No Certain Cure but Cleanliness a Preventive.
SOME THEORIES TESTED.
The Harm Done by Drs. Ferran and Koch— Pure Air, Pure Water and Wholesome Food Required to Combat the Disease.
In recent conversations Dr. Thomas H. Buckler cf Baltimore, has had considerable to say in regard to the prevention of cholera. Most of what follows was said in particular reference to the City of Baltimore, but applies to all intents and purposes equally well to the City of San Francisco. Of the cholera epidemic he says "In 1832 when the population did not exceed 90,000, the number of deaths reported from epidemic cholera was 853. In May and June, 1849, preceding the edvest of cholera, an epidemic typhus made its appearance among the free negroes of the city. It was confined almost exclusively to this race, only two cases having been noted in whites. In rows of houses occupied by Germans, Irish and free blacks, it would invariably single out the latter, in many instances seizing an entire family. It came alike from all sections of the city, and invariably from filthy and unwholesome localities. This disease was highly infectious in character, and in its pathological lesions corresponded in almost every essential particular with yellow fever which occurred at Gibraltar, and is described by Louis. Many of these cases were taken to the Almshouse and a large number to the old smallpox hospital, fitted up for the purpose." After describing the old Almshouse, where the cholera epidemic of 1849 occurred, the topography of the surrounding country, (the western outskirts of the city,) the hygienic conditions of the Almshouse, which he said "seemed to be, of all other places, the field, not only for the spontaneous origin, but also for the growth and spread of disease," and the inefficiency of existing systems of quarantine, Dr. Buckler states that during the prevalence of the epidemic typhus before referred to as occurring among the free blacks of the city in June, 1849, eighty-three cases in all were sent to the Almshouse. Thirty-nine proved fatal. Of these all but one were colored people.
THE CITY WAS CLEANED UP.
Fearing that the typhus might become general, and in view of the fact that the city was threatened with an invasion of cholera, the physicians of the Almshouse, Drs. Buckler and Willis H. Baxley, gave notice to the public of the malignant character of the disease, and advised that the municipal regulations relating to cleanliness and public hygiene be rigidly enforced. In accordance with this recommendation all the lanes, alleys and byways were put in a thoroughly wholesome condition. The merchants had the wharves, then in a very filthy condition, cleansed and sprinkled with lime at their own expense. On the first of July the first case of cholera occurred at the Almshouse. It seems to have originated there, as did several other cases following in quick succession. In the meantime the Almshouse had been thoroughly cleansed. It was discovered by Dr. Buckler, however, that a cesspool had overflowed and was in a very filthy condition. Other sources of impurity were also discovered outside the north wall of the enclosure, and Dr. Buckler finally satisfied himself that a large space of ground "was one putrid and pestilential mass, capable of generating under the ardent rays of a midsummer sun the most poisonous and deadly exhalations.' Of the inmates of the Almshouse, 155 were attacked with cholera and 86 died. The proportion of deaths was much larger among the blacks than among the whites, a large number of the colored patients, however, had already been broken down by typhus. From the fact that while nearly one half of the male inmates were seized with cholera, more than four fifths of the opposite sex escaped, Dr. Buckler deduces the conclusion that this was precisely what might be expected if the malarial influence already alluded to exercised any control over the disease, for the men, having outdoor occupations, were most exposed to atmospheric influences. During the month of July, when the cholera prevailed, 76 persons eloped and 56 were discharged by the Board, most of whom went to the city to hide. In several instances they wera seized with cholera, and in this condition carried back to the Almshouse. These facts indicate that notwithstanding this constant and unrestricted intercourse, the disease confined itself to its favorite haunts. "It is fair to conclude." adds Dr. Buckler, *that but for the existence of the local impurities, cholera would never have visited the Almshouse." With the entire restoration of the establishment to a proper sanitary condition, the disease entirely ceased. The malaria acting probably as the strong predisposing cause of ill-health,”' says Dr. Buckler, *'exerted its influence by depressing the nervous system and lowering vitality, to as to interfere with a healthy performance of all the different functions. Thus predisposed, the inmates were rendered not only more susceptible to the imposition of morbid poisons, or to the action of any other exciting causes of disease, but at the same time their chances of recovery were greatly diminished, owing to the weakened state of their vital powers of resistance."
CLEANLINESS THE ONLY PREVENTIVE.
The appearance of epidemic cholera at the Almshouse gave a fresh impulse to the work of purification and induced a strict adherence to the sanitary measures previously adopted, so that all the avenues of the city were kept in the most perfect order. In accordance with Dr. Buckler's suggestion, committees of citizens were appointed in every ward to examine the premises connected with the various blocks of buildings and to see to the prompt removal of impurities. - The result was there were only four cases of cholera in the city, although it had been raging at the Almshouse. Mild cholerine, however, prevailed in almost every section of the city, showing that the cholera atmosphere pervaded this region. The conclusion, therefore, is inevitable that, to quote Dr. Buckler's words, " the immunity which Baltimore experienced in 1849 was owing entirely to the thorough purification which the city underwent in anticipation of the advent of cholera. Admitting the conclusion to be just, the inhabitants of Baltimore may enjoy the comfortable assurance that they have nothing to fear from future epidemics of this much-dreaded disease, provided they will see that judicious sanitary measures are properly carried out; but if they refuse to profit by their past experience, they must only expect to suffer a well-merited rebuke for their negligence." In other words, pure air, pure water and wholesome food, are the only conditions required to combat the disease. Baltimore's experience in 1849 has been the experience of communities all over the world. In .Europe the cities which have suffered most were in a filthy condition. At Naples and Toulon, where the epidemic raged most virulently, but little attention was paid to cleansing the streets. In Spain the disease has been prolonged because of the universal disregard of sanitary laws. Dr. Ferran, by inducing the people to believe that inoculation was an efficacious preventive, has done great harm by causing them to turn their attention- from the only real preventive — cleanliness. Dr. Koch's investigations have had a similar tendency. They have proved nothing, and on the other hand have encouraged persons to think that cholera can' be cured, and that sanitary precautions are comparatively useless. The germ theory of Koch is not a new thing, as it was partially investigated by Dr. Buckler and Dr. Christopher Johnson during the Almshouse epidemic in 1849,
VARIOUS CHOLERA THEORIES.
In his pamphlet under the heading "Theories Tested," Dr. Buckley says : "Before the removal of the nuisances (at the Alms House) the various cholera theories were tested as far as practicable. Saucers containing solutions of acetate of lead, nitrate of silver and other delicate re-agents were placed on the margin of the pond and at various other points back of the north wall, and numerous strips of chemically-pure paper wet with solutions of these salts were hung out at night over the different pools. Paper prepared with Sconbine'e solution of iodide of potassa and starch were also used to test the presence of ozone. Duplicate experiments were instituted in the city at the same time, but without any very satisfactory results in either of the trials, the changes which occurred being nearly alike at the two places.
"With a view of testing the cryptogamic and animalcular theories, plates of microscopic glass attached to threads by means of sealing-wax, were dipped in solutions of sugar, starch and gum acacia, and hung back of the north wall and in the cholera hospital. Other plates of glass were covered over with glycerine, remarkable for its property of remaining fluid for a long time .when exposed to the air, and these, like the former, were suspended in various places about the establishment. Sugar, and starch were selected because of the known tendency to vegetable germs to form on these compounds,and it was supposed if animalcula existed in the air, that some of these would of necessity be caught on the moist and tenacious glycerine. These. plates of glass having been thus treated, were carefully examined by Dr. Christopher Johnston, aided by powerful lenses, but he was unable to detect' the slightest trace of vegetable germe,animalcula or microscopic organisms of any sort.
NO CERTAIN CURE FOR CHOLERA.
The only true course, in Dr. Buckler's opinion, is to bend all energies to the prevention of the disease. When we get perfect sanitation, says Dr. Buckler, cholera will become a disease of the past. When there was universal ignorance and disregard of sanitary laws, and every city and town was a pig-sty, the black death, the plague and the sweating disease, which are now diseases of the past, ravaged many communities. Cholera will also become, like them, an obsolete disease if due regard is paid to sanitary laws. There is no certain cure for cholera, but it can be prevented, as was shown in Baltimore in 1849. Quarantine, Dr. Buckler thinks, is of no value if the city is in good sanitary condition. A number of cases might be brought here and they might die, but nobody would take the cholera. Dr. Buckler cays cholera is such a mysterious disease that it cannot be safely predicted whether it will or will not appear in this country next year. Baltimore, however, the Doctor stated, has nothing to fear if a rigid system of sanitation is enforced.
In view of the ravages of cholera abroad, the cleansing of the city cannot be begun too soon. Once cleaned, the city should be kept clean. As Dr. Buckler shows in his history of the almshouse epidemic in 1849, the thorough cleansing of the city of Baltimore in that year resulted in a marked decrease in zymotic diseases of all kinds, so that even if the cholera fails to come, any city will reap a sufficient return in the general benefit resulting from the scheme of the sanitation proposed.
|
|
