Letters on the Cholera Morbus. Fergusson William

Pt_1 [Pg 5] views, in which that public is concerned, ought to be declared as soon as discovered. To show how erroneous some of the data are from which people are likely to have drawn conclusions, is the main cause of my wish to occupy the attention of the public; and in doing this, it is certainly not my wish to give offence to respectable persons, though I may have occasion to notice their errors or omissions.

      Previous to proceeding to the consideration of other points, it may be observed, that all doubt is at an end as to the identity of the Indian, Russian, Prussian, and Austrian epidemic cholera; no greater difference being observed in the grades of the disease in any two of those countries, than is to be found at different times, or in different places, in each of them respectively. At the risk of being considered a very incompetent judge, if nothing worse, I shall not hesitate to say, that if the same assemblage, or grouping of symptoms be admitted as constituting the same disease, it may at any time be established, to the entire satisfaction of an unprejudiced tribunal, that cases of cholera, not unfrequently proving fatal, and corresponding in every particular to the average of cases as they have appeared in the above countries, have been frequently remarked as occurring in other countries including England; and yet no cordon or quarantine regulations, on the presumption of the disease spreading by "contagion." For my own part, without referring to events out of Europe, I have been long quite familiar, and I know several others who are equally so, with cholera, in which a perfect similarity to the symptoms of the Indian or Russian cholera has existed: the collapse—the deadly coldness with a clammy skin—the irritability of the stomach, and prodigious discharge from the bowels of an opaque serous fluid (untinged with bile in the slightest degree)—with a corresponding shrinking of flesh and integuments—the pulseless and livid extremities—the ghastly aspect of countenance and sinking of the eyes—the restlessness so great, that the patient has not been able to remain for a moment in any one position—yet, with all this, nobody dreamt of the disease being communicable; no precautions were taken on those occasions "to prevent the spreading of the disease," and no epidemics followed. In the Glasgow Herald of the 5th ult., will be found a paper by Mr. Marshall, (a gentleman who seems to reason with great acuteness), which illustrates this part of our subject. This gentleman appears to have had a good deal of experience in Ceylon when the disease raged there, and I shall have occasion to refer hereafter to his statements, which I consider of great value. Nobody can be so absurd as to expect, that in the instances to which I refer, all the symptoms which have ever been enumerated, should have occurred in each case; for neither in India nor any-where else could all the grave symptoms be possibly united in any one case; for instance, great retching, and a profuse serous discharge from the bowels, have very commonly occurred where the disease has terminated fatally: yet it is not less certain, that even in the epidemics of the same year, death has often taken place in India more speedily where the stomach and bowels have been but little affected, or not at all. To those who give the subject of cholera all the attention which it merits, the Pt_1 [Pg 6] consideration of some of those cases which have, within the last few weeks, appeared in the journals of this country, cannot fail to prove of high interest, and must inspire the public with confidence, inasmuch as they show, beyond all doubt, that the disease called cholera, as it has appeared in this country, and however perfectly its symptoms may resemble the epidemic cholera of other countries, is not communicable. On some of those cases so properly placed before the public, I shall perhaps be soon able to offer a few remarks: meanwhile, I shall here give the abstract of a case, the details of which have not as yet, I believe, appeared, and which must greatly strengthen people in their opinion, that these cholera cases, however formidable the symptoms, and though they sometimes end rapidly in death, still do not possess the property of communicating the disease to others. I do not mean to state that I have myself seen the case, the details of which I am about to give, but aware of the accuracy of the gentleman who has forwarded them to me, I can say, that although the communication was not made by the medical gentleman in charge of the patient, the utmost reliance may be placed on the fidelity of those details:—

      Thursday, August 11th, 1831, Martin M'Neal, aged 42, of the 7th Fusileers, stationed at Hull, was attacked at a little before four a.m., with severe purging and vomiting—when seen by his surgeon at about four o'clock, was labouring under spasms of the abdominal muscles, and of the calves of the legs. What he had vomited was considered as being merely the contents of the stomach, and, as the tongue was not observed to be stained of a yellow colour, it was inferred that no bile had been thrown up. He took seventy drops of laudanum, and diluents were ordered. Half-past six, seen again by the surgeon, who was informed that he had vomited the tea which he had taken; no appearance of bile in what he had thrown up; watery stools, with a small quantity of feculent matter; thirst; the spasms in abdomen and legs continued; countenance not expressive of anxiety; skin temperate; pulse 68 and soft; the forehead covered with moisture. Ordered ten grains of calomel, with two of opium, which were rejected by the stomach, though not immediately.

      Eight o'clock a.m. The features sinking, the temperature of the body now below the natural standard, especially the extremities; pulse small; tongue cold and moist; a great deal of retching, and a fluid vomited resembling barley-water, but more viscid; constant inclination to go to stool, but passed nothing; the spasms more violent and continued; a state of collapse the most terrific succeeded. At nine o'clock, only a very feeble action of the heart could be ascertained as going on, even with the aid of the stethoscope; the body cold, and covered with a clammy sweat, the features greatly sunk; the face discoloured; the lips blue; the tongue moist, and very cold; the hands and feet blue, cold, and shrivelled, as if they had been soaked in water, like washerwomen's hands; no pulsation to be detected throughout the whole extent of the upper or lower extremities; the voice changed, and power of utterance diminished. He replied to questions with reluctance, and in monosyllables; Pt_1

       [Pg 7] the spasms became more violent, the abdomen being, to the feel, as hard as a board, and the legs drawn up; cold as the body was, he could not bear the application of heat, and he threw off the bed-clothes; passed no urine since first seen; the eyes became glassy and fixed; the spasms like those of tetanus or hydrophobia; the restlessness so great, that it required restraint to keep him for ever so short a time in any one position. A vein having been opened in one of his arms, from 16 to 20 ounces of blood were drawn with the greatest difficulty. During the flowing of the blood, there was great writhing of the body, and the spasms were very severe—friction had been arduously employed, and at ten a.m. he took a draught containing two and a half drachms of laudanum, and the vomiting having ceased, he fell asleep. At two p.m. re-action took place, so as to give hopes of recovery. At four p.m. the coldness of the body, discoloration, &c., returned, but without a return of the vomiting or spasms. At about half-past eight he died, after a few convulsive sobs.

      On a post-mortem examination, polypi were found in the ventricles of the heart, and the cavæ were filled with dark blood. Some red patches were noticed on the mucuous membrane; but the communication forwarded to me does not specify on what precise part of the stomach or intestinal canal; and my friend does not appear to attach much importance to them, from their common occurrence in a variety of other diseases. It remains to be noticed, that the above man had been at a fair in the neighbourhood on the 9th (two days preceding his attack), where, as is stated, he ate freely of fruit, and got intoxicated. On the 10th he also went to the fair, but was seen to go to bed sober that night. The disease did not spread to others, either by direct or indirect contact with this patient.

      Now let us be frank, and instead of temporising with the question, take up in one hand the paper on "cholera spasmodica" just issued, for our guidance, from the College of Physicians by the London Board of Health, and in the other, this case of Martin M'Neal (far from being a singular case this year, in most of the important symptoms)—let the symptoms be compared by those who are desirous that the truth should be ascertained, or by those who are not, and if distinctions can be made out, I must ever after follow the philosophy of the man who doubted his own existence. The case, as it bears on certain questions connected with cholera, is worth volumes of what has been said on the same subject. Let it be examined by the most fastidious, and the complete identity cannot be got rid of, even to the blue skin, the shrivelled fingers, the cold tongue, the change in voice, and the suppression of urine, considered in some of the descriptions to be found in the pamphlet issued by the Board of Health, as so characteristic of the "Indian" cholera;