Weekly National Intelligencer

The Cholera

The British Government, through its "General Board of Health," has issued a circular containing remarks upon the ascertained nature of the epidemic which has recently made its appearance in England and Scotland, with suggestions for its prevention and its treatment. As it is possible that the cholera may come in search of victims to our shores also, we copy the circular, omitting such portions as are locally inapplicable:

General Board of Health,

Gwydyr House, October 5, 1848.

The General Board of Health, having considered the official accounts which have been received of the course of the Asiatic cholera since the presentation of the reports of the metropolitan sanitary commissioners, and having consulted medical practitioners of eminence and of special knowledge of the subject, and having compared the tenor of those recent accounts with the observations made respecting the former mode of the propagation of Asiatic cholera in Europe, have now to represent-

That the experience obtained of this disease during its former invasions of the country in the years 1831 and 1832, and the still larger experience acquired during its recent progress through Persia, Egypt, Syria, Russia, Poland, and Prussia, appears to afford ground for the correction of some views formerly entertained concerning it which have an important bearing on the measures, both of prevention and alleviation, that are expedient to be adopted.

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 the 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 and the real means of protection, and fixes it on those which are imaginary; creates panic; leads to the neglect and 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 to occur in this country. Moreover, the preventive measures founded on 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 evidence also proves that cholera almost always affords, by premonitory symptoms, warning of its approach, in time for the employment of means capable of arresting its progress. If, indeed, in certain situations, as where there is an unusual concentration of the poison, or in certain individuals who are peculiarly predisposed to the disease, the attack may sometimes appear to be instantaneous, still the general conclusions, that cholera is not in itself contagious, and that it commonly gives distinct warning of its approach, are two great facts well calculated to divest this disease of its chief terrors, and to show the paramount importance of the means of prevention, so much more certain than those of cure.

The proved identity of the causes which promote the origin and spread of epidemic diseases in general, with those that favor the introduction and spread of Asiatic cholera, appears to indicate the true measures of precaution and prevention against a pestilence, which after an absence of sixteen years, and at a season when other formidable epidemic diseases are unusually prevalent and deadly, menaces a third visitation; and the General Board of Health would appeal to all classes for their cordial co-operation in carrying into effect the measures which careful consideration has led them to recommend, in the full conviction that the powers given by the legislature for this purpose, though they may not be fully adequate, and though the time to use them may be short, cannot fail, with such co-operation, to be attended with highly beneficial results.

Great benefit having been derived from the cleansings that were resorted to on the former visitation of cholera, and experience having shown that preventive measures against cholera are also preventive against typhus and other epidemic and endemic diseases, the boards of guardians should carry into immediate effect all practical measures of external and internal cleansing of dwellings in the ill-conditioned districts.

The chief predisposing causes 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 amidst 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 recognised, and the practical recommendations founded thereon are "to keep the person and 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."

Housekeepers 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 about their houses. 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.

If, notwithstanding every precautionary measure which can be taken, this disease should unhappily break out in any district, then it will be essential to the safety of the inhabitants that they should be fully impressed with the importance of paying instant attention to the premonitory symptom that announces the commencement of the attack.

This premonitory symptom is looseness of the bowels, which there is reason to regard as universally preceding the setting in of the more dangerous stage of the disease. Sometimes, indeed under the circumstances already described, namely, where the poison exists in unusual intensity, or the constitutional predisposition is unusually great, the first stage may appear to be suppressed, as occasionally happens in violent attacks of other diseases: but in cholera this event is so rare as to be practically of no account: and in all countries, and under all varieties of conditions in which this disease has been epidemic, the experience as to this point uniformly agrees with what is observed at the present moment at Hamburg.

"In most cases," writes the British Consul respecting the epidemic, which has just broken out in that city, "the disease has first manifested itself in a slight relaxation of the bowels, from which, if properly attended to, the patient generally recovers; but if the symptoms are neglected, spasmodic attacks ensue, and death follows mostly in from four to six hours."

This looseness of the bowels may be accompanied with some degree of pain, which, however, is generally slight; but in many cases pain is wholly absent, and for some hours, and even days, this bowel complaint may be so slight as to appear trifling; so that without a previous knowledge of the importance of the warning, it might escape notice altogether.

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.

Medical authorities are agreed that the 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 among the most useful, namely, twenty grains of opium confection, mixed with two table-spoonfuls of peppermint water, or with 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 severe. 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, whenever 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 that followed a hearty meal taken immediately after a protracted fast. In our own 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 Volant, 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 flannels 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 to 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 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 over 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.

It has not been deemed necessary or proper to give instructions for the treatment of the advanced stage, from the confident expectation that the proposed arrangement will supply medical attendance to all cases that may reach that condition, by which means the specific symptoms of each individual case will receive their appropriate treatment.

Though the season of danger may demand some extraordinary exertion and sacrifice on the part of all classes, yet this period will probably not be protracted; since, on the former visitation of cholera, it seldom remained in any place which it attacked longer than a few months, and rarely more than a few weeks, while it may be reasonably expected that the improvements effected with a view to check its progress will be equally efficacious in shortening its duration; and that these improvements will not be temporary, like the occasion that called for them, but will be attended with lasting benefit.

In conclusion, the General Board of Health would again urge the consideration that whatever is preventive of cholera is equally preventive of typhus and of every other epidemic and constantly recurring disease; and would earnestly call the attention of all classes to the striking and consoling fact that, formidable as this malady is in its intense form and developed stage, there is no disease against which it is in our power to take such effectual precaution, both as collective communities and private individuals, by vigilant attention to it in its first premonitory stage, and by the removal of those agencies which are known to promote the spread of all epidemic diseases. Though, therefore, the issues of events are not in our hands, there is ground for hope and even confidence in the sustained and resolute employment of the means of protection which experience and science have now placed within our reach.

By order of the General Board of Health:

HENRY AUSTIN, Secretary.