first time. Matters like these must go through a committee; and he would even add that the judgment of the committee upon them must not be considered as binding upon Parliament.

The observant mind will easily detect here, as well as in other parts of the speech, an endeavour to avoid shocking the prejudices of his Liverpool friends, without becoming their partizan. In the preceding year, when Mr. Huskisson was re-elected for Liverpool, his constituents endeavoured to extract from him a declaration of war against the East-India Company; but all he would say was that he should "endeavour to apply to the subject the general principles which he had long professed, at the same time considering the claims which that great company fairly have upon the country;" adding, with respect to the Bank and the East-India Company, "I am strongly opposed to monopolies of any kind, and think it highly proper that institutions, which have risen up under different circumstances, should undergo a modification, suited to the changing circumstances of the country."

We shall touch upon only one other topic,-Parliamentary reform. To this measure, that is, to a sweeping change in the constitution of the representation, this liberal and enlightened statesman was a decided enemy; not because he was averse to a system of purification, or to the disfranchisement of corrupt boroughs-of which his determined vote on the East Retford case is a pledge; but because he apprehended serious consequences from extensive innovation. His sentiments on this point were frequently, reiterated; they underwent no alteration notwithstanding the changes which he witnessed and even brought about in the principles of our domestic as well as foreign policy. "From the settled aversion which I feel to every system of what is called Parliamentary reform," he observes, in 1829, in a speech (one of his best) which is authenticated by his own MS. notes, "I cannot say I hail with much satisfaction any question which brings, even indirectly, that subject more or less under the review and discussion of this house. I am as far as any man from courting any thing which looks like a general revision of the constitutional body; but when the existence of such abuses and general corruption as have been proved long and habitually to exist in the borough of East Retford are brought to light, and exhibited in proof before us, we have no alternative but to apply some remedy to the specific evil. Further than this I shall never be prepared to go. I take my stand upon the aggregate excellence of our representative system, and I leave to others, to take what delight they may in hunting out the anomalies of its detail, having no desire myself to join in that critical examination." He added, in a singularly prophetic spirit: "I shall regret this success (of ministers against the utter disfranchisement of the borough), because I am convinced that it will increase, in the public mind, the feeling which already exists in favour of Parliamentary reform,-because I feel it will ensure the adoption of a course, which must pave the way for a general Parliamentary reform."

We here close our notice of a most valuable work, observing that it is extremely well got up, and we may add, well printed.

Asiat.Jour. N.S.VOL.6.No.21.

K

THE Board of Health,t in compliance with the directions of the Lords of his Majesty's Most Honourable Privy Council, have examined the following gentlemen, formerly employed in different branches of the medical department in India, viz, Dr. Daun, Dr. Alexander, Dr. Ashburner, Dr. Birch, Mr. Wybrow, Mr. Boyle, and Mr. Meicle, respecting the disease called Cholera Spasmodica in that climate. From their evidence, and from the great body of information contained in the printed medical reports drawn up by order of the several governments of Bengal, Madras, and Bombay, the Board has formed a detailed account of the symptoms of the disease, and given a view of the great outlines of practice adopted in India.

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To these are annexed a description of the same disease, as it appeared in Moscow, given by Dr. Keir, an English physician, long resident in that capital, and an extract from the joint report of Doctors Russell and Barry, employed by his Majesty's Government to investigate the nature of the same dreadful malady now raging at St. Petersburgh.

The Board refers medical practitioners to the reports above-mentioned generally; but as they are not accessible to many individuals, from the circumstance of their not having been published, it more particularly calls their attention to the statement drawn up by Sir Gilbert Blane, and inserted in vol. xi. of the Transactions of the Medico-Chirurgical Society, the correctness of which has been verified to a committee of the College of Physicians by Dr. Russell, formerly resident in Calcutta, during the prevalence of this disease; -to the works of Mr. Annesley on the Diseases of India;-to an Essay on the Cholera by Mr. George Hamilton Bell;-to other works by gentlemen formerly practitioners in that country, which are now before the public; and to the "History of the Epidemic Spasmodic Cholera of Russia," by Dr. Bisset Hawkins.

The attack of the disease in extreme cases is so sudden, that, from a state of apparent good health, or with the feeling only of trifling ailment, an individual sustains as rapid a loss of bodily power as if he were suddenly struck down, or placed under the immediate effects of some poison; the countenance assuming a death-like appearance, the skin becoming cold, and giving to the hand (as expressed by some observers) the sensation of coldness and moisture which is perceived on touching a frog; by others represented as the coldness of the skin of a person already dead. The pulse is either feeble, intermitting, fluttering, or lost; a livid circle is observed round the eyelids; the eyes are sunk in their sockets; the tongue is cold, and either clean, or covered with a slight white fur; and in many instances even the breath is cold. In cases of this severity, the vomiting and purging characteristic of the disease do not commonly take place so early as in milder attacks, but seem to be delayed until the almost overpowered functions of the body make a slight effort at reaction. It is worthy of remark that, unless death takes place in these ex

Papers relative to the Disease called Cholera Spasmodica in India, now prevailing in the North of Europe. Printed by authority of the Lords of His Majesty's Most Honourable Privy Council.

+ Board of health: Sir H. Halford, Bart., G.C.H., president; Dr. Maton, Dr. Turner, Dr. Warren, Dr. Macmichael, Dr. Holland; Sir T. Byam Martin, G.C.B., Comptroller of the Navy; Hon. Edward Stewart, Deputy Chairman of the Board of Customs; Sir James Macgrigor, T.C.D., Director General of the Army; Sir William Burnett, K.C.H., Medical Commissioner of the Navy; Sir William Pym, Superintendent General of Quarantine; Dr. Seymour, secretary.

treme cases within a few hours, some effort of the animal power is made to rally the constitution; and this point is insisted upon here, because it will direct the mind of practitioners to the particular moment when bleeding, and certain other parts of practice, recommended in the Indian reports, can be enforced in this country with probable success. Vomiting soon succeeds; first of some of the usual contents of the stomach, next of a turbid fluid like whey, white of egg, water-gruel, or rice-water; described perhaps more accurately as a serous fluid, containing flocculi of coagulated albumen, The lower bowels seem to let go their contents; what happens to be lodged in the rectum is passed more or less in its natural state; the next discharges are similar to those thrown up from the stomach, and are passed with violence, as if squirted from a syringe. The same similitude may be applied to the vomiting. Spasms, beginning at the toes and fingers, soon follow, and extend by degrees to the larger muscles of the legs and arms, and to those of the abdomen. These vary in intensity, but are sometimes so violent as to put on the appearance of

tetanus.

In some severe cases the vomiting is slight, in others considerable, and the purging and vomiting precede each other without any known rule; but whichever may be the precursor, a severe burning heat is early felt at the præcordia; there is an invincible desire for cold liquids, particularly water; and, although the skin and tongue are cold to the touch, and the pulse nearly lost, or even imperceptible, the patient complains of intense heat, and has an almost insuperable aversion to any application of it to the skin. The spasms increase, sometimes spreading gradually, sometimes suddenly, to the abdomen, as high as the scrobiculus cordis. The next severe symptoms are, an intolerable sense of weight and constriction felt upon the chest, accompanied with anxious breathing, the spasms continuing at the same time; a leaden or bluish appearance of the countenance, the tongue, fingers, and toes assuming the same colour; the palms of the hands and soles of the feet becoming shrivelled; the fingers and toes giving the appearance of having been corrugated by long immersion in hot water. There is, throughout, a suppression of the secretion of urine, of the secretions of the mouth and nose; no bile is seen in the evacuations, and it may be generally observed, that all the functions employed in carrying on life are suspended, or alarmingly weakened, except that of the brain, which appears, in these extreme cases, to suffer little, the intellectual power usually remaining perfect to the last moment of existence, At length a calm succeeds, and death. The last period is commonly marked by a subsidence of the severe symptoms, without improvement of the pulse or return of natural heat; but occasionally terminates in convulsive spasm. Within an hour or two from the commencement of such a seizure, and sometimes sooner, the pulse is often not to be felt at the wrist, or in the temporal arteries. If it be discoverable, it will usually be found beating from eighty to a hundred strokes in a minute; this, however, is not invariable, the pulse being not unfrequently quicker. The powers of the constitution often yield to such an attack at the end of four hours, and seldom sustain it longer than eight..

We have described the symptoms of the extreme case, in the usual order of their occurrence; but it will be obvious, that in a disease which proceeds so quickly to a fatal termination, medical practitioners will seldom see their patient until the greater number of these symptoms have taken place.

In the less rapid and more ordinary form, sickness at the stomach, slight vomiting, or perhaps two or three loose evacuations of the bowels, which do not attract much attention, mark the commencement of the attack; a burning

sense of heat soon felt at the præcordia excites suspicion of the disease; an increased purging and vomiting of the peculiar liquid, immediately decides its presence, unless previously proved by the prostration of strength, and an expression of the countenance not often exhibited, except when death is to be expected within a few hours. The symptoms before described follow each other in similar, but slower succession: the spasms of the extremities increase with the vomiting and purging, and particularly in proportion to the constriction of the thorax; and this form of the disease, which creeps om at first insi diously, and is in its progress more slow, by giving a greater opportunity for assistance, is, if treated early, more tractable; but if neglected, equally fatal with the more sudden seizures. Such cases last from twelve to thirty-six hours. The principal difference consists in the diffusion of the symptoms through a greater space of time; a misfortune, it is true, to the patient, if the disease prove ultimately fatal ; but advantageous, y affording an interval for the natural powers of the constitution to rally themselves, and for the employment of the resources of medical art. But there is another remarkable distinction well worthy of attention. It has been observed before, that in the more rapid cases, the intellectual faculties suffer but little; and it may be added here, that the disturbance of them is not delirium, but rather a confusion and hesitation of mind resembling slight intoxication. In those of longer duration, if the individuals, either by the natural vigour of their constitution, or medical assis tance, sustain the shock beyond the period of twenty-four hours, suffusion of the tunica conjunctiva often takes place, not unfrequently delirium, and even

coma,

It is remarked that those who survive seventy-two hours generally recovery but there are exceptions even to this: for though, according to the Reports of the Medical Practitioners in the Presidencies of Bombay and Madras, the recovery from this seizure commonly terminates the disease; or, as is stated in the latter, the sequelæ are those dependent upon some previous ailment of the individual; yet the Bengal Report details a series of subsequent symptoms resembling those of low nervous fever, which, when they proved fatal, usually terminated within eleven days from the commencement of the seizure called cholera. To complete the outline, an account of these symptoms, extracted from the Bengal Report, will be given hereafter; and we may observe, that they correspond accurately with the description given by Dr. Keir of the second stage of the disease, as it appeared at Moscow from the beginning of the month of October to the earlier part of the month of March. But we will previously point out the manner in which the recovery from this seizure commonly takes place. The first symptoms are the abatement of the spasms and difficulty of breathing, a return of heat to the surface of the body, and a restoration of the pulse; these, however, are equivocal, from being often only ́emporary, and the prognostic from them is very uncertain, unless they follow a progressive march of amendment; sleep and warm perspiration attending it are of more importance and more certain signs of recovery. The return of the secretion and evacuation of urine is reckoned one of the most favourable signs; the next is the passage of bile by the bowels, and if this be freely established, and accompanied with an improvement of the pulse and of the tempe rature of the skin, the patient is soon placed in a state of security from the attack; but it will appear from the following extract from the Bengal Report, that upon this recovery he has often a serious stage of disease to encounter, the description of which is given in the words of the author. Before, however, we proceed to this, we must remark that the seizure, when not fatal, has

three modes of termination; one in immediate convalescence, accompanied only with great weakness a second, in which large evacuations of vitiated bile are passed for several days, sometimes attended with blood and with pecu liar pains in the bowels, particularly in the rectum the third is of a febrile nature, of which the following account is supplied from the information given in the Bengal Report, viz. 9*0* me; sult is at pos "The fever which almost invariably attended this second stage of the dis ease,*** partook much of the nature of the common bilious attacks of these latitudes. There was a hot, dry skin, a foul deeply-furred tongue, parched mouth, thirst, sick stomach, restlessness, watchfulness, and quick variable pulse, sometimes with delirium and stupor, and other marked affections of the brain. Generally, when the disorder proved fatal in this stage, the tongue, from being cream-coloured, became brown, and sometimes black, hard, and more deeply furred; the teeth and lips were covered with sordes, the state of the skin varied, chills alternating with heats, the pulse became extremely quick, weak, and tremulous, hiccough, catching of the breath, great restlessness and deep moaning succeeded, and the patient sunk incoherent and insen sible under the debilitating effects of low nervous fever and frequent dark, tarry alvine discharges." It is to be observed that the able author of the Ben gal Report doubts whether these symptoms can be considered as “forming any integrant or necessary part of the disorder itself," or whether they belonged to the bilious seizures of the climate. A reference to the annexed account of the second stage of the disease at Moscow, during the coldest season of the year, will probably satisfy this doubt by proving that climate was unconcerned in producing them.

Appearances on Dissection.

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The appearances after death varied much in different individuals, and appa rently according to the duration of the disease. In those who died within eight or ten hours, the stomach was generally found in a relaxed, dilated state, loaded with the same fluids as had been thrown up during life; sometimes containing food which had been swallowed, and not returned although the vomiting had been excessive. The internal and peritoneal coats of the sto mach were in these instances pale and bloodless; the small and great intestines bore the same appearance; the arch of the colon when the spasms had reached the abdomen before death, and sometimes the sigmoid flexure of it, were so contracted as to be less in diameter than the duodenum. The former was most commonly observed, the latter only occasionally. No appearance of bile vor fæces was found in the intestines. The bladder was generally empty. The liver, and vessels which pass to the vena cava inferior, were turgid with blood; this turgescence extended to the vena cava superior, to the right side of the heart, and in some instances to the left ventricle: blood was in the same manner stagnant in the lungs, marking a congestion in the whole venous circulation of the larger vessels: the blood in the vessels was unusually black, resembling tar in colour and consistence. It is worthy of remark, that this local accumu➡ lation of blood was uniformly found in all fatal cases, whether they were of rapid or slower termination, and was particularly evident, as might be expected, in those in which the oppression of the breathing had prevailed with most vio lence. The gall bladder was turgid with bile, the gall duct commonly pervious, but bearing no marks of bile having recently passed.

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In cases of longer duration, the same leading appearances were observed, but often with great addition. The vessels of the stomach in these instances were