ON CERTAIN ARRANGEMENTS 
MADE IN THE 
CITY OF GLASGOW, 1866, 
WITH A VIEW TO THE 
PRETENTION OF EPIDEMIC CHOLERA. 
WITH AN APPENDIX. 
BY 
W. T. GAIRDNEE, M.D., LL.D., 
PROFESSOR OF MEDICINE IN THE UNIVERSITY OP GLASGOW, SCOTLAND. 
REPRINTED FROM THE 
TRANSACTIONS OF THE ASSOCIATION OF AMERICAN PHYSICIANS, 
SEPTEMBER, 1891. IVith the Author s Compliments. [Reprinted from the Transactions of the Association of American Physicians, 
September, 1891.] 
ON CERTAIN ARRANGEMENTS MADE IN T 
CITY OF GLASGOW, 1866, WITH A 
TO THE PREVENTION OF 
EPIDEMIC CHOLERA. 
With an Appendix. 
W. T. GAIEDNEE, M.D., LL.D.. 
PROFESSOR OF MEDICINE IN THE UNIVERSITY OF GLASGOW, SCOTLAND. 
I believe I shall not detain yon very long in this, almost ex 
tempore, address or paper (if paper it may be called), because you 
will very speedily discover that it is not a paper, but only the 
materials out of which a more or less elaborate paper might have 
been built had the opportunity occurred. 
When conversing with your President, Dr. "William Pepper, at 
Newport, since my arrival and only some days in advance of this 
Congress, it seemed to be worth while considering whether certain 
experiences which had occurred to me during the last threatened 
invasion of cholera in Glasgow during the autumn of 1866 could 
be presented verbally, or on the basis of brief notes, without details 
of facts or documents, so as to be a suitable communication for this 
Congress. Dr. Pepper has ruled that it is to be so; and here I 
am, accordingly, not to read a paper, but to make a short state- 
ment, which, from the very nature of these circumstances, must be 
as concise and as much detached from documentary details, facts, 
and statistics as I can possibly make it. And yet I think that 
even this bare statement of my experiences as the Medical Health 
Officer of the city of Glasgow in 1866 cannot fail to have a certain 
interest for you. 
America, to us of the old country, is the land of experiments, 
political, social, religious, educational, and sanitary; yet it does not 
appear to me that I have ever heard of anything, either on your 2 
PREVENTION OF EPIDEMIC CHOLERA. 
vast continent or in my own little island of populous places, pre- 
cisely on the lines of what lam now about to narrate. The prac- 
tical issue before my mind is whether out of this experience I can 
place before you any considerations of importance applying, of 
course, with variations founded on local differences, to any circum- 
stances arising or likely to arise in the midst of your complex and 
ever-extending civilization. If I shall have the good fortune of 
exciting or stimulating one fruitful idea, one speculation which can 
be carried forward into action in this wide continent, my task will 
have been accomplished, because the good seed will have fallen 
into good ground, and will in time bring forth its results. I may 
add that my own opportunities of initiation in such matters may 
be said to be over, and I have, therefore, no personal, nor even any 
official, object to be gained or lost by this paper. 
On going from Edinburgh to Glasgow, in 1862, as Professor of 
Medicine in the University, the position was offered to me—almost, 
indeed, forced upon me by the authorities—of the medical chief of 
the Sanitary Administration, then about to be recast at the instance 
of Mr. John Ure, a most devoted sanitarian, and afterward Lord 
Provost, or chief magistrate of the city. This position I held for 
nearly ten years, and then resigned it, being succeeded by ray good 
friend, Dr. J. B. Russell, known, I am certain, by reputation to 
many of you, as he is to us all over Great Britain, as one of the 
most diligent, most active-minded, most original, and withal most 
trustworthy of public medical officers; and if I have still any 
legitimate pride in having held that office for a few years from its 
commencement, it is in having laid some of the first foundations 
for a superstructure which has, under his admirable superintend- 
ence, become almost a model of civic sanitary administration. 
Still the precise conditions of the experiment I have now to relate 
have not chanced to recur during the period of Dr. Russell’s tenure 
of office, nor are the administrative means and machinery at dis- 
posal now precisely what they were in 1866. So far as my infor- 
mation extends, therefore, the experience I have now to record is, 
as regards its method and its mechanism in some respects, abso- 
lutely unique. 
Typhus fever, our ever-present, ever-watchful plague in Glasgow, 
and in all our cities inhabited largely by dense Irish populations, GAIRDNER. 
3 
was, at the time I speak of, so much of a home pestilence that it 
had ceased to be regarded as anything extraordinary, even when 
represented by hundreds, not to say thousands, of cases. It was 
held, in fact, by the legal advisers of the local authority that ex- 
ceptional measures could not legally be taken against typhus fever 
until the hundreds had become thousands; that, in fact, it was not 
legally within our competency to “shut the stable door” effectually 
until, as the proverb says, “ the steed was stolen.” This was the 
main defect of the local Sanitary Act under which the administra- 
tion had to be conducted in 1866; and it is necessary thus to em- 
phasize it, because it may just be possible that in some of your 
various States and Territories a similar defect may still hamper the 
work of your medical officers; and at all events it is the contrast 
to this state of matters, as arising from the widespread apprehension 
of cholera and the comparative ease of getting power to do things 
more thoroughly, that will give the key-note, as it were, to the 
present address. I desire, however, to add, as the necessary sequel 
of what has now been set forth, that the defect alluded to has long 
ceased to exist in Glasgow; indeed, it only required the experience 
of a very few years to show that it was a bad and utterly false 
economy to build hospitals and institute sanitary works of disin- 
fection, etc., upon a temporary plan, and as if intended only for an 
epidemic emergency, specially declared to be such. 
In August, 1865, however, it became ray duty to report to the 
Lord Provost and magistrates as regards a circular letter addressed 
to the heads of our municipalities generally, by the Secretary of the 
Privy Council, “ referring to the recent appearance of cholera in 
Egypt and the occurrence of some cases in Turkey and in Italy;” 
the object of the communication being, as stated, “that the authori- 
ties of your locality may be enabled to take such steps as they 
think proper for the preservation of the health of the inhabitants 
of their neighborhood.” I will not detail here the proceedings 
which more immediately followed from this warning-note of the 
Privy Council; the only point on which I wish now to insist is 
that it placed the probable advent of that disease so clearly and 
definitely before the authorities and the citizens generally as to 
constitute an exceptional case of apprehended epidemic disease, and 
thus to set in motion at once the provisions under the local Act of 4 
PREVENTION OF EPIDEMIC CHOLERA. 
Parliament for dealing with such exceptional cases.1 While, there- 
fore, it absolutely required a new and a much stronger Act of 
Parliament, or rather more than one such Act, to clear the way, 
even for dealing effectually with what was regarded as a home-bred 
pestilence, in the case of typhus fever, the medical officer and staff 
found themselves at once invested, as regards cholera, with almost 
autocratic powers, limited only by the consent of the magistrates, 
which, as it happened, was in this instance easily obtained, and in 
thorough accord at the time with public opinion. 
In the latter part of 1865, as the result of the powers thus 
obtained, numerous measures of general sanitary improvement were 
urged on, to which it is not necessary now to allude, because in any 
case they would have had to be undertaken, sooner or later, though 
possibly not considered as urgent. One of these was a detailed 
examination and report on all the public wells to be discovered 
within the bounds of the local authority; these being by no means 
numerous, as they had mostly been superseded long before by the 
excellent supplies from Loch Katrine and elsewhere, furnishing to 
the inhabitants a mean quantity of fifty gallons per day for each 
individual of the population, and this of the purest water, perhaps, 
ever distributed to any municipality in the world. The Loch 
Katrine water-supply was introduced in 1859; my concern, there- 
fore, was not with the supply, but with its distribution. In order 
to obtain the full advantages of a thoroughly good water, and to 
remove the temptations to use for drinking any less perfect sources 
of supply, it was necessary in some cases to suppress the latter 
altogether, replacing them by the Loch Katrine water; or, in other 
cases where no evil appeared likely to result, leaving one, possibly 
less pure, supply open for washing or bathing, while the Loch 
Katrine water was abundantly distributed for drinking purposes. 
But on these details, though interesting enough in themselves, I do 
not intend to dwell at present. My own belief, from first to last, 
was that the Loch Katrine water would prove, at least in a cora- 
1 The precise legal import of the remark above, under the provisions of the local 
Act then in force, was that by a certain form of declaration, published in the news- 
papers by the medical officer, sections of the Act were brought into operation, at the 
instance of the Lord Provost and magistrates directly, without undergoing considera- 
tion or criticism by the board of police, which, at the time referred to, was the sani- 
tary local authority for all ordinary occasions. GAIRDNER. 
5 
parative sense, the salvation of Glasgow from the worst ravages of 
Asiatic cholera; and this anticipation was fully justified by the 
result. 
But we had to do with a vast population, largely composed of 
the operative classes, and in by far too large a proportion composed 
of those classes with whom the crowding of a whole household, and 
perhaps a lodger or two, into one apartment, represents the average 
condition of domestic comfort. Moreover, this large mass of 
wretchedly housed persons was also densely packed upon a ground- 
space smaller in reference to the numbers of population than in any 
city of Great Britain and Ireland, with the single exception of 
Liverpool. In some parts of Glasgow it was the case at this time 
that nearly a thousand persons lived upon a superficial acre of 
ground. The habits of these people were, of course, often ex- 
tremely filthy, and even the possibility of cleanliness was too 
often denied to them by the faults of construction in their enor- 
mous tenement-houses, without any proper lavatory arrangements, 
or even distribution of water, and very often without anything 
like suitable means of getting rid of the discharges. All these 
faults, moreover, were, as it were, ingrained; not only expressed 
in the habits of the existing generation, but inherited from their 
predecessors, in so much that I had had occasion to point out that 
not only epidemic disease, commonly so-called, but also tubercular 
diseases, pneumonia, bronchitis and respiratory diseases generally, 
and, above all, an enormous death-rate of very young children, 
marked these densely occupied portions of the city to a degree 
many times greater than was the case in the more privileged and 
happily placed portions of the community. Such measures as had 
been considered possible up to this date, in the face of a rising 
epidemic of typhus fever (nearly at its height in 1865-66), were 
chiefly police regulations as regards gross overcrowding, hospitals 
for the sick, arrangements for ambulances, etc., disinfection of 
rooms and of clothing, and, in some cases, the compulsory clear- 
ance of whole tenements so as to permit of the removal temporarily 
both of the infected and non-infected inmates, and the more com- 
plete use of the means of disinfection. 
All this, although it cost us all much time and forethought, and 
the city considerable annual expenditure, was done; and yet I had 6 
PREVENTION OF EPIDEMIC CHOLERA. 
the habit of expressing myself freely to the effect that we were 
only “ scratching the surface ”—that is to say, that to meet fully 
and adequately the abiding causes of typhus fever in our midst, it 
would be necessary to obtain greatly increased powers, and use 
them largely for the destruction, and perhaps reconstruction, of 
certain localities. These powers were finally obtained in a local 
Act of Parliament, called the uGlasgow City Improvement Act,” 
for the promotion of which we were chiefly indebted to Mr. John 
Blackie, then Lord Provost, and the late Mr. John Carrick, city 
architect, one of the most admirable of officials, whose sure instinct, 
amounting to something like genius, but founded on practical ex- 
perience and guided at once by wisdom as to the end to be achieved 
and knowledge of men as to the means to be used, was of inesti- 
mable service. All this is now a matter of history, and Ido not 
mean to detain you upon it, my object being merely to indicate to 
you the state of the population on which the cholera was expected 
to fall in 1866, before any of these greater reforms to which I have 
alluded had been even initiated, much less carried out, as they have 
been since, under Dr. Russell’s tenure of office, with excellent re- 
sults which he has officially demonstrated.1 
Now, gentlemen, with all the confidence I then had, and, as it 
now appears, justly entertained, of the probable effect of a pure 
water-supply as a protection against the worst epidemic excesses of 
Asiatic cholera, it was impossible to observe from day to day and 
from week to week, this terrible disease drawing nearer to us in 
Europe, and finally in England, without a vast and indefinite sense 
of responsibility and of possible disaster. It had been amply shown 
in 1848, and still more clearly in 1854, that places which had ob- 
tained a purer water-supply suffered notably less, and, conversely> 
that other places in which the water-supply had deteriorated, suf- 
fered more in the later than in the earlier epidemics. But with all 
the hopes which could be founded on this recorded experience, it 
was impossible not to fear that a population such as ours then was, 
already decimated by epidemic disease, and living too often in the 
most grossly insanitary circumstances, having, moreover, at all 
times a very much higher death-rate overhead than any other city 
1 “ Results of the City Improvement Act,” by J. B. Russell, M.D. (In the Trans- 
actions of the Glasgow Philosophical Society.) GAIRDNER. 
7 
of the United Kingdom except Liverpool, might still be heavily hit, 
as it wore, in accidental localities by the epidemic that was looked 
on as now bound to come. 
In all the past epidemics of cholera, Glasgow had suffered 
severely, in some of them most severely, and not least in the epi- 
demic of 1854, the one immediately preceding. It was, therefore, 
with no ordinary solicitude that we proceeded in the early months 
of 1866 to make such arrangements as might be found most suita- 
ble for protecting our only too vulnerable masses of dense popula- 
tion from a scourge in regard to which imagination might possibly, 
indeed, outrun the reality, but for every avoidable case of which, 
actually occurring, we could not fail to hold ourselves in a measure 
responsible. lam happy to say that the Lord Provost and magis- 
trates, as well as the citizens generally, were all of one mind in 
this matter. There was no mere unmanly sense of panic, but all 
arrangements in advance were left to the authorities, and the med- 
ical officer had therefore, speaking practically, a “ free hand.” 
The first thing that occupied us, apart from those early precau- 
tionary measures to which I have already referred, was the ques- 
tion of hospitals for the sick. With a view to typhus fever and 
other epidemics, a considerable amount of hospital accommodation 
had been already provided by the local authority, in addition to 
the Royal Infirmary and the hospitals of the several parishes, which 
were administered by separate boards of managers, and supported 
either by parochial assessments, or by the voluntary liberality of 
the citizens and others. 
It was determined, under the circumstances, to request the several 
parishes to undertake the hospital accommodation for fever and all 
other epidemics except cholera, pro tempore, so that the hospital of 
the local authority might be cleared, and held open for cholera 
cases exclusively, so long as it might be required. Dr. Russell, 
who had even at this time won the confidence of all as the medical 
superintendent of the epidemic hospitals of the local authority, was 
appointed to deal with the details of this department, to engage a 
staff of nurses, etc., and to obtain all the furnishings and equip- 
ments for such hospitals as might be under the control of the local 
authority temporarily during the cholera epidemic. Ultimately, 
one other temporary hospital was built and fully furnished in ad- 8 
PREVENTION OF EPIDEMIC CHOLERA. 
vance, in a very central situation, and provision was made as re- 
gards sites, etc., for four others; but of these only the hospital in 
Glasgow Green was actually brought into use, and this only for a 
few weeks during the incidence of the epidemic.1 
I may mention, in passing, that the enrolment of suitable nurses 
proved a work of the utmost difficulty, involving almost heart- 
breaking disappointments in detail, from the great number of applica- 
tions from persons morally or otherwise wholly unsuitable, and the 
small number available who could in any way be relied upon. 
Had the epidemic proved much more severe, this would have been 
one of our greatest difficulties, but it was surmounted by the pa- 
tience and foresight of Dr. Russell. 
The next point was the arrangement, in advance, of a medical 
staff. In this, happily, no serious difficulty was encountered, either 
on the side of the authorities or of the medical men in practice. 
In a very short time the medical officer was enabled to submit 
arrangements as to remuneration, etc., which gave general satisfac- 
tion, and about eighty of the fully qualified medical practitioners of 
the city, many of them having had previous experience, and ail of 
unquestionable status, were enrolled as willing to undertake the treat- 
ment of cases of choleraic disease at the instance of medical or other 
visitors, or of the local authority. As it was anticipated, however, 
that in the event of serious panic, or of even trivial diarrhoea! dis- 
ease occurring in a locality, there might be an undue amount of 
disturbance, or even unnecessary calls upon this medical staff, 
especially during the night, it was determined to interpose a staff 
of house-to-house visitors, not necessarily qualified medical practi- 
tioners (though having sufficient medical information to deal with 
ordinary or false alarms), between the strictly medical staff in the 
infected districts and the general population. The precedent here 
followed was that of previous epidemics in Great Britain, in which 
the principle of house-to-house visitation had been always found to 
1 It was placed under the medical care of Dr. James Adams, whose great experience 
in former epidemics was thus turned to account, Dr. Russell himself taking medical 
charge of the hospital in Parliamentary Road, already alluded to. The nursing staff 
was arranged so as to be common to both hospitals (as it would have been also to the 
others had they been required), and to be detailed by Dr. Russell for service where 
most urgently wanted. The kitchen arrangements and the disinfecting staff, as also 
the supply of beds, bedding, etc., was also managed for the Parliamentary Road. GAIRDNER. 
9 
be of great service in ascertaining and dealing with the premonitions 
of the choleraic attack. 
Closely associated with these arrangements was the opening of 
dispensaries, or depots for medicines and disinfectants, to be open 
day and night during the whole period of an apprehended epidemic, 
in all quarters of the city. Here, too, as in the case of the medical 
staff, no serious difficulty occurred. The machinery was, in fact, 
already provided, partly by the shops of the chemists and drug- 
gists, and partly by the surgeries of the medical practitioners. It 
was necessary only to secure a constant day-and-night service in a 
certain number of these, selected with a view to convenient access 
in all parts of the town, and to furnish them with all the remedies 
and disinfectant substances recommended by the authorities, as also 
with a uniform series of printed labels, boxes, and bottles for giving 
out daily supplies of disinfectants for use, on application, so as to 
save at once time and expense, and to secure as far as possible uni- 
form quality in the leading articles dispensed. In addition, these 
depots were to be used as houses of call, where information might 
be given of cases either of real or of apprehended choleraic or diar- 
rhceal disease; where also medical assistance could be at once 
secured, if necessary, or the services of the official disinfectors 
could be called into requisition, or house-to-house visitation could 
be organized, so far as immediately required in case of first alarms. 
The name and address of several of these depots was to be placed 
at the disposal of each household, in a manner presently to be 
described. 
I need hardly add to the above, that the whole of the ordinary 
cleansing and disinfecting staff, as existing permanently in connec- 
tion with the sanitary office and cleansing department, required to 
be largely reinforced, even long in advance of the first indication 
of a local epidemic]; for the instructions of the Privy Council, 
already alluded to, in August, 1865, had brought the subject of 
much more thorough cleansing before the authorities all over the 
kingdom, and reports were daily transmitted, both to the cleansing 
department and to the office of the master of works, involving a 
great amount of additional work, which went on increasing in 
proportion as the attention of the citizens was drawn to the subject, 
on the one hand by the gradual approach of the epidemic and on 10 
PREVENTION OF EPIDEMIC CHOLERA. 
the other by the invitations of the medical officer to make known 
any obvious cases of defect or neglect. The provision of disin- 
fectants on a large scale and on the most approved principles then 
ascertained, was entrusted to the cleansing department, which also 
undertook to furnish the depots above named. 
But when all this, and more, had been done or arranged for, the 
problem was still ever pressing on my mind, How to get the prac- 
tical knowledge of what had been and was being done for their 
protection brought home effectually to the minds of the people 
chiefly concerned. This was a very serious matter, perhaps the 
most serious matter of all. There were at this time nearly 
100,000 separate households or about 500,000 inhabitants in what 
was officially reckoned as “ Glasgow,” being under one municipal 
government as such. Many of these households, as we had had 
ample and sad experience, were living in a state of almost brutish 
ignorance and neglect. Epidemic disease generally had almost no 
effect on the daily lives of such people—it was taken as a thing of 
course, and met, if with any emotions at all, with a kind of sullen, 
blank fatalism and despair. A new and to most of us a terrible 
epidemic disease might produce the same effect or want of effect; 
or, on the other hand, it might lead to an unreasoning panic, always 
the most unprofitable and even disastrous of mental states; because 
no fruitful action ever arises or can arise out of mere selfish cow- 
ardice. The thing to be done, therefore, as it appeared to me at 
this time, was to get at the heads of these separate households or at 
least at some of the members of them, by personal and direct com- 
munications, so as to press home to their convictions by the best 
simple arguments that could be devised, what was being done for 
them and what, on the other hand, they might reasonably be 
expected to do—indeed in some cases could only do—for them- 
selves. Without this, it seemed not unlikely that the whole 
arrangements might break down at the very point where interfer- 
ence was required. Suppose, for instance, that an imported case 
of the genuine Oriental cholera, or of diarrhoea tending in that 
direction, was brought into one of these households—how were we 
officials to hear of it ? Possibly through the sudden death of the 
patient and a sudden frenzy of alarm paralyzing all combined and 
effective action for good. Possibly, on the other hand, not at all, GAIRDNER. 
11 
or only after quite a number of cases of choleraic diarrhoea, not 
fatal but dangerous and scattering infection everywhere, had suc- 
ceeded in arousing the slumbering sense of fear. It appeared to 
me that there was or ought to be a better way than either of 
these: but I was not quite clear as to what was the better way, 
especially as time was pressing and the object was rather to 
anticipate than merely to meet the advent of the disease which 
had already been heard of in several of our towns, both in England 
and Scotland. 
When in this state of mind, I chanced to encounter a much- 
respected clergyman of one of our Presbyterian denominations, and 
I opened my mind to him on the subject. I asked if he could 
suggest to me how to obtain at once some hundreds of willing and 
intelligent workers, not necessarily with much medical or physio- 
logical knowledge, but broad-minded and sympathetic, who would 
personally visit and carry medical instructions about cholera down 
into the homes of the poor—it being understood that if cholera or 
anything like it should actually appear in any district or block of 
houses, these volunteers would be replaced at once by medical 
visitors. His answer was unhesitating; and it was in the form of 
a question ; “ Why not apply to the churches ? they will do it and 
give you all the volunteers you want, only for the love of God.” 
The reply was exactly on the line of my own thought, but I ven- 
tured to remark that I, as a public officer, could make no distinc- 
tions among the churches. u Ask them all ',” he replied ;“ on that 
point, at least, they ought all to combine and I believe they will 
do it.” 
Acting on this hint, I wrote a circular letter in the character of 
medical officer of the city, pointing out what had been done and 
what had still yet to be done, and I called upon all the churches 
indifferently, in which worship took place on Sundays in Glasgow 
(over three hundred in number), to assist in this work, by sending 
a deputation of their office-bearers to meet me in the City Hall at 
a certain date. The idea spread and was rapidly taken up—at the 
meeting in question nearly all the churches were represented and 
undertook to furnish me, on an average, with (say) ten picked men 
each. I said that as medical officer I would be responsible for the 
disposal of these hastily gathered forces, it being understood that 12 
PREVENTION OF EPIDEMIC CHOLERA. 
while suggestions would be received very willingly as to one or 
other district being taken up as matter of convenience by particular 
churches, I must in the end be able to dispose of the volunteers 
absolutely without fear, favor or partiality, and that they must 
needs all work on one and the same plan. For this purpose I had 
the whole city divided; first, into seven or eight considerable dis- 
tricts, and these again into minor subdivisions, no account being 
taken of church districts in doing so. In the ultimate subdivisions 
the enumerator’s divisions at the last census were brought into 
operation; and finally, a series of maps were carefully prepared 
on the largest Ordnance scale of twenty-five inches to the mile, 
by which (within certain limits of difference) a certain proportion 
of families] living in a particular close, or wynd, or row, or street 
could be assigned to one visitor, who from the section of the map 
sent to him could not fail to know exactly the limits assigned to 
him in his visits. While this work was in progress, the churches 
had their own meetings in many of the larger districts and were 
maturing their own plans. The enthusiasm in the work was very 
considerable and increased with its progress. 
The first quite definite proposals came from the western district, 
at the instance of two of the most respected clergymen in Glasgow, 
Dr. Marshall Lang, then of Anderston Established Church, and 
the late Dr. Somerville (well-known since then as a foreign traveller 
and missionary on behalf of his church), of the Free Presbyterian 
Church in Anderston. These two reverend gentlemen had no 
difficulty of course in carrying with them the whole of the Presby- 
terians and other allied denominations, but I thought it of impor- 
tance to remark at the outset, that from my point of view as 
medical officer, we must also have the Roman Catholics and the 
Unitarians, and indeed all others willing to contribute; and that 
there must be no distinctions. This being fully assented to, the 
western district was at once set to work and in a few weeks the 
map (above alluded to) of each cooperator’s district was in his 
hands, with a paper of instructions which he was understood to 
make the basis of his work, and as such, to carry down to his dis- 
trict (Appendix No, I.), A little later the enthusiasm spread and 
the other districts came in; it being understood from the first that 
if the poorer congregations, from having fewer persons of sufficient GAIRDNER. 
13 
independence and leisure, were in danger of being under-manned as 
regards their quota, the more wealthy congregations should be 
asked to furnish more visitors in proportion. In the end, 3000 to 
4000 intelligent and active visitors had their instructions and were 
actively at work in their various sections, informing the people 
and reporting to us at the sanitary office, or to the cleansing, or 
the master of works’ department. 
The effect of this great movement, both immediate and ultimate, 
was very remarkable. In the first place, it was universally felt 
that the apprehended epidemic of cholera had been provided against 
in a way that entirely removed local and increasing panic. The 
feeling of a common interest and of united and sympathetic action 
in view of a common danger pervaded all classes of the community, 
and led to a reliance upon the means provided which could not, I 
think, have been attained in any other conceivable way. The public 
were so pleased with the hospital accommodation provided by the 
authorities, that on their being admitted to view the new temporary 
hospital, all the objections which had been urged against it, as 
occupying a portion of “ the people’s park,” were at once tran- 
quillized. The feelings of satisfaction with the arrangements 
adopted for the limitation of the area of disease, and the medical 
and other regulations set forth, both as regards prevention and 
treatment, made it clear to the most unreasoning and the most 
ignorant that their safety lay in the early and an unreserved com- 
munication with the authorities. There was no panic, and no 
disposition either to conceal or to exaggerate individual cases of 
diarrhoeal disease. Everything that was done was done quietly, 
without undue notoriety and at the same time without omitting 
any just precaution. And the ultimate result was that Glasgow, 
with its teeming and badly situated population of the industrial and 
often pauperized classes, was able, after the epidemic had passed, to 
show a death-rate from cholera very much less than that of any 
large town in Scotland, except Paisley, which had from the first 
adopted somewhat similar precautions. About sixty-six cases of true 
cholera and a few hundred of choleraic diarrhoea were all that were 
contributed by a great city of half a million of inhabitants to the 
sum of this epidemic in Scotland. And the whole of the visitors 
from the churches concurred in affirming that their work during 14 
PREVENTION OF EPIDEMIC CHOLERA. 
the period of apprehension, as above described, had been fraught 
with inestimable advantages to themselves as well as to the poorer 
population, by bringing them into actual contact with the condition 
of existence prevailing among thousands of their neighbors. 
One point of detail still demands notice, as bearing on the first 
cases reported. Several of these were imported cases, and therefore 
isolated, but, of course, carefully watched for in the first instance. 
It appeared probable that the various newspapers, seeking on all 
hands to obtain the first intelligence of the epidemic as advancing 
from Liverpool and other cities having communications with Glas- 
gow, might possibly exaggerate or distort in reporting cases of 
which imperfect information alone could be obtained. To obviate 
this source of mischief, a book was opened at the sanitary office, in 
which the most strict directions were given that everything bearing 
on the possible advent of cholera was to be carefully entered 
and reported from day to day, even when the information ob- 
tained was open to doubt, the correction in this case being given 
after the investigation which immediately followed the report. 
Tills book was open to all the newspapers alike, and, in fact, to 
everyone anxious to be assured of the facts. By this means all 
merely sensational reporting was held in check, and a true state- 
ment of the facts each day was issued to the public. lam sure that 
a great deal of unnecessary excitement was obviated by this step. 
In the course of August and September, 1866, the first cases of a 
suspicious kind were reported. In the middle of December all 
traces of an undue amount of diarrheeal disease had ceased. Before 
the first day of January, 1867, I was able to report the apprehen- 
sion of epidemic cholera as having been entirely removed ; and on 
New Year’s day (always a popular holiday in Scotland) it became 
the duty of the medical officer to suggest (of course without any 
pretension to dictation) that the day might be fitly commemorated 
by a public service, or services, of thanksgiving to Almighty God, 
on the ground of deliverance from the threatened plague. The sug- 
gestion was largely adopted, many of the churches being opened on 
the occasion with a large attendance of devout worshippers, many 
or most of whom had intelligently followed the whole course of the 
proceedings here narrated. 
On Good Friday of the same year (1867) a public meeting was GAIRDNER. 
15 
held in the City Hall of Glasgow, attended by a large number of 
the clergy and laity of various denominations, in which resolutions 
wore passed commending the scheme of visitation by the churches 
during cholera to the notice of the public, as being fraught with 
almost indefinite possibilities of good, and as deserving of a more 
permanent existence. Several of the most eminent speakers—Drs. 
Norman Macleod, Marshall Lang, and others—enlarged upon the 
truly Christian character of the movement, expressing the wish 
that such a broad and practical Christianity as was evinced in this 
effort to remove the causes of disease might well be looked upon as 
alike a benefit to the population at large and to the churches them- 
selves. The visitors employed on this occasion were almost unani- 
mously of the opinion that both from the point of view of religion 
and of beneficence, it was highly desirable that such a movement of 
real Christian charity should be continued and perpetuated, if pos- 
sible. The medical officer remarked on this occasion that an auto 
da fe (an act of faith) had at one time a very terrible and sinister 
meaning in the Spanish language, in the days of the Inquisition. 
Was it not within the compass of a more genuine and real Chris- 
tianity, denuded of doctrinal distinctions, but tending ever to prac- 
tical works of mercy and kindness, so to avail itself of movements 
of sanitary progress as to claim a share in them on the part of the 
church universal, undisturbed by sectarianisms, and in the name of 
the common Lord? Unfortunately, it was not possible so to 
apply in a permanent fashion the lessons of the cholera epidemic 
of 1866 ; but they remain, nevertheless, as a notable evidence of 
what may be done under the influence of like circumstances in 
future; and with this view I have now placed a brief sketch of 
the facts before this Congress.1 
1 A notable example of what Mr. Matthew Arnold might have called the “ Philis- 
tine ” point of view of these transactions was contained in the remark of a very- 
eminent citizen of Glasgow at the time, viz., that after all the fuss made about the 
cholera, and all the expense incurred in its prevention, “ the cholera did not come ! ” 16 
PREVENTION OF EPIDEMIC CHOLERA. 
APPENDIX. 
Abstract of Instructions Issued from the Sanitary Department, 
Glasgow, 1866, in Respect to Asiatic Cholera. 
I. “Instructions for District Visitors in Time of Cholera or when Cholera 
is Threatened.” 
The object of these instructions was to place District Visitors in commu- 
nication, on the one hand, with the people, and, on the other hand, with 
the sanitary authorities, with a view to the observation and reporting of 
removable defects; the procuring of external cleansing; the removal of 
night soil; the use of personal influence as to cleansing and ventilation ; 
the opening of windows, or at least their construction so as to open at the 
top, in accordance with the law; the use of whitewash where necessary, the 
materials being furnished by the authorities on requisition of the Visitor; 
the use of personal urgency upon the inhabitants as to cleanliness of person, 
of clothing, and of bedding; and, further, all possible instructions concern- 
ing the use of plain, wholesome food, and of clean, fresh water and milk, 
with cautions against the undue use of strong drinks. It was further made 
part of the duty of the District Visitors to inform the inhabitants that “ in 
all cases of diarrhoea, or of serious derangement of the stomach or bowels 
resembling cholera, persons should be recommended to go to bed, to keep 
quiet and warm, and to send instantly for medical advice.’’ 
11. “ Instructions for Medical House-to-house Visitors in Districts in which 
Cholera Prevails or Threatens to Prevail.” 
This set of instructions was much in accordance with the preceding, but 
was specialized by the medical character of the Visitor, and had general 
application to what is called ‘‘house-to-house visitation,’’ so well under- 
stood and practised in former epidemics. 
111. “Instructions on Disinfection, for Medical Officers, District Visitors, and 
others, in Case of Cholera, Choleraic Diarrhoea, and other Diseases of Like 
Character.” 
This was a very detailed paper, involving all the principles of the germ- 
theory and of disinfection, as then understood, in reference to cholera— 
e.g., indicating that “It has been ascertained by scientific investigation 
that cholera, although much less infectious or contagious (in the ordinary 
sense of the words) than such diseases as fever or smallpox, has the special 
property of communicating to the discharges from the bodies of the sick a 
dangerous quality ; that these discharges may endanger life by soiling bed- 
linen, or vessels, or the floor, or the hands of attendants, or privies and 
water-closets, or collections of ordure in open courts, sinks, ash-pits, dung- 
steads, or common sewers, or, finally, by sinking into the ground, or other- 
wise polluting the drinking water; and that the danger is not diminished, G A IRD NE R. 
17 
but rather (as there is reason to believe) increased, by decomposition of the 
choleraic discharges in connection with masses of ordinary filth. It follows, 
therefore, that all choleraic discharges, and all things soiled by them, should 
be disinfected and cleansed immediately; and where this cannot be per- 
fectly done, the disinfection should be carried out in detail over the whole 
sphere of the infection—i. e., into courts, sinks, privies, ash-pits, dungsteads, 
common sewers, and in some cases into the soil and the water, as above 
described. It is further to be carefully kept in view, that these principles 
are to be applied not merely in cholera, but in every case which can be 
detected of diarrhoea or other disease carrying the suspicion or possibility 
of cholera ; inasmuch as no practical security exists, on the great scale, for 
the freedom from infectious quality (in times Avhen cholera is prevailing) of 
the discharges in any case of diarrhceal disease; and almost all cases of 
true cholera are preceded by a diarrhoea, which probably may endanger 
others nearly as much as the true cholera itself.” 
The methods of disinfection recommended were the adding to the sus- 
pected discharges, immediately, of a measured portion of the common green 
vitrol or sulphate of iron corresponding to a daily weighed quantity of 
about two avoirdupois ounces for an adult and one avoirdupois ounce for a 
child during each day in which the disease lasts, and, for at least several 
days afterward, until all possible risk is over; and, further, the disinfection 
of all matters capable of being so treated by the addition of carbolic acid 
in the proportion of a teaspoonful of ordinary commercial acid for the dis- 
charges of one individual for one day. In disinfecting clothing, chloride 
of zinc was recommended, and, speaking generally, the use of blue litmus 
paper, as regards all matter so disinfected, in order to secure a distinct acid 
reaction. Supplies of all these materials were kept constantly available, in 
a state for immediate use, and were to be had, on personal application, at 
the depots indicated by the authorities. 
IV. “ Instructions for the Inspector of Cleansing, as to Disinfection in Cholera 
and Diarrhoea. 
This instruction need scarcely be given in detail. It was founded on the 
idea that the services of an inspector could be brought into immediate 
requisition, at any suspected point, both for the advice of the inhabitants 
and for practical work. 
V. "Instructions for Chemists and Druggists, and for all Persons Charged 
with the Supply of Disinfectants.” 
The supply was to be gratuitous, in divided quantities, which were 
carefully labelled and marked, “For one day’s supply,” and also with direc- 
tions for use in accordance with the preceding. The depots at which these 
supplies were furnished were kept open day and night during the time 
when cholera was apprehended, and were so arranged that, throughout the 
whole city, a depot was available within a short distance. 18 
PREVENTION OF EPIDEMIC CHOLERA. 
VI. “ Plain Directions for the People. (For distribution by District 
Visitors.)” 
The object of this paper (covering four pages octavo) was ‘‘to represent 
to the people of the district what things are necessary to be done in view of 
an epidemic of cholera, and, if possible, so done as to prevent the epidemic 
from visiting Glasgow at all.’’ 
The inmate of the house is recommended to welcome the Visitor who 
delivers the paper, to talk freely with him, and to think carefully over 
what he says. The instructions given are under the following heads : 
1. “Whoever would avoid cholera must, above all things, be clean ; but 
cleanliness out and out is not always an easy matter. Think of these things 
for a little, viz.: Do you wash often and thoroughly and all over? Do you 
wash your children every day, and from head to foot? Do you keep no 
dirty clothes on your person or in the house ? Do you allow no dirty dishes, 
no dirty plates nor spoons, no ditty towels, no dirty brushes, no dirty floors, 
walls, closets, beds, bed-curtains? Is the house always tidy and 
pure without and within? Do you always breathe a clean, pure air, by 
taking care to open the window very often? Do you use freely the great 
blessing of clean and pure water, as you may have it abundantly ? or do 
you keep it in the house until it is tainted and unclean ? Remember that 
unless you have clean air and clean water, there is no perfect cleanliness ; 
and it is your own fault if you have not enough of both.” 
Paragraphs 2 and 3 contain similar details in regard to cleansing by the 
authorities, the use of unwholesome food, etc. 
4. “Be equally careful of what you drink. All that has been said of 
eating applies also to drinking. And more: be sure that cholera will find 
out the drunkards first, and destroy them in the greatest numbers. It is a 
frightful delusion to suppose that you can keep away cholera by strong 
drink. Medical men of experience will tell you, with one accord, that 
tipplers have been by far the most numerous victims in all the epidemics.” 
6. “Ask your Visitor where to apply in case anything goes wrong. It is 
a mistake to suppose that cholera will strike you down all of a sudden : it 
will give warning, if you will take warning. Do not give way to alarm( 
therefore, but remember always that too much looseness of the bowels, 
especially if without a known cause and without pain, should lead you to 
give notice in the proper quarter, in order that a Medical Visitor may be 
sent with medicines and disinfectants, if you are unable to command them 
otherwise. There are few cases of cholera that may not be checked in the 
very earliest stages, and nothing, therefore, can be more unreasonable than 
to send for the doctor for the first time, in a hurry, after the disease has 
got beyond the power of medicine. It is quite true that very many cases of 
what is called diarrhoea have really nothing to do with cholera; but no harm 
is done by simply giving notice, and a little good advice at the beginning 
will save a great deal of trouble in the end—‘ a stitch in time saves nine. 
These instructions are intended not to frighten you, but to lead you to be 
wise in time.” GAIRDNER. 
19 
Enclosed in this paper, which was left in every household, was a slip 
corresponding with the section of the city in which the house was located, 
and giving at least names of three depots where every kind of written 
information or inquiry could be handed in, and where every kind of disin- 
fectant recommended could he procured. A form for communicating such 
information as to the existence either of cholera or of simple diarrhoea in 
the house was supplied along with this paper, giving, the date; second, 
the patient’s name and name of the householder where lodged; third, the age 
of the patient; fourth, a very exact definition of the address: the object 
being that the deposit of an information paper should be as promptly as 
possible followed up by a call either from an authorized and qualified 
medical practitioner or from one of the medical visitors employed by the 
authorities, and to whom it was confided to judge of the urgency of the 
circumstances with a view to further proceedings or to the administration 
of simple remedies. 
VII. This last instruction, issued at the instance of the Secretary to the 
Privy Council, was for' pilots, tug-masters, and masters of ships entering the 
Clyde, in reference to cholera and diarrhceal disease. It is noted as having 
been issued on the fourth day of May, 1866, and is signed by the Lord 
Provost of Glasgow and the Provost of Greenock; its object being to pro- 
tect the ports by giving instant information of any case of suspicious dis- 
ease, and offering hospital facilities for the treatment of such case. The 
instructions, however, proceed so directly on the basis of those framed in 
London and elsewhere, that it appears unnecessary to give them here in 
detail.