Letters on the Cholera Morbus Part 2

In confirmation of the opinion of Mr. Searle, we have now the evidence of the medical commission sent by the French government to Poland.

Dr. Londe, President of that commission, arrived in Paris some days ago.

He announced to the minister in whose department the quarantine lies, as well as to M. Hely D'Oissel, President of the Superior Council of Health, that it was proved in Poland, entirely to his satisfaction, as well as to the satisfaction of his five colleagues, that the cholera _is not a contagious disease_.

The Minister of War also sent _four_ medical men to Warsaw. Three of them have already declared against contagion; so it may be presumed that the day is not far distant when those true plagues of society, cordons and quarantines against cholera, shall be abolished. Hear the opinion of a medical Journalist in France,--after describing, a few days ago, the quarantine and cordon regulations in force in that country:--"But what effect is to be produced by these extraordinary measures, this immense display of means, and all these obstructions to the intercourse of communities, against a disease not contagious; a disease propagating itself epidemically; and which nothing has. .h.i.therto been able to arrest?

To increase its ravages a hundred-fold,--to ruin the country, and to make the people revolt against measures which draw down on them misery and death at the same time." What honest man would not _now_ wish that in this country the cholera question were placed _in Chancery_; where, I have no doubt, it would be quickly disposed of. I shall merely add, that the ten medical men sent from France to Poland, for the purpose of studying the nature of cholera, have all remained unattacked by the disease.

October 15, 1831.

LETTER V.

It was well and wisely said, that to know any-thing thoroughly, it must be known in all its details; and, to gain the confidence of the public in the belief of non-contagion in cholera, it is in vain that they are informed that certain alleged facts, brought forward industriously by contagionists, are quite groundless, unless proofs are given showing this to be the case. The public must, in short, have those alleged instances of contagion which have gained currency circ.u.mstantially disproved, or they will still listen to a doctrine leading to the disorganization of the community wherever it is acted upon. It is solely upon this ground that these letters have any claim to attention.

Dr. James Johnson, of London, has, since my last letter, publicly contradicted, with all the bluntness and energy of honest conviction, the statement by Sir Gilbert Blane, Drs. Macmichael, Hawkins, &c., as to the importation of the cholera into the Mauritius by the Topaze frigate; but _evidence_ is what people want on these occasions, and, relative to the case in question, probably the public will consider what is to be found in my third and fourth letters, quite conclusive. Having again mentioned the Mauritius, I cannot refrain from expressing my great surprise that Mr. Kennedy, who has lately published on cholera, should give, with the view of showing "the dread and confusion existing at the time," a proclamation by General Darling, while he does not furnish a word about the result of the proceedings inst.i.tuted by that officer, as detailed in my third letter, relative to the non-contagious nature of the disease, a point of all others the most important to the public. As to accounts regarding the confusion caused by the appearance of epidemic cholera, we have had no lack of them in the public papers during many months past, from quarters nearer home.

Regarding a statement made by Dr. Hawkins in his book on cholera, viz.

"That Moreau de Jonnes has taken great pains to prove that the disease was imported into the Russian province of Orenburg," Dr. H. omits to tell us how completely he failed in the endeavour. In the _Edinburgh Medical and Surgical Journal_ for July, 1831, there is a review of a memoir by Professor Lichtenstadt, of St. Petersburg, in which M.

Moreau's speculations are put to flight. From the efforts of this _pains-taking_ gentleman (M. Moreau) in the cause of contagion in cholera, as well as yellow-fever, he seems to be considered in this country as a medical man; but this is not the case: he raised himself by merit, not only to military rank, but also to literary distinction, and is a member of the Academy of Sciences, where he displays an imagination the most vivid, but as to the sober tact necessary for the investigation of such questions as those connected with the contagion or non-contagion of cholera and yellow-fever, he is considered _below par_. He saw the yellow-fever in 1802-3, at Martinique, while _aid-de-camp_ to the Governor, and still adheres to the errors respecting it which he imbibed in his youth, and when he was misled by occurrences taking place _within a malaria boundary_, where hundreds of instances are always at hand, furnis.h.i.+ng the sort of _post hoc propter hoc_ evidence of contagion with which some people are satisfied, but which is not one bit less absurd, than if a good lady, living in the marshes of Kent, were to insist upon it, that her daughter Eliza took the ague from her daughter Jane, because they lived together. Strange to say, however, M. Casimir Perier, the Prime Minister of France, seems to be guided, according to French journals, by the opinions of this gentleman on cholera, instead of by different medical commissions sent to Warsaw, &c.

The question of contagion in cholera has been now put to the test in every possible way, let us view it for a moment, as compared with what has occurred in regard to typhus at the London Fever Hospital, according to that excellent observer Dr. Tweedie, physician to the establishment.

Doubts, as we all know, have been of late years raised as to the contagion of typhus, but I believe nothing that has as yet appeared is so well calculated to remove those doubts as the statements by this gentleman (_see "Ill.u.s.trations of Fever"_), where he shows that it has been remarked for a series of years that "the resident medical officers, matrons, porters, laundresses, and domestic servants not connected with the wards, and every female who has ever performed the duties of a nurse, have one and all been the subjects of fever,"--while, _in the Small-Pox Hospital_, which adjoins it, according to the statements of the physician, "no case of genuine fever has occurred among the medical officers or domestics of that inst.i.tution for the last eight years." Had typhus been produced in the attendants by _malaria_ of the locality, those persons in the service of the neighbouring Small-Pox Hospital should also have been attacked to a greater or less extent, it is reasonable to suppose, within the period mentioned. Now let this be compared with all that has been stated respecting attendants on cholera patients, and let it be compared with the following excellent fact in ill.u.s.tration, showing how numbers labouring under the disease, and brought from the inauspicious spot where they were attacked to a place occupied by healthy troops, did not, _even under the disadvantage of a confined s.p.a.ce_, communicate the disease to a single individual:--"It has been remarked by many pract.i.tioners, that although they had brought cholera patients into crowded wards of hospitals, no case of the disease occurred among the sick previously in hospital, or among the hospital attendants. My own experience enables me fully to confirm this. The Military Hospital at Dharwar, an oblong apartment of about 90 feet by 20, was within the fort, and the lines of the garrison were about a mile distant outside of the walls of the fort. On two different occasions (in 1820 and 1821), when the disease prevailed epidemically among the troops of that station, while I was in medical charge of the garrison, but while no cases had occurred in the fort within which the hospital was situated, the patients were brought at once from their quarters to the hospital, which, on each occasion, was crowded with sick labouring under other disorders. No attempt was made to separate the cholera patients.

On one of these occasions, no case of cholera occurred within the hospital; on the other, one of the sick was attacked, but he was a convalescent sepoy, who had not been prevented from leaving the fort during the day. The disease, on each of those occasions, was confined to a particular subdivision of the lines, and none of those within the fort were attacked." (_Bell on Cholera_, p. 92.)

I have already quoted from Dr. Zoubkoff of Moscow, once a believer in contagion; every word in his pamphlet is precious; let but the following be read, and who will then say that "the seclusion of the sick should be insisted on?"--"The individuals of the hospitals, including soldiers and attendants on the sick, were about thirty-two in number, who, excepting the medical men, had never attended any sick; we all handled, more or less, the bodies of the patients, the corpses, and the clothes of the sick; have had our hands covered with their cold sweat, and steeped in the bath while the patients were in it; have inhaled their breath and the vapours of their baths; have tasted the drinks contained in their vessels, all without taking any kind of precaution, and all without having suffered any ill effects. We received into our hospital sixty-five cholera patients, and I appeal to the testimony of the thirty-six survivors, whether we took any precautions in putting them into the bath or in handling them--whether we were not seated sometimes on the bed of one, sometimes on that of another, talking to them. On returning home directly from the hospital, and without using chloride of lime, or changing my clothes, I sat down to table with my family, and received the caresses of my children, firmly convinced that I did not bring them a fatal poison either in my clothes or in my breath. n.o.body shut his door either against me or my colleagues; n.o.body was afraid to touch the hand of the physician who came direct from an hospital--that hand which had just before wiped the perspiration from the brow of cholera patients. From the time that people had experience of the disease, n.o.body that I am aware of shunned the sick." Who, after this, can read over with common patience directions for the separation of a cholera patient from his friends, as if "_an accursed thing_?" or who (_il faut trancher le mot_) will now follow those directions?

As to the good Sir Gilbert Blane, who has distributed far and wide a circular containing a description the most _nave_ on record, of the epidemic cholera, hard must be the heart which could refuse making the allowance which he claims for himself and his memoir; and though he brands those who see, in his account of the marchings and counter-marchings of the disease, nothing on a level with the intellect of the present age, as a parcel of prejudiced imbeciles, we must still feel towards him all the respect due to a parent arrived at a time of life when things are not as they were wont to be, _nec mens, nec aetas_. I may be among those he accuses of sometimes employing "unintelligible jargon," but shall not retort while I confess my inability to understand such expressions as "some obscure occurrence of unwholesome circ.u.mstances" which seem to have, according to him, both "brought" the disease to Jessore in 1817, and produced it there at the same time. Sir Gilbert marks out for the public what he considers as forming one of the princ.i.p.al differences between the English and Indian cholera, viz. that in the latter the discharges "consist of a liquid resembling thin gruel, in the English disease they are feculent and bilious." Now if he has read the India reports, he must have found abundance of evidence showing that sometimes there were _even bilious stools_[12] not at all like what he describes; and, again, if he is in the habit of reading the journals, he must have found _abundant_ evidence of malignant cholera with discharges like water-gruel in this country. As to the French Consul at Aleppo having escaped with 200 other individuals confined to his residence, I shall only say, as it is Sir Gilbert Blane who relates the circ.u.mstance, that he _forgot_ to mention that the aforesaid persons had retired to a residence _outside_ the city; which, permits me to a.s.sure you, Sir Gilbert, just makes all the difference in hundreds of cases:--they happened to retire to "_clene air_;" and had they carried 50 ague cases or 50 cholera cases with them (it matters not one atom which), the result would have been exactly the same. The mention of Barcelona and the yellow-fever, by Sir Gilbert, was, as Dr. Macmichael would term it, rather _unlucky_ for his cause, though probably lucky for humanity; for it cannot be too generally known that, during the yellow-fever epidemic there in 1821, more than 60,000 people left the city, and spread themselves all over Spain, without a single instance of the disease having been communicated, WHILE, AT BARCELONETTA, THE INFAMOUS CORDON SYSTEM PREVENTED THE UNFORTUNATE INHABITANTS FROM GOING BEYOND THE WALLS, AND THE CONSEQUENCES OF SHUTTING THEM UP WERE MOST HORRID.

[Footnote 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_.]

Little need be said respecting the pure a.s.sumptions of Sir Gilbert as to the movements of the malady by land and by water, for those vague and hacknied statements have been again and again refuted; but we may remark that whereas all former accounts respecting the cholera in 1817, in the army of the Marquis of Hastings, state that the disease broke out somewhat suddenly in the camp on the banks of the Sinde, Sir Gilbert, without deigning to give his authority, makes the army set out for "Upper India accompanied by this epidemic." We find that Mr. Kennedy, another advocate for contagion in cholera, differs from Sir Gilbert as to the disease having accompanied the grand army on the march; for he says the appearance of the malady was announced in camp in the early part of November, when "the first cases excited little alarm." In referring, in a former letter, to the sickness in the above army, I showed from the text of the Bengal report, how a change of position produced a return of health in the troops; but Mr. Kennedy states that the disease had greatly declined a few days before the removal, so that it had lost "its infecting power." Nevertheless it appears by this gentleman's account, a little farther on, that "in their progressive movement the grounds which they occupied during the night as temporary encampments were generally found in the morning, strewed with the dead like a field of battle"! This gentleman tells us that he has laid down a law of "increase and decline appertaining to cholera," by which, and the a.s.sistance of _currents of contagion_, it would appear all these things are reconciled wonderfully. Several of the points upon which he grounds his belief of contagion have been already touched upon in these letters, and the rest, considering the state of the cholera question in Europe just now, may be allowed to pa.s.s at whatever value the public may, after due examination, think it is ent.i.tled to. Let it be borne in mind that all contagionists who speak of the cholera in the army of the Marquis of Hastings, forget to tell us that though many thousand native followers had fled from that army during the epidemic, the disease did not appear in the towns situated in the surrounding country, _till the following year_, as may be seen at a glance by reference to Mr. Kennedy's and other maps.

We have another contagionist in the field--a writer in the _Foreign Quarterly Review_, the value of whose observations may appear from his statement, that "in 1828 the disease broke out in Orenburg, and was supposed [_supposed_!] to have been introduced by the caravans which arrive there from Upper Asia, or [_or_, nothing like a second string] by the Kingiss-Cossacks, who are adjoining this town, and were said [_were said_!] to have been about this time affected with the disease." This single extract furnishes an excellent specimen of the sort of _proofs_ which the contagionists, to a man, seem to be satisfied with as to the cholera being "carried" from place to place. This gentleman must surely be under some very erroneous impression, when he states that, "According to the reports of the Medical Board of Ceylon, the disease made its appearance in 1819 at Jaffnah in Ceylon, imported from Palamcottah, with which Jaffnah holds constant intercourse, and thence it was propagated over the island." Now there is every reason to believe that a reference to the doc.u.ments from Ceylon will shew that no report as to the importation of the disease was ever drawn up, for Drs. Farrel and Davy, as well as Messrs. Marshall, Nicholson, and others, who served in that island, are, to this hour, clearly against contagion. But as the writer tells us that he is furnished with unpublished doc.u.ments respecting the cholera at St. Petersburg, by the chief of the medical department of the quarantine in this country, we do not think it necessary to say one word more--_ex pede Herculem_.

I rejoice to observe that Dr. James Johnson has, at last, _spoken out_ upon the quarantine question; and I trust that others will now follow his example. It is only to be regretted, that a gentleman possessing such influence with the public as Dr. Johnson does, should have so long with-held his powerful aid on the occasion; but his motives were, I am quite sure, most conscientious; and I believe that he, as well as others, might have been prevented by a feeling of delicacy from going beyond a certain point.

Since my last letter a code of regulations, in the antic.i.p.ation of cholera, has been published by the Board of Health. _Let our prayers be offered up with fervency tenfold greater than before, that our land may not be afflicted with this dire malady._ The following statement, however, may not be altogether useless at this moment. According to the _Journal des Debats_ of the 24th instant, the Emperor of Austria, in a letter to his High Chancellor, dated Schoenbrunn, October 10th, and published in the _Austrian Observer_ of the 12th, formally makes the most magnanimous declaration to his people, THAT HE HAD COMMITTED AN ERROR IN ADOPTING THE VEXATIOUS AND WORSE-THAN USELESS QUARANTINE AND CORDON REGULATIONS AGAINST CHOLERA; that he did so before the nature of the disease was so fully understood; admits that those regulations have been found, after full experience, to have produced consequences more calamitous than those arising from the disease itself ("_plus funeste encore que les maux que provenaient de la maladie elle-meme_.") He kindly makes excuses for still maintaining a modified quarantine system at certain points, in consequence, as he states, of the opinions still existing in the dominions of some of his neighbours, _for otherwise his commercial relations would be broken off. To secure his maritime intercourse, he must do as they do!_ We find that as _all_ the Prussian cordons have been dissolved, _their vessels_ are excluded from entrance into certain places on the Elbe. What a horrid state of things! But, as a reference will shew, this was one of the things stated in my first letter as likely to occur: it is surely a fit subject for immediate arrangement between governments. In the mean time, we cannot but profit by the great lesson just received from Austria.

I shall add no more on the present occasion, than that my last information from Edinburgh notifies the death, from _Scotch cholera_, of two respectable females in that city, after an illness of only a few hours.

LETTER VI.

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

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

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

Let me ask why _all_ the doc.u.ments of importance forwarded to the Board of Health are not published in the collection just issued? Why are those forwarded by _the Medical Gentleman sent to Dantzic_ not published.[13]

Why has not an important doc.u.ment forwarded by our Consul at Riga not been published? Above all, why has not allusion been made in their papers to those cases of PURE SPASMODIC CHOLERA, which have occurred in various parts of England within the last five months, and the details of which has been faithfully transmitted to them. If those cases be inquired into thoroughly and impartially, and that several of them be not found to be PERFECTLY IDENTIC with the epidemic cholera of India, of Russia, &c., I hereby promise the public to disclose my name, and to suffer all the ignomy of a person making false statements. Indeed, I may confidently a.s.sure the public, that in at least one case which occurred about two months ago, the opinion of a gentleman who had practiced in India, and who had investigated the history of the symptoms, the ident.i.ty with those of Asiatic cholera, was not denied.

The establishment of this point is of itself sufficient to overthrow all supposition as to the importation of the disease.

[Footnote 13: Since the above was written, I find that this gentleman has adduced the strongest proofs possible against contagion.]

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

Nov. 9, 1831.

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 fas.h.i.+on 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, pract.i.tioners 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 pa.s.sed 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 ma.s.s, 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 quant.i.ties 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 a.s.sumed 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 pa.s.sing 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 circ.u.mstance 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 a.s.sertion, 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 a.s.sumed 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 pa.s.sed as facts, by contagionists _enrages_? 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 a.s.sured 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 Amba.s.sador 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 cla.s.ses, 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.

[Footnote 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.]

[Footnote 15: As these most remarkable circ.u.mstances 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.]

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 was.h.i.+ng, and too little about this.

November 10th.

LETTER VIII.