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

THE CHOLERA

GENERAL BOARD OF HEALTH—NOTIFICATION.
General Board of Health, Whitehall,
September 20, 1853.
It is the painful duty of the General Board of Health
to notify a third visitation of epidemic cholera. This
disease, again breaking out in Persia, has extended
within the present year over a large portion of Russia,
stretching as far northwards as Archangel, on the shores
of the Arctic Ocean. It has ravaged Denmark, Nor-
way, and Sweden, and then developing itself in the
north of Germany, it has attacked Stettin, Berlin, Rot-
terdam, and Hamburg ; and subsequently it has ap-
peared 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 has every where over-
leaped the barriers which quarantine has erected to stay
its progress ; and where this means of protection has
been most rigidly enforced, it has not only disappointed
the expectation of those who have relied upon it as a
safeguard, often to the neglect and exclusion of the most
important precautions, but has aggravated the evils of
the pestilence, and added disastrous consequences of its
own.

The experience already obtained of this pestilence at
Newcastle, Gateshead, and Hexham is decisive, that
where the conditions are favourable to its localisation
and development, as is the case in these towns, the
disease has lost nothing of its former virulence. In ; the
two former, indeed, the severity of the disease, as far as
it has yet extended, has greatly exceeded that of any
former visitation, and it has attacked in all those places,
as it has abroad, a much larger proportion of the mid-
dle and higher classes.
It is deeply to be lamented that the interval between
the last visitation of this pestilence and the present has
not been generally employed in effecting a larger amount
as improvements in our cities and towns. From such
inspections as the General Board have recently been
enabled to make of the populous districts, the former
seats of the disease, in approhension of its re-appearance,
they are compelled to state that there are extensive dis-
tricts, and even entire towns, in which no perceptible
improvement of any kind has been effected. On the
other hand, there are instances in which, even where no
general permanent works of improvement have been
effected, better supplies of water, extensive flagging and
paving, more frequent scavenging, and a more active
removal of nuisances in epidemic localities, have been
accomplished. Combined and permanent works, involv-
ing elaborate engineering measures, capable of remedy-
ing the neglect of years, cannot be 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
cases of cholera have occurred in the improved parts of
the town ; and during the whole of the epidemic in the
metropolis in 1849, not a single case of cholera occurred
in any one of the model dwellings for the poor, occupied
by similar classes of the population, though the pesti-
lence raged in the districts in which these buildings are
situated, and there were instances of two and even four
deaths in single houses close to their walls.
Even in towns in which the greatest amount of im-
provement 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 invested under the Public Health Act with ample
powers for cleansing, for the removal of nuisances, for
preventing the carrying on of unwholesome or noxious
trades in such a manner as to injure health, for prevent-
ing the occupation of cellars as dwelling-houses unless
under certain conditions, for preventing 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 as to endanger the health of any
person, until such house shall have been properly and
effectually whitewashed, cleansed and purified, and for
administering the Common Lodging Houses Act, the
provisions of which are most important. All those
powers should be exercised at the present juncture with
extraordinary 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 extra-
ordinary care. In removing accumulations of filth pre-
cautions should be taken for disinfection and for prevent-
ing the increase of noxious evaporation. 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 removed, 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 descrip-
tions occupied by the poorer classes, especially by the
Irish, an 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 guardians, 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 of
in England and Wales 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 enforce-
ment of orders required for the public service being with
the magistrates or municipal authorities. It is col:15-
r dently expected that a common feeling will give prece-
dence to the branch of service specially needed on this
occasion, and ensure that unity of action which it is the
main object of the rules and regulations issued herewith
to authorise and promote for the common object.
Experience has shown that in the case of the actual
outbreak of the epidemic, the chief measures to be relied
on for checking its spread are those which prevent over-
crowding, remove persons from affected houses, and
bring the affected population under prompt and proper
treatment during the premonitory stage of the disease.
During the epidemic of 1849 an organisation for affect-
ing 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 gra-
tuitous supply of medicines, the establishment of houses
of refuge for the reception of such indigent persons as
appeared to be in imminent danger, resident in the most
filthy and overcrowded houses, the provision of tempo-
rary 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
most susceptible and destitute classes to a distance
from infected localities. The result of this system
was, that out of 130,000 premonitory cases brought
under its operation, no fewer than 6,000 of which were
on the point of passing into the developed stage, only
250 went into the collapsed stage of cholera, or
one in 520. But of the 43,737 cases under visitation in
the metropolis, including 978 cases on the point of
passing into the collapsed stage of cholera, only 52
actually did so—not I in 800 ; so that taking together
the general result of this extended experience, it appears
that the proportion of cases under early treatment which
passed frOulthie 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 first appearance of this disease in an
epidemic form ; and, as none can tell where or how sud-
denly the pestilence may alight, it is the duty of local
authorities to be prepared for the emergency before its
arrival. Preparation 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 the disease
which each individual may take for himself, or the heads
of families or establishments for those under their charge,
the first in importance are personal and household
cleanliness, and the freest ventilation of living and sleep-
ing rooms with pure air; the purity of the air we breathe
being even more 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 essen-
tial precaution is not to neglect for a single hour any
degree of looseness of bowels. This symptom being
commonly without 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 diarrhcea is
all but universal, and that life depends on instant atten-
tion to this symptom.
Thus, one physician says, "He has never yet seen a case
without premonitory symptoms ;" another states, " He
has found in a great number of instances where the men
said they had been first seized with collapse, there had
been neglected diarrhoea for 24 or even 48 hours, or
longer !' another declares, "In all cases of co llaps!;in-
vestigated, it is found there had been neglected
diarr-
hoea." Even in the cases in which death takes place
with the greatest rapidity, the suddenness is apparent
only, not real ; for the fatal collapse is the final but gra-
dual result of diarrhoea neglected for several hours, and
sometimes entire days. It must, then, be repeated, that
in any district in which cholera is epidemic, life may de-
pend on obtaining prompt and proper relief for painless
and apparently trifling looseness of the bowels.
The measure of precaution next in importance relates
to the proper regulation of the diet. Great moderation,
both of food and drink, is absolutely essential to safety
during the whole duration of the epidemic period ; an
act of indiscretion has been often followed by a severe
attack ; intemperance at such a time is traught with the
most extreme danger. During the epidemic of 1849,
sudden and fatal attacks of the disease followed imme-
diately on the indulgence of habits of drinking after the
receipt of weekly wages. The intervals between the
meals should not be long ; cholera being uniformly found
to prevail with extraordinary intensity among the classes
that observe the protracted fasts common in Eastern and
some European countries.
The utmost practicable care should be taken against
fatigue, which is a very powerful predispos;ng cause of
the disease. Employers and persons engaged in laborious
occupations should endeavour as far as possible so to ar-
range the amount and time of work as to avoid physical
exhaustion.

Warm clothing is of great importance. During the
present epidemic in Hamburgh, it has been found that
incautious exposure to cold and damp has brought on an
attack as rapidly as improper food or excess. This pre-
caution against damp is rendered doubly important by the
peculiarity of the present season Long-continued and
excessive rains have in many places surcharged the
ground with moisture, especially unit-stilled tad-low-