The Express.
London, England, 1866-08-11 00:00:00

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LONDON, SATURDAY, AUGUST 11.

Ix the event of a severe outbreak of cholera in
a crowded district, what hospital arrangements are
the best ? This is a question which should be con-
sidered and decided without loss of time. Granted
that some steps must be taken towards the
safety of the healthy by separating them from the
sick, what is the best mode for all parties in which
this can be effected f And here it must be noted
that in the nature of things whatever plan is
adopted must fail to give universal satisfaction. We
are all, however, doubtless, agreed upon this,
that so long as the building is not placed near to
our particular dwelling, the provision of a cholera
hospital for our parish is an excellent
idea. At all events, this appears to be the pre-
vailing notion in the parish of St. Marylebone. It
seems that the sanitary committee have bought an
iron house, said to have been formerly used as a
cholera hospital at Bethnal-green, and are putting
it up in the stoneyard at the northern end of the
pariah. The inhabitants of the neighbourhood
have held an " indignation " meeting to protest
against the proceeding. They say that the stone-
yard is in the centre of a quarter densely popu-
lated by poor persons. They suggest the work-
house yard as the best position for the hospital.
This kind of opposition is am foolish as it is pro-
foundly selfish. Since the first appearance of
cholera in this country such an incident
as the transmission of the disease from
a cholera hospital to the neighbourhood
in which it was placed has never occurred. So
much is now known about the nature of the
disease that with the must ordinary precautions
such a transmission is not in the least liable to
occur. For the rest, if cholera hospitals are to be
employed at all they must be planted in the centre
of densely populated and poor districts. It is in
such quarters that cholera always rages most
fiercely. It is amongst this class of inhabitants
that the assistance of hospital shelter is, if ever,
required. It is absolutely necessary, if life is to
be saved, that the distance to be traversed shall
be as small as possible. On the other hand, the
Poor-law Board has notified to the guardians that
" it is inexpedient that the accommodation to be
" provided for cholera patients should be in the
" workhouse or on the workhouse premises."
This is a most proper suggestion. To force
upon the workhouses, already overcrowded
and wretchedly organized, as recent investigations
have shown them generally to be, the onerous
charge of patients who need more constant atten-
tion than any other class of sick, would be as cer-
tainly absurd as it would probably be destructive.
The establishment of cholera hospitals is one of
three methods by which the sick can be separated
from the healthy. This can be effected also by
the ad fission of cholera patients into general
hosp►tals. Lastly, there is the mode to which we
referred lately—the preparation of houses of
refuge for the healthy members of an attacked
household. Certain disadvantages, as well as ad-
vantages, attach to each of these methods, and it
will probably be found in practice best to avoid
reliance upon one to the entire exclusion of the
others.

The metropolitan hospitals have already,
without exception, set apart special wards
for the treatment of cholera patients. A
very unanimous feeling was evinced in the replies
received by the Epidemiological Society to in-
quiries of eminent authorities upon this subject,
that it was, on the whole, unadvisable that cholera
patients should be admitted into the ordinary
wards of general hospitals. At the same time, it
was thought that such patients could be safely
admitted into special wards in general hospitals,
due precautions being taken. And so in most of
the metropolitan hospitals there may now
be seen rows of empty beds, abundance
of appliances, and every requirement for
the occasion. Meantime the staff awaits with the
anxiety of zealous interest the approach of the
enemy whose alarms are heard sounding at so
short a distance. This exhibition of energy on
the part of the hospital authorities is highly to be
praised. It should serve as a stimulus to the
parishes to exhibit a like amount of zeal. Unfor-
tunately in some instances it is likely, from
what we learn, to produce a contrary effect. The
parish, instead of making its own preparations,
relies upon those of the hospital most near to it.
Now it is manifest that a serious error may be thus
committed. Even the London Hospital, with ex-
ceptionally large accommodation, has been nearly
overwhelmed by the influx of patients whom it
has received.
It is quite unreasonable to expect from the
comparatively small institutions at the west end of
London accommodation for more than a few pa-