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, _cæteris
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. Hèly 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.