Читать книгу Letters from a Mourning City - Axel Munthe - Страница 8

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HE unexpected reappearance of the cholera last week led to a fearful panic. In a single day the town became as empty and as silent as during the worst days of the epidemic; the streets again reeked of the horrid smell of sulphur, and through the night the fires burned as before in the public squares; the ambulance societies, which had begun to disperse, again prepared themselves for instant action, and to all appearance the days of mourning were about to recommence for the poor town of Naples. The people began to lose their power of endurance, and a certain agitation of evil omen was noticeable in the poor quarters. The municipal authorities did their best to compose the minds of the multitude, and the newspapers were again recommended to dissemble the real state of affairs. Doctors here have been speculating upon the reasons of this violent and unforeseen increase of cases, and the newspapers are still full of such discussion. Most of them have come to the conclusion that the real cause is to be traced to il vino nuovo, which was tried rather too often on the Ottobrata feast-day, last Thursday. As one proof of how the day was abused, a correspondent quotes a merry party of four lazzaroni who suddenly discovered themselves to be rich enough to buy twenty-four litres of vino di Posilipo, and who, bewildered perhaps at the novelty of the situation, and determined to wipe out every trace thereof—tossed off the whole lot there and then. The gay party wound up at the Conocchia hospital, every one of them being struck down with cholera during the night.

The idea that the recrudescence of the epidemic is due to the excesses of Thursday's holiday is of course a reassuring, but not, I am afraid, a correct one. I cannot understand how doctors can bring themselves to believe that one day's wine-drinking is sufficient to account for so sudden an increase of cases; that amongst the joyous crowd who up at Posilipo on Thursday last drank a farewell toast to the cholera, many were subsequently attacked, I am quite willing to believe; but allowing the minimum of time for the incubation of cholera, it is nevertheless longer than the hours which transpired between Thursday evening and Friday morning, when most of the cases were announced. Without wishing to enter into this question, which is out of place here, my own opinion is that the increase of the epidemic may be traced to the varied temperature of the last few days, (a sudden fall of the barometer, a change of wind, condition of the water underground, etc.) A careful observation of the patients at the hospital—who had certainly nothing to do with Thursday's merry-makings—inclines me to this view, for the greater part of them exhibited a considerable change for the worse, coinciding exactly in point of time with the outbreak in the town.

Besides, and this is an experience corroborated by most people here, any sudden change of temperature must interfere with the process of digestion, and must for that very reason predispose reception of disease. Another fact not willingly admitted but nevertheless indubitable—a certain laxity has crept into the Sanitary Society's administrations, extending even to the doctors themselves. As far as these latter are concerned it is not to be wondered at—human beings, like the rest of us, physical exhaustion is bound to assert itself sooner or later, and they have had a hard time of it. For the first weeks everything went without a hitch, most of them (and to the honour of the medical staff of Naples be it said) went to their duty through fire, risking their own lives to save the lives of others. To the sense of duty that bade them stand at their post must be added the scientific interest, which was the magnet that attracted a goodly number; here were many experiences to be gained, many dark riddles to be solved—many laurels to be won. It is as yet too early in the day to decide how far Science has been satisfied, but this much I can tell you: if, as we are given to understand, the deepest interest centres in the search after Truth, then the doctors have every reason to congratulate themselves, and their zeal ought to be more ardent than ever—for nothing has been discovered. They have gone forward to meet this epidemic with fresh weapons, with all the most important results of recent experiences, Koch's discovery of the cholera microbes, etc. etc., but one can only bear witness to the fact how much yet remains to be discovered, ere we can hope to attain to some positive practical result as to the special treatment which the cholera patient requires,—if such a result be indeed attainable at all.

And this outbreak has been if anything more terrible than the last; 10,000 cases taken en bloc give a mortality of 6000; and in certain infected quarters the mortality has increased to eighty per cent (at Fuorigrotta, in the neighbourhood of Naples, twenty-five out of twenty-nine patients died; the death-rate of Torre del Greco and several other suburbs has been enormous). If the hygienic and therapeutic conditions of the town are not all that they might be, the hospitals, on the other hand, have been well served by able men, and eager investigators. Everything has been tried, very little headway made. I, who have casually been brought into contact with some hundred cholera patients, have arrived at a very profound conclusion with which I am quite willing to acquaint you here, where there is no chance of the doctors overhearing us. To my mind the cholera patients may be divided into two large classes: those who are going to live, and those who are going to die. And only towards the last is it at all possible to decide in which class to include the patient. The same curious characteristic which distinguishes the epidemic itself, is also discernible in the patient's case. We are at a loss to understand why one patient dies after a few hours, another after a day or two, whilst the third recovers, notwithstanding the fact that the disease has developed itself with precisely the same symptoms, and, as far as one is able to judge, with precisely the same virulence in all three cases; why one patient, who seems to have been but slightly attacked, should suddenly fall into the agonies of death, whilst another, who lies in the last phase of cholera, and whom the doctor has already made over to the priest, should unexpectedly recover. We stand here on unknown, untrodden ground; the usual indices, the patient's power of resistance, age, etc., all are at fault in this case.

And whatever may have been said concerning cholera and other contagious diseases, that the virus loses its intensity with the actual decrease of the epidemic itself, that the cases towards the end are of a milder character—I cannot see that the argument holds good here. The cholera at the present moment is decidedly on the wane, in spite of which there are a number of these foudroyant cases every day. For instance, yesterday, during the morning inspection (at eight o'clock), seven cholera patients were received at the Santa Maddalena Hospital, all seven had been perfectly well the previous night, and by ten P.M. six of them were already dead. People are now being struck down in the streets, just as they were during the worst days of the epidemic, and the man who drove me out to Granatello day before yesterday, fell off the box whilst waiting for me, dying four hours later—the poor fellow never got his fare after all.

And it was just the same last year in Egypt, when the cholera was supposed to be extinct in Alexandria; after twelve days, during which there had not been a single case at the cholera hospital, the disease returned with the same virulence in the case of one of the French doctors, poor Thuillier, who was roused at three o'clock one morning by the first symptoms of cholera, and about whom at eight o'clock the news had already been telegraphed to Paris that he was at the point of death! True, that as far as he was concerned, a sort of artificial life had been kept up for about twelve hours, but it was absolutely useless, and almost cruel under these circumstances, where the extinction of life is not synonymous with ceasing to live, but with ceasing to die.

As I write Thuillier's name I am reminded of a graceful act of Dr. Koch's, the celebrated German savant. Koch happened to be in Egypt at the same time as the French doctors, pupils of Pasteur, who had been sent out by their Government to study the cholera question. As is well known, Koch and Pasteur have come to close quarters on many a scientific battlefield, and the discussion has been carried on with a vehemence of which the origin, alas, can be traced to political animosity; for Koch, no matter how great a man, is nevertheless le Prussien in the sensitive Frenchman's eyes. Even in Alexandria some latent enmity existed between the French and German emissaries. The great German experimentalist had a fine opportunity of proving that the echo of these slight differences dies away when face to face with death, and that the grave is the neutral ground on which all men meet. Dr. Koch was present when the French physicians laid their colleague in the grave, and in his own name and that of the other German doctors, he laid two laurel wreaths upon the coffin—"they are simple," said he, "but still they are made of laurel—they are those we offer heroes!"

I wander from my subject, but Koch's name is so intimately connected with everything concerning cholera, that I may almost be allowed to do so.