Poor relief in the time of cholera

We reported yesterday on the Scottish Records Association conference on healthcare in Scotland before the NHS. One of the speakers discussed cholera outbreaks and the measures taken to deal with them. There was a major outbreak of cholera in Scotland in 1832, traces of which can be found in a variety of record sources - there was a spike in mortality, which can be traced in burial registers; newspapers of the time feature regular reports of cholera cases and attempts to cope with the consequences; and Kirk Session records often at least mention the epidemic.

Inchinnan, in Renfrewshire, was no exception. The Kirk Session and heritors were so concerned that they formed a committee of health to try to cope with the health crisis:

At a meeting of the heritors and Kirk Session held at Inchinnan on the 26th day of January 1832

The meeting considering the prevailing alarm on the subject of Cholera authorise the Kirk Treasurer to place at the disposal of the following Gentlemen as a Committee, such as Sum as they may find it necessary to expend in medicines, clothing, or such other way as they may consider most likely to promote the health and comfort of the poor of the Parish.

​The following are named as a committee for the above purpose.
Mr Lockhart, Minr
Mr Fulton
Mr Gibson, Brownsfield
Mr Snodgrass, Portnauld
Mr Alexander, Craigend
Mr Willm Kelloch, Freeland
Mr Galloway, the Schoolmaster
Mr Lockhart, to be convener.

The committee didn't waste much time - they met again four days later, having carried out an inspection of much of the parish:

​At Inchinnan, the thirtieth day of January 1832. We the Committee appointed at the meeting of Heritors and Kirk Session to inspect the different dwelling houses in the Parish, for the purpose of removing nuisances and providing for the comfort of the indigent, report that we this day commenced our survey at the Manse, and visited all the families to the North of the old Greenock road, as far as Peter Barr’s Gateside, and in addition Greenhead, Broomlands, and Luckensford.
Generally speaking the appearance of the Houses and people was satisfactory but we found it necessary to order as follows.

1. Widow Paul, 2 flannel dresses to be made by Miss Norris.
2. Widow Barr, whose case was noticed at the meeting of Heritors and Kirk Session, one cart of coals also two flannel dresses, made as above.
3. At the Old Schoolhouse, found the apartments very clean and neat, but the walls of the Schoolroom were so damp as to have led the mistress to abandon it and teach in her Kitchen, adjourning which was a dark closet, so damp and unwholesome that we ordered a small window to be placed in the back wall.
4. William Smith at Broomlands to remove a heap of saw dust and rubbish which produced an unpleasant smell.
5. Henry Mcfarlane’s house to receive an opening in the back Widow. Pighouse and dunghill to be removed as far as his limits.
6. William Allan. Back window to be made to open, potatoes below the Bed to be removed.
7. Rober Cowan – to remove potatoes as above.
8. Hugh Mirren to remove potatoes from under bed, to receive six yards of flannel and a pair of blankets.
9. Mrs Carswell – window to be made to open, dunghill to be removed.
10. Euphemia McArthur, to remove dunghill and to receive one cart of coals.
11. Mrs Smith, the Landlord’s wife, dunghill to be removed.
12. William Paton, to remove dunghill & necessary
13. Bernard Duffy, to remove his pig house and to receive a pair of blankets and six yards of flannel
14. Daniel Carmichael, the last of fifteen children, has his mother residing with him, whom he supports as well as he can; to remove his pigs, and his mother to receive a pair of blankets and six yards of flannel.
15. William Thompson’s window to be made to open, and dunghill to be removed.
16. James Allison – window in a bad state, dunghill to be removed
17. Laird Scott to remove off the rubbish before his houses
18. John Ruxton – Pighouse and dunghill to be removed. To receive six yards of flannel for children at Miss Norris’ discretion.
19. Robert Crawford to remove dunghill from behind his house and pighouse from before.
20. Widow Slater – Her house to be thoroughly cleaned, without expense to herself, to receive one pair of blankets, two flannel dresses and one cart of coals.
21. James Cameron to remove his dunghill
22. Robert McAllister to receive two flannel shirts and a coat of shepherd’s cloth lined with plaiding. To remove his ashes pit.
23. Widow Blackwood’s window, Barshill to be made to open, and two dunghills to be removed.
24. Widow Clark’s window to be made to open, potatoes to be removed from under her bed.
25. James Gilmour’s house unwholesome from damp
26. James Caldwell – Dunghill to be removed.

The Committee, that no delay might take place in removing the nuisances reported, requested Mr Snodgrass to instruct the two men who are now working by his order on the road to superintend and give assistance during said operation. The foot path opposite Broomlands was found strewed with excrement, and the Committee considered it indispensable that one or more necessaries be erected forthwith.

This is a mix of reasonable preventive measures and concern for the general well-being of the poor of the parish, but I have to admit I was a little surprised to learn the heritors agreeing to build a "necessary", essentially a public toilet, although it was likely very basic, perhaps little more than a hole in the ground. The notion of potatoes causing cholera was somewhat more surprising though.

The Committee met again the next day, having completed their inspections:

Inchinnan, Feb 1 1832
2nd day
The Committee resumed their labours this day and finished inspecting all the dwelling houses in Inchinnan. They ordered as follows:

1. Newmains – Window to be opened in shoemaker’s house
2. John Whitelaw to receive a pair of blankets and plaiding trousers.
3. Jean Reid, the blind pauper, to receive a pair of blankets and six yds of flannel
4. Linburn – Mrs McArthur. Dunghill to be removed & to receive a pair of blankets.
5. Mrs Hughes to receive a pair of blankets and remove a dunghill.
6. John Leech, pauper, residing in Paisley, to receive a pair of blankets, and to get a temporary addition to his aliment of two shillings per month.

Two weeks later, the Committee met again. Clearly, their concern had increased. They ordered a printed circular to be printed, giving advice to parishioners, and used poor funds to buy a stock of medicines for the use of the poor in the parish - an interesting example of public health care provision before the 1845 Poor Law required local authorities to do so.

3d day.
At Inchinnan Schoolhouse
The seventeenth day of Feb 1832 – the Members of Committee met owing to the near approach of cholera they considered it expedient to associate the following individuals with them, viz

Messrs James Donaldson, Willm Smith, James McKean & Willm Craig, who readily agreed to give what assistance may be in their power in the event of the disease breaking out in this place.

Mr Lockhart reported that he had ordered directions to be printed for the use of the Parish. Also a set of medicines as recommended by the different boards of health. The Committee approved of these steps, and authorized Mr Galloway to defray the expenses thus incurred.

The Committee requests Mr Lockhart to intimate from the Pulpit the places where the medicines were deposited, and also to warn the people against harbouring or serving vagrants, and that the laws will be put in force againsst those trespassing.

It was reported by a member of committee that the people had in general complied with the instructions in regard to cleanliness, ventilation &c.

​It was agreed that the Committee should from time to time examine the places from which the nuisances had been removed, also that they should use their influence in their respective neighbourhoods to rouse the prejudiced from their apathy, and disountenance the false reports so generally circulated against the medical profession.

By now the parish authorities were concerned about strangers bringing the disease to Inchinnan, and were warning parishioners to have no dealings with vagrants and unlicensed hawkers. Interestingly, they were also ordering follow-up inspections of places they'd previously visited where they'd ordered the removal of "nuisances".

Four days later the printed circular was ready for distribution to every house in the parish:

At Inchinnan Feb 21st 1832
The Committee of health met and examined printed directions, as annexed, which had been formerly ordered – they approved of the same, and directed the Parish Officer to be employed to distribute a copy to every Family in the Parish, and to receive two shillings and sixpence for his trouble.

The text of the circular makes interesting reading:

​CHOLERA
Preventives – Be clean in your person. Wear flannels next the skin. Keep the bowels well defended from cold, and never sit down with wet or cold feet. Abstain from small beer, and use spiritous liquours very moderately. Use no water that is not pure. The use of strong broth and butcher meat is salutary. Avoid raw vegetables, and boil well what you eat. Do not go out in the morning without breaking your fast. Avoid getting wet, or going out at night. Avoid also large towns, infected places, and public houses.
Piggeries, Dunghills, and Cess-pools ought to be at some distance and frequently cleaned. Let the house be regularly ventilated, and well swept. When you wash it, choose a sunny day, and do it in the morning, so that there may be no damp when you shut up at night. Keep your doors dry.
Symptoms and treatment – Cholera generally begins with giddiness, languour, and uneasiness in the bowels, accompanied by looseness more or less. When such symptoms appear, no time ought to be lost in sending for medical advice – but in the mean time, 30 drops of Laudanum, and 3 teaspoonfuls of Castor Oil may be taken in a little hot brandy and water. Go to bed immediately, and keep yourself warm. Heated bricks or hot bottles may be applied, or bags of hot bran or salt. Place a mustard blister on the stomach. Let your drink consist of warm barley-water in small portions. Cold water is dangerous, and Salts must on no account be taken.
Should the Castor Oil &c be thrown up, take 30 drops of plain Laudanum.
Families ought to provide themselves with Laudanum and the other articles, as all depends on taking the disease at the first.
Inchinnan, 18th February 1832.

Laudanum of course was a tincture of opium. While it could certainly ease the most obvious symptom of cholera - diarrhoea - it really wasn't a cure, and as one of the speakers at the SRA conference pointed out, opium poisoning was a significant problem in Scotland in the 19th century.

The next entry is three weeks later. It would appear that the exhortations to parishioners not to deal with vagrants and unlicensed hawkers had not had the desired effect, as the heritors decided to hire a Constable to patrol the road to keep strangers out:

Inchinnan March 12th 1832
At the Schooolhouse, met this day the members of the Committee of health, and appointed Mr Gibson & Mr Willm Killoch to employ and station a Constable at Walkinshaw Bridge to prevent beggars & unlicensed hawkers from passing out from Paisley. Mr Lockhart & James Snodgrass to arrange with the toll keeper at Inchinnan Bridge so as to prevent vagrants from getting into the Parish by that quarter.

The meeting agree to give Willm Brisbane the remaining pair of blankets, his body clothes and bedding having been burned along with Mr McKean’s shop where he lodged.

Unfortunately, there are no further minutes of the health committee, so it's not clear what the outcome was, but it is clear that there was concern for the health of paupers, at least in one parish in Renfrewshire, although doubtless there was likely an element of self-interest in preventing an outbreak.

That cholera was not eradicated is however made clear by the fact that immediately below a copy of the printed circular in the Kirk Session minute book is a note, in a different hand from the surrounding entries, and dated some years later, with suggested treatments for cholera outbreaks:

Recommendations
Glasgow Constitutional, Jany 6th 1849. Dr Laurie Eevery person shd have Laudanum in the house, and after a sudden or more than usually copious stool, he shd resort to it, & especially in the morning. Take one teaspoonful of Laudanum, as an injection in half a glass of water, and ½ a tea spoonful of Laudanum by the mouth. He shd do this without waiting for the Doctor until the Dr did come.
After Laudanum has been used, as already stated, it has been found beneficial to administer opium, & afterwards, opium and valerial together.
Dr Campbell, Calton – found that in every case by doses of Laudanum & essences of peppermint, the disease was checked, if early administered, if within 25 minutes after the attack, he had found it invariably successful.
Dr J Adams – According to the opinion of ¾ of the profession, Laudanum was the best thing to administer at the outset. Every family should have it in the house. From 3 o’clock til 10 a hundred drops of Laudanum had been given.
Dr Boag stated the great importance of getting the houses in affected districts cleansed & the removal of the families to some place of Refuge while the cleansing was getting done.

Evidently, treatment of cholera hadn't advanced much in the intervening years.