In turning now more particularly to the work, or rather compilation, of Dr. Bisset Hawkins, let us see whether we cannot discover among what he terms "marks of haste" in getting it up for "the curiosity of the public" (curiosity, Dr. Hawkins!), some omissions of a very important nature on the subject of a disease respecting which, we presume, he wished to enlighten the public. And first, glancing back to cholera in the Mauritius, Dr. Hawkins might, had he not been so pressed for time, have referred to the appearance of cholera in 1829, at Grandport in that island; when, as duly and officially ascertained, it could not be a question of importation by any ship whatever. The facility with which he supplies us with "facts,"—the false facts reprobated by Bacon, and said by Cullen to produce more mischief in our profession than false theories—is quite surprising; he tells us, point blank (p. 31), speaking of India, that "when cholera is once established in a marching regiment, it continues its course in spite of change of position, food, or other circumstances!" Never did a medical man make an assertion more unpardonable, especially if he applies the term marching regiment as it is usually applied. Dr. Hawkins leads us to suppose that he has examined the India reports on cholera. What then are we to think when we find in that for Bengal the following most interesting and conclusive statements ever placed on record? Respecting the Grand Army under the Marquis of Hastings, consisting of 11,500 fighting men, and encamped in November 1817 on the banks of the Sinde, the official report states that the disease "as it were in an instant gained fresh vigour, and at once burst forth with irresistible violence in every direction. Unsubjected to the laws of contact, and proximity of situation, which had been observed to mark and retard the course of other pestilences, it surpassed the plague in the width of its range, and outstripped the most fatal diseases hitherto known, in the destructive rapidity of its progress. Previously to the 14th it had overspread every part of the camp, sparing neither sex nor age, in the undistinguishing virulence of its attacks."—"From the 14th to the 20th or 22d, the mortality had become so general as to depress the stoutest spirits. The sick were already so numerous, and still pouring in so quickly from every quarter, that the medical men, although night and day at their posts, were no longer able to administer to their necessities. The whole camp then put on the appearance of a hospital. The noise and bustle almost inseparable from the intercourse of large bodies of people had nearly subsided. Nothing was to be seen but individuals anxiously hurrying from one division of a camp to another, to inquire after the fate of their dead or dying companions, and melancholy groups of natives bearing the biers of their departed relatives to the river. At length even this consolation was denied to them, for the mortality latterly became so great that there was neither time nor hands to carry off the bodies, which were then thrown into the neighbouring ravines, or hastily committed to the earth on the spots on which they had expired." Let us now inquire how this appalling mortality was arrested;—the report goes on to inform us:—"It was clear that such a frightful state of things could not last long, and that unless some immediate check were given to the disorder, it must soon depopulate the camp. It was therefore wisely determined by the Commander-in-chief to move in search of a healthier soil and of purer air," which they found when they "crossed the clear stream of the Bitwah, and upon its high and dry banks at Erich soon got rid of the pestilence, and met with returning health." Now just fancy epidemic cholera a disease transmissible by "susceptible articles," and what an inexhaustible stock must this large army, with its thousands of followers, have long carried about with them; but, instead of this, they were soon in a condition to take the field. Against the above historical fact men of ingenuity may advance what they please. There is no doubt that, in the above instance, severe cases of cholera occurred during the move, the poison taken into the system on the inauspicious spot, not having produced its effects at once; it is needless to point out what occurs in this respect in remittent and intermittent fevers. The India reports furnish further evidence of mere removal producing health, where cholera had previously existed. Mr. Bell, a gentleman who had served in India, and who has lately written upon the disease,[9] informs us (p. 84), that "removing a camp a few miles, has frequently put an entire and immediate stop to the occurrence of new cases; and when the disease prevailed destructively in a village, the natives often got rid of it by deserting their houses for a time, though in doing so they necessarily exposed themselves to many discomforts, which, caeteris paribus, we should be inclined to consider exciting causes of an infectious or contagious epidemic." We even find that troops have, as it may be said, out-marched the disease, or rather the cause of the disease; that is, moved with rapidity over an extensive surface where the atmosphere was impure, and thereby escaped—on the principle that travellers are in the habit of passing as quickly as they can across the pontine marshes. Mr. Bell says, "In July, 1819, I marched from Madras in medical charge of a large party of young officers who had just arrived in India, and who were on their way to join regiments in the interior of the country. There was also a detachment of Sepoys, and the usual number of attendants and camp-followers of such a party in India. The cholera prevailed at Madras when we left it. Until the 5th day's march (fifty miles from Madras) no cases of the disease occurred. On that day several of the party were attacked on the line of march; and, during the next three stages, we continued to have additional cases. Cholera prevailed in the countries through which we were passing. In consultation with the commanding officer of the detachment, it was determined that we should leave the disease behind us; and as we were informed that the country beyond the Ghauts was free from it, we marched, without a halt, until we reached the high table land of Mysore. The consequence was, that we left the disease at Vellore eighty-seven miles from Madras, and we had none of it until we had marched seventy miles further (seven stages), when we again found it at one of our appointed places of encampment; but our camp was, in consequence, pushed on a few miles, and only one case, a fatal one, occurred in the detachment; the man was attacked on the line of march. We again left the disease, and were free from it during the next 115 miles of travelling; we then had it during three stages, and found many villages deserted. We once more left it, and reached our journey's end, 260 miles further, without again meeting it. Thus, in a journey of 560 miles, this detachment was exposed to, and left the disease behind it, four different times; and on none of those occasions did a single case occur beyond the tainted spots." What a lesson for Dr. Hawkins! But for whom could Dr. Hawkins have written his curious book? Hear Mr. Bell in respect to the common error of the disease following high roads and navigable rivers only:—"I have known the disease to prevail for several weeks at a village in the Southern Mahratta country, within a few miles of the principal station of the district, and then leave that division of the country entirely; or, perhaps, cases would occur at some distant point. In travelling on circuit with the Judge of that district, I have found the disease prevailing destructively in a small and secluded village, while no cases were reported from any other part of the district." What is further stated by Mr. Bell will tend to explain why so much delusion has existed with regard to the progress of the disease being remarkably in the direction of lines of commerce, or great intercourse:—"When travelling on circuit, I have found the disease prevailing in a district before any report had been made of the fact, notwithstanding the most positive orders on the subject; and I am persuaded, that were any of the instances adduced in support of the statement under consideration strictly inquired into, it would be found that the usual apathy of the natives of India had prevented their noticing the existence of the disease until the fact was brought prominently forward by the presence of Europeans. It should also be brought to mind, that cholera asphyxia is not a new disease to these natives, but seems to be, in many places, almost endemical, whilst it is well known that strangers, in such circumstances, become more obnoxious to the disease than the inhabitants of the country. Moreover, travellers have superadded to the remote cause of the disease, fatigue and road discomforts, which are not trifling in a country where there are neither inns nor carriages." (p. 89.) Cholera only attacks a certain proportion of a population, and is it wonderful that we should hear more of epidemic on high roads, where the population is greatest? High roads too are often along the course of rivers; and is there not some reason for believing, that there is often along the course of rivers, whether navigable or not, certain conditions of the atmosphere unfavourable to health? When Dr. Hawkins stated, as we find at p. 131 he has done, that where the inhabitants of certain hilly ranges in India escaped the disease, "these have been said to have interdicted all intercourse with the people below," he should have quoted some respectable authority, for otherwise, should we unhappily be visited by this disease, the people of our plains may one day wage an unjust war against the sturdy Highlanders or Welsh mountaineers.[10] Little do the discussers of politics dream of the high interest of this part of the cholera question, and little can they conceive the unnecessary afflictions which the doctrine of the contagionists are calculated to bring on the nation. Let no part of the public suppose for a moment that this is a question concerning medical men more than it does them; all are very deeply concerned, the heads of families more especially so.

[Footnote 9: This is by far the best work yet published in England on the cholera, but it is to be regretted that the author has not alluded to the works of gentlemen who have a priority of claim to some of the opinions he has published: I think that, in particular, Mr. Orton's book, printed in India, should have been noticed.]

[Footnote 10: Something of this kind would have infallibly taken place, had certain insane proposals lately made respecting the shutting in of the people of Sunderland, been carried into effect.]

We see that the identity of the European and Indian epidemic cholera is admitted on all sides; we have abundant proof that whatever can be said as to the progress of the disease, its anomalies, &c., in the former country, have been also noted respecting it in the latter; and Dr. Hawkins, when he put forth his book, had most assuredly abundant materials upon which to form a rational opinion. It is by no small effort, therefore, that I can prevent all the respect due to him from evaporating, when he declares, at page 165, that "the disease in India was probably communicable from person to person, and that in Europe it has undeniably proved so." But Dr. Hawkins is a Fellow of the College of Physicians, and we must not press this point further than to wish others to recollect that he has told us that he drew up his book in haste; and, moreover, that he wished to gratify the curiosity of the public. The Riga story about the hemp and the fifteen labourers I shall leave in good hands, the British Consul's at that city, who was required to draw up, for his government, a statement of the progress, &c. of the cholera there, of which the following is an extract:—

"The fact of non-contagion seems determined, as far as a question can be so, which must rest solely upon negative evidence. The strongest possible proof is, the circumstance, that not one of the persons employed in removing the dead bodies (which is done without any precaution) has been taken ill. The statement of fifteen labourers being attacked, while opening a pack of hemp, is a notorious falsehood. Some physicians incline to the opinion, that the disease may sometimes be caught by infection, where the habit of body of the individual is predisposed to receive it; the majority of the faculty, however, maintain a contrary doctrine, and the result of the hospital practice is in their favour. There are 78 persons employed in the principal hospital here; of these only two have been attacked, one of whom was an 'Inspecteur de Salle,' and not in immediate attendance upon the sick. I am assured that the other hospitals offer the same results, but as I cannot obtain equally authentic information respecting them, I confine myself to this statement, on which you may rely. On the other hand, in private families, several instances have occurred where the illness of one individual has been followed by that of others: but, generally, only where the first case has proved fatal, and the survivors have given way to grief and alarm. Mercenary attendants have seldom been attacked, and, as mental agitation is proved to be one of the principal agents in propagating or generating the disease, these isolated cases are attributed to that cause rather than infection.

"It is impossible to trace the origin of the disease to the barks; indeed it had not manifested itself at the place whence they come till after it had broken out here. The nearest point infected was Schowlen (at a distance of 200 wersts), and it appeared simultaneously in three different places at Riga, without touching the interjacent country. The first cases were two stone-masons, working in the Petersburg suburbs, a person in the citadel, and a lady resident in the town. None of these persons had had the slightest communication with the crews of barks, or other strangers, and the quarter inhabited by people of that description was later attacked, though it has ultimately suffered most.

"None of the medical men entertain the slightest doubt of the action of atmospheric influence—so many undeniable instances of the spontaneous generation of the disease having occurred. Half the town has been visited by diarrhoea, and the slightest deviation from the regimen now prescribed (consisting principally in abstinence from acids, fruit, beer, &c.) invariably produces an attack of that nature, and, generally, cholera: fright, and intoxication, produce the same effect.

"Numerous instances could be produced of persons in perfect health, some of whom had not left their rooms since the breaking out of the disease, having been attacked by cholera, almost instantaneously after having imprudently indulged in sour milk, cucumbers, &c. It is a curious circumstance, bearing on this question, that several individuals coming from Riga have died at Wenden, and other parts of Livonia, without a single inhabitant catching the disease; on the other hand, it spreads in Courland, and on the Prussian frontier, notwithstanding every effort to check its progress. The intemperance of the Russians during the holidays has swelled the number of fresh cases, the progressive diminution of which had previously led us to look forward to a speedy termination of the calamity." This is a pretty fair specimen of the undeniable manner in which cholera is proved to be contagious in Europe, and we shall, for the present, leave Dr. Hawkins in possession of the full enjoyment of such proofs.

Some attempt was made at Sunderland, to establish that, in the case which I mentioned in my last as having proved fatal there, the disease had been imported from foreign parts, but due inquiry having been made by the collector of the customs, this proved to be unfounded; the man's name was Robert Henry, a pilot:—he died on the 14th of August.[11]

[Footnote 11: In a former letter I alluded to cases of cholera which appeared this year at Port Glasgow; I find that the highly interesting details of those cases have been just published:—they should be read by everybody who takes the smallest interest in the important questions connected with the cholera. The London publishers are Whittaker and Co.]

Abroad we find that, unhappily, the cholera has made its appearance at Hamburgh; official information to this effect arrived from our Consul at that place, on Tuesday the 11th inst. (October). The absurdity of cordons and quarantines is becoming daily more evident. By accounts from Vienna, dated the 26th September, the Imperial Aulic Council had directed certain lines of cordon to be broken up, seeing, as is stated, that they were inefficacious; and by accounts of the same date, the Emperor had promised his people not to establish cordons between certain states.

We find at the close of a pamphlet on cholera, lately published by Mr. Searle, a gentleman who served in India, and who was in Warsaw during the greater part of the epidemic which prevailed there this year, the following statement:—"I have only to add, that after all I have heard, either in India or in Poland, after all I have read, seen, or thought upon the subject, I arrive at this conclusion, that the disease is not contagious."

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 hitherto 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 circumstantially 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 instituted 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 Lichtenstaedt, 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, furnishing 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 "Illustrations 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 institution 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 illustration, 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 space, communicate the disease to a single individual:—"It has been remarked by many practitioners, 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. Nobody shut his door either against me or my colleagues; nobody 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, nobody 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 naive 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 circumstances" 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 principal 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 circumstance, that he forgot to mention that the aforesaid persons had retired to a residence outside the city; which, permits me to assure 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 assumptions 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 assistance 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 pass at whatever value the public may, after due examination, think it is entitled 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 documents 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 documents 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 anticipation 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 God and man did I not protest, most loudly, against those regulations, which shall have for their base, an assumption, 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 constitution 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 unbiassed 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 Devonshire 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 institute 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 documents 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 document 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 assure 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 identity 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 fashion 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, practitioners 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 passed 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 mass, 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 quantities 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 assumed 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 passing 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 circumstance 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 assertion, 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 assumed 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 passed 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 assured 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 Ambassador 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 classes, 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 circumstances have not appeared in the statements of our Russian medical commission, we must either presume that the Duke is not correct, or that those facts have escaped the notice of the commission.]

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 washing, and too little about this.

November 10th.



LETTER VIII.

Already has the problem of the contagious or non-contagious nature of this disease been solved upon our own land; and as sophistry can no longer erect impediments to the due distribution of the resources of this pre-eminently humane nation, it is to be hoped that not an hour will be lost in shaping the arrangements accordingly. What now becomes of the doctrine of a poison, piercing and rapid as the sun's rays, emanating from the bodies of the sick—nay, from the bodies of those who are not sick, but who have been near them or near their houses? In the occurrences at Newcastle and Sunderland, how has the fifty times refuted doctrine of the disease spreading from a point in two ways, or in one way, tallied with the facts? We were desired to believe that in India, Persia, &c., "the contagion travelled," as the expression is, very slow, because this entity of men's brains was obliged to wend its way with the march of a regiment, or with the slow caravan: now, however, when fifty facilities for the most rapid conveyance have been afforded every hour since its first appearance, it will not put itself one bit out of its usual course. And then what dangers to the attendants on the sick to the members of the same family—to the washerwomen—to the clergymen—to the buriers of the dead—even to those who passed the door of the poor sufferer! Well, what of all this has occurred? Why it has occurred that this doctrine, supported by many who were honest, but had not duly examined alleged facts, and by others, I regret to say, whose interests guided their statements—that the absurdity of this doctrine has now been displayed in the broad light of day. Make allowance (even in this year of great notoriety for susceptibility to cholera in the people at large in this country) for insusceptibility on the part of numbers who came into contact at Sunderland and Newcastle, with the persons of cholera patients, with their beds, their furniture, their clothes, &c., yet, if there had ever been the slightest foundation for the assertions of the contagionists, what numbers ought to have been contaminated, in all directions over the face of the country, even within the first few days, considering the wonderful degree of intercourse kept up between all parts. But we find that, as in Austria and Prussia, "la maladie de la terre" is not disposed here to accommodate itself to vain speculations. Now the matter may be reduced to the simple rules of arithmetic, viz.:—if, as "contagionists par metier" say, the poison from the body of one individual be, in the twinkling of an eye, and in more ways than one, transmitted to the bodies of a certain number who have been near him, &c., how many thousands, or tens of thousands, in every direction, should, in a multiplied series of communications and transmissions, be now affected?

Those who have watched the course of matters connected with cholera in this country, have not failed to perceive, for some time past, the intent and purport of the assertion so industriously put forth—that the disease might be introduced by people in perfect health; and we have just seen how this ruse has been attempted to be played off at Sunderland, as the history of such matters informs us has been done before in other instances, and public vengeance invoked most foully and unjustly upon the heads of guiltless persons in the Custom House or Quarantine Department, for "permitting a breach of regulations;" but the several pure cases of spasmodic cholera, in many parts of England besides Sunderland, long before—months before—the arrival of the ship (as shewn in a former letter) leave no pretence for any supposition of this kind.

I request that the public may particularly remark, that, frequently as those cases have been cited as proofs of the absurdity of expecting the arrival of the disease by a ship, THEIR IDENTITY HAS NEVER ONCE BEEN DISPUTED BY THOSE MOST ANXIOUS TO PROVE THEIR CASE. No; the point has, in common parlance, been always shirked; for whoever should doubt it, would only hold himself up to the ridicule of the profession, and to admit it would be to give up the importation farce.

Others have remarked before me that, though a very common, it is a very erroneous mode of expression, to say of cholera, that it has travelled to such or such a place, or has arrived at such or such places, for it is the cause of the malady which is found to prevail, for a longer or shorter time, at those different points. It cannot be expected that people should explain such matters, for, with regard to them, our knowledge seems to be in its infancy, and "we want a sense for atoms." However, as people's minds are a good deal occupied upon the point, and as many are driven to the idea of contagion in the face even of evidence, from not being able to make any thing of this casse-tete, the best guess will probably be found in the quotation from Dr. Davy, at page 19.

I perceive that the Berlin Gazette is humanely occupied in recommending others to profit by the mistakes regarding contagion which occurred in that country:—"Dr. Sacks, in No. 38 of his Cholera Journal, published here, has again shewn, against Dr. Rush, the fallibility of the doctrine of contagion, as well as the mischievous impracticability of the attempts founded on it to arrest the progress of the disorder by cutting off the communications. It is to be hoped that the alarm so methodically excited by scientific and magisterial authority in the countries to the west of us [!!] will cease, after the ample experience which we have dearly purchased (with some popular tumults), and that the system of incommunication will be at once done away with by all enlightened governments, after what has passed among us."—I am sure, good people, nobody can yet say whether those calling themselves scientific, will allow us to profit by your sad experience; but I believe that the people of Sunderland are not to be shut in, but allowed to remove, if they choose, in spite of silly speculations.

It may not be uninteresting to mention here, that there are no quarantines and no choleras in Bohemia or Hanover.



LETTER IX.

The following statement from the Duke de Mortemar will be considered probably, very curious, considering that, as already stated, he seems to believe in something like contagion—and for no earthly reason, one may suppose, than from his inability to satisfy himself of the existence of another cause—as if it were not sufficient to prove that in reality the moon is not made of green cheese, but one must prove what it is made of! But, to the quotation—"The conviction now established, that intercourse with sick produces no increase of danger, should henceforth diminish the dread of this calamity (the cholera). It differs from the plague in this, that it does not, by its sole appearance, take away all hope of help, and destroy all the ties of family and affection. Henceforth those attacked will not be abandoned without aid and consolation; and separation or removal to hospital, the source of despair, will no longer increase the danger. The sick may in future be attended without fears for one's self, or for those with whom we live." How delightful is the simplicity of truth! Why, Sir, a morceau like this, and from an honourable man, let him call himself contagionist or what he may, is more precious at this moment than Persian turkois or Grecian gems. Make me an example, men say, of the culprits "who let the cholera morbus into Sunderland," concealed in "susceptible" articles!—yes, and that we may be on a level in other matters, destroy me some half dozen witches, too, as we were wont to do of yore. But let us have more tidings from Russia to comfort the country of our affections in the hour of her affliction, when so much craft and subtlety is on foot to scare her. Dr. Lefevre, physician to our embassy at St. Petersburg, has just given to the public an account of his observations there during the epidemic, from which the following extracts are made:—

"As far as my practice is concerned both in the quarter allotted to me, and also in private houses in different parts of the town, I have no proof whatever that the disease is contagious.

"The first patient I saw was upon the third day of the epidemic, and upon strict inquiry I could not trace the least connexion between the patient, or those who were about her person, with that part of the town where it first appeared—a distance of several versts.

"As regards the attendants of the sick, in no one instance have I found them affected by the disease, though in many cases they paid the most assiduous attention, watched day and night by the beds of the afflicted, and administered to all their wants.

"I knew four sisters watch anxiously over a fifth severely attacked with cholera, and yet receive no injury from their care.

"In one case I attended a carpenter in a large room, where there were at least thirty men, who all slept on the floor among the shavings; and, though it was a severe and fatal case, no other instance occurred among his companions.

"In private practice, among those in easy circumstances, I have known the wife attend the husband, the husband the wife, parents their children, children their parents, and in fatal cases, where, from long attendance and anxiety of mind, we might conceive the influence of predisposition to operate, in no instance have I found the disease communicated to the attendants."—p. 32, 33.

"The present disease has borne throughout the character of an epidemic, and when the proofs advanced in proof of its contagion have been minutely examined, they have been generally found incorrect; whereas it is clear and open to every inquirer, that the cholera did not occur in many places which had the greatest intercourse with St. Petersburg at the height of the malady, and that it broke out in many others which have been subjected to the strictest quarantine."—p. 34.[16]

[Footnote 16: It is remarkable enough that Aretaeus, who lived, according to some authors, in the first century, gives exactly the same reason which Dr. Lefevre does for the suppression of urine in cholera. So true it is, that that symptom, considered as one of the characteristics of the Indian cholera, was observed in ancient times.]

Hear all this, Legislators! Boards of Health throughout the country, hear it! Then you will be able to judge how exceedingly frivolous the idle opinions and reports are which you have obtruded so industriously upon your notice.

But one more short quotation from Dr. Lefevre, a gentleman certainly not among the number of those who stand denounced before the professional world as unworthy of belief. He says:—"As for many reports which have been circulated, and which, prima facie, seem to militate against the statement [communication to attendants, &c.]. I have endeavoured to pay the most impartial attention to them; but I have never found, upon thorough investigation, that their correctness could be relied upon: and in many instances I have ascertained them to be designedly false."—DESIGNEDLY FALSE! Alas! toute ca on trouve dans l'article HOMME; and any body who chooses to investigate, as I have done, the history of epidemics, will find that falsehoods foul have been resorted to—shamelessly resorted to—by persons having a direct interest in maintaining certain views. Enough, then, has been said to put Boards of Health, &c. on their guard against admitting facts for their guidance from any quarter whatever, if the purity of the source be not right well established. There is too much at stake just now to permit of our yielding with ill-timed complaisance to any authority without observing this very necessary preliminary.

One word, and with all due respect, before closing, on the subject of Dr. James Johnson's "contingent contagion," which, though occurring in some diseases, and extremely feasible in regard to others, will, if he goes over the evidence again, I am sure, be shown not to apply to cholera, which is strictly a disease of places, not persons, and can no more be generated by individuals than ague itself can. I can only say of it, with the philosophic poet, that—

——————————"A secret venom oft Corrupts the air, the water, and the land."

Mr. Searle, an English gentleman, well known for his work on cholera, has just returned from Warsaw, where he had the charge of the principal cholera hospital during the epidemic. The statements of this gentleman respecting contagion, being now published, I am induced from their high interest to give them here:—

"I have only to add my most entire conviction that the disease is not contagious, or, in other words, communicable from one person to another in the ordinary sense of the words—a conviction, which, is founded not only upon the nature of the disease, but also upon observations made with reference to the subject, during a period of no less than fourteen years. Facts, however, being deservedly of more weight than mere opinions, I beg leave to adduce the following, in the hope of relieving the minds of the timid from that groundless alarm, which might otherwise not only interfere with or prevent the proper attendance upon the sick, but becomes itself a pre-disposing or exciting cause of the disease; all parties agreeing that of all the debilitating agencies operating upon the human system, there is no one which tends to render it so peculiarly susceptible of disease, and of cholera in particular, than fear.

"The facts referred to are these:—during two months of the period, that I was physician to the principal hospital at Warsaw, devoted to the reception and treatment of this disease, out of about thirty persons attached to the hospital, the greater number of them were in constant attendance upon the sick, which latter were, to the number of from thirty to sixty, constantly under treatment; there were, therefore, patients in every stage of the disease. Several of these attendants, slept every night in the same apartments with the sick, on the beds which happened to be unoccupied, with all the windows and doors frequently closed. These men, too, were further employed in assisting at the dissection of, and sewing up of, the bodies of such as were examined, which were very numerous; cleansing also the dissecting-room, and burying the dead. And yet, notwithstanding all this, only one, during the period of two months, was attacked by the disease, and this an habitual drunkard, under circumstances, which entirely negative contagion, (supposing it to exist), as he had nothing whatever to do with the persons of the sick, though he occasionally assisted at the interment of the dead. He was merely a subordinate assistant to the apothecary, who occupied a detached building with some of the families of the attendants; all of whom likewise escaped the disease. This man, I repeat, was the only one attacked, and then under the following circumstances."

Here Mr. S. relates how this man, having been intoxicated for several days—was, as a punishment locked up almost naked in a damp room for two nights, having previously been severely beaten.

From the foregoing facts, and others pretty similar in all parts of the world where this disease has prevailed, we are, I think, fairly called upon to discard all special pleading, and to admit that man's best endeavours have not been able to make it communicable by any manner of means.



LETTER X.

At a meeting held some days ago by the members of the Royal Academy of Medicine of Paris, Dr. Londe (President of the French Medical Commission sent to Poland to investigate the nature of the cholera) stated, with regard to the questions of the origin and communicability of the disease, that it appeared by a document to which he referred, that 1st. "The cholera did not exist in the Russian corps which fought at Iganie," the place where the first battle with the Poles took place. 2d. "That the two thousand Russian prisoners taken on that occasion, and observed at Praga for ten days under the most perfect separation, [dans un isolement complet] did not give a single case of cholera." 3d. "That the corps [of the Polish army] which was not at Iganie, had more cases of cholera than those which were there." Dr. Londe stated cases of the spontaneous development of the disease in different individuals—of a French Lady confined to her bed, during two months previous to her attack of cholera, of which she died in twenty-two hours—of a woman of a religious order, who had been confined to her bed for six months, and while crossing a balcony, the aspect of which was to the Vistula, was attacked with cholera, and died within four hours. Dr. Londe, among other proofs that the disease was not transmissible, or, as some prefer calling it, not communicable, stated, "the immunity of wounded and others mixed with the cholera patients in the hospitals; the immunity of medical men, of attendants, of inspectors, and of the families of the different employes attached to the service of cholera patients; the example of a porter, who died of the disease, without his wife or children, who slept in the same bed with him, having been attacked; the example of three women attacked (two of whom died, and one recovered), and the children at their breasts, one of six months, and the other two of twelve, not contracting the disease."

At a subsequent meeting of the Academy, a letter from Dr. Gaymard, one of the Commission to St. Petersburg, was read, in which it was stated, while referring to the comparative mortality at different points there, that, "The cause of this enormous difference was, that the authorities wished to isolate the sick—[Observe this well reader]—and even send them out of the city; now the hospital is on a steep mountain, and, to get to it, the carriages were obliged to take a long circuit through a sandy road, which occupied an hour at least; and if we add to the exposure to the air, the fatigue of this removal, and the time which elapsed after the invasion of the disease, the deplorable state of the patient on his arrival, and the great mortality may be accounted for."

"The progress of the disease was the same as in other places; it was at the moment when it arrived at its height, and when, consequently, the greatest intercourse [Observe reader!] took place with the sick, that the number of attacks wonderfully diminished all at once (tout a coup), and without any appreciable cause. The points of the city most distant from each other were invaded. Numbers of families crowded [entasses] who had given aid to cholera patients, remained free from the disease, while persons isolated in high and healthy situations [usually healthy meant of course] were attacked. It especially attacked the poorer classes, and those given to spirituous liquors. Scarcely twenty persons in easy circumstances were attacked, and even the greater part of these had deviated from a regular system."

The inferences drawn, according to a medical journal, from the whole of Dr. Gaymard's communication, are—

"1. That the system of sanatory measures, adopted in Russia, did not any where stop the disease.

"2. That without entering on the question as to the advantages to be derived from a moral influence arising out of sanatory cordons, placed round a vast state like France, these measures are to be regarded as useless in the interior, in towns, and round houses.

"3. That nothing has been able to obstruct the progressive advance of the disease in a direction from India westward.

"4. That the formation of temporary hospitals, and domiciliary succour, are the only measures which can alleviate this great scourge."

A letter from Dr. Gaymard to Dr. Keraudren was read at the meeting of the Academy, in which it was stated, that in an Hospital at Moscow, in which Dr. Delauny was employed from the month of December, 1830, to the end of December, 1831, 587 cholera patients, and 860 cases of other diseases, were treated—"Not one of the latter was attacked with cholera, although the hospital consists of one building, the coridors communicating with each other, and the same linen serving indiscriminately for all. The attendants did not prove to be more liable to attacks. The relatives were suffered to visit their friends in hospital, and this step produced the best impression on the populace, who remained calm. They can establish at Moscow, that there was not the smallest analogy between the cholera and the plague which ravaged that city in the reign of Catharine." Dr. Gaymard declares, that, having gone to Russia without preconceived ideas on the subject, "he is convinced that interior quarrantines, and the isolation of houses and of sick in towns, has been accompanied by disastrous consequences." Is there yet enough of evidence to shew that this disease is positively not to be made communicable from the sick?

Honour still be to those of the profession who, from conscientious and honorable motives, have changed from non-contagionists to contagionists in regard to this disease; and all that should be demanded is, that their opinions may not for one moment be suffered to outweigh, on an occasion of vital importance, the great mass of evidence now on record quite in accordance with that just stated. One gentleman of unquestionable respectability gives as a reason (seemingly his very strongest) for a change of opinion, that he has been credibly informed that when the cholera broke out on one side of the street in a certain village in Russia, a medical man had a barrier put up by which the communication with the other side was cut off, and the disease thus, happily, prevented from extending. Now, admitting to the full extent the appearance of the disease on one side of the village only—a thing by the way hitherto as little proved as many others on the contagion side of the question—still, if there be any one thing more striking than another, in the history of the progress of cholera, it is this very circumstance of opposite rows of houses, or of barracks, or bazaars, or lines of camp, being free, while the disease raged in the others, and without any sort of barricading or restriction of intercourse. If people choose to take the trouble to look for the evidence, plenty of such is recorded. Now just consider for one moment how this famous Russian story stands: had the barricading begun early, the matter would have stood an examination a little better; but this man of good intentions never thought of his barriers till the one-sided progress of the disease had been manifest enough, without them:—and then consider how the communication had existed between both rows before those barriers were put up, and how impossible it was, unless by a file of soldiers, to have debarred all communication:—let all this be considered, and probably the case will stand at its true value, which is, if I may take the liberty of saying so,—just nothing at all. Let us bear in mind the circumstance already quoted from the East India records,—of one company of the 14th Regiment, at the extreme end of a barrack, escaping the disease, almost wholly, while it raged in the other nine; and this without a barrier too. But such circumstances are by no means of rare occurrence in other diseases arising from deteriorated atmosphere. Mr. Wilson, a naval surgeon, has shewn how yellow fever has prevailed on one side of a ship, and I have had pointed out to me, by a person who lived near it for thirty years, a spot on this our earth where ague attacks only those inhabiting the houses in one particular line, and without any difference as to elevation or other appreciable cause, except that the sun's rays do not impinge equally on both ranges in the morning and evening.

The advancement of the cause of truth has, no doubt, suffered some check in this country, by the announcement that another gentleman of great respectability (Mr. Orton) finds his belief as to non-contagion in cholera a good deal shaken: but we find that this change has not arisen from further personal knowledge of the disease, and if it be from any representations regarding occurrences in Europe, connected with cholera, we have seen how, from almost all quarters, the evidence lies quite on the side of his first opinions. Whatever the change may be owing to, we should continue, as in other cases, not to give an undue preference even to opinions coming from him, to well authenticated facts—facts, among which some particularly strong are still furnished by himself, even in the second edition of his book:—"It must be admitted that, in a vast number of instances in India, those persons [medical men and attendants] have suffered no more from the complaint than if they had been attending so many wounded men. This is a fact which, however embarrassing to the medical inquirer, [for our part we cannot see the embarrassment] is highly consolatory in a practical point of view, both to him and to all whose close intercourse with the sick is imperatively required."—(p. 316)—"We are therefore forced to the conclusion, however, at variance with the common laws of contagion, that in this disease,—at least in India, the most intimate intercourse with the sick is not, in general, productive of more infection than the average quantity throughout the community." (p. 326). Let us contrast the statements in the following paragraphs:—"For in all its long and various courses, it may be traced from place to place, and has never, as far as our information extends, started up at distant periods of time and space, leaving any considerable intervening tracts of country untouched." (p. 329)—"All attempts to trace the epidemic to its origin at a point, appears to have failed, and to have shewn that it had not one, but various local sources in the level and alluvial, the marshy and jungly tract of country which forms the delta of the Ganges, and extends from thence to the Burraumposter." (p. 329) Now let us observe what follows regarding the particular regularity in the progress of the disease, as just mentioned:—"Another instance of irregularity in its course, even in those provinces where it appears to have been most regular, is stated [now pray observe] in its having skipped from Verdoopatly to a village near Palamacotta, leaving a distance of sixty miles at first unaffected." (p. 332)!!—This is not the way to obtain proselytes I presume.

The situation of our medical brethren at Sunderland is most perplexing, and demands the kindest consideration on the part of the country at large; but let nothing which has occurred disturb the harmony so essential to the general welfare of that place, should their combined efforts be hereafter required on any occasion of public calamity. In truth both parties may be said to be right—the one in stating that the disease in question is Indian cholera, because the symptoms are precisely similar—the other that it is not Indian cholera, because it exists in Sunderland, and without having been imported—IN NEITHER COUNTRY IS IT COMMUNICABLE FROM ONE PERSON TO ANOTHER, as is now plainly shown upon evidence of a nature which will bear any investigation; and if blame, on account of injury to commerce, be fairly attributable to any, it is to those who, all the world over, pronounced this disease, on grounds the most untenable, a disease of a contagious or communicable nature. Let the Sunderland Board of Health not imagine that their situation is new, for similar odium has fallen on the first who told the plain truth, in other instances—at Tortosa, a few years ago, the first physician who announced the appearance of the yellow fever, was, according to different writers, stoned to death; and at Barcelona, in 1821, a similar fate had well nigh occurred to Dr. Bahi, one of the most eminent men there—we need not, I presume, fear that a scene of this kind will take place in this country,—though the cries of "no cholera!" and "down with Ogden!" have been heard.

One word as to observations regarding the needlessness of discussing the contagion question: the truth is, that the cleanliness and comfort of the people excepted, you can no more make other arrangements with propriety, till this point be settled, than a General can near the enemy by whom he is threatened, till it be ascertained whether that enemy be cavalry or infantry.

My object in these letters is not to obtrude opinions upon the public, being well aware that they cannot be so well entitled as those of many others, to attention; but I wish to place before the public, for their consideration, a collection of facts which I think are likely to be of no small importance at a moment like the present. In addition to the many authorities referred to in the foregoing pages, I would beg to call the public attention to a paper in the Windsor Express of the 12th November, by Dr. Fergusson, Inspector General of Hospitals, a gentleman of great experience, and who has given the coup de grace to the opinion of contagion in cholera. Indeed the opinion now seems to be virtually abandoned; for, as to quarantine on our ships from Sunderland, it is, perhaps, a thing that cannot be avoided, if the main consideration be the expediency of the case, until an arrangement between leading nations takes place. We have seen, in regard to Austria, how the matter stands, and our ships from every port in the country would be refused admission into foreign ports, if we did not subject those from Sunderland to quarantine; which state of things, it is hoped, will now be soon put an end to.