Eight medical students were attached to the establishment, of whom four occupied apartments with a northern exposure, and four were lodged in rooms with a southern exposure. The four whose rooms were exposed to the north were attacked, the four whose rooms were not thus exposed escaped.
The manager, also, who slept in a room above that of the students looking to the north, was attacked: his family, whose rooms looked to the south, escaped.
Men, after some difficulty and delay, were employed to remove the filth and drain the ravine, the whole surface of which, after having been thoroughly cleansed by a stream of water, was thickly covered with lime, over which was put a deep stratum of earth. The men employed in this work were attacked with cholera, as were some of the several inmates of the almshouse who had been dispersed throughout Baltimore, but the disease did not spread to any other persons in the city. From the 25th of July, the day on which the drainage was completed, the disease suddenly declined from 11 the day previous, to 3, and, by the 9th of August, had entirely disappeared.
In the case of Baltimore, and the Baltimore almshouse, a neglected spot was severely visited by the pestilence, while, by well-directed exertion, an entire city escaped. In our own country an instance has lately occurred (1854) in which, by similar exertion, a particular spot escaped, while a populous town was devastated by the plague.
No town in Great Britain has ever been so severely visited by cholera as Newcastle, yet the garrison of Newcastle has wholly escaped.
The barracks in which the garrison of Newcastle is quartered are situated about three-quarters of a mile from the centre of the town. In houses at distances varying from 20 to 200 yards of the barrack gates, numerous deaths from cholera took place, and in a village 250 yards from the barracks the pestilence prevailed to a frightful extent for many days, numbering one or more victims in almost every cottage.
On the outbreak of the pestilence in the town, the medical officers of the garrison, with the sanction and assistance of their superior officers, exerted themselves with great promptitude and energy to carry into effect all the means at their command, calculated to lessen the severity of an attack from which they could not hope altogether to escape. The sewers, drains, privies, and ashpits were thoroughly cleansed; all accumulations of filth were removed; the spots where such filth had been collected were purified; the freest possible ventilation was established day and night in living and sleeping rooms; overcrowding was guarded against; the diet of the residents was, as far as practicable, regulated; the men were strictly confined to barracks after evening roll-call, and were forbidden to go into the low and infected parts of the town; amusements were encouraged in the vicinity of the barracks; every endeavour was made to procure a cheerful compliance with the requirements insisted on, without exciting fear; and there was a medical inspection of the men twice, and of the women and children, once daily.
The influence of the epidemic poison upon the troops was demonstrated by the fact that among 519 persons, the total strength of the garrison, there were 451 cases of premonitory diarrhœa, of which 421 were among the 391 men, irrespective of the officers, women, and children, the attacks being in some instances obstinate, and recurring more than once. Yet such was the success of the judicious measures which had been adopted, that no case of cholera occurred within the barracks during the whole period of the epidemic; and every case of diarrhœa was stopped from passing on to the developed stage of the disease: while in Newcastle there were upwards of 4000 attacks, and 1543 deaths.[[31]]
[31]. Results of Sanitary Improvement by Dr Southwood Smith, 1854.