Again: Professor Simpson, of Edinburgh, tracted cholera from London, by a vessel, to Leith, where the sick of this vessel were placed in quarantine on a hospital-ship. The nurses of this hospital-ship were attacked with the disease, no other cases of it having as yet occurred in Scotland. On shore, it first assailed persons who had been in communication with the sick in hospital. In this manner the first six cases that occurred in Scotland were traced to the ship which had arrived from London, where cholera was prevailing, and on which, during her voyage, passengers sickened of cholera.
In the same way Professor Alison traced the first four cases in Edinburgh. And these two very eminent physicians had no doubt of the contagiousness of cholera in the epidemic in question.
So, too, Mr. Moir, of Musselburg, showed that the first twenty-three cases of cholera in Prestonpans could be traced, by an unbroken chain of contact with the person or the clothing of cholera patients, back to a first case, which came, already ill, from a district in which cholera then existed.
During the first epidemic in the Untied States, a vessel took some cases to Charleston, s.C. They were strictly quarantined under military guard. Many of the soldiers took the disease and died. So did some of the physicians and nurses who were sent from the city to take care of the sick. But not a case occurred in the city nor in any person who had not been in contact with the sick.
Such facts as these can hardly be explained on any theory of chances.
On the other side of the question, epidemics of cholera are authentically described, in which the spread of the disease could not be sufficiently accounted for by its mere contagiousness. An English commission, sent to investigate this very question, reported that in Asia, Turkey and Russia, the history of cholera precludes the idea of its having spread solely by contagion, or of its being an eminently contagious disease. Instances are adduced of its invading a large district or city, at several distant points simultaneously, and of its attacking so many persons within a short space of time that the doctrine of contagion alone would be inadequate to explain the facts.
The strictest quarantine has not kept out the disease; as for example, at Moscow, where, to no purpose, a large garrison preserved around the city a prohibitive cordon, kept with a strictness known only in the Russian army.
At Charleston, although quarantine kept the cholera out in 1832, it was of no avail in 1833. Though it seemed to preserve New York in December, 1848, yet cholera passed its barriers in June, 1849.
Finally, it has been observed that, in some places and at some seasons, although cholera has been introduced and persons have been exposed to its infection, yet it does not extend certainly not for a long time. This was the case in London in 1831, and in New York in December, 1848. On other occasions it spreads like wild-fire, as at Paris, in 1832, where, in one month, it carried off 20,000 persons.
But this last argument is not conclusive against the contagiousness of cholera; for the same apparent reluctance to extend itself was observed in the case of the plague (universally regarded as contagious) in Cuprus, 1759. It has been observed of small-pox and of typhus on some occasions.
From all the evidence on this subject we may conclude that, while in certain epidemics cholera has undoubtedly been introduced and propagated by contagion, yet the degree of contagiousness of the disease has greatly varied in different places, at different times and under different circumstances. We think that “contagiousness is not an essential attribute” of this (if of any) disease; “it is an accident, depending upon many modifying causes” (Russell); and that, in most cases of disease (cholera as well as other diseases), the question is not so much one of kind (contagious or not contagious) as rather one of degree (highly contagious or slightly so).
It appears that, at all times, there have been requisite for the prevalence of cholera, in a community a peculiar state of the atmosphere and peculiar local conditions. And, almost always, those who are attacked by cholera are found to have been previously subjected to the influence of certain predisposing causes.
Admitting, therefore, the importance of contagion as a means of conveying the seed of cholera, we perceive that there must be in the individual in whom the seed is planted a congenial soil; and there must be, likewise, in the general conditions of atmosphere and mode of life to which that individual is subjected a favourable climate. If these be lacking, the seed will not germinate and bear fruit after its kind.
Let us inquire what conditions constitute this favorable climate and congenial soil; what are some of the predisposing causes of cholera.
1. CLIMATE AND TOPOGRAPHY. Hot climates and the warm season of the year predispose to cholera. The epidemic of 1817 began in a hot summer in Hindustan. In all climates the disease has been temporarily checked, if not extinguished, by cold weather. The apparent exception in Russia is explained by the habits of the Russian people the great heat and the extreme filth of their winter habitations. The epidemic of the past autumn in France seems to have been checked by the coming on of cool weather.
Cholera has prevailed most severely, though not exclusively, along the sea- coast and in the course of large rivers, more particularly where the land is law, flat and swampy, or imperfectly drained. The low “made land” of commercial cities is its favorite feeding-ground. In this cholera resembles typhus and diphtheria.
2. HYGIENIC CONDITIONS. No fact is better established, and none is more important to be widely known, than this: That wherever FILTH abounds there cholera makes itself at home. The exhalations from an undrained soil, saturated with the washings of uncleaned streets; an atmosphere tainted by the effluvia from accumulated decaying garbage and from animal and human excretions these furnish a climate in which the seed of cholera will rapidly develop and grow with rank luxuriance. This is demonstrated by both positive and negative evidence.
In London, cholera was longest prevalent and was most deadly in the uncleansed and overcrowded tenement houses. In New-York, in 1832, it began in Cherry and Roosevelt streets, and then appeared in Reade, Duane and Washington streets. It raged furiously at the Five Points, in the “rotten row” in Laurens street, and at Corlaer’s Hook. In 1849 it first appeared in Baxter street, then in Mulberry street. It then broke out in Stanton and in Thompson streets. Whoever is familiar with these localities will recognize in their names the synonyms of vegetable decay and animal filth, and will also know them as the undrained sites of ancient swamps and pounds, the water of which still stands, sending up vapors through their oozy soil. See General Viele’s recent pamphlet and map, “The Topography and Hydrology of New-York.”
On the other hand, it is stated on good authority that not a single case of cholera occurred in any of the new “Model Lodging Houses” of London, which are clean, dry, light and well ventilated, and which are not allowed to be overcrowded. In 1849, in Philadelphia, which, with the partial exception of two districts, was prepared for cholera by thorough cleansing, only 747 persons died of that disease, while in New-York 5,071 died of it. Boston was still more carefully purified, and the cholera confined itself to a few narrow lanes and crooked streets of the city.
But the impure air that favors cholera is not found in filthy, narrow streets alone. It may exist in splendid houses, upon our cleanest and broadest avenues, if the sewers which drain the houses be defective, clogged, or not ventilated. It may exist in ANY sick-room, anywhere, if ventilation and cleanliness of person and of furniture be neglected.
3. PERSONAL HABITS. It is universally conceded that the free use of alcoholic drinks predisposes to cholera. It should be remembered, however, that habitual drunkards are also habitually filthy, and irregular in their habits, and are often destitute. Those who, having previously abstained from liquor, resort to its free use for the purpose of warding off cholera, thereby only increase their liability to the disease. On the other hand, those who are habituated to the moderate use of wine run a risk if they suddenly discontinue this habit.
Excesses and extremes of all kinds predispose to cholera. Excessive filth does so. So does excessive bathing, with a view to extreme cleanliness; for it reduces the heat of the body, and debilitates the system. The inordinate use of either animal or vegetable food is a predisposing cause. But so, most emphatically, is fasting or abstinence, especially as regards animal food. The excessive mortality from cholera in Paris, which we have mentioned, occurred during the fastings of Lent. Nothing like it occurred at any other period. In a part of Louisiana, where nearly all the people are Papists, the mortality during a cholera epidemic was quadrupled during and after a three-days’ fast.
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.