Letters on the Cholera Morbus.. Fergusson William
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 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. 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.
"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 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."
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,