A LETTER TO THE CHAIRMAN OF THE BOARD OF GUARDIANS OF THE SHEFFIELD UNION, ON THE PREVENTION OF CHOLERA, BY J. C. HALL, M.D., (Fellow of the Royal College of Physicians, Edinburgh; late Lecturer on the Practice of Medicine at the Sheffield Medical School, dtc. &c ) [PUBLISHED BY SPECIAL REQUEST OF THE BOARD.] "The crisis of man's destiny is no"w a recurring danger. To-day, child of man, tend thou charily the minutes : the harvest of thy yesterday; the seed corn of thy morrow. What more ? To-day is the golden chance wherewith to snatch fruition." — Tapper. LONDON: LONGMAN AND CO. SHEFFIELD : J. PEARCE, JUN., HIGH-STREET. 1853. LETTER. Sib, At such a time as this, when our country is visited by Malignant or Asiatic Cholera, I venture to address you in your official capacity; and perhaps, after having for nearly twenty years devoted a considerable portion of my time to a consideraion of those causes which increase the Bills of Mortality and seriously affect the Health of Towns ; after having had the honour of preparing for the Government of Lord Morpeth a portion of that statement which his lordship placed before the House of Commons on introducing the Health of Towns Bill ; and after having, on the visitation of the Cholera in 1847 and also at the present time, had the preparation for " The Times" of a series of articles on the prevention of Cholera, I hope I shall not be considered presumptuous in doing so. If any precedent were required for taking this step, it has been supplied by a letter addressed to the public authorities of Newcastle, by one of the leading physicians of that town. * My object in addressing you, Sir, and through you the other Members of the Board of Guardians, is to consider how we may best guard against the danger now hanging over us. Although the fact that Malignant Cholera has again reached our shores cannot longer be questioned, as yet the towns of Newcastle and Gateshead have only suffered severely ; how long it may be ere the disease reach Sheffield, no human being can tell. A little space may yet be afforded us to take the necessary * Dr. G. Robinson, Lecturer on the Practice of Medicine, Newcastle ; also, Dr. T. Shapter, Physician to the Devon and Exeter Hospital. 1 precautions : if we are wise, Sir, we shall waste no longer the hours which yet are mercifully extended to us, and if we so employ ourselves, although we may not altogether escape the pestilence, we shall most certainly mitigate its severity, by at once removing those numerous nuisances which I know to exist in Sheffield, and which the Order in Council (putting into force the Act for the Prevention of Epidemic, Endemic, and Contagious Diseases throughout the whole of Great Britain,) dated this day, September 15th, 1853, gives you ample powers to accomplish. In a letter with which I have been favoured by Dr. Sutherland, the Physician to the General Board of Health, he points out the necessity of the authorities in every town at once commencing operations, and he adds, " the great evil committed by Local Authorities the last time arose partly from neglect of prevention while there ivas time for it, but the worst of all evils arose from thinking that nothing could be done." After urging upon me the importance of insisting upon these things in my next letter to "The Times," the Doctor adds "not a moment should be lost in cleansing towns and whitewashing houses. If the people put off doing this, lam warranted by the experience already acquired at Newcastle, in saying the mortality will be frightful." * The same day I communicated this advice to the Mayor, who, in the course of an hour called upon me, most kindly listened to my suggestions, and with his usual promptitude, ordered the police to attend to some of them. He also thought I should at once communicate with you. We know, Sir, the old haunts of the Cholera in Sheffield ; and from what is taking place at Newcastle it will in all probabilty again walkjin the same courts and lanes you saw it in for the most part before. In at once commencing the cleansing of them, some precautions must be taken, for in removing heaps of filth * From the 31st of August to the 18th of September, 1853, the appallingnnmber of 557 have died at Newcastle from Cholera and Diarrhoea ; (in 1831, in the same number of days, only 91) — no class has escaped the pestilence — all ranks have died ! ! 5 and night soil, great care should be used to prevent the extrication of large quantities of poisonous gases ; such gases always existing in accumulations of animal and vegetable remains. Such removals, should always take place between the hours of twelve at night and six in the morning. Certain metallic salts — for example, green and blue copperas, chloride of zinc, nitrate of lead, and chloride of lime — have been used at Newcastle for this purpose. Chlorine is, however, in my opinion, far the best for this object. It is cheap, can be prepared in a short time, and is highly efficacious. It is obtained by mixing the black oxide of manganese with common salt, and pouring upon it the oil of vitriol and water. This should be poured upon heaps of filth during their removal, and also used in the cleansing of privies, the evils arising from which just now are very great, and will demand immediate attention. Another evil must also at once be attended to : I allude to the grates in the different parts of every street connected with the sewers ; they are generally without "traps" and the stench arising from many of them most disgusting. A visit to many of the courts and back lanes will discover them, and the houses in them to be very filthy, and the privies disgusting. The lime washing of these houses, and the washing out from time to time of the courts and lanes with the fire-engine, as very wisely proposed by the Clerk of this Union, will be found most useful. It has been resorted to at Newcastle, with the best results. It is hardly necessary to suggest that the greatest care should be taken to inspect provisions of every kind brought into our various markets, and that the sale of such as may be found unfit for human food should at once be prohibited. Pigs, when kept in yards near the abodes of the living, are often a great nuisance, one that will require the attention of the Inspector. The same remark will apply to Butcher's Shops and Slaughter Houses. The practice of throwing the entrails 6 of sheep and pigs into ash-holes behind dwelling-houses is highly improper, at all times injurious to the health of the inhabitants, and ought not to be permitted. Should the Cholera attack the inhabitants of Sheffield, and take the same course it has taken at Newcastle, it will be ushered in by an attack of diarrhoea, which, if attended to in time, may generally be cured. One of the last reports made to the Board of Guardians at Newcastle shews that, even violent as diarrhoea is there, of 300 cases treated as soon as discovered, only eight ran on to collapse. In the letter of Dr. Sutherland before me, he says " on the last visitation, Sheffield had 5319 epidemic cases, but such was the efficiency of the preventive measures, that not one of these fell into collapse or died. All I can say is, I should be very well satisfied with such a result anywhere, and I shall be glad if you can induce the Sheffield authorities to renew their exertions now." It cannot be too generally known that the Cholera is promoted by dirt, by drunkenness, by slothfulness, and the fear these debilitating influences create ; that the best antidotes are pure air, cleanliness of person, of house, and of premises, and TEMPERANCE ! ! Our dangers will not be increased, Sir, by at once fairly looking them in the face ; on the contrary, the way to avoid danger is at once to meet it; at once to supply the machinery by which existing nuisances may be swept away, and by providing stations where the poor may obtain proper medical assistance and medicines, on the first attack of diarrhoea. To remain in our present condition until Cholera attack us would be almost criminal : we may yet have time to prevent much of the mortality that attends it ; for we are at length fully aware that Cholera will not prevail as an epidemic — will not decimate a population — will not break out at one hundred parts of the same town unless the local sources of atmospheric pollution and bodily disorders abundantly exist, and although so long as these depressing agents continue, the pestilence will remain, the removal of them removes also the predisposition to pestilence. 7 I fear we have yet to set about the greater portion of this important work. I can only regret more urgent demands on my time do not enable me to deal with the subject in a way its importance requires ; still, if these hastily written remarks are not of any great service, I trust they may, by directing your attention to some of the circumstances which exercise the most powerful influence in maintaining the epidemic constitution of the atmosphere of Sheffield, not be altogether destitute of utility. There are many other topics that suggest themselves. I venture not, however, to trespass at greater length ; and, therefore give the following brief resume of what experience seems to suggest on the present threatened visitation. PREVENTION OF CHOLERA.* i The immediate removal of all nuisances, from whatever cause arising. Privies, ash-pits, cess-pools, and house drains, sewers, pigs, slaughter-houses, &c. &c. &c. Great care being taken in doing so. 2 The washing out, as often as necessary, with the fire-engine, of back courts, lanes, &c. By an arrangement with the Water Company, in many cases, the cost of the fire-engines could be saved : the water being now supplied at a sufficiently high pressure. 3 A house-to-house visitation, to ascertain the health of the inhabitants, to treat cases of Bowel Complaint as soon as they arise, to cleanse and to lime-wash such houses as are dirty, and the courts in which they are built. 4. To establish stations where the poor may by night, or by day, be supplied with proper medicines and medical attendance. 5 The nightly visitation of all the lodging-houses in the town, to see that the rooms are not over crowded ; to see that they are lime-washed ; and to see also, that tramps coming from Newcastle or other towns where Cholera is severe, are not labouring under diarrhoea. G To see that all the grates in the town have proper traps. 7 That printed papers be left generally at houses, giving simple directions for the preservation of health ; the lime-washing of houses ; cleanliness — ventilation of lodging-rooms ; pointing out * See Appendix. 9 the very great importance of temperance, and requesting that immediate notice be given of any nuisance. * 8 Inspection of provisions. 9. Water supply to the houses of the poor. 10. Burial Grounds to be closed, if necessary. Graves to be made of a sufficient depth. 11. Supply of food, coals, &c. to widows and the very destitute, in the worst localities. 12. To provide a Cholera Hospital. To this Hospital removals might be made from over-crowded houses of those thought to be in danger ; nurses being sent to attend on those labouring under the complaint. Such, Sir, appear to me some of the points to which your attention should be especially directed. We have at our command Light! Air! Water! three great and powerful sanitary agents — agents all sufficient for the preservation of health and the removal of disease. And would that, through you, I could advise the masses of my fellow townsmen to remember the importance of the most strict temperance both in eating and in drinking : in this moment of threatened danger let no one seek consolation or courage in a dram, or resort to the bottle, or the beer-barrel as an antidote to fear. Intemperance always enfeebles the constitution, and the broken down in constitution ever supply a majority of the victims of pestilence. During the last visitation, the greatest number of cases of diarrhoea were reported on the Sunday and Monday. See Appendix. 10 I trust, Sir, the inhabitants of Sheffield will become convinced of the importance, not only of at once providing the means by which existing nuisances may be removed, but of preventing their recurrence, for, by so doing, we shall improve the health, prolong the lives, and increase the happiness of all classes. In this good work I shall, at all times, be most truly happy to assist you. I have the honour to be, Sir, Your very obedient Servant, JOHN CHARLES HALL, M.D. Surrey Street, Sheffield, Sept. 15, 1853. To the Chairman of the Board of Gfuardians of the Sheffield Union. APPENDIX. " A people who can understand and act upon the counsels which God has given it, is safe in the most dangerous crisis of its fate." — Guizot. HINTS FOE THE PREVENTION OF CHOLERA. Attention is earnestly called to the following suggestions for the Prevention of Cholera. I.— INJURIOUS FOOD. Avoid the use of unwholesome food, particularly Meat that is at all tainted; Stale Fish, more especially Shell Fish; Raw Vegetables; Sour unripe Fruit; Acid Drinks ; and Cold Water when the body is heated. lI.— INTEMPERANCE. Do not become intoxicated. Avoid any intemperate use of Spirits, Wines, Beer, or Porter. lII.— BAD HABITS. Avoid over Fatigue, Late Hours, Crowded Assemblies, and all habits which depress the Powers of the Constitution. IV.— PURGATIVE MEDICINES. Avoid the unadvised use of Salts, Senna, or other Laxative Medicines. V.— CLEANLINESS. Cleanse and lime wash your houses and outbuildings. Kemove all Animals, such as Pigs, Poultry, Rabbits, &c, from your yards. Never permit Stagnant Water or Filth of any kind to collect near your dwellings. Attend to the Drains of your house, and wash them down night and morning even when well trapped. Should an offensive odour arise, examine the trap, and 12 as soon as possible remove the cause. Take care that the Street Drains near your house are in a proper condition, and the Street kept clean. Never throw offensive matters into the Street. Be very particular as to the Cleanliness of your Person ; Sponge the body daily with cold water, and use a coarse cloth or flesh-brush afterwards. VI.— VENTILATION. During the day admit Air freely into every room of your house. See that the shop in which many of you are working together is well Ventilated. Bed Eoom : — Admit Air by night also, particularly if many sleep in the same room. Avoid the over- crowding of Bed Rooms. Expose the Bed freely to the Air during the day. Remove Chimney Boards and all obstructions to the free passage of Air. By taking a brick from over the fireplace near the ceiling, and placing a bit of thin silk over the hole, to keep out the soot ; or by taking out one of the upper panes of glass, and substituting ribs of glass in its place, efficient Ventilation will very easily be effected. VII.— CLOTHING. Wear such Clothes as will keep the body warm and dry. In cold and damp weather, wear Flannel Belts round the Loins, which experience proves to be highly advantageous. Keep your feet dry. VIII.— DIET. Eat good wholesome Food. Meat, Stale-Bread, Rice, Sago, Good Potatoes. Drink, in moderate quantity, Cocoa, Tea, Coffee, Milk. IX.— PREMONITOEY SYMPTOMS OF ASIATIC CHOLERA. When Cholera is Epidemic, indisposition more or less prevails. Some are attacked with giddiness, prostration of strength, general coldness of the body, faintness. Others, with violent sickness, pains in the bowels cramps, Diarrhoea. We are now aware that Cholera, if treated in its early stages, may be combated with every hope of success. As all these symptoms are premonitory of an attack, go to bed, apply a mustard plaster to the pit of the stomach, warm water bottles to the feet, and consult at once your own private Medical Attendant, or apply directly to the Medical Station provided by the authorities. Ifg* Do not destroy this Paper : if you are indifferent to your health, others may not be so. J. PEARCE, JUN., PRINTER, 24, HIGH STREET, SHEFFIELD.