Letters on the Cholera Morbus Part 4

FINIS.

Nichols and Sons, Printers, Cranbourn-street, Leicester-square.

WINDSOR: PRINTED BY R. OXLEY, AT THE EXPRESS OFFICE.

LETTERS

ON THE

CHOLERA MORBUS,

&c. &c. &c.

WINDSOR, FEB. 9, 1832.

Salus populi suprema lex.

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

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

[Footnote 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.]

That it could have been descried on no other than the above line must be self-evident, but to say that it has followed it in the manner that a contagious disease ought to have done, in our own country for instance, is at variance with the fact. From Sunderland and Newcastle to the south, the ways were open, the stream of population dense and continuous, the conveyances innumerable, the communications uninterrupted and constant.

Towards the thinly-peopled north how different the aspect,--townships rare, the country often high, cold, and dreary, in many parts of the line without inhabitants or the dwellings of man for many miles together, yet does the disease suddenly alight at Haddington, a hundred miles off, without having touched the towns of Berwick, Dunbar, or any of the intermediate places. It is said to have been carried there by vagrant paupers from Sunderland. Can this be true? Could any such with the disease upon them in any shape, have encountered such a winter journey without leaving traces of it in their course?[18] or, if they carried it in their clothing, the winds of the hills must have disinfected these _fomites_ long before their arrival. No contagionist, however unscrupulous and enthusiastic, nor quarantine authority however vigilant, can pretend to say how the disease has been introduced at the different points of Sunderland, Haddington, and Kirkintulloch,--no more than he can tell why it has appeared at Doncaster, Portsmouth, and an infinity of other places without spreading. Even now, it lingers at the gates of the great open cities of Edinburgh and Glasgow, as if like a malarious disease, (which I by no means say that it is) it better found its food in the hamlet and the tent, in fact, amongst the inhabitants of ground tenements, than in paved towns and stone buildings. We must go farther and acknowledge, that for many months past our atmosphere has been tainted with the miasm or poison of Cholera Morbus, as manifested by unusual cases of the disease almost everywhere, and that these harbingers of the pestilence only wanted such an ally as the drunken jubilee at Gateshead, or atmospherical conditions and changes of which we know nothing, to give it current and power. That the epidemic current of disease wherever men exist and congregate together, must, in the first instance, resemble the contagious so strongly as to make it impossible to distinguish the one from the other, must be self-evident; and it is only after the touchstone has been applied, and proof of non-communicability been obtained, as at Sunderland, that the impartial observer can be enabled to discern the difference.--Still, however, must he be puzzled with the inexplicable phenomena of this strange pestilence, but if he feel himself at a loss for an argument against contagion, he has only to turn to one of the most recent communications from the Central Board of Health, where he will find that "That the subsidiary force under Col.

Adams, which arrived in perfect health _in the neighbourhood_ of a village of India infected with Cholera, had seventy cases of the disease the night of its arrival, and twenty deaths the next day," as if the march under a tropical sun, and the encampment upon malarious ground, or beneath a poisoned atmosphere, were all to go for nothing; and that the neighbourhood of an infected village, with which it is not stated that they held communication, had in that instantaneous manner alone, produced the disease. This is surely drawing too largely upon our credulity, and practising upon our fears beyond the mark.

[Footnote 18: The Cholera in this country would appear always to travel with the pedestrian, and to eschew the stage coach even as an outside pa.s.senger.]

The anti-contagionist, in acknowledging his ignorance, leaves the question open to examination; but the contagionist has solved the problem to his own mind, and closed the field of investigation, without, however, ceasing to denounce the antagonist who would disturb a conclusion which has given him so much contentment.--Let us here examine, for a moment, who in this case best befriends his fellow men.

The latter, in vindication of a principle which he cannot prove, would shut the book of enquiry, sacrifice and abandon the sick, (for to this it must ever come the moment pestilential contagion is proclaimed,) extinguish human sympathy in panic fear, and sever every tie of domestic life,--the other would wait for proofs before he proclaimed the ban, and even then, with pestilence steaming before him, would doubt whether that pestilence could be best extinguished, or whether it would not be aggravated into ten-fold virulence, by excommunicating the sick.

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

[Footnote 19: Parliament voted a reward of 5000 to Doctor Carmichael Smith for the discovery.]

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

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

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 sh.o.r.es, 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 pa.s.sed 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 a.n.a.logy 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--pa.s.sing 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--_const.i.tution 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 woodc.o.c.ks 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, a.s.sisting the poorer cla.s.ses of the community, in the better condition of those cla.s.ses themselves, compared with the poor of other countries, and in the devoted courage and a.s.sistance 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 dest.i.tute, 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 a.s.sumed 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 circ.u.mstances 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 pract.i.tioner 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 embarra.s.sing circ.u.mstances of warfare and disease, out of a hundred medical men, with their a.s.sistants 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 cla.s.ses of the community; but the above fact is alone sufficient to prove that it cannot be a personal contagion.

[Footnote 20: Vide Medical Gazette.]

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 una.s.sisted, unpurified, uncleansed amidst their acc.u.mulated 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 munic.i.p.al 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 pa.s.ses 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 circ.u.mstances 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 un.o.bstructed, 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 subst.i.tuting for it a fact.i.tious 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 G.o.d 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]

[Footnote 21: The oven on that account need not lose character with bread-eaters, for according to the old adage, Omne vitium per ignem excoquitur.]

[Footnote 22: Light too, more especially when a.s.sisted 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.]

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, trespa.s.s 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._