Kitabı oku: «Letters on the Cholera Morbus.», sayfa 7

LETTER X

At a meeting held some days ago by the members of the Royal Academy of Medicine of Paris, Dr. Londe (President of the French Medical Commission sent to Poland to investigate the nature of the cholera) stated, with regard to the questions of the origin and communicability of the disease, that it appeared by a document to which he referred, that 1st. "The cholera did not exist in the Russian corps which fought at Iganie," the place where the first battle with the Poles took place. 2d. "That the two thousand Russian prisoners taken on that occasion, and observed at Praga for ten days under the most perfect separation, [dans un isolement complet] did not give a single case of cholera." 3d. "That the corps [of the Polish army] which was not at Iganie, had more cases of cholera than those which were there." Dr. Londe stated cases of the spontaneous development of the disease in different individuals – of a French Lady confined to her bed, during two months previous to her attack of cholera, of which she died in twenty-two hours – of a woman of a religious order, who had been confined to her bed for six months, and while crossing a balcony, the aspect of which was to the Vistula, was attacked with cholera, and died within four hours. Dr. Londe, among other proofs that the disease was not transmissible, or, as some prefer calling it, not communicable, stated, "the immunity of wounded and others mixed with the cholera patients in the hospitals; the immunity of medical men, of attendants, of inspectors, and of the families of the different employés attached to the service of cholera patients; the example of a porter, who died of the disease, without his wife or children, who slept in the same bed with him, having been attacked; the example of three women attacked (two of whom died, and one recovered), and the children at their breasts, one of six months, and the other two of twelve, not contracting the disease."

At a subsequent meeting of the Academy, a letter from Dr. Gaymard, one of the Commission to St. Petersburg, was read, in which it was stated, while referring to the comparative mortality at different points there, that, "The cause of this enormous difference was, that the authorities wished to isolate the sick – [Observe this well reader] – and even send them out of the city; now the hospital is on a steep mountain, and, to get to it, the carriages were obliged to take a long circuit through a sandy road, which occupied an hour at least; and if we add to the exposure to the air, the fatigue of this removal, and the time which elapsed after the invasion of the disease, the deplorable state of the patient on his arrival, and the great mortality may be accounted for."

"The progress of the disease was the same as in other places; it was at the moment when it arrived at its height, and when, consequently, the greatest intercourse [Observe reader!] took place with the sick, that the number of attacks wonderfully diminished all at once (tout à coup), and without any appreciable cause. The points of the city most distant from each other were invaded. Numbers of families crowded [entassés] who had given aid to cholera patients, remained free from the disease, while persons isolated in high and healthy situations [usually healthy meant of course] were attacked. It especially attacked the poorer classes, and those given to spirituous liquors. Scarcely twenty persons in easy circumstances were attacked, and even the greater part of these had deviated from a regular system."

The inferences drawn, according to a medical journal, from the whole of Dr. Gaymard's communication, are —

"1. That the system of sanatory measures, adopted in Russia, did not any where stop the disease.

"2. That without entering on the question as to the advantages to be derived from a moral influence arising out of sanatory cordons, placed round a vast state like France, these measures are to be regarded as useless in the interior, in towns, and round houses.

"3. That nothing has been able to obstruct the progressive advance of the disease in a direction from India westward.

"4. That the formation of temporary hospitals, and domiciliary succour, are the only measures which can alleviate this great scourge."

A letter from Dr. Gaymard to Dr. Keraudren was read at the meeting of the Academy, in which it was stated, that in an Hospital at Moscow, in which Dr. Delauny was employed from the month of December, 1830, to the end of December, 1831, 587 cholera patients, and 860 cases of other diseases, were treated – "Not one of the latter was attacked with cholera, although the hospital consists of one building, the coridors communicating with each other, and the same linen serving indiscriminately for all. The attendants did not prove to be more liable to attacks. The relatives were suffered to visit their friends in hospital, and this step produced the best impression on the populace, who remained calm. They can establish at Moscow, that there was not the smallest analogy between the cholera and the plague which ravaged that city in the reign of Catharine." Dr. Gaymard declares, that, having gone to Russia without preconceived ideas on the subject, "he is convinced that interior quarrantines, and the isolation of houses and of sick in towns, has been accompanied by disastrous consequences." Is there yet enough of evidence to shew that this disease is positively not to be made communicable from the sick?

Honour still be to those of the profession who, from conscientious and honorable motives, have changed from non-contagionists to contagionists in regard to this disease; and all that should be demanded is, that their opinions may not for one moment be suffered to outweigh, on an occasion of vital importance, the great mass of evidence now on record quite in accordance with that just stated. One gentleman of unquestionable respectability gives as a reason (seemingly his very strongest) for a change of opinion, that he has been credibly informed that when the cholera broke out on one side of the street in a certain village in Russia, a medical man had a barrier put up by which the communication with the other side was cut off, and the disease thus, happily, prevented from extending. Now, admitting to the full extent the appearance of the disease on one side of the village only – a thing by the way hitherto as little proved as many others on the contagion side of the question – still, if there be any one thing more striking than another, in the history of the progress of cholera, it is this very circumstance of opposite rows of houses, or of barracks, or bazaars, or lines of camp, being free, while the disease raged in the others, and without any sort of barricading or restriction of intercourse. If people choose to take the trouble to look for the evidence, plenty of such is recorded. Now just consider for one moment how this famous Russian story stands: had the barricading begun early, the matter would have stood an examination a little better; but this man of good intentions never thought of his barriers till the one-sided progress of the disease had been manifest enough, without them: – and then consider how the communication had existed between both rows before those barriers were put up, and how impossible it was, unless by a file of soldiers, to have debarred all communication: – let all this be considered, and probably the case will stand at its true value, which is, if I may take the liberty of saying so, – just nothing at all. Let us bear in mind the circumstance already quoted from the East India records, – of one company of the 14th Regiment, at the extreme end of a barrack, escaping the disease, almost wholly, while it raged in the other nine; and this without a barrier too. But such circumstances are by no means of rare occurrence in other diseases arising from deteriorated atmosphere. Mr. Wilson, a naval surgeon, has shewn how yellow fever has prevailed on one side of a ship, and I have had pointed out to me, by a person who lived near it for thirty years, a spot on this our earth where ague attacks only those inhabiting the houses in one particular line, and without any difference as to elevation or other appreciable cause, except that the sun's rays do not impinge equally on both ranges in the morning and evening.

The advancement of the cause of truth has, no doubt, suffered some check in this country, by the announcement that another gentleman of great respectability (Mr. Orton) finds his belief as to non-contagion in cholera a good deal shaken: but we find that this change has not arisen from further personal knowledge of the disease, and if it be from any representations regarding occurrences in Europe, connected with cholera, we have seen how, from almost all quarters, the evidence lies quite on the side of his first opinions. Whatever the change may be owing to, we should continue, as in other cases, not to give an undue preference even to opinions coming from him, to well authenticated facts – facts, among which some particularly strong are still furnished by himself, even in the second edition of his book: – "It must be admitted that, in a vast number of instances in India, those persons [medical men and attendants] have suffered no more from the complaint than if they had been attending so many wounded men. This is a fact which, however embarrassing to the medical inquirer, [for our part we cannot see the embarrassment] is highly consolatory in a practical point of view, both to him and to all whose close intercourse with the sick is imperatively required." – (p. 316) – "We are therefore forced to the conclusion, however, at variance with the common laws of contagion, that in this disease, – at least in India, the most intimate intercourse with the sick is not, in general, productive of more infection than the average quantity throughout the community." (p. 326). Let us contrast the statements in the following paragraphs: – "For in all its long and various courses, it may be traced from place to place, and has never, as far as our information extends, started up at distant periods of time and space, leaving any considerable intervening tracts of country untouched." (p. 329) – "All attempts to trace the epidemic to its origin at a point, appears to have failed, and to have shewn that it had not one, but various local sources in the level and alluvial, the marshy and jungly tract of country which forms the delta of the Ganges, and extends from thence to the Burraumposter." (p. 329) Now let us observe what follows regarding the particular regularity in the progress of the disease, as just mentioned: – "Another instance of irregularity in its course, even in those provinces where it appears to have been most regular, is stated [now pray observe] in its having skipped from Verdoopatly to a village near Palamacotta, leaving a distance of sixty miles at first unaffected." (p. 332)!! – This is not the way to obtain proselytes I presume.

The situation of our medical brethren at Sunderland is most perplexing, and demands the kindest consideration on the part of the country at large; but let nothing which has occurred disturb the harmony so essential to the general welfare of that place, should their combined efforts be hereafter required on any occasion of public calamity. In truth both parties may be said to be right – the one in stating that the disease in question is Indian cholera, because the symptoms are precisely similar – the other that it is not Indian cholera, because it exists in Sunderland, and without having been imported – in neither country is it communicable from one person to another, as is now plainly shown upon evidence of a nature which will bear any investigation; and if blame, on account of injury to commerce, be fairly attributable to any, it is to those who, all the world over, pronounced this disease, on grounds the most untenable, a disease of a contagious or communicable nature. Let the Sunderland Board of Health not imagine that their situation is new, for similar odium has fallen on the first who told the plain truth, in other instances – at Tortosa, a few years ago, the first physician who announced the appearance of the yellow fever, was, according to different writers, stoned to death; and at Barcelona, in 1821, a similar fate had well nigh occurred to Dr. Bahi, one of the most eminent men there – we need not, I presume, fear that a scene of this kind will take place in this country, – though the cries of "no cholera!" and "down with Ogden!" have been heard.

One word as to observations regarding the needlessness of discussing the contagion question: the truth is, that the cleanliness and comfort of the people excepted, you can no more make other arrangements with propriety, till this point be settled, than a General can near the enemy by whom he is threatened, till it be ascertained whether that enemy be cavalry or infantry.

My object in these letters is not to obtrude opinions upon the public, being well aware that they cannot be so well entitled as those of many others, to attention; but I wish to place before the public, for their consideration, a collection of facts which I think are likely to be of no small importance at a moment like the present. In addition to the many authorities referred to in the foregoing pages, I would beg to call the public attention to a paper in the Windsor Express of the 12th November, by Dr. Fergusson, Inspector General of Hospitals, a gentleman of great experience, and who has given the coup de grace to the opinion of contagion in cholera. Indeed the opinion now seems to be virtually abandoned; for, as to quarantine on our ships from Sunderland, it is, perhaps, a thing that cannot be avoided, if the main consideration be the expediency of the case, until an arrangement between leading nations takes place. We have seen, in regard to Austria, how the matter stands, and our ships from every port in the country would be refused admission into foreign ports, if we did not subject those from Sunderland to quarantine; which state of things, it is hoped, will now be soon put an end to.

FINIS

LETTERS
ON THE
CHOLERA MORBUS,
&c. &c. &c

Windsor, Feb. 9, 1832.

Salus populi suprema Lex

In writing the following letters, which I have given in the order of their respective dates, I was actuated by the state of the public mind at the time in regard to the dreaded disease of which they principally treat. The two first were addressed to the Editor of the Windsor Express, and the third to a Medical Society here, of which I am a member. The contemplation of the subject has beguiled many hours of sickness and bodily pain, and I now commit the result to the press in a more connected form, from the same motives, I believe, that influence other writers – zeal in the cause of truth, whatever that may turn out to be, and predilection for what has flowed from my own pen, not however without the desire and belief, that what I have thus written may prove useful in the discussion of a question which has in no small degree agitated our three kingdoms, and most deeply interested every civilized nation on the face of the earth.

No one, unless he can take it upon him to define the true nature of this new malignant Cholera Morbus, can be warranted utterly to deny the existence of contagion, but he may at the least be permitted to say, that if contagion do exist at all, it must be the weakest in its powers of diffusion, and the safest to approach of any that has ever yet been known amongst diseases. Amateur physicians from the Continent, and from every part of the United Kingdoms, eager and keen for Cholera, and more numerous than the patients themselves, beset and surrounded the sick in Sunderland with all the fearless self-exposing zeal of the missionary character, yet no one could contrive, even in the foulest dens of that sea-port, to produce the disease in his own person, or to carry it in his saturated clothing to the healthier quarters of the town where he himself had his lodging.¹⁷ Surely if the disease had been typhus fever, or any other capable of contaminating the atmosphere of a sick apartment, or giving out infection more directly from the body of a patient, the result must have been different; its course, notwithstanding, has been most unaccountably and peculiarly its own – slow and sure for the most part, the infected wave has rolled on from its tropical origin in the far distant east, to the borders of the arctic circle in the west – not unfrequently in the face of the strongest winds, as if the blighting action of those atmospherical currents had prepared the surface of the earth, as well as the human body for the reception and deposition of the poison; but so far from always following the stream and line of population as has been attempted to be shown, it has often run directly counter to both, seldom or never desolating the large cities of Europe, like the plague and other true contagions, but rather wasting its fury upon encampments of troops, as in the east, or the villages and hamlets of thickly peopled rural districts.

That it could have been descried on no other than the above line must be self-evident, but to say that it has followed it in the manner that a contagious disease ought to have done, in our own country for instance, is at variance with the fact. From Sunderland and Newcastle to the south, the ways were open, the stream of population dense and continuous, the conveyances innumerable, the communications uninterrupted and constant. Towards the thinly-peopled north how different the aspect, – townships rare, the country often high, cold, and dreary, in many parts of the line without inhabitants or the dwellings of man for many miles together, yet does the disease suddenly alight at Haddington, a hundred miles off, without having touched the towns of Berwick, Dunbar, or any of the intermediate places. It is said to have been carried there by vagrant paupers from Sunderland. Can this be true? Could any such with the disease upon them in any shape, have encountered such a winter journey without leaving traces of it in their course?¹⁸ or, if they carried it in their clothing, the winds of the hills must have disinfected these fomites long before their arrival. No contagionist, however unscrupulous and enthusiastic, nor quarantine authority however vigilant, can pretend to say how the disease has been introduced at the different points of Sunderland, Haddington, and Kirkintulloch, – no more than he can tell why it has appeared at Doncaster, Portsmouth, and an infinity of other places without spreading. Even now, it lingers at the gates of the great open cities of Edinburgh and Glasgow, as if like a malarious disease, (which I by no means say that it is) it better found its food in the hamlet and the tent, in fact, amongst the inhabitants of ground tenements, than in paved towns and stone buildings. We must go farther and acknowledge, that for many months past our atmosphere has been tainted with the miasm or poison of Cholera Morbus, as manifested by unusual cases of the disease almost everywhere, and that these harbingers of the pestilence only wanted such an ally as the drunken jubilee at Gateshead, or atmospherical conditions and changes of which we know nothing, to give it current and power. That the epidemic current of disease wherever men exist and congregate together, must, in the first instance, resemble the contagious so strongly as to make it impossible to distinguish the one from the other, must be self-evident; and it is only after the touchstone has been applied, and proof of non-communicability been obtained, as at Sunderland, that the impartial observer can be enabled to discern the difference. – Still, however, must he be puzzled with the inexplicable phenomena of this strange pestilence, but if he feel himself at a loss for an argument against contagion, he has only to turn to one of the most recent communications from the Central Board of Health, where he will find that "That the subsidiary force under Col. Adams, which arrived in perfect health in the neighbourhood of a village of India infected with Cholera, had seventy cases of the disease the night of its arrival, and twenty deaths the next day," as if the march under a tropical sun, and the encampment upon malarious ground, or beneath a poisoned atmosphere, were all to go for nothing; and that the neighbourhood of an infected village, with which it is not stated that they held communication, had in that instantaneous manner alone, produced the disease. This is surely drawing too largely upon our credulity, and practising upon our fears beyond the mark.

The anti-contagionist, in acknowledging his ignorance, leaves the question open to examination; but the contagionist has solved the problem to his own mind, and closed the field of investigation, without, however, ceasing to denounce the antagonist who would disturb a conclusion which has given him so much contentment. – Let us here examine, for a moment, who in this case best befriends his fellow men. The latter, in vindication of a principle which he cannot prove, would shut the book of enquiry, sacrifice and abandon the sick, (for to this it must ever come the moment pestilential contagion is proclaimed,) extinguish human sympathy in panic fear, and sever every tie of domestic life, – the other would wait for proofs before he proclaimed the ban, and even then, with pestilence steaming before him, would doubt whether that pestilence could be best extinguished, or whether it would not be aggravated into ten-fold virulence, by excommunicating the sick.

In my first letter I have endeavoured to unveil the mystery and fallacy of fumigations, for which our government has paid so dear,¹⁹ and in place of the chemical disinfectants so much extolled, of the applicability of which we know nothing, and which have always failed whenever they were depended upon, have recommended the simple and sure ones of heat, light, water, and air, with one exception, the elements of our forefathers, which combined always with all possible purity of atmosphere, person, and habitation, have been found as sure and certain in effect as they are practical and easy of application.

Of our quarantine laws I have spoken freely, because I believe their present application, in many instances, to be unnecessary cruel and mischievous. Too long have they been regarded as an engine of State, connected with vested interests and official patronage, against which it was unsafe to murmur, however pernicious they might be to commerce, or discreditable to a country laying claim to medical knowledge. The regulation for preventing the importation of tropical yellow fever, (which is altogether a malarious disease of the highest temperature of heat and unwholesome locality,) into England or even into Gibraltar, stands eminent for absurdity. It has long been denounced by abler pens than mine, and I know not how it can be farther exposed, unless we could induce the inhabitants of our West India Colonies to enforce the lex talionis, and institute quarantines, which they might do with the same or better reason, against the importation of pleurises and catarrhs from the colder regions of Europe; a practical joke of this kind has been known to succeed after reason, argument, and evidence, amounting to the most palpable demonstration, had proved of no avail.

While I have thus impugned the authority of boards and missions, and establishments, I trust it never can be imputed to me that I could have intended any, the smallest personal allusion, to the eminent and estimable men of whom they are composed, – all such I utterly disclaim; and to the individual, in particular, who presided over our mission to Russia, who has been my colleague in the public service, and whose friendship I have enjoyed from early youth, during a period of more than forty years, I would here, were it the proper place, pay the tribute of respect which the usefulness of his life, and excellence of his character, deserves.