Kitabı oku: «Letters on the Cholera Morbus.», sayfa 5

LETTER V

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 stools¹² 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.

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 Schœnbrunn, 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.

LETTER VI

At a moment when the subject of cholera has become so deeply interesting, the good of the public can surely not be better consulted by the press than when it devotes its columns (even to the exclusion of some political and other questions of importance) to details of plain facts connected with the contagious or non-contagious nature of that malady – a question beyond all others regarding it, of most importance, for upon it must hinge all sanatory or conservative regulations, and a mistake must, in the event of an epidemic breaking out, directly involve thousands in ruin. In the case of felony, where but the life of a single individual is at stake – nay, not only in the case of felony, but in the case of a simple misdemeanour, or even in the simple case of debt – we see the questions of yes or no examined by the Judges of the land with due rigour; while, on the point to which I refer, and which affects so deeply the dearest interests of whole communities, evidence has been acted upon so vague as to make some people fancy that we have retrograded to the age of witchcraft. Be it recollected that we shall not have the same excuse as some of our continental neighbours had for running into frightful errors – for we have their dear-bought experience laid broadly before us; and to profit duly by it, it only requires a scrutiny by a tribunal, wholly, if you please, non-medical, such as may be formed within an hour in this metropolis; nothing short of this will do. All, till then, will be vacillation; and when the enemy does come in force, we shall find ourselves just as much at a loss how to act as our continental neighbours were on the first appearance of cholera among them; I say after its first appearance, for we find that they all discovered, plainly enough latterly, what was best to be done. Small indeed may be the chance of the present order of things as to quarantines, the separation of persons attacked, &c., being changed by anything which I can offer; but, having many years experience of disease – having had no small share of experience in this disease in particular, and having, perhaps, paid as much attention to all that has been said about it as any man living, I should be wanting in my duty towards God and man did I not protest, most loudly, against those regulations, which shall have for their base, an assumption, that a being affected with cholera can, in any manner whatever, transmit, or communicate, the disease to others, however close or long continued the intercourse may be; because such doctrine is totally in opposition to all the fair or solid evidence now before the public; – because it is calculated, in numberless instances, to predispose the constitution to the disease, by exciting terror equal to that in the case of plague; – because it is teaching us Christians to do what Jews, and others, never do, to abandon the being who has so many ties upon our affections; – because the desertion of friends and relatives, and the being left solely in charge, perhaps, of a feeble and aged hireling (if even such can be got, which I much doubt when terror is so held out,) must tend directly to depress those functions which, from the nature of the disease, it should be our great effort to support; – finally, because a proper and unbiassed examination of the question will shew, that all these horrors are likely to arise out of regulations which may, with equal justice, be applied to ague, to the remittent fevers of some countries, or to the Devonshire cholic, as to cholera.

Happily, it is not yet too late to set about correcting erroneous opinions, pregnant with overwhelming mischief, for hitherto the measures acted upon have only affected our commerce and finances to a certain extent; but it appears to me that not a moment should be lost, in order to prevent a public panic; and, in order to prevent those calamities which, in addition to the effects of the disease itself, occurred, as we have seen, on the Continent. Let then, I say, a Commission be forthwith appointed, composed of persons accustomed to weigh evidence in other cases, and who will not be likely to give more than its due weight to the authority of any individuals. Let this be done, and, in the decision, we shall be sure to obtain all that human wisdom can arrive at on so important a subject; and the public cannot hesitate to submit to whatever may afterwards be proposed. It will then be seen whether the London Board of Health have decided as wisely as they have hastily. For my part, I shall for ever reject what may be held as evidence in human affairs, if it be not shewn that an individual attending another labouring under cholera, runs no further risk of being infected than an individual attending an ague patient does of being infected by this latter disease. What a blessing (in case of our being visited by an epidemic) should this turn out to be the decision of those whose opinions would be more likely to be regarded by the public than mine are likely to be.

Many, I am quite aware, are the professional men of experience now in this country, who feel with me on this occasion, but who, in deference to views emanating from authority, refrain from coming forward: – let me entreat them, however, to consider the importance of their suggestions to the community at large, at this moment; and let me beg of them to come forward and implore government to institute a special commission for the re-consideration of measures, founded on evidence the most vague that it is possible to conceive; or, perhaps, I should rather say, against whatever deserves the name of evidence. Every feeling should be sacrificed, by professional men, for the public good; we must even run the greatest risk of incurring the displeasure of those of our friends who are in the Board of Health. That we do run some risk is pretty plain, from the conduct of a vile journalist closely connected with an individual of a paid party, who has threatened us unbelievers in generally-exploded doctrines, with a fate nothing short of that which overwhelmed some of the inhabitants of Pompeii.

Let me ask why all the documents of importance forwarded to the Board of Health are not published in the collection just issued? Why are those forwarded by the Medical Gentleman sent to Dantzic not published.¹³ Why has not an important document forwarded by our Consul at Riga not been published? Above all, why has not allusion been made in their papers to those cases of pure spasmodic cholera, which have occurred in various parts of England within the last five months, and the details of which has been faithfully transmitted to them. If those cases be inquired into thoroughly and impartially, and that several of them be not found to be perfectly identic with the epidemic cholera of India, of Russia, &c., I hereby promise the public to disclose my name, and to suffer all the ignomy of a person making false statements. Indeed, I may confidently assure the public, that in at least one case which occurred about two months ago, the opinion of a gentleman who had practiced in India, and who had investigated the history of the symptoms, the identity with those of Asiatic cholera, was not denied. The establishment of this point is of itself sufficient to overthrow all supposition as to the importation of the disease.

In the case of Richard Martin, whose death occurred at Sunderland about two months ago – in the case of Martin M'Neal, of the 7th Fusileers, which occurred at Hull, on the 11th of August last – in the cases at Port Glasgow, as detailed in a pamphlet by Dr. Marshall of that place – as well as several other cases which occurred throughout the year, and the details of many of which are in possession of the Board of Health – the advocates, "par metier," of contagion in cholera, have not a loop-hole to creep out at. Take but a few of the symptoms in one of those cases as taken down by the Medical Gentleman in charge, – "The body was cold, and covered by a clammy sweat – the features completely sunk —the lips blue, the face discoloured – tongue moist and very cold – the hands and feet blue, cold, and as if steeped in water, like a washerwoman's hand; the extremities cold to the axillæ and groins, and no pulse discoverable lower; the voice changed, and the speech short and laborious. He answered with reluctance, and in monosyllables." This man had the pale dejections, and several other symptoms, considered so characteristic of the Asiatic cholera; yet no spreading took place from him, nor ever will in similar cases. With the exception of the vomiting and purging, there is, in the state of patients labouring under this form of cholera, a great similarity to the first stage of the malignant fevers of the Pontine Marshes, and many other places, and the patient need not be one bit the more avoided. Let this be, therefore, no small consolation, when we find that, by the official news of this day, five more deaths have occurred at Sunderland.

Nov. 9, 1831.