THE PUBLIC HEALTH.
The Gazette of Tuesday contained a "Notification" by the General Board of Health, on the subject of the cholera. It is dated Whitehall, April 17, and bears the signature of Mr. Tom Taylor, the Secretary of the Board. At the outset, Boards of Guardians, Local Boards of Health, Parochial Boards, and other local authorities, are warned "against placing a false security in the present apparent disappearance of epidemic cholera." It has been found that the attack in 1831 was the precursor of a more severe attack in 1832 ; that in 1848, when about 1000 persons died in London, the epidemic almost disappeared in the following spring, to return with redoubled violence in the autumn, carrying off 17,000 persons. Last year, the epidemic exceeded in virulence that of 1848 ; destroyed during the first months of its course nearly double the number of victims, and has been followed by a lull more complete than that in the spring of 1849.
"But within the last month, the disease has again become more active, and a gradual increase has taken place in the number of deaths ; raising, for this month, the total deaths in England and Scotland to twice the amount of the corresponding period of 1849. The analogy of the preceding visita- tions, therefore, justifies the apprehension that the disease, instead of having ceased, is in its period of incubation, and that the epidemic, in its decided form and full force, is yet to come." It is remarked that the disease now seizes its victims and hurries them more rapidly through its fatal course than it did formerly; that the pre- monitory stage of diarrhcea, heretofore well marked, is now generally much shorter in duration, and passes more directly into cholera ; and that from 1831 to 1853 the proportion of the better class attacked and carried off has continually increased. In 1849, 81 per cent of those who died in the Metropolis were labourers and artisans, and 15 per cent trades- men ; but recently the proportion of the former has been 72 per cent, of the latter 24 per cent. In the same manner, the proportion of the deaths of the gentry and professional classes has risen from 2.6 per eent in 1849 to 3.2 per cent. As a further indication of the increasing activity of the disease, it is shown that while the interval between the that and second visitations was sixteen years, the interval between the second and third has only been four years.
Attention is drawn to the pecuniary loss occasioned by cholera, as well As lees of life ; and it is estimated that the total cost of the visitation in 1848 and 1849, to England and Scotland alone, was not less than 2,000,0001. While some local authorities are on the alert to carry into effect every practicable means of prevention, others continue to manifest reluctance, to disregard the premonitory symptoms, to suppress all knowledge of them, and thus to necessitate hasty and imperfect measures when the epidemic breaks out in full force. Not only is this the case as regards medical arrangements, but the neglect of timely cleansing operations causes them to be performed hurriedly, so as in many cases to produce an aggravation of the disease.
During the prevalence of an epidemic, the ordinary mortality is swelled far above the average ; and there is no reasonable ground to hope that a loss of life will not take place this year, similar to that which occurred during previous visitations of the cholera, if not greater.
Having remarked that in the actual condition of great numbers of places in all our towns, it is only palliatives that can be applied, the Board proceed to point out what can be done.
" 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 im- portance of hastening on the completion of such operations as are necessary for the abolition of cesspools, and the substitution of the water-closet appara- tus; by laying down wherever possible, especially in epidemic districts and localities, impermeable and self-cleansing house-drains, and by providing ample supplies of water. Hitherto, almost exclusive attention has been given to the construction of main sewers : but experience has shown that these alone, without systematized connexion with self-cleansing house- drains and ample supplies of water, are of little avail in the prevention of disease ; but that where foul cesspools have been the principal sanitary evil, as from house to house these have been filled up, and the water-closet sub- stituted, the outbreak and spread of fever and other forms of zymotic dis- ease have been at once arrested.
" At the same time that these works are proceeded with, the damp and miry surface in front and at the back of houses should be removed by paving. There are instances in which this single improvement has appa- rently protected the inhabitants of courts and streets from the recurrence of ordinary epidemics. A flagged surface further affords the means of more effectual cleansing by the hose and jet. Paving may be done in many in- stances 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 in the front streets, there will be comparatively few instances in which it will be necessary, on the completion of the works, i to break up the pavements in order to put in house-drains.
" The Board regard with satisfaction the progress made by some local boards, in spite of much opposition and misrepresentation, in carrying into effect in their respective towns a combined and complete system of sad works at moderate cost. Out of 182 cities and towns, comprising upwar of 2,000,000 of town population under the Public Health Act, 126 have had surveys made, the first step for effecting improved works. In 70 towns plans for such works have been laid out, and in 13 more the main or public works have been completed. It is expected that in about 35 other towns similar works will be in operation in the course of another year. " The act itself, constituting the necessary authority and conferring the requisite powers for carrying eat these works, has been obtained at the ave- rage expense of 1121.; that is, a little more than a twelfth part of the ave- rage expense of a local act. In the towns in which the works are the most advanced, and which may be taken as average examples of the whole, the public works of drainage have been completed at the average cost of ld. per week per house. "The supply of water, including the works within the house, the service- pipes, sinks, water-closet, and house-drains, has been afforded, with principal and interest, at a rate under 2fd. per week per house ; making the total ex- pense for the whole of these works 31d. per week per house.
" Sanctions for the execution of such works, after careful examination of their efficiency, economy, and completeness, have been given to the amount
of upwards of 1,000,000/. ; and it is estimated that there will be required for the towns already under the act the further sanction of upwards of 6,000,0001." Already the amount of sickness in these places has been diminished, although the works are not complete. But no works can prevent the operations of the causes of disease in cellars, under-ground kitchens, filthy and over-crowded habitations, where entire families live in one room, and where there is a total and habitual disregard both of cleanliness and breathing-space. Under such circumstances, pestilence will break out, and all that can be done will be to mitigate it by well-directed measures of cleansing, and especially by house-to-house visitations. It is shown that, in consequence of energetic cleansing in the recent cases of Tyne- mouth and the Barracks at Newcastle, no case of cholera occurred ; and that in the Bahamas the mortality scarcely reached one per cent, while Bermuda, uncleansed, was devastated.
The Registrar-General records the fact that there were two deaths from cholera last week in the Metropolis : a significant pendant to the notifi- cation of the Board of Health.
Previous page
