Anything, in food or regimen, that irritates the bowels predisposes to cholera. So does fatigue or violent exercise. Reduction of the temperature of the body by exposure to night air or by excessive bathing has the same effect.
But the most powerful of all predisposing causes are moral: fear, depressing dread PANIC! We should strive against this in every way. And we shall be most likely to avoid panic this summer if we now faithfully employ every means to ward off the disease we dread.
III.
From a study of the history and the predisposing causes of the cholera, we turn to the practical questions: How may we ward off the disease? Or how, if it come among us, may we circumscribe its extent and moderate its malignity?
Preventive measures may be collective, undertaken by the state, for the common goods; or individual, set on foot by individuals, or single families, for their own benefit.
QUARANTINE. Do its advantages compensate for the inconveniences and sufferings to individuals, and the great losses, by restrictions on commerce, which it involves?
It is not known that quarantine regulations have ever protected any community during the entire course of any epidemic. Yet, on the other hand, there is abundant evidence that a strict quarantine has interposed, for a time at least, an effectual bar to the advance of the disease, thus postponing its visitations, though it could not prevent them. To all who properly value human life above convenience in journeying and the uninterrupted flow of trade, this fact is a sufficient argument in favor of a strict quarantine.
Indirectly, a quarantine may operate for goods or for evil. For good, if, while it postpones the invasion of cholera for three or six months, it nevertheless warns us to prepare for its inevitable coming. For evil, if, by its temporary success in staying the pestilence, it deludes us into fancying that the destroyer will pass us by, and that we need take no care to set our houses and cities in order against his coming. For, it is probable that, by the aid of a rigid quarantine, we gain the advantage of ample warning and of time to adopt the necessary hygienic measures for mitigating the severity and circumscribing the extent of the disease.
The chief of these measures is the removal of decaying organic matter from our houses and neighborhood. Epidemics of cholera have been very aptly called “Providential admonitions to `clean up.'” They come with the graduated severity characteristic of Providential warnings. We see them far off. Their approach is gradual. At last they come to our doors; and there their advance is stayed for a time by change of season or by our quarantine. During all this time, if we have understood the warning, we may have been diligently removing from our midst the predisposing causes of the diseases. In proportion to our promptiness in taking warning, and to our diligent faithfulness in preparing, will be the gentleness of the final visitation. When, last June, we heard of cholera in Egypt, we should have begun to clean our city. Now that it has knocked at out doors, we have still, in all likelihood, some weeks in which to make ready.
Of course, our streets must be cleaned. And means should be taken to prevent garbage, being thrown into the streets. Many families throw refuse into the streets, through ignorance and carelessness. A friendly word in explanation of the bad consequences that result from it would be more effective in preventing it than a city ordinance. Every citizen may make it his duty to make such representations and expostulations to his delinquent neighbours. In so doing he will subserve his own interests.
But the greater part of the bad air of our houses comes from cess-pools and sewers. Cess-pools and privy-vaults should be emptied and cleansed during the cold winter months. Drains leading from houses to cess-pools or sewers should be carefully cleared, and all traps in such drains or in soil-pipes should be opened and cleansed. It will be found in many instances, that traps in waste and soil pipes, and under kitchen-sinks, although they allow water to pass, are, nevertheless, often clogged with considerable quantities of most offensive matter.
DRAINAGE. Many houses in New-York and its suburbs stand upon “made ground,” which is not properly drained. The cellars and surrounding grounds are damp. Such localities should, if possible, be well drained. If this be impossible, the cellars and lower stories must be kept thoroughly ventilated, and the walls and cellar floors frequently whitewashed, to destroy the fungi which dampness and confined air develop. It must not be forgotten that ventilation requires provision for both the entrance and egress of currents of air.
VENTILATION. Wherever air stagnates, whether in cellars or elsewhere in houses, there dampness collects, and the lower forms of vegetation develop, and an atmosphere results which predisposes to disease. In apartments which are constantly occupied by human beings, the exhalations accumulate upon the walls and taint the atmosphere. Frequent applications of white-wash and abundant ventilation are suitable correctives. These remarks apply to all of our residences, and not merely to tenement houses and outbuildings.
DRINKING-WATER is often made impure by decaying vegetable or animal matters, and is then a fruitful source of disease. Wells dug near privies or cess-pools, or near which drains are laid, should always be examined with reference to this fact.
From some of the dangers thus far enumerated the residents of New-York are exempt. But, to a greater extent than most other people, they are endangered by
UNVENTILATED SEWERS. The sewers receive the refuse from our houses. If the sewers were properly constructed, this refuse would never stagnate in them. But even so, decomposition of organic matter must continually go on in them, evolving noxious gases. To prevent these gases from flowing back into the houses through the waste and soil pipes, stench-traps are placed in these pipes. They consist of an elbow formed in the pipe, and in which water remains, constituting a barrier to the backward flow of the gases. But this is an effective barrier only so long as the gases are subjected to no upward pressure. If the gases be subjected to such pressure, they bubble up through the water in the trap, and pass into the house through the outlets of bath-tubs, wash-basins, and closets.
Now, it is notorious that in but few of the sewers of New York is the flow of matter unimpeded. No provision is made for the outlet of gases from the sewers. The gases accumulate, and, by this accumulation and by the heat evolved in their generation, they become subjected to pressure. They bubble up through the stench-trap, and pervade the house. Thus.
OUR HOUSES VENTILATE OUR SEWERS! Our refuse is discharged into the sewers, only that it may there be converted into poisonous gases, and be received again, in that form, into our houses. The more completely, under these circumstances, a house is provided with the “modern conveniences,” the more deadly a habitation it is! There are houses in Fifth avenue and in Twenty-third street which have illustrated these facts by the sad experience of their inmates.
In many houses there are, besides the main stench-trap already described, secondary traps under each basin, closet, or sink. In these cases, the portion of pipe intervening between the main and the secondary traps becomes a “closed chamber,” in which the poisonous gases forced up from the sewer are confined. Any increase of temperature, even the varying heat of the house, will expand these gases, and cause them to bubble up through the secondary traps, and into the house, as before.
These most serious dangers may be obviated by ventilating the sewers or the water-pipes. The latter can be done for himself by every householder. It is only necessary to connect with his waste or soil pipe, just below the uppermost trap, a small pipe, which shall be led up through the roof, and shall open into the atmosphere, allowing the gases to escape. This will prevent any pressure of gas below the traps. Personal observation and experience have convinced us of the great value of this ventilation of waste-pipes. On a large scale, ventilation of sewers in English towns has reduced the mortality from typhus to one-half its former amount.
It should be noted that, as may of the predisposing causes of cholera are the same as those of typhus and of diphtheria, so preventives of the former are also preventives of the latter hardly less deadly maladies.
It is question of practical importance whether, in case it has been impossible to empty and clean cess-pools and vaults before the appearance of cholera, it would be safe to do so after the disease has begun to prevail. We think not. It would be better not to disturb the accumulation of organic matter. But we may intercept the gases which arise from these collections, and may hold them, employing for this purpose a mixture of substances which chemically unite with the gases and substances which mechanically absorb them; as, for example, a mixture of equal parts of ground plaster and of pulverized charcoal (or coal ashes) with the addition of one-eight part of copperas (sulphate of iron). This should be spread upon the surface of the contents of the cesspool or privy-vault.
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.