Cholera 1832
EXTRACTS FROM CORRESPONDENCE AND REPORTS RELATIVE TO THE CHOLERA AT TRANENT. N. B.
Cockenzie, Sunday evening, 15th January, 1832. By Prestonpans.
Sir,
Having heard this forenoon that a boy had died in the village of Tranent, after a short illness, this morning, I wrote to Mr. Cunningham, surgeon there, requesting to be informed of the nature of the complaint; and have now the honour to enclose a note from Messrs. Cunningham and Seton, surgeons, stating, "that there can be no doubt but that Cholera had made its appearance in Tranent."
Since receiving the note above alluded to, I have been at Tranent, and seen Mr. Cunningham, who informed me, that a sister of the boy who died in the morning, is also dead, and that another almost hopeless case is at present going on.
The boy and young woman are children of John Reid, a collier, (in my employment); the lad Peter, aged 12, went to his work as usual, below ground, yesterday morning, and while there, was taken ill; he fainted twice before reaching home; his strength became prostrated; the symptoms of Cholera, so often described, followed, and he expired this morning. His sister Helen, aged 25, was also at work below ground yesterday, during her usual hours; she was quite well last night, and sat up till about twelve o'clock, (preparing a dress for a procession, which she intended to join in to-morrow) when she also was seized with the complaint, and died about two this afternoon.
The supposed hopeless case I have mentioned, is that of Andrew Mustard, aged about 40, whose mother died on Thursday morning, after a short illness, but as she was above 70, and had been complaining, more or less, for several years, no particular notice was taken of her complaint. Now, it is likewise supposed to have been Cholera she died of.
Tranent is about seven miles west from Haddington, on the great post road to Edinburgh; it contains about 1,700 inhabitants, and, with the exception of some respectable shopkeepers and tradesmen, they are chiefly composed of colliers and other labouring people. I have the honour to be,
Sir,
Your most obedient servant,
(Signed) H. FRAS. CADELL, J. P.
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Cockenzie, Monday Evening, Jan. 16, 1832.
Sir,
The death since yesterday, is that of Andrew Mustard, whose hopeless case I mentioned in my last. One of the new cases is John Reid, father of the boy and young woman who died yesterday; the other is a beggar, at present residing in a low lodging-house in Tranent.
Prestonpans and Tranent are contiguous parishes, the former is distant from the latter about two miles. An hospital is to be forthwith established at Tranent.
I have the honour to be,
Sir,
Your most obedient servant,
(Signed) H. FRAS. CADELL, J. P.
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Cockenzie, Jan. 20, 1832, Half-past Eight, P. M.
Sir,
Doctor Morries arrived here last night about 7, P. M. I immediately accompanied him to Tranent, where, with Mr. Seton, he visited many of the Cholera patients: he again visited them this morning. The local Board, at their Meeting to-day, approved of what had been done, and appointed him to take charge of an hospital now nearly ready for receiving patients, and nominated him Medical Secretary to the Board: as such he has signed this day's Report.
On account of regulations formed by different Burgh Towns, for the expulsion of vagrants, a more than usual influx of that description of people, has taken place at Tranent for some weeks past: one beggar has died; two are included in the remaining cases.
It may be worth while to mention, that last Monday, being the first Monday of the year, old style, or, as it is called "Old handsel-Monday," was a day of great festivity and rejoicing amongst the lower orders of society in this part of the country; and many of the unfortunate cases which have occurred yesterday and to-day, may, I fear, in a great measure, be attributed to intoxication, and exposure to the atmospherical air while in that state.
The disease has hitherto been confined to the dirtiest part of the town, with a few exceptions, and the most dissipated and irregular living people have been its victims. There are several striking instances of two, three, and four members of the same family being taken ill in succession.
H. FRAS. CADELL.
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Cockenzie, 21st January, 1832.
Sir,
Mr. Alexander Campbell, surgeon in Edinburgh, clerk to Dr. Christison at the Infirmary, has been engaged as hospital surgeon, under Dr. Morries.
Soup has been served out of the kitchen at Tranent this afternoon.
Enclosed is a handbill, numbers of copies of which have been circulated throughout the parishes of Tranent and Prestonpans.
I am extremely sorry to state, that three cases of Cholera have taken place at the western extremity of Prestonpans last night and this morning, and two of them have already proved fatal.
The first case was that of James Renton, at Prestongrange Colliery. He became unwell about 9 P. M., yesterday; he continued working until about 12; medical aid was called about 4 this morning; he died this afternoon; age about 30.
The second case is a child of James Renton, mentioned above. It was seized about 11 last night, and died about twelve hours after, age about two.
The third case is Mrs. Oxley, wife of a miner, now going on.
A soup kitchen was completed in Prestonpans this afternoon. Soup will be distributed from it on Monday.
(Signed) H. FRAS. CADELL.
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W. Maclean, Esq.
Sec. Central Board of Health, London.
Cockenzie, 22d Jan. 1832, Half-past Eight, P. M.
Sir,
Prestonpans not being yet sufficiently organized, I cannot send you a regular report of the disease in that place; but I am authorized by Dr. Morries to say, that he has visited some of the cases, and has no doubt of the existence of Cholera.
The new cases I have heard of, after being twice at Prestonpans to-day—are,
1st. ________Copeland, a carpenter, who made the coffin for Renton and his child, (the fatal cases of yesterday.)
2nd. A woman named Shaw, who was seized this forenoon, while looking from her stair-head, at the assemblage of people at Renton and child's funeral.
3d & 4th. Two children of widow Bolton, who attended Renton's family when in distress.
5th. Robert Smith.
6th. Name unknown.
I am engaged in correspondence regarding an Hospital at Prestonpans. I hope that an eligible house will be procured there to-morrow.
The hospital at Tranent is now fitted up, and furnished with attendants; this day I have arranged for an addition to it.
Soup has been liberally served out at Tranent, yesterday and this day.
(Signed) H. FRAS. CADELL.
[The daily reports received from Tranent, by the Central Board, include a nominal list of the patients, specifying their name, age, occupation, and habits, with the event of the illness. Beggars and dissipated persons form the majority of the fatal cases.]
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OFFICIAL COMMUNICATIONS FROM THE BOARD OF HEALTH OF MUSSELBURGH, N. B.
No. I.
TO THE PRESIDENT OF THE CENTRAL BOARD OF HEALTH, LONDON.
Musselburgh, Jan. 20,1832.
Sir,
I am requested by the Medical Practitioners, who have formed themselves into a local Board of Health for the parish of Inveresk, to communicate to you that a case of Cholera Asphyxia occurred here, on Wednesday, 18th instant.
It was followed yesterday (Thursday, 19th) by nine other cases, three of which died in the course of the day. At this date, Friday, three o'clock afternoon, seventeen fresh cases are reported, and six deaths: making in all, since the appearance of the disease on Wednesday, twenty-seven cases, and ten deaths.
Before the disease had reached East Lothian, Sir John Hope, the Vice-Lieutenant of the County, assisted by the Magistrates and gentlemen of the place, had a public Meeting, portioned out the parish into districts, and resident inspectors were appointed to make a general survey, and compel such steps as were necessary to ensure general cleanliness, and provide for the public safety, by reporting on the poverty or the disease therein. Subscriptions were subsequently made for the establishment of a soup kitchen, and three hundred messes of excellent soup have, for the last fortnight, been distributed to the necessitous, three times a week. Wine has been allowed from the public funds, for the cases of Typhus, which has been prevailing among the families of the poor; the more filthy dwellings have been ordered to be lime-washed, and coals and blankets have been distributed, as necessity has pointed out.
Last night, the Medical gentlemen practising, or resident in the parish, held a Meeting, at which it was agreed to divide the town and suburbs into districts; each taking superintendence of a part.
From these a local Board of Health was then selected to conduct correspondence, and collect, daily, the reports of the cases, and of such modes of treatment as have been found most efficient in their results.
Resolutions were also passed regarding the steps most necessary for preserving the public safety, and checking the spread of the disease.
We have deemed it, Sir, necessary to transmit you this communication without loss of time; and beg to be favoured with your answer and instructions.
Until such time, we shall continue to transmit a daily report.
I have the honour to be,
Sir,
Your most obedient servant,
D. M. MOIR.
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No. II.
Musselburgh, Jan. 21,1832.
Sir,
From its being post hour, and some of the Schedules not yet sent me from the different districts, I have only time to say, that from those given in, the state of Cholera with us is as follows:
Remaining yesterday, 17. New cases to-day, 17. Deaths today, 5. Remaining, 29.
I enclose a hand-bill which I caused to be thrown off to-day and distributed; and have every reason to hope that our cases will become daily more mild.—(See No. IV.)
To the Chairman of Central Board.
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No. III.
Musselburgh, 22d January, 1832.
Sir,
I enclose the schedules and numbers, which I have been able to obtain for this day, up to hour of post, for the different districts of this parish. From these it would appear, that from the last night's
I have the honour to be, Sir,
Your obedient servant,
D. M. MOIR.
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No. IV.
NOTICE CIRCULATED BY THE MUSSELBURGH BOARD OF HEALTH.
"Notice is hereby given to the public, that the parish of Inveresk has been divided into districts, for the speedier and more certain relief of persons attacked with Cholera; and that application for attendance must be made as follows :—
[The Districts and names of the Medical Inspectors are here specified.]
The Board of Health, however, wish it to be distinctly understood, that families will continue to be visited by their regular Medical Attendants. In cases of urgency, or where such are not immediately to be had, the nearest Resident Surgeon will be glad to take charge in the mean time.
The Local Medical Board wish particularly to impress on the community the necessity of avoiding every species of dissipation, as such particularly predisposes to attacks of this disease. At the same time they would recommend a comfortable and nutritious diet, strict attention to cleanliness, and regular hours.
As the attack is generally preceded by a degree of sickness at the stomach, and looseness of bowels, they beg to caution against the use of severe purgative medicines; and recommend, on such symptoms making their appearance, that a little brandy and water be taken, to which laudanum has been added, in the proportion of twenty or twenty-five drops to a grown person, and so downwards according to age. Ten drops may be given to children of from ten to twelve.
Should these means prove ineffectual, and vomiting supervene, application should be made to the nearest Medical Practitioner, as directed in this advertisement.
Caldrons of hot water are kept for the public use in Market Place, Musselburgh, and at the head of Bridge Street, Fisherrow."
Signed D. M. MOIR, Sec.
Local Board of Health.
[Extracted from The Cholera Gazette January 1832]
Remarks on the History and Etiology of Cholera.
By David Craigie, M. D. Fellow of the Royal College of Physicians, Edinburgh, one of the Ordinary Physicians to the Royal Infirmary of that City, Inspector of Anatomy for the City and County, and late Physician to the Temporary Castle-Hill Cholera Hospital.
The following is a partial extract from this paper and is limited to the direct history of the 1831-32 outbreak. We have included the details of the outbreak in Edinburgh and other non-mining areas.
II. and III.—When cholera made its first appearance in this country, at Sunderland in September 1831, it was by many believed to have been imported by vessels from the Baltic; and several endeavours were made to trace the particular vessels by which the disease was introduced. This idea the two cases given by Dr Hazlewood and Mr Mordey, as occurring at Southwick and Pallion, on the 5th and 9th of August, were sufficient to render excessively doubtful, if not to overthrow entirely. A similar case, occurring in Newton, on the 6th January 1833, under the care of Mr Steele, is given in the work of Mr G. H. Bell. The most conclusive of all I conceive is the following, which took place in July in Newbigging, a small district or suburb of Musselburgh.
Robert Reid, aged 51, a potter, and exposed in consequence of working at the kiln, to great and sudden vicissitudes of heat and cold, was attacked, on Monday the 11th July 1831, with diarrhoea in the evening, for which he took some sulphur; and the diarrhoea, after continuing the greater part of Tuesday the 12th, stopped apparently spontaneously. On Wednesday he attended at Lasswade the funeral of a child, so that he must have been considerably better. On Thursday his duty led him to draw a kiln, as it is technically named; and in this operation he was much overheated. He was soon after attacked with sickness and vomiting, followed by cramps, and profuse loose discharges from the bowels, which continued the whole of the night. These discharges were gruelly and watery from the stomach, and like dirty soap water or dirty milk from the bowels ; and they literally poured from him so as to pass through the bed beneath him, and wet the floor beneath the bed as if water had been spilt on it, and were entirely void of feculent smell. These symptoms were accompanied with painful cramps, first in the toes, then in the arms, then in the calves and thighs. On the morning of Friday the 15th a little after 7, he was visited by Dr Stephen, who found him with contracted features, eyes sunk in the orbits, the lips pale, the voice almost inaudible, the surface and extremities cold, the hands cold and incurvated, the skin clammy, the muscles of the thigh cramped in the form of hard rigid lumps, and the pulse not to be felt at the wrist. The thebaic pills relieved some of the sickness; and the application of warmth with the use of brandy, produced a temporary alleviation, with return of heat. But he continued much in the same state, with weak almost extinct voice, and coldness of the extremities and surface, except at the epigastrium, and died on Monday the 18th, about 9 in the morning.
Three remarkable circumstances deserve notice in this case. 1. It occurred in the person of a man who was living on the very place where six months after some of the fatal, and several severe, cases took place. 2. It began in the form of diarrhoea at first, and was mild, and underwent a temporary suspension, apparently independently of remedies. 3. It was believed to be at first a case of ordinary cholera, incident to the season ; but Dr Stephen, when he afterwards saw and treated the cases of malignant epidemic cholera, admitted that the symptoms on the morning of Friday were in all respects similar to those of the epidemic distemper which in January and February 1832 committed such ravages in this neighbourhood.
No other similar case, however, had been observed to occur in this vicinity till the night of Monday the 16th January 1832. On Tuesday morning, 17th, Mr Sibbald was called to a Mrs Wilkie, aged 60, living in a close or lane, on the south-east bank of the Esk, nearly opposite the wooden bridge called Cairncross's Bounds. She had been attacked on Monday evening by the account, with purging and vomiting of watery fluid, continuing during the night; and on the following morning, when seen by Mr Sibbald, the countenance was dingy or leaden coloured, the eyes sunk, the voice whispering, the pulse scarcely to be felt, and the extremities cold and covered with clammy moisture. In this state she continued till Wednesday night, when she died. Some attempt was made to trace the case of this woman to the person of a soldier, who was said to have been in Haddington, where the disease was still lingering, and who, though never himself having had the disease, was stated, by visiting the house of Mrs Wilkie, to have thereby been capable of communicating its productive principle. Mr Sibbald, however, as well as Dr Stephen, assured me that no such person had been in the house of Mrs Wilkie, and that it was impossible to discover that she had been in communication with any person previously affected by cholera. In the subsequent course of the disease, the same locality, which is very low, damp, and not particularly cleanly, furnished many cases of the disease.
It was generally believed that no other case occurred till the morning of Thursday the 19th, when that of Charles Webster, in Robertson's Close, took place. This statement is in the main correct, and I shall advert to the case of Webster in due course. I must remark, however, that when in Musselburgh on the 22d January, I saw several persons labouring under various forms of gastro-enteric disorder, for instance, diarrhoea alone, vomiting and diarrhoea, &c, who, on strict interrogation, admitted that they had on Wednesday the 18th, been labouring under bowel complaint in various degrees of severity. This was the case especially with the girl Jess Kinghorn, living in a house close by the aqueduct that runs past the hair-cloth manufactory, and with several other persons who had been working at that establishment.
In the meanwhile, however, that is, before any other marked or impressive case had occurred in Musselburgh, the disease-had appeared between the night of Wednesday the 18th, and the morning of Thursday the 19th January, at Coalpits, a small village or hamlet about a mile above Musselburgh, on the east or south bank of the Esk. This place consists of about 40 houses, arranged in two rectangular lines, one parallel to the bank, the other at right angles to the course of the river. The line along the bank consists of 12 cottages; that at right angles to it consists of 27; and a single house, a little larger than the rest, is placed at the opposite corner. All consist of one story or flat only, built on the ground; all have earthen or brick floors; and all are inhabited by colliers or persons connected with the pitmen. The first case occurred in the person of Mrs Clarkson, aged about 36, who was attacked between two and three in the morning of Thursday 19th January with vomiting, purging, and cramps, followed by general coldness, and died the same evening between six and seven o'clock. This woman never was at Tranent or Haddington, nor any way to the east where the disease was prevailing, but had been on Monday 16th to Fisherrow, where the disease had not yet appeared. The cottage in which she lived is one of those in the line near the Esk.
The disease next appeared in the person of Jean Galloway, alias Mrs Currie, aged about 50, on Thursday 19th about twelve, in the usual way; and she died that evening at ten. Mrs Currie had rubbed the previous patient; but the interval between exposure and attack appears to be instantaneous. None of her family, consisting of her husband and three children, were attacked.
On the same day, Thursday 19th, Mrs Sneddon, aet. 49, who had been well on Wednesday, but afterwards acknowledged she had laboured under looseness without pain for three weeks, was attacked with sickness, vomiting, and more violent purging. This, which was the third case, recovered.
Mrs Moffat, aet. 60, was then attacked with the usual symptoms on Friday the 20th, at two pm., and died on Saturday morning between four and five, after 14 hours illness. This woman had visited Mrs Clarkson on Monday; but the interval also appears to be too short for the influence of a contagious poison. None of the family, consisting of three sons and two daughters, were attacked.
The fifth case occurred in the person of George Clarkson, aet. 48, the husband of No. 1. He had been at the funeral of his wife on the afternoon of Saturday 21st between 3 and 4; he became sick, and vomited and purged copiously the same night; all Sunday he was in a state of collapse; and he died on Monday, twenty minutes after one in the morning. This family consisted of eight persons, one son by a former marriage, one son and daughter, twins at the breast, and a servant; yet of these eight, the father and mother only were attacked and cut off.
On the evening of the same day, the sixth case occurred in the person of Elizabeth Hine, a woman of 29, unmarried. Her first symptoms were cramps, speedily followed by vomiting and purging, and the usual symptoms of collapse. She lingered, however, till the 28th, when she died between seven and eight in the evening. This woman, who was said to be stout, healthy, and vigorous, had assisted Mrs Clarkson.
On the same day, Saturday 21st, James Sneddon, aet. 45, collier, who had been thoroughly exposed to moisture at the Prestongrange pit, and had been labouring under bowel complaints since Wednesday the 18th, was attacked with cold shivering and vomiting. The diarrhoea he states continued as white as curd and whey for two days. This appears, however, to have stopped almost spontaneously, for he took no medicine till Thursday 26th, and he recovered.
His daughter Elizabeth Sneddon, aged 16, who was attacked on Tuesday 24th at eight pm. with sickness, vomiting, and profuse purging of clear water and slime, was less fortunate. These symptoms were speedily followed by pain of the back, general chillness, with great heat at the epigastric region, and a blue or leaden colour of the face, and blueness of the lips, and death at eight on Wednesday evening.
During the night of the same day, Tuesday 24th, Violet Inglis or Mrs Gray, a woman of 45, whose health had been deranged since the cessation of menstrual secretion, and who had suffered bowel complaint for several days before, was seized with vomiting and cramp, in addition to the bowel complaint, the discharges of which became then profuse and watery; and she died on the morning of the 25th, after twelve hours illness. This woman lived in the corner house nearest the Esk, which was clean and well aired, but with a brick floor. No other person of a family of eight was attacked.
Next day Jane Gray, a child of three, and niece to Mrs Gray, came with her mother to the funeral. The child was three hours in the house, in a room a good way apart from that in which the corpse was, and without communication with it. At the end of this time she became sick and vomited, was attacked in the course of the evening with looseness, and these symptoms having increased the following day, she died on the 27th, about eleven pm. She was one of a family of ten, none of whom were attacked.
The last person attacked in this hamlet was Janet Wilson, set. 35, mother of a family of six children, deserted some time before by her husband, and supported by parochial aid, who, on Sunday the 5th February, was seized with looseness, vomiting and cramps, speedily followed by chillness of the surface, and leaden coloured countenance, and death about ten am. on Monday the 6th.
Thus in this place of 40 houses, there were eleven cases and nine deaths. It was at first asserted that James Sneddon had brought the disease from Prestongrange pit, where it was alleged Tranent people were working; but Sneddon was not the first person attacked, and he assured me himself that no one at that pit had been affected by the disease, except himself. But even if they had, it is easy to see, that exposure to the humidity of the pit which was one of the wettest in the neighbourhood, was quite sufficient with the atmospheric constitution to produce the disease. All these cases, it may be observed, occurred, except the last, within a very short space of each other; and it is impossible to conceive the one communicated from the other.
I have already said that the disease had appeared on Monday the 16th at Musselburgh. On Wednesday the 18th January no new case had occurred; but early on Thursday 19th, the second decided case appeared in the person of Charles Webster, a stout healthy man of 38, living in Robertson's Close, not far from the Old Bridge. This man, who had gone to bed on the night of Wednesday the 18th, quite well, with the intention of rising to dig a grave for the corpse of a relative, who had died not of cholera, but of old age, in a state of destitution, was awakened next morning at four with a bowel complaint, which was so severe and profuse that his wife attempted to dissuade him from going out to the burying ground. He persevered, nevertheless, was attacked with vomiting in the grave, returned without completing the task, with all the symptoms of the disease, and died the same evening in a state of complete collapse. Webster had no communication whatever with any person who had been at Tranent or Haddington. The locality in which he lived soon afterwards furnished seven fatal cases.
The same day, Thursday, 19th, Thomas Hilson, a young man of 17, a potter, residing in Ponton's Close, on the south side of the High Street, Musselburgh, was attacked about twelve with profuse diarrhoea, followed by vomiting, cramps, and the usual symptoms proceeding to collapse, in which state he died the following day. This was the third death; and by this time several other persons were taken ill. Thus Anne Weir, aet. 37, married, living on the south side of the High Street of Musselburgh, in Ponton's Land, was attacked on Wednesday night with pain in the bowels, and vomiting followed by diarrhoea, and was proceeding to collapse, when she was seen by Mr Moir. She was better on Saturday the 21st, and made a slow but pretty good recovery. In the same locality with Hilson, Mrs Jardine, aged 45, was attacked on Thursday, and died on Friday ; and a day or two after, Ann Moody was attacked and died. In Cairncross's Bounds, where the first case occurred, several more immediately followed. On Thursday afternoon, 19th, at five, Mrs Black was sufficiently well to look at the funeral of Mrs Wilkie; yet was attacked that night, and was lifeless before twenty-four hours had elapsed. A woman named Shivers, and another named Chestnut, were then attacked but recovered; and Chestnut's husband had symptoms.
In the meantime the disease was daily and hourly spreading. On the 21st, when about twenty persons had already been cut off by it, fresh attacks were taking place every hour. Several of them indeed were mere diarrhoea or diarrhoeas with slight vomiting, and perhaps would have proceeded to cholera only if neglected. But the number of persons complaining of more or less looseness of the bowels on this day was considerable. These persons were living in different parts of the town, some in Newbigging, some in Musselburgh, and one or two in Fisherrow; for in the latter place the disease had not yet appeared generally. About five or six persons, generally females, employed at the hair-cloth manufactory, had been attacked between Thursday and Saturday, chiefly with diarrhoea.
On Sunday, the 22d, the genuine choleric form of the disease appeared at Newbigging in the person of a man of 26, named Nisbett, who died next morning at three; the same day in Anne Renton, a woman of 50, who was immediately bled to the amount of eighteen ounces and recovered; and a few other cases of diarrhoea took place in the same neighbourhood. The woman attacked last had visited the man Nisbett; but she was taken ill immediately, so that the disease must have been in her person previous to the visit.
After this date the disease broke out in different parts of the town and its suburbs, all without communication with persons previously attacked; so that it was impossible to trace the course of the epidemic. It was manifestly, however, more partial to certain localities than to others. Thus it appeared on the 26th and 28th in Robertson's Close in Fisherrow, where it had already cut off Webster, and attacked and destroyed seven persons almost successively;—Mrs Beveridge, aged 45, two sons of 15 and 18, and a child of 2 1/2; Mrs Scott, aged 45; George Jack, aged 45, and his son, a boy of 14. It was also very prevalent in the houses situate in the closes and narrow alleys communicating with the main street, and what is termed the back of Fisherrow. These alleys were remarkable for the accumulation of animal matter in a state of decomposition; all the houses have earthen floors, which are constantly wet, with every species of humidity. They were also imperfectly ventilated, and in several of them, in which there was either no window except a hole in the roof for the issue of the smoke, or the window had been shut up, the air was corrupted in the extreme. In these hovels the disease was frequent, rapid, and very fatal; and I am certain that I do not exaggerate when I say, that at least 150 of the fatal cases occurred in the situation now mentioned. This, indeed, is by far the most densely peopled part of Musselburgh; and when the disease appeared it seemed to find its most ready victims in this neighbourhood.
In this part of Fisherrow, if it were wished to demonstrate communication it could easily be done; for the inhabitants were in constant mutual intercourse. This, however, would not serve to explain the progress of the disorder among them; for on the one hand, the attacks were often simultaneous in one locality, or after intervals so short that it was impossible to imagine the disease to be communicated by any principle capable of such rapid maturation; and, on the other, in remote localities, where it was known that no intercourse had taken place with localities infected, the disease broke out spontaneously.
It is further remarkable, that while there were at Newbigging, which is a more elevated district, remote from the sea and the Esk, about 80 or 85 cases of diarrhoea, not above 28 of well-marked cholera and only 13 fatal cases, there were in the Fisherrow district about 180 cases of well-marked cholera. This fact may serve to illustrate the influence of low flat districts and the vicinity of masses of water, since Fisherrow may be regarded as standing on a dead level between the Esk on the east, and the sea on the north and west.
One professional gentleman who, however, had been liable to diarrhoea, and was of a sickly delicate constitution, was attacked, and cut off by the disease. Another gentleman had diarrhoea, which, however, subsided, under the use of the blue pill. None of the attendants who rubbed or nursed were taken ill except a woman, who was attacked with symptoms of continued fever.
Two persons employed in digging graves fell victims to the disease; but, to show the weight of this evidence, it must be stated, that one man was attacked while shaving, inconsequence of the dead cart passing the window with two coffins in it.
The disease appeared in one instance in a private asylum for insane persons, but did not spread beyond the individual first attacked.
The disease began to attack smaller numbers about the 20th of February; and, after the cases had been comparatively fewer in number and milder in intensity, the last bad case of very decided collapse occurred on the 24th February, in the person of a man named William Jones, aet. 24, who was in perfect collapse on the 28th, and died that night.
The whole course of the epidemic was therefore completed in the space of about thirty-nine days; and during this time about 400 persons had been attacked with various symptoms of gastro-enteric irritation, and about 208 had been cut off in the state, in general, of collapse. This is a degree of rapidity of progress that accords very imperfectly with the characters of a contagious disorder; and the circumstance ought to be regarded by those who know the characters of the introduction, diffusion, and propagation of contagious distempers, as, along with others, decisive against the idea, that it was connected with any contagious principle.
It is further very remarkable, that during the whole of this period, though the intercourse between Musselburgh and Fisherrow and Edinburgh was by no means suspended, no case occurred in the latter city which could be traced to unequivocal communication with the former places.
The first distinct case which took place in Edinburgh appears to have been in the night between the 26th and 27th January, in the person of a man named Anderson, residing in the West Bow. This man had been at Musselburgh in a house where a fatal case had taken place. The same night the disease appeared in a girl who lived in a close off the West Bow, and who is said, on recovery, to have acknowledged, that she slept in the bed of a patient who had laboured under the disease at Prestonpans. On the 28th, a case which occurred about three miles from town in a young woman who had attended her mother in Musselburgh, was brought to Queensberry House, and terminated fatally. No case after this occurred till the 9th February, when two cases occurred in Ward 19, Canongate. A few days afterwards it appeared in a woman of 60, whose grandson was said to have spent some days in Musselburgh or Fisherrow. The boy had no symptom himself; but, some days after he returned to Edinburgh, the grandmother was attacked, and died. But suppose that it be admitted that these were examples of the importation of the disease from infected districts, this hypothesis will not account for the subsequent cases, none of which could be traced beyond the persons originally attacked. Thus in the Hardwell Close, a very filthy moist, and densely peopled locality in the Pleasance, cases took place early in February, without any possibility of tracing them to communication with Musselburgh; and here they continued to recur during the subsequent course of the epidemic. John Ewing, aged 50, a gardener, residing in 108, George Street, but little employed, and earning only a scanty subsistence in a garden near the Union Dairy, and who had never been out of town farther than that, was attacked on the 24th February, and died that night. A man was attacked at this time, about the 28th February, with the disease from no other ostensible cause than working to overheating at some out-door work in the neighbourhood of the damp meadow below Salisbury Craigs; and to some similar cause, as I shall show, most of the subsequent cases could be traced. David Scott, aged 35, a milk-carrier, of intemperate habits, had diarrhoea all Tuesday, 13th March, and after drinking a large quantity of cold water while overheated and perspiring at 5 pm. was almost immediately after attacked by vomiting and cramps, with profuse purging. He was admitted into hospital at 6, and died next morning at 4 am. It must not be denied that the disease proceeded very slowly and gradually; and while, in the early part of February, there were days on which no case occurred, about the middle and latter part of the month the cases were two daily, - on two days, the 17th and 22d, three, - and on the 15th, 19th, 25th, and 26th and 29th, only one, - and on the 28th none.
From this time to the 7th March no new case appears to have taken place, - at least none was reported; and though on the 7th one case appeared, it was only on the 11th that five took place, which were all in the Water of Leith, and in which the disease had appeared without the possibility of tracing its origin, and continued to spread until about forty-nine persons had been attacked, and twenty-seven had been destroyed, by the 24th of March. The rate of attacks in this village were afterwards on the 12th, four; 13th, three; 14th, thirteen; 15th, three; 16th, seven; 17th, three; 18th, two; 20th, two; 22d, two; and after this period, for a few days, it was abated; and the 23d, 24th, and 25th, afforded no case; the 26th one; the 27th three; and the 28th, two. After this it augmented at the rate of three daily; and eventually the disease continued till the 29th April, when it became extinct as an epidemic in this village. At the same time the disease was prevailing in other localities along the course of that stream, - for instance, at Canonmills and Bonnington, - but affecting smaller numbers, by reason of the thinner population. In the Water of Leith, however, the disease again appeared on the 4th of July, and continued to prevail, though in a very limited form, till the 15th. After which this village remained healthy till the end of August, when cases began to prevail, and continued to occur at intervals, both there and at Canonmills, till the middle of November.
It is impossible, in the space to which I must restrict these observations, to advert minutely to the progress and diffusion of the disease; and I must confine myself to the notice of such prominent facts, as may convey some idea of the mode in which the disease proceeded.
The disease presented in Edinburgh three epidemic periods of prevalence,—one which I date from February to the 14th of June, the second from the 16th of June to the 29th July, and the third from the 1st of August to the 1st of December.
At the commencement of the first period the disease advanced very slowly in the months of March and April in the city of Edinburgh, at the rate of from five to ten or fifteen new cases daily; one day affording four or five new cases, and the subsequent one seven, eight, or ten. On the 22d they rose to twelve, and increased by one each of the two subsequent days,—fell again to twelve on the 25th, rose to fifteen on the 26th, fell to ten on the 27th, to seven on the 28th, and all at once, rose to twenty-six on the 29th. This was the greatest number during the first period of the epidemic. A considerable number of these cases occurred in various closes in the West Bow, Grant's Close, and Grassmarket, Cowie's Close, Burt's Close, Plainstone Close, Foulis' Close. Others, however, occurred in very different localities, for instance in Richmond Place and South Richmond Street.
On the following day, they fell to twelve; on the 1st May, there were only five, and on the 2d, they rose to seventeen; after this they did not rise above seven, till the 9th, when they were fourteen; and after the 14th, they seldom rose above two cases daily. On the 26th of May, and on the 8th, 12th, 1 4th and 15th of June, there were no cases; and at this time the disease appeared to undergo a temporary abatement.
It was nevertheless remarkable that at Portobello, after it had been gone for some time, and the hospital there even had been shut, it appeared suddenly and unexpectedly about the 10th, when an old woman, in easy circumstances, and living in a well-aired comfortable house, became the first victim in the course of about 20 hours. In this case it was impossible to trace any communication of a satisfactory description; and the disease appeared to arise spontaneously, or in consequence of the prevalence of cold damp east wind. The same day a young man named Marshall, mentioned in my last communication, was attacked with a severe form of the disease, proceeding rapidly to collapse, from no other apparent cause than working on the beach without his jacket, and heating himself in the face of a cold sea breeze. It must not be omitted also, that the hovel in which he lived was built on the ground with a damp earthen floor; and, above all, that the sleeping apartments of the family were in direct communication with the filth of a cowhouse. It is nevertheless remarkable, that, though in both these cases the other members of the family continued in close and assiduous attendance, none of them ever had a symptom of the disease.
Many similar instances of attack and exemption occurred very much in the same way. Thus, Richard Mason, a man living in Drummond Street, was, after having overheated himself in dragging a small car to Portobello and back to Edinburgh, attacked on the evening of Monday 2d July at 10, and died next morning at nine. Thomas Pearson, aged 58, a labouring man, living in a foul and badly aired court in the Pleasance, had walked first to Cramond, thence to Leith, thence by the sea shore to Portobello, on Monday the 2d July, and sat down to rest himself on the way, and drank some cold water. He proceeded to Portobello, and thence to Edinburgh, where he was attacked that night with profuse vomiting and purging, rapidly followed by cramps, and then by the usual symptoms of collapse, and continued in this state till Wednesday night, when he expired. In this instance no communication whatever with any infected person could be traced.
Numberless similar examples occurred; and, in short, the instances in which the disease arose in this manner were so preponderating, that it was quite impossible to trace them to personal communication.
It undoubtedly happened that occasionally more than one member of a family were attacked. Thus a man named Murray, living in Wood's Court, West Nicolson Street, was attacked on Friday the 29th, and died on Saturday; and his wife was seized between the night of Tuesday 3d and Wednesday 4th July, and died the following day. In this case, however, both parties, it may be observed, were exposed to the same general causes of food, and mode of living; Mrs M. had been five days under diarrhoea; and none of the individuals who attended and nursed Mrs Murray to the last were affected by the disease.
After the temporary abatement at the middle of June, the disease began to spread more extensively again at the close of that month, and during July ; and on the 26th and 30th of the former month nine cases, and on the 27th, thirteen occurred; on the 1st July, fourteen, on the 3d, sixteen, on the 4th, twenty, on the 6th, nineteen, on the 7th and 9th, eighteen, and on the 11th, fifteen; and after this date the cases began again to diminish to seven, four, six, and one daily, with the exception of the 18th and 23d, on each of which days thirteen cases occurred. On the 27th and 31st, there was only one, and on the 29th, no new case took place.
This subsidence, however, was of short duration ; for though the disease did not, during the course of this month, break out very extensively or violently, there never was a day without from four to five new cases. The disease further observed the same fluctuations as in former months, that is, for one or two or even three days, there were only four, five, or six cases, but on the fourth day they might rise all at once to sixteen, or eighteen, or twenty. Thus, on the 16th, they rose to fourteen, having been only six the previous day; and though they were five and four on the 17th and 18th, respectively, there were twelve on the 19th, and nineteen on the 20th. This was the greatest number on any single day in the month of August.
The weather, I may add, was, during the greater part of this month, dry and steady, though chill at night. The barometer varied from 29° to 29 3/4° and the greatest diurnal heat never exceeded 70°.
During September the daily numbers varied from four, which was the lowest, to twelve (5th), thirteen (16th and 25th), fourteen (1st and 18th), fifteen (15th), sixteen on the 28th, and 19th, which was the highest.
In the beginning of October, they assumed a very sudden increase, and after being twenty-two on the 1st, and twenty-three on the 2d, they rose all at once on the 3d to forty-four, and on 4th to forty-five, which was the greatest daily number observed during the whole course of the epidemic.
These cases came from all parts of the town; but the greatest number certainly came from such localities as, Castle Bank, Roxburgh's Close, Middle Meal-market Stairs, James's Street, Aird's Close, Fairley's Entry, Burt's Close, and especially Jamaica Street and the vicinity.
On the 5th, the numbers again fell to twenty-three, but rose on the 6th to thirty, were twenty-seven on the 7th, and fell to eighteen on the 8th, on the 9th to thirteen, but rose on the 10th to twenty-six, and were on the subsequent days successively nineteen, eighteen, thirteen, fifteen, and twenty-two, which was the number of the 15th; and after this they did not again rise above fourteen, which was the number of the 23d, but kept varying from four or five to ten or twelve.
In the month of November the disease began to undergo a manifest abatement in the extent of its prevalence; but the attacks continued as virulent and rapid as ever. The greatest daily number of cases in the course of this month was seven, which was the number of the 3d; and in general they varied from two to three daily, till the 10th, in which no new case was reported. Two cases, however, occurred on the 11th, two on the 12th and 14th, and one on the 13th; and the 15th, 16th, 17th, 18th, and 19th were again days of immunity. Two occurred on the 20th, 22d, and 24th; and the 21st and 23d were days of immunity. The 24th produced two cases, and the 25th, 26th, 29th, and 30th, each three. The first three days of December were days of total exemption ; the 4th, 5th, 6th, 8th, and 9th, had one each; the 7th and 11th, each two, and the other days none. After this the disease ceased to exist in its epidemic form.
The total number of persons attacked was 1886.
The total number of deaths 1065.
The total recoveries 821.
Though, from the localities in which the disease prevailed, and the dates at which it was most prevalent, taken alone, not much precise information illustrative of its etiology can be obtained, I think these circumstances, combined with those of families and individuals attacked, afford elements of great importance.
It was, in the first place, remarkable, that, in a large proportion of cases, only one individual of a family was attacked; and not only the returns afford numerous examples of this, but the cases in the Castle-Hill Hospital might often be adduced to confirm this inference. Of 318 cases admitted, I find 291 examples of single attacks in the same family. The wife was occasionally attacked while the husband escaped; and conversely, the husband, if a drunken, irregular, or enfeebled and unhealthy person, was attacked and destroyed, and the wife escaped, and without one of the children being attacked; and, on the other hand, while a son or a daughter was attacked and cut off, not one of the family showed the smallest symptom of the disease. This shall be illustrated more fully afterwards.
In the second place, when two or more persons of the same family were attacked, it was in general simultaneously, or within so short an interval that it was physiologically impossible that the one should have communicated the disease to the other. The following examples will illustrate the nature of this inference.
Christian Fairbairn, a woman of 55, residing at Canonmills, was attacked on the 27th March at four in the morning, and died the same day at half-past three in the afternoon in the Castle-Hill Hospital. Her brother, who lived in the same house, locked his door that evening, and forthwith drank sixteen ounces of whisky. When the door was broken open on the morning of the 28th, this man was found in a state of complete collapse. He was admitted into the hospital at noon, and died at a quarter past one.
Charles Dickie, a boy of 5, was attacked at three p. H. of the 28th April, and died at four pm. on the 29th. His mother, Catherine Dickie, aged 40, was attacked at four of the morning of the 29th, but recovered. A girl of 14, named Mary Dickie, was attacked at the same lodgings at three pm. of the 28th; and a boy named Nathaniel Dickie, sent from the Police Office, had been attacked at two pm. with choleric purging.
Isabella Johnson, 30, Brown's Court, Water of Leith, drank some sour beer on the night of March 12th, and was immediately after attacked by the disease, and died. Her daughter was attacked on the 14th.
George Cruickshanks and his wife, residing in Gosford's Close, were both attacked on the morning of the 5th July, the latter first apparently from their own testimony, but not above two hours before the husband. A man named Macculloch, living in Brown's Close, High Street, went to bed apparently, on the night of Tuesday, 17th July, with little complaint, but was found stiff and dead in the morning by his family. The body was inspected, and presented the usual appearances of choleric subjects. One of the sons was attacked the same morning with diarrhoea, which became so profuse in the course of the day that next morning, 19th, when he was vomiting, he came immediately to the hospital, and recovered. Eliza Martin, aged 25, Post-Office Close, was attacked with cholera on the night of the 27th September; and her mother the day after presented all the usual symptoms. Margaret Sutherland, aged 11, residing in Libberton's Wynd, was attacked on the 9th October; and in the course of the same day her mother was attacked. The former recovered; the latter died.
Now it is a common character of the whole of these cases, that though they took place in individuals belonging to the same family, living under the same roof, and in constant mutual communication, yet in each the interval between the attack of the first and that of the second was too short to warrant the conclusion, that the morbific principle of the latter was derived from the former. It is impossible, according to the rules of philosophical reasoning, and the known laws of physiology, to imagine that the human body is capable of communicating a morbific poisonous principle before it has manifest symptoms of disorder. It is difficult to conceive that the human body, even at the very commencement of a train of morbid action, can have elaborated any new principle capable of reproducing the same action; and it is most natural to think that the morbid process must be fully established, before it can give birth to the material agent, which, according to the hypothesis of contagious principles, is supposed to communicate the disease. In the short space of two hours, six, eight, or even twelve hours, it is impossible to believe that a poison can be generated in the human body, emitted from it, and communicated to the frame of a healthy person, so as to produce all the morbid phenomena, which had only commenced a few hours before in the system of the individual who is supposed to have communicated the poisonous principle. All this, however, we must admit, according to the hypothesis of contagious propagation in these cases now referred to, and many similar ones. We must believe, for example, that the man Fairbairn, who was taken ill about seven or eight hours after his sister, and had been removed from their house, had already in the short space of one or two hours been infected by her. We must believe that Mrs Cruickshanks had, after two hours illness, infected her husband; and that the man Macculloch had infected his son before five in the morning of Wednesday the 17th, since the young man had gone out at six, and did not return till he found himself unwell.
These facts and arguments, which require no further commentary, I submit to the consideration of those who are acquainted with the laws by which the propagation of contagious diseases is regulated. If it be not an inevitable conclusion, I think it is by far the most probable one, that these cases depended on the operation of the same general cause, whatever that may be.
On the other hand, when more than one of a family were attacked, it sometimes happened, that a space of four, five, or six weeks intervened, so as to render it impossible to refer the second attack to infection from the first. Thus James Barr, a sickly boy of 10, living at Castle Bank, was attacked on the 7th July, and died on the 11th. Every other member of this family remained free from the disease till the 29th September,—a space of nearly twelve weeks, when a younger brother, aged 7, was, after eating some raw fruit and vegetables, attacked with the usual symptoms, but recovered.
Thirdly, in other instances, where several members of the same family were attacked, either simultaneously or successively, the occurrence of the disease could be traced to indigence, penury, and more or less destitution. This was remarkably illustrated in the case of a family named Denham, residing in Stockbridge. Adam Denham, a boy of 11, was attacked on the 27th October, and died the next day; William, a younger brother of 8, was attacked on the 28th, and after showing symptoms of amendment, expired at length on the 3d November; and Mary Denham, their sister, a girl of 13, was attacked on the 29th, and with great difficulty recovered. It was afterwards ascertained that this family, whose appearance was much above that of the usual rank of our hospital cases, had been for weeks in great penury and distress, which produced an effect so much more striking on their health, in consequence of their anxiety to conceal it; and it was only when the first boy was in the agonies of death that they consented to come to the quarantine establishment. As the three cases followed each other with such rapidity, it seems more natural to believe that they all proceeded from the same general cause, than that the one derived the disease from the other.
These facts I think of more moment in estimating the influence of contagion, than those which are derived from the disease extending to attendants and others. The latter, of which we had numerous and forcible examples, are easily explained away by the doctrine of susceptibility or insusceptibility. The former show that what is named efficient propagation, or the formation of a disease in the frame of a person previously healthy, who has been exposed to another after a given time, cannot have place, unless there is both time for exposure and time for maturation of the alleged poisonous principle.
It is nevertheless not unnecessary to remark, that in no instance did the disease appear to be communicated to any of the attendants in the Castle-Hill Hospital; and in no instance was any one of them affected by the disease. One woman, who had been a nurse in the cholera hospital in Leith, and who was residing at Brown's Court, Leith Walk, was attacked on the 9th April, and immediately brought to the hospital, where she died on the 11th. One of our nurses, who was dismissed for drunkenness, went to the Drummond Street Hospital, where she was soon attacked, and cut off by the disease. One woman also, who was enfeebled, and had for years a bad leg, and was acting as nurse in the latter institution, was cut off by a rapid attack of cholera. But in all these cases, it may justly be presumed that these persons would have been attacked, whether they had been exposed to the disease or not. Wherever drunkenness, late hours, disease or infirmity, or much fatigue were in operation, they invariably rendered the subjects of them liable to cholera.
I will not, however, deny, that some cases took place which certainly had the appearance of communication from the sick to the sound; and, as I have no wish to suppress such examples, I shall give a few of them.
A man named Nimmo, who was in destitute circumstances, resident in Gibb's Entry, was attacked on the 13th June, and died the same day. On the 18th, his daughter and another woman, who was not resident there, but only a visitor, were attacked.
Miss H. aged 45, resident in George Street, was attacked at 5 am., 7th July, and died at half-past eleven the same night. Her father had diarrhoea on the 8th, yet on the 10th was able to walk in the Queen's Street Gardens, from which, however, he came home with loss of voice, and died the same evening. The woman who came two days after to wash the clothes in the house was immediately attacked.
A lady, rather past the middle period of life, residing for the time in George Square, and liable to habitual diarrhoea, was, after one of her usual attacks, on Friday 17th September, seized in the morning of the 18th with all the usual symptoms of violent cholera, which proceeded to collapse, and terminated fatally on the morning of the 19th. No other person of the same family was attacked; but the woman who acted as nurse, and who had carried off the shift of the deceased with the pious intention of communicating the disease to her husband, was herself attacked by the disease on the 22d, and died in Drummond Street Hospital. I do not believe, however, that this woman was longer or more freely exposed to the emanation from the patient than I was myself or the servant of the house; and I have every reason to believe that the mere fatigue, the night watching, and the consequent stimulation by spirits, to which she absurdly conceived herself entitled, were sufficient to induce the disease at such a period.
Mr Taylor also informed me, that Mrs Lockhart, aged 42, was attacked on the 9th of August, and died on the morning of the 10th, Friday. Mrs Forrest, aged 28, a stout healthy woman, and her mother, Mrs Smith, attended her for two nights. On the 10th, Mrs Smith had symptoms, but recovered. On the 11th, Mrs Forrest had a bowel complaint, which went on the whole day, Saturday; she applied for Mr Taylor's assistance, at three on Sunday the 12th, and she died that night. Mr Lockhart had the disease on Sunday, the 12th. These cases, however, may be equally referred to the influence of the locality in which Mrs Smith and Mrs Forrest had spent two nights.
Mrs Borthwick, aged 35, on the 7th August, washed the clothes of a child who had died of cholera on the 4th. She was immediately after leaving washing attacked about eight that evening by the usual symptoms, and died on the morning of the 9th. This woman was very apprehensive, but did not know that the clothes she was washing were those of a choleric case. Her husband was attacked on the 15th, and died on the 17th.
To these cases, as examples of transmission of the distemper from one individual to another, I do not myself attach much importance; because I can easily see that if such a distemper can attack one individual spontaneously, or from the operation of atmospherical causes, or in consequence of gross errors of diet, nothing can prevent it from attacking others in the same manner. In short, when the disease was observed during the whole course of the epidemic, to be springing up every other day in situations the most different, and among persons who had no possible intercourse with the sick, I cannot perceive by what means it can be regarded as contagious in its origin, or that the assumption of contagion would account for its propagation. On the night of the 2d November, two cases took place in the same ward in the Royal Infirmary, in persons who had not been by any means exposed to the disease; and next day a third followed. The same night, the disease attacked a man in the Calton Jail. It was afterwards ascertained that the patients thus attacked, who were women in bad general health, had been eating raw fruit the previous night.
Had the disease been in any degree or mode contagious, it is difficult to understand by what means the medical and other attendants escaped. Mr Rae, the house-surgeon, and Mr Ferris, the apothecary, were up alternate nights during all those periods of the epidemic in which cases were numerous or severe; and the day-duty of these gentlemen was so oppressive, that more than once I found them asleep, from downright fatigue, during the day. I in general spent from seven to eight hours daily at the hospital. Beside the regular hours of visit, at tea and three, I was often there at seven in the morning, and very often between nine and eleven at night, so that if free exposure be requisite to communicate the disorder, that was not wanting. I do not think I could have done the same with impunity in a Fever Hospital.
In the exposure of professional persons, however, especially if persuaded of the non-contagious character of the disease, there is nothing wonderful. Our managers manifested in the same way a most perfect disregard to the alleged contagious character of the disease. Not only did the Lord President visit the hospital frequently, and examine patients; but our ordinary managers, Mr George Forbes and Mr Cowan, made daily visits, at which they spent a considerable time, in seeing the most hopeless cases, and often in direct communication with them. The former gentleman, indeed, during the worst period of the epidemic, visited the wards twice daily, and, by his assiduous attentions, contributed very much to the efficiency of the hospital establishment.
In short, I think, that, from the foregoing facts and arguments, it may be justly concluded, that the disease may attack any person who has been exposed to cold or humidity, either while overheated, or while enfeebled by intoxication, by disorder of the alimentary canal, or by any cause which impairs the energy of the circulation of the cutaneous and mucous system. I think it also clearly results from the facts observed during this epidemic, that though more general, more sudden, and more virulent, in certain low and humid or filthy localities, it often depends chiefly on atmospherical causes, since like influenza it attacks at once large bodies of human beings, who are situate at very distant and remote parts of a community, and parts also widely differing in physical and local peculiarities.
If it be asked how we are to explain the comprehensive and epidemic prevalence of the disease, I willingly acknowledge my inability, otherwise than by referring it to atmospherical causes. From this, however, it does not result that we are to assume the presence of a contagious principle. The first step in the investigation of causes is to divest the subject of every assumption and every principle not susceptible of strict demonstration, and, by excluding every inference of partial application, to confine the inquiry within the narrowest possible limits.
I have further to observe, that, connected with the habitudes and modes of living of the individuals, there are other circumstances which operate very powerfully as predisposing and exciting causes. The influence of some of these may be understood from the account of the morbid appearances found in the bodies of those cut off by the disease, the general tendency of which is to show that morbid states of certain organs, and correspondent dynamic disorder, constitute powerful predispositions to choleric attacks. With the view of rendering the influence of age, sex, and habits more distinct and obvious, I have now to subjoin the following statements.
The proportion of females attacked by cholera was much larger than of males. It is unfortunate that the sexes and ages are not always specified in the general reports, so that we are precluded from giving exact results from the whole epidemic. I shall, however, give the results obtained by the admissions into the Castle-Hill Hospital; and I think they were kept with such care that just reliance may be placed on them.
The total number of females attacked was 199. Of these forty-one either were, or stated themselves to be, married; thirty-eight were in the avowed character of public women ; eight were in the condition of those who had been public women; two were of loose characters, though not avowedly public ;five were in circumstances of extreme indigence; and all the residue were either unmarried, widows, or persons of whom no satisfactory statement was given. Of the whole 199, forty-one were habitually intemperate and drunkards; and this class generally included the whole of the public females, who, indeed, were in general the most miserable and depraved-looking wretches that could be seen. Of these, ten at least were sent from the Police Office, or picked up in the streets. From the latter class, combined with that of widows and indigent women in general, the mortality chiefly resulted.
Of married women attacked after their husbands, besides the instance of Mrs Murray already mentioned, I can find only three unequivocal examples, which occurred in Mrs Macpherson, Mrs Weir, and Mrs Furlough.
The entire number of men attacked was 118. Of these twenty-one were habitually intemperate and irregular; eight addicted to the excessive use of ardent spirits ; and three had been drunk for several days previous to the attack. Of other persons, of whose previous habits no information could be obtained, six were sent from the Police Office, and two were picked up in the street. There is no reason to believe that those circumstances indicate the sobriety of these persons.
It was not an object of particular inquiry to ascertain whether the male patients were married or had relatives. But we have at least twenty-three instances of married men whose wives or children were not affected by the disease. The wives of Thomas Phillip, Robert Spiers, Andrew Butler, Matthew Girvan, John Gillies, Kenneth Forbes, and Alexander Blackburn; the daughters of Alexander Haigg, and Fergus Gunn, the sister of William Scott, the elder sister of the three Denhams, and the brother of Alexander Gordon, of which cases all except three were fatal, attended their respective relatives assiduously throughout the course of the disease, yet never presented a single symptom.
With the view of demonstrating the connection between age and the liability to the attacks of epidemic cholera, I may subjoin the following results.
Of 199 females the numbers attacked and destroyed, according to the ages, were:-
Of 119 males attacked and destroyed by the disease, the ages were the following:-
From these tables it would result that the greatest numbers attacked were among the women between the ages of 20 and 40; that the chance of attack is as great between 20 and 30 as between 30 and 40; that the liability between 50 and 60 is nearly equal to that between 10 and 20; and that the liability is diminished below 10 and above 60.
Among males, in like manner, the greatest numbers are attacked between 40 and 60; and the numerical liability is nearly equal between 35 and 40, 40 and 50, and 50 and 60.
The mortality among the females was greatest between 30 and 40, less between 40 and 50, and nearly the same between 10 and 20 as between 50 and 60.
The mortality among males was most remarkable between 30 and 40 and 40 and 50; next between 50 and 60, then between 10 and 20.
IV. A single word may dispose of the subject of infection from the dead body. The number of bodies examined at the Castle-Hill Hospital was 54, of which 26 were inspected during the period when I had charge. In no case was any one either of those present or those occupied affected by the smallest symptom of the disease. We often commenced the dissections early in the morning, when it is commonly believed the body is peculiarly susceptible of infection; and the dissections occupied in general several hours daily. If complete exposure, therefore, were required, this could not fail to constitute it. Results equally conclusive were obtained at the other hospitals at which subjects were dissected with the same immunity. In short, this fancy of the dead subject infecting, which is physiologically impossible, and in some degree absurd, may be said to be proved experimentally to be quite unfounded. It is, nevertheless important to remark, that the proof or the refutation of the infection of the dead subject has nothing to do with the question of the infection of the living body; and attacks, even it' occurring in this mode, prove nothing as to the contagious quality of the disease.
[Edinburgh Medical & Surgical Journal, Vol 39, 1833]