The Sun.
London, England, 1854-04-20 00:00:00

THE CHOLERA.

The following notification, dated April 17, has been
issued by the General Board of Health, Whitehall :
" The General Board of Health deem it their duty to
warn boards of guardians, local boards of health, parochial
boards, and other local authorities against' placing a false
security in the present apparent disappearance of epidemic
cholera.
"It is of the last importance to bear in mind that a simi-
lar decline of the pestilence took place at corresponding
periods of its progress on both its former visitations.
" The attack of 1831 was premonitory of a more severe
and wide-spread outbreak in 1832.
"The epidemic of 1848, which in the autumn of that
year numbered nearly 1,000 victims in the metropolis,
almost wholly disappeared in the spring, yet returned with
redoubled violence in the summer, destroyed nearly 2,000
persons weekly for several weeks in succession, and pro,
duced, including deaths from dia.rrlacea, a total mortality
of more than 17,000.
"In like manner the outbreak of last autumn, which
commenced with greater, virulence than the epidemic. of
1848, and destroyed in the metropolis during the first
months of its course double the number of victims, has
been followed by a lull which has been more complete thans
that of 1849. But within the Lest month the disease has
again become more active, and a gradual increase has taken
place in the number of deathe,•raising for this month the
total deaths in England and Scotland to twice
of the corresponding period of 1849. the amount
The
preceding visitations therefore justitiee:he analogy
the apprehensionof the
that the disease, instep, I of having ceased, is .
itsperiod
of incubation, and that the epidemic, in its decided form
and full force is yet to come.
" The modifications in its character which the
it doubly
the pestilencethly
to re
has recently exhibited are of-a nature
necessary that the first indications of its appearance in a
locality should be vigilantly watched., In the majority of
the places which it has hitherto attacked is has seized its
victims more suddenly, and hurried them through its fatal
course with greater rapidity than on any preceding visits-
• tion.
"One stage of the disease, formerly well marked, and of
the utmost value with reference tothe opportunity afforded
for the application of the means of prevention, is now gene-
rally much shorter in duration, and often even suppressed_
namely, that denoted by the term, approaching cholera.'
i
premonitary diarrhcea does still ndeeexist, but that also
is commonly of shorter-duration, andsses more directly
and rapidly into oholera, and cholera itself into collapse.
~ During its first visitation in 1831 and 1832, the attacks
of the epidemic, with few exceptions, were confined to the
poorer portions of the population residing in the most
neglected and nnhealty districts. In 1848 and 1849 it was
fatal to larger numbers of the middle classes inhabiting
better-conditioned localities and houses. As far as the
disease has yet advanced, the proportion of the better class
attacked is still greater than in 1849.
In that year among the total number of persons who
perished by the epidemic in the metropolis 81 per cent.
were labourers and artisans, and 15 per cent. were trades-
men ; but in the places in which the disease has lately pre-
vailed the proportion of deaths among labourers and arti-
sans has been only 72 per cent., while the mortality among
tradesmen has reached 24 per cent. In like manner in the
epidemic of 1849 the proportion of the deaths of the gen-
try and professional persons to the total deaths was 2.6
per cent., but recently it has risen to 3.2 per cent. In other
countries the disease has not spared the highest classes,
and if the safeguards against it are neglected, there is no
reason why it should in our own.
"It is further indicative of an increasing activity and
intensity in the pestilence that, while the interval between
its first and second visitations was 16 years, the interval
between its second lend third visitations has been only four
years ; and that its second visitation was far more exten-
sive and mortal than the first. In the absence of more
efficient precautions against it, there appears no reasonable
ground for the expectation that the third will be less ex-
tensive and mortal than the second.
" Besides the loss of life, the pecuniary loss occasioned by
these local outbreaks demands attention. Irrespective of
the permanent expense entailed on towns both by public
rates and private contributions for the maintenance of
- widows, orphans, and others pauperised by the epidemic,
the losses sustained by individual tradesmen, from the in-
terruption, and in some instances the almost total suspen-
sion of commerce, are most severe. In some recent in-
stances the sums thus lost would have sufficed to defray
a very large proportion of the outlay required to place the
town in a permanently safe and satisfactory Sanitary con-
dition. It is estimated that the total cost of the visita-
tion of 1848 and 1849 to England and Scotland, exclusive
• of the cost to Ireland, could not have been less than
2,000,0001.
" From these considerations the board have learnt with,
great regret that since the lull in the epidemic local autho-
rities in numerous instances have suspended the preventive
measures which they had actively commenced, under the
assumption that the visitation of cholera is over, and that
therefore the occasion for further watchfulness and effort
has ceased.
" While it is satisfactory to stjtte that a great and grow-
ing number of local autherities now manifest an earnest
desire to carry into effect every practicable means of pre-
vention, there are some who show the same reluctance as
formerly to admit the plainest facts evidencing the
near approach of an outbreak. Instead of preparing to
meet the danger, they shut their eyes against it. Cases
of diarrhoea !veering in unusual intensity, in unusual
numbers, and at an unusual season, they regard
as of no real significance. Successive deaths, with the
symptoms of malignant cholera, they call deaths from Eng-
lish cholera, as if changing the name altered the evil. They
suppress, as far and as long as possible, the knowledge of all
local forewarnings, whence a false security is maintained,
which, on the outbreak of the pestilence, gives place to panic.
On the arrival of one of the board's medical inspectors,
who, under such circumstances, is usually sent for, he'finds
the union medical officers distracted with the sudden de-
mands made upon them—demands greater than they could
possibly satisfy were they to devote day and night to the
service, which indeed .many of them.do, to the peril and
some to the loss of their own lives. 'Thus occupied with
the treatment of cases, they are wholly unable to devise,
organise, and superintend measures for preventing the
spread of the pestilence among the population as yet runt-
tacked. Additional medical assistance has now to be sought
from a distance ; properly qualified house to house visitors
to perform the service of bringing the premonitory cases
under immediate treatment are to be obtained; houses of
refuge are to be procured; dispensaries are to be opened--
in short, the whole preventive system has to be organised,
and before these arraugements can be made, which ought
to have been completed before a single case of the diseaso
occurred, the pestilence is at its height.
" One consequence of this neglect of the proper period
of preparation is, that in the actual presence of the epide-
mic, some of the most powerful predisposing causes of the
disease cannot be removed without the risk of increasing
the evils intended to be remedied. Cleansing operations,
which at all times require caution, are then hifrriedly and
precipitately resorted to, and are sometimes performed in
such a manner as to produce positive aggravation of the
disease. In some instances cesspool matter has been dis-
charged even into the kennels of the streets, and the contents
of foul.ditches, in a state to give off poisonous exhalations
on the slightest agitation, have been spread on the banks
close tohabitations. The board deem it necessary again to
caution local authorities against such a culpable mode of pro-
ceeding, which even in ordinary seasons would be attended
with imminent danger ; but that danger is greatly in-
creased at an epidemic period. Though accumulations of
filth may be removed with perfect safety, with the proper
use of disinfecting
deuce of persons of competentsubstance
knowledge,
under the superi. nten-
season the emanations from decomposingwse, yet in Taeupidveem,iee.
table matter acquire so much, potecytaatniamta that time,
it is better to leave collections of foul refuse undisturbed,' and to cover them temporarily with layers of quicklime or
of fresh earth.
" Wherever it has not been already done, an efficient
scavenging staff should be immediately organised and kept
in unremitting action. The mortality from the epidemic
in towns well scavenged has in some instances been only
one-half of that in ill-scavenged towns, both being in other
respects in similarly imperfect sanitary conditions.
It is sometimes observed, as a ground for inaction,
that extraordinary epidemics merely take the place ordi-
.nary epidemics, and only destroy, in a - shorter space of
time, those who would have perished, probably within the
Year, by some form of zymotie disease.
" Nut even if this were true, it cannot be too strongly
impressed on local authorities that ordinary epidemics,
which nifty take the place of an extraordinary epidemic,
are themselves preventible, and are in great measure
prevented by proper sanitary arrangements, as is
seen in the comparative immunity from these diseases
among the inmates of well-managed union houses and
prisons; of well-regulated lodging-honses, and of improved
dwellings for the labouring classes. If, therefore, from the
favourable state of the weather, or from some unknown
cause, the disease should return only with diminished
foreseer should not recinsat all as a general epidemic. no
properly directed effort can fail to be of benefit equivalent
to the expense incurred. It should not require the occur-
ience of an extraordinary disease, terrifying the imagina-
tion by the suddenness of its attack and the rapidity
of its
course, to call forth such efforts ; they • are called for by
ordinary epidemics, which, though less alarming as being
• always present, are for that very reason far more mortal
than extraordinary epidemic.
e" It is, however, so far from being true that an extraor- di"
epidemic' does not increase the average mei--
t'4l-ItYs *at It sometimes swells' that mortality nearly by
the whole n umber of
the' use, to a IrTscAis who perish by it. This was
1849. Out of '2int.g 'Arable intent, in the epidemic of
mortality of that 4,2 401000 were added to the
there is no eround year. Judging from past experience,
not take plebe° in the aPe at. a similar loss of life will
exertions are made to ilo)rPeT:e"
g summer, unless timely
only that timely exertion can nt e calamity, and it is now
._ be made. It is at the pre-
sent juncture that the test meneieneryloowere conferred by
the order in Connell Sor -enforcin
cleansing, and for the removal s.terhal and internal
exercised. with the utmost oval
nneSences, should be
Y. vigilance, and strin-
gency.,
" Nor should it "be forgotten that. within thet time of preparation which may, yet be allowed us, in h
condition of great numbers of places in all Our to e actual
al
Only palliatives that can be applied. 'Where there'islt i-
drainage, to proper water supply, no waterclosets, nothir
but foul cesspools, only limited benefits can be expected g
"For this reason the board would urge on local boards
of health, whose works under the, Public Health Act are
the most advanced,
the great importance of hastening ea,
the completion of such operations as are necessary for the
abolition of cesspools,
and the substitution of the water.closet apparatus, by laying down, wherever possible, asps.
daily in epidemic districts and localities, impermeable
and 861f-cleansing house drains, and by'providing ample
supplies of water. Hitherto, almost exclusive attention
has been given to the constraxction of main servers,but ex-
perience has shown that these alone, without systematized
connexion with house
. drains and ample
1 'u the prevention of
self-cleansing
of ter. :ire (f little avail
dVasa,iesbut that‘m ;he.
to house these. ave been
re jeul cesspools have been the prin.
aiyal sanitary evil, as fiend houset .
bstituted, the outbreak
%keel sups and the %rates-clue° su •
sPrea4 Or fever, and other forms of Xyrisotic dieeaae,
hive peen at oars arrested.
'. d with,
eie
"At the saws 61114 that Etia.id works are pre,—
of
the. damp and may saiface in front sad at tare back
houses sleouid I',a removal by paving. There are ini nro-
3tances
to which this siossle improeement has apparent
tooted the inhabitants of taarts and streets from the re-
=Fence ,of ordinary epidemics. A flagged surface fur-
ther affords the means of more effectual cleansing by the
. hose and jet. Paving may be done in many instances
without waiting for the completion ,of drainage works,
and, where the principle has been adopted of draining from
the backs of houses, instead of through them into sewers
it.the front streets, there will be comparatively few in-
stances in which it will be necessary, on the completion of
the works, to break up the pavements, in order to put
in house drains.
" The board regard with satiefaetioa the progress made
bz some local boards, in spite of much opposition and mis-
representation, in carrying, into effect in their respective
towns s combined and OaraPl3t3iYetira of sanitary works at