tive
portions,
are
glaringly conspicuous
in the construc-
tive parts. If these statements are true, a sense of bewilderment after perusal is not to be wondered at. We do
not propose now
follow Dr. Cuntngham
to
topics, philosophical and special, which he has broached. Most, if not all, of the errors of investigation and fallacies of reasoning which he has noted and discussed are by no means peculiar to cholera inquiries. They belong to the idola which Bacon so clearly and graphically classified and described?the idols of the den and theatre more especially. These are matters which do not admit of dispute, and Dr. Cuningham has rendered a good service in insisting all the
through
upon
strict adherence
a
philosophy
in
all
to the canons of
investigations
cholera and
inductive
discussions
and
other
epidemic diseases. throughout his paper that his application of the excellent principles which he lays down is, to say the least, partial. Take for example the terms which we have selected as a
relating But
to
there
indications
are
title for this article?" Great facts and little facts." "
The facts
must
regarding
be considered
as
the
of disease
general history
well
the results of local in-
as
in this way these great facts will often prevent wrong conclusions being drawn from the little facts. What are the great facts and little facts ? The great
quiry
>
facts
are
simply
arithmetical
generalizations,
sions of the relations of cholera
cases or
expresstated
deaths,
aggregates of units, to space and time?geography and season. The little facts are studies of individual
as
Gilu IitMart ittcbical ?alette.
cases or groups of cases,
SEPTEMBER, 1883.
stances under which
they
and little have reference GREAT FACTS AND LITTLE FACTS.
Surgeon-General J. M. Cuningham took sion, during a recent visit to England, to
occa-
read
in relation occurred.
evidently
graphical area and length of time. the comprehension of the induction
to
The to
the circumterms
great
extent of geo-
In other
words,
is the feature
or
of it which entitles it to the attribute of great-
quality
Epidemiological Society of London a the Sanitary lessons of Indian Epidemics."
ness, the extension or elaboration of it to that of littleness. Is this a true maxim ? Is it consistent with reason
This paper will be found, reported in extenso, in the Medical Times and Gazette of 21st July. It is an able
experience? The phenomenon under inquiry is a very special one, primarily and essentially appertaining
before the paper
on
"
interesting essay, and contains views with which cordially agree, and other views to which we can-
and we
general effect of the paper is somewhat bewildering, and its general tendency is to-
not assent.
The
wards
agnosticism. There are great and true princidown in the article ; but there are also some laid ples fallacies stated in it. Its tone and contenstartling tion
are
mainly destructive, but,
structive, the
very
which
emphatically
are so
errors
in
so
far
as
of observation and
it is
con-
reasoning,
condemned in the destruc-
and
to
individual
logical
man.
The term cholera
term, is itself
as an
abstraction.
a mere
epidemioIt
simply
aggregate of instances of a particular thing?a disease; each instance or case being so simi-
indicates lar
an
to every other that
braced in reason
one
all the instances
descriptive
to suppose that if we
instance, different
we
to
are
at
produce
work, the
can
be
There is
em-
every
knew the causation of one
should know that of all.
causes
the paper,
term.
as
same
Even if many
is hinted elsewhere in kind of disturbance
25^ of
THE INDIAN MEDICAL GAZETTE.
the
investigation of instances is only possible way of ascertaining them, health,
still the
and the because it is
general term becomes less accurate no longer an expression of one thing but
influence
or
single expression covering fallaciously a complexity of things or influences. Now with reference to cholera, the greatest fact possible would be a knowledge of its immediate cause or causes. Such knowledge is not and cannot be contained in and educed a
from the so-called great
facts, that is, the
results
of
arithmetical numeration of cases as they occur in space and time. It is not there. Unless some other kind of inquiry is superadded, or the aid of
is
imagination
arithmetical
generaliabsolutely barren, and reliance on them must necessarily result in nihilism or fatalism, absence of knowledge, despair of knowledge, scepticism and inaction. But arithmetical generali-
zations in
cases
invoked,
of this sort
are
zations may be used as a means of research. Other series of facts in space and time may be compared with and
them,
surmise
and
by analysing be hit
may
speculating But
upon.
happy
a
this
surmise
has to be verified
by enquiry into particular cases. If verified by particular investigation,?investigation repeated and varied but always sufficiently minute and searching, and equally so?then this becomes The movements of the heavenly the great fact. bodies were for ages made the subject' of conscientious and laborious observation and record, and great facts and laws were formulated regarding them; but not until Newton found in the fall of to
the whole system did the
ments become
a
subject
of
observation of Newton's revolutionized it
was
the
apple
knowledge.
key
these
move-
This
single
fact
which
the great
of cosmical
knowledge
our
an
true cause of
physics
and stable basis.
So, in vaccination, the really great fact was Jenner's lucky interview with the dairymaid and the small experi-
and
placed
to
subsequently
made.
So
in
as
the cause,
and
pointed speculation
property in the fermented apple that caused the pain and paralysis. But it
rife
was
was
new
the Devonshire colic statistics
cider and apples
was
it
case
of
a
he
which
ments
the
on
not
as
to what
till Sir George Baker studied the
cases,
suspected their plumbic origin, and found lead in the liquor, that the true cause and true method of prevention of the disease were discovered. And ,
will be, we are convinced, in the case of cholera. The great fact we are in quest of is its proxiso
it
mate cause
or
causes.
The arithmetical method may
suggest, but it must
come
[September, 1883.
cannot
surroundings, an influence,
demonstrate
or
prove.
Discovery
of
cases
and their
and this whether the cause is
or
an
or
from
investigation
a poison entity or a force, communicable portable, infectious directly or indirectly.
Dr. Cuningham
docs
not seem to
realize the
un-
doubted truth that the arithmetical method involves a large exercise of two things which he objects to,
namely opinion and assumption. The great facts of prevalence in space and time are naked and infructuous if they are not clothed and fertilised by an To make anything of exercise of imagination. them at all, even to make them capable of verbal expression, departure from stern reality is necesWe have pointed this out as regards cholera sary. considered as an epidemic. What does the term "cholera area" mean ? A geographical area in which cases of cholera have occurred simultaneously or successively. But, as Dr. Cuningham shows, the great majority of places within the area exhibit no trace or sign of cholera, and a great majority of persons living in the of
area
escape the disease.
proof that the
human
body.
is not
a
jot
places suffer from cholera assumption. It is people living in
To assert that
involves the wildest
places
Nay, there
of cholera exists outside of the
cause
that suffer. The cholera
in which cholera is
area
so-called is
an area
exceptional event, whether we or regard places populations. The boundaries of it are entirely arbitrary. If cases of cholera occurred simultaneously in Calcutta, Peshawur, Cairo, Constantian
nople, Paris, London,
New
York,
and San Francisco?
what would the boundaries of the cholera
When in Calcutta
cases occur
and the
free,
rest are
in 6
of its
area
18
what is the true cholera
be ?
wards, area
?
term is, when analysed, absurd. Indeed the whole doctrine of affection of localities rather than
The
of communities, and of communities rather than of individuals, is full of difficulty. Nor is the matter
simplified by postulating a force in place of a material, and discrediting the possible agency of germs. Is it quite certain that a force is immaterial ? At any rate it must have a material substratum, and forces are merely modes of motion or energy of matter in various states and relations; and even if the assumed cholera poison were a material, a germ, or entity, it would still exercise its prejudicial effect on the body dynamically. It seems to us immaterial whether the disturbance of the vital dynamics of the body is due to physical or vital dynamics outside of the body; material cannot be banish-
CURRENT MEDICAL TOPICS.
September, 1883.] ed in either case,
it
Again, agent
poison poison is
does
really signify causing cholera
It is
not.
or
beyond speculation.
not
influence
or
force.
nor can
a
mere
invisible gas as a salt or
whether the is called
matter of terms.
necessarily organized
not
or
a
A An
particulate.
vapour may be as truly poisonous It is a pity, we think, that Dr. germ.
or a
Cuningham discredits germs. Even if these little organisms are an evidence rather than a cause of disease, they are still objects of intense scientific interest, and the doctrine that they are disease carriers and distributors, rather than disease originators, is gaining ground. In this light their great minuteness and immense numbers would rather fall in with than contradict the
And the
stress
most
lera
on
with
a
position
which Dr. Cuningham lays the
namely,
on,
is
not
It is
certain
quite
cholera.
It must
filth under
particular
cause or
cho-
inconsistent
no means
particular kind,
a
of
dependance
sanitary neglect, by theory.
modified germ that filth of itself does be filth of
through their
cholera distribution
of
theory
agency.
development of cholera in filthy places is observed to take place under circumstances most favourable to the decay of organic matter and the development of these lowly organisms, namely, a
conditions,
and the
combination
heat and
of
closely resembling
moisture. cholera
Moreover, caused
by putrefaction, and in which these little organisms are seen. These, howcases
most
organic
ever,
are
are
matter
in
matters
of speculation; but when all is
state of
a
so
dark
the faint flicker
supplied by presumptions, probabilities speculations should not be rudely extinguished, illumination from any other more specially when source or by any other method is so hopeless, we had almost written impossible. and
On the whole,
we
do not think that Dr. Cuningham
has advanced knowledge nor
by
such
his destructive arguments, as aim at construction, and
by
suggestions
for the present the
regarding cholera is, prevailing where men appreciable intervals of time
great
fact
that
it is
live,
and
passing
at
one
place
of human habitation
from
We
are
a
disease of
men
absolutely ignorant
cholera apart
from man, and
of
the
to another. existence of
the contamination
or
places occupation areas, by anything capable of cholera in man is a pure causing assumption. There are reasons for supposing that man is under certain of
circumstances
or
a
carrier and distributor of cholera,
and that in
some way men
places come
to infect each
infect
257
one
other, is
a
another,
but how
problem
almost
necessitate
a
The
postulate
of
locality theory de novo origin
would in each
each occasion of outbreak. separate locality, No doubt cholera and every other disease which is liable to present an epidemic aspect, must originally and
on
origin, but it would, in the present state of knowledge and thought, be very difficult to maintain a distinct origin for every case or group of cases of a disease presenting an epidemic have had
facies.
a
de
novo
portions,
are
glaringly conspicuous
in the construc-
tive parts. If these statements are true, a sense of bewilderment after perusal is not to be wondered at. We do
not propose now
follow Dr. Cuntngham
to
topics, philosophical and special, which he has broached. Most, if not all, of the errors of investigation and fallacies of reasoning which he has noted and discussed are by no means peculiar to cholera inquiries. They belong to the idola which Bacon so clearly and graphically classified and described?the idols of the den and theatre more especially. These are matters which do not admit of dispute, and Dr. Cuningham has rendered a good service in insisting all the
through
upon
strict adherence
a
philosophy
in
all
to the canons of
investigations
cholera and
inductive
discussions
and
other
epidemic diseases. throughout his paper that his application of the excellent principles which he lays down is, to say the least, partial. Take for example the terms which we have selected as a
relating But
to
there
indications
are
title for this article?" Great facts and little facts." "
The facts
must
regarding
be considered
as
the
of disease
general history
well
the results of local in-
as
in this way these great facts will often prevent wrong conclusions being drawn from the little facts. What are the great facts and little facts ? The great
quiry
>
facts
are
simply
arithmetical
generalizations,
sions of the relations of cholera
cases or
expresstated
deaths,
aggregates of units, to space and time?geography and season. The little facts are studies of individual
as
Gilu IitMart ittcbical ?alette.
cases or groups of cases,
SEPTEMBER, 1883.
stances under which
they
and little have reference GREAT FACTS AND LITTLE FACTS.
Surgeon-General J. M. Cuningham took sion, during a recent visit to England, to
occa-
read
in relation occurred.
evidently
graphical area and length of time. the comprehension of the induction
to
The to
the circumterms
great
extent of geo-
In other
words,
is the feature
or
of it which entitles it to the attribute of great-
quality
Epidemiological Society of London a the Sanitary lessons of Indian Epidemics."
ness, the extension or elaboration of it to that of littleness. Is this a true maxim ? Is it consistent with reason
This paper will be found, reported in extenso, in the Medical Times and Gazette of 21st July. It is an able
experience? The phenomenon under inquiry is a very special one, primarily and essentially appertaining
before the paper
on
"
interesting essay, and contains views with which cordially agree, and other views to which we can-
and we
general effect of the paper is somewhat bewildering, and its general tendency is to-
not assent.
The
wards
agnosticism. There are great and true princidown in the article ; but there are also some laid ples fallacies stated in it. Its tone and contenstartling tion
are
mainly destructive, but,
structive, the
very
which
emphatically
are so
errors
in
so
far
as
of observation and
it is
con-
reasoning,
condemned in the destruc-
and
to
individual
logical
man.
The term cholera
term, is itself
as an
abstraction.
a mere
epidemioIt
simply
aggregate of instances of a particular thing?a disease; each instance or case being so simi-
indicates lar
an
to every other that
braced in reason
one
all the instances
descriptive
to suppose that if we
instance, different
we
to
are
at
produce
work, the
can
be
There is
em-
every
knew the causation of one
should know that of all.
causes
the paper,
term.
as
same
Even if many
is hinted elsewhere in kind of disturbance
25^ of
THE INDIAN MEDICAL GAZETTE.
the
investigation of instances is only possible way of ascertaining them, health,
still the
and the because it is
general term becomes less accurate no longer an expression of one thing but
influence
or
single expression covering fallaciously a complexity of things or influences. Now with reference to cholera, the greatest fact possible would be a knowledge of its immediate cause or causes. Such knowledge is not and cannot be contained in and educed a
from the so-called great
facts, that is, the
results
of
arithmetical numeration of cases as they occur in space and time. It is not there. Unless some other kind of inquiry is superadded, or the aid of
is
imagination
arithmetical
generaliabsolutely barren, and reliance on them must necessarily result in nihilism or fatalism, absence of knowledge, despair of knowledge, scepticism and inaction. But arithmetical generali-
zations in
cases
invoked,
of this sort
are
zations may be used as a means of research. Other series of facts in space and time may be compared with and
them,
surmise
and
by analysing be hit
may
speculating But
upon.
happy
a
this
surmise
has to be verified
by enquiry into particular cases. If verified by particular investigation,?investigation repeated and varied but always sufficiently minute and searching, and equally so?then this becomes The movements of the heavenly the great fact. bodies were for ages made the subject' of conscientious and laborious observation and record, and great facts and laws were formulated regarding them; but not until Newton found in the fall of to
the whole system did the
ments become
a
subject
of
observation of Newton's revolutionized it
was
the
apple
knowledge.
key
these
move-
This
single
fact
which
the great
of cosmical
knowledge
our
an
true cause of
physics
and stable basis.
So, in vaccination, the really great fact was Jenner's lucky interview with the dairymaid and the small experi-
and
placed
to
subsequently
made.
So
in
as
the cause,
and
pointed speculation
property in the fermented apple that caused the pain and paralysis. But it
rife
was
was
new
the Devonshire colic statistics
cider and apples
was
it
case
of
a
he
which
ments
the
on
not
as
to what
till Sir George Baker studied the
cases,
suspected their plumbic origin, and found lead in the liquor, that the true cause and true method of prevention of the disease were discovered. And ,
will be, we are convinced, in the case of cholera. The great fact we are in quest of is its proxiso
it
mate cause
or
causes.
The arithmetical method may
suggest, but it must
come
[September, 1883.
cannot
surroundings, an influence,
demonstrate
or
prove.
Discovery
of
cases
and their
and this whether the cause is
or
an
or
from
investigation
a poison entity or a force, communicable portable, infectious directly or indirectly.
Dr. Cuningham
docs
not seem to
realize the
un-
doubted truth that the arithmetical method involves a large exercise of two things which he objects to,
namely opinion and assumption. The great facts of prevalence in space and time are naked and infructuous if they are not clothed and fertilised by an To make anything of exercise of imagination. them at all, even to make them capable of verbal expression, departure from stern reality is necesWe have pointed this out as regards cholera sary. considered as an epidemic. What does the term "cholera area" mean ? A geographical area in which cases of cholera have occurred simultaneously or successively. But, as Dr. Cuningham shows, the great majority of places within the area exhibit no trace or sign of cholera, and a great majority of persons living in the of
area
escape the disease.
proof that the
human
body.
is not
a
jot
places suffer from cholera assumption. It is people living in
To assert that
involves the wildest
places
Nay, there
of cholera exists outside of the
cause
that suffer. The cholera
in which cholera is
area
so-called is
an area
exceptional event, whether we or regard places populations. The boundaries of it are entirely arbitrary. If cases of cholera occurred simultaneously in Calcutta, Peshawur, Cairo, Constantian
nople, Paris, London,
New
York,
and San Francisco?
what would the boundaries of the cholera
When in Calcutta
cases occur
and the
free,
rest are
in 6
of its
area
18
what is the true cholera
be ?
wards, area
?
term is, when analysed, absurd. Indeed the whole doctrine of affection of localities rather than
The
of communities, and of communities rather than of individuals, is full of difficulty. Nor is the matter
simplified by postulating a force in place of a material, and discrediting the possible agency of germs. Is it quite certain that a force is immaterial ? At any rate it must have a material substratum, and forces are merely modes of motion or energy of matter in various states and relations; and even if the assumed cholera poison were a material, a germ, or entity, it would still exercise its prejudicial effect on the body dynamically. It seems to us immaterial whether the disturbance of the vital dynamics of the body is due to physical or vital dynamics outside of the body; material cannot be banish-
CURRENT MEDICAL TOPICS.
September, 1883.] ed in either case,
it
Again, agent
poison poison is
does
really signify causing cholera
It is
not.
or
beyond speculation.
not
influence
or
force.
nor can
a
mere
invisible gas as a salt or
whether the is called
matter of terms.
necessarily organized
not
or
a
A An
particulate.
vapour may be as truly poisonous It is a pity, we think, that Dr. germ.
or a
Cuningham discredits germs. Even if these little organisms are an evidence rather than a cause of disease, they are still objects of intense scientific interest, and the doctrine that they are disease carriers and distributors, rather than disease originators, is gaining ground. In this light their great minuteness and immense numbers would rather fall in with than contradict the
And the
stress
most
lera
on
with
a
position
which Dr. Cuningham lays the
namely,
on,
is
not
It is
certain
quite
cholera.
It must
filth under
particular
cause or
cho-
inconsistent
no means
particular kind,
a
of
dependance
sanitary neglect, by theory.
modified germ that filth of itself does be filth of
through their
cholera distribution
of
theory
agency.
development of cholera in filthy places is observed to take place under circumstances most favourable to the decay of organic matter and the development of these lowly organisms, namely, a
conditions,
and the
combination
heat and
of
closely resembling
moisture. cholera
Moreover, caused
by putrefaction, and in which these little organisms are seen. These, howcases
most
organic
ever,
are
are
matter
in
matters
of speculation; but when all is
state of
a
so
dark
the faint flicker
supplied by presumptions, probabilities speculations should not be rudely extinguished, illumination from any other more specially when source or by any other method is so hopeless, we had almost written impossible. and
On the whole,
we
do not think that Dr. Cuningham
has advanced knowledge nor
by
such
his destructive arguments, as aim at construction, and
by
suggestions
for the present the
regarding cholera is, prevailing where men appreciable intervals of time
great
fact
that
it is
live,
and
passing
at
one
place
of human habitation
from
We
are
a
disease of
men
absolutely ignorant
cholera apart
from man, and
of
the
to another. existence of
the contamination
or
places occupation areas, by anything capable of cholera in man is a pure causing assumption. There are reasons for supposing that man is under certain of
circumstances
or
a
carrier and distributor of cholera,
and that in
some way men
places come
to infect each
infect
257
one
other, is
a
another,
but how
problem
almost
necessitate
a
The
postulate
of
locality theory de novo origin
would in each
each occasion of outbreak. separate locality, No doubt cholera and every other disease which is liable to present an epidemic aspect, must originally and
on
origin, but it would, in the present state of knowledge and thought, be very difficult to maintain a distinct origin for every case or group of cases of a disease presenting an epidemic have had
facies.
a
de
novo
