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GENERAL BOARD OF HEALTH.
MEDICAL COUNCIL.
REPORTOF
THE MEDICAL COUNCIL
TO
THE RIGHT RON. SIR BENJAMIN HALL, BARrr., M.P.,President of the General Board oj Health, ~c. ~c. ~·c.,
IN RET.A'fION TO
THE OI-IOLERA-EPIDEMIO OF 1854.
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LONDON:PRINTED BY GEORGE E. EYRE .AND WtLLIA'M SPOTTISWOODE,
PRINTERS TO THE QUEEN'S 
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GENERAL REPORTOF
'THE JVlEDICAL COUNCIL.
To the Right Hon. Sir BENJAMIN HALL, Bart., M.P.,President of the General Board of Health.
SIR,IN presenting om Report of inquiries conducted under
your sanction into the COUl'~eand phenomena of the lateEpidemic of Cholera, the Medical Council may be allowed toexpress their satisfaction at Science having at length beenrecognised by the State as the ally of civil jurisprudence,and as the guide to a more enlightened code of medicalpolice. They trust that this propitious movement may beregarded as the inauguration of a system ultimately destinedto carry its ameliorating influence through all the ramifi-cations of our sanitary institutions; and that the presentfragmentary and imperfect application of medical know-ledge in several departments of. the State, may give placeto a complete and comprehensive system, under the soledirection and control of one central department.
From the multifarious character of the objects embraced bythis wide inquiry, it was found expedient to distribute theminto several classes, and to entrust the examination of eachclass to a special section of the Council.
Of such special sections of the Medical Council, therewere three: one, constituted to report on such scientificinquiries as it had seemed expedient to institute; a second,to digest from the general mass of contributed material what-ever facts could illustrate the relative advantages of rivalmethods rif treatment; a third, to invite from the cultivatorsof science in foreign. couaitries any information which couldbe given as to the results of their kindred investigations."
* The members of the three Committees wore respectively as follows:CO;\IMIT1.'EEFOR SCIENTU'IC mQuIRIEs.-Dr. Amott, Dr. Baly, Dr. Fan,
My. Owen, Mr. Simon.Tm;;AThlENT OmlMI'l"l'EE.-Dr. Alderson, Dr. Babington, Dr. Paris,
Dr. Tweedie, Mr. ""T~tl'c1.OmDI1'l'TEl!1 FOR FOREIGNCOlumSl'OXDENm:.-Dl'. Babington, Mr. Bacot,
Sir In.rnesClurk,l\Il'. Lawrence.A 2
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As it was the paramount object of the Council to col-lect from members of their profession all the facts whichmedical observation and experience could afford; so wasit their first duty to frame such a formula of instructions asmight secure amplitude, accuracy, and technical uniformityin the returns they were thus desirous to obtain; and whenwe consider the crushing pressure under which om: medicalbrethren laboured during the ravages of this fearful epidemic,too much praise cannot be accorded to them for the alacrityand goodwill with which they responded to the call.
In adverting to the results respectively obtained by thethree Committees of their body, the Council must firstexpress regret that their Committee for Foreign Correspon-dence have not been successful in their endeavours to elicitsatisfactory information; but it may be justly pleaded thatdifficulties of no ordinary kind embarrassed all our inquiries,which no amount of zeal and diligence could overcome. Itwill be remembered that the Medical Council was not calledinto existence until the epidemic had all-cady passed its cul-minating point i the way had not been sufficiently clearedby preliminary inquiries, and the prospective path of inves-tigation had notbeen traced or enlightened by any scientificpioneers.
The Scientific Committee have collected some valuableinformation with regard to the past epidemics, and muchmore as a guide to future inquiry. This is more especiallythe case with respect to the impure condition of' the Lon-don atmosphere, and its capability of influencing the inten-sity of an epidemic; to the foul state of the Thames, andits share in rendering the atmosphere impure; and to thefarther intimate connexion between cholera and local sani-tary defec·ts. An inquiry still pending, but nearly completed,will, it is believed, show an equally close relation betweenthe epidemic and the impurity of the water used as abeverage.
The various sources of atmospheric impurity are too wellknown to require enumeration, but there is one which, onaccount of' its paramount importance, cannot he passed overwithout comment, viz., the present system of sewers. TheMedical Council do not presume to judge of the merits ofconflicting systems, 01' to decide which best fulfils certaintheoretical conditions for the conveyance of a given volume offluid; but they confidently assert that the existing sewers oftenfail in a~coll1plishing their main obje?~. Instead of carrying offalmost inodorously the excrementitious and refuse matters
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of the population, they evolve offensive effluvia, provokinggeneral and grave complaint; and it is a fact worthy ofremark, that the intensity of this nuisance is greatly aggra-vated in certain parts of the metropolis by obstructions towhich their drainage is subject by reason of its outfall into atidal river. The reckless disturbance of the contents ofsewers, and their exposure all an extended surface, moreespecially pending an epidemic, is a practice which the Medi-cal Council feel it necessary to reprobate.
The Scientific Committee lay great stress upon thatsource of impurity which results within dwellings from over-crowding the inhabitants, from defects of drainage, and fromwant of cleanliness and ventilation; and they deem it indis-pensable for the protection of the poor that the local authori-ties should vigilantly exercise the powers committed to themfor preventing SUC}l evils. The good effects of sanitary im-provements have, been strikingly exemplified in the modellodging-houses, and in public baths and wash-houses. Theestablishment of burial-places beyond the boundaries of themetropolis is another circumstance of prime importance,and the relief thus afforded to overcrowded churchyards will,no doubt, be regarded by the future historian as one of thegreatest improvements in the nineteenth century.
The Metropolis Local Management Bill, introduced byyourself, and already sanctioned by'one branch of the Legis-lature, isa subject of sincere congratulation, since it promisesefficient sanitary government for the metropolis; and it isto be devoutly hoped that similar measures, equally neededfor the whole country, will speedily follow. All theseconsiderations are forcibly pressed upon us by the probabilitythat epidemics of cholera may be frequent, if they do notactually become persistent; as we are fearfully remindedthat the interval between the epidemics of 1831-2 and thatof 18<18-9 was 17 years, whereas the late epidemic followedthe second after an interval only of five years.
Nor are such measures to be regarded merely as safe-guards against the invasion of cholera; they are equallyapplicable, and not less effective, against the spread of otherepidemics, such as the varieties of continued fever and scar-latina, which have been lately stated by the College ofPhysicians to be far more destructive to human life thaneven the periodical scourge of cholera.
The Scientific: Committee have taken pains to investigatethe possible relations subsisting between the! outbreaks of'cholera and certain meteorological conditi0IMr. Glaisher's
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elaborate report will be studied with great interest. If in asubject so obscured by inappreciable influences he has notsucceeded in arriving at absolute demonstration, he has gonevery far to establish high probabilities, which future obser-vation may raise into certainties. And, here again let usremark, that his admirable system of observations could notbe fully ovganized un til the epidemic had already attained itsclimax. ~ He has, ",1,,10w@Vel',shown, that during the threeepidemics there has existed a great predominance of calm,rendering the season defective ill those atmospheric changes'which renew the purity of the air, and, at the same time, anundue height of the barometer, operating against vaporousdiffusion; and further, a great excess in the temperature ofthe Thames at night, as compared with that of the superin-cumbent atmosphere, giving rise to nocturnal clouds of vapour,which are necessarily charged with impurities derived fromthe foul contents of the river. The great principle whichwas first laid down in Dr. Fan's Report to the RegistrarGeneral respecting the relative immunity enjoyed at par-ticular altitudes may be connected with this new link ofevidence. Mr. Glaisher has clearly shown that in the low-lying districts, wherein the epidemic assumed its highest.malignity, the ail' was stagnant, and moisture. impregnatedwith impurities, was especially induced to hover.
Special examinations of the atmosphere were conducted byDr. Thomson and Mr. Rainey, but their results possess littlemore than a negative interest, since they failed to discoveran y new or significant element of all organic or inorganicnature, as a possible agent in the causation of cholera.
The chemical and microscopical inquiries into the water-supply of houses and districts suffering from cholera havebeen investigated by Dr. Thomson and Dr. Hassall, and theresults are embodied in the Report of the Scientific Committee;and as the period is now at hand when the water companieswill be required to have their sources of supply amended, the'Medical Council state that the facts before them show thenecessity of a stringent enforcement of the provisions of theMetropolis Water Act, and of an inquiry as to how far theseprovisions are adequate to insure the purity and wholesome-ness of the water supplied to the public. For the abolitionof cesspools-in itself 11 sanitary advantage-i--has indirectlyled to another evi1. The excrements of the population arenow to a great extent poured into the Thames; and, asmight have been expected, our chemical and microscopicalinquirers concur il1 stating' that ~~'~cySof tht~ abominable
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filth are found by them in the drinking-water supplied to alarge part of the population,
The extraordinary irruption of cholera in the Soho districtwhich was carefully examined by' Mr. Fraser, Mr. Hughes]and Mr. Ludlow, cloes not appeal' to afford allY exception togeneralizations respecting local states of uncleanliness, over-crowding, and imperfect ventilation. The suddenness of theoutbreak, its immediate climax, and short duration, all pointto some atmospheric or other widely-diffused agent still to bediscovered, and forbid the assumption, in this instance, ofn.ny communication of the disease from person to person,either by infection 01' by contamination of water with theexcretions of the sick.
In undertaking the pathology of the disease the Committeefor Scientific Inquiries laboured under the disadvantage towhich we have frequently adverted-the delay of all inquiryuntil the epidemic had already passed a c1imax; for, as theJrjustly remark, "in order to obtain large results, it is mostdesirable that such inquiry should be commenced at an earlyperiod of the epidemic, and that, moreover, it should to someextent be continued in the absence of the disease which theyaim at elucidating." Forms of instruction were, however, asspeedily as possible prepared for circulation in order to obtainreturns as to the stages of the disease, its duration, fatality,and relative frequency. A considerable amount of informa-tion was thus collected, and will be found embodied in atabular form.
The duties of the Treatmen: Committee consisted, in thefirst place, in the invention of a mode by which the individualexperience of practitioners might he brought under one com-prehensive view, and thus has the science of statistics, for thefirst time, been applied on a large scale to medical treatment,The degree of faith which may be accorded to the inferencesdeduced hy this method has been evidenced by the corrobo-rative results of several separate sets of returns, or variousmaterials separately worked, which have displayed corre-sponding' results. The difficulty of devising a mode ofextracting statistical facts {i.om voluminous returns suffi-ciently shows that the work ought only to be considered as inthe progress of development; and the same considerationjustifies a belief that the farther prosecution of the inquiry,aided by the experience now gained, may carry it forwardtowards a far greater state of perfection, and elucidate truthsOf still greater' value, -
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The facts elicited relate chiefly to the absolute inutility orrelative inefficiency of certain classes of medicines and. mea-sures, thus clearing away valueless modes of treatment andredeeming from idle waste the few short and. hurried, butprecious, moments during which succour may be available,and securing that brief interval for the use of more promisingmeans, or for others which are yet fairly open for judiciousex?,eriment.
I'here is one feature in this inquiry to which the Treat-ment Committee direct particular attention. It appeared tothem that a most interesting line of investigation, promisingvaluable and instructive practical -results, was opened bytracing the success of certain modes of treatment underwhich, according to their analysis of the evidence, the stageof collapse was avoided, and the far less dangerous alterna-tive of consecutive fever was accepted.
It is much to be desired that a more' extended body ofevidence should be accumulated on this important topic, towhich a scrupulously careful analysis should be applied.The prospect of discovering truths of high practical impor-tance by this investigation is enhanced by the statement ofcertain corroborative facts enunciated in the Report of theScientific Committee.
Statistical Tables are appended to the Report of theScientific Committee, to which the Council desire to directespecial attention, as they exhibit a compendious summaryof the extent of the epidemic, its duration, its comparativemortality in different districts, and at different ages.
In concluding our Report, and thus bringing the duties ofthe Medical Council to a termination, we most earnestly, butrespectfully, urge upon the Government the paramount im-portance of pursuing with unabated diligence that path ofinvestigation which Science sanctions, and into which thecircumstances of the late epidemics had directed andguided us.
That which has been so repeatedly and wisely urgedregarding the removal of accumulating filth, and the correc-tion of nuisances, during intervals comparatively free fromdisease, may be pleaded with equal truth as to the necessityof an uninterrupted continuance of scientific inquiries duirngthe same seasons of immunity, from which alone can wereasonably expect to obtain the requisite data for a truetheory of the causes, or a wise plan for the cure of any futureepidemic.
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From regarding the future necessity for continued and com-petent investigation, the Council gratefully recur to the assist-ance they have received under your presidency. Themembers cannot separate without recording the deep sensethey entertain of the kindness and courteous attention withwhich, on all occasions, you have been pleased to accepttheir suggestions; nor can they refrain from expressing theirregret that political changes are removing you from an officewith which yOUl' name will remain identified, and from theadministration of laws which you have given so much painsto establish.
JOHN AYRTON PAIUS,Chairman.
General Board of Health,July 26, 1855 .
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