If we view the progress of this terrific malady, as it tends to
disorganise society wherever it shows itself, as it causes the
destruction of human life on an extensive scale, or as it cramps
commerce, and causes vast expense in the maintenance of quarantine and
cordon establishments, no subject can surely be, at this moment, of
deeper interest. It is to be regretted, indeed, that, in this country,
political questions (of great magnitude certainly), should have
prevented the legislature, and society at large, from examining, with
due severity, all the data connected with cholera, in order to avert,
should we unhappily be afflicted with an epidemic visitation of this
disease, that state of confusion, bordering on anarchy, which we find
has occurred in some of those countries where it has this year appeared.
Were this letter intended for the eyes of medical men only, it would
be unnecessary to say that, during epidemics, the safety of thousands
rests upon the solution of these simple questions:--Is the disease
communicable to a healthy person, from the body of another person
labouring under it, either _directly_, by touching him, or _indirectly_,
by touching any substance (as clothes, &c.) which might have been in
contact with him, or by inhaling the air about his person, either during
his illness or after death?--Or is it, on the other hand, a disease
with the appearance and progress of which sick persons, individually
or collectively, have no influence, the sole cause of its presence
depending on unknown states of the atmosphere, or on terrestrial
emanations, or on a principle, _aura_, or whatever else it may be
called, elicited under certain circumstances, from both the earth and
air?--In the one case we have what the French, very generally I believe,
term _mediate_ and _immediate_ contagion, while the term _infection_
would seem to be reserved by some of the most distinguished of
their physicians for the production of diseases by a deteriorated
atmosphere:--much confusion would certainly be avoided by this adoption
of terms.[1] Now it is evident, that incalculable mischief must arise
when a community acts upon erroneous decisions on the above questions;
for, if we proceed in our measures on the principle of the disease not
being either directly or indirectly transmissible, and that it should,
nevertheless, be so in fact, we shall consign many to the grave, by
not advising measures of separation between those in health, and
the persons, clothes, &c., of the sick. On the other hand, should
governments and the heads of families, act on the principle of the
disease being transmissible from person to person, while the fact may
be, that the disease is produced in each person by his breathing the
deteriorated atmosphere of a certain limited surface, the calamity in
this case must be very great; for, as has happened on the Continent
lately, cordons may be established to prevent flight, _when flight, in
certain cases, would seem to be the only means of safety to many_; and
families, under a false impression, may be induced to shut themselves
up in localities, where "every breeze is bane."
[Footnote 1: As medical men in this Country employ the word _infection_
and _contagion_ in various senses, I shall, generally substitute
_transmissible_ or _communicable_, to avoid obscurity.]
Hence then the importance, to the state and to individuals, of a rigid
investigation of these subjects. It is matter of general regret, I
believe, among medical men, that hitherto the question of cholera has
not always been handled in this country with due impartiality. Even
some honest men, from erroneous views as to what they consider "the
safe side" of the question, and forgetting that the safe side can
only be that on which truth lies (for then the people will know
_what_ to do in the event of an epidemic), openly favour the side of
_communicability_, contrary to their inward conviction; while the good
people of the quarantine have been stoutly at work in making out that
precautions are as necessary in the cholera as in plague. Meantime our
merchants, and indeed the whole nation, are filled with astonishment,
on discovering that neighbouring states enforce a quarantine against
ships from the British dominions, when those states find that cases of
disease are reported to them as occurring among us, resembling more
or less those which we have so loudly, and I must add prematurely,
declared to be transmissible. It is quite true that, however decidedly
the question may be set at rest in this country, our commerce, should
we act upon the principle, of the disease not being transmissible,
would be subject to vexatious measures, at least for a time, on the
part of other states; but let England take the lead in instituting a
full inquiry into the whole subject, by a Committee of the House of
Commons; and if the question be decided against quarantines and
cordons by that body, other countries will quickly follow the example,
and explode them as being much worse than useless, as far as their
application to cholera may be concerned. It is very remarkable how, in
these matters, one country shapes its course by what seems to be the
rule in others; and, as far as the point merely affects commerce,
without regard to ulterior considerations, it is not very surprising
that this should be the case; but it is not till an epidemic shall
have actually made its appearance among us, that the consequences of
the temporising, or the precipitation, of medical men can appear in
all their horrors. Let no man hesitate to retract an opinion already
declared, on a question of the highest importance to society, if he
should see good reason for doing so, after a patient and unbiassed
reconsideration of all the facts. We are bound, in every way, to act
with good faith towards the public, and erroneous views, in which
that public is concerned, ought to be declared as soon as discovered.
To show how erroneous some of the data are from which people are
likely to have drawn conclusions, is the main cause of my wish to
occupy the attention of the public; and in doing this, it is certainly
not my wish to give offence to respectable persons, though I may have
occasion to notice their errors or omissions.
Previous to proceeding to the consideration of other points, it may be
observed, that all doubt is at an end as to the identity of the Indian,
Russian, Prussian, and Austrian epidemic cholera; no greater difference
being observed in the grades of the disease in any two of those
countries, than is to be found at different times, or in different
places, in each of them respectively. At the risk of being considered a
very incompetent judge, if nothing worse, I shall not hesitate to say,
that if the same assemblage, or grouping of symptoms be admitted as
constituting the same disease, it may at any time be established, to the
entire satisfaction of an unprejudiced tribunal, that cases of cholera,
not unfrequently proving fatal, and corresponding in every particular to
the average of cases as they have appeared in the above countries, have
been frequently remarked as occurring in other countries including
England; and yet no cordon or quarantine regulations, on the presumption
of the disease spreading by "contagion." For my own part, without
referring to events out of Europe, I have been long quite familiar, and
I know several others who are equally so, with cholera, in which a
perfect similarity to the symptoms of the Indian or Russian cholera has
existed: the collapse--the deadly coldness with a clammy skin--the
irritability of the stomach, and prodigious discharge from the bowels
of an opaque serous fluid (untinged with bile in the slightest
degree)--with a corresponding shrinking of flesh and integuments--the
pulseless and livid extremities--the ghastly aspect of countenance and
sinking of the eyes--the restlessness so great, that the patient has not
been able to remain for a moment in any one position--yet, with all
this, nobody dreamt of the disease being communicable; no precautions
were taken on those occasions "to prevent the spreading of the disease,"
and no epidemics followed. In the _Glasgow Herald_ of the 5th ult., will
be found a paper by Mr. Marshall, (a gentleman who seems to reason with
great acuteness), which illustrates this part of our subject. This
gentleman appears to have had a good deal of experience in Ceylon when
the disease raged there, and I shall have occasion to refer hereafter to
his statements, which I consider of great value. Nobody can be so absurd
as to expect, that in the instances to which I refer, _all_ the symptoms
which have ever been enumerated, should have occurred in each case; for
neither in India nor any-where else could all the grave symptoms be
possibly united in any one case; for instance, great retching, and a
profuse serous discharge from the bowels, have very commonly occurred
where the disease has terminated fatally: yet it is not less certain,
that even in the epidemics of the same year, death has often taken place
in India more speedily where the stomach and bowels have been but little
affected, or not at all. To those who give the subject of cholera all
the attention which it merits, the consideration of some of those cases
which have, within the last few weeks, appeared in the journals of this
country, cannot fail to prove of high interest, and must inspire the
public with confidence, inasmuch as they show, _beyond all doubt_, that
the disease called cholera, as it has appeared in this country, and
however perfectly its symptoms may resemble the epidemic cholera of
other countries, _is not_ communicable. On some of those cases so
properly placed before the public, I shall perhaps be soon able to offer
a few remarks: meanwhile, I shall here give the abstract of a case, the
details of which have not as yet, I believe, appeared, and which must
greatly strengthen people in their opinion, that these cholera cases,
however formidable the symptoms, and though they sometimes end rapidly
in death, still do not possess the property of communicating the disease
to others. I do not mean to state that I have myself seen the case, the
details of which I am about to give, but aware of the accuracy of the
gentleman who has forwarded them to me, I can say, that although the
communication was not made by the medical gentleman in charge of the
patient, the utmost reliance may be placed on the fidelity of those
details:--
Thursday, August 11th, 1831, Martin M'Neal, aged 42, of the 7th
Fusileers, stationed at Hull, was attacked at a little before four A.M.,
with severe purging and vomiting--when seen by his surgeon at about four
o'clock, was labouring under spasms of the abdominal muscles, and of the
calves of the legs. What he had vomited was considered as being merely
the contents of the stomach, and, as the tongue was not observed to be
stained of a yellow colour, it was inferred that no bile had been thrown
up. He took seventy drops of laudanum, and diluents were ordered.
Half-past six, seen again by the surgeon, who was informed that he had
vomited the tea which he had taken; no appearance of bile in what he had
thrown up; watery stools, with a small quantity of feculent matter;
thirst; the spasms in abdomen and legs continued; countenance not
expressive of anxiety; skin temperate; pulse 68 and soft; the forehead
covered with moisture. Ordered ten grains of calomel, with two of opium,
which were rejected by the stomach, though not immediately.
Eight o'clock A.M. The features sinking, the temperature of the body now
below the natural standard, especially the extremities; pulse small;
tongue cold and moist; a great deal of retching, and a fluid vomited
resembling barley-water, but more viscid; constant inclination to go to
stool, but passed nothing; the spasms more violent and continued; a
state of collapse the most terrific succeeded. At nine o'clock, only a
very feeble action of the heart could be ascertained as going on, even
with the aid of the stethoscope; the body cold, and covered with a
clammy sweat, the features greatly sunk; the face discoloured; the lips
blue; the tongue moist, and very cold; the hands and feet blue, cold,
and shrivelled, as if they had been soaked in water, like washerwomen's
hands; no pulsation to be detected throughout the whole extent of
the upper or lower extremities; the voice changed, and power of
utterance diminished. He replied to questions with reluctance, and in
monosyllables; the spasms became more violent, the abdomen being, to
the feel, as hard as a board, and the legs drawn up; cold as the body
was, he could not bear the application of heat, and he threw off the
bed-clothes; passed no urine since first seen; the eyes became glassy
and fixed; the spasms like those of tetanus or hydrophobia; the
restlessness so great, that it required restraint to keep him for ever
so short a time in any one position. A vein having been opened in one
of his arms, from 16 to 20 ounces of blood were drawn with the greatest
difficulty. During the flowing of the blood, there was great writhing of
the body, and the spasms were very severe--friction had been arduously
employed, and at ten A.M. he took a draught containing two and a half
drachms of laudanum, and the vomiting having ceased, he fell asleep. At
two P.M. re-action took place, so as to give hopes of recovery. At four
P.M. the coldness of the body, discoloration, &c., returned, but without
a return of the vomiting or spasms. At about half-past eight he died,
after a few convulsive sobs.
On a post-mortem examination, polypi were found in the ventricles of
the heart, and the cavæ were filled with dark blood. Some red patches
were noticed on the mucuous membrane; but the communication forwarded
to me does not specify on what precise part of the stomach or
intestinal canal; and my friend does not appear to attach much
importance to them, from their common occurrence in a variety of other
diseases. It remains to be noticed, that the above man had been at a
fair in the neighbourhood on the 9th (two days preceding his attack),
where, as is stated, he ate freely of fruit, and got intoxicated. On
the 10th he also went to the fair, but was seen to go to bed sober
that night. The disease did not spread to others, either by direct
or indirect contact with this patient.
Now let us be frank, and instead of temporising with the question, take
up in one hand the paper on "cholera spasmodica" just issued, for our
guidance, from the College of Physicians by the London Board of Health,
and in the other, this case of Martin M'Neal (far from being a singular
case this year, in most of the important symptoms),--let the symptoms be
compared by those who are desirous that the truth should be ascertained,
or by those who are not, and if distinctions can be made out, I must
ever after follow the philosophy of the man who doubted his own
existence. The case, as it bears on certain questions connected with
cholera, _is worth volumes of what has been said on the same subject_.
Let it be examined by the most fastidious, and the complete identity
cannot be got rid of, even to the _blue_ skin, the _shrivelled fingers_,
the _cold tongue_, the _change in voice_, and the _suppression of
urine_, considered in some of the descriptions to be found in the
pamphlet issued by the Board of Health, as so characteristic of the
"Indian" cholera; and this, too, under a "constitution of the
atmosphere" so remarkably disposed to favour the production of cholera
of one kind or other, that Dr. Gooch, were he alive, or any close
reasoner like him, must be satisfied, that were this remarkable form of
the disease communicable, no circumstance was absent which can at all
be considered essential to its propagation. As the symptoms in the case
of M'Neal, were, perhaps, more characteristically grouped than in any
other case which has been recorded in this country, so it has also in
all probability occurred, that more individuals had been in contact with
him during his illness and after his death, as the facility in obtaining
persons to attend the sick, rub their bodies, &c., must be vastly
greater in the army than in ordinary life; so that in such cases it is
not a question of one or two escaping, but of _many_, which is always
the great test.
Of the College of Physicians we are all bound to speak with every
feeling of respect, but had the document transmitted by that learned
body to our government, on the 9th of June last, expressed only a
"philosophic doubt," instead of making an assertion, the question
relative to the contagion or non-contagion of the disease, now making
ravages in various parts of Europe, would be less shackled among us.
People are naturally little disposed to place themselves, with the
knowledge they may have obtained from experience and other sources, in
opposition to such a body as the College: but as, in their letter to
government of the 18th of June, they profess their readiness, should it
be necessary, to "re-consider" their opinion, we, who see reason to
differ from them, may be excused for publishing our remarks. It seems
surprising enough that, in their letter to government of the 9th of
June, the College should have given as a reason for their decision
as to the disease being infectious (meaning, evidently, what some call
contagious, or transmissible from _persons_)--"having no other means of
judging of the nature and symptoms of the cholera than those furnished
by the documents submitted to us." Now, according to the printed
parliamentary papers, among the documents here referred to as having
been sent by the Council to the College, was one from Sir William
Crichton, Physician in Ordinary to the Emperor of Russia, in which a
clear account is given of the symptoms as they presented themselves in
that country; and, if the College had previously doubted of the identity
of the Russian and Indian cholera, a comparison of the symptoms, as they
were detailed by Sir William, with those described in various places in
the _three volumes_ of printed Reports on the cholera of India, in the
college library, must at once have established the point in the
affirmative. In fact, we know, that the evidence of Dr. Russell, given
before the College, when he heard Sir William's description of the
disease read, fully proved this identity to the satisfaction of the
College. Had the vast mass of information contained in the India
Reports, together with the information since accumulated by our Army
Medical Department, been consulted, all which are highly creditable to
those concerned in drawing them up, and contain incomparably better
evidence, that is, evidence more to be relied on, than any which can be
procured from Russia or any other part of the world--had these sources
of information been consulted, as many think they should in all fairness
have been, the College would probably have spoken more doubtingly as
to cholera, in any form, possessing the property of propagating itself
from person to person. Much of what passes current in favour of the
communication of cholera rests, I perceive, on statements the most
vague, assertions in a general way, as to the security of those who shut
themselves up, &c. To show how little reliance is to be placed on such
statements, even when they come from what ought to be good authority,
let us take an instance which happened in the case of yellow fever.
Doctor, now Sir William Pym, superintendent of the quarantine
department, published a book on this disease in 1815, in which he
stated, that the people shut up in a dock-yard, during the epidemic of
1814, in Gibraltar, escaped the disease, and Mr. William Fraser, also of
the quarantine, and who was on the spot, made a similar statement. Now,
we all believed this in England for several years, when a publication
appeared from Dr. O'Halloran, of the medical department of Gibraltar
garrison, in which he stated that he had made inquiries from the
authorities at that place, and that he discovered the whole statement to
have been without the smallest foundation, and furnishes the particulars
of cases which occurred in the dock-yard, among which were some deaths;
this has never since been replied to--so much as a caution in the
selection of proofs.
To show, further, how absurdly statements respecting the efficacy of
cordons will sometimes be made, it may be mentioned that M. D'Argout,
French minister of public works, standing up in his place in the
chamber, _on the 3rd instant_ (_Septr._), and producing his estimates
for additional cordons, &c., stated, by way of proving the efficacy of
such establishments, that in Prussia, where, according to him, cordon
precautions had been pre-eminently rigorous, and where "_le territoire
a été defendu pied à pied_," such special enforcement of the regulations
was attended with "_assez de succès_:" in the meantime the next mail
brings us the official announcement (_dated Berlin, Sept. 1_) of the
disease having made its appearance there!
To conclude, for the present: if there be one reason more than another
why the question of cholera should be scrutinized by the highest
tribunal--a parliamentary committee--it is, that in the "papers" just
issued by the Board of Health, the following passage occurs (page
36):--"But in the event of such removal not being practicable, on
account of extreme illness or otherwise, the prevention of all
intercourse with the sick, even of the family of the person attacked,
must be rigidly observed, unless," &c. There are some who can duly
appreciate all the consequences of this; but let us hope that the
question is still open to further evidence, in order to ascertain
whether it be really necessary that, in the event of a cholera epidemic,
"The living shall fly from
The sick they should cherish."