Reports On Cholera In Scotland, 1848-9.
from the "Monthly Journal of Medical Science" 1849
(From Dr Grieve, Physician to the Dumfries and Galloway Royal Infirmary, and Consulting Physician to the Crichton Royal Institution).—The history of cholera as it prevailed in Dumfries in 1848, presents no small analogy to that which prevailed in 1832 ; indeed in many respects it proved an exact counterpart, its rise, progress, decline, habitats, duration, number of persons attacked, and comparative mortality, being as nearly as possible, the same ; nor did the meteorological phenomena differ to any great extent, the malady continuing to rage with the same remarkable severity, apparently independent of, and uninfluenced by every possible variety of weather and temperature. In regard to the much vexed question, is cholera contagious or not? I have carefully, and without having any preconceived opinions to support, examined and dispassionately weighed all the facts connected with the history of both epidemics, and I am bound to say, that I have no rational grounds for believing it to be contagious; on the contrary I believe that it has its origin in, and is propagated by other sources than the communication of the sick with the healthy, and that exhalations from the human body have not the power of reproducing the disease.
If it spreads by contagion at all, it is unusual, and exceptional, and under circumstances which science has as yet failed to recognize. I believe the choleraic virus, or a materies morbi exists in, and is diffused through, the medium of the atmosphere, but under what peculiar circumstances this malaria is generated I am at a loss to determine; certainly it appears to be independent of, and unconnected with effluvia arising from the decomposition of vegetable and animal matters.
I shall now endeavour to prove that cholera as it prevailed in Dumfries in 1832, and 1848, had a spontaneous or sporadic origin, and that no sources of contagion or infection existed, from which in either epidemic the first cases could have contracted the disease; and that its diffusion can only be satisfactorily accounted for, by admitting the influence of epidemic causes. In 1832, the first case occurred on the 15th September, and in 1848, on the 16th November; and it has been proved beyond a doubt, that neither of these individuals had ever been in contact with infected persons, or in any district where cholera prevailed; in fact, on both occasions when the disease broke out in Dumfries, the nearest infected town was Edinburgh, with which neither of the individuals, it has been satisfactorily ascertained, had any communication direct or indirect.
The next well authenticated cases did not occur (as would naturally be supposed) if contagion had anything to do with it in the same house or tenement, or in the same street or locality, or amongst the attendants or relatives, but in different parts of the town, not one of these persons had seen, or had any communication with those first attacked ; nor have I found in my experience of both epidemics in Dumfries, that those more particularly exposed to the influence of contagion by attendance on the sick, viz :—medical men, nurses, and relatives, were more liable to be attacked with the disease, than others not so exposed. Not one of our nurses in Dumfries was seized, though engaged night and day, in all possible conditions of moral and physical depression, in attendance upon the sick. Upwards of eighty cases of cholera were treated in the Infirmary, and when the first case of cholera was admitted, there were about thirty patients in the house, none of whom took the disease. No pains were taken to isolate them from the infected; on the contrary several of them volunteered and were permitted to attend upon the sick, and continued to do so during the prevalence of the epidemic, which extended over a period of two months; and during this time, of all those in attendance upon the sick, nurses and medical men included, only one nurse was attacked ; and she it has been proved, had a day or two previously been in the town, thus exposing herself to epidemic influences. The Crichton Royal Institution, situated in the neighbourhood of Dumfries, was placed by the superintendent, Dr Browne, under a restrictive cordon, and no cases of cholera occurred in the Institution. This, however, can have little or no influence on the question of contagion, inasmuch as there were other Institutions, such as the Almshouses, in which no cases occurred, though no similar quarantine measures were had recourse to. No cases occurred in the House of Refuge, a fact which in my opinion is strongly corroborative of the non-contagious nature of epidemic cholera. Let us suppose that instead of cases of cholera, we had an equal number of persons removed from houses or localities, in which acknowledged contagious diseases, such as measles, small-pox, fever, whether scarlet, puerperal, or typhus had prevailed, would it not, I ask, have been considered extraordinary if some instances of these diseases had not been manifested among the refugees?
We have numerous and well authenticated instances of persons residing in the surrounding districts and neighbouring parishes, who having come into Dumfries for a longer or shorter period, but without having seen or come into contact with infected individuals, have returned home and been taken with cholera, without any extension of the disease to their relatives or attendants. Cases in point have occurred in the parishes of Dumfries, Troqueer, Tinwald, Caerlaverock; and in the town of Annan, sixteen miles from Dumfries, several cases of cholera occurred during the epidemic of 1832, all of them imported cases, the disease not extending to a single inhabitant of Annan. In short, I have had occasion to observe during my experience of both epidemics, innumerable instances of exemption from cholera under the most adverse and depressing circumstances. With the above facts before us, it is impossible not to recognize in the spontaneous origin, the rapid diffusion, and in Dumfries equally rapid decline, of cholera, a prevailing epidemic influence, and which contagion per se, would fail to explain or account for.
(From Dr Hamilton).- The first case of cholera which occurred in this locality during the present epidemic, was imported. A Highlander, in search of employment, from Dalkeith, Edinburgh (where cholera then prevailed), and Borrowstouness, in succession, was seized with cholera between Borrowstouness and Falkirk, and came to the office of the parochial board here on November 2, where he lingered for some time and died. He passed through the village of Laurieston, a mile and a half to the east of Falkirk, but I cannot say whether he halted there.
On November 13, a case occurred in Laurieston, which was then reported as only "suspicious," but which, now that I have seen this epidemic, I have no hesitation in pronouncing Asiatic cholera, which proved fatal in thirty-five hours. On December 16, a second child, lying in the same bed as the preceding, was seized, and died in thirty hours. In a few days afterwards a third child, in the same bed also, was seized with similar symptoms, and recovered. And on December 6, the mother of these children, still occupying the same bed, was seized with blueness of surface, cramps, and vomiting, but she also recovered. The husband, the only other member of the family, had also diarrhoea; but no other cases showed themselves in this village for some time afterwards.
On December 6, a man Broom, of dissipated habits, living in a damp public house on the side of the Forth and Clyde canal, two miles from Laurieston, and about half a mile north from Falkirk, was seized with particularly well marked symptoms of the disease, and died. Immediately after this date, there occurred in this locality, on the sides of the canal and of the Carron river, at Grangemouth, two miles to the east, and in other places in this neighbourhood, a rapid succession of cases, amounting probably (for they have been very irregularly reported) to about 400.
The virulence of the epidemic at its first outbreak was extreme. After Broom's case, 39 others are reported, up to January 30, of whom only 7, or 1 in 5.5 recovered.
Immediately succeeding these cases, under nearly the same treatment, at about two miles distance, nearly 2 out of every 3 seized recovered, a statement which shows the futility of deductions as to treatment from mere statistics in this disease.
One of these, William Rae, a strong labourer, without, it is stated, any premonitory symptoms, was seized, and was seen within twenty minutes by Mr Thomas Girdwood, surgeon, and by myself within half an hour. We both found the pulse at the wrist already extinct, and the surface cold and blue. I have not heard of any case here which proved fatal in less than four hours; but one man I am aware died after being ill for that space of time.
The general characters of the epidemic have been very much the same in this quarter as I have seen described in the periodicals, as occurring in other ports of the country. Cramps have often been absent, especially in children, who have suffered in a large ratio, and frequently neither the purging nor the vomiting has corresponded to the general severity of the affection.
In the severer forms of the disease, I have not seen, and I have not heard of, any particular treatment that has here proved successful. A few cases have recovered which appeared almost beyond hope, without any particular treatment apparently having produced this. When of a milder, though still very severe type, opium or laudanum, combined with stimulants, internally and externally, a cloth soaked in turpentine and applied extensively over the abdomen, with a very hot cataplasm above it, have in ray own practice seemed to me the means that could be most relied on for controlling the symptoms.
Damp localities, filthy dwellings, externally and internally, and especially confined, ill-ventilated, and overcrowded apartments seem to me to have been here among the chief immediate causes of the development of the disease. In the houses of the collier population, to which I shall immediately refer, as well as in a large proportion of the other houses where the disease broke out, no proper ventilation could be obtained, from the windows and doors all opening towards the same direction. If we add to this the circumstance, that among this class, as remarked to me by one of themselves, a cholera case usually proved nearly as attractive in drawing them together as a marriage festivity, we shall have explained to us, I suspect, the chief cause of the activity of the pestilence in these instances.
We seem to have pretty conclusive evidence of the extensive diffusion of some unknown and unusual agent in this district, from the almost universal prevalence before cholera appeared, and since then, of diarrhoea and of flatus in the bowels, as well as from the capricious mode in which the epidemic has, in some instances, broken out in different and distant localities. I do not see, for example, how we can otherwise explain the occurrence of some of the first cases, especially that of Broom's, and of some others which immediately followed. The agent referred to seems to have been sufficiently powerful to have produced these spontaneously, or if they were connected with previously existing cases, the link in the chain of connexion has escaped our notice. As the epidemic proceeded, however, the case became altered. I think there have been numerous instances in which the disease was propagated in a manner similar to what we see in typhus or in scarlatina; or, in other words, it has shown itself to be contagious. Of this I shall give a few proofs.
1st. On December 31, 1848, a person named Ure came from Shotts, sleeping one night near Coatbridge, where cholera prevailed, to Stenhousemuir, three miles from Falkirk, where no case of cholera had up to that time been reported. He was shortly after seized with cholera, and died in twenty-four housa, and in two days afterwards in the same house, his mother also [part missing] Johnston, who was seized on January 15, and died in her own house at some distance from Mrs Walker's; and on January 16, her husband, Henry Johnston, was also seized and died. Or again, about the same date, and in the same locality, a man, Ure, was seized and died, and his daughter, who attended him, was immediately after seized and died in the house of a Mrs Anderson, who in a day or two afterwards was also seized, but recovered. Here is another striking case of the same kind: Margaret Mellis, living in Bainsford, was seized on January 4th, and died on the 5th. In two days afterwards her mother was seized in the same house, and died. While the mother was ill, another daughter, living in Falkirk, went to see her, stopping a night in the house. She was seized immediately afterwards, and lay in another sister's house in Grahamston, about half a mile distant, who, as well as one of her children, was immediately also seized, the two sisters lying in the same bed. Or, here is a still more striking instance: A man, Brodie, lived at the beginning of February, in a house in Falkirk, where several cases of cholera had occurred. He was in Laurieston (in which place no case of cholera had occurred for five weeks) on February 5, and went into the house of William M'Gregor, where he was seized with cholera, and was removed next night in a cart to his own house in Falkirk, and died. On February 7, Mrs M'Gregor was seized with diarrhoea. On February 8, her child, two years old, previously quite healthy, was seized with cholera, and died; and on February 10, Mrs M'Gregor was also seized, and died on February 12, on which day William M'Gregor was seized, and died on February 16. On February 15, Marion Crichton, a woman living in a room above W. M'Gregor, and who was frequently in his house, was seized, but recovered; and on February 16, Jane M'Gregor, sister of W. M'Gregor, and living next door to him, was seized and died. Another woman, Ellen Renny, who acted as nurse to M'Gregor, had diarrhoea on February 9, and was seized with cholera, in Jane M'Gregor's house, on February 16; and on the same day her child was also seized. Still more, on February 20, Agnes Smith, another nurse to these parties, was also seized with purging, cramps in the belly, and blueness of surface.
2d. The same thing is strikingly shown by merely looking at the chain furnished by the dates at which the disease attacked, in Bainsford and Falkirk, several families connected by relationship, and who naturally had constant intercourse with the parties affected, but whose houses were situated at considerable distances from each other.
On December 16, Mrs Thomas Miller, living in Bainsford, was seized, and died on the 17th. She was attended by her sister, Mrs Rankine, from Falkirk (where cholera was not then prevailing), who was seized on the 19th, and died in her own house, after lingering for some weeks. On the 30th, Mrs Rankine's daughter was seized, and recovered. On December 24th, Mrs Thomas Logan, living in Bainsford, sister-in-law of Mrs Miller, having previously been affected with diarrhoea, was seized, and died on the 25th. Mrs Charles Logan (mother-in-law to the above, but living separate from her) dressed the dead body of this patient, and was seized on the 26th, and died on the 27th. On December 30th, Charles Logan, son of the preceding, and living in the same house, was seized. On the same day, John Millar, father of Mrs T. Logan, was seized, and died; and on January 4, Thomas Logan, husband of the same, was seized, and recovered. On January 5, William Logan's wife was seized, and recovered; and on January 8th, William Logan's son was also seized, and recovered. It is further to be observed, that excepting this string of relations, and the cases previously mentioned as having occurred in Bainsford, only five other cases are reported as occurring there from December 16th to January 8th, although there are in this village about 250 families.
3d. It seems to me that the same conclusion must be arrived at from observing what occurred at two collieries in this neighbourhood, where the disease broke out, the particulars connected with which have been kindly furnished to me by Mr T. Girdwood and Mr Coubrough, surgeons here. It first made its appearance at Skinflats colliery, near Grangemouth, ten to twenty feet above the level of the sea. The houses inhabited by these colliers, consisting generally of two rooms, are built on a clayey soil, are as usual with this class dirty, internally and externally, and are badly constructed, there being no proper means for ventilation, as has been already mentioned. The number of houses inhabited by the colliers when the first case occurred was 40; the number of persons living in these was 273, and the number of families 48. This gives an average of 7 to each house. The disease broke out on January 3, and the last case occurred on February 9. During that period 83 persons have been affected, and 36 have died, giving an average of nearly 1 in 3 affected, and of more than 1 in 7.5 dead. Of the forty houses occupied, there are only three into which the disease did not enter.
It is instructive to notice the course pursued by the epidemic in this locality. The colliers' houses form a continuous line, running from south to north, for a few hundred yards, being at their northern extremity connected with the small village of Old Skinflats, which consists of eleven families (thirty-eight individuals) not colliers, besides a few collier families also. Now, it is remarkable, that cholera, which broke out a little to the south of Old Skinflats, had attacked a great part of the "colliers' row," and had on the 8th and 9th attacked two collier families in the village, but had not, up to January 13th, when about sixty colliers had been seized, affected a single individual of the eleven families living in Old Skinflats. On the 14th, however, it broke out in the house of a person of the name of Millar, who kept a public house, and who, though he would not allow the colliers to drink in his house, I am informed, supplied drink to those who came for it, at all hours. This family suffered severely, six were seized, and five died. The only other of the thirty-eight inhabitants of the village affected, was a Captain ______, of irregular habits, who, it is stated, was in Millar's house getting whisky, immediately previous to being seized. These facts seem to me precisely analogous to what I noticed in 1847, among the railway labourers living in Camelon, near Falkirk, when typhus spread extensively among them, but attacked in a small proportion the other classes (mostly nailers, sufficiently dirty in their habits too) among whom they resided, and the explanation of the facts will be found I think the same in both instances. The other inhabitants had little intercourse with either the colliers or the railway labourers, and therefore remained comparatively free from the diseases which attacked both.
I have not been able to find any distinct connection between the first cases at Skinflats, and those at Grangemouth, Bainsford, or any other place where the disease at the time prevailed. In Kinnaird colliery, however, in which it broke out on January 9th, the connection with Skinflats, from which it is distant rather more than a mile, is very distinct. Jean Marshall had been attending her sister, affected with the disease at Skinflats, and was sent home to David Marshall's, her father, on the 9th, while affected with the premonitory symptoms, and became very ill, passing into the collapse stage, but recovered. Peter Marshall, uncle to J. M. (who resides a quarter of a mile distant from David Marshall, but who had, it is stated to me by the Inspector of the parish, been in David Marshall's house immediately previous to becoming affected), was seized on the 12th, and David Marshall, father of J. M. on the 14th. On the 18th, Robert Duncan, residing next house to Peter Marshall, and who rubbed him, and was often in his house, was seized; and within six days from this date, two children and his wife were also in succession seized. The whole four died, and other cases immediately followed in the same locality. On January 24th, a sister of Jean Marshall came to visit her from Carronshore, a neighbouring village, and on going home was seized and died. Shortly afterwards this person's husband was also affected, in Carronshore. Many other facts, similar to those I have mentioned, might, I have little doubt, be collected in this neighbourhood; and if we admit, that in these contagion was probably the means by which the disease spread, the presumption becomes very strong that, in the still more numerous class of cases, where two, three, four, five, or even more were seized in succession in the same room, and often in the same bed, contagion there also was the chief cause of the diffusion of the disease. It is to be remarked also, that mere filthiness will not account, in many cases, for the rapid spreading of the disease in families. Millar's, for example, at Skinflats, was a remarkably clean and well-kept house, and yet six were affected in it.
Continued contiguity to the sick, confined apartments and want of ventilation in these, and the officious crowding of friends or strangers into the house of the affected persons, have certainly appeared to me the chief immediate causes of the rapid diffusion of this disease. None of the surgeons, who generally remain only a short time in each house, has been affected in this district, but several nurses, as has been mentioned, have fallen victims to it. Whenever I have been able to enforce due attention to isolation and ventilation, I have seen no instance in which more than one individual became affected in a house; whereas, where this has not been attended to, the list of instances in which more than one person has been seized in a family is truly startling. Reckoning nurses or attendants upon the sick, for the time being, as members of the family, I am aware, including the whole cases, of forty-seven instances in which two in the same house became affected ; of twenty-three instances in which three in the same house became affected; of three instances in which four became affected ; of six instances in which five became affected; of four instances in which six became affected ; of two instances in which seven became affected; and of one instance in which eight in one room were affected. In two confined and filthy tenements, included in this list, twenty-four were seized.
Some interesting facts bearing upon the question of contagion, have been communicated to me. Mr Coubrough, surgeon here, states to me that Mary Easton, residing at Kinnaird, washed the bed-clothes in which Andrew Turnbull died (cholera being the disease), and was shortly afterwards seized with the same, and Mr Ronald, surgeon here, has mentioned to me an exactly similar case which occurred to him in Stenhousemuir. Another fact is communicated to me by Mr Waddel, surgeon here. Two grand-children of Mr A.'s, residing in Grahamston, part of the burgh of Falkirk, were brought to Mr A.'s house from Kilsyth, where both their parents had, a day or two previously, died of cholera. Within three days Mr A. was seized; his wife, and also the nurse who attended him, followed, and all three died. It may be remarked here, that very few cases had occurred previously in this locality, but since that time (February 6th), a number of others have occurred in rapid succession. I have already had occasion to make a similar observation as to other places more than once in this report.
Mr Adams, surgeon, Grangemouth, has communicated to me a singularly interesting case as connected with this question. Miss _______ came from Glasgow, to visit her friends at Grangemouth, on December 26th, in both of which places cholera was then prevailing. She was seized the same night, and died next day. The bed-clothes were all subsequently cleaned, and the room fumigated. On February 17th, upwards of seven weeks after this lady's death, Mr and Mrs _______, having for a night or two occupied the bed and bed-room, in which Miss _______ died, were both seized with symptoms of cholera, but recovered. At the latter date, cholera, which had for a fortnight disappeared from the town, attacked four or five other individuals.
Immediately subsequent to the disappearance of cholera at Skinflats, a low fever attacked some of the inhabitants, and, about February 22, scarlatina also showed itself. What relations do the poisons producing these three affections hold to each other? Are they different, or are they only modifications of the same subtle agent? Bearing upon this point, I had occasion to see a curious case:- A girl, who had been resident at Skinflats, was removed (February 10) to Stenhousemuir, two or three miles distant. She had been complaining ever since, and I had to see her on February 19, when she appeared to me to be labouring under the low fever I have mentioned. On February 22, she was attacked with cholera; and in about ten days afterwards, a sister, who lay in the same bed, was also seized with the same.
Larkhall, Near Hamilton
(From Dr Weir).—The village, in general, is situate in an airy and healthy localty, being for the most part built on an eminence or ridge between the rivers Clyde and Avon. Typhus fever is generally less prevalent and less fatal here than in other villages in the neighbourhood. The population amounts to nearly 3000, mostly composed of weavers, and a few colliers, which classes, from the nature of their trade, are often placed in peculiarly poor circumstances. The houses for the most part are clean, and well ventilated, but in a certain part of the village, of a lower situation than the rest, the houses are very damp and unwholesome, the drainage very bad, and the dunghills, &c, close to the walls; this part, likewise, is inhabited by a worse class of people, accustomed to indulge freely in spirituous liquors; it was here to the greatest extent, I may almost say wholly, that the cholera prevailed.
The disease commenced about the 1st December, and to the 10th February there have been upwards of fifty cases, of which seventeen have proved fatal. More children under fourteen years of age were seized with it than adults; but on the whole they seemed to withstand the virulence of the disease better, and recovered more easily, than the old people; nearly all the fatal cases were of adults. Those of intemperate habits stood the disease worst of all; although living in comfortable houses, with plenty of food and fire, they suffered more, and died in a shorter time, than those who lived in damp localities, exposed to both cold and hunger.
Larkhall is about four miles south from Hamilton; and the nearest place where cholera prevailed at the time it first appeared, was Coatbridge, about twelve miles distant.
With regard to the transmission of cholera no accurate facts are known, and it is doubtful whether it may have been brought from other places, or originated spontaneously. There was always a constant communication kept up between this and Coatbridge by the colliers. Previous, however, to the first case of cholera, diarrhoea was present to a great extent.
Though not so contagious as small-pox or measles, which usually attack once in a lifetime, yet so far as I have experienced, if typhus fever be contagious, the same may be said of cholera, it occurs in the same localities, for the most part attacks the same class of people, and follows exactly the same laws as typhus fever. Nurses, friends, and next door neighbours are more liable to be seized with it than those who do not come in contact with it, though living in the same locality.
(From Dr Matthew Paterson).—On the 9th of December 1848, cholera made its first appearance here, and its first victim was a young man named Robertson, reputed to be of intemperate habits. He left Dumfries to join his father and family, who had come to Moffat shortly after the outbreak of the epidemic in Dumfries. Robertson was seized before he reached Moffat. He died about three hours afterwards.
On the 25th of the same month, a shoemaker's wife of the name of Ewart was taken ill with cholera in the seventh month of pregnancy, and died after twenty-three hours illness. In this case the exposure was indirect; she was in the habit of frequently visiting her husband's cousin, who washed the clothes belonging to the deceased Robertson. On Saturday, the 30th December, Ann Blyth was seized with cholera, and died after thirteen hours illness. She had washed out the house and clothes of the deceased Mrs Ewart. On the 2d January 1849, a man named Ewart, uncle-in-law of the deceased Mrs Ewart, was seized, and died from the complaint after a short illness.
On the 6th January 1849, another case occurred ; this was the only one that did not terminate fatally ; and, so far as known to me, was not exposed directly or indirectly to the choleraic contagion.
On the 27th January a young man, John Walsh, from Selkirk, 'en route' to Thornhill, was seized when about thirteen miles from Moffat, but continue his journey till he came to a shepherd's hut, about eight miles from Moffat He died after an illness of twenty-one hours.
(From Mr J. Mitchell, Surgeon). - The disease has appeared here in the endemic form, and as yet has confined itself to one locality. This locality is bounded on one side by a churchyard wall, and on the other by a stream which runs through the centre of the village, and perform the office of a common sewer. All the cases, fifteen in number, have occurred in the immediate neighbourhood of this stream. One half of the cases were persons of very dissipated habits, while in all there was a very obvious destitution. Besides these fifteen cases, we have had many cases of diarrhoea, which might possibly have lapsed into cholera but for treatment. In October, November, and December of 1844, we had nearly as many cases of typhus fever and with two exceptions, they occurred in this very locality. The confinement of the disease to this locality is all the more strange, as it is by no means the worst in the village; and in a place called the Cowgate, which would rival the old wynd of Glasgow, not a case of diarrhoea even has occurred to my knowledge save one. With regard to the typhus of '44, the most of the cases could be easily traced to contagion. In the present disease I cannot say that one case can be so traced. We have had cases occurring on the ground floor of a house on one day, and in the upper flat the day following, but no contact of the par ties; while, in a case which I shall not soon forget, a man lay with his mistress for the greater part of a night, the latter being collapsed (and indeed dying by his side) and yet he escaped. None of the attendants have been seized except in one case, where a young woman, being in attendance upon three patients simultaneously taken ill in the same house, was herself affected on the following morning. On the whole, I should say that if contagious, it is greatly less so than typhus; but little dependence is to be placed upon any conclusion arrived at on a review of such a limited number of cases.
(From Dr W. B. Hamilton).—Cholera appeared here on 1st January, cases occurring at intervals of two or three days till it reached it height about the 30th, when it was very general and fatal; since that it has gradually declined, though there are still cases occurring here and there.
We could not trace the first case as being imported from any infected locality. It has observed the same course, in regard to locality, that it did in its attack in 1832; so that, were a third attack impending, the inhabitants of certain tenements here would feel particularly uneasy. These localities are generally subject to fevers of a typhoid character.
I have seen nothing to make me consider it a contagious disease. I am more inclined to think it in some way associated with defective drainage. I think this opinion is well supported by its course here.
In an isolated house, in a street where not a case had previously occurred, saw five persons struck down with it within three hours of each other—these persons were living in different families, and for the most part not aware of each others’ illness: these five all died. The houses on either side [missing]
They were all in one badly ventilated close, with the exception of two. One of these was the case of a midwife, and the other in that of a tavern-keeper. Both were strong women, and the midwife was in close attendance upon the tavern-keeper. The husband of the latter came from Grangemouth with the disease upon him. Three women lived under one roof. Two recovered and one died; the mother of one came from a distance to the funeral, and died in a few hours' illness.
There were three recoveries and four deaths in all. A child who suckled in a case where the mother died, lingered with every symptom of cholera, and died in two days.
My faith is much shaken in the supposed non-contagion of the disease.
It must be noticed, however, that the state of the drainage in the only locality where the disease appeared, was horrible, and that there was an interval of ten days between the first four and the last three cases.
Another case of doubtful nature was observed in a boy of five years old, who recovered.
(From Dr Turnbull).—The first case of cholera reported occurred in a man, who was seen, I believe, only a very short time before his death. He had not, to the best of my knowledge, been exposed to any contagion. The person who dressed his body took the disease, and died; and, I believe, the same fate befell one of the women who dressed her body.
All these cases occurred in one locality. None of those cases having been seen by either my father or myself, I cannot give any accurate information respecting them. The following facts, however, are what came under our own personal observation. About the time the above cases occurred, my father was called to two cases in separate apartments in one house, in a distant locality from the other cases. Both cases occurred at the same time, and both died the same day; neither had been exposed to any contagion whatever; and, although the house was damp, ill ventilated, and crowded, no other case occurred in it.
We were called to many cases where one only of a large family was seized, notwithstanding the constant communication between all the members of the family. One girl we were attending for small-pox was seized, while confined to bed from this disease, and died after a few hours illness. She had certainly not been exposed to contagion; and, although there were many persons living in the house, which was situated in a very bad locality, no one else was seized. We almost never, in fact, saw two cases in the same house. In one house, however, which was in a most filthy state, two persons died shortly one after the other. A third person was seized in the adjoining room, and died; and after her death a family went to reside in the house, shortly after which one of the members took it, and died.
In by far the greatest majority of cases we could trace the disease to no contagion, and it generally seized only one member of a family. Of this fact I could give very numerous instances. Judging from what we saw here, I believe all the medical men arrived at the conclusion that it was not, strictly speaking, a contagious disease; and the cases (of which there were several) which occurred in the country, especially led us to arrive at this conclusion.
(From Dr Fisher, Portobello).—The village of Niddry is situated about three miles to the south-east of Edinburgh, being nearly equidistant from the city and Musselburgh, and about two miles directly south of the Firth of Forth. It consists of a straggling row of houses, about thirty in number; the locality is low and damp; it is shaded from the south by a grove of trees, and is enclosed in a semi-circle by a small stream. The houses are mostly of a very wretched description, many being thatched, and destitute of flooring and ceiling. The drainage, before the appearance of cholera, was most defective, indeed scarcely any existed; the houses were surrounded by accumulations of filth, and an enormous manure-heap, composed of night-soil and urine from the adjacent city, lay in the immediate neighbourhood. The majority of the inhabitants were in destitute circumstances; some received employment as day labourers, but not a few were in the receipt of parochial aid. The number of inhabitants at the outbreak of the disease was 138, of whom 70 were adults, and 68 children. 17 persons were attacked with cholera in the village, and 2 in its immediate vicinity; in all 19 cases, 10 of which proved fatal.
The disease first manifested itself on the morning of 1st November 1848, in the person of Janet Walker, age 11, who died the same morning. This girl had been previously in good health, and had not been in communication with any place in which the disease prevailed. Mrs Nicholl, age 43, was attacked the same evening, and died next day. This woman was in attendance on the first case, and assisted in dressing the body. She was seized in about an hour afterwards with the disease in the most decided form. A woman named Tait, who had been for some time resident in the village, went into Edinburgh on the same forenoon, that of 1st November, and was there, in the course of the evening, seized with cholera. On the 3d November, Mrs Callender, age 38, was attacked and died on the 4th. She had not been in communication with the sick. On the 4th, Peter Banks, age 37, was attacked, and died on the 6th; no communication with sick. On the 5th, Peter Nicholl, age 12, in communication with mother, attacked on 1st; recovered. Same evening, David Preston, age 30, had been attending the previous case during the day.- He died. On the 6th, Lawrence Nicholl, age 7, recovered ; mother and brother previously attacked. On the 7th, Robert Dixon, age 64, died same day ; no communication with sick. On the 9th, Mrs Hall, age 33, recovered; no communication with sick. James Callander, age 7, died on 21st; mother was seized on the 3d. On the 13th, Isabella Banks, age 6, recovered; father attacked on 4th. On 15th, Rubina Nicholl, recovered; mother and brothers previously attacked. This was the fourth case in Mrs Nicholl's house. This girl was again severely seized on 23d, and a second time recovered. On 18th, Jessie Banks, age 3, died; father and sister attacked on 6th and 13th. On 21st, Mary Robertson, age 45, died same evening; no communication with sick. Grace Murdoch, age 29 ; died ; no communication with sick. Ann Dixon, age 60, recovered. Husband attacked on 7th. On 26th, Thomas Robertson, age 7, recovered; mother attacked on 21st. W. Moore, age 5, recovered; no communication with sick. On 28th, Isabel Denholm, recovered; attended Murdoch and Robertson.
Thus eleven of the nineteen cases had been in actual contact with the sick; in the remaining cases, no communication, or even proximity, excepting that of residing in the same village, could be traced. With regard to the introduction of the disease in the case of the girl Walker, on careful inquiry there could not be found the slightest ground for supposing that she or any of her family, had been near any sick person. Supposing, for the sake of argument, that cholera is contagious, I would ask what is its period of incubation? Enquiring into the Niddry cases on this supposition, the results are most incongruous. For example, Mrs Nicholl, and David Preston, were attacked within at most one or two hours after exposure; while James Callander, a weakly child, and Mrs Banks' children, were seized after an interval of six or seven days. Five days intervened between exposure and attack of T. Robertson, and fourteen in the case of Anne Dixon.
It is impossible to give the proportion of those attacked, to those in contact with [missing] the sick, and in none of these instances did any untoward symptom arise, and I am aware that the same course was on several occasions pursued during the prevalence of the disease in this place (Portobello) with a like result.
I have enumerated only those cases which were distinctly marked, and of whose nature there was no doubt. Many cases of diarrhoea occurred in the month during which the epidemic prevailed in Niddry, but these were generally quite amenable to the usual treatment. In the cases which I have enumerated above, the invasion of the disease was invariably sudden, the worst features of the malady supervening with great rapidity. The remedies which I principally relied on, were calomel in large and repeated doses, opiates in small quantities, and stimuli. I found naphtha useful in checking vomiting, and the stimulating bath was of service in children.
The epidemic prevailed in Niddry for the period of one month, and its subsidence and disappearance were nearly simultaneous with the carrying out of various sanitary measures, such as the improvement of drainage, and the promotion of cleanliness.
(From Mr Robert Edwards, of Lasswade). - Several cases of cholera had occurred in the house of a farmer at Straiton (a village near Loanhead, where the epidemic was remarkably severe), and on the 7th January one of his servants (Janet Inglis) had premonitory symptoms of the disease. On the 8th she went to reside with her father and stepmother at Carrington, where at that time cholera had not shown itself. Immediately on her arrival she had acute symptoms of cholera, but eventually recovered. On the 14th, her stepmother, who had nursed her, took cholera in the same house at Carrington, and died after sixteen hours illness. Mrs Lyall, who attended the stepmother of Janet Inglis while ill, took cholera on the 14th, and died on the 19th. On the 18th, Thomas Law, who had visited Mrs Lyall's house during her illness, took cholera, and died on the 23d. On the evening of the 18th, Charles M'lnnes, a lodger with Thomas Law, on returning to his lodgings, took cholera, and eventually recovered. On the 20th, Thomas Law's wife took cholera, and died at noon on the 21st; and Robert Inglis, father of the first patient, on the 20th took cholera, and recovered. These were all the cases in Carrington up to the 1st February—[The date of the letter.]
Carrington is situated in a healthy locality, and is a remarkably clean village. The dwellings are not crowded, every cottage having two apartments, inhabitants are temperate. Inglis, Law, and M'lnnes, were all labourers, and were neither poor nor ill fed. No circumstance in their habits nor in the locality of Carrington were, in my opinion, likely to predispose them to cholera - excepting Mrs Inglis, who was not by any means a robust person; Mrs Lyall, who had for a considerable time past been subject to attacks of diarrhoea; and Thomas Law and his wife, who were both aged and infirm.
Three houses only were visited by cholera in Carrington. The houses of Inglis and Lyall were separated merely by an entry of a few feet. Thomas Law's house, about two hundred yards distant.
Charles M'lnnes, upon seeing Law unwell, upon his returning to his lodgings, grew frightened, and fled the house; but, feeling himself growing ill in his new habitation, he was compelled to return to his lodgings, and lay up. No symptoms of cholera whatever have made their appearance in the house where he took premonitory symptoms up to this date.
(From Dr Paxton of Kilmarnock).—Riccarton is a village of a thousand inhabitants, to the south of Kilmarnock, and separated from it by the river Irvine. We may divide the village into three portions. In the first, the houses are built on a patch of alluvial land, little above the ordinary level of the river, liable to be flooded by it, and which was so just before the breaking out of the disease. The houses here are nearly all of two stories, much subdivided, and densely inhabited by a rather poor population of labourers, and of (of late) unemployed calico-printers, also a few coal-miners. The second is considerably above the first portion; it is built on a rising ground quite out of the reach of inundations, and surrounds an open space, in the centre of which stands a crowded church-yard, a good deal higher than the floors of the surrounding houses. These are all old and crammed by a very poor population, chiefly Irish, a good many of whom are on the poor's roll.
The third portion of the village is formed by the houses built on each side of a road lately opened to Ayr, nearly parallel to, and within thirty or forty yards of the old village. The houses are comfortable cottages, generally inhabited by one, and in no case by more than two families. The people are of a superior class, being partly the better class of artizans, and partly miners belonging to the coal works of Mr Cuninhame of Caprington Castle, and all picked men, well attended to both morally and physically.
In the first two portions of the village the drainage is very bad, the sewers being merely open drains filled with almost stagnant waters, &c, and there are dung-pits at the back of every house; cleanliness, unless enforced, is very little attended to. In the third portion, the people are cleanly, and the roadway being cut and levelled a foot or two below the natural surface of the ground (over which the houses are built), ensures dryness and drainage, although still not very perfect; the dung-pits, &c, are almost all back from the houses at the extremity of the gardens.
The supply of water over the whole village is scanty, being taken from open wells, or from the river.
The first case occurred on the 20th January, on the alluvial flat in the first division of the village, in a house inhabited by an unemployed printer, the patient being a child of his who died next day. The house had been flooded to the depth of a foot a few days before that time. Only one other case occurred in this man's house, an older child who recovered. The second case was an old woman behind the church-yard, in the second division of the village, who also died; she had no communication with any one out of the village. The third case was an Irish labourer, who was at his work when seized; his lodging was in the neighbourhood of the church-yard, though not immediately adjoining it, and in one of the worst houses in the village, a horse and pigs having been kept in the house, and the dung-pits at the back of it were in a shocking state. A number more of this man's family became affected with the disease.
The cholera went on after this spreading rapidly on the alluvial flat, and around the church-yard, infesting the same houses, and selecting the same families and even individuals, as had been affected with typhus fever, in an epidemic which prevailed very extensively in the village in the summer of 1847. In the third locality, the new portion, only a single case occurred, and the man from previous bad health was in poor circumstances, and thus, perhaps from both causes, predisposed to the disease - he recovered.
The evidence here seems rather against contagion, as none of the medical attendants were seized; the assistants also all escaped with the exception of a nurse, but as she was taken from a lodging in one of the worst localities, this ought to go for nothing. I am also aware of three families in the village who had relatives in Hurlford, where the disease prevailed in a very severe form. None of those who merely went and came to see their relations were affected, nor did they communicate the disease to their families, but one woman who went and resided there, to wait on a son, took it and died.
We have found in this village that families who have been better circumstanced as to means, and cleanliness, &c, have enjoyed a remarkable immunity from the disease. The coal-miners here, who as was remarked above, are a very superior class of men in every respect to those of any locality I am acquainted with, have suffered very little, and not at all, except where their houses have been in the bad localities; thus forming a remarkable exception to what has taken place elsewhere in this district, where the mining population has in general suffered most severely, as at Hurlford, which is only a mile and a half distant.
Cholera prevailed in Hurlford some time before it visited Riccarton; also in Galston, New Milns, and Darvel villages, respectively one and a half, five, seven, and nine miles distant, and all higher up on the banks of the Irvine, the same stream which flows past Riccarton; there had also been some scattered cases in Kilmarnock, previously to the 20th January.
Since the first case on the 20th January up to this date, there have been in all 146 cases. Cured 114, died 26, remaining under treatment 6 cases.
Dalkeith And Its Neighbourhood
(From Dr Thomson).—The first case of the disease appeared here on the 27th of October last. It was without doubt an imported one. The subject of it had reason to be frequently in Edinburgh, and had been, previous to his seizure, in one of its infected districts. He was of intemperate habits, seldom took a regular meal, and altogether a most likely individual to fall a victim to the disease. The attack proved rapidly fatal. None of the attendants who were continually in close contact with the patient - and that in a small apartment - took the disease, though some of them appeared much predisposed from over fatigue.
No other case occurred in the town until the first of December, in the course of which month, there were eight cases according to the official return, but ten according to my own knowledge. After a temporary cessation, a man was brought into the town in the collapsed stage of cholera, from the parish of Dalhousie, to which place he was reported to have proceeded from an infected district in Edinburgh. He was conveyed to our hospital here, where he shortly died. As after the first, no case followed this last imported one. Of the eight cases that were returned during December, 6 occurred in a short, narrow, and ill-ventilated wynd. The other two that were not returned, occurred there also. Had I been asked where cholera was most likely to begin in Dalkeith, I should certainly have said in this wynd, and moreover, I should have pointed out the very close in which cholera did make its first appearance. The second case was a woman who attended the first house, next, her husband who lived in the opposite close, and then a girl in the same with the first. All of these died. Altogether, there were 6 cases that originated in this small spot. I feel convinced that more cases would have occurred, had not the most destitute been removed to a house of refuge. Some of them were suffering from bowel complaint at the time of their removal.
At Newton, a distance of a mile and a half or two miles from Dalkeith, cholera has been prevailing for some time past. With one or two exceptions, the cases have all occurred amongst colliers, most of whose houses are very damp, and, otherwise, in a miserably bad sanitary state. I attended the second case of cholera that occurred in this district, which proved fatal in the stage of consecutive fever. Upon inquiry, I found that the patient had been predisposed from intemperance—had not been near the first case, but that he had been visiting his relations in the neighbourhood at Newton Farm, where I was attending several farm-servants and their families on account of severe diarrhoea. I believe that the origin of cholera at Newton, cannot be satisfactorily attributed to, nor do I think that its progress has hitherto given much evidence of, contagion. The disease did not break out suddenly as at Loanhead. For nearly a fortnight before the first case occurred, bowel complaints were very general; so much was this the case, that the people themselves felt convinced that there was some common and external cause affecting all. The influence, affecting all so simultaneously, seemed to become more and more powerful, until at last, bona fide symptoms of cholera manifested themselves. At Newton Farm, where there were so many eases of diarrhoea, only one became choleraic. This is to be attributed to the better condition of the people as compared with the colliers. Amongst the latter, the same thing was observed. The most predisposed and vulnerable had cholera, while the others of stronger constitution had only diarrhoea. Though the distance between Newton and Dalkeith is so short, and notwithstanding the frequent intercourse between the two parishes, not one case of cholera has occurred here since the appearance of the epidemic at Newton.
(From Dr Craig).—Previous to Wednesday, the 3d of January last, I had not seen or heard of any case of cholera in this town and neighbourhood; but on that day visited, along with Dr Service, a lad seventeen years of age, at the Eglinton iron-works, having well-marked symptoms of cholera. Dr Service also stated that on the Sunday previous he had been called to a girl about five years of age, who lived a few doors from this patient, and found her in a somewhat similar state, but not so well marked, and she had rallied considerably on Monday morning, and the pulse having returned, he thought her out of danger. This girl, however, became worse gradually, and died on the Thursday following with symptoms of oppressed brain. She had been brought from Carnbroe two days before Dr Service saw her, and at the time she left, her friends stated that there was no case of cholera there; but I observed from the newspapers that on the same night she was seized, there were thirteen cases of cholera at Carnbroe, most of which terminated fatally. Whether the friends' statement, in regard to there being no case of cholera when the girl left be correct, I have not been able to ascertain.
The next case we were called to was on Thursday the 5th, the wife of a miner, and next day her husband was seized. Both of these persons I afterwards ascertained had been in company with the person first mentioned while affected with the disease. I ought to nave mentioned that he had bowel complaint for two days before we saw him, and had been vomiting and purging in the pit amongst his neighbour workmen, and was assisted home by them in a very exhausted state. These three cases having all rallied from the state of collapse, the impression became general that it was not cholera at all, and no little hostility was displayed against the doctors for saying so. On Saturday I found, however, that bowel complaints were very general, but no application was made for medical advice, the people being determined to treat themselves. On Sunday evening, however, the calls for medicine became frequent, and soon after midnight, I had several requests to go to the iron-works. I could see that things were in a bad state, for grief, alarm, and despair were painted in every countenance. On going down I found that Dr Service had been there before me. Several died in a few hours after we saw them. As early as possible I reported the state of matters to the parochial board, who dispatched me to Dalry for additional medical aid. I brought Mr Hunter along with me, and together we went through every house belonging to the works, numbering from eighty to ninety. We found about forty affected with the disease, twenty-seven of whom were completely collapsed. What I wish especially to note is, that by far the greater number of these were miners, who wrought in the same pit with the two men who were attacked the previous week. To follow the progress of the malady at the iron-works would be foreign to my present purpose, further than to observe in reference to a statement made by Dr Grainger in proof of the non-contagious nature of the disease, that not a single visitor to the Tooting Asylum took it—that the visitors to the ironworks enjoyed no such immunity. I had occasion to engage a woman as sick nurse for a destitute family; she went there on Sunday evening, took the disease on Wednesday, and died on Thursday. A man belonging to Kilwinning went out to look after his daughter who was ill; a week after he came home, he was seized with the malady and died. A woman came from Kilmarnock to attend some of her friends, who were ill; she also took the disease. Two boys came from Barrhead, in quest of work, but when they came the disease had broke out, and they could not get work, and were afraid to go into any house; they crept under a furnace near to some of the houses where the disease was; in the morning one of them was found seized with cholera.
From the violence of the attack at the works, the inhabitants were struck with terror—every one that could get into a house anywhere else fled from it. One man, with his wife and mother-in-law, fled to the Kilbirnie coal miners' houses, near Dalry, and, immediately on his arrival, he took cholera and died, and in less than a week the disease broke out there. Another man fled to Stevenston, and took the disease—in a few days it broke out there. Another went to Hurlford, near Kilmarnock, and took the malady, and immediately it broke out there. Are we then to look on these occurrences in the relation of cause and effect, or view them merely as coincidences?
I will now relate some facts in regard to its introduction into the town, which fell more immediately under my own eye. For more than two weeks after its appearance at the iron-works, we had not a single case here, although these are little more than a quarter of a mile in distance from this place. The first case which I attended was that of a miner who wrought at the iron-works - rather a severe case; but he ultimately recovered. His wife took the disease slightly; and his father-in-law, an old man, who visited him four days afterwards, took the disease and died. The next case which I shall select as an example, from amongst many, exhibits very strong evidence of contagion. It was that of the grave-digger - he lived in an isolated part of the town, and had no communication with the disease, except burying those who died at the ironworks. He had assisted at about thirty funerals when he was seized. He recovered, and, as soon as he was able, went out among his relations. His father, an old man, died of cholera - so did his sister-in-law - her husband (being his, the grave-digger's, brother); and two of her children had the disease in a mild form. Two of the grave-digger's sisters, both married women, also took it; the one recovered, and the other is at present apparently dying from the consecutive fever. The husband of the latter, and a son of the former, also took the disease, but in a milder form. All these persons live a considerable distance from each other, where there had been no cases of cholera previously, but all of them had had communication with the grave-digger, or with one another, while labouring under the complaint before they took it themselves. I could give many examples equally indicative of the contagious nature of the disease, and, on comparing notes with the other medical men here, I find that they have all been led to the same conclusion by similar examples. One other fact which I observed was, that persons who washed the clothes or bed-clothes of those who were affected were particularly liable to take the disease. Four cases of this kind occur to me at this moment, and all of these proved fatal. The Eglinton iron-works are situated on a dry and well-aired spot; the houses are largo and well-aired, and all self-contained. Some of them, from the habits of the occupants, were kept in a very dirty state, but not more so than they were for months before the malady broke out, when there was no disease of any kind amongst them. The deaths were more numerous in the ill-kept dwellings which were in this state; but this, in my opinion, was sufficiently accounted for by personal, independent of local, circumstances.
In the town it has been equally prevalent and fatal, in the newest, the best aired, and isolated houses, as in the lowest hovels; and in the neighbourhood of the worst nuisances, and in second and third stories, as on ground-floors.
(From J. B. Thomson, L.R.C.S., Edinburgh).
Coalsnaughton is a mining village in the parish of Tillicoultry, county of Clackmannan. The village is generally the most healthy part of the parish, having an airy and elevated position on the south bank of the Devon. The soil around clayey and retentive—the water, as in most coal districts, is scarce and bad— the locality is filthy—the houses are damp, and the people poor. The population of Coalsnaughton is about 800, a few being employed in the woollen factories, but the majority engaged in mining operations. When cholera appeared here, the inhabitants were suffering from want of work, and the privations induced by a strike among the miners.
The number of cholera cases during this visitation was as follows :- Eighteen dead; thirty-three recovered; fifty-one in all. Of these nineteen were males, and thirty-two females ; five were pregnant and four nursing; of the adults seized several were intemperate, but this could not be charged against the majority of the sufferers, many of whom were young persons—twelve being under ten years of age. The epidemic was short-lived, beginning on the 31st January, reaching its height of severity on the 15th February, and disappearing (with a solitary exception) on the 25th February. During the prevalence of Asiatic cholera here, upwards of 100 persons laboured under diarrhoea, and were generally relieved by an opium pill, and improved diet. In the great proportion of the decided cases of cholera the premonitory symptom of diarrhoea took place several days before serious symptoms supervened.
As to the contagious or non-contagious nature of the disease, we offer the following facts:-
The importation of the disease could not be traced to any contagious influence. The first case was in a very respectable family, where the only suspicion of its transmission rested upon a lodger, who, about the same time had been in the vicinity of Stirling, an unaffected locality. The lodger himself continued well. The same thing happened in the house of the first cholera patient in the adjacent village of Alva. Can this explain the mode of importation from place to place?
The propagation of cholera in Coalsnaughton could not be well explained by contagion. Within two or three days from its first appearance, cases happened in different localities, where no communication existed betwixt the patients or their families. These early cases—one at the east, one at the west, and a third in the centre of the village—became the foci from which the cases seemed to radiate. Indeed, the cases may be classed as occurring in these three localities, a large portion of the village being exempt. The number of persons who waited on and had nearest intercourse with the sick, were not victims to the disease in such proportion as others who merely lived in these infected localities, and did not hold immediate intercourse with the sick. The epidemic seemed to spread to all, with few exceptions, in these infected localities. In many instances only one of a family suffered, and only one or two of the nurses and attendants. In one crowded house where the corpse of a cholera patient was, in spite of the parochial authorities, kept three days, no others were affected. Several persons lay alongside of children for the sake of heat all the time of the disease, and are still well—two women under cholera continued to suckle as long as the secretion of milk continued, and as soon as it returned, and the infants escaped. Only in one remarkable instance were a number of the connexions seized, but this might not be from contagion, for it ought to be noticed that these were all living in infected localities at the time of the attack. Upon the whole, the cases of cholera here did not countenance the idea of the disease being either imported or propagated by contagion.
(From a Correspondent.)—There has not been a new case of cholera here for nearly two months. The entire number of cases was fifty, of which thirteen died. Upwards of 150 individuals suffered during the same period from choleric diarrhoea. The small mortality was due mainly to the mild form of the disease during the last fortnight of its prevalence, and in part, probably also, to the success of the treatment - which was in many cases very marked. In reference to the origin of the disease, I observed before - that among the cases occurring in Dunsdale contagion could not be satisfactorily made out. The evidences of its operation were more obvious among those cases which occurred in the elevated part of the town, and which is distant from Dunsdale about half a mile. The first fatal case there was a woman, who, although she lived in the high part of Selkirk, worked during the day in Dunsdale, where she may be supposed to have got the disease. The next case in the high locality, also fatal, was a woman who lived in the same house with the last, and had waited upon her. The nurse, who was paid by the parochial board to attend the first case, was the next victim. She lived at some distance. The woman who had washed the clothes of the first case after the burial, then suffered. Although living in the elevated part of the town, her house was a considerable distance from the dwellings of the previous cases. She had a severe attack, but recovered. Lastly, the husband of the nurse above referred to, had cholera, and recovered. Of the other six individuals living in the high part of Selkirk who suffered from cholera, several were operatives in the manufactories of Dunsdale, where they passed the greater part of the day.
It is worth remarking that the operatives and poor of Selkirk were very grateful for the attention and kindness shown them during the prevalence of cholera. They had a meeting among themselves, at which thanks were most cordially voted to the chief magistrate, medical gentlemen, and others. A handsome sum was subscribed for presentation to the inspector of poor, whose attention well merited this mark of their gratitude.
(From Dr Fleming).—There were seven cases—five fatal. The first case was an Irishwoman, who became sick a few hours after her arrival from Roxburgh. At the time of her residence there cholera prevailed in the neighbouring town of Kelso. She passed through Edinburgh on her way to Kirkliston, but denied having seen any affected person there, or previously. This woman died. Her husband left Kirkliston for Edinburgh on the day of her funeral, and was seized there the same afternoon. He was taken to the Cholera Hospital, in Surgeon Square, where he recovered. The second victim in Kirkliston was a man who lived next door but one to the first case, with whom he must have been at least in indirect communication. He denied having seen her while ill. The sister of the doctor who attended these two cases was the third victim ; and the fourth was Dr Braid himself. Although the sister died before her brother, who alone had been in immediate communication with the sick,—it is deserving of note, that he had been suffering from premonitory diarrhoea for two days previous to her seizure, during which period the disease may be supposed to have passed to her by direct contagion. The fifth case, a woman, lived in the house adjoining the dwelling of the second case. She recovered. The nurse who attended Dr Braid and his sister, and who lived on the side of the village most distant from the previous cases, made the sixth case. She died. Lastly, the brother of the second case had a sharp attack, but made a good recovery. During the month of February 1849, when these cases occurred, there were few or no bowel complaints in Kirkliston. Diarrhoea had prevailed there epidemically in the months of October and November 1848.
(From Dr Cruickshank).—John Rafferty, a labourer, said to be of temperate habits, was seized on the 24th January and died on the 25th. He came from Kilmarnock a short time before. No one here seems to have known him, and the family he lodged with took fright, and left this part of the country the day after he died.
The next case was that of a field-labourer, Ann Wilson. She had come shortly before to lodge in the same house with the former patient. She did not assist or go near him during his illness; but, on the 27th and 28th, she remained at home from her work, and assisted to wash his clothes and the bedding. Up to this time she was perfectly well; but, about ten o'clock on the night of the 28th, she was seized with symptoms of cholera, and died on the 29th.
These two cases are the only ones that have occurred here. There have been a great number of cases of diarrhoea here for the last three months, which the inhabitants would have to be cholera; none of them were fatal. I may mention that I am a non-contagionist, although the cases related rather point otherwise.
(From Dr R. Logan).—We have had no cases of cholera in its epidemic form in this place or in the neighbouring town of Lanark : there have been isolated cases imported in three instances, which proved fatal, in the neighbouring villages, without any extension of the disease.
(From Dr Selkirk).—This district escaped the ravages of the late prevailing epidemic cholera. Dysentery, diarrhoea, and anomalous intestinal "pains," however, prevailed to an extent and intensity unprecedented in the locality.
All the cases treated in this district were imported, with one exception.
Case I.—A young man, employed at the St Rollox Station, Glasgow, was seized on an afternoon in the latter part of December 1848, and arrived at the residence of his friends here three hours after seizure; he recovered. Free intercourse by friends and acquaintances was permitted: the disease was not propagated.
Case II.—Brought from Holytown or Carnbroe district, and died from secondary affection of the brain ; none of the friends became affected.
Case III.—The exceptional case occurring sporadically, above alluded to; this patient recovered : no other seizure took place.
Case IV.—Arrived from Airdrie—died in the algide stage; no case followed.
Case V.—(Communicated by Dr France, jun., Lesmahagow).—A female, while visiting her sick relations at Holytown or Coatbridge, was seized with cholera, and brought to Draffan, Lesmahagow ; she recovered : the disease progressed no farther.
Case VI.—(Communicated).—A female from parish of Stonehouse was seized while in attendance upon sick relatives at Carnbroe—returned and died of the affection : the disease was not transmitted to any other person.
[From the small space at our disposal this month for Medical News, and from the valuable reports with which we have been lately favoured from Glasgow and elsewhere, we are obliged to defer the conclusion and summary of these Reports on Cholera till July Edits. M. J.]
From Dr Barker, Physician to the Dumfries and Galloway Royal Infirmary.—Dumfries is situated, as it were, in the centre of a large cup, being completely surrounded by tolerably high hills in every direction, with a gap in their continuity at the north for the entrance of the river Nith into the valley, and another at the south for its exit. About two miles, at its nearest point to the south-east, lies the extensive morass of Lochar Moss, about ten miles in length, and averaging between two and three miles in breadth. During the last two years there has been a great accession of Irish labourers, employed in the formation of the Nithsdale railway, by which the aggregate condition of the town has been rendered worse and more squalid. The principal streets of the town are clean, but the back lanes and closes are very much the reverse, and ill ventilated. These remarks apply equally to both sides of the river, to Maxwelltown as well as Dumfries. There is no water in the town except that which is carried up from the river in water carts, rain water collected in cisterns, or the water obtained from wells. The drainage may be stated as equally deficient; although several large drains have been made under the principal streets, they do not extend to the back streets and closes, the places particularly requiring them. Besides, they arc made of such immense dimensions, that it is perfectly impossible for them to be properly flushed.
All the time that cholera was in Dumfries, viz., from the 16th of November 1848 till about the 16th of January 1849, the atmospheric phenomena were very remarkable, the weather being exceedingly tempestuous. The river rose on one occasion higher than it had been seen for sixty or seventy years. The aurora borealis was several times very vivid in the months of October and November. There were two severe thunder storms, the one in the beginning and the other at the end of December. From the 10th of November 1848 till the 15th of January 1849, inclusive, the mean height of the barometer, at 9 A.m., was 29.79 inches; at 9 P.m., 29.78 inches; with a mean daily range of 0.32 inches. However, on two successive days, about the time cholera was leaving us, viz., on the 10th and 11th of January, the daily range was 1.08 in. and 1.11in. respectively. The mean temperature at 9 a.m., was 39.54degrees ; and at 8 p.m., 40.73degrees. The number of days on which rain or snow fell was 39. During the first half of the period, the prevalent direction of the wind ranged from south-west to north-west; and during the latter, from south-east to northeast. The wind was—calm, 1 day ; moderate, 22.5 days ; brisk, 13 days; strong, I6.5 days; boisterous, 9 days. During the epidemic of 1832 the aurora borealis was, as in this one, very vivid, but the weather was considerably different, being constantly moist, calm, and cloudy. The epidemic was terminated by a thunder-storm. (See "The Leading Phenomena of Epidemic Cholera." ByAmbrose Blacklock, Madras Medical Board. Madras, 1848.)
Fever was very prevalent, and dysentery may almost be said to have been epidemic for at least two months before the accession of cholera; but when the latter made its appearance, we had no more fever—even in the infirmary we had only one case—and dysentery was replaced by diarrhoea and cholera.
Of the patients admitted into the infirmary, speaking generally, the most of them came from the streets and closes which had previously furnished us with fever cases. Nearly one-half of them (eighty in all), were dissipated, or, atbleast, questionable in their habits; and most of them were ill-fed and exposed to the weather. In my private practice, out of forty-cases, only five were of dissipated or questionable habits.
My time of acting-physician at the infirmary being from the 1st of September till the 1st of January, all the cases were under my charge except six, who were admitted subsequently to the latter date. I therefore feel called upon to correct the statements made in your "Journal" of this month (May) regarding the cholera in Dumfries. The greatest care was taken to keep the cholera patients separate from the others. As there was only one case of fever in the house, the four fever wards were set apart for the reception of cholera cases, and these wards occupy the whole of the upper storey of the house: the solitary fever patient remained in one of them, but that could not be helped. When these upper wards were full, a large ward in the extreme wing was used; but all the other patients were removed from it to other wards, or dismissed. One of the surgical patients acted as night-nurse for the cholera wards, for twelve or fourteen nights, when we had difficulty in procuring nurses. Another man presented himself in the waiting room as an out-patient, but was not ailing much ; when, as he was not afraid of the disease, I engaged him to come into the house as a nurse, which he did for payment, and acted as such so long as we had cholera patients. We had thus, during its continuance, five nurses for the cholera wards solely, one of whom died almost at the commencement of the epidemic of cholera, after twenty-three hours' illness, which she could scarcely have caught, as reported, by going up into the town, as there were, at that time, almost no cases of cholera in the town, except in St Michael's Street, and its immediate vicinity, at the southern end of which the infirmary stands. At the time of her seizure, this was the principal nurse for the upper wards, and was, of course, the one who had most to do with the cholera cases. Of the officers of the infirmary, Mr M'Lauchlan, the acting surgeon, died on the 10th of December, as was reported to the Board of Health. As his time for attending the infirmary was the same as mine, and as we met there every day, I asked him to go up to the wards with me whenever he could spare as much time, which he frequently did, as he was much interested in the history of the disease; and he went round the wards with me within a week of his death. Thus we had one death out of nine resident medical men; none of the others had cholera, I believe, but more than the half of them were confined to the house, for some days at least, with the premonitory diarrhoea. Out of twelve medical men who were brought to Dumfries during the visitation, two were attacked very severely, of whom one died. Whilst I am perfectly sure that cholera spread in Dumfries as an epidemic, I am by no means sure that it did not spread also by contagion, more particularly when a number of cases were congregated together, without a due amount of proper ventilation. It may not be out of place to mention here, the appearance of cholera at Clarencefield, although I cannot, at the moment, find a paper to give me the correct dates. Clarencefield is a small village in the parish of Ruthwell, nine-and-a-half miles south-east from Dumfries, between which places a postman went regularly every second day. Having been in Dumfries, in the beginning of December, this postman was seized with cholera after reaching home, and died. The medical man of the parish, who attended him, and who had not been near Dumfries, was next seized and died. A female, who waited upon one or both of them, was also seized, but recovered. And an elderly lady, who had been near none of these three, was also seized with cholera, and recovered: however, a relative of hers, a medical gentleman returned from India, was living in the house with her, and he had been frequently visiting both the postman and the medical man during their illness. In this instance there were no other cases, so that it would be difficult to consider the above an epidemic visitation.
[We have been favoured with a letter by Dr M'Cheyne of Clarencefield, in which an additional case is mentioned ; that of a blacksmith, who had been in Dumfries, and had attended the funeral of a person who died of cholera. This was the first case in Clarencefield.—Edit. M. J.]
In the epidemic of 1832, the total number of cases reported in Dumfries, as given in the minutes of the Board of Health in 1832, was 837 ; and the total number of deaths, 421. The total number of cases reported in Maxwelltown was 237, and the total number of deaths, 127. The epidemic of 1848-9 was much milder, at least as regards numbers, than the former one, there being, as nearly as can be calculated, more than 240 cases, and 100 deaths, fewer in Dumfries ; and twenty-three cases and thirteen deaths fewer in Maxwelltown. In this epidemic a considerable number of the cases and deaths were amongst children, who, in the former one, enjoyed an almost perfect immunity.
The chief localities of the disease in Dumfries in 1832 were Queensberry Street, and St Michael's Street, inclusive of Burns' Street and the east side of Nith Place; to which, for 1848-9, Irish Street may be added, in which there was a good number of deaths amongst persons of the upper classes. The chief localities in Maxwelltown, in 1832, were Church Street, College Street, Glasgow Street, Market Street, and Old Bridge Street. During the epidemic of 1848-9 the worst localities were much the same, with the exception of College Street, which was not so bad as some of the other streets ; and this is to be wondered at, as it is very narrow and dirty, and contains a great majority of the poorest inhabitants; but it has the benefit of being very near the river in its entire length, and at a considerable elevation above it.
17th May, 1849.—(From Dr Manford).—The disease made its appearance first in the village of Campbelton, situate ten miles east of Inverness, in the middle of March, and is attributed by many, particularly those holding contagionist views, to the washing of clothes, which hud been brought to Campbelton, and belonged to a person who died of cholera in Glasgow.
On the 30th March, the first case appeared in Inverness—it was that of a man sixty years of age. Neither the patient nor any of his friends, so far as I have been able to learn, had any communication or intercourse whatever with Campbelton, or any other infected place. He died on the second day collapsed, having had the usual premonitory and other symptoms. The second case was a girl seven years of age. She died on the 7th day from the effects of secondary fever, after all the usual symptoms, except spasms had disappeared. The disease progressed slowly up to 26th April, when, in all, twenty-one cases had been reported, of which eleven recovered, and ten died. Nearly all the deaths were the first cases, which we attributed to delay in applying for medical advice. The people could not be induced to believe that it was cholera, but that the diarrhoea, &c, was the effect of the present unusual brackish quality of the water of the river Ness. Almost all the cases were confined to a low, dirty, damp locality, near the river, the water percolating through its gravelly banks, and acting upon decomposed animal and vegetable matter. I may mention that the father of the second party attacked, had, a week before his child was taken ill, returned from Glasgow. He was attacked on the 10th, and died after thirteen hours' illness. So far as we could discover, he showed no symptoms of the disease before cholera exhibited itself in the child. He evinced beforehand, and while apparently in robust health, great apprehension of an attack of the disease. His wife also was attacked with premonitory symptoms, but recovered. No other case occurred in Inverness which could be traced to an infected locality. A young woman left her service to attend her sister, a married woman, labouring under malignant cholera—the sister died, and the house was shut up. The young woman took up her residence next door—she was attacked four days after, and died next day. She never had any fear of the disease, believing that it was the effect of the water, but she was much exhausted by fatigue in attending her sister, besides being of a delicate, unhealthy constitution, and predisposed by other causes. The woman employed to attend the last, as well as a previous and fatal case, was attacked and recovered. She was discovered to be a person of intemperate habits, but unfortunately she was the only nurse we could procure in the emergency.
From 26th April to 5th May, no cases occurred; but on the latter day a woman residing on the opposite side of the river, and her two sons, aged nine and twelve, were attacked. The woman recovered—the boys died; the first after twelve, the second after twenty-four hours' illness, of severe vomiting, purging, and cramps, ending in collapse. No case since.
Such is a brief history of cholera here at this time, and I may just state that from my observation of the disease now, and during its prevalence here in 1834, nothing has occurred to alter the views I have hitherto held regarding its epidemic influence, aggravated by local and other predisposing causes.
(From Mr J. Tolmie, M.R.C.S.E.) - [We have received the following report from the Secretary of the committee appointed by the Edinburgh Colleges, to investigate cholera, as the committee considers its early publication to be important, the facts having been frequently stated in a very imperfect form.]
On the 22d February, the wife of a pensioner, residing in Campbelton, went to Glasgow for the purpose of bringing home the children of a brother, whose wife had died of cholera in the end of January. She returned here on the 3d of March, bringing with her two children, a box containing some blankets, counterpanes, tablecloths, together with the children's clothes, and some other articles of furniture, which had been used by her deceased sister-in-law. On the night of Wednesday the 14th March she washed the blankets, and other clothes brought from Glasgow, and emptied the suds into a covered drain which ran between her house and the house of her landlord, John Leitch, next door to her. Her landlord, assisted by his son, had been for two or three days employed in thatching his house ; and the clay which was mixed up for the purpose of securing the straw thatch, lay at the pensioner's door, and close by the grating of the drain. The younger Leitch, who was in the habit of lighting his pipe, and resting himself, in the pensioner's house, was, on the morning of Friday the 16th, attacked with diarrhoea, which continued with exhausting severity all day. In the evening, about five o'clock, he fainted on coming into the house, and was carried to bed by his father.
At midnight I was called in for the first time, and found the father and son in the last stage of Asiatic cholera, collapsed and pulseless, suffering much from cramps, and still passing colourless dejections. The father, a man of seventy-six years, was taken ill in the evening. Both died on the 17th, within three hours of each other. The third case of cholera occurred on the night of the 18th, in a house adjoining that of John Leitch, in the person of a labourer named Diaper, who had been talking to Leitch on the 16th, and who had taken some purgative medicine on the 17th. This man eventually recovered, though he passed no urine till the 22d; but the female who nursed him during the first day of his illness—a cleanly, but not very temperate, person—was seized on the morning of the 20th, and died on the 21st. The father of this young woman, who nursed his daughter, was attacked by the pestilence on the evening of the 20th, and died on the 22d.
Alex. Fraser and Jean M'Donald, who lived about 200 yards from the house where cholera first appeared, were likewise taken ill on the 20th. The former died on the 21st, the latter recovered. In these two cases, I could not trace any direct communication with cholera houses. On the 22d, widow Urquhart, aged about sixty, became ill ; also a child of two years of age. The latter had suffered for several days from diarrhoea accompanying dentition, and lived in an ill-drained and filthy locality. Both died on the 24th. On the 23d, widow Macbean, an old woman, who had seen widow Urquhart on the 22d, took ill, and on the same day, John Mackenzie, one of the nurses. The former died on the 24th ; the latter, whose case was one of great severity, recovered—but his wife, who nursed him assiduously, became ill on the 28th, and died on the 29th. And the son of widow Macbean was attacked on the 24th, in the room which his mother occupied, and died on the 26th.
A sister, a brother, and a brother-in-law, of widow Urquhart, two of them living in the same house, who had all three been ministering to her wants, took ill successively on the 25th, 26th, and 29th.
From the 16th March to the 1st April, there occurred forty-one cases, and fourteen deaths.
In the cases cited above, it will be observed that, with very few exceptions, intercourse with the affected could be distinctly traced ; and this fact was almost uniformly observable throughout the epidemic. Atmospheric and telluric agency, which exerts a powerful influence in the propagation of the pestilence, did not appear to operate very actively in the present instance ; for persons in the locality where it appeared, who secluded themselves and families from all communication with infected houses, escaped; while their susceptibility, as regards unhealthy situation, insufficient or innutrient sustentation, modes of living, and neglect of personal cleanliness, were apparently the same as those seized. When the disease appeared in Campbelton, there was no cholera locality nearer than Glasgow. The pensioner or his wife had no symptom of the disease; although the man, to appease the clamour of the people, volunteered to become a nurse, and performed all the duties diligently and fearlessly for upwards of a fortnight. One of his children had diarrhoea. The preceding remarks bear exclusively on the manner in which the disease was imported or propagated in Campbelton. As regards the treatment, 1 can offer little or nothing new—but must mention that I considered turpentine in small and repeated doses useful as a stimulant, and as forwarding the torpid functions of the kidneys.
I must add that my impressions of the non-contagious nature of cholera, formed from my acquaintance with the disease in 1832, are very much shaken.
(From Dr Thomson.)—During the prevalence of cholera in Scotland in 1832, Jedburgh enjoyed a complete immunity from its ravages. The circumstances which marked the introduction of this terrible plague into the town, at its second invasion, are of a somewhat peculiar character. An offender apprehended in Dumfries, while cholera raged virulently there, for a serious crime committed in Roxburghshire, was lodged in the county prison in that town until the proper officers arrived to convey him in safety to Jedburgh. The day previous to his removal, 17th Dec, he was under medical treatment for vomiting and purging; the diarrhoea continued along the journey, and when he arrived in Jedburgh on the 19th Dec, he manifested unequivocal signs of Asiatic cholera, of which he subsequently died. Very soon after, the 21st Dec, the disease made its appearance among the community, and rapidly diffused itself over the whole town. The first case, which proved fatal in fifteen hours, occurred within fifty yards of the house occupied hy the prisoner pro tempore; and nearly all the other cases can be traced to direct communication with persons labouring under the disease. One case more especially ought to be recorded, where the patient was attended by four relatives successively, each of whom was seized with cholera and died. It deserves to be noticed, that the residences of the sufferers, with very few exceptions, were of the worst description, low, damp, and confined; and their habits intemperate and improvident.