Rules for the Prevention of Cholera

Public health notice (photograph)

By: Anonymous

Date: August 14, 1892

Source: New York Board of Health.

About the Author: The New York Board of Health was set up in 1806 and moved control of health affairs from the state to the city. However, for the first sixty years of its existence, the Board confined its activities to fighting epidemics of diseases such as cholera and did little other public health work. In 1866, the Board was organized more formally and in 1870 it became the Health Department, which was divided into the Sanitary Bureau and the Bureau of Records. The former was further divided into four divisions: Contagious Diseases, General and Special Sanitary Inspection, Plumbing and Ventilation, and Offensive Trades and Food Inspection. In 1890, the Division of Contagious Diseases divided New York City into eleven districts, each headed by a medical sanitary inspector who was a physician responsible for general sanitary conditions in the district.

INTRODUCTION

Cholera is an acute bacterial infection whose causative agent, Vibrio cholerae, was identified by the German bacteriologist Robert Koch (1843–1910) in 1883. The disease had existed in Southeast Asia for many centuries and began to spread to Europe and America from the early nineteenth century through trading and immigration. Epidemic cholera reached England in 1831 and North America in 1832. The disease was much feared because of its mortality rate of up to 40 percent. Death from cholera was caused by massive dehydration, which led to kidney failure, with low blood pressure and low blood glucose being complicating features. It was initially believed that cholera was caused by a miasma or "bad air," until the germ theories of Koch and Louis Pasteur (1822–1895) were established during the second half of the nineteenth century.

The New York Board of Health had already experienced some success in fighting the 1866 cholera outbreak. This success was used as a springboard to make much-needed improvements in public health, such as reporting and investigating cases of infectious disease and emphasizing disinfection as a means of control. The "Rules for the Prevention of Cholera" would not be out of place in New York City today. The mention of germs shows an awareness of the new theory of disease. It was known that infection occurs through ingestion of contaminated food and water and that V. cholerae is destroyed by boiling. Therefore, the advice to avoid unboiled water and raw, uncooked foods is sensible, as is the guidance on handwashing and personal hygiene.

PRIMARY SOURCE

RULES FOR THE PREVENTION OF CHOLERA

See primary source image.

PRIMARY SOURCE

RULES FOR THE PREVENTION OF CHOLERA

As Officially Recommended by the N.Y. Board of Health.Health Department, New York, Aug. 11, 1892.

PREVENTION OF CHOLERA EASIER THAN CURE. HOW CAUGHT.

Healthy persons "catch" cholera by taking into their systems through the mouth, as in their food or drink, or from their hands, knives, forks, plates, tumblers, clothing, etc., the germs of the disease which are always present in the discharges from the stomach and bowels of those sick with cholera.

Thorough cooking destroys the cholera germs; therefore:

DON'T eat raw, uncooked articles of any kind, not even milk.

DON'T eat or drink to excess. Use plain, wholesome, digestible food, as indigestion and diarrhoea favor an attack of cholera.

DON'T drink unboiled water.

DON'T eat or drink articles unless they have been thoroughly and recently cooked or boiled, and the more recent and hotter they are the safer.

DON'T employ utensils in eating or drinking unless they have been recently put in boiling water; the more recent the better.

DON'T eat or handle food or drink with unwashed hands, or receive it from the unwashed hands of others.

DON'T use the hands for any purpose when soiled with cholera discharges. Thoroughly cleanse them at once.

Personal cleanliness and cleanliness of the living and sleeping rooms and their contents, and thorough ventilation, should be rigidly enforced. Foul water closets, sinks, Croton faucets, cellars, etc., should be avoided, and, when present, should be referred to the Health Board at once, and be remedied.

PRECAUTIONARY MEASURES OF TREATMENT.

The successful treatment and the prevention of the spread of this disease demand that its earliest manifestations be promptly recognized and treated; therefore,

DON'T doctor yourself for bowel complaint, but go to bed and send for the nearest physician at once. Send for your family physician; send to a dispensary or hospital; send to the Health Department; send to the nearest police station for medical aid.

DON'T wait, but send at once. If taken ill in the street, seek the nearest drug store, dispensary, hospital or police station and demand prompt medical attention.

DON'T permit vomit or diarrhoeal discharge to come in contact with food, drink or clothing. These discharges should be received in proper vessels, and kept covered until removed under competent directions. Pour boiling water on them, put a strong solution of carbolic acid in them (not less than one part of acid to twenty of hot soapsuds or water.)

DON'T wear, handle or use any article of clothing or furniture that are soiled with cholera discharges. Pour boiling water on them or put them into and scrub them with the carbolic acid solution mentioned above, and promptly request the Health Board to remove them.

DON'T be frightened, but do be cautious, and avoid excesses and unnecessary exposures of every kind.

By order of the Board of Health.

EMMONS CLARK, Secretary

CHARLES G. WILSON, President

More than twenty years ago, when it was found that prevention of cholera was easier than cure, a prescription drawn up by eminent doctors was published in the Sun, and it took the name of the Sun cholera medicine.

We have seen it in constant use for nearly two score years, and found it to be one of the best remedies for looseness of the bowels ever yet devised.

We commend it to all our friends. Even when no cholera is anticipated, it is an excellent remedy for ordinary Summer complaint, colic, diarrhoea, dysentery, etc.

Take equal parts of tincture of cayenne pepper, tincture of opium, tincture of rhubarb, essence of peppermint and spirits of camphor. Mix well. Dose, 15 to 30 drops in a little cold water, according to age and violence of symptoms, repeated every fifteen or twenty minutes until relief is obtained.

Compliments of the THE NEW YORK RECORDER, the Home Newspaper of the Metropolis.

SIGNIFICANCE

In 1890, Jacob Riis (1849–1914), a police reporter for the New York Tribune, published an influential book titled How the Other Half Lives, which highlighted the steps still necessary to improve public health and sanitation in the city. Meanwhile, a fifth cholera pandemic was underway in China, Japan, Egypt, Russia, and Germany. In late August 1892, there was news of an outbreak in Hamburg and infected passengers on a ship from that city were headed for New York, bringing with them the threat of contagion. Quarantining of these passengers, and other efforts by the Boards of Health, stopped the pandemic spreading to the U.S.

Hermann M. Biggs, a physician who was well acquainted with the pioneering work of Koch and Pasteur, had become consultant pathologist to the New York Department of Health in 1888 and was influential in the fight against cholera in the city. With the threat of a new epidemic, Biggs was able to obtain funds to set up a bacteriological laboratory under his leadership. It was, perhaps, the first laboratory in the world to be used for the routine diagnosis of disease using the latest scientific methods, and it provided a valuable model for governments elsewhere to follow. Laboratory results were used to show instances of pollution in the local water supply, and this led to preventive legislation. The laboratory's work also led to the chlorination of the water supply in 1911 and the pasteurization of milk in 1912, both important advances in the fight against infectious diseases, such as cholera. For many years, the municipal bacteriological laboratory in New York was the leading medical research center in the country.

FURTHER RESOURCES

Books

Crisci, Madeline. Public Health in New York City in the Late Nineteenth Century. Bethesda: U.S. Department of Health and Human Services, 1990.

Lock, Stephen, John M. Last, and George Dunea, eds. The Oxford Illustrated Companion to Medicine. Oxford: Oxford University Press, 2001.

Periodicals

Baumgartner, Leona. "One Hundred Years of Health: New York City, 1866–1966." Bulletin of the New York Academy of Medicine 45 (1969): 555-575.