XXIII. WE RECOMMEND that local Boards of Health, and other persons interested, endeavor to ascertain, by exact observation, the effect of mill-ponds, and other collections or streams of water, and of their rise and fall, upon the health of the neighboring inhabitants. We have seen (pp. 73–76) that the question involved in this recommendation has had an historical interest; though it seems of late to be almost entirely forgotten. The streams at the waterfalls, in all parts of the Commonwealth, are obstructed in their courses for manufacturing purposes; and if cases of fever or other disease occur in the neighborhood, the people have generally attributed them to some uncontrollable agency; while possibly, perhaps, they may arise from causes which their own hands have created, and which are capable of removal. It is then a question of permanent interest and importance. If mill-ponds, or stagnant waters of any kind, or places where they have existed, produce disease under certain conditions, it should be known, and certain other conditions should be provided, under which they may be permitted without injury, and without which they should not be permitted at all. Theory, vague suggestion, presumptive assertion, cannot decide the question. It can be fully done only by an extensive series of exact observations, through several years, concerning the nature of the diseases, the external circumstances under which they occur, and the condition of the water, and of the places where water has been, in the neighborhood, truthfully made, uninfluenced by party or pecuniary interests, for no other purpose than to obtain the truth. The plan of observation stated in our XVIth recommendation might be adopted. And are not some hundreds of lives, supposed to be annually lost in this State for want of this information, worth our while to obtain it? XXIV. WE RECOMMEND that the local Boards of Health provide for periodical house-to-house visitation, for the prevention of epidemic diseases, and for other sanitary purposes. The approach of many epidemic diseases is often foreshadowed by some derangement in the general health; and, if properly attended to at that time, the fatal effects may be prevented. This is especially proper in regard to cholera and dysentery. The premonitory symptoms of cholera are seldom absent; and if these are seasonably observed and properly treated, the disease is controllable. There are few diseases over which curative measures have less, and few over which preventive measures have greater power. This well-known characteristic of the disease led persons in many places in England, during last year, to organize a system of house-to-house visitation, by which every family, sick or well, in a given district, was visited daily by some authorized person, whether invited or not; and every inmate who had the least symptom of the disease received advice and treatment. The objects aimed at were "1. The discovery and immediate treatment of every case of diarrhoea, in localities where cholera prevailed, and where the patients had not applied at the dispensaries, in order to prevent, as far as possible, the development of the disease. "2. To prevent persons who might not apply for medical aid, even in cholera, from dying without such aid. "3. To bring cases of cholera under treatment, at the earliest possible period of the disease. "4. To keep a constant medical inspection over affected districts and houses, so as to insure their being kept in a proper sanitary condition. "5. To exercise a moral agency over the population, by giving such instructions in regard to cleanliness, ventilation, and personal habits, as might appear needful, and by explaining and enforcing the necessity for immediate application to the dispensaries, or medical officers, by all parties who might be taken ill during the intervals between the daily visits." This measure was attended with eminent success, and was found to be one of the greatest economy as well as humanity. We select the following statement of its effects in one district, as an illustration of what occurred in many others : "In Sheffield, an effective body of medical officers have been appointed for the discovery of persons laboring under the premonitory symptoms of cholera, and for bringing such persons under immediate medical treatment. Besides an adequate staff of house-to-house visitors, numerous dispensaries have been opened in convenient parts of the town, for supplying all such persons gratuitously with proper medicine. Handbills have been extensively distributed, particularly among the most susceptible part of the population, giving them the necessary information respecting these dispensaries, and warning them of the danger of neglecting any degree of bowel complaint. Every person, on making application to a dispensary for a dose of medicine, on receiving the medicine, is required to give his name and address; this is forwarded at once to a medical officer, who visits the patient without delay. So thoroughly have the people in Sheffield had their attention directed to the symptoms which precede cholera, and so well do they understand and appreciate the information which has been given them, that it is stated that the house-to-house visitors scarcely ever meet with a case of diarrhoea which has not been attended by a medical man in consequence of their having previously applied at one of the dispensaries for a gratuitous dose of medicine. During the first week that this system of visitation has been in practice, the visitors discovered 1582 cases of premonitory diarrhoea, and on the second week, 1387; in all, in one fortnight, 2969. Out of this great number, only four deaths have occurred; but in parts of the town not under visitation, among the wealthier classes, attended by their own private medical friends, there have occurred seven deaths. In a rural district connected with Sheffield,—namely, Altercliffe,—not during this period under visitation, with 279 cases of diarrhoea, there were 23 cases of cholera, and 11 deaths. No stronger evidence can well be conceived of the efficiency of that preventive measure which is founded on the fact, which experience has too fully proved, that persons in general laboring under premonitory symptoms are not aware of their danger, and that, if those persons are to be saved, they must be sought out in their dwellings, and placed at once under proper treatment." The success which attended the measure in particular localities, led the Board of Health to issue, on the 1st of September, 1849, a general order for its introduction into London, and the result for the first 52 days, up to October 22, was as follows: Passed into cholera after treatment, Had it not been for these visitations, very many more of these cases would have terminated in cholera and death. What facts can more forcibly illustrate the utility of preventive measures? We earnestly commend the plan to every city and village in which cholera, dysentery, and other similar diseases, may appear as epidemics. The expenses which would attend its execution would be far less than result from the effects of the disease, when suffered to take its ordinary course under ordinary treatment. Small-pox, too, might in this manner be easily exterminated from any city.' XXV. WE recommend that measures be taken to ascertain the amount of sickness suffered in different localities; and among persons of different classes, professions, and occupations. Every person is liable to sickness. The extent of that liability, however, varies in different places and circumstances, and in the same place and circumstances in different ages and seasons. It has some, though not an exact, relation to mortal 1 Dr. Simon, the able Officer of Health for the city of London, issued, on the 21st of September, 1849, the following excellent instructions to the house-to-house visitors under his supervision, as to the manner in which they should perform their duties: "It will be his duty to visit every house in the district assigned to him by the ordinary medical officer of the locality, once each day, at the least; and, wherever several families inhabit one and the same house, it will be his duty at each visit to see one adult member at least, of every such family. "These visits should be made as early as possible in the day, and the severer cases of indisposition should be revisited in the afternoon, (or as early and as often as may be necessary,) in order to ascertain the result of the treatment adopted. "The medical duties of the visitor are restricted to the treatment of diarrhoea and other premonitory symptoms; so soon as any case shall have passed or shall appear to be on the point of passing into cholera, it shall be the visitor's duty immediately to transfer the case to the ordinary medical officer, and to take care that the latter officer be apprised thereof without delay. "The visitor shall be provided with medicines suitable to any emergency likely to fall within his observation; but in cases of no urgency he shall prescribe, and shall refer the patient to the depot of his district, where medicine may be procured. "The visitor shall take notes of the particulars specified in the tabular form with which he will be furnished, and at the close of each day's visitation he shall communicate this return to the ordinary medical officer with whom he acts, and shall receive that officer's directions for the next day's visitation. "The visitor shall insert in his return a notice of every locality where cleansing (either external or internal) shall appear requisite; and wherever he shall find the condition of a house irremediably bad, or the inhabitants so densely crowded as to endanger life, he shall make this the subject of a special report. "Especially he should impress on the persons with whom he communicates, the extreme danger of neglecting diarrhoea, and the necessity of obtaining medical advice as speedily as possible. "He should likewise explain to them the arrangements for medical relief which prevail in the district, and should see that they know the residence of the ordinary medical officer; so ity. Some diseases under some circumstances produce more sickness in proportion to the mortality than others. It has been supposed by Mr. Edmonds, an author entitled to credit, (Lancet, Vol. II, for 1839, p. 185,) that the average relation existing between the rate of sickness and the rate of mortality is two years of sickness to each death. "If ailments of a lighter kind are included, the proportion of sickness rises to 21 years to each death. Assuming two years to be the proportion of sickness to each death at every age, it will follow that the proportion of the living constantly sick at any age will always be double the proportion of the population of the same age dying in one year. If the deaths at any age are at the rate of 2 per cent., or 1 in 50 per annum, the proportion of the living constantly sick will be 4 per cent., or 1 in 25." There are several reasons why this subject should be fully and carefully investigated, and that exact facts in relation to different populations, existing under different circumstances, that, in case of any sudden seizure in the intervals of his own visitation, there may be no ignorance of the best course for procuring medical assistance. "All persons suffering with bowel complaint, however slight, or with sickness or other unusual ailment, are earnestly requested to procure immediate assistance, either from their ordinary medical advisers, or from the medical officer of the district, whose surgery will be open day and night, for dispensing all necessary medicines." The tabular forms alluded to are to contain the following particulars : Particulars of Household Visitation in the parish of Visitor, Mr. Medical Officer, Mr. Symptoms requir- Passed into cholera since last re port. |