Part 4

There are also innumerable instances which prove the communication of cholera, by individual cases of the disease, in the most convincing manner. Instances such as the following seem free from every source of fallacy.

I called lately to inquire respecting the death of Mrs. Gore, the wife of a labourer, from cholera, at New Leigham Road, Streatham. I found that a son of the deceased had been living and working at Chelsea. He came home ill with a bowel complaint, of which he died in a day or two. His death took place on August 18th. His mother, who attended on him, was taken ill on the next day, and died the day following (August 20th). There were no other deaths from cholera registered in any of the metropolitan districts, down to the 26th August, within two or three miles of the above place; the nearest being at Brixton, Norwood, or Lower Tooting.

The first case of decided Asiatic cholera in London, in the autumn of 1848, was that of a seaman named John Harnold, who had newly arrived by the Elbe steamer from Hamburgh, where the disease was prevailing. He left the vessel, and went to live at No. 8, New Lane, Gainsford Street, Horsleydown. He was seized with cholera on the 22nd of September, and died in a few hours. Dr. Parkes, who made an inquiry into the early cases of cholera, on behalf of the then Board of Health, considered this as the first undoubted case of cholera.

Now the next case of cholera, in London, occurred in the very room in which the above patient died. A man named Blenkinsopp came to lodge in the same room. He was attacked with cholera on the 30th September, and was attended by Mr. Russell of Thornton Street, Horsleydown, who had attended John Harnold. Mr. Russell informed me that, in the case of Blenkinsopp, there were rice-water evacuations; and, amongst other decided symptoms of cholera, complete suppression of urine from Saturday till Tuesday morning; and after this the patient had consecutive fever. Mr. Russell had seen a great deal of cholera in 1832, and considered this a genuine case of the disease; and the history of it leaves no room for doubt.

The following instances are quoted from an interesting work by Dr. Simpson of York, entitled “Observations on Asiatic Cholera”:—“The first cases in the series occurred at Moor Monkton, a healthy agricultural village, situated to the north-west of York, and distant six miles from that place. At the time when the first case occurred, the malady was not known to be prevailing anywhere in the neighbourhood, nor, indeed, at any place within a distance of thirty miles.

“John Barnes, aged 39, an agricultural labourer, became severely indisposed on the 28th of December 1832; he had been suffering from diarrhœa and cramps for two days previously. He was visited by Mr. George Hopps, a respectable surgeon at Redhouse, who, finding him sinking into collapse, requested an interview with his brother, Mr. J. Hopps, of York. This experienced practitioner at once recognised the case as one of Asiatic cholera; and, having bestowed considerable attention on the investigation of that disease, immediately enquired for some probable source of contagion, but in vain: no such source could be discovered. When he repeated his visit on the day following, the patient was dead; but Mrs. Barnes (the wife), Matthew Metcalfe, and Benjamin Muscroft, two persons who had visited Barnes on the preceding day, were all labouring under the disease, but recovered. John Foster, Ann Dunn, and widow Creyke, all of whom had communicated with the patients above named, were attacked by premonitory indisposition, which was however arrested. Whilst the surgeons were vainly endeavouring to discover whence the disease could possibly have arisen, the mystery was all at once, and most unexpectedly, unravelled by the arrival in the village of the son of the deceased John Barnes. This young man was apprentice to his uncle, a shoemaker, living at Leeds. He informed the surgeons that his uncle’s wife (his father’s sister) had died of cholera a fortnight before that time, and that, as she had no children, her wearing apparel had been sent to Monkton by a common carrier. The clothes had not been washed; Barnes had opened the box in the evening; on the next day he had fallen sick of the disease.

“During the illness of Mrs. Barnes, her mother, who was living at Tockwith, a healthy village five miles distant from Moor Monkton, was requested to attend her. She went to Monkton accordingly, remained with her daughter for two days, washed hey daughter’s linen, and set out on her return home, apparently in good health. Whilst in the act of walking home she was seized with the malady, and fell down in collapse on the road. She was conveyed home to her cottage, and placed by the side of her bedridden husband. He, and also the daughter who resided with them, took the malady. All the three died within two days. Only one other case occurred in the village of Tockwith, and it was not a fatal case.” (p. 136.)

“A man came from Hull (where cholera was prevailing), by trade a painter; his name and age are unknown. He lodged at the house of Samuel Wride, at Pocklington; was attacked on his arrival on the 8th of September, and died on the 9th. Samuel Wride himself was attacked on the 11th of September, and died shortly afterwards. These comprise the first cases.

“The next was that of a person named Kneeshaw, who had been at Wride’s house. But as this forms one of a series connected with the former, furnished by Dr. Laycock, who has very obligingly taken the trouble to verify the dates and facts of the latter part of the series, it will be best to give the notes of these cases in that gentleman’s own words.

“‘My dear Dr. Simpson,—Mrs. Kneeshaw was attacked with cholera on Monday, September 9th, and her son William on the 10th. He died on Saturday the 15th; she lived three weeks; they lived at Pocklington. On Sunday, September 16th, Mr. and Mrs. Flint, and Mr. and Mrs. Giles Kneeshaw, and two children, went to Pocklington to see Mrs. Kneeshaw. Mrs. Flint was her daughter. They all returned the same day, except Mr. M. G. Kneeshaw, who stayed at Pocklington, until Monday, September 24th, when he returned to York. At three o’clock on the same day, he was attacked with cholera, and died Tuesday, September 25th, at three o’clock in the morning. [There had been no cholera in York for some time.] On Thursday, September 27th, Mrs. Flint was attacked, but recovered. On Saturday, September 29th, her sister, Mrs. Stead, came from Pocklington to York, to attend upon her; was attacked on Monday, October the 1st, and died October the 6th.

“‘Mrs. Hardcastle, of No. 10, Lord Mayor’s Walk, York, was attacked with cholera on October 3rd, and died the same day. Miss Agar, residing with her, died of cholera on October 7th. Miss Robinson, who had come from Hull to take care of the house, after the death of Mrs. Hardcastle and Miss Agar, was attacked, and died on October 11th. Mr. C. Agar, of Stonegate, York, went to see Mrs. Hardcastle on October 3rd, was attacked next day, and died October 6th, early in the morning. On Monday, October 8th, Mrs. Agar, the mother of Mr. C. Agar, was attacked, and on the same day, one of the servants; both recovered. They had lived with Mr. Agar. All the above dates and facts I have verified.

“‘I am, dear Dr. Simpson, yours very truly, “‘T. LAYCOCK.

“‘Lendal, December 1st, 1849.’” (p. 160.)

Several other instances of the communication of cholera, quite as striking as the above, are related in Dr. Simpson’s work.

The following account of the propagation of cholera has been published, along with several other histories of the same kind, in a pamphlet by Dr. Bryson.

“Mr. Greene, of Fraserburgh, gives the following account of the introduction of cholera into two villages in Scotland. Two boats, one belonging to Cairnbulgh and the other to Inveralochy, met at Montrose, and their crews on several occasions strolled through the town in company, although aware that it was at that time infected with cholera. On their passage homeward, they were obliged to put into Gourdon, where one man belonging to the Cairnbulgh boat died on the 22nd of September, after an illness of fourteen hours, with all the symptoms of cholera. Several of the men of both boats were at the same time attacked with serous diarrhœa, of which three of them had not recovered when they reached their respective homes; nor indeed until the first cases of the epidemic broke out in the villages.

“In Inveralochy the first case appeared on the 28th of September, three or four days after the arrival of the boat; the sufferer, the father of one of the crew, had been engaged in removing the cargo along with other members of his family. Two other cases occurred in this family; one on the 30th of September, and one on the 1st of October.

“In Cairnbulgh, the first cases appeared on the 29th and 30th of September respectively, and both patients had also been engaged in removing the cargo of the boat (shell-fish) belonging to that village. No other cases appeared until the 3rd of October; so that from the 28th of September to the 3rd of October none were attacked in either village, but those who had come in contact with the suspected boats, or their crews.

“The subsequent cases were chiefly among relatives of those first attacked; and the order of their propagation was as follows. In Inveralochy, the first case was the father of a family; the second, his wife; the third, a daughter living with her parents; the fourth, a daughter who was married and lived in a different house, but who attended her father and mother during their illness; the fifth, the husband of the latter; and the sixth, his mother. Other cases occurred at the same time, although they were not known to have communicated with the former. One of them was the father of a family; the second his son, who was seized the day after his father, and a daughter the next day.”

The following instances of communication of cholera are taken from amongst many others in the “Report on Epidemic Cholera to the Royal College of Physicians”, by Dr. Baly.

“Stockport. (Dr. Rayner and Mr. J. Rayner, reporters). Sarah Dixon went to Liverpool, September 1st, to bury her sister, who had died of cholera there; returned to Stockport on September 3rd; was attacked with cholera on the 4th; was taken home by her mother to her mother’s house, a quarter of a mile distant; was in collapse, but recovered. Her mother was attacked on the 11th, and died. The brother, James Dixon, came from High Water to see his mother, and was attacked on the 14th.

“Liverpool. (Mr. Henry Taylor, reporter.) A nurse attended a patient in Great Howard Street (at the lower part of the town), and on her return home, near Everton (the higher part of the town), was seized, and died. The nurse who attended her was also seized, and died. No other case had occurred previously in that neighbourhood, and none followed for about a fortnight.

“Hedon. (Dr. Sandwith, reporter.) Mrs. N. went from Paul, a village close to the Humber, to Hedon, two miles off, to nurse her brother in cholera; the next day, after his death, went to nurse Mrs. B., also at Hedon; within two days was attacked herself; was removed to a lodging-house; the son of the lodging-house keeper was attacked the next day, and died. Mrs. N.’s son removed her back to Paul; was himself attacked two days afterwards, and died.”

It would be easy, by going through the medical journals and works which have been published on cholera, to quote as many cases similar to the above as would fill a large volume. But the above instances are quite sufficient to show that cholera can be communicated from the sick to the healthy; for it is quite impossible that even a tenth part of these cases of consecutive illness could have followed each other by mere coincidence, without being connected as cause and effect.

Besides the facts above mentioned, which prove that cholera is communicated from person to person, there are others which show, first, that being present in the same room with a patient, and attending on him, do not necessarily expose a person to the morbid poison; and, secondly, that it is not always requisite that a person should be very near a cholera patient in order to take the disease, as the morbid matter producing it may be transmitted to a distance. It used to be generally assumed, that if cholera were a catching or communicable disease, it must spread by effluvia given off from the patient into the surrounding air, and inhaled by others into the lungs. This assumption led to very conflicting opinions respecting the disease. A little reflection shews, however, that we have no right thus to limit the way in which a disease may be propagated, for the communicable diseases of which we have a correct knowledge spread in very different manners. The itch, and certain other diseases of the skin, are propagated in one way; syphilis, in another way; and intestinal worms in a third way, quite distinct from either of the others.

A consideration of the pathology of cholera is capable of indicating to us the manner in which the disease is communicated. If it were ushered in by fever, or any other general constitutional disorder, then we should be furnished with no clue to the way in which the morbid poison enters the system; whether, for instance, by the alimentary canal, by the lungs, or in some other manner, but should be left to determine this point by circumstances unconnected with the pathology of the disease. But from all that I have been able to learn of cholera, both from my own observations and the descriptions of others, I conclude that cholera invariably commences with the affection of the alimentary canal. The disease often proceeds with so little feeling of general illness, that the patient does not consider himself in danger, or even apply for advice, till the malady is far advanced. In a few cases, indeed, there are dizziness, faintness, and a feeling of sinking, before discharges from the stomach or bowels actually take place; but there can be no doubt that these symptoms depend on the exudation from the mucous membrane, which is soon afterwards copiously evacuated. This is only what occurs in certain cases of hæmorrhage into the alimentary canal, where all the symptoms of loss of blood are present before that fluid shows itself in the evacuations. In those rare cases, called “cholera sicca,” in which no purging takes place, the intestines have been found distended with the excretion peculiar to the disease, whenever an examination of the body has taken place after death. In all the cases of cholera that I have attended, the loss of fluid from the stomach and bowels has been sufficient to account for the collapse, when the previous condition of the patient was taken into account, together with the suddenness of the loss, and the circumstance that the process of absorption appears to be suspended.

The symptoms which follow the affection of the alimentary canal in cholera are exactly those which this affection is adequate, and, indeed, could not fail to produce. The analyses which have been made of the blood of cholera patients, show that the watery fluid effused into the stomach and bowels is not replaced by absorption, or is replaced only to a small extent. The analyses of Dr. O’Shaughnessy and others, during the cholera of 1831–32, show that the amount of water in the blood was very much diminished in proportion to the solid constituents, and that the salts of the blood were also diminished. The analyses of Dr. Garrod and Dr. Parkes, in the spring of 1849, were more numerous and exact. The amount of water in the blood of healthy persons is on the average 785 parts in 1000; whereas, in the average of the analyses performed by Drs. Garrod and Parkes, it was only 733 parts, while the amount of solid constituents of the blood, relatively to the water, was increased from 215—the healthy standard—to 267. The globules, together with the albumen and other organic constituents of the serum, amount in the healthy state to 208 parts in 1000, while in the blood of cholera patients they amounted to 256 parts. The saline constituents in 1000 parts of blood are somewhat increased, on account of the great diminution of water; but, when estimated in relation to the other solid ingredients, or to the whole quantity existing in the healthy body, the amount is diminished. Dr. Garrod is of the opinion that a chemical analysis will determine whether or not a specimen of blood has been derived from a cholera patient.

The stools and vomited matters in cholera consist of water, containing a small quantity of the salts of the blood, and a very little albuminous substance. The change in the blood is precisely that which the loss by the alimentary canal ought to produce; and, indeed, it is physically impossible that the alteration in the blood can be caused in any other way. The sweating which takes place in an advanced stage of the disease may increase the density of the blood to a trifling extent; but it does not come on till the blood is already altered, and it is only a consequence of the diminished force of the circulation, like the sweating met with in collapse from hæmorrhage or severe injuries, and in faintness from venesection.