3. Finally, gentlemen—in the probable anticipation that next year Cholera will prevail in London with at least its former severity, it may be claimed of my office, that I should say something with respect to personal precautions for avoidance of the disease. While most willing to place at your disposal any useful results of my practical experience in the matter, I cannot but feel the great difficulty of making general suggestions in a form really capable of particular application.
From the eminently local prevalence of the poison, it may be inferred that, for all whose circumstances allow an option in the matter, the first and most important precaution would consist in avoiding those localities where the epidemic is active. Our knowledge of the subject enables us confidently to say that, if in one spot the chance of being attacked by Cholera is as 1 to 100, in another it becomes 1 to 50, in a third 1 to 5, in a fourth almost an equal chance whether to be attacked or not. Nothing is gained towards security by the mere act of leaving our metropolitan area, if one resorts to some other place where the system of drainage is equally vicious, or where—as at our nearest bathing-place, the beach is made almost as offensive by sewage as here the river-banks.[86] From earlier statements in my Report, it will be obvious to you that the eligible sites of residence are those which stand high and dry, with clean effectual drainage of their soils and houses, conveying all organic refuse beyond range of the local atmosphere.
[86] Unless the sanitary improvement of Brighton be soon set about in earnest, the reputation for healthiness, which established its prosperity, will undergo a very sensible reverse. The natural advantages of the place are now almost neutralised by the evil adverted to in the text, and by other filthinesses of the kind.—J. S., 1854.
I will not pass this part of the subject without admitting that the course here suggested might involve a considerable desertion of particular localities, and a transient injury to their commerce. This unavoidable result of proclaiming the laws of the disease, I must regret in regard of its personal bearings. But the facts of the case are all-important for the public; and sanitary improvement will perhaps move more quickly in the country, when it is known that the pecuniary prosperity of places may suffer from their reputation for endemic disease.
In case of Cholera prevailing with severity in spots containing a dense poor population, great assistance would be given to medical and sanitary measures, if a number of empty unlet houses, healthily situated, were at the disposal of the authorities; into which, under proper regulations, they might induce certain of the poorest families to migrate for a time, as to places of refuge, till the disease should have subsided about their original dwellings.
For persons, whose circumstances or duties retain them unavoidably in the midst of those suffering districts where the poison is most active, the best counsel I can offer—even if at first hearing it seem vague—is, that they should be vigilant as to preserving the greatest possible soundness and vigour of general health; keeping the body, so far as may be, undisturbed by extremes of heat and cold, undepressed by long confinement, unfluttered by violent passions, unexhausted by physical or mental fatigue, untried by any excess or any privation; taking for diet a sufficiency of fit and nutritive food, rather in generous measure than otherwise, but far from the confines of intemperance; and giving meanwhile a prompt attention and cure to whatever accidental ailments may arise.
Such, in general language, are our best fortifications against the poison. It may be well, however, to add that in our metropolitan climate—perhaps everywhere else—the human frame tends to require some periodical aid from medicine. It may be the excitement and labour of London; it may be its atmosphere; it may be native peculiarity: but thus the fact stands—that there are few persons who do not at intervals require the re-establishing effects of what is called tonic treatment. Probably three-fourths of the prescriptions we write are aimed at this mere tendency to depression in the human body, as manifested in one form or another. Now, as a man, going on some distant voyage of exploration, submits his chronometer to a last intelligent scrutiny, before he exposes it to the ordeal of other climates, so, in this matter of frequenting infected districts, men will do prudently, before they pass into perils which may test their powers of resistance, to see that they carry about with them no enfeeblement or disrepair which a short submission to medical discipline could effectually remove. For with epidemic poisons generally, and in a marked degree with Asiatic Cholera, it seems that all states of languor, depression, and debility enhance the risk of infection.[87]
[87] For my medical readers, I may suggest that perhaps the daily use of sulphate of quinine, in small doses, during the height of the epidemic, would seem to deserve trial as a prophylactic; subject, of course, to what each practitioner is best able to estimate—of personal peculiarity in the patient, forbidding the use of this drug.—J. S., 1854.
Beyond these general cautions, there is yet one which requires very particular mention.
In respect of the commencement and predispositions of the disease, it is now well known—first, that in this country it habitually begins with diarrhœa of a painless and apparently trivial character; secondly, that diarrhœa, however produced, is, of all known personal conditions, the one most likely to invite an attack of Cholera at times when that disease is epidemic; thirdly, that during the prevalence of Cholera, side by side with it in a district, there is always a vast amount of epidemic diarrhœa, apparently constituting slighter degrees or earlier stages of the same disease; that this condition is just as amenable to treatment as the confirmed collapse of Cholera is utterly the opposite; and—since we can never say how incurable a few hours may render this insidious symptom, that its immediate arrest is a consideration of vital importance.