Mr. Grainger, who quotes the above circumstance in his Appendix to the Report on Cholera, also says:[[41]] “Dr. Evans, of Bedford, related to me an equally well-marked instance. A few years ago, he was staying at Versailles, with his lady, when they both became affected with the ague, and, on inquiry, the following facts were disclosed. The town of Versailles is supplied with water for domestic purposes from the Seine, at Marli. At the time in question, a large tank, supplying one particular quarter, was damaged, and the mayor, without consulting the medical authorities, provided a supply of water, consisting of the surface-drainage of the surrounding country, which is of a marshy character. The regular inhabitants would not use this polluted water; but Dr. and Mrs. Evans, who were at an hotel, drank of it unwittingly, and it was also used by a regiment of cavalry. The result was, that those who drank the water suffered from intermittent fever of so severe a type, that seven or eight of the soldiers, fine young men, died on one day, Sept. 1, 1845. On a careful investigation it was ascertained that those only of the troops who had drunk the marsh water were attacked; all the others, though breathing the same atmosphere, having escaped, as did also the townspeople.”
In all the instances I have just quoted, the cause of ague, whatever it may be, was swallowed with the water, not inhaled with the air; and on questioning two patients, ill with this complaint, in St. George’s Hospital, after harvesting in Kent, they told me that they had often been obliged to drink water from the ditches. The disease of the liver and spleen, to which persons are subject after attacks of intermittent fever, also confirms the view that its material cause enters the system by the alimentary canal, and not by the lungs; and it is of importance to remark, that Hippocrates observed, that drinking stagnating waters caused hard swellings of the spleen.[[42]]
Whether the unknown cause of ague has been produced in the system of a previous patient, like the pus of small-pox and the eggs of tape-worm, or whether it has been produced externally, there is, at present, no sufficient evidence to show. In the case first supposed, the disease would be a communicable one, in the second it would not.
There is one circumstance which seems to indicate that the specific cause of intermittent fevers undergoes a development or multiplication within the system of the patient,—it is, that a period of dormancy, or incubation, has been observed, in many cases, between the visit to the unhealthy locality and the illness which followed; for, as I have already remarked, every poisonous or injurious substance causes symptoms as soon as it has been absorbed in sufficient quantity.
The communication of ague from person to person has not been observed, and supposing this disease to be communicable, it may be so only indirectly, for the materies morbi eliminated from one patient may require to undergo a process of development or procreation out of the body before it enters another patient, like certain flukes infesting some of the lower animals, and procreating by alternate generations.
The measures which are required for the prevention of cholera, and all diseases which are communicated in the same way as cholera, are of a very simple kind. They may be divided into those which may be carried out in the presence of an epidemic, and those which, as they require time, should be taken beforehand.
The measures which should be adopted during the presence of cholera may be enumerated as follows:—
1st. The strictest cleanliness should be observed by those about the sick. There should be a hand-basin, water, and towel, in every room where there is a cholera patient, and care should be taken that they are frequently used by the nurse and other attendants, more particularly before touching any food.
2nd. The soiled bed linen and body linen of the patient should be immersed in water as soon as they are removed, until such time as they can be washed, lest the evacuations should become dry, and be wafted about as a fine dust. Articles of bedding and clothing which cannot be washed, should be exposed for some time to a temperature of 212° or upwards.
MEASURES REQUIRED FOR THE PREVENTION OF CHOLERA.