1847.]

Evidence in the Madras Report.

26

477

tion;""for there are few subjects, perhaps, on which so little diversity of sentiment has existed." And he adds: It is not contended, by those who embrace the doctrine of Infection, that Cholera has not arisen spontaneously, as well at the present as in former times; nor is it considered that this circumstance affects the question." Most true; it does not affect the question whether the disease ever manifests an infectious character; but it most vitally affects the question whether Dr. Copland's opinion, that infection is the principal agent in its dissemination, can be reconciled with the history of the epidemic. Without saying more upon this point, we shall only remind the reader that Dr. Johnson has given, in the last two editions of his work on Tropical Climates, a tabular analysis of the individual reports-amounting in all to 65-from which the general report has been constructed.

As respects the question of the infectiousness of the disease, we find the following summary at the end of this analytic table.

42 make no allusion to contagion. Of these 42, the great majority speak of the disease as an epidemic arising from some atmospheric or terrestrial cause; and, as the queries of the Madras Board particularly directed the attention of medical officers to the subject of contagion, we may fairly conclude that, when no allusion to contagion is made, no proofs of it presented themselves to the observers. Mr. Scott, the Secretary of the Board, sums up the opinions of the contagionists and anti-contagionists, and gives no opinion himself on either side."

So much for the evidence on the important question of the infectiousness of Cholera, to be derived from the three Presidential Reports. We leave it to the reader himself to decide whether he will agree with Dr. Copland in the following propositions :

"I have now shown, from the chief sources, that the disbelief of infection, in respect of the pestilential cholera, was not general in India-that the productions which issued from the three Medical Boards very strongly favoured, and indeed proved, the existence of this property, that two out of the three actually insisted upon the activity of its influence, and that, therefore, the dangerous opinion, so very generally propagated, and even acted upon, both in this and foreign countries, that the authorities of India did not consider the disease infectious, is entirely without foundation in truth."

Before taking leave of the important branch of testimony furnished by writers who witnessed the epidemic at the time of, and after, its outbreak in 1817, Dr. Copland briefly alludes to the published opinions of three gentlemen who have written upon the subject-viz. Mr. Orton, Mr.

Annesley, and Dr. H. Kennedy. The first he quotes as a decided (!) infectionist; the second, as one who ought to be, although he has declared himself otherwise; and the last as an infectionist, who "justly places particular stress upon the peculiar odour exhaled from the bodies of the affected, as indicating the generation of a principle calculated to propagate the målady!" He has not considered it necessary to allude to any other of the numerous writers who have recorded what they saw of the disease in India. This omission is surely much to be regretted; it seems scarcely fair either to those gentlemen who have benefited the public by making known their experience on an important subject, or to the reader who must certainly wish to be made acquainted with all the most valuable testimony upon it. Let us very briefly notice the names, at least, of some of the most competent witnesses.

We have already said that Mr. Annesley, a high authority certainly, is a non-infectionist. "The limitation of the disease," says he, "to places where there existed no natural obstacles to its extension, militates most conclusively against any idea as to its being a contagious (infectious) disease, and seems to point to the existence of some difference in the quality of the atmosphere." Dr. Whitelaw Ainslie, a very experienced medical officer in the Company's Service, expressed a similar opinion. He has distinctly stated that Epidemic Cholera does not differ, in essential pathological characters, from the Sporadic disease; but only in grade, depending

The work on Epidemic Cholera by this gentleman is certainly a very able and instructive one. He is of opinion that some of the pestilences which devastated Europe in the 14th and 15th centuries-especially the sweating sicknesswere almost identical with Cholera. While he advocates the infectiousness of the disease, he candidly admits that "contagion (infection) alone is inadequate to the production of an epidemic disease;" and that "there is little, if any, increase of danger from the most intimate communication with the sick during the prevalence of the disease, above that which attends the common intercourse of society:"-that, "in Bengal, not more than three medical officers out of the whole list were known to have been attacked up to 1820, and but one died, although nearly the whole of them had largely witnessed the disease;"-that, "although the importation of the disease has so often been found immediately to precede its appearance in the inhabitants of a place, and even the first case to arise in the neighbourhood of the imported virus, it has scarcely ever been possible to trace these cases to personal communication in any thing like a regular series, as may generally be done with the plague and other decidedly contagious disorders." Mr. Orton, we may remark in conclusion, believes that "it is by means of fomites that the disease is, in a great measure, propagated over a country."

+ This gentleman, the 2nd edition (recently published) of whose "Notes on the Epidemic Cholera " was noticed in the number of this Journal for January last, has not, we may remark, adduced a single instance from his own observation of the infectiousness of Cholera. After quoting from the reports of others, he closes his remarks with these words: "I know no character, belonging to any contagious disease, which Cholera does not appear to me to possess ; and if it be not contagious, I know no other disease which I should be inclined to consider so!" Although an infectionist, Dr. Kennedy does not agree with our author in regarding the Pestilential Cholera as a new disease: "there is nothing to surprise us that this disease raged as an epidemic 40 years ago." This was written in 1826.

1847.]

Testimonies to its Non-infectiousness.

479

on various causes, of the nature of which we are ignorant." * Dr. Smith has stated, as the result of his observations in India, that no instance ever came under his notice where the diseased person infected another; and the immunity of the attendants, as well as of the friends of the sick, who often crowd around the death-bed of their unfortunate comrades, sufficiently proves that the disease is not propagated either by contact or by atmospheric infection.† Dr. H. Young, who was in Calcutta when the pestilence broke out there in 1817, has expressed his strong conviction "of the non-contagious nature" of the disease. Mr. Corbyn says: "from personal experience, I feel satisfied that the notion of the Cholera being contagious (infectious) is quite unfounded." Unquestionably, one of the ablest writers on Epidemic Cholera is Mr. G. Hamilton Bell. His work was universally acknowledged to be a most valuable production, based on very ample experience, and replete with an immense amount of information. He served in India from 1818 to 1827, and, from his position as residency surgeon at Tanjore, possessed unusual advantages for watching the disease under every aspect. Dr. Copland has perhaps done wisely not to grapple with either the facts or the reasonings so powerfully enforced in Mr. Bell's work. It is there emphatically asserted, that "Cholera Asphyxia is not a new disease to those natives (of India), but seems to be in many places almost endemical';" and that" it has been repeatedly ascertained that Cholera patients may be carried into hospitals crowded with patients labouring under other diseases, without these or the hospital attendants having the disease communicated to them." Mr. Searle also, who saw much of the pestilential Cholera both in India and in Europe, has spoken to nearly the same effect. T. He attributes the disease to the operation of a malaria, aided by a peculiar condition or epidemic constitution of the atmosphere. But it is unnecessary to enlarge our list of authors who have published accounts of their experience of Cholera in the East. Suffice it to remind the reader that the late Dr. Johnson-than whom never was a medical writer better fitted to sift evidence and enucleate the truth as well as Mr. Martin, whose authority on tropical diseases is deservedly so high, have uniformly rejected the doctrine so warmly espoused by Dr. Copland, that infection is the principal, or even an influential, agent in the diffusion of the disease.

Such then being the case, we cannot help saying how much surprised we were on reading the following passage-more remarkable certainly for rhetorical embellishment than for scientific argumentation-in our author's narrative.

"Are we to expect these comprehensive views of the history and modes of

* Observations on the Cholera Morbus of India, 1825.

† A few Practical Observations on the Spasmodic Cholera of India, 1830. Remarks on the Cholera Morbus, 1831.

Treatise on the Epidemic Cholera in India, 1832.

A Treatise on Cholera Asphyxia, or Epidemic Cholera, as it appeared in Asia

and in Europe, 1831.

¶ Cholera, its Nature, Cause, and Treatment, 1831.

propagation of a disease from those who have seen but a little, and described only what they have seen; or from those who dispassionately investigate the origin, the cause, the phenomena, and the relation of all that has been observed and recorded, and cautiously weigh the evidence on either side of a disputed topic connected with it? The captain of a company, or even a colonel performs an important part, individually, in an army during a general engagement; but he can know little, personally, of the disposition, changes, and evolutions of all its parts, and of the plan of strategy, according to which it first acted, or was led to change its operations, in order to meet or conteract those of its opponent. Like the commander-in-chief of the whole army, we, who collect, compile, arrange, and digest facts, on both the one side and the other of a disputed subject-who observe closely what has occurred within the sphere of our own experiencewho compose, weigh and meditate upon the whole evidence, personal as well as testimonial, with our minds uninfluenced by prematurely conceived ideas, are the best suited to investigate and to conclude respecting them. Placed, by the number of accumulated facts, and by minds accustomed to view and to investigate the difficult operations of Nature, on the elevated table-land of human science, we may be admitted to be more able to take in a comprehensive view of the causes and nature of disease, and to come to accurate conclusions respecting it, than many of those who, as observation has shown, have drawn hasty inferences from a few and very imperfectly investigated occurrences."

Quitting now the testimony of East Indian authorities on the important subject which we have under consideration, we must invite the reader to accompany us in examining the evidence adduced by Dr. Copland and others respecting the transported infection of Cholera, after the pestilence had left the limits of Hindostan, and had entered upon that westward course of mysterious advance which it pursued until it reached the shores of America. Our author's notice of this part of his enquiry is intentionally very brief; "because," says he, "the identity of the malady in both hemispheres having been fully and generally admitted, and its infectious nature in India having been completely proved (!), it must necessarily possess the same character in Europe, unless counteracted by powerful means."

That the greater number of the instances enumerated by Dr. C. of the disease being supposed, or believed, or considered, or said, (for he very properly avoids making any strong assertion), to have been conveyed to different places by vessels from infected parts, and of the exemption of certain other places from its invasion, in consequence of quarantine and other precautions, are of the most questionable authenticity, must be apparent to every one. What will the reader think of such proofs as these?

"M. Hubenthal states that a peasant having arrived from Arkatal, on the borders of Persia, at the village of Neskatshne, to visit an uncle, was seized upon the night of his arrival with the disease. The persons engaged in restoring the heat of the body by friction, &c., four in number, were attacked on the following day, and three of them died. Precautions were taken by the police to arrest the progress of the pestilence in the village, and it spread no further!”

Here is another proof:

"Dr. Meunier states that, at Bagdad, where a third of the inhabitants was attacked, none were affected but those who approached the sick! Dr. Reimann says, that there was not a single instance of a town or village in Russia which contracted the malady without previous communication with houses or persons affected!"

1847.]

Its Appearance at Astracan and Orenburg.

481

It would be altogether unprofitable to endeavour to arrive at any thing like a satisfactory conclusion on the point at issue, by quoting the conflicting opinions of different writers as to the manner in which the pestilence was at first introduced into Astracan and other towns in that remote region. We should not, however, omit to allude to the evidence of Mr. Cormick, who was at Tabriz in October, 1822, at which time the disease had reached the western boundary of Persia, and was steadily advancing in the same direction. This gentleman utterly repudiated the notion of the disease spreading by infection.*

When the Cholera appeared at Astracan in 1823, the Russian Government resorted to restrictive measures to arrest its progress.† "Whether

or not these measures (we quote from Dr. C.) were the cause of its disappearance may be difficult to determine; but it did disappear, and it was not till 1830 that it showed itself again in that city." Here, the reader will observe, there is a candid admission of doubt on the point mentioned; yet, strange to say, a few pages farther on, when combating the objections of the non-infectionists as to the utter inefficiency of any quarantine measures, our author does not hesitate boldly to affirm that "these succeeded for eight years in arresting its entrance into that place (Astracan") ! This is an easy way of settling a disputed point to one's own fancy.

We have already stated that the outbreak of the pestilence-after having been scarcely heard of for several years-in Orenburg in 1829, has been candidly admitted by almost every writer to be utterly unaccounted for. In the Russian Official Reports, Dr. Lichtenstadt has distinctly acknowledged that it was not possible to trace the invasion to any communication with infected places. The majority of the medical men in Orenburg, at first, denied that the disease was transmissible from one person to another; but several of them afterwards qualified this opinion, and declared for its infectiousness, although still professing their utter inability to explain how the disease arose, or whence it came. Dr. Lichtenstadt has informed us that none of the medical men, and scarcely any of the attendants upon the sick were attacked. It is also well worthy of notice, that a malarious condition of the atmosphere prevailed at Orenburg during, if not before, the outbreak of the pestilence there; as will be seen from the following statement of Dr. Onufriev, physician of the circle or district: "During the prevalence of the Epidemic, there was scarcely a single inhabitant of the city who had not some symptoms of disordered digestion. One complained of oppression and pain in the breast; another of headache, slight sickness, looseness of the bowels, and the like." This, we need scarcely

*Medico-Chirurgical Transactions, Vol. xii.

+ Dr. Craigie of Edinburgh, who wrote so much and so ably on Cholera in the Edinburgh Medical and Surgical Journal, which, for many years, he conducted with distinguished ability, informs us that-

"Each of these cities (Astracan, Moscow, and St. Petersburg) was placed under a rigid system of seclusion and separation from infected places, by means of strong lines of military posts and barriers, which, in the case of Moscow, were two-fold. Notwithstanding these precautions, however, the disease appeared in every one of these cities, and without the possibility of tracing it in any instance to unequivocal importation.