Читать книгу Letters on the Cholera Morbus - Fergusson William - Страница 4

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In my last letter I adverted to the opinion forwarded to his Majesty's Council on the 9th of June last from the College of Physicians, in which the cholera, now so prevalent in many parts of Europe, was declared to be communicable from person to person. We saw that they admitted in that letter (see page 16 of the Parliamentary Papers on Cholera) the limited nature of the proofs upon which their opinion was formed; but I had not the reasons which I supposed I had for concluding, that because Pt_1

[Pg 10] they used the words "ready to reconsider," in their communication of the 18th of same month to the Council, they intended to reconsider the whole question. Indeed this seems now obvious enough, as one of the Fellows of the College who signed the Report from that body on the 9th of June (Dr. Macmichael) has published a pamphlet in support of the opinion already given, in the shape of a letter addressed to the President of the College, whose views, Dr. Macmichael tells us, entirely coincide with his own; so that there is now too much reason to apprehend that in this quarter the door is closed. Contagionist as I am, in regard to those diseases where there is evidence of contagion, I find nothing in Dr. Macmichael's letter which can make an impression on those who are at all in the habit of investigating such subjects,[2] and who, dismissing such inductions as those which he seems to consider legitimate, rely solely on facts rigorously examined. He must surely be aware that most of the points which he seems to think ought to have such influence in leading the public to believe in the contagion of cholera, might equally apply to the influenza which this year prevailed in Europe, and last year in China, &c.; or to the influenza of 1803, which traversed over continents and oceans, sometimes in the wind's eye, sometimes not, as frequently mentioned by the late Professor Gregory of Edinburgh. Who will now stand up and try to maintain that the disease in those epidemics was propagated from person to person? Could more have been made of so bad a cause as contagion in cholera, few perhaps could have succeeded better than Dr. Macmichael, and no discourtesy shall be offered him by me, though he does sometimes loose his temper, and say, among other things not over civil, nor quite comme il faut, from a Fellow of the College, that all who do not agree with him as to contagion "will fully abandon all the ordinary maxims of prudence, and remain obstinately blind to the dictates of common sense!"—fort, mais peu philosophique Monsieur le Docteur. The time has gone by when ingenious men of the profession, like Dr. Macmichael, might argue common sense out of us; it will not even serve any purpose now that other names are so studiously introduced as entirely coinciding with Dr. Macmichael; for, in these days of reform in every thing, opinions, will only be set down at their just value by those who pay attention to the subject.

[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.

Referring once more to the Report of the 9th of June, made by the College to the Council, and signed by the President as well as by Dr. Macmichael, the cholera was there pronounced to be a communicable disease, when they had, as they freely admit, "no other means of judging of the nature and symptoms of the cholera than those furnished by the documents submitted to them." The documents submitted were the following, as appears from the collection of papers published by order of Parliament:—Two reports made to our government by Dr. Walker, from Russia; a report from Petersburgh by Dr. Albers, a Prussian physician; and Pt_1

[Pg 11] a report, with inclosures, regarding Russian quarantine regulations, from St. Petersburg, by Sir W. Creighton. Dr. Walker, who was sent from St. Petersburg to Moscow, by our ambassador at the former place; states, in his first report, dated in March, that the medical men seemed to differ on the subject of contagion, but adds, "I may so far state, that by far the greater number of medical men are disposed to think it not contagious." He says, that on his arrival at Moscow, the cholera was almost extinct there; that in twelve days he had been able to see only twenty-four cases, and that he had no means of forming an opinion of his own as to contagion. In a second report, dated in April from St. Petersburg, this gentleman repeats his former statement as to the majority of the Moscow medical men not believing the disease to be contagious (or, as the College prefer terming it, infectious), and gives the grounds on which their belief is formed, on which he makes some observations. He seems extremely fair, for while he states that, according to his information, a peculiar state of the atmosphere "was proved by almost every person in the city (Moscow), feeling, during the time, some inconvenience or other, which wanted only the exciting cause of catching cold, or of some irregularity in diet, to bring on cholera;" that "very few of those immediately about the patients were taken ill;" that he "did not learn that the contagionists in Moscow had any strong particular instances to prove the communication of the disease from one individual to another;" and that he had "heard of several instances brought forward in support of the opinion (contagion), but they are not fair ones:" he yet mentions where exceptions seem to have taken place as to hospital attendants not being attacked, but he has neglected to tell us (a very common omission in similar statements), whether or not the hospitals in which attendants were attacked were situated in or near places where the atmosphere seemed equally productive of the disease in those not employed in attending on sick. This clearly makes all the difference, for there is no earthly reason why people about the sick should not be attacked, if they breathe the same atmosphere which would seem to have so particular an effect in producing the disease in others; indeed there are good reasons why, during an epidemic, attendants should be attacked in greater proportion; for the constant fatigue, night-work, &c., must greatly predispose them to disease of any kind, while the great additional number always required on those occasions, precludes the supposition of the majority so employed being seasoned hospital attendants, having constitutions impenetrable to contagion. Those questions are now well understood as to yellow fever, about which so much misconception had once existed. The proofs by disinterested authors (by which I mean those unconnected with quarantine establishments, or who are not governed by the expediency of the case) in the West Indies, America, and other places, show this in a clear light; but the proofs which have for some time past appeared in various journals respecting the occurrences at Gibraltar, during the epidemic of 1828, are particularly illustrative. By the testimony of three or four writers, we find that within certain points, those in attendance on sick, in houses as well as hospitals, were attacked with the fever, in common with those who were not in attendance on sick; but that, where people remained at ever so short a distance beyond Pt_1 [Pg 12] those points, during the epidemic influence, not a single instance occurred of their being attacked, though great numbers had been in the closest contact with the sick, and frequently too, it would appear, under circumstances when contagion, had it existed, was not impeded in its usual course by a very free atmosphere:—sick individuals, for instance, lying in a small house, hut, or tent, surrounded, during a longer or shorter space of time, by their relatives, &c. A full exposure of some very curious mis-statements on these points, made by our medical chief of the quarantine, will be found from the pen of the surgeon of the 23d regiment, in the Edinburgh Medical and Surgical Journal, No. 106.[3] Those who are acquainted with the progress of cholera in India, must be aware how a difference in the height of places, or of a few hundred yards (indeed sometimes of a few yards) distance, has been observed to make all the difference between great suffering and complete immunity:—the printed and manuscript reports from India furnish a vast number of instances of this kind; and, incredible as it may appear, they furnish instances where, notwithstanding the freest intercourse, there has been an abrupt line of demarcation observed, beyond which the disease did not prevail. A most remarkable instance of this occurred in the King's 14th regiment, in 1819, during a cholera epidemic, when the light company of the regiment escaped almost untouched, owing to no other apparent cause than that they occupied the extremity of a range of barrack in which all the other companies were stationed! so that there would truly seem to be more things "on earth than are dreamt of in the philosophy" of contagionists. This seems so remarkable an event, that the circumstance should be more particularly stated:—"The disease commenced in the eastern wing of the barracks, and proceeded in a westerly direction, but suddenly stopped at the 9th company; the light infantry escaping with one or two slight cases only."—(Bengal Rep. 311.) It appears (loc. cit.) that 221 attacks took place in the other nine companies. We find (Bombay Rep. p. 11.) that, from a little difference in situation, two cavalry regiments in a camp were altogether exempt from the disease, while all the other regiments were attacked. Previous to closing these remarks, which seemed to me called for on Dr. Walker's second Report, it is fair to state, that in certain Russian towns which he names, he found that the medical men and others were convinced that the cholera was brought to them "somehow or other," an impression quite common in like cases, as we learn from Humboldt, and less to be wondered at in Russia than most places which could be mentioned. Pt_1 [Pg 13] It will not be a misemployment of time to consider now the next document laid before the College, to enable them to form their opinion—the Report of Dr. Albers, dated in March, and sent from St. Petersburg;—this gentleman, who was at the head of a commission sent by the Prussian government to Moscow, states, that at St. Petersburgh, where the disease did not then reign, the authorities and physicians were contagionists; but at Moscow, where it had committed such ravages, "almost all strenuously maintain that cholera is not contagious." The following extract seems to merit particular attention:—

"When the cholera first reached Moscow, all the physicians of this city were persuaded of its contagious nature, but the experience gained in the course of the epidemic, has produced an entirely opposite conviction. They found that it was impossible for any length of time completely to isolate such a city as Moscow, containing 300,000 inhabitants, and having a circumference of nearly seven miles (versts?), and perceived daily the frequent frustrations of the measures adopted. During the epidemic, it is certain that upwards of 40,000 inhabitants quitted Moscow, of whom a large number never performed quarantine; and notwithstanding this fact, no case is on record of the cholera having been transferred from Moscow to other places, and it is equally certain, that in no situation appointed for quarantine, any case of cholera has occurred. That the distemper is not contagious, has been yet more ascertained by the experience gathered in this city (Moscow). In many houses it happened, that one individual attacked by cholera was attended indiscriminately by all the relatives, and yet did the disease not spread to any of the inmates. It was finally found, that not only the nurses continued free of the distemper, but also that they promiscuously attended the sick chamber, and visited their friends, without in the least communicating the disease. There are even cases fully authenticated, that nurses, to quiet timid females labouring under cholera, have shared their beds during the nights, and that they, notwithstanding, have escaped uninjured in the same manner as physicians in hospitals have, without any bad consequences, made use of warm water used (a moment before) by cholera patients for bathing.

[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.

"These, and numerous other examples which, during the epidemic (we ought, perhaps, to call it endemic) became known to every inhabitant of Moscow, have confirmed the conviction of the non-infectious nature of the disease, a conviction in which their personal safety was so much concerned.

"It is also highly worthy of observation, that all those who stand up for contagion, have not witnessed the cholera, which is, therefore, especially objected to their opinion by their opponents." He closes by the observation, "The result of my own daily experience, therefore, perfectly agrees with the above-stated principle, namely, notwithstanding all my inquiries, I have met with no instance which could render it at all probable that the cholera is disseminated by inanimate objects." The words in italics are as in the Parliamentary papers on Cholera, pp. 8 and 9. Here is something to help to guide people in forming opinions, and to help governments on quarantine questions; but owing to a portion of the "perverseness" which Dr. Macmichael in anger talks about, Dr. Albers still Pt_1 [Pg 14] speculates upon cholera being contagious, and the College, it would seem, take up his speculations and sink his very important facts. Sir William Creighton's Report gives what puports to be an extract from a memorial of his on cholera, given in to the St. Petersburg Medical Council, tending to establish the contagious character of the disease; and with this a report by the extraordinary committee appointed by the Emperor to inquire into the Moscow epidemic. The disease had not appeared at St. Petersburg when he drew up his Memorial, and it does not appear from any-thing which can be seen in the extracts he furnishes, that he had personal knowledge of any part of what he relates. He gives the reported progress of the disease on the Volga and the Don, but is extremely deficient exactly where one might have expected that, from the greater efficiency of police authorities, &c., his information on contagion would have been more precise, viz., the introduction of the disease into Moscow, which could not, it would seem have been by material objects, for, according to the Committee, composed "of the most eminent public officers,"—"the opinion of those who do not admit the possibility of contagion by means of material objects, has for its support both the majority of voices, and the scrupulous observance of facts. The members of the Medical Council have been convinced by their own experience, as also by the reports of the physicians of the hospitals, that, after having been in frequent and even habitual communication with the sick, their own clothes have never communicated the disease to any one, even without employing means of purification. Convalescents have continued to wear clothes which they wore during the disease—even furs—without having them purified, and they have had no relapse. At the opening of bodies of persons who had died of cholera, to the minute inspection of which four or five hours a day for nearly a month were devoted, neither those who attended at their operations, nor any of the assisting physicians, nor any of the attendants, caught the infection, although, with the exception of the first day, scarcely any precautions were used. But what appears still more conclusive, a physician who had received several wounds in separating the flesh, continued his operations, having only touched the injured parts with caustic. A drunken invalid having also wounded himself, had an abscess, which doubtless showed the pernicious action of the dead flesh, but the cholera morbus did not attack him. In fine, foreign Savans, such as Moreau de Jonnés and Gravier, who have recognized, in various relations, the contagious nature of the cholera morbus, do not admit its propagation by means of goods and merchandise." (Parl. Papers on Chol. p. 13.) With the above documents the Council transmitted to the College a short description of the process of cleaning hemp in the Russian ports; and, lastly, the copy of a letter to the clerk of the Council from our ever-vigilant, though never-sufficiently-to-be-remunerated, head guardian of the quarantine department, who, taking the alarm, very properly recommends, as in duty bound, that a stir be forthwith made in all the pools, and creeks, and bays, &c., of the united kingdom, in order that all those notoriously "susceptible" old offenders, skins, hemp, flax, rags, &c., may be prevented from carrying into execution their felonious intention of covering the landing of a dire enemy. In truth, from the grave as well as from the sublime, there often seems to be "but a step;" and in reading Pt_1 [Pg 15] over this gentleman's suggestions about susceptibles and non-susceptibles, one may fancy himself, instead of being in the land of thinking people, to be in the land of Egypt, where, as we are informed (Madden, 1825), the sage matrons discuss the point, whether a cat be not a better vehicle for contagion than a dog:—a horse may be trusted, they say, but as to an ass, he is the most incorrigible of contagion smugglers;—of fresh bread we never need be afraid, but the susceptibility of butcher's meat is quite an established thing:—or we might fancy ourselves transported to regions of romance, where it is matter of profound deliberation, whether an egg shall be broken at the large or the small end. Such things are too bad for the nineteenth century; and in England, too, with her enlightened parliament! But until these questions are better examined, our guardian must bestir himself about articles susceptible of cholera contagion, while he enjoys his good quarantine pay, his good half pay from another department as I believe, and withall, if we are not misinformed, a smart pension from the Gibraltar revenue, for what granted nobody can tell.

The documents above referred to, would appear then to be the whole on which the College admit that they formed their opinions, and people may now judge whether the verdict be according to the evidence, or whether it be not something in the lucus a non lucendo mode of drawing conclusions:—most persons will probably think that, on such evidence, there might at least have been a qualified opinion. It appears, however, that having come to a decision on the 9th of June, that the disease was communicable from person to person, they in three days after, approved of persons being sent to Russia to find out whether they had decided rightly or not. Are we now to expect that, should the occasion need, they will heroically make war against their own declared opinion? For my part I expect from them all that should be expected from men; and the liberal part of the world will not fail to see from this, that I do not despair of even Dr. Macmichael, being still open to conviction. Let it not be for a moment understood that, in any-thing which has been said, or which may remain to be said respecting this gentleman, or in any-thing which may be hereafter said respecting Dr. Bisset Hawkins's work, I mean to insinuate that contagion in cholera is not with them a matter of conscience; but I certainly do mean to say that their zeal has manifestly warped their judgment; and not only this, but that it has prevented them from laying statements before the public on the cholera questions with all the impartiality we might have expected from gentlemen of their character in the profession.

In Dr. Macmichael's pamphlet, consisting of thirty-two pages, and professing to be a consideration of the question, "Is cholera contagious?" we scarcely find the disease mentioned till we come to page 25; the pages up to this being occupied chiefly by a recapitulation of opinions formerly given "on the progress of opinion upon the subject of contagion;"—on the opinions of old writers as to the contagion of plague, small-pox, measles, &c.:—he would infer that whereas small-pox and certain other diseases have, by more accurate observations made in comparatively modern times, been taken from the place they once held, and Pt_1

[Pg 16] ranged among diseases decidedly contagious, so ought cholera also to be now pronounced contagious! As an inducement to us to adopt this as good logic, he assures us that the list of diseases deemed contagious by wise men is on the increase—that non-contagionists are perverse people, blunderers, and so forth! As to his epithets, it shall only be said that among the disbelievers of contagion in cholera, and certain other diseases probably reputed contagious by Dr. Macmichael, are to be found hundreds possessing as much candour, as cultivated minds, and as much practical knowledge of their profession, as any contagionists, whether they be Fellows of a College or not; but as to the statement of Dr. Macmichael, is it true that we have been adding to the list of contagious diseases? Not within the last fifty years certainly. Even the influenza of 1803 was, if I mistake not greatly, termed, very generally, "infectious catarrh," but what professional man would term the influenza of 1831 so? Are there not yet remaining traces of the generally exploded doctrine of even contagion in ague, at one time attempted to be maintained? M. Adouard, of Paris, still indeed holds out. Do we not know that Portal, at one period of his life at least, would not, for fear of "infection," open the body of a person who had died of phthisis? Where is the medical man now to be found who would set up such a plea? or where, except in countries doomed to eternal barbarism, are patients labouring under consumption avoided now, as they were in several parts of the world at one time, just as if they laboured under plague, and all for the simpleton's reason that the disease often runs through families? What disinterested man will, on due examination of all that has been written on yellow fever, stand up now in support of its being a contagious disease, of which some thirty or forty years ago there was so general a belief? On croup, and a few more diseases, many still think it wise to doubt. Is dysentery, known to make such ravages sometimes, especially in armies, considered now, as at one time, to be contagious? If Dr. Macmichael's pamphlet was intended altogether for readers not of the profession, which seems very probable, his purposes will perhaps be answered, at least for a time, but I do not see how it can make an impression on medical men. Why not have been a little more candid when quoting Sydenham on small-pox, &c. and have quoted what that author says of the disease which he (Dr. M.) professes to write about—the cholera? The public would have means of judging how far the disease which was prevalent in 1669, resembled the "cholera spasmodica," &c., of late years. Many insist upon an identity (Orton among others), and yet Sydenham saw no reason for suspecting a communicable property. It might have been more to the point had Dr. Macmichael, instead of quoting old authorities on small-pox, measles, &c. quoted some authorities to disprove that Orton and others are wrong when they state it as their belief that some of those old epidemics in Europe, about which so much obscurity hangs, were nothing more or less than the cholera spasmodica. Mead's short sketch of the "sweating sickness" does not seem very inapplicable:—"Excessive fainting and inquietude inward burnings, headach, sweating, vomiting, and Pt_1 [Pg 17] diarrhœa."[4] In the letter to the President of the College we see no small anxiety to prove that the malignant cholera is of modern origin also in India, for the proofs from Hindoo authorities, as given in the volume of Madras Reports, are slighted. These Reports, as well as those of the other presidencies, are exceedingly scarce, but whoever can obtain access to them will find in the translations at pp. 253 and 255 (not at page 3, as quoted by Dr. Macmichael), enough probably to satisfy him that cholera is the disease alluded to there. But I think that we have at page 31 of Dr. Macmichael's letter, no small proof of a peculiarity of opinion, when we find that he there states that the evidence in the Madras Reports of the existence of epidemics of malignant cholera in India, on several occasions previous to 1817, rests on imperfect records, and that the description of the disease is too vague to prove the identity with the modern spasmodic cholera; for in this opinion he seems, as far as I have been able to discover, to stand alone among writers on cholera;—indeed it seems established, on the fullest authority, that cholera, in the same form in which it has appeared epidemically of late years, has committed ravages in India on more than one occasion formerly:—this is fully admitted by Mr. Orton, an East India practitioner, who is one of the few contagionists.