Kitabı oku: «Letters on the Cholera Morbus.», sayfa 8

LETTER I.
TO THE EDITOR OF THE WINDSOR EXPRESS

Sir, – Being well aware of the handsome manner in which you have always opened the columns of your liberal journal to correspondents upon every subject of public interest, I make no further apology for addressing through the Windsor Express, some observations to the inhabitants of Windsor and its neighbourhood upon the all-engrossing subject of Cholera Morbus.

That pestilence, despite of quarantine laws, boards of health, and sanatory regulations, has now avowedly reached our shores, and we may be permitted at last to acknowledge the presence of the enemy – to describe to the affrighted people the true nature of the terrors with which he is clothed – and to point out how these can be best combatted or avoided.

That the seeds of his fury have long been sown amongst us may be proved, and will be proved, ere long, by reference to fatal cases of unwonted Cholera Morbus appearing, occasionally during the last six months, in London, Port Glasgow, Abingdon, Hull, and many other places, which, as it did not spread, have been passed unheeded by our health conservators; but, had the poison then been sufficiently matured to give it epidemic current, would have been blazed forth as imported pestilence. Some one or other of the ships constantly arriving from the north of Europe could easily have been fixed upon as acting the part of Pandora's box, and smugglers from her dispatched instanter to carry the disease into the inland quarters of the kingdom. I write in this manner, not from petulance, but from the analogy of the yellow fever, where this very game I am now describing, has so often been played with success in the south of Europe; and will be played off again, for so long as lucrative boards of health and gainful quarantine establishments, with extensive influence and patronage, shall continue to be resorted to for protection against a non-existent – an impossible contagion.

But to the disease in question. – It must have had a spontaneous origin somewhere, and that origin has been clearly traced to a populous unhealthy town in the East Indies – no infection was ever pretended to have been carried there, yet, it devastated with uncontroulable fury, extending from district to district, but in the most irregular and unaccountable manner, sparing the unwholesome localities in its immediate neighbourhood, yet attacking the more salubrious at a distance – passing by the most populous towns in its direct course at one time, but returning to them in fury at another, staying in none, however crowded, yet attacking all some time or other, until almost every part of the Indian peninsula had experienced its visitation.

There is an old term, as old as the good old English physician, Sydenham —constitution of the atmosphere– and to what else than to some inscrutable condition of the element in which we live, and breathe, and have our being – in fact to an atmospheric poison beyond our ken, can we ascribe the terrific gambols of such a destroyer. 'Tis on record, that when our armies were serving in the pestilential districts of India, hundreds, without any noticeable warning, would be taken ill in the course of a single night, and thousands in the course of a few days, in one wing of the army, while the other wing, upon different ground, and consequently under a different current of atmosphere, although in the course of the regular necessary communication between troops in the field, would remain perfectly free from the disease. It would then cease as suddenly and unaccountably as it began, – attacking, weeks after, the previously unscathed division of the army, or not attacking it at all at the time, yet returning at a distant interval, when all traces of the former epidemic had ceased, and committing the same devastation. Now, will any man, not utterly blinded by prejudice, candidly reviewing these facts, pretend to say, that this could be a personal contagion, cognizable by, and amenable to, any of the known or even supposable laws of infection – that the hundreds of the night infected one another, or that the thousands of the few days owed their disease to personal communication, – as well affect to believe that the African Simoon, which prostrates the caravan, and leaves the bones of the traveller to whiten in the sandy desert, could be a visitation of imported pestilence.

It may then be asked, have we no protection against this fearful plague? No means of warding it off? Certainly none against its visitation! It will come – it will go; we can neither keep it out, or retain it, if we wished, amongst us. The region of its influence is above us and beyond our controul; and we might as well pretend to arrest the influx of the swallows in summer, and the woodcocks in the winter season, by cordons of troops and quarantine regulations, as by such means to stay the influence, of an atmospheric poison; but in our moral courage, in our improved civilization, in the perfecting of our medical and health police, in the generous charitable spirit of the higher orders, assisting the poorer classes of the community, in the better condition of those classes themselves, compared with the poor of other countries, and in the devoted courage and assistance of the medical profession every where, we shall have the best resources. Trusting to these, it has been found that, in countries far less favoured than ours, wherever the impending pestilence has only threatened a visitation, there the panic has been terrible, and people have even died of fear; but when it actually arrived, and they were obliged to look it in the face, they found, that by putting their trust in what I have just laid down, they were in comparative safety; that, the destitute, the uncleanly, above all, the intemperate and the debauched, were almost its only victims; that the epidemic poison, whatever it might be, had strength to prevail only against those who had been previously unnerved by fear, or weakened by debauchery; and that moral courage, generous but temperate living, and regularity of habits in every respect, proved nearly a certain safe-guard. They found further, that quarantine regulations were worse than useless – that the gigantic military organization of Russia – the rigorous military despotism of Prussia – and the all-searching police of Austria, with their walled towns, and guards and gates, and cordons of troops, were powerless against this unseen pestilence, and that as soon as the quarantine laws were relaxed, and free communication allowed, the disease assumed a milder character, and speedily disappeared.

I say, then, confidently, that Cholera Morbus never will commit ravages in this country, beyond the bounds of the worst purlieus of society, unless it be fostered into infectious, pestilential activity, by the absurd, however well-meant, measures of the conservative boards of health, such as have been just recommended in what has always been esteemed the most influential, best-informed journal of England, I mean the Quarterly Review. If the writer of the article who recommends the enforcement of the ancient quarantine laws in all their strictness, be a medical man, he surely ought to know, that wherever human beings are confined and congregated together in undue numbers, more especially if they be in a state of disease, there the matter of contagion, the typhoid principle, the septic (putrefactive) human poison or by what other name it may be called, is infallibly generated and extends itself, but in its own impure atmosphere only, as a personal infection to those who approach it, under the form and features of the prevailing epidemic, whatever that may be. Hence we have all heard of contagious pleurisies, catarrhs, dysenteries, ulcers, &c., and if the doctrines of that writer be received, we shall soon also hear of contagious Cholera Morbus with a vengeance. His exhortations would go to shut up the sick from human intercourse, to proclaim the ban of society against them, and under the most pitiable circumstances of bodily distress, to proscribe them as objects of terror and danger, instead of being as they actually are, helpless innocuous fellow creatures, calling loudly for our promptest succour and commiseration in their utmost need. They would go further to array man against his fellow man in all the cruel selfishness of panic terror, sever the dearest domestic ties, paralize commerce, suspend manufactures, and destroy the subsistance of thousands, and all for the gratification of a prejudice which has been proved to be utterly baseless in every country of Europe from Archangel to Hamburgh and Sunderland. Happily for our country, these measures are now as absurd and impracticable as they would be tyrannical and unjust. They could not be borne even under the despotic military sway of Prussia and Russia, and in this free country it would be impossible to enforce them for a single week. The very attempt would at once, throughout the whole land, produce confusion and misery incalculable.

I say, on the contrary, throw open their dwellings to the free air of heaven, the best cordial and diluent of foul atmosphere in every disease – let their fellow townsmen hasten to carry them food, fuel, cordials, cloathing, and bedding, speak to them the words of consolation, and should they have fear to approach the sick, I take it upon me to say, they will be accompanied by any and every medical practitioner of the place, who, in their presence, will minister to the afflicted, inspire their breath, and perform every other professional office of humanity, without the smallest fear or risk of infection; for they read the daily records of their profession, where it has been proved to them, that in the open but crowded hospitals of Warsaw, under the most embarrassing circumstances of warfare and disease, out of a hundred medical men, with their assistants and attendants, frequenting the sick wards of Cholera, not one took the disease; that, for the sake of proving its nature, they even went so far as to clothe themselves with the vestments of the dying, to sleep in the beds of the recently dead, and to innoculate themselves in every way with the blood and fluids of the worst cases, without, in a single instance, producing Cholera Morbus.²⁰ The accounts may not, indeed, cannot be the same from every other quarter, for medical men must be as liable to fall under the influence of an atmospherical epidemic disease as other classes of the community; but the above fact is alone sufficient to prove that it cannot be a personal contagion.

Even should that worst of true contagions, the plague of the Levant, which every nation is bound to guard against, despite of all our precautions, be introduced amongst us, measures better calculated for the destruction of a community, could scarcely be devised, than the ancient quarantine regulations; for they certainly would convert every house proscribed by their mark, into a den and focus of the most concentrated pestilential contagion, ensuring fearful retribution upon those who had thus so blindly shut them up. The mark alone, besides being equivalent to a sentence of death upon all the inmates, would effect all this – the sick would be left to die unassisted, unpurified, uncleansed amidst their accumulated contagion, and the dead, as has happened before, lie unburied or scarcely covered in, till they putrified in pestiferous heaps. Most certainly it would be proper and beneficial, even a duty, for all who could afford the means, and were not detained by public duties, to fly the place, and equally proper for the other residents who continued in health, to segregate themselves as they best could. – Plenty of free labour amongst those who must ever work for their daily bread, would still remain for all municipal purposes, and these our rulers, so far from consenting thus to proscribe the sick, should employ openly in giving them every succour and aid, under the direction and with instructions of safety from a well arranged medical police. It would not be difficult to show, that the mortality, during the last great plague in London, was increased a hundred fold, by following the very measures now recommended in these regulations; and, that the barbarous predestinarian Turk, in the very head quarters of the plague itself, who despises all regulation, but attends his sick friend to the last, never yet brought down upon his country such calamitous visitations of pestilence, as enlightened Christian nations have inflicted upon themselves, by ill-judged laws. The Turk, to be sure, by rejecting all precaution, and admitting, without scruple, infection into his ports, sees Constantinople invaded by the plague every year; but, when not preposterously interfered with, it passes away, even amongst that wretched population, like a common epidemic, without leaving any remarkable traces of devastation behind it: and surely to establish and make a pest-house of the dwelling of every patient who might be discovered or even suspected to be ill, would be most preposterous. The writing on the wall would not be more apalling to the people, and scarcely less fatal to the object, than the cry of mad dog in the streets, with this difference, that when the dog was killed, the scene would be closed, but the proscribed patient would remain, even in his death and after it, to avenge the wrong.

But sufficient to the day is the evil thereof, the question is now of Cholera Morbus; I am willing to meet any objection, and the most obvious one that can be offered to me, (if it be not an imported disease) is its first appearance in our commercial sea-ports. To this I might answer, that it has been hovering over us, making occasional stoops, for the last six months, even in the most inland parts of the country; but I will waive that advantage, and meet it on plainer grounds of argument and truth. – An atmospherical poison must evidently possess the greatest influence, where it finds the human race under the most unfavourable circumstances of living, habits, locality, and condition. Now, where can these be met with so obviously as in our large sea-port towns on the lowest levels of the country, and in their crowded alleys, always near to the harbour for the shipping? There the disease, if its seeds existed in the atmosphere, would be most likely to break out in preference to all other situations; and if at the time of its so appearing, ships should arrive, as they are constantly doing from all parts of the world, whose crews, according to the custom of sailors, plunge instantly into drunkenness and debauchery, and present as it were, ready prepared, the very subjects the pestilence was waiting for; how easy then, for an alarmed or prejudiced board of health to point out the supposed importing vessel, and freight her with a cargo of the new pestilence from any part of the world they may choose to fix upon. This is no imaginary case; it was for long of annual occurrence with respect to the yellow fever, both in the West Indies and North America. "There our thoughtless intemperate sailors were not only the first to suffer from the epidemic, in its course or about to begin, but they were denounced as the importers, by the prejudiced vulgar, and the accusation was loudly re-echoed even amongst the better informed, by all who wished to make themselves believe that pestilence could not be a native product of their own atmosphere and habitations."

Before I have done, I feel called upon to say a few words upon the efficacy of fumigation as a preservative against Cholera Morbus and other infectious diseases. In regard to the first the question is settled. In Russia, throughout Germany, and I believe everywhere else in Europe, they were productive of no good, they did mischief, and were therefore discontinued. This has been verified by reports from the seats of the disease everywhere. In regard to other contagions I can speak, not without knowledge, at least not without experience, for it was the business and the duty of my military life, during a long course of years, to see them practised in ships, barracks, hospitals, and cantonements, and I can truly declare I never saw contagion in the smallest degree arrested by them, and that disease never failed to spread, and follow its course unobstructed, and unimpeded by their use. In the well-conditioned houses of the affluent where ventilation and cleanliness are matters of habit and domestic discipline, they may be a harmless plaything during the prevalence of scarlet fever and such like infections, or even do a little good by inspiring the attendants with confidence, however false, as a preservative against contagion; but in the confined dwellings of the poor they are positively mischievous, because they cannot be used without shutting out the wholesome atmospheric air, and substituting for it a factitious gas, which for aught we know, or can know of the nature of the contagious vapour, whether acid, alkaline, or anything else, may actually be adding to its deleterious principle instead of neutralising it: but in thus striking away a prop from the confidence of the poor, I thank God I can furnish them with other preservatives and disinfectants, which I take it upon me to say, they will find as simple and practicable as they are infallible. For the first, the liberal use of cold water and observance of free ventilation, with slaked lime to wash the walls, and quick lime when they can get it, to purify their dung heaps and necessaries, are among the best; but when actually infected, then heat is the only purificator yet known of an infected dwelling. Let boiling water be plentifully used to every part of the house and article of furniture to which it can be made applicable. Let portable iron stoves, filled with ignited charcoal only, be placed in the apartment closely shut, and the heat kept up for a few hours to any safe degree of not less than 120° Farenheit, and let foul infected beds and mattresses be placed in a baker's oven heated to the same,²¹ and my life for it no infection can after that possibly adhere to houses, clothes, or furniture. The living fountain of infection from the patient himself, constantly giving out the fresh material, cannot of course be so closed, but whether he lives or dies, if the above be observed, he will leave no infection behind him.²²

It is now time to bring this tedious letter to a close; I shall be happy, through the same channel, to give any information, or answer any inquiries that may be authenticated by the signature of the writer; but anonymous writing of any kind, I shall not consider myself bound to notice. Should the dreaded disease spread its ravages throughout our population, I may then, at some future early opportunity, trusting to your indulgence, trespass again upon your columns with further communications on this most interesting subject.

WILLIAM FERGUSSON,

Inspector-General of Hospitals.

P.S. – Throughout the foregoing letter, I have used the words contagion and infection as precisely synonymous terms, meaning communicability of disease from one person to another.

November 9, 1831.

LETTER II.
TO THE EDITOR OF THE WINDSOR EXPRESS

Sir, – In my last letter, I treated of the practicability of guarding our country against the now European and Continental disease, malignant Cholera Morbus, by quarantine regulations. In the present one, it is my intention still in a popular manner to scrutinise more deeply, the doctrine of imported contagions; to point out, if I can, those true contagions which can be warded off by our own exertions, in contradistinction to others which are altogether beyond our controul; and here it may be as well to premise, that when I use the term epidemic, I mean atmospheric influence, endemic-terrestrial influence, or emanation from the soil; and by pestilential, I mean the spread of malignant disease without any reference to its source. The terms contagion and infection have already been explained.

It must be evident, that legislative precaution can only be made applicable to the first of these. The last being unchangeable by human authority, are not to be assailed by any decrees we can fulminate against them; and if it can be shown, which it has been by our best and latest reports, that Cholera Morbus eminently and indisputably belongs to that class – that the strictest cordons of armed men could not avail to save the towns of the continent, nor the strictest quarantine our own shores, from its invasion – it surely must be time to cease those vain attempts, to lay down the arms that have proved so useless, and turn our undivided attention, now that it has fairly got amongst us, to conservative police, and the treatment of the disease; but as the contagionists still insist that it was imported from Hamburgh to Sunderland, it behoves us to clear away this preliminary difficulty before proceeding to other points of the enquiry.

I take it for granted, that ships proceeding from Sunderland to Hamburgh could only be colliers, and that according to the custom of such vessels, they returned, as they do from the port of London, light; and I admit, that on or about the time of their return, Cholera Morbus, under the severe form which characterises the Asiatic disease, made its appearance in that port, presenting a fair prima facie case of imported contagion; but as at the period of its thus breaking out in Sunderland, a case equally as fatal and severe shewed itself, according to the public accounts, in the upper part of Newcastle, 10 miles off; another equally well-marked, in a healthy quarter in Edinburgh; a third, not long before in Rugby, in the very centre of the kingdom; and a fourth in Sunderland itself, as far back as the month of August, as well as many others in different parts of the country;²³ it became incumbent on the quarantine authorities, indeed upon all men interested in the question, whether contagionists or otherwise, to shew the true state of these vessels, as well as of the cases above alluded to, and whether the Cholera Morbus had ever been on board of them, either at Hamburgh or during the homeward voyage, so as by any possibility they could have introduced the disease into an English port. Now will any person pretend to say that this has been done, or that it could not have been done, or deny that it was a measure, which, if properly executed, would have thrown light upon the true character of the disease, not only for the information of our own government but of every government in Europe; that deputations from the Board of Health, backed and supported by all the power and machinery of government, with the suspected ships locked up in quarantine, and the persons of the crews actually in their power, could not have verified to the very letter, the history of every hour and day of their health, from the moment of their arrival at Hamburgh till their return into port? This measure was so obviously and imperiously called for, as constituting the only rational ground on which the importing contagionists could stand, or their opponents meet them in argument, that after having waited in vain for the report, I raised my own feeble voice in the only department to which I had access, urging an immediate, though then late, investigation. No good cause, having truth for its basis, could have been so overlooked, and without unfairness or illiberality, we are irresistibly forced to the conclusion, that had the enquiry (the only one, by the bye, worth pursuing, as bearing directly on the question at issue) been pushed to the proof, it would have shown the utter nullity of quarantine guards against atmospherical pestilence, the thorough baselessness of the doctrine of importation.

Without entering into the miserable disputes on this subject, which, amidst a tissue of fable and prejudice, self-interest and misrepresentation, have so often disgraced the medical profession at Gibraltar; I shall now proceed to shew, by reference to general causes, how baseless and mischievous have been the same doctrines and authority when exercised in that part of the British dominions: —

Within the last thirty years, yellow fever has, at least four times, invaded the fortress of Gibraltar; during which time also, the population of its over-crowded town has more than quadrupled, presenting as fair a field, for the generation within, or reception from without, of imported pestilence as can well be imagined, – yet plague, the truest of all contagions, typhus fever, and other infectious diseases, have never prevailed, as far as I know, amongst them. The plague of the Levant has not been there, I believe, for 150 years; yet Gibraltar, the free port of the Mediterranean, open to every flag, stands directly in the course of the only maritime outlet, from its abode and birth-place in the east, being in fact, to use the language of the road, the house of call for the commerce of all nations coming from the upper Mediterranean. Now, can there be a more obvious inference from all this, than that the plague, being a true contagion, may be kept off without difficulty, by ordinary quarantine precautions; but the other being an endemic malarious disease, generated during particular seasons, within the garrison itself, and the offspring of its own soil, is altogether beyond their controul. The malarious or marsh poison, which in our colder latitudes produces common ague, in the warmer, remittent fever, and in unfavourable southern localities of Europe, (such as those of crowded towns, where the heat has been steadily for some time of an intertropical degree) – true yellow fever, which is no more than the highest grade of malarious disease; but this has never occurred in European towns, unless during the driest seasons – seasons actually blighted by drought, when hot withering land winds have destroyed surface vegetation, and as in the locality of Gibraltar, have left the low-lying becalmed, and leeward town to corrupt without perflation or ventilation amidst its own accumulated exhalations. I know not how I can better illustrate the situation of Gibraltar in these pestiferous seasons, than by a quotation from a report of my own on the Island of Guadaloupe, in the year 1816, which, though written without any possible reference to the question at issue, has become more apposite than anything else I could advance; "all regular currents of wind have the effect of dispersing malaria; when this purifying influence is with-held, either through the circumstances of season, or when it cannot be made to sweep the land on account of the intervention of high hills, the consequences are most fatal. The leeward shores of Guadaloupe, for a course of nearly 30 miles, under the shelter of a very steep ridge of volcanic mountains, never felt the sea breeze, nor any breeze but the night land-wind from the mountains; and though the soil, which I have often examined, is a remarkably open, dry and pure one, being mostly sand and gravel, altogether, and positively without marsh, in the most dangerous places, it is inconceivably pestiferous throughout the whole tract, and in no place more so than the bare sandy beach near the high-water mark. The coloured people alone ever venture to inhabit it; and when they see strangers tarrying on the shore after nightfall, they never fail to warn them of their danger. The same remark holds good in regard to the greater part of the leeward coasts of Martinique, and the leeward alluvial bases and recesses²⁴ of hills, in whatever port of the torrid zone they may be placed, with the exception, probably of the immediate sites of towns, where the pavements prevent the rain-water being absorbed into the soil, and hold it up to speedy evaporation." Now, conceive a populous crowded town placed in this situation, and you have exactly what Gibraltar and the other towns of Spain and North America, liable to yellow fever, must become in such seasons as I have above described, only, that as they grow more populous and crowded, the danger must be greater, and its visitations more frequent, unless the internal health police be made to keep pace in improvement, with the increasing population.

Now in the name of injured commerce – of the deluded people of England – of medical science – of truth and humanity – what occasion can their be to institute an expensive quarantine against such a state of things as this, which can only be mitigated by domestic health police; or why conjure up the unreal phantom of an imported plague, to delude the unhappy sufferers, as much in regard to the true nature of the disease, as to the measures best calculated for their own preservation; when it must be evident that the pestilence has sprung from amidst themselves, and that had it been an external contagion in any degree, the ordinary quarantine, as in case of the plague, would certainly have kept it off; but the question of the contagion of yellow fever, so important to commerce and humanity; and which, like the Cholera, has more than once been used to alarm the coasts of England, demands yet further investigation.

For nearly 40 years have the medical departments of our army and navy been furnished with evidence, from beyond the Atlantic, that this disease possessed no contagious property whatever. These proofs now lie recorded by hundreds in their respective offices, and I take it upon me to say, they will not be found contradicted by more than one out of a hundred, amongst all the reports from the West Indies, which is as much the birth-place of the yellow fever, as Egypt is of the plague: yet, in the face of such a mass of evidence, as great or greater probably than ever was accumulated upon any medical question, has our Government been deluded, to vex commerce with unnecessary restraints, to inflict needless cruelties upon commercial communities, (for what cruelty can be greater than after destroying their means of subsistence by quarantine laws, to pen them up in a den of pestilence, there to perish without escape, amidst their own malarious poison?) and to burden the country with the costs of expensive quarantine establishments. Surely if these departments had done their duty, or will now do it, in so far as to furnish our rulers with an abstract of that evidence, with or without their own opinions, for opinions are as dust in the balance when put in competition with recorded facts, it must be impossible that the delusion could be suffered to endure for another year; or should they unluckily fail thereby to produce conviction on Government, they can refer to the records of commerce, and of our transport departments, which will shew, if enquiry be made, that no ship, however deeply infected before she left the port, (and all ships were uniformly so infected wherever the pestilence raged) ever yet produced, or was able to carry a case of yellow fever beyond the boundaries of the tropics, on the homeward voyage, and that therefore the stories of conveying it beyond seas to Gibraltar, must have been absolutely chimerical. It would indeed, have been a work of supererrogation, little called for, for I think I have fully shown that Gibraltar must be abundantly qualified to manufacture yellow fever for herself.