Kitabı oku: «Letters on the Cholera Morbus.», sayfa 6

LETTER VII

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.

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.

LETTER VIII

Already has the problem of the contagious or non-contagious nature of this disease been solved upon our own land; and as sophistry can no longer erect impediments to the due distribution of the resources of this pre-eminently humane nation, it is to be hoped that not an hour will be lost in shaping the arrangements accordingly. What now becomes of the doctrine of a poison, piercing and rapid as the sun's rays, emanating from the bodies of the sick – nay, from the bodies of those who are not sick, but who have been near them or near their houses? In the occurrences at Newcastle and Sunderland, how has the fifty times refuted doctrine of the disease spreading from a point in two ways, or in one way, tallied with the facts? We were desired to believe that in India, Persia, &c., "the contagion travelled," as the expression is, very slow, because this entity of men's brains was obliged to wend its way with the march of a regiment, or with the slow caravan: now, however, when fifty facilities for the most rapid conveyance have been afforded every hour since its first appearance, it will not put itself one bit out of its usual course. And then what dangers to the attendants on the sick to the members of the same family – to the washerwomen – to the clergymen – to the buriers of the dead – even to those who passed the door of the poor sufferer! Well, what of all this has occurred? Why it has occurred that this doctrine, supported by many who were honest, but had not duly examined alleged facts, and by others, I regret to say, whose interests guided their statements – that the absurdity of this doctrine has now been displayed in the broad light of day. Make allowance (even in this year of great notoriety for susceptibility to cholera in the people at large in this country) for insusceptibility on the part of numbers who came into contact at Sunderland and Newcastle, with the persons of cholera patients, with their beds, their furniture, their clothes, &c., yet, if there had ever been the slightest foundation for the assertions of the contagionists, what numbers ought to have been contaminated, in all directions over the face of the country, even within the first few days, considering the wonderful degree of intercourse kept up between all parts. But we find that, as in Austria and Prussia, "la maladie de la terre" is not disposed here to accommodate itself to vain speculations. Now the matter may be reduced to the simple rules of arithmetic, viz.: – if, as "contagionists par metier" say, the poison from the body of one individual be, in the twinkling of an eye, and in more ways than one, transmitted to the bodies of a certain number who have been near him, &c., how many thousands, or tens of thousands, in every direction, should, in a multiplied series of communications and transmissions, be now affected?

Those who have watched the course of matters connected with cholera in this country, have not failed to perceive, for some time past, the intent and purport of the assertion so industriously put forth – that the disease might be introduced by people in perfect health; and we have just seen how this ruse has been attempted to be played off at Sunderland, as the history of such matters informs us has been done before in other instances, and public vengeance invoked most foully and unjustly upon the heads of guiltless persons in the Custom House or Quarantine Department, for "permitting a breach of regulations;" but the several pure cases of spasmodic cholera, in many parts of England besides Sunderland, long before – months before – the arrival of the ship (as shewn in a former letter) leave no pretence for any supposition of this kind.

I request that the public may particularly remark, that, frequently as those cases have been cited as proofs of the absurdity of expecting the arrival of the disease by a ship, their identity has never once been disputed by those most anxious to prove their case. No; the point has, in common parlance, been always shirked; for whoever should doubt it, would only hold himself up to the ridicule of the profession, and to admit it would be to give up the importation farce.

Others have remarked before me that, though a very common, it is a very erroneous mode of expression, to say of cholera, that it has travelled to such or such a place, or has arrived at such or such places, for it is the cause of the malady which is found to prevail, for a longer or shorter time, at those different points. It cannot be expected that people should explain such matters, for, with regard to them, our knowledge seems to be in its infancy, and "we want a sense for atoms." However, as people's minds are a good deal occupied upon the point, and as many are driven to the idea of contagion in the face even of evidence, from not being able to make any thing of this casse-tête, the best guess will probably be found in the quotation from Dr. Davy, at page 19.

I perceive that the Berlin Gazette is humanely occupied in recommending others to profit by the mistakes regarding contagion which occurred in that country: – "Dr. Sacks, in No. 38 of his Cholera Journal, published here, has again shewn, against Dr. Rush, the fallibility of the doctrine of contagion, as well as the mischievous impracticability of the attempts founded on it to arrest the progress of the disorder by cutting off the communications. It is to be hoped that the alarm so methodically excited by scientific and magisterial authority in the countries to the west of us [!!] will cease, after the ample experience which we have dearly purchased (with some popular tumults), and that the system of incommunication will be at once done away with by all enlightened governments, after what has passed among us." – I am sure, good people, nobody can yet say whether those calling themselves scientific, will allow us to profit by your sad experience; but I believe that the people of Sunderland are not to be shut in, but allowed to remove, if they choose, in spite of silly speculations.

It may not be uninteresting to mention here, that there are no quarantines and no choleras in Bohemia or Hanover.

LETTER IX

The following statement from the Duke de Mortemar will be considered probably, very curious, considering that, as already stated, he seems to believe in something like contagion – and for no earthly reason, one may suppose, than from his inability to satisfy himself of the existence of another cause – as if it were not sufficient to prove that in reality the moon is not made of green cheese, but one must prove what it is made of! But, to the quotation – "The conviction now established, that intercourse with sick produces no increase of danger, should henceforth diminish the dread of this calamity (the cholera). It differs from the plague in this, that it does not, by its sole appearance, take away all hope of help, and destroy all the ties of family and affection. Henceforth those attacked will not be abandoned without aid and consolation; and separation or removal to hospital, the source of despair, will no longer increase the danger. The sick may in future be attended without fears for one's self, or for those with whom we live." How delightful is the simplicity of truth! Why, Sir, a morceau like this, and from an honourable man, let him call himself contagionist or what he may, is more precious at this moment than Persian turkois or Grecian gems. Make me an example, men say, of the culprits "who let the cholera morbus into Sunderland," concealed in "susceptible" articles! – yes, and that we may be on a level in other matters, destroy me some half dozen witches, too, as we were wont to do of yore. But let us have more tidings from Russia to comfort the country of our affections in the hour of her affliction, when so much craft and subtlety is on foot to scare her. Dr. Lefevre, physician to our embassy at St. Petersburg, has just given to the public an account of his observations there during the epidemic, from which the following extracts are made: —

"As far as my practice is concerned both in the quarter allotted to me, and also in private houses in different parts of the town, I have no proof whatever that the disease is contagious.

"The first patient I saw was upon the third day of the epidemic, and upon strict inquiry I could not trace the least connexion between the patient, or those who were about her person, with that part of the town where it first appeared – a distance of several versts.

"As regards the attendants of the sick, in no one instance have I found them affected by the disease, though in many cases they paid the most assiduous attention, watched day and night by the beds of the afflicted, and administered to all their wants.

"I knew four sisters watch anxiously over a fifth severely attacked with cholera, and yet receive no injury from their care.

"In one case I attended a carpenter in a large room, where there were at least thirty men, who all slept on the floor among the shavings; and, though it was a severe and fatal case, no other instance occurred among his companions.

"In private practice, among those in easy circumstances, I have known the wife attend the husband, the husband the wife, parents their children, children their parents, and in fatal cases, where, from long attendance and anxiety of mind, we might conceive the influence of predisposition to operate, in no instance have I found the disease communicated to the attendants." – p. 32, 33.

"The present disease has borne throughout the character of an epidemic, and when the proofs advanced in proof of its contagion have been minutely examined, they have been generally found incorrect; whereas it is clear and open to every inquirer, that the cholera did not occur in many places which had the greatest intercourse with St. Petersburg at the height of the malady, and that it broke out in many others which have been subjected to the strictest quarantine." – p. 34.¹⁶

Hear all this, Legislators! Boards of Health throughout the country, hear it! Then you will be able to judge how exceedingly frivolous the idle opinions and reports are which you have obtruded so industriously upon your notice.

But one more short quotation from Dr. Lefevre, a gentleman certainly not among the number of those who stand denounced before the professional world as unworthy of belief. He says: – "As for many reports which have been circulated, and which, primâ facie, seem to militate against the statement [communication to attendants, &c.]. I have endeavoured to pay the most impartial attention to them; but I have never found, upon thorough investigation, that their correctness could be relied upon: and in many instances I have ascertained them to be designedly false." – Designedly false! Alas! toute ça on trouve dans l'article Homme; and any body who chooses to investigate, as I have done, the history of epidemics, will find that falsehoods foul have been resorted to – shamelessly resorted to – by persons having a direct interest in maintaining certain views. Enough, then, has been said to put Boards of Health, &c. on their guard against admitting facts for their guidance from any quarter whatever, if the purity of the source be not right well established. There is too much at stake just now to permit of our yielding with ill-timed complaisance to any authority without observing this very necessary preliminary.

One word, and with all due respect, before closing, on the subject of Dr. James Johnson's "contingent contagion," which, though occurring in some diseases, and extremely feasible in regard to others, will, if he goes over the evidence again, I am sure, be shown not to apply to cholera, which is strictly a disease of places, not persons, and can no more be generated by individuals than ague itself can. I can only say of it, with the philosophic poet, that —

–"A secret venom oft

Corrupts the air, the water, and the land."

Mr. Searle, an English gentleman, well known for his work on cholera, has just returned from Warsaw, where he had the charge of the principal cholera hospital during the epidemic. The statements of this gentleman respecting contagion, being now published, I am induced from their high interest to give them here: —

"I have only to add my most entire conviction that the disease is not contagious, or, in other words, communicable from one person to another in the ordinary sense of the words – a conviction, which, is founded not only upon the nature of the disease, but also upon observations made with reference to the subject, during a period of no less than fourteen years. Facts, however, being deservedly of more weight than mere opinions, I beg leave to adduce the following, in the hope of relieving the minds of the timid from that groundless alarm, which might otherwise not only interfere with or prevent the proper attendance upon the sick, but becomes itself a pre-disposing or exciting cause of the disease; all parties agreeing that of all the debilitating agencies operating upon the human system, there is no one which tends to render it so peculiarly susceptible of disease, and of cholera in particular, than fear.

"The facts referred to are these: – during two months of the period, that I was physician to the principal hospital at Warsaw, devoted to the reception and treatment of this disease, out of about thirty persons attached to the hospital, the greater number of them were in constant attendance upon the sick, which latter were, to the number of from thirty to sixty, constantly under treatment; there were, therefore, patients in every stage of the disease. Several of these attendants, slept every night in the same apartments with the sick, on the beds which happened to be unoccupied, with all the windows and doors frequently closed. These men, too, were further employed in assisting at the dissection of, and sewing up of, the bodies of such as were examined, which were very numerous; cleansing also the dissecting-room, and burying the dead. And yet, notwithstanding all this, only one, during the period of two months, was attacked by the disease, and this an habitual drunkard, under circumstances, which entirely negative contagion, (supposing it to exist), as he had nothing whatever to do with the persons of the sick, though he occasionally assisted at the interment of the dead. He was merely a subordinate assistant to the apothecary, who occupied a detached building with some of the families of the attendants; all of whom likewise escaped the disease. This man, I repeat, was the only one attacked, and then under the following circumstances."

Here Mr. S. relates how this man, having been intoxicated for several days – was, as a punishment locked up almost naked in a damp room for two nights, having previously been severely beaten.

From the foregoing facts, and others pretty similar in all parts of the world where this disease has prevailed, we are, I think, fairly called upon to discard all special pleading, and to admit that man's best endeavours have not been able to make it communicable by any manner of means.