Observations on the influence of epidemics of fever in checking the advance of those of cholera / by Robert Lawson.

  • Lawson, Robert.
Date:
[1870]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the influence of epidemics of fever in checking the advance of those of cholera / by Robert Lawson. 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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    IN CHECKING THE ADVANCE OF THOSE OF CHOLERA. By Robert Lawson, Inspector-General of Hospitals. Though much has been said and written in support of different opinions as to the means by whicli epidemics of cholera were diffused, comparatively little attention has been paid to the courses these pursued, or to the causes which seem to have influenced their progress from time to time, and to have ulti- mately turned each into the particular track which it followed. It is obvious that, as the acquaintance with the natural history of the disease increases, the application of the theories so eagerly supported at present by many epi- demiologists will be narrowed more and more, and a point will ultimately be reached where, with a knowledge of causes as yet little heeded, rational expla- nations may be given of much that now seems unaccountable. The object of this communication is to contribute to the attainment of so desirable an end, by directing attention to a characteristic feature in the relations of fever to cholera. While investigating the course of pandemic waves, I became aware of the influence epidemics of fever exercise in cheeking the advance of those of cholera, and vice versd. Fever has frequently prevailed over an extensive area, and though cholera, also embracing a large area, approached the other, yet, while the fever continued, epidemic cholera, as an epidemic, has never penetrated the fever field. Sporadic cases of cholera have frequently been met with a long way within tlie boundary of the fever field, and similarly cases of fever within that of cholera, but still the fact remains that, though the fever and cholera fields approached each other, neither disease took the place of the other until its force as an epidemic was broken. This ftxct sanctions the inference that the conditions which generate fever epidemics are not only different from those which produce epidemics of choleia, but are also incompatible with them ; and further, that sometimes the one set of conditions, sometimes the other, exists over a largfe area of the earth's surface, and that the one will give way to the other without any marked change in the habits or circumstances of the population these, areas embrace. The importance, therefore, of I'ightly estimating the influence exercised by one of these diseases over the diffusion of the other is obvious. In the following relation, I have given, briefly, the course of cholera epidemics from India noi-thwards, from 1818, and have jjhiced in a ])arallel column th-3 epidemics of febrile disease which were met with in their vicinity about the same time. The information available on these j)oints is but too often fragmentary and incomplete, and does not show in all cases, the close limitation of the cholera fields by those occupied by fever, but, as far as the evidence goes, it bears out the general fact in every instance, that where fever prevailed there cholera did not penetrate. In particularising the various epi- demics mentioned below, I have employed the nrincijiles detailed in the Papers on Pandemic Waves in the Sanitary Reports for the Army for 18G4 and 18GG, and refer the reader to the map accompanying the latter communication for fuither information thereon :— In 1817, 1«19, and 1821, fever was In 18)8, a cholerific wave passed particularly severe in Cutch and the isodinal, 30° N., and there was a Guzerat, and northwards towards severe epidemic of cholera in Northern Rajpootana ; it was frequent also in India, which continued into 1819 the intermediate years. There was but it did not extend across, or even