It was well and wisely said, that to know any-thing thoroughly, it must
be known in all its details; and, to gain the confidence of the public
in the belief of non-contagion in cholera, it is in vain that they are
informed that certain alleged facts, brought forward industriously
by contagionists, are quite groundless, unless proofs are given showing
this to be the case. The public must, in short, have those alleged
instances of contagion which have gained currency circumstantially
disproved, or they will still listen to a doctrine leading to the
disorganization of the community wherever it is acted upon. It is
solely upon this ground that these letters have any claim to attention.
Dr. James Johnson, of London, has, since my last letter, publicly
contradicted, with all the bluntness and energy of honest conviction,
the statement by Sir Gilbert Blane, Drs. Macmichael, Hawkins, &c., as to
the importation of the cholera into the Mauritius by the Topaze frigate;
but _evidence_ is what people want on these occasions, and, relative to
the case in question, probably the public will consider what is to be
found in my third and fourth letters, quite conclusive. Having again
mentioned the Mauritius, I cannot refrain from expressing my great
surprise that Mr. Kennedy, who has lately published on cholera, should
give, with the view of showing "the dread and confusion existing at the
time," a proclamation by General Darling, while he does not furnish a
word about the result of the proceedings instituted by that officer, as
detailed in my third letter, relative to the non-contagious nature of
the disease, a point of all others the most important to the public. As
to accounts regarding the confusion caused by the appearance of epidemic
cholera, we have had no lack of them in the public papers during many
months past, from quarters nearer home.
Regarding a statement made by Dr. Hawkins in his book on cholera, viz.
"That Moreau de Jonnés has taken great pains to prove that the disease
was imported into the Russian province of Orenburg," Dr. H. omits to
tell us how completely he failed in the endeavour. In the _Edinburgh
Medical and Surgical Journal_ for July, 1831, there is a review of a
memoir by Professor Lichtenstädt, of St. Petersburg, in which M.
Moreau's speculations are put to flight. From the efforts of this
_pains-taking_ gentleman (M. Moreau) in the cause of contagion in
cholera, as well as yellow-fever, he seems to be considered in this
country as a medical man; but this is not the case: he raised himself by
merit, not only to military rank, but also to literary distinction, and
is a member of the Academy of Sciences, where he displays an imagination
the most vivid, but as to the sober tact necessary for the investigation
of such questions as those connected with the contagion or non-contagion
of cholera and yellow-fever, he is considered _below par_. He saw the
yellow-fever in 1802-3, at Martinique, while _aid-de-camp_ to the
Governor, and still adheres to the errors respecting it which he imbibed
in his youth, and when he was misled by occurrences taking place _within
a malaria boundary_, where hundreds of instances are always at hand,
furnishing the sort of _post hoc propter hoc_ evidence of contagion with
which some people are satisfied, but which is not one bit less absurd,
than if a good lady, living in the marshes of Kent, were to insist upon
it, that her daughter Eliza took the ague from her daughter Jane,
because they lived together. Strange to say, however, M. Casimir Perier,
the Prime Minister of France, seems to be guided, according to French
journals, by the opinions of this gentleman on cholera, instead of by
different medical commissions sent to Warsaw, &c.
The question of contagion in cholera has been now put to the test in
every possible way, let us view it for a moment, as compared with what
has occurred in regard to typhus at the London Fever Hospital, according
to that excellent observer Dr. Tweedie, physician to the establishment.
Doubts, as we all know, have been of late years raised as to the
contagion of typhus, but I believe nothing that has as yet appeared is
so well calculated to remove those doubts as the statements by this
gentleman (_see "Illustrations of Fever"_), where he shows that it has
been remarked for a series of years that "the resident medical officers,
matrons, porters, laundresses, and domestic servants not connected with
the wards, and every female who has ever performed the duties of a
nurse, have one and all been the subjects of fever,"--while, _in the
Small-Pox Hospital_, which adjoins it, according to the statements of
the physician, "no case of genuine fever has occurred among the medical
officers or domestics of that institution for the last eight years." Had
typhus been produced in the attendants by _malaria_ of the locality,
those persons in the service of the neighbouring Small-Pox Hospital
should also have been attacked to a greater or less extent, it is
reasonable to suppose, within the period mentioned. Now let this be
compared with all that has been stated respecting attendants on cholera
patients, and let it be compared with the following excellent fact in
illustration, showing how numbers labouring under the disease, and
brought from the inauspicious spot where they were attacked to a place
occupied by healthy troops, did not, _even under the disadvantage of a
confined space_, communicate the disease to a single individual:--"It
has been remarked by many practitioners, that although they had brought
cholera patients into crowded wards of hospitals, no case of the disease
occurred among the sick previously in hospital, or among the hospital
attendants. My own experience enables me fully to confirm this. The
Military Hospital at Dharwar, an oblong apartment of about 90 feet by
20, was within the fort, and the lines of the garrison were about a mile
distant outside of the walls of the fort. On two different occasions (in
1820 and 1821), when the disease prevailed epidemically among the troops
of that station, while I was in medical charge of the garrison, but
while no cases had occurred in the fort within which the hospital was
situated, the patients were brought at once from their quarters to the
hospital, which, on each occasion, was crowded with sick labouring under
other disorders. No attempt was made to separate the cholera patients.
On one of these occasions, no case of cholera occurred within the
hospital; on the other, one of the sick was attacked, but he was a
convalescent sepoy, who had not been prevented from leaving the fort
during the day. The disease, on each of those occasions, was confined
to a particular subdivision of the lines, and none of those within the
fort were attacked." (_Bell on Cholera_, p. 92.)
I have already quoted from Dr. Zoubkoff of Moscow, once a believer in
contagion; every word in his pamphlet is precious; let but the following
be read, and who will then say that "the seclusion of the sick should be
insisted on?"--"The individuals of the hospitals, including soldiers and
attendants on the sick, were about thirty-two in number, who, excepting
the medical men, had never attended any sick; we all handled, more or
less, the bodies of the patients, the corpses, and the clothes of the
sick; have had our hands covered with their cold sweat, and steeped in
the bath while the patients were in it; have inhaled their breath and
the vapours of their baths; have tasted the drinks contained in their
vessels, all without taking any kind of precaution, and all without
having suffered any ill effects. We received into our hospital
sixty-five cholera patients, and I appeal to the testimony of the
thirty-six survivors, whether we took any precautions in putting them
into the bath or in handling them--whether we were not seated sometimes
on the bed of one, sometimes on that of another, talking to them. On
returning home directly from the hospital, and without using chloride
of lime, or changing my clothes, I sat down to table with my family, and
received the caresses of my children, firmly convinced that I did not
bring them a fatal poison either in my clothes or in my breath. Nobody
shut his door either against me or my colleagues; nobody was afraid to
touch the hand of the physician who came direct from an hospital--that
hand which had just before wiped the perspiration from the brow of
cholera patients. From the time that people had experience of the
disease, nobody that I am aware of shunned the sick." Who, after this,
can read over with common patience directions for the separation of a
cholera patient from his friends, as if "_an accursed thing_?" or who
(_il faut trancher le mot_) will now follow those directions?
As to the good Sir Gilbert Blane, who has distributed far and wide a
circular containing a description the most _naïve_ on record, of the
epidemic cholera, hard must be the heart which could refuse making
the allowance which he claims for himself and his memoir; and though
he brands those who see, in his account of the marchings and
counter-marchings of the disease, nothing on a level with the
intellect of the present age, as a parcel of prejudiced imbeciles,
we must still feel towards him all the respect due to a parent arrived
at a time of life when things are not as they were wont to be,
_nec mens, nec ætas_. I may be among those he accuses of sometimes
employing "unintelligible jargon," but shall not retort while I confess
my inability to understand such expressions as "some obscure occurrence
of unwholesome circumstances" which seem to have, according to him,
both "brought" the disease to Jessore in 1817, and produced it there
at the same time. Sir Gilbert marks out for the public what he
considers as forming one of the principal differences between the
English and Indian cholera, viz. that in the latter the discharges
"consist of a liquid resembling thin gruel, in the English disease
they are feculent and bilious." Now if he has read the India reports,
he must have found abundance of evidence showing that sometimes there
were _even bilious stools_[12] not at all like what he describes; and,
again, if he is in the habit of reading the journals, he must have
found _abundant_ evidence of malignant cholera with discharges like
water-gruel in this country. As to the French Consul at Aleppo having
escaped with 200 other individuals confined to his residence, I shall
only say, as it is Sir Gilbert Blane who relates the circumstance,
that he _forgot_ to mention that the aforesaid persons had retired to
a residence _outside_ the city; which, permits me to assure you, Sir
Gilbert, just makes all the difference in hundreds of cases:--they
happened to retire to "_clene air_;" and had they carried 50 ague
cases or 50 cholera cases with them (it matters not one atom which),
the result would have been exactly the same. The mention of Barcelona
and the yellow-fever, by Sir Gilbert, was, as Dr. Macmichael would
term it, rather _unlucky_ for his cause, though probably lucky for
humanity; for it cannot be too generally known that, during the
yellow-fever epidemic there in 1821, more than 60,000 people left the
city, and spread themselves all over Spain, without a single instance
of the disease having been communicated, WHILE, AT BARCELONETTA, THE
INFAMOUS CORDON SYSTEM PREVENTED THE UNFORTUNATE INHABITANTS FROM
GOING BEYOND THE WALLS, AND THE CONSEQUENCES OF SHUTTING THEM UP WERE
MOST HORRID.
[Footnote 12: See Orton on Cholera, who is most explicit upon this
point, and cites from the India Reports:--so that the distinctions
attempted to be drawn in this respect between the "cholera of India,"
and that of other countries, are, after all, _quite untenable_.]
Little need be said respecting the pure assumptions of Sir Gilbert as
to the movements of the malady by land and by water, for those vague and
hacknied statements have been again and again refuted; but we may remark
that whereas all former accounts respecting the cholera in 1817, in the
army of the Marquis of Hastings, state that the disease broke out
somewhat suddenly in the camp on the banks of the Sinde, Sir Gilbert,
without deigning to give his authority, makes the army set out for
"Upper India accompanied by this epidemic." We find that Mr. Kennedy,
another advocate for contagion in cholera, differs from Sir Gilbert as
to the disease having accompanied the grand army on the march; for he
says the appearance of the malady was announced in camp in the early
part of November, when "the first cases excited little alarm." In
referring, in a former letter, to the sickness in the above army, I
showed from the text of the Bengal report, how a change of position
produced a return of health in the troops; but Mr. Kennedy states that
the disease had greatly declined a few days before the removal, so that
it had lost "its infecting power." Nevertheless it appears by this
gentleman's account, a little farther on, that "in their progressive
movement the grounds which they occupied during the night as temporary
encampments were generally found in the morning, strewed with the dead
like a field of battle"! This gentleman tells us that he has laid down a
law of "increase and decline appertaining to cholera," by which, and the
assistance of _currents of contagion_, it would appear all these things
are reconciled wonderfully. Several of the points upon which he grounds
his belief of contagion have been already touched upon in these letters,
and the rest, considering the state of the cholera question in Europe
just now, may be allowed to pass at whatever value the public may, after
due examination, think it is entitled to. Let it be borne in mind that
all contagionists who speak of the cholera in the army of the Marquis of
Hastings, forget to tell us that though many thousand native followers
had fled from that army during the epidemic, the disease did not appear
in the towns situated in the surrounding country, _till the following
year_, as may be seen at a glance by reference to Mr. Kennedy's and
other maps.
We have another contagionist in the field--a writer in the _Foreign
Quarterly Review_, the value of whose observations may appear from his
statement, that "in 1828 the disease broke out in Orenburg, and was
supposed [_supposed_!] to have been introduced by the caravans which
arrive there from Upper Asia, or [_or_, nothing like a second string] by
the Kingiss-Cossacks, who are adjoining this town, and were said [_were
said_!] to have been about this time affected with the disease." This
single extract furnishes an excellent specimen of the sort of _proofs_
which the contagionists, to a man, seem to be satisfied with as to the
cholera being "carried" from place to place. This gentleman must surely
be under some very erroneous impression, when he states that, "According
to the reports of the Medical Board of Ceylon, the disease made its
appearance in 1819 at Jaffnah in Ceylon, imported from Palamcottah, with
which Jaffnah holds constant intercourse, and thence it was propagated
over the island." Now there is every reason to believe that a reference
to the documents from Ceylon will shew that no report as to the
importation of the disease was ever drawn up, for Drs. Farrel and Davy,
as well as Messrs. Marshall, Nicholson, and others, who served in that
island, are, to this hour, clearly against contagion. But as the writer
tells us that he is furnished with unpublished documents respecting the
cholera at St. Petersburg, by the chief of the medical department of the
quarantine in this country, we do not think it necessary to say one word
more--_ex pede Herculem_.
I rejoice to observe that Dr. James Johnson has, at last, _spoken out_
upon the quarantine question; and I trust that others will now follow
his example. It is only to be regretted, that a gentleman possessing
such influence with the public as Dr. Johnson does, should have so long
with-held his powerful aid on the occasion; but his motives were, I am
quite sure, most conscientious; and I believe that he, as well as
others, might have been prevented by a feeling of delicacy from going
beyond a certain point.
Since my last letter a code of regulations, in the anticipation of
cholera, has been published by the Board of Health. _Let our prayers be
offered up with fervency tenfold greater than before, that our land may
not be afflicted with this dire malady._ The following statement,
however, may not be altogether useless at this moment. According to the
_Journal des Debats_ of the 24th instant, the Emperor of Austria, in a
letter to his High Chancellor, dated Schoenbrunn, October 10th, and
published in the _Austrian Observer_ of the 12th, formally makes the
most magnanimous declaration to his people, THAT HE HAD COMMITTED AN
ERROR IN ADOPTING THE VEXATIOUS AND WORSE-THAN USELESS QUARANTINE AND
CORDON REGULATIONS AGAINST CHOLERA; that he did so before the nature of
the disease was so fully understood; admits that those regulations have
been found, after full experience, to have produced consequences more
calamitous than those arising from the disease itself ("_plus funeste
encore que les maux que provenaient de la maladie elle-même_.") He
kindly makes excuses for still maintaining a modified quarantine system
at certain points, in consequence, as he states, of the opinions still
existing in the dominions of some of his neighbours, _for otherwise his
commercial relations would be broken off. To secure his maritime
intercourse, he must do as they do!_ We find that as _all_ the Prussian
cordons have been dissolved, _their vessels_ are excluded from entrance
into certain places on the Elbe. What a horrid state of things! But, as
a reference will shew, this was one of the things stated in my first
letter as likely to occur: it is surely a fit subject for immediate
arrangement between governments. In the mean time, we cannot but profit
by the great lesson just received from Austria.
I shall add no more on the present occasion, than that my last
information from Edinburgh notifies the death, from _Scotch cholera_,
of two respectable females in that city, after an illness of only a few
hours.