25 AUGUST 1866, Page 15


SIR,—There is one sentence in your last week's exposition of Pettenkofer's views as to cholera, which I do not feel sure that the Professor himself would agree to. It is this,—" It comes, then, to this, that any town which will go to the expense of having all its streets and houses well scoured, and securing for its citizens a constant supply of pure drinking water, can thus secure for itself, according to Professor Petteukofer's theory, perfect immunity from the attacks of cholera?" A town which has taken all these precautions may, I think, according to l'ettenkofer, still be amen- able to an attack of cholera ; for if its subsoil is porous, it may still retain in its superficially placed strata much of the impurity with which the anti-sanitary arrangements of our forefathers saturated their surroundings. According to Pettenkofer, five conditions, two of which depend on personal and three on local causes, are necessary for the spread of cholera. The first personal condition is the presence in the place in which cholera is to spread of the particular and specific cholera poison, cell or ferment, which originates in the rejeetamenta of choleraic patients, and also in the excreta of healthy persons who have come from choleraic dis- tricts. The second personal condition is the receptivity or suscep- tibility, often self-superinduced, of the person to be infected. The first local condition is a porosity and permeability to air and water of the subsoil. The second is the presence at a greater or less depth from the surface of this porous subsoil of what Pettenkofer calls Grundwasser—though he tells us that his opponents will not use his nomenclature—and what we call "springs," and also " handsprings " or "subsoil water." This second local condition is specially deadly when the level of the " springs," or of the " landsprings," as the case may be, has just fallen unusually low, after having been previously unusually high. The third local condition, without which the diffusion of cholera is impossible, is the presence, more or less diffused, in a subsoil of the character specified, of those organic matters which modern sewage whirls away from our precincts, but which ancient slovenliness left to fester all around its houses in cess- pits and iniddens. Now in this, as in many other cases, the sins of the fathers are visited upon the children, and soils may retain for almost indefinite periods the taint of organic impurities which were allowed to soak into them even generations ago. A greater greenness in the growing grass or corn enables us to recognize even now the graves at Culloden, and indeed the burial-places of yet. older British warriors, who knew as little of the broadsword as they did of the bayonet.. Now, it is possible that in extreme cases such as these, the greater exuberance of vegetation may depend upon other conditions than that of its finding putrefiable organic matter to feed upon in the soil ; but it is impossible to escape from the evidence which goes to show that animal, and specially human, life may be seriously affected by the disturbance of organic matters which have lain in the earth undisturbed for very long periods. We have the excellent authority of Vicq d'Azyr for saying that an epidemic was caused in Auvergne by the opening of an old cemetery, and similar histories are not wanting in the records of our East Indian medicine. The facts that Loudon churchyards help to destroy life by their exhalations, whilst vegetable life may remain dormant yet alive for ages when buried in the earth, may seem unlike enough to each other, but they are really alike, inasmuch as they both show that the earth beneath and around our houses may harbour and preserve organic agents in a condition from which they may arise and prove potent for mischief for periods which are practically indefinite. Finally, Pettenkofer's own words are, " A considerable time, even many years, must pass before the organic matters in the soil are so changed and decomposed that the cholera germ can no longer develop itself when the other necessary conditions

are present." The sewering of Vienna and Munich, he goes on to say, is a most desirable thing ; but he advises us, in the con- tingency of the impending of a cholera epidemic, to put our trust in means which starve the cholera germ by destroy- ing the alkalinity of the sewage. Let us, he might say, by all means avoid any further impregnation of the earth around our dwellings with sewage ; but it would be as foolish for us to expect that by putting sanitary measures and sew- age in force on the spur of the moment we can nullify the impurities which years of neglect have accumulated and infil- trated all around us, as it would be for a repentant drunkard to expect that his fluids and tissues would become instantaneously renovated on the instant of his taking the pledge to total absti- nence. Much good may, it is true, be done even at the moment by abating local nuisances ; but they can only be abated at the moment, they cannot be nullified ; whereas the personal element of a specific poison can be nullified and destroyed in the rejecta- menta by the employment of acidifying disinfectants. Sanitary measures and systems of the kind specified in your article may or may not prove, ultimately, to be omnipotent against epidemics; but if they are to have this power, they must have time allowed . them to acquire it in. The best case may be injured by an over- statement ; and I think it is an overstatement of the virtues of sanitarian reforms to say that towns perfectly sewered and sup- plied with perfectly pure water are perfectly safe against cholera. But the overstatement may become a just statement of the case when we add to it the qualifying clause, "if these arrangements have been at work for a sufficiently long time."

I take this opportunity of saying that Pettenkofer's views, of which, as expounded in his own Zeitschrift fur Biologie, a sketch appeared in the Standard of Monday, August 6, are now acces- sible to the reader of German in a shilling pamphlet, published at Munich, under the joint editorship of himself, of Dr. Griesinger, of Berlin, and of Dr. Wunderlich, of Leipsic, three names of very high rank and authority in German, and indeed in all medical literature.

There is little added in this pamphlet, and nothing that is contradictory to the views which are put out at much greater length in Pettenkofer's Memoirs in the Zeitschrift fiir Biologie, but the following four or five points, specially insisted upon in the smaller publication, deserve notice at the present crisis.

In the pamphlet, which bears we may say the title Cholera Regu- lations, special stress is laid on the importance of employing for the disinfection of sewage some one of the different metallic salts, and particularly for several economic as well as chemical reasons the sulphate of iron, which will keep up in it an acid, in preference to the chloride of lime, which possesses and produces an alkaline reaction. For actual experience has shown that a particular atmosphere is necessary for the life of the cholera germ, and this particular atmosphere is furnished by the alkaline exhalation of decomposing human sewage. The establishment of Observirungs-spitals for persons afflicted with premonitory diarrhoea is recommended in the pamphlet as well as in the papers published in the Zeitschrift. Four per cent. only of persons so affected and so removed to " Houses of Observation " were found to pass on into confirmed cholera—a result sufficiently confirma- tory of the recommendation. But in these days, when English doctors and doctrines differ so widely as to treatment, it is im- portant to say that the Germans, like most of our East Indian practitioners, recommend small doses of opium as the best medicine for precursory symptoms.

That it is now universally allowed that choleraic excreta are the source of the specific cholera germ may be seen from the literary fact that a dispute as to the first discoverer of the all- important fact, " a Prioritals streit," as the Germans call it, has been raging for now more than ten years on the Continent. The safety which, by acting on the obvious corollary of this result and disinfecting their excreta, we can insure to ourselves, is as great as that which a complete (and impossible) quarantine would have secured, or as that which a non-porous, non-springy, non-con- taminating subsoil does actually confer.

The language of the German Professors seems intended to con- vey the impression that drinking water may, when it is impure, favour the spread of cholera rather by its general anti-sanitary powers than by becoming the vehicle for the specific cholera germ. But they do not positively declare themselves, at least in this pamphlet, to be opponents of Dr. Snow's explanation of such facts as those put on record by the Registrar-General in the papers of this day.

Of season and of temperature, as influencing the progress of cholera, our Professors say nothing. But it is obvious that ac-

cording to their views the influence of heat and of cold, which latter we are now hoping for, can count but for little except indi- rectly. Heat promotes evaporation of moisture, and so will in many soils lower the level of the Grundwasser, and it favours certain decompositions which render the soil alkaline, whilst cold works in precisely the opposite direction. And so far, but no. farther, our common opinion is correct. In chilly, and therefore by virtue and help of the Gulf Stream, rainy England, cholera and typhoid fever are summer and fine autumn diseases; but this seasonal distribution does not hold good in by any means all other countries, nor even in this always.

I am happy to be able to say that the system of disinfection so strongly recommended, and carried out with such gratifying results in Germany during the severe epidemic of last year, is being put into operation throughout this city, under the superintendence of Dr. Child, the Medical Inspector of our Local Board of Health. A somewhat similar system of disinfecting has been carried out and, I presume, is still being carried out in Bristol during the present month, and the cholera which broke out there at the beginning of this month seems, according to the Registrar-General's Report of this day, to have ceased there. It is very probable, though possibly not a matter of demonstration, that the attainment of this result has been due to the labours and energy of the two well known medical advisers of Bristol, Drs. Budd and Davies. And it is well to say that both the theory and the practice of the former of those gentlemen have been laid before the public in a small pamphlet, a perusal of which, by showing the almost entire unison and harmony of the advice given by Dr. Budd in the west of England and by Professor Pettenkofer in the south of Germany, ought to prompt the dullest and the most sluggish to follow their recommendations.

For as it seems to me, the system of disinfection as a means of prophylaxis against cholera has at once the strongest scientific and the strongest moral claims upon our attention at the present moment. As to its scientific claims, the theory upon which it is founded reconciles and explains much that was previously obscure, confusing, and contradictory in the otiology of the disease, and in the few cases in which it has as yet been found practicable either in Germany or England to put it to the test of actual experiment, the results which it was predicted would ensue upon its application have actually occurred. In a moral point of view it has even stronger claims upon our attention in a world in which and in a matter in which " probability is the very guide of life." At the preserit moment no other practicable means for prophylaxis on the large scale has even been hinted at.

The otiose scepticism which is content to deny and disbelieve overtly and genially enough, everything which it has never chosen to examine into, becomes at a crisis like the present simply a public offence.

There is a larger and less amusing class of men whose minds are just active enough to make them good at objections without making them good at anything else. On the present, as on most other occasions, such men content themselves with making sug- gestions in the helpful negative shape familiar to them, and they warm into sympathy with investigation only so far as they hope to see our present means for doing good superseded in the progress of discovery, and those who have availed themselves of such imperfect light as they could at the time obtain discredited thus as clumsy bunglers. Such persons are more powerful just now than under ordinary circumstances for provoking anger; in a population which knows itself to be mortal, they are fortunately less powerful for producing mischief.—I am, Sir, your obedient