MEASURES REQUIRED FOR THE PREVENTION OF CHOLERA.
3rd. Care should be taken that the water employed for drinking and preparing food (whether it come from a pump-well, or be conveyed in pipes) is not contaminated with the contents of cesspools, house-drains, or sewers;or, in the event that water free from suspicion cannot be obtained, it should be well boiled, and, if possible, also filtered.
Works are in progress for supplying a great part of London with water from the Thames, obtained, like that of the Lambeth Company, above Teddington Lock. Although this is not the best possible source for supplying a large town, it is a great improvement on the practice of many of the water companies; and the water, owing to filtration, and especially to its detention in large reservoirs, will probably be quite salubrious: at all events it will be much safer than that of the shallow pump-wells of London, which are fed from very polluted sources. It is very desirable that the handles of nearly all the street-pumps of London and other large towns should be fastened up, and the water used only for such purposes as watering the streets. A proper supply of water for the shipping in the Thames is much wanted. Water acquires a flat taste by being boiled; but if it is filtered after it becomes cold, it gets re-aerated, and the flat or vapid taste is entirely removed.
4th. When cholera prevails very much in the neighbourhood, all the provisions which are brought into the house should be well washed with clean water, and exposed to a temperature of 212° Fahr.; or at least they should undergo one of these processes, and be purified either by water or by fire. By being careful to wash the hands, and taking due precautions with regard to food, I consider that a person may spend his time amongst cholera patients without exposing himself to any danger.
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 mostopulent 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 companiesfor 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.