DEFENCE AGAINST CHOLERA, 
AND OTHER 
PREVENTABLE DISEASES. 
♦ 
THE. DUTY OF CITIZENS AND LOCALfHEALTH BOARDS 
IN 
MEASURES OF PREVENTION. 
PRESENTED BY // 
THE STATE BOARD OF HEALTH OF WISCONSIN, 
MAY, iSSs- 
“ Panic is born of a vague terror of the unknown, and has 
no relationship to that clear comprehension of a source of pos- 
sible danger and the means of avoiding it which promotes 
calmness and justifies confidence.” 
MADISON, WIS.; 
DEMOCRAT PRINTING CO., STATE PRINTERS. 
1885. DEFENCE AGAINST CHOLERA, 
AND OTHER 
PREVENTABLE DISEASES 
Those who have most thoroughly studied the history of 
Cholera, and are therefore best informed concerning it, are 
practically united in the belief that it will appear in this 
country during the present year. Should it do so we have 
no reason to suppose that Wisconsin will remain exempt 
from it unless we secure exemption by our own exertions. 
These exertions will not be lost if Cholera does not come, 
for the sanitary measures which will prevent it, are the best 
safeguards against other diseases also. 
Of some things respecting Cholera we may be certain. 
Among these are the facts that though it cannot originate 
in Wisconsin, it may at any time be brought to us in the 
persons of those affe ',ted by it, or more probably in the 
soiled clothing and bedding of those who have had it. If in 
any place to which it may come it finds a soil fitted for its 
development, its progress will be that of an epidemic, strik- 
ing terror to the whole community and completely paralyz- 
ing business therein. If through possible and proper sani- 
tary precautions it finds no such soil, it will die for lack of 
food in the households to which it may first be brought. 
Such has so often been its history that neither the State or 
municipalities or private citizens can afford in the face of 
present warnings to be idle now. It is true that the 
disease may not come to us. It is equally true that it is liable 
to come and that we are not now ready to meet it. 
To wait is to lose the golden opportunity for its prevention. 4 
If the disease should come it will then be too late to com- 
mence the work of preparation. Effective sanitary oper- 
ations can be carried on now; in the presence of Cholera 
they cannot. 
In view of these facts and of our advanced knowledge of 
the ways in which Cholera and other diseases may be pre- 
vented, it is the full belief of the State Board of Health that 
never before has so great a responsibility rested on both 
Boards of Health and on individual citizens, and that to a 
large extent the people will themselves be responsible for 
the presence of Cholera should it prevail, unless they observe 
such measures as are best adapted to prevent it, and unless 
they give also the full weight of their influence in favor of 
the work necessary to be done by organized health boards. 
Such measures are within our power, but to secure their 
benefits they must he adopted promptly; they must be thor- 
ough, and they must he continuous. A spasmodic cleaning 
of premises is not sufficient, but cleanliness having been se- 
cured, must be unceasingly maintained, and 
IN THIS WORK ALL MUST HELP. 
Health Boards have their own peculiar duties and private 
citizens have theirs also, but these duties do not conflict, and 
each class should be helpful to the other. It should be well 
and distinctly understood at the outset that such thorough 
work as is herein contemplated costs time, and labor, and 
money, and the question of cost should be wholly subordi- 
nated to that of thoroughness. What the private citizen can 
not or will not do, should everywhere be supplemented by 
what is done by health boards and sanitary organizations. 
The executive officers of such boards should be selected for 
promptness and faithfulness, and for intelligent acquaint- 
ance with the necessary work. They should be invested 
with ample, and if circumstances require it, with seemingly 
arbitrary powers; they must be supplied with money to pay 
for the work done and they should themselves be liberally 
paid for their services, their labors being regarded as for the 
mutual insurance of all citizens against disease and death. 
There can in fact be no real security that sanitary work is 5 
well done without the intelligent oversight of an official 
vested with ample powers to compel it to be done, for, how- 
ever thoroughly one may cleanse his own premises, he is at 
the mercy of his less careful or less liberal neighbor, who 
may disregard all precautions. Filth, foul odors, and pol- 
luted water supplies are no respecters of persons, and no 
virtue or carefulness can save one from the consequences of 
his neighbor’s sanitary sins. 
In many cases it is believed that simple ignorance of what 
is needed to be done, and of what can be done, is the sole 
or at least the chief thing that stands in the way of its 
accomplishment. It is with the view of pointing out these 
clearly and as authoritatively as possible, that the following 
suggestions are made by the State Board of Health, and 
their adoption is urgently recommended: 
WHAT THE HOUSEHOLDER SHOULD DO. 
This is by far the most important part of the work of de- 
fence from disease, the part, in fact, without which all else 
will, in most cases, prove futile. In-doors, the cellar should 
first be looked after; all decaying and germinating vege- 
tables should be removed therefrom with all accumulations 
of rubbish of every kind, and the whole should be destroyed 
by burning, or removed to the compost heap to be carted 
away. The cellar walls should be whitewashed with fresh 
lime, and every possible facility should be given for the 
entrance of fresh air and sunshine. If it be not thoroughly 
dry and free from odors, the drainage must be carefully 
looked after and corrected, until dryness and purity of air is 
secured. The cellar is too often left damp, dark and the 
receptacle of many things that favor disease in the house- 
hold, because of mere thoughtlessness. It is known that 
milk and many other articles of food absorb odors and the 
germs of disease very readily, and in this way the decaying 
contents of the cellar may find entrance into the systems of 
the dwellers in the house above. 
The wood-shed and all storage rooms next need attention 
and the same careful removal of all unhealthful rubbish 
that has been practiced in the case of the cellar, is to be ob- 6 
served here also. If in-the house there are any rooms that 
are dark and damp, let them be especially looked to. If to 
admit fresh air and sunshine freely it be necessary to re- 
move a partition, to enlarge a door-way or to cut a new 
window in any such room, it will be the best economy and 
in the interest of health to do so. There are no purifiers or 
disinfectants that can take the place of fresh air and sun- 
light, and no room from which they are excluded can be 
healthful. Many a room has been changed from an un- 
healthful to a wholesome living apartment by such simple 
means as these, and by the removal of dense foliage which 
prevented the free entrance of nature’s disinfectants. 
Out of doors not less care should be taken of the back 
yard than is taken of the front yard; both should be made 
and kept clean. All accumulations of rubbish, filth or refuse 
should be removed from the premises wholly and burned, or 
so disposed of that no harm to the neighbors can result 
therefrom. The condition of the drains should be examined; 
care should be taken to see that they are unobstructed, and 
that they are ventilated by a free opening into them outside 
of the house. Cesspools should not be tolerated at all if it be 
possible to avoid their use. If they are absolutely necessary 
they should be so constructed as to be water-tight, so that 
leakage into the surrounding soil, and later, into the well, 
may be prevented. At proper intervals their contents should 
be wholly removed, but during the heated season it will 
probably be wiser to have them frequently and effectively 
disinfected, but not otherwise disturbed. The contents of 
the privy vault should be disinfected and removed, and the 
vault should be again disinfected after cleansing. It would 
be an immense stride toward a better sanitation if privy 
vaults were everywhere abolished, and water-closets substi- 
tuted wherever practicable, the dry earth system being em- 
ployed elsewhere. This should certainly be done in all 
thickly settled localities, for in them the privy vault is al- 
most certain to be in dangerous proximity to the well. No 
expensive appliances are necessary; simply have no vault 
whatever, but put a large pail under the seat, and cover 
each deposit plentifully with fine, dry earth or with coal 7 
(not wood) ashes. This is the whole principle of even the 
most expensive earth-closet arrangements, and nothing more 
than this is needed. Dry earth used in this way is a perfect 
deodorizer, and the contents of the pail may be handled 
without offense, and used as a garden fertilizer. The only 
essential things are that the earth be dry and in fine poivder, 
and that it be used in quantity sufficient to absorb all mois- 
ture. 
All other outbuildings, such as barns, stables, pig-pens, 
cow-sheds and the like, need of course such careful attention 
to cleanliness as will keep them free from offence to sight 
and smell;* fresh lime whitewash should be frequently 
applied; the refuse should be so disposed of daily as to create 
no offence. 
But all these things being done, there yet remains one 
other matter to be looked after with most anxious care the 
channel through which it is believed that disease germs 
most frequently gain entrance to the system, and the unsus- 
pected source of many cases of sickness,— the water supply. 
In by far the greater majority of cases the well is the reli- 
ance of the people of Wisconsin, and the condition that 
exists in most villages and cities having no water supply is 
truthfully described as follows: In the small area of the 
back yard there are “ three holes in the ground, one for a 
cess-pool, one for the privy vault and one for the well.” 
Each of these drains the ground for a certain distance around 
it, the area of drainage differing in different soils and with 
the depth of the excavation. The well, being the deepest of 
these excavations, too frequently receives the drainage of 
both the others, and it is a serious mistake to believe that 
such drainage is purified by its passage through the soil. 
* Note.—The difficulty of keeping pig-pens in a cleanly and inoffensive 
condition is so great, and they are so liable to become nuisances even when 
unusual care and attention is given to them, that they should be tolerated 
only in places where the residents are comparatively few in number or 
where they can be sufficiently removed from all dwellings. If allowed at 
all in cities, villages, or other thickly populated localities they should be 
most carefully regulated with regard to the number of animals kept in 
them and the condition in which they are maintained. 8 
It may be freed from suspended matters and thus rendered 
clear to the eye, but chemical tests, and disease resulting 
from its use, show that the water into which it has found its 
way is unsafe and dangerous. In fact, the presumption in 
regard to the wrnter from wells in all cities and villages is 
that it is unfit for use, and the circumstances of its being 
bright, clear and palatable afford no evidence to the con- 
trary. During the prevalence of any form of Diarrhoeal 
disease, and especially if there be anything like Cholera in 
the country, no water from any well should be used without 
being previously boiled.* Boiled water is insipid to the 
taste, it is true, but it may easily be rendered palatable by 
the addition of some acid or by being made into a weak tea. 
Finally, the private citizen, having thus cared for his own 
premises, putting and keeping them in conditions of most 
scrupulous cleanliness, has only to insist that his neighbor 
shall exercise similar precautions, and to encourage and as- 
sist the health authorities, both local and general, in the per- 
formance of the work committed to their charge, in order to 
bring about the results of such work, which will be immun- 
ity from such unnecessary sickness of all kinds, a dimim 
ished death-rate, and a feeling of security that though 
Cholera or other disease may be brought to the community 
wherein such work is done, it can (if that work be supple- 
mented by careful attention to personal cleanliness) find 
no fitting soil for development, and that hence its visitation 
will be light and its duration brief. 
WHAT LOCAL HEALTH BOARDS SHOULD DO. 
The law specifically requires the organization of such a 
board in every town, village and city of the state. To this 
rule there are no exceptions, and every board organized is 
required to appoint a health officer within ten days from the 
time of organization, and to report his name and address to 
the State Board of Health immediately, thus forming a me- 
dium of communication between the state and local boards. 
*Note.— It will be understood, of course, that the ordinary dug or bored 
private well is here referred to, and not the deep Artesian wells such as 
furnish the water supply for some of our towns and cities. 9 
The law directs that, when practicable, the health officer 
shall be a physician, but wisely leaves it possible to appoint 
some other person when a physician cannot be appointed. A 
recent statute emphasizes the relation between the State 
Board and the local boards of health, and requires the latter 
to co-operate with the former. The first duty, then, of all 
town, village and city boards is that of efficiently organiz- 
ing a local board of health, and reporting the organization 
with the name and address of the health officer to the State 
Board of Health, if this has not already been done. 
The work of all local health boards should be comprehen- 
sive, and at this time of apparent danger, especially 
thorough. Slaughter-houses and all other business estab- 
lishments that produce offensive refuse, should be looked 
after with particular care; all stagnant ponds of water 
should be drained if possible and filled up; defects in the 
public sewerage should be corrected, streets and alleys and 
public thoroughfares should be thoroughly cleaned, and 
comprehensive health ordinances, requiring the correction of 
all unsanitary conditions on private premises, should be pre- 
pared, published and rigidly enforced. The health officer 
should be vested with ample powers for these purposes, and 
in the exercise of these powers he should be sustained not 
only by the health board but by all good citizens. 
In addition to these things, in all incorporated villages 
and cities, the health board should provide for systematic 
surveys, by which every house in every part of each such 
village or city shall be visited, thoroughly examined, and a 
record of all unsanitary conditions shown by such examina- 
tion made and kept for future use, upon blank forms suit- 
ably prepared for the purpose. Such a record should 
embody the following facts: 
1. Such designation of the place by street and number 
that it may be identified without the possibility of mistake. 
2. A general description of the premises, whether high 
or low, dry or damp, well drained or not, and facilities for 
drainage. 
o. A general description of the house, whether of v ood 
or brick, in good or bad repair, names of owner and occu- 10 
pants, and, particularly if it be a tenement house, whether 
over-crowded or not. 
4. The general condition of all out-buildings in regard to 
cleanliness. 
5, The source of water supply. 
G. A particular account of all existing unsanitary condi- 
tions, such as accumulations of garbage, foul cesspools, 
privy-vaults either full or in bad condition, and the prox- 
imity of cess-pool, privy or stable to the well, if any exists. 
7. If possible, a record of any form of sickness existing 
at the time of examination or recently prevalent, especially 
if any deaths have occurred and if the disease has been of 
Diarrhoeal Dysenteric, or Typhoid form. 
8. The recommendations of the sanitary inspector. 
Immediately upon the completion of this inspection the 
owner or occupant of any premises upon which unsanitary 
conditions are found to exist, should receive specific directions 
for their removal or correction, and a reasonable but limited 
time should be assigned within which the improvement is 
to be effected. At the end of this time, if the directions 
given have not been carried out, the necessary work should 
be done by the local health board at the expense of the prop- 
erty. In making such an inspection as is here suggested, 
especial attention should be paid to the condition of board- 
ing houses, lodging houses and hotels, particularly those of 
the lower grades, and if at any time Diarrhoeal diseases 
prevail, all such establishments should be watched and 
guarded with the most zealous care, and their privies should 
be disinfected daily. 
But besides all this. Local Health Boards havo an import- 
ant duty in regard to newly arrived immigrants who fre- 
quently come from a part of the old world where contagious 
disease has prevailed, bringing with them, more often in 
their baggage than in their persons, the germs of such dis- 
ease. A time therefore when such new-comers are sources 
of the greatest danger is that when they are unpacking their 
effects, and then, and for several days thereafter they should 
be under the careful observation of the Health officer, which 
observation should also extend to any neighbors who may 11 
have been visitors to such family, especially if they have 
lent help in the unpacking and arrangement of the house- 
hold effects. Any deviation from perfect health in the 
newly arrived family or in any visitors to them should be 
carefully and promptly examined. Persons coming from 
districts known to be infected with any contagious disease, 
should be kept under the same careful surveillance until all 
danger of the development of disease in them or from them 
has passed.* 
At all times the duly appointed health officer should be 
invested with ample authority to act in any emergency. 
Should Cholera or other dangerous disease come, there will 
be then no time to call the health board together for the dis- 
cussion of plans. These must be definitely decided on be- 
forehand, so that what can be done and what is to be done, 
shall be clearly understood. If Cholera or Small Pox or 
other virulent disease appear'in a private house, it should be 
at once quarantined, all well persons whose presence is not 
absolutely needful therein should be removed, and closely 
contiguous houses should either be abandoned for the time 
being or kept under the closest watch. Should death occur 
the burial of the body should be speedy and private. 
DISINFECTION AND DISINFECTANTS. 
The term disinfection is used here rather in its popular 
than in its strict sense. For cleansing premises in the ab- 
sence of any specific “'germs” of disease, the use of those 
germicides or true disinfectants which would be recom- 
mended in the presence of such germs, is not necessary. To 
deodorize and sufficiently to disinfect privy vaults, cess- 
pools, drains and similar places as a measure of cleanliness 
the plentiful use of copperas or sulphate of iron, or of chlor- 
ide of lime (as recommended by the Committee on Disin- 
fectants of the American Public Health Association) will be 
sufficient. The copperas may be prepared for use by dis- 
solving one and one-half pounds in a gallon of water. The 
*Note—ln either of these cases if it is practicable to disinfect the bag- 
gage of such newcomers by fumigating it with sulphur, it would be wise 
to do so. 12 
chloride of liras may be used either by sprinkling the dry 
powder freely over any place or material which it is needful 
to disinfect, or by dissolving one pound in four gallons of 
water. Of either solution, a sufficient quantity to keep 
down all offensive odors should be used daily or as often as 
occasion may require. Fresh lime should not be used. Should 
Cholera or other virulent disease make its appearance, more 
powerful and specific disinfectants will be required, and full 
directions for preparing such and for their safe and efficient 
use will be published in due season by this Board. 
The duty of preparation which devolves upon local health 
boards, also devolves upon the officers and managers of our 
state institutions of every kind. Such officers should see that a 
thorough examination of the buildings under their care is 
made, and that all unhealthful conditions are removed. The 
water supply, the sewerage, all matters relating to the dis- 
position of filth or refuse material of any kind should be in- 
spected with a view to the removal of all defects, and the 
maintenance of the highest and best sanitary conditions. 
The same duty is incumbent on sheriffs and keepers of jails, 
upon the heads of reformatory institutions of every kind, 
to any one of which persons in the incipient stages of dis- 
ease may be brought at any time. The power of these offi- 
cers is ample and undoubted for these purposes, and there 
can be no reasonable excuse if, in or about any such institu- 
tion there are at any time conditions which favor the devel- 
opment of disease if it should unfortunately be brought to 
them. 
By direction of the State Board of Health. 
J. T. REEVE, M. D., 
Secretary. 
Note.— This circular is printed for gratuitous distribution. Any citizen 
of the state desiring copies can obtain them by application to the Secre- 
tary of the State Board of Health, Appleton, Wisconsin. 
Secretary.