Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Report of the General Board of Health on the epidemic cholera of 1848 & 1849in 2015
5
MAP
I. A
7. F R 1 C
P L
R O
ir B 1 A\
E P E N D
/2<
18/iS
/ C H 1 N A
—A
1848 & 1849.
Presented to both Houses of Parliament by Command of Her Majesty,
LONDON: PRINTED BY W. CLOWES & SONS, STAMFORD STREET,
FOR HER majesty's STATIONERY OFFICE.
1850.
ACCN. j
SOiJRCC j
DATh j
LIST OF MAPS, DIAGRAMS, AND TABLES.
Map of the Progress of Cholera from Hindostan to Great Britain, to face Title-page of
Report.
^iagram of comparison of Mortality, from all causes and from Cholera, in the Metro-
y- polis, to face page 26 of Report.
Plan of Glasgow, to face Title-page of Appendix A.
Plate 1, to face page 46 of Report.
Plate 6, to face page 55 of Appendix A.
Plate 7, to face page 56 of Appendix A.
Plate 8, to face page 103 of Report.
Plates 9 and 10, to face page 80 of Appendix A.
Plates 11, 12, and 13, to face page 104 of Report.
Plate 14, to face page 119 of Appendix A.
Plan of Hamburg, to face Title of Appendix B.
Cholera Map of the Metropolis .
Sections of ditto .... Plan of the parish of St. Leonard, Shoreditch
Map of the parish of Bethnal-green
Table A. Cost of Widowhood and Orphanage in 12 Unions, p. 151.
Table B. Progress of Epidemic Cholera in Great Britain, p. 152.
Table 1. Return of Deaths from Cholera in 60 weeks in the Metropolis, to be placed
at the end of Appendix B.
Tables 2 and 3. Analysis of Deaths from Cholera, to be placed at the end of the
Report.
CONTENTS.
Extensive experience of the Epidemic 2
Progress of the Epidemic in India ....... 3
Extension of the Epidemic to Persia ....... 4
Progress through Asiatic Turkey and Georgia . . . . • 5
Arrival at Moscow 6
Outbreak in Egypt 7
Warnings given of its approach, preceded by general prevalence of >
^ Diarrhoea
Comparative severity of the Epidemic . . . . ... 11
Progress of the Epidemic in the Metropolis, and unwillingness to acknow-l
ledge the presence of the Disease ...... i ' .„,j,
History of early Cases in the Metropolis ...... 14
, , , , in other Towns ....... 15-17
Warning addressed to Local Authorities 19
Haunts of Fever and Cholera the same—instances from Superintending \
Inspector's Reports ) "
Prevalence near the Banks of the Thames , j 24
Comparative Mortality in North and South Disti-icts .... 25
Atmospheric Changes in London........ 26
, , , , at Kurrachee 27
Influence of Heat and Moisture.—Influence of the Atmosphere . . 28, 29
Attacks not confined to the weak and sickly. Disease not confined to the\
Poor / ^^^^
Localizing Causes.—Overcrowding 36-39
Filth—Artificial Manure . 40-42
Poisonous EfiEluvia wafted to a distance 44
Town Refuse 45
Experience of Prison at Brest . . . . . . . .46 Malaria from Putrescent Mud, Foul Canals and Ditches .... 47-49
Dampness.—Dampness of Houses on hill sides 50, 51
Injurious effects of polluted Drainage 52
iv CONTENTS.
' Page Predisposing effects of Dampness "»....«. 53 Higher flats ofHouses the most unhealthy 54 Want of Drains.—Drains unskilfully constructed 55, 56
Emanations from Foul Sexrers 57
Graveyards 58
Food.—Effects of improper Articles of Food • . . • • 63, 64
Effects of Intemperance .•....,•.65 Fatigue ............66 Exemptions from attack, Metropolitan Buildings and others . . . 67-69
Ships, Prisons, Lunatic Asylums 70-72
Benefit from minor Improvements.—From removal of Nuisances . . 73-75
Excessive Mortality followed by excess of Births . • . . • 76
Eesults of Inquiry at Bristol and other places . . • • • . 77, 78
Eesponsibility of Local Authorities. . . < • i/ • • 79
Neglect of Preventive Measures in the Metropolis 80,81
, , , , in Provincial Towns • . • , 82, 83
External and Internal Cleansing 84, 85
Lime-washing . . . . . . . . • . . 86, 87
House-to-House Visitation .88 Premonitory Diarrhoea in Towns in England and Scotland ... 89
Unity of the Disease in all its Stages 90
Proofs that Diarrhoea is premonitory of Cholera 91, 92
Transition of Diarrhoea into Fever ....... 93
Comparative Mortality of different Stages of Diarrhoea . . • • 94
Neglect of Premonitory Diarrhoea by the Poor in the Metropolis . .95-97
Apathy produced by Epidemic Influence 98-100
Kesults of House-to-House Visitation 101, 102
, , in Dumfries and other Scotch Towns 103, 104
^ , , in Manchester 105
, , Sheffield 107, 108
the Metropolis . . . . • . 109,110
Kesults of Visitation System in Shoreditch, and Western Districts . 114,115
General Kesults of Visitation ....... 116-119
Extent of Relief 120
Gratitude of the Poor in the Metropolis and other Towns . . .121 Testimony of Superintending Inspectors 122,123
Houses of Kefuge ....••>... 124
,, ,, to Tents 128
Cholera Hospitals 129-131
Expense of Epidemics . . • • • • • . .136 Objects of Diseases Prevention Act 137
Obstacles to Administration of Act 138
Administration of Act by Guardians of the Poor . . ... 139-141
JZeal and Devotion of Medical Officers . . • • .s.
• • .142 General Conclusions . . ^ 143-149
Districts under Inspection 2
Signs of an Epidemic Constitution . 4
Epidemics haunt the same localities ....... 5
Marks of developed Cholera 6
Localizing Causes of Cholera 7
Illustrations of localizing Causes of Cholera—Errors of Diet . . . 8, 9
Fatal results of overcrowding and defective Ventilation . . . . 10, 11
Cholera in Taunton Union Workhouse 12, 13
Predisposing effects of bad Water Supply 14, 15
Fatal effects of Emanations from Town Eefuse 16,17
Predisposing effects of Dampness 18-20
Sanitary evils from defective Structure of large Tenements ... 21
Greater liability of top flats to Cholera 22
Outbreak of Cholera in Eedcross-street, Bristol . . . . . 23, 24
Fatal results of defective Sanitary improvements . . . . . 25, 26
Effects of overcrowded^Grave-yards . 27-29
Effects of Malaria in producing attacks of Cholera • . • • . 30, 31
Fatal effects of intemperate habits during Epidemics .... 32
Fatal effects of fatigue ......... 33 Abstract of localizing causes of Cholera . . * • » % • 34-40
Localizing causes removable . . . . . . . .41,42 Places of Eefuge . . 43, 44 Premonitory Stage of Cholera 45, 46 Identity of Cholera in its progressive Stages ...... 47, 48 Necessity of checking the earlier Stages •«.••. 49 Apathy produced by the poison of Cholera ...•«. 50 Necessity of House-to-House Visitation....... 51 Medical House-to-House Visitation 52 Organization of House-to-House Visitation ...... 53 Medical Visitation first adopted in Dumfiries ...... 54 Striking results of Medical Visitation . . . , . , . 55, 56 Eeports on Cholera in Dumfries . . . . . . . . 57-69 Eeport on Cholera in Glasgow 70-86
^ Manchester 87-100 Hull 101-106
Sheffield 107-110 Abstract of Eeports on Cholera in Liverpool 111-113
J > , , Wolverhampton . • . . .114 >9 3 1 Dundee 115-117
,} Hamilton . . . . . .118 >> 5 5 Glengarnock Iron-works. Coatbridge . 119
5» 5 5 Carnbroe 120
5 5 5 5 Leeds ...... 121
i 5 5 5 t Sunderland 122
»t Edinburgh .... 123, 124
.5 5, Bristol 125; 126 Advantages of Home Treatment of Cholera 127 Statistics of Home and Hospital Treatment 128 Necessity of Home Treatment of Cholera 129
vi CONTENTS.
P^GE Early Interment of the Dead 130,131 Necessity of intermediate Reception Houses ..... 132, 133 Execution of Regulations 134 Defective administration of preparatory Measures 135 Regulations for medical Relief 136
Defects in Legislative Provisions 137, 138 Loss of life from the nature of the Authority 139
Cholera on board the " American Eagle" 140-145
Conclusions . . 146-149
—
Table L Daily Table of Premomtory Cases and Cholera in Glasgow lSl-153
Table II. Aggregate returns for each district in Glasgow . . 154
Table III. Daily ratios of Premonitory Cases to Cholera in Glasgow 155
Table IV. Statistics of Cholera in Parkhead 156
Table Y. Statistics of Cholera iu Hull 157
Table VI. Statistics of Cholera in Manchester 159
Table VII. Statistics of Cholera in Districts of Manchester . . 160
Table VIII. Statistics of Cholera in Paisley and Charleston . . 160
Table IX. Statistics of Cholera in Bristol 1 62
• Duties of Bledical Officers, &c. in Dumfries ..... 163
Instructions to Medical Officers in Glasgow ..... 164
APPENDIX B.
Cholera preceded by Fever 4
Increase of Zymotic Diseases . . . .' . ... 5,
6
Cholera in 1832-33 and 1848-49 13
Temperature, Electricity, &c. .14 Definition of Cholera 15
Estimate of Attacks . . . . . . . . . .16,17
On Cholera Hospitals . 18
Influence of Age 19
Cholera among Hop-pickers . . . . . . . . . 26, 27
Influence of Locality 28, 29
Localities attacked . . . • . . . . . . 30, 31
River Localities . 34
Fever tind Cholera Tract .37 Cholera in Bethnal Green 38
Localization of Cholera '
in Prisons
Millbank Prison
Newgate Prison .
Bridewell Prison
Model Prison
Cholera in Lunatic Asylums Bethlem and Hanwell Eemarks on Asylums Epidemics controllable
Instance at Berlin
Privy Atmosphere Influence of Animal Effluvia
Defective Water Supply Influence of Foul Water Instance of Jacob's Island Contamination of Water Drunkenness
Effects of Bad Food .
) )
of Cholera Stools Existence of a Premonitory Stage Premonitory Diarrhoea Experience of Berlin
Page
43
42
43
44
45
46
47
48
49
50
Treatment of Diarrhoea 111-114
Neglect of Diarrhoea 115-117
House-to-House Visitation . . . . . . . . .145 Period of Commencement ......... 146
Extent of House Visitation 147
Duties of Medical Inspectors ........ 148
, , Visitors 149
in Hackney . . . . . .. . . . .Ill , , in Clerkenwell, St. Luke's, &c 162
in Whitechapel ......... 163
Testimony of Medical Visitors 166-168
Data for House Visitation . . . . . . . . 169-171
Lay Visitors 172
Eeview of House Visitation . . . . . • • • .177 Conclusion 178-180
Appendix 181-198
When in the month of July, 1849, we presented
a Report, giving an account of our first proceedings in
the execution of the Public Health Act, and the Diseases
Prevention Act, which we were appointed to admi-
nister, Asiatic Cholera was prevailing extensively iii
numerous parts of the country, and the epidemic had not
yet reached its height. Though fully aware of the im-
perfection which must unavoidably attach to an account
of the pestilence written while it was still extend-
ing its destructive course ; yet it seemed desirable to
promulgate without delay the practical results, as far as
they were then obtained, of the measures of prevention
and relief which we had deemed it our duty to recom- mend and enforce. On the first return of cholera, our knowledge of the disease was comparatively limited.
Several essential facts, had then been scarcely noticed, or were fully appreciated only by a few careful observers,
who had taken no means to make them generally known, and other most important points which have since been rendered certain, were at that period wholly unknown :
but we could only take for our guidance in the measures of prevention which we were immediately called upon to
devise the broadest basis of experience which was at that time available.
The epidemic having now, for the present at least,
finished its course, and a large body of evidence having been accumulated respecting it, derived from the whole experience of this country, and in part also from that of other nations, we propose to present a summary of the
2 Extensive experience of the Epidemic.
results of that experience, with a view particularly to
show how far the intentions of the Legislature have been carried into effect, and with what amount of success ; and what further legislative provisions are required for the
prevention in future of this pestilence, the scourge of
modern times, as well as of other epidemic diseases.
We beg to call attention to the full and elaborate
Reports of our medical inspectors, Dr. Sutherland and Mr. Grainger, which are given at length in the Appen- dix. During the whole course of the epidemic they,
more than any private practitioners, and more probably
than any other public servants, were engaged in a per-
sonal and laborious examination of the conditions con-
nected with the propagation of the disease, and in super-
intending in different towns in various parts of the king-
dom, the application of the measures which, on the best
consideration, were judged necessary to meet the most formidable attacks of the disease. These Reports, though
written independently, and each having a strict and exclusive relation to its respective field of service, will be
found to present a remarkable coincidence in regard to
the main subjects which are brought under conside-
ration.
Before proceeding to state the results of the late expe-
rience of this epidemic, an experience which is more extended and complete than any with which we are
acquainted in relation to any other pestilence, it may be
useful briefly to describe the course which it took on
this occasion, in its progress from India to this country.
From Despatches received from time to time by Your Majesty's Government from foreign ministers and con-
suls, we are enabled to present a tolerably distinct view
of its course, from the place of its outbreak to its arrival
in Great Britain.
epidemic form, in 1817, in Hindostan, down to the period
of its last great irruption into Western Asia and Europe,
the disease had never been absent from some part or
other of the Indian peninsula. In the period included
in the Parliamentary Returns, from 1825 to 1844, it
caused annually nearly one-eighth of the whole mor-
Progress of the Epidemic in India. 3
tality of the European soldiers, and nearly one-fifth of
all the deaths among native soldiers.
At the beginning of the hot season of 1845 it broke
out with o-reat violence in Caboul ; it devastated whole
districts in Affghanistan and the Punjaub, and com-
mitted frightful ravages at Ferozepore and Loodianah,
in Northern India. It attacked Umballa in July, 1845,
where nearly all the first cases proved fatal, and in the
course of the autumn it appeared at Kurnaul, Cawnpore,
and other towns.
autumn of that year, both in the western and southern
parts of the Island of Ceylon, this destructive disease
was succeeded by an outbreak of cholera at Taff'rea,
where it raged with such violence, that out of 4,111
persons who were its first victims, 3,655 perished. This
outbreak was there attributed not to any imported infec-
tion, but to some endemic influence supposed to have
been called forth by the irregular recurrence of the rains
in the late season, which, instead of appearing at the
accustomed time and continuing for the ordinary period,
were much later than usual, and interrupted and partial
in their duration. No expectation was entertained of
any material mitigation of the divSease until the recur-
;
accordingly it continued to ravage various parts of the
island, especially the districts which had recently been the special seats of small-pox.*
In the early part of 1846 it prevailed extensively and severely in various towns and villages in the southern parts of the Madras Presidency, particularly at Madura and Bellary.
Then advancing in a north-west direction in its pro- gress to Bombay, " an awful visitation," is stated to have taken place at Sholapoor and its vicinity, the disease
* In many of the towns and villages attacked by cholera, in its prepress through the Madras Presidency, it was preceded and accompanied l;y emall- pox.
B 2
4 Extension of the Epidemic to Persia.
first appearing in the camp of the 33rd Regiment N. I.,
when on their march to Jaulnah. Spreading thence to
the south Mahratta country it almost depopulated seve- ral villages in its course; and on no occasion, at least
for many years past, had it proved so fatal to the native
population.
It subsequently appeared at Poonah, Bombay, and Ahmedabad.
Still steadily maintaining a north-west course it arrived
coastward at Scinde, where it first broke out at the sea-
coast, and gradually it extended upwards to Hydrabad and Sehwan.
In the month of June an attack of extraordinary-
severity took place at Kurrachee, at the mouth of the
Indus, where the disease is stated to have cut off a
tenth part of the population, including 725 European and native soldiers in sixteen days. It is important to
remark, that upwards of six months before this violent
outbreak, namely, in the month of November, 1845,
•several sporadic cases of the disease, which proved fatal
with great rapidity, occurred in the town.
While the pestilence was raging at Kurrachee, it broke
•out in Persia, and appeared as early as the month of
May with great severity at Aden, at the mouth of the
Red Sea, after a violent and unusual fall of rain.
Its progress through Persia was so rapid and fatal as
to produce the utmost consternation among the inhabit-
ants of the principal towns of that country. By the
month of July it reached Teheran, where, out of a popu-
lation of 60,000 it destroyed 12,000 persons, 300 deaths
occurring daily, for several days in succession. In this
town and neighbourhood it attacked with the utmost
violence the rich as well as the poor, several members of
the Royal Family having been among the first to perish
by it.
• From Teheran it proceeded by a north-west course to
Tabreez, becoming more deadly as it advanced, for out
of a population of 30,000, Q,Q77 persons perished, the
greater part within the space of 20 days ; from 450 to
500 deaths being reported daily while the pestilence con-
tinued at its height.
From Tabreez it turned off in a south-east direction
towards Ispahan, which it reached in September, where
it committed great havoc among the higher as well as
the lower classes. Then, proceeding westward, it reached
Baohdad at the latter end of the month, spreading such
consternation among the inhabitants, that in a few days
the town was deserted ; the shops were closed ; public
offices were unattended, and all business was suspended.
In this town and a narrow circle round it its victims are
computed to have exceeded 30,000 souls.
From Baghdad, instead of pursuing its westward
course, it again turned directly back in a south-east
direction, taking the road through Cashan to Sheerez.
From this retrograde course a hope was at first enter-
tained that it would not extend its ravages to Europe,
since instead of proceeding, as in 1831, in a direct line
from India to Europe, through Russia and Turkey, it
appeared to be retracing its steps towards the region in
which it took its origin.
In a short time, however, all ground for this expecta-
tion vanished ; for in October it entered Asiatic Turkey,
breaking out at IMossul, and reaching as far northward
as Diarbekar. At the same time penetrating into Syria,
it spread to Damascus, in a few days reached Aleppo,
and in the following month (December) it extended its
ravages over the whole of the…
5
MAP
I. A
7. F R 1 C
P L
R O
ir B 1 A\
E P E N D
/2<
18/iS
/ C H 1 N A
—A
1848 & 1849.
Presented to both Houses of Parliament by Command of Her Majesty,
LONDON: PRINTED BY W. CLOWES & SONS, STAMFORD STREET,
FOR HER majesty's STATIONERY OFFICE.
1850.
ACCN. j
SOiJRCC j
DATh j
LIST OF MAPS, DIAGRAMS, AND TABLES.
Map of the Progress of Cholera from Hindostan to Great Britain, to face Title-page of
Report.
^iagram of comparison of Mortality, from all causes and from Cholera, in the Metro-
y- polis, to face page 26 of Report.
Plan of Glasgow, to face Title-page of Appendix A.
Plate 1, to face page 46 of Report.
Plate 6, to face page 55 of Appendix A.
Plate 7, to face page 56 of Appendix A.
Plate 8, to face page 103 of Report.
Plates 9 and 10, to face page 80 of Appendix A.
Plates 11, 12, and 13, to face page 104 of Report.
Plate 14, to face page 119 of Appendix A.
Plan of Hamburg, to face Title of Appendix B.
Cholera Map of the Metropolis .
Sections of ditto .... Plan of the parish of St. Leonard, Shoreditch
Map of the parish of Bethnal-green
Table A. Cost of Widowhood and Orphanage in 12 Unions, p. 151.
Table B. Progress of Epidemic Cholera in Great Britain, p. 152.
Table 1. Return of Deaths from Cholera in 60 weeks in the Metropolis, to be placed
at the end of Appendix B.
Tables 2 and 3. Analysis of Deaths from Cholera, to be placed at the end of the
Report.
CONTENTS.
Extensive experience of the Epidemic 2
Progress of the Epidemic in India ....... 3
Extension of the Epidemic to Persia ....... 4
Progress through Asiatic Turkey and Georgia . . . . • 5
Arrival at Moscow 6
Outbreak in Egypt 7
Warnings given of its approach, preceded by general prevalence of >
^ Diarrhoea
Comparative severity of the Epidemic . . . . ... 11
Progress of the Epidemic in the Metropolis, and unwillingness to acknow-l
ledge the presence of the Disease ...... i ' .„,j,
History of early Cases in the Metropolis ...... 14
, , , , in other Towns ....... 15-17
Warning addressed to Local Authorities 19
Haunts of Fever and Cholera the same—instances from Superintending \
Inspector's Reports ) "
Prevalence near the Banks of the Thames , j 24
Comparative Mortality in North and South Disti-icts .... 25
Atmospheric Changes in London........ 26
, , , , at Kurrachee 27
Influence of Heat and Moisture.—Influence of the Atmosphere . . 28, 29
Attacks not confined to the weak and sickly. Disease not confined to the\
Poor / ^^^^
Localizing Causes.—Overcrowding 36-39
Filth—Artificial Manure . 40-42
Poisonous EfiEluvia wafted to a distance 44
Town Refuse 45
Experience of Prison at Brest . . . . . . . .46 Malaria from Putrescent Mud, Foul Canals and Ditches .... 47-49
Dampness.—Dampness of Houses on hill sides 50, 51
Injurious effects of polluted Drainage 52
iv CONTENTS.
' Page Predisposing effects of Dampness "»....«. 53 Higher flats ofHouses the most unhealthy 54 Want of Drains.—Drains unskilfully constructed 55, 56
Emanations from Foul Sexrers 57
Graveyards 58
Food.—Effects of improper Articles of Food • . . • • 63, 64
Effects of Intemperance .•....,•.65 Fatigue ............66 Exemptions from attack, Metropolitan Buildings and others . . . 67-69
Ships, Prisons, Lunatic Asylums 70-72
Benefit from minor Improvements.—From removal of Nuisances . . 73-75
Excessive Mortality followed by excess of Births . • . . • 76
Eesults of Inquiry at Bristol and other places . . • • • . 77, 78
Eesponsibility of Local Authorities. . . < • i/ • • 79
Neglect of Preventive Measures in the Metropolis 80,81
, , , , in Provincial Towns • . • , 82, 83
External and Internal Cleansing 84, 85
Lime-washing . . . . . . . . • . . 86, 87
House-to-House Visitation .88 Premonitory Diarrhoea in Towns in England and Scotland ... 89
Unity of the Disease in all its Stages 90
Proofs that Diarrhoea is premonitory of Cholera 91, 92
Transition of Diarrhoea into Fever ....... 93
Comparative Mortality of different Stages of Diarrhoea . . • • 94
Neglect of Premonitory Diarrhoea by the Poor in the Metropolis . .95-97
Apathy produced by Epidemic Influence 98-100
Kesults of House-to-House Visitation 101, 102
, , in Dumfries and other Scotch Towns 103, 104
^ , , in Manchester 105
, , Sheffield 107, 108
the Metropolis . . . . • . 109,110
Kesults of Visitation System in Shoreditch, and Western Districts . 114,115
General Kesults of Visitation ....... 116-119
Extent of Relief 120
Gratitude of the Poor in the Metropolis and other Towns . . .121 Testimony of Superintending Inspectors 122,123
Houses of Kefuge ....••>... 124
,, ,, to Tents 128
Cholera Hospitals 129-131
Expense of Epidemics . . • • • • • . .136 Objects of Diseases Prevention Act 137
Obstacles to Administration of Act 138
Administration of Act by Guardians of the Poor . . ... 139-141
JZeal and Devotion of Medical Officers . . • • .s.
• • .142 General Conclusions . . ^ 143-149
Districts under Inspection 2
Signs of an Epidemic Constitution . 4
Epidemics haunt the same localities ....... 5
Marks of developed Cholera 6
Localizing Causes of Cholera 7
Illustrations of localizing Causes of Cholera—Errors of Diet . . . 8, 9
Fatal results of overcrowding and defective Ventilation . . . . 10, 11
Cholera in Taunton Union Workhouse 12, 13
Predisposing effects of bad Water Supply 14, 15
Fatal effects of Emanations from Town Eefuse 16,17
Predisposing effects of Dampness 18-20
Sanitary evils from defective Structure of large Tenements ... 21
Greater liability of top flats to Cholera 22
Outbreak of Cholera in Eedcross-street, Bristol . . . . . 23, 24
Fatal results of defective Sanitary improvements . . . . . 25, 26
Effects of overcrowded^Grave-yards . 27-29
Effects of Malaria in producing attacks of Cholera • . • • . 30, 31
Fatal effects of intemperate habits during Epidemics .... 32
Fatal effects of fatigue ......... 33 Abstract of localizing causes of Cholera . . * • » % • 34-40
Localizing causes removable . . . . . . . .41,42 Places of Eefuge . . 43, 44 Premonitory Stage of Cholera 45, 46 Identity of Cholera in its progressive Stages ...... 47, 48 Necessity of checking the earlier Stages •«.••. 49 Apathy produced by the poison of Cholera ...•«. 50 Necessity of House-to-House Visitation....... 51 Medical House-to-House Visitation 52 Organization of House-to-House Visitation ...... 53 Medical Visitation first adopted in Dumfiries ...... 54 Striking results of Medical Visitation . . . , . , . 55, 56 Eeports on Cholera in Dumfries . . . . . . . . 57-69 Eeport on Cholera in Glasgow 70-86
^ Manchester 87-100 Hull 101-106
Sheffield 107-110 Abstract of Eeports on Cholera in Liverpool 111-113
J > , , Wolverhampton . • . . .114 >9 3 1 Dundee 115-117
,} Hamilton . . . . . .118 >> 5 5 Glengarnock Iron-works. Coatbridge . 119
5» 5 5 Carnbroe 120
5 5 5 5 Leeds ...... 121
i 5 5 5 t Sunderland 122
»t Edinburgh .... 123, 124
.5 5, Bristol 125; 126 Advantages of Home Treatment of Cholera 127 Statistics of Home and Hospital Treatment 128 Necessity of Home Treatment of Cholera 129
vi CONTENTS.
P^GE Early Interment of the Dead 130,131 Necessity of intermediate Reception Houses ..... 132, 133 Execution of Regulations 134 Defective administration of preparatory Measures 135 Regulations for medical Relief 136
Defects in Legislative Provisions 137, 138 Loss of life from the nature of the Authority 139
Cholera on board the " American Eagle" 140-145
Conclusions . . 146-149
—
Table L Daily Table of Premomtory Cases and Cholera in Glasgow lSl-153
Table II. Aggregate returns for each district in Glasgow . . 154
Table III. Daily ratios of Premonitory Cases to Cholera in Glasgow 155
Table IV. Statistics of Cholera in Parkhead 156
Table Y. Statistics of Cholera iu Hull 157
Table VI. Statistics of Cholera in Manchester 159
Table VII. Statistics of Cholera in Districts of Manchester . . 160
Table VIII. Statistics of Cholera in Paisley and Charleston . . 160
Table IX. Statistics of Cholera in Bristol 1 62
• Duties of Bledical Officers, &c. in Dumfries ..... 163
Instructions to Medical Officers in Glasgow ..... 164
APPENDIX B.
Cholera preceded by Fever 4
Increase of Zymotic Diseases . . . .' . ... 5,
6
Cholera in 1832-33 and 1848-49 13
Temperature, Electricity, &c. .14 Definition of Cholera 15
Estimate of Attacks . . . . . . . . . .16,17
On Cholera Hospitals . 18
Influence of Age 19
Cholera among Hop-pickers . . . . . . . . . 26, 27
Influence of Locality 28, 29
Localities attacked . . . • . . . . . . 30, 31
River Localities . 34
Fever tind Cholera Tract .37 Cholera in Bethnal Green 38
Localization of Cholera '
in Prisons
Millbank Prison
Newgate Prison .
Bridewell Prison
Model Prison
Cholera in Lunatic Asylums Bethlem and Hanwell Eemarks on Asylums Epidemics controllable
Instance at Berlin
Privy Atmosphere Influence of Animal Effluvia
Defective Water Supply Influence of Foul Water Instance of Jacob's Island Contamination of Water Drunkenness
Effects of Bad Food .
) )
of Cholera Stools Existence of a Premonitory Stage Premonitory Diarrhoea Experience of Berlin
Page
43
42
43
44
45
46
47
48
49
50
Treatment of Diarrhoea 111-114
Neglect of Diarrhoea 115-117
House-to-House Visitation . . . . . . . . .145 Period of Commencement ......... 146
Extent of House Visitation 147
Duties of Medical Inspectors ........ 148
, , Visitors 149
in Hackney . . . . . .. . . . .Ill , , in Clerkenwell, St. Luke's, &c 162
in Whitechapel ......... 163
Testimony of Medical Visitors 166-168
Data for House Visitation . . . . . . . . 169-171
Lay Visitors 172
Eeview of House Visitation . . . . . • • • .177 Conclusion 178-180
Appendix 181-198
When in the month of July, 1849, we presented
a Report, giving an account of our first proceedings in
the execution of the Public Health Act, and the Diseases
Prevention Act, which we were appointed to admi-
nister, Asiatic Cholera was prevailing extensively iii
numerous parts of the country, and the epidemic had not
yet reached its height. Though fully aware of the im-
perfection which must unavoidably attach to an account
of the pestilence written while it was still extend-
ing its destructive course ; yet it seemed desirable to
promulgate without delay the practical results, as far as
they were then obtained, of the measures of prevention
and relief which we had deemed it our duty to recom- mend and enforce. On the first return of cholera, our knowledge of the disease was comparatively limited.
Several essential facts, had then been scarcely noticed, or were fully appreciated only by a few careful observers,
who had taken no means to make them generally known, and other most important points which have since been rendered certain, were at that period wholly unknown :
but we could only take for our guidance in the measures of prevention which we were immediately called upon to
devise the broadest basis of experience which was at that time available.
The epidemic having now, for the present at least,
finished its course, and a large body of evidence having been accumulated respecting it, derived from the whole experience of this country, and in part also from that of other nations, we propose to present a summary of the
2 Extensive experience of the Epidemic.
results of that experience, with a view particularly to
show how far the intentions of the Legislature have been carried into effect, and with what amount of success ; and what further legislative provisions are required for the
prevention in future of this pestilence, the scourge of
modern times, as well as of other epidemic diseases.
We beg to call attention to the full and elaborate
Reports of our medical inspectors, Dr. Sutherland and Mr. Grainger, which are given at length in the Appen- dix. During the whole course of the epidemic they,
more than any private practitioners, and more probably
than any other public servants, were engaged in a per-
sonal and laborious examination of the conditions con-
nected with the propagation of the disease, and in super-
intending in different towns in various parts of the king-
dom, the application of the measures which, on the best
consideration, were judged necessary to meet the most formidable attacks of the disease. These Reports, though
written independently, and each having a strict and exclusive relation to its respective field of service, will be
found to present a remarkable coincidence in regard to
the main subjects which are brought under conside-
ration.
Before proceeding to state the results of the late expe-
rience of this epidemic, an experience which is more extended and complete than any with which we are
acquainted in relation to any other pestilence, it may be
useful briefly to describe the course which it took on
this occasion, in its progress from India to this country.
From Despatches received from time to time by Your Majesty's Government from foreign ministers and con-
suls, we are enabled to present a tolerably distinct view
of its course, from the place of its outbreak to its arrival
in Great Britain.
epidemic form, in 1817, in Hindostan, down to the period
of its last great irruption into Western Asia and Europe,
the disease had never been absent from some part or
other of the Indian peninsula. In the period included
in the Parliamentary Returns, from 1825 to 1844, it
caused annually nearly one-eighth of the whole mor-
Progress of the Epidemic in India. 3
tality of the European soldiers, and nearly one-fifth of
all the deaths among native soldiers.
At the beginning of the hot season of 1845 it broke
out with o-reat violence in Caboul ; it devastated whole
districts in Affghanistan and the Punjaub, and com-
mitted frightful ravages at Ferozepore and Loodianah,
in Northern India. It attacked Umballa in July, 1845,
where nearly all the first cases proved fatal, and in the
course of the autumn it appeared at Kurnaul, Cawnpore,
and other towns.
autumn of that year, both in the western and southern
parts of the Island of Ceylon, this destructive disease
was succeeded by an outbreak of cholera at Taff'rea,
where it raged with such violence, that out of 4,111
persons who were its first victims, 3,655 perished. This
outbreak was there attributed not to any imported infec-
tion, but to some endemic influence supposed to have
been called forth by the irregular recurrence of the rains
in the late season, which, instead of appearing at the
accustomed time and continuing for the ordinary period,
were much later than usual, and interrupted and partial
in their duration. No expectation was entertained of
any material mitigation of the divSease until the recur-
;
accordingly it continued to ravage various parts of the
island, especially the districts which had recently been the special seats of small-pox.*
In the early part of 1846 it prevailed extensively and severely in various towns and villages in the southern parts of the Madras Presidency, particularly at Madura and Bellary.
Then advancing in a north-west direction in its pro- gress to Bombay, " an awful visitation," is stated to have taken place at Sholapoor and its vicinity, the disease
* In many of the towns and villages attacked by cholera, in its prepress through the Madras Presidency, it was preceded and accompanied l;y emall- pox.
B 2
4 Extension of the Epidemic to Persia.
first appearing in the camp of the 33rd Regiment N. I.,
when on their march to Jaulnah. Spreading thence to
the south Mahratta country it almost depopulated seve- ral villages in its course; and on no occasion, at least
for many years past, had it proved so fatal to the native
population.
It subsequently appeared at Poonah, Bombay, and Ahmedabad.
Still steadily maintaining a north-west course it arrived
coastward at Scinde, where it first broke out at the sea-
coast, and gradually it extended upwards to Hydrabad and Sehwan.
In the month of June an attack of extraordinary-
severity took place at Kurrachee, at the mouth of the
Indus, where the disease is stated to have cut off a
tenth part of the population, including 725 European and native soldiers in sixteen days. It is important to
remark, that upwards of six months before this violent
outbreak, namely, in the month of November, 1845,
•several sporadic cases of the disease, which proved fatal
with great rapidity, occurred in the town.
While the pestilence was raging at Kurrachee, it broke
•out in Persia, and appeared as early as the month of
May with great severity at Aden, at the mouth of the
Red Sea, after a violent and unusual fall of rain.
Its progress through Persia was so rapid and fatal as
to produce the utmost consternation among the inhabit-
ants of the principal towns of that country. By the
month of July it reached Teheran, where, out of a popu-
lation of 60,000 it destroyed 12,000 persons, 300 deaths
occurring daily, for several days in succession. In this
town and neighbourhood it attacked with the utmost
violence the rich as well as the poor, several members of
the Royal Family having been among the first to perish
by it.
• From Teheran it proceeded by a north-west course to
Tabreez, becoming more deadly as it advanced, for out
of a population of 30,000, Q,Q77 persons perished, the
greater part within the space of 20 days ; from 450 to
500 deaths being reported daily while the pestilence con-
tinued at its height.
From Tabreez it turned off in a south-east direction
towards Ispahan, which it reached in September, where
it committed great havoc among the higher as well as
the lower classes. Then, proceeding westward, it reached
Baohdad at the latter end of the month, spreading such
consternation among the inhabitants, that in a few days
the town was deserted ; the shops were closed ; public
offices were unattended, and all business was suspended.
In this town and a narrow circle round it its victims are
computed to have exceeded 30,000 souls.
From Baghdad, instead of pursuing its westward
course, it again turned directly back in a south-east
direction, taking the road through Cashan to Sheerez.
From this retrograde course a hope was at first enter-
tained that it would not extend its ravages to Europe,
since instead of proceeding, as in 1831, in a direct line
from India to Europe, through Russia and Turkey, it
appeared to be retracing its steps towards the region in
which it took its origin.
In a short time, however, all ground for this expecta-
tion vanished ; for in October it entered Asiatic Turkey,
breaking out at IMossul, and reaching as far northward
as Diarbekar. At the same time penetrating into Syria,
it spread to Damascus, in a few days reached Aleppo,
and in the following month (December) it extended its
ravages over the whole of the…
Related Documents
![[The 1853-1856 cholera epidemic in the Portuguese press]](https://static.cupdf.com/doc/110x72/632650423952a2ddda0b5ae2/the-1853-1856-cholera-epidemic-in-the-portuguese-press.jpg)
