The Caledonian

The Cholera—Its Approach.

The spread of the Cholera into England—
The probability that it will visit our country
soon, makes it a subject of deep interest to
all of our people. We therefore copy the
following lengthy, but important article upon
the subject from the Boston Mercantile Journal:

There is some reason to believe that the
cholera will make its appearance in this country
in the course of a few months. It is following
in the same track as in 1831-2, and is
advancing at about the same rate of progression.
Its ravages, however, have not been
so great during its present progress, neither
has the disease proved so formidable as on its
former appearance. Not only has the medical
faculty acquired a more accurate knowledge of
the nature of the disease, but it has
been found to yield more readily to medical
treatment. There is, consequently, no reason
to expect that the malady will prove as
fatal as in 1832. In this section of the country
we may reasonably expect an immunity
from this disease to the same extent as in
that year. The theory of Dr Jackson, that it
never ravages regions which are, geologically,
based upon a granite formation, is plausible,
and is supported by well-attested facts.
A communication, confirming the theory of
Dr. Jackson, recently appeared in the Cincinnati
Gaz., in which the writer adduced many
instances in which the cholera passed over
tracts of country of the character mentioned,
in various parts of the United States and Europe,
whilst it ravaged neighboring tracts of
a different geological structure.

Doubtless a few cases of this disease will
occur in our midst, and it is the duty not only
of the public authorities, but of every private
citizen, to adopt the proper precautions
to prevent its spread. Every individual
should possess an accurate knowledge of the
predisposing causes and characteristics of
the disease, and they will thus be enabled to
guard against an attack.

The cholera is formidable only in its name.
With proper treatment, it may be checked
in its earlier stages as readily as any other
disease. It is only through neglect that it
proves fatal. This will become evident by
the following statement of the nature of the
attack, which is extracted from an address
of the Central Board of Health, Dublin:

"It seems to be a well established fact, and
one that cannot be too strongly impressed
upon the minds of the people generally, as
upon this fact depends the best mode of successfully
contending with the disease, that in
nearly all cases of cholera there are two stages
of the disease, the first being merely diarrhoea,
or simple looseness of the bowels;
the second being the stage of collapse, or blue
cholera, marked by cramps, failure of the circulation,
lividity of the skin, cold clammy
perspiration, and all the other well-known
symptoms of the disease. In the first stage
of the disease medical treatment is frequently
successful, in the second stage too often of
no avail.

The first stage, diarrhoea, or mere looseness
of the bowels, may be of only a few
hours' duration, or may continue from one to
several days. It is most important to bear
in mind, that this diarrhoea may be entirely
without pain; indeed, it is most frequently
without pain, or merely accompanied with
trifling griping uneasiness. This absence of
pain, or the little accompanying uneasiness,
has too often thrown the patient off his guard
who has thus neglected the warning of his
danger, and has allowed the time for cure to
pass by.

It may be safely asserted, that during the
prevalence of an epidemic of cholera, diarrhoea
or looseness of the bowels, which is
free from pain, is more dangerous, more likely
to be the first stage of the disease, than diarrhoea,
accompanied with griping or pain.
Let it, then, be clearly understood, that when
the epidemic is prevalent, mere looseness of
the bowels, with or without pain, may be the
commencement or first stage of cholera—
that the disease is generally curable in this
stage, and that not a moment should be lost
in applying for relief.

The cholera is not contagious. This fact has
been well-established. It is an epidemic.
which is transmitted by certain atmospheric
influences, but actual contact with a person
afflicted with the disease, is not necessarily
dangerous. On this point we have the following
remarks in the "official notification
of the General Board of Health, London," a
document of much interest and importance:

"The extent, uniform tenor, and undoubted
authority of the evidence obtained from
observers of all classes, in different countries
and climates, and amidst all varieties of the
physical, political, and social conditions of
its people, appear to discredit the once prevalent
opinion that cholera is, in itself, contagious;
an opinion which, if fallacious, must
be mischievous, since it diverts attention from
the true source of danger, & the real means of
protection, & fixes it on those which are imaginary;
creates panic: leads to the neglect
& abandonment of the sick; occasions great
expense for what is worse than useless; and
withdraws attention from that brief but important
interval between the commencement
and the development of the disease during
which remedial measures are most effective
in its cure.

Although it is so far true that certain conditions
may favor its spread from person to
person, as when great numbers of the sick
are crowded together in close unventilated
apartments, yet this is not to be considered
as affecting the general principle of its non-
contagious nature nor are such conditions
likely preventive measures in this country
founded Moreover the theory of contagion—namely, internal quarantine
regulations, sanitary cordons, and the isolation
of the sick, on which formerly the strongest
reliance was placed, have been recently
abandoned in all countries where cholera has
appeared, from the general experience of
their inefficiency."

The predisposing causes and conditions
which may lead to a spread of this disease
are thus stated in the document above mentioned:

"The chief predisposing cause of every
epidemic, and especially of cholera, are damp
moisture, filth, animal and vegetable matters
in a state of decomposition, and in general,
whatever produces atmospheric impurity; all
of which have the effect of lowering the
health and vigor of the system, and of increasing
the susceptibility to disease, particularly
among the young, the aged, and the
feeble.

The attacks of cholera are uniformly found
to be most frequent and virulent in low-lying
districts, on the banks of rivers, in the neighborhood
of sewer mouths, and wherever there
are large collections of refuse, particularly a-
midst human dwellings. In a recent proclamation,
issued for the protection of the
population of the Russian empire, the important
influence of these and similar causes has
been recognized, and the practical recommendations
founded thereon are 'to keep the
person and the dwelling place clean, to allow
of no sinks close to the house, to admit of no
poultry or animals within the house, to keep
every apartment as airy as possible by ventilation,
and to prevent crowding wherever
there are sick.'

Householders of all classes should be warned
that their first means of safety lies in the
removal of dung heaps and solid and liquid
filth of every description from beneath or a-
bout their houses and premises. Though
persons long familiarized to the presence of
such refuse may not perceive its offensiveness
nor believe in its noxious properties, yet all
who desire to secure themselves from danger
should labor for the entire removal of
filth, and the thorough cleansing of their
premises; which also the law will require of
each person for the protection of his neighbors,
as well as for his own safety.

Next to the perfect cleansing of the premises,
dryness ought to be carefully promoted
which will, of course require the keeping up
of sufficient fires, particularly in the damp
and unhealthy districts, where this means
should be resorted to for the sake of ventilation
as well as of warmth and dryness.

From information recently obtained from
Russia, it appears that in some barracks, and
other places in which large numbers
of people are congregated, where these conditions
have been attended to in a manner
that may be equally practised in private
houses, there has been a comparative immunity
from the prevailing epidemic, exactly
as in this country, where, in public institutions,
though as yet by no means perfect in
the means of ventilation, there has been an
almost entire exemption from epidemics
which have ravaged private houses in the
very same districts."

The following advice in relation to the
measures to be adopted on the appearance
of this disease, and its treatment, is also published
by the Central Board of Health. Although
intended for Great Britain, the advice
may be of service in this country. The profound
knowledge and experience of the practitioners
composing this Board lend great
weight to their recommendations:

"It must be repeated, however, that whenever
Asiatic cholera is epidemic, the slightest
degree of looseness of the bowels ought to
be regarded and treated as the commencement
of the disease, which at this stage is capable
of being arrested by simple means; but
if neglected only for a few hours may suddenly
assume a fatal form.

It will be indispensable, therefore, on the
first outbreak of the cholera, that the local authorities
should immediately make arrangements
for daily house to house inspections
of the poorer localities in their respective districts;
this being the only practical means by
which, in the most dangerous situations and
among the most susceptible subjects, the existence
of the premonitory symptom can be
ascertained in time to administer the proper
remedies, so as to arrest the progress of the
disorder.

Heads of families, masters of schools and
work houses, proprietors of large establishments
and works, such as factories, mines,
warehouses, wharfs and docks, should either
be their own inspectors, or employ some trustworthy
agent to examine daily every person
in their employment, and to give at once the
proper remedy, if the premonitory symptom
should be present.

Each member of the visiting committee
should be provided with proper remedies,
prepared in appropriate doses for administration
on the spot, in every instance in which
the premonitory symptom is found to exist;
and should report every person so treated as
requiring the instant attention of the medical
officer.

Dispensaries for bowel complaints should
be established at convenient stations, at which
the neighboring inhabitants may apply for the
proper remedies and advice the moment they
are attacked by the premonitory symptom.
Experience having shown that the establishment
of cholera hospitals was not successful,
the best provision practicable must be
made for affording assistance to the individuals
who may need it at their own houses;
and one of the best modes of effecting this
object will probably be the selection of proper
persons, who may be instructed as nurses
in the special services required on this occasion,
and paid for devoting their whole time
to attendance on the sick at their own habitations,
under the direction of the medical officers.

It will also be necessary to engage a sufficient
number of medical officers, at a suitable
remuneration, some to devote their whole
time, by day and night, to the service of the
dispensaries, and others to attend the sick
at their own dwellings.

As, however, cases may occur of extreme
destitution in neighborhoods and houses
wholly unfit for the curative treatment of the
sick, provision should be made for the reception
of such cases, either in the common hospitals,
in the union houses, or in separate a-
partments specially prepared for the purpose,
and properly warmed and ventilated.

remedies proper for the premonitory symptom
are the same as those found efficacious
in common diarrhoea; that the most simple
remedies will suffice, if given on the first
manifestation of this symptom; and that the
following, which are within the reach and
management of every one, may be regarded
as amongst the most useful, namely: Twenty
grains of opiate confection, mixed with
two table spoonsful of peppermint water, or
with a little weak brandy and water, and repeated
every three or four hours, or oftener,
if the attack is severe, until the looseness of
the bowels is stopped; or an ounce of the
compound chalk mixture, with ten or fifteen
grains of the aromatic confection, and from
five to ten drops of laudanum, repeated in
the same manner. From half a drachm to
a drachm of tincture of catechu may be added
to this last, if the attack is severer.
Half these quantities should be given to
young persons under fifteen, and still smaller
doses to infants.

It is recommended to repeat these remedies
night and morning, for some days after
the looseness of the bowels has been stopped.
But in all cases, it is desirable, wherever
practicable that even in this earliest stage of
the disorder recourse should be had to medical
advice on the spot.

Next in importance to the immediate employment
of such remedies is attention to
proper diet and clothing. Whenever Asiatic
cholera is epidemic, there is invariably
found among great numbers of the inhabitants
an extraordinary tendency to irritation
of the bowels, and this fact suggests, that every
article of food which is known to favor a
relaxed state of the bowels should, as far as
possible be avoided—such as every variety of
green vegetables, whether cooked or not, as
cabbage, cucumber, and salad. It will be
important also to abstain from fruits of all
kinds, though ripe and even cooked, and
whether dried or preserved. The most wholesome
articles of vegetable diet are—well baked,
but not new bread, rice, oatmeal, and good
potatoes. Pickles should be avoided. Articles
of food and drink which, in ordinary
seasons, are generally wholesome, and agree
well with the individual constitution, may,
under this unusual condition, prove highly
dangerous. The diet should be solid rather
than fluid; and those who have the means of
choosing, should live principally on animal
food, as affording the most concentrated and
invigorating diet; avoiding salted and smoked
meats, pork, salted and shell fish, cider,
perry, ginger-beer, lemonade, acid liquors of
all descriptions, and ardent spirits. Great
moderation, both in food and drink, is absolutely
essential to safety, during the whole
duration of the epidemic period." One single
act of indiscretion has, in many instances,
been followed by a speedy and fatal attack.
The intervals between the meals should not
be long, cholera being uniformly found to prevail
with extraordinary intensity among the
classes that observe the protracted fasts common
in Eastern and some European countries.

The practical importance of these cautions
might be illustrated by striking examples. Dr.
Adair Crawford states that, in Russia, the
most intense of all the attacks were those
which followed a hearty meal taken immediately
after a protracted fast. In our country,
during its former visitation, the most frequent
and deadly attacks were observed to be
those that took place in the middle of the
night, a few hours after a heavy supper. The
three fatal cases that have just occurred to
sailors who had been at Hamburg, and who
were brought sick to Hull, turned out, on inquiry,
to have followed very shortly after the
men had eaten a large quantity of plums, and
had drunk freely of sour beer; and the two
still more recent fatal cases on board the ship
Violent, of Sunderland, both occurred in drunkards,
who persisted in the practice of intoxication,
notwithstanding the earnest warnings
that were given them against the dangers of
intemperance.

On account of the intimate connexion between
the external skin and the internal lining
membrane of the bowels, warm clothing
is of great importance. The wearing of flannel
next the skin is, therefore, advisable. Recent
experience on the continent seems to
show that it was useful to wear, in the day
time, a flannel bandage round the body, and
this may become necessary in our own country
during the damp and cold weather of the
approaching season.

Particular attention should be paid to keeping
the feet warm and dry, changing the
clothes immediately after exposure to wet,
and maintaining the sitting and bed rooms
well aired, dry, and warm.

It may be necessary to add a caution against
the use of cold purgative medicines,
such as salts, particularly Glauber salts, Epsom
salts, and Seidlitz powders, which, taken
in any quantity, in such a season, are
dangerous. Drastic purgatives of all kinds
should be avoided, such as senna, colocynth,
and aloes, except under special medical direction.

If, notwithstanding, these precautionary
measures, a person is seized suddenly with
cold, giddiness, nausea, vomiting and
cramps, under circumstances in which instant
medical assistance cannot be procured, the
concurrent testimony of the most experienced
medical authority shows that the proper
course is to get as soon as possible into a
warm bed; to apply warmth by means of heated
flannel, or bottles filled with hot water, or
bags of heated chamomile flowers, sand, bran,
or salt, to the feet and along the spine; to
have the extremities diligently rubbed, to apply
a large poultice of mustard and vinegar
in the region of the stomach, keeping it on fifteen
or twenty minutes; and to take every
half hour a teaspoonful of sal volatile in a little
hot water, or a dessert spoonful of brandy
in a little hot water, or a wine glass of hot
wine whey, made by pouring a wine glass
of sherry into a tumbler of hot milk—in a
word, to do every thing practicable to procure
a warm, general perspiration, until the
arrival of the medical attendant, whose immediate
care under such circumstances, is indispensable.