Papers Relating to Foreign Affairs, Accompanying the Annual Message of the President to the First Session Thirty-ninth Congress
Mr. Morris to Mr. Seward
Sir: I have the honor to acknowledge the reçeipt of despatch No. 92, and to enclose a translation which I have made of a pamphlet in French by Dr. Bozzi, physician to the imperial arsenal, on the contagious properties of Asiatic cholera. The observations of Dr. Bozzi, being founded upon professional experience during one of the most fatal visitations of cholera on record, seem to me to be of sufficient importance to be communicated to the department for the instruction of the American public and medical authorities.
I have the honor to be, very respectfully, your obedient servant,
Hon. William H. Seward, Secretary of State.
Observations on the contagious properties of the Asiatic cholera, and of the absolute necessity of opposing its progress by the most rigid and perfect system of quarantine, suggested by professional experience at Constantinople during the summer of 1865, by Dr. Bozzi, physician to the imperial arsenal; translated for the Department of State by E. Joy Morris, United States minister to Turkey.
Whether the Asiatic cholera is to be contagious or not, is a question of the first importance to the public health of the world. Notwithstanding the many facts demonstrated of its contagious nature, the advocates of the contrary doctrine—and they have thus far been in the majority—have enforced their views in the discussion of measures of quarantine against the invasion of this disease; they have opposed every such measure, as not only incapable of preserving a country from this terrible scourge, but also as inflicting great damage on commercial and industrial interests. Even when quarantine restrictions have been adopted, no regard has been paid to the term of incubation of contagious maladies, nor to other circumstances equally important to be taken into consideration, in order that sanitary measures may produce their proper effect. This is the reason why the cholera has been imported into so many different countries.
The Asiatic cholera was confined for several centuries to its place of origin in Hindostan, and it was only when new and more rapid avenues of communication were opened, and commercial intercourse became more general and easy, that it was enabled to break through the limits imposed on it by nature. In its invading march it has followed with a wonderful [Page 307] fidelity the most frequented and the most convenient routes, turning aside from natural obstacles, and not penetrating where it was opposed by severe sanitary precautions. The German states, by extraordinary expedients, have preserved themselves from the cholera, although it has desolated neighboring countries, from which they are spared only by conventional lines of demarcation. Graves, a careful observer and profound savant, in reference to the invasions of Asiatic cholera, remarks that “it is a very striking fact, and which ought to have great weight in proving the importation of this terrible epidemic, that it has never appeared in any town until the time materially necessary for its arrival from the infected country had elapsed, and it would be easy to show that the facility of its propagation varies according to the rapidity of its means of communication.”
It seems to me unnecessary here to cite the many facts which observers of great merit have published in proof of the contagious properties of Asiatic cholera. Those which have occurred during the present visitation of the cholera are more than sufficient to overthrow all the theories of the non-contagionists, and to remove all further doubt as to its truly contagious nature.
Carried to Mecca by infected pilgrims from India, the pestilence there made unparalleled ravages on account of the conjunction of extremely unfavorable hygienic conditions. It was imported into Egypt by infected Arab pilgrims; into Syria, Cyprus, and Smyrna by fugitives from Egypt, where the fury of the epidemic had caused such a panic among the inhabitants that the steamers were no longer sufficient for the transportation of an emigration which had suddenly taken the most extraordinary proportions.
The cholera was introduced into Constantinople by the Turkish steam frigate Monkbiri-Sourour, which arrived from Egypt the 28th of June, 1865, and from which several cholera patients were sent to the marine hospital. Before the debarcation of these cholera invalids there had not been a single case of cholera at Constantinople. Soon after this event, however, the disease communicated itself in the first instance to the hospital attendants, and subsequently to other soldiers or employés of the navy, who had frequent or constant intercourse with this locality. Following continually the same order of propagation, it extended its ravages into the different quarters of the capital. Thus the military operatives of the arsenal, and the marines, who occupied in common the same barracks, the sentinels, the crews of vessels at anchor before the arsenal, and the inhabitants of the adjacent quarter of Cassim Pacha, all in close proximity to the infected hospital, and in continual intercourse with the personnel of the same, were the first to be attacked by the cholera. Almost at the same time the disease broke out at Yeni-Keny, on the Bosphorus, separated from the first seat of the epidemic by several quarters and villages, and none of which had yet been visited by the cholera.
It was evident that the air had not borne it there; it was, on the contrary, proved that it was a civil operative of the arsenal who first carried the cholera to Yeni-Keny. Mr. Franceschini, of Bologna, has very properly observed that the cholera is introduced by infected persons, and that it does not fall from the clouds.
During the prevalence of the epidemic at Constantinople it was the poorer classes who, from their unwholesome manner of life, suffered most. At the cholera hospital of Conniberhané all of the six military attendants died of the disease. The chief druggist of the engineer school, with his wife and four children, died of cholera. In my service in the two barracks of the imperial Ottoman Maimé all the infirmiérs were attacked by cholera, but almost all were saved.
At the Princes islands an aged lady died of cholera in a chamber which contained several beds. The physicians prohibited the members of the family from sleeping in the chamber until it was disinfected. His injunctions were not heeded. What followed? The daughter of the deceased, her husband, a child, and a maid-servant all soon after also died.
An honorable family of Aleppo, residing at Pera, had given hospitality to a woman and her child; the last was carried off in a few days later by an attack of cholera. The head of the house begged the woman to leave the premises, and he caused the chamber where the child had died to be carefully closed up, but neglected to take the necessary preservative measures. A few days later his youngest son was attacked by cholera, and almost at the same time his wife also, and a domestic, who was employed in the house only during the day, fell ill of cholera. All the necessary hygienic measures were adopted to prevent the other members of the family from taking the disease, and they were successful. Thus this worthy family had the double satisfaction of being, in great part, preserved from the attacks of the epidemic, and of seeing cured all who had suffered from it.
Several philanthropic physicians fell victims to this fearful scourge; their names are engraved in the hearts of the poor, and they have done honor to humanity. In the city I have observed that when the disease broke out in a family the members of it generally were attacked; thus a number of families were entirely destroyed, and others have lost a great part of their members. In the space of a few days only about six hundred keys of houses, in which all the inmates had perished by cholera, were delivered to the authorities. One-quarter of the capital was almost entirely depopulated. The family and servants of a pacha, consisting of twenty-six persons, all died of cholera except three.
These are fearful facts. Do the non-contagionists require more conclusive proof of the contagious character of cholera? In many instances persons living near an infected locality [Page 308] were attacked by cholera when they were in anywise predisposed to the same. It has happened that families which fled from places of summer resort where the cholera was raging to their winter residences in-quarters,-where it had almost ceased to exist, except in isolated and insignificant cases, have been the first to be attacked by the malady, and these have communicated it to a great number of the inhabitants of the same street without spreading further. Two opposite extremities of Talaola were most singularly devastated by the cholera—Arkardja and Agio Athanassi. Arkardja was infected by the family of the engineer Kosti Kalfa, which had returned from Koulely, a village on the Bosphorus, where, the day before their departure, one of their children had died of cholera in a few hours after the disease manifested itself. Agio Athanassi was infected by the families which fled from Threpia, where the pestilence had displayed itself in all its fury. The village of Yeni-Keny underwent three successive invasions. The manner of the first invasion I have already explained; the second and third were produced by the return of the inhabitants of different parts of the town from the country, whither they had fled on the first appearance of the cholera.
In other quarters of the capital the reappearance of the cholera was due to the same causes. These facts again are an additional proof that the cholera does not travel of itself, but that it is carried from place to place by infected human agents, if no impediment be offered to its progress. The radius of action of a cholera centre does not extend very far; but when a number of localities are infected, the contagious miasma may be absorbed by a great number of individuals at the same time, and thus it may take the usual course of epidemic diseases. It is frequently objected against the contagious nature of cholera that many persons who have had constant relations with those affected by it have not been attacked. But did there ever exist a contagious malady which communicated itself to all who came in contact with it? Do not, also, according to general opinion, the most contagious diseases encounter constitutions either temporarily or absolutely refractory? Such immunity is to be explained by peculiar idiosyncrasies or other individual circumstances. The non-contaglonists also insist if the cholera were contagious it would diffuse itself throughout the towns in which it has merely made its appearance. They ask, moreover, why it is that countries which it has traversed have remained exempt, notwithstanding their commercial relations with infected regions? It is easy to refute all these opinions: 1st, we repeat that there are permanent and temporary immunities dependent on the peculiar physical and moral characteristics of individuals which render them unsusceptible of the disease; 2d, the cholera which, it is pretended, was observed on a very small number of persons, was it really the Asiatic cholera? There is nothing to prove it. Is it shown that no measure was taken to prevent the importation of the epidemic? Or, if it was introduced because of the absence of opposition, was no precaution adopted against the first locality attacked? May it not be that the persons near these sites had not the constitutional predisposition to the disease? Is there evidence to show that a considerable number of persons of an uninfected region had frequent, and even constant, intercourse with cholera centres, without being attacked by the disease? No; absolutely no. Such a state of facts has no existence. And even admitting that the epidemic spared certain regions through which it passed, or that it merely manifested itself in them without exercising any ravages, must we necessarily conclude from this that it was not imported, and that it is not contagious? Certainly not; for it has been proven beyond doubt that such localities as are in an excellent hygienic condition are but slightly susceptible of cholera infection. Is it possible, also, that all countries present a combination of circumstances favorable to the propagation and intensity of the disease? When several cases of cholera have occurred in a particular spot, has it not been after the arrival of persons from some infected locality? It may be objected that cases of cholera have sometimes been observed where there was no communication with infected places. This is not satisfactorily proven; but even if it be admitted, it is not at all surprising, for, if isolated cases of cholera have been noticed in certain countries, it is because they have previously been visited by the cholera through importation. Why should we not admit the possibility of the seeds of contagion remaining in a dormant state? Numerous examples show that it is possible for them so to exist for a long period of time. Not a single case of cholera has ever been seen in any place which had not been previously visited by it. The fact of the importation of cholera by human beings being incontestable, its contagious properties follow as a necessary consequence.
Its mode of propagation has given rise to a quarrel of words among medical men. Some insist that Asiatic cholera is disseminated by miasmatic and contagious infection; others, by inhalation; and there are those who would have us believe that it is communicated by the immediate contact of cholera poison contained in the vomitings and evacuations, or by the absorption of a volatile poison emitted by them. (Bund.) Franceschi, of Bologna, is of the opinion that it is generated from cholera matter liable to fermentation, ard which, brought into contact with the putrid atmosphere of an inhabited locality, produces there an analogous fermentation which gives rise to infection and the disease. Others finally regard it only as a spontaneous infection united with the local influences. All these different modes of accounting for the propagation of cholera are, I repeat, but a quarrel of words; but this quarrel may have very grave consequences. If we obstinately refuse to see in these facts anything else than evidences of spontaneous infection, we shall be disposed to abandon preservative [Page 309] measures, and the isolation which can alone prevent the introduction and extension of the Asiatic cholera.
Where a malady has manifested itself after the introduction into a country of an undeniable cause of miasmatic disengagement, (degagement)—if persons exposed have been immediately attacked, as facts have demonstrated, or if, transported and dispersed in various places, they have, in their turn, become the sources whence a malady of the same nature has diffused itself in such localities, can there be any doubt of the contagious nature of this kind of disease? To deny evident facts, and lose one’s self in abstract explanations, is an abandonment of the only road which leads to the discovery of truth.
Thus the researches of Pettenkofer upon the influence of the sun, and the interpretations of Schoenheim, generalized by Stermer, having for an object to prove that the cause of the propagation of the cholera is the diminution of atmospheric ozone, are the product only of chimerical imaginations, and which cannot have any weight when confronted with the array of facts proving that the disease is introduced by importation.
From the preceding exposition the following inferences may be deduced:
1st. Asiatic cholera can only be produced spontaneously in Hindustan—its place of birth. It is only there that the special causes of soil and climate exist which periodically have developed it for several years.
2d. If Asiatic cholera makes its appearance in any other country, it is an evidence that it was brought there either by emigrants, pilgrims, or by passengers all alike infected. Certain matters, susceptible of impregnation by contagions miasma, and for its retention for a considerable period of time may also diffuse the disease, unless very strict measures of prevention are adopted against them.
3d. Asiatic cholera has always, in its march of invasion, followed the most rapid lines of communication, and those which render commercial intercourse men easy and frequent.
4th Persons in the immediate vicinity of a cholera locality, and who are in constant intercourse with those under the influence of the disease, are much more liable to be attacked than those at a distance, or who, having but occasional relations with such a site, adopt the hygienic precautions which have a recognized efficacy.
5th. A grave responsibility in future must rest upon those intrusted with the quarantine services. It is desirable that sanitary physicians should be men of experience, and without preconceived ideas; such as have passed years in the practical observation of diseases, and not in meditating theories, and in losing themselves frequently in the field of illusions.
6th. With regard to the time of duration of the incubation of contagious maladies, it is indispensable that the quarantine isolation of persons should be fixed at twenty-four days, and the same term should be re-imposed again in cases of death. Inanimate and infected organic matter, and which may for a long time preserve the seeds of contagion, should be treated with extreme precaution, and efficient means be employed to destroy the seeds of disease with which it is impregnated. Too great rigor cannot be used in such cases.
Honor to the men who do not fear to sacrifice every possible interest in order to preserve the health and life of the nations.
To corroborate, in the most striking manner, what we have said on the advantages of rigid quarantine restrictions in resisting the invasion of cholera, we subjoin the following facts of recent occurrence:
Several maritime towns on the coast of the Ottoman empire having established strict quarantines against the recent cholera invasions, have been preserved from the epidemic, notwithstanding the extraordinary affluence of emigrants arriving from Turkish towns where it was raging. One of these exempted cities, Salonica, has had several mortal cases of cholera in its lazaretto, but the disease could not penetrate within the town, because of the wise and rigorous measures adopted against it. Greece has likewise been saved from the cholera by a similar course of action. In Italy also, wherever prudent and severe anti-cholera restrictions were established, the epidemic did not make its appearance, while in those towns where no such antagonistical measures were adopted this scourge of humanity has exhibited itself in its most desolating aspects.