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doubt have been attributed with some plausibility by the post-hoc-ergo
Mr. Wallace, in his report, notices the general prevalence either of febrile symptoms, or bowel-complaint among all persons, during the existence of cholera. How much this has been the case in London, those who have any practice can testify. In this country some practitioners have been astonished by comparatively sudden deaths of patients apparently convalescent. Several such cases are mentioned in these reports. Two such examples, but not strong ones, are given by Mr. Whyte.
"The European lived three days or more from the attack of the disease; warmth, a natural pulse, perspiration, and yellow-coloured stools, had returned; but a degree of coma came on, for which he was bled; and I believe he died about the third day, coldness having re-appeared. The sepoy was attacked at day-light, admitted at 11 o'clock, and died at 4 the following evening. I saw him a few hours before death, and could just perceive his pulse; vomiting was completely suppressed, and purging nearly so, although tenesmus urged him to remain almost continually upon the stool. However, I thought him in a fair way to recover, and was astonished a few hours after to receive a report of his death." 65.
The following circumstances strongly militating against contagion, are related by the same gentleman.
"Convinced, as I am, of the total absence of contagion in this disease, I have observed the late revival in some measure of this opinion with some degree of pain. Surely, if it was at all contagious, the fact of its being so could not long remain doubtful. In the general hospital here, there were three sepoys, who resided continually from the first appearance of the epidemic, inhaling at every inspiration by day and night, mouthfuls of infection. If the atmosphere was really loaded with contagious effluvia, arising from the bodies of the numerous inhabitants of the hospital, the escape of these men (which has been complete) would be miraculous indeed, living as they were in the very midst of these effluvia, and so near their source. Allowing that the constant habit of doing so procured them an exemption from the influence of this contagion, the same thing cannot be said of the friends and relations who were attending upon the patients, nor of six dooly bearers, changed daily, and who used to assist the sick into and out the bath, and in every other way; thereby exposed to be infected with the disease, whether it is conveyed through the medium of the atmosphere, or by touch and yet I have not known one instance of dooly bearers, friends, and attendants of the sick being so infected; nor have any of our hallalchores, or hospital assistants suffered. One of our correspondents supposes, that the disease has travelled in a direct route at the easy rate of 15 miles a day, and believes, if it could be proved, that it has not shewn itself in any village, that had remained insulated or unconnected with other villages, where the disease was. Until this is proved, it is quite as easy to believe the contrary. In the mean time, we have seen it affecting a particular part in one cantonment for days, without reaching another part, although a constant communication was kept up between these parts all the while." 105.
But we dare not proceed farther. With respect to the treatment, we can only say that, on the whole, the testimony of the reporters greatly preponderates in favour of bleeding and calomel. On the other items it is unnecessary for us to say any thing at present. It is singular that throughout these reports no mention is made of blueness, that favourite colour of the cholerics of Europe. Here we conclude the Bombay Report. It was drawn
up suddenly after the irruption of the epidemic, and is much more incomplete than either of the other two reports from Bengal and Madras. Nevertheless it is worthy of record, and we give it a place for the purpose of future reference, when the original document will not be procurable.
REPORT ON THE EPIDEMIC CHOLERA MORBUS, AS IT VISITED THE TERRITORIES SUBJECT TO THE PRESIDENCY OF BENGAL, IN THE YEARS 1817, 1818, AND 1819. Drawn up by Order of the Government, under the Superintendence of the Medical Board. By James Jameson, Assist. Surgeon and Secretary to the Board. Octavo, pp. 325. Calcutta, 1820.
THE epidemic cholera made its first appearance in the division of our Indian possessions subject to the presidency of Bengal. But the Bengal Board were not the first to report upon the malady; on the contrary, the Medical Board of Bombay published their Report in the year 1818, whilst the present was deferred until 1820. This circumstance is important, as it serves to explain some inaccuracies and errors into which ourselves and others have fallen. On the strength of one statement, for instance, the Bombay Board asserted that the epidemic broke out first in Zilla Jessore, and radiated from thence to all parts of India. The Editor of this Journal was the first in this country to receive the Bombay Report from the hands of Dr. Steuart, who had drawn it up. He published all the statements it contained as authentic, and, thus disseminated, they have subsequently been copied into every work upon the subject, and adopted as the basis of medical reasoning. We shall presently see, how erroneous the common opinion on the origin of the disease has been proved by careful and accurate investigations.
The method adopted by the Bengal Board to procure information respecting the epidemic was this. A circular, specifying the points on which replies were desirable, was forwarded to all the individuals on the list of the Medical Department. Queries embracing the main topics of interest and importance-atmospheric influence and conditions, contagion, endemic influence, the time and mode of appearance of the disease at any place, its rise, progress, and decline, its mortality, its pathological characters, its treatment, its sequelæ, and so on, were specifically addressed to two hundred and thirty-eight individuals. One hundred and twenty-four only sent replies at all, a circumstance calculated to elicit, in our opinion, equal regret, surprise, and dissatisfaction from all who have the good of their fellowmen or the interests of the profession itself at heart. Why men should superciliously hold their tongues on such an occasion, we cannot so much as conceive; but let that pass. Twenty-four answered merely to state their inability, in any way, to assist the Board, in the proposed enquiry. In this perhaps many were right. The remaining hundred communicated much
valuable information, the whole of which has been embodied in, and indeed has formed the Report of the Board. We should state here, that this differs from the reports of the Bombay and Madras Boards in one great respect. In the latter the individual reports, or copious extracts from them, are given in detail, and are merely preceded by a summary of the evidence on the part of the Board. In this (the Bengal) we have no individual reports, but the statements of all have been consolidated and fused into a systematic and consistent treatise. Each plan presents its advantages, and on the whole we are well satisfied that both have been adopted. The method that has been pursued is delineated in the following short quotation.
"It was therefore determined to abandon this method; and in its stead, to adopt the form of a digest or compendium of all the facts within reach. In doing this, the mode of describing diseases, usually adhered to by practical writers, has been followed, with as little deviation as possible; that is, the symptoms have been treated of first; then the causes, proximate, remote, predisposing and exciting; then the mortality caused by the disease; then some peculiarities observed by it; and lastly the method of cure. To the whole have been prefixed an introduction describing the rise and progress of the Epidemic; and a sketch of the Weather in Bengal, and in the Upper Provinces, during several years antecedent to its appearance.-Pref. x.
Mr. Jameson quotes many passages from ancient writers to prove that all the symptoms of the disease have been enumerated in former times. In our analysis of the Madras Report, and in our observations on the epidemic in the last number of this Journal, we have touched so freely on this subject, that we need not revert to it. It must require a vast amount of credulity or incredulity to assert or to imagine now, that the epidemic presents any new, undescribed, or pathognomonic symptoms by which it may be known from other described visitations of cholera. The man who could make such an assertion must be very ignorant, very obstinate, or very impudent. Nay, not only has the disease been delineated in all its essential characters and conditions, but no doubt can exist of its having raged as an EPIDEMIC in India, if not elsewhere. Thus, in the Spring of 1781, an epidemic malady, characterized by dreadful spasms of the extremities and trunk, with distressing vomiting and purging, laid hold of a detachment five thousand strong, under Colonel Pearse, in the Northern Circars. Men dropped down by dozens, and even those less severely affected were generally dead or past recovery in less than an hour. Death raged in the camp, the road was strewed with the dying and the dead, and not less than seven hundred men were cut off. The mode of attack, the persons attacked, and the progress of the attack were precisely similar to what has been latterly observed during the present epidemic. But the disease did not cease after disabling Colonel Pearse's detachment. It passed southward, reached Calcutta, occasioned for a fortnight a very great mortality, then passed northward, and, owing to the imperfection of the documents preserved, its course can be traced no longer. The disease then has undoubtedly existed, nay, has been described as an epidemic. Then in what does the epidemic cholera before us and upon us differ from former recorded visitations? Simply in this, that its sphere has been more extended, its influence more deadly, its might more irresistible, than we have known them heretofore. We have no symptom, no cadaveric characters, no general nor partial laws, no phenomena about it or within it,
which can enable us to say that it is a new disease, a malady which had never previously been witnessed, experienced, or described. To deny this is to deny undisputed facts and fly in the face of all philosophic reasoning -it is to make assertion superior to proof-to prefer dogmatic prejudice to authentic records. On the part of those who know no better, this is folly; in those who have the means of reference and consultation, it is worse, it is delusion, wilful delusion.
This introduction to the Report occupies, with the preface which we have been considering, 68 pages. The former is chiefly occupied with remarks on the condition of the seasons in Bengal, previous to the eruption of the epidemic. It appears that great and unusual atmospheric vicissitudes, or rather alterations, had commenced, and that they continued till after the epide mic had made some progress. For a description of the unnatural character
of the seasons, we must refer such of our readers as are curious on the matter, to the Report; it is enough for our present purpose that such was the case. As might be expected, the human constitution, as well as the thermometer, felt the changes. Throughout 1816, low fevers predominated, and Indostan was visited by the infectious malignant sore throat, a disease previously known there only by name. In the upper Provinces, bilious remittent fever raged epidemically, and occasioned such mortality, as surpassed 'any thing on record in the medical annals of Bengal." The military stations wore a gloom hardly to be imagined—the visits of families were almost put a stop to, and the few that were made were those of condolence for departed relatives and friends-in many Native villages, the whole population was ill, and shops were shut for want of people to attend them-the banks of the rivers were at all times covered with the dying and the dead— in Cutch and in Sindh, several cities were said to be so depopulated, that the living were unable to bury the dead, a circumstance that even De Foe denies to have occurred in the great plague in London—and throughout upper Indostan, the horned cattle were so sickly, that their bodies could be seen strewed in vast numbers in the pastures by passing travellers. Such was the state of public health in India in 1816. The cholera had not yet appeared. The previous seasons had been most unnatural, and we presume had been most unwholesome; at all events, man and cattle died, and Native and European were smitten with the epidemic maladies.
Hic quondam morbo cœli miseranda coorta est
The cold season of 1816-17, brought, not health and pleasure, azure skies, elasticity and vigour to animal nature, freshness and verdure to the plant of the garden and grass of the plain. It brought not these its natural gifts, but mist and fog and sultry winds, the appurtenances of an Indian Autumn, not a Winter. Now, however, European and Native were healthy, there was a sort of pause, a breathing time between the pestilential fever that had just been, and the mightier pestilence that was about to be. February, March, April of 1817 presented "singular deviations" from their ordinary course-the rains set in twenty days earlier than usual, on the 25th of May-this month, with June, July, August, were extraordinarily
wet, "an immense quantity" of rain falling, the river being quite full, the country generally under water, and the previous comparative healthiness giving way to fever, hepatitis, flux, and acute rheumatism. In August the Natives for the first time began to suffer severely from the epidemic cholera. The consideration of the seasons is pursued with patience and ability by Mr. Jameson as far as the month of May, 1819. We may state generally that the variations to which we have already referred, and for a more particular and precise knowledge of which we must direct those who wish for it to the original Report, continued until the latter month, when southerly winds and settled weather set in, and the cholera withdrew from Bengal. It is singular that on two occasions, in February 1818 and in April 1819, sudden changes of temperature appeared to revive the epidemic which had previously been dormant and declining.
"This sketch of the weather being now brought to a conclusion, some apology may be necessary for its prolixity and minuteness of detail.-It might, indeed, have been wished, to make it less dry and tedious.-But it was only by entering largely into particulars, and by minutely following the successive variations of each period, and thus affording the reader an opportunity of comparing them with the fluctuations in the healthiness of those periods, that we could hope to trace a connexion between the generation of the prevailing pestilence, and the preceding irregularities in the season. How far this has been successfully done, must be left to the reader's judgment, when he shall have perused the account of the rise of the epidemic now about to be given.-This, at least, he will not doubt, that there was a remarkable coincidence between the extraordinary irregularities manifested throughout India in 1816 and 1817, and the rise of the epidemic; and that its subsequent abatements and revivals, were in some measure dependent on corresponding vicissitudes in the state of the weather." lxviii.
We have thought it necessary to devote some little attention to the atmospheric constitution of India, or at least of Bengal, prior to the out-break of the epidemic. It is undoubtedly true that, since its establishment, the latter has in some degree defied all seasons and conquered all climates. But it is no less consistent with experience and with common sense, that circumstances may exert great power in exciting a disease, which, when it is in being, exert but a feeble influence upon it. Thus cold applied to the surface of the body will excite pneumonia, but this being induced the removal of the cold is not followed by a removal of its original consequence. The difference between the cases is this, that in the former we have a general disposition to disease created, in the latter an insulated malady. Whether the irregularity of the seasons was the cause of the epidemic cholera, or whether it was not, it is certain and indisputable that irregularity did prevail to a very unusual extent, that epidemic fevers of a grave description occurred in the latter part of 1816, that the unnatural character of the seasons continued, and that in 1817 the epidemic made its appearance. These are facts, let men found what doctrines upon them fancy or reason may dictate. We proceed to the section on the rise and progress of the disease.
Cholera morbus has prevailed more or less endemically during the hot and rainy seasons of every successive year, in the lower Provinces of Hindostan. But previously to 1817, its influence was limited, and its sphere circumscribed. During the first six months of 1817 it shewed itself sooner, and was more common than in former years. In Nuddea and other dis