*?mmmg£% 

BOWRON'S OBSERVATIONS 

ON THE 

ORIGIN OF CHOLERA. 









OBSERVATIONS ON THE ORIGIN AND CAUSES OF MALIGNANT CHOLERA. 





nv 

JOHN S. BOWRON, M. D. 

. • • 

NEW-YORK: 

CHARLES 5. FRANCIS, 252 BROADWAY. 

1 835. 



Entered according to Act of Congress, in ihe year 1835, by Charles S. Francis, in the Clerk's Office of the District Court of the Southern District of New-York. 

ARMED FORCES MEDICAL LIBRARY WASHINGTON, D. C. 

JAS VAN NOR.DEN, PRINTER, 49 WILLIAM-STREET. 



/r? ¦» 

TO THE 

PRESIDENT AND MEMBERS 

OF THE 

MEDICAL SOCIETY OF NEW-YORK, 

THE FOLLOWING OBSERVATIONS 

ARE RESPECTFULLY INSCRIBED, 

nv- 

THE AUTHOR. 



O* During the prevalence of Cholera in this city, in 1834, a committee was appointed by the Medical Society, to investigate the origin, pathology, and treatment of that disease. In order to facilitate the inquiries upon this subject, it was thought proper to form sub-committees, and give to each a particular branch of the investigation. The writer of these observa. tions had the honour of being appointed chairman of the committee on the origin of the disease. In pursuance of this appointment, the following observations were written. At the next regular meeting of the Society, it was expected that the report would have been read; but owing to unavoidable and imperative circumstances, the chairman was unable to attend the meeting, and consequently the report was not read to the Society. 

At the solicitation of a number of his medical friends, he has been induced to offer these pages to the public. He therefore deems it his duty to state, that for the opinions advanced in these observations, he is alone responsible. If there are errors of opinion, or doctrine, his able and highly distinguished colleagues* are not accountable for them. 



It will be perceived that these observations are thrown rather into the form of a review of the different doctrines on this subject, with the intention of bringing to a proper solution the long disputed question of the origin of malignant Cholera. To produce, in a paper of this kind, even a small proportion of the evidence that might be furnished in support of the opinion we have advanced of. the causes of this disease cannot be expected. How far we are warranted in the conclusions we have arrived at, is most respectfully submitted to the public to determine. 

*T)rs. Mott, J. M. Smith, P. U. Johnston, J. K. Jiodgera, llobson, Bliss, Post, Poixotto, A. L. Anderson, Coit, Cornell Gilmnn, Chikls, Ludlow, Committee. 



i 

/ 

OBSERVATIONS ON THE ORIGIN OF CHOLERA. 

An investigation of the origin of pestilential and epidemic diseases is, perhaps, of as much importance to the statesman as to the physician. For, as to all practical purposes, a thorough knowledge of the pathological condition of the different organs of the system, affords nearly all the information that is requisite for the adoption of correct principles of therapeutics. In all ages of the world, however, the statesman has had to deplore the destructive ravages of epidemic diseases, which have in a few months destroyed the brightest prospects of a whole nation, and frequently laid the foundation for the downfall of empires. In every instance of the extensive prevalence of a pestilential disease, all the important pursuits of human industry have been arrested. Commerce, manufactories, and the mechanic arts, on which the wealth and prosperity of a nation are mainly dependent, are always so completely prostrated, that many years are frequently re- 

1 



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6 

quired to regain the prosperity which a few weeks prevalence of a destructive disease has prostrated. The importance, therefore, of the subject of epidemics, to the government of a country, cannot be too highly appreciated. And it certainly affords matter of astonishment, that politicians, who have been renowned for their talents and abilities, should have so entirely neglected to investigate a subject of infinitely more importance to the interests of their country, than most of those minor questions, upon which they have exhausted the treasure of a whole people. 

Notwithstanding, however, the comparatively greater importance of this subject to the legislator than the physician, the medical philosopher has in all countries, unaided by the patronage of government, devoted his best time and talents to unfold the mystery that frequently envelopes the origin and propagation of pestilential diseases. It is, therefore, to the medical profession, who are justly considered as the conservators of the public health, that the people look for an explanation of those causes which are frequently so destructive to human life. It must also be allowed, that an acquaintance with the nature of those causes which are productive of disease, will materially aid us in our pathological inquiries, and thereby promote the adoption of correct practice. 

In all countries, however, the medical inquirer who has attempted to unfold the etiology of epidemics, has had to contend against the prejudices 



7 

of the ignorant, and the iflexible opposition of those skeptics in science, who, to obtain a cover for their deficiency of knowledge, endeavour to throw discredit upon the labour of others, and stigmatize the most profound researches of the philosopher, as the visionary production of theory. To trace causes from effects is what they particularly condemn. They will not believe in any thing but what they can see and feel. They seem not to know, that many of the most important truths have been discovered from a careful investigation of those phenomena, which have resulted from causes that would otherwise have remained in impenetrable obscurity. What would have been the present condition of chemistry, if the immortal cultivators of that science had neglected to appeal to effects, and analogy, in unfolding the mysteries of the material world ? We should still have been amused with the crude doctrines of ancient times, and consoled ourselves with the idea that we were right in discarding all theories, and pertinaciously adhering to the opinion, that there were only four elements in the whole universe. 

If the same amount of evidence, that would be considered conclusive in establishing the ordinary principles connected with philosophy, will be admitted as sufficient to demonstrate certain facts connected with the nature of the poison of Cholera, we think every person who will take the trouble to examine the subject for himself, will be satisfied that the existence of particular agents invariably attends the progress of this disease. 



8 

When we are told that the afflux and reflux of the tides is the effect of the attraction of a certain planet upon the waters of the ocean, and we find } by observation, that the fact conforms with the theory, we are at once satisfied with the explanation. When we are shown that, by placing certain chemical bodies under the influence of particular circumstances, a gas will be produced destructive to human life, we do not think it necessary to look further for the production of the deleterious agent. If we find animal life destroyed by confinement in rooms in which the combustion of charcoal has taken place, and that by a suspension of the combustion the danger is removed, we are entirely convinced that the poisonous gas must have been produced from the decomposition of the ignited charcoal. But when we are told that certain phenomena, resulting from a disordered system, are the effects of a miasmal poison, generated from particular materials which are shown to exist, we are at once incredulous, and are disposed to doubt every thing we cannot infallibly exhibit to view. Those who indulge in a spirit of skepticism of this kind it will be very difficult to convince. Such, however, as are willing to draw inferences from facts, and are ready to allow, that circumstantial evidence is in many cases of equal importance with positive testimony, will find, from the accumulated facts that have been collected by the most attentive observers, sufficient evidence to justify a positive decision. 



9 

In every age of the world we find that new poisons have been generated. Some have obtained a lasting and permanent existence, whilst others have for a short time produced their destructive effects, and then entirely disappeared, leaving no other evidence of their ever having existed than what is to be found in the historical records of those times. It was, therefore, correctly remarked by Dr. Hunter, that in populous cities particularly, new poisons were frequently produced. Hence we find, from the annals of past times, that the most virulent infections have been generated, which have been exceedingly destructive to human life. The Black Plague, which at one time threatened to depopulate the whole of Europe, was no doubt produced by a miasmal poison, generated by a concurrence of causes that have never since that time again occurred. 

We might name many other pestilential complaints which have destroyed immense numbers of the human species, but which are not known at present to exist ; and a great many others that are now afflicting mankind, might also be enumerated; so that the production of a new infection is not a matter to excite our surprise. It is, indeed, rather to be wondered at, that these deleterious agents have not been oftener produced. For, when we take into consideration the incessant mutation and changes that are constantly taking place among the particles of matter, we should naturally expect that they would be almost constantly generated. This, however, is 



10 

not the case; on the contrary, we find that these morbid agents are rarely produced. The world, however, will no doubt long continue, if not for ever, to suffer from those which apparently have obtained a permanent existence among us. And certainly the most terrific of all is the infection of Cholera. 

In order to facilitate our inquiries, and narrow down an extensive subject, it will be necessary to examine what are the most obvious facts connected with the prevalence of this disease. If we shall find that Cholera is governed by circumstances and laws, that are evident to every observer ; and that where these circumstances do not exist, there Cholera does not prevail, the conclusion is irresistible, that there must be a necessary connexion between these circumstances and the disease. After a period of more than eighteen years, during which time Cholera has prevailed in almost every quarter of the globe, we certainly have had sufficient opportunity to determine whether these circumstances are to be considered as accidental occurrences, not necessary to the prevalence of the disease, or whether they have not, in all places, and in all countries, invariably and necessarily accompanied the complaint ; and that where these local causes have not existed, the pestilential Cholera has never yet prevailed. In order that we should not be charged with forming a conclusion from insufficient data, we shall take the liberty of noticing the progress of Cholera in different places since its first appearance. 



11 

\ 

Previous, however, to proceeding to this inquiry, we will briefly examine the question, whether this disease is contagious, meteoratious, or infectious. That it is one of the three there can be no doubt. It will, therefore, aid our inquiries, to determine to which division the complaint most probably belongs. In this examination we shall avail ourselves of the facts that have been collected by the most eminent writers. It will be impossible, however, in the narrow limits to which these observations are confined to make quotations or references. We shall barely notice the prominent facts, which have been so ably portrayed by Orton, Kennedy, Annesley, Searls, Scott, Keir, Barry, Duncan, Ainsworth, Russell, Walker, and many others. In determining the classification of Cholera, we shall be governed by the laws, so ably illustrated by Professor Smith of this city. It is due to truth and candour to declare in this place, that the work on Epidemics, by Professor Smith, has formed an era in Eteological science, and should be considered as the first authority extant on that subject. 

With respect to the contagiousness of Cholera we shall say but little ; for, notwithstanding there are many circumstances which are very strong in confirmation of that opinion,there is not connected with this disease those qualities which would properly class it among contagious complaints. "By contagion," says Dr. Johnson,* " is understood a 

* Medico Chirurgical Review. 





12 



poison generated by morbid animal secretion, possessing the power of inducing a like morbid action in healthy bodies, whereby it is indefinitely reproduced and multiplied." It will be found that Cholera does not possess those attributes of contagion. Every one who has seen much of the disease must have noticed the fact, that whenever a person labouring under Cholera is removed to a healthy situation, where particular attention is paid to cleanliness and ventilation, the disease does not extend beyond the person first affected. We have seen a great many instances of this kind, where, if there had been contagion, it would have been impossible for all the friends and attendants of the sick to have escaped. We have seen the heads of families, attacked with Cholera in its most malignant form, assiduously attended by their relatives, who, in every possible way, were for hours and days constantly exposed to the exhalations emitted from the sick, and were also in constant contact with them, and not one of all those thus exposed have contracted the disease. It now and then happens that particular persons may frequently come in contact with contagious diseases, and escape the complaints; but such occurrences are uncommon. When, however, we see hundreds breathing the atmosphere, for hours together, that must have been saturated with the morbific poison, if the disease was contagious, and all escape without a single exception, we are compelled to believe that the disease cannot be contagious. And when we see examples 



13 

of this kind almost incessantly, the evidence against contagion is perfectly conclusive. 

It has been attempted by some eminent phisicians, to show that some forms of contagion can only be generated in an impure atmosphere. Hence, they contend that many diseases, which they consider undoubtedly contagious, can only be propagated in an atmosphere impregnated with impurities. But even admitting this opinion, which we believe to be untenable, there would be insurmountable difficulties to overcome. For, by this doctrine, we should be compelled to allow that the contagion would be indefinitely multiplied, so long as these impurities continued to exist, in connexion with the other circumstances which are deemed essential to its production. This, however, is not the case, as every person who has seen the disease must know. But without wasting time upon other arguments, to establish the non-contagiousness of Cholera, we will barely mention one fact, which, of itself, fully demonstrates that the disease is not contagious. It has been remarked, by all the writers on this complaint, that in those places where the disease has prevailed with the most intense violence, and new subjects have been constantly exposed to the atmosphere surrounding the sick and dying, all at once, at the very time when, if we considered the disease contagious, we should suppose the morbid poison accumulated to the greatest intensity, the disease has suddenly and almost entirely disappeared, without any perceptible change in those 

2 



14 



places, or in the state of the atmosphere. Such an occurrence never happened with any contagious disease whatever. 

We will suppose, for illustration, that a certain establishment should be appropriated for the reception of patients labouring under small-pox, and that persons and attendants, unprotected from the contagion, should be incessantly about the sick, crowding the apartments, and breathing an atmosphere loaded with contagion, would not the disease continue to exist so long as all those circumstances remained the same ? Most assuredly it would ; and the same thing would be observed of all other contagious diseases. It is singular that these acknowledged facts have not led some of our most eminent physicians to doubt of the contagious nature of Cholera, as well as the Plague, which is also undoubtedly an infectious complaint. 

We use the terms meteoratious diseases, to designate those complaints which are produced by certain indefinable constitutions of the atmosphere, independent of any miasmal impregnation, or other extraneous causes. It is not often that meteoratious complaints prevail, disconnected with other causes. When they are observed to prevail without any connexion with other extraneous circumstances, the uniformity of their course, and the general and indiscriminate manner in which all classes of the community are affected by them, is pecularly characteristic of this form of disease. The rich and the poor, the inhabitants of the lowest valley, and the 



15 

highest mountains, the splendid palaces of the wealthy, and the wretched huts of the destitute and filthy, are equally subject to their visitations. This form of disease is never known to affect one part of a city, in preference to another; but in every instance on record, almost every part of an extended districthasbeen simultaneously attacked. 

The best illustration of the prevalence of meteoratious complaints, will be seen in the progress of common influenza. The rapidity of its march from one point to another ; and its indiscriminate attack of all classes of people, without respect to age or sex, affords a happy example of the uniform extension of this class of cpmplaints, over all portions of the globe. If we keep in view these characteristic features of meteoratious affections, it will be impossible to confound them with either infectious or contagious complaints. The laws which govern both contagious and infectious diseases, are so widely dissimilar from those of meteoratious complaints, that we are confident a very little examination would satisfy any careful observer, of the total difference that exists between them. It also appears to us utterly impossible to reconcile the progress and prevalence of Cholera, with the character of a simple meteoratious disease. The appearance of Cholera in this city, will afford abundant refutation of the opinion, that this disease is solely produced by a peculiar constitution of the atmosphere, which must necessarily pervade all parts of the city at the same time. The fact is notorious, and established 



16 

by testimony, which the most hardy speculator will not deny, that certain localities, and particular classes of the^ inhabitants, were almost exclusively affected by it. 

If Cholera is simply a meteoratious complaint, would not all classes, the rich and the poor, the cleanly and the uncleanly, be equally affected by it 1 Most certainly ; but many eminent physicians contend, that the great efficient cause is in the atmosphere, and that the disease is only excited into action by ordinary local causes. We would ask if it is possible that the efficient and primary cause of the most potent and destructive disease recorded in the annals of the world, could be constantly inhaled by all classes, the tender infant, the delicate female, and the aged and infirm, without producing effects that would be most manifest and alarming 1 Can we for a moment entertain the opinion, that it only requires the operation of common local causes, to manifest its deadly fury 1 ? 

To countenance such an opinion, we should be compelled to believe that a deleterious influence, more destructive than the contagion of small-pox, can be breathed, and that for months, without any material derangement of the animal functions whatever, by a great majority of the population of a whole city, whilst some local cause in particular districts, not essential to the production of the disease, would be sufficient to make it assume its most fatal form. We see in those same localities small-pox, and other contagious complaints, take their usual course without any material increase 



17 

of mortality over other parts of the city. In order, therefore, to account for the tenfold greater mortality of Cholera in these districts, over small-pox, we must admit that the atmospheric cause, producing Cholera, is at least ten times more virulent, than the contagion of small-pox. And we must also believe that this deadly poison can be for a long time constantly inhaled, in other places, without any sensible effects. We conceive that such an opinion cannot be entertained by any one who will take the trouble to examine the subject attentively. 

We are not disposed to deny, but, on the contrary, are firmly of the opinion, that a peculiar constitution of the atmosphere is essential to the production of Cholera; not, however, as the principal, but rather as a concurrent cause, necessary for the developement of the poison. We see that most contagious and infectious diseases, require a peculiar meteoratious influence to produce an extensive prevalence of them. And in all epidemics, some occult cause pervading the atmosphere, remarkably modifies the character of the prevailing disease. And it is highly probable, that in Cholera, it may require a concurrence of meteoration, with other causes, to effect the formation of the infectious miasma. It is a curious question, and worthy of the most profound investigation, whether the poison can be produced in various and distant places, barely by a concurrence of the meteoration with the other materials from which the infection is formed, without the introduction 



18 

of the morbific poison from a foreign source, to act as a kind of leaven. It is certainly probable that this is generally the case. We are, however, strongly of the opinion, that in a great many instances, Cholera would not have appeared? if the infection or fomitus, had not been introduced from other places. But where all the materials abound, it may frequently only require a concurrence of the atmospheric cause, to set the chemical process in operation. It is doubtful whether the poison could be multiplied even by the introduction of some of the infection from other places, unless there should, at the same time, exist this peculiar meteoration. This is not idle speculation, unsupported by analogy. Every person acquainted with the principles of chemical philosophy, is aware that all the different gases and compound bodies, require certain circumstances of heat, fluidity, proximation, &c. to promote their production. Even the ordinary action of fermentation can only be effected through the operation of certain conditions of temperature and moisture, so that analogy powerfully corroborates the opinion, founded upon observations, that the concurrent operation of meteoration is necessary to generate and promote the extension of the infection of malignant Cholera. 

That this meteoration may also have an influence in producing some of the accompanying symptoms of the disease, is very likely. The fact, that particular nervous affections, as well as bowel 



19 

complaints, are very common preceding and during the prevalence of Cholera, would, of itself, sufficiently indicate the existence of some general cause, affecting the great mass of the people, to a greater or less extent. Ithas alwaysbeen observed, that whenever there has existed a peculiar atmospheric influence, determining the character of an epidemic disease, all other complaints have been in a considerable degree modified by it. It may hence arise, that many of those cases which have been considered as Cholera, and which have arisen under unusual circumstances of temperance, seclusion, and in cleanly habitations, remote from all apparent local causes, may in reality have been other diseases, assuming some of the characteristic symptoms of Cholera. That errors of this kind have frequently occurred, there can be no doubt. 

From the foregoing considerations, and other reasons that might be advanced, we are compelled to conclude that pestilential Cholera is not properly, and independently of the operation of a specific infection, a meteoratious epidemic. 

We will now briefly examine the testimony, which in our opinion conclusively establishes the doctrine, that Cholera is an infectious complaint. In a paper of this kind, it would be impossible even to refer to the mass of evidence which has been accumulating for eighteen years, and which to us appears irresistible, in establishing the infectious character of malignant Cholera. We shall therefore barely avail ourselves of the most 



20 

prominent facts which are given by different writers on this disease. Before, however, we proceed to this inquiry, we will concisely express our meaning of the term infection. Dr. Joseph M. Smith defines infection to be " a febrific agent, produced by a decomposition of animal and vegitable substances. It usually exists in the state of a gas or miasma, and in this form, occurs in filthy houses, ships, jails, hospitals, and cities: and also in marshes, and fenny, and low districts of country."* It has also been justly remarked by professor Smith, that " the secret influences of the atmosphere, too, especially those which favour the prevalence of pestilential epidemics, may be supposed to have an agency in varying the properties of miasmata." Keeping those clear and lucid definitions in view, and we shall have no difficulty in demonstrating the existence of this miasma in almost every place where Cholera has appeared. 

Inattention to the complete and absolute distinction between infection and contagion, has been a fruithful source of most of the confusion that has prevailed relative to the character of epidemic diseases. Most European as well as American writers use the terms as synonymous, whereas in truth they should express entirely different agents. We might, with equal propriety, denominate the mineral poisons contagious, as 

* Btiology and Philosophy of Epidemics. 



21 

to apply that term to express the nature of miasmal infection. Contagion never originates from a decomposition of dead animal and vegetable matter. It is always produced by an action of the living solids. We are anxious that this fact should be kept in view, for without this discrimination, we are constantly exposed to perplexity and confusion, in our investigation of the most simple subjects. We are free to confess that had many of those able writers on Cholera, in Europe and the Indies, kept these distinctions properly in view, in their masterly productions, we should have been possessed of all the information that the subject is susceptible of. For the want of a proper distinction between contagion and infection, they have diverged from the great point, at the very moment when they had all but decided the question. 

Cholera first made its appearance in New- York in the latter part of June, 1832. The first well authenticated cases, appeared in a small wooden building in Cherry-street. The house was a dirty ill-ventilated place, surrounded by other tenements eqally filthy, and there were also in the neighbourhood, many sources of miasma. From this point, the disease spread in various directions, until it was seen in different and distant parts of the city. It was always, however, found among the poorer classes, in places where great numbers were congregated together, living in a vitiated atmosphere, filled with the emanations of all the corrupting materials that vice and profligacy could engender. We have stated that Cholera first ap- 

8 



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peared in this city in the latter part of June. And this is unquestionably the fact ; but whether the first cases occurred in Cherry-street, is not so certain. We are well convinced that a great deal of error has arisen in many places, in consequence of the positive manner in which the precise time is mentioned, when the first case is said to have appeared. In large cities, it is highly probable that many cases of Cholera may have existed for some days, before the real nature of the disease was suspected. 

Cholera has never prevailed generally over the city. Particular localities, and certain neighbourhoods, have borne nearly the whole force of the pestilence. And the fact is now, we believe, universally admitted by every one, that those neighbourhoods were situated in parts of the city where impurities of every kind abounded. Certain sections of the city, in consequence of their unhealthy locality, and the multitude of poor dwellings that have been erected in them, are almost exclusively inhabited by those whose vices, or misfortunes, compel them to congregate in vast numbers, in a single house. In some of those dwellings, it is no uncommon occurrence to find from fifteen to twenty families. It would perhaps be considered unnecessary to give a statistical account of these particular sections. We will, however, particularize two neighbourhoods, which will serve as an illustration of other localities where Cholera prevailed with the greatest violence. 

In that part of the city lying east of Broadway, 



23 

which is built upon made ground, formed by the filling up of a large tract of marshy soil, which, previous to the filling in, was constantly inundated by water, is situated that portion of the city which is generally known by the name of " five points." Here we find, collected together, in the most wretced tenements, swarms of the poor and most abandoned of our population, whose vices and poverty have, after a series of years, produced such a state of filth and pollution, as is rarely witnessed among human beings. Here we find a congenial atmosphere for the production of the infection of Cholera. The frightful ravages of the disease in this section, was most appalling. It was no uncommon occurrence for more than twenty to fall victims in a single house. Whilst those streets immediately surrounding the infected district, Broadway, Chatham-street, Bowery, and Grand-street, which were inhabited by a respectable portion of our citizens, remained in comparative health, 

In that part of Laurens-street extending from Canal-street, some distance north, we find the dwellings, in most places, filled with a class of inhabitants of the most poor and wretched description. Many of the houses are filled with coloured people and whites, living promiscuously in dirt and debauchery. This part of the street, and the small alleys extending from it, are constantly covered by all kinds of corruptible materials. Most of the houses are absolutely saturated with morbific matter of the most offensive kind. 



24 

In this neighbourhood, Cholera prevailed with horrid destruction. The dying and the dead were literally strewed about, like slaughtered victims on the field of battle, and vast numbers, before they could be removed for interment, were in a state of loathsome putrefaction. 

Nearly the same condition of things was invariably found in every section of the city where Cholera prevailed. From these infected districts the poison of Cholera was " radiated,"* and to a greater or less extent affected the adjacent streets. But very few cases appeared in neighbourhoods differently circumstanced. When cases were observed in other places, they could generally be traced to some infected district. 

In the summer of 1834, the same circumstances always accompanied the pestilence. In Centre-street, and all other places where much of the disease was found, the hovels of the poor, the filthy tenements of the outcasts of society, the polluted habitations of the vicious and abandoned, were the great laboratories for the production of this malignant, infectious poison. 

That cases of Cholera now and then appeared in situations apparently remote from infected districts, is most certain, but occurrences of this kind very rarely happened. Not indeed so frequently as might have been expected, when we take into consideration the unreserved inter- 

* Dr. Reese. 



25 

m 

course that was constantly maintained with the various parts of the city, and the consequent exposure to the infectious miasma, which we believe existed in certain sections. We can, however, account for this, by a reference to the fact, that it was not often the case that those who were comfortably situated, ventured into the abodes of those whose vices and poverty rendered them almost a distinct class in the community. And as the infectious materials were more concentrated, in the interior of their houses, where the access of the air was almost excluded, the danger of passing along the streets only, would necessarily be greatly diminished. 

At Quebec, and Montreal, where this disease first made its appearance on this continent, the same classes of people were almost exclusively the unhappy victims of its fury. The poor and unfortunate emigrants from foreign countries, crowded together on the wharves, and in filthy cabins and huts, destitute of all the comforts of life, and weighed down with the distressing circumstances that always attend strangers in a foreign land, were the first and severest sufferers ; and it is highly probable that they brought with them to our shores the infectious leaven, which has subsequently produced so much of misery and death. We say that it is highly probable that this was the case, although it does not necessarily follow, that because we believe a disease infectious, 

that therefore it must, in all instances, be imported. It is more likely that the majority of 



26 

i* 

infectious poisons are of such a gaseous nature that they cannot be transported to distant places. 

There are, however, so many instances where Cholera could be most certainly traced from one place to another, as to warrant the opinion that the infection can be carried in the form of fomitus. In this way we can satisfactorily account for those cases which have furnished strong arguments in favour of contagion. The singular and remarkable manner in which Cholera, on its first introduction in Canada, followed the tide of emigration, passing along the navigable streams, and public ways, seemed strongly to indicate, that the poison, or at least the germ of infection, was carried with them from place to place. We ought frankly to declare, that we have always been strongly disinclined to entertain the opinion, that the poison of Cholera was frequently carriedfrom one place to another. Such, however, is the force of evidence in confirmation of this opinion, that we are most reluctantly compelled to acknowledge, that in all probability, the infection is more frequently transported, than we have been in the habit of admitting. Even admitting, however, this to be frequently the case, it does not furnish sufficient ground for the adoption of rigid quarantine regulations. For should we allow that in many instances the infection may have been introduced from abroad, still if there should not exist those materials which are essential to its propagation, the poison would not be multiplied. And again, if all the materials of public and domestic 





27 





filth should be present in any place where Cholera may be introduced, if there should not also exist at the same time, a meteoration favourable to the production of this form of infection, the disease would not spread to any considerable extent. 

From Quebec and Montreal, we may follow the disease back on its course to its first appearance at Sunderland, in England. The probability of the disease being imported from Russian ports into Sunderland, is strongly supported by undeniable testimony ; but whether imported or not, it is known to all who are conversant with the locality of this place, that all those materials, vitiated human affluvia, and public filth, that are necessary for the propogation of the infectious miasma, are found here in the greatest abundance. Those narrow lanes, " crowded with the thickly populated houses of the poor, badly paved, with a gutter in the centre, where all the filth of human habitations is heedlessly thrown, and still more carelessly left to accumulate for weeks together,"* formed the great focus of Cholera. So wretchedly foul was the atmosphere in these narrow passages, that Magendie, who arrived there during the prevalence of the malady, was anxious to obtain some of the pestiferous air, in order to subject it to chemical analysis. The adjoining parish, is a neat, well built, and airy town, and 

* Ainsworth. 



28 

m 

consequently malignant Cholera, which was devestating Sunderland, could not prevail in the cleanly habitations of Bishopwearmouth. 

At Paris, where this disease produced extensive ravages, it commenced its epidemic career in the same kind of localities that were observed in every other place where it prevailed. The first cases appeared on a damp island on the Seine, among the most wretched classes of population, inhabiting narrow, dirty, and ill-ventilated streets. From thence it spread in various directions over the city, and mostly affecting those whose habits and manner of living were similar to those where it commenced. That persons differently situated were occasionally attacked, we freely admit. Indeed, if this had not been the case in Paris, as well as all other places, it would be a conclusive argument against the infectious nature of the disease. For if the Cholera poison could not affect all classes of the community, in proportion to their exposure to the noxious miasma, making due allowance for the influence of predisposing causes, it would afford strong evidence against infection. We only want to show, that the great laboratories for the production of the morbific poison, are the same, or nearly the same, in all countries ; and where these agents, domestic and public filth, do not abound, there Cholera does not prevail. 

The disease made its appearance in Hamburg, among the same class of people. The first cases occurred in a cellar, deep, damp, and unventilated, inhabited by upwards of forty persons, of the 



29 

Very lowest order, living in the midst of the most offensive impurities. In situations similar to this, the disease was almost entirely confined, in Hamburg. The narrow, dark, and filthy alleys, and crowded streets, were the only places visited by the malady. 

At Warsaw, there is a particular quarter inhabited almost exclusively by the rich, who live in elegant houses, well ventilated, and free from miasmatic materials. This quarter of the city almost entirely escaped the infection, which was confined in such a remarkable manner to the impure habitations of the indigent and wretched, that an intelligent observer* of the Cholera, as it appeared in that city, was compelled to the conclusion, that the disease was confined almost entirely to the lower orders. 

The appearance of Cholera at Orenburg, has furnished the lovers of the marvellous with some slight grounds for their credulity, in disbelieving all explanations of the nature of the agents which produce the disease ; but fortunately for the cause of truth, the concurrent testimony of all the eyewitnesses of the malady in that city, unite in stating that " the lowest classes, particularly those residing in wet, damp, confined, dirty apartments,"f were almost exclusively the victims of Cholera. Even in Orenburg, we have the most conclusive evidence of the baneful influence of 

* M. Bnerre de Boismont. f Russian Official Reports. 

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public and domestic impurities, which every where form the agents for the production of the Cholera poison. 

Astrachan, the commercial emporium between Asia and Europe, is situated on the banks of the Wolga, about sixty miles from its mouth, where it opens into the Caspian Sea. The city is built on a marshy soil, and is surrounded by an atmosphere loaded with humidity. In its locality it has a striking resemblance to the towns on the Delta of the Ganges, where Cholera first originated. It was in this city the pestilence first made its dreadful eruption into Europe, and it is most likely the infection was generated in the city, without being introduced from the towns of Asia. 

It is worthy of particular notice, that in all those places where the infection appeared to be generated, and prevail with great severity, there has invariably been found most of those local causes and peculiar circumstances, which exist in the place where Cholera first originated ; and it will also generally be observed, that in those cities into which the infection seemed to be imported from foreign places, there were fewer apparent local causes, and a less concentration of infectious materials, than in those places where the disease appeared to originate. In the city of Astrachan, and the adjacent towns, the malady was governed by the same laws and circumstances, which in all other places were found to attend the progress of the pestilence. 

To avoid an unnecessary repetition of the same 



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facts, which we have already been compelled to narrate very frequently, in order that we might demonstrate the existence of the same infectious materials, wherever the disease has prevailed, we shall omit to notice the prevalence of this malady in most of the cities of Asia, where we should be able to show a mass of powerful testimony, which is comparatively of infinitely greater weight, than any we have yet adduced on this subject. We might, if it were necessary, bring forward the evidence of its frightful mortality in all those cities of the east, where its desolating march has consigned millions to premature graves. Such a narrative, besides being incompatible with the objects we have in view, would also require volumes to give even a concise account of its ravages. We shall therefore conclude this reference to its prevalence in particular places, and other countries, by a concise notice of its first appearance in Bengal. 

It is well known that malignant Cholera first originated in Jessore, a city of Bengal, in 1817. The city is situated in a marshy milarious country, surrounded on all sides by stagnant lakes, and impenetrable jungles. It is perhaps the most filthy and the most miserably constructed city of any in the world ; crowded, ill-ventilated, and exposed to effluvia of the most offensive kinds. "So unforeseen and unparalleled," says Mr. Kennedy, "was the attack, that the functionaries in extreme consternation closed the civil courts of the district, and business of every description was abandoned for a time. Even at the beginning, the 



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disease seems to have exerted a very destructive power. In the short space of a few weeks, 10,000 of the inhabitants perished in the single district of Jessore." Struck with dismay at the appalling ravages of this new destroyer of mankind, the terrified inhabitants fled in all directions to the country, to escape impending death, until the city was literally deserted. 

Soon after, the disease appeared at Calcutta;l cutta ; and here we have the most conclusive and satisfactory evidence of the nature of the infection, that can possibly be demanded by the most skeptical. The city of Calcutta is artificially, and in reality, completely divided into two parts. The English half, which properly constitutes the " City of Palaces," and the Native Town. "The Native Town," says Mr. Kennedy, "is chiefly composed of miserable lanes, narrow, dirty, and unpaved ; and the majority of the dwellings are low huts, with side walls built of mud, mats, and bamboos, and covered Vith small tiles. In these filthy receptacles, where all kinds of disgusting animal and vegetable odours abound, the distemper ran a long and wide career of destruction," whilst the English half almost entirely escaped, and continued nearly in their usual health ; and from that time to this, the inhabitants of the English portion have remained comparatively exempt from this disease. 

In no other city, can this complete and entire division between the dwellings of the rich and the poor, the cleanly and the filthy, be so fully exhibited. But in so far as these distinctions 



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have been observed to exist in other places, so far have the same results been uniformly witnessed. It would therefore be a waste of time, and lead to a constant reiteration of the same facts, were we further to notice the progress of Cholera in other places and countries. Every where, we shall find that human filth, whether found in private dwellings, jails, hospitals, or in ships, whatever other decomposing materials may be necessary to act conjointly in the production of the morbific miasma; and that there are others, we have no doubt, though they cannot be so uniformly shown to exist; these agents, accumulated animal filth, such as we find necessary for the production of typhus,* jail-fever, and plague, must be present, in all places where malignant Cholera prevails epidemically. If we should trace its course, from the '•' succulent marshes of India, to the barren deserts of Arabia, from the frigid regions of the north, to the burning countries of the torrid zone, or mark its progress in those temperate climates bordering the equatorial line, every where the same class of people, the poor and wretched, those who are surrounded by the miasms arising from uncleanliness and animal excretions, are almost exclusively the victims, who are doomed to be cloven down by the infectious poison of Cholera. 

We might, by comparison, also exhibit innumerable instances where the violence of the 

* Dr. P. S. Townsend of this city, has made the same observations. 





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disease was increased or mitigated in proportion to the purity or uncleanliness of different places. In the well regulated and intellectual city of Edinburgh, where every attention was bestowed by the public guardians to remove every local cause of disease, the mighty pestilence was divested of its terrors, and but few fell victims. At Aleppo, where every thing was directly the reverse of Edinburgh, where congregated thousands lived in filth and wretchedness, Cholera spread through the city with the rapidity of fire, and with the most frightful mortality. At Tripoli, which is a well-ventilated, and very clean city, the disease could not spread for want of the essential materials of domestic impurities ; whilst at Antioch, where human filth is found in its most disgusting forms, its progress was terrible. In the pure and uncontaminated atmosphere of Boston, Cholera has not prevailed ; but at New-Orleans, where all kinds of impurities abound, this distemper finds the necessary materials, and hundreds are annually cut down by the infection. 

It is then abundantly evident, that wherever Cholera prevails epidemically, there we invariably and necessarily find all those materials which are essential to the production of infection ; and we also find, that all those places where those infectious materials do not exist, are uniformly exempt from the pestilence. The deduction is therefore inevitable, that there must be a necessary connexion between those infectious materials and the disease. 



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It therefore only remains for us to show, that this infection is of a specific kind, producing, in all cases where it has its full effect, a specific disease, which is uniform in its character and symptoms. In order to demonstrate this fact, we must prove that persons have contracted this disease, by coming in contact, or breathing an atmosphere known to be contaminated by the morbific poison. In addition to the mass of circumstantial testimony which we have already given in corroboration of of this fact, the following positive proof will no doubt be considered conclusive, and entirely sufficient, without wasting time in detailing a great many instances of a similar kind. 

The brig Amelia left New-York during the prevalence of the Cholera, on the 19th of October, 1832. This vessel had onboard upwards of one hundred persons, about one hundred of whom were steerage passengers. Six days after leaving the city, Cholera made its appearance among several of those who occupied the steerage. It is proper to remark, that in consequence of the bad weather, the passengers had but little opportunity of walking on deck, and the necessary result of so many being confined in the steerage, was the production of a great deal of vitiated and confined air. By the thirty-first of October, twelve days from its first appearance on board the brig, twenty-four persons had died with Cholera, Alarmed at the fatality of this destructive malady, and the vessel being in a leaky condition, the brig was run on shore on a small island in the vicinity 





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of Charleston, railed Folly Island. Being interdicted all communication with the city, the pas-* sengers were confined to the vessel, or on the island. In order to prevent the escape of any of the passengers and crew into Charleston, a guard was ordered down to enforce the most rigid quarantine. By these precautionary means, only one person from on board the brig, affected with Cholera, got into the city. The disease, however, did not spread in Charleston, notwithstanding he was visited by hundreds of the inhabitants. Very different, however, was it with those unfortunate men who visited the vessel. Of the wreckers who went on board, most of them were very soon affected, and eight of them died with Cholera. Nearly all of the guard were more or less affected, v and nine severely. Four negroes, left on the island by their owner, were attacked by the disease, and three of them perished. In short, nearly all who had any communication with the vessel, or the contaminated materials brought from her to the island, were considerably affected, and most of them with the severest and most fatal form of Cholera. During all this time, the city of Charleston was perfectly healthy, as well as all other places in the vicinity. Can there be any doubt as to the source of all this mischief? Is it not evident, and beyond the possibility of any mistake in this matter, that there must have been produced on board this ill-fated brig, a noxious poison, which destroyed the unfortunate beings who came in contact with it ? 

Were these facts submitted to the decision 



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of any judicial body whatever, there would not be a moment's hesitation in forming an opinion. That it was not contagion is most conclusively proven by the case, from the brig, which appeared in the city. This man was visited by hundreds, who, in every possible way, by contact, as well as by breathing the air, for hours, of his apartment, were subjected in every way to the action of contagion, if there was any, yet not one contracted the disease. That it was not epidemic influence of the atmosphere producing this fatal malady, is also demonstrated by the circumstance, that all the adjacent places were perfectly healthy, even to within a few yards of the vessel; and none of the inhabitants, except such as visited the brig, or the contaminated materials from ship-board, were affected by any of the symptoms of Cholera. The conclusion is therefore inevitable, that there must have been generated on board this vessel an infectious miasma, which produced the malignant Cholera in those who were exposed to its influence. 

We have been more minute in detailing the circumstances of this vessel, on account of the completely isolated facts which it presents. In a populous city, notwithstanding, the same causes may be in operation, yet there is greater difficulty in presenting them to view, in such a conclusive manner, as to obviate all the objections that ingenious men are sometimes disposed to throw around the most plain and palpable facts. In the case of the brig, the circumstances are so entirely 

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separated from all connexion with surrounding objects, that even to admit a doubt that all those men from the city of Charleston, who visited the vessel in a state of perfect health, and contracted the disease in consequence of going on board, must have received the infection from the poisoned atmosphere of the brig, would justly expose a person to the imputation of having a disposition for unreasonable skepticism. It is equally certain that the infection was of a specific kind, for it produced in all, the same concourse of symptoms which are peculiar, and characteristic of malignant Cholera. 

In opposition to all the circumstantial and positive evidence which might be adduced in support of the infectious nature of Cholera, we hear it frequently asserted, that cases have often occured, where it has been impossible to discover any local cause of the disease, or to trace them to any known source of infection whatever. That such cases have now and then happened, is freely admitted ; but they no more militate against the doctrine of the infectious nature of the malady, than do similar occurrences that are every day witnessed, with regard to all those complaints which are universally acknowledged to be contagious. How often do we see cases of small-pox, measles, and other contagious complaints, which we are unable to trace to any known source of these diseases'! Would it not be preposterous for us, from these apparent exceptions, to deny the contagiousness of these complaints ! That 



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as few cases, in proportion to the numbers attacked with Cholera, are observed, where no traces of infection can be discovered, as what are noticed in small-pox, we think is susceptible of the clearest proof. 

It will no doubt be inquired, how it should happen, that this disease, after existing for a short time in a particular neighbourhood, where, to all appearances, the same condition of things should still remain, it should suddenly disappear. The same thing is observed of plague, and some other infectious diseases, and results as a necessary consequence of our theory. 

The opinion that a gaseous miasma is the product of some chemical change, produced by a decomposition of animal and vegetable substances, necessarily implies, that so soon as the chemical changes are complete, the production of the infectious miasma must cease. We are constantly noticing analogous facts, in the production of many kinds of gases, in chemical laboratories. So soon as all the materials, necessary for the production of any gas, are decomposed, or even one of the materials, the formation of it is at once suspended. It has often been remarked of Cholera, by those who have appeared to have no definite idea of its origin, that it would seem to pass over a particular district, with all the rapidity of fire passing through combustible malerials. They have thus happily illustrated the progress of this infection, without supposing there was any analogy between the production of the 



40 

two phenomena. Another cause for the sudden disappearance of this disease may occasionally be, although we should presume but seldom, the subsidence of that meteoration, which we have before stated, we considered most probably necessary, to favour the production of this particular infection, and which, perhaps, could not be generated extensively in the absence of such meteoration. 

It will, perhaps, be expected, that we should notice some of those exciting and predisposing causes, which favour the action of the infection upon the human system. As these, however, are nearly the same with those which are the common exciting causes of many other complaints, it seems hardly necessary to revert to them on the present occasion. 

In concluding these brief observations upon the causes of this potent malady, we cannot refrain from expressing our opinion of the great and imperative duty that devolves upon legislators, and the guardians of the public health. Should we form an opinion of its probable continuance in our own country, from what we have seen of its course in India, we should have just grounds to apprehend that the pestilence would continue to afflict us occasionally for many years to come. From the view we have taken of the subject, the obvious means of prevention are most apparent. To what extent the public authorities would have power to purify the dwellings of those who are inattentive to these important 



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duties, we are unable to determine. Their power, however, over all those important public arrangements, the regulation of streets, and the prevention of nuisances of all kinds, is unlimited ; and imposes upon them the most solemn obligations to their country, to leave nothing undone which is essential to the health and prosperity of the people. So deeply impressed are we of the great principles contended for in these observations, that we have no hesitation to declare our firm conviction, that could the city of New- York be completely purified of all local causes of infection— the houses of the poor and filthy be properly cleansed of all domestic impurities ; the streets and alleys thoroughly washed with pure water — the great emporium of the western world would always hereafter remain exempt from the ravages of this desolating scourge of the human race. 

THE END. 

ERRATA. 

Page 12, line 29, for morbific read morbid. Page 18 " 6, for Mmitus read fofmites. 













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