Part 14

5th. When a case of cholera or other communicable disease appears among persons living in a crowded room, the healthy should be removed to another apartment, where it is practicable, leaving only those who are useful to wait on the sick.

6th. As it would be impossible to clean out coal-pits, and establish privies and lavatories in them, or even to provide the means of eating a meal with anything like common decency, the time of working should be divided into periods of four hours instead of eight, so that the pitmen might go home to their meals, and be prevented from taking food into the mines.

7th. The communicability of cholera ought not to be disguised from the people, under the idea that the knowledge of it would cause a panic, or occasion the sick to be deserted.

British people would not desert their friends or relatives in illness, though they should incur danger by attending to them; but the truth is, that to look on cholera as a “catching” disease, which one may avoid by a few simple precautions, is a much less discouraging doctrine than that which supposes it to depend on some mysterious state of the atmosphere in which we are all of us immersed and obliged to breathe.

The measures which can be taken beforehand to provide against cholera and other epidemic diseases, which are communicated in a similar way, are—

8th. To effect good and perfect drainage.

9th. To provide an ample supply of water quite free from contamination with the contents of sewers, cesspools, and house-drains, or the refuse of people who navigate the rivers.

10th. To provide model lodging-houses for the vagrant class, and sufficient house room for the poor generally.

The great benefit of the model lodging-houses arises from the circumstance that the apartments for cooking, eating, and sleeping, are distinct, and that all the proper offices which cleanliness and decency require are provided. The very poor who choose to avail themselves of these institutions, suffer a rate of mortality as low as that of the most opulent classes. The public washhouses, which enable poor persons to wash the soiled linen of the sick or the healthy, without doing it in the midst of the plates and dishes and provisions of the family, are well calculated to prevent the spread of disease.

11th. To inculcate habits of personal and domestic cleanliness among the people everywhere.

12th. Some attention should undoubtedly be directed to persons, and especially ships, arriving from infected places, in order to segregate the sick from the healthy. In the instance of cholera, the supervision would generally not require to be of long duration.

In the autumn of 1853, certain German emigrants, on their way to America, who had crossed the sea from Hamburgh and Rotterdam, where cholera was prevailing, to the port of Hull, and had gone thence, by rail, to Liverpool, were seized with cholera (some of them fatally) in the latter town; and it is most likely to the well-regulated Emigrant’s Home, in which these cases occurred, that the town of Liverpool owed its freedom from the epidemic at that time. And a little medical supervision, and the detention of some of the emigrants for a short time in Liverpool, before their embarcation, would probably have prevented the great mortality which occurred in some of the emigrant ships during their passage to America.

The measures which are intended to prevent disease should be founded on a correct knowledge of its causes. For want of this knowledge, the efforts which have been made to oppose cholera have often had a contrary effect. In 1849, for instance, the sewers of London were frequently flushed with water,—a measure which was calculated to increase the disease in two ways: first, by driving the cholera evacuations into the river before there was time for the poison to be rendered inert by decomposition; and second, by making increased calls on the various companies for water to flush the sewers with,—so that the water which they sent to their customers remained for a shorter time in the reservoirs before being distributed. It should be remarked, also, that the contents of the sewers were driven into the Thames by the flushing, at low water, and remained flowing up the stream for four or five hours afterwards. Flushing the sewers was not repeated during the recent epidemic, but increased quantities of water were distributed by some of the Companies, and at more frequent intervals, causing the water-butts to overflow for hours together into the drains, and producing nearly the same effect as flushing the sewers; in addition to which, the water in the butts of the Southwark and Vauxhall Company’s customers was prevented from settling, as it might have done if less frequently disturbed.

I feel confident, however, that by attending to the above-mentioned precautions, which I consider to be based on a correct knowledge of the cause of cholera, this disease may be rendered extremely rare, if indeed it may not be altogether banished from civilized countries. And the diminution of mortality ought not to stop with cholera. The deaths registered under the name of typhus consist chiefly of the typhoid fever mentioned above. Its victims are composed chiefly of persons of adult age, who are taken away from their families and connections. In 1847 upwards of 20,000 deaths were registered in England from typhus, and in 1848 upwards of 30,000 deaths. It is probable that seven times as many deaths have taken place from typhus as from cholera, since the latter disease first visited England in 1831; and there is great reason to hope that this mortality may in future be prevented by proper precautions, resulting from a correct knowledge of the mode of communication of the malady.

APPENDIX,

Containing the number of deaths from cholera registered in the four weeks ending 5th August, 1854, together with the supply of water in the houses in which the fatal attacks took place, in all the sub-districts to which the water supply of either the Southwark and Vauxhall or the Lambeth Company extends. (See Table VII, page 84.) The registers of deaths are copied from the Weekly Returns of the Registrar-General.

ST. SAVIOUR, SOUTHWARK. Christchurch.

At 34, Charlotte Street, on 29th July, a stock-maker, aged 29, “Asiatic cholera 18 hours”

Lambeth.

At 45, Gravel Lane, on 1st August, the widow of a farmer, aged 48, “cholera 12 hours”

Southwark & Vauxhall.

At 1, Alpha Place, on 1st August, a barrister’s clerk, aged 57, “cholera 24 hours”

Southwark and Vauxhall.

ST. SAVIOUR, SOUTHWARK. St. Saviour.

At 1, Park Street, on 25th July, the wife of a labourer, aged 35, “Asiatic cholera 14¹⁄₂ hours”

Southwark & Vauxhall.

At 40, Bankside, on 25th July, the son of a locksmith, aged 5 years, “cholera 12 hours”

Southwark and Vauxhall.