and were it not that seamen work in a purer external atmosphere, that they are below decks comparatively for short intervals only, and that in general they are men at the most robust periods of life, it is probable that epidemic disease would be still more frequent among them; an inference supported by the fact that whenever passengers, emigrants, and others are, owing to stormy weather, much confined to the berths below, some form of malignant disease is almost sure to break out. Footnote 29: See pp. 57, 129, works executed after this was written. [ED.] * * * * * There are not wanting instances in which the energetic adoption of such measures as were available, particularly the enforcement of all practicable means of cleansing, and the resolute removal of nuisances, warded off Cholera to a very great extent, even under circumstances in which a formidable attack appeared inevitable; and perhaps it may serve for encouragement and guidance to direct attention to one or two of such examples.[30] Footnote 30: The two following examples are taken from “Results of Sanitary Improvement,” by Dr Southwood Smith, 1854. [ED.] One of the most remarkable of these occurred at Baltimore, during the prevalence of epidemic cholera in America, in 1849. The population of that city was about 149,000 souls. The site of the town is naturally salubrious, and parts of it are well built; but the districts near the river occupied by the poorer classes are low and damp, and liable to remittent and intermittent fevers, and, therefore, predisposed to cholera. In the spring of 1849, the pestilence, which had attacked with great violence several neighbouring towns, appeared to be close upon the city. A general conviction prevailed, both among the authorities and the citizens, that uncleanliness had much to do with the development and spread of the disease; they therefore spared neither money nor labour to purify the city, and they gave the execution of the cleansing operations to experienced and energetic officers, who performed the work so vigorously, that it was generally admitted that never before had the town been in so clean a state, or so thoroughly purified, as during the summer months of the year 1849. About the middle of June, while cholera was prevailing at New York, Cincinnati, and other places, north and west of Baltimore, diarrhœa broke out, and became general over the whole city, accompanied by another symptom which was universal, affecting even those who had no positive attack of diarrhœa; namely, an indefinable sense of oppression over the whole region of the abdomen, seldom amounting to pain, but constantly calling attention to that part of the body.