It was well and wisely said, that to know any-thing thoroughly, it must be known in all its details; and, to gain the confidence of the public in the belief of non-contagion in cholera, it is in vain that they are informed that certain alleged facts, brought forward industriously by contagionists, are quite groundless, unless proofs are given showing this to be the case. The public must, in short, have those alleged instances of contagion which have gained currency circumstantially disproved, or they will still listen to a doctrine leading to the disorganization of the community wherever it is acted upon. It is solely upon this ground that these letters have any claim to attention. Dr.James Johnson, of London, has, since my last letter, publicly contradicted, with all the bluntness and energy of honest conviction, the statement by Sir Gilbert Blane, Drs.Macmichael, Hawkins, &c., as to the importation of the cholera into the Mauritius by the Topaze frigate; but evidence is what people want on these occasions, and, relative to the case in question, probably the public will consider what is to be found in my third and fourth letters, quite conclusive. Having again mentioned the Mauritius, I cannot refrain from expressing my great surprise that Mr.Kennedy, who has lately published on cholera, should give, with the view of showing "the dread and confusion existing at the time," a proclamation by General Darling, while he does not furnish a word about the result of the proceedings instituted by that officer, as detailed in my third letter, relative to the non-contagious nature of the disease, a point of all others the most important to the public. As to accounts regarding the confusion caused by the appearance of epidemic cholera, we have had no lack of them in the public papers during many months past, from quarters nearer home.

Regarding a statement made by Dr.Hawkins in his book on cholera, viz. "That Moreau deJonnÉs has taken great pains to prove that the disease was imported into the Russian province of Orenburg," Dr.H. omits to tell us how completely he failed in the endeavour. In the Edinburgh Medical and Surgical Journal for July,1831, there is a review of a memoir by Professor LichtenstÄdt, of St.Petersburg, in which M.Moreau's speculations are put to flight. From the efforts of this pains-taking gentleman (M.Moreau) in the cause of contagion in cholera, as well as yellow-fever, he seems to be considered in this country as a medical man; but this is not the case: he raised himself by merit, not only to military rank, but also to literary distinction, and is a member of the Academy of Sciences, where he displays an imagination the most vivid, but as to the sober tact necessary for the investigation of such questions as those connected with the contagion or non-contagion of cholera and yellow-fever, he is considered below par. He saw the yellow-fever in 1802-3, at Martinique, while aid-de-camp to the Governor, and still adheres to the errors respecting it which he imbibed in his youth, and when he was misled by occurrences taking place within a malaria boundary, where hundreds of instances are always Pt_1
[Pg 37] at hand, furnishing the sort of post hoc propter hoc evidence of contagion with which some people are satisfied, but which is not one bit less absurd, than if a good lady, living in the marshes of Kent, were to insist upon it, that her daughter Eliza took the ague from her daughter Jane, because they lived together. Strange to say, however, M.Casimir Perier, the Prime Minister of France, seems to be guided, according to French journals, by the opinions of this gentleman on cholera, instead of by different medical commissions sent to Warsaw, &c.

The question of contagion in cholera has been now put to the test in every possible way, let us view it for a moment, as compared with what has occurred in regard to typhus at the London Fever Hospital, according to that excellent observer Dr.Tweedie, physician to the establishment. Doubts, as we all know, have been of late years raised as to the contagion of typhus, but I believe nothing that has as yet appeared is so well calculated to remove those doubts as the statements by this gentleman (see "Illustrations of Fever"), where he shows that it has been remarked for a series of years that "the resident medical officers, matrons, porters, laundresses, and domestic servants not connected with the wards, and every female who has ever performed the duties of a nurse, have one and all been the subjects of fever,"—while, in the Small-Pox Hospital, which adjoins it, according to the statements of the physician, "no case of genuine fever has occurred among the medical officers or domestics of that institution for the last eight years." Had typhus been produced in the attendants by malaria of the locality, those persons in the service of the neighbouring Small-Pox Hospital should also have been attacked to a greater or less extent, it is reasonable to suppose, within the period mentioned. Now let this be compared with all that has been stated respecting attendants on cholera patients, and let it be compared with the following excellent fact in illustration, showing how numbers labouring under the disease, and brought from the inauspicious spot where they were attacked to a place occupied by healthy troops, did not, even under the disadvantage of a confined space, communicate the disease to a single individual:—"It has been remarked by many practitioners, that although they had brought cholera patients into crowded wards of hospitals, no case of the disease occurred among the sick previously in hospital, or among the hospital attendants. My own experience enables me fully to confirm this. The Military Hospital at Dharwar, an oblong apartment of about 90 feet by 20, was within the fort, and the lines of the garrison were about a mile distant outside of the walls of the fort. On two different occasions (in 1820 and 1821), when the disease prevailed epidemically among the troops of that station, while I was in medical charge of the garrison, but while no cases had occurred in the fort within which the hospital was situated, the patients were brought at once from their quarters to the hospital, which, on each occasion, was crowded with sick labouring under other disorders. No attempt was made to separate the cholera patients. On one of these occasions, no case of cholera occurred within the hospital; on the other, one of the sick was attacked, but he was a convalescent sepoy, who had not been prevented from leaving the fort during the day. The disease, on Pt_1
[Pg 38] each of those occasions, was confined to a particular subdivision of the lines, and none of those within the fort were attacked." (Bell on Cholera, p.92.)

I have already quoted from Dr.Zoubkoff of Moscow, once a believer in contagion; every word in his pamphlet is precious; let but the following be read, and who will then say that "the seclusion of the sick should be insisted on?"—"The individuals of the hospitals, including soldiers and attendants on the sick, were about thirty-two in number, who, excepting the medical men, had never attended any sick; we all handled, more or less, the bodies of the patients, the corpses, and the clothes of the sick; have had our hands covered with their cold sweat, and steeped in the bath while the patients were in it; have inhaled their breath and the vapours of their baths; have tasted the drinks contained in their vessels, all without taking any kind of precaution, and all without having suffered any ill effects. We received into our hospital sixty-five cholera patients, and I appeal to the testimony of the thirty-six survivors, whether we took any precautions in putting them into the bath or in handling them—whether we were not seated sometimes on the bed of one, sometimes on that of another, talking to them. On returning home directly from the hospital, and without using chloride of lime, or changing my clothes, I sat down to table with my family, and received the caresses of my children, firmly convinced that I did not bring them a fatal poison either in my clothes or in my breath. Nobody shut his door either against me or my colleagues; nobody was afraid to touch the hand of the physician who came direct from an hospital—that hand which had just before wiped the perspiration from the brow of cholera patients. From the time that people had experience of the disease, nobody that I am aware of shunned the sick." Who, after this, can read over with common patience directions for the separation of a cholera patient from his friends, as if "an accursed thing?" or who (il faut trancher lemot) will now follow those directions?

As to the good Sir Gilbert Blane, who has distributed far and wide a circular containing a description the most naÏve on record, of the epidemic cholera, hard must be the heart which could refuse making the allowance which he claims for himself and his memoir; and though he brands those who see, in his account of the marchings and counter-marchings of the disease, nothing on a level with the intellect of the present age, as a parcel of prejudiced imbeciles, we must still feel towards him all the respect due to a parent arrived at a time of life when things are not as they were wont to be, nec mens, necÆtas. I may be among those he accuses of sometimes employing "unintelligible jargon," but shall not retort while I confess my inability to understand such expressions as "some obscure occurrence of unwholesome circumstances" which seem to have, according to him, both "brought" the disease to Jessore in 1817, and produced it there at the same time. Sir Gilbert marks out for the public what he considers as forming one of the principal differences between the English and Indian cholera, viz. that in the latter the discharges "consist of a liquid resembling thin gruel, in the English disease they are feculent and bilious." Now if he has read the Pt_1
[Pg 39] India reports, he must have found abundance of evidence showing that sometimes there were even bilious stools[12] not at all like what he describes; and, again, if he is in the habit of reading the journals, he must have found abundant evidence of malignant cholera with discharges like water-gruel in this country. As to the French Consul at Aleppo having escaped with 200 other individuals confined to his residence, I shall only say, as it is Sir Gilbert Blane who relates the circumstance, that he forgot to mention that the aforesaid persons had retired to a residence outside the city; which, permits me to assure you, Sir Gilbert, just makes all the difference in hundreds of cases:—they happened to retire to "clene air;" and had they carried 50 ague cases or 50 cholera cases with them (it matters not one atom which), the result would have been exactly the same. The mention of Barcelona and the yellow-fever, by Sir Gilbert, was, as Dr.Macmichael would term it, rather unlucky for his cause, though probably lucky for humanity; for it cannot be too generally known that, during the yellow-fever epidemic there in 1821, more than 60,000 people left the city, and spread themselves all over Spain, without a single instance of the disease having been communicated, while, at Barcelonetta, the infamous cordon system prevented the unfortunate inhabitants from going beyond the walls, and the consequences of shutting them up were most horrid.

Little need be said respecting the pure assumptions of Sir Gilbert as to the movements of the malady by land and by water, for those vague and hacknied statements have been again and again refuted; but we may remark that whereas all former accounts respecting the cholera in 1817, in the army of the Marquis of Hastings, state that the disease broke out somewhat suddenly in the camp on the banks of the Sinde, Sir Gilbert, without deigning to give his authority, makes the army set out for "Upper India accompanied by this epidemic." We find that Mr.Kennedy, another advocate for contagion in cholera, differs from SirGilbert as to the disease having accompanied the grand army on the march; for he says the appearance of the malady was announced in camp in the early part of November, when "the first cases excited little alarm." In referring, in a former letter, to the sickness in the above army, I showed from the text of the Bengal report, how a change of position produced a return of health in the troops; but Mr.Kennedy states that the disease had greatly declined a few days before the removal, so that it had lost "its infecting power." Nevertheless it appears by this gentleman's account, a little farther on, that "in their progressive movement the grounds which they occupied during the night as temporary encampments were generally found in the morning, strewed with the dead like a field of battle"! This gentleman tells us that he has laid down a law of "increase and decline appertaining to cholera," by which, and the assistance of currents of contagion, Pt_1
[Pg 40] it would appear all these things are reconciled wonderfully. Several of the points upon which he grounds his belief of contagion have been already touched upon in these letters, and the rest, considering the state of the cholera question in Europe just now, may be allowed to pass at whatever value the public may, after due examination, think it is entitled to. Let it be borne in mind that all contagionists who speak of the cholera in the army of the Marquis of Hastings, forget to tell us that though many thousand native followers had fled from that army during the epidemic, the disease did not appear in the towns situated in the surrounding country, till the following year, as may be seen at a glance by reference to Mr.Kennedy's and other maps.

We have another contagionist in the field—a writer in the Foreign Quarterly Review, the value of whose observations may appear from his statement, that "in1828 the disease broke out in Orenburg, and was supposed [supposed!] to have been introduced by the caravans which arrive there from Upper Asia, or [or, nothing like a second string] by the Kingiss-Cossacks, who are adjoining this town, and were said [were said!] to have been about this time affected with the disease." This single extract furnishes an excellent specimen of the sort of proofs which the contagionists, to a man, seem to be satisfied with as to the cholera being "carried" from place to place. This gentleman must surely be under some very erroneous impression, when he states that, "According to the reports of the Medical Board of Ceylon, the disease made its appearance in 1819 at Jaffnah in Ceylon, imported from Palamcottah, with which Jaffnah holds constant intercourse, and thence it was propagated over the island." Now there is every reason to believe that a reference to the documents from Ceylon will shew that no report as to the importation of the disease was ever drawn up, for Drs.Farrel and Davy, as well as Messrs. Marshall, Nicholson, and others, who served in that island, are, to this hour, clearly against contagion. But as the writer tells us that he is furnished with unpublished documents respecting the cholera at St.Petersburg, by the chief of the medical department of the quarantine in this country, we do not think it necessary to say one word more—ex pede Herculem.

I rejoice to observe that Dr.James Johnson has, at last, spoken out upon the quarantine question; and I trust that others will now follow his example. It is only to be regretted, that a gentleman possessing such influence with the public as Dr.Johnson does, should have so long with-held his powerful aid on the occasion; but his motives were, I am quite sure, most conscientious; and I believe that he, as well as others, might have been prevented by a feeling of delicacy from going beyond a certain point.

Since my last letter a code of regulations, in the anticipation of cholera, has been published by the Board of Health. Let our prayers be offered up with fervency tenfold greater than before, that our land may not be afflicted with this dire malady. The following statement, however, may not be altogether useless at this moment. According to the Journal des Debats of the 24th instant, the Emperor of Austria, in a letter to his High Chancellor, dated Schoenbrunn, October10th, and published in the Pt_1
[Pg 41] Austrian Observer of the 12th, formally makes the most magnanimous declaration to his people, that he had committed an error in adopting the vexatious and worse-than useless quarantine and cordon regulations against cholera; that he did so before the nature of the disease was so fully understood; admits that those regulations have been found, after full experience, to have produced consequences more calamitous than those arising from the disease itself ("plus funeste encore que les maux que provenaient de la maladie elle-mÊme.") He kindly makes excuses for still maintaining a modified quarantine system at certain points, in consequence, as he states, of the opinions still existing in the dominions of some of his neighbours, for otherwise his commercial relations would be broken off. To secure his maritime intercourse, he must do as they do! We find that as all the Prussian cordons have been dissolved, their vessels are excluded from entrance into certain places on the Elbe. What a horrid state of things! But, as a reference will shew, this was one of the things stated in my first letter as likely to occur: it is surely a fit subject for immediate arrangement between governments. In the mean time, we cannot but profit by the great lesson just received from Austria.

I shall add no more on the present occasion, than that my last information from Edinburgh notifies the death, from Scotch cholera, of two respectable females in that city, after an illness of only a few hours.