View report page

14
to place, it is a matter which admits of little doubt that it propagates itself with
remarkable readiness wherever it finds a nidus in collections of fœcal filth; and that
one, at least, of the modes in which it gains access to the system, is through the
contamination of drinking water by the virus of the disease. Is it not fair to infer
that amongst the causes which prevented an outbreak to the extent of former outbreaks
in these places, may be placed the very important sanitary improvements which,
since the passing of the Metropolis Local Government Act, have been effected in
these places as well as throughout all the poorer localities in the parish? I do not
pretend that they are in a state of perfection even now—they are very far, yet, from
that—but two things certainly have been done. Cesspools have been universally
destroyed, which used to fester under the very windows, and sometimes under the
floors of the houses in these places; and in a large number rotten water butts have
been replaced by new ones; water supplied where there was none formerly; butts,
in many places, as in the White Conduit district, replaced by covered cisterns; and
active endeavours kept up to maintain some amount of cleanliness in receptacles of
all kinds. In two of the worst of the Irish Courts—Waters Court and Rose and
Crown Court—special amendments were made, not very long before the outbreak, as
regards water supply, which I cannot avoid thinking were very useful in preserving
the inhabitants of these places when the disease was raging so near to them, as the
Elder Walk district. The exemption of these people is most remarkable. In
Waters Court a constant supply was furnished from the main; and in Rose and
Crown Court a large cistern was erected, so thoroughly well covered that not a
particle of extraneous matter of any kind could possibly get into it.
Measures adopted for preventing the spread of the disease—and their results.
On the occurrence of the first case of cholera on the 23rd of July, my earliest
care was to make such provisional arrangements, pending the action of the Vestry
under the Privy Council order, as in the event of an immediate extension of the
disease would enable me to remove any cases that might happen to one of our local
Hospitals, and in other ways to facilitate the arrangements which it was clear would
have to be made. In this I was much assisted by the advice and concurrence of the
Chairman of the Sanitary Committee, whom I at once consulted, and whose experience
of every epidemic outbreak which had formerly occurred here rendered his
advice and opinion valuable. The outbreak in Elder Walk occurred on the day on
which the Vestry met to put in force the order of the Privy Council; and as it was
left to me to make any temporary arrangements to meet an emergency, I sent a
medical visitor, Mr. Macleod, to Elder Walk the next morning, with a supply of
medicine, and directions to visit every house in the neighbourhood with a view to
discover cases of diarrhoea, and to treat them at once. In nearly all cases it happens
that some ordinary looseness of the bowels precedes, by some few hours, true
choleraic symptoms; and it is in this premonitory* stage that most good can be
* Where preceding the more violent symptoms by only' "a few hours," this stage is more correctly designated
the initiatory stage. Tho diarrhoea can only be termed "premonitory" when it precedes them for a day or
two. However, I use the term "premonitory " as it is, I believe, ordinarily employed in this country.