HOW TO PREVENT AND OPPOSE THE CHOLER&jgNHH^ PLAIN INSTRUCTIONS" FOR HEADS OF FAMILIES AND OTHERS, ISSUED BY THE NATIONAL HEALTH SOCIETY. Chairman : Ernest Hart, Esq. Secretary : F. Lankester. Offices : 44, Berners Street, Oxford Street, W. 1. Everyone can help. — The recent appearance of Cholera in some French towns, and the possibility that before long it may be imported into this country, make it desirable that some plain facts about the disease, and the way in which it spreads, should be generally known and understood. Although outbreaks of Cholera have of late years been rare in England, it is necessary to remember that this disease may at any moment appear amongst us. The only way of fighting against it with success is to destroy its breeding places. The spread of 2 Cholera is due to filth, and to drinking water or milk not absolutely pure and free from all pollution. Cleanliness of every kind is therefore the great safeguard against the coming of the disease, and against catching it if it comes. It is within the power of every householder to give valuable help in preventing the spread of Cholera, just as it is in his power, by neglecting to look after his own house, to endanger not only his own life, but also the lives of his neighbours. 2. Accumulations of Filth. —It behoves every householder to guard against all accumulations of dirt within or near his house ; against any possible access of filth to his food or drink ; against all foul smells, from whatever cause ; and against impurity of air. No refuse must be allowed to lie in the yard or elsewhere. The dustbin must be properly covered so as to keep the contents dry, and must be regularly cleared out every second or third day. All animal and vegetable refuse should be burnt in the kitchen fire. All slops and liquid refuse should be poured down a gulley outside the house. 3. Sinks and Drains. — The waste pipe from the sink should be trapped close to the sink ; and should not lead quite into the drain, but pass through the wall and discharge in the open air outside, over a trapped gulley communicating with the 3 drain. The sink should be well flushed with clean water at least once a day. All gutters, gulleys, and drains should be kept clean and clear, and well sluiced down daily with water. The water closet must have a plentiful supply of water, and be kept scrupulously clean. The pan must be well flushed after each time of using. Where a midden or pail privy or an earth closet is in use, the contents should be removed as often as possible, and the receptacle thoroughly washed out with a solution of sulphate of iron {green vitriol). It is of the utmost consequence to avoid all foul smells, as from closets, sinks, drains, and the like. It should be remembered that closets, sinks, and drains, if not properly constructed and kept clean (and they are very commonly not healthily made or often enough cleaned), will allow foul air to come up by the same channel that water goes down. If therefore you are in any doubt, or if the sinks or drains are in want of water or allow any smel] to come up, go to the Inspector of Nuisances (whose .address will be found on page 8) and ask him to see to it. 4. Water-supply. — The cistern should be covered, and not placed in a dwelling-room. The overflow pipe must not lead directly to the drain, but should discharge in the open air. There musf 4 be a separate cistern for the supply of the water closet. All cisterns should be thoroughly cleaned out at frequent intervals. No water should be drunk which comes out of a dirty cistern or butt, or which has been standing near a closet or sink, or which is turbid or discoloured. It is well to filter water before drinking it ; or, preferably, to boil it. When Cholera has actually appeared in the country all water should certainly be boiled. Drinking water from surfacewells or pumps, or from rivers or ponds, into which sewage finds its way in however small quantity, i& a main cause of the spread of Cholera. 5. House and Premises. — Areas, pavements, yards, and passages must be kept clean, and no standing pools of water must be allowed. Floors also must be frequently cleansed ; ceilings and walls whitewashed, or, if papered, dusted down frequently. All windows and doors should be kept open for several hours daily, and all ' closeness ' avoided. 6. Eating and Drinking. — Moderation in eating and drinking, and care in the choice of food, are most important. Stale, unsound, or unripe fruit or vegetables must on no account be eaten. Tainted fish, meat, sausages, etc., are most dangerous. Sour or tainted milk must be avoided, and in any case it is well to boil the milk. If pure 5 fresh milk cannot be obtained, the condensed milk is a good substitute. 7. Cleanliness and Clothing.— Great at- tention should be paid to personal cleanliness and clothing. The whole body should be sponged or washed daily with cold or tepid soap and water. Flannel should be worn next the skin over the whole body, to avoid chill. Sudden checks to perspiration and over-fatigue should be carefully avoided. The earliest symptom of Cholera is looseness of the bowels ; and when Cholera is about, the lightest attack of Diarrhoea must be attended to at once. Should a case of Cholera appear in your house or amongst your family, the following precautions should be observed : 8. Treatment Of Patient. — On the appearance of the first symptoms, the patient should be kept in a separate room, from which all needless articles of furniture have been removed. A person should be set apart to attend to him, and everyone else should be turned out of the room. It is best not to attempt to give any medicine to the patient ; 6 'but he should be kept lying down in bed. Instant information of the case should be sent to the Medical Officer of Health at the address given on the last page, and medical advice should also be sought without any delay. 9. Precautions in the Sick-Room.— All discharges from the stomach and bowels of the patient are highly dangerous and tend to spread the disease. They should be immediately received into a vessel containing a solution of sulphate of iron (green vitriol), of the strength of one ounce to a pint of water. Disinfectants, with instructions for their use, will be readily supplied on application to the Sanitary Inspector, whose address is given on the last page ; but it is well to keep on the premises a solution of a quarter of a pint of liquid carbolic acid to one gallon of water, and use this for all purposes of disinfection described below, such as washing of hands, receiving soiled clothing, scrubbing of floors, and the like. Wherever the discharges of -a patient, from stomach or bowels, have touched the floor, wall, or furniture, the place or article must be immediately washed and scrubbed with the disinfecting solution. Rags should be used in preference to handkerchiefs for wiping away the discharges from the nose ,and mouth of the patient, and all such rags should 7 be at once burnt. The body-linen and bed-linen of the patient should be changed as soon as soiled, and placed in a pan in which a solution of some disinfectant has been placed. No articles should be sent out to the wash without having been previously boiled. If too bulky for this, application must be made to the Sanitary Inspector for their disinfection in a proper disinfecting chamber. The attendant should be careful to wash his or her hands frequently in water containing carbolic acid solution, and always before taking any food. 10. Caution against Pania— lf Cholera should unhappily reach England and become prevalent in our midst, it is important for everyone to remember that he is responsible for doing his share in warding off the common enemy. If the enemy arrives, he has to be met boldly, and to be fought on his own ground. Cleanliness and courage ar& the strongest weapons against him; panic and fear are the very worst. Moreover, it is useful for the public very distinctly to remember that pains taken and costs incurred for the purposes to which these Instructions refer cannot in any event be regarded as wasted. The local conditions which would enable Cholera, if imported, to spread its infection in thiscountry, are conditions which day by day, in the absence of Cholera, create and spread other diseases, 8 such as typhoid fever, diarrhoea, diphtheria, and the like — diseases which, being never absent from the country, are, in the long run, far more destructive than Cholera. The address of the Medical Officer of Health for your District is — Dr. And of the Inspector of Nuisances — Mr. Immediate information should be sent to these officers of the occurrence of any case of Cholera in your house or amongst your neighbours. Published by Allman and Son, 67, New Oxford Street, for the National Health Society, 44, Berners Street, W. Price Id. each, 9d. per dozen, ss, per 100, and £1 is, per 1000.