Letters on the Cholera Morbus.

The puerile stories, therefore, of infection being taken from following a coffined corpse to the grave, without reference to the state of grief, fear, and fatigue, not improbably, of drunkenness, in the mourners, must be unworthy of attention. I am no friend to the absurdly long interval which in this country is allowed to elapse,32 even in the hottest weather, between death and burial; but still more do I deprecate the indecent haste which would give sanction to panic, and incur the risk or even the suspicion of interment before dissolution. In regard to separate burying grounds, should the disease come to spread, I am sure no one will expect, after what has just been said, that I should attempt to argue the question seriously, nor enter a protest against the further gratuitous wrong of withholding the rites of sepulture in consecrated ground from the victims of an epidemic or even a contagious disease. – Nothing could warrant such a measure but want of room in the ordinary churchyards, where police should never be allowed to interfere with the rights and feelings or property, of the living, unless to ensure the privacy of funerals; nothing being so appalling to an alarmed people as the spectacle of death in their streets, or so trying to the health of the mourners, as tedious funeral ceremonies amidst a crowd of people.

Were I called upon to criticise what I have now written, and to review all that I have seen, read, and heard on the subject, I would conscientiously declare that the importation of Cholera Morbus into England or anywhere else, had been clearly negatived, and its non-contagious character almost as clearly established, always however with the proviso and exception of the possibility of its being made a temporary contingent contagion, amidst filth and poverty, and impurity of atmosphere, from overcrowding and accumulation of sick, but neither transmissible nor transportable out of its own locality, through human intercourse. As the disease, like all the other great plagues, which at various periods have desolated the earth, evidently came from the east, it would be most desirable in pursuing our investigation, to have a clear knowledge of the mode of its introduction into Russia on the eastern boundary of Europe. Unfortunately we can place no dependence upon the reports that have been published to prove importation there, which are lame and contradictory, although coming from the avowed partizans of contagion; but even had they been better gotten up, we could not, unless they had been confirmed by the experience of other nations, have received them with implicit reliance.

The Russian Employé of the provinces, mendacior Parthis, not from greater innate moral depravity than others, but from the corruptions of a despotic government which compel him to live under the rod of a master, amidst a superstitious barbarous population, whose dangerous prejudices he dare not offend, can only give utterance to what his tyrants command. Even at the more civilized capital of Petersburgh, the mob rose in arms to murder the foreign physicians when they did not act according to their liking. Could the truth then be heard on such a field, or what native officer would venture to impugn the authority of his rulers, proclaiming contagion? If he did, he must cease to live in the official sense of the word. Throughout Europe, from east to west, the disease has followed its own route according to its own incomprehensible laws, despite of every obstacle and precaution. We have the authority of our own Central Board for believing that the disease cannot be conveyed by merchandize of any kind, and that of our mission to Russia for greatly doubting whether it can adhere to personal clothing or bedding; and will it be pretended that human beings, labouring under such a distemper in any form, could have been the vehicles of spreading it in a straight line for thousands of miles throughout civilized nations, armed and prepared to defend themselves against its inroads, – they tried, but in vain. We, too, may strive to discover the demon of the pestilence amidst the clouds of the climate, or the winds of Heaven. He remains hidden to our view; and until better revealed, it only remains for us to exercise towards our fellow men those duties which humanity prompts, civilization teaches, and religion enjoins.

POSTSCRIPT

My friend, Doctor Stanford, of the Medical Staff, now settled here, has given me the following valuable information, which my own observation confirms, regarding the agency of panic, in promoting the diffusion of epidemic disease. He happened to be serving with part of the British army, at Cadiz, when an eruption of yellow fever took place there, in the autumn of 1813, and as usually happens amongst medical men, the first time they have seen that fever, some of them were staunch contagionists, and impressed that belief upon the corps to which they belonged. In all these the disease was most fatal to great numbers. The men being half dead with fear, before they were taken ill, speedily became its victims, to the great terror and danger of their surviving comrades; but in the other regiments, where no alarm had been sounded, the soldiers took the chances of the epidemic with the same steady courage they would have faced the bullets of the enemy, in the lottery of battle; escaping an attack for the most part altogether, or if seized, recovering from it in a large proportion. From this picture let us take a lesson, in case the impending epidemic should ever come to spread in the populous towns of England, and the cry of contagion be proclaimed in their streets. The very word will spread terror and dismay throughout the people, causing multitudes to be infected, who would otherwise, in all probability, have escaped an attack, and afterwards consign them to death in despair, when they find themselves the marked and fated victims of a new plague. Whatever they see around them, must confirm and aggravate their despair, for desertion and excommunication in all dangerous diseases, too certainly seal the fate of the patient. It will be vain to tell them that hireling attendance has been provided, – the life of the Choleraic depends upon the instant aid – the able bodied willing aid of affectionate friends, who will devote themselves to the task, and persevere indefatigably to the last. If these be driven from his bed, his last stay is gone, for without their active co-operation the best prescription of the physician is only so much waste paper. What, let me ask, must have been the fate of the patient, and what the consequent panic, if the case of Cholera that occurred in London, a month ago at the Barracks of the Foot Guards, had been proclaimed, and treated as a contagion? The poor fellow was promptly surrounded by his fearless comrades, who with their kind hands recalled and preserved the vital heat on the surface, by persevering in the affectionate duty of rubbing him for many hours; but had the Medical Staff of the regiment been true contagionists, they must, as in duty bound, have commanded, and compelled every one of them to fly the infection. It depended upon them, to have spread around a far wilder and more dangerous contagion than that of Cholera Morbus, or any other disease, – the contagion of fear – and from what occurred at Cadiz, as above related, it is to be hoped our medical men will now see how much they will have it in their power, when Cholera comes, to pronounce, or to withhold sentence of desolation upon a community. The word Contagion will be the word of doom, for then the healthy will fly their homes, and the sick be deserted; but a countenance and bearing, devoid of that groundless fear, will at once command the aid, and inspire the hopes that are powerful to save in the most desperate diseases.

It is stated, in a Scotch newspaper, that two poor travellers, passing from Kirkintulloch to Falkirk, ran the risque of being stoned to death by the populace of the latter place, and were saved from the immolation only by escaping into a house; and in an Irish one, that some shipwrecked sailors incurred a similar danger. Such barbarities must, in the nature of things, be practised every where under a reign of terror, however humane or christianized the people may be – even the fatalism of the Turk would not be proof against it. In Spain they have been enacted in all their horrors (thanks to the quarantine laws) upon the unfortunate victims of yellow fever;33 and we shall soon see them repeated amongst ourselves, unless the plain truth be promulgated by authority to the people. Let them be told if such be the pleasure of our rulers, (for it is not worth while disputing the point), that Cholera Morbus is a contagion, but of so safe a nature in regard to communicability, that not one in a hundred, or even a thousand, take the disease, – that in this country, besides being a transient passing disease, which according to certain laws and peculiarities of its own, will assuredly take its departure in no long time; it is limited almost always to particular spots and localities – that it is in their own power, while it remains, to correct the infectious atmosphere of these spots, by attention to health police – that they may fearlessly approach their sick friends with impunity, for that the danger resides in the above atmosphere, and not in the person of the patient; and that in all situations they may defy it, for as long as they observe sobriety of life and regularity of habits. Thus will public confidence be restored, and thus be verified the homely adage of, "honesty, in all human affairs, being ever the best policy"; for the concealment, or perversion of the truth, however much it may be made to serve the purposes of the passing day, can never ultimately promote the ends of good government and true humanity, but must lead, sooner or later, to the exposure of the delusion, or what would be far worse, to the perpetuation of error and prejudice, and grossest abuse of the people, in regard to those interests committed to our charge.

Doctor Henry, of Manchester, has, in a late paper, published some most interesting experiments, upon the disinfecting power of heat. He found that the vaccine virus was deprived of its infecting quality, at 140° of Farenheit, and that the contagions of Scarlatina, and Typhus fever, from fomites, were certainly dissipated and destroyed, at the dry heat of boiling water. In regard to these last, he might surely have ventured to fix the standard of safety at a greatly lower temperature; for if the grosser vaccine matter could be rendered inert at 140°, there can be little doubt of the subtile gaseous emanations, which constitute the aerial contagions, being dissipated by the same agent, at an inferior degree. In the absence of direct experiment, we may venture to infer, that 120° would suffice, to nullify these last. Such, at least, has been the belief of those, who have been employed to purify ships, barracks, and hospitals, from contagion, and I should think it must have been founded on experience.34

He does not treat of the disinfecting property of light, although such an agent was well worthy of his notice; for the power, which in closely stopped bottles can deprive Cayenne Pepper of its sting – render our Prussic Acid as harmless as cream, and convert the strongest medicinal powders into so much powder of post, can also avail to destroy the matter and principle of Contagion. In fact, no other is used for purifying goods, at our Lazzarettoes, where suspected articles of merchandise, after some nugatory fumigations, are simply exposed to light and air with such certain effect, that there is not, I believe, in this country, any record of infection being propagated from them afterwards. The experiments of Doctor Henry are as simple and beautiful in themselves, as they promise to be useful and important, for now even the horrible contagion of hospital gangrene would appear to be under the controul of the pure agent he has been describing; and the principle now established of light and heat, the grand vivifying powers of the creation, being the sure and true preservers of the creature, man, from the poisons generated even by himself, and otherwise around him, calls for our admiration and gratitude, as shewing that these agents and emanations of Almighty power can be made, in the hands of the practical philosopher, to serve the purposes of domestic science, and in as far as we can see, to fulfil, at least in that respect, the best intentions of the Creator.

1

As medical men in this Country employ the word infection and contagion in various senses, I shall, generally substitute transmissible or communicable, to avoid obscurity.

2

I presume that I shall not be misunderstood when I say, Would that the cholera were contagious– for then we might have every reasonable hope of staying the progress of the calamity by those cordon and quarantine regulations which are now not merely useless, but the bane of society, when applied to cholera or other non-contagious diseases.

3

The writer of this, who may be known by application at the printer's, when the present excitement is at an end, is not only prepared to show, on a fitting occasion, the correctness of the statements of Dr. Smith as well as those by Dr. O'Halloran just referred to – but also, that in the investigations, in 1828, connected with the question of yellow fever at Gibraltar, facts were perverted in the most scandalous manner, in order to prove the disease imported and contagious: – that individuals had been suborned: – that persons had been in the habit of putting leading questions to witnesses: – that those who gave false evidence have been, in a particular manner, remunerated: – that threats were held out: – and, in short, that occurrences of a nature to excite the indignation of mankind, took place on that occasion; and merited a punishment, not less severe, than a Naval Officer who should give, designedly, a false bearing and distance of rocks.

4

If the progress of the sweating sickness was similar to that of cholera, the advice of the King to Wolsey was sound; for instead of recommending him to rely on any-thing like cordon systems, or to shut himself up surrounded by his guards, he tells him (see Ellis's letters) to "fly to clene air incontinently," on the approach of the disease. I use the words approach of the disease occasionally, as it is a manner of expression in general use, but it is far from being strictly applicable when I speak of cholera; the cause of the disease it is which I admit travels or springs up at points, and not the disease itself in the persons of individuals, or its germs in inanimate substances.

5

Somebody is said to have seen a man on board with vomiting and spasms, on the day before she moved to this anchorage, but the surgeon of the ship has not stated this.

6

The same Army Medical gentleman, who had been sent to Port Glasgow, was sent to Hull to report upon this case: – he arrived there too late, but having seen the details of the case, he admitted that he saw no reason to declare them different from those which occurred in the Indian cholera.

7

Since writing the above, I find that this scene has actually occurred lately at Dantzic where a few miserable medical men illustrated their doctrines of contagion, by skulking at a certain distance about the sick, dressed up in oil skins, like the disgusting figures we see in books, of the Marseilles doctors in the Lazaretto. (See Sun Newspaper, 22nd, Nov.)

8

Since the above was written it has been very clearly shewn how easily proofs of this kind may be furnished to all disposed to receive them. We perceive that a disease officially announced as the true cholera, has existed for nearly a month past at Sunderland, and that among the thousands of people who left it within that time, nothing could be more easy, had the disease appeared epidemically in other parts of England, than to point out the particular individual who had "brought it" in some way or other; and this is the manner in which all the fables about the propagation of cholera from one district to another have gained credence. (Nov. 24th.)

9

This is by far the best work yet published in England on the cholera, but it is to be regretted that the author has not alluded to the works of gentlemen who have a priority of claim to some of the opinions he has published: I think that, in particular, Mr. Orton's book, printed in India, should have been noticed.

10

Something of this kind would have infallibly taken place, had certain insane proposals lately made respecting the shutting in of the people of Sunderland, been carried into effect.

11

In a former letter I alluded to cases of cholera which appeared this year at Port Glasgow; I find that the highly interesting details of those cases have been just published: —they should be read by everybody who takes the smallest interest in the important questions connected with the cholera. The London publishers are Whittaker and Co.

12

See Orton on Cholera, who is most explicit upon this point, and cites from the India Reports: – so that the distinctions attempted to be drawn in this respect between the "cholera of India," and that of other countries, are, after all, quite untenable.

13

Since the above was written, I find that this gentleman has adduced the strongest proofs possible against contagion.

14

I am aware that very lately certain memoranda have been referred to from the surgeon, but this is merely an expiring effort, and of no avail against the official Report drawn up.

15

As these most remarkable circumstances have not appeared in the statements of our Russian medical commission, we must either presume that the Duke is not correct, or that those facts have escaped the notice of the commission.

16

It is remarkable enough that Aretæus, who lived, according to some authors, in the first century, gives exactly the same reason which Dr. Lefevre does for the suppression of urine in cholera. So true it is, that that symptom, considered as one of the characteristics of the Indian cholera, was observed in ancient times.

17

The numbers were so great (to which I should probably have added one had my health permitted) as actually to make gala day in Sunderland, and to call forth a public expression of regret at their departure.

18

The Cholera in this country would appear always to travel with the pedestrian, and to eschew the stage coach even as an outside passenger.

19

Parliament voted a reward of £5000 to Doctor Carmichael Smith for the discovery.

20

Vide Medical Gazette.

21

The oven on that account need not lose character with bread-eaters, for according to the old adage, Omne vitium per ignem excoquitur.

22

Light too, more especially when assisted by a current of atmospheric air, is a true and sure disinfectant, but it is not so applicable as heat in the common contagions, from requiring an exposure of the infected substances for days together, or even a longer period, before it can be made effective.

23

Two of a type most unusual for this country, and the Winter Season, have occurred in the vale of the Thames, not far from here, which, as they both recovered, and the disease did not spread in any way, were very properly allowed to pass without sounding any alarm, but the gentleman who attended one of the cases, and had been familiar with the disease in India, at once recognized it again, in its principal distinguishing features.

24

The leeward niches and recesses of hills, however dry and rocky, become in these seasons of drought, absolute dens of malaria, this will be found proven in my reports made especially of the islands of Dominique and Trinidad, which may be seen at the Army Medical Board Office.

25

Vide Russian Ukase.

26

Vide Reports from Russia.

27

For as long as men congregate together, and every supposable degree of communication must of necessity be constantly taking place amongst them, to distinguish a spreading epidemic from a contagious disease when it first breaks out, must obviously be a matter of impossibility; and upon this point the contagionists and their antagonists may rail for ever, – the one will see nothing but contagion, whether in the dead or the living body, and the other will refer every fresh case to atmospheric or terrestrial influence, and both with as much apparent reason as they possibly could desire: but the candid impartial investigator, who waits to observe the course of the disease before coming to a conclusion, and refers to the facts furnished in the Cholera Hospitals of Warsaw and the sick quarters of Sunderland, will never be deceived in regard to its real nature, nor propagate the appalling belief that Cholera Morbus can be made a transportable and transmissible contagion.

28

Vide Orton, Kennedy, &c.

29

The precise words are "20 peasants of Swedia, robust, vigorous, and in the flower of life, were labouring at the harvest work, when on the 9th. of July, at noon, one was suddenly attacked, and the others in a short time showed symptoms of the disorder. In three hours, the entire band was exhausted; before sunset many had ceased to live, and by the morrow there was no survivor."

30

The remainder of the paper, as presented to the Society, treated of Typhus fever, and other matter, that had no reference to the disease in question.

31

Even when a living product, we are authorised to believe, from observations made upon the plague, that it cannot be propelled to a greater distance than a few feet from the body of the patient – that it is heavier than common air, settling down in a remarkable manner upon the sick bed, and saturating the lower strata of the atmosphere in the sick apartment.

32

After sending these letters to the press, I saw in the public prints that the Bishop of the Diocese had forbidden the funerals of the dead from Cholera to be received in the churches of London. Instead of thus forbidding a part, better have the whole of the service performed there (where crowds do not come) under cover from the weather, than in the open churchyard, where the mourners uncovered, are exposed in every way to damp and cold, and the jostling of the mob; better still have all the service deemed necessary, performed at the residence of the deceased.

33

Vide O'Halloran, upon the Yellow Fever in Spain.

34

As far back as the years 1796-7-8, this fact was familiar to us in the St. Domingo war, only we were satisfied with a minimum heat of 120°, from a belief that a temperature of that height, as it coagulated the ova of insects (the cock roach for instance), and was otherwise incompatible with insect life, would avail to dissipate contagion.