Letters on the Cholera Morbus Part 3

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 ent.i.ty 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 pa.s.sed 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 a.s.sertions 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 a.s.sertion 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_ s.h.i.+p (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 s.h.i.+p, THEIR IDENt.i.tY HAS NEVER ONCE BEEN DISPUTED BY THOSE MOST ANXIOUS TO PROVE THEIR CASE. No; the point has, in common parlance, been always _s.h.i.+rked_; 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 _ca.s.se-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 pa.s.sed among us."--I am sure, good people, n.o.body 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 emba.s.sy 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 a.s.siduous 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 circ.u.mstances, 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 princ.i.p.al 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 princ.i.p.al 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 a.s.sisting 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 circ.u.mstances, which entirely negative contagion, (supposing it to exist), as he had nothing whatever to do with the persons of the sick, though he occasionally a.s.sisted at the interment of the dead. He was merely a subordinate a.s.sistant 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 circ.u.mstances."

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 doc.u.ment 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 b.r.e.a.s.t.s, 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 [_enta.s.ses_] 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 cla.s.ses, and those given to spirituous liquors.

Scarcely twenty persons in easy circ.u.mstances 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 a.n.a.logy 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 ma.s.s 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 circ.u.mstance 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 circ.u.mstance 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 circ.u.mstances 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 s.h.i.+p, 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 embarra.s.sing to the medical inquirer, [for our part we cannot see the _embarra.s.sment_]

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 quant.i.ty 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 s.p.a.ce, 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, p.r.o.nounced 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 ent.i.tled 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 s.h.i.+ps 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 s.h.i.+ps 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.