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diff --git a/28147.txt b/28147.txt new file mode 100644 index 0000000..2981ea0 --- /dev/null +++ b/28147.txt @@ -0,0 +1,4644 @@ +The Project Gutenberg EBook of Letters on the Cholera Morbus., by +James Gillkrest and William Fergusson + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +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 + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK LETTERS ON THE CHOLERA MORBUS. *** + + + + +Produced by Bryan Ness, C. St. Charleskindt, and the Online +Distributed Proofreading Team at https://www.pgdp.net (This +file was produced from images generously made available +by The Internet Archive/American Libraries.) + + + + + + + + + +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 cavae 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 ete defendu pied a pied_," such special enforcement of the regulations +was attended with "_assez de succes_:" 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 Jonnes 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 metier_ 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 metier_, 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 _attaches_ and _employes_ 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 punctualite 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 +(_depenses 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, _caeteris +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. Hely 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 Jonnes 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 Lichtenstaedt, 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 _naive_ 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 aetas_. 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-meme_.") 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 axillae 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 _enrages_? 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-tete_, +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 Aretaeus, 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, _prima 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 ca 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 _employes_ 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 a +coup_), and without any appreciable cause. The points of the city most +distant from each other were invaded. Numbers of families crowded +[_entasses_] 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 L5000 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 deg. 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 Employe 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 deg. +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 deg., 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 deg. 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 deg., 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 & employe, coridors, +land wind & land-wind, reccommended & recommended, versts & wersts, +clothing & cloathing, apalling & appalling, prima facie & prima facie, +alledged, and par metier & par metier. + +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 caon to 'ca on' (toute ca 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 (_employes_ attached) + Page 53: Changed authorties to authorities (authorities wished) + Page 54: Changed dimished to diminished (diminished all at once) + Page 54: Changed a to a (tout a coup) + Page 54: Changed entasses to entasses (crowded [_entasses_]) + 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 + +*** END OF THIS PROJECT GUTENBERG EBOOK LETTERS ON THE CHOLERA MORBUS. *** + +***** This file should be named 28147.txt or 28147.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/2/8/1/4/28147/ + +Produced by Bryan Ness, C. 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