In Egypt there is not, it is true, a "cruel and inhuman desertion" of the unfortunate plague patients; for, among other reasons, being predestinarians, they think it makes no sort of difference whether they attend on the sick or not. Those who act upon the principle of cholera being a highly contagious disease, may perhaps consider it necessary to recommend, among their precautions, that the medical men and attendants should be enveloped in those hideous dresses used in some countries by those who approach plague patients[7]—fancy, in the case of a sick female, or even of a man of pretty good nerves, the effect of but half the precautions one hears of, as proper to be observed. It is quite a mistake to suppose that the sick have not been sometimes abandoned during the prevalence of epidemics; and that too in cases where medical men had very erroneously voted the disease contagious:—among other horrid things arising
[Pt_1
[Pg 26] out of mistaken views, who that has ever read it, can forget the account given by Dr. Halloran, of the wretched yellow-fever patient in Spain, who, with a rope tied round him, was dragged along for some distance by a guard, when he was put into a shed, where he was suffered to die, without even water to quench his thirst? I admit that, even with the views of non-contagionists, difficulties obviously present themselves in regard to the safety of those about the sick, when the latter are in such a state as will not admit of their removal to a more auspicious spot from that in which there is reason to believe they inhaled the noxious atmosphere. From what has been observed in India and other places, however, there is often sufficient warning in a feeling of malaise, &c., and the distance to favoured spots, where people may be observed not to be attacked, may be very short,—sometimes, as we have seen, but a few yards, so that a removal of the patient, with his friends, may be practicable, in a vast number of cases, previous to the setting in of the more serious symptoms.
[7] Since writing the above, I find that this scene has actually occurred lately at Dantzic where a few miserable medical men illustrated their doctrines of contagion, by skulking at a certain distance about the sick, dressed up in oil skins, like the disgusting figures we see in books, of the Marseilles doctors in the Lazaretto. (See Sun Newspaper, 22nd, Nov.)
I shall conclude this by cursorily referring to two circumstances which have within a short time occurred on the Continent, and which seem to me to be of no small importance in regard to cholera questions. It appears that the committee appointed by the French Chamber of Deputies to inquire into the questions connected with voting an additional sum to meet cordon and quarantine expenses, in the event of the cholera making its appearance in or near France, have made their report to the Chamber. They declare that in India the cholera was proved not to have been transmissible; and that in regard to Russia, it was not introduced, as always contended for by some persons:—they refer to the city of Thorn as exempt from the disease, though free from cordons, and in the midst of a country where it prevails, while the disease appeared in St. Petersburg and Moscow, notwithstanding their cordons, and even in Prussia, where sanatory laws where executed "avec une punctualité et une rigeur ailleurs inconnues." The money is nevertheless granted; it is always a good thing to have, but they have set one curious condition upon its being granted, which displays consummate tact, for it is to be employed solely in disbursements of a particular nature (dépenses materielles), including, it may be presumed, temporary hospitals, &c.; and that it is by no means ("nullement") to go into the pockets of individuals.
The other circumstance to which I allude is that, like Russia and Austria, Prussia has found that quarantines and cordons do not check the progress of cholera. The king declares that the appearance of the disease in his provinces, has thrown new light on the question; he specifies certain restrictions as to intercourse, which were forthwith to be removed, and declares his intention to modify the whole. In short, it is quite plain that, as Dr. Johnson has it in his last journal,—those regulations will, "in more countries than Russia, be useless to all but those employed in executing them."
LETTER IV.
It need scarcely be said how much it behooves all medical men to keep in view the subject of the wide-spreading cholera, and not to suffer themselves to be led from an attentive consideration of all that appertains to it, by the great political questions which at present convulse the whole kingdom.
I totally disagree with Dr. Macmichael, as I believe most people will, that the notion of contagion in many diseases is "far from being natural and obvious to the mind;" for, since the time that contagious properties have been generally allowed to belong to certain diseases, there has been a strong disposition to consider this as the most natural and obvious mode of explaining the spreading of other diseases. A person sees evidence of the transmission, mediate as well as immediate, of small-pox, from one person to another; and, in other diseases, the origin of which may be involved in obscurity, he is greatly prone to assign a similar cause which may seem to reconcile things so satisfactorily to his mind. Indeed there seems, in many parts of the world, a degree of popularity as to quarantine regulations, which is well understood and turned to proper account by the initiated in the mysteries of that department:—for what more common than the expression—"we cannot be too careful in our attempts to keep out such or such a disease?" For my part, I admit that I can more easily comprehend the propagation of certain epidemics by contagion, than I can by any other means, when unaccompanied by sensible atmospheric changes; and if I reject contagion in cholera, it is because whatever we have in the shape of fair evidence, is quite conclusive as to the non-existence of any such principle. Indeed abundance of evidence now lies before the public, from various sources, in proof of the saying of Fontenelle being fully applicable to the question of cholera—"When a thing is accounted for in two ways, the truth is usually on the side most opposed to appearances." How well mistaken opinions as to contagion in cholera are illustrated in a pamphlet which has just appeared from Dr. Zoubkoff of Moscow! This gentleman, it appears, has been a firm believer in contagion, until the experience afforded him during the prevalence of the disease in that city proved the contrary. He tells us (p. 10), that in the hospital (Yakimanka) he saw "to his great astonishment, that all the attendants, all the soldiers, handled the sick, supported their heads while they vomited, placed them in the bath, and buried the dead; always without precaution, and always without being attacked by cholera." He saw that even the breath of cholera patients was inhaled by others with impunity; he saw, that throughout the district of which he had charge, the disease did not spread through the crowded buildings, or in families where some had been attacked, and that exposure to exciting causes determined the attack in many instances. He saw all this, gives the public the benefit of the copious notes which he made of details as to