Asiatic cholera in Bristol in 1866 / by William Budd.

  • Budd, William, 1811-1880.
Date:
[1867?]
Catalogue details

Licence: Public Domain Mark

Credit: Asiatic cholera in Bristol in 1866 / by William Budd. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    'W I companying Map b, which, at my request, my friend Mr. Davies has filled up for me, in illustration of the , outbreak. The twenty-six red dots to be seen on the map mark the site of the twenty-six cases of cho- ’ lera already referred to. The first thing that strikes i attention in regard to them is their wide-spread and ■ very scattered distribution. In the lower levels, at ! least, there is scarcely any district that has not its ired plague-spot. To use the words of Mr. Davies, i the city has been tried by the enemy at almost i every point. In fourteen of the number, the red. dots stand alone. These fourteen were all cases in which dis- i infection was actively put in force from the first, and which remained absolutely barren and without issue. In twelve cases, the red dots are accompanied by one, two, or three, and in one instance by as many as four, green ones. The green are the offspring of tthe red. They belong to cases in which, for the most jpart, from some cause or other, some delay—in one 'or two, indeed, considerable delay—occurred in the : application of the disinfecting plan, and in which tthe first case was followed by one or more cases of i cholera or choleraic diarrhoea in the same house. In tthree instances, but in three only, the disease was conveyed to an adjoining house; in two others, to a I house in the neighbourhood. I need hardly say how much these last cases add tto the weight of the evidence. For, had all remained asterile, it might have been plausibly argued, that tour exemption from an epidemic in Bristol was not cdue to the measures taken to prevent it, but to some ; peculiarity in the cases, or to the excellence of our ssanitary condition. So far from this was the truth, j tthat the moment any failure occurred in the prompt | sapplication of these measures, the distemper showed II its old tendency to spread. Of the second group of cases, marked by the green ■ dots, eight ended fatally—making twenty-nine deaths i: in the whole. The green and red dots together, to the number : cof forty-nine, mark the sum total of cases of cholera |-which have occurred in this town in the present year. The one important feature for us, in the map be- Iffore us, is its great dissimilarity to other published I tmaps of cholera outbreaks. It is well known to •those who are versed in the literature of this subject, •that great numbers of cholera maps exist, constructed con this same plan. I myself possess a goodly collee- jttion; and in their one essential character, to be pre- sently named, they all differ entirely from this one. ^Indeed, as far as I know, there is no extant map of cholera which at all resembles it. Many city out- Ibbreaks there have been, no doubt, with even fewer cases in proportion to the population; but I caunot :at present call to mind one in which there have been •at once so many distinct and wide-scattered centres of infection, and so little local infection following lupon them. A3 there is nothing like contrast to put results of this kind in their true light, I have appended to this :map a map of a former outbreak of cholera in Bristol !)—that of 1832. Unfortunately, there are no maps of the outbreaks of 1849 and 1854; but, had such maps been made, they would have presented, with the variation in point of numbers specified in a former page, exactly the same general features as 'this one. The 1832 map exhibits in a striking degree the peculiar feature to which, in the memorandum I ad- dressed in 1803 to the Calcutta Cholera Commission, I drew attention as characteristic of them all.* The red dots, instead of being scattered in an isolated * Vide Memoranda on Cholera. way, and with wide intervals between, over the in- habited area, as in Map b, occur here in dense clus- ters, representing so many cholera-fields, in each of which they lie “ thick as leaves in Yallombrosa”.* This, as I have elsewhere shown, so far from being an accident, has its root in the very essence of the disorder. It springs from the fact—common to this and a large group of other contagions diseases—that the contagious germs, from being cast off in a liquid vehicle, necessarily, in the first instance, impregnate the soil around the infected man, and propagate the disease by infecting the ground. The contrast between these two maps is striking enough as it stands; but the contrast between the facts in the two cases was even greater than here appears. For the forty-nine dots, green and red in Map b, represent the sum total of cases; whereas the three hundred and sixty-six dots in Map a repre- sent infected houses only, and stand for at least double, if not three times, their number of infected people. Each map may be best read by the light of the other. In general terms, b may be described as a map of cholera with the seed destroyed, and, as a consequence, robbed of its offspring; a, as a map of cholera with the seed cast loose and allowed to fruc- tify. Of the two, it is difficult to say whether the one, as illustrating the natural law of propagation, or the other, as illustrating the frustration of this law by human interference, be the more interesting. It is impossible not to be struck with the force and beautiful simplicity of the evidence, as thus pre- sented. Pick up the first man who passes in the street, and, with one or two explanatory hints, he shall read the phenomena as readily as the phy- sician who has followed all the steps of the in- duction by which their true interpretation has been reached. I do not disguise from myself, indeed, that a very specific objection may be plausibly laid, in limine, against the view here taken of these results. Appended to this paper is a document with which Mr. Davies has kindly furnished me, and in which that gentleman has given, in a tabular form, the principal conditions amid which the individual cases occurred. On looking down the column headed “ Water Supply”, it will be seen that the great ma- jority of the sufferers—three-fourths of the whole, to speak more precisely—drew their drinking-water from the Company’s pipes, or, in other words, were supplied with water free from the possibility of sewage-contamination.f Those who hold that drink- ing-water is the only or even the chief medium for the dissemination of the cholera poison, may, therefore, fairly argue that we owe our exemption from an epi- demic visitation in Bristol, not to the use of dis- infectants at all, but to the purity of this important element. It must not be forgotten, indeed, that in seven of the cases, the drinking-water used was well-water; and that, in three of the seven, it formed the supply of crowded courts. But as, in all seven, Mr. Davies very properly shut ofF this water as soon as he had cognisance of the facts, these cases were from that * This map was copied for me by Mr. I.avars, of this city, from a map which illustrates a Government “ lteport on the Sanitary Con- dition of Bristol and other Large Towns,” hy the late Sir H. De la Ueclie. The red dots only give tho sito of cholera in Bristol and Clitton. For a complete view of the epidemic, some lifty or a hun- dred moro, distributed in the same clustered manner, would have to he added for Bedminster. + I took, on public grounds, an activo part in the formation of the Bristol Water Works Company, uud was a member of the first Board of Directors. Two conditions were made by me a sine qua non of my joining the Board : 1. That the water should he drawn irom sources beyond tho possible reach of sewage contamination : 2. That it should he distributed under the constant pressure system.