history, before we venture to generalise or form a confident opinion. The present paper, as already said, is merely intended to be a narrative of events, and to afford materials for future reference and for the impartial discussion of the question.

Precautions against Cholera. By HENRY JACKSON.

My object in writing the following notes is to bring before the Association a statement of the preparations which were made (and carried out) in the Sheffield Union, to meet the expected invasion of Cholera in 1849.

The experience derived from the outbreak of cholera in 1832 had been so melancholy, that it seemed desirable that some other means should be adopted for the prevention of the disease, than those which had excited so much consternation in the minds of the people of Sheffield in that year. Amongst these I enumerate the daily publication at the Town Hall of the returns, by which the minds of the people were kept in a constant state of alarm, the passage of flaming tar barrels through the streets-the sight of the cholera baskets in which patients suffering from diarrhoea or premonitory symptoms were carried to the hospital of the district.

The hospital surgeons were required to attend night and day on inmates of the hospitals, and to receive all cases reported to them by the visitors.

The visitors and the hospital surgeons were required to send daily reports to the sanitary committee.

Six dispensaries were established for the distribution of medicine at all hours, to applicants.

Nurses were engaged at one guinea per week, on board wages.

August 23.-A considerable increase in the number of cases of diarrhoea and dysentery having been reported, the dispensaries were opened.

August 27.-The committee authorised the occupation of a house in Mill Sands, to be used as a hospital, and called the attention of the Board of Highways to the condition of certain streets.

August 29.-212 applications for medicine having been made at the dispensaries, two medical men were added to the ordinary staff, and ex-hospital surgeons were appointed. The salary of the visitors was raised to two guineas per diem. It was also directed that interments should take place within 24 hours of the time of death by cholera, and that the tolling of the "passing bell" should be discontinued. It was also decided that 24 hours should be a sufficient notice for the removal of nuisances.

Swine question. Two additional inspectors were appointed. September 4.-Three night surgeons were placed on duty, or rather, their appointment confirmed. Two qualified dispensers were appointed at salaries of 40s. and 35s. per week. The Home of

Refuge was reported as fit for use, and the Hospital for Diarrhoea nearly so.

September 7.-A house was taken for the reception of cases of cholera-another hospital surgeon was appointed, and also two more visitors. During the preceding week there had been 1,582 cases of diarrhoea and premonitory symptoms of cholera, but only one of those who had applied for medicine had died. Inquiry was made about the sanitary condition of certain houses.

September 10.-A sub-committee was appointed to arrange for a supply of pure water to Allercliffe.

Two more medical officers and three dispensers were appointed, and auxiliary dispensaries were ordered to be established in the neighbouring villages.

At this time there were six hospital surgeons; three on duty from 7 P. M. to 7 A. M.; three from 7 A. M. to 7 P. M.

September 14.-Two more medical officers were appointed, and orders given for the purifying and cleansing of Allercliffe.

September 25.-The number of cases of diarrhoea having decreased, the services of four of the visitors were discontinued.

Sanitary measures were ordered in all parts of the Union.

October 1.-The committee called upon the Water Company to furnish a supply of water during a period of eight hours at least in each day; stating that a considerable number of deaths in the winter had been caused by an insufficient supply of pure water and the consequent use of the impure water of the river.

October 4.-The committee met Dr. Sutherland, and explained to him the sanitary measures which had been adopted.

October 9.-Four only of the extraordinary medical officers remained on duty-the salaries of the dispensers were diminished, and some of the dispensaries were given up.

On February 25, 1850, the House of Recovery and the diarrhoea wards were finally closed:

In 1832 the expenses were ...
In 1849

...

...

£2,900 £2,816 1s. 7d. Deaths 402. 1849.-Cases of cholera and diarrhea 7294 Deaths 66.

1832.-Cases of cholera 1347

Adopting the view that these alarming measures acted prejudicially on health, the sanitary committee, on the expected invasion of cholera in 1849, took steps to meet it by the following measures:-August 20. The committee met to organise a visitation from house to house, in case of the appearance of cholera. The union was divided into two districts, the town and the country, and the town again subdivided into north and south. It was resolved to establish two hospitals, one in each subdivision of the town, for the reception of patients suffering from diarrhoea and the premonitory symptoms of cholera, and also a house of refuge for the healthy members of households visited by the cholera. The ordinary medical offices of the several districts of the union were appointed visitors, and their salary was

fixed at £1 1s. per diem. The medical officer of the poorhouse was appointed visitor of the house, and of the house of refuge; and provision was made for the temporary increase of the staff as necessity required; and medical officers were appointed at a salary of £2 28. per diem to the two hospitals.

The duties of the visitors were-to visit every infected and unhealthy district once in every eight hours; to examine every inmate in each house, in order to ascertain the state of health; in cases of cholera, to prescribe immediately; to report to the hospital surgeons of the district; to cause the immediate removal to the house of refuge of the healthy inmates; and to direct the removal of patients.

Suggestions to Municipal and other Public Boards, on the most efficient means of meeting the impending visitation of Spasmodic Cholera. By P. O'CALLAGHAN.

In the year 1832 I happened to have medical charge of the garrison of Limerick, under the district superintendence of the late Sir James Pitcairn, during the memorable outbreak of spasmodic cholera. I believe the number of cholera cases in that garrison was nearly a third of those in the whole of the troops serving in Ireland at that time. My responsible and arduous duties on that occasion gave me the most favourable opportunities for studying this extraordinary disease, not only in the military hospitals but likewise in the crowded civil establishments and refuges extemporised for the reception of the numerous cases of cholera in that populous city; and much subsequent experience and observation enabled me to test the value of the practical knowledge thus acquired.

Long before the idea was accepted, or even generally entertained, by the medical profession, I satisfied myself that the cholera was not a contagious disease, and that it was incapable of reproduction from the human body, either alive or dead. I was also convinced that it was produced by a subtle atmospheric poison, borne along in suspension in the air, but not in chemical solution. It would on this supposition be likely to invade localities capriciously as it were, and in various degrees of intensity; and in general would be more under medical control in its advent and retrocession, because the poison would be in those times in smaller quantity and more diluted. I have been further convinced that this singular poison is material, and. that its specific gravity is a little greater than the atmosphere, although it may be wafted forcibly in its stronger currents; for I have observed that it had always a tendency to subsidence in calm and stagnant states of the air.

This latter supposition will serve to explain many of its strange phenomena. For instance, I have remarked that most persons were attacked towards morning, after they had lain several hours in a horizontal position, near the floors of their apartments, and probably immersed in the most polluted portions of the vitiated air during that time.

It was surprising to observe how local and circumscribed the disease would be found under these circumstances. It would thus occasionally happen, that even the lee side of a ship might be alone infected, if the vessel had been sailing any length of time with a side wind.

I have observed the disease to stoop as it were, and pounce upon a single bell-tent in a large camp, leaving all the others perfectly unharmed; and in another striking instance, I have seen one side of a large barrack-room attacked, although not a single case occurred on the opposite side, which was equally crowded. The immunity of the uninfected side in the latter case, appeared to me to have been caused by the poisoned air having been blown over it through high windows, and deposited on the beds under the opposite wall.

From these observations it can be easily conceived that this terrible atmospheric poison is mainly influenced in its course by the winds, and that any locality in which it unhappily might prevail should look for a storm or strong gale of wind as the most merciful of all providential visitations; for I believe that neither the heat nor the cold, the humidity or dryness of the air have the smallest influence in lessening its virulence.

If this theory should be true, it must follow that the worst localities are those in which the air is least circulated-such as narrow and crowded streets in low situations, enclosed courts, areas, cellars. &c., &c. These unwholesome places are unluckily the most densely populated; and the physical condition of the inhabitants, from a combination of various causes, is in the worst possible state to resist infection, or struggle against disease.

It is therefore too hastily assumed that the locality, or something about the locality, is capable of generating this peculiar poison; as if this state of things was new, and had not always existed even in a far worse degree than at present. The drainage is first accused as the teterrima causa, next that universal culprit the water, then the graveyards, slaughter-houses, shambles, and even many of our most useful manufactories; in short everything that produces a disagreeable smell. Nothing however appears to be more conclusively established than the fact, that smells are not noxious in proportion to their sensational offensiveness. On the contrary, there are good reasons for supposing that the agreeable fragrance of many perfumes, and in some cases the grateful odour of certain plants, become exciting causes of serious constitutional disturbance. For example, it is too well known that the pleasant scent of a new mown hayfield is far more injurious to many than the most noisome effluvium from a knackers' reeking slaughter house.

This is not simply a theoretical idea, supported by mere assertion. Let any person of ordinary acuteness of observation take a morning walk through that most elegant, spacious, and best stocked of all gardens, Covent Garden, he cannot help being struck with the generally pale and unhealthy aspect of its occupants, who sit enthroned in their airy and well-ventilated stalls, surrounded with

piles of delicious fruits and gorgeous bouquets of sweet-scented flowers. If he will then take the trouble to extend his walk only a little way further, and try to wend his way through the narrow, close, and offensive purlieus of Newport Market, those loathsome depots and receptacles of animal matter in all its stages of decomposition, he will probably be compelled to hold a handkerchief before his nose; but he will see, at the same time with astonishment, the rosy and chubby checks of the boisterous children who inconveniently obstruct his way, and the florid glow of rude health in the countenances of their robust parents. The most eloquent leaders in the most popular journals should not delude the public into the unjust impression that the useful trades of the butcher, skin-dresser, glue-maker, chandler, &c., &c., are more unhealthy occupations than those of the greengrocer, fruiterer, milliner, bouquet maker, &c., &c. The contrary is the actual fact.

When the sewage of London was discharged into the Thames, a short time ago, the stench from the river at low water was exceed ingly offensive. This effluvium was almost intolerable, especially in the Houses of Parliament and the neighbourhood. The whole of the press was unanimous in its clamorous demand for the suppression of such an alarming public nuisance, and London was menaced day after day with a pestilence which never came. On the contrary, the health returns clearly proved that the metropolis was unusually free from epidemic disease on the occasion.

I would not, however, venture to intrude my humble interposition against the general voice of the press, and the laudable exertions of the authorities for the removal of local nuisances on sanitary grounds. This would be far from my desire, for I consider that these municipal exertions which are usually excited by a panic ought to be stimulated and encouraged by all means on such

occasions.

My sole object, however, at present is to urge, with all the ear nestness in my power, the paramount duty of providing beforehand for the immediate removal of decided cases of cholera from infected localities. The necessity for making such preparations is, in my opinion, of the most vital consequence, not only for the more favourable treatment of the patients themselves, but likewise for the absolute safety of the medical officers and their attendants. In furtherance of this object I would recommend that all cholera hospitals should be made ambulatory where possible, or at all events easily and expeditiously removable. For such a purpose nothing appears to me to be so easily procurable, and so thoroughly available, as a large canvas tent. This suggestion, which was submitted many years ago to the consideration of the head of the Military Medical Department, I am happy to hear has been since occasionally adopted with the most beneficial results. I must confess I looked with serious apprehension upon a former recommendation of the General Board of Health-viz., that a medical staff should be organised for the purpose

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