The Sun.
London, England, 1853-12-06 00:00:00

ence of this arrangement that can decide whether it will
be the most effectual for your purpose ; but in the mean-
time, I have studied so to dispose the industry of your in-
creased staff, under the arrangement you have ordered, as
to obtain the most systematic and efficient discharge of
those duties which you have desired me to superintend.
" Reckoning that each inspector, if he fulfilled no other
duty, could report on the condition of about 50 houses per
diem, I presume that henceforth, in each of your five more
important districts, from 100 to 120 houses can •be visited
weekly by the inspector, without encroaching on the time
required for his other duties.

"The general plan on which I would propose that this
force should be disposed, is the following :—First, as here-
tofore, the weekly list would contain all places needing in-
vestigation, on the ground of such deaths and illness as
are usually associated with preventible causes, in order
that any sanitary defects may at once be remedied ; se-
condly, in each week there would fall due a certain num-
ber of sanitary works (relating to house drainage, water
supply, and the like), for which you would have pre-
viously issued orders, requiring them to be completed with-
in a stated time ; and on the satisfactory execution of
these it will be the inspector's duty to examine and certify ;
thirdly, in each district I would have a certain rota of
visitation, according to the badness of the spot and its
known liability to fall into filthy and unwholesome condi-
tions, requiring one set of houses to be seen weekly,
another set fortnightly, another monthly, another quar-
terly,- and so on—a rota varying from time to time with
the changing circumstances of each locality; and out of
this rota. each week would supply a stated number of cases
for inquiry, to which I should occasionally acid certain of
those establishments in which offensive occupations are
pursued. Thus, in the large number of weekly visits
which I suppose the inspector to make, there would be a
certain proportion of that more elaborate kind which in-
volves an examination of the entire house ; another pro-
portion, made for the sole purpose of seeing that previous
orders have been executed; another proportion, repeated
at fixed intervals, simply to ascertain that houses once
cleansed and repaired are not relapsing into filth, nor their
works becoming inefficient.
" By utilising' on some such plan as this, the increased
staff which you have appointed for the purpose, and by
giving to its execution my continual superintendence, I
trust to be able, from time to time, to certify you that the
city becomes better and better capable of resisting epidemic
invasion. From such statement as I have set before you
on the local affinities of disease—not of cholera only, but of
typhus and its kindred, you will be prepared to expect in-
creased sanitary advantages from this more systematic sup-
pression of the causes of death ; and I believe you will not
be disappointed. Whether the anticipated pestilence rage
in the metropolis next summer or not, you will be com-
batting, day by day, the influence of other malignant dis-
eases. Whenever it may be in my power to tell you gene-
rally of the city,• that the dwellings of the poor are no
longer crowded and stifling, nor their walls mouldy, nor
their yards and cellars unpaved and sodden, nor their
water supply defective, nor their drainage stinking, nor
their atmosphere hurt by the neighbouring nuisance,—
then, gentlemen, whether cholera test your success or not,
surely you will have contributed much to conquer more
habitual enemies. For, whatever there may be specific
and exceptional in the, production of cholera, at least it
touches no healthy spot. The local conditions which wel-
come its occasional presence, are in its absence, hour by
hour, the workers of other death ; and, in rendering a lo-
cality secure against the one, you will also have made it
less vulnerable by the others.
"As a last suggestion on this part of my subject, there
are two steps which I would recommend to your hon.
Court as likely to assist the labours of your officers and to
bring a large quantity of important information before you.
First (according to a plan adopted here in the last epidemic)
that printed notices should be posted in every back street,
court, and alley of the city, and should be renewed once a-
month, advising the careful maintenance of cleanliness in

all houses, and-inviting all persons who are aggrieved by
any nuisance, or by neglect of scavengers and dustmen, or
by any defect of water supply, forthwith to make com-
plaint at your office, or to the inspector of the district,
whose name and addressC might be subjoined ; secondly,
that a circular letter be written to all persons in parochial
authority, also to the clergy, to heads of visiting societies,
and the like, begging them to communicate with your
officers on every occasion when any uncleanliness or
nuisance may come within their knowledge.
"3. Finally, gentlemen, in the probable anticipation
that next year cholera will prevail in London with at least
its former severity, it may be claimed of my office that I
should say something with respect to personal precautions
for avoidance of the disease. While most willing to place
at your disposal any useful results of my practical experi-
ence in the matter, I cannot but feel the great difficulty of
making general suggestions in a form really capable of par-
ticular application.
" From the eminently local prevalence of the poison, it
may be inferred that, for all whose circumstances admit of
option in the matter, the first and most important precau-
tion would consist in avoiding those localities where the
epidemic is active. Our knowledge of the subject enables
us confidently to say that if in one spot the chance of being
attacked by cholera is as 1 to 100, in another it becomes 1
to 50, in a third 1 to 5, in a fourth almost an equal chance
whether to be attacked or not. Nothing is gained towards
security by the mere act of leaving our metropolitan area,
if one resorts to some other place where the system of drain-
age is equally vicious, or where—as at our nearest bathing
place—the beach is made almost as offensive by sewerage
as here the river banks. From earlier statements in my
report will be obvious to you that the eligible sites of resi-
dence are those which stand high and dry, with clean,
effectual drainage of their soils and houses conveying all
organic refuse beyond range of the local atmosphere.
" I will not pass this part of the subject without ad-
mitting that the course here suggested might involve
a considerable desertion of particular localities and a tran-
sient injury to their commerce. This unavoidable result
of proclaiming the conditions of the disease I must regret
in regard of its personal bearings. But the facts of the
case are all-important for the public ; and sanitory im-
provement will, perhaps, move more quickly in this
country when it is known that the pecuniary prosperity of
places may suffer from their reputation for endemic
disease.
"In case of cholera prevailing with severity in spots
containing a dense poor population great assistance would
be given to medical and sanitary measures if a number of
empty, unlet houses, healthily situated, were at the dis-
posal of the authorities, into which, under proper regula-
tions, they might induce certain of the poorest families to
migrate for a time, as to places of refuge, till the diseases
should have subsided about their original dwellings.
" For persons, whose circumstances or duties retain
them unavoidably in the midst of those suffering districts
where the poison is most active, the best counsel I can
offer, even if at first hearing it seem vague, is, that they
should be vigilant as to preserving the greatest possible
soundness and vigour of general health ; keeping the body,
so far as may be, undisturbed by extremes of cold, unde-
pressed by long confinement, unfluttered by violent pas-
sions, unexhausted by physical or mental fatigue, untried
by any excess or any privation ; taking for diet a suffi-
ciency of fit and nutritive food, rather in generous measure
than otherwise, but far from the confines of intemperance ;
and giving meanwhile a prompt attention and cure to
whatever accidental ailments may arise.
" Such, in general language, are our best fortifications
against the poison. It may be well, however, to add,
that in our metropolitan climate—perhaps everywhere
else—the human frame tends to require some periodical
aid from medicine. It may be the excitement and labour
of London ; it may be its atmosphere ; it may be native
peculiarity; but thus the fact stands, that there are few
persons who do not at intervals require the re-establishing
effects of what is called tonic treatment. Probably three-
fourths of the prescriptions we write are aimed at this
mere tendency to depression in the human body, as mani-
fested in one form or another. Now, as a man, going on
some distant voyage of eiploration, submits his chronom-
eter to a last intelligent scrutiny before he exposes it to
the ordeal of other climates, so, iu this matter of frequent-
ing infected districts, men will do prudently, before they
pass into perils which may test their powers of resistance,
to see that they carry about with them no enfeeblement
or disrepair, which a short submission to medical discipline
could effectually remove. For with epidemic poisons
generally, and in a marked degree with Asiatic cholera, it
seems that all states of langour, depression, and debility
enhance the risk of infection.

"Beyond these general cautions there is yet one
which requires very particular mention.
"In respect of the commencement and predisposition of
the disease, it is now well known, first, that in this country
it habitually begins with diarrhoea of a painless and appa-
rently trivial character; secondly, that diarrhoea, however
produced, is, of all known personal conditions, the one
most likely to invite an attack of cholera at times when
that disease is epidemic ; thirdly, that during the preva-
lence of cholera, side by side with it in a district there is
always a vast amount of epidemic diarrhoea, apparently
constituting slighter degrees or earlier stages of the same
disease; that this condition is just as amenable to treat-
ment as the confirmed collapse of cholera is utterly the
opposite ; and, since we can never say how incurable a few
hours may render this insidious symptom, that its imme-
diate arrest is a consideration of vital importance.
"Precautions against causing diarrhea to one's-self by
errors of diet will vary somewhat with different individ-
uals. Every person of ordinary discretion knows the habits
of his own body, and can be tolerably confident, within
certain limits of food, that he gives himself no occasion of
sickness. He remembers articles of diet which his neigh-
bour, perhaps, may innocently indulge in, but which to
himself are the occasion of inward disorder—of purging or
vomiting, ' bilious attack' or nettle-rash, headache, night-
mare, or some other inconvenience. This knowledge fixes
the limit which it primarily behoves him to regard, taking
such food only it to his body as experience has shown best
to agree with it, and adhering to this course without panic
as to particular accustomed articles, and without abrupt
discontinuance of old harmless habits.
" Apart from personal peculiarities, the chief dangers of
diet appear to lie as follows ---1. In those excesses of meat
and drink which (especially under circumstances of fatigue)
occasion sickness to the stomach, or an increased labour of
digestion. 2. In taking food, solid or fluid, which is mid-
way in some process of chemical transition—half-fer-
mented beer and wino, water containing organic matters,
meat, and game, and venison no longer fresh, and not com-
pletely cooked, fish and shellfish in any state but the most
perfect freshness, fruit or vegetables long gathered or badly
kept, and the like. 8. In a profusion of cold sour drink.
4 In partaking largely of those articles of diet which
habitually, or by reason of imperfect cooking, pass un-
changed through the intestinal canal. 5. In the indiscreet
use of purgative medicines, or in taking any article of diet
which is likely to produce the same effect. _ _

" In short, if care be taken under all these heads to avoid
occasions of intestinal disturbance : if the diet, while ge-
nerous, be simple 'and strictly temperate ; if regular hours
be given to sleep, to meals, to industry, to recreation; if a
fair proportion of outdoor exercise be taken ; if damp and
extremes of temperature be guarded against, and all prac-
ticable pains be given to avoid the sources of bodily and
mental depression,—danger will be reduced to its mini-
mum ; and whatever effects the epidemic may happen to
produce can be readily recognised and boldly encountered.
Should these effects arise in their customary form of diar-
rhoea, it is of absolute urgent necessity that immediate
medical treatment should be resorted to ; and so impor-
tant for the safety of life is the recognition of this symp-
tom in the earliest stage of its occurrence, that no un-
wonted.action of the bowels should pass unobserved.
" The public constantly ask to be informed of some drug,
or combination of dings, to which under these circum-
stances they may have immediate recourse. But after
very careful consideration of this subject, after hearing
arguments on both sides, and reading those prescriptions
which have been recommended for adoption, I venture to
express my opinion, that the safest course for the public,

in regard of this threatened disease, will be to follow the
same principle as guides them in their ordinary seizures of
illness, and to obtain as quickly as possible the aid of £heir
customary medical advisers. There is an invincible apti-
tude in the public to misapply all precautionary medicines
within their reach ; often superstitiously to treat them as
charms, under the protection of which they may neglect
temperance of diet and all other solicitude for health ;
often ignorantly to employ them in cases for which their
use is forbidden ; often, at the instigation of panic, to
abuse them by preposterous and hurtful excess. Nervous
and uneducated persons, instead of employing their astrin-
gent dose simply to stop any undue action from the bowels,
would be apt, as the danger neared them, to make it an
habitual dram, in order to anticipate any such action ; and
the frequent after-necessity for purgative medicine, thus
created, would constitute the very danger they desire to
avoid. Recognising, therefore, at its full value the im-
portance of immediately treating, in every case, the first
phenomena of epidemic diarrhea, I must yet doubt whe-
ther the conditions of medical science and general educa-
cation are such as to justify the promulgation of general
formulae so liable to extensive abuse. I speak, of course,
with particular reference to the metropolis. In remote
rural districts, it may often be desirable that discreet and
intelligent persons—the clergy, for instance—should ob-
tain from their medical neighbours some stringent prepa-
ration, to which, in the very rare event of real emergency,
temporary recourse might be had ; but, for so hazard-
ous a condition of disease, I must repeat, as a general
rule, that no nostrum, even in the best-intentioned hands
of ignorance, can supply the place of medical discrimina-
tion.

" During the acute prevalence of the epidemic in any
particular locality, it becomes, of great importance to
bring the uneducated classes of society, as far as possible,
under systematic medical care ; in the absence of which
they are likely to neglect all premonitions of the disease,
and thus to incur much unnecessary danger. To fulfill this
objects, as regards the poor, express provision has been
made by the law; and it might be well for other classes,
under similar exposure to attack, to consider how far they
could arrange for their households a similar plan of protec-
tion. Under any order in Council, which brings into action
the extraordinary powers of the Nuisances Prevention Law,
the General Board of Health acquires authority to enjoin on
boards of guardians throughout the country that they pro-
vide for ' persons afflicted by or threatened with' the dis-
ease such medical aid as may be required ; and the actual
working of this has been, that on all occasions of epide-
mic cholera prevailing in particular localities, the General
Board of Health has called on the local boards of guardians
to establish systematic house-to-house visitation for disco-
vering and treating among the poor all premonitory symp-
toms of the disease.
"In the too probable event of its becoming necessary
next year to establish this system of medical organisation
in parts of the metropolis, I have no reason to doubt that
a requisition to that effect will be addressed to the guar-
dians of the city poor; and, in this anticipation, I think it
desirable to bring, in conclusion, one more point under
notice of your hon. Court. During the former invasion
the guardians within the city of London resisted the re-
quirements of the General Board of Health, and the first
fourteen weeks of the epidemic consequently passed with-
out the establishment of any visitational system for arrest-
ing its progress. In the fifteenth week, however, the cor-
poration of the city undertook the unperformed duty not
legally devolving on them, and requested me to make
arrangements for the purpose of its execution. With the
assistance of the several medical officers of the city unions,
I immediately organised the requisite staff, and from that
moment to the close of the epidemic there continued under
my superintendence a systematic visitation of the poor,
with beneficial, though tardy and imperfect results.
" Recalling these incidents to the recollection of your
hon. Court, I would beg to observe that no similar endea-
vour can fully succeed, except as a system—well considered
beforehand, and adjusted to the various circumstances
which may require its application. Uncertainties of
responsibility and conflicts of jurisdiction woAld inevitably
occasion a large sacrifice of life ; and, therefore, before the
time when the cholera is likely to become epidemic, it
should be, definitively settled who is to undertake this
organisation. YOur Committee can have no jurisdiction
in the matter ; and the interference of the corporation
would be only at its own option. The legal responsibility
rests solely with the boards of guardians; and it seems to
me indispensable that, before the time for action arrives,
the corporation should determine its intentions, in order
that the boards of guardians, if again called upon to organ-
ise arrangements of the kind in question, may know dis-
tinctly, either that the corporation has relieved them of
their teak, or that there rests on them the undivided obli-
.

-
gation of providing for the crisis.
" 111, Gentlemen, in concluding this report, I will not
attempt to disguise from yon that it has been written under
feelings of considerable apprehension, and, I am fully con-
scious that, in thus expressing myself, I am liable to the
imputation of raising unnecessary alarm.
"If the possible mischief to be wrought by epidemic
cholera lay in some fixed inflexible fate, whatever opinion
or knowledge I might hold on the subject of its return,
silence would be better than speech, and I could gladly re-
frain from vexing the public ear by gloomy forebodings of
an inevitable future.

"But from this supposition the case differs diametrically;
and the people of England are not like timid cattle, capable
only when blindfold of confronting danger. It belongs to
their race, it belongs to their dignity of manhood, to take
deliberate cognisance of their foes, and not lightly to cede
the victory. A people that has fought the greatest battles,
not of arms alone, but of genius and skilful toil, is little
likely to be scared at the necessity of meeting lame danger
by appropriate devices of science. A people that has in-
augurated railways, that has scanned the Menai Strait,
and reared the Crystal Palace, can hardly fear the enter-
prise of draining poison from its infected towns. A people
that has freed its foreign slaves at twenty millions' ran-
som will never let its home population perish, for cheap-
ness sake, in the ignominous, ferment of their filth.
" Therefore; gentlemen, advisedly, I state the danger as
it seems to me. England has again become subject to a
plague, the. recurrence of which, or the duration or the
malignity, no human being can predict.
" But if I state the danger, so likewise, to the best of my
belief, Ist to the remedy and defence. Colossal statistics
concur with circumstantial inquiry to refer this disease, in
common with many others that scourge our population,
distinctly and infallibly to the working of local causes—of
causes susceptible of removal—of causes which it devolves
on our Legislature to remove.

" Toe exemption we seek is worth a heavy purchase.
My thoughts turn involuntarily to the epidemics of former
centuries, to their frequent returns and iminmse fatality.
I reflect on the Plague, and how it influenced the average
death-rate of London ; how in 1593 it doubled it, it 1603
tripled it, in 1625 quadrupled it; and how (after a less
considerable visitation in 1636) it actually multiplied the
mortality sevenfold in the tremendous epidemic of 1665.
The ravages of that pestilence are but appreciated in the
lid that we esteem the Great Fire of London a cheap
equivalent for their arrest, looking to that eventful con-
flagration of the metropolis with gratitude rather than
horror, because of the mightier evils that were extin-
guished with its flames.
"To so frightful a development as this, cholera, by
many degrees, has not attained ; but, ignorant as we are
of its laws and resources, we dare not surmise, at any re-
newed invasion, what increment of severity it may have
won. In the simple fact, that our country has again be-
ef me subject to pestilential epidemics, there lies an amount
of threat only to be measured by those who are conver-
sant, by history or experience, with the possible develop-
ment of such disease.
" Therefore, gentlemen, having the deapest assurance
that these unexplored possibilities of evil may be fore-
closed by appropriate means, I should ill deserve your con-
fidence if I shrank from setting before you, however un-
gracious the task, my deliberat estimate of the peril.
" It belongs to my local office to tell you of local cures;
and this I have sought to do. I have suggested that, by
active supeiintendence of all houses within your jurisdic-
tion, there may be suppressed ir. detail, those several
causes of the disease which arise in individual neglect ;
that, by elaborate care as to the cleanliness of pavements,
markets, docks, and sewers, something may be done to-
wards the mitigation of more general causes ; that, by a
well-organised system of medical visitation, very much
may be effected towards encountering attacks of the disease
while still amenable to treatment. That these, with si-
milar precautions, are therefore to be recommended.
" And not for a moment would I seem to depreciate
such measures, palliative only, and partial though they
be. By their judicious application, from Aldgate to the
Temple, life may possibly be saved to same hundreds ; to
children that are fondly loved, to parents that are the stay
of numbers.
" But against the full significance of any epidemic, I
am bound to tell you that these are but poor substitutes
for protection. To render them effectual—even in their
narrow sphere of operation—there must be g. eat vigilance
and great expenditure ; a weary vigilance and a dispropor-
tionate expenditure, because chiefly given to defeat in de-
tail what should have been prevented in principle. And,
be done what may in this palliative spirit, the sources of
the disease are substantially unstayed ; for the faults, to
which its metropolitan prevalence is due, consist not
simply in a number of individual mismanagement; but
include a common and radical misconstruction as their
chief.

" No city, so far as science may be trusted, can deserve
immunity from epidemic disease except by making ab-
solute cleanliness the first law of its existence ; such clean-
liness, I mean, as consists in the perfect adaptation of
drainage, water supply, scavenage, and ventilation to the
purposes they should respectively fulfil; such cleanliness
as consists in carrying away by these means, inoffensively,
all refuse materials of life—gaseous or fluid—from the per-
son, the house, the factory, or the thoroughfare, as soon as
possible after their formation, and with as near an ap-
proach as their several natures allow, to one continuous
current of removal.

"To realise for London this conception of how a city
should cleanse itself, may involve, no doubt, the perfection
of numberless details. Yet, most of all, it would presup-
pose a comprehensive organisation of plan and method ;
not alone for that intramural unity of system which is
needful for all the works, not least for those of drainage
and water supply, but equally to harmonise these works
with other extramural arrangements for utilising to the
country the boundless wealth of metropolitan refuse—for
distributing to the uses of agriculture what is then rescued
from the cha-acter of filth--for requiting to the fields, in
gifts for vegetation, what they have rendered to the town,
in food for man
" How far the construction of London has proceeded on
the recognition of such objects, or how far the advantages
of such a plan have been; realised, it could only be a
mockery to ask. Our metropolis, by successive accretions,
has covered mile after mile of land. Each new addition
has been made with scarcely more reference to the legiti-
mate necessities of life than if it had clustered there by
crystalisation. With no scientific forecast to plan the
whole, with little but chance and cheapness to shape the
parts, our desultory architecture has eclipsed the con-
ditions of health. Draining uphill or downhill, as the
case might be, and running their aqueducts at random
from chalk quarries, or river mud, or pending sewage in
their cellars and digging beside it for water, blocking up
the inlets of freshness, and, equally, the outlets of nui-
sance, constructing sewers to struggle with th© Thames,
now to pollute its ebb, now to be obstructed by its flow,
the builders of many generations have accumulated sani-
tary errors in so intricate a system that their apprehen-
sion and their cure seem equally remote.
" Therefore, by reason of causes ramified through the
whole metropolis, and deep-rooted in its soil, which bind
all parts together in one common endurance of their effects
—therefore, cannot epidemic disease be thoroughly con-
quered by any exertions, or by any amelioration, short of
the complete and comprehensive cure. Against the danger
we dread no shelter is to be found in petty reforms and
patchwork legislation. Not to inspectorships of nuisance,
but to the large mind of State policy, one must look for a
real emancipation from this threatening plague.
"A child's intelieat can appreciate the wild absurdity
of seeking at P.'lll what here runs to waste beneath our
pavements—of ripening only epidemic disease wi h what
might augment the food of the people—of waiting like our
ancestors to expiate the neglected divinity of water in
some bitter purgation by fire.
" But it needs the grasp of political rauterships apt Tao