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Les diagrammes suivants illustrent la mithode. by errata led to ent Line pelure, 'apon d 1 2 3 32X 1 2 3 4 5 6 rvi tf I € MJ l2 N ^"^ MEMORANDUM OH €mB^MmA f AOoriKP AT A MEDICAL COXFERENCK HELD IN THE BUREAU OF AGRICULTURE, IX MARCH, 1866. 3?TtI3SrTEID B^Sr .A.TJTHCOR.IT'Sr. •-.■^Tity n •11 I a* PKINTED FOK THE BLTKKAU OV AaRlcrUXKE AXD STATISTICS. i86e. i ■ ■:<'' 'I ■I • a I k>^- T MEMORANDUM ON S) ADOPTED AT A MEDICAL CONFERENCE HELD IN THE BUREAU OF AGRICULTURE, IN MARCH, 1866. ►ItlKTTEID B^Z" A.TJTI3:ORlT"Y. PRINTED FUR THE BUREAU OF AGRiCULTURE AND STATISTICS. isee. M Adopted I of ihtj Go^ Agricultur General ii Since legions, a the localit arising ou re-agitate It is of the ma a fertile condensec corporatio undispute character tile dutiei in time ( delaying the objee Govern nu this docui In ai mind, us visited b^ MEMORANDUM ON CHOLERA, Adopted by a Medical Conference convened at Ottawa, the Seat of iht) Governrnoiit of Canada, by the Honorable the Minister of Agriculture, pursuant to an Order of His t^xceliency the Governor General in Council. MARCH, 1866. MEMBERS OF THE CONFERENCE. Dr. MacDorinell— C/mfrwian. — Van Cortland. — Hill. — Landry. — Dick::on. — Aikins. — Beaubien. — Grant. — Tache — Reporter. PRELIMINARY REMARKS. Since the recent outbreak of Asiatic CJwlera in the Levantine regions, and its spread into countries nnore directly connected with the localities of its origiuj all the vexed and complicated questions arising out of the consideration of this terrible scourge have been re-agitated throughout the world. It is not the intention, in this memorandum, to examine any of the many hypothetical opinions and svstems arising from such a fertile subject of discussion; but to collect in a somewhat condensed compass, for the guidance of individuals, associations, corporations uid civil authorities, such practical information as is undisputed amongst unbiast \ and well-informed minds, about the character of the disease and its ordinary way of propagation, about tne duties ot every one towards himself and his fellow-creatures in time of pestilence, about the best means ol preventing or delaying its appearance and mitii»ating its effects. These were the objects of the calling together of this Conference by the Government, and are consequently the subjects dwelt upon in this document. In answer to the questions naturally arising in everyone'^ mind, us to whether it is probable that this continent will be visited by cholera this year, and whether the disease is likely to bo more or less disastrous tliaii fonneily, many very coiilradictoiy thous^li very decided opinions have already been jjivon throiiy;h the pul>lio press and medical purioilicals However, as there i** some dan:^(;r in the promnlgatiou of opinions which cannot bo foundoil on any tangible or well-dedned reaso.vs, it seems belter to candidly acknowledge thit sncrh eventualities are not within the reach of human science to unravel, but that they must be HccejMtnl as they are to happen with a fiibmissivo and courageous spirit ; and it is wise to be {)repared ior the wor.-t. Anottier (juestion, upon which volumes of contradictory argu- ments have boon written, scores of laws enacted, ameniled, repealed antl re-enacted, whether strict quarantine can secure immunity to a country against the importation or spread of pesti- lential diseases, appears to have been answered by experience in this sense: th it, although the strictest quarantines (as a gencnal fact) have certainly failed in securing, in toto, the advantages promised by the extreme partisans of such measures, these measures, nevertheless, have always proved themselves to be highly beneficial in delaying the time of the invasion of the malady, in mitigating its efffCls and preventing that extension which is known to take place where no such precautions are observed. No one denies tliat every reasonable separation of infected persons or things from the hea thy and clean, generally speaking, is beneficial ; and every one admits that hygienic measures are extremely advantageous at all times. It is, therefore, with such views and with the tletermination of carefully avoiding the counsels of carelessness, on the one side, and pusillanimity, on the other, that the investigations connected with the adoption of this memor- andum have been prosecuted. It is earnestly hf)ped that the following short chapters and paragraphs (though containing nothing assumed to be new for persons acquainted with moral, medical and social sciences) will not be without good results, intended specially as they are : 1st. To confirm the public mind against useless and dangerous fears, by showing that the first duty, as well as the better under- stood interest of every one, is to meet manfully, with a truly devout Bpuit, the threatening scourge ; 2nd. To diflTuse amongst the people a sufficient knowledge of what ought to be done to alleviate the calamity and to guard against errors which are so apt to pervade a community in times of such visitations. Should everything be followed out that is recommended in this Memorandum and be executed, and should the threatened pestilence not invade Canada, it could never become the subject oiilrailit'.toiy rn through as there i** I cannot bo f'onis belter ! not within ey must be I courageous lictory argu- , atueniled, can secure !ad of peKti- r experience as a genciral J advantages sures, these selves to be asion of the mt extension ^cautions are n of infected lly speaicing, measures are re, with such X the counsels on the other, ( this mernor- chapters and J be new for sciences) will By are : lud dangerous better under- a truly devout annongst the ne to alleviate ire so apt to onnmendod in he threatened le the subject of the «liglitni«t regret, as being bo mneh time and expengo u^ioleflflly thrown away; ber-ise all the measines are calculated, in every respect, lo improve generally the moral, the domestic, Mul the ifouiul habits of our ^Kipulation. CHAPTER I. PESTILENTIAL DISEASES. To make use of the happy expression of M. Tardieu, " It is " well lo bear in mind that pestilential diseases are not of that " class of which it has been given to man to penotrato the origin " and to understand the principle." From time immtsmorial the world has boon periodically subjected to tfie ravages of epidemic or pestilen'ial diseases, varying in their intensity and peregrinations, mysterious in their origin, aiid from whose o.'casional recurronces mankind, in all probability, will never be free. § 1. EXTERNAL CHARACTER!) 0¥ CJHOLERA. Any discourse of a purely scientific nature would be out oi place in such a document a.-; this; but it is of all imporlanco to insert in this Memorandum such information as would render the disease, in its a>ceitaine(l character and effects, generally under- stood by members of the community at large : because no one knows to what extent even a small amount of knowledge may become useful in removing painful and dangerous fears or equally perilous feelings of blind security, also in avoiding fatal errors, and thus making in many instances and many ways its possessor serviceable to himself, relatives and fellow-creatures generally. Cholera is apt to appear in every climate (very few countries, indeed, having escaped its visitation) ; it attacks both sexes, every age, and all conditions of life, the poorest and the wealthiest, the weak and the strong. Generally, but not always, it appears more fatal where misery, filth and crowding are to be met with, and intemperance and other vices are sure' to render its blows more disastrous. The approach of Cholera is often preceded by contagious, endemic or epidemic diseases and a more than ususal prevalence of affections of the stomach and bowels, and oftentimes also by diseases of a disastrous nature (epizooties;, attacking domestic animals. Occasionally the appearance of Cholera seems to have a /? / / / marktiil ffTocl eMtliei in iticreHsinf; or dimiiiishifig tlio iiilpncify of other concomitiiiit (li.-tcaHe.s ; at other tirn«!«i it apppnrn to fail to exerciflfl the sli^htost efTect on thorn. The experitmce of Canadiiin mmlitMl praclitidiuMrt has ;rono, however, fo far to establish that Cholera Una genurally Hiiporneduil in a great nu'a.iiiro .ill other diseases. ThoTB are only two eircntnsfance.s connected with tiii.i scourge which soinn to ob.iervo a determined character of constancy, these are the ra'io of mortality to the nntnber of persons attacked, and the influence of continual cold on the duration of the pestilence. The ratio of mortality almost at all times and in all countries Is never below one-third, and sometimes averages from forty to fif\y deaths for every o le hundred cases of confirined Cholera. The appearance of the cold season invariably checks the intensity of the malady in moderate climates, and generally stops it entirely in severe climates. Whether these well -asserted facts are of the negative, the dubial or the positive category, it is well that they should be made known to the public, to prepare the minds of all to see things as they are, in time of trial, and to guard against too illusory and hopeful expectations as well as against foolish fears; for a great many have fallen, and a great many are apt to fall easy victims of Chohra through imprudence and carelessness caused by an optimist view of the state of the matter, as well as through terror and despondency brought on by an exaggerated idea of the existing danger. It is well that a general elementary knowledge of the real symptoms of Cholera shouUl be possessed by every member of the community. Generally speaking, then, an attack of Cholera is preceded by a kind of malady called Cholerine, which may end, however, whhout a full development of the disease, but which seems to act ordinarily as its precursor. The symptoms of Ckoltnne, also called premonitory symp* toms, are the following, not always, however, to be met with in the same order, nor all at one time, nor the same in every person affected :— Noisy motions in the bowels, pains in the belly, loose evacuations, generally bilious, sense of general uneasiness and weakness, loss of appetite, whiteness of the tongue, sometimes there is headache and very frequently inclination to vomit. In connection with these symptoms it should be remembered that, in time of Cholera, there is a great disposition to looseness of the bowels, which, if not attended to carefully, is apt to terminate in Cholerine, as well as Cholerine in confirmed Cholera. When the premonitory symptoms are followed by a real Attack of Cholera, and when Cholera comes on without it, the y/jy n inlppfiity of r« to fail to of Canadiiiii stsiblish thnt iiro .ill other this .ic'onr;^o staricy, these iltacked, aiul pestilence. I countries Vom forty to ned Cholera. the intensity )ps it entirely cts are of the ell that they minds of all rd a»?ainst too foolish fears; e apt to fall carelessness er, as well as exaggerated e of the real y member of ik of Cholera , which may se, but which nitorij symp' met with in every person e belly, loose easiness and i) sometimes vomit. remembered I looseness of to terminate era. 1 by a real Ithout it, the / / pr0£frc«8 of iho dirfoase is charecteit/.ed by successive stages, wincK are respedlively designated by some anthers by the names of — l«t, period of invasion •, 2n(1, period of slate or collapse ; Srd, period rrt reaction ; 4th, period of terminatMn^ «r tfimply ftrik, second, third and fourth staj^es The poriod of invasion is characterized by sevoral rr all the ibllowifig syrrtptorns: diarrlioja, vonutina;, pains in the rogionn ot the stomach, cramps, general diminution of animal heat, coolness ot extremities, iricreasinp constrictinja; sensation in the regions ot 'i\\B stenRac*h, anxioas expression ef countenance, witk aheration '-^f the voice very peculiar to the malady, pvilse quick and growing weaker and weaker, eyes depressed and snnk in their orbits, HvitI and contracted appearance of the face, irresij^ible thirst and desire lor cold water and suppression of urine. The period of «ifaf«(or coUapat) is characterized by an increase in the severity of the former symptoms, the skin in general becomes 'livid and blueish in color and bedewed v/ith cold perspiration, the «kin of the fingers assumes the same appearance as those of a drowned person, the pains and cramps increase to agony, the •evacuations become of a whitish fluid, like thin grcei or rice water, they are often jmsscd wkhotrt the knowledge of the patient, the skin emks a fettid smell, a squalid appeaianoe pervades the whole sHtface of the body, the breath is colder and colder, the respiration is much labored, a profound prostration of every vital ■action follows, and death quickly closes the sc-ene ; but the iritelled, remains alinort as perfect as in state tff health nearly to the last. Tho period of teACtion, when it fortanalely occut&, shows the followng symptoms: the pnlse nses gradually, the blue coloration 'of the skin disa[ipears with the tetOTning warmth of surface, the respiratory movements beoome more regular, the voice is by ilegrees Fc^ored to its normal tone, a warm moderate perspiration shows itiiielf on the »kin, the counteiMince is mere natural and the face becomes moreur Jess tur^d and the eyes somewhat injected> SomtAimes the reaction is too violent, afid tlren there is danger of congefitidn of internal organs, specially of the brain. The period of ietmincUion is characterized by a graduai return towards the normal state and by tiro re-establishmont of '.he urinaiy and bilious secretions, 'COupJed with the diaaj^pearance of the flushed and violent symptoms of reaction. But here again, there isdanger of this short convalescence merging into a secondary xifTection somewhat resembing typhoid fever. All these symptoms may vary a little in form^ they vary a great deal in intensity, and somewhat also in order of succession i *hey may be all present and well marked in many ca.«»es, whil.-'- < / / y m others some few symptoms maybe absent, or nearfy so; hul taken several at one time, they are characteristic of Asiatic Cholera. Death may happen at any one of these four periods, but mosi generally takes place in the second stage. The fatal termination of the disease, as well as recovery from it, may bo determined, in a fevf hours, and may be delayed for a few days. Deaths have been recorded to have happened after four hours of conftrn>ed Cholera, and cases of seventy hours of sickness have also been reported ; however, stich short and long duration are both extremely rare exceptions. § 2. PROPAGATIOM of the DtSEASE. This is not the place to discuss whether Cholera is a contagi- ous, epidemic or infectious disease; from all we know about this mysterious malady, it may possibly partake of the three characters intended to be defitied by these words. Jt is certain that, first noticed in India, the scourge is exotic for all other countries than south-eastern Asia, from which continent it takes its much-dreaded name, known throughout the world as Asiatic Cholera. From the place of its birth, the scourge, at unfi::ed and varied periods, starts on its tout around the globe, following the grand loutes of travel and commerce', sometimes accompanying an army on its march, sometimes following in the wake of pilgririrs going to the rendezvous of their devotions, or a caravan of merchants : asceniling or descending large rivers and crossing the wide oceam, stopping at all the centres of population and spreading terror and death along its passage. When Cholera began its migi'ations, it went first from India to Persia, then eas'erly to the end ef the continent of Asia and to the islands of the Indian Archipelago and westerly to Russia, Poland ami Germany, and from central Europe to its northern portions and the British lsle». It then moved south-easterly, ravaging France, Spain, Italy and the neighboi-iiig countries, and traversing the Metfiterranean it wen-t to North Afi ifca ; :it t-he same time, having crossed the Atlantic Ocear>, it fnand its way to America, ar>d thence returned to Asia thronigh Egypt. The abo\''e-described peregrination of Cholera was the first one undertaken by this terrible traveller. He walked someti)rnc3 slowly, at other times advanced either by steady or rapid stirides, resting occasionally, however, until he had accompiisbttl his voyage, which began in the Delta of the Ganges in the year 1817 and terminated in the vicinity of the Red Sea in 1834. < {' /c?'?^:^: earfy so; hut c of Asiatic ieds, but mosJ recovery from delayed for a appened after enty hours of lofl aiKi Jong I is a confagi- low about this ree characfers jur^e is exotic hich continent t the world as le scourge, at md the Jiiobe, ce", sometimes I lowing in the devotions, or a rge rivers and } of population Tst from India 3f Asia and to ply to Russia, 10 its northern )Outh-easterIy, countries, and i ; :U ^he same k[ its way to n. was the first :ed sometJrflca rapid stitides, 3mplisb(btl his the year 1817 Sir.ce its first appearance as a oosmopoiilan travelling scouige, Cholera, varying in some instances the course of its progress, has 110 less than five times visited the European and American continents, m spite of all mnasares adopted by diflisreut countries to exclude its presence, and at all iimt'H preserving us incognito about everything appertaining to its nature and personality. Many discussions are still maintained to the manner in which Ciiolera is carried in it.< voyages through land and over water. There being no doubt Iha^ it is portable, it is wiser to act under the admission that it is carried by persons, efiects and merchaudi/e, and even by the winds of ihjd air and currents and streams. At the present time. Cholera is on its sixth general tour. It appears to have left Asia for the West wUh the Mahf a san-itary nature against the intro- duction and spread of Cholera was established at Quebec irs February, 1832, and was composed of Drs. Mo4rin, Parent anct Perrault. Subsequently,, a rather numereus Board of Health wa» erganiaed', a-nd regulations passeti for the inspection and seq^ues- l5ration of ships coming from infected port«^. Tiie Chadera— bavmgr previously appeared in New York, Boston, and olher places in the- United States>- notwithstanding that it has been, reportied ^ the eontrary by some writers — made its fost appearsfnee in Canskda aJi Quebee, where it was introduced by the shipping on the 8th of June, aad spread at once its destructive inftueuce in the neigh- boring parishes^ It was in Montreal on the lOth of Juwe. Thence ft extended its ravages to mostly all She localities of Upper and- Lower Canada, and disappeared entirely at tfhe end of the month of Oetober^ having lasted in all about four months. The seeond Cholera fdlowed the first within a very short Dime, and took place in 1834.. At its fiast appearance, in the latter part of May, m the Quarantine Station at G»osse Isle, it affeete(S so mild a character that it was not consideretl to be confirmetJ Asiatic Cholera, and it preserved its mild form for a short period. It assuraedy however, a more violent character through Canada at the end oi July aad during the rwnth of August, but finally disappeared with the month of September, the Sanitary Commis- sioners having had a High Mass of thanksgiving chanted in the cathedral of Quebec on the 2nd of October. The above fact is most important, as famishing conclusive evidence of the ee.ssation of the malady at a fixed date. This seeond sojeum of the pestil- ence in Canada having also lasted about four months. The third Cholera — which is for us the Cholera of 1849, while for some countries it is the scourge of 1847 and for others of 1848 — seems to have entered Canada by Kingston, where it made its appearance at the end of May, 1849. The pestilence had previ- eusly tothat diate appeared in several parts of the United States^, and was at that time rapidly aiscending the Missiesippr and the Missouri Ri^ "rs. Some slight cases occurred in Quebec on the 11th of July^, ! and th at Grc choler John from tine, a rest o «ame from on bos Thetl two d immi| meaisl almosi inamel board i«il about fiir October^ 1831, made public a meeting of nediately after New York, to- »e community iiist the intro- at Quebec ira ,n, Parent ami of Health wa» Ml and seq^ues- hadera— bavmgf jr places in the- reported to- the- se in Canada at; &a the 8ih of B in the neigh- nce H extended Lower Canada, ith of October^ m a very short nee, in the latter Isle, it afiet;te(S ta be- confirmetl ir a s-hort period, rough Canada a6 ;nst, but finally initaiy Cosnmis- r chanted in the he above fact is 3 of the eessatiori am of the pestil- )nths. ira of 1849, while ■or others of 1848. (vhers it made it& ilence had previ- ;ie United States^, ssiissippt and the the 11th of July, TI and a few more on the I2th ; then it spread through almost the whole of Canada, its raVAges being in some places greater, but in many places less, and also generally less destructive than in 1832. It seems to have disappeared entirely about the middle oi October, after a few days of recurrence in Montreal, having lasted in all this time about four months and a half. The fourth apidemic of Cholera in Canada took place in 1851. It was introduced through the States, and Quebec was the last of our cities to receive it. The appearance of the plague took place under a rather mild form in August, and the last cases were observed no later than the first days of October. It lasted only about two months, taking Canada as a whole, and only five weeks at Quebec, from the 25th of August to the 2nd of October, having caused 206 deaths in that city. On one of the last days it existed in Quebee, a ship, the Perthshire, sailed for England: almost immediately after her departure from Quebec the pilot was seized with cholera and died. The captain and one sailor having also been attacked, the mat« anchored the ship at I'Isle Verte ; but in a few days both patients got well and the vessel started again without any further case and completed her voyage. The fifth epidemic took place in 1854. It first entered Canada at Quebee on the 20th of Juae, and for this attack we have the whole history of the importation of the malady, in a Report of Drs. Landry and Jackson and Mr. Gauthier, Commissioners appointed to investigate the facts eonaeeted with the introduction of Cholera of 1854 into Canada. Two emigrant ships, both from Liverpool —the Glenmanna and the John Howell — having each a medical attendant, arrived at Grosse Isle before the middle of June. The Glenmanna had cholera on board and had lost a number of passengers at sea ; the John Howell had no cholera, but had lost five passengers at sea from measles. They both disenr.barked their sick at the Quaran- tine, and two or three days after proceeded to Quebec with the rest of their passengers. The two ships were inspected on the «ame day, the 17th of June, in the port of Quebec, and found free from all sickness ; two infants, however, having died of debility on board the John Howell between the Quarantine and Quebec The two fihips apparently remained exempt from all sickness for two days, and were admitted to pratique on the 19th. The immigrants went ashore, some of them returning to the ships for meals and to sleep, when, on the 2(kh; the eholera brake out almost simultaneously in both ships, whence several cases were inaraediately pent to the Marine Hospital. Then it appeared oe board some other ships, and subsequetttly spresid. 12 From Quebec, and apparently following the course ot the immitrrants in their journey west, the cholera seems to have appeared in tiie under-mentioned cities at these respective dates: At Montreal, on the 22nil of June, among immigrants first. At Kingston, on the 25th, on the person of a resident, having had no other communication with the immigrants than looking at them on the wharf, but being a man of intemperate habits and in miserable circumstances. At Toronto, on the 25th, on two residents, who were not known to have had communication with the immigrants. Fn Hamilton, on the 23r(i and 24th June, on immigrants. The Cholera of 1854 ended in the latter part of the month of September, having lasted about three months. The Central Board of Health closed its labors on the 22nd of September by formal resolution. The Report from which these informations are gathered speaks of the immunity from cholera enjoyed by the town of Brockville, on the St. Tawrence, although shualed on the same grand route as the ravaged cities, towns and villages bordering the river side, and although immigrants had been allowed to go ashore in passing by. A fact of some importance is also recorded in the same Report, which it is well io insert : The cholera appeared in the Provincial Penitentiary at Kings- ton on the 21st of July — that is, nearly a month afier it had commenced its ravages among the inhabitants of the surrounding neighborhood. The number of deaths from cholera throughout the whole of Canada during this last epidemic, as recorded in the minute book of the Central Board of Health of 1851, is put down at. 3,486 ; a figure which, from the enormous difficulties to be met with in collecting correct statistical informations, must of necessity fall a good deal shoit of the reality. The difficulties — insurmountable when the small localities have to be accounted for — have rendered impossible any attempt at gathering in this Memorandum figurative statistics of the former cholera epidemics, besides the figures above given. These figures may convey a deductive idea of the lo<-ses inflicted by cholera on our country, when it is known that the number recorded is necessarily below the mark, and that the epidemic of 1854 was about one of the mildest of the five. i I 13 jurse ot the Ims to have tctive dates : [rants first. [dent, having in looking at labits and in [re not known ligrants. the month of [Central Board ber by formal are gathered r the town of on the same acres bordering allowed to go e same Report, itiary at Kings- h after it had the surrounding ut the whole of he minute book wn at. 3,486; a be met with in necessity fall a small localities ible any attempt ics of the former n. !a of the looses known that the k, and that the the five. 1 \ CHAPTER II. PUBLIC AND PRIVATE DUTIES AS CONNECTED WITH CHOLERA. The impending danger of a public calamity, and still more, its appearance in the mid.>t of a community, in adding to the ordinary wants adds necessarily to the duties of all- The State, the municipal corporations, the different associa- tions, some professional corps and private individuals, have each special duties, more or less onerous, more or less dangerous often- times to perform. Cho era being, as it is, one of the most awfnl of all scourges, cannot appear, not even be simply threatening, without a general call for the performance of such duties, in the accomplishment of which it is within the province of every one to render eminent services to his fellow-citi/ens. Besides, it needs the concurrence of every one ; for, in vain the State would try to do its part, if the municipal and other public bodies were refusing their concurrence, or, which amount-* to the same thing, were dereiictant in doing their share of the work ; in vain would the municipalities and public bodies, in harmony with the State, attempt to accomplish their part, if institutions, families and private individuals were careless of their own. There is a community of interest to be subserved in averting the common danger : there must also be a community of action in preparation and defence for such an object. On the Government devolves the duty of the general organiz- ation, of the gathering of the forces, of the promulgation of general information, of the external purveillance. It is its duly to keep the grand watch, and to defend the approaches, if they can be defended. The law embodied in chapter 38 of the Consolidated Statutes of Canada and the laws relating to Quarantine have defined whjit part the State is to take in such measures, besides what appertains to the nature of State administration. To bring to bear on the subject wise views and judicious counsels for all, to remind the minor bodies and the public at large of what is required from them by the law of the land, are also a part of the duties of the State: it is also its duty to institute a Central Board of Health, with whom all other Boards, and even individuals, can correspond, in order to impart to the composing portion of the whole body unity of purpose and uniformity of action. Such observations are made not to teach the State, but rather to warn people against the too common error of expecting more irom the Government than the Government can possibly perform, 14 negl lA msl and thus individuals or corporations migl^ needed in such circumstances. More special duties devolve upon municipal bodies ; but they are restricted within narrower limits as to space. Each corporation is to see that every possible thing for the salubrity of their locality is done, that the poor are furnished with the necessaries of life, and, in case of sickness, with the necessaries called for by their painful situation : they have to invite to their assistance the counsels of men who, by their p )sition and their avocations, can advise them in devising local measures and calling for general action from the higher authorities, if wanted. Public institutions, families and individuals hare to show themselves willing and obedient in accomplishing what is required from them, in avoiding what is forbidden and in extending to others such help as h within their reach to dispense. It is a constant duty for every citizen of a community to guard against everything which could be offensive or detrimental to his neighbors or to socieiy in general ; but that duly becomes a great deal more stringent in case of calamity, when the difficulties and the burdens of human life have become much heavier. There is in such time more responsibility in every act of private and civil life, when the neglev t of wanted precautions, when the indulging in something dangerous, when the diffusion of a simple foolish joke or an ill-timed rumor can bring into the bosom of your own family or lo the fireside of your neighbour f orrow, terror and even death. A time of pestilence, when the hand of the Almighty is laid upon us, ought to be a time of more than ordinary composure, sobriety of mind and body, of simplicity and dignity of manners, of watchfulness over ourselves and of charity to fellow creatures. The remainder of this Memorandum is devoted to outline the general principles by which the conduct of public bodie«« and private individuals should be directed during an epidemic. Intended for all and being of necessity restricted to generalities, this paper is not supposed to impart a profound knowledge of things which are not, and which cannot be, otherwise than the exclusive privilege of men devoted to the special study of medicine. Moreover, it would be dangerous to say more than what can be sufficiently well understood by the people at large, because otherwise a misinterpretation of an unavoidably haf acquiced notion might lead to very fatal mistakes. If fully impressed of its tenor and honestly actuated by a high sense of duty, they will always know when (either in a public or in a private capacity) they can take upon themselves to i I will agam elasse( Separ; ideas 4th, treatrn T the fui by la' necess all Its 1 I ; what id mst odies ; but they lach corporation of their locality essaries of life, led for by their assistance iho avocations, can ing for general hare to show what is required tending to others munity to guard jtrimental to his becomes a great 3 difRculties and avier. in every act of ited precautions, hen the diffusion an bring into the your neighbour Almighty is laid inary composure, ;nity of manners, ellow creatures, ted to outline the ublic bodie"* and g an epidemic, i to generalitifis, nd knowledge of herwise than the special study of ire than what can It large, because ly haf acquii-ed ly actuated by a rheu (either in a ton themselves to i i 15 act, and when they should call to their aid the connsels or administration of men whose specific mission is to acvjuire for all, what all caunot, by any possibility, be made to acquire for themselves. CHAPTER III. MEASURES AGAINST CHOLERA. It is useless and also highly detrimental (this cannot be too often relocated) to (latter ourselves with the idea that, if such a particvilar thing were done in such a paiticular manner, complete immunity from this disease would be attained; it is equally dangerous to despond under the depressmg belief that nothing can be done to miiigate the evil. Cholera has visited almost the world entire (continents and islands) at least five times, in spite of all measures adopted by the most enlightened and civilized countries to prohibit its intro- duction. It must be accepted, then, as a truth, that cholera must and will prevail whenever the higher counsels of the Almighty decree that it shall be so. But God has given to man a certain power over things natural, in accordance with the general laws established by Him j and the legitimate use of such power, if not always attended with complete success, never fails, however, to be followed by some good results. It tias been even so with Cholera. A happy disposition of soul and mind, good salubrious conditions of iile, caution and hopeful faith, moderate and temperate habits, have saved, and will always save, thousands from the effects of this and other scourges. Notwithstanding that the same views have already been enunciated, it is thought important to bring them again and again before the notice of the public, even at the risk of being considered tedious. The measures to be adopted against Cholera, and in fact against any contagious epidemic or endemic disease, may be classed under the following headings : — 1st, Sequestration or Separation ; •2nd, Hygienic precautions ; 3rd, Diffusion of sound ideas and judicious advice, and incu!<"ation of obedience thereto; 4th, Piophylatic timely interference ; 5th, Intelligent curative treatment. The measure.j of the first class are evidently appertaining to the functions of the Government and municipal bodies, as defined by law ; the measures of the second, third and fourth classes necessitate the co-operation of the community generally, and of all its members individually ; the measures of the fifth and last 16 relate to duties which devolve on members of ihe medical profes- sion, and, under their guidance, on henltli officers, Sisteis of Charity ami other attendants on the sick, and on them alone. If !ld to reflect on th )f the njiortance performance of liis own duties, do them well and not embarrass others in tha acf.omplishment ot theirs, and if all were to work in harmony, ^'ood will, devotion and forbearance, without assuming other than their own task, at the same time fulfilling it unflinch- ingly, it would be no e;reat stretch of prophecy to predict grand results for present and future good. § 1. SEQUESTRATION. The means of sequestration or separation, as a prever.live measure, are of two kinds: firstly, tliose employed agaiast tlie intioduction of pestilence from infected countries; ar \, secondly, thotse which are adopted in centres of population, witi.i.i a country already invaded by an infectious or epidemic disease. The fiist are effected by the establishment of Quarantine or Lazarettos ; the second, by the establishment of temporary special hospitals or refuges in isolated situations, if possible. >uch measures, it has leen already said, are useful and extremely advantage us; but it would be a dangerous fallacy to calculate upon their absolute success, and to neglect the far better measures of a moral, sanitary and hygienic character A few remarks and observations would be suf.icient to con- vince every unsophisticated mind ot this troth. To be satisfied of the infallible result of a Quarantine would require that the certdiuty of the disease being contagious be thoroughly estab- lished ; or, if simply infectious, it would requirr a certain j-o.sitive knowledge of the nature of its moile of traiistnisoion, of the lime it can lay latent on persons or things, and a close insight into the nature of chemical or other agents capable of destroying the virus. It would again require the certitude of its being incapable of travelling on the winds and with the currents of running waters, or, if otherwise, to be fully aware of the exact distance at which the virus cannot be any more hurtfid by having lost its propagating influence. It would also necessitate an absoUite prohibition of every intercourse, mediate or immediate, between all persons or things appertaining to the country to be protected, and also of every thing or person started from all suspected or infected regions, and even from all persons anil things connected with the Quarantine station itself, such station uecomirg ipso facto an infected spot. Even if we were entirely conversant with the mysterious I ance, is on t -rover; point made circut Grosae 17 edical profes- rs, Sisteis of til uloiie. ilance of the not embarrass ere to work in lout assuming ig it uriflinch- predict grand 5 a prever.live kI agaiiist the ar (, secondly, iti.i.i a country ase. The fiist ar Lazarettos ; >ecial hospitals are useful and erous fallacy to ct the far better 31 er if.icient t'; con- To be satisfied equire that the oroughly estab- fertani j-o.sitive ion, of the time insight into the oying the virus. ig incapable of running waters, stance at which t its propagating ibition of every arsons or things d also of every ted regions, and the Quarantine infected spot. the mysterious I jffopagatiom of those malailies, such total r,rr.hil)iiion of intercoiirso between countries in constant intercourse with one another would be, in ii.^elf, a j^reat calamity. The recent successful instance of sequestration at New York, on board the English ship Atalanta, connected as it is perhaps with i)olitical, social »-ad commercial tendencies of the day (not altogether medical), has received amongst our republican neighbors an advt)cacy o£ absolute prohibition by means of extremely rigid quariintine and non-inteicourse. To adopt extreme measures on the isolated experience of the ca.se of the Atatanta would be j'"dulg!ng in the very fatal philosophical error of arguing of the g^iueral by the particular; and possibly the non-spreading of the disease in the case of the Atalanta may, after all, be attributed to the presence of the cold season. All this reasoning, nevertheless, is not a plea for the aban- donment of the principle of sequestration and of measures of quarantine, as already and repeatedly enunciated. Happily, however, ihere is a middle course that can be observed, equally distant from extreme determination called for by most opposite opinions. It would be impossible, even if it were of absolute necessity, to guard the country against the importation of Cholera on the line of our inland frontier, extending over \ undreds of miles. But here it may be said that our neighbors, in defending themselves from such an importation into their own territory, are virtually making us participants of the same advantages. That argument, however, cannot, apply to our numerous ports situated along the coast of the Gulf and the lower St. Lawrence, such as are the free port of Gaspe, the ports of Paspebiac, Perce, Rimouski, Escoumins, and the ports of the Counties of Saguenay and Chicoutimi. A medical health officer chosen on the spot might perhaps be appointed at each of these ports, with instructions to inspect every ship, and in case of sickness to stop each ship from pratique, and by instituting the ship herself as quarantine ground for tlie master and crew, whdst those on board may be submitted to special treatment, till the sickness has disappeared, providing for any case in which, by death, itie crew is reduced to an insufficient number of hands. The point, however, at which a quarantine is of all import- ance, as proved by the constant exp .rience of former epidemics, is on the St. Lawrence at the entrance of the port of Quebec. The government possesses already, and very fortunately, at that very point an admirable establishment, which only requires to be made at times of more than ordinary dangers adequate to ihe circumstances. A better selection for a Quarantine than the Grosae Isle Station caanot be made, aituated as it U at some thirty \h oi\d miles from Qiiebf^c,oii aii inland of about tilH) acres siiperlici08> with deep water and jjjootl anohora^^o, al least three miles dislatil from any parish or village, and yet aufRciently near to prompt and commodious public meanis of communication. There can bo practiced a reasonable sequerttration. ombraciuf!^, on one side, the relative security from infection which quarantine measures can afford, and, on '' er sida, noither vexatious nor riMnous to commeice and int. i tonal intercourse. The rules to be adopted to carry on such a reasonable quarantine need not be kid down in Ihia iNlemorandum ; they constitute no new science to propound, being well considered and set down in the works of many author* and in the codes of most nations. This document, being intended for all, cannot enter into lengthy details, and, moreover, as this part of the preventive measures devolves upon the State, the Executive has already, and can always have, at its command the means of information sought for to determine its action. There is, as connected with the Quarantine, a question on which it is important that the public should possess some practical information, in order to prevent one-sided notions taking possession of the public mind and thus become a subject of very serious embarrassment. This question may be thus written : What rules shall apply to steamers of passenger lines frequenting the ports of Quebec and Mohtreal, one of which — the Canadian Ocean, tSteamskip CKtrnpany'^s Line — is subsidised by our Government and carries our European weekly mail ? It seems impossible to exempt them entirely from quarantine when coming from a country laboring under the scourge ; but a strict quarantine for such ships may prove very disastrous, even absolutely ruinous for the company and calamitous for commerce in general. This simple expose of the question at once suggests that it is one of no small importance, and one which is fraught with serious difficulties. Without any attempt to solve the question in this Memoran- dum, jt will not prove useless^ it is hoped, to suggest a measure, the adoption of which may result: (if not always, at least in several instances) in the avoidance of the greatest danger, on one side, and of immense losses to the company, passengers and merchants, on the other. This measure is suggested by the practice for a long time adopted by the Austrian Government towords their company of steamers trading between Smyrna and Trieste. This practice would secure an increased ef^ciency in the case of our steamers, from some modifications of a more stringent nature and from the i I might 19 •68 siiperlicicS) miles dislatit to prompt and Ml. embracing, ich quarantine voxalious nor Tlie rules to need not bo 10 new science n the works of his document, y details, and> devolves upon ays have, at its ) determine its a question on i some practical .king possession of very serious en : What rules iting the ports of inadian Ocean )ur Government from quarantine scourge; but a disastrous, even js for commerce ggests that it is gilt with serious 1 this Memoran- ^est a measure) ays, at least in t danger, on one passengers and for a long time leir company of This practice of our steamers, 1^ and from the i fact of the greater length of the passage between I.ivorpool and Quebec than between Smyrna and Trieste. To follow this practice woiiKl require that a special medical health ollicer is placed on boiiiil eacli stcarntM-, which will then be, whether there is discaso or not on board, a?«similiitod to a (jiiaiantiiio station. This ofTicer to be appointed by Covenunent, at the first warning of Cholera, for a limilod lequiied time, bu.-*ide8 tlio ordinary physician of Iho ship. During the storage of the cargo sanitary precautions would have to bo enforced and preventive disinfection practiced in a way not to damage the goods, by the use, for instance, of dry hypochloride of lime or some equally efficacious disinfectants, and whitewashing of ship and boxes with limo water. These recommendations are not made in ignorance of what can be said against the real efficacy of such measures, but it is assumed that the wiser course is to incline towards the saUn side. Every day of the passage sanitary measures would have to be resorted to, according to regulations made to that effect, and amonasl others the goods and effects of the passengers in daily use would have to be ventilated on deck. In the case of five days having elapsed since the last attack of cholera on board, at the moment of arrival at Grosse Isle, all those yet on sick and convalescent lists being landed, the ship, without further detention, would be permitted to proceed to Quebec, and, if free from cholera on her arrival at Quebec, then allowed to pratique, if not free from Cholera, ordered to remain at anchor at the mouth of the St. Charles, to be dealt with according to the orders of the inspecting physician at the port after consultaU n with the Quebec Board of Health. In the case of detention at Grosse Isle, a shorter period, less stringent measures of purification to be adopted for these ships than with ordinary vessels. Even partial admission to pratique might be allowed them. Wow comes the consideration of the second sort of sequestration which has been indicated at the beginning of this section, that is, isolated Cholera Hospitals in cities. Very little requires to be said on the subject in this Memor- andum, further than that the adoption of such hospitals, and several of them in large cities, is a measure of paramount importance. These hospitals, of course, are de^lin6d to receive the poor, to avoid the formation of focu.e of insalubrity and disease. Out of place is intended to mean where they are not wanted for actual and immediate use ; for example, collections of hides and bones are out of place every where else than in the establishments where they are to be converted into leather, glue, animal charcoal or any other industrial product ; and the establishments themselves are out of place in the midst of centres of population ) again manure and composts are out of place any where else than on the farms they are destined to fertilize. suspension. The Lambeth -water was obtained from IIani])ton, wiiile that of tlie S*outhwark Companj' was pumped up from the river near Vauxhall-bridge, These two companies possessed mains in the same streets, and supplied the Iiouses indiscriminately. Analysis alone enabled me to detect the two waters, as the inhabi- tants, without consultating their water receipts, were unable to state the source of supply. And although the population supplied by the two companies was precisely in the same condition, except as to water, the cholera deaths in the houses supi)lied by the Lambeth Company were 37 to every 10,001, and in those by the Southwark Comi)any 130 to 10,(J0,t, or as one to every three and a half. I conclude from the data supplied that 2,500 persons wure destroyed by the Southwark water, who would have been saved if they could have obtained the Lambeth water. It is a remarkable fact that the Lambeth water, in the epidemic of 1848-49 was more fatal in its effects than the Southwark, the Lambeth Company taking their water lower down the river at that time. The mortality in houses supplied by the Lambeth wat^r was 126 In lO.COO while t4ie deaths in houses supplied by the Southwark water were 118 in 10,010. 33 10 splf-evidout a ! usoloss uttering neglect of these constant evils ent proof of the ore the public, t, after havinjr )tten. igs and private son sets in and There is in I of old wooden ig in the streets partial decom. sture of all sorts ntry early in the ng useful, y be mostly all ,nd Ventilation. ings public and are factors of e bodies. Every ■ decomposition, fertile cau^e of d to mean where 5 ; for example, T Avhere else than ed into leather, •oduct; and the midst of centres ut of place any irtilize. n, wliile that of the ;hall-briclge. These supplied the liouses aters, as the inhabi- ' state the source of lanies was precisely :he houses supplied ; by the Southwark conclude from the k water, who would It is a remarkable e fatal in its effects Dwer down the river h wat^r was 125 in r werell8inl0,0t0. < ' Cleauliness i^ obtained by scratching away, washing ofiP and carting to the fields all offensive matters. In the cleaning of pol- luted places the use of a little chloride of lime in the water may be of great benefit. 'I'he same remark however which has been made about disturbing masses of matters during hot weather and in time of pestilence, also applies to filth collected on walls and other surfaces of dwellings and premises when under the immediate influence of extreme heat and moisture, putreftiction and diffusion of miasm, acquires an immense impetus under such circumstances, consequently it might not be unattended with danger to undertake any extensive hot water washings of these dwellings during sultry weather: and it mighc be better to cover the surfaces of such dwellings or their appurtenances with a thick coat of paint or lime. As several allusions have already been made to disinfectants it is just as well to remark, so that it be well understood, firstly : that substances called disinfectants in common language, are not all possessed of such properties : Secondly, that even real disinfec- tants, (like all other precautionary measures) although of beneficial use, are not in themselves infallible resources — they are simply good adjuvants. Thus the acquiring of the best conditions of salubrity is not a simple but a complex problem, the result can only be obtained by the operations of various forces converging towards the same point of action. But tew of the best disinfectants will be mentioned here, in order not to create confusion in the mind of persons not deeply versed in these matters, and also in order that special attention being concentrated on a few, more certainty of an ample supply of them is obtained, and the prevention of possible speculation im- posing on the credulity of the people. Qnick Lime is recommended for its cheapness, for its being so readily obtainable everywhere, for its easy application and for its being so familiarly known to every one. It is well also to mention purifying qualities of powdered charcoal. Chloride of lime, sulphates of iron and copper, and permanganate of potash, or Condy's fluids, are the other disinfectants recommend ed ; and it is hoped that they will be imporled (not being yet man- ufactured in the country) by druggists and merchants, in ample quantities and sold at a reasonable trade price. These substances are not to be employed indiscriminately in places actually occupied by people ; they are specially intended for sewers, heaps of dirt or manure, outside privies, night pails, &c. If otherwise employed they ought to be so under the direction of medical men or apothecaries. Chloride of iime may be used in the proportion of one pound of Chloride to a gallon cf water, and it is assumed that a pound of 24 chloride of lime so diluted is sufficient to partially disinfect one thousand gallons of running sewerage ; when used for washing a much weaker mixture is to be made, say an ounce to a gallon of water, and the articles are to be well rinced and cleaned in pure water, and well exposed afterwards. In every case the chloride must be well mixed with water. Sulphates of Iron and copper may be used in the proportion of a pound to a gallon of water for disinfecting filth and sewerage. Condy's strong or red fluid may be diluted in the proportion of one gallon to fifty gallons of water, and the weak or green fluid in the proportion of one to thirty gallons. However strong may be the faith in disinfectants, in spite of what is alleged against them, they can never supersede or cause to be overlooked the more reliable measures, as are cleanliness and ventilation for instance. Good ventilation infers firstly perfect cleanliness of dwellings ; secondly, the avoidance of crowding, coupled with a free circulation of wholesome air. The enunciation of this oroad principle is suggestive of advice in a general form : that crowded and long standing gatherings of people are to be (as much as religious, educational, military and civic duties can permit) avoided during the reign of pestilence, especially at night, and that this precaution or rule applies not only to the interior of buildings, but even to meetings in the open air. Of course in the application of such a principle no one ought to indulge in pusillanimity and the drawing of extreme consequences. Times of epidemic are not times to fly from the service of God in his own house ; and they are no excuse *br dereliction of other public duties, but they are times for prudence on the part of legit- imate rulers, and of obedience on the part of other members of the community. It would be a desirable measure that, during the prev- alence of Cholera, colleges and schools should be closed and vacated. It is a rule to be always observed during mild seasons, that churches, public halls, and rooms in ordinary dwellings, when not actually occupied, should be open by means of their windows to the access of currents of fresh air, as sweeping as the state of the atmosphere and artificial means when at command can allow. This suggestion is not to be understood as recommending the introduction of cold draughts or direct strong cmn-ents of air where persons are standing, sitting or reposing ; but under these circum- stances ventilation sliould be effected quietly as well as steadily. Fresh air is a commodity which men can use and abuse. In the present state of science no fixed formula cai be given for the space of room allowance requisite for each person, nor is there any one admitted method of ventilating buildings, for the " strong •j is everv I dwellin I ceptiblc to aban r I disinfect one for washing a a gallon of eaned in pure } the chloride ;he proportion and sewerage, portion of one m fluid in the ig may be the nst them, they more n^liable mce. J of dwellings ; free circulation jstive of advice ■ nratherings of , military and . of pestilence, ipplies not only n the open air. one ought to 3 consequences, i service of God iction of other e part of legit- members of the uring the prev- be closed and Id seasons, that lings, when not windows to the he state of the nd can allow, ommending the nts of air where >r these circum- ^rell as steadily, buse. a cai be given b person, nor i.s Hidings, for the 55 simple "reason that ventilation depends on a multitude of circum- stances, varying with the external ambient air, the habits, tempera- ments, healthy or unhealthy condition of persons, the dispositions and situations of tenements, and so forth. A man can be ventilated to death by frosh air in a box and can be sufFonated by foul air in an immense hall. It devolves uj)on every one in his public or private capacity to adopt measures of this kind, and upon the local Boards of Health during the preva- lence of epidemics to see that no uncommon evils resulting from deficiencies of space and ventilation are allowed to endanger the public health. A special mention is to bo made here of the annoyance and discomfort very often met Avith l)v our travellin;; communitv, which may be, in time of pestilence the source of groat danger, that is the overcrowdiTig of cars on Railways, and sometimes of Steamoi-s with passengers. In such times there should be no more than one person lor each bed of a sleeping car, and no more pass- engers in any other vehicle than there are seats to Accommo- date. While speaking of Railways it is deemed of the utmost importance to revert to the necessity of remedying the abominable nuisance of privies of .all our Railway Stations', and to the detesta- ble habit of soiling the approaches of every stopping place on our Railroad tracks. The privies of Cars and Steamers should also be the object of very special attention and supervision. Without a great display of dogmatical science it is easy to pro- nounce whether the atmosphere of an apart:nentis close, overloaded with noxious gasaes or odors, either too hot or too cold, too dry or too moist, for ordinary purposes. Besides it would be impossible to alter at once, or for many years to come, even if it were a necessity, the permanent circumstances of dwellings public or private. So it is better to leave aside those questions of discussion and to lesortin addition to the simple and common means of keep- ing everything clean, of making use of the doors, windows, wickets, and also of large fans to agitate the air of the inside, where the surronndinjr external atmosphere is still and heavy. It is a great criterion to judge of the sanitary condition of any lodging that its inhabitants who have dwelt in it for a reasonable time (all' other things being equal) have a comparatively looking clean, strong and healthy appearance. Under these circumstances there is every reason to believe that the perils of residing in sVich a dwelling are not great, even if there were something evidently sus- ceptible, of being ameliorated. This of course would be no reason to abandon any idea of progressive improvement, but it wotild be a ae aufficient cause not to adopt vexatious measures against the proprietor or inmates of such tenements. It is a precaution of the utmost importance (the abandonment of which might be felt fatal to many lives) that the stoves or heat ing apparatus of dvrellings should be kept during all season in good "working order, so that they can be used moderately in case of sudden lowering of the temperature and also in case of extreme dampness. JFor although ordinary and gradual diminution of temperature and continuous action of cold season such as heralds the approach of winter has a marked effect on the stopping of the disease, the same •effect is by no means produced by an abrupt change from a hot day to a fevr hours of summer cold : such change, besides its depressing effect on the animal functioiis especially those of the stomach and bowels, seems to act by the way of reaction as an intensifying agent ■on the decomposition of organic matters, which cannot be entirely removed from the immediate vicinty of human abodes. It is not needless to remark that a heating apparatus is also a most useful means of effecting ventilation. It is an important duty devolving on the municipal authorities of towns and cities to see that all adulterations and alterations of articles of food and common beverage are prevented. A large town or city o ught to have a medical inspector, who being a practical chemist and a microscopist should watch over the buyiag and selling of all alimentary substances in common use. As to preservations of a purely hygienic character applying particularly to ordinary daily regime, they do not differ from those which apply at other times, with the exception that some innocent indulgences, such as friendly gatherings, might perhaps better be xivoided, as well as anything indifferent in itself which ia known by •every one to have a depressive effect on the natural functions of the organism, and particularly any over exertion of the mind and body. Again and again let it be repeated that drunkeness, immoderate oise of food and drink, excesses and vice in general arejjerse predis- posmg causes of sickness, cholera specially and fatal con plica tion of the malady. There is no necessity ir time of epidemic for a change of customary habits and diet provided they are good ; far from it, there may be danger in making any important change. But if the habits or diet are bad it is of much moment that they should be modified,, and that such modification should take place before the appearance of the 3C0urge,in order that all the functions of the body harmonize with such changed state of things before the ^ime of trial has arrived. i 27 against the abandonment toves or heat season in good case of sudden erne dampness, nperature and e approach of ease, the same from a hot day s its depressing e stomach and ensifying agent mot be entirely ides. It is not a most useful ::ipal authorities d alterations of I. A large town ing a practical lyiag and selling racter applying lififer from those ; some innocent rhapa better be ich ia known by ral functions of f the mind and Less, immoderate &ni perse predia- fatal cou plica ),'>■• , 0r a change of d j far from it, nge. aoment that they lould take place all the functions things before the I Every article of food and every beverage or preparation known by a person r-o having on his bowels a loosening effect or producing costiveness are to be avoided ; the first on account of their actual action, the second aa necessitating afterwards the use of aperient medicines, or being apt to bring a reaction to the same effect. Care should also be taken not to fast when attending the sick, nor lo remain too long without food at any time during pestilencQ. Occasional use of bathing and the constant habit of daily cleanliness of person are evidently needed, but caution should be observed against too prolonged and frequent bathing. It is well to wear warmer than ordinary summer clothing^ especially flannel next the skin, because there is in times of Cholera a predisposition to sudden chilliness, against which it is wise to be constantly guarded ; the use of flannel belts on the belly is often recommended, and great care should be taken not to allow the feet to become cold and damp, especially when not in actual bodily activity. As seen in the preceding lines, the principles of hygiene are in the main very simple, still their being enforced with strict observance on the public requires not a small share of industry and understanding on the part of those who are entrusted with that duty. The execution however of some of the measures (as applied to local circumstances) required in case of epidemic are exclusively within the province of the medical profession, and it stands to reason that there should be a comparatively large proportion of its members in the composition of the local Boards of Health. This is not to grant a favor, but rather is it an onerous and responsible duty imposed on a class of the community more strictly obliged by the nature of their avocation to undertake it. §3. IN8TBUCTI0K8 AND ADVICE. One of the evils connected with the appearance of publie pestilence is the indulgence in spreading reports, rumors and opinions of all sorts. Thence timid people are frightened, and excitable people lose their self-possession. Men of systematic ideas propound wild theories, and credulous persons adopt them as absolute trtiths. Speculators fere ulso apt to take their chance of such times, and long beforb the appiearahce of Cholera, advertisements are seen offering for sale all sorts of remedies and specifics for that scourge. Patent medicines, pre- viously announced as curative compounds against almost every known ailment, are presented with a new placard, in which the word Cholera is added to the already long catalogue of fever^ •28 debility, iiiflammatiop., gaugreue, diabetes, sunpressiou of uiino, constipation, diarrhoea, &c., &c., all of which are to be cured under 111! circumstances, real, possible or imaginary. Thus and in many other ways charlatanism is opening its meshes to credulity and fears. To lend a too credidou)i ear to all these reports, rumors, pre- dictions and promises becomes the source of much danger. The press should be guarded from giving countenance to such p^irtios for the injurious effects therefrom resulting-, could thoy be realized, would be found to be of alarming magnitude. The duty of every one is very simple, and to accomplish it is the only mcaus of expecting immunity for oursolf and of being useful to otliera. The laws of the country have provided that public bodies should bo selected in each locality, to collect information, to watch over the progress of the malady and to give orders for the execution of all necessary measures ; the wi.sest course, surely is to look to those per.sons for information if needed and to accomplish cheerfully atid laithfuUy what is recommended or ordered by them. If sickness should come, there is a class of men whoso minds Jiave been directed to the study of the functions of the human frame and the cure of disease ; their duty as well as their interest is to effect i\ll that human skill can do to restore health, aud on their suc.(?ess rest *heir honor, peace and comfort; it is true, they may be unsuccessful in their efforts, but far less 4"i$k .^yi^ ,|je. incurred th{^u at the hands of irrespousiblo persons. .,},,. . . .,, .. .r •• . ..:. ".. , :. Some advice is much needed in rolation to the attendance on th« sick dui'iiig ClioloLa, beeausp cowardly; fear may lead ppople even to f(U'get what tliey owe to their fellow creatures and |uy.eu. to theii' u(;ar relatives; and on the other side ill advised devotedne^ss may (.xj.ose poopb.' to unnecessary danger. A very simple rulo pioviously uiTcixmI lo tli(,' reflections of a sound intel'ect and to the feeiin-s of nn liouest lioart may do a great deal of good. Whoever is the sick and wherevor he lays the prey to the malady, whatever your statiun iiL,|ife you owe to him help and comfort j^Jf .hesis in jieed of medical assistance seek it; if he reqyuires anything iu your power to give, give it to him ; ,if he has no attendance attend to him or procure them for him. J^ut if.the sick pei^son happens to be well |)rovided and attended to, then there is no occa)^pn-i^,gp. fjtjftr him unless he is a bosom friei^ or a i^eUtive. .;;r, , i, •',.. ,; i.r This Pjlaceifl just as good as any other to insert a remark which is to be taken as one of paramount importunco. The ^artiQlqs ;0f clothing and bedding which have been soiled by the dejections of the sick are to ,be first disinfecte/- reacived iu p^ils cont^.ininj^ some i sion of urine, be cured under IS and ill many 3 credulity and jj, rumors, pre- i danger. The to such ptii'tios hoy be lealized, Lccomplish it is f and of beinjj- -ided that public ?ct information, ve orders for the iirae, surely is to 1 to accomplish rdered by them, len whose minds ;he hijman frame r interejit is to til, and on their rue, they may be )e incurred than '■.* : I - ■.' I- '^ \-i ■ e atteuduuce on nay lead ppople ,ves and le.vcu. to Ised devotedneiis \'ery simple rule I'ect and to the i^ood. Whoever lalady, whatever fort j\ if ,h.e>i3 in my thing iu your nee attend to him appens to be \w\\ i.V^.gp n«ar him :t a, remark which The ,iaitiQl(J3;0f the dejectioiis of d carefully ; if of lor. buried. ..Th^ 3 containin};; aomo I I ^9 disinfectants, and are not to be then thrown into sewers, privies or ce33pool3, but are to be interred at some depth. The crowding of people around a sick bed is especially bad in regard to Cholera. In duty and honor you are bound to face every danger when called upon for a g >od purpose, in duty you are bound to avoid the smallest risk when there is no useful object to be attained. If we except unwholesome crowding, there is not. generally speaking, so great danger as people may fancy in the attendance on the sick, and provided that the precautions indicated in this memorandum are observed, there is hardly any more peril than in the mere walking the streets of a locality under the scourge. Most of the medical men, sisters of charity and attendants of hos- pitals in the country, have weathered several Epidemics without having been seriously ill, although living in cloee communication with the sick day and night for months ; their secret has been to avoid fear, to be calm, cleanly and prudent. * In time of Cholera Cemeteries must be the subject of rery strict attention and are not to be allowed as places of public resort ; it is better not to attend funerals in large numbers. Once on this subject it is well to guard against preHpitate as well as too long delayed burials. The medical members of local Boards can frame instructions to jjersons connected with such a service, the inspec- tion of a medical man is sometimes absolutely necessary. With proper precautions, there would be no danger in allowing families who have :he means of going into the expenses necessitated to carry on such precautions to have the consolation of having their dead buried in the usual way adopted by them, and be allowed the usual church service. § 4. PnOPHYI-ACTIC TIMEI-V TREATMENT. In time of Cholera epidemics the stomach and bowels are apt to ])e easily deranged, and great care should be taken to remedy, at once, such derangements, without fancying any danger when there is actually none. Sometimes Cholera is preceded by Choler- ine or premonitory frymptonis, and sometimes it comes on without warning, even sor/ietimes without many of its most striking char- acteristic symptoms. Iu every case of u sudden ailment, whenever medical aid can \>c obtained, it should be procured. Hut in the absence of such assistance, there are measures and simple treatment some of which may be administered by the piUient himself, and others by any assistant : it is uecessary that thei-efore such measures sliould be k:»'j\v!i by rvery body. 30 Auy one attacked l)y pains in tho BtomacU or bowels, clioUcs, diarrhoea, however slight in appe?.rance, should moderate his diet, and even abstJ^ia frqm strong or any food, he should avoid fatigue, cold and dampness, clothe himself warmly, aud make a moderate u«e of some warm aromatic drink like infusion of tea, chamomile, ginger, mint, coffee or similar substances. If the symptoms increasQ, or even at the onset of tl»e com, fplaint, there is a sensation of qhill and inclination to vomit- ttien the patient mi|st be put in a warm bed between woollen blankets or sheets. %he use of aromatic drinks are to be continued .and frictions under the bod clothes, not uncovering any part of the body, and every other, external means of warming the skin are to- be applied. It has been deemed wiser to abstain from offering any sugges- tion concerning treatment by medicines or drugs, on account of the danger accompanying the use of su9h agents \yr other than medical practitioners. . , Once on the subject of duties comnect^d with attendance on 4he sick, it is proper to remark that whilst itjia .^t all times the duty of the physician and others to mai^tain a cheerful and encouraging idem^auor towards a patient, yet it wo^ld be exceedingly culpable especially with suqh a prompt malady as Cholera, to conceal from the patient h.\3 true condition. ■ , Certain precautionary public n^easurea of a prophylactic or preventive character, which may be adopted with immense advan- tage everywhere, and which are of absoiutt; necessity in large towns and cities have to be indicated in general terms. Amongst such measures the appointment of a medical health inspector stands first. The duties of such ofiicer would be to •examine beforehand, and during the prevalence of epidemic, the streets, yards, edifices, dwellings, wells and other water supply, to see whether such hygienic conditions, which are of a feasible nature under the circumstances have been adopted, and to report thereon •to the local Board of Health and to the Municipal Corporation. This officer would also be entrusted with the duty of imparting gei^erally to the ])eople such information as is likely to be of use in warning some against incurring unforeseen dangers, in allevia- ting the terrors caused by the apprehension of exaggerated or totally imaginary perils, and in detecting incipient sickness and enforcing treatment. Such service has been already established with good results in several European countries under the title of preventive domicialiry visits. The establishment of temporary public dispensaries in different parts of large cities, under the immediate control of the local Board X)f Health is also a measure of the utmost importance where every 31 owels, cliolic3, crulo his diet, avoid fatigue, ce A moderate a, chamomile, ot of the com, iou to vomit- twee n woollen Lo be contjaaed my part of the the skin are to ng any sugges- account of the er than medical .If* 'li attendance on i times the duty ad encouraging dingly culpable ira, to conceal prophylactic or immense advan- f in large towns medical health ;r would be to f epidemic, the vater supply, to feasible nature report thereon orporation. ty of imparting ly to be of use }rs, in allevia- ixaggerated or it sickness and idy established ier the title of .ries in different the local Board ce where every « <>)ne could be furnished with such remedies as are recommended for the treatment of premonitory symptoms, or with those prescribed by a medical attendant at a cheap price for all, and gratuitously for the poor. The same establishment could also be made a deposi' of disinfectants, and of flannels and other articles for the destitute, to be delivered on the production of a ticket from the local authorities at the cos*^r of the municipality. In largo communities it would be also advisable to have always in requisition proper vehicles or ambulances for the removal of the sick, such conveyances could be in connection with the service of both Cholera hospitals and dispensaries., tn.i > , . ,, . i § 5. tl Vv% •!,, h ■u n't'! ri'lw ^ CURATIVE TkEATMENT; The treatment of Cholera is one of the most difficult of all therapeutic efforts which can be required from even the most eX' perienced medical man. To enunciate such a proposition is to say that none but a professional practitioner should undertake such a task. To meet the symptons of the malady as they appear in their protean form, in accordance with the general lawa which govern the human body and the pieacquired knowledge of the many agents employed as medicines, is the problem, to solve which is not a little perplexing for the most accomplished physician. Thence the wisest counsel which can be given to the family, friends or charitable attendants of any person apparently laboring under an attack of Cholera is : — Send for tlie physician I But there are many people in the new settlements and in the backward parts of the country (and the c; se may also happen in older and nearer parishes and townships) who cannot obtain the advice or ministration of a physician and there are a great many more who by no possibility, can procure such help in time, for these parties some advice may become of great value, if not in ti'aching what is to be donoat least in warning thiem of what they ought not to do. In the preceding section the prophylactic and primary treat- ment of premonitory symptoms or incipient Cholera has been described and such treatment, in the total absence of a physician or while waiting his arrival, can be undertaken by any intelligent person and is to be resorted to without fail : but now we have to deal with the confirmed malady, when the symptoms have changed and when the disease is undergoing a rapid succession of phases, calling consequently for a succession of modes of treatment different from one another. In the absence of a physician then, the four stages of Cholera 32 may be treated in the following manner. At the period odnvasion and during the following period of collapse the external measures recommended for pi'emonitort/ symptoms are to be continued, that ifl to say, keeping the sick in a recumbent position in bed between woollen sheets or blankets dry and warm — frictions under the bedding to avoid the action of cold air, the use of hot bricks, sinapisms turpentine stupes and other stimulating agents not however carried to vesication or blistering the skin, in one word, appliances to the surface of the body to restore the animal heat. At this stage ordinary stimulants may be used internally to endeavor to revive the pulse and powers of the organisation generally. The period of reaction when well characterized by subsidence of the worst symptoms and not accompauied with congestion requires no special treatment. In case of sign of congestion and non reappearance or contin- uous scarcity of urine, the only remedies which can be attempted without danger by a stranger to medicine would be the warm foot bath, friction with mustard or other rubeficient to the feet and calves of the legs and diluent drinks like linseed tea not too thick, poultices in the region of the kidneys (or hollowed part of the back) in order to restore the urinary functions. Congestion may be detected by non medical attendants some- times oy noticing an extra turgescence and redness of the face, if the ' ead is threatened or by a sensation of fullness if another part is the seat of the rush of blood, an increased anxiety in both cases. If the period of termination is accompanied with no unfavor- able symptoms, and if the urinary functions are well established, the better plan is to let the patient alone as far as medication is con- cerned, and to begin feeding him gradually — but if symptoms of a typhoid type supervene, which may be noticed principally by the oppressed aspect of the patient, anxiety, unsteadiness, and a some- what stupid appearance oFconntenance, accompanied or followed by delirium ; some stimulants in small quantities are to be given to the patient, and beef tea administered to him, as exhaustion and want of action is generally the cause of the complication at that period of Chole'-a. Of course such remarks are onlv intended for the guidance of people in the absence of modical attendance. To attempt more than such a simple treatment carried out with oaio, attetvtieu and perseverance would be, to say the least, risking a good deal. A precept to be invariably followed is to leave the sick entirely to nature's care, rather than to try drains and remedies, the effects and results of which are almost perfectly unknown and at unascer- tained periods of the maladv. i i re> 33 od of invasion rnal mcuures mtinued, that bed between ler the bedding ck.4, sinapisma wever carried )liances to the internally to organization by subsidence congestion ,nce or contin- be attempted the warm foot feet and calves hick, poultices back) in order • 1". endants aome- of the face, if another part is both cases, h no unfavor- 11 established, licationis con- ymptoms of a cipally by the 3, and a some- ov followed by »e given to the tion and want that period of ided for the ice. xrried out with least, risking e sick entirely ;s, the effects id at unascer- ■■-I It has been thought a duty not to close these remarks without touching a point of great magnitude ua well uu of great delicacy, that is, in case of the actual death of a pregnant woman the Caisarean section ought to be performed, if allowed by the family ; although there is probably very little chance of saving tlio child, for the leason that no harm is done on one side,, and that a great result may possibly bo obtained on the other. § (1. A HKRVICK TO UE KKNDKllBn TO SOCIETY. being founded in a great measure on the Medical science study of facts grouped together, the importance of collecting the I'actrt f ounected with the lamentable events of such a noticeable eharucter as itho passage of Cholora in a country become selfevi- doiit. Unfortunately very little has been recorded of the shitistics of former epidemics in Canada, ami this very little even can only he gathered by the very tedious, imperfect, and not very reliable mode of collecting them from the several newspapers of the time, with the exception of some interesting oflicial reports and papers, which are, however, limited to special points. 1^ Canada is again visited by the threatening scourge, pre cautions should be taken that the experience acc^uired during its prevale.. ce be not lost to science;'''"!' '^''/ "''^ ^-'^ ,^vn^.^m ^. ■ Statistics ought to be collected by local Boards and directed to the Central Board. Even the most limited fields of observation are very apt, when brought tog'ether, to throw light on a subject 6'f siieh interest. It has been ascertainpd in some European countries that the observations made In small localities, when collected by men of real tact, have a particular interest, being generally more accurately made. The officers charged with such Labour in large cities are over burdened with \foi*lf,dnd' not being so welt, '^ 6, n(l often not at all acquainted with the persons and their ciri^timstances cannot sometimes give certain interesting particulars which are so easily ascertained in small places where everything Is of public notoriety. Blanks of a uniform plan should be furnished, to be filled by every clergyman, medical practitioner, hospital official, health officer, sexton and other persons connected with the service of the sick and dead. The returns of sickness and death ought to contain, as much as possible the following information : the number of cases of real cholera and the number of cases of other diseases, the number of deaths from cholera and the number of deaths from other diseases. The date of the attack, the date of recovery or date of death, 34 the ago of the patient and box, his profeflsion or trade, his general habits, hiM nationality, the duration of the ailment. To these statements might be added any remarks the collector of such statistics could furnish, which would appear to him of any value. Very interesting and very useful information could also be re. corded ; the way the cholera was introduced into the locality and the precise moment (if possible) of its appearance and disappearance ^ what was the dominant sickness before the appearance of Cholera, and whether sickness and mortality from other causes have decreased or increased during the prevalence of the disease, and whether they have kept away or relumed back, as the case may be, after the disappearance of the scouge. The apparent effect of certain local influences and of the hygienic conditions on the malady, the description of the measures adopted for the prophylaxy or the mitigation of Cholera and all other Information In regard t3 the sanitary conditlonn of the locality as a whole and of the dwellings and premises. It would be very useful to collect thermometrlcal, and wheo possible, barometrical and hygrometrlcal observations made from day to day before, during and after the Epidemic. A description of the locality ; the quality and distribution of Its waters, rivers^ lakes, marshes, &c., and the quotation of number of cases and of deaths as compared with the geographical situation. If such a mass of information could be accurately brought to- gether, it would be paying to science and to mankind a tribute every country owes to Uie haman confraternity, by not allowing to be wasted such dearly acquired experience. J. C. TACHlS, JRiporier^ OtTAVA, Bureau of Aorioultcrk, March, 1866. ;■' e, his general 8 the collector to him of aoj [Id also be re. locality and lisappearanco ; 30 of Cholera, r causes have e disease, and the case may arent effect of litions on the the prophylaxy in in regard to >f the dwellingg cal, and when ms made from A description waters, riverB, f cases and of I »ly brought to- ikind a tribute lot allowing to \ TACH^,