441 



PESTILENCE. 



PESTILEXCE. 



443 



principally negroes, who seemed peculiarly subject to the disease. At 

 this date, more than 2000 out of 4300 slaves belonging to government 

 were cut off by it, and of those belonging to the planters nearly as 

 many. 



The disease as it appeared in Europe in the two last outbreaks pre- 

 sented no new features. There was the same great mortality at the onset. 

 It travelled from city to city in the same manner and gradxially dis- 

 appeared. It broke out in England in 1848, and was present in London 

 in 1849. It subsided and again appeared in 1853, and in London in 

 1854. Since that time it has gradually subsided, and no great epidemic 

 has occurred in Europe since. 



The number of persons attacked in a community by cholera has 

 varied very considerably. In no instance has a whole population been 

 attacked during an outbreak. In the marching corps of our army the 

 number attacked has been from 17 to 330 for 1000 men. Moreau de 

 Jonnes has given the following estimate for the numbers attacked in 

 the countries of Europe. 



France . . 1 in 300 Belgium . . . ] in 120 



Russia . . . 1 in 20 Great Britain and 



Austria . . 1 in 30 Ireland . . 1 in 131 



Poknd . . . 1 in 32 Holland . .. 1 in 144 



Prussia . . 1 in 100 Germany . . 1 in 700 



Cause* cf Cholera. That the whole series of phenomena results 

 from the action of a morbific poison on the body, there can be no 

 doubt ; that this morbific matter is indigenous to some countries, 

 and apparently has its origin in certain peculiar conditions of the soil, 

 is supposed to be true from the effects which we find to be produced 

 upon animal bodies living in these districts. But why the miasm 

 arising from the overflow of the Nile should produce plague; that of 

 the Ganges, cholera ; that of the parts situated in the tropics, yellow 

 fever; or our own marshes, simple intermittentwe are entirely 

 ignorant ; nor can we, in the present state of our knowledge, at all 

 account for the epidemic spread of some of these endemic diseases. 



Notwithstanding the extensive knowledge acquired from the recent 

 outbreaks of the disease in Europe, no consistent theory of its cause has 

 been proposed. Whilst its history would seem to point out the produc- 

 tion of a poison in the interior of Asia, which was gradually conveyed to 

 other parts of the world, there is not wanting evidence to show that 

 similar epidemics have occurred without any trace of such origin. 

 It seems not impossible that, under certain meteorological or other 

 external circumstances, the ordinary diarrhoea or cholera of a 

 district may acquire a contagious character ; that is, the body may 

 generate a poisonous matter, which, being carried into an otherwise 

 healthy system, may engender the disease. Such a contagious cha- 

 racter is occasionally assumed by diseases which do not ordinarily 

 present this character, as erysipelas and dysentery. The following 

 summary of the various theories which have been entertained to 

 account for the spread of cholera is given by Dr. Aitken, in his ' Science 

 and Practice of Medicine ' : 



f. 1. "That the disease spreads by an atmospheric influence, or epi- 

 demic constitution by a succession of local outbreaks, and that the 

 particular localities affected are determined by certain ' localising con- 

 ditions," which are, first, all those well-known circumstances which 

 render places insalubrious ; and second, a susceptibility to the disease 

 in the inhabitants of such places, produced by the habitual respiration 

 of an impure atmosphere." 



2. " That the cause of cholera is a morbific matter, which undergoes 

 increase only within the human body, and is propagated by means of 

 emanations from the bodies of the sick ; in other words, simply by 

 contagion." 



3. " It is supposed that the poison of cholera is swallowed, and acts 

 directly on the mucous membrane of the intestines, and is at the same 

 time reproduced in the alimentary canal, and passes out much increased 

 with the discharges ; and that these discharges afterwards, in various 

 ways, but chiefly by becoming mixed with the drinking waters in 

 rivers and wells, reach the alimentary canals of other persons, and 

 produce the like disease in them." 



4. "Assuming that the cause of cholera is a morbific matter, or 

 poison, it is supposed that it is reproduced only in the air, and within 

 the bodies of those whom it affects, and that its diffusion is due to the 

 agency of the atmosphere." 



5. " It is supposed that the cholera poison is increased by a species 

 of fermentation, or other mode of reproduction, in impure, damp, and 

 stagnant air ; and it is maintained that it nevertheless is distributed 

 and diffused by means of human intercourse, it being carried in ships 

 and other vehicles, and even in the clothes, especially in the foul 

 clothes of vagrants, and the accumulated baggage of armies." 



6. " It is assumed that the material causes of the disease may be 

 increased and propagated in and by impure air, as well as in and by 

 the human body." 



Those who deny the existence of any specific poison, give the 

 greatest prominence to meteorological conditions and the external cir- 

 cumstances that induce a predisposition to the disease. Those who 

 a-lrnit the existence of a poison, cannot deny the controlling influences 

 exercised by these agencies. 



Although there is no evidence to connect all attacks of cholera with 

 a particular state of the atmosphere, there is much evidence to show 



that cholera occurs, as a rule, with an increased temperature, and that, 

 cceterls paribus, the higher the temperature the more virulent is the 

 disease. During the first outbreak of cholera in Great Britain, the 

 temperature of the preceding year had not only been unusually high, 

 but the atmosphere, both inland and sea, was unusually stagnant, close, 

 and hot. This state of the atmosphere was observed both in the 

 second and third outbreaks. Mr. Glashier observes, that there was a 

 misty condition of the atmosphere, and that the readings of the baro- 

 meter were remarkably high ; while in the two last a total absence of 

 ozone was observed. In other parts of the world similar phenomena 

 have been observed. Such states of the atmosphere are attended with 

 a marked tendency to putrefactive change in organic substances, and 

 the consequent diffusion of their products in the air. 



But whilst these general conditions of the atmosphere have existed 

 during an outbreak of cholera, the occurrence and spread of the disease 

 has been determined by a variety of circumstances, which have acted 

 as predisposing causes in individuals. Amongst the most active of 

 these may be mentioned impure water, lowness of site of dwelling, and 

 the emanations of animal and vegetable refuse. 



The action of impure water is well illustrated in the history of the 

 two epidemics occurring in London in 1849 and 1854. The district of 

 Lambeth, in 1849, was supplied with water by two companies, the 

 Lambeth and Vauxhall water companies, both deriving their water 

 from the Thames at Battersea. In this year, the population which was 

 supplied by those companies suffered equally from cholera. But 

 when the cholera revisited London in 1854, the Lambeth company 

 was obtaining a new supply of water higher up the river, at Thames 

 Ditton, beyond the tidal action of the river. The consequence of this 

 improved supply was very remarkable in its action on the predispo- 

 sition of the inhabitants to take cholera ; for although the Lambeth 

 company supplied houses in the same streets, and over precisely the 

 same character of population, as the Vauxhall company, it was found 

 that the deaths from cholera in the latter population were as 7 to 1 of 

 the former. In all respects the supply of water was the same, but that 

 in the one case the company supplied a water more highly charged 

 with organic impurities than in the other. A still more striking case, 

 illustrative of the influence of impure water in the production of 

 cholera, occurred in the district of Broad Street, Golden Square, St. 

 James's, Westminster, in 1854. In the course of five or six days, from 

 the 30th of August, not less than five hundred persons died of cholera 

 out of a population of not more than four or five thousand. After a 

 rigorous investigation, it was ascertained that the majority of those 

 persons had partaken of water from the pump in Broad Street, which 

 on examination was found to communicate with a cesspool in an 

 adjoining house. (' Report on the Cholera Outbreak in the Parish of 

 St. James, Westminster, in 1854.') Numerous other examples are 

 recorded of the connection of cholera with the drinking of impure 

 water. 



With regard to the locality of houses, Dr. Fair has shown, for 

 London, that nothing has so constant a relation to the fatality of 

 cholera as the elevation of site. He has shown that, just as we ascend 

 from the banks of the river Thames to the higher localities around it, 

 the mortality of cholera diminished. This is undoubtedly connected 

 with the fact that the greatest accumulation of organic refuse occurs 

 on the banks of rivers into which the sewage of a city is poured. 



The effluvia which pass off from decomposing animal and vegetable 

 matter seem to have a great influence in predisposing the system to 

 the reception of the choleraic poison. It is well known that the atmo- 

 sphere of dissecting rooms, and places where animal bodies are decom- 

 posing, produce on those exposed to it a tendency to diarrhoea. This 

 is also the case with the excretions of animals, when they are allowed 

 to undergo putrefactive changes. Hence it has been found that 

 diarrhoea and cholera prevail especially in those houses aud streets 

 which are undrained, and where human refuse is allowed to accumu- 

 late in cesspools. The instances recorded of the breaking out of 

 cholera in the neighbourhood of foul drains, or of recently opened 

 cesspools, are very numerous and conclusive on this point. In many 

 towns in England, where the inhabitants suffered severely from a first 

 attack, they obtained during the subsequent visitations an entire 

 immunity, by the improvement of the drainage and the substitution of 

 water-closets for privies and cesspools. 



Independently of external causes, there are certain facts connected 

 with the individual that act as predisposing causes. Thus, with regard 

 to age and sex, Dr. Fair found that males suffered more than females 

 at the ages under 25 years, but between 25 and 45 the females suffered 

 more than the males. During the prevalence of cholera in Paris in 

 1832, it was found that the mortality was least from 6 years to 20, 

 greater from 30 to 40, and greatest of all above 40 years. Jlabits of 

 life exercise a great influence in predisposing to cholera, and there is no 

 question that, in all countries, the lower classes have suffered more 

 than the upper clisses. This was observed in India, where, in all the 

 large rfties, the natives suffered more than the European population ; 

 where the Brahmin merchant suffered less than the ryot, and the ryot 

 less than the pariah. In the cities of Europe, everywhere the poor and 

 ill-fed suffered most. As a rule, Mohammedan nations have suffered 

 more than European, and the Hindoos more than Mohammedans. As 

 indicating the influence of low diet, it has been stated that the Moham- 

 medans suffered much more ^during their rigid fasts. The excessive 



