Having given, in my last letter, Dr. Davy's views as to the cause of
cholera, I may so far remark just now regarding them, that they are not
new, or peculiar to him; and that it may be well, before Dr. Macmichael
or others pronounce them vague, that they should inquire whether some
of those causes have not been assigned for the production of certain
epidemics, by one of the soundest heads of Dr. Macmichael's college--Dr.
Prout, who seems, if we have not greatly mistaken him, to have been led
to the opinion by some experiments of Herschell, detailed in the
Philosophical Transactions of the year 1824. They should recollect that
other competent persons devoted to researches on such subjects (Sir R.
Phillips among the number) admit _specific local atmospheres_ (not at
all _malaria_ in the usual sense of the term), produced by irregular
streams of specific atoms from the interior of the earth, and "arising
from the action and re-action of so heterogeneous a mass." For my part
I feel no greater difficulty in understanding how our bodies, "fearfully
and wonderfully made" as we are, should be influenced by those actions,
re-actions, and combinations, to which Sir Richard refers, and of
"whose origin and progress the life and observation of man can have no
cognizance," than how they are influenced by other invisible agents,
the existence of which I am compelled to admit.--If the writer of the
article on cholera in the _Westminster Review_, for October, 1831, do
not find all his objections met by these observations, I must only refer
him to the _quid divinum_ of Hippocrates:--but I must protest against
logic such has been employed by certain members of our Board of Health,
who lately, on the examination of gentlemen of the profession who
had served in India, and who had declared the disease not to be
communicable, came to the conclusion that it must, nevertheless, be
so, as those gentlemen could not show _what it was_ owing to.
Most extraordinary certainly it does appear, that while Dr. Macmichael
goes to the trouble of giving us (p. 27) the views of _a captain_ (!) as
to the progress of cholera at a certain place in India, he should have
refrained altogether from referring, on the point of contagion or
non-contagion, to the report of such a person as Dr. Davy, or to the
reports of this gentleman's colleagues at Ceylon, Drs. Farrell and
Marshall. Had Dr. Macmichael added a little to his extract from Capt.
Sykes, by informing us of what that gentleman states as to the great
mortality ("350 in one day") in the town of Punderpoor, "when the
disease first commenced its ravages there," people would have means of
judging how unlike this was to a contagious disease creeping from person
to person in its commencement.
It is painful to be obliged to comment on the manner in which Dr. Bisset
Hawkins has handled the questions relative to the Ceylon epidemic, which
seems far from being impartial; for, while he quotes (p. 172) Dr. Davy,
"a medical officer well known in the scientific world," as stating that
the cause of the disease is not in any _sensible_ changes in the state
of the atmosphere, he breaks off suddenly at the word _atmosphere_,
proceeds to talk of the changes in the muscles and blood of persons who
die of the disease, and passing over the part quoted from Dr. Davy, near
the close of my last letter, Dr. Hawkins leaves his readers to draw a
very natural conclusion--that, as Dr. Davy admitted that there were no
prevalent _sensible_ states of the atmosphere to which the cholera could
be attributed, _he, therefore_, believed it to have been propagated by
contagion, an inference which we now see must be quite wide of the mark.
Dr. Hawkins had, it appears, like many other medical gentlemen, access
to the reports from Ceylon, &c., in the office of the chief of the army
medical department in London, and it is to be regretted I think that,
with respect to one of the Ceylon reports, he only tells us (p. 174)
that "Mr. Staff-Surgeon Marshall reports from Candy, that of fifty cases
which had occurred, forty died." Why more had not been quoted from a
gentleman who had such ample means of witnessing the disease in its very
worst form, I must leave to others to say; but, referring again to the
highly interesting letter from Mr. Marshall on cholera, which appeared
in the _Glasgow Herald_, of the 5th of August last, and in which, from
many important observations which every body interested in cholera
should read and study, the following remarks will be found:--"In no one
instance did it seem to prevail among people residing in the same house
or barracks, so as to excite a suspicion that the contact of the sick
with the healthy contributed to its propagation." "The Indian Cholera,
as it is sometimes called, appears not to be essentially different from
cholera as it occurs in this and all other countries." "I consider it,
therefore, impossible for a medical practitioner to speak decisively
from having seen one, or even a few cases of cholera in this country,
and to say whether they are precursors of '_the epidemic_ cholera' or
not. That the disease is ever propagated by means of personal contact,
or by the clothes of the sick, has not, as far as I know, been
satisfactorily proved. The quality of contagion was never attributed
to the disease in Ceylon, and I believe no-where did it occur in
greater severity. I am aware that an attempt has been made to distinguish
the ordinary cholera of this country from the 'epidemic cholera,' by means
of the colour or quality of the discharges from the bowels. In the
former it is said the discharge is chiefly bile, while in the latter it
is said to bear no traces of bile, but to be colourless and watery. How
far is this alleged diagnosis well founded? I am disposed to believe
that, in all severe cases of cholera, whether it be the cholera of this
country, or the epidemic cholera, the secretion of bile is either
suppressed, or the fluid is retained in the gall-bladder." Mr. Marshall,
it may be observed, is the gentleman who was selected by the late
Secretary at War, in consequence of his known intelligence, to remodel
the regulations relative to military pensioners; and I understand that,
in consequence of the manner in which he executed that very important
duty, he has since been promoted. After what appears from the above
quotations, how perfectly unwarrantable must the assertion of Dr. Bisset
Hawkins seem, that "from the Coromandel coast it seems to have been
transported by sea to Ceylon!"
We shall, I think, be able to see that the assumption of Drs. Macmichael
and Hawkins, as to the importation of the disease into the Mauritius
from Ceylon, is equally groundless with that of its alledged importation
into the latter island; and here we have to notice the same want of
candour on the part of those gentlemen, in not having furnished that
public, which they professed to enlighten on the subject of cholera,
with those proofs within their reach best calculated to display the
truth; be it a part of my duty to supply the omissions of these
gentlemen in this respect. The following is a copy of a letter
accompanying the medical commission report at that island forwarded
to General Darling, the then commanding officer, by the senior medical
gentleman there.
"Port Louis, Nov. 23, 1819.
"I have the honour of transmitting the reports of the French and
English medical gentlemen on the prevalent disease; both classes of the
profession seem to be unanimous in not supposing it contagious, or of
foreign introduction. From the disease pervading classes _who have
nothing in common but the air they breathe_, it can be believed that the
cause may exist in the atmosphere. A similar disease prevailed in this
island in 1775, after a long dry season."
(Signed) W. A. BURKE,
Inspector of Hospitals.
In the reports referred to in the above letter, there is the most ample
evidence of the true cholera having appeared at different points in the
colony _before the_ arrival of the Topaze frigate, the ship _accused_ by
contagionists _par métier_, of having introduced the disease; so that,
contrary to what Dr. Macmichael supposes, those who disbelieve the
communicability of cholera, have no necessity whatever in this case for
pleading a coinsidency between the breaking out of the disease, and the
arrival of the frigate; indeed, his friend Dr. Hawkins seems to be aware
of this, when he is obliged to have recourse to such an argument as that
"it is, at all events, clear that the disease had not been _epidemic_ at
the Mauritius before the arrival from Ceylon;" so that the beginning of
an epidemic is to be excluded from forming a part or parcel of the
epidemic! Why is it that in medicine alone such modes of reasoning are
ever ventured upon!
We know, from the history of cholera in India, that not only ships lying
in certain harbours have had the disease appear on board, but even
vessels sailing down one coast have suffered from it, while sailing up
another has freed them from it, without the nonsense of going into
harbour to "expurgate." Now, with respect to the _Topaze_, it appears
that while lying in harbour in Ceylon, the disease broke out on
board her; that after she got into "_clene air_" at sea, the disease
disappeared, seventeen cases only having occurred from the time she left
the island, and she arrived at the Mauritius, as Dr. Hawkins admits,
without any appearance whatever of the cholera on board. On the day
after her arrival, she sent several cases ("chronic dysentry, hepatitis,
and general debility") to hospital, but not one of cholera; neither did
any case occur on board during her stay there, at anchor a mile and a
half from shore, and constantly communicating with shore,[5] while a
considerable number of deaths took place from cholera _in the merchant
vessels anchored near shore_.
[Footnote 5: Somebody is said to have seen a man on board with vomiting
and spasms, on the day before she moved to this anchorage, but the
surgeon of the ship has not stated this.]
As to the introduction of cholera from the Mauritius into Bourbon, where
it appeared but very partially, Dr. Macmichael very properly does not
say one word. There was abundance of "precaution" work, it is said,
and those who choose, are at liberty to give credit to the story of
its having been smuggled on shore by some negro slaves landed from a
Mauritius vessel. As to the _precautions_ to which the writer in _The
Westminster Review_ attributes the non-extension of the disease in this
island, hundreds of instances are recorded, in addition to those which
we have already quoted, of the disease stopping short, without cordons
or precautions of any kind--one remarkable instance is mentioned by Dr.
Annesley, where, _without seclusion_, the disease did not reach the
ground occupied by two cavalry regiments, although it made ravages in
all the other regiments in the same camp.
We have, perhaps, a right to demand from those gentlemen who display
such peculiar tact in the discovery of ships by which the cholera has,
at divers times, been imported into continents and islands, the names
of those ships which brought to this country, in the course of the
present year, the "_contagion_" which has produced, at so many
different points, cases of severe cholera, causing death in some
instances, and in which the identity with the "Indian cholera," the
"Russian cholera," &c., has been so _perfect_, that all the "perverse
ingenuity" of man cannot point out a difference. If it cannot be shown
that in this, we non-contagionists in cholera are in error, people
will surely see reason for abandoning the cause of cordons, &c., in
this disease,--a cause which, in truth, now rests mainly for support
upon a sort of conventional understanding, unconnected altogether, it
would appear, with the facts of the case, and entered into, we are
bound to suppose, before the full extent of the mischief likely to
arise from it had been taken into consideration. Admitting for a
moment that a case of cholera possessing contagious properties could
be imported into this country this year, will anybody say that a
"constitution of the atmosphere" favourable to its communicability to
healthy individuals, has not existed _in a very high degree_:--can a
spot be named in which cholera, generally of a mild grade, has not
prevailed? And if contagionists cannot point out a difference between
some of the severe cases to which public attention has been drawn, and
the most marked cases of the Indian or Russian cholera, I think that
now there should be an end to all argument in support of their cause.
Without at all going to the extent which might be warranted, I would
beg to be informed of the names of the ships by which the contagion
was brought, which caused the illness of the following individuals; or
if they be allowed, as I presume must be the case, not to have been
infected at all in this way, all that has been said regarding the
identity of the foreign and severe form of the home disease, must be
shown to be without foundation:--the detailed case of Patrick Geary,
which occurred in the Westminster Hospital,--the fatal case of Mr.
Wright, surgeon, 29, Berwick-street,--the cases, some of them fatal,
which occurred at Port Glasgow, and regarding which, a special inquiry
was instituted,--a case in Guy's Hospital, which caused some anxiety
about the middle of July last,--a case reported in a medical
periodical in August last, as having occurred in Ireland,--the fatal
case, as reported in my first letter, of Martin M'Neal,[6]--a second
case reported in a medical periodical in August,--a fatal case on the
12th of August last at Sunderland, reported upon to the Home Secretary
by the mayor of that town,--three cases reported in No. 421 of THE
LANCET,--a very remarkable case duly reported upon in September,
from the Military Hospital at Stoke, near Davenport, and a case with
thorough "congee stools," spasms, &c. (the details of which I may
hereafter forward), which occurred at Winchester on the 22d of
September, in the 19th Foot, in a man of regular habits, and of _the
nature_ of which case the medical gentleman in charge had no doubt.
[Footnote 6: The same Army Medical gentleman, who had been sent to Port
Glasgow, was sent to Hull to report upon this case:--he arrived there
too late, but having seen the details of the case, he admitted that he
saw no reason to declare them different from those which occurred in the
Indian cholera.]
I quite agree with those who are of opinion, that in this and most other
countries, cases may be every year met with exhibiting symptoms similar
to those which have presented themselves in any one of the above.
Instead of amusing us, when next writing upon cholera, with a quotation
about small-pox from Rhazes, bearing nonsense upon the face of it, some
of those who maintain the contagious property of Indian or any other
cholera, may probably take the trouble to give the information on the
above cases, so greatly required for the purpose of enlightening the
public.
I must now beg to return to an examination of one or two more of the
_very select_ quotations made by Dr. Macmichael, with the view, as
he is pleased to tell us, of placing the statements on both sides
in juxtaposition. He is well pleased to give us from Dr. Taylor,
assistant-surgeon,--what indeed never amounted to more than report, and
of the truth or falsehood of which this gentleman does not pretend to
say he had any knowledge himself,--that a traveller passing from the
Deacan to Bombay, found the disease prevailing at Panwell, through which
he passed, and so took it on with him to Bombay; but whether the man had
the disease, or whether he took its germs with him in some very
susceptible article of dress, is not stated by Dr. Taylor; however, he
states (what we are only surprised does not happen oftener in those
cases, when we consider similarity of constitution--of habits--of site
or aspect of their dwellings, &c.) that several members of a family, and
neighbours "were attacked within a very short period of each other;" but
when Dr. Taylor goes on to say, "In bringing forward these facts,
however, it may be proper at the same time to state, that of the
forty-four assistants employed under me, only three were seized with the
complaint;" he gets out of favour at once, and his observation is called
"unlucky," being but a _negative_ proof, and Dr. Macmichael adds, what
everybody must agree with him in, that positive instances of contagion
must outweigh all negative proofs:--to be sure:--but Dr. Macmichael's
saying this, does not show that positive proofs exist. Give us but
positive proofs, give even but a _few_, which surely may be done, if
the disease be really communicable, and where contagion has been so
ardently sought after by all sorts of _attachés_ and _employés_ of the
cordon and quarantine systems in the different countries on the
Continent. We could produce no mean authority to show, that _a long
succession of negative proofs_ must be received as amounting to a moral
certainty; and what greater proof can we have of non-contagion in any
disease, than we have in the fact regarding epidemic cholera, as well
as yellow fever, that attendants on the sick are not more liable than
others to be attacked? Regard should, of course, always be paid, in
taking this point into consideration, to what has been already noticed
in my second letter, or the inferences must be most erroneous. Dr.
Macmichael quotes the statement of Dr. Burrell, 65th regiment (and takes
care to put the quotation in italics too), that at Seroor, in 1818,
"almost every attendant in hospital had had the disease. There are about
thirty attendants in hospitals." Now, along with hundreds of other
instances, what does Dr. French, of the 49th regiment, say, in his
Report of 1829? That no medical man, servant, or individual of any kind,
in attendance on the sick, was taken ill at Berhampore, when the cholera
prevailed there that year, and refers, to his Report for 1825, in which
he remarked the same thing in the hospital of the 67th regiment at
Poonah; contrary, as he observes, to what occurred some years before in
the 65th regiment at Seroor, about forty miles distant. In the two
instances quoted by Dr. French, and in that by Dr. Burrell, all those
about the sick stood in the same relation towards them, and all the
difference will be found probably to have been, that the hospital of the
65th _was within the limit of the deteriorated atmosphere, where the
cause existed equally (as in the case of ague and yellow fever) whether
persons were present or not_.
In Egypt there is not, it is true, a "cruel and inhuman desertion" of
the unfortunate plague patients; for, among other reasons, being
predestinarians, they think it makes no sort of difference whether
they attend on the sick or not. Those who act upon the principle of
cholera being a highly contagious disease, may perhaps consider it
necessary to recommend, among their _precautions_, that the medical
men and attendants should be enveloped in those hideous dresses used
in some countries by those who approach plague patients[7]--fancy, in
the case of a sick female, or even of a man of pretty good nerves, the
effect of but half the precautions one hears of, as proper to be
observed. It is quite a mistake to suppose that the sick have not been
sometimes abandoned during the prevalence of epidemics; and that too
in cases where medical men had very erroneously voted the disease
contagious:--among other horrid things arising out of mistaken views,
who that has ever read it, can forget the account given by Dr.
Halloran, of the wretched yellow-fever patient in Spain, who, with a
rope tied round him, was dragged along for some distance by a guard,
when he was put into a shed, where he was suffered to die, without
even water to quench his thirst? I admit that, even with the views of
non-contagionists, difficulties obviously present themselves in regard
to the safety of those about the sick, when the latter are in such a
state as will not admit of their removal to a more auspicious spot
from that in which there is reason to believe they inhaled the noxious
atmosphere. From what has been observed in India and other places,
however, there is often sufficient warning in a feeling of _malaise_,
&c., and the distance to favoured spots, where people may be observed
not to be attacked, may be very short,--sometimes, as we have seen,
but a few yards, so that a removal of the patient, _with his friends_,
may be practicable, in a vast number of cases, previous to the setting
in of the more serious symptoms.
[Footnote 7: Since writing the above, I find that this scene has
actually occurred lately at Dantzic where a few miserable medical men
illustrated their doctrines of contagion, by skulking at a certain
distance about the sick, dressed up in oil skins, like the disgusting
figures we see in books, of the Marseilles doctors in the Lazaretto.
(See Sun Newspaper, 22nd, Nov.)]
I shall conclude this by cursorily referring to two circumstances which
have within a short time occurred on the Continent, and which seem to me
to be of no small importance in regard to cholera questions. It appears
that the committee appointed by the French Chamber of Deputies to
inquire into the questions connected with voting an additional sum to
meet cordon and quarantine expenses, in the event of the cholera making
its appearance in or near France, have made their report to the Chamber.
They declare that in India the cholera was proved not to have been
transmissible; and that in regard to Russia, it was not introduced, as
always contended for by some persons:--they refer to the city of Thorn
as exempt from the disease, though free from cordons, and in the midst
of a country where it prevails, while the disease appeared in St.
Petersburg and Moscow, notwithstanding their cordons, and even in
Prussia, where sanatory laws where executed "_avec une punctualité et
une rigeur ailleurs inconnues_." The money is nevertheless granted;
it is always a good thing to have, but they have set one curious
_condition_ upon its being granted, which displays consummate tact,
for it is to be employed solely in disbursements of a particular nature
(_dépenses materielles_), including, it may be presumed, temporary
hospitals, &c.; and that it is by no means ("_nullement_") to go into
the pockets of individuals.
The other circumstance to which I allude is that, like Russia and
Austria, Prussia has found that quarantines and cordons do not check
the progress of cholera. The king declares that the appearance of the
disease in his provinces, has thrown _new light_ on the question; he
specifies certain restrictions as to intercourse, which were forthwith
to be removed, and declares his intention to modify the whole. In
short, it is quite plain that, as Dr. Johnson has it in his last
journal,--those regulations will, "_in more countries than Russia,
be useless to all but those employed in executing them_."