IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I >^ i^ 12.2 ii 40 nil 2.0 iim L25 ||u III— < 6" — ► V] 0% /a % / Photographic Sciences Corporatton 23 WIST MAIN STRUT WnSTM.N.Y. 14510 (716) •73-4503 fc CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Instituta for Historical IMicroraproductions / Inttitut Canadian da microrapioductions hiatoriquas Technical and Bibliographic Notes/IMotes techniques et bibliographiques The Institute h .s attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the'images in the reproduction, or which may significantly change the usual method of filming, are checked below. 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Lorsque le document est trop grand pour Atre reproduit en un seul clichA. il est film* A partir de I'angle supArieur gauche, de gauche A droite. et de haut en bas. en prenant le nombre d'images nAcessaire. lies diagrammes suivants illustrent la mAthode. ly errata ed to mt me pelure, i$on A 1 2 3 32X 1 2 3 4 5 6 /?3i :U.^LtAM> IRe-pritUedfor the u$tof MagistrateH^Clergymen, Local Boards of Health, JHembers of the Medical Profea* ftioHi and a few privatefriends in NovO'Scotia. 4'c] { FOR .VOTE, SEE PAGE .Vo. i. ) SIR, Central Board of Health, Cvuncil Office, mUehalt, \5th Dec. IS3I. A, GKBKABLY to the Intimation given }>y this Board in the concluding Paragraph of their Circular, dated 14th Ult., I have the Honor to transmit the subjoined " Sanitary Instructions for Communities supposed to be actually attacked by Spasmodic Cholera," with some Observations on the Nature and Treatment of the Disease, drawn up by Drs. Kussell and Barry. Every Individual being deeply interested m the Preservation of the Public Health, it is the bounden Duty of all to endeavour to arrest the Spread of Disease at its very Commencement. In order to attain this important object — 1st. The most efficient Arrangements should bemaJeby the Local Boards of Health, and other Authorities, to obtain the earliest and must correct intelligence of every suspicious Case which may occur within their Juriediction. 2a^ .\l i^r,u" n(2) carried to the Grave by the lewest possible Number of Persons. The Funeral Service to be performec'i in the open Air. 8th. It is of the utmost Importance to the Public Health that an improvcil Diet, and Fannel Clothing, at least Flannel Belts and Woollen Stockings, should be given to the Poor. No Person should ever allow himself to sit down and get cool, with wet Feet : Indeed the most particular Attention should be paid to keeping the Feet dry and warm. Uepletion and Indigestion should be guarded ngainst; all raw Vegetables, acescent, unwholesome Food and Drink avoided. Temperance should be most rigidly observed in every thing. In short, no Means should be neglected which may tend to preserve individual Health. The Neglect of any or all of these Cautions would not of themselves produce the specific Diseue called Spasmodic Cholera ; but such Negject would most assuredly dis- pose the Individual living in an infected Atmosphere to be attacked by this Disease, when most probable he might otherwi.se have escaped. The most eflectuRl Means by which this Disease may be prevented from extending, is to enable the Poor, who are generally the first attacked, to oppose to its Iniluence, as far as practicable, those Ameliorations in Diet, Clothing, and Lodging, which public and private Charity will, it is hoped, not fail to produce. i Vbacrcatiuns on the J\aturc and Trealtnent of the Ditease, dratcn up by Lrs. Itussell and Barry. ''Of the Two great Classes of Functions performed by the Organs of which Man is composed, One only is attacked in this Disease. The operations of the Semes and of the Intellii^ence are either left untouched, or are aiTectcd but in a secondary Manner. Those functions, on the contrary, by which Existence as a living Being is preserved; those complicated Powers, by Means of which wc are for ever appropriating and converting into a Part of ourselves Portiens of the Matter around us; are all and at once deranged by the Attack of this terrible Malady. Nutrition is annihilated ; Respiration becomes difficult, irregular, and inefficient; the involuntary Muscles no longer perform their Task ; the voluntary are drawn into Contractions by other Powers >han the Will ; the Blood ceases to circulate ; its Physical k'roperties are altered ; its serous Portion is suddenly thrown out upon the intestinal mucous Surface of the Body; the Secretions are all arrested; and animal Heat is no longer produced. Under such rapidly destructive, and almost universal Derangement of Func- tion, the roost energetic Efibrts should be directed to reproduce what the Disease has rendered Nature unable to keep up; viz. 1st. Fluidity, Heat, and Motion in the Blood. „.,'.'• , ,, , 3nd. Regulated Action in the voluntary, and involuntary Muscles. Lastly, but above every other Consideration, renewed Energy in the Nervous ._,„; . Centre, the Source of all Vitality and Function. ; . . /, a-j No Remedy at all approaching to the Nature of a Specific has been as yet discovered for this Disease. In fact, no One Mode of Cure can be usefully ■> iHsuM ,0 fu.Jlg'.} ni l.^f^rfL-fv, Funer.i Dn ( 3 ) employed under all the Circumstances of any Disease The Grades of Intensity, and the grouping of the Symptoms with which Spasmodic Cholera makes its Attacks, vary with the Conditions of the Subject ; its Treatment therefore, Diust vary with these Grades and Conditions. The leading preliminary Symptoms generally are, either Diarrhoea, Spasms, Apoplectic Vertigo with Nausea, imperfect vomiting, or various Combinations uf these Symptoms. , j, ^j,. . -. When the Diarrhoea aftbrds Time for distinst Treatment, it ought to be arrested at once by the most prompt and efficient Measures ; — by Opium iu moderate Doses ; Astringents ; local Bleeding by Leeches, if the Subject be plethoric; by Cordials and Sulphate of Quinine, if there be cold Sweats; by con- fming the Patient strictly to Bed, and keeping up Heat ; by Diet ; by Emetics. Should Spasms be the first and leading; Symptom, Subnitratc of Bismuth, Cupping along the Course of the Spine, Cordial, and .\ntispasmodic Medicines, Opium, Frictions, and dry Warmth are indicated. But when the Patient is suddenly seized with Vertigo, Nausea, Coldness, Loss of Fulse, Blueness of the Skin, shrinking of the Features and Extremities, with more or les^t watery Discharges and Cramps ; constituting an aggravated Case of the worst Type; whefher this State shall have come on without Warning, or shall have supervened upon either or both of the preliminary Sets of Symptoms already mentioned, Time must not be wasted upon inert .Measures. Such a I'iUient will inevitably perish, and within a very few Hours, if the paralysed vital Functions be not quickly restored. Let him then be immediately placed between warm Blankets ; and should no Medical Persor. be at hand, let Two Table-spoons full of common Kitchen Salt dissolved in Goz. of warm Water, be given immediately, and at onco, if hf; be an Adult. Let dry and steady Heat be applied along the Course oi the Spine, and to the Pic of the Stomach, (if no other .Means be at hand,) by a Succession of heated Plates or Platters. Let the upper and lower Extremities be surrounded with Bags of heated Bran, Corn, Ashes or Sand, and assiduously rubbed with a warm Hand, and a little Uil or Grease to protect the Skin. Energetic, complete vomiting will probably be produced by the Salt : with Tenesmus. and perhaps bilious purging. J Nervous .7!; TV. Should a Medical Man be on the Spot, a moderate Bleeding, if it can be obtained, would be desirable, previously to, or immediately after the Admini- stration of the Salt, or of any other Emetic which may be prelerred. The extensively deranged Action of those Organs, whose Nerves are chiefly derived from, or connected with, the Spinal Marrow ; the anatomical Characters found about that great Source of Vitality, after Death, in many Coses of this Disease ; together with the Success stated by Or. Lauge, Chief Physician at Cronstadt, to have attended the Practice mentioned below, founded upon these Views, in Twelve out of Fourteen aggravated Cases, fully justify the following Recommendation. V In Cases such as those just described, let the actual Cautery be freely applied to One or Two, or more Places on either Side of the Spine, as if for the Purpose of forming good-sized Issues. Should the heated Iron have produced •.*? 1 * f '-'■ ' '^: any Kiciieroent of the nerrous Power, and the Salt-emetic have caused aoy Portion of the Bile to flow throuj;h its proper Duct, a great Step will have been accomplished towards Recovery from the Stage of Collapse. Cordials and Opiates judicionsly administered; Siaaptsois attd other external Stimulants; Mercurials, with mild Aromatic Aperients, which the Intelligence and Activity of British Medical Practioners will not fail to adapt to the actual Circumstances -of *Bo|i Qmirk ■ill •Midyri tl ^)8.yj ^tiy<}j^|s^|y to the Sjage of ]|,e-ac^iop. The Organs, during the Collapse of this Disease, probably oiling to deficient Vitality, often give no Indication of having been acted upon by repeated Doses of certain pawerfUl Medicines, which under other C'rcunistances would have produced the most pronounced Effects. ' li is tbere|bre suggested, that this tem- porary Insensibility of the System shoul^ tiot inciiicate the Administration of such repeated Quantities as could, by Aoicumulation, Svhen the Organs begin to reco- * ver their Vitality, give rise to unfavorable Results. Thirst being a most distressing Symptom of tbis Disease, the Quality and the Temperature of the Drink should perhaps be left to the Choice; of the Patient; but the Quantity taken at a time should pot exceed Four Ounces, and should be acidulated with Nitrous Acid, if the Patient will bear it. Should the Disease prove extensively, and radidly epidemic in a large Com- munity, it would be prudent to establish Stations at convenient Distances from each other, where Medical Assistance and 01ediciaes might be procured without the Risk of Disappointment or delay. The Details of these Arrangements are left to the Wisdom of JLiOcal Boards of Health. As t^e iSymptoms of the consecutive Stage of feverish Re-action in Cholera differ bnt little, if a! aJJ, from those of ordinary Typhus, except, perhaps in the greater Rapidity with which tfaey but too often run to a fatal Termination ; and as this Kind of Fdver is treated in no part of the World with more Siiccess than in England, the entire Management of this Stage of the Disease is left to the ^eal and Science of the Profession at large. Attentive Nursing, and assiduous, well-directed Rubbing, are of the utmost Importance ; a strictly horizontal Position, however, mustbe maintained until the Heart shall have, partly at least, recovered its Action. An erect or even semi- erect position, during the Collapse, has been often observed to produce instant Death. Warm Baths therefore, for tbis and other Reasons, are worse than useless ; evaporating Fluids, and indeed all Moisture applied to the Skin, seem to be contradicted for obvious Reasons. Hot Air Baths, so contrived as to be ap- plicable in a recumbent Posture, and admitting Access to the Patient for the Purpose of Friction, may be of use." \| '^ I have the Honor to be. Int.' Your most obedient Servant, £. Stewart, Chairman. * The Individutl who cauNs this i«-print to bo mado at Halifax, of an important document from the Central Board of Health in London, earaeitl/ requeiti, t^at every PWaon into whoie Hand* thit copy 'ma)r aome, will preiervt it, and g^re Its conftUi eveqr ^m^Ue cueula^on.