THE AVOIDANCE OF DISEASES MARKED WITH PALPABLE CONTAGIOUS POISONS—THE
LIMITED RANGE OF ACTION OF CONTAGION.
It was shewn in the first part of this work, that the contagious poisons
of disease, such as the matter of small-pox, are known to act in two
modes only, _first_, by application of the palpable matter itself to a
person, or by contactual contagion; _secondly_, by application of
clothes or other such substances, impregnated with that matter, forming
what has been styled fomitic or mediate contagion. It was also shewn,
that their action through the medium of the atmosphere, has never been
ascertained. Experiments were detailed, which were performed on those
poisons, to ascertain their capability to become dissolved in the air,
and their evidence was as strong as it possibly could be, against their
possessing that attribute.
It was, in short, fully ascertained, that contagious diseases do not
propagate by atmospheric contagion.
Contagious diseases propagate among those who expose their persons to
contact with the matters or clothes impregnated with them. There are
many facts of an incontrovertible character, which prove the occasional
operation of the former mode at least, and to render probable, that of
the latter; and hence, whatever attention is paid to cleanliness of the
sick person, his apartment, and to the prevention and removal of
vitiated air, persons touching a body, when there is present on its
surface specific contagious poison, such as the matter of small-pox, or
even handling clothes, which have become impregnated with it, incur a
risk of being affected with the same disease, by means of that matter or
fomitic contagion.
In all the contagious diseases (those in which there is eliminated a
palpable poison, or matter capable of causing the same disease in
others), their respective matters are invariably formed, and are apt to
propagate in the modes specified, so that visitors and other attendants
should ever be upon their guard, the first not to touch the sick person
at all, and the latter not to touch more than is necessary, and to take
precaution to render the risk as slight as possible.
Subjoined is a list of diseases which are known to be contagious, or to
be possessed of a matter of the nature referred to, and that are
therefore wont to be propagated by contact with the sick, or with his
clothes.
Small-Pox.
Scarlet Fever.
Measles.
Chicken-Pox.
Cow-Pox.
Itch.
Plague.
Porrigo.
&c.
These are almost the only diseases known in this country, which are
positively ascertained to be characterized by the elimination of
contagious matter, and which, therefore, there is any risk of getting by
contagion. The continued fever of this country has been supposed, by
some physicians, to be a contagious disease, from there being sometimes
observed pimples on persons affected with it; but that is by no means an
ascertained point.
Those above enumerated seem to include all the most important diseases
in this country, which are capable of being propagated by contagion,
acting in either of the two ways already described. Some of them are
capable of affecting the same individual only once, and some affect
persons as often as they are exposed to their specific contagious
matters.
How comparatively small, then, is the range of contagion,—an agent which
has been thought to accomplish worlds of mischief, and to destroy almost
whole communities.
Visitors may approach within a very short distance of persons afflicted
with these distempers, without danger of suffering, provided they do not
touch the bodies or the clothes.
They have nothing to apprehend from the atmosphere, if attention is paid
to the maintenance of its purity,—such as is necessary in other
situations, as well as in the sick-room.
Never brought into that immediate contact with the poisons which is
necessary for their propagation, they stand in need of no directions for
their removal or counteraction.
Those persons, on the other hand, who are called upon to touch the
patient and his clothes, are exposed to danger; and they should lessen
its amount, by instantly putting their hands into warm water, and by
freely washing them, with the assistance of soap,—and that ablution
should be performed after each instance of contact.
I have often had occasion to feel the pulse of persons ill of the worst
forms of confluent and black small-pox, and any risk that has thereby
been incurred, has been removed or remedied by immediately washing the
hand as directed.
In addition to washing, after that process is done, a small quantity of
a strong smelling liquid, such as Lavender water or Eau de Cologne,
should be poured into the hands. Their grateful odour may hide or cover
that of the apartment, which the attendant may mistake for contagious
air, as is often done, and thereby remove groundless apprehension. These
seem to be the chief precautions that are necessary for meeting the
dangers of contagion, if there is included what is sometimes used, viz.
a covering for the hand,—a glove and the like,—which, as being harmless,
and such as may possibly be useful, should be employed; and likewise the
avoiding of eating and drinking with the same instruments and vessels
used by the sick persons.
The propagation of disease by contagion, in the modes already stated,
though it can take place, and though it sometimes does take place, still
there are the strongest grounds for supposing it a comparatively rare
occurrence.
I have already shewn, at the beginning of this work, that in one form,
the atmospheric, contagion never operates, and I am now prepared to
assert, that in the two forms in which alone it can act, that the
instances of its undoubted agency are by no means nearly so common as
they are commonly believed to be, especially in connexion with those
acute diseases, accompanied with fever.
It is my belief, founded on much observation, study, and reflection,
that almost all cases of those contagious diseases, arise from causes or
circumstances connected with those great agencies already detailed at
full length, as inductive of pestilence in general, and of a nature
epidemic, endemial, meteorological, and the like.
I am led to the opinion, that this course of origin, even in contagious
diseases, is the rule, and that the origin of disease, by contagion,
whether contactual or mediate, is the exception. The grounds of this
opinion are,—
_1st_, A fact well ascertained, and of which I had lately two instances,
in houses contiguous. Infants neither inoculated, nor vaccinated, lie
with their mothers and others ill of small-pox, and do not take that
distemper.
_2d_, Women, while labouring under small-pox, occasionally bear children
in perfect health.
The above are common occurrences, and I am in possession of the
particulars of several which came under my own observation in the
beginning of 1838.
These cases prove the occasional, nay, the frequent inactivity of
contagious poison, even when applied in a palpable form, and in a recent
condition, to the bodies even of those who are not protected against its
operation by inoculation for cow or small-pox, or by a previous attack
of disease; and this inactivity is observed too, when the most ample
opportunity is afforded for the action of the poison, viz. while
children are asleep together in the same bed, and when infants are upon
the breast of mothers affected with small-pox.
Those very children who thus escape taking disease by contagion, are
frequently known to be seized with that identical disease, at some
future time, varying from months to years, when no other case is known
to exist in the neighbourhood, and where there is no room to suspect the
operation of contagion.
It is, I believe, as common as the contrary course, for small-pox, and
other reputed contagious diseases, after appearing in one house in a
town or hamlet, to break out in others at a distance and in different
directions, and not to progress from that which was first attacked to
those lying adjacent, or to spread around as from a centre.
For example, the first case of Typhus Fever which occurred in my
practice, in January 1839, was at Meadow Mill, a village half a mile
north of Tranent; the second case was at a hamlet called Redcoll, about
four miles east; the fourth and fifth cases occurred in Tranent; while
the sixth and last for that month appeared at Elphinstone, a village
situated about two miles to the south-west of Tranent.
I am led also to the opinion, that the ordinary cases, even of those
diseases which are known to be occasionally propagated by contagious
poison, do not arise from contagion, but from other circumstances and
agencies; by the history of the plague, for while that scourge is
ravaging in the East, and destroying hundreds daily, it frequently
ceases, immediately upon the overflowing of the Nile, which buries and
covers the pestiferous soil, and the putrefying materials which had been
exhaling noxious emanations.
This sudden departure or cessation of plague, upon the overflowing of
the Nile, proves that contagion, though it may be the cause of some
cases of that disease, is not the occasion of the vast majority,—the
great mass of cases, in short, which constitute the Epidemic; and goes
far to prove that distemper to be dependent upon an unwholesome
condition of the soil, or vitiated atmosphere, and other widely extended
and unwholesome agencies, of a nature totally different from specific
contagious poison.
That fact goes to prove, in reference to one disease, viz. Plague, what
I believe holds with all other contagious distempers, that contagion, at
most, is only an occasional, while such influences as those to which
reference has been made, are the constant and general causes of
sickness.