Letters on the Cholera Morbus.

Without entering into the miserable disputes on this subject, which, amidst a tissue of fable and prejudice, self-interest and misrepresentation, have so often disgraced the medical profession at Gibraltar; I shall now proceed to shew, by reference to general causes, how baseless and mischievous have been the same doctrines and authority when exercised in that part of the British dominions: —

Within the last thirty years, yellow fever has, at least four times, invaded the fortress of Gibraltar; during which time also, the population of its over-crowded town has more than quadrupled, presenting as fair a field, for the generation within, or reception from without, of imported pestilence as can well be imagined, – yet plague, the truest of all contagions, typhus fever, and other infectious diseases, have never prevailed, as far as I know, amongst them. The plague of the Levant has not been there, I believe, for 150 years; yet Gibraltar, the free port of the Mediterranean, open to every flag, stands directly in the course of the only maritime outlet, from its abode and birth-place in the east, being in fact, to use the language of the road, the house of call for the commerce of all nations coming from the upper Mediterranean. Now, can there be a more obvious inference from all this, than that the plague, being a true contagion, may be kept off without difficulty, by ordinary quarantine precautions; but the other being an endemic malarious disease, generated during particular seasons, within the garrison itself, and the offspring of its own soil, is altogether beyond their controul. The malarious or marsh poison, which in our colder latitudes produces common ague, in the warmer, remittent fever, and in unfavourable southern localities of Europe, (such as those of crowded towns, where the heat has been steadily for some time of an intertropical degree) – true yellow fever, which is no more than the highest grade of malarious disease; but this has never occurred in European towns, unless during the driest seasons – seasons actually blighted by drought, when hot withering land winds have destroyed surface vegetation, and as in the locality of Gibraltar, have left the low-lying becalmed, and leeward town to corrupt without perflation or ventilation amidst its own accumulated exhalations. I know not how I can better illustrate the situation of Gibraltar in these pestiferous seasons, than by a quotation from a report of my own on the Island of Guadaloupe, in the year 1816, which, though written without any possible reference to the question at issue, has become more apposite than anything else I could advance; "all regular currents of wind have the effect of dispersing malaria; when this purifying influence is with-held, either through the circumstances of season, or when it cannot be made to sweep the land on account of the intervention of high hills, the consequences are most fatal. The leeward shores of Guadaloupe, for a course of nearly 30 miles, under the shelter of a very steep ridge of volcanic mountains, never felt the sea breeze, nor any breeze but the night land-wind from the mountains; and though the soil, which I have often examined, is a remarkably open, dry and pure one, being mostly sand and gravel, altogether, and positively without marsh, in the most dangerous places, it is inconceivably pestiferous throughout the whole tract, and in no place more so than the bare sandy beach near the high-water mark. The coloured people alone ever venture to inhabit it; and when they see strangers tarrying on the shore after nightfall, they never fail to warn them of their danger. The same remark holds good in regard to the greater part of the leeward coasts of Martinique, and the leeward alluvial bases and recesses24 of hills, in whatever port of the torrid zone they may be placed, with the exception, probably of the immediate sites of towns, where the pavements prevent the rain-water being absorbed into the soil, and hold it up to speedy evaporation." Now, conceive a populous crowded town placed in this situation, and you have exactly what Gibraltar and the other towns of Spain and North America, liable to yellow fever, must become in such seasons as I have above described, only, that as they grow more populous and crowded, the danger must be greater, and its visitations more frequent, unless the internal health police be made to keep pace in improvement, with the increasing population.

Now in the name of injured commerce – of the deluded people of England – of medical science – of truth and humanity – what occasion can their be to institute an expensive quarantine against such a state of things as this, which can only be mitigated by domestic health police; or why conjure up the unreal phantom of an imported plague, to delude the unhappy sufferers, as much in regard to the true nature of the disease, as to the measures best calculated for their own preservation; when it must be evident that the pestilence has sprung from amidst themselves, and that had it been an external contagion in any degree, the ordinary quarantine, as in case of the plague, would certainly have kept it off; but the question of the contagion of yellow fever, so important to commerce and humanity; and which, like the Cholera, has more than once been used to alarm the coasts of England, demands yet further investigation.

For nearly 40 years have the medical departments of our army and navy been furnished with evidence, from beyond the Atlantic, that this disease possessed no contagious property whatever. These proofs now lie recorded by hundreds in their respective offices, and I take it upon me to say, they will not be found contradicted by more than one out of a hundred, amongst all the reports from the West Indies, which is as much the birth-place of the yellow fever, as Egypt is of the plague: yet, in the face of such a mass of evidence, as great or greater probably than ever was accumulated upon any medical question, has our Government been deluded, to vex commerce with unnecessary restraints, to inflict needless cruelties upon commercial communities, (for what cruelty can be greater than after destroying their means of subsistence by quarantine laws, to pen them up in a den of pestilence, there to perish without escape, amidst their own malarious poison?) and to burden the country with the costs of expensive quarantine establishments. Surely if these departments had done their duty, or will now do it, in so far as to furnish our rulers with an abstract of that evidence, with or without their own opinions, for opinions are as dust in the balance when put in competition with recorded facts, it must be impossible that the delusion could be suffered to endure for another year; or should they unluckily fail thereby to produce conviction on Government, they can refer to the records of commerce, and of our transport departments, which will shew, if enquiry be made, that no ship, however deeply infected before she left the port, (and all ships were uniformly so infected wherever the pestilence raged) ever yet produced, or was able to carry a case of yellow fever beyond the boundaries of the tropics, on the homeward voyage, and that therefore the stories of conveying it beyond seas to Gibraltar, must have been absolutely chimerical. It would indeed, have been a work of supererrogation, little called for, for I think I have fully shown that Gibraltar must be abundantly qualified to manufacture yellow fever for herself.

No less chimerical will be the attempt to shut out Cholera Morbus from our shores by quarantine laws, because throughout Europe, ready prepared, alarmed, and in arms against it, they have succeeded nowhere; whereas, had it been a true contagion and nothing else, they must, with ordinary care, have succeeded everywhere; the disease, as if in mockery, broke through the cordons of armed men, sweeping over the walls of fortified towns, and following its course, even across seas, to the shores of Britain; and yet we are still pretending to oppose it with these foiled weapons.

We are indeed told, by authority, that its appearance in towns has always been coincident with the arrival of barges from inland, or by ships from the sea, but if it be not shown at the same time that the crews of these barges had been infected with the disease, or if, as at Sunderland, no person on board the ships can be identified as having introduced it, while we know that the disease actually was there two months before, we may well ask at what time of the year barges and ships do not arrive in a commercial seaport, or where an epidemic disease, during pestiferous seasons could be more likely to break out than where the most likely subjects are thrown into the most likely places for its explosion, such as newly arrived sailors in an unwholesome seaport, where the license of the shore, or the despondency of quarantine imprisonment must equally dispose them to become its victims. – Besides, what kind of quarantine can we possibly establish with the smallest chance of being successful against men who have not got, and never had the disease. Merchandise has been declared incapable of conveying the infection,25 and are we to interdict the hulls and rigging of Vessels bearing healthy crews, or are we to shut our ports at once against all commerce with the North of Europe, and would this prove successful if we did? a reference to a familiar epidemic will I think at once answer this question.

It is only three months ago that the epidemic Catarrh or Influenza spread throughout the land, travelling like the Cholera in India, when it went up the monsoon, without regard to the East wind; and what could be more likely than the blighting drying process of such a wind, in either the one or the other case, to prepare the body for falling under the influence of whatever disease might be afloat in the atmosphere. In general this passing disease can be distinctly traced, as having affected our continental neighbours on the other side of the channel before ourselves: now can it be supposed that any quarantine could have prevented its first invasion, or arrested its farther progress amongst us. How ridiculous would have been the attempt, and yet with the experience of all Europe before us, have we been enacting that very part with the Cholera Morbus: but further, the same authority which calls for the establishment of quarantine in our ports, tells us that neither proximity nor contact with the sick,26 is requisite for the production of the disease: now can anything further be wanting beyond this admission, to prove that it must be an epidemic atmospherical poison, and not a personal contagion, and that, under such circumstances, the establishment of quarantine against persons and goods, would manifestly be absurd and uncalled for. So fully satisfied has the Austrian Government been made by experience, of the futility and cruelty of such quarantines, that the Emperor apologises to his subjects for having inflicted them. The King of Prussia makes a similar amende, and the Emperor of Russia convinced by the same experience, abolished or greatly relaxed his quarantines several mouths ago.

I am by no means prepared to assert, because I cannot possibly know to the contrary, although from the analogy of other disease I do not believe it, that the Cholera Morbus may not become contagious under certain conditions of the atmosphere, but these cannot be made subject to quarantine laws, and I am fully prepared to acknowledge, that as in the case of other epidemics, it may be made contagious through defective police; but independent of these, it possesses other powers and qualities of self-diffusion, which we can neither understand nor controul. Such, however, is not the case with that other phantom of our quarantine laws – the yellow fever – which can never, under any circumstances of atmosphere, without the aid of the last be made a contagious disease. I speak thus decisively from my experience of its character, as one of the survivors of the St. Domingo war, where, in a period of little more than four years, nearly 700 British commissioned officers, and 30,000 men were swept away by its virulence; as also from subsequent experience, after an interval of 20 years, when in the course of time and service, I became principal medical officer of the windward and leeward colonies, and in that capacity, surveyed and reported upon the whole of these transatlantic possessions.

It was my intention, in these times of panic, to designate to my countrymen, in as far as I could, the true essential intrinsic contagions of the British Isles, (for such there are, and terrible ones too,) which prevail under all circumstances of season, atmosphere, and locality, as contradistinguished from the factitious ones, of our own creating, and the imaginary or false which often spread epidemically, (for there may be an epidemic as well as contagious current of disease)27 although they possess no contagious property whatever; as well as the foreign contagions, which if we relax in due precaution, may, at any time, be introduced amongst us – but the unreasonable length of this letter, for a newspaper communication, warns me to stop.

I have written thus earnestly, because I deeply feel what I have here put down. It is possible I may have made mistakes, but if I have, they are not intentional, and I shall be happy to be corrected, for I do not live at the head quarters of communication, and my broken health prevents my frequenting in person, the field of investigation. In candour I ought to declare, that the establishment of quarantine against this new and hideous pestilence in the first instance, was the most sacred duty of Government, but now that its true character has been made known, and the futility of quarantine restrictions demonstrated, I feel equally bound, as one of the lieges, to enter my humble protest against their continuance.

Should I write again, I shall still adopt the same popular style, for no other can be adapted to a newspaper communication, and the subject-matter is as interesting to the public, and every head of a family, as it can be to the professional reader; and, in thus making use of your columns, as I can have no motive but that of ardent research after truth, I know that I may always rely upon your assistance and co-operation.

WILLIAM FERGUSSON,Inspector-General of Hospitals.

Windsor, Nov. 26, 1831.

LETTER III.

TO THE MEDICAL SOCIETY OF WINDSOR

In this paper it is my intention to treat of the contagious diseases of the British Isles, as well as to offer to the Society some observations on malignant Cholera Morbus, and the mode of its propagation from the tropical regions, where it first arose, to the colder latitudes of Europe.

Having already published two letters on this last part of my subject, I need not here take up your time in recapitulating their contents, but proceed to the consideration of some remaining points of the enquiry; which I find I have either overlooked, or not been so explicit in illustration, as I otherwise might, had I been addressing a body of professional men, instead of the community where I live, with the view of disabusing their minds from the effects of irrational panic, and opening their eyes to what I deemed true measures of preservation against the impending disease; and here I may as well add that when I wrote in a newspaper and adopted the style suited to such a channel of communication, I knew none so likely to attract the attention of those influential men, who might possess the power and the will, when disabused of prejudice, to enforce proper laws, instead of running the course that had already been imposed upon them, by men interested in the upholding of our quarantine establishments, or by prejudiced, however well meaning, Boards of Health.

In looking over those letters, I find that the points most open to dispute are the course of the disease throughout the Indian peninsula, and its progress to the frontiers of Russia; as well as its supposed infectious nature, and mode of propagation by human intercourse. In regard to the first, there is no contagionist however avowed and uncompromising, who does not admit that this erratic disease did not often wander from its straight line when the most promising fields lay directly before it; or stop short most unaccountably in its progress, when the richest harvest of victims seemed actually within its jaws – that its course was circuitous when, according to the laws of contagion, it ought to have been straight, – that it refused its prey at one time, and returned to it at another, in a manner that showed its progress was governed by laws which we could neither understand nor controul; and if we search the reports of contagionist writers, we shall find fully as much, and as strong evidence of its progress being independent of human intercourse, as of its being propagated and governed by the laws of contagion.28

To the question, which has so often been triumphantly asked, of its progress to the Russian frontiers being conducted by caravans along the great highways of human intercourse, and what else than contagion could cause it to be so carried? An admirable journalist has already replied by asking in his turn, on what other line than amongst the haunts of men could we possibly have found, or detected a human disease? And surely the question is most pertinent, for in those barbarous regions that interpose between Russia and India, where the wolf and the robber hold divided alternate sway, and isolated man dares not fix his habitation, but must congregate for safety; where else than in those great thoroughfares could the disease have found its food; or if beyond these, man, almost as ignorant and as savage as the wolf, could have been found; who under such circumstances would have recognised, described, and testified to its existence? Even at Sunderland, amongst ourselves, its existence was long hotly disputed by the learned of the faculty; and the fatalist barbarian of these regions would have dismissed the enquiry with a prayer of resignation, while he bowed his head to the grave, or if his strength permitted, with a stroke of his dagger against the impious enquirer who had dared to interfere with the immutable decrees of fate. The stories too of its importation into Russia, are exactly the same as have come to us from our own Gibraltar, in the case of the yellow fever, and may be expected to come from every other quarter where a well paid officious quarantine is established to find infection in its own defence, and to trace its course in proof of their own services and utility. Under such circumstances, this well gotten up drama of importation may be rehearsed in every epidemic, adapted in all its parts to every place and every disease, they wish to make contagious. First will be presented, as at Gibraltar, the actual importers – their course traced – the disease identified – its reception denounced, and quarantine established; and this will go down until sober minded disinterested men become engaged in the enquiry, when it will turn out in all probability, that the importers, as at Sunderland, never had the disease – that it was in the place long before their arrival – that in its supposed course, it either had no existence, or had long ceased – in fact that the importation was a fable, the product either of design or an alarmed imagination. On this point I shall not here farther dwell, but proceed to the still keenly disputed question of its contagious, or non-contagious nature.

Amongst all those who have advocated the affirmative side of the question, an anonymous writer in the Lancet, of Nov. 19th. seems to me the ablest special pleader of his party, and the best informed on the subject, which he has grappled with a degree of acumen and power that must at once have secured him the victory, in any cause that had truth for its basis, or that could have stood by itself; but strong and scornful as he is, he has himself furnished the weapons for his own defeat, and has only to be correctly quoted in his own words, for answer to the most imposing and powerful of his arguments. I take it for granted, that no one will give credit to instantaneous infection, at first sight, but allow that an interval must elapse between the reception of the virus, and explosion of the disease. Kennedy and the best of the contagionist authors, have fixed the intervening time from two days to a longer uncertain period; yet that writer (in the Lancet) proceeds to tell us, in proof of the virulence of the contagion, that when twenty healthy reapers went into the harvest field at Swedia, near Tripoli, and one of them at mid-day was struck down with the disease, he then instantly, as if, instead of being prostrate on the ground, he had run a muck for the propagation of Cholera Morbus, infected all the rest, so that the whole were down within three hours, and all were dead before the following morning.29– All this too in the open air. Another writer of note relates that when a healthy ship on the outward voyage arrived in Madras Roads, her people were seized with Cholera Morbus that very morning; but they go further than this, and command us to believe in its contagious powers, without sight at all, quoting the report from our Commissioners in Russia, where it is officially announced "that neither the presence, nor contact of the patient is necessary to communicate the disease." Surely in candour we may be allowed to say that when they limit their views to contagion alone, they have attributed powers to it, which it never did, and never can possess. That some other principle, besides their favourite one, must have been in operation, as well in the field of Swedia, when it struck down the reapers, as when it blighted our armies in the East, for these sudden bursts and explosions of pestilence are incompatible with the laws and progress of natural contagion, – that if, under a tropical temperature, which dissipates all infection, there be contagion in the disease, their must also be other powers of diffusion hitherto inscrutable, incomprehensible, and uncontroulable, – that their doctrine of contagion exclusively, is superficial narrow, and intolerant, and their arguments in support of it, no more than a delusion of prejudice, a piece of consummate special pleading to make the worse appear the better reason.30

Before concluding these observations, I would wish to make a few remarks upon some points of the enquiry which have been either too cursorily passed over, or not noticed at all; and first of its supposed attraction for, and adherence to the lines and courses of rivers whether navigable or otherwise. I do not think this quality of the disease has been assumed on grounds sufficient to justify anything like an exclusive preference. Along these lines, no doubt, it has very frequently been found, because a malarious, a terrestrial, a contagious, or indeed any other disease, would for many reasons, best prevail on the lowest levels of the country, or the deepest lines on its surface, like the vallies of rivers, provided the food on which it fed – population – there abounded. It would be difficult almost anywhere to point out a populous city unconnected with the sea, rivers, or canals, the water population of which, from their habits of life and occupations, everywhere crowded, dirty, careless, and exposed, must always afford ready materials for any epidemic to work upon, and this may have given currency to the prevailing opinion; but I rather believe, when enquiry comes to be made, it will be found that the worst ravages of Cholera Morbus have been experienced in the great level open plains of Upper Germany, and the boundless jungly districts of India, remote from, or at least unconnected with water communication, denoting thereby atmospheric influence and agency, rather than any other.

Another consideration of some importance is the burial of the dead, which according to published reports, has in some places been enforced in so hurried a manner as deeply to wound the feelings of surviving relatives, and in others to give rise to the horrid suspicion of premature interment. Can this have been necessary in any disease, even allowing it to be contagious, or was it wise and dignified in the medical profession to make this concession to popular prejudice, at all times when excited, so unmanageable and troublesome. Although we cannot analyse the matter of contagion, we surely know enough of it to feel assured, that it must be a production and exhalation from the living body, arising out of certain processes going on there, in other words out of the disease itself, which disease must cease along with the life of the patient, and the exhalation be furnished no longer – that during life it was sublimed, so as to leave the body and become diffused around through the agency of the animal heat, created by the functions of respiration and circulation of the blood, which being foreclosed and the supplies cut off, all that remained of it floating before death in the atmosphere, must be condensed upon the cold corpse and lie harmless.31 It must also be evident that when putrefaction begins, no production of what belonged to the living body can remain unchanged, but must undergo the transformation in form, substance and quality, ordained for all things; for putrefaction, although it may possibly produce a disease after its own character, is not pestilence, nor even compatible with it in the case of specific diseases.