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introduction by means of the secret and surreptitious intercourse which is known to exist between the coast of England and the opposite shores.
* By such means this fatal disorder, in spite of all quarantine regulations, and of the utmost vigilance on the part of the Government, might be introduced into the United Kingdom : and it is clear that this danger can only be obviated by the most strenuous efforts on the part of all persons of any influence, to put a stop to such practices; the utmost.exertions should be used to effect this end. The magistrates, the clergy, and all persons resident on the coast, it is hoped, will endeavour to impress upon the population of their different districts (and particularly of the retired villages along the sea-shore), the danger to which they expose themselves in engaging in illicit intercourse with persons coming from the continent; and should appeal to their fears in warning them of the imminent risk which they incur by holding any communication with smugglers, and others who may evade the quarantine regulations.
To meet the other objects adverted to in the introduction,-namely, to prepare for the possible contingency of the country being visited by this disorder, as well as to assist in its prevention, it is recommended that in every town and village, commencing with those on the coast, there should be established a local board of health, to consist of the chief and other magistrates, the clergyman of the parish, two or more physcians or medical practitioners, and three or more of the principal inhabitants ; and one of the medical members should be appointed to correspond with the Board of Health in London.
* Every large town should be divided into districts, having a district committee of two or three members, one of whom should be of the medical profession, to watch over its health, and to give the earliest information to the Board of Health in the town, whose instructions they will carry into effect.
* As the most effectual means of preventing the spreading of any pestilence has always been found to be the immediate separation of the sick from the healthy, it is of the utmost importance that the very first cases of cholera which may appear, should be made known as early as possible; concealment of the sick would not only endanger the safety of the public, but (as success in the treatment of the cholera has been found mainly to depend on medical assistance having been given in the earliest stage of the disease) would likewise deprive the patient of his best chance of recovery:
To carry into effect the separation of the sick from the healthy, it would be very expedient that one or more houses should be kept in view in each town or its neighbourhood, as places to which every case of the disease, as soon as detected, might be removed, provided the family of the affected person consent to such removal, and in case of refusal, a conspicuous mark (“ Sick”) should be placed in front of the house, to warn persons that it is in quarantine : and even when persons with the disease shall have been removed, and the house shall have been purified, the word “ Caution" should be substituted, as denoting suspicion of the disease, and the inhabitants of such house should not be at liberty to move out or communicate with other persons, until, by the authority of the local board, the mark shall have been removed.
'In some towns it may be found possible to appropriate a public hospital to this purpose, or should any barrack exist in the neighbourhood,
it might, under the authority of the Commander of the Forces, be similarly applied.
· Wherever it may be allowed to remove the sick from their habitations to the previously selected and detached buildings, the houses from which they have been so removed, as well as the houses in which the sick have chosen to remain, should be thoroughly purified in the following manner :
Decayed articles, such as rags, cordage, papers, old clothes, hangings, should be burnt; filth of every description removed, clothing and furniture should be submitted to copious effusions of water, and boiled in a strong ley; drains and privies thoroughly cleansed by streams of water and chloride of lime ; ablution of wood-work should be performed by a strong ley of soap and water; the walls of the house, from the cellar to the garret, should be hot lime-washed, all loose and decayed pieces of plastering should be removed.
• Free and continued admission of fresh air to all parts of the house and furniture should be enjoined for at least a week.
• It is impossible to impress too strongly the necessity of extreme cleanliness and free ventilation : they are points of the very greatest importance, whether in the houses of the sick, or generally as a measure of precaution.
· It is recommended that those who may fall victims to this formidable disease, should be buried in a detached ground in the vicinity of the house that may have been selected for the reception of cholera patients. By this regulation it is intended to confine as much as possible every source of infection to one spot; on the same principle, all persons
be ployed in the removal of the sick from their own houses, as well as all those who may attend upon cholera patients in the capacity of nurses, should live apart from the rest of the community.
• It should here be observed, that the fewer the nuinber of persons employed in these duties the better, as then the chance of spreading the infection by their means will be diminished.
• Wherever objections arise to the removal of the sick from the healthy, or other causes exist to render such a step not advisable, the same prospect of success in extinguishing the seeds of the pestilence cannot be expected.
Much, however, may be done, even in these difficult circumstances, by following the same principles of prudence, and by avoiding all unnecessary communication with the public out of doors : all articles of food, or other necessaries required by the family, should be placed in front of the house, and received by one of the inhabitants of the house, after the person delivering them shall have retired.
* Until the time during which the contagion of cholera lies dormant in the human frame has been more accurately ascertained, it will be necessary, for the sake of perfect security, that convalescents from the disease, and those who have had any communication with them, should be kept under observation for a period of not less than twenty days.
• The occupiers of each house where the disease may occur, or be supposed to have occurred, are enjoined to report the fact immediately to the local board of health in the town where they reside, in order that the professional member of such board may immediately visit, report, and, if per
mitted to do so, cause the patient to be removed to the place allotted for the sick.
• In every town the name and residence of each of the members of the district committee should be fixed on the doors of the church, or other conspicuous place.
« All intercourse with any infected town, and the neighbouring country, must be prevented by the best means within the power of the magistrates, who will have to make regulations for the supply of provisions ; but such regulations are intended only for extreme cases; and the difficulty of carrying such a plan into effect on any extended scale will undoubtedly be great; but, as a precaution of great importance, it is most essential that it should be an object of consideration, in order to guard against the spreading of infection.
• Other measures, of a more coercive nature, may be rendered expedient for the common safety, if unfortunately so fatal a disease should ever shew itself in this country in the terrific way in which it has appeared in various parts of Europe; and it may become necessary to draw troops, or a strong body of police, around infected places, as utterly to exclude the inhabitants froin all intercourse with the country ; and we feel sure that what is demanded for the common safety of the state will always be acquiesced in with a willing submission to the necessity which imposes it.
• The Board particularly invites attention to a fact confirmed by all the communications received from abroad,—viz., that the poor, ill-fed, and unhealthy part of the population, and especially those who have been addicted to drinking spirituous liquors, and indulgence in irregular habits, have been the greatest sufferers from this disease, and that the infection has been most virulent, and has spread more rapidly and extensively in the districts of towns where the streets are narrow, and the population crowded, and where little or no attention has been paid to cleanliness and ventilation. They are aware of the difficulty of removing the evils referred to, but they trust that attention thus awakened will insure the most active endeavours of all magistrates, resident clergymen, and persons of influence or authority, to promote their mitigation, and as the amount of danger, and the necessity of precaution, may become more apparent, they will look with increased confidence to the individual exertions of those who may be enabled to employ them beneficially in furtherance of the suggestions above stated.
• Board of Health, College of Physicians, Oct. 20. • The following are the early symptoms of the disease in its most marked form, as it occurred to the observation of Dr. Russell and Dr. Barry, at St. Petersburgh, corroborated by the accounts from other places where the disease has prevailed :
Giddiness, sick stomach, nervous agitation, intermittent, slow, or small pulse, cramps beginning at the tops of the fingers and toes, and rapidly approaching the trunk, give the first warning.
Voiniting or purging, or both these evacuations, of a liquid like ricewater or whey, or barley-water, come on; the features become sharp and .contracted, the eye sinks, the look is expressive of terror and wildness;
the lips, face, neck, hands, and feet, and soon after the thighs, arms, and whole surface, assume a leaden, blue, purple, black, or deep brown tint, according to the complexion of the individual, varying in shade with the intensity of the attack. The fingers and toes are reduced in size, the skin and soft parts covering them are wrinkled, shrivelled, and folded; the nails put on a bluish pearly white; the larger superficial veins are marked by flat lines of a deeper black; the pulse becomes either small as a thread, and scarcely vibrating, or else totally extinct.
• The skin is deadly cold, and often dantp, the tongue always moist, often white and loaded, but flabby and chilled, like a piece of dead flesh. The voice is nearly gone : the respiration quick, irregular, and imperfectly performed. The patient speaks in a whisper. He struggles for breath, and often lays his hand on his heart to point out the seat of his distress. Sometimes there are rigid spasms of the legs, thighs, and loins. The secretion of urine is totally suspended ; vomiting and purgings, which are far from being the most important or dangerous symptoms, and which, in a very great number of cases of the disease have not been profuse, or have been arrested by medicine early in the attack, succeed.
It is evident that the most urgent and peculiar symptom of this disease is the sudden depression of the vital powers; proved by the diminished action of the heart, the coldness of the surface and extremities, and the stagnant state of the whole circulation. It is important to advert to this fact, as pointing out the instant measures which may safely and beneficially be employed where medical aid cannot immediately be procured. All means tending to restore the circulation and maintain the warmth of the body should be had recourse to without delay. The patients should always immediately be put to bed, wrapped up in hot blankets, and warmth should be sustained by other external applications, such as repeated frictions with flannels and camphorated spirits ; poultices of mustard and linseed (equal parts) to the stomach, particularly where pain and vomiting exist; similar poultices to the feet and legs, to restore their warmth. The returning heat of the body may be promoted by bags containing hot salt or bran applied to different parts of it. For the same purpose of restoring and sustaining the circulation, white wine whey, with spice, hot brandy and water, or sal volatile, in the dose of a tea-spoonful in hot water, frequently repeated, or from five to twenty drops of some of the essential oils, as peppermint, cloves, or cajeput, in a wine glass of water, may be adıninistered ; with the same view, where the stomach will bear it, warm broth with spice may be employed. In very severe cases, or where medical aid is difficult to be obtained, from twenty to forty drops of laudanum may be given, in any of the warm drinks previously recommended.
These simple means are proposed as resources in the incipient stage of the disease, where medical aid has not yet been obtained.
' In reference to the further means to be adopted in the treatment of this disease, it is necessary to state, that no specific remedy has yet been ascertained ; nor has any plan of cure been sufficiently commended by success to warrant its express recommendation from authority. The Board bave already published a detailed statement of the methods of treatment adopted in India, and of the different opinions entertained as to the use of bleeding, emetics, calomel, opium, &c.
There is reason to believe that more information on this subject may be obtained from those parts of the
continent where the disease is now prevailing; but even should it be otherwise, the greatest confidence may be reposed in the intelligence and zeal which the medical practitioners of this country will employ in establishing an appropriate method of cure.
HENRY HALFORD, President of the Board. These regulations are admirably clear, and all of a practical nature. We recommend the most particular attention with respect to the ventilation of houses, and the cleansing of the out-offices and drains, especially in close and narrow streets.
To the poor we should say, with the Board, be of all things cautious in the use of spirituous liquors, and we may add of beer, of which not a glass should be taken beyond the quantity that is strictly necessary. Regard should be had to the quality of any spirits and malt liquor that may be taken. Weak, flat, sour beer, it is well known, is among
the most deleterious of all drinks. It is wonderful to how small a portion of liquid one may safely and even comfortably reduce one's daily allowance, by making the experiment. Every thing that tends to debilitate the system, or to lower the vital energy, as excesses of every description, should be carefully avoided. Whatever has the effect of preserving and improving that energy, serves, in the opinion of Dr. Hawkins, to render the system impregnable to the operations of the malady. We should guard also against exposure to cold, chills, and to wet and moisture; keep at a distance from marshy or swampy districts, attend diligently to the regularity of the functions of the bowels, but not by means of salts or other debilitating purgatives. The surface of the body should be kept by means of flannel and good clothing, in a warm perspirable state, but not so warm as to bring on excessive perspirations. Our diet should be moderate, and easy of digestion, generous without being exciting, and simple without being low. The mind should be kept as much as possible, in an even cheerful tenour, and, particularly, the imagination should not be allowed to dwell upon the disease as an object of terror. Indeed, we should think as little of it as possible, unless in the way of those precautions which prudence recommends. “There is a moral courage,' as Dr. Hawkins sensibly observes, which is possessed by individuals who are even the weakest, perhaps, as respects physical powers, and which in them resists more efficiently the cause of the disease, than the bodily power of the strongest, who are not similarly endowed with this species of mental energy. Those who dread not the attack of disease, especially of epidemic disease, and who yet possess sufficient prudence to avoid unnecessary exposure to their predisposing and exciting causes, may generally be considered as subjected to comparatively little risk from them.
According to all the accounts from every part of Europe where the malady has appeared, there is no point more clearly ascertained than this, that the poor have been its principal victims. Their scanty nourishment, their very indifferent food, their confinement,