Swampy undrained soils, the banks of rivers, the margins of harbours, and other low lying localities, with places where organic remains are artificially accumulated, or allowed to accumulate, prove the most prolific positions in the production of cholera, as well as of periodic fever.
Both before the outbreak of cholera, and on its subsidence, fever of type, more or less distinctly marked, with predominance of gastric symptoms, are more frequent than usual.
Some remarks, as already stated, were made on this subject in the “Medical Notes on China;” it may be added that many circumstances might be cited, tending to show that there is a close connection, not only between the causes of cholera and periodic fever, but also between it and endemic fever generally.
All this is very vague and unsatisfactory, but with such generalities, negatives and probabilities, it is feared we must for the present at least, be as content as we can, unless we are disposed to leap to conclusions, without finding the steps of evidence by which alone they can be safely reached; or are willing to subscribe the creed, that cholera, however first produced, is reproduced only through the instrumentality of the human body—that, by whatever acts, combination of acts, or of accidents it began, it is continued solely by contagion.
The essential cause of cholera—the causa sine qua non est—as well as of other things in nature with what are more familiar, is, and perhaps ever will be, beyond the reach of human penetration; and were its nature and properties ascertained, such knowledge might contribute little or nothing to our means of resisting its effects. But while this ignorance exists, and candour requires its confession, there is none respecting the associated concurrent agents, through whose influence it acquires extended prevalence and augmented fatal force. They have been already alluded to, and are so palpable as to be beyond question; and as they are on the surface, and susceptible of abatement or removal, it becomes us to deal with them promptly, vigorously, and perseveringly.
They divide themselves into two classes, the first of which concern private citizens, both as individuals, and as forming families; the second are subjects for legislative enactments, and consequent executive interference, constructive and restrictive.
Respecting the first, it may appear superfluous to reiterate what has been so often repeated, and universally admitted, namely the paramount importance of sobriety, cleanliness, and industry, in conjunction with sufficiency of nutritious food; nor to aver that if the former were more sedulously practised, there would be much less ground for complaint of the last than unhappily there is. It would be out of place to enlarge on such a subject here, but it may be allowable in passing to observe, that it behoves the more intelligent and wealthy members of the community, lay as well as clerical, to unite and help the more ignorant and needy in the great—vast as to results—reform, which it contemplates and embraces. A good deal has been attempted, and something has been done, but much is wanting. The work is great, requires many labourers, and gives scope for the combined exertions of enlightened philanthropists of all kinds. Yet we may say of it, without profanation or levity, and in the literal meaning of the words—truly the harvest is great but the labourers are few.
The second class of reformatory measures required for the object in view must devolve on the legislature, and on authorities constituted by it, as all experience shows they cannot be entrusted to the voluntary efforts of individuals, or to those of municipal, or other local self-acting bodies. The enlarged and disinterested consideration of men having authority, independent of the conflicting interests, and removed from the prejudiced opinions, affecting particular places, who look to the welfare of the whole, must do the work, if it be ever done effectually. Enlightened and benevolent men in parliament and out of it have not been scared from the undertaking by the obstacles real and fictitious in the way. Let them however, especially those in parliament persevere, leading others to join them as they assuredly will, disregarding the selfish and ignorant objections raised against their truly patriotic efforts, and they cannot fail of their reward.
The measures especially required comprise the form and situation of houses, width of streets, complete underground drainage, and the instant removal or destruction of refuse organic substances from and on the surface, by strict enactments, rigidly enforced. This like the former, is a hacknied theme, but it not the less important on that account, and its interest can never be exhausted till the objects which it embraces are accomplished.
If it were objected that such interference by the state in the ordinary affairs of life would trench injuriously on the liberty of the subject, it should be answered that the functions of government are not merely repressive of public outrage, and punitive of offences against the person, that improvements of the people’s condition at large ought to be its great aim, and that it can no more be justified in permitting the lieges, by omission of what is right or commission of what is wrong, to poison themselves on a great scale, than it would be in looking complacently on at the suicide of individuals.