A PARTING GLANCE AT THE CHOLERA.
IT is reported of a patient, that in silent dudgeon, he unex- pectedly rose and left his couch, while his astonished physicians were in grave consultation over him ; and the cholera seems gliding away as unceremoniously with the muggy September Weather, leaving the doctors utterly at fault as to the precise na- ture and origin of the malady. In this stage of the disorder, and before the scene for this turn closes on the pestilence, it may be permitted to the plain logic of common sense, founded on the incidents of the expiring visitation, to attempt a solution of some of its chief perplexities. From the bias of theory and routine it frequently happens that the learned professions, whether medical or legal, will in their endeavours to explain a phienomenon em- barrass themselves with recondite conjectures, overlooking the simple truth that lies on the surface before them. Thus, in the cholera mystery, two investigators detected, or imagined they had detected, (for other observers, not less scrutinizing in their microscopical researches, have not been so successful,) in the ejecta of the disease, certain cells identical with those found in the vitiated air of cesspools ; all which might be scientific and true, having the obvious explanation, that from similar compounded matte; similar results will arise : but the question immediately occurred, why ? what was it that, under like conditions, induced the formation of the fungoid cells, if fungoid they were ?—for others who believe they have detected the cells are not agreed as to the species. Had this explanation been af- forded, the world would have been brought nearer to a compre-
hension of the generation of cholera : as it is, Messrs. Swayne and Brittan can only claim to have observed an effect or an ac- companiment of the malady, not its original predisposing Cause; and the effect they observed is not confined either to cholera or cesspools. Therefore let us try by analogy, and in non-medical terms, to approximate nearer to the long-wished-for desideratum, and by solving the enigma relieve the age from one of its most distressing terrors. The human stomach, as most persons are aware, is an apparatus of varying susceptibility : it differs in the young and old, in the full and fasting, in summer and winter, on land and at sea, in a hot moist atmosphere and in one dry and gelid, in places open and salubrious, and in those crowded, uncleanly, or ill-ventilated. It is also very apprehensive of good or ill, judicious or unskilful treatment : if overloaded or irritated, either by the quantity or quality of the viands taken, it tries to right itself by the forcible expulsion of its contents ; and if this course of ill-treatment has been long continued or often repeated, a state of extreme irrita- bility is produced, and the convulsive efforts it makes to restore an equilibrium between the powers of digestion and the aliment to be digested are proportionately augmented and violent. Like a generous steed, it will often bear much and long, but it rebels at last ; and the intensity of the reaction will be commensurate to the preexisting causes of neglect, annoyance, or oppression.
What is here sought to be explained in somewhat figurative terms has been experienced in different degrees by most persons who have attained middle age; and if applied to the history or cholera, will go far to explain its apparently complex phtenomena, as manifested in its attacks on different classes of society, its en- demic or epidemic visitation in particular seasons, and the other circumstances just indicated, favourable or adverse, tending to in- fluence the force of stomachic action. Fatal cases of cholera n every year doubtless form a fractional portion of the annual mortality ; but when limited to a few individuals or families they do not arrest public attention. The great fall victims to them from luxurious excess, irregularities of living, mental anxiety, or constitutional debility ; the poor, more especially from low diet, bad air, intem- perance, and overpeopled habitations. In lieu of being individual or local, the visitation may be more prevalent, extending through an entire country, or different countries simultaneously or in sac- cession, and be induced by more general causes,—by adverse seasons, that deteriorate or lessen the staple food of nations,- or by a hot, humid, or other unhealthy condition of the atmosphere. Any of these causes, it is notorious, will produce general debility in the digestive powers; and if severe and protracted, may occasion such extreme irritability of the stomach and bowels as to give rise to the aggravated type of cholera denominated the Asiatic or spasmodic, whose convulsive agonies are so overpower- ing and prolonged, that from mere exhaustion the sufferer sinks under them.
Apply this exposition to the cholera that now seems to have nearly spent its force on the range of victims predisposed to its in- roads by the causes mentioned,—just as every winter destroys the animal and vegetable life unable to withstand its inclemency,— and we shall find that it satisfactorily explains its most remarkable features during the current year. The affluent have fallen victims to it in common with the indigent, because in one class as in the other are persons with a disordered, neglected, or debilitated digestion. Even men eminent in medical science have sunk under it ; and for the same reason, that there are among them indi- viduals just as reckless of health as others, or who trust too much to the power of art in case of need to save or relieve them. Secondly, its ravages have not been limited to places reputedly unhealthy : it has been severe in the Isle of Wight, at Margate, at Erith, and other localities; and why ? Because there are in these favoured spots, as elsewhere, persons who live intempe- rately or unwholesomely, and thereby incur with others the esta- blished penalties for defying Nature's sanative admonitions. It has even raged on Goodwin Sands; and for this reason, that ships are not remarkably healthy places, and from excess, neg- ligence, or unsuitable regimen, disordered stomachs may assail their inmates, despite of the counteraction of sea-breezes. Bir- mingham is said not to have had above half a dozen indigenous cases of cholera ; and many other places might doubtless be enu- merated not less fortunate, and the reason of exemption not diffi- cult to assign. Probably, from some retarding or counteractive condition of such localities, they are not yet ripe for it; and they may be visited next year, or the year after. In London the dis- ease has not been half so destructive as in Paris ; and this dis- crepancy may be explained by the consideration, that the French capital, in proportion to its size, is a city of more thronged and promiscuous resort, dissipation, and indulgence, than that of England.
From Germany, Italy, Spain, Portugal, and canal-streaked murky Holland, little or nothing has been heard of the unusual prevalence of cholera. How is this? Does it not negative the poetical descriptions with which mankind have been amused or alarmed—how the disease is occasioned by an insidious and myste- rious atmospheric current, charged with the miasma of death, which periodically makes the tour of the globe from East to West like an avenging demon? Were this so, is it not strange that while Moscow and Petersburg, London and Paris, have been visited, the vast intervening territorial range of Germany., Greece, and Italy, have escaped? It is the extremes and quick vicissitudes of physical condition that cholera most affects: hence the German States, the Italian Peninsula, and the Mores, may have been unvisited, while the fast-living go-ahead popu- ]ations of England, France, New York, New Orleans, and the precariously-fed inhabitants of Muscovy and Ireland, have been victimized. If any morbific poison be borne on the wings of the wind from the far East, why then, as Dr. Arnott has sensibly remarked in the Times, it cannot be of extreme virulence, for those in sound and vigorous health invariably resist the attacks of the invader. But the atmospheric theory of a baneful current is radically untenable. It is contrary to the ascertained "law of storms" : no atmospheric current ever travels round the globe, or half round it ; the spicy gale that wafts over the Indus or the Ganges never reaches the banks of the Seine or the Thames. Currents of air, as late meteorological observations have fully established, are circular, not rectilinear, and the range of their evolutions are circumscribed within orbits of no great diameter.
By divesting cholera of its mystery, we disarm it of half its terrors and noxious power. The more our experience of its nature is enlarged, the more fully it appears to be established that it is not a new malady of the human species—that it is not conta- gious—that it is not a local or class disease—and that it is not periodical; but governed by laws of intensity and recurrence similar to those that ordinarily determine in typhus and other epidemic maladies the state of individuals and communities. Were we required to state in one proposition the cause of cholera, de- duced from the preceding retrospect, we should say at once, that it is occasioned by impaired or overmatched digestive powers, produced by the quantity or quality of the nutriment taken for a brief or continuous antecedent period ; and that its attacks are aggravated or accelerated by impure air, uncleanliness, deficient exercise, mental anxiety, or other adventitious circumstances known to influence the general health.
Severe cases of cholera have been known to be induced in healthy subjects without premonitory symptoms, simply by a single instance of subjection to prolonged fatigue and inanition, and then a hasty indulgence of too miscellaneous or too stimula- tive a repast. The cases of the two unhappy Chartists, who lately and almost simultaneously died of cholera in the prisons, afford a forcible and practical illustration. Chagrin, water- gruel, sudden transition to inaction, and close confinement, appear to have destroyed them.
Cholera, we conclude, is a complaint of the stomach or bowels, or both, aggravated, it may be, in its European symptoms by the conditions and extremes of modern civilization. But this last is a conclusion we should be slow to admit: the visitations of the plague, to which disease it is analogous, if not identical in type, were more frequent and fatal in their ravages. In 665, after a remarkably dry summer, a destructive pestilence depopulated the island : during twenty years this scourge continued to visit and revisit the provinces of Britain and Ireland. Another desolation of the same kind, that continued for three years, decimating all ranks and degrees, occurred in 897. The great plague of Edward the Third's reign is supposed to have carried off half the na- tion: London especially felt its violence, there being in one year 50,000 persons buried in one churchyard, now the site of the Charterhouse. In the year 1500, the enormous number, consider- ing the then diminutive population of the capital, of 30,000 people, were swept off in London by the pestilence ; and Henry the Seventh, with his court, fled to Calais to escape it. Again in 1548, we read that Edward the Sixth and his court were obliged to remove to Hatfield to escape the great plague raging in London. At this visitation the filthiness of the city was thought, for the first time, to have something to do with producing the epidemic ; And the town-ditch was ordered to be cleaned at the expense of the City Companies. This, too, was the opinion of the learned Erasmus a little later; who traced the frequent plagues of Eng- land to the "dirty and slovenly habits of the inhabitants," and to their wooden houses, that projected forward as they rose in height, keeping out the "sunshine and air from the street be- neath."
Without continuing lower, to more dreadful but better-known examples of pestilence, we can find nothing in the attacks of cholera since isn to match these hastily grouped antecedents of the vanishing disease.
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