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.
The puerile stories, therefore, of infection being taken from following a coffined corpse to the grave, without reference to the state of grief, fear, and fatigue, not improbably, of drunkenness, in the mourners, must be unworthy of attention. I am no friend to the absurdly long interval which in this country is allowed to elapse,32 even in the hottest weather, between death and burial; but still more do I deprecate the indecent haste which would give sanction to panic, and incur the risk or even the suspicion of interment before dissolution. In regard to separate burying grounds, should the disease come to spread, I am sure no one will expect, after what has just been said, that I should attempt to argue the question seriously, nor enter a protest against the further gratuitous wrong of withholding the rites of sepulture in consecrated ground from the victims of an epidemic or even a contagious disease. – Nothing could warrant such a measure but want of room in the ordinary churchyards, where police should never be allowed to interfere with the rights and feelings or property, of the living, unless to ensure the privacy of funerals; nothing being so appalling to an alarmed people as the spectacle of death in their streets, or so trying to the health of the mourners, as tedious funeral ceremonies amidst a crowd of people.
Were I called upon to criticise what I have now written, and to review all that I have seen, read, and heard on the subject, I would conscientiously declare that the importation of Cholera Morbus into England or anywhere else, had been clearly negatived, and its non-contagious character almost as clearly established, always however with the proviso and exception of the possibility of its being made a temporary contingent contagion, amidst filth and poverty, and impurity of atmosphere, from overcrowding and accumulation of sick, but neither transmissible nor transportable out of its own locality, through human intercourse. As the disease, like all the other great plagues, which at various periods have desolated the earth, evidently came from the east, it would be most desirable in pursuing our investigation, to have a clear knowledge of the mode of its introduction into Russia on the eastern boundary of Europe. Unfortunately we can place no dependence upon the reports that have been published to prove importation there, which are lame and contradictory, although coming from the avowed partizans of contagion; but even had they been better gotten up, we could not, unless they had been confirmed by the experience of other nations, have received them with implicit reliance.
The Russian Employé of the provinces, mendacior Parthis, not from greater innate moral depravity than others, but from the corruptions of a despotic government which compel him to live under the rod of a master, amidst a superstitious barbarous population, whose dangerous prejudices he dare not offend, can only give utterance to what his tyrants command. Even at the more civilized capital of Petersburgh, the mob rose in arms to murder the foreign physicians when they did not act according to their liking. Could the truth then be heard on such a field, or what native officer would venture to impugn the authority of his rulers, proclaiming contagion? If he did, he must cease to live in the official sense of the word. Throughout Europe, from east to west, the disease has followed its own route according to its own incomprehensible laws, despite of every obstacle and precaution. We have the authority of our own Central Board for believing that the disease cannot be conveyed by merchandize of any kind, and that of our mission to Russia for greatly doubting whether it can adhere to personal clothing or bedding; and will it be pretended that human beings, labouring under such a distemper in any form, could have been the vehicles of spreading it in a straight line for thousands of miles throughout civilized nations, armed and prepared to defend themselves against its inroads, – they tried, but in vain. We, too, may strive to discover the demon of the pestilence amidst the clouds of the climate, or the winds of Heaven. He remains hidden to our view; and until better revealed, it only remains for us to exercise towards our fellow men those duties which humanity prompts, civilization teaches, and religion enjoins.