The Medico-chirurgical Review, and Journal of Practical Medicine

which such a change can be ascribed, unless by supposing that a diminution of temperature, together with exposure, may have called into action some latent remains of an active poison; otherwise it seems difficult to reconcile those facts with what it is observed in ordinary epidemics.

It will be observed that Mr. Jukes, in his report, remarks that the disease as it first appeared at Tannah, did not go through families when one had become affected; he has since seen sufficient reason to alter his opinion in regard to that particular; and we think that we have observed in several instances, that the disease has shewn a greater tendency to spread, where the first attacks have proceeded in their course to a fatal termination, which they invariably do when not counteracted by medicine. How far the same thing has been observed to happen in other epidemics we cannot determine." xiv.

For a description of the disease and of its symptoms, the reporter quotes the words of a letter from the Bengal Board: these we need not insert here. In that letter the occurrence of consecutive fever is mentioned, but in a manner which is far from applicable to its character in the epidemic cholera of Europe. The Bombay Board, however, distinctly deny its existence on that side of India, and although that denial has been previously alluded to in this Journal, we cannot refrain from explicitly inserting it in this place.

"After the above luminous description, and what will be found in the reports which follow, it appears quite superfluous to enter here into any farther detail of the symptoms of this disease; we shall only therefore mention, that the subsequent fever which it appears has generally accompanied it in Bengal, has been but little if at all observed on this side of India; and as we have before noticed may be owing in a great degree to the more extended influence of those causes which are known to produce the bilious remittent fever as an epidemic in the Bengal provinces than on this side of the Peninsula; for it can scarcely be supposed that a disease, so uniform in its attack and in its course, should, as it were, deviate from itself in any considerable degree, without the agency of some local cause; and we entirely agree in the opinion that it cannot be fairly considered as forming a part of it." xxii.

The Board go on to notice the accurate description of the disease which Sydenham has given us. The logical consequences of this observation were pointed out in our last number, and need not again be insisted on. After noticing the fact of cholera having been described by other authors, and by Dr. James Johnson the latest, and after endeavouring to offer an etymological explanation of the term, mort-de-chien, and mordexim, the reporters make the following remarks on the question of contagion.

"The exciting and proximate causes of this interesting epidemic, although of the greatest importance to be understood, are like those of most other epidemical diseases, concealed under complete obscurity, atra caligine mersæ.' Great difference of opinion exists among practitioners, as to its contagious or non-contagious influence, and this difference very naturally arises out of the difficulty of the subject; and when we consider the various and opposite opinions entertained by the most experienced practitioners of Europe on the same question, respecting the influenza of 1803, and the divided sentiments which have so long agitated the medical world on the subject of the yellow fever, and even typhus itself, we do not venture at present to decide on so important a point. Several irresistible facts already noticed or related in the following reports and its marked anomaly from all hitherto known simple epidemics, would seem to favor the doctrine of contagion, while the contrary supposition is only supported by a species of negative evidence. This is a question however of the greatest

importance and ought not to be too hastily entertained as proved, nor rejected as unfounded; but prosecuted with that diligent enquiry and cautious induction which on every subject of science are so necessary to the attainment of truth; and we entertain a confident hope that the wide range through India, which the disease has taken, will have afforded to some gentlemen more ample means of determining it than we possess." xxx.

The predisposing causes are more obvious, and on this point more unanimity of opinion has prevailed.

Rapid atmospherical vicissitudes in regard either to temperature or moisture; exposure of the body to currents of cold air, particularly the chill of the evening, after being heated by violent exercise of any kind inducing debility or exhaustion; low marshy situations; insufficient clothing; flatulent and indigestible food, especially crude and watery vegetables, which compose a large proportion of the diet of the natives; and particularly that gradual undermining of the constitution which arises in a condensed, dirty, and ill-fed mass of population, are all unquestionably powerful predisposing causes; and though not necessary to the production of the disease, do, when present, offer a more unlimited range to the operation of the original cause, whatever that may be. Sad experience has however shown that the absence of all those affords no security against the attack; although it appears that a much smaller proportion of the. higher orders of society have suffered from it on this side of India, than in the Bengal provinces; and in this Island, the disease has been confined almost exclusively to that class who are most exposed to the severest labour and privation.” xxxi.

Here we see a great feature of similarity between the Indian and European epidemic; we allude to its choice of low and paludal localities, and of the poor and the wretched as its victims. When we say that the speculations of the Board on the proximate cause of the disease are unsatisfactory, we accuse them of no more, than all who have ventured to theorize on the subject have been guilty of. They are inclined to think that sometimes the poison acts more immediately on the vascular, sometimes on the nervous system. The Board make no mention whatever of premonitory symptoms, in fact they explicitly state that the first perceptible ones consist in a spasmodic affection of the stomach.

"The most general attack seems to consist in a spasmodic affection of the stomach, duodenum, and more especially the biliary ducts (the total absence of bile in the matter voided upwards or downwards being perhaps the most uniform characteristic of the disease,) which quickly extending through the whole intestinal canal, discharges its contents; for it has often been observed that the purging more resembles the forcible squirting from a syringe, than the operation of a common cathartic. It is more than probable, however, that these are merely the first perceptible symptoms, for it would appear that a great change has already taken place in the circulating system, and that the action of the heart itself has been greatly diminished before they occur. This seems evident from the numerous cases in which neither vomiting nor purging are present, and in which the first appearance of disease is the almost total suspension of the vital functions, immediately followed by severe spasmodic affections of the muscles, and coldness of the extremities. It is said that a diminution of the nervous influence occasions contractions or spasms of the muscles, and it is perhaps equally probable that a diminution of the stimulus of the circulating fluid, and especially of the vital heat which it constantly supplies, may produce the same effect. This, indeed, appears to lay the foundation of the cold stage, and the chain of distressing symptoms that accompany it. There are perhaps few dis

eases attended with such fatal effects, to which the human frame is subjected, of which so little of the first attack has been observed by practitioners; and this may be perhaps easily accounted for by the insidious nature of the attack itself, which is generally unaccompanied with any alarming symptoms, but more particularly when we consider the nature and circumstances of those subjects who have been chiefly presented to our view. They are composed of the poor and labouring classes, who are occupied in obtaining subsistence for the day that is passing, and who, while the excitement which labour and exercise produce remains, may feel but little inconvenience; but the moment that ceases, may speedily become its victims; hence it has been generally observed that the attacks are most frequent in the night." xxxiv.

The Board moot the question, whether the disease is ever ushered in among the natives by a stage of excitement. Dr. Burrell asserts, in his report, that among Europeans it decidedly is so, unless prevented by particular circumstances, as exposure to a draught of cold air.

“As far, too, as we have had opportunities of observing the commencement of the disease in natives (which have been confined chiefly to domestic servants, who, fully aware of its fatal nature, seemed anxious to avail themselves of the remedies which they knew we were ready to administer, and which may have amounted to twenty or thirty cases), after a few watery stools, or pain in the bowels, sometimes accompanied with vomiting, we could distinctly perceive a preternatural heat of the skin, with a small, quick and thready pulse, laborious breathing, and in some attended with such a change of features and countenance as to render them with difficulty recognizable by their employers. In such cases, if medicine be not immediately exhibited, it is equally certain that the disease, in a few hours, assumes all the worst forms that have been described, namely, coldness, sinking of the pulse, spasms, and death. It must, however, be acknowledged, that this stage of excitement is by no means so distinctly unfolded among the natives as among Europeans, and this may depend upon constitutional causes.' xxxvi.

The Board here draw attention to the description of congestive typhus given by the late Dr. Armstrong, and observe, that those who are most intimate with the various forms of the attack of cholera, will be struck with the similarity of the two diseases at their first appearance, while experience has proved that they are best met by the same remedies.

Lastly, the Board advert to the subject of treatment. On this we may be brief. Blood-letting they consider the sheet anchor in Europeans. Now we know that the great majority of Europeans in India are persons in the prime of life, troops, for instance, and in comparative vigour. On the contrary, we have the authority of the Board for the fact, that those attacked among the natives were, in Bengal, as here, the poor, squalid, and debilitated. With them blood-letting lost its powers, by the same rule and for the same reason, that blood-letting was found even mischievous amidst the half-starved Irish in Southwark. Next to blood-letting the Board rank calomel, which often preserved life when the former could not be put in practice. When the disease was met on its first attack, a single scruple dose of calomel, with 60 minims of laudanum, and an ounce of castor oil seven or eight hours afterwards, was in many cases sufficient to complete the cure. Other means are auxiliaries, but as such are useful, particularly the warm bath and stimulating frictions.

"In a disease, therefore, in which we have every reason to believe that venous

congestion has taken place to a great extent, we conclude that the liver, from its peculiar circulation and structure, is more immediately liable to become seriously and permanently injured, it should not be omitted. We have before mentioned that Dr. James Johnson, of the Royal Navy, seems to have been the first to have pointed out the best method of cure; since most of the foregoing remarks were written, we have seen the second edition of that gentleman's valuable work, in which we find a strong corroborative testimony to the utility of blood-letting in this disease, or one somewhat similar to it, on the coast of Brazil, by Mr. Sheppard of Witney, without the assistance of any other remedy. The public are greatly indebted to Mr. Corbyn, of the Bengal Establishment, for his clear and comprehensive letter on this subject at a time when the disease was producing the most dreadful ravages: the early communication of his practice has been the means of saving thousands of lives in situations where Dr. Johnson's work might not be known."

xlii.

The Board, in conclusion, are of opinion, that whatever other name be given to the disease, that of cholera should be discontinued. They agree with Sydenham in thinking, that from common cholera, both the disease they report on and that he described, are, toto cœlo, of a different nature. "Quisquis autem cholera morbi legitimi phænomena studiosè collegerit, fatebitur, morbum istum, quamvis eorundem symptomatum nonnullis stipatum, ab hoc nostro toto cœlo distare." Here is another dilemma in which the high cholera party are placed. They say that the present is an exclusively new disease, unlike that of Sydenham, who merely delineated common cholera. Yet Sydenham himself, no mean authority, like the Pythagorean, haud sordidus auctor naturæ verique, repudiates this dictum, and declares that what he saw was not common cholera. Sydenham, then describes a peculiar disease-the Indian Boards affirm that it is identical with the Indian cholera -the high cholera party assert that the Indian cholera is identical with our own epidemic and yet they deny that our own epidemic is analogous with that described by Sydenham. This is merely one of the many and great inconsistencies of reasoning and argument into which certain persons have plunged themselves, by their breathless haste to prove the present epidemic a totally new and a most pestilential malady.

Here the general summary of the Board is terminated, and the individual reports, upon which it is chiefly founded, begin. These, as we said before, are forty in number. We shall throw the chief particulars into the form of a table, resembling that which we gave in our analysis of the Madras Report. Any features of particular interest or importance, will be mentioned in a succinct manner at the conclusion of the tabular statement.

TABULAR ANALYSIS of the INDIVIDUAL REPORTS transmitted to the BOMBAY PRESIDENCY.