It may be inferred, from what I have stated at the close of my letter
of yesterday, that if a Commission be appointed, I look forward to its
being shewn, as clear as the sun at noon day, that the most complete
illusion has existed, and, on the part of many, still exists, with
regard to the term _Indian_ or _Asiatic_ cholera; for a form of cholera
possessing characters quite peculiar to the disease in that country, and
unknown, till very lately, in other countries, _has never existed
there_. Cholera, from a cause as inscrutable, perhaps, as the cause of
life itself, has prevailed there, and in other parts of the world, in
its severest forms, and to a greater extent than previously recorded;
but, whether we speak of the mild form, or of a severe form, proceeding
or not to the destruction of life, the symptoms have everywhere been
precisely the same. In this country it has been over and over again
remarked, that, so far back as 1669, the spasmodic cholera prevailed
epidemically under the observation of Dr. Sydenham, who records it. For
many years after the time of Dr. Cullen, who frequently promulgated
opinions founded on those of some fancy author rather than on his own
observation, it was very much the fashion to speak of redundancy of
bile, or of acrid bile, as the cause of the whole train of symptoms in
this disease; but, since the attention of medical men has been more
particularly drawn to the subject, practitioners may be found in every
town in England who can inform you that, in severe cases of cholera,
they have generally observed that no bile whatever has appeared till
the patient began to get better. Abundance of cases of this kind are
furnished by the different medical journals of this year. In fifty-two
cases of cholera which passed under my observation in the year 1828, the
_absence_ of bile was always most remarkable. I made my observations
with extraordinary care. One of the cases proved fatal, in which the
group of symptoms deemed characteristic of the Indian or Indo-Russian
cholera, was most perfect, and in the mass, the symptoms were as
aggravated as they have often been observed to be in India;--in several,
spasms, coldness of the body, and even convulsions, having been present.
To those who have attended to the subject of cholera, nothing can be
more absurd than to hear people say such or such a case cannot be _the
true_ cholera, or the Indian cholera, or the Russian cholera, because
_all_ the symptoms ever mentioned are not present: as if, in the
epidemic cholera of India and other places, even some of the symptoms
considered the most prominent (as spasms, and the disturbance of the
stomach and bowels) were not often absent, and that too in some of the
most rapidly, fatal cases! I feel persuaded that much injustice is done
to a gentleman lately sent to Sunderland, in attributing to him the
very ridiculous opinion, _that because_ the disease did not spread, it
was _therefore_ not identical with the Indian cholera. No person is
justified in speaking of the cholera of India as a disease _sui
gineris_, and in which a certain group of severe symptoms are always
present, when evidence, such as the following is on record:--"On the
22nd instant, when the men had been duly warned of their danger from not
reporting themselves sooner, I got into hospital a different description
of cases, viz.--men with a full pulse, hot skin," &c. (_Dr. Burrell to
Dr. Milne, Seroor, 27th of July, 1818_)--"But I must tell you that we
have, too, cases of common cholera." (_Mr. Craw, Seroor--Bengal Report,
p. 48_)--"The cases which terminated favourably presented very different
symptoms [from the low form of the disease.] As I saw the men
immediately after they were attacked, they came to me with a quick
_full_ pulse, and in several instances pain in the head; there was no
sweating."--"in several cases _bile_ appeared from the first in
considerable quantities in the egesta; and these were more manageable
than those in which no bile was ejected, although the spasms and
vomiting (the most distressing symptoms of the complaint) were equally
violent." (_Mr. Campbell, Seroor,--see Orton, 2nd ed. p. 18_)--"In
conclusion, I am happy to inform you that, for the last three days the
disease has been evidently on the decline, and, during that period, most
of the cases have assumed a different and much milder type, and,
comparatively, are little dangerous. It approaches somewhat to fever;
the patient complains of severe pain in the legs, sometimes vomiting
a watery fluid, and sometimes bile." (_White--Bengal Reports, p. 68._)
The same gentleman afterwards observes, "The disease continues to
present a milder aspect, and now occurs but rarely: loss of pulse and
coldness are seldom observed."
On the decline of a particular epidemic, Mr. Alardyce observed many
cases in the 34th regiment, with _bilious_ discharges throughout.
(Orton, 1st Ed. 128). Finally, referring to the work of Mr. Orton, a
gentleman who served in India, and who, being a contagionist, will be
considered, I suppose, not bad authority by those who are of his
opinion, we find the following declaration. (p. 26, 1st Ed.) "My own
experience has been very conclusive with regard to the sthenic form of
the disease. I have found a very considerable number of cases
exhibiting, singly, or in partial combination, every possible degree,
and almost every kind of increased action."--"Very full, hard, and quick
pulse, hot skin, and flushed surface; evacuations of bile, [you are
requested to note this, reader] both by vomiting and stool, from the
commencement of the attack. And, finally, I have seen some of those
cases passing into the low form of the disease."--"The inference from
these facts is plain, however opposite these two forms of disease may
appear, _there is no essential or general difference between them_."
After such authorities, and what has elsewhere been shewn, can any
cavelling be for one moment permitted as to the cholera in Sunderland
not being of the same nature as that of India? It may be now clearly
seen that in India as in Sunderland, the same variety of grades occurred
in the disease.
In making my communications for the benefit of the public, it is my wish
to spare the feelings of Sir Gilbert Blane; but as he persists in giving
as facts often refuted tales of contagion, in order to uphold doctrines
which he must observe are tumbling into ruins in all directions, it
becomes necessary that his work of mischief should no longer remain
unnoticed.
Not a single circumstance which he quotes relative to the marchings
and the voyages of the contagion of cholera will bear the slightest
examination; and yet he has detailed them as if, on his simple
assertion, they were to be received as things proved, and, consequently,
as so many points to be held in view when the public are in search of
rules whereby they may be guided. The examination of his assumed facts
for one short hour, by a competent tribunal, would prove this to be the
case; here it is impossible to enter upon them all: but let us just
refer to his _management_ of the question relative to the importation of
the disease into the Mauritius by the _Topaze_ frigate, which he says
was not believed there to be the case--and _why_ was it not believed?
Sir Gilbert takes special care not to tell the public, but they now have
the reason from me, at page 22.
If a commission be appointed, half an hour will suffice to place before
them, from the medical office in Berkeley-street, the reports alluded to
from the Mauritius, by which it is made apparent that long before the
arrival of the aforesaid frigate, the disease had shown itself in the
Mauritius.[14] What is the public to think of us and our profession,
when vague statements are daily attempted to be passed as facts, by
contagionists _enragés_? One more short reference to Sir Gilbert's
facts.--While referring to the progress of cholera in India, &c. from
1817, he says, in a note, "it is remarkable enough that while the great
oriental epidemic appeared thus on the eastern extremity of the
Mediterranean, the great western pestilence, the yellow fever, was
raging in its western extremity, Gibraltar, Malaga, Barcelona, Leghorn,
&c." Now, it is a historical fact, that, at Gibraltar, this disease did
not appear between 1814 and 1828--_and at Leghorn not since 1804_! At
Malaga, I believe, it did not prevail since 1814! So we have here a
pretty good specimen of the accuracy of some of those who undertake to
come forward as guides to the public on an occasion of great urgency and
peril. By some of Sir Gilbert's abettors, we are assured that his "facts
are perfectly reconcileable with the hypothesis of the cholera being of
an infectious nature." A fig for all hypothesis just now! Let us have
something like the old English trial by jury. May I be allowed to
introduce a fresh evidence to the public notice, in addition to the
thousand-and-one whose testimony is already recorded. He is worthy of
belief for two good reasons in particular; the one because he still
(unable to explain what can never be explained, perhaps), calls himself
a contagionist, and, in the next place, the statements being from a
high official personage, he could not offer them unless true to his
Government, as hundreds might have it in their power to contradict them
if not accurate. My witness is not a Doctor, but a _Duke_--the Duke de
_Mortemar_, lately Ambassador from the French Court to St. Petersburg,
who has just published a pamphlet on cholera, a few short extracts
from which, but those most important ones, I shall here give. Read
them!--people of all classes, read them over and over again! "An
important truth seems to be proved by what we shall here relate,
which is, that woods seem to diminish the influence of cholera, and
that cantons in the middle of thick woods, and placed in the centre
of infected countries, have altogether escaped the devastating
calamity!"--"The island of Kristofsky, placed in the centre of the
populous islands of St. Petersburg, communicating with each other by
two magnificent bridges, and with the city by thousands of boats, which
carried every day, and particularly on Sundays, a great number of people
to this charming spot. The island of Kristofsky, we say, _was preserved
completely from attacks of the cholera_; there was not a _single_ person
ill of the disease in three villages upon it." He continues to state
particulars, which, for want of time, cannot be here given, and
adds--"To what is this salubrity of Kristofsky, inhabited by the same
sort of people as St. Petersburg, to be attributed, fed in the same
manner, and following a similar _regime_,--communicating with each other
daily, if it be not to the influence of the superb forest which shelters
it? The firs, which are magnificent as well as abundant, surround the
houses."[15] He notices that the town is low and humid, and that "it is
made filthy every Sunday by the great numbers who resort to it, and who
gorge themselves with intoxicating drink." In a third letter I shall be
able to furnish further extracts from this most interesting pamphlet.
[Footnote 14: I am aware that very lately certain memoranda have been
referred to from the surgeon, but this is merely an expiring effort, and
of no avail against the official Report drawn up.]
[Footnote 15: As these most remarkable circumstances have not appeared
in the statements of our Russian medical commission, we must either
presume that the Duke is not correct, or that those facts have _escaped
the notice_ of the commission.]
In a letter lately inserted in a newspaper, the greatest injustice
is done to the Board of Health by the comments made on their
recommendations for the _treatment_ of cholera--_it is not true_ that
they have reccommended _specifics_, and I must add my feeble voice in
full approbation of all they have suggested on this point. Let the
public remark that they most judiciously point at the application of
_dry_ heat, not baths, which always greatly distress the patient, and,
indeed, have sometimes been observed (that is, where the coldness and
debility are very great) to accelerate a fatal issue. Of all the
arrangements to which a humane public can direct their attention, there
is nothing so essential as warmth. I would, therefore, humbly beg to
suggest, that funds for the purpose of purchasing coals for gratuitous
issue to the poor should be at once established in all directions. Too
much, I think, has been said about ventilation and washing, and too
little about this.
November 10th.