t Vuhtit 313ralt.

The following official notification of the presence of epidemic cholera in England appeared in the Gazette of Tuesday.

"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 first breaking out in Per- sia, 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, Norway, and Sweden and then developing itself in the North of Germany, it has attacked Stettin, Berlin, Rotterdam and Hamburg ; and subsequently it has appeared in England, again break- ing 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 widespread course it has everywhere overleaped 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, Gates- head, and Hexham is decisive, that where the conditions are favourable to its localization and development' as is the ease 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 middle 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 effect- ing a larger amount of improvement in our cities and towns. From such inspections as the General Board have recently been enabled to make of the state of populous districts, the former seats of the disease, in apprehension of its reappearance, 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 sca- venging, and a more active removal of nuisances in epidemic localities, have been accomplished. Combined and permanent works, involving elaborate engineering measures, capable of remedying the neglect of years, can- not 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 im rovements, 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 oc- curred in any one of the model dwellings for the poor, occupied by similar classes of the population' though the pestilence raged in the districts in which those 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 improvement has been effected, and in which works under the Public Kealth Act are most advanced, much remains to be done, and may be done. Local boards of health are in- vested 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 preventing the occu- pation of cellars as dwelling-houses unless under certain conditions, for pre- venting 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 pro- perly and effectually whitewashed, cleansed, and purified, and for admmis- tering the Common Lodginghouses 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 extraordinary care. In removing accumulations of filth, precau- tions should be taken for disinfection and for preventing the increase of nos-

boas evaporation. The contents of foul drains, sewers, and ditches, should in no caae be spread upon the surface, and nolarge 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 lodginghouses but in tenements of all descriptions occupied by the poorer classes, especially by the Irish—an evil preventable, and to a considerable extent removeable- should be at once and by all practicable means reduced. "Wherever local boards of health exist, they should in all cases cooperate with the boards of guardians; and it is believed that the boards of guardians will, on their part, cooperate with local boards. The existing means for the extraordinary service now required are divided amongst independent local jurisdictions; medical officers 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 enforcement of orders required for the public service being with the ma- „aistrates or municipal authorities. It is confidently expected that a common feeling will give precedence to the branch of service specially needed on this occasion, and insure that unity of action which it is the main object of the rules and regulations issued herewith to authorize and promote, for the com- mon object. "Experience has shown that in the case of the actual outbreak of the epi- demic, 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 infected population under prompt and proper treatment during the pre- monitory stage of the disease. During the epidemic of 1849 an organization for effecting 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 gratuitous 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 temporary 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 un- der its operation, no fewer than 6000 of which were on the point of passing into the developed stage, only 250 went into the collapsed stage of claolera, or one in 520. But of the 43,737 cases under visitation in the Metropolis, including 978 cams on the point of passing into the collapsed stage of cholera, only 52 actually did so—not one in 800; so that taking together the general result of this extended experience, it appears that the proportion of eases un- der early treatment which passed from the 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 I 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 suddenly ' 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 neces- sity 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 indi- vidual 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 sleeping 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 essential precaution is, not to neglect for a single hour any degree of looseness of bowels. This symptom being com- monly 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 re- quired, 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 attention to this symptom.

"Thus, one physician says, He has never yet seen a case without pre- monitory 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 diarrhcea for twenty-four or even forty-eight hours, or longer' ; another declares, 'In all cases of collapse investigated, it is found there had been neglected diarrhcea.' Even inthe 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 gradual result of diarrhcea neglected for several hours, and sometimes entire days. It must, then, be repeated,. that In any district in which cholera is epidemic, life may depend 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 abso- lutely essential to safety during the whole duration of the epidemic period : an act of indiscretion has been often followed by a severe attack ; intemper- ance at such a time is fraught with the most extreme danger. During the epidemic of 1849, sudden and fatal attacks of the disease followed immediately en 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 predisposing oause 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 Hamburg, it has been found that incautious exposure to cold and damp has brought on an attack as rapidly as improper food or excess. This precaution 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 undrained and low-lying districts; placing in many instances the land contiguous to towns, and beyond the usual range of town drainage, almost in the condition of marshes. The ex- halations arising from a surface thus saturated often with water, holding decomposing matter in solution, spread to the towns and affect the inhabi- tants, however well drained the immediate sites of the towns may be. The General Board were so apprehensive that disease would be extensively pro- duced by this unusual and dangerous state of a large portion of the country, (tta apprehension which was subsequently realized by the breaking out of disease, allied in character to cholera, in sixty towns,) that in their notifica- tion issued in December 1852, they represented to local authorities that this calamity afforded a special occasion for administering extraordinary assist- ance to the poor, to enable them to keep large fires in their rooms, to pro- tect themselves from cold an.d damp by warm clothing, to sustain their strength by a solid and nutritive diet, and to counteract the predisposition to disease induced under these peculiar circumstances, by suitable tonics and other remedies, under medical direction. This representation was made when there was a threatening of the return of cholera ; it is now amongst us, and the General Board would remind the affluent, that the op- portune supply to their poorer neighbours and dependents of wholesome food, warm clothing, and bedding, and even such remedies (to be always in readi- ness) as their medical attendant may recommend for looseness of bowels, is charity in the truest sense, and may be the means of saving many lives. It is also much to be desired, and the General Board would strongly recom- mend, that the higher classes should coOperate with the clergy, who have done so much to promote the object of the Legislature under the Public Health Act, in making frequent visits among the poor, and impressing upon them the importance of following the instructions here laid down, with re- ference to which there is a perfect accordance between the College of Physi- cians and the General Board of Health.

"In conclusion, after the large experience of this disease which has been obtained since the General Board of Health issued their first notification, (1848,) they can now repeat with greater confidence what they then urged, that, formidable as this malady is in its intense form and developed stage, there is no disease against which it is in our power to take such effectual precaution, both as collective communities and private individuals, by at- tention to it in its first or premonitory stage, and by the removal of those agencies which are known to propagate the spread of all epidemic diseases, or where that may be impracticable by removal from them. Though, there- fore, the issues of events are not in our hands, there is ground for hope, and even confidence, in the sustained and resolute employment of the means of protection which experience and science have now placed within our reach. "By order of the General Board of Health,

"Cnanaes MACAULAY, Secretary.” The General Board of Health has also issued special directions and re- gulations for the use of local bodies, officials, and the public in general. The document has been written in the circuitous official style ; but its purport is briefly what follows.

Union and parish guardians are to make out, from medical and other in- formation, lists of places where diseases lately precai led, or at present pre- vail; and then to direct the medical officer to examine the health of the people in these places. The guardians are also to superintend the cleansing of public ways and places; to cleanse them themselves, if the proper author- ities fail ; to direct individuals to cleanse particular nuisances near their respective dwellings ; to visit dwellings in parishes or unions, where them is no " governing body" ; to remove nuisances themselves, where the owners are too poor to do it or to do it quickly ; to provide medical visitation, from house to house, wherever an epidemic is present or imminent ; to provide hospitals for poor sick people ; to provide general medical superintendence for sanitary action ; to print handbills publishing the official and other useful instructions; and to supply the Board of Health with a daily list of persons attacked by any epidemic disease, with particulars of their cases and treat- ment.

All local bodies having the care of public ways or places are to see to the " continued cleansing" of such ways and places as the medical officers re- port in a state dangerous to health.

The medical officer of each district or union is instructed to visit the unhealthy places reported by the guardians, and examine the houses, with a sanitary view ; to inquire into the health of people in workshops, common lodginghouses, and schools, and to treat, by himself or others, all cases of diarrhoea in those places; to report to the guardians all nuisances ; to report at once any unusual amount of diarrhoaa, and any case of epidemic or con- tagious disease ; to order the separation of the inmates or other necessary measure in schools, workhouses, or lodginghouses, where any disease breaks out ; to cause the removal of patients from crowded rooms ' • and to speedily remove from the rooms of the living, corpses of persons who died from con- tagious or epidemic disease. All medical men are directed to report cases of death from epidemic or contagious disease to the medical officer of the district.

The instructions for the general public are simple. Occupiers of houses shall, when directed by the guardians or medical officers, continuously cleanse the places adjoining their houses, and remove nuisances. Any person pre- sent at a death from epidemic disease, not attended by a medical man, 113 to notify the same to the medical officer of the district. The above directions relating to nuisances equally apply to "any matter injurious to the health of any person." In the washing of streets, persons are directed to use fluids or substances for preventing the escape of noxious effluvia during the operation.

Lord Shaftesbury, who has been travelling on the Continent for the benefit of his health, is returning to London to take his place at the Ge- neral Board of Health. Mr. Grainger, Superintending Inspector, who has been visiting Newcastle, has returned to town to confer with the Ge- neral Board.

A case of endemic cholera has occurred in Marylebone. Owen Cronin, a youth of seventeen, was taken ill on Monday night ; the doctor saw him on Tuesday, and gave him some medicine ; but he died on Wednes- day morning. The court in which he lived (York Court, East Street, Manchester Square) is a nest of miserable habitations let out as lodging- houses to a swarm of people. In Cronin's house nine persons lived in one small room; and there is no yard to the hovel. A Coroner's Jury found, "That the deceased died of endemic cholera, caused by the foul air and accumulation of filth in York Court." A case of Asiatic cho- lera has occurred in White Street, Moore Lane, a crowded part of the City. A young woman was seized on Tuesday, and notwithstanding immediate medical aid, she died on Thursday morning.

Around Rosemary Lane, in the City, the accumulation of dirt and de- composing vegetable matter in the public dust-bins has caused several cases of fever—no fewer than 90 in one spot. Sometimes five or six weeks elapse before the dust-bins are cleared : the dustmen employed by the contractors who have engaged to clear the bins neglect their duties, and in many cases are impudent in demanding fees. Mr. lladlow, medical offi- cer of one of the City unions, brought the matter on Tuesday before the City Commissioners of Sewers ; and instructions to remove the nuisances were given to the Inspectors.

Two cases of cholera have occurred on board the Dreadnought hospital- ship, moored off Greenwich. One severe case occurred at Woolwich ; but the person attacked recovered. [These three cases are reported in the daily papers, but it is not said whether the cholera is Asiatic or not.]

One singular case of Asiatic cholera has occurred at Manchester. A. woman was taken ill at four o'clock on Tuesday afternoon, and died at half-past nine the next morning. The peculiarities are, that there was no diarrhrea, and nothing but dry retching of a very violent character. The woman lived in a low and dirty part of the town.

The Manchester Town-Council is active in repairing bad drains. It has abated the nuisance arising from chemical works in Redbank, Bes- wick, Union Bridge, and other thickly-peopled neighbourhoods.

The deaths at Newcastle from cholera for the last six days have averaged 94 daily. The total of deaths in the town up to the present date has been 995. During the same number of days in 1831-'2 the deaths were only 161.

The general state of Newcastle has been very dirty, but a place called Sandgate has been the worst in the town ; the inhabitants being crowded together without regard either to decency or cleanliness. The London Board of Health peremptorily advised the immediate removal of the population—about four thousand in all. Some have been removed, and are now lodged healthily in tents, lent by the Board of Ordnance : some have dispersed themselves over the better part of the town ; while the cholera has fiercely broken out among the people still living in the place. Two of the most over-crowded churchyards in the town were closed on Saturday, and three others are to be closed. The upper and middle classes seem to suffer from the disease as much as the lower classes.

The accounts of the mortality in Gateshead are incomplete, but the virulence of the epidemic seems to be declining : on Saturday last the deaths were 30, but on Wednesday they were only 12. The fatal results for the last fifteen days, compared with the mortality in 1831-'2, are 259 to 129.

At Hexham, during the last five days, deaths from cholera have oc- curred, making 11 since the first appearance of the disease.

Three fatal cases have occurred in Durham.

In South Shields, five deaths from cholera have occurred this week. In four of the cases the persons attacked lived in unwholesome houses. The sanitary measures are actively carried on. "The lower parts of the town are being swept with some thousands of tons of salt-water daily, and ancient nuisances and stenches which have held their ground for the past quarter of a century have been swept into the sea. The seamen on board the shipping in the Tyne are in a pretty healthy condition."

There is a considerable amount of diarrhcea in North Shields, but, as yet, no cholera. North Shields is within twenty minutes' run of New- castle by rail, and an immense number of persons pass between the towns during the course of each day.

In Edinburgh, on Friday, a case occurred "presenting all the appear- ance of Asiatic cholera." The Commissioners of Police and the Resident Commissioners in each -ward are active in sanitary precautions.

Official precautions against the cholera have been taken. The act 11th and 12th Victoria, "for the removal of nuisances, and prevention of con- tagious, endemic, and epidemic diseases," has been ordered to be put in force throughout Ireland immediately, and for the next six months.

In Belfast, one case of Asiatic cholera. The patient, a little girl of fifteen, is going on favourably.