It was surprising to observe how local and circumscribed the disease would be found under these circumstances. It would thus occasionally happen, that even the lee side of a ship might be alone infected, if the vessel had been sailing any length of time with a side wind.

I have observed the disease to stoop as it were, and pounce upon a single bell-tent in a large camp, leaving all the others perfectly unharmed; and in another striking instance, I have seen one side of a large barrack-room attacked, although not a single case occurred on the opposite side, which was equally crowded. The immunity of the uninfected side in the latter case, appeared to me to have been caused by the poisoned air having been blown over it through high windows, and deposited on the beds under the opposite wall.

From these observations it can be easily conceived that this ter rible atmospheric poison is mainly influenced in its course by the winds, and that any locality in which it unhappily might prevail should look for a storm or strong gale of wind as the most merciful of all providential visitations; for I believe that neither the heat nor the cold, the humidity or dryness of the air have the smallest influence in lessening its virulence.

If this theory should be true, it must follow that the worst localities are those in which the air is least circulated-such as narrow and crowded streets in low situations, enclosed courts, areas, cellars, &c., &c. These unwholesome places are unluckily the most densely populated; and the physical condition of the inhabitants, from a combination of various causes, is in the worst possible state to resist infection, or struggle against disease.

It is therefore too hastily assumed that the locality, or something about the locality, is capable of generating this peculiar poison; as if this state of things was new, and had not always existed even in a far worse degree than at present. The drainage is first accused as the teterrima causa, next that universal culprit the water, then the graveyards, slaughter-houses, shambles, and even many of our most useful manufactories; in short everything that produces a disagreeable smell. Nothing however appears to be more conclusively established than the fact, that smells are not noxious in proportion to their sensational offensiveness. On the contrary, there are good reasons for supposing that the agreeable fragrance of many perfumes, and in some cases the grateful odour of certain plants, become exciting causes of serious constitutional disturbance. For example, it is too well known that the pleasant scent of a new mown hayfield is far more injurious to many than the most noisome effluvium from a knackers' reeking slaughter house.

This is not simply a theoretical idea, supported by mere assertion. Let any person of ordinary acuteness of observation take a morning walk through that most elegant, spacious, and best stocked of all gardens, Covent Garden, he cannot help being struck with the generally pale and unhealthy aspect of its occupants, who sit enthroned in their airy and well-ventilated stalls, surrounded with

piles of delicious fruits and gorgeous bouquets of sweet-scented flowers. If he will then take the trouble to extend his walk only a little way further, and try to wend his way through the narrow, close, and offensive purlieus of Newport Market, those loathsome depots and receptacles of animal matter in all its stages of decomposition, he will probably be compelled to hold a handkerchief before his nose; but he will see, at the same time with astonishment, the rosy and chubby cheeks of the boisterous children who inconveniently obstruct his way, and the florid glow of rude health in the countenances of their robust parents. The most eloquent leaders in the most popular journals should not delude the public into the unjust impression that the useful trades of the butcher, skin-dresser, glue-maker, chandler, &c., &c., are more unhealthy occupations than those of the greengrocer, fruiterer, milliner, bouquet maker, &c., &c. The contrary is the actual fact.

When the sewage of London was discharged into the Thames, a short time ago, the stench from the river at low water was exceedingly offensive. This effluvium was almost intolerable, especially in the Houses of Parliament and the neighbourhood. The whole of the press was unanimous in its clamorous demand for the suppression of such an alarming public nuisance, and London was menaced day after day with a pestilence which never came. On the contrary, the health returns clearly proved that the metropolis was unusually free from epidemic disease on the occasion.

I would not, however, venture to intrude my humble interposition against the general voice of the press, and the laudable exertions of the authorities for the removal of local nuisances on sanitary grounds. This would be far from my desire, for I consider that these municipal exertions which are usually excited by a panic ought to be stimulated and encouraged by all means on such occasions.

My sole object, however, at present is to urge, with all the ear. nestness in my power, the paramount duty of providing beforehand for the immediate removal of decided cases of cholera from infected localities. The necessity for making such preparations is, in my opinion, of the most vital consequence, not only for the more favourable treatment of the patients themselves, but likewise for the absolute safety of the medical officers and their attendants. In furtherance of this object I would recommend that all cholera hospitals should be made ambulatory where possible, or at all events easily and expeditiously removable. For such a purpose nothing appears to me to be so easily procurable, and so thoroughly available, as a large canvas tent. This suggestion, which was submitted many years ago to the consideration of the head of the Military Medical Department, I am happy to hear has been since occasionally adopted with the most beneficial results. I must confess I looked with serious apprehension upon a former recommendation of the General Board of Health-viz., that a medical staff should be organised for the purpose

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of house-to-house visitation, and the local treatment of cholera cases. As well might they have recommended that medical men should be sent down into foul mines, with the senseless object of resuscitating the unfortunate creatures whom they might find there gasping in the agonies of choke-damp.

This unhappily was the arrangement, or rather want of arrangement, in the town of Sligo in 1832. No cholera hospitals were established, and the sick were all treated in their own houses. The consequences were appalling; most of the doctors, patients, and attendants were soon carried off, and that devoted town was rapidly decimated. I was, however, rejoiced at the authoritative recommendation of the Central Board for the early treatment of " premonitory symptoms." When the cholera visited this country a second time, I think in 1849, the 11th Hussars (of which regiment I was then the surgeon) were quartered at Hounslow. The disease prevailed to a great extent in the neighbourhood, and was alarmingly fatal in the town and surrounding villages. Our barracks at that time was most unfavourably circumstanced. Its construction was bad, its ventilation and drainage very defective, and it was in great part enclosed by a foul and stagnant ditch.

My principal efforts then were directed to arrest, if possible, the disease in its first symptoms. For this purpose every barrack-room was supplied with a bottle of an astringent medicine composed of the compound chalk mixture, catechu, and opium. This was given in charge to an intelligent non-commissioned officer, with orders to give a tablespoonful to every man who complained of the slightest premonitory symptoms, and even to repeat the dose, if necessary, before the man could be removed to the hospital.

This barrack-room self-treatment was attended with the happiest results, and was almost invariably successful.

Few of such cases even required admission into the cholera ward, still fewer assumed an alarming character, and none proved fatal. This is the arrangement which I would now venture to urge upon all local boards of health for general adoption. Let there be at once established convenient depôts for the immediate and gratuitous administration of this description of medicine, and appliances for the speedy removal of the decided cases, either of rich or poor, from the infected atmosphere in which they may happen to be immersed; and I feel confident that, under Providence, this dreaded visitation will become divested of much of its malignity, and much of its

terror.

The greater portion of this communication had been submitted years ago in the form of a special report to the Director-General of the Army Medical Department, and subsequently to the President of the College of Physicians. It is, therefore, in some degree, an official document. But I feel it a conscientious duty not to withhold it from the public on this occasion.

The treatment of spasmodic cholera in its advanced stages, for

obvious reasons, could not be introduced into this communication, nor discussed before a non-professional audience. But on this matter I may observe, that I believe no case of spasmodic cholera, even in its worst stage of collapse, should be looked upon as utterly hopeless,

I

CONTAMINATION OF AIR.

The Air of Houses and Workshops. General Views.
By R. ANGUS SMITH, Ph.D., F.R.S.

HAVE been desired to write a short paper on the state of the air in unventilated places, and in doing so I may say that I shall not attempt to make a collection of new facts, but place only a few already published in such a light before the meeting as may seem to fit best the purposes of this Association. Writing as I am on the sea coast, in one of a long line of houses stretching on both sides of the Firth of Clyde, scarcely interrupted except apparently in parts where some more fortunate proprietor possesses a larger share of the beautiful shore, I cannot come to the conclusion that fine air is an object of little value to my countrymen. And when we look at the coast of England and Wales, on the hills especially of the north and west, we find a population in such deep enjoyment of the pleasure of breathing pure air, and the delight it brings, that we may well inquire why an association that desires to teach the public should not attend to matters on which the public require less information. And yet it is right that we should give it attention, as there is still a great deal to be learnt.

When we leave our country and look over Europe we see there also a great movement of the best informed classes towards the seas, the mountains, the rivers, lakes and woods. Although the admiration of scenery is frequently the chief incentive to motion, it is no less true that the air is one of the chief objects of attention, even among those who travel only with the professed object of seeing; and it is the chief object of those who desire to be cured.

If men spend so much time and money on the pursuit of pure air, we might fairly conclude that they have done their best to obtain it perfectly pure at home. As a rule, men do a great deal to this end, but there are many difficulties in the way even of those who understand its value.

A friend tells me that when he was a boy he went to hear a sermon in a small house with low ceiling, such as is still well known in Scotland, but was much more common in our school days; the room was a mass of human beings, who could with their hands have touched, or nearly touched, the ceiling, and the few tallow candles which were burning began to grow dim, and at last to go out. It is

scarcely surprising that the hearers looked on this as a fit emblem of the darkness of the preacher's mind, and a reproof for attempting to preach without an education and a license. I am not aware that we can take a truer or a higher view of the subject. It was a sign of ignorance. The people went out, and the candles revived. We may wonder why such cases do not occur more frequently. If the rooms are tight, so as to prevent passage of air, the time when candles burn badly arrives very soon.

In a leaden chamber, which I constructed for experiments of the kind, there was far more room for each individual than in the cottage of the preacher alluded to, but the extinction of the candles became a very common thing. There was no entrance for air by the smallest holes. Our houses are full of chinks, and very fortunately so, although there are men who build so well that there is a difficulty in obtaining the proper supply of air. Such a room I was once called to see; it had no chimney, and the windows were made by a carpenter who did his work unfortunately well, for five people were found insensible, and one child was found dead. Are we to conclude from this that our houses ought to be badly built, and that huts are the healthiest spots when built with little or no mortar? No such conclusion would be permitted, however reasonable it might be. We are in a strong current towards improvement, and our houses will continue to be built better and better. Even if discomfort followed, we would insist on believing that if improvement has come to one department it will come also to another, and now we must await, not without impatience, that these dwellings which we have constructed shall be heated and ventilated in such a manner as shall contribute to our comfort and our health.

I am not inclined to go to extremes, nor even to go far, at least at present. I believe that a man who has large rooms not overcrowded has solved the problem for himself in a very satisfactory, although not yet perfect way; but unfortunately large rooms are not common, and in some parts of the country rooms seem to be growing smaller instead of larger, the rents having grown great, and the warming of large rooms having been found a difficulty. We are often much annoyed in a small room with an atmosphere which must be changed very frequently by opening the doors or the windows, no plan of ventilation has suggested itself as practical, especially in an old house and one on which it is not allowed to try experiments. In some houses, where the rooms are large, a condition of air is obtained little better than in the small, because the occupiers, determined to have the best lighting that can be obtained, burn too much gas, but in such cases the gas is often compelled at last to give way to the smaller lamp on the table. In such cases of great heating the air near the ceiling is very bad, hot, and sulphurous. The amount of carbonic acid has been found to be five times the amount out of doors. Even in other large and new houses no attempt to cure this evil is made. This is cured only by giving up the luxury of great gas lights.