TRANSACTIONS OF THE SECTIONS. 157 



opinion stated by tte Editor of the ' British and Foreign Medical Review,' that " at 

 the present day, the question is not whether Cholera is contagious or not, but how 

 often it spreads by the agency of human bodies, and how often without that agency*." 



This he considers to be precisely the same doctrine as he has always held on this 

 subject, because, while contending that the disease " has a contagious property," at 

 least in this climate, he has always explained that he meant that it could be propa- 

 gated by intercourse of the sick with the healthy, without pledging himself to any 

 opinion as to the mode of communication ; and not only without denying the possi- 

 bility, but at the same time urging the evidence, of its having another mode of dif- 

 fusing itself at certain times and places, chiefly in the hot climates, so as to form 

 tainted districts, of very various dimensions ; within which the immediate proximity 

 of the sick seems to have little or no effect either of one kind or another on its pro- 

 pagation. 



He alluded to the now generally admitted contagious property of the disease, 

 chiefly as affording a good illustration of the truth and importance of the statistical 

 principle above stated, that a single positive fact may afford conclusive evidence on 

 such a question, if supported, as it often may be when the first invasion of a com- 

 munity by an epidemic is observed, by a large body of negative evidence. As far 

 back as 1832, when the first cases of the true mahgnant cholera were seen in Edin- 

 burgh, it was asserted by him and by others of the Medical Board, then regulating 

 the means of prevention which were adopted, that the very first fatal case which 

 originated in Edinburgh in a person who had not quitted the city, was sufficient to 

 establish this point, because it was fully ascertained, — that when the inspection 

 of the whole of Edinburgh and Leith, i. e. of not less than 140,000 persons, was 

 complete and minute, this first case occurred in an old woman whose son had had 

 full intercourse with persons sick of the disease at Musselburgh, had been seized 

 with the symptoms in rather a mild form on his return to Edinburgh, and had 

 been nursed by her in a small ill-aired closet, during the whole day next but one 

 preceding that on which she was herself seized. No other case existed in Edin- 

 burgh at the time, and no other originated in the town for at least ten days after. 

 If the disease was capable of propagation in this way, she was thus peculiarly and 

 undeniably exposed to the contagion; but if it had not this property, no reason 

 existed why she should be the first affected rather than any other of the 140,000 

 inhabitants of Edinburgh and Leith, many of whom in all parts of the town and 

 suburbs showed their liability to the disease by becoming affected during ten months 

 following that introduction. 



A considerable number of cases have been put on record since that time, where 

 similar facts have been ascertained in regard to the ^rs^ introduction of Cholera into 

 a large community f ; and the author is anxious that it should be remarked, that in 

 all such cases it is not the mere fact of a succession of cases having occurred in 

 persons having intercourse with patients already affected, but it is the fact of that 

 succession of cases having occurred among such persons only, out of a large com- 

 munity in other respects equally liable to the disease, — and for some length of time, — 

 that is relied on as decisive evidence of the efficacy of intercourse with the sick in 

 exciting the disease. If this principle had been admitted as established, when the 

 evidence was complete in 1832, it seems impossible to doubt that it must have so 

 far guided the legal regulations for the prevention of the disease, and that it would 

 have been effectual in saving many lives, especially if combined with the practice, 

 also adopted in Edinburgh in 1832, and since recommended by the Board of Health 

 in London, and adopted in different parts of the country, of establishing Houses of 

 Refuge in places threatened with Cholera, for the reception, not of the first persons 

 who might take the disease, but of the other inhabitants of the same houses or 

 rooms with those patients, whose services might not be necessary for taking care of 

 them. In these Houses of Refuge, the persons known by experience to be the most 

 likely to form the first series of cases in that town or district, may be lodged, kept 

 in pure air, regularly fed, preserved from cold, and other frequently concurrent 



* British and Foreign Review, January 1854, p. 298. 



t See e.g. the cases noticed by the present author, as to the introduction of the disease 

 in Belfast, Campbelltowii, Banff, Dollar, and Arbroath, British and Foreign Medico-Cliirurgical 

 Review, January 1854, p. 12 et seq., and Appendix, p. 29S. 



