The Project Gutenberg EBook of Letters on the Cholera Morbus., by
James Gillkrest and William Fergusson
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Title: Letters on the Cholera Morbus.
Containing ample evidence that this disease, under whatever
name known, cannot be transmitted from the persons of those
labouring under it to other individuals, by contact--through
the medium of inanimate substances--or through the medium
of the atmosphere; and that all restrictions, by cordons
and quarantine regulations, are, as far as regards this
disease, not merely useless, but highly injurious to the
community.
Author: James Gillkrest
William Fergusson
Release Date: February 20, 2009 [EBook #28147]
Language: English
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Transcriber's Note
This text does not refer to epidemic cholera. The term "cholera morbus"
was used in the 19th and early 20th centuries to describe both
non-epidemic cholera and gastrointestinal diseases that mimicked
cholera. The term "cholera morbus" is found in older references but is
not in current scientific use. The condition "cholera morbus" is now
referred to as "acute gastroenteritis."
Spelling variations and inconsistencies have been retained to match the
original text. Only such cases which strongly indicated the presence
of inadvertent typographical error have been corrected; a detailed list
of these corrections can be found at the end of this text.
This ebook consists of two separate parts. The first from 1831 ("LETTERS
ON THE CHOLERA MORBUS.") contains Letters I-X; and the second from 1832
("LETTERS ON THE CHOLERA MORBUS, &c. &c. &c.") contains Letters I-III
and a Postscript. Transcriber's Notes at the end of the text refer to
"Pt_1" and "Pt_2" for ease of navigation.
LETTERS
ON THE
CHOLERA MORBUS.
CONTAINING
AMPLE EVIDENCE THAT THIS DISEASE, UNDER WHATEVER NAME KNOWN, CANNOT BE
TRANSMITTED FROM THE PERSONS OF THOSE LABOURING UNDER IT TO OTHER
INDIVIDUALS, BY CONTACT--THROUGH THE MEDIUM OF INANIMATE SUBSTANCES--OR
THROUGH THE MEDIUM OF THE ATMOSPHERE; AND THAT ALL RESTRICTIONS, BY
CORDONS AND QUARANTINE REGULATIONS, ARE, AS FAR AS REGARDS THIS DISEASE,
NOT MERELY USELESS, BUT HIGHLY INJURIOUS TO THE COMMUNITY.
_By a Professional Man of Thirty Years experience, in various parts of
the World._
LONDON:
NICHOLS AND SONS, PRINTERS, EARL'S COURT, CRANBOURN STREET LEICESTER
SQUARE.
1831.
The first series of these Letters, consisting of five, appeared in the
months of September and October of the present year; five others,
written in a more popular form, were inserted in a Newspaper from time
to time, in the course of this month:--a few additions and alterations,
preparatory to their appearance in the shape of a pamphlet, have been
made.
If, at a moment like the present, they prove in any manner useful to the
public, the writer will feel great satisfaction.
November 26th, 1831.
LETTERS ON THE CHOLERA MORBUS;
SHEWING THAT IT IS
NOT A COMMUNICABLE DISEASE.
LETTER I.
If we view the progress of this terrific malady, as it tends to
disorganise society wherever it shows itself, as it causes the
destruction of human life on an extensive scale, or as it cramps
commerce, and causes vast expense in the maintenance of quarantine and
cordon establishments, no subject can surely be, at this moment, of
deeper interest. It is to be regretted, indeed, that, in this country,
political questions (of great magnitude certainly), should have
prevented the legislature, and society at large, from examining, with
due severity, all the data connected with cholera, in order to avert,
should we unhappily be afflicted with an epidemic visitation of this
disease, that state of confusion, bordering on anarchy, which we find
has occurred in some of those countries where it has this year appeared.
Were this letter intended for the eyes of medical men only, it would
be unnecessary to say that, during epidemics, the safety of thousands
rests upon the solution of these simple questions:--Is the disease
communicable to a healthy person, from the body of another person
labouring under it, either _directly_, by touching him, or _indirectly_,
by touching any substance (as clothes, &c.) which might have been in
contact with him, or by inhaling the air about his person, either during
his illness or after death?--Or is it, on the other hand, a disease
with the appearance and progress of which sick persons, individually
or collectively, have no influence, the sole cause of its presence
depending on unknown states of the atmosphere, or on terrestrial
emanations, or on a principle, _aura_, or whatever else it may be
called, elicited under certain circumstances, from both the earth and
air?--In the one case we have what the French, very generally I believe,
term _mediate_ and _immediate_ contagion, while the term _infection_
would seem to be reserved by some of the most distinguished of
their physicians for the production of diseases by a deteriorated
atmosphere:--much confusion would certainly be avoided by this adoption
of terms.[1] Now it is evident, that incalculable mischief must arise
when a community acts upon erroneous decisions on the above questions;
for, if we proceed in our measures on the principle of the disease not
being either directly or indirectly transmissible, and that it should,
nevertheless, be so in fact, we shall consign many to the grave, by
not advising measures of separation between those in health, and
the persons, clothes, &c., of the sick. On the other hand, should
governments and the heads of families, act on the principle of the
disease being transmissible from person to person, while the fact may
be, that the disease is produced in each person by his breathing the
deteriorated atmosphere of a certain limited surface, the calamity in
this case must be very great; for, as has happened on the Continent
lately, cordons may be established to prevent flight, _when flight, in
certain cases, would seem to be the only means of safety to many_; and
families, under a false impression, may be induced to shut themselves
up in localities, where "every breeze is bane."
[Footnote 1: As medical men in this Country employ the word _infection_
and _contagion_ in various senses, I shall, generally substitute
_transmissible_ or _communicable_, to avoid obscurity.]
Hence then the importance, to the state and to individuals, of a rigid
investigation of these subjects. It is matter of general regret, I
believe, among medical men, that hitherto the question of cholera has
not always been handled in this country with due impartiality. Even
some honest men, from erroneous views as to what they consider "the
safe side" of the question, and forgetting that the safe side can
only be that on which truth lies (for then the people will know
_what_ to do in the event of an epidemic), openly favour the side of
_communicability_, contrary to their inward conviction; while the good
people of the quarantine have been stoutly at work in making out that
precautions are as necessary in the cholera as in plague. Meantime our
merchants, and indeed the whole nation, are filled with astonishment,
on discovering that neighbouring states enforce a quarantine against
ships from the British dominions, when those states find that cases of
disease are reported to them as occurring among us, resembling more
or less those which we have so loudly, and I must add prematurely,
declared to be transmissible. It is quite true that, however decidedly
the question may be set at rest in this country, our commerce, should
we act upon the principle, of the disease not being transmissible,
would be subject to vexatious measures, at least for a time, on the
part of other states; but let England take the lead in instituting a
full inquiry into the whole subject, by a Committee of the House of
Commons; and if the question be decided against quarantines and
cordons by that body, other countries will quickly follow the example,
and explode them as being much worse than useless, as far as their
application to cholera may be concerned. It is very remarkable how, in
these matters, one country shapes its course by what seems to be the
rule in others; and, as far as the point merely affects commerce,
without regard to ulterior considerations, it is not very surprising
that this should be the case; but it is not till an epidemic shall
have actually made its appearance among us, that the consequences of
the temporising, or the precipitation, of medical men can appear in
all their horrors. Let no man hesitate to retract an opinion already
declared, on a question of the highest importance to society, if he
should see good reason for doing so, after a patient and unbiassed
reconsideration of all the facts. We are bound, in every way, to act
with good faith towards the public, and erroneous views, in which
that public is concerned, ought to be declared as soon as discovered.
To show how erroneous some of the data are from which people are
likely to have drawn conclusions, is the main cause of my wish to
occupy the attention of the public; and in doing this, it is certainly
not my wish to give offence to respectable persons, though I may have
occasion to notice their errors or omissions.
Previous to proceeding to the consideration of other points, it may be
observed, that all doubt is at an end as to the identity of the Indian,
Russian, Prussian, and Austrian epidemic cholera; no greater difference
being observed in the grades of the disease in any two of those
countries, than is to be found at different times, or in different
places, in each of them respectively. At the risk of being considered a
very incompetent judge, if nothing worse, I shall not hesitate to say,
that if the same assemblage, or grouping of symptoms be admitted as
constituting the same disease, it may at any time be established, to the
entire satisfaction of an unprejudiced tribunal, that cases of cholera,
not unfrequently proving fatal, and corresponding in every particular to
the average of cases as they have appeared in the above countries, have
been frequently remarked as occurring in other countries including
England; and yet no cordon or quarantine regulations, on the presumption
of the disease spreading by "contagion." For my own part, without
referring to events out of Europe, I have been long quite familiar, and
I know several others who are equally so, with cholera, in which a
perfect similarity to the symptoms of the Indian or Russian cholera has
existed: the collapse--the deadly coldness with a clammy skin--the
irritability of the stomach, and prodigious discharge from the bowels
of an opaque serous fluid (untinged with bile in the slightest
degree)--with a corresponding shrinking of flesh and integuments--the
pulseless and livid extremities--the ghastly aspect of countenance and
sinking of the eyes--the restlessness so great, that the patient has not
been able to remain for a moment in any one position--yet, with all
this, nobody dreamt of the disease being communicable; no precautions
were taken on those occasions "to prevent the spreading of the disease,"
and no epidemics followed. In the _Glasgow Herald_ of the 5th ult., will
be found a paper by Mr. Marshall, (a gentleman who seems to reason with
great acuteness), which illustrates this part of our subject. This
gentleman appears to have had a good deal of experience in Ceylon when
the disease raged there, and I shall have occasion to refer hereafter to
his statements, which I consider of great value. Nobody can be so absurd
as to expect, that in the instances to which I refer, _all_ the symptoms
which have ever been enumerated, should have occurred in each case; for
neither in India nor any-where else could all the grave symptoms be
possibly united in any one case; for instance, great retching, and a
profuse serous discharge from the bowels, have very commonly occurred
where the disease has terminated fatally: yet it is not less certain,
that even in the epidemics of the same year, death has often taken place
in India more speedily where the stomach and bowels have been but little
affected, or not at all. To those who give the subject of cholera all
the attention which it merits, the consideration of some of those cases
which have, within the last few weeks, appeared in the journals of this
country, cannot fail to prove of high interest, and must inspire the
public with confidence, inasmuch as they show, _beyond all doubt_, that
the disease called cholera, as it has appeared in this country, and
however perfectly its symptoms may resemble the epidemic cholera of
other countries, _is not_ communicable. On some of those cases so
properly placed before the public, I shall perhaps be soon able to offer
a few remarks: meanwhile, I shall here give the abstract of a case, the
details of which have not as yet, I believe, appeared, and which must
greatly strengthen people in their opinion, that these cholera cases,
however formidable the symptoms, and though they sometimes end rapidly
in death, still do not possess the property of communicating the disease
to others. I do not mean to state that I have myself seen the case, the
details of which I am about to give, but aware of the accuracy of the
gentleman who has forwarded them to me, I can say, that although the
communication was not made by the medical gentleman in charge of the
patient, the utmost reliance may be placed on the fidelity of those
details:--
Thursday, August 11th, 1831, Martin M'Neal, aged 42, of the 7th
Fusileers, stationed at Hull, was attacked at a little before four A.M.,
with severe purging and vomiting--when seen by his surgeon at about four
o'clock, was labouring under spasms of the abdominal muscles, and of the
calves of the legs. What he had vomited was considered as being merely
the contents of the stomach, and, as the tongue was not observed to be
stained of a yellow colour, it was inferred that no bile had been thrown
up. He took seventy drops of laudanum, and diluents were ordered.
Half-past six, seen again by the surgeon, who was informed that he had
vomited the tea which he had taken; no appearance of bile in what he had
thrown up; watery stools, with a small quantity of feculent matter;
thirst; the spasms in abdomen and legs continued; countenance not
expressive of anxiety; skin temperate; pulse 68 and soft; the forehead
covered with moisture. Ordered ten grains of calomel, with two of opium,
which were rejected by the stomach, though not immediately.
Eight o'clock A.M. The features sinking, the temperature of the body now
below the natural standard, especially the extremities; pulse small;
tongue cold and moist; a great deal of retching, and a fluid vomited
resembling barley-water, but more viscid; constant inclination to go to
stool, but passed nothing; the spasms more violent and continued; a
state of collapse the most terrific succeeded. At nine o'clock, only a
very feeble action of the heart could be ascertained as going on, even
with the aid of the stethoscope; the body cold, and covered with a
clammy sweat, the features greatly sunk; the face discoloured; the lips
blue; the tongue moist, and very cold; the hands and feet blue, cold,
and shrivelled, as if they had been soaked in water, like washerwomen's
hands; no pulsation to be detected throughout the whole extent of
the upper or lower extremities; the voice changed, and power of
utterance diminished. He replied to questions with reluctance, and in
monosyllables; the spasms became more violent, the abdomen being, to
the feel, as hard as a board, and the legs drawn up; cold as the body
was, he could not bear the application of heat, and he threw off the
bed-clothes; passed no urine since first seen; the eyes became glassy
and fixed; the spasms like those of tetanus or hydrophobia; the
restlessness so great, that it required restraint to keep him for ever
so short a time in any one position. A vein having been opened in one
of his arms, from 16 to 20 ounces of blood were drawn with the greatest
difficulty. During the flowing of the blood, there was great writhing of
the body, and the spasms were very severe--friction had been arduously
employed, and at ten A.M. he took a draught containing two and a half
drachms of laudanum, and the vomiting having ceased, he fell asleep. At
two P.M. re-action took place, so as to give hopes of recovery. At four
P.M. the coldness of the body, discoloration, &c., returned, but without
a return of the vomiting or spasms. At about half-past eight he died,
after a few convulsive sobs.
On a post-mortem examination, polypi were found in the ventricles of
the heart, and the cavæ were filled with dark blood. Some red patches
were noticed on the mucuous membrane; but the communication forwarded
to me does not specify on what precise part of the stomach or
intestinal canal; and my friend does not appear to attach much
importance to them, from their common occurrence in a variety of other
diseases. It remains to be noticed, that the above man had been at a
fair in the neighbourhood on the 9th (two days preceding his attack),
where, as is stated, he ate freely of fruit, and got intoxicated. On
the 10th he also went to the fair, but was seen to go to bed sober
that night. The disease did not spread to others, either by direct
or indirect contact with this patient.
Now let us be frank, and instead of temporising with the question, take
up in one hand the paper on "cholera spasmodica" just issued, for our
guidance, from the College of Physicians by the London Board of Health,
and in the other, this case of Martin M'Neal (far from being a singular
case this year, in most of the important symptoms),--let the symptoms be
compared by those who are desirous that the truth should be ascertained,
or by those who are not, and if distinctions can be made out, I must
ever after follow the philosophy of the man who doubted his own
existence. The case, as it bears on certain questions connected with
cholera, _is worth volumes of what has been said on the same subject_.
Let it be examined by the most fastidious, and the complete identity
cannot be got rid of, even to the _blue_ skin, the _shrivelled fingers_,
the _cold tongue_, the _change in voice_, and the _suppression of
urine_, considered in some of the descriptions to be found in the
pamphlet issued by the Board of Health, as so characteristic of the
"Indian" cholera; and this, too, under a "constitution of the
atmosphere" so remarkably disposed to favour the production of cholera
of one kind or other, that Dr. Gooch, were he alive, or any close
reasoner like him, must be satisfied, that were this remarkable form of
the disease communicable, no circumstance was absent which can at all
be considered essential to its propagation. As the symptoms in the case
of M'Neal, were, perhaps, more characteristically grouped than in any
other case which has been recorded in this country, so it has also in
all probability occurred, that more individuals had been in contact with
him during his illness and after his death, as the facility in obtaining
persons to attend the sick, rub their bodies, &c., must be vastly
greater in the army than in ordinary life; so that in such cases it is
not a question of one or two escaping, but of _many_, which is always
the great test.
Of the College of Physicians we are all bound to speak with every
feeling of respect, but had the document transmitted by that learned
body to our government, on the 9th of June last, expressed only a
"philosophic doubt," instead of making an assertion, the question
relative to the contagion or non-contagion of the disease, now making
ravages in various parts of Europe, would be less shackled among us.
People are naturally little disposed to place themselves, with the
knowledge they may have obtained from experience and other sources, in
opposition to such a body as the College: but as, in their letter to
government of the 18th of June, they profess their readiness, should it
be necessary, to "re-consider" their opinion, we, who see reason to
differ from them, may be excused for publishing our remarks. It seems
surprising enough that, in their letter to government of the 9th of
June, the College should have given as a reason for their decision
as to the disease being infectious (meaning, evidently, what some call
contagious, or transmissible from _persons_)--"having no other means of
judging of the nature and symptoms of the cholera than those furnished
by the documents submitted to us." Now, according to the printed
parliamentary papers, among the documents here referred to as having
been sent by the Council to the College, was one from Sir William
Crichton, Physician in Ordinary to the Emperor of Russia, in which a
clear account is given of the symptoms as they presented themselves in
that country; and, if the College had previously doubted of the identity
of the Russian and Indian cholera, a comparison of the symptoms, as they
were detailed by Sir William, with those described in various places in
the _three volumes_ of printed Reports on the cholera of India, in the
college library, must at once have established the point in the
affirmative. In fact, we know, that the evidence of Dr. Russell, given
before the College, when he heard Sir William's description of the
disease read, fully proved this identity to the satisfaction of the
College. Had the vast mass of information contained in the India
Reports, together with the information since accumulated by our Army
Medical Department, been consulted, all which are highly creditable to
those concerned in drawing them up, and contain incomparably better
evidence, that is, evidence more to be relied on, than any which can be
procured from Russia or any other part of the world--had these sources
of information been consulted, as many think they should in all fairness
have been, the College would probably have spoken more doubtingly as
to cholera, in any form, possessing the property of propagating itself
from person to person. Much of what passes current in favour of the
communication of cholera rests, I perceive, on statements the most
vague, assertions in a general way, as to the security of those who shut
themselves up, &c. To show how little reliance is to be placed on such
statements, even when they come from what ought to be good authority,
let us take an instance which happened in the case of yellow fever.
Doctor, now Sir William Pym, superintendent of the quarantine
department, published a book on this disease in 1815, in which he
stated, that the people shut up in a dock-yard, during the epidemic of
1814, in Gibraltar, escaped the disease, and Mr. William Fraser, also of
the quarantine, and who was on the spot, made a similar statement. Now,
we all believed this in England for several years, when a publication
appeared from Dr. O'Halloran, of the medical department of Gibraltar
garrison, in which he stated that he had made inquiries from the
authorities at that place, and that he discovered the whole statement to
have been without the smallest foundation, and furnishes the particulars
of cases which occurred in the dock-yard, among which were some deaths;
this has never since been replied to--so much as a caution in the
selection of proofs.
To show, further, how absurdly statements respecting the efficacy of
cordons will sometimes be made, it may be mentioned that M. D'Argout,
French minister of public works, standing up in his place in the
chamber, _on the 3rd instant_ (_Septr._), and producing his estimates
for additional cordons, &c., stated, by way of proving the efficacy of
such establishments, that in Prussia, where, according to him, cordon
precautions had been pre-eminently rigorous, and where "_le territoire
a été defendu pied à pied_," such special enforcement of the regulations
was attended with "_assez de succès_:" in the meantime the next mail
brings us the official announcement (_dated Berlin, Sept. 1_) of the
disease having made its appearance there!
To conclude, for the present: if there be one reason more than another
why the question of cholera should be scrutinized by the highest
tribunal--a parliamentary committee--it is, that in the "papers" just
issued by the Board of Health, the following passage occurs (page
36):--"But in the event of such removal not being practicable, on
account of extreme illness or otherwise, the prevention of all
intercourse with the sick, even of the family of the person attacked,
must be rigidly observed, unless," &c. There are some who can duly
appreciate all the consequences of this; but let us hope that the
question is still open to further evidence, in order to ascertain
whether it be really necessary that, in the event of a cholera epidemic,
"The living shall fly from
The sick they should cherish."
LETTER II.
In my last letter I adverted to the opinion forwarded to his Majesty's
Council on the 9th of June last from the College of Physicians, in which
the cholera, now so prevalent in many parts of Europe, was declared to
be communicable from person to person. We saw that they admitted in that
letter (see page 16 of the Parliamentary Papers on Cholera) the limited
nature of the proofs upon which their opinion was formed; but I had not
the reasons which I supposed I had for concluding, that because they
used the words "ready to reconsider," in their communication of the 18th
of same month to the Council, they intended to _reconsider_ the whole
question. Indeed this seems now obvious enough, as one of the Fellows of
the College who signed the Report from that body on the 9th of June
(Dr. Macmichael) has published a pamphlet in support of the opinion
already given, in the shape of a letter addressed to the President of the
College, whose views, Dr. Macmichael tells us, _entirely coincide_ with
his own; so that there is now too much reason to apprehend that in this
quarter the door is closed. Contagionist as I am, in regard to those
diseases where there is evidence of contagion, I find nothing in Dr.
Macmichael's letter which can make an impression on those who are at all
in the habit of investigating such subjects,[2] and who, dismissing such
inductions as those which he seems to consider legitimate, rely solely
on facts rigorously examined. He must surely be aware that most of the
points which he seems to think ought to have such influence in leading
the public to believe in the contagion of cholera, might equally apply
to the influenza which this year prevailed in Europe, and last year in
China, &c.; or to the influenza of 1803, which traversed over continents
and oceans, _sometimes in the wind's eye, sometimes not_, as frequently
mentioned by the late Professor Gregory of Edinburgh. Who will now stand
up and try to maintain that the disease in those epidemics was
propagated from person to person? Could more have been made of so bad a
cause as contagion in cholera, few perhaps could have succeeded better
than Dr. Macmichael, and no discourtesy shall be offered him by me,
though he does sometimes loose his temper, and say, among other things
not over civil, nor quite _comme il faut_, from a Fellow of the College,
that all who do not agree with him as to contagion "will fully abandon
all the ordinary maxims of prudence, and remain obstinately blind to the
dictates of common sense!"--_fort, mais peu philosophique Monsieur le
Docteur_. The time has gone by when ingenious men of the profession,
like Dr. Macmichael, might argue common sense out of us; it will not
even serve any purpose now that other names are so studiously introduced
as _entirely coinciding_ with Dr. Macmichael; for, in these days of
reform in every thing, _opinions_, will only be set down at their just
value by those who pay attention to the subject.
[Footnote 2: I presume that I shall not be misunderstood when I say,
_Would that the cholera were contagious_--for then we might have every
reasonable hope of staying the progress of the calamity by those cordon
and quarantine regulations which are now not merely useless, but the
bane of society, when applied to cholera or other non-contagious
diseases.]
Referring once more to the Report of the 9th of June, made by the
College to the Council, and signed by the President as well as by
Dr. Macmichael, the cholera was there pronounced to be a communicable
disease, when they had, as they freely admit, "no other means of judging
of the nature and symptoms of the cholera than those furnished by the
documents submitted to them." The documents submitted were the
following, as appears from the collection of papers published by order
of Parliament:--Two reports made to our government by Dr. Walker, from
Russia; a report from Petersburgh by Dr. Albers, a Prussian physician;
and a report, with inclosures, regarding Russian quarantine regulations,
from St. Petersburg, by Sir W. Creighton. Dr. Walker, who was sent from
St. Petersburg to Moscow, by our ambassador at the former place; states,
in his first report, dated in March, that the medical men seemed to
differ on the subject of contagion, but adds, "I may so far state, that
by far the greater number of medical men are disposed to think it not
contagious." He says, that on his arrival at Moscow, the cholera was
almost extinct there; that in twelve days he had been able to see only
twenty-four cases, and that he had no means of forming an opinion of
his own as to contagion. In a second report, dated in April from St.
Petersburg, this gentleman repeats his former statement as to the
majority of the Moscow medical men not believing the disease to be
contagious (or, as the College prefer terming it, infectious), and gives
the grounds on which their belief is formed, on which he makes some
observations. He seems extremely fair, for while he states that,
according to his information, a peculiar state of the atmosphere "was
proved by almost every person in the city (Moscow), feeling, during the
time, some inconvenience or other, which wanted only the exciting cause
of catching cold, or of some irregularity in diet, to bring on cholera;"
that "very few of those immediately about the patients were taken ill;"
that he "did not learn that the contagionists in Moscow had any strong
particular instances to prove the communication of the disease from one
individual to another;" and that he had "heard of several instances
brought forward in support of the opinion (contagion), but they are not
fair ones:" he yet mentions where exceptions seem to have taken place as
to hospital attendants not being attacked, but he has neglected to tell
us (a very common omission in similar statements), whether or not the
hospitals in which attendants were attacked were situated in or near
places where the atmosphere seemed _equally productive of the disease
in those not employed in attending on sick_. This clearly makes all the
difference, for there is no earthly reason why people about the sick
should not be attacked, if they breathe the same atmosphere which would
seem to have so particular an effect in producing the disease in others;
indeed there are good reasons why, during an epidemic, attendants should
be attacked in greater proportion; for the constant fatigue, night-work,
&c., must greatly predispose them to disease of any kind, while the
great additional number always required on those occasions, precludes
the supposition of the majority so employed being _seasoned_ hospital
attendants, having constitutions impenetrable to contagion. Those
questions are _now_ well understood as to yellow fever, about which so
much misconception had once existed. The proofs by disinterested authors
(by which I mean those unconnected with quarantine establishments, or
who are not governed by the _expediency_ of the case) in the West
Indies, America, and other places, show this in a clear light; but the
proofs which have for some time past appeared in various journals
respecting the occurrences at Gibraltar, during the epidemic of 1828,
are particularly illustrative. By the testimony of three or four
writers, we find that _within certain points_, those in attendance on
sick, in houses as well as hospitals, were attacked with the fever, in
common with those who were not in attendance on sick; but that, where
people remained at ever so short a distance beyond those points, during
the epidemic influence, _not a single instance_ occurred of their being
attacked, though great numbers had been in the closest contact with the
sick, and frequently too, it would appear, under circumstances when
contagion, had it existed, was not impeded in its usual course by a very
free atmosphere:--_sick individuals, for instance, lying in a small
house, hut, or tent, surrounded, during a longer or shorter space of
time, by their relatives, &c._ A full exposure of some very curious
mis-statements on these points, made by our medical chief of the
quarantine, will be found from the pen of the surgeon of the 23d
regiment, in the _Edinburgh Medical and Surgical Journal_, No. 106.[3]
Those who are acquainted with the progress of cholera in India, must be
aware how a difference in the height of places, or of a few hundred
yards (_indeed sometimes of a few yards_) distance, has been observed to
make all the difference between great suffering and complete
immunity:--the printed and manuscript reports from India furnish a vast
number of instances of this kind; and, incredible as it may appear, they
furnish instances where, _notwithstanding the freest intercourse_, there
has been an abrupt line of demarcation observed, beyond which the
disease did not prevail. A most remarkable instance of this occurred in
the King's 14th regiment, in 1819, during a cholera epidemic, when the
light company of the regiment escaped almost untouched, owing to no
other apparent cause than that they occupied the extremity of a range of
barrack in which all the other companies were stationed! so that there
would truly seem to be more things "on earth than are dreamt of in the
philosophy" of contagionists. This seems so remarkable an event, that
the circumstance should be more particularly stated:--"The disease
commenced in the eastern wing of the barracks, and proceeded in a
westerly direction, but suddenly stopped at the 9th company; the
light infantry escaping with one or two slight cases only."--(_Bengal
Rep._ 311.) It appears (_loc. cit._) that 221 attacks took place in the
other nine companies. We find (_Bombay Rep._ p. 11.) that, from a little
difference in situation, two cavalry regiments in a camp were altogether
exempt from the disease, while all the other regiments were attacked.
Previous to closing these remarks, which seemed to me called for on
Dr. Walker's second Report, it is fair to state, that in certain Russian
towns which he names, he found that the medical men and others were
convinced that the cholera was brought to them "_somehow or other_," an
impression quite common in like cases, as we learn from Humboldt, and
less to be wondered at in Russia than most places which could be
mentioned. It will not be a misemployment of time to consider now the
next document laid before the College, to enable them to form their
opinion,--the Report of Dr. Albers, dated in March, and sent from St.
Petersburg;--this gentleman, who was at the head of a commission sent
by the Prussian government to Moscow, states, that at St. Petersburgh,
_where the disease did not then reign_, the authorities and physicians
were contagionists; but at Moscow, where it had committed such ravages,
"almost all strenuously maintain that cholera is not contagious." The
following extract seems to merit particular attention:--
"When the cholera first reached Moscow, all the physicians of this city
were persuaded of its contagious nature, but the experience gained in
the course of the epidemic, has produced an entirely opposite
conviction. They found that it was impossible for any length of time
completely to isolate such a city as Moscow, containing 300,000
inhabitants, and having a circumference of nearly seven miles (versts?),
and perceived daily the frequent frustrations of the measures adopted.
During the epidemic, it is certain that upwards of 40,000 inhabitants
quitted Moscow, of whom a large number never performed quarantine; and
notwithstanding this fact, _no case is on record of the cholera having
been transferred from Moscow to other places_, and it is equally
certain, that in _no situation_ appointed for quarantine, _any case of
cholera has occurred_. That the distemper is not contagious, has been
yet more ascertained by the experience gathered in this city (Moscow).
In many houses it happened, that one individual attacked by cholera was
attended indiscriminately by all the relatives, and yet did the disease
not spread to any of the inmates. It was finally found, that not only
the nurses continued free of the distemper, but also that they
promiscuously attended the sick chamber, and visited their friends,
without in the least communicating the disease. There are even cases
fully authenticated, that nurses, to quiet timid females labouring under
cholera, have shared their beds during the nights, and that they,
notwithstanding, have escaped uninjured in the same manner as physicians
in hospitals have, without any bad consequences, made use of warm water
used (a moment before) by cholera patients for bathing.
[Footnote 3: The writer of this, who may be known by application at
the printer's, when the present excitement is at an end, is not only
prepared to show, _on a fitting occasion_, the correctness of the
statements of Dr. Smith as well as those by Dr. O'Halloran just
referred to--but also, that in the investigations, in 1828, connected
with the question of yellow fever at Gibraltar, facts were perverted
in the most scandalous manner, in order to prove the disease imported
and contagious:--that individuals had been suborned:--that persons had
been in the habit of putting leading questions to witnesses:--that
those who gave false evidence have been, in a particular manner,
remunerated:--that threats were held out:--and, in short, that
occurrences of a nature to excite the indignation of mankind, took
place on that occasion; and merited a punishment, not less severe,
than a Naval Officer who should give, designedly, a false bearing and
distance of rocks.]
"These, and numerous other examples which, during the epidemic (we
ought, perhaps, to call it endemic) became known to every inhabitant of
Moscow, have confirmed the conviction of the non-infectious nature of
the disease, a conviction in which their personal safety was so much
concerned.
"It is also highly worthy of observation, that all those who stand up
for contagion, _have not witnessed_ the cholera, which is, therefore,
especially objected to their opinion by their opponents." He closes by
the observation, "The result of my own daily experience, therefore,
perfectly agrees with the above-stated principle, namely, notwithstanding
all my inquiries, I _have met with no instance which could render it at
all probable that the cholera is disseminated by inanimate objects_." The
words in italics are as in the Parliamentary papers on Cholera, pp. 8 and
9. Here is something to help to guide people in forming opinions, and to
help governments on quarantine questions; but owing to a portion of the
"perverseness" which Dr. Macmichael in anger talks about, Dr. Albers
still _speculates_ upon cholera being contagious, and the College, it
would seem, take up his speculations and sink his very important facts.
Sir William Creighton's Report gives what puports to be an extract from
a memorial of his on cholera, given in to the St. Petersburg Medical
Council, tending to establish the contagious character of the disease;
and with this a report by the extraordinary committee appointed by the
Emperor to inquire into the Moscow epidemic. The disease had not appeared
at St. Petersburg when he drew up his Memorial, and it does not appear
from any-thing which can be seen in the extracts he furnishes, that he
had personal knowledge of any part of what he relates. He gives the
reported progress of the disease on the Volga and the Don, but is
extremely deficient exactly where one might have expected that, from the
greater efficiency of police authorities, &c., his information on
contagion would have been more precise, viz., the introduction of the
disease into Moscow, which could not, it would seem have been by material
objects, for, according to the Committee, composed "of the most eminent
public officers,"--"the opinion of those who do not admit the possibility
of contagion by means of material objects, has for its support both the
majority of voices, and the scrupulous observance of facts. The members
of the Medical Council have been convinced by their own experience, as
also by the reports of the physicians of the hospitals, that, after
having been in frequent and even habitual communication with the sick,
their own clothes have never communicated the disease to any one, even
without employing means of purification. Convalescents have continued to
wear clothes which they wore during the disease--even furs--without
having them purified, and they have had no relapse. At the opening of
bodies of persons who had died of cholera, to the minute inspection of
which four or five hours a day for nearly a month were devoted, neither
those who attended at their operations, nor any of the assisting
physicians, nor any of the attendants, caught the infection, although,
with the exception of the first day, scarcely any precautions were used.
But what appears still more conclusive, a physician who had received
several wounds in separating the flesh, continued his operations, having
only touched the injured parts with caustic. A drunken invalid having
also wounded himself, had an abscess, which doubtless showed the
pernicious action of the dead flesh, but the cholera morbus did not
attack him. In fine, foreign _Savans_, such as Moreau de Jonnés and
Gravier, who have recognized, in various relations, the contagious nature
of the cholera morbus, do not admit its propagation by means of goods and
merchandise." (_Parl. Papers on Chol._ p. 13.) With the above documents
the Council transmitted to the College a short description of the process
of cleaning hemp in the Russian ports; and, lastly, the copy of a
letter to the clerk of the Council from our ever-vigilant, though
never-sufficiently-to-be-remunerated, head guardian of the quarantine
department, who, taking the alarm, very properly recommends, as in duty
bound, that a stir be forthwith made in all the pools, and creeks, and
bays, &c., of the united kingdom, in order that all those notoriously
"susceptible" old offenders, skins, hemp, flax, rags, &c., may be
prevented from carrying into execution their felonious intention of
covering the landing of a dire enemy. In truth, from the grave as well
as from the sublime, there often seems to be "but a step;" and in
reading over this gentleman's suggestions about _susceptibles_ and
_non-susceptibles_, one may fancy himself, instead of being in the
land of thinking people, to be in the land of Egypt, where, as we are
informed (Madden, 1825), the sage matrons discuss the point, whether a
cat be not a better vehicle for contagion than a dog:--a horse may be
trusted, they say, but as to an ass, he is the most incorrigible of
contagion smugglers;--of fresh bread we never need be afraid, but the
susceptibility of butcher's meat is quite an established thing:--or we
might fancy ourselves transported to regions of romance, where it is
matter of profound deliberation, whether an egg shall be broken at the
large or the small end. Such things are too bad for the nineteenth
century; and in England, too, with her enlightened parliament! But until
these questions are better examined, our guardian must bestir himself
about articles susceptible of cholera contagion, while he enjoys his
good quarantine pay, his good half pay from another department as I
believe, and withall, if we are not misinformed, a smart pension from
the Gibraltar revenue, for what granted nobody can tell.
The documents above referred to, would appear then to be the whole on
which the College admit that they formed their opinions, and people may
now judge whether the verdict be according to the evidence, or whether
it be not something in the _lucus a non lucendo_ mode of drawing
conclusions:--most persons will probably think that, on such evidence,
there might at least have been a qualified opinion. It appears, however,
that having come to _a decision_ on the 9th of June, that the disease
was communicable from person to person, they in three days after,
approved of persons being sent to Russia to find out whether they had
decided rightly or not. Are we now to expect that, should the occasion
need, they will heroically make war against their own declared opinion?
For my part I expect from them all that should be expected from men; and
the liberal part of the world will not fail to see from this, that I do
not despair of even Dr. Macmichael, being still open to conviction. Let
it not be for a moment understood that, in any-thing which has been
said, or which may remain to be said respecting this gentleman, or in
any-thing which may be hereafter said respecting Dr. Bisset Hawkins's
work, I mean to insinuate that contagion in cholera is not with them a
matter of conscience; but I certainly do mean to say that their zeal has
manifestly warped their judgment; and not only this, but that it has
prevented them from laying statements before the public on the cholera
questions with all the impartiality we might have expected from
gentlemen of their character in the profession.
In Dr. Macmichael's pamphlet, consisting of thirty-two pages, and
professing to be a consideration of the question, "Is cholera
contagious?" we scarcely find the disease mentioned till we come to page
25; the pages up to this being occupied chiefly by a recapitulation of
opinions formerly given "on the progress of opinion upon the subject of
contagion;"--on the opinions of old writers as to the contagion of
plague, small-pox, measles, &c.:--he would infer that whereas small-pox
and certain other diseases have, by more accurate observations made in
comparatively modern times, been taken from the place they once held,
and ranged among diseases decidedly contagious, so ought cholera also
to be now pronounced contagious! As an inducement to us to adopt this
as good logic, he assures us that the list of diseases deemed contagious
by wise men is on the increase--that non-contagionists are _perverse_
people, _blunderers_, and so forth! As to his epithets, it shall only be
said that among the disbelievers of contagion in cholera, and certain
other diseases probably reputed contagious by Dr. Macmichael, are to be
found hundreds possessing as much candour, as cultivated minds, and as
much practical knowledge of their profession, as any contagionists,
whether they be Fellows of a College or not; but as to the statement
of Dr. Macmichael, is it true that we have been adding to the list of
contagious diseases? Not within the last fifty years certainly. Even the
influenza of 1803 was, if I mistake not greatly, termed, very generally,
"infectious catarrh," but what professional man would term the influenza
of 1831 so? Are there not yet remaining traces of the generally exploded
doctrine of even contagion in ague, at one time attempted to be
maintained? M. Adouard, of Paris, still indeed holds out. Do we not know
that Portal, at one period of his life at least, would not, for fear of
"infection," open the body of a person who had died of phthisis? Where
is the medical man now to be found who would set up such a plea? or
where, except in countries doomed to eternal barbarism, are patients
labouring under consumption avoided now, as they were in several parts
of the world at one time, just as if they laboured under plague, and all
for the simpleton's reason that the disease _often runs through
families_? What disinterested man will, on due examination of all that
has been written on yellow fever, stand up now in support of its being a
contagious disease, of which some thirty or forty years ago there was so
general a belief? On croup, and a few more diseases, many still think it
_wise to doubt_. Is dysentery, known to make such ravages sometimes,
especially in armies, considered now, as at one time, to be contagious?
If Dr. Macmichael's pamphlet was intended altogether for readers not of
the profession, _which seems very probable_, his purposes will perhaps
be answered, at least for a time, but I do not see how it can make an
impression on medical men. Why not have been a little more candid when
quoting Sydenham on small-pox, &c. and have quoted what that author says
of the disease which he (Dr. M.) professes to write about,--the cholera?
The public would have means of judging how far the disease which was
prevalent in 1669, resembled the "cholera spasmodica," &c., of late
years. Many insist upon an identity (Orton among others), and yet
Sydenham saw no reason for suspecting a communicable property. It might
have been more to the point had Dr. Macmichael, instead of quoting old
authorities on small-pox, measles, &c. quoted some authorities to
disprove that Orton and others are wrong when they state it as their
belief that some of those old epidemics in Europe, about which so much
obscurity hangs, were nothing more or less than the cholera spasmodica.
Mead's short sketch of the "sweating sickness" does not seem very
inapplicable:--"Excessive fainting and inquietude inward burnings,
headach, sweating, vomiting, and diarrhoea."[4] In the letter to the
President of the College we see no small anxiety to prove that the
malignant cholera is of modern origin also in India, for the proofs from
Hindoo authorities, as given in the volume of _Madras Reports_, are
slighted. These Reports, as well as those of the other presidencies,
are exceedingly scarce, but whoever can obtain access to them will find
in the translations at pp. 253 and 255 (not at page 3, as quoted by
Dr. Macmichael), enough probably to satisfy him that cholera is the
disease alluded to there. But I think that we have at page 31 of
Dr. Macmichael's letter, no small proof of a peculiarity of opinion, when
we find that he there states that the evidence in the _Madras Reports_
of the existence of epidemics of malignant cholera in India, on several
occasions previous to 1817, rests on imperfect records, and that the
description of the disease is too vague to prove the identity with the
modern spasmodic cholera; for in this opinion he seems, as far as I have
been able to discover, to stand alone among writers on cholera;--indeed
it seems established, _on the fullest authority_, that cholera, in the
same form in which it has appeared epidemically of late years, has
committed ravages in India on more than one occasion formerly:--this is
fully admitted by Mr. Orton, an East India practitioner, who is one of
the few contagionists.
[Footnote 4: If the progress of the sweating sickness was similar to
that of cholera, the advice of the King to Wolsey was sound; for instead
of recommending him to rely on any-thing like cordon systems, or to shut
himself up surrounded by his guards, he tells him (see _Ellis's_
letters) to "fly to _clene_ air incontinently," on the approach of the
disease. I use the words _approach of the disease_ occasionally, as it
is a manner of expression in general use, but it is far from being
strictly applicable when I speak of cholera; _the cause_ of the disease
it is which I admit travels or springs up at points, and not the disease
itself in the persons of individuals, or its germs in inanimate
substances.]
For one piece of tact the author of the letter deserves great credit;
for whereas his College collectively, when forming their opinion on the
questions proposed to them by the Council, seemed to throw all India
records overboard,--he, in his individual capacity, as author of the
letter, sends after them all the Russian reports in support of
contagion; for anxious as he is to prove his point, not a word do we get
of the _on dits_ so current in Russia about persons being attacked with
the disease from smelling to hemp arrived from such or such a place;
from having looked at a boatman who had been up the Volga or down the
Volga, &c. &c.: all which statements, when duty inquired into, prove to
be unsupported by any thing in the shape of respectable authority, and
this is now, in all probability, pretty generally known to be the case,
as Dr. Macmichael must be quite aware of.
To the medical gentlemen of India who have been concerned in the
official reports, which do them, _en masse_, so much credit, Dr.
Macmichael is little disposed to be complimentary; and, indeed, he seems
to insinuate that those were rather stupid fellows who did not come to
what he is pleased to consider "a just and right conclusion," as to
contagion; he thinks, however, that he has got a few of "the most
candid" to join in his belief. We shall see whether he had better
reason to look towards the Ganges and Beema for a confirmation of his
doctrines, than he had toward the Don or the Volga. How does the case
stand with respect to one of the gentlemen whom he quotes,--Mr. Jukes,
of the Bombay Establishment? This gentleman, like all who speak of
cholera, mentions circumstances as to the progress of the disease
which he cannot comprehend, and Dr. Macmichael shows us what those
circumstances are; but Dr. Macmichael does not exhibit to us _what does_
come perfectly within Mr. Jukes's comprehension, but which is not quite
so suitable to the doctor's purpose. This omission I shall take the
liberty to supply from an official letter from Mr. Jukes in the Bombay
Reports:--"I have had no reason to think it has been contagious here,
neither myself nor any of my assistants, who have been constantly
amongst the sick, nor any of the hospital attendants, have had the
disease. It has not gone through families when one has become affected.
It is very unlike contagion too, in many particulars." &c.--(_Bombay
Reports_, page 172.)--Ought we not to be a little surprised that so
great an admirer of candour, as Dr. Macmichael seems to be, should,
while so anxious to give every information to his readers, calculated to
throw light upon the subject of cholera, omits the above important
paragraph, which we find, by the way _immediately precedes_ the one upon
opinions and difficulties which he quotes from the same gentleman? But
let us examine what the amount of force is, which can be obtained from
that part of Mr. Jukes's paper, which it does please Dr. Macmichael to
quote:--"If it be something general in the atmosphere, why has it not
hitherto made its appearance in some two distinct parts of the province
at the same time? Nothing of this kind has, I believe, been observed. It
still seems creeping from village to village, rages for a few days, and
then begins to decline." I find myself unable, at this moment, to
ascertain the extent of Mr. Jukes's means of obtaining information as
to what was passing in other parts of his province; but I think the
following quotation, on which I am just now able to lay my hand, will
not only satisfactorily meet what is here stated, but must, in the
public opinion, be treasured, as it serves at once to displace most
erroneous ideas long prevalent, and which, I believe, greatly influenced
men's decisions as to contagion:--"It may, then, first be remarked,
that the rise and progress of the disorder were attended by such
circumstances as showed it to be entirely independent of contagion for
its propagation. Thus we have seen that it arose at nearly one and the
same time in many different places, and that in the same month, nay,
in the same week, it was raging in the unconnected and far-distant
districts of Behar and Dacca." (Bengal Reports, p. 125.) Again (p. 9),
that in Bengal "it at once raged simultaneously in various and remote
quarters, without displaying a predilection for any one tract or
district more than for another; or any thing like regularity of
succesion in the chain of its operations." In support of what is stated
in these extracts, the fullest details are given as to dates and places;
and at page 9 of those Reports, a curious fact is given, "That the large
and populous city of Moorshedabad, from extent and local position
apparently very favourably circumstanced for the attacks of the
epidemic, should have escaped with comparatively little loss, whilst all
around was so severely scourged." This seems to have been pretty similar
to what is now taking place with respect to the city of Thorn, which
remains free from cholera, though the communication is open with divers
infected places in every direction. Should Thorn still be attacked by
the disease (as it sooner or later will, in all human probability), the
contagionists _par métier_ will try to establish a case of hemp or
hare-skin importation, I have no doubt. I wonder much that Dr.
Macmichael or Dr. B. Hawkins, when favouring us with eastern quotations,
did not give the public the opinion of Dr. Davy, who is so well known
in Europe, and who saw the cholera in Ceylon; his conjecture (quite
accessible, I believe, to every medical man in London) may perhaps be
as valuable as that of any other person. The following is a copy of
it:--"The cause of the disease is not any sensible change in the
atmosphere; yet, considering the progress of the disease, its epidemic
nature, the immense extent of country it has spread over, we can hardly
refuse to acknowledge that its cause, though imperceptible, though yet
unknown, does exist in the atmosphere. It may be extricated from the
bowels of the earth, as miasmata were formerly supposed to be; it may
be generated in the air, it may have the properties of radiant matter,
and, like heat and light, it may be capable of passing through space
unimpeded by currents; like electricity, it may be capable of moving
from place to place in an imperceptible moment of time." Dr. Davy is an
army physician, and the report of which this is an extract, may be seen
at the Army Medical Office, a place which, of late years, has become a
magazine of medical information of the most valuable kind in Europe.
There is this difference between army and other information on cholera,
that (whether in the King's or E. I. Company's service) the statements
given by the medical gentlemen have their accuracy more or less
guaranteed by a certain system of military control over the documents
they draw up: thus, in the circumstance already noticed as having
occurred in the 14th regiment, we have every reason to rely upon its
accuracy, which we could not have in a similar statement among the
population of any country; and we have, I think, no reason to believe
that in pronouncing the cholera of Ceylon not contagious, Dr. Davy, as
well as two other gentlemen of high character and experience (Drs.
Farrel and Marshall), have not gone upon such data as may bear scrutiny.
LETTER III.
Having given, in my last letter, Dr. Davy's views as to the cause of
cholera, I may so far remark just now regarding them, that they are not
new, or peculiar to him; and that it may be well, before Dr. Macmichael
or others pronounce them vague, that they should inquire whether some
of those causes have not been assigned for the production of certain
epidemics, by one of the soundest heads of Dr. Macmichael's college--Dr.
Prout, who seems, if we have not greatly mistaken him, to have been led
to the opinion by some experiments of Herschell, detailed in the
Philosophical Transactions of the year 1824. They should recollect that
other competent persons devoted to researches on such subjects (Sir R.
Phillips among the number) admit _specific local atmospheres_ (not at
all _malaria_ in the usual sense of the term), produced by irregular
streams of specific atoms from the interior of the earth, and "arising
from the action and re-action of so heterogeneous a mass." For my part
I feel no greater difficulty in understanding how our bodies, "fearfully
and wonderfully made" as we are, should be influenced by those actions,
re-actions, and combinations, to which Sir Richard refers, and of
"whose origin and progress the life and observation of man can have no
cognizance," than how they are influenced by other invisible agents,
the existence of which I am compelled to admit.--If the writer of the
article on cholera in the _Westminster Review_, for October, 1831, do
not find all his objections met by these observations, I must only refer
him to the _quid divinum_ of Hippocrates:--but I must protest against
logic such has been employed by certain members of our Board of Health,
who lately, on the examination of gentlemen of the profession who
had served in India, and who had declared the disease not to be
communicable, came to the conclusion that it must, nevertheless, be
so, as those gentlemen could not show _what it was_ owing to.
Most extraordinary certainly it does appear, that while Dr. Macmichael
goes to the trouble of giving us (p. 27) the views of _a captain_ (!) as
to the progress of cholera at a certain place in India, he should have
refrained altogether from referring, on the point of contagion or
non-contagion, to the report of such a person as Dr. Davy, or to the
reports of this gentleman's colleagues at Ceylon, Drs. Farrell and
Marshall. Had Dr. Macmichael added a little to his extract from Capt.
Sykes, by informing us of what that gentleman states as to the great
mortality ("350 in one day") in the town of Punderpoor, "when the
disease first commenced its ravages there," people would have means of
judging how unlike this was to a contagious disease creeping from person
to person in its commencement.
It is painful to be obliged to comment on the manner in which Dr. Bisset
Hawkins has handled the questions relative to the Ceylon epidemic, which
seems far from being impartial; for, while he quotes (p. 172) Dr. Davy,
"a medical officer well known in the scientific world," as stating that
the cause of the disease is not in any _sensible_ changes in the state
of the atmosphere, he breaks off suddenly at the word _atmosphere_,
proceeds to talk of the changes in the muscles and blood of persons who
die of the disease, and passing over the part quoted from Dr. Davy, near
the close of my last letter, Dr. Hawkins leaves his readers to draw a
very natural conclusion--that, as Dr. Davy admitted that there were no
prevalent _sensible_ states of the atmosphere to which the cholera could
be attributed, _he, therefore_, believed it to have been propagated by
contagion, an inference which we now see must be quite wide of the mark.
Dr. Hawkins had, it appears, like many other medical gentlemen, access
to the reports from Ceylon, &c., in the office of the chief of the army
medical department in London, and it is to be regretted I think that,
with respect to one of the Ceylon reports, he only tells us (p. 174)
that "Mr. Staff-Surgeon Marshall reports from Candy, that of fifty cases
which had occurred, forty died." Why more had not been quoted from a
gentleman who had such ample means of witnessing the disease in its very
worst form, I must leave to others to say; but, referring again to the
highly interesting letter from Mr. Marshall on cholera, which appeared
in the _Glasgow Herald_, of the 5th of August last, and in which, from
many important observations which every body interested in cholera
should read and study, the following remarks will be found:--"In no one
instance did it seem to prevail among people residing in the same house
or barracks, so as to excite a suspicion that the contact of the sick
with the healthy contributed to its propagation." "The Indian Cholera,
as it is sometimes called, appears not to be essentially different from
cholera as it occurs in this and all other countries." "I consider it,
therefore, impossible for a medical practitioner to speak decisively
from having seen one, or even a few cases of cholera in this country,
and to say whether they are precursors of '_the epidemic_ cholera' or
not. That the disease is ever propagated by means of personal contact,
or by the clothes of the sick, has not, as far as I know, been
satisfactorily proved. The quality of contagion was never attributed
to the disease in Ceylon, and I believe no-where did it occur in
greater severity. I am aware that an attempt has been made to distinguish
the ordinary cholera of this country from the 'epidemic cholera,' by means
of the colour or quality of the discharges from the bowels. In the
former it is said the discharge is chiefly bile, while in the latter it
is said to bear no traces of bile, but to be colourless and watery. How
far is this alleged diagnosis well founded? I am disposed to believe
that, in all severe cases of cholera, whether it be the cholera of this
country, or the epidemic cholera, the secretion of bile is either
suppressed, or the fluid is retained in the gall-bladder." Mr. Marshall,
it may be observed, is the gentleman who was selected by the late
Secretary at War, in consequence of his known intelligence, to remodel
the regulations relative to military pensioners; and I understand that,
in consequence of the manner in which he executed that very important
duty, he has since been promoted. After what appears from the above
quotations, how perfectly unwarrantable must the assertion of Dr. Bisset
Hawkins seem, that "from the Coromandel coast it seems to have been
transported by sea to Ceylon!"
We shall, I think, be able to see that the assumption of Drs. Macmichael
and Hawkins, as to the importation of the disease into the Mauritius
from Ceylon, is equally groundless with that of its alledged importation
into the latter island; and here we have to notice the same want of
candour on the part of those gentlemen, in not having furnished that
public, which they professed to enlighten on the subject of cholera,
with those proofs within their reach best calculated to display the
truth; be it a part of my duty to supply the omissions of these
gentlemen in this respect. The following is a copy of a letter
accompanying the medical commission report at that island forwarded
to General Darling, the then commanding officer, by the senior medical
gentleman there.
"Port Louis, Nov. 23, 1819.
"I have the honour of transmitting the reports of the French and
English medical gentlemen on the prevalent disease; both classes of the
profession seem to be unanimous in not supposing it contagious, or of
foreign introduction. From the disease pervading classes _who have
nothing in common but the air they breathe_, it can be believed that the
cause may exist in the atmosphere. A similar disease prevailed in this
island in 1775, after a long dry season."
(Signed) W. A. BURKE,
Inspector of Hospitals.
In the reports referred to in the above letter, there is the most ample
evidence of the true cholera having appeared at different points in the
colony _before the_ arrival of the Topaze frigate, the ship _accused_ by
contagionists _par métier_, of having introduced the disease; so that,
contrary to what Dr. Macmichael supposes, those who disbelieve the
communicability of cholera, have no necessity whatever in this case for
pleading a coinsidency between the breaking out of the disease, and the
arrival of the frigate; indeed, his friend Dr. Hawkins seems to be aware
of this, when he is obliged to have recourse to such an argument as that
"it is, at all events, clear that the disease had not been _epidemic_ at
the Mauritius before the arrival from Ceylon;" so that the beginning of
an epidemic is to be excluded from forming a part or parcel of the
epidemic! Why is it that in medicine alone such modes of reasoning are
ever ventured upon!
We know, from the history of cholera in India, that not only ships lying
in certain harbours have had the disease appear on board, but even
vessels sailing down one coast have suffered from it, while sailing up
another has freed them from it, without the nonsense of going into
harbour to "expurgate." Now, with respect to the _Topaze_, it appears
that while lying in harbour in Ceylon, the disease broke out on
board her; that after she got into "_clene air_" at sea, the disease
disappeared, seventeen cases only having occurred from the time she left
the island, and she arrived at the Mauritius, as Dr. Hawkins admits,
without any appearance whatever of the cholera on board. On the day
after her arrival, she sent several cases ("chronic dysentry, hepatitis,
and general debility") to hospital, but not one of cholera; neither did
any case occur on board during her stay there, at anchor a mile and a
half from shore, and constantly communicating with shore,[5] while a
considerable number of deaths took place from cholera _in the merchant
vessels anchored near shore_.
[Footnote 5: Somebody is said to have seen a man on board with vomiting
and spasms, on the day before she moved to this anchorage, but the
surgeon of the ship has not stated this.]
As to the introduction of cholera from the Mauritius into Bourbon, where
it appeared but very partially, Dr. Macmichael very properly does not
say one word. There was abundance of "precaution" work, it is said,
and those who choose, are at liberty to give credit to the story of
its having been smuggled on shore by some negro slaves landed from a
Mauritius vessel. As to the _precautions_ to which the writer in _The
Westminster Review_ attributes the non-extension of the disease in this
island, hundreds of instances are recorded, in addition to those which
we have already quoted, of the disease stopping short, without cordons
or precautions of any kind--one remarkable instance is mentioned by Dr.
Annesley, where, _without seclusion_, the disease did not reach the
ground occupied by two cavalry regiments, although it made ravages in
all the other regiments in the same camp.
We have, perhaps, a right to demand from those gentlemen who display
such peculiar tact in the discovery of ships by which the cholera has,
at divers times, been imported into continents and islands, the names
of those ships which brought to this country, in the course of the
present year, the "_contagion_" which has produced, at so many
different points, cases of severe cholera, causing death in some
instances, and in which the identity with the "Indian cholera," the
"Russian cholera," &c., has been so _perfect_, that all the "perverse
ingenuity" of man cannot point out a difference. If it cannot be shown
that in this, we non-contagionists in cholera are in error, people
will surely see reason for abandoning the cause of cordons, &c., in
this disease,--a cause which, in truth, now rests mainly for support
upon a sort of conventional understanding, unconnected altogether, it
would appear, with the facts of the case, and entered into, we are
bound to suppose, before the full extent of the mischief likely to
arise from it had been taken into consideration. Admitting for a
moment that a case of cholera possessing contagious properties could
be imported into this country this year, will anybody say that a
"constitution of the atmosphere" favourable to its communicability to
healthy individuals, has not existed _in a very high degree_:--can a
spot be named in which cholera, generally of a mild grade, has not
prevailed? And if contagionists cannot point out a difference between
some of the severe cases to which public attention has been drawn, and
the most marked cases of the Indian or Russian cholera, I think that
now there should be an end to all argument in support of their cause.
Without at all going to the extent which might be warranted, I would
beg to be informed of the names of the ships by which the contagion
was brought, which caused the illness of the following individuals; or
if they be allowed, as I presume must be the case, not to have been
infected at all in this way, all that has been said regarding the
identity of the foreign and severe form of the home disease, must be
shown to be without foundation:--the detailed case of Patrick Geary,
which occurred in the Westminster Hospital,--the fatal case of Mr.
Wright, surgeon, 29, Berwick-street,--the cases, some of them fatal,
which occurred at Port Glasgow, and regarding which, a special inquiry
was instituted,--a case in Guy's Hospital, which caused some anxiety
about the middle of July last,--a case reported in a medical
periodical in August last, as having occurred in Ireland,--the fatal
case, as reported in my first letter, of Martin M'Neal,[6]--a second
case reported in a medical periodical in August,--a fatal case on the
12th of August last at Sunderland, reported upon to the Home Secretary
by the mayor of that town,--three cases reported in No. 421 of THE
LANCET,--a very remarkable case duly reported upon in September,
from the Military Hospital at Stoke, near Davenport, and a case with
thorough "congee stools," spasms, &c. (the details of which I may
hereafter forward), which occurred at Winchester on the 22d of
September, in the 19th Foot, in a man of regular habits, and of _the
nature_ of which case the medical gentleman in charge had no doubt.
[Footnote 6: The same Army Medical gentleman, who had been sent to Port
Glasgow, was sent to Hull to report upon this case:--he arrived there
too late, but having seen the details of the case, he admitted that he
saw no reason to declare them different from those which occurred in the
Indian cholera.]
I quite agree with those who are of opinion, that in this and most other
countries, cases may be every year met with exhibiting symptoms similar
to those which have presented themselves in any one of the above.
Instead of amusing us, when next writing upon cholera, with a quotation
about small-pox from Rhazes, bearing nonsense upon the face of it, some
of those who maintain the contagious property of Indian or any other
cholera, may probably take the trouble to give the information on the
above cases, so greatly required for the purpose of enlightening the
public.
I must now beg to return to an examination of one or two more of the
_very select_ quotations made by Dr. Macmichael, with the view, as
he is pleased to tell us, of placing the statements on both sides
in juxtaposition. He is well pleased to give us from Dr. Taylor,
assistant-surgeon,--what indeed never amounted to more than report, and
of the truth or falsehood of which this gentleman does not pretend to
say he had any knowledge himself,--that a traveller passing from the
Deacan to Bombay, found the disease prevailing at Panwell, through which
he passed, and so took it on with him to Bombay; but whether the man had
the disease, or whether he took its germs with him in some very
susceptible article of dress, is not stated by Dr. Taylor; however, he
states (what we are only surprised does not happen oftener in those
cases, when we consider similarity of constitution--of habits--of site
or aspect of their dwellings, &c.) that several members of a family, and
neighbours "were attacked within a very short period of each other;" but
when Dr. Taylor goes on to say, "In bringing forward these facts,
however, it may be proper at the same time to state, that of the
forty-four assistants employed under me, only three were seized with the
complaint;" he gets out of favour at once, and his observation is called
"unlucky," being but a _negative_ proof, and Dr. Macmichael adds, what
everybody must agree with him in, that positive instances of contagion
must outweigh all negative proofs:--to be sure:--but Dr. Macmichael's
saying this, does not show that positive proofs exist. Give us but
positive proofs, give even but a _few_, which surely may be done, if
the disease be really communicable, and where contagion has been so
ardently sought after by all sorts of _attachés_ and _employés_ of the
cordon and quarantine systems in the different countries on the
Continent. We could produce no mean authority to show, that _a long
succession of negative proofs_ must be received as amounting to a moral
certainty; and what greater proof can we have of non-contagion in any
disease, than we have in the fact regarding epidemic cholera, as well
as yellow fever, that attendants on the sick are not more liable than
others to be attacked? Regard should, of course, always be paid, in
taking this point into consideration, to what has been already noticed
in my second letter, or the inferences must be most erroneous. Dr.
Macmichael quotes the statement of Dr. Burrell, 65th regiment (and takes
care to put the quotation in italics too), that at Seroor, in 1818,
"almost every attendant in hospital had had the disease. There are about
thirty attendants in hospitals." Now, along with hundreds of other
instances, what does Dr. French, of the 49th regiment, say, in his
Report of 1829? That no medical man, servant, or individual of any kind,
in attendance on the sick, was taken ill at Berhampore, when the cholera
prevailed there that year, and refers, to his Report for 1825, in which
he remarked the same thing in the hospital of the 67th regiment at
Poonah; contrary, as he observes, to what occurred some years before in
the 65th regiment at Seroor, about forty miles distant. In the two
instances quoted by Dr. French, and in that by Dr. Burrell, all those
about the sick stood in the same relation towards them, and all the
difference will be found probably to have been, that the hospital of the
65th _was within the limit of the deteriorated atmosphere, where the
cause existed equally (as in the case of ague and yellow fever) whether
persons were present or not_.
In Egypt there is not, it is true, a "cruel and inhuman desertion" of
the unfortunate plague patients; for, among other reasons, being
predestinarians, they think it makes no sort of difference whether
they attend on the sick or not. Those who act upon the principle of
cholera being a highly contagious disease, may perhaps consider it
necessary to recommend, among their _precautions_, that the medical
men and attendants should be enveloped in those hideous dresses used
in some countries by those who approach plague patients[7]--fancy, in
the case of a sick female, or even of a man of pretty good nerves, the
effect of but half the precautions one hears of, as proper to be
observed. It is quite a mistake to suppose that the sick have not been
sometimes abandoned during the prevalence of epidemics; and that too
in cases where medical men had very erroneously voted the disease
contagious:--among other horrid things arising out of mistaken views,
who that has ever read it, can forget the account given by Dr.
Halloran, of the wretched yellow-fever patient in Spain, who, with a
rope tied round him, was dragged along for some distance by a guard,
when he was put into a shed, where he was suffered to die, without
even water to quench his thirst? I admit that, even with the views of
non-contagionists, difficulties obviously present themselves in regard
to the safety of those about the sick, when the latter are in such a
state as will not admit of their removal to a more auspicious spot
from that in which there is reason to believe they inhaled the noxious
atmosphere. From what has been observed in India and other places,
however, there is often sufficient warning in a feeling of _malaise_,
&c., and the distance to favoured spots, where people may be observed
not to be attacked, may be very short,--sometimes, as we have seen,
but a few yards, so that a removal of the patient, _with his friends_,
may be practicable, in a vast number of cases, previous to the setting
in of the more serious symptoms.
[Footnote 7: Since writing the above, I find that this scene has
actually occurred lately at Dantzic where a few miserable medical men
illustrated their doctrines of contagion, by skulking at a certain
distance about the sick, dressed up in oil skins, like the disgusting
figures we see in books, of the Marseilles doctors in the Lazaretto.
(See Sun Newspaper, 22nd, Nov.)]
I shall conclude this by cursorily referring to two circumstances which
have within a short time occurred on the Continent, and which seem to me
to be of no small importance in regard to cholera questions. It appears
that the committee appointed by the French Chamber of Deputies to
inquire into the questions connected with voting an additional sum to
meet cordon and quarantine expenses, in the event of the cholera making
its appearance in or near France, have made their report to the Chamber.
They declare that in India the cholera was proved not to have been
transmissible; and that in regard to Russia, it was not introduced, as
always contended for by some persons:--they refer to the city of Thorn
as exempt from the disease, though free from cordons, and in the midst
of a country where it prevails, while the disease appeared in St.
Petersburg and Moscow, notwithstanding their cordons, and even in
Prussia, where sanatory laws where executed "_avec une punctualité et
une rigeur ailleurs inconnues_." The money is nevertheless granted;
it is always a good thing to have, but they have set one curious
_condition_ upon its being granted, which displays consummate tact,
for it is to be employed solely in disbursements of a particular nature
(_dépenses materielles_), including, it may be presumed, temporary
hospitals, &c.; and that it is by no means ("_nullement_") to go into
the pockets of individuals.
The other circumstance to which I allude is that, like Russia and
Austria, Prussia has found that quarantines and cordons do not check
the progress of cholera. The king declares that the appearance of the
disease in his provinces, has thrown _new light_ on the question; he
specifies certain restrictions as to intercourse, which were forthwith
to be removed, and declares his intention to modify the whole. In
short, it is quite plain that, as Dr. Johnson has it in his last
journal,--those regulations will, "_in more countries than Russia,
be useless to all but those employed in executing them_."
LETTER IV.
It need scarcely be said how much it behooves all medical men to keep
in view the subject of the wide-spreading cholera, and not to suffer
themselves to be led from an attentive consideration of all that
appertains to it, by the great political questions which at present
convulse the whole kingdom.
I totally disagree with Dr. Macmichael, as I believe most people will,
that the notion of _contagion_ in many diseases is "far from being
natural and obvious to the mind;" for, since the time that contagious
properties have been generally allowed to belong to certain diseases,
there has been a strong disposition to consider this as the most natural
and obvious mode of explaining the spreading of other diseases. A person
sees evidence of the transmission, _mediate_ as well as _immediate_,
of small-pox, from one person to another; and, in other diseases, the
origin of which may be involved in obscurity, he is greatly prone
to assign a similar cause which may seem to reconcile things so
satisfactorily to his mind. Indeed there seems, in many parts of the
world, a degree of _popularity_ as to quarantine regulations, which
is well understood and turned to proper account by the initiated in
the mysteries of that department:--for what more common than the
expression--"we cannot be too careful in our attempts to _keep out_
such or such a disease?" For my part, I admit that I can more easily
comprehend the propagation of certain epidemics by contagion, than I
can by any other means, _when unaccompanied by sensible atmospheric
changes_; and if I reject contagion in cholera, it is because whatever
we have in the shape of fair evidence, is quite conclusive as to the
non-existence of any such principle. Indeed abundance of evidence now
lies before the public, from various sources, in proof of the saying of
Fontenelle being fully applicable to the question of cholera--"When a
thing is accounted for in two ways, the truth is usually on the side
most opposed to _appearances_." How well mistaken opinions as to
contagion in cholera are illustrated in a pamphlet which has just
appeared from Dr. Zoubkoff of Moscow! This gentleman, it appears, has
been a firm believer in contagion, until the experience afforded him
during the prevalence of the disease in that city proved the contrary.
He tells us (p. 10), that in the hospital (Yakimanka) he saw "_to his
great astonishment_, that all the attendants, all the soldiers, handled
the sick, supported their heads while they vomited, placed them in the
bath, and buried the dead; always without precaution, and always without
being attacked by cholera." He saw that even the breath of cholera
patients was inhaled by others with impunity; he saw, that throughout
the district of which he had charge, the disease did not spread through
the crowded buildings, or in families where some had been attacked, and
that exposure to exciting causes _determined_ the attack in many
instances. He saw all this, gives the public the benefit of the copious
notes which he made of details as to persons, places, &c., and now
ridicules the idea of contagion in cholera. Grant to the advocates of
contagion in cholera but all the data they require, and they will
afterwards prove every disease which can be mentioned to be contagious.
Hundreds of people, we will say, for instance, come daily from a sickly
district to a healthy one, and yet no disease for some time appears; but
at last an "inexplicable condition of the air," and "not appreciable by
any of our senses" (admitted by Dr. Macmichael and others as liable to
occur, but _only in aid_ of contagion), take place; cases begin to
appear about a particular day, and nothing is now more easy than to make
out details of arrivals, there being a wide field for selection; and
even how individuals had spoken to persons subsequently attacked--had
stopped at their doors--had passed their houses, &c.[8] Causation is at
once connected with antecedence, at least for a time, by the people at
large, who see their government putting on cordons and quarantines,
and the most vague public rumour becomes an assumed fact. We even
find, as may be seen in the quotation given from Dr. Walker's report,
that contagionists are driven to the "somehow or other" mode of the
introduction of cholera by individuals; so that it may be deplored, with
respect to this disease, in the words of Bacon, that "men of learning
are too frequently led, from ignorance or credulity, to avail themselves
of mere rumours or whispers of experience as confirmation, and sometimes
as the very ground-work, of their philosophy, ascribing to them the same
authority as if they rested upon legitimate testimony. Like to a
government which should regulate its measures, not by official
information of its accredited ambassadors, but by the gossipings of
newsmongers in the streets. Such, in truth, is the manner in which the
interests of philosophy, as far as experience is concerned, have
hitherto been administered. Nothing is to be found which has been duly
investigated,--nothing which has been verified by a careful examination
of proof."
[Footnote 8: Since the above was written it has been very clearly shewn
how easily proofs of _this kind_ may be furnished to all disposed to
receive them. We perceive that a disease officially announced as _the
true_ cholera, has existed for nearly a month past at Sunderland, and
that among the thousands of people who left it within that time, nothing
could be more easy, had the disease appeared epidemically in other parts
of England, than to point out the _particular individual_ who had
"brought it" in some way or other; and this is the manner in which all
the fables about the propagation of cholera from one district to another
have gained credence. (Nov. 24th.)]
In their efforts to make out their case, there would seem to be no end
to the contradictions and inconsistencies into which the advocates
of contagion in cholera are led. At one moment we are required to
believe that the disease may be transmitted through the medium of an
unpurified letter, over seas and continents, to individuals residing
in countries widely differing in climate, while, in the next, we are
told--regarding the numberless instances of persons of all habits who
remain unattacked though in close contact with the diseased--that the
constitution of the atmosphere necessary for the germination of the
contagion is not present; and this, although we see the disease
attacking all indiscriminately, those who are not near the sick as
well as those who are at a very short distance, as on the opposite
side of a ravine, of a rivulet, of a barrack, or even of a road. They
assume that wherever the disease appears, _three_ causes must be in
operation--contagion--peculiar states of atmosphere (heat now clearly
proved not _essential_, as at one time believed)--and susceptibility
in the habit of the individual. However unphilosophical it is held to
be to multiply causes, the advocates of contagion are not likely to
reduce the number, as this would at once cramp them in their pleadings
before a court where sophistry is not always quickly detected. Those
who see irresistible motives for dismissing all idea of contagion,
look, on the contrary, for the production of cholera, to sources,
admitted from remote times to have a powerful influence on our
systems, though invisible--though not to be detected by the ingenuity
of man, and though proved to exist only by their effects.
Many who do not believe that cholera can be propagated by contagion
under ordinary circumstances, have still a strong impression that by
crowding patients together, as in hospitals or in a ship, the
disease may acquire contagious properties. Now we find that when the
_experimentum crucis_ of extensive experience is contrasted with the
feasibility of this, cholera, like ague, has not been rendered one bit
more contagious by crowding patients together than it has been shown to
be under other circumstances. We do not require to be told that placing
many persons together in ill-ventilated places, whether they labour
under ague, or catarrh, or rheumatism, or cholera, as well as where no
disease at all exists among them, as in the Calcutta black-hole affair,
and other instances, which might be quoted, _fever_, of a malignant
form, is likely to be the consequence, but assuredly not ague, or
catarrh, or rheumatism, or cholera. On this point we are furnished with
details by Dr. Zoubkoff, of Moscow, in addition to the many previously
on record. It may be here mentioned that, on a point which I have
already referred to, this gentleman says (p. 43), "I shall merely
observe that at Moscow, where the police are remarked for their
activity, they cannot yet ascertain who was the first individual
attacked with cholera. It was believed at one time that the disease
first showed itself on the 17th of September; afterwards the 15th was
fixed upon, and at last persons went so far back as August and July."
As this gentleman _had been_ a contagionist, occupied a very responsible
situation during the Moscow epidemic, and quotes time and place in
support of his assertions, I consider his memoir more worthy of
translation than fifty of your Keraudrens.
Respecting those mysterious visitations which from time to time
afflict mankind, it may be stated that we have a remarkable instance
in the "_dandy_" or "_dangy_" disease of the West India Islands,
which, of late years, has attracted the notice of the profession as
being quite a new malady, though nobody, as far as I am aware of, has
ever stated it to have been an imported one. We find also that within
the last three years a disease, quite novel in its characters, has
been very prevalent in the neighbourhood of Paris. It has proved fatal
in many instances, and the physicians, unable to assign it a place
under the head of previously-described disease, have been obliged
to invent the term "Acrodynia" for it. I am not aware that even
M. Pariset, the medical chief of quarantine in France, ever supposed
this disease to have been _imported_, and to this hour the cause of
its appearance remains in as much obscurity among the Savans of Paris,
as that of the epidemic cholera.
Considering all the evidence on the subject of cholera in India, in
Russia, Prussia, and Austria, one cannot help feeling greatly astonished
on perceiving that Dr. Macmichael (p. 31 of his pamphlet) insinuates
that the spreading of the disease in Europe has been owing to the views
of the subject taken by the medical men of India.
In turning now more particularly to the work, or rather compilation,
of Dr. Bisset Hawkins, let us see whether we cannot discover among what
he terms "marks of haste" in getting it up for "the curiosity of the
public" (_curiosity_, Dr. Hawkins!), some omissions of a very important
nature on the subject of a disease respecting which, we presume, he
wished to enlighten the public. And first, glancing back to cholera in
the Mauritius, Dr. Hawkins might, had he not been so pressed for time,
have referred to the appearance of cholera in 1829, at Grandport in that
island; when, as duly and officially ascertained, it could not be a
question of importation by any ship whatever. The facility with which he
supplies us with "facts,"--the _false facts_ reprobated by Bacon, and
said by Cullen to produce more mischief in our profession than false
theories--is quite surprising; he tells us, point blank (p. 31),
speaking of India, that "when cholera is once established in a marching
regiment, it continues its course in spite of change of position, food,
or other circumstances!" Never did a medical man make an assertion more
unpardonable, especially if he applies the term _marching regiment_ as
it is usually applied. Dr. Hawkins leads us to suppose that he has
examined the India reports on cholera. What then are we to think when we
find in that for Bengal the following most interesting and conclusive
statements ever placed on record? Respecting the Grand Army under the
Marquis of Hastings, consisting of 11,500 fighting men, and encamped in
November 1817 on the banks of the Sinde, the official report states that
the disease "as it were in an instant gained fresh vigour, and at once
burst forth with irresistible violence in every direction. Unsubjected
to the laws of contact, and proximity of situation, which had been
observed to mark and retard the course of other pestilences, it
surpassed the plague in the width of its range, and outstripped the most
fatal diseases hitherto known, in the destructive rapidity of its
progress. Previously to the 14th it had overspread every part of the
camp, sparing neither sex nor age, in the undistinguishing virulence of
its attacks."--"From the 14th to the 20th or 22d, the mortality had
become so general as to depress the stoutest spirits. The sick were
already so numerous, and still pouring in so quickly from every quarter,
that the medical men, although night and day at their posts, were no
longer able to administer to their necessities. The whole camp then put
on the appearance of a hospital. The noise and bustle almost inseparable
from the intercourse of large bodies of people had nearly subsided.
Nothing was to be seen but individuals anxiously hurrying from one
division of a camp to another, to inquire after the fate of their dead
or dying companions, and melancholy groups of natives bearing the
biers of their departed relatives to the river. At length even this
consolation was denied to them, for the mortality latterly became so
great that there was neither time nor hands to carry off the bodies,
which were then thrown into the neighbouring ravines, or hastily
committed to the earth on the spots on which they had expired." Let us
now inquire how this appalling mortality was arrested;--the report goes
on to inform us:--"It was clear that such a frightful state of things
could not last long, and that unless some immediate check were given to
the disorder, it must soon depopulate the camp. It was therefore wisely
determined by the Commander-in-chief _to move in search of a healthier
soil and of purer air_," which they found when they "crossed the clear
stream of the Bitwah, and upon its high and dry banks at Erich soon got
rid of the pestilence, and met with returning health." Now just fancy
epidemic cholera a disease transmissible by "susceptible articles," and
what an inexhaustible stock must this large army, with its thousands of
followers, have long carried about with them; but, instead of this, they
were soon in a condition to take the field. Against the above historical
fact men of ingenuity may advance what they please. There is no doubt
that, in the above instance, severe cases of cholera occurred _during
the move_, the poison taken into the system on the inauspicious spot,
not having produced its effects at once; it is needless to point out
what occurs in this respect in remittent and intermittent fevers. The
India reports furnish further evidence of mere removal producing health,
where cholera had previously existed. Mr. Bell, a gentleman who had
served in India, and who has lately written upon the disease,[9] informs
us (p. 84), that "removing a camp a few miles, has frequently put an
entire and immediate stop to the occurrence of new cases; and when the
disease prevailed destructively in a village, the natives often got rid
of it by deserting their houses for a time, though in doing so they
necessarily exposed themselves to many discomforts, which, _cæteris
paribus_, we should be inclined to consider exciting causes of an
infectious or contagious epidemic." We even find that troops have, as
it may be said, _out-marched_ the disease, or rather the cause of the
disease; that is, moved with rapidity over an extensive surface where
the atmosphere was impure, and thereby escaped--on the principle that
travellers are in the habit of passing as quickly as they can across the
pontine marshes. Mr. Bell says, "In July, 1819, I marched from Madras in
medical charge of a large party of young officers who had just arrived
in India, and who were on their way to join regiments in the interior of
the country. There was also a detachment of Sepoys, and the usual number
of attendants and camp-followers of such a party in India. The cholera
prevailed at Madras when we left it. Until the 5th day's march (fifty
miles from Madras) no cases of the disease occurred. On that day several
of the party were attacked on the line of march; and, during the next
three stages, we continued to have additional cases. Cholera prevailed
in the countries through which we were passing. In consultation with the
commanding officer of the detachment, it was determined that we should
_leave the disease behind us_; and as we were informed that the country
beyond the Ghauts was free from it, we marched, without a halt, until we
reached the high table land of Mysore. The consequence was, that we left
the disease at Vellore eighty-seven miles from Madras, and we had none
of it until we had marched seventy miles further (seven stages), when we
again found it at one of our appointed places of encampment; but our
camp was, in consequence, pushed on a few miles, and only one case, a
fatal one, occurred in the detachment; the man was attacked on the line
of march. We again left the disease, and were free from it during the
next 115 miles of travelling; we then had it during three stages, and
found many villages deserted. We once more left it, and reached our
journey's end, 260 miles further, without again meeting it. Thus, in a
journey of 560 miles, this detachment was exposed to, and left the
disease behind it, four different times; and on none of those occasions
did a single case occur beyond the tainted spots." What a lesson for
Dr. Hawkins! But _for whom_ could Dr. Hawkins have written his _curious_
book? Hear Mr. Bell in respect to the common error of the disease
following high roads and navigable rivers only:--"I have known the
disease to prevail for several weeks at a village in the Southern
Mahratta country, within a few miles of the principal station of the
district, and then leave that division of the country entirely; or,
perhaps, cases would occur at some distant point. In travelling on
circuit with the Judge of that district, I have found the disease
prevailing destructively in a small and secluded village, while no cases
were reported from any other part of the district." What is further
stated by Mr. Bell will tend to explain why so much delusion has existed
with regard to the progress of the disease being remarkably in the
direction of lines of commerce, or great intercourse:--"When travelling
on circuit, I have found the disease prevailing in a district _before
any report had been made of the fact, notwithstanding the most positive
orders on the subject_; and I am persuaded, that were any of the
instances adduced in support of the statement under consideration
strictly inquired into, it would be found that the usual apathy of the
natives of India had prevented their noticing the existence of the
disease until the fact was brought prominently forward by the presence
of Europeans. It should also be brought to mind, that cholera asphyxia
is not a new disease to these natives, but seems to be, in many places,
almost endemical, whilst it is well known that strangers, in such
circumstances, become more obnoxious to the disease than the inhabitants
of the country. Moreover, travellers have superadded to the remote cause
of the disease, fatigue and road discomforts, which are not trifling in
a country where there are neither inns nor carriages." (p. 89.) Cholera
only attacks a certain proportion of a population, and is it wonderful
that we should hear more of epidemic on high roads, where the population
is greatest? High roads too are often along the course of rivers; and
is there not some reason for believing, that there is often along the
course of rivers, whether navigable or not, certain conditions of the
atmosphere unfavourable to health? When Dr. Hawkins stated, as we find
at p. 131 he has done, that where the inhabitants of certain hilly
ranges in India escaped the disease, "these have been said to have
interdicted all intercourse with the people below," he should have
quoted some respectable authority, for otherwise, should we unhappily be
visited by this disease, the people of our plains may one day wage an
unjust war against the sturdy Highlanders or Welsh mountaineers.[10]
Little do the discussers of politics dream of the high interest of
this part of the cholera question, and little can they conceive the
unnecessary afflictions which the doctrine of the contagionists are
calculated to bring on the nation. Let no part of the public suppose for
a moment that this is a question concerning medical men more than it
does them; _all_ are _very_ deeply concerned, the heads of families more
especially so.
[Footnote 9: This is by far the best work yet published in England on
the cholera, but it is to be regretted that the author has not alluded
to the works of gentlemen who have a priority of claim to some of the
opinions he has published: I think that, in particular, Mr. Orton's
book, printed in India, should have been noticed.]
[Footnote 10: Something of this kind would have infallibly taken place,
had certain insane proposals lately made respecting the _shutting in_
of the people of Sunderland, been carried into effect.]
We see that the identity of the European and Indian epidemic cholera is
admitted on all sides; we have abundant proof that whatever can be said
as to the progress of the disease, its anomalies, &c., in the former
country, have been also noted respecting it in the latter; and Dr.
Hawkins, when he put forth his book, had most assuredly abundant
materials upon which to form a rational opinion. It is by no small
effort, therefore, that I can prevent all the respect due to him from
evaporating, when he declares, at page 165, that "the disease in India
was _probably_ communicable from person to person, and that in Europe it
has _undeniably_ proved so." But Dr. Hawkins is a Fellow of the College
of Physicians, and we must not press this point further than to wish
others to recollect that he has told us that he drew up his book in
haste; and, moreover, that he wished to gratify the _curiosity_ of the
public. The Riga story about the hemp and the fifteen labourers I shall
leave in good hands, the British Consul's at that city, who was required
to draw up, for his government, a statement of the progress, &c. of
the cholera there, of which the following is an extract:--
"The fact of non-contagion seems determined, as far as a question can
be so, which must rest solely upon negative evidence. The strongest
possible proof is, the circumstance, that not one of the persons
employed in removing the dead bodies (which is done without any
precaution) has been taken ill. _The statement of fifteen labourers
being attacked, while opening a pack of hemp, is a notorious falsehood._
Some physicians incline to the opinion, that the disease may sometimes
be caught by infection, where the habit of body of the individual is
predisposed to receive it; the majority of the faculty, however,
maintain a contrary doctrine, and the result of the hospital practice
is in their favour. There are 78 persons employed in the principal
hospital here; of these only two have been attacked, one of whom was an
'_Inspecteur de Salle_,' and not in immediate attendance upon the sick.
I am assured that the other hospitals offer the same results, but as I
cannot obtain equally authentic information respecting them, I confine
myself to this statement, on which you may rely. On the other hand, in
private families, several instances have occurred where the illness of
one individual has been followed by that of others: but, generally, only
where the first case has proved fatal, and the survivors have given way
to grief and alarm. Mercenary attendants have seldom been attacked,
and, as mental agitation is proved to be one of the principal agents
in propagating or generating the disease, these isolated cases are
attributed to that cause rather than infection.
"It is impossible to trace the origin of the disease to the barks;
indeed it had not manifested itself at the place whence they come till
after it had broken out here. The nearest point infected was Schowlen
(at a distance of 200 wersts), and it appeared simultaneously in three
different places at Riga, without touching the interjacent country. The
first cases were two stone-masons, working in the Petersburg suburbs, a
person in the citadel, and a lady resident in the town. None of these
persons had had the slightest communication with the crews of barks, or
other strangers, and the quarter inhabited by people of that description
was later attacked, though it has ultimately suffered most.
"None of the medical men entertain the slightest doubt of the action of
atmospheric influence--so many undeniable instances of the spontaneous
generation of the disease having occurred. Half the town has been
visited by diarrhoea, and the slightest deviation from the regimen now
prescribed (consisting principally in abstinence from acids, fruit,
beer, &c.) invariably produces an attack of that nature, and, generally,
cholera: fright, and intoxication, produce the same effect.
"Numerous instances could be produced of persons in perfect health, some
of whom had not left their rooms since the breaking out of the disease,
having been attacked by cholera, almost instantaneously after having
imprudently indulged in sour milk, cucumbers, &c. It is a curious
circumstance, bearing on this question, that several individuals coming
from Riga have died at Wenden, and other parts of Livonia, without a
single inhabitant catching the disease; on the other hand, it spreads in
Courland, and on the Prussian frontier, notwithstanding every effort to
check its progress. The intemperance of the Russians during the holidays
has swelled the number of fresh cases, the progressive diminution of
which had previously led us to look forward to a speedy termination of
the calamity." This is a pretty fair specimen of the _undeniable_ manner
in which cholera is proved to be contagious in Europe, and we shall, for
the present, leave Dr. Hawkins in possession of the full enjoyment of
such proofs.
Some attempt was made at Sunderland, to establish that, in the case
which I mentioned in my last as having proved fatal there, the disease
had been imported from foreign parts, but due inquiry having been made
by the collector of the customs, this proved to be unfounded; the man's
name was Robert Henry, a pilot:--he died _on the 14th of August_.[11]
[Footnote 11: In a former letter I alluded to cases of cholera which
appeared this year at Port Glasgow; I find that the highly interesting
details of those cases have been just published:--_they should be read
by everybody who takes the smallest interest in the important questions
connected with the cholera_. The London publishers are Whittaker and
Co.]
Abroad we find that, unhappily, the cholera has made its appearance at
Hamburgh; official information to this effect arrived from our Consul
at that place, on Tuesday the 11th inst. (October). The absurdity of
cordons and quarantines is becoming daily more evident. By accounts
from Vienna, dated the 26th September, the Imperial Aulic Council had
directed certain lines of cordon to be broken up, seeing, as is stated,
that they were inefficacious; and by accounts of the same date, the
Emperor had promised his people not to establish cordons between certain
states.
We find at the close of a pamphlet on cholera, lately published by Mr.
Searle, a gentleman who served in India, and who was in Warsaw during
the greater part of the epidemic which prevailed there this year, the
following statement:--"I have only to add, that after all I have heard,
either in India or in Poland, after all I have read, seen, or thought
upon the subject, I arrive at this conclusion, that the disease is not
contagious."
In confirmation of the opinion of Mr. Searle, we have now the evidence
of the medical commission sent by the French government to Poland.
Dr. Londe, President of that commission, arrived in Paris some days ago.
He announced to the minister in whose department the quarantine lies,
as well as to M. Hèly D'Oissel, President of the Superior Council of
Health, that it was proved in Poland, entirely to his satisfaction,
as well as to the satisfaction of his five colleagues, that the cholera
_is not a contagious disease_.
The Minister of War also sent _four_ medical men to Warsaw. Three of
them have already declared against contagion; so it may be presumed that
the day is not far distant when those true plagues of society, cordons
and quarantines against cholera, shall be abolished. Hear the opinion of
a medical Journalist in France,--after describing, a few days ago, the
quarantine and cordon regulations in force in that country:--"But what
effect is to be produced by these extraordinary measures, this immense
display of means, and all these obstructions to the intercourse of
communities, against a disease not contagious; a disease propagating
itself epidemically; and which nothing has hitherto been able to arrest?
To increase its ravages a hundred-fold,--to ruin the country, and to
make the people revolt against measures which draw down on them misery
and death at the same time." What honest man would not _now_ wish that
in this country the cholera question were placed _in Chancery_; where,
I have no doubt, it would be quickly disposed of. I shall merely add,
that the ten medical men sent from France to Poland, for the purpose
of studying the nature of cholera, have all remained unattacked by the
disease.
October 15, 1831.
LETTER V.
It was well and wisely said, that to know any-thing thoroughly, it must
be known in all its details; and, to gain the confidence of the public
in the belief of non-contagion in cholera, it is in vain that they are
informed that certain alleged facts, brought forward industriously
by contagionists, are quite groundless, unless proofs are given showing
this to be the case. The public must, in short, have those alleged
instances of contagion which have gained currency circumstantially
disproved, or they will still listen to a doctrine leading to the
disorganization of the community wherever it is acted upon. It is
solely upon this ground that these letters have any claim to attention.
Dr. James Johnson, of London, has, since my last letter, publicly
contradicted, with all the bluntness and energy of honest conviction,
the statement by Sir Gilbert Blane, Drs. Macmichael, Hawkins, &c., as to
the importation of the cholera into the Mauritius by the Topaze frigate;
but _evidence_ is what people want on these occasions, and, relative to
the case in question, probably the public will consider what is to be
found in my third and fourth letters, quite conclusive. Having again
mentioned the Mauritius, I cannot refrain from expressing my great
surprise that Mr. Kennedy, who has lately published on cholera, should
give, with the view of showing "the dread and confusion existing at the
time," a proclamation by General Darling, while he does not furnish a
word about the result of the proceedings instituted by that officer, as
detailed in my third letter, relative to the non-contagious nature of
the disease, a point of all others the most important to the public. As
to accounts regarding the confusion caused by the appearance of epidemic
cholera, we have had no lack of them in the public papers during many
months past, from quarters nearer home.
Regarding a statement made by Dr. Hawkins in his book on cholera, viz.
"That Moreau de Jonnés has taken great pains to prove that the disease
was imported into the Russian province of Orenburg," Dr. H. omits to
tell us how completely he failed in the endeavour. In the _Edinburgh
Medical and Surgical Journal_ for July, 1831, there is a review of a
memoir by Professor Lichtenstädt, of St. Petersburg, in which M.
Moreau's speculations are put to flight. From the efforts of this
_pains-taking_ gentleman (M. Moreau) in the cause of contagion in
cholera, as well as yellow-fever, he seems to be considered in this
country as a medical man; but this is not the case: he raised himself by
merit, not only to military rank, but also to literary distinction, and
is a member of the Academy of Sciences, where he displays an imagination
the most vivid, but as to the sober tact necessary for the investigation
of such questions as those connected with the contagion or non-contagion
of cholera and yellow-fever, he is considered _below par_. He saw the
yellow-fever in 1802-3, at Martinique, while _aid-de-camp_ to the
Governor, and still adheres to the errors respecting it which he imbibed
in his youth, and when he was misled by occurrences taking place _within
a malaria boundary_, where hundreds of instances are always at hand,
furnishing the sort of _post hoc propter hoc_ evidence of contagion with
which some people are satisfied, but which is not one bit less absurd,
than if a good lady, living in the marshes of Kent, were to insist upon
it, that her daughter Eliza took the ague from her daughter Jane,
because they lived together. Strange to say, however, M. Casimir Perier,
the Prime Minister of France, seems to be guided, according to French
journals, by the opinions of this gentleman on cholera, instead of by
different medical commissions sent to Warsaw, &c.
The question of contagion in cholera has been now put to the test in
every possible way, let us view it for a moment, as compared with what
has occurred in regard to typhus at the London Fever Hospital, according
to that excellent observer Dr. Tweedie, physician to the establishment.
Doubts, as we all know, have been of late years raised as to the
contagion of typhus, but I believe nothing that has as yet appeared is
so well calculated to remove those doubts as the statements by this
gentleman (_see "Illustrations of Fever"_), where he shows that it has
been remarked for a series of years that "the resident medical officers,
matrons, porters, laundresses, and domestic servants not connected with
the wards, and every female who has ever performed the duties of a
nurse, have one and all been the subjects of fever,"--while, _in the
Small-Pox Hospital_, which adjoins it, according to the statements of
the physician, "no case of genuine fever has occurred among the medical
officers or domestics of that institution for the last eight years." Had
typhus been produced in the attendants by _malaria_ of the locality,
those persons in the service of the neighbouring Small-Pox Hospital
should also have been attacked to a greater or less extent, it is
reasonable to suppose, within the period mentioned. Now let this be
compared with all that has been stated respecting attendants on cholera
patients, and let it be compared with the following excellent fact in
illustration, showing how numbers labouring under the disease, and
brought from the inauspicious spot where they were attacked to a place
occupied by healthy troops, did not, _even under the disadvantage of a
confined space_, communicate the disease to a single individual:--"It
has been remarked by many practitioners, that although they had brought
cholera patients into crowded wards of hospitals, no case of the disease
occurred among the sick previously in hospital, or among the hospital
attendants. My own experience enables me fully to confirm this. The
Military Hospital at Dharwar, an oblong apartment of about 90 feet by
20, was within the fort, and the lines of the garrison were about a mile
distant outside of the walls of the fort. On two different occasions (in
1820 and 1821), when the disease prevailed epidemically among the troops
of that station, while I was in medical charge of the garrison, but
while no cases had occurred in the fort within which the hospital was
situated, the patients were brought at once from their quarters to the
hospital, which, on each occasion, was crowded with sick labouring under
other disorders. No attempt was made to separate the cholera patients.
On one of these occasions, no case of cholera occurred within the
hospital; on the other, one of the sick was attacked, but he was a
convalescent sepoy, who had not been prevented from leaving the fort
during the day. The disease, on each of those occasions, was confined
to a particular subdivision of the lines, and none of those within the
fort were attacked." (_Bell on Cholera_, p. 92.)
I have already quoted from Dr. Zoubkoff of Moscow, once a believer in
contagion; every word in his pamphlet is precious; let but the following
be read, and who will then say that "the seclusion of the sick should be
insisted on?"--"The individuals of the hospitals, including soldiers and
attendants on the sick, were about thirty-two in number, who, excepting
the medical men, had never attended any sick; we all handled, more or
less, the bodies of the patients, the corpses, and the clothes of the
sick; have had our hands covered with their cold sweat, and steeped in
the bath while the patients were in it; have inhaled their breath and
the vapours of their baths; have tasted the drinks contained in their
vessels, all without taking any kind of precaution, and all without
having suffered any ill effects. We received into our hospital
sixty-five cholera patients, and I appeal to the testimony of the
thirty-six survivors, whether we took any precautions in putting them
into the bath or in handling them--whether we were not seated sometimes
on the bed of one, sometimes on that of another, talking to them. On
returning home directly from the hospital, and without using chloride
of lime, or changing my clothes, I sat down to table with my family, and
received the caresses of my children, firmly convinced that I did not
bring them a fatal poison either in my clothes or in my breath. Nobody
shut his door either against me or my colleagues; nobody was afraid to
touch the hand of the physician who came direct from an hospital--that
hand which had just before wiped the perspiration from the brow of
cholera patients. From the time that people had experience of the
disease, nobody that I am aware of shunned the sick." Who, after this,
can read over with common patience directions for the separation of a
cholera patient from his friends, as if "_an accursed thing_?" or who
(_il faut trancher le mot_) will now follow those directions?
As to the good Sir Gilbert Blane, who has distributed far and wide a
circular containing a description the most _naïve_ on record, of the
epidemic cholera, hard must be the heart which could refuse making
the allowance which he claims for himself and his memoir; and though
he brands those who see, in his account of the marchings and
counter-marchings of the disease, nothing on a level with the
intellect of the present age, as a parcel of prejudiced imbeciles,
we must still feel towards him all the respect due to a parent arrived
at a time of life when things are not as they were wont to be,
_nec mens, nec ætas_. I may be among those he accuses of sometimes
employing "unintelligible jargon," but shall not retort while I confess
my inability to understand such expressions as "some obscure occurrence
of unwholesome circumstances" which seem to have, according to him,
both "brought" the disease to Jessore in 1817, and produced it there
at the same time. Sir Gilbert marks out for the public what he
considers as forming one of the principal differences between the
English and Indian cholera, viz. that in the latter the discharges
"consist of a liquid resembling thin gruel, in the English disease
they are feculent and bilious." Now if he has read the India reports,
he must have found abundance of evidence showing that sometimes there
were _even bilious stools_[12] not at all like what he describes; and,
again, if he is in the habit of reading the journals, he must have
found _abundant_ evidence of malignant cholera with discharges like
water-gruel in this country. As to the French Consul at Aleppo having
escaped with 200 other individuals confined to his residence, I shall
only say, as it is Sir Gilbert Blane who relates the circumstance,
that he _forgot_ to mention that the aforesaid persons had retired to
a residence _outside_ the city; which, permits me to assure you, Sir
Gilbert, just makes all the difference in hundreds of cases:--they
happened to retire to "_clene air_;" and had they carried 50 ague
cases or 50 cholera cases with them (it matters not one atom which),
the result would have been exactly the same. The mention of Barcelona
and the yellow-fever, by Sir Gilbert, was, as Dr. Macmichael would
term it, rather _unlucky_ for his cause, though probably lucky for
humanity; for it cannot be too generally known that, during the
yellow-fever epidemic there in 1821, more than 60,000 people left the
city, and spread themselves all over Spain, without a single instance
of the disease having been communicated, WHILE, AT BARCELONETTA, THE
INFAMOUS CORDON SYSTEM PREVENTED THE UNFORTUNATE INHABITANTS FROM
GOING BEYOND THE WALLS, AND THE CONSEQUENCES OF SHUTTING THEM UP WERE
MOST HORRID.
[Footnote 12: See Orton on Cholera, who is most explicit upon this
point, and cites from the India Reports:--so that the distinctions
attempted to be drawn in this respect between the "cholera of India,"
and that of other countries, are, after all, _quite untenable_.]
Little need be said respecting the pure assumptions of Sir Gilbert as
to the movements of the malady by land and by water, for those vague and
hacknied statements have been again and again refuted; but we may remark
that whereas all former accounts respecting the cholera in 1817, in the
army of the Marquis of Hastings, state that the disease broke out
somewhat suddenly in the camp on the banks of the Sinde, Sir Gilbert,
without deigning to give his authority, makes the army set out for
"Upper India accompanied by this epidemic." We find that Mr. Kennedy,
another advocate for contagion in cholera, differs from Sir Gilbert as
to the disease having accompanied the grand army on the march; for he
says the appearance of the malady was announced in camp in the early
part of November, when "the first cases excited little alarm." In
referring, in a former letter, to the sickness in the above army, I
showed from the text of the Bengal report, how a change of position
produced a return of health in the troops; but Mr. Kennedy states that
the disease had greatly declined a few days before the removal, so that
it had lost "its infecting power." Nevertheless it appears by this
gentleman's account, a little farther on, that "in their progressive
movement the grounds which they occupied during the night as temporary
encampments were generally found in the morning, strewed with the dead
like a field of battle"! This gentleman tells us that he has laid down a
law of "increase and decline appertaining to cholera," by which, and the
assistance of _currents of contagion_, it would appear all these things
are reconciled wonderfully. Several of the points upon which he grounds
his belief of contagion have been already touched upon in these letters,
and the rest, considering the state of the cholera question in Europe
just now, may be allowed to pass at whatever value the public may, after
due examination, think it is entitled to. Let it be borne in mind that
all contagionists who speak of the cholera in the army of the Marquis of
Hastings, forget to tell us that though many thousand native followers
had fled from that army during the epidemic, the disease did not appear
in the towns situated in the surrounding country, _till the following
year_, as may be seen at a glance by reference to Mr. Kennedy's and
other maps.
We have another contagionist in the field--a writer in the _Foreign
Quarterly Review_, the value of whose observations may appear from his
statement, that "in 1828 the disease broke out in Orenburg, and was
supposed [_supposed_!] to have been introduced by the caravans which
arrive there from Upper Asia, or [_or_, nothing like a second string] by
the Kingiss-Cossacks, who are adjoining this town, and were said [_were
said_!] to have been about this time affected with the disease." This
single extract furnishes an excellent specimen of the sort of _proofs_
which the contagionists, to a man, seem to be satisfied with as to the
cholera being "carried" from place to place. This gentleman must surely
be under some very erroneous impression, when he states that, "According
to the reports of the Medical Board of Ceylon, the disease made its
appearance in 1819 at Jaffnah in Ceylon, imported from Palamcottah, with
which Jaffnah holds constant intercourse, and thence it was propagated
over the island." Now there is every reason to believe that a reference
to the documents from Ceylon will shew that no report as to the
importation of the disease was ever drawn up, for Drs. Farrel and Davy,
as well as Messrs. Marshall, Nicholson, and others, who served in that
island, are, to this hour, clearly against contagion. But as the writer
tells us that he is furnished with unpublished documents respecting the
cholera at St. Petersburg, by the chief of the medical department of the
quarantine in this country, we do not think it necessary to say one word
more--_ex pede Herculem_.
I rejoice to observe that Dr. James Johnson has, at last, _spoken out_
upon the quarantine question; and I trust that others will now follow
his example. It is only to be regretted, that a gentleman possessing
such influence with the public as Dr. Johnson does, should have so long
with-held his powerful aid on the occasion; but his motives were, I am
quite sure, most conscientious; and I believe that he, as well as
others, might have been prevented by a feeling of delicacy from going
beyond a certain point.
Since my last letter a code of regulations, in the anticipation of
cholera, has been published by the Board of Health. _Let our prayers be
offered up with fervency tenfold greater than before, that our land may
not be afflicted with this dire malady._ The following statement,
however, may not be altogether useless at this moment. According to the
_Journal des Debats_ of the 24th instant, the Emperor of Austria, in a
letter to his High Chancellor, dated Schoenbrunn, October 10th, and
published in the _Austrian Observer_ of the 12th, formally makes the
most magnanimous declaration to his people, THAT HE HAD COMMITTED AN
ERROR IN ADOPTING THE VEXATIOUS AND WORSE-THAN USELESS QUARANTINE AND
CORDON REGULATIONS AGAINST CHOLERA; that he did so before the nature of
the disease was so fully understood; admits that those regulations have
been found, after full experience, to have produced consequences more
calamitous than those arising from the disease itself ("_plus funeste
encore que les maux que provenaient de la maladie elle-même_.") He
kindly makes excuses for still maintaining a modified quarantine system
at certain points, in consequence, as he states, of the opinions still
existing in the dominions of some of his neighbours, _for otherwise his
commercial relations would be broken off. To secure his maritime
intercourse, he must do as they do!_ We find that as _all_ the Prussian
cordons have been dissolved, _their vessels_ are excluded from entrance
into certain places on the Elbe. What a horrid state of things! But, as
a reference will shew, this was one of the things stated in my first
letter as likely to occur: it is surely a fit subject for immediate
arrangement between governments. In the mean time, we cannot but profit
by the great lesson just received from Austria.
I shall add no more on the present occasion, than that my last
information from Edinburgh notifies the death, from _Scotch cholera_,
of two respectable females in that city, after an illness of only a few
hours.
LETTER VI.
At a moment when the subject of cholera has become so deeply
interesting, the good of the public can surely not be better consulted
by the press than when it devotes its columns (even to the exclusion of
some political and other questions of importance) to details of plain
facts connected with the contagious or non-contagious nature of that
malady--a _question beyond all others regarding it, of most importance_,
for upon it must hinge all sanatory or conservative regulations, and a
mistake must, in the event of an epidemic breaking out, directly involve
thousands in ruin. In the case of felony, where but the life of a single
individual is at stake--nay, not only in the case of felony, but in the
case of a simple misdemeanour, or even in the simple case of debt--we
see the questions of yes or no examined by the Judges of the land with
due rigour; while, on the point to which I refer, and which affects
so deeply the dearest interests of whole communities, evidence has
been acted upon so vague as to make some people fancy that we have
retrograded to the age of witchcraft. Be it recollected that we shall
not have the same excuse as some of our continental neighbours had for
running into frightful errors--for we have their dear-bought experience
laid broadly before us; and to profit duly by it, it only requires a
scrutiny by a tribunal, wholly, if you please, non-medical, such as may
be formed within an hour in this metropolis; nothing short of this will
do. All, till then, will be vacillation; and when the enemy does come in
force, we shall find ourselves just as much at a loss how to act as our
continental neighbours were on the first appearance of cholera among
them; I say after its first appearance, for we find that they all
discovered, plainly enough latterly, what was best to be done. Small
indeed may be the chance of the present order of things as to
quarantines, the separation of persons attacked, &c., being changed
by anything which I can offer; but, having many years experience of
disease--having had no small share of experience in this disease in
particular, and having, perhaps, paid as much attention to all that has
been said about it as any man living, I should be wanting in my duty
towards God and man did I not protest, most loudly, against those
regulations, which shall have for their base, an assumption, that a
being affected with cholera can, IN ANY MANNER WHATEVER, transmit, or
communicate, the disease to others, _however close or long continued the
intercourse may be_; because such doctrine is totally in opposition to
all the fair or solid evidence now before the public;--because it is
calculated, in numberless instances, to predispose the constitution
to the disease, by exciting terror equal to that in the case of
plague;--because it is teaching us Christians to do what Jews, and
others, never do, to abandon the being who has so many ties upon our
affections;--because the desertion of friends and relatives, and the
being left solely in charge, perhaps, of a feeble and aged hireling (if
even such can be got, which I much doubt when terror is so held out,)
must tend directly to depress those functions which, from the nature of
the disease, it should be our great effort to support;--finally, because
a proper and unbiassed examination of the question will shew, that all
these horrors are likely to arise out of regulations which may, with
equal justice, be applied to ague, to the remittent fevers of some
countries, or to the Devonshire cholic, as to cholera.
Happily, it is not yet too late to set about correcting erroneous
opinions, pregnant with overwhelming mischief, for hitherto the measures
acted upon have only affected our commerce and finances to a certain
extent; but it appears to me that not a moment should be lost, in order
to prevent a public panic; and, in order to prevent those calamities
which, in addition to the effects of the disease itself, occurred, as we
have seen, on the Continent. Let then, I say, a Commission be forthwith
appointed, composed of persons accustomed to weigh evidence in other
cases, and who will not be likely to give more than its due weight to
the authority of any individuals. Let this be done, and, in the
decision, we shall be sure to obtain all that human wisdom can arrive at
on so important a subject; and the public cannot hesitate to submit to
whatever may afterwards be proposed. It will then be seen whether the
London Board of Health have decided as wisely as they have hastily. For
my part, I shall for ever reject what may be held as evidence in human
affairs, if it be not shewn that an individual attending another
labouring under cholera, runs no further risk of being infected than
an individual attending an ague patient does of being infected by this
latter disease. What a blessing (in case of our being visited by an
epidemic) should this turn out to be the decision of those whose
opinions would be more likely to be regarded by the public than mine
are likely to be.
Many, I am quite aware, are the professional men of experience now in
this country, who feel with me on this occasion, but who, in deference
to views emanating from authority, refrain from coming forward:--let me
entreat them, however, to consider the importance of their suggestions
to the community at large, at this moment; and let me beg of them to
come forward and implore government to institute a special commission
for the re-consideration of measures, founded on evidence the most vague
that it is possible to conceive; or, perhaps, I should rather say,
_against_ whatever deserves the name of evidence. Every feeling should
be sacrificed, by professional men, for the public good; we must even
run the greatest risk of incurring the displeasure of those of our
friends who are in the Board of Health. That we do run some risk is
pretty plain, from the conduct of a vile journalist closely connected
with an individual of a paid party, who has threatened us unbelievers in
generally-exploded doctrines, with a fate nothing short of that which
overwhelmed some of the inhabitants of Pompeii.
Let me ask why _all_ the documents of importance forwarded to the Board
of Health are not published in the collection just issued? Why are those
forwarded by _the Medical Gentleman sent to Dantzic_ not published.[13]
Why has not an important document forwarded by our Consul at Riga not
been published? Above all, why has not allusion been made in their
papers to those cases of PURE SPASMODIC CHOLERA, which have occurred in
various parts of England within the last five months, and the details
of which has been faithfully transmitted to them. If those cases be
inquired into thoroughly and impartially, and that several of them be
not found to be PERFECTLY IDENTIC with the epidemic cholera of India,
of Russia, &c., I hereby promise the public to disclose my name, and
to suffer all the ignomy of a person making false statements. Indeed,
I may confidently assure the public, that in at least one case which
occurred about two months ago, the opinion of a gentleman who had
practiced in India, and who had investigated the history of the
symptoms, the identity with those of Asiatic cholera, was not denied.
The establishment of this point is of itself sufficient to overthrow
all supposition as to the importation of the disease.
[Footnote 13: Since the above was written, I find that this gentleman
has adduced the strongest proofs possible against contagion.]
In the case of Richard Martin, whose death occurred at Sunderland about
two months ago--in the case of Martin M'Neal, of the 7th Fusileers,
which occurred at Hull, on the 11th of August last--in the cases at Port
Glasgow, as detailed in a pamphlet by Dr. Marshall of that place--as
well as several other cases which occurred throughout the year, and the
details of many of which are in possession of the Board of Health--the
advocates, "_par metier_," of contagion in cholera, have not a loop-hole
to creep out at. Take but a few of the symptoms in one of those cases
as taken down by the Medical Gentleman in charge,--"The body was cold,
and covered by a clammy sweat--the features completely sunk--_the lips
blue_, the face discoloured--tongue moist and very cold--the hands and
feet blue, cold, and as if steeped in water, like a washerwoman's hand;
the extremities cold to the axillæ and groins, and no pulse discoverable
lower; the voice changed, and the speech short and laborious. He
answered with reluctance, and in monosyllables." This man had the pale
dejections, and several other symptoms, considered so characteristic of
the Asiatic cholera; yet no spreading took place from him, nor ever will
in similar cases. With the exception of the vomiting and purging, there
is, in the state of patients labouring under this form of cholera, a
great similarity to the first stage of the malignant fevers of the
Pontine Marshes, and many other places, and the patient need not be one
bit the more avoided. Let this be, therefore, no small consolation, when
we find that, by the official news of this day, five more deaths have
occurred at Sunderland.
Nov. 9, 1831.
LETTER VII.
It may be inferred, from what I have stated at the close of my letter
of yesterday, that if a Commission be appointed, I look forward to its
being shewn, as clear as the sun at noon day, that the most complete
illusion has existed, and, on the part of many, still exists, with
regard to the term _Indian_ or _Asiatic_ cholera; for a form of cholera
possessing characters quite peculiar to the disease in that country, and
unknown, till very lately, in other countries, _has never existed
there_. Cholera, from a cause as inscrutable, perhaps, as the cause of
life itself, has prevailed there, and in other parts of the world, in
its severest forms, and to a greater extent than previously recorded;
but, whether we speak of the mild form, or of a severe form, proceeding
or not to the destruction of life, the symptoms have everywhere been
precisely the same. In this country it has been over and over again
remarked, that, so far back as 1669, the spasmodic cholera prevailed
epidemically under the observation of Dr. Sydenham, who records it. For
many years after the time of Dr. Cullen, who frequently promulgated
opinions founded on those of some fancy author rather than on his own
observation, it was very much the fashion to speak of redundancy of
bile, or of acrid bile, as the cause of the whole train of symptoms in
this disease; but, since the attention of medical men has been more
particularly drawn to the subject, practitioners may be found in every
town in England who can inform you that, in severe cases of cholera,
they have generally observed that no bile whatever has appeared till
the patient began to get better. Abundance of cases of this kind are
furnished by the different medical journals of this year. In fifty-two
cases of cholera which passed under my observation in the year 1828, the
_absence_ of bile was always most remarkable. I made my observations
with extraordinary care. One of the cases proved fatal, in which the
group of symptoms deemed characteristic of the Indian or Indo-Russian
cholera, was most perfect, and in the mass, the symptoms were as
aggravated as they have often been observed to be in India;--in several,
spasms, coldness of the body, and even convulsions, having been present.
To those who have attended to the subject of cholera, nothing can be
more absurd than to hear people say such or such a case cannot be _the
true_ cholera, or the Indian cholera, or the Russian cholera, because
_all_ the symptoms ever mentioned are not present: as if, in the
epidemic cholera of India and other places, even some of the symptoms
considered the most prominent (as spasms, and the disturbance of the
stomach and bowels) were not often absent, and that too in some of the
most rapidly, fatal cases! I feel persuaded that much injustice is done
to a gentleman lately sent to Sunderland, in attributing to him the
very ridiculous opinion, _that because_ the disease did not spread, it
was _therefore_ not identical with the Indian cholera. No person is
justified in speaking of the cholera of India as a disease _sui
gineris_, and in which a certain group of severe symptoms are always
present, when evidence, such as the following is on record:--"On the
22nd instant, when the men had been duly warned of their danger from not
reporting themselves sooner, I got into hospital a different description
of cases, viz.--men with a full pulse, hot skin," &c. (_Dr. Burrell to
Dr. Milne, Seroor, 27th of July, 1818_)--"But I must tell you that we
have, too, cases of common cholera." (_Mr. Craw, Seroor--Bengal Report,
p. 48_)--"The cases which terminated favourably presented very different
symptoms [from the low form of the disease.] As I saw the men
immediately after they were attacked, they came to me with a quick
_full_ pulse, and in several instances pain in the head; there was no
sweating."--"in several cases _bile_ appeared from the first in
considerable quantities in the egesta; and these were more manageable
than those in which no bile was ejected, although the spasms and
vomiting (the most distressing symptoms of the complaint) were equally
violent." (_Mr. Campbell, Seroor,--see Orton, 2nd ed. p. 18_)--"In
conclusion, I am happy to inform you that, for the last three days the
disease has been evidently on the decline, and, during that period, most
of the cases have assumed a different and much milder type, and,
comparatively, are little dangerous. It approaches somewhat to fever;
the patient complains of severe pain in the legs, sometimes vomiting
a watery fluid, and sometimes bile." (_White--Bengal Reports, p. 68._)
The same gentleman afterwards observes, "The disease continues to
present a milder aspect, and now occurs but rarely: loss of pulse and
coldness are seldom observed."
On the decline of a particular epidemic, Mr. Alardyce observed many
cases in the 34th regiment, with _bilious_ discharges throughout.
(Orton, 1st Ed. 128). Finally, referring to the work of Mr. Orton, a
gentleman who served in India, and who, being a contagionist, will be
considered, I suppose, not bad authority by those who are of his
opinion, we find the following declaration. (p. 26, 1st Ed.) "My own
experience has been very conclusive with regard to the sthenic form of
the disease. I have found a very considerable number of cases
exhibiting, singly, or in partial combination, every possible degree,
and almost every kind of increased action."--"Very full, hard, and quick
pulse, hot skin, and flushed surface; evacuations of bile, [you are
requested to note this, reader] both by vomiting and stool, from the
commencement of the attack. And, finally, I have seen some of those
cases passing into the low form of the disease."--"The inference from
these facts is plain, however opposite these two forms of disease may
appear, _there is no essential or general difference between them_."
After such authorities, and what has elsewhere been shewn, can any
cavelling be for one moment permitted as to the cholera in Sunderland
not being of the same nature as that of India? It may be now clearly
seen that in India as in Sunderland, the same variety of grades occurred
in the disease.
In making my communications for the benefit of the public, it is my wish
to spare the feelings of Sir Gilbert Blane; but as he persists in giving
as facts often refuted tales of contagion, in order to uphold doctrines
which he must observe are tumbling into ruins in all directions, it
becomes necessary that his work of mischief should no longer remain
unnoticed.
Not a single circumstance which he quotes relative to the marchings
and the voyages of the contagion of cholera will bear the slightest
examination; and yet he has detailed them as if, on his simple
assertion, they were to be received as things proved, and, consequently,
as so many points to be held in view when the public are in search of
rules whereby they may be guided. The examination of his assumed facts
for one short hour, by a competent tribunal, would prove this to be the
case; here it is impossible to enter upon them all: but let us just
refer to his _management_ of the question relative to the importation of
the disease into the Mauritius by the _Topaze_ frigate, which he says
was not believed there to be the case--and _why_ was it not believed?
Sir Gilbert takes special care not to tell the public, but they now have
the reason from me, at page 22.
If a commission be appointed, half an hour will suffice to place before
them, from the medical office in Berkeley-street, the reports alluded to
from the Mauritius, by which it is made apparent that long before the
arrival of the aforesaid frigate, the disease had shown itself in the
Mauritius.[14] What is the public to think of us and our profession,
when vague statements are daily attempted to be passed as facts, by
contagionists _enragés_? One more short reference to Sir Gilbert's
facts.--While referring to the progress of cholera in India, &c. from
1817, he says, in a note, "it is remarkable enough that while the great
oriental epidemic appeared thus on the eastern extremity of the
Mediterranean, the great western pestilence, the yellow fever, was
raging in its western extremity, Gibraltar, Malaga, Barcelona, Leghorn,
&c." Now, it is a historical fact, that, at Gibraltar, this disease did
not appear between 1814 and 1828--_and at Leghorn not since 1804_! At
Malaga, I believe, it did not prevail since 1814! So we have here a
pretty good specimen of the accuracy of some of those who undertake to
come forward as guides to the public on an occasion of great urgency and
peril. By some of Sir Gilbert's abettors, we are assured that his "facts
are perfectly reconcileable with the hypothesis of the cholera being of
an infectious nature." A fig for all hypothesis just now! Let us have
something like the old English trial by jury. May I be allowed to
introduce a fresh evidence to the public notice, in addition to the
thousand-and-one whose testimony is already recorded. He is worthy of
belief for two good reasons in particular; the one because he still
(unable to explain what can never be explained, perhaps), calls himself
a contagionist, and, in the next place, the statements being from a
high official personage, he could not offer them unless true to his
Government, as hundreds might have it in their power to contradict them
if not accurate. My witness is not a Doctor, but a _Duke_--the Duke de
_Mortemar_, lately Ambassador from the French Court to St. Petersburg,
who has just published a pamphlet on cholera, a few short extracts
from which, but those most important ones, I shall here give. Read
them!--people of all classes, read them over and over again! "An
important truth seems to be proved by what we shall here relate,
which is, that woods seem to diminish the influence of cholera, and
that cantons in the middle of thick woods, and placed in the centre
of infected countries, have altogether escaped the devastating
calamity!"--"The island of Kristofsky, placed in the centre of the
populous islands of St. Petersburg, communicating with each other by
two magnificent bridges, and with the city by thousands of boats, which
carried every day, and particularly on Sundays, a great number of people
to this charming spot. The island of Kristofsky, we say, _was preserved
completely from attacks of the cholera_; there was not a _single_ person
ill of the disease in three villages upon it." He continues to state
particulars, which, for want of time, cannot be here given, and
adds--"To what is this salubrity of Kristofsky, inhabited by the same
sort of people as St. Petersburg, to be attributed, fed in the same
manner, and following a similar _regime_,--communicating with each other
daily, if it be not to the influence of the superb forest which shelters
it? The firs, which are magnificent as well as abundant, surround the
houses."[15] He notices that the town is low and humid, and that "it is
made filthy every Sunday by the great numbers who resort to it, and who
gorge themselves with intoxicating drink." In a third letter I shall be
able to furnish further extracts from this most interesting pamphlet.
[Footnote 14: I am aware that very lately certain memoranda have been
referred to from the surgeon, but this is merely an expiring effort, and
of no avail against the official Report drawn up.]
[Footnote 15: As these most remarkable circumstances have not appeared
in the statements of our Russian medical commission, we must either
presume that the Duke is not correct, or that those facts have _escaped
the notice_ of the commission.]
In a letter lately inserted in a newspaper, the greatest injustice
is done to the Board of Health by the comments made on their
recommendations for the _treatment_ of cholera--_it is not true_ that
they have reccommended _specifics_, and I must add my feeble voice in
full approbation of all they have suggested on this point. Let the
public remark that they most judiciously point at the application of
_dry_ heat, not baths, which always greatly distress the patient, and,
indeed, have sometimes been observed (that is, where the coldness and
debility are very great) to accelerate a fatal issue. Of all the
arrangements to which a humane public can direct their attention, there
is nothing so essential as warmth. I would, therefore, humbly beg to
suggest, that funds for the purpose of purchasing coals for gratuitous
issue to the poor should be at once established in all directions. Too
much, I think, has been said about ventilation and washing, and too
little about this.
November 10th.
LETTER VIII.
Already has the problem of the contagious or non-contagious nature of
this disease been solved upon our own land; and as sophistry can no
longer erect impediments to the due distribution of the resources of
this pre-eminently humane nation, it is to be hoped that not an hour
will be lost in shaping the arrangements accordingly. What now becomes
of the doctrine of a poison, piercing and rapid as the sun's rays,
emanating from the bodies of the sick--nay, from the bodies of those who
are not sick, but who have been near them or near their houses? In the
occurrences at Newcastle and Sunderland, how has the fifty times refuted
doctrine of the disease spreading from a point in _two_ ways, or in one
way, tallied with the facts? We were desired to believe that in India,
Persia, &c., "the contagion _travelled_," as the expression is, very
slow, because this entity of men's brains was obliged to wend its way
with the march of a regiment, or with the slow caravan: now, however,
when fifty facilities for the most rapid conveyance have been afforded
every hour since its first appearance, it will not put itself one bit
out of its usual course. And then what dangers to the attendants on the
sick to the members of the same family--to the washerwomen--to the
clergymen--to the buriers of the dead--even to those who passed the door
of the poor sufferer! Well, what of all this has occurred? Why it has
occurred that this doctrine, supported by many who were honest, but had
not duly examined alleged facts, and by others, I regret to say, whose
interests guided their statements--that the absurdity of this doctrine
has now been displayed in the broad light of day. Make allowance (even
in this year of great notoriety for susceptibility to cholera in the
people at large in this country) for _insusceptibility_ on the part of
numbers who came into contact at Sunderland and Newcastle, with the
persons of cholera patients, with their beds, their furniture, their
clothes, &c., yet, if there had ever been the slightest foundation
for the assertions of the contagionists, what numbers _ought_ to have
been contaminated, in all directions over the face of the country,
even within the first few days, considering the wonderful degree of
intercourse kept up between all parts. But we find that, as in Austria
and Prussia, "_la maladie de la terre_" is not disposed here to
accommodate itself to vain speculations. _Now_ the matter may be
reduced to the simple rules of arithmetic, viz.:--if, as "contagionists
_par metier_" say, the poison from the body of one individual be, in
the twinkling of an eye, and in more ways than one, transmitted to
the bodies of a certain number who have been near him, &c., how many
thousands, or tens of thousands, in every direction, should, in a
multiplied series of communications and transmissions, be now affected?
Those who have watched the course of matters connected with cholera in
this country, have not failed to perceive, for some time past, the
intent and purport of the assertion so industriously put forth--that the
disease might be introduced by people in perfect health; and we have
just seen how this _ruse_ has been attempted to be played off at
Sunderland, as the history of such matters informs us has been done
before in other instances, and public vengeance invoked most _foully and
unjustly_ upon the heads of guiltless persons in the Custom House or
Quarantine Department, for "permitting a breach of regulations;" but the
several pure cases of spasmodic cholera, in many parts of England
besides Sunderland, long before--months before--the arrival of _the_
ship (as shewn in a former letter) leave no pretence for any supposition
of this kind.
I request that the public may particularly remark, that, frequently as
those cases have been cited as proofs of the absurdity of _expecting the
arrival_ of the disease by a ship, THEIR IDENTITY HAS NEVER ONCE BEEN
DISPUTED BY THOSE MOST ANXIOUS TO PROVE THEIR CASE. No; the point has,
in common parlance, been always _shirked_; for whoever should doubt it,
would only hold himself up to the ridicule of the profession, and to
admit it would be to give up the importation farce.
Others have remarked before me that, though a very common, it is a very
erroneous mode of expression, to say of cholera, that _it has travelled_
to such or such a place, _or has arrived_ at such or such places, for it
is _the cause_ of the malady which is found to prevail, for a longer or
shorter time, at those different points. It cannot be expected that
people should explain such matters, for, with regard to them, our
knowledge seems to be in its infancy, and "we want a sense for atoms."
However, as people's minds are a good deal occupied upon the point,
and as many are driven to the idea of contagion in the face even of
evidence, from not being able to make any thing of this _casse-tête_,
the _best guess_ will probably be found in the quotation from Dr. Davy,
at page 19.
I perceive that the Berlin Gazette is humanely occupied in recommending
others to profit by the mistakes regarding contagion which occurred in
that country:--"Dr. Sacks, in No. 38 of his Cholera Journal, published
here, has again shewn, against Dr. Rush, the fallibility of the doctrine
of contagion, as well as the mischievous impracticability of the
attempts founded on it to arrest the progress of the disorder by cutting
off the communications. It is to be hoped that the alarm so methodically
excited by scientific and magisterial authority in the countries to the
west of us [!!] will cease, after the ample experience which we have
dearly purchased (with some popular tumults), and that the system of
incommunication will be at once done away with by all enlightened
governments, after what has passed among us."--I am sure, good people,
nobody can yet say whether those calling themselves scientific, will
allow us to profit by your sad experience; but I believe that the people
of Sunderland are not to be shut in, but allowed to remove, if they
choose, in spite of silly speculations.
It may not be uninteresting to mention here, that there are no
quarantines and no choleras in Bohemia or Hanover.
LETTER IX.
The following statement from the Duke de Mortemar will be considered
probably, very curious, considering that, as already stated, he seems
to believe in something like contagion--and for no earthly reason, one
may suppose, than from his inability to satisfy himself of the existence
of another cause--as if it were not sufficient to prove that in reality
the moon _is not_ made of green cheese, but one must prove _what it is_
made of! But, to the quotation--"The conviction now established, that
intercourse with sick produces no increase of danger, should henceforth
diminish the dread of this calamity (the cholera). It differs from the
plague in this, that it does not, by its sole appearance, take away
all hope of help, and destroy all the ties of family and affection.
Henceforth those attacked will not be abandoned without aid and
consolation; and separation or removal to hospital, the source of
despair, will no longer increase the danger. The sick may in future be
attended without fears for one's self, or for those with whom we live."
How delightful is the simplicity of truth! Why, Sir, a morceau like
this, and from an honourable man, let him call himself contagionist or
what he may, is more precious at this moment than Persian turkois or
Grecian gems. Make me an example, men say, of the culprits "who let
the cholera morbus into Sunderland," concealed in "susceptible"
articles!--yes, and that we may be on a level in other matters, destroy
me some half dozen witches, too, as we were wont to do of yore. But
let us have more tidings from Russia to comfort the country of our
affections in the hour of her affliction, when so much craft and
subtlety is on foot to scare her. Dr. Lefevre, physician to our embassy
at St. Petersburg, has just given to the public an account of his
observations there during the epidemic, from which the following
extracts are made:--
"As far as my practice is concerned both in the quarter allotted to me,
and also in private houses in different parts of the town, I have no
proof whatever that the disease is contagious.
"The first patient I saw was upon the third day of the epidemic, and
upon strict inquiry I could not trace the least connexion between the
patient, or those who were about her person, with that part of the town
where it first appeared--a distance of several versts.
"As regards the attendants of the sick, in no one instance have I found
them affected by the disease, though in many cases they paid the most
assiduous attention, watched day and night by the beds of the afflicted,
and administered to all their wants.
"I knew four sisters watch anxiously over a fifth severely attacked with
cholera, and yet receive no injury from their care.
"In one case I attended a carpenter in a large room, where there were at
least thirty men, who all slept on the floor among the shavings; and,
though it was a severe and fatal case, no other instance occurred among
his companions.
"In private practice, among those in easy circumstances, I have known
the wife attend the husband, the husband the wife, parents their
children, children their parents, and in fatal cases, where, from long
attendance and anxiety of mind, we might conceive the influence of
predisposition to operate, in no instance have I found the disease
communicated to the attendants."--p. 32, 33.
"The present disease has borne throughout the character of an epidemic,
and when the proofs advanced in proof of its contagion have been
minutely examined, they have been generally found incorrect; whereas
it is clear and open to every inquirer, that the cholera did not occur
in many places which had the greatest intercourse with St. Petersburg
at the height of the malady, and that it broke out in many others which
have been subjected to the strictest quarantine."--p. 34.[16]
[Footnote 16: It is remarkable enough that Aretæus, who lived, according
to some authors, in the first century, gives exactly the same reason
which Dr. Lefevre does for the suppression of urine in cholera. So true
it is, that that symptom, considered as one of the characteristics of
the Indian cholera, was observed in ancient times.]
Hear all this, Legislators! Boards of Health throughout the country,
hear it! Then you will be able to judge how exceedingly frivolous the
idle _opinions_ and _reports_ are which you have obtruded so
industriously upon your notice.
But one more short quotation from Dr. Lefevre, a gentleman certainly
not among the number of those who stand denounced before the
professional world as unworthy of belief. He says:--"As for many
reports which have been circulated, and which, _primâ facie_, seem to
militate against the statement [communication to attendants, &c.]. I
have endeavoured to pay the most impartial attention to them; but I
have never found, upon thorough investigation, that their correctness
could be relied upon: and in many instances I have ascertained them to
be designedly false."--DESIGNEDLY FALSE! Alas! _toute ça on trouve
dans l'article_ HOMME; and any body who chooses to investigate, as
I have done, the history of epidemics, will find that falsehoods foul
have been resorted to--shamelessly resorted to--by persons having a
direct interest in maintaining certain views. Enough, then, has been
said to put Boards of Health, &c. on their guard against admitting
_facts_ for their guidance from any quarter whatever, if the purity
of the source be not right well established. There is too much at stake
just now to permit of our yielding with ill-timed complaisance to
_any authority_ without observing this very necessary preliminary.
One word, and with all due respect, before closing, on the subject of
Dr. James Johnson's "_contingent_ contagion," which, though occurring
in some diseases, and extremely _feasible_ in regard to others, will,
if he goes over the evidence again, I am sure, be shown not to apply to
cholera, which is strictly a disease of _places_, not persons, and can
no more be generated by individuals than ague itself can. I can only say
of it, with the philosophic poet, that--
--------------------"A secret venom oft
Corrupts the air, the water, and the land."
Mr. Searle, an English gentleman, well known for his work on cholera,
has just returned from Warsaw, where he had the charge of the principal
cholera hospital during the epidemic. The statements of this gentleman
respecting contagion, being now published, I am induced from their high
interest to give them here:--
"I have only to add my most entire conviction that the disease is not
contagious, or, in other words, communicable from one person to another
in the ordinary sense of the words--a conviction, which, is founded not
only upon the nature of the disease, but also upon observations made
with reference to the subject, during a period of no less than fourteen
years. Facts, however, being deservedly of more weight than mere
opinions, I beg leave to adduce the following, in the hope of relieving
the minds of the timid from that groundless alarm, which might otherwise
not only interfere with or prevent the proper attendance upon the sick,
but becomes itself a pre-disposing or exciting cause of the disease; all
parties agreeing that of all the debilitating agencies operating upon
the human system, there is no one which tends to render it so peculiarly
susceptible of disease, and of cholera in particular, than fear.
"The facts referred to are these:--during two months of the period, that
I was physician to the principal hospital at Warsaw, devoted to the
reception and treatment of this disease, out of about thirty persons
attached to the hospital, the greater number of them were in constant
attendance upon the sick, which latter were, to the number of from
thirty to sixty, constantly under treatment; there were, therefore,
patients in every stage of the disease. Several of these attendants,
slept every night in the same apartments with the sick, on the beds
which happened to be unoccupied, with all the windows and doors
frequently closed. These men, too, were further employed in assisting
at the dissection of, and sewing up of, the bodies of such as were
examined, which were very numerous; cleansing also the dissecting-room,
and burying the dead. And yet, notwithstanding all this, only one,
during the period of two months, was attacked by the disease, and this
an habitual drunkard, under circumstances, which entirely negative
contagion, (supposing it to exist), as he had nothing whatever to do
with the persons of the sick, though he occasionally assisted at the
interment of the dead. He was merely a subordinate assistant to the
apothecary, who occupied a detached building with some of the families
of the attendants; all of whom likewise escaped the disease. This man,
I repeat, was the only one attacked, and then under the following
circumstances."
Here Mr. S. relates how this man, having been intoxicated for several
days--was, as a punishment locked up almost naked in a damp room for two
nights, having previously been severely beaten.
From the foregoing facts, and others pretty similar in all parts of the
world where this disease has prevailed, we are, I think, fairly called
upon to discard all special pleading, and to admit that man's _best
endeavours_ have not been able _to make it_ communicable by any manner
of means.
LETTER X.
At a meeting held some days ago by the members of the Royal Academy of
Medicine of Paris, Dr. Londe (President of the French Medical Commission
sent to Poland to investigate the nature of the cholera) stated, with
regard to the questions of the origin and _communicability_ of the
disease, that it appeared by a document to which he referred, that
1st. "The cholera did not exist in the Russian corps which fought at
_Iganie_," the place where the first battle with the Poles took place.
2d. "That the two thousand Russian prisoners taken on that occasion, and
observed at Praga for ten days under the most perfect separation, [_dans
un isolement complet_] did not give a single case of cholera." 3d. "That
the corps [of the Polish army] which was not at _Iganie_, had more cases
of cholera than those which were there." Dr. Londe stated cases of the
spontaneous development of the disease in different individuals--of a
French Lady confined to her bed, during two months previous to her
attack of cholera, of which she died in twenty-two hours--of a woman of
a religious order, who had been confined to her bed for six months, and
while crossing a balcony, the aspect of which was to the Vistula, was
attacked with cholera, and died within four hours. Dr. Londe, among
other proofs that the disease was not transmissible, or, as some prefer
calling it, not communicable, stated, "the immunity of wounded and
others mixed with the cholera patients in the hospitals; the immunity of
medical men, of attendants, of inspectors, and of the families of the
different _employés_ attached to the service of cholera patients;
the example of a porter, who died of the disease, without his wife or
children, who slept in the same bed with him, having been attacked; the
example of three women attacked (two of whom died, and one recovered),
and the children at their breasts, one of six months, and the other two
of twelve, not contracting the disease."
At a subsequent meeting of the Academy, a letter from Dr. Gaymard, one
of the Commission to St. Petersburg, was read, in which it was stated,
while referring to the comparative mortality at different points there,
that, "The cause of this enormous difference was, that the authorities
wished to isolate the sick--[Observe this well reader]--and even send
them out of the city; now the hospital is on a steep mountain, and, to
get to it, the carriages were obliged to take a long circuit through a
sandy road, which occupied an hour at least; and if we add to the
exposure to the air, the fatigue of this removal, and the time which
elapsed after the invasion of the disease, the deplorable state of the
patient on his arrival, and the great mortality may be accounted for."
"The progress of the disease was the same as in other places; it was at
the moment when it arrived at its height, and when, consequently, the
greatest intercourse [Observe reader!] took place with the sick, that
the number of attacks wonderfully diminished all at once (_tout à
coup_), and without any appreciable cause. The points of the city most
distant from each other were invaded. Numbers of families crowded
[_entassés_] who had given aid to cholera patients, remained free from
the disease, while persons isolated in high and healthy situations
[_usually_ healthy meant of course] were attacked. It especially
attacked the poorer classes, and those given to spirituous liquors.
Scarcely twenty persons in easy circumstances were attacked, and even
the greater part of these had deviated from a regular system."
The inferences drawn, according to a medical journal, from the whole
of Dr. Gaymard's communication, are--
"1. That the system of sanatory measures, adopted in Russia, did not
any where stop the disease.
"2. That without entering on the question as to the advantages to be
derived from a moral influence arising out of sanatory cordons, placed
round a vast state like France, these measures are to be regarded as
useless in the interior, in towns, and round houses.
"3. That nothing has been able to obstruct the progressive advance of
the disease in a direction from India westward.
"4. That the formation of temporary hospitals, and domiciliary succour,
are the only measures which can alleviate this great scourge."
A letter from Dr. Gaymard to Dr. Keraudren was read at the meeting of
the Academy, in which it was stated, that in an Hospital at Moscow, in
which Dr. Delauny was employed from the month of December, 1830, to
the end of December, 1831, 587 cholera patients, and 860 cases of
other diseases, were treated--"Not one of the latter was attacked
with cholera, although the hospital consists of one building, the
coridors communicating with each other, and the same linen serving
indiscriminately for all. The attendants did not prove to be more
liable to attacks. The relatives were suffered to visit their friends
in hospital, and this step produced the best impression on the
populace, who remained calm. They can establish at Moscow, that there
was not the smallest analogy between the cholera and the plague which
ravaged that city in the reign of Catharine." Dr. Gaymard declares,
that, having gone to Russia without preconceived ideas on the subject,
"he is convinced that interior quarrantines, and the isolation of
houses and of sick in towns, has been accompanied by disastrous
consequences." Is there yet enough of evidence to shew that this
disease is positively _not to be made_ communicable from the sick?
Honour still be to those of the profession who, from conscientious and
honorable motives, have changed from non-contagionists to contagionists
in regard to this disease; and all that should be demanded is, that
their _opinions_ may not for one moment be suffered to outweigh, on
an occasion of vital importance, the great mass of evidence now on
record quite in accordance with that just stated. One gentleman of
unquestionable respectability gives as a reason (seemingly his very
strongest) for a change of opinion, that he has been credibly informed
that when the cholera broke out on one side of the street in a certain
village in Russia, a medical man had a barrier put up by which the
communication with the other side was cut off, and the disease thus,
happily, prevented from extending. Now, admitting to the full extent the
appearance of the disease on one side of the village only--a thing by
the way hitherto as little proved as many others on the contagion side
of the question--still, if there be any one thing more striking than
another, in the history of the progress of cholera, it is this very
circumstance of opposite rows of houses, or of barracks, or bazaars, or
lines of camp, being free, while the disease raged in the others, and
without any sort of barricading or restriction of intercourse. If people
choose to take the trouble to look for the evidence, _plenty_ of such is
recorded. Now just consider for one moment how this famous Russian story
stands: had the barricading begun early, the matter would have stood an
examination a little better; but this man of good intentions never
thought of his barriers till the one-sided progress of the disease had
been manifest enough, _without them_:--and then consider how the
communication had existed between both rows before those barriers were
put up, and how impossible it was, unless by a file of soldiers, to have
debarred all communication:--let all this be considered, and probably
the case will stand at its true value, which is, if I may take the
liberty of saying so,--just nothing at all. Let us bear in mind the
circumstance already quoted from the East India records,--of one company
of the 14th Regiment, at the extreme end of a barrack, escaping the
disease, almost wholly, while it raged in the other nine; and this
without a barrier too. But such circumstances are by no means of rare
occurrence in other diseases arising from deteriorated atmosphere. Mr.
Wilson, a naval surgeon, has shewn how yellow fever has prevailed _on
one side_ of a ship, and I have had pointed out to me, by a person who
lived near it for thirty years, a spot on this our earth where _ague_
attacks only those inhabiting the houses in one particular line, and
without any difference as to elevation or other appreciable cause,
except that the sun's rays do not impinge equally on both ranges in the
morning and evening.
The advancement of the cause of truth has, no doubt, suffered some check
in this country, by the announcement that another gentleman of great
respectability (Mr. Orton) finds his belief as to non-contagion in
cholera a good deal shaken: but we find that this change has not arisen
from further personal knowledge of the disease, and if it be from any
representations regarding occurrences in Europe, connected with cholera,
we have seen how, from almost all quarters, the evidence lies quite on
the side of his first opinions. Whatever the change may be owing to, we
should continue, as in other cases, not to give an undue preference even
to opinions coming from him, to well authenticated facts--facts, among
which some particularly strong are still furnished _by himself_, even in
the second edition of his book:--"It must be admitted that, in a vast
number of instances in India, those persons [medical men and attendants]
have suffered no more from the complaint than if they had been attending
so many wounded men. This is a fact which, however embarrassing to
the medical inquirer, [for our part we cannot see the _embarrassment_]
is highly consolatory in a practical point of view, both to him and
to all whose close intercourse with the sick is imperatively
required."--(_p. 316_)--"We are therefore forced to the conclusion,
however, at variance with the common laws of contagion, that in this
disease,--at least in India, the most intimate intercourse with the sick
is not, in general, productive of more infection than the average quantity
throughout the community." (_p. 326_). Let us contrast the statements in
the following paragraphs:--"For in all its long and various courses, it
may be traced from place to place, and has never, as far as our information
extends, started up at distant periods of time and space, leaving any
considerable intervening tracts of country untouched." (p. 329)--"All
attempts to trace the epidemic to its origin at a point, appears to have
failed, and to have shewn that it had not one, but various local sources
in the level and alluvial, the marshy and jungly tract of country which
forms the delta of the Ganges, and extends from thence to the
Burraumposter." (p. 329) Now let us observe what follows regarding the
particular _regularity_ in the progress of the disease, as just
mentioned:--"Another instance of irregularity in its course, even in
those provinces where it appears to have been most regular, is stated
[now pray observe] in its having skipped from Verdoopatly to a village
near Palamacotta, leaving a distance of sixty miles at first
unaffected." (p. 332)!!--This is not the way to obtain proselytes I
presume.
The situation of our medical brethren at Sunderland is most perplexing,
and demands the kindest consideration on the part of the country at
large; but let nothing which has occurred disturb the harmony so
essential to the general welfare of that place, should their combined
efforts be hereafter required on any occasion of public calamity. In
truth both parties may be said to be right--the one in stating that
the disease in question _is Indian cholera_, because the symptoms are
precisely similar--the other that it _is not Indian cholera_, because
it exists in Sunderland, and without having been imported--IN NEITHER
COUNTRY IS IT COMMUNICABLE FROM ONE PERSON TO ANOTHER, as is now plainly
shown upon evidence of a nature which will bear any investigation; and
if blame, on account of injury to commerce, be fairly attributable to
any, it is to those who, all the world over, pronounced this disease, on
grounds the most untenable, a disease of a contagious or communicable
nature. Let the Sunderland Board of Health not imagine that their
situation is new, for similar odium has fallen _on the first_ who told
the plain truth, in other instances--at Tortosa, a few years ago, the
first physician who announced the appearance of the yellow fever, was,
according to different writers, _stoned to death_; and at Barcelona, in
1821, a similar fate had well nigh occurred to Dr. Bahi, one of the
most eminent men there--we need not, I presume, fear that a scene of
this kind will take place in this country,--though the cries of "no
cholera!" and "down with Ogden!" have been heard.
One word as to observations regarding the needlessness of discussing the
contagion question: the truth is, that the cleanliness and comfort of
the people excepted, you can no more make _other arrangements_ with
propriety, till this point be settled, than a General can near the enemy
by whom he is threatened, till it be ascertained whether that enemy be
cavalry or infantry.
My object in these letters is not to obtrude opinions upon the public,
being well aware that they cannot be so well entitled as those of many
others, to attention; but I wish to place before the public, for their
consideration, a collection of facts which I think are likely to be of
no small importance at a moment like the present. In addition to the
many authorities referred to in the foregoing pages, I would beg to
call the public attention to a paper in the _Windsor Express_ of the
12th November, by Dr. Fergusson, Inspector General of Hospitals, a
gentleman of great experience, and who has given the _coup de grace_
to the opinion of contagion in cholera. Indeed the opinion now seems
to be virtually abandoned; for, as to quarantine on our ships from
Sunderland, it is, perhaps, a thing that cannot be avoided, if the main
consideration be _the expediency of the case_, until an arrangement
between leading nations takes place. We have seen, in regard to Austria,
how the matter stands, and our ships from every port in the country
would be refused admission into foreign ports, if we did not subject
those from Sunderland to quarantine; which state of things, it is hoped,
will now be soon put an end to.
FINIS.
Nichols and Sons, Printers,
Cranbourn-street, Leicester-square.
WINDSOR:
PRINTED BY R. OXLEY, AT THE EXPRESS OFFICE.
LETTERS
ON THE
CHOLERA MORBUS,
&c. &c. &c.
WINDSOR, FEB. 9, 1832.
Salus populi suprema lex.
In writing the following letters, which I have given in the order of
their respective dates, I was actuated by the state of the public mind
at the time in regard to the dreaded disease of which they principally
treat. The two first were addressed to the Editor of the WINDSOR
EXPRESS, and the third to a Medical Society here, of which I am a
member. The contemplation of the subject has beguiled many hours of
sickness and bodily pain, and I now commit the result to the press in a
more connected form, from the same motives, I believe, that influence
other writers--zeal in the cause of truth, whatever that may turn out to
be, and predilection for what has flowed from my own pen, not however
without the desire and belief, that what I have thus written may prove
useful in the discussion of a question which has in no small degree
agitated our three kingdoms, and most deeply interested every civilized
nation on the face of the earth.
No one, unless he can take it upon him to define the true nature of
this new malignant Cholera Morbus, can be warranted utterly to deny
the existence of contagion, but he may at the least be permitted to
say, that if contagion do exist at all, it must be the weakest in
its powers of diffusion, and the safest to approach of any that has
ever yet been known amongst diseases. Amateur physicians from the
Continent, and from every part of the United Kingdoms, eager and keen
for Cholera, and more numerous than the patients themselves, beset and
surrounded the sick in Sunderland with all the fearless self-exposing
zeal of the missionary character, yet no one could contrive, even in
the foulest dens of that sea-port, to produce the disease in his own
person, or to carry it in his saturated clothing to the healthier
quarters of the town where he himself had his lodging.[17] Surely
if the disease had been typhus fever, or any other capable of
contaminating the atmosphere of a sick apartment, or giving out
infection more directly from the body of a patient, the result must
have been different; its course, notwithstanding, has been most
unaccountably and peculiarly its own--slow and sure for the most part,
the infected wave has rolled on from its tropical origin in the far
distant east, to the borders of the arctic circle in the west--not
unfrequently in the face of the strongest winds, as if the blighting
action of those atmospherical currents had prepared the surface of the
earth, as well as the human body for the reception and deposition of
the poison; but so far from always following the stream and line of
population as has been attempted to be shown, it has often run
directly counter to both, seldom or never desolating the large cities
of Europe, like the plague and other true contagions, but rather
wasting its fury upon encampments of troops, as in the east, or the
villages and hamlets of thickly peopled rural districts.
[Footnote 17: The numbers were so great (to which I should probably
have added one had my health permitted) as actually to make gala day in
Sunderland, and to call forth a public expression of regret at their
departure.]
That it could have been descried on no other than the above line must be
self-evident, but to say that it has followed it in the manner that a
contagious disease ought to have done, in our own country for instance,
is at variance with the fact. From Sunderland and Newcastle to the south,
the ways were open, the stream of population dense and continuous, the
conveyances innumerable, the communications uninterrupted and constant.
Towards the thinly-peopled north how different the aspect,--townships
rare, the country often high, cold, and dreary, in many parts of the line
without inhabitants or the dwellings of man for many miles together,
yet does the disease suddenly alight at Haddington, a hundred miles off,
without having touched the towns of Berwick, Dunbar, or any of the
intermediate places. It is said to have been carried there by vagrant
paupers from Sunderland. Can this be true? Could any such with the
disease upon them in any shape, have encountered such a winter journey
without leaving traces of it in their course?[18] or, if they carried
it in their clothing, the winds of the hills must have disinfected
these _fomites_ long before their arrival. No contagionist, however
unscrupulous and enthusiastic, nor quarantine authority however vigilant,
can pretend to say how the disease has been introduced at the different
points of Sunderland, Haddington, and Kirkintulloch,--no more than he can
tell why it has appeared at Doncaster, Portsmouth, and an infinity of
other places without spreading. Even now, it lingers at the gates of
the great open cities of Edinburgh and Glasgow, as if like a malarious
disease, (which I by no means say that it is) it better found its food
in the hamlet and the tent, in fact, amongst the inhabitants of ground
tenements, than in paved towns and stone buildings. We must go farther
and acknowledge, that for many months past our atmosphere has been
tainted with the miasm or poison of Cholera Morbus, as manifested by
unusual cases of the disease almost everywhere, and that these harbingers
of the pestilence only wanted such an ally as the drunken jubilee at
Gateshead, or atmospherical conditions and changes of which we know
nothing, to give it current and power. That the epidemic current of
disease wherever men exist and congregate together, must, in the first
instance, resemble the contagious so strongly as to make it impossible to
distinguish the one from the other, must be self-evident; and it is only
after the touchstone has been applied, and proof of non-communicability
been obtained, as at Sunderland, that the impartial observer can be
enabled to discern the difference.--Still, however, must he be puzzled
with the inexplicable phenomena of this strange pestilence, but if he
feel himself at a loss for an argument against contagion, he has only to
turn to one of the most recent communications from the Central Board of
Health, where he will find that "That the subsidiary force under Col.
Adams, which arrived in perfect health _in the neighbourhood_ of a
village of India infected with Cholera, had seventy cases of the disease
the night of its arrival, and twenty deaths the next day," as if the
march under a tropical sun, and the encampment upon malarious ground, or
beneath a poisoned atmosphere, were all to go for nothing; and that the
neighbourhood of an infected village, with which it is not stated that
they held communication, had in that instantaneous manner alone, produced
the disease. This is surely drawing too largely upon our credulity, and
practising upon our fears beyond the mark.
[Footnote 18: The Cholera in this country would appear always to travel
with the pedestrian, and to eschew the stage coach even as an outside
passenger.]
The anti-contagionist, in acknowledging his ignorance, leaves the
question open to examination; but the contagionist has solved the
problem to his own mind, and closed the field of investigation, without,
however, ceasing to denounce the antagonist who would disturb a
conclusion which has given him so much contentment.--Let us here
examine, for a moment, who in this case best befriends his fellow men.
The latter, in vindication of a principle which he cannot prove, would
shut the book of enquiry, sacrifice and abandon the sick, (for to this
it must ever come the moment pestilential contagion is proclaimed,)
extinguish human sympathy in panic fear, and sever every tie of domestic
life,--the other would wait for proofs before he proclaimed the ban, and
even then, with pestilence steaming before him, would doubt whether
that pestilence could be best extinguished, or whether it would not be
aggravated into ten-fold virulence, by excommunicating the sick.
In my first letter I have endeavoured to unveil the mystery and fallacy
of fumigations, for which our government has paid so dear,[19] and
in place of the chemical disinfectants so much extolled, of the
applicability of which we know nothing, and which have always failed
whenever they were depended upon, have recommended the simple and sure
ones of heat, light, water, and air, with one exception, the elements
of our forefathers, which combined always with all possible purity of
atmosphere, person, and habitation, have been found as sure and certain
in effect as they are practical and easy of application.
[Footnote 19: Parliament voted a reward of £5000 to Doctor Carmichael
Smith for the discovery.]
Of our quarantine laws I have spoken freely, because I believe their
present application, in many instances, to be unnecessary cruel and
mischievous. Too long have they been regarded as an engine of State,
connected with vested interests and official patronage, against which
it was unsafe to murmur, however pernicious they might be to commerce,
or discreditable to a country laying claim to medical knowledge. The
regulation for preventing the importation of tropical yellow fever,
(which is altogether a malarious disease of the highest temperature of
heat and unwholesome locality,) into England or even into Gibraltar,
stands eminent for absurdity. It has long been denounced by abler pens
than mine, and I know not how it can be farther exposed, unless we could
induce the inhabitants of our West India Colonies to enforce the lex
talionis, and institute quarantines, which they might do with the same
or better reason, against the importation of pleurises and catarrhs from
the colder regions of Europe; a practical joke of this kind has been
known to succeed after reason, argument, and evidence, amounting to the
most palpable demonstration, had proved of no avail.
While I have thus impugned the authority of boards and missions, and
establishments, I trust it never can be imputed to me that I could
have intended any, the smallest personal allusion, to the eminent and
estimable men of whom they are composed,--all such I utterly disclaim;
and to the individual, in particular, who presided over our mission to
Russia, who has been my colleague in the public service, and whose
friendship I have enjoyed from early youth, during a period of more
than forty years, I would here, were it the proper place, pay the
tribute of respect which the usefulness of his life, and excellence
of his character, deserves.
LETTER I.
TO THE EDITOR OF THE WINDSOR EXPRESS.
Sir,--Being well aware of the handsome manner in which you have always
opened the columns of your liberal journal to correspondents upon every
subject of public interest, I make no further apology for addressing
through the WINDSOR EXPRESS, some observations to the inhabitants of
Windsor and its neighbourhood upon the all-engrossing subject of Cholera
Morbus.
That pestilence, despite of quarantine laws, boards of health, and
sanatory regulations, has now avowedly reached our shores, and we may be
permitted at last to acknowledge the presence of the enemy--to describe
to the affrighted people the true nature of the terrors with which he is
clothed--and to point out how these can be best combatted or avoided.
That the seeds of his fury have long been sown amongst us may be proved,
and will be proved, ere long, by reference to fatal cases of unwonted
Cholera Morbus appearing, occasionally during the last six months, in
London, Port Glasgow, Abingdon, Hull, and many other places, which, as
it did not spread, have been passed unheeded by our health conservators;
but, had the poison then been sufficiently matured to give it epidemic
current, would have been blazed forth as imported pestilence. Some one
or other of the ships constantly arriving from the north of Europe could
easily have been fixed upon as acting the part of Pandora's box, and
smugglers from her dispatched instanter to carry the disease into the
inland quarters of the kingdom. I write in this manner, not from
petulance, but from the analogy of the yellow fever, where this very
game I am now describing, has so often been played with success in the
south of Europe; and will be played off again, for so long as lucrative
boards of health and gainful quarantine establishments, with extensive
influence and patronage, shall continue to be resorted to for protection
against a non-existent--an impossible contagion.
But to the disease in question.--It must have had a spontaneous origin
somewhere, and that origin has been clearly traced to a populous
unhealthy town in the East Indies--no infection was ever pretended to
have been carried there, yet, it devastated with uncontroulable fury,
extending from district to district, but in the most irregular and
unaccountable manner, sparing the unwholesome localities in its
immediate neighbourhood, yet attacking the more salubrious at a
distance--passing by the most populous towns in its direct course at
one time, but returning to them in fury at another, staying in none,
however crowded, yet attacking all some time or other, until almost
every part of the Indian peninsula had experienced its visitation.
There is an old term, as old as the good old English physician,
Sydenham--_constitution of the atmosphere_--and to what else than to
some inscrutable condition of the element in which we live, and breathe,
and have our being--in fact to an atmospheric poison beyond our ken,
can we ascribe the terrific gambols of such a destroyer. 'Tis on record,
that when our armies were serving in the pestilential districts of
India, hundreds, without any noticeable warning, would be taken ill in
the course of a single night, and thousands in the course of a few days,
in one wing of the army, while the other wing, upon different ground,
and consequently under a different current of atmosphere, although in
the course of the regular necessary communication between troops in the
field, would remain perfectly free from the disease. It would then cease
as suddenly and unaccountably as it began,--attacking, weeks after, the
previously unscathed division of the army, or not attacking it at all
at the time, yet returning at a distant interval, when all traces of the
former epidemic had ceased, and committing the same devastation. Now,
will any man, not utterly blinded by prejudice, candidly reviewing
these facts, pretend to say, that this could be a personal contagion,
cognizable by, and amenable to, any of the known or even supposable laws
of infection--that the hundreds of the night infected one another, or
that the thousands of the few days owed their disease to personal
communication,--as well affect to believe that the African Simoon, which
prostrates the caravan, and leaves the bones of the traveller to whiten
in the sandy desert, could be a visitation of imported pestilence.
It may then be asked, have we no protection against this fearful plague?
No means of warding it off? Certainly none against its visitation! It
will come--it will go; we can neither keep it out, or retain it, if we
wished, amongst us. The region of its influence is above us and beyond
our controul; and we might as well pretend to arrest the influx of the
swallows in summer, and the woodcocks in the winter season, by cordons
of troops and quarantine regulations, as by such means to stay the
influence, of an atmospheric poison; but in our moral courage, in our
improved civilization, in the perfecting of our medical and health
police, in the generous charitable spirit of the higher orders,
assisting the poorer classes of the community, in the better condition
of those classes themselves, compared with the poor of other countries,
and in the devoted courage and assistance of the medical profession
every where, we shall have the best resources. Trusting to these, it has
been found that, in countries far less favoured than ours, wherever the
impending pestilence has only threatened a visitation, there the panic
has been terrible, and people have even died of fear; but when it
actually arrived, and they were obliged to look it in the face, they
found, that by putting their trust in what I have just laid down, they
were in comparative safety; that, the destitute, the uncleanly, above
all, the intemperate and the debauched, were almost its only victims;
that the epidemic poison, whatever it might be, had strength to prevail
only against those who had been previously unnerved by fear, or weakened
by debauchery; and that moral courage, generous but temperate living,
and regularity of habits in every respect, proved nearly a certain
safe-guard. They found further, that quarantine regulations were worse
than useless--that the gigantic military organization of Russia--the
rigorous military despotism of Prussia--and the all-searching police of
Austria, with their walled towns, and guards and gates, and cordons of
troops, were powerless against this unseen pestilence, and that as soon
as the quarantine laws were relaxed, and free communication allowed, the
disease assumed a milder character, and speedily disappeared.
I say, then, confidently, that Cholera Morbus never will commit ravages
in this country, beyond the bounds of the worst purlieus of society,
unless it be fostered into infectious, pestilential activity, by the
absurd, however well-meant, measures of the conservative boards of
health, such as have been just recommended in what has always been
esteemed the most influential, best-informed journal of England, I mean
the QUARTERLY REVIEW. If the writer of the article who recommends the
enforcement of the ancient quarantine laws in all their strictness, be
a medical man, he surely ought to know, that wherever human beings are
confined and congregated together in undue numbers, more especially if
they be in a state of disease, there the matter of contagion, the
typhoid principle, the septic (putrefactive) human poison or by what
other name it may be called, is infallibly generated and extends itself,
but in its own impure atmosphere only, as a personal infection to those
who approach it, under the form and features of the prevailing epidemic,
whatever that may be. Hence we have all heard of contagious pleurisies,
catarrhs, dysenteries, ulcers, &c., and if the doctrines of that writer
be received, we shall soon also hear of contagious Cholera Morbus with
a vengeance. His exhortations would go to shut up the sick from human
intercourse, to proclaim the ban of society against them, and under the
most pitiable circumstances of bodily distress, to proscribe them as
objects of terror and danger, instead of being as they actually are,
helpless innocuous fellow creatures, calling loudly for our promptest
succour and commiseration in their utmost need. They would go further to
array man against his fellow man in all the cruel selfishness of panic
terror, sever the dearest domestic ties, paralize commerce, suspend
manufactures, and destroy the subsistance of thousands, and all for the
gratification of a prejudice which has been proved to be utterly
baseless in every country of Europe from Archangel to Hamburgh and
Sunderland. Happily for our country, these measures are now as absurd
and impracticable as they would be tyrannical and unjust. They could not
be borne even under the despotic military sway of Prussia and Russia,
and in this free country it would be impossible to enforce them for a
single week. The very attempt would at once, throughout the whole land,
produce confusion and misery incalculable.
I say, on the contrary, throw open their dwellings to the free air
of heaven, the best cordial and diluent of foul atmosphere in every
disease--let their fellow townsmen hasten to carry them food,
fuel, cordials, cloathing, and bedding, speak to them the words of
consolation, and should they have fear to approach the sick, I take
it upon me to say, they will be accompanied by any and every medical
practitioner of the place, who, in their presence, will minister to the
afflicted, inspire their breath, and perform every other professional
office of humanity, without the smallest fear or risk of infection; for
they read the daily records of their profession, where it has been
proved to them, that in the open but crowded hospitals of Warsaw, under
the most embarrassing circumstances of warfare and disease, out of a
hundred medical men, with their assistants and attendants, frequenting
the sick wards of Cholera, not one took the disease; that, for the sake
of proving its nature, they even went so far as to clothe themselves
with the vestments of the dying, to sleep in the beds of the recently
dead, and to innoculate themselves in every way with the blood and
fluids of the worst cases, without, in a single instance, producing
Cholera Morbus.[20] The accounts may not, indeed, cannot be the same
from every other quarter, for medical men must be as liable to fall
under the influence of an atmospherical epidemic disease as other
classes of the community; but the above fact is alone sufficient to
prove that it cannot be a personal contagion.
[Footnote 20: Vide Medical Gazette.]
Even should that worst of true contagions, the plague of the Levant,
which every nation is bound to guard against, despite of all our
precautions, be introduced amongst us, measures better calculated for
the destruction of a community, could scarcely be devised, than the
ancient quarantine regulations; for they certainly would convert every
house proscribed by their mark, into a den and focus of the most
concentrated pestilential contagion, ensuring fearful retribution upon
those who had thus so blindly shut them up. The mark alone, besides
being equivalent to a sentence of death upon all the inmates, would
effect all this--the sick would be left to die unassisted, unpurified,
uncleansed amidst their accumulated contagion, and the dead, as has
happened before, lie unburied or scarcely covered in, till they
putrified in pestiferous heaps. Most certainly it would be proper and
beneficial, even a duty, for all who could afford the means, and were
not detained by public duties, to fly the place, and equally proper for
the other residents who continued in health, to segregate themselves as
they best could.--Plenty of free labour amongst those who must ever work
for their daily bread, would still remain for all municipal purposes,
and these our rulers, so far from consenting thus to proscribe the sick,
should employ openly in giving them every succour and aid, under the
direction and with instructions of safety from a well arranged medical
police. It would not be difficult to show, that the mortality, during
the last great plague in London, was increased a hundred fold, by
following the very measures now recommended in these regulations; and,
that the barbarous predestinarian Turk, in the very head quarters of the
plague itself, who despises all regulation, but attends his sick friend
to the last, never yet brought down upon his country such calamitous
visitations of pestilence, as enlightened Christian nations have
inflicted upon themselves, by ill-judged laws. The Turk, to be sure, by
rejecting all precaution, and admitting, without scruple, infection into
his ports, sees Constantinople invaded by the plague every year; but,
when not preposterously interfered with, it passes away, even amongst
that wretched population, like a common epidemic, without leaving any
remarkable traces of devastation behind it: and surely to establish and
make a pest-house of the dwelling of every patient who might be
discovered or even suspected to be ill, would be most preposterous.
The writing on the wall would not be more apalling to the people, and
scarcely less fatal to the object, than the cry of mad dog in the
streets, with this difference, that when the dog was killed, the scene
would be closed, but the proscribed patient would remain, even in his
death and after it, to avenge the wrong.
But sufficient to the day is the evil thereof, the question is now of
Cholera Morbus; I am willing to meet any objection, and the most obvious
one that can be offered to me, (if it be not an imported disease) is its
first appearance in our commercial sea-ports. To this I might answer,
that it has been hovering over us, making occasional stoops, for the
last six months, even in the most inland parts of the country; but I
will waive that advantage, and meet it on plainer grounds of argument
and truth.--An atmospherical poison must evidently possess the greatest
influence, where it finds the human race under the most unfavourable
circumstances of living, habits, locality, and condition. Now, where can
these be met with so obviously as in our large sea-port towns on the
lowest levels of the country, and in their crowded alleys, always near
to the harbour for the shipping? There the disease, if its seeds existed
in the atmosphere, would be most likely to break out in preference to
all other situations; and if at the time of its so appearing, ships
should arrive, as they are constantly doing from all parts of the world,
whose crews, according to the custom of sailors, plunge instantly into
drunkenness and debauchery, and present as it were, ready prepared, the
very subjects the pestilence was waiting for; how easy then, for an
alarmed or prejudiced board of health to point out the supposed
importing vessel, and freight her with a cargo of the new pestilence
from any part of the world they may choose to fix upon. This is no
imaginary case; it was for long of annual occurrence with respect to the
yellow fever, both in the West Indies and North America. "There our
thoughtless intemperate sailors were not only the first to suffer from
the epidemic, in its course or about to begin, but they were denounced
as the importers, by the prejudiced vulgar, and the accusation was
loudly re-echoed even amongst the better informed, by all who wished to
make themselves believe that pestilence could not be a native product
of their own atmosphere and habitations."
Before I have done, I feel called upon to say a few words upon the
efficacy of fumigation as a preservative against Cholera Morbus and
other infectious diseases. In regard to the first the question is
settled. In Russia, throughout Germany, and I believe everywhere else in
Europe, they were productive of no good, they did mischief, and were
therefore discontinued. This has been verified by reports from the seats
of the disease everywhere. In regard to other contagions I can speak,
not without knowledge, at least not without experience, for it was the
business and the duty of my military life, during a long course of
years, to see them practised in ships, barracks, hospitals, and
cantonements, and I can truly declare I never saw contagion in the
smallest degree arrested by them, and that disease never failed to
spread, and follow its course unobstructed, and unimpeded by their use.
In the well-conditioned houses of the affluent where ventilation and
cleanliness are matters of habit and domestic discipline, they may be a
harmless plaything during the prevalence of scarlet fever and such like
infections, or even do a little good by inspiring the attendants with
confidence, however false, as a preservative against contagion; but in
the confined dwellings of the poor they are positively mischievous,
because they cannot be used without shutting out the wholesome
atmospheric air, and substituting for it a factitious gas, which for
aught we know, or can know of the nature of the contagious vapour,
whether acid, alkaline, or anything else, may actually be adding to its
deleterious principle instead of neutralising it: but in thus striking
away a prop from the confidence of the poor, I thank God I can furnish
them with other preservatives and disinfectants, which I take it upon me
to say, they will find as simple and practicable as they are infallible.
For the first, the liberal use of cold water and observance of free
ventilation, with slaked lime to wash the walls, and quick lime when
they can get it, to purify their dung heaps and necessaries, are among
the best; but when actually infected, then heat is the only purificator
yet known of an infected dwelling. Let boiling water be plentifully used
to every part of the house and article of furniture to which it can be
made applicable. Let portable iron stoves, filled with ignited charcoal
only, be placed in the apartment closely shut, and the heat kept up for
a few hours to any safe degree of not less than 120° Farenheit, and let
foul infected beds and mattresses be placed in a baker's oven heated to
the same,[21] and my life for it no infection can after that possibly
adhere to houses, clothes, or furniture. The living fountain of
infection from the patient himself, constantly giving out the fresh
material, cannot of course be so closed, but whether he lives or dies,
if the above be observed, he will leave no infection behind him.[22]
[Footnote 21: The oven on that account need not lose character with
bread-eaters, for according to the old adage, Omne vitium per ignem
excoquitur.]
[Footnote 22: Light too, more especially when assisted by a current
of atmospheric air, is a true and sure disinfectant, but it is not so
applicable as heat in the common contagions, from requiring an exposure
of the infected substances for days together, or even a longer period,
before it can be made effective.]
It is now time to bring this tedious letter to a close; I shall be
happy, through the same channel, to give any information, or answer any
inquiries that may be authenticated by the signature of the writer; but
anonymous writing of any kind, I shall not consider myself bound to
notice. Should the dreaded disease spread its ravages throughout our
population, I may then, at some future early opportunity, trusting to
your indulgence, trespass again upon your columns with further
communications on this most interesting subject.
WILLIAM FERGUSSON,
Inspector-General of Hospitals.
P.S.--Throughout the foregoing letter, I have used the words contagion
and infection as precisely synonymous terms, meaning communicability
of disease from one person to another.
_November 9, 1831._
LETTER II.
TO THE EDITOR OF THE WINDSOR EXPRESS.
Sir,--In my last letter, I treated of the practicability of guarding
our country against the now European and Continental disease, malignant
Cholera Morbus, by quarantine regulations. In the present one, it is
my intention still in a popular manner to scrutinise more deeply,
the doctrine of imported contagions; to point out, if I can, those
true contagions which can be warded off by our own exertions, in
contradistinction to others which are altogether beyond our controul;
and here it may be as well to premise, that when I use the term
epidemic, I mean atmospheric influence, endemic-terrestrial influence,
or emanation from the soil; and by pestilential, I mean the spread of
malignant disease without any reference to its source. The terms
contagion and infection have already been explained.
It must be evident, that legislative precaution can only be made
applicable to the first of these. The last being unchangeable by human
authority, are not to be assailed by any decrees we can fulminate
against them; and if it can be shown, which it has been by our best and
latest reports, that Cholera Morbus eminently and indisputably belongs
to that class--that the strictest cordons of armed men could not avail
to save the towns of the continent, nor the strictest quarantine our
own shores, from its invasion--it surely must be time to cease those
vain attempts, to lay down the arms that have proved so useless, and
turn our undivided attention, now that it has fairly got amongst us,
to conservative police, and the treatment of the disease; but as the
contagionists still insist that it was imported from Hamburgh to
Sunderland, it behoves us to clear away this preliminary difficulty
before proceeding to other points of the enquiry.
I take it for granted, that ships proceeding from Sunderland to Hamburgh
could only be colliers, and that according to the custom of such
vessels, they returned, as they do from the port of London, light; and I
admit, that on or about the time of their return, Cholera Morbus, under
the severe form which characterises the Asiatic disease, made its
appearance in that port, presenting a fair _prima facie_ case of
imported contagion; but as at the period of its thus breaking out in
Sunderland, a case equally as fatal and severe shewed itself, according
to the public accounts, in the upper part of Newcastle, 10 miles off;
another equally well-marked, in a healthy quarter in Edinburgh; a third,
not long before in Rugby, in the very centre of the kingdom; and a
fourth in Sunderland itself, as far back as the month of August, as
well as many others in different parts of the country;[23] it became
incumbent on the quarantine authorities, indeed upon all men interested
in the question, whether contagionists or otherwise, to shew the true
state of these vessels, as well as of the cases above alluded to, and
whether the Cholera Morbus had ever been on board of them, either at
Hamburgh or during the homeward voyage, so as by any possibility they
could have introduced the disease into an English port. Now will any
person pretend to say that this has been done, or that it could not have
been done, or deny that it was a measure, which, if properly executed,
would have thrown light upon the true character of the disease, not only
for the information of our own government but of every government in
Europe; that deputations from the Board of Health, backed and supported
by all the power and machinery of government, with the suspected ships
locked up in quarantine, and the persons of the crews actually in their
power, could not have verified to the very letter, the history of every
hour and day of their health, from the moment of their arrival at
Hamburgh till their return into port? This measure was so obviously and
imperiously called for, as constituting the only rational ground on
which the importing contagionists could stand, or their opponents meet
them in argument, that after having waited in vain for the report, I
raised my own feeble voice in the only department to which I had access,
urging an immediate, though then late, investigation. No good cause,
having truth for its basis, could have been so overlooked, and without
unfairness or illiberality, we are irresistibly forced to the
conclusion, that had the enquiry (the only one, by the bye, worth
pursuing, as bearing directly on the question at issue) been pushed to
the proof, it would have shown the utter nullity of quarantine guards
against atmospherical pestilence, the thorough baselessness of the
doctrine of importation.
[Footnote 23: Two of a type most unusual for this country, and the
Winter Season, have occurred in the vale of the Thames, not far from
here, which, as they both recovered, and the disease did not spread in
any way, were very properly allowed to pass without sounding any alarm,
but the gentleman who attended one of the cases, and had been familiar
with the disease in India, at once recognized it again, in its principal
distinguishing features.]
Without entering into the miserable disputes on this subject,
which, amidst a tissue of fable and prejudice, self-interest and
misrepresentation, have so often disgraced the medical profession at
Gibraltar; I shall now proceed to shew, by reference to general causes,
how baseless and mischievous have been the same doctrines and authority
when exercised in that part of the British dominions:--
Within the last thirty years, yellow fever has, at least four times,
invaded the fortress of Gibraltar; during which time also, the
population of its over-crowded town has more than quadrupled, presenting
as fair a field, for the generation within, or reception from without,
of imported pestilence as can well be imagined,--yet plague, the truest
of all contagions, typhus fever, and other infectious diseases, have
never prevailed, as far as I know, amongst them. The plague of the
Levant has not been there, I believe, for 150 years; yet Gibraltar, the
free port of the Mediterranean, open to every flag, stands directly in
the course of the only maritime outlet, from its abode and birth-place
in the east, being in fact, to use the language of the road, the
house of call for the commerce of all nations coming from the upper
Mediterranean. Now, can there be a more obvious inference from all this,
than that the plague, being a true contagion, may be kept off without
difficulty, by ordinary quarantine precautions; but the other being an
endemic malarious disease, generated during particular seasons, within
the garrison itself, and the offspring of its own soil, is altogether
beyond their controul. The malarious or marsh poison, which in our
colder latitudes produces common ague, in the warmer, remittent fever,
and in unfavourable southern localities of Europe, (such as those of
crowded towns, where the heat has been steadily for some time of an
intertropical degree)--true yellow fever, which is no more than the
highest grade of malarious disease; but this has never occurred in
European towns, unless during the driest seasons--seasons actually
blighted by drought, when hot withering land winds have destroyed
surface vegetation, and as in the locality of Gibraltar, have left the
low-lying becalmed, and leeward town to corrupt without perflation or
ventilation amidst its own accumulated exhalations. I know not how I
can better illustrate the situation of Gibraltar in these pestiferous
seasons, than by a quotation from a report of my own on the Island of
Guadaloupe, in the year 1816, which, though written without any possible
reference to the question at issue, has become more apposite than
anything else I could advance; "all regular currents of wind have the
effect of dispersing malaria; when this purifying influence is
with-held, either through the circumstances of season, or when it
cannot be made to sweep the land on account of the intervention of
high hills, the consequences are most fatal. The leeward shores of
Guadaloupe, for a course of nearly 30 miles, under the shelter of a very
steep ridge of volcanic mountains, never felt the sea breeze, nor any
breeze but the night land-wind from the mountains; _and though the soil,
which I have often examined, is a remarkably open, dry and pure one,
being mostly sand and gravel, altogether, and positively without marsh,
in the most dangerous places, it is inconceivably pestiferous throughout
the whole tract, and in no place more so than the bare sandy beach near
the high-water mark_. The coloured people alone ever venture to inhabit
it; and when they see strangers tarrying on the shore after nightfall,
they never fail to warn them of their danger. The same remark holds good
in regard to the greater part of the leeward coasts of Martinique, _and
the leeward alluvial bases and recesses[24] of hills, in whatever port
of the torrid zone they may be placed_, with the exception, probably of
the immediate sites of towns, where the pavements prevent the rain-water
being absorbed into the soil, and hold it up to speedy evaporation."
Now, conceive a populous crowded town placed in this situation, and you
have exactly what Gibraltar and the other towns of Spain and North
America, liable to yellow fever, must become in such seasons as I have
above described, only, that as they grow more populous and crowded, the
danger must be greater, and its visitations more frequent, unless the
internal health police be made to keep pace in improvement, with the
increasing population.
[Footnote 24: The leeward niches and recesses of hills, however dry and
rocky, become in these seasons of drought, absolute dens of malaria,
this will be found proven in my reports made especially of the islands
of Dominique and Trinidad, which may be seen at the Army Medical Board
Office.]
Now in the name of injured commerce--of the deluded people of
England--of medical science--of truth and humanity--what occasion can
their be to institute an expensive quarantine against such a state of
things as this, which can only be mitigated by domestic health police;
or why conjure up the unreal phantom of an imported plague, to delude
the unhappy sufferers, as much in regard to the true nature of the
disease, as to the measures best calculated for their own preservation;
when it must be evident that the pestilence has sprung from amidst
themselves, and that had it been an external contagion in any degree,
the ordinary quarantine, as in case of the plague, would certainly have
kept it off; but the question of the contagion of yellow fever, so
important to commerce and humanity; and which, like the Cholera, has
more than once been used to alarm the coasts of England, demands yet
further investigation.
For nearly 40 years have the medical departments of our army and navy
been furnished with evidence, from beyond the Atlantic, that this
disease possessed no contagious property whatever. These proofs now lie
recorded by hundreds in their respective offices, and I take it upon me
to say, they will not be found contradicted by more than one out of a
hundred, amongst all the reports from the West Indies, which is as much
the birth-place of the yellow fever, as Egypt is of the plague: yet, in
the face of such a mass of evidence, as great or greater probably than
ever was accumulated upon any medical question, has our Government been
deluded, to vex commerce with unnecessary restraints, to inflict
needless cruelties upon commercial communities, (for what cruelty can be
greater than after destroying their means of subsistence by quarantine
laws, to pen them up in a den of pestilence, there to perish without
escape, amidst their own malarious poison?) and to burden the country
with the costs of expensive quarantine establishments. Surely if these
departments had done their duty, or will now do it, in so far as to
furnish our rulers with an abstract of that evidence, with or without
their own opinions, for opinions are as dust in the balance when put in
competition with recorded facts, it must be impossible that the delusion
could be suffered to endure for another year; or should they unluckily
fail thereby to produce conviction on Government, they can refer to the
records of commerce, and of our transport departments, which will shew,
if enquiry be made, that no ship, however deeply infected before she
left the port, (and all ships were uniformly so infected wherever the
pestilence raged) ever yet produced, or was able to carry a case of
yellow fever beyond the boundaries of the tropics, on the homeward
voyage, and that therefore the stories of conveying it beyond seas to
Gibraltar, must have been absolutely chimerical. It would indeed, have
been a work of supererrogation, little called for, for I think I have
fully shown that Gibraltar must be abundantly qualified to manufacture
yellow fever for herself.
No less chimerical will be the attempt to shut out Cholera Morbus from
our shores by quarantine laws, because throughout Europe, ready
prepared, alarmed, and in arms against it, they have succeeded nowhere;
whereas, had it been a true contagion and nothing else, they must, with
ordinary care, have succeeded everywhere; the disease, as if in mockery,
broke through the cordons of armed men, sweeping over the walls of
fortified towns, and following its course, even across seas, to the
shores of Britain; and yet we are still pretending to oppose it with
these foiled weapons.
We are indeed told, by authority, that its appearance in towns has
always been coincident with the arrival of barges from inland, or by
ships from the sea, but if it be not shown at the same time that the
crews of these barges had been infected with the disease, or if, as at
Sunderland, no person on board the ships can be identified as having
introduced it, while we know that the disease actually was there two
months before, we may well ask at what time of the year barges and ships
do not arrive in a commercial seaport, or where an epidemic disease,
during pestiferous seasons could be more likely to break out than where
the most likely subjects are thrown into the most likely places for its
explosion, such as newly arrived sailors in an unwholesome seaport,
where the license of the shore, or the despondency of quarantine
imprisonment must equally dispose them to become its victims.--Besides,
what kind of quarantine can we possibly establish with the smallest
chance of being successful against men who have not got, and never had
the disease. Merchandise has been declared incapable of conveying the
infection,[25] and are we to interdict the hulls and rigging of Vessels
bearing healthy crews, or are we to shut our ports at once against all
commerce with the North of Europe, and would this prove successful if we
did? a reference to a familiar epidemic will I think at once answer this
question.
[Footnote 25: Vide Russian Ukase.]
It is only three months ago that the epidemic Catarrh or Influenza
spread throughout the land, travelling like the Cholera in India, when
it went up the monsoon, without regard to the East wind; and what could
be more likely than the blighting drying process of such a wind, in
either the one or the other case, to prepare the body for falling under
the influence of whatever disease might be afloat in the atmosphere.
In general this passing disease can be distinctly traced, as having
affected our continental neighbours on the other side of the channel
before ourselves: now can it be supposed that any quarantine could have
prevented its first invasion, or arrested its farther progress amongst
us. How ridiculous would have been the attempt, and yet with the
experience of all Europe before us, have we been enacting that very part
with the Cholera Morbus: but further, the same authority which calls for
the establishment of quarantine in our ports, tells us that neither
proximity nor contact with the sick,[26] is requisite for the production
of the disease: now can anything further be wanting beyond this
admission, to prove that it must be an epidemic atmospherical poison,
and not a personal contagion, and that, under such circumstances, the
establishment of quarantine against persons and goods, would manifestly
be absurd and uncalled for. So fully satisfied has the Austrian
Government been made by experience, of the futility and cruelty of such
quarantines, that the Emperor apologises to his subjects for having
inflicted them. The King of Prussia makes a similar _amende_, and the
Emperor of Russia convinced by the same experience, abolished or greatly
relaxed his quarantines several mouths ago.
[Footnote 26: Vide Reports from Russia.]
I am by no means prepared to assert, because I cannot possibly know to
the contrary, although from the analogy of other disease I do not
believe it, that the Cholera Morbus may not become contagious under
certain conditions of the atmosphere, but these cannot be made subject
to quarantine laws, and I am fully prepared to acknowledge, that as in
the case of other epidemics, it may be made contagious through defective
police; but independent of these, it possesses other powers and
qualities of self-diffusion, which we can neither understand nor
controul. Such, however, is not the case with that other phantom of
our quarantine laws--the yellow fever--which can never, under any
circumstances of atmosphere, without the aid of the last be made a
contagious disease. I speak thus decisively from my experience of its
character, as one of the survivors of the St. Domingo war, where, in a
period of little more than four years, nearly 700 British commissioned
officers, and 30,000 men were swept away by its virulence; as also from
subsequent experience, after an interval of 20 years, when in the course
of time and service, I became principal medical officer of the windward
and leeward colonies, and in that capacity, surveyed and reported upon
the whole of these transatlantic possessions.
It was my intention, in these times of panic, to designate to my
countrymen, in as far as I could, the true essential intrinsic
contagions of the British Isles, (for such there are, and terrible ones
too,) which prevail under all circumstances of season, atmosphere, and
locality, as contradistinguished from the factitious ones, of our own
creating, and the imaginary or false which often spread epidemically,
(for there may be an epidemic as well as contagious current of
disease)[27] although they possess no contagious property whatever; as
well as the foreign contagions, which if we relax in due precaution,
may, at any time, be introduced amongst us--but the unreasonable length
of this letter, for a newspaper communication, warns me to stop.
[Footnote 27: For as long as men congregate together, and every
supposable degree of communication must of necessity be constantly
taking place amongst them, to distinguish a spreading epidemic from a
contagious disease when it first breaks out, must obviously be a matter
of impossibility; and upon this point the contagionists and their
antagonists may rail for ever,--the one will see nothing but contagion,
whether in the dead or the living body, and the other will refer every
fresh case to atmospheric or terrestrial influence, and both with as
much apparent reason as they possibly could desire: but the candid
impartial investigator, who waits to observe the course of the disease
before coming to a conclusion, and refers to the facts furnished in the
Cholera Hospitals of Warsaw and the sick quarters of Sunderland, will
never be deceived in regard to its real nature, nor propagate the
appalling belief that Cholera Morbus can be made a transportable and
transmissible contagion.]
I have written thus earnestly, because I deeply feel what I have here
put down. It is possible I may have made mistakes, but if I have, they
are not intentional, and I shall be happy to be corrected, for I do
not live at the head quarters of communication, and my broken health
prevents my frequenting in person, the field of investigation. In
candour I ought to declare, that the establishment of quarantine against
this new and hideous pestilence in the first instance, was the most
sacred duty of Government, but now that its true character has been made
known, and the futility of quarantine restrictions demonstrated, I feel
equally bound, as one of the lieges, to enter my humble protest against
their continuance.
Should I write again, I shall still adopt the same popular style,
for no other can be adapted to a newspaper communication, and the
subject-matter is as interesting to the public, and every head of a
family, as it can be to the professional reader; and, in thus making
use of your columns, as I can have no motive but that of ardent
research after truth, I know that I may always rely upon your
assistance and co-operation.
WILLIAM FERGUSSON,
Inspector-General of Hospitals.
_Windsor, Nov. 26, 1831._
LETTER III.
TO THE MEDICAL SOCIETY OF WINDSOR.
In this paper it is my intention to treat of the contagious diseases of
the British Isles, as well as to offer to the Society some observations
on malignant Cholera Morbus, and the mode of its propagation from the
tropical regions, where it first arose, to the colder latitudes of
Europe.
Having already published two letters on this last part of my subject,
I need not here take up your time in recapitulating their contents, but
proceed to the consideration of some remaining points of the enquiry;
which I find I have either overlooked, or not been so explicit in
illustration, as I otherwise might, had I been addressing a body of
professional men, instead of the community where I live, with the view
of _disabusing_ their minds from the effects of irrational panic, and
opening their eyes to what I deemed true measures of preservation
against the impending disease; and here I may as well add that when I
wrote in a newspaper and adopted the style suited to such a channel of
communication, I knew none so likely to attract the attention of those
influential men, who might possess the power and the will, when
disabused of prejudice, to enforce proper laws, instead of running the
course that had already been imposed upon them, by men interested in the
upholding of our quarantine establishments, or by prejudiced, however
well meaning, Boards of Health.
In looking over those letters, I find that the points most open to
dispute are the course of the disease throughout the Indian peninsula,
and its progress to the frontiers of Russia; as well as its supposed
infectious nature, and mode of propagation by human intercourse. In
regard to the first, there is no contagionist however avowed and
uncompromising, who does not admit that this erratic disease did not
often wander from its straight line when the most promising fields lay
directly before it; or stop short most unaccountably in its progress,
when the richest harvest of victims seemed actually within its
jaws--that its course was circuitous when, according to the laws of
contagion, it ought to have been straight,--that it refused its prey
at one time, and returned to it at another, in a manner that showed its
progress was governed by laws which we could neither understand nor
controul; and if we search the reports of contagionist writers, we
shall find fully as much, and as strong evidence of its progress being
independent of human intercourse, as of its being propagated and
governed by the laws of contagion.[28]
[Footnote 28: Vide Orton, Kennedy, &c.]
To the question, which has so often been triumphantly asked, of its
progress to the Russian frontiers being conducted by caravans along the
great highways of human intercourse, and what else than contagion could
cause it to be so carried? An admirable journalist has already replied
by asking in his turn, on what other line than amongst the haunts of men
could we possibly have found, or detected a human disease? And surely
the question is most pertinent, for in those barbarous regions that
interpose between Russia and India, where the wolf and the robber hold
divided alternate sway, and isolated man dares not fix his habitation,
but must congregate for safety; where else than in those great
thoroughfares could the disease have found its food; or if beyond these,
man, almost as ignorant and as savage as the wolf, could have been
found; who under such circumstances would have recognised, described,
and testified to its existence? Even at Sunderland, amongst ourselves,
its existence was long hotly disputed by the learned of the faculty; and
the fatalist barbarian of these regions would have dismissed the enquiry
with a prayer of resignation, while he bowed his head to the grave, or
if his strength permitted, with a stroke of his dagger against the
impious enquirer who had dared to interfere with the immutable decrees
of fate. The stories too of its importation into Russia, are exactly the
same as have come to us from our own Gibraltar, in the case of the
yellow fever, and may be expected to come from every other quarter where
a well paid officious quarantine is established to find infection in
its own defence, and to trace its course in proof of their own services
and utility. Under such circumstances, this well gotten up drama of
importation may be rehearsed in every epidemic, adapted in all its parts
to every place and every disease, they wish to make contagious. First
will be presented, as at Gibraltar, the actual importers--their course
traced--the disease identified--its reception denounced, and quarantine
established; and this will go down until sober minded disinterested men
become engaged in the enquiry, when it will turn out in all probability,
that the importers, as at Sunderland, never had the disease--that it was
in the place long before their arrival--that in its supposed course, it
either had no existence, or had long ceased--in fact that the
importation was a fable, the product either of design or an alarmed
imagination. On this point I shall not here farther dwell, but proceed
to the still keenly disputed question of its contagious, or
non-contagious nature.
Amongst all those who have advocated the affirmative side of the
question, an anonymous writer in the LANCET, of Nov. 19th. seems to me
the ablest special pleader of his party, and the best informed on the
subject, which he has grappled with a degree of acumen and power that
must at once have secured him the victory, in any cause that had truth
for its basis, or that could have stood by itself; but strong and
scornful as he is, he has himself furnished the weapons for his own
defeat, and has only to be correctly quoted in his own words, for answer
to the most imposing and powerful of his arguments. I take it for
granted, that no one will give credit to instantaneous infection, at
first sight, but allow that an interval must elapse between the
reception of the virus, and explosion of the disease. Kennedy and the
best of the contagionist authors, have fixed the intervening time from
two days to a longer uncertain period; yet that writer (in the LANCET)
proceeds to tell us, in proof of the virulence of the contagion, that
when twenty healthy reapers went into the harvest field at Swedia, near
Tripoli, and one of them at mid-day was struck down with the disease, he
then instantly, as if, instead of being prostrate on the ground, he had
run a muck for the propagation of Cholera Morbus, infected all the rest,
so that the whole were down within three hours, and all were dead before
the following morning.[29]--All this too in the open air. Another writer
of note relates that when a healthy ship on the outward voyage arrived
in Madras Roads, her people were seized with Cholera Morbus that very
morning; but they go further than this, and command us to believe in its
contagious powers, without sight at all, quoting the report from our
Commissioners in Russia, where it is officially announced "that neither
the presence, nor contact of the patient is necessary to communicate the
disease." Surely in candour we may be allowed to say that when they
limit their views to contagion alone, they have attributed powers to it,
which it never did, and never can possess. That some other principle,
besides their favourite one, must have been in operation, as well in the
field of Swedia, when it struck down the reapers, as when it blighted
our armies in the East, for these sudden bursts and explosions of
pestilence are incompatible with the laws and progress of natural
contagion,--that if, under a tropical temperature, which dissipates all
infection, there be contagion in the disease, their must also be other
powers of diffusion hitherto inscrutable, incomprehensible, and
uncontroulable,--that their doctrine of contagion exclusively, is
superficial narrow, and intolerant, and their arguments in support of
it, no more than a delusion of prejudice, a piece of consummate special
pleading to make the worse appear the better reason.[30]
[Footnote 29: The precise words are "20 peasants of Swedia, robust,
vigorous, and in the flower of life, were labouring at the harvest work,
when on the 9th. of July, at noon, one was suddenly attacked, and the
others in a short time showed symptoms of the disorder. In three hours,
the entire band was exhausted; before sunset many had ceased to live,
and by the morrow there was no survivor."]
[Footnote 30: The remainder of the paper, as presented to the Society,
treated of Typhus fever, and other matter, that had no reference to the
disease in question.]
Before concluding these observations, I would wish to make a few remarks
upon some points of the enquiry which have been either too cursorily
passed over, or not noticed at all; and first of its supposed attraction
for, and adherence to the lines and courses of rivers whether navigable
or otherwise. I do not think this quality of the disease has been
assumed on grounds sufficient to justify anything like an exclusive
preference. Along these lines, no doubt, it has very frequently been
found, because a malarious, a terrestrial, a contagious, or indeed any
other disease, would for many reasons, best prevail on the lowest levels
of the country, or the deepest lines on its surface, like the vallies of
rivers, provided the food on which it fed--population--there abounded.
It would be difficult almost anywhere to point out a populous city
unconnected with the sea, rivers, or canals, the water population of
which, from their habits of life and occupations, everywhere crowded,
dirty, careless, and exposed, must always afford ready materials for
any epidemic to work upon, and this may have given currency to the
prevailing opinion; but I rather believe, when enquiry comes to be made,
it will be found that the worst ravages of Cholera Morbus have been
experienced in the great level open plains of Upper Germany, and the
boundless jungly districts of India, remote from, or at least
unconnected with water communication, denoting thereby atmospheric
influence and agency, rather than any other.
Another consideration of some importance is the burial of the dead,
which according to published reports, has in some places been enforced
in so hurried a manner as deeply to wound the feelings of surviving
relatives, and in others to give rise to the horrid suspicion of
premature interment. Can this have been necessary in any disease, even
allowing it to be contagious, or was it wise and dignified in the
medical profession to make this concession to popular prejudice, at all
times when excited, so unmanageable and troublesome. Although we cannot
analyse the matter of contagion, we surely know enough of it to feel
assured, that it must be a production and exhalation from the living
body, arising out of certain processes going on there, in other words
out of the disease itself, which disease must cease along with the life
of the patient, and the exhalation be furnished no longer--that during
life it was sublimed, so as to leave the body and become diffused around
through the agency of the animal heat, created by the functions of
respiration and circulation of the blood, which being foreclosed and the
supplies cut off, all that remained of it floating before death in the
atmosphere, must be condensed upon the cold corpse and lie harmless.[31]
It must also be evident that when putrefaction begins, no production of
what belonged to the living body can remain unchanged, but must undergo
the transformation in form, substance and quality, ordained for all
things; for putrefaction, although it may possibly produce a disease
after its own character, is not pestilence, nor even compatible with it
in the case of specific diseases.
[Footnote 31: Even when a living product, we are authorised to believe,
from observations made upon the plague, that it cannot be propelled to
a greater distance than a few feet from the body of the patient--that it
is heavier than common air, settling down in a remarkable manner upon
the sick bed, and saturating the lower strata of the atmosphere in the
sick apartment.]
The puerile stories, therefore, of infection being taken from following
a coffined corpse to the grave, without reference to the state of
grief, fear, and fatigue, not improbably, of drunkenness, in the
mourners, must be unworthy of attention. I am no friend to the absurdly
long interval which in this country is allowed to elapse,[32] even in
the hottest weather, between death and burial; but still more do I
deprecate the indecent haste which would give sanction to panic, and
incur the risk or even the suspicion of interment before dissolution.
In regard to separate burying grounds, should the disease come to
spread, I am sure no one will expect, after what has just been said,
that I should attempt to argue the question seriously, nor enter a
protest against the further gratuitous wrong of withholding the rites
of sepulture in consecrated ground from the victims of an epidemic or
even a contagious disease.--Nothing could warrant such a measure but
want of room in the ordinary churchyards, where police should never be
allowed to interfere with the rights and feelings or property, of the
living, unless to ensure the privacy of funerals; nothing being so
appalling to an alarmed people as the spectacle of death in their
streets, or so trying to the health of the mourners, as tedious funeral
ceremonies amidst a crowd of people.
[Footnote 32: After sending these letters to the press, I saw in the
public prints that the Bishop of the Diocese had forbidden the funerals
of the dead from Cholera to be received in the churches of London.
Instead of thus forbidding a part, better have the whole of the service
performed there (where crowds do not come) under cover from the weather,
than in the open churchyard, where the mourners uncovered, are exposed
in every way to damp and cold, and the jostling of the mob; better still
have all the service deemed necessary, performed at the residence of
the deceased.]
Were I called upon to criticise what I have now written, and to
review all that I have seen, read, and heard on the subject, I would
conscientiously declare that the importation of Cholera Morbus into
England or anywhere else, had been clearly negatived, and its
non-contagious character almost as clearly established, always however
with the proviso and exception of the possibility of its being made a
temporary contingent contagion, amidst filth and poverty, and impurity
of atmosphere, from overcrowding and accumulation of sick, but neither
transmissible nor transportable out of its own locality, through human
intercourse. As the disease, like all the other great plagues, which at
various periods have desolated the earth, evidently came from the east,
it would be most desirable in pursuing our investigation, to have a
clear knowledge of the mode of its introduction into Russia on the
eastern boundary of Europe. Unfortunately we can place no dependence
upon the reports that have been published to prove importation there,
which are lame and contradictory, although coming from the avowed
partizans of contagion; but even had they been better gotten up, we
could not, unless they had been confirmed by the experience of other
nations, have received them with implicit reliance.
The Russian Employé of the provinces, _mendacior Parthis_, not from
greater innate moral depravity than others, but from the corruptions
of a despotic government which compel him to live under the rod of a
master, amidst a superstitious barbarous population, whose dangerous
prejudices he dare not offend, can only give utterance to what his
tyrants command. Even at the more civilized capital of Petersburgh, the
mob rose in arms to murder the foreign physicians when they did not act
according to their liking. Could the truth then be heard on such a
field, or what native officer would venture to impugn the authority
of his rulers, proclaiming contagion? If he did, he must cease to live
in the official sense of the word. Throughout Europe, from east to
west, the disease has followed its own route according to its own
incomprehensible laws, despite of every obstacle and precaution. We have
the authority of our own Central Board for believing that the disease
cannot be conveyed by merchandize of any kind, and that of our mission
to Russia for greatly doubting whether it can adhere to personal
clothing or bedding; and will it be pretended that human beings,
labouring under such a distemper in any form, could have been the
vehicles of spreading it in a straight line for thousands of miles
throughout civilized nations, armed and prepared to defend themselves
against its inroads,--they tried, but in vain. We, too, may strive to
discover the demon of the pestilence amidst the clouds of the climate,
or the winds of Heaven. He remains hidden to our view; and until better
revealed, it only remains for us to exercise towards our fellow men
those duties which humanity prompts, civilization teaches, and religion
enjoins.
POSTSCRIPT.
My friend, Doctor Stanford, of the Medical Staff, now settled here, has
given me the following valuable information, which my own observation
confirms, regarding the agency of panic, in promoting the diffusion of
epidemic disease. He happened to be serving with part of the British
army, at Cadiz, when an eruption of yellow fever took place there, in
the autumn of 1813, and as usually happens amongst medical men, the
first time they have seen that fever, some of them were staunch
contagionists, and impressed that belief upon the corps to which they
belonged. In all these the disease was most fatal to great numbers. The
men being half dead with fear, before they were taken ill, speedily
became its victims, to the great terror and danger of their surviving
comrades; but in the other regiments, where no alarm had been sounded,
the soldiers took the chances of the epidemic with the same steady
courage they would have faced the bullets of the enemy, in the lottery
of battle; escaping an attack for the most part altogether, or if
seized, recovering from it in a large proportion. From this picture let
us take a lesson, in case the impending epidemic should ever come to
spread in the populous towns of England, and the cry of contagion be
proclaimed in their streets. The very word will spread terror and dismay
throughout the people, causing multitudes to be infected, who would
otherwise, in all probability, have escaped an attack, and afterwards
consign them to death in despair, when they find themselves the marked
and fated victims of a new plague. Whatever they see around them, must
confirm and aggravate their despair, for desertion and excommunication
in all dangerous diseases, too certainly seal the fate of the patient.
It will be vain to tell them that hireling attendance has been
provided,--the life of the Choleraic depends upon the instant aid--the
able bodied willing aid of affectionate friends, who will devote
themselves to the task, and persevere indefatigably to the last. If
these be driven from his bed, his last stay is gone, for without their
active co-operation the best prescription of the physician is only so
much waste paper. What, let me ask, must have been the fate of the
patient, and what the consequent panic, if the case of Cholera that
occurred in London, a month ago at the Barracks of the Foot Guards,
had been proclaimed, and treated as a contagion? The poor fellow was
promptly surrounded by his fearless comrades, who with their kind hands
recalled and preserved the vital heat on the surface, by persevering in
the affectionate duty of rubbing him for many hours; but had the Medical
Staff of the regiment been true contagionists, they must, as in duty
bound, have commanded, and compelled every one of them to fly the
infection. It depended upon them, to have spread around a far wilder
and more dangerous contagion than that of Cholera Morbus, or any other
disease,--the contagion of fear--and from what occurred at Cadiz, as
above related, it is to be hoped our medical men will now see how much
they will have it in their power, when Cholera comes, to pronounce, or
to withhold sentence of desolation upon a community. The word Contagion
will be the word of doom, for then the healthy will fly their homes,
and the sick be deserted; but a countenance and bearing, devoid of that
groundless fear, will at once command the aid, and inspire the hopes
that are powerful to save in the most desperate diseases.
It is stated, in a Scotch newspaper, that two poor travellers, passing
from Kirkintulloch to Falkirk, ran the risque of being stoned to death
by the populace of the latter place, and were saved from the immolation
only by escaping into a house; and in an Irish one, that some
shipwrecked sailors incurred a similar danger. Such barbarities
must, in the nature of things, be practised every where under a reign
of terror, however humane or christianized the people may be--even the
fatalism of the Turk would not be proof against it. In Spain they have
been enacted in all their horrors (thanks to the quarantine laws) upon
the unfortunate victims of yellow fever;[33] and we shall soon see them
repeated amongst ourselves, unless the plain truth be promulgated by
authority to the people. Let them be told if such be the pleasure of
our rulers, (for it is not worth while disputing the point), that
Cholera Morbus is a contagion, but of so safe a nature in regard to
communicability, that not one in a hundred, or even a thousand, take
the disease,--that in this country, besides being a transient passing
disease, which according to certain laws and peculiarities of its own,
will assuredly take its departure in no long time; it is limited almost
always to particular spots and localities--that it is in their own
power, while it remains, to correct the infectious atmosphere of these
spots, by attention to health police--that they may fearlessly approach
their sick friends with impunity, for that the danger resides in the
above atmosphere, and not in the person of the patient; and that in all
situations they may defy it, for as long as they observe sobriety of
life and regularity of habits. Thus will public confidence be restored,
and thus be verified the homely adage of, "honesty, in all human
affairs, being ever the best policy"; for the concealment, or perversion
of the truth, however much it may be made to serve the purposes of the
passing day, can never ultimately promote the ends of good government
and true humanity, but must lead, sooner or later, to the exposure of
the delusion, or what would be far worse, to the perpetuation of error
and prejudice, and grossest abuse of the people, in regard to those
interests committed to our charge.
[Footnote 33: Vide O'Halloran, upon the Yellow Fever in Spain.]
* * * * *
Doctor Henry, of Manchester, has, in a late paper, published some most
interesting experiments, upon the disinfecting power of heat. He found
that the vaccine virus was deprived of its infecting quality, at 140°
of Farenheit, and that the contagions of Scarlatina, and Typhus fever,
from fomites, were certainly dissipated and destroyed, at the dry heat
of boiling water. In regard to these last, he might surely have ventured
to fix the standard of safety at a greatly lower temperature; for if the
grosser vaccine matter could be rendered inert at 140°, there can be
little doubt of the subtile gaseous emanations, which constitute the
aerial contagions, being dissipated by the same agent, at an inferior
degree. In the absence of direct experiment, we may venture to infer,
that 120° would suffice, to nullify these last. Such, at least, has been
the belief of those, who have been employed to purify ships, barracks,
and hospitals, from contagion, and I should think it must have been
founded on experience.[34]
[Footnote 34: As far back as the years 1796-7-8, this fact was familiar
to us in the St. Domingo war, only we were satisfied with a minimum heat
of 120°, from a belief that a temperature of that height, as it
coagulated the ova of insects (the cock roach for instance), and was
otherwise incompatible with insect life, would avail to dissipate
contagion.]
He does not treat of the disinfecting property of light, although such
an agent was well worthy of his notice; for the power, which in closely
stopped bottles can deprive Cayenne Pepper of its sting--render our
Prussic Acid as harmless as cream, and convert the strongest medicinal
powders into so much powder of _post_, can also avail to destroy the
matter and principle of Contagion. In fact, no other is used for
purifying goods, at our Lazzarettoes, where suspected articles of
merchandise, after some nugatory fumigations, are simply exposed to
light and air with such certain effect, that there is not, I believe,
in this country, any record of infection being propagated from them
afterwards. The experiments of Doctor Henry are as simple and beautiful
in themselves, as they promise to be useful and important, for now even
the horrible contagion of hospital gangrene would appear to be under
the controul of the pure agent he has been describing; and the principle
now established of light and heat, the grand vivifying powers of the
creation, being the sure and true preservers of the creature, man, from
the poisons generated even by himself, and otherwise around him, calls
for our admiration and gratitude, as shewing that these agents and
emanations of Almighty power can be made, in the hands of the practical
philosopher, to serve the purposes of domestic science, and in as far
as we can see, to fulfil, at least in that respect, the best intentions
of the Creator.
WINDSOR:
PRINTED RY R. OXLEY, AT THE EXPRESS OFFICE.
Transcriber's Note
Spelling variations have been retained in this ebook to match the
original text, e.g., quarrantines & quarantines, shew & show,
Farrell & Farrel, control & controul, employe & employé, coridors,
land wind & land-wind, reccommended & recommended, versts & wersts,
clothing & cloathing, apalling & appalling, prima facie & primâ facie,
alledged, and par metier & par métier.
Placement of footnote markers has been regularized to be located
outside of neighboring punctuation.
The following typographical corrections have been made to this text:
PART I
Foot 1: Removed stray comma (As medical men in this Country employ)
Page 6: Changed possesss to possess (still do not possess)
Page 13: Removed superfluous quote marks (Petersburg;--this gentleman)
Page 19: Removed duplicate word 'of' (has become a magazine of)
Page 19: Changed . to , (the cause of cholera,)
Page 21: Changed , to . (&c., in the office)
Page 22: Changed Mauritus to Mauritius (at the Mauritius before)
Page 22: Added . to Dr (Dr. Hawkins admits)
Page 24: Changed . to , (Martin M'Neal[6],)
Page 24: Changed knowlege to knowledge (any knowledge himself)
Page 26: Changed circustances to circumstances (two circumstances)
Page 28: Removed duplicate word 'a' (at least for a time)
Page 32: Changed intercouse to intercourse (or great intercourse)
Page 33: Added . to Dr (and Dr. Hawkins)
Foot 11: Changed importan to important (in the important)
Page 39: Moved misplaced comma (at Barcelonetta, the)
Page 45: Changed teminated to terminated (terminated favourably)
Page 46: Removed stray hyphen (he persists in giving)
Page 50: Moved misplaced period (this calamity (the cholera).)
Page 51: Changed çaon to 'ça on' (toute ça on trouve)
Page 53: Deleted superfluous end-quotes (took place.)
Page 53: Changed confied to confined (been confined to her bed)
Page 53: Changed macron to aigu accent (_employés_ attached)
Page 53: Changed authorties to authorities (authorities wished)
Page 54: Changed dimished to diminished (diminished all at once)
Page 54: Changed á to à (tout à coup)
Page 54: Changed entassès to entassés (crowded [_entassés_])
Page 54: Changed Franec to France (state like France)
Page 56: Added missing end-quotes (to the Burraumposter.")
Page 57: Changed em-dash to hyphen (Leicester-square)
PART II
Page 11: Changed typhoi'd to typhoid (the typhoid principle)
Page 15: Changed affluuent to affluent (houses of the affluent)
Page 17: Changed 'in' to 'In' (In my last letter)
Page 21: Changed absorded to absorbed (absorbed into the soil)
Page 22: Changed 'in' to 'it' (would certainly have kept it)
Page 24: Changed procees to process (drying process)
Page 26: Changed saered to sacred (the most sacred duty)
Page 30: Added missing ending punctuation (following morning.)
Page 31: Removed duplicate word always (always afford)
End of the Project Gutenberg EBook of Letters on the Cholera Morbus., by
James Gillkrest and William Fergusson
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