:enema already obtained of this pestilence at
Newcastle, 0 iteshead, end Heehaw is d .cisive, that where
the conditions are favourable to its local:se:ion and develop-
ment, as is the ease in thesitowns, the disease hes lost
nothing of its former virulence. In the two former, indeed,
the severity of the disease, as far as it has yet extended,
has gr.atiy exceeded that of any former visitation, and it
has attacked in all those places, es it has abroad, a much
larger proportion of the middle end higher classes.
It is deeply to be lamented that the interval between the
la•t visitation of this pestilence and the present has not been
generally employed in effecting a larger amount of im-
provement in our cities and town:. From such inspections
as the (haunt Board have recently been enabled to make
of the state of populous districts, the former seats of the
disease, in apprehension of its re-appearance, they are com-
pelled to state that there are extensive districts, and even
entire towns, in which no perceptible improvement of any
kind has been 'Gelid. Oa the other hand there ere in-
stances in which, even where no general permanent works
of improvement h►ve been effected, better supplies of water,
extensive flagging end paving, more frequent scavenging,
and a more active removal of nuisances in epidemic localities
have been accomplished. Combined and permanent works,
involving elaborate engineering measures, capable of
remedying the neglect of years, Cannot he effected in a few
weeks. But the consciousness of past neglect should
stimulate to immediate and resolute exertion, that all
which the time requires and which can be done may be
done. The results in some instances, even of limited and
partial improvements, are highly encouraging. During
the present epidemic in Hamburg, which has now been
prevailing upwards of six weeks, only six cues of cholera
have occurred in the improved parts of the town ; and 11
during the whole of the epidemic in the metropolis in
1519, not a single ease of cholera occurred in any one of the
model dwellings fur the poor, occupied by similar classes of
the population, though the pestilence raged in the districts
in which these buildings ant situated, and there were in-
stances of two and even lour deaths in single houses close to
their walls.

Even in towns in which the greatest amount of improve-
ment has been effected, and in which works under the
Public Health Act are most advanced, much remains to be
done, and may be done. Local boards of health are in-
vested under the Public Health Act with ample powers fur
cleansing, for the removal of nuisances, fur preventing the
carrying on of unwholesome or noxious trades in such a
manner as to injure health, for preventing the occupation of
cellars as dwelling-houses unless under certain conditions,
for preventin.; the occupation of any dwelling-house which,
on the certificate of an officer of health, shall appear to be
in such a filthy and unwholesome state u to endanger the
health of any person, until such house shah have been pro-
perly and effectually whitewashed, cleansed, and purified,
and for administering the Common Lodging Howes Act,
the provisions of which are most important. All those
powers should be exercised at the present juncture with ex-
traordinary activity, vigilance, and stringency.
But though it may be needful to prosecute the work
of cleansing more vigorously than in ordinary periods, yet
it should be done under supervision and with extraordi-
nary care. In removing accumulations of filth precautions
should be taken for disinfection and for preventing the ia-
crease of noxious evaporatioa. The contents of foul drains,
sewers, and ditches should in no case be spread upon the
surface, and no large accumulation of filth should be re.
moved, excepting under the direction of a medical officer.
The escape of noxious effluvia is far more dangerous in an
epidemic than in an ordinary season.
The evil of overcrowding, so general not only in common
lodging-houses but in tenements of all descriptions occu-
' pied by the poorer classes, especially by the Irish, au evil
preventible and to a considerable extent removable, should
be at once and by all practicable means reduced.
' Wherever local boards of health exist, they should in
all cases co-operate with the boards of guardians, and it is
believed that the boards of guardian, will, on their part,
co-operate with local boards. The existing means for
the extraordinary service now required are divided
amongst independent local jurisdictions; medical officers
in England and Wale* being under boards of guardians ;
works of sewage and cleansing in towns, not under the
Public Health Act, being under town commissioners acting
under local acts; and the enforcement of orders required
for the public service being with the magistrates or muni-
cipal authorities. It is confidently expected that a common
feeling will ;tiro precedence to the branch of service spe-
cially needed on this occasion, and ensure that unity of
action which it is the main object of the rules and regula-
tions issued herewith to authorise and promote for the
common object.
Experience has shown that in the ease of the actual
outbreak of the epidemic, the chief measures to be relied
on for checking its spread are these which prevent over
crowding, remove _persons from affected houses, and bring
the infected population under prompt and proper treat-
ment during the premonitory stage of the disease. During
the epidemic of 1849 an organisation for effecting these
objects was brought into operation, the main parts of
which were the establishment of a system of house-to-house
visitation, the opening of dispensaries and houses of refuge
in affected districts for the gratuitous supply of medicines,
the establishment of houses of refuge for the reception
. .

of such indigent persons as appeared to be en imr mi-
Dent danger, resident in the most filthy and over-
crowded houses, the provision of temporary hospitals
for the reception of those who could not be properly
treated at their own homes, and in some instances
the supply of tents for the removal of the moot susceptible
and destitute classes to a distance from infected localities.
The result of this system was, that out of 130,000 premoni-
tory cues brought under its operation, no fewer than 6,000
of which were on the point of passing into the developed
stage, only 260 went into the collapsed stage of cholera, or
one en 520. But of the 43,737 cases under visitation in the
metropolis, including 078 cases on the point of passing into
the collapsed stage of cholera, only 62 actually did so—not
1 in 800; to that taking together the general result of this
extended experience, it appears that the proportion of cues
under early treatment which passed from the premonitory
into the developed stage varied from 1 in 500 to 1 in 800.
No doubt is now entertained of the efficacy of this system,
or of the duty of local authorities to carry it into effect on
the very Gist appearance of this disease in an epidemic
form ; and, as none can tell where or how suddenly the
pestilence may alight, it is the duty of local authorities to
be prepared fur the emergency before its arrival. Prepara-
tion will be attended with little cost ; the power to act with
promptitude and efficiency when the necessity for action
arises will be attended with a great economy of money as
well as of life.

With reference to those precautions against tho disease
which each individusl may take for himself, or the heads
of families or establishments for the under their charge,
_ . . .

the first in imprtance are personal aad household cleanly:
sees, and the freest ventilation of living and sleeping
11001111 with pure air ; the purity of the air we breathe
being even mare essential than the wholesomeness of food
and drink.

When the disease has actually broken out and become
epidemic in any district or locality, then the one essential
precaution is not to neglect for a single haus any degree of
looseness of bowels. This symptom being commonly with-
out pain, and so slight that it is difficult to conceive that it
can be of the smallest consequence, naturally leads to
neglect, and this neglect has cost the lives of thousands.
Were any additional proof of this required it would be
found in the events that are now occurring at Newcastle
and Gateshead ; all the medical men there bear testimony
that premonitory diarrhao is all but universal, and that
life depends on instant attention to this symptom.
Thus, one physician says, " lie has layer yet seen a use
without premonitory symptoms;" another states, "lie
has found in a great number of instances where the men
said they had been first seized with collapse, there had been
neglected diarrhtna for 24 or even 4S hours, or longer ;"