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9
It will be seen that the poorer classes suffered far more severely than the
middle or upper classes.
Amongst exciting causes, I clearly traced intemperance as a very common
one; another was bad drainage; another was infection or contagion, especially in
the houses of the poor, where cleanliness was not observed, and ventilation was
defective. The disease appeared to spread from one room to another in the same
house where there was crowding, and in the earlier cases where disinfection was
not vigorously carried out. None of the nurses at University College Hospital,
where 96 cases (71 of Cholera, and 25 Choleraic Diarrhoea) were treated, contracted
the disease. None of the Medical visitors took the disease, although
several had troublesome diarrhoea. I believe the escape of the nurses and
doctors was mainly due to the observance of strict cleanliness, and great care
in immediately disinfecting and removing all discharges from the sick, and
attention to ventilation. Unless such precautions are observed, Cholera is undoubtedly
contagious and infectious ; but with proper precautions, I believe its
infection need not be feared. No cases came to my knowledge in St. Pancras
where the disease was clearly propagated by drinking water; but during
previous epidemics, and in other districts, this mode of its propagation has been
abundantly proved.
Only one case of Cholera occurred in the Workhouse itself, and one ease in
the Casual wards. The one from the Workhouse was a nurse who was pregnant,
and had been doctoring herself with strong aperient pills; and there seemed to
be no other cause to account for this isolated case, except the use of these pills,
for some time after the bowels had been acting freely. She died with all
the symptoms of Asiatic Cholera. There was no Choleraic diarrhoea in the
house at the time. This case certainly is opposed to the plan of treatment
recommended by some recent writers, of giving purgatives to cure the premonitory
diarrhoea during an epidemic of Cholera.
Of one thing I was fully convinced during the epidemic, and that was of
the value of disinfection in arresting the spread of the disease. The two disinfectants
chiefly employed, were carbolic acid and fire. Owing to the want of
a place to which infected linen and clothes could be sent to be purified and
washed, it was necessary in many cases, to burn articles which might with
safety have been kept for future use, if proper appliances had been available.
Great difficulty was found in some cases in finding a suitable place for burning
bedding and clothes. When they could not be burnt at the rear of the houses
where the disease had existed, they were sent either to a yard belonging to
Mr. Culverhouse, the contractor, or to some open space in the northern part of
the Parish. In either case, this was attended with considerable expense.
Disinfection is quite as important in dealing with Small Pox, Typhus Fever,
and Scarlet Fever, as in the case of Cholera, and might be accomplished with as
much certainty. The Sanitary Act, 1866, imposes this duty upon the Vestry,
and the subject is one which demands your serious consideration. An establishment
is required to which all infected clothing and bedding can be sent, either
to be destroyed, or to be purified. Several distinct apparatuses are required,—a
furnace for burning articles not fit to be purified, a hot chamber for disinfecting
things which will be damaged by boiling water, and the ordinary appliances for
boiling, washing, and drying linen. A properly constructed truck or other
vehicle, would be required to remove infected articles. In Liverpool, two
establishments of this kind are in operation. If such arrangements were made
and properly carried out, they would be of very great value in arresting the