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1847.]

Recommendations of our Boards of Health.

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"Cholera is communicable from one person to another," and now recommending, until further information could be procured, "that articles of merchandise admitted into this country from infected places should be submitted to the usual regulations of quarantine"!

The Government, doubtless not satisfied with the mere advice here given, required from the College a more detailed statement of their reasons on which this advice was founded. Accordingly, a long letter was drawn up, embodying chiefly the account given by Sir William Crichton (who, be it remembered, expressly denied the transmission of the disease by inanimate objects), to which allusion has been made in a previous page.

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The recommendations, we may remark, that were issued by the first Board of Health, in October 1831, were so extravagantly stringent-to the effect, for example of "immediate separation of the sick from the healthy"" conspicuous marks on infected houses"-" rags, papers, old clothes, &c. to be burnt"-" all articles of food to be placed in front of infected houses, and received by one of the family, after the person delivering them shall have retired," with many other precautions of a like character that within a fortnight from their promulgation they were cancelled, and a new Board, consisting of men who had witnessed the disease, was instituted. Thereupon, the public was informed upon authority that “Cholera is not more infectious than Fever," that "this disease seldom spreads in families, and rarely passes to those about the sick, under proper observances of cleanliness and ventilation," &c. &c. !

We shall not say more upon the operations of the second or Central Board of Health than merely to recall to our reader's memory that one of their last acts was to issue a recommendation to the hospitals of the metropolis-and consequently to all public institutions of the kind elsewhereto receive Cholera patients, in future, as they would patients labouring under any other disease. Need a single word of comment be made upon this truly valuable advice?—an advice which we trust may be always acted upon on any future visitation, either of the Cholera or of any other form of pestilence.

From London, let us pass over to Dublin, and thence to the French metropolis, and see what the leading men in these distinguished seats of professional literature thought upon the subject in hand.

The Board of Health for Ireland, in one of the first documents which they issued (March 1832), candidly admitted that" they were not able to trace the disease to any communication, by which it might have been introduced into the neighbourhood of Dublin ;"* and, soon after the breaking out of the pestilence in Paris, the following most important manifesto was published there :

"The undersigned physicians and surgeons of the Hôtel Dieu think it their duty to declare, in the interest of truth, that, although this hospital has received

* Dr. Bullen of Cork, in his pamphlet on the Cholera in that city-which, by the bye, was not affected for several weeks after the appearance of the disease in Dublin, although constant and uninterrupted communication existed between them-has told us that, "upon every enquiry, there are no grounds for supposing that cholera was imported into Cork."

the greatest number of persons affected with the cholera, they have not observed any circumstance which authorises them to suspect that the disorder is contagious. (Signed) Petit, Husson, Magendie, Honon, Sanson, Gendrin, Recamier, Dupuytren, Breschet, Gueneau de Mussy, Caillard, Bailly.-Paris, March 31,

1832."

Most of the other hospitals in the French metropolis followed the example of the Hotel Dieu.

The Report, also, of the Academy of Medicine in France expressed a decided opinion against the infectiousness of Cholera. Allusion is made in this report to the majority of the residents in Paris experiencing, in a greater or less degree, the influence of the epidemic constitution.

Leaving now the shores of Europe, we must turn our attention, for a few moments, to those of the New World, where the pestilence made its appearance in the Summer of 1832. It has always seemed to us that by far the strongest argument for the views of the importationists is the circumstance of the disease having manifested itself in parts of the globe, separated from each other by thousands of miles of sea between, and this too, as it has been very confidently asserted by these gentlemen, soon after the arrival of vessels from an infected port. It is therefore necessary to examine, with all possible fairness and impartiality, the proofs of the assertion in question. The two most remarkable instances of the alleged introduction of the pestilential cholera into regions, very far apart from each other by intermediate sea, are those of the Mauritius in 1819, and of Canada in 1832. The former is perhaps the more remarkable of the two; and, being also the earliest in point of date, as well as the least generally known, we shall first look at its history.

Dr. Copland-following the statements of Moreau de Jonnes and some other writers, chiefly French, on the subject-has ascribed the introduction of the cholera into the Mauritius to infection derived from the Topaze frigate, which had arrived from Trincomalee, where the disease, it is asserted, prevailed at the time of her departure.

Let us see on what grounds this opinion-which has been repeated by one author from another, without any circumstantial evidence having ever been adduced-rests. With the view of ascertaining the authentic particulars of the case, we have examined the original official reports sent home by our military medical officers then resident upon the island, and which are now preserved at the Army Medical Office here.* We beg most distinctly to assure our readers that the following statements are entirely derived from these documents, that we have added nothing and have withheld nothing; all that we profess to do being to give a brief abstract of their contents. The most perfect reliance may therefore be placed on what we set down. A committee of English and French medical men was appointed by the Governor of the Mauritius, General Darling, to enquire into all the circumstances connected with the appearance of the cholera on that island. It is from the report of their deliberations, signed by Dr. Burke, the then chief medical officer there, that the following memoranda are derived.

* Our best thanks are due to Dr. Smith for the ready permission which he granted us of inspecting these reports.

1847.]

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How did it reach the Mauritius?

489

In the course of the month of September, 1819, a few cases, exhibiting all the characters of malignant Cholera, occurred in the private practice of one or two of these gentlemen: some of these cases proved rapidly fatal. The Topaze frigate from Trincomalee arrived on the 29th of October; and, on the following day, 30 of her crew, suffering either from Dysentery or Hepatitis, were landed and received into the hospital of the 56th Regiment; there was no case of Cholera on board at the time, nor afterwards, while the frigate lay there.*

Numbers of negresses and other women were admitted on board, and there was free communication kept up with the shore. No case however of the disease occurred for upwards of four weeks after the arrival of the vessel; and then it occurred not in the hospital of the 56th regiment, but in the barracks at Port Louis. The first case in this regiment did not take place for two or three days later. After this time, the disease made its appearance in various places, and at length committed great and widespread ravages. It may be worthy of notice that, while the crews of many of the merchantmen suffered severely, not a single case occurred on board the Topaze. It is particularly remarked by Dr. Burke, that "none of the hospital attendants up to this date (19th Dec.) have been attacked." A similar statement is made by Dr. Kinnis, surgeon of the 56th regiment. During the prevalence of the epidemic, there was a sudden and unusually severe outbreak of the disease at a place called the Powder Mills; but, by withdrawing the soldiers from the locality, it soon subsided. Their com

*As it is of primary importance to determine the sanitary condition of this vessel, before and after her arrival at the Mauritius, the following details, derived from the report of her surgeon, Mr. Foy, will doubtless be read with much interest. The Topaze left Trincomalee with a number of her crew suffering from dysentery, diarrhoea, and fever. During the voyage, 17 of the dysenteric patients -63 in number-were seized with Cholera; and, of these 17, three died. Mr. Foy remarks:-"what has contributed to retard the recovery of the sick is a Scorbutic Diathesis, which has been for some time very general amongst the crew; to this I attributed the many cases of obstinate diarrhea on board." He then proceeds to state that the whole mortality on board the Topaze, during the 18 months that she had been in commission, amounted to not more than 16 deaths. Of these, six were from Dysentery, five from Cholera, three from Hepatitis, one from Pneumonia, and one from Phrenitis. Mr. Foy never for a moment entertained the idea of the Cholera having been imported into the Mauritius by the frigate. Five days after his arrival there, he wrote to Dr. Burke officially, that no contagious (infectious) disease exists on board, that none existed during the voyage, nor, to the best of my knowledge and belief, did any exist at the places we sailed from."

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How do these statements agree with the assertions of M. Moreau de Jonnes in his semi-official communication to the French Government, two or three years later? He takes it for granted, that the disease was introduced into the Mauritius " par les communications maritimes; and straightway he goes on to inform us that, "in the month of November, an English frigate arrived at Port St. Louis from Calcutta, having lost a number of her crew from a disease which raged on board!"

The circumstance of a disease like Cholera breaking out on board of a vessel at sea, and which had been quite free from it at the date of her departure from the last port, is a very interesting one. Might not the advocates of the Animalcular Theory of dissemination reasonably press it into their service?

manding officer stated to Dr. Burke that," in many of the cases, the men had been griped and purged for several days before being attacked with Cholera." The pestilence continued to prevail at Port Louis and in different parts of the island until March in the following year, when it entirely ceased. The mortality amounted to about 8000,* of which above 1300 cases occurred in Port Louis alone.

Now, with respect to the question of the disease having been imported into the Mauritius and spreading by infection there, the following data will probably satisfy most of our readers. The closing sentence of the report alluded to above, and which is signed by the names of 14 French and 4 English medical men, stands thus:-"La Commission de Santé n'a aucun motif de croire la maladie regnante contagieuse, et cette opinion est unanime parmi tous les membres ;" and Dr. Burke, in transmitting the report to the Governor, uses these words :-" Both classes of the profession seem to be unanimous in not supposing the disease to be contagious (infectious) or of foreign introduction." Among the precautionary means recommended by the Commission, no allusion is made to quarantine or other restrictive measures.

We have omitted to notice that Dr. Burke distinctly states that the weather at the Mauritius had been very unhealthy for many months before the appearance of the Cholera; so much so, that the natives had anticipated a sickly season. Some of the cases seem to have been of the most malignant character; for Dr. B. mentions that "he had been called to see some patients who, by their own report and that of their friends, would seem to have been struck as if by lightning." Dr. Kinnis alludes to the almost entire immunity of children from the disease, and to the very small proportion of women who were seized.

In conclusion, it may be worthy to state that, from enquiries which Dr. Burke made at the time, it appears that a disease, very similar to the then existing epidemic, had been known at the Mauritius so far back as 1775-at which period we know that a malignant epidemic cholera existed in India. This circumstance, although certainly not sufficiently authenticated, deserves at least to be mentioned.

What, then, is the evidence respecting the Cholera having been imported into the Mauritius by the Topaze frigate? That a ship, with a crew of nearly 400 men, left her last port without a single case of Cholera on board, but with upwards of 100 on the sick-list from dysentery, hepatitis, and other tropical diseases; that three fatal cases of Cholera occurred

during the voyage; that no other case took place before her arrival at the Mauritius at the end of October, or during her stay there; that a few cases of the disease had been witnessed on the island in the month of September; that no fresh cases occurred for three or four weeks after the arrival of the frigate, in spite of there having been a free and unrestricted communication between the ship and the shore; and then, that the disease made its appearance not in the hospital to which her sick had been conveyed, but in another part of the town. Need a single word be added, in

* Dr. Copland says 20,000. This exaggerated statement was first made, we believe, in the Quarterly Review.

1847.]

How did it reach North America?

491

the way of comment or remark, upon this simple enumeration of facts, the entire accuracy of which is authenticated, beyond all reach of doubt, by the written evidence of the medical men, civil and military, resident upon the island at the time?

With respect to the introduction of the disease into the neighbouring island of Bourbon, Dr. Kinnis states, in his report (the date of which is March, 1820), that," after running its course here, it appeared at Bourbon in defiance of the most vigorous quarantine;" and Dr. Collier, who succeeded Dr. Burke as chief medical officer at the Mauritius, and acted as the head of the quarantine establishment there, mentions in his report, dated some years subsequently, that "Governor Mylius did not succeed by quarantine in shutting out the disease from the island of Bourbon, but that it appeared there in February (1820), and spread there in spite of lazarettos and other precautionary measures.

So much for the oft-cited case of the Mauritius. We shall now see whether the evidence of those medical men in Canada, who had the best opportunities of becoming acquainted with all the circumstances connected with the appearance of the Cholera there, is more favourable to the importation doctrine so energetically insisted upon by Dr. Copland. The following data are taken almost entirely from a very long and carefully drawn-up report upon the subject by Dr. Stewart, Deputy-Inspector of Hospitals, then chief medical officer in Canada.

The first case of Cholera in Montreal occurred on the 9th of June, and in the person of an Irish emigrant who had arrived that day from Quebec, in the Voyageur steam-boat. This person had landed at Quebec in perfect health, from a vessel in which one or two of the passengers only had been sick during the voyage from Cork; nor was there any Cholera on board at the time of her arrival. On the following day (10th), another emigrant was seized, and "the disease appeared at the same time in distant and opposite parts of the town." It soon burst out everywhere. The first case among the soldiers in the garrison of Montreal occurred on the 12th (June); and, from this date to the 18th, there were 75 admissions into the hospital. In the course of the 19th, the regiment in which it appeared was moved from their barracks, &c., which were deemed un

* We have had the pleasure of conversing with Dr. Collier-who, after a very lengthened period of active service abroad in the East and West Indies, is now resident in London--upon the subject, and we had the satisfaction of finding that his views are altogether in accordance with those which we have advocated in the present article. He is entirely opposed to the doctrine of importation by infection, and feels assured that the extension of a disease like Cholera is quite independent of personal communication. It is, perhaps, scarcely necessary to add that Dr. Collier-as indeed every other medical man who has been in the East--recognises no essential difference between the endemic Spasmodic Cholera of India, and the "Choleric Pestilence" of Dr. Copland.

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This steamer had left Quebec, on the preceding day, with such a multitude passengers that she was obliged to put back and land a number of them there, before she could proceed on her voyage with the rest. It would seem that Cholera broke out that very night among some of those who had been landed, and who had taken up their abodes in one of the lowest and filthiest parts of the

town.

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