Ce qu’il y’a d’extraordinaire c’est que ceux qui fatiguent leur raison pour lui faire rapporter de certains événements à des vertus occultes n’ont pas un moindre effort à faire pour s’empêcher d’en voir la véritable cause.
It has been attempted, in the preceding part of this work, to prove, on general principles, and by a reference to analogous objects, that atmospheric contagion cannot exist; but, lest that object should appear unaccomplished, and that the data are insufficient for the conclusion proposed, it is purposed to test the merits of the question by the consideration of the history and phenomena of disease.
Those circumstances, connected with the appearance and propagation of disease, on which the doctrine of atmospheric contagion rests, will be inquired into, and their weight and importance duly ascertained. This inquiry will be prosecuted as if no such investigation as the preceding had been made, and as if the existence of that agency was not irreconcilable with well ascertained laws; and, for the sake of argument, the possibility of its existence will be conceded.
The facts in the history of disease, which are held as lending countenance to the doctrine of atmospheric contagion—of proving its existence, are, chiefly, the general prevalence of disease at one and the same time among the members of the same family, of the inhabitants of the same town, district, and country,—its affecting the visitors and attendants of the sick,—and its observation in places hitherto healthy, shortly after communication with those ravaged with the distemper. These facts cannot be denied; and all that can be done is to weigh their value, as proofs of the existence of atmospheric contagion, and the first mentioned will occupy our attention.
The widely-spread prevalence of disease at the same time among the inhabitants of a country or district, is almost invariably held as affording proof of the presence and operation of atmospheric contagion.
The ravages of pestilence, rapid, wide, and deadly, are noticed in the histories of all nations, and at intervals they have been experienced during the long period of the existence of the world; and the destruction of whole armies, and the annihilation of entire nations, prove how widely spread its operation has sometimes been.
Did the circumstance of disease being widely spread prove its propagation by atmospheric contagion, then the matter were at rest; but the propriety of such an inference is questionable.
Let it be supposed that there is prevailing, in a district of country, disease to a great amount, that is to say, many cases of the same distemper.
That single circumstance proves nothing in reference to atmospheric contagion, more than to any other probable cause of disease. It shews, merely, that there is in wide operation some cause or causes of sickness; and it is totally unwarrantable to conclude that one agency, more than another, is the efficient cause, without further information directly bearing on the subject.
It is with the knowledge of the single fact, and in total ignorance of others, or with total blindness to them, that atmospheric contagion is pronounced to be the active agent.
Now it is not the peculiar property, the exclusive prerogative of that principle, to cause disease; at least, that character has not been openly sought by its advocates, though the tone of common conversation, and of medical writings on the subject, would seem to imply that it had been tacitly granted.
That cannot be conceded. Many other agencies are known to be productive of sickness, and have, on many occasions, induced pestilence of a deadly character, that has ravaged in no despicable limits.
The isolated fact itself of disease being widely extended in the absence of particulars, after proving that some cause existed, should legitimately go to create a suspicion, that the cause or causes which had produced the first cases, and acted as the ordinary springs of the malady, were continuing to operate on other individuals. Such would be known to be capable of producing the effect observed, for the satisfactory reason, that it or they had already accomplished it. How much more wise, under such circumstances, it would be to suspect the continuance of that influence with the continuance of effects identically the same as it or they had already produced, than to call in a principle whose only evidence of existence was the presence of effects, the same as had been only a short time before produced by a different agency, and of whose removal or absence there was not a particle of proof.
But a little inquiry will, on most occasions, elicit the fact, that some pestiferous influences exist; and it will, in general, be soon enough to pronounce on the probable causes of a distemper after that investigation has been made.
Disease in general, unconnected with alterations in the texture of the organs, is neither more nor less than a derangement of the functions performed by the body; and as it partakes of a general or local character, so the disease is either local or general; and, as it relates to functions, more or less important, so it is more or less dangerous.
It must be obvious, that a machine so nicely balanced, so complicated and so exquisitely wrought as the human body, must be liable, on many occasions, to have its operations impeded and deranged; and, although sometimes said to be a little world of itself, still, it is dependent on surrounding agencies. It requires a pure atmosphere for respiration, food to supply the waste it continually suffers, and drink to appease thirst, and to take the place of the fluids that are constantly draining from it.
The human body is necessarily brought in contact with the external world; and many are the injuries it suffers therefrom, both directly and remotely.
The derangements of the functions of the body are in general owing to circumstances of an unwholesome character, for the most part relating to food, drink, the various steps in nutrition, the atmosphere, its temperature, dryness, moistness, purity, &c. &c., and chemical and mechanical agents, to whose action the body is exposed.
Were it not for the operation of unfavourable circumstances of the nature specified, a body in health, were no special interposition of the Almighty hand made, would go on in the healthy performance of its functions, till the frailty and decay, incident to old age, would overtake it.
In general those diseases which are observed to prevail to a great extent, and over a large tract of country at the same time, are so uniformly coincident with circumstances of an unwholesome tendency, connected with those agencies above referred to, that they appear at once to the candid and unprejudiced inquirer, to stand in the relation of cause and effect. Surely it should cause no difficulty, nor occasion any necessity for the calling in a principle, atmospheric contagion, without any other evidence, that those effects are occasionally found not confined to one spot merely, but are seen developed in an extended sphere—for, assuredly, it can require no extraordinary effort of the mind to conceive that the agent acting and causing disease in one place, or individual case, may with equal force, and with a like result, act in many situations, and in respect to many persons.
The presence of certain operations in several situations by no means proves that they have reproduced themselves.
Day-light is manifest in many countries, within certain latitudes at the same hour, but it has never been suggested that this circumstance in one of them has been propagated by that of another, through any occult principle, or whatever else such an agency may be called.
Had the case not presented at once, and in so direct and striking a manner, a sufficient cause for the effects observed, then we doubt not, that, perhaps, individuals would relieve themselves of any present difficulty, and attribute what they could not readily explain, to the operation of a principle having as little evidence of its entity as atmospheric contagion itself. But the sun is too glorious, too resplendent an object to be overlooked, and its effects are too immediate, to permit the possibility of the most unreflecting, not marking its relation as cause to the effect observed.
But, unfortunately, the relation between widely spread diseases or epidemics, as they are called, and circumstances connected with the agencies before referred to, is not so striking—though it is as close. There is no object so bright to draw the same attention to it, and to proclaim it from east to west, from the dawn of morning till the fall of evening, like that luminary dispersing light as he appears to traverse the heavens.
Yet there is room to believe that the presence of epidemics is always accompanied, or shortly preceded, by circumstances, which, though by reason of their less striking character, and less immediate operation, are sometimes overlooked or neglected, yet do exist, and, were inquiry made by those able for the purpose, doubtless would be found.
In most of the epidemics recorded, some such agencies or circumstances were in operation. They were known to be so—and in almost all that have come under our own observation, and they have neither been few nor carelessly noted—there have, on nearly every occasion, been found the influences to which we allude.
We are led to believe an agent to be the cause of an effect when the one follows upon the operation or presence of the other, uniformly, and on every occasion, when the latter bears some relation in its amount to the force and length of duration of the former—and when the effect ceases with the removal of the agent. Such a close connection, as subsists in that case, entitles the former or agent to be held as the cause of the effect observed.
For those very reasons day-light is said to be the effect of the sun that comes with it, remains with it, and goes with it.
Let us see if the same connection holds with disease and those agencies and circumstances we have cursorily referred to.
Those agencies and circumstances, relating to food, drink, air, heat, contagious matter, &c. &c. are known to present themselves, and with them are presented diseases. They are known to remain, and with them are known to continue diseases. They are known to disappear, and with them all the world knows diseases disappear also.
These being the causes of epidemic or widely spread disease, as such a connection proves, it is altogether superfluous to admit the operation of atmospheric contagion, whose existence has never been known, but by the very circumstances which it is said to bring about.
It is surely most unwise, when we see disease arising with the existence of unwholesome circumstances, such as scarcity of food, unwholesome quality of it, great vicissitudes of weather, uncommon conditions of the atmosphere, want of sufficient clothing or incommensurate with the severities of the season, the operation of depressing passions, and the like,—growing with their intensity—extending where they extend—abating where they decrease—and finally disappearing when they disappear—to refuse to grant the relation as cause and effect, and to plunge into the tide of difficulties such ill-timed incredulity creates, with nothing but the appearance, nothing but the assurance, of an object to grasp at.
In general, such a connection can be made out between the existence of wide-spread disease and such circumstances.
If, in respect to some diseases, so intimate a connection cannot be observed, the probability is, that it is the obscurity connected with these subjects, the less direct way in which they operate and the remote time at which their effects may be experienced on the body, that are the occasion of the difficulty. The human body, unlike mere inanimate matter, has the power of withstanding, at least for a time, the operation of unwholesome influences, if not very virulent; and it is only natural to allow, that, in respect to a machine so complicated, affected by so many agencies, and standing in so many relations, there will be less complete directness of operation, than with simple or inanimate substances, and more variety in the amount and duration of the effect.
On these accounts, the indications of the case are less direct and obvious, and it should cause no great surprise, that being considered, and the fact of the imperfect state of our knowledge on the varieties of the agencies referred to, being kept in mind, that the causes of disease cannot at all times be completely and satisfactorily ascertained.
Our knowledge of the derangements of health, from the operation of these agencies, on some of which we are dependent, and with others of which we are constantly brought in contact, is fast increasing, and the relation between the former and the varieties in the latter is becoming clear and precise. There is, therefore, reason to hope that difficulties which now baffle us, will soon be explained away, and that much of that mist that has long overhung the causes of pestilence, will soon be dissipated.
Certain circumstances produce certain uniform effects, and in every instance where they are operating, their effects will be produced, provided no agency is acting adequate to neutralize them. Not one hill only, in northern latitudes, has its summit whitened with snow, nor does sterility mark a few spots only in the immense deserts of Africa and Asia.
The same features are spread far and wide. They owe their existence to agencies acting in immense spheres corresponding with their own.
The sphere of those circumstances connected with the agents so often referred to, that produce disease, is sometimes large, and no astonishment need be felt, if that of disease is also large, since a relation ever holds between the extent of a cause and its effects.
It would certainly be ample time to call in the assistance of atmospheric contagion to account for the propagation of disease, when its sphere or circle is found to be positively eccentric of that of those circumstances alluded to.
But we are satisfied that such a contingency is of very rare occurrence, and even when it is said to exist, we shall require some undoubted assurance that the non-correspondence is not the result of ignorance of the extent of these hurtful circumstances, rather than the actual absence of relation between them.
It is not our intention at present to enlarge on the causes of disease, yet we maintain, that such a relation as that referred to, will in almost every instance be made out, if candid and efficient inquiry be instituted; so that, even granting that atmospheric contagion exists, there can be no room for its operation. And we are of opinion, that if, in some extraordinary instance, no such relation can be detected, the progress which every department of science is making will in time achieve what may not be accomplished at present.
The history of nations and the records of medicine shew, that, coincident with epidemic sickness, there have, for the most part, been noticed certain circumstances operating which were prejudicial to the welfare of the human body. For example, famine, bad or unwholesome food, great and long continued droughts, great rains followed by intense heat, sudden vicissitudes of weather, dissipation, irregularities, depressed state of mind, insufficient clothing and fuel, and unwholesome water.
These, and many similar circumstances known to prevail in the haunts of pestilence, must exert a great, a very powerful, influence on the human body, and, when the question of the probable causes of its diseases is mooted, it argues a strange and discreditable blindness to obvious facts, to overlook the part which they must exert in their production; and a strong and dangerous partiality to a questionable principle, to attribute the whole calamity to atmospheric contagion.
Few points have been held so conclusive of the existence of atmospheric contagion, as the circumstance of the attendants and visitors of the sick being attacked with the same distemper, during, or shortly after, their communication.
It is vain to deny, that where a person is ill of a disease, such as fever, that those about him, the members of his family, his attendants, and his visitors, are sometimes attacked with the same distemper.
Such is a common occurrence, but common as it is, it cannot prove that the efficient cause is atmospheric contagion.
Were it established that atmospheric contagion existed in that individual disease, and in that individual case, then it might be admitted that the circumstance did lend some countenance to the supposition, and should perhaps entitle the case to examination.
But it has never been shown that that principle positively exists. There is, as has already been observed, no proof, saving that drawn from the very circumstances for which it is called in to account.
Thus it is entitled to no exclusive respect.
Here is then an agency, of whose existence there is no evidence of a sufficient nature, and here there is reason to believe that the same circumstances are operating widely, and upon the relatives, the attendants, and visitors of the sick, which have already produced the disease in those visited.
These circumstances, in general, are ascertained to be acting upon these individuals, and where they cannot, from their obscure nature, be recognised, there is reason, from the very circumstance of the sick having been affected, to conclude that they are operating, though perhaps in an insidious way. Now, a question arises, whether it is wisest to attribute the prevalence of disease among those holding communication with the sick, to the operation of atmospheric contagion, or to those circumstances and agencies which caused the disease originally, and which there is room to believe are exerting their influence over them also.
It has been said in the preceding chapter, that, during the prevalence of widely spread or epidemic disease, there are generally found circumstances of an unwholesome tendency, favouring its career, and that the range of their action corresponds with that of pestilence. That being the case, as it undoubtedly is, it would be proper, before admitting the operation of atmospheric contagion, to shew that no such circumstances were in operation. An inquiry would be necessary; and their presence being proven, it would not be short of imbecility to attribute to that agency, effects such as are wont to follow their action. It would be to call in a principle whose existence has never been proven, and which, therefore, must be held as at least doubtful, to account for phenomena, the ordinary results of circumstances present, which would indeed be absurd.
Before the operation of atmospheric contagion could with propriety be entertained, it behoved to shew that those circumstances which induced disease in the visited, were not operating with those holding communication with them.
But in all those cases in which atmospheric contagion is held as acting, no attempt is made to prove such absence, and the belief in its presence is not the less strong because these circumstances can be proved to be present.
It is a self-evident truth that some agency or agencies, totally independent of atmospheric contagion must have been in operation, and acting as the cause of disease in the first case or cases that occurred. For this ample reason, that, for atmospheric contagion to exist at all, it is obviously necessary that disease pre-existed, since it is the product of disease, and of disease only.
Thus, then, it is proved, that some causes, totally independent of atmospheric contagion, produce the first cases of an epidemic, or widely spread disease. Now, there is no evidence that these same causes are not operating upon those who visit the sick, and in absence of any facts to the contrary, and of the operation of an equally active and undoubted agent, there is justice in thinking it probable that they are acting, more especially if the self-same results are manifested—and this may, with safety, be done, even when direct testimony cannot be obtained—which is very seldom entirely the case.
The causes of the disease being widely extended, and the visited patient being ill from the operation of forces shared in common with many, it is only fair to conclude that as relatives, attendants, and visitors are like the great mass of people thus operated upon—that they, cæteris paribus, are as likely to be affected with the prevalent disease, as those who are suffering were previous to its invasion.
They do suffer, but not in general in a greater proportion than other persons having no communication, and similarly situated in other respects.
It would be ample time to look for the operation of some other agency in addition to those commonly experienced, when the portion of the community, holding communication with the sick, is affected with disease in a greater proportion than that portion having none.
Now, with a few exceptions, it is the result of much patient investigation, not only into the experience of others, but of many epidemics we have had the most ample means of noting, that, in general, in respect to diseases held to be propagated by atmospheric contagion, those who have communication with the sick, do not suffer in a greater proportion than those who keep apart, but remain in the sphere in which the agencies and circumstances are operating, which produced the first cases.
These exceptions are—
These exceptions will meet with a little consideration, in order to shew in what manner, and wherefore, those persons are seized in greater proportion, and to prove that it is not in consequence of atmospheric contagion.
This statement is important, and is made cautiously, and only after the most detailed examination, and unprejudiced weighing of evidence.
The facts which have led to that conclusion might be detailed, but, as they would occupy much room, and perhaps prove uninteresting to the general reader, they will be withheld, however, to be produced, if any sufficient objections be made.
That statement is contrary to common belief, which attributes disease in a much greater proportion to those communicating with the sick, than to those keeping apart; but that is not of much consequence, since implicit reliance is not to be placed upon the opinions on that subject, held either by the public or the medical profession.
On the whole, disease does affect, in a greater ratio, those who communicate with the sick, than those who do not, the instances which we excepted being included. But the difference, on the whole, is very trifling, at least much less than is usually supposed.
One of the reasons that the difference is thought to be much more than is actually the case, is, that every case of a visitor or attendant being affected with disease, after or during communication, is bruited about, and becomes the subject of much gossip; while that of hundreds, equally exposed, who escape, is treated very judiciously with silence. There is no impartial hearing of evidence. All that is heard is taken in favour of one side, and instead of an opinion being formed from the whole bearings of the case, one is got up on partial statements, which, however, as it agrees with preconceived notions, answers very well.
But that is not the way in which a case so important should be treated. Be it hoped that medical men, at least, will take more enlarged views, when their own reputation and the public weal are at stake.
The partial statements remind us strongly of the self-deception of which many persons are the dupes, in respect to fortune-telling and the solving of dreams. Every instance of the divination of the fortune-teller, or the solution of a dream, having any, the most far-fetched, correspondence with the future history of the individual, is stored up in the memory, and adduced as undeniable evidence of the truth of those dark arts, however much a thousand facts may cry out against them as vile impositions. The prognostications must, of necessity, be right sometimes, in much the same manner as Louis the 14th declared those astrologers must at some time be correct, who were constantly foretelling his death.
We now proceed to inquire into the circumstances which cause disease to attack those having communication with the sick, in a greater proportion than is observed to hold with those apart from them, yet living in the sphere of the epidemic causes, that is, generally speaking, in the same locality.
Exception 1st, The greater proportion in which relatives and others inhabiting the same house with one sick of disease, are attacked, we would explain in this manner:—
1st, The relatives, if inhabiting the same locality, are, like others, liable to the disease.
They are suffering in general under depression from apprehension of losing a dear friend.
They are, perhaps, under an apprehension that they themselves may be affected with the same distemper. They may have a dread of atmospheric contagion, or, as is often the case, may have a presentiment of fatal sickness.
They are irregular in the time of taking diet—have often no appetite—are deprived of their night’s rest—maintain long and anxious watchings—and are in general in that feverish state of mind that precludes the possibility of taking due rest.
They are deprived of their wonted exercise in the open air, and of that elasticity of mind and body which it imparts.
They respire an atmosphere, though not contagious, often, and especially in the houses of the poor, deprived of its oxygen or more important principle, and tainted with the admixture of adventitious vapours or gases arising from the excretions, and perhaps the fermenting of impurities often found collected on the skin.
It would be wonderful, where there is a widely-spread disposition to disease, say to fever, if members of the same family, inhabiting the same house, in which one of them lay ill of that distemper, did not take ill, seeing how much they are exposed to it.
Nor is it to be thought extraordinary that relatives living in the same locality, but in different houses, or even in different villages, should take the disease also after visiting the house of a sick friend. What has been stated will sufficiently explain that occurrence.
Here it will perhaps be permitted to make a slight digression to mention a fact which has given much credit to the doctrine of atmospheric contagion,—the simultaneous invasion of fever among relatives, living together, in different houses, in different villages, and in very different parts of the country. We are aware of several extraordinary instances, where from ten to twenty of the same family were ill, at the same time, of fever, several of whom were living far apart.
It is in vain to think of atmospheric contagion being the cause. Possibly that notion might be entertained in reference to those living together, and having communication,—but cannot possibly apply to those in remote and different parts of the country. We know of instances where a family has been seized with fever in our village, and members of the same, living at great distances, forty and sixty miles, have suffered the same distemper at or nearly at the same time, without any communication having subsisted, either by person, by packets, or by letter.
These extraordinary circumstances speak of something more than atmospheric contagion. That could not possibly have extended to those relatives who had no communication; and it is remarkable that, in those instances, disease did not go as with the other members of the community, attacking at leisure, now this, now that one, but almost on the same day, many different members of the same family.
We have sometimes thought, from the consideration of such circumstances, that there is something like a community of disposition causing members of the same family to be similarly affected by like agents, more than subsists between men who are unconnected:—something like an idiosyncrasy, which goes to make them suffer after the same fashion.
There are such things as family characters, family idiosyncracies, family dispositions, family peculiarities of bodily conformation, and family temperaments; and may there not exist some family disposition, to be similarly affected by like circumstances?
The case appears well worthy of philosophical inquiry, something beyond the untenable puerilities of Mesmerians.
2d Exception.—Visitors and attendants are liable to increase their ordinary chance of taking the prevalent distemper, by touching the body or clothes of the sick, when he labours under a disease marked by a palpable contagious poison. Though the poison cannot be diffused through the air, it may, and sometimes does, act by contact, which we call contactual or immediate contagion. That, of course, can operate in those diseases only in which a palpable poison is eliminated. Those diseases are in this country chiefly small-pox, chicken-pox; the plague, if it can now be said to be a disease of this country; the itch; and, as is commonly believed, measles, scarlet fever, &c. &c.
Though the propagation of these diseases may take place from contact with their peculiar contagious matters, we are disposed to think, that, at least with most of them, especially the latter, the cases which occur in that way are very few.
It is sometimes difficult to produce disease, even when the skin is cut, and the matter is then introduced. That step sometimes fails in respect to cow-pox matter, even when fresh; and small-pox matter we have known to be in contact with the tips of the finger for a minute or so, in innumerable cases, as in feeling the pulse, and no disease has followed. Women affected with small-pox bear healthy children.
Almost the only diseases which we are disposed to think are propagated by contact with the person or clothes of the sick, are small-pox, chicken-pox, scabies, plague, &c. They all possess palpable matters in abundance.
Many instances are known to us, where children have got small-pox, and of grown-up people who have got itch, from sleeping with those sick of these distempers, and thus coming in contact with them closely, and for some time; and where they have not been seized with them, when only breathing the same atmosphere used by those sick.
Thus visitors and attendants may get disease by contact with palpable contagious matter, that is, by contactual contagion, and by touching clothes impregnated with the same, that is, by fomitic contagion, which they would not have taken, had they merely been respiring the air used by the patients.
3d Exception.—The visitors, and those in general holding communication with the sick, are also liable to be affected more with disease than others who remain free of it, on account of the sorrow usually felt on all occasions of public calamities, and particularly of very mortal pestilence, and more especially experienced in all its acuteness, in the silent sick-room of a friend.
Among the scenes our professional duties call us to witness, there is, perhaps, none so touching as the sorrow-striken countenances of friends, directed to the sick, nay, perhaps the deathbed of one they love; and we have noted the unspeakable sorrow then felt, the deep anguish then experienced, and the silence more touching than eloquence that reigns throughout the sick-room, as an awful contemplation, truly indicative of a depression that is calculated to throw its sufferers into the same situation which they so much deplore in others.
That sorrow attendant on such calamities, and that was so well marked, when cholera lately assailed the nations of the earth, throws into the shade almost every other form, sinks deep into the soul, and enervates every principle of life. It gives a pall to every taste, a disregard to all enjoyment, deprives the unhappy victim of that serenity and composure so favourable to health, and, on the contrary, imparts a restlessness to body and mind, until at length his system becomes a very nidus of disease.
None who have attentively watched the course of widely-spread disease, can doubt that that sorrow, so generally experienced on those occasions, is an active instrument, and a strong abettor of the original epidemic influences. It must be obvious to them, that those strong and deeply-felt emotions, with which man contemplates his relatives, his neighbours, aye, his very race, falling around him,—feeling, too, that he is in the midst of danger, and can do nothing for his security,—must produce a withering influence on the most vital functions of the body, and prove the immediate cause of disease.
Under such circumstances, when disease manifests itself, it certainly cannot be wise to disregard the part they must enact in the production of the effect observed, and to attribute the whole, or nearly the whole, to the operation of atmospheric contagion, which has already been shewn to be without sufficient evidence of its existence, in any one case, or in any one disease.
The visitors, also, are exposed to the action of an atmosphere, which, as it is sometimes impure, is liable to be hurtful.
4th Exception.—That of the attendants in Fever Institutions. It has often been remarked, that in some fever institutions the nurses and medical clerks resident in the house, are attacked with fever in a much greater ratio than holds with the population around. The difference has been seen on some occasions to be very great, and from information collected on the subject, we are disposed to think, on some occasions, and in reference to some institutions at least, that the statement is correct. That fact has been attributed to atmospheric contagion; and we shall proceed to inquire if it is not more likely that it is dependent on other circumstances which are operating, and that are known to be adequate for the effect observed.
The history of the Royal Infirmary of Edinburgh, and of Queensberry House, an institution for the reception of fever patients, shews that on some occasions almost all the clerks and nurses waiting upon those affected with fever, have been seized with it also.
And it would appear to be owing to some agency peculiar to fever patients or their wards; for in regard to the first-mentioned institution, it is ascertained that it is with those attendants only, who wait upon those patients, that the greater amount of sickness is experienced. Those attendants exclusively occupied in the surgical wards being attacked in no greater proportion than those unconnected with the institution.
This is certainly an important fact, and one on which the advocates of atmospheric contagion are wont to place no small weight. Did that principle exist, there is perhaps no fact in the whole history of medicine, on which we would place more reliance in proving its operation, for it is self-evident that nothing relating to the general unwholesomeness of the institution can be entitled to much activity in this case, for any insalubrious tendency of its situation, of the soil on which it stands, or emanations therefrom, and of the general economy and discipline, cannot be confined in their operation to one apartment or ward, cannot possibly be experienced in the fever wards only.
But an occurrence of this kind is apt to be too readily received and made the ground of many inferences. In itself it certainly is a strong, a cogent fact, and such as naturally leads the mind to believe, that, as some very potent agency is at work, it may be that of atmospheric contagion, which in alleged activity is surpassed by none.
Before proceeding to explain the occurrence, on principles very different from atmospheric contagion, it is right to say that it is such as does not occur in connection with all such institutions; and that, if the case which has been stated, proves it is likely such a principle as contagion is present in these institutions, that others of a directly opposite nature, and as much to the purpose, can be produced to shew, granting the possibility, that it is not present in other institutions, much larger.
By physicians of the first eminence, such occurrences as that referred to in connection with the Royal Infirmary of Edinburgh, are held as decisive proof of the operation of contagious atmosphere.
Dr Alexander Tweedie, a physician of London, and one justly eminent, after mentioning the self-same cause, goes on to say, in a sufficiently assured tone,—“No statement more conclusive, as to the contagious nature of fever, need be adduced: and if such facts will not lead to conviction, the mind of such a sceptic must be strangely constructed indeed.”
The case had been made much stronger, and would have stood inquiry much better, had Dr Tweedie shewn, that the occurrence he treats of was not solitary or uncommon, but was such as is wont to be observed in all like institutions.
He should have known, that it is not from extraordinary, nor even from unique cases alone, that knowledge is to be obtained, nor laws deduced, of the ordinary characters, and action of disease. It is dangerous to deduce inferences, and construct laws, from the knowledge of one circumstance, and where, too, many can be obtained bearing on the case.
Let us see if this occurrence holds with other establishments. We will find that it by no means always holds.
Dr Bateman, who saw much of fever, and gave it much of his active consideration, in his excellent Treatise on Contagious Fever, says,—“During the fourteen years, in the course of which I have almost daily been in contact with persons labouring under contagious fever, not only myself, but all the nurses have been preserved from infection, with one exception, down to the period of the present epidemic” (in the London House of Recovery).[3]
3. Bateman on Contagious Fever, p. 154. 1818.
Similar cases of exemption might be given, but it seems unnecessary to say more here.
But though Dr Bateman’s evidence in a manner meets the case recorded, connected with the Royal Infirmary of Edinburgh, yet it does not disprove its correctness; and we proceed to explain what has been held as only to be explained by the presence of atmospheric contagion.
But though the case could not at present be explained, we deny that one such circumstantial piece of evidence should outweigh the many facts, and the results of reasoning, that have been laid before the reader, and that are yet to follow.
When evidence is contradictory, it is well to ascertain on which side it preponderates; and even when it is nicely balanced, which is not the case here, it should be tested by a reference to general principles. That was done in the first part of this work, and the reader cannot have forgotten the result.
We are disposed to think, that the great prevalence of fever among the nurses and resident medical attendants of fever institutions, and fever wards in general hospitals, which does occasionally occur, is, in no small degree, owing to the particularly great contamination of the atmosphere, which is liable to take place from the peculiarly strong tendency there is in the body of those labouring under fever, especially of the low or typhoid character, to run to putrescence.
The body, it is ascertained, so afflicted, is particularly prone to putrefaction, as is sufficiently attested by the presence of black spots upon the surface, sordes upon the teeth and gums, and the general appearance of corruption, often sufficiently manifest.
The secretions and excretions are marked at first by a putrid character, and in a short time they are in an active state of putrefaction. In that state, chemical changes take place, gases are evolved, such as nitrogen, hydrogen, carbureted hydrogen, phosphureted hydrogen, singly and combined, forming for instance ammonia, which is a combination of hydrogen and nitrogen: they become mingled with the atmosphere, and impart to it pestiferous qualities.
In fever, the body is much more prone to run into the state of putrefaction, than when in health, or even when affected with merely local disease. The whole system is then affected, the whole functions are deranged, the decayed parts of the blood and solids are not removed, nor are they corrected by admixture with new and purer elements obtained from the products of digestion. The correcting influence of exercise is lost, and likewise the assistance it gives to the due performance of the various secretions; and it need not cause surprise that a body so situated, for days and weeks, becomes at length prone to putrefaction.
It will perhaps be argued, that the same corruption or contamination of the air is as likely to take place in the surgical wards, where patients are kept having sores, &c. But in those wards, in general, there is not the same amount of tendency to putrefaction. Their health is often excellent, their functions are often not at all deranged, and their bodies, in general, are not more prone to putrefaction than those in health.
There are, to be sure, a multitude of sores and the like, but, as long as they are healthy, and the matter is good, there is no risk of their injuring the air, provided they are kept tolerably clean.
Healthy matter is a bland and innocent fluid, not more prone to putrefaction than healthy blood. When healthy, matter may be present in an apartment or ward in abundance, without the least injury being felt by those respiring the atmosphere in the room in which it is contained, as the history of surgical hospitals amply proves.
But as soon as matter, by any means, becomes of a bad character, acrid, fretting, unkind, and prone to putrefaction, then it sends forth gases, and perhaps, compound agents, produced by their combination, which mingle with the atmosphere, impart to it most virulent properties, and thus produce havoc among the various patients, as great, as well marked, and as dreadful as those sometimes observed among the attendants of fever patients, from the supposed operation of what has been considered atmospheric contagion.
Wounds are much connected with the state of the general health. Where that, by any means, is affected in a serious manner, the wound takes on an unhealthy aspect, and the matter, which before was bland, becomes acrid and irritating. If the body is affected with a putrid taint, then the matter takes on the same, and from the emanations spoken of, disease spreads around the ward.
That dreadful disease, called hospital gangrene, was some years ago a common affection in military hospitals, from effluvia, and inattention to ventilation; and it was common to observe healthy wounds taking on a sphacelating character, from such causes. Sir John Pringle says, “I have seen instances of it (hospital fever), beginning in a ward, where there was no other cause, but one of the men having a mortified leg.”[4]