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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:

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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.1

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

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 bis 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

Street.

Number.

Floor.

Sex.

Summary of Household Visitation in the City.

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 2 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.

Age.

should be known. We shall allude to two principal ones only:

1. It would subserve a pecuniary purpose. The wealth of a country consists in its capacity for labor. That people who enjoy the greatest vital force,-the highest degree of health,— and apply it most skilfully to the production of wealth, are the most wealthy. It is their capital, their means of subsistence. Persons who sustain a low vitality only, generally have little skill to apply what they possess, contribute little or nothing to the general welfare, and may, and often actually do, become a public burden. This is one view. Another presents itself in the vast number of associations existing, under the names of Friendly Societies, Health Insurance Companies, Odd Fellows, and other titles, the object of which is, directly or indirectly, by the payment of a certain sum, to secure support to the members during the contingency of sickness. For the stability of these societies, and the security of the members themselves, it is necessary that the rate of sickness under different circumstances should be definitely ascertained. So long as it is not known, no just rates of payment can be established. Some of the Health Insurance Companies in this State have closed their business, because they have had to pay out more than they received. Some lodges of Odd Fellows have also been obliged to curtail their payments. All these institutions are now groping in the dark in regard to these matters, and many of them, it is believed, cannot exist under the rates of payment proposed to be made. A misapprehension of the principles on which they should have been founded and managed, is a principal cause of their failure. Health insurance might be so managed as to be a legitimate business, of a useful character.

2. It would subserve a sanitary purpose, and show the exact condition of the people. Some interesting facts on this subject are already known. The Manchester Statistical Society have given the average number of days of sickness annually suffered by each of the operatives engaged in various branches of industry, from which it appears that, in the Staffordshire potteries, under the age of 60, it is 9.03 days; in the silk mills, 7.08 days; in the woolen mills, 7.08 days; in the

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