EPIDEMIC CHOLERA?kora.matrix.msu.edu/.../15...CorbynCholera-entire.pdf · SPASMODIC CHOLERA OF...

ACCOUNTOF THE

EPIDEMIC SPASMODIC CHOLERA?WHICH HAS

LATELY PREVAILED IN INDIA,AND

OTHER ADJACENT COUNTRIES AND ISLANDS, AND AT SEA.

COMMUNICATED IN A LETTER FROM

FREDERICK CORBYN, Es2.ASSISTANT SURGEON ON THE BENGAL ESTABLISHMENT, AND

MEMBER OF THE COLLEGE OF SURGEONS OF LONDON.

WITH

COMMUNICATIONS ON THE SAME SUBJECT,BY FAVOR OF THE

CHAIRMAN AND DEPUTY CHAIRMANOF THE

EAST INDIA COMPANY;AND

FROM THE ISLANDS OF THE MAURITIUS AND CEYLON,BY FAVOR OF THE MEDICAL BOARD OF THE ARMY;

WITH REMARKS.

By SIR GILBERT BLANE, BART. FI.R.S.PHYSICIAN TO THE KING.

Recad May 9, 1820.

MY DEAR SIR, Sauger, September 7, 1819.

I RECEIVED your communication through theGovernor General, containing enquiries regardingthe epidemic which has desolated India for the lasttwo years. Itk November 1817, I drew up a de-scription, with an account of a treatment which Ihad adopted, and found remarkably successful.This was contained in a single sheet, and printed

ON THE SPASMODIC CHOLERA OF INDIA. 111

copies of it were distributed by public authority toall the different stations. In August, 1818, I putit into the form of a small tract, wlhich was alsoprinted in this country. But as a considerable timehas since elapsed, I shall, in order to satisfy your en-quiries, relate the further progress of it since -thattime, with a detail of the practice as confirmed andimprove'd by further observation and experience.

This singular and calamitous epidemic com-menced in August, 1817, at Jessore, about ahundred miles to the N. E. of Calcutta, andspreading from village to 'village, destroyingthousands of the inhabitants, it reached Calcuttaearly in September. It extended from thence intoBehar, depopulating many large cities, till the in.hlabitants fled to other spots. Benares, Allahabad,Goriuckpore, Lucknow, Cawnpore, Delhi, Agra,Muttra, Meerat, and Barcilly, have all suffered insuccession; and it is curious and important to re-mark, that it did not appear in these districts atthe same time, but leaving one it soon shewed it-self in another.

At length it appeared in the grand army, firstat Mundellah, then in the Jubbulpore and Saugerdistricts. From tlhence it spread to Nagpore, andcontinued its course over the Deccan in a violentdegree. - At Hussingabad its ravages were terriblefor several days; and taking its course all alongthe banks of the Nerbuddah it reached Tannah.

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Visiting the famous cities of Aurungabad andAhmednugger, it spread to Poonah; from thenceto Panwell in the direction of the coast, where itextended to the north and south, visiting Salsette,and reached Bombay in the second week of Sep-tember, 1818, one year after its first appearance atCalcutta.

While this was passing in the west of the Penin-sula, the epidemic was making the like progress tothe east and south, progressively spreading on thewhole Coromandel coast, and we have heard of itspassing from thence to Ceylon, to the pure air andtemperate climate of Siam, from thence to Malac-ca, and along the straits of Sunda to China*. Sothat in less than two years it had embraced a spacefrom the most northern parts ofIndostan to Ceylon,and from the Indus to China. It has also made itsappearance on board-vessels, both in harbour andat sea. So alarming indeed has been the extentand rapidity of the progress of this dreadful pesti-lence, that it becomes a duty to warn Europe of itsdanger, for we learn from the practice of Syden-ham that this disease was twice epidemic in Lon-don, in the end of summer and the beginning ofautumn.

In my farther account of this disease I shall takethe liberty of quoting amply from the Bombay

* It has since reached the Mauritius.3

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SPASMODIC CIIOLERA OF INDIA.

communications. These authorities pretty ge-nerally concur with what I laid down with regardto it, as it appeared in the centre division of thearmy. The vomiting and purging ofwatery-matterinvariably took place. The absence of biliary fluidin the stomach and duodenum was also singularlyexemplified, and its return was considered as af.fording a favourable prognosis. Dr. Burrell, Sur-geon of his Majesty's 65th regiment, observedthat " the first symptoms of the attack were lan-guor with occasional pains and sense of numbnessin the extremities, violent head-ache and thirst:shortly there ensued nausea, vomiting of slimymatter, but no appearance of bilefrom the stomachor bowels; then followed spasms so violent assometimes to require six men to hold the patient.

Mr. Assistant Surgeon Whyte, from whose accu-rate and well-defined account I shall take the li-berty of quoting largely, agrees, that in the wholeof his practice there was the same appearance inthis ejected and evacuated matter. "The diseasegenerally begins," says Mr. Whyte, " with awatery purging, unattended with griping or anypain. At an interval, generally from half anhour to five or six hours, but sometimes withoutany interval, comes on vomiting of a white fluid;and I will here add my testimony to a heap ofevidence already accumulated, that in this form ofthe disease, I have never observed any thing re-

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.11 ACCOUNT OF. THE

sembling bile discharged upwards or downwards.The vomiting and purging are soon- followed bygreat debility and sitnking of the pulse; the extre-mities become cold; the eye sinks into the socket;the vessels of the tunica adnata are injected withblood, from which if the disease advances a filmin a few hours is formed ; the features express thedeepest anguish, and the eyelids are either whollyor half closed. The patient invariably complainsof great heat at the stomach, and calls incessantlyfor cold drink, althoughi he is warned of the dan-ger attending it. The tenesmus now becomesviolent, although nothing is discharged but thefluid above-mentioned, and a substance like thecoagulated white of an egg. The uneasiness andjactitation are so great, that it is with the utmostdifficulty that we can get an opportunity of feel-ing the pulse, which by this time is not alwaysperceptible, although it is generally so till thespasms come on. These attack at no fixed or de-termined period of the disease, but in general notfor many hours after the commencement of theVomiting and purging. Medicine given beforetheir appearance will generally be attended withsuccess."

This is one peculiarity differing from the epi-demic of the centre division, in which the spasmscame on before the vomiting and purging. I wit-nessed some cases latterly, in whiclh these muscu-

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SPASMODIC CHOLERA OF INDIA.

lar spasms attacked the calves of the legs and ab-domen, subsequently to the accession of thepurging and vomiting; but in these cases there wasevident spasm of the stomach and bowels.

"The spasms are always of the tonic kind, at-tack first the toes and legs, and extend up to thethighs, chest, and arms. When they reach thechest, the breathing becomes so urgent, the senseof suffocation so great, that the diaphragm must Ithink be spasmodically affeeted at the sanme time."

"The most unfavourable and dangerous signsare the coldness of the surface extending to theregion of the heart and stomach. The skin underthe nails becomes inverted towards the outer skin;the tongue becomes icy cold; an universal colli-quitive sweat comes on with shrivelling of the cu-ticle of the palms of the hands and soles of thefeet, the spasms declining while these symptoms-continue to increase. In general all pain andspasm leave the patient before death, and althoughthe heart cannot be felt to beat, he expresses himself easy, and says lie is better. But sometimes Ihave seen him in the greatest agony, rolling Nhim-self on the ground and groaning, sometimes bellowing, most piteously. This latter circumstance,is, I think, confined to patients who linger threeor four days before death comes to their relief, inwhom the disease appeared at .first to have -beenvanquished, but whose vi&s medicatrix naturw was

I[ 2 -

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not strong enouglh to maintain that complete re-action of the system on which the restoration ofhealth depends."

With regard to the appearances on inspectionafter 'death, I shall also borrow largely from Mr.Whyte, to whose zeal and exertions, as well as li-beral communications, his professional brethrenare much indebted.

" Upon opening the abdomen, the most strikingappearance was, the enormous distension of thestomach and bowels, not with air, for they werenearly throughout filled with something of a con-sistence intermediate between that of a fluid and asolid; there was not much of bloody turgescenceon their surface, but they wanted the moisture andglossy appearance of health. The liver was muchenlarged, apparently from the quantity of bloodcontained in its vessels, and on one part of itsconvex surface there was a considerable extravasa-tion of blood. The gall-bladder was filled withbile, and projecting beyond the edge of the liver.The bile was of a very dark color, and the gall-ducts pervious. The stomach was filled with animmense quantity of half-digested rice and meat.The contents of the small intestines were dark-colored, apparently from an admixture of bile.The contents of the large intestines resembled incolor what was evacuated per anum before death,that is of a whitish colour, and fragments of a

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5PASMODIC CHOLERA OF INDIA.

tape-worm were found, parts of which had beendischarged while the patient was alive. The blad-der was quite empty and wholly shrunk into thepelvis. I thought the kidnies were of a diminishedsize. The lungs were so much collapsed that theyappeared hardly to fill one-half of the cavity of thechest. The left portion of them was markedwith several black spots, but whether they wererecent I could not determine. There was nofluid in the pericardium. In the Europeans theappearances in the chest were exactly similar tothe above, with the exception of the black-coloredspots. The stomach and intestines were muchdistended, but with wind only, as appeared fromtheir collapsing the moment a puncture was madeinto them ; but the veins on the outside of both, aswell as those of the mesentery and mesocolon wereturgid with blood, so was the liver, and the gall-bladder was, as in the other case, full of bile. Theurinary bladder was completely empty. I shallconclude with remarking, that from the contents ofthe small intestines in the Sepoy being dark-co-lored, while those of the large retained the lightcolor which marks all the discharge in this disease,it Appears to me that in this case the disorder wasproceeding to a favourable termination, whichwould have been completed had the patient'sstrength been sufficient."

An important question arises regarding its con-tagious or non-contagious nature. So many of

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those who are exposed to it, escape it, that I amunwilling,as well as unable, to believe it contagious-;and were such belief general, it would be produc-tive of great inconvenience and distress, by thedereliction of the sick to which it would give occa-sion. Among those who have reported on thisdisease, there is a difference of opinion on this sub-ject. Mr. Surgeon Anderson says, "' It is sup-posed to exist in the atmosphere, from its pervadingevery where so extensively; but how comes it tospread in opposition to a continual current of air,namely the S. W. Monsoon ? Nevertheless the ideaof its being contagious is entertained by few."

Mr. Surgeon Jukes, in.his report to the MedicalBoard, states, that he had no reason to believe thatthe disease had been contagious. " Neither myselfnor any ofmy assistants, who have been constantlyamong the sick, nor any ofthe Hospital attendants,have had the disease. It has not gone throughfamilies when one has become affected*. It is veryunlike contagion too in many particulars. In ge-neral. I think it has been remarked, that the great-est number of people are affected the first few daysafter it has made its appearance in any place;whereas contagion would be quite the reverse.There is undoubtedly considerable obscurity how-ever at present belonging to this very singular

* It appears from the preface of the Medical Boaid to theirreport, that Mr. Jukes afterwards altered his opitnion on this sub-ject.

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epidemic, and the laws by wwhich itLhas been mov-ing, from place to place, are very unlike those ofcommon epidemics. If the exciting cause besomething in the atmosphere, which has had itsinfluence from Bengal to the Deccan, how did itcome directiy against the S. W. wind that has beenblowing upon this coast since June? How does ithappen that the winids from the ocean still spreadthe disease? And if it be something general in theatmosphere, wlhy has it not hitherto made its ap-pearance in some two distinct parts of the pro-vince at the same time ? Nothing of this kind has,I believe, been- observed. It still seems to becreeping from village to village, rages for a fewdays, and then begins to decline."

Nevertheless I have to inform you, tlhat the ge.neral opinion is against contagion.

In some situations in India the climate exceedsthat of many parts of the world in salubrity andregular temperature, and in which sickness and en-demic disease has seldom prevailed. Yet from theNepaul range of hills running in a line with thesnowy mountains which surround the beautifulvalley of' Catmandoo, to the sandy desert plains ex-tending from the Indus along the Ganges and toCape Comerin, has this dreadful epidemic spreaditself.

I have observed the disease vary by perceptible

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ACCOUNT OF THL

degrees with the changes of temperature, and asthese changes took place, it seemed capable ofoperating powerfully upon nman and beast; and al-though it cannot cease to be marvellous, yet in thegrand army a number of cattle died in the mostsudden and unaccountable manner. It is a fact,that the indigent and naked part of the lowerorder of natives seemed to be principally affectedby the epidemic influence. I mean those whowere confined to particular parts of India, and hadnever travelled elsewhere; whilst those who hadlearned how to evade the severities and vicissitudesof climate escaped the accumulated sufferings andaggravated forms of the disease. In those peculiarlocal situations in India where the land was fertileand teemed with vegetation of rice to a noxiousdegree; in others, where the grass grew man'sheiglht; and in forests of timber and of brushwoodwhere the rays of the sun seldom penetrated,where the waters of grand sacred streams, theGanges and Hoogly, receded from the land andleft a muddy soil and putrid exhalation; nay, inthe very spots where, for years out of remembrance,exhalations rose from marshy bogs, acted upon byintense and -suffocating heat, even in these verybaneful districts, this disease was never known tillnow; the villages which these deleterious landscontained are now, I am informed, entirely depo.pulated. The pestilence added to miasmita had amost terrible effect. But if the history ended here,we might indeed assign these local effluvia as a

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SPASMODIC CHOLERA OF INDIA 1

cause, but the fairest portion of the Indian Conti-nent, where health was no illusion, where sicknesswas a stranger, where mountains rose covered withthe finest verdure, where rain fell muonthly in re-freshing showers, where there. was no deluging ofplains or noxious vapours to contaminate the air,no forest nor grass-jungle to impede its free circu.lation, where the heat was temperate, equable, and-invigorating, where the land was fertilized and thehusbandman rewarded, where the luxuriance ofna.ture exhibited a beauteous prospect from the ad-jacent height; it is too true that in this happycountry, the variation of temperature was amazing.ly great; the disease appeared, and this beautifulcountry was nearly depopulated.

It now affords me particular pleasure, as it willbe highly gratifying to you, -to turn from the me-lancholy scene I have just described, and informyou that the treatment I have hitherto followed,and which the Marquis of Hastings, whose greatanxiety on the subject cannot be enough-admiredand commended, did me the- honor to have pub-lished in -general orders and circulated in -thearmy- throughout India, has proved eminentlysuccessful. I shall now quote the authority ofothers for the excellence of the remedies which Ifound so decidedly and invariably successful inmy own practice, and it is gratifying to me to re-flect, that through the promulgation and generatl

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adoption of them, an incalculable number of liveshas been saved.

The outline of the treatment alluded to, is, toadminister twenty grains of calowel (in powdernot in pills) and to wash it down with sixty dropsof laudanum and twenty drops of oil of pepper-mint in two ounces of water, to bleed fieely in the.early stage, and to support the warmth by externalheat, the hot bath and hot friction, and internallyby cordials.

The first report is dated Seroor, the 22d of July1818, by Mr. Assistant Surgeon Wallace. Heremarks " The disease is mnost formidable. Wehave found the large doses of calomel, oil of pep-permint andlaudanum, generally succeed in check-ing the purging and vomiting. But the most for-midable symptoms are the sudden debility andcoldness, which seem to indicate the use of themost powerful stimulants. The hot bath has beenfound very useful." This gentleman's third re.port states as follows: "I believe Mr. Corbyn'spractice to be very efficacious when adopted early.'The mnajority of cases did not apply for relief untilthey had be.en attacked for some hours, and themedicines were almost invariably rejected in com-mon with every other liquid. I determined toadminister the medicine in another form, andrubbed-up two grains of soft opium, with fifteengrains of calomel, and about two drachms of'

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SPASMODIC CItOLEM OF INDIA. 12l

honey. This was gradually swallowed, beingdropt into the patient's mouth by the finger.After this he was placed in the hot bath, and smallquantities of hot arrack and water mixed withspices and sugar given to drink. The patientcommonly fell asleep, and in favourable casesawoke free from danger. In others the coldnessand spasms recurred, when recourse was again hadto the hot bath, and opium administered in va-rious forms. Twenty-two cases only were ad-mitted yesterday, and all of them except two hlaverecovered."

Dr. G. Burrell, Surgeon of-the 65th regiment,dates his report at Seroor, 27th July 1818, andmakes the following return. It broke out on the18th instant.

Admitted 21st . . 122d . . 62sd . . 6s4th . . 1825th . .2226th . . 7

60 Died, 4.

"On admission I bled in every instance, in ge-neral to a good extent. Where universal spasmexisted, venesection was carried ad deliqujum, andthe patient was at the same time put into a hot

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bath of 1100. The spasms were, by these means,invariably relieved, nausea and vomiting alleviated,so that the stomach bore the exhibition of calomelin scruple doses, combined with laudanum, whichdoses were frequently repeated; in short, theopium was given under every denomination, withcalomel, and I believe the calomel will be found torest on most stomachs per se.

The next report is from Mr. Surgeon Whyte,dated Seroor, the 28th of July, 1818. He states,"The practice I had followed was that first recom-mended by Johnson*, and since by Mr. Corbyn,in which the corner stone and sheet anchor is ca-lomel, in a dose of fifteen or twenty grains of theformer, to an adult according to his strength."

We now come to that of Mr. Assistant SurgeonDaws. His letter is directed to Dr. Jukes atTannah, dated at Aurangabad, 29th of July, 1818'.He remarks as follows: " I presutme you have seenthe letter written by Mr. Corbyn, who had chargeofthe Native Hospital, centre division of the army,at Eritch, to Captain Franklyn, Assistant Quarter-Master General of the same division. On this sub-ject I could not perhaps do better than recommendyou to pursuie the plan of treatment therein laiddown, as it is. the same, with very little variation,

* In his work on the influence of tropical climates on Europeanconstitutions, where he quotes the case of a seaman who hadswallowed a scruple of calomel.

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that I have adopted, and you will be glad to hearthat the success of my own practice tends to cor-roborate it."

The next report is from Mr. Surgeon Craw,dated Seroor, soth July, 1818. He observes:" The calomel and laudanum plan, with most dif-fusible stimuli, and the hot bath, have been emi-nently successful; and ifapplication is made withinfour or six hours from the first appearance of thedisease, the cure is almost certainly effected." Inanother place he remarks, that a bleeding quoadvires, the calomel and opiate, the hot bath, warmclothing, and frictions spirituous or anodyne, formthe chain of treatment in the European Hospitalshere, and these are repeated again and again as thesymptoms may seem to demand. Under this plan,and an early application for relief, I think the dis-ease is not fatal in more than one in a hundredcases.

The following report is from Mr. Assistant Sur-geon Campbell of the 22d dragoons, dated fromSeroor. " The scruple dose of calomel with Cor-byn's anodyne draught was given every two hours,but when the spasms and vomiting had ceased, thelaudanum was omitted, the calomel continued, andthe stimulants more frequently given."-

The next report is from Mr. Assistant SurgeonTod, dated Camp Chumargoody, August 8, 18-18.

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"The way I have administered medicine is by giv-ing calomel, one scruple, and washing it down withtinctura opii, one drachm, and water, two ounces,and repeating them after an hour, if the first dose isrejected. I have sometimes left the initerval of anhour, which generally succeeds; but I have, in afew instances, been under the necessity of giving itthree or four times." In another place, this gentle-man adds," I have had altogether an hundred caseswhere the calomel and opium plan has been fol-lowed, and though ten or twelve have died, thesewere either such aged subjects that no rationalhope of recovery could be entertained, or werebrought in at such an advanced stage of thecomplaint as to be beyond the power of medi-cine.

Mr. Assistant Surgeon Milwood writes the nextreport, which is dated Ahmednugger, 2d August,1818. "I will now give my treatment with myreason for the addition I have made toMr. Corbyn's.There are two great objects to be attained for therecovery of the patient: 1st, to allay the vomitingand purging; 2ndly, to restore the pulse and heatof the extremities and produce sleep. In order toeiTect these, I have, in addition to one scruple ofcalomel, put five grains ofantimonial powder, andadded to the draught one drachm of spt. aether.nitros. In the course of two hours I give tengrains of calomel and five of antimonial powder,with half the draught which I prepare with cam-

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phor mixture in place of plain water, and repeatthis as it is required. The best laxative I havefound to be carbonate of magnesia, four scruples.It remains on the stomach, and generally causestwo or three plentiful evacuations.

Mr., Assistant Surgeon Richards reports as fol-lows. Punderpoor, 3d of August, 1818. "Up toth?mo'rning the admissions amount to 170; outof which eight casualties have occurred." Thisgentleman bled, and used the calomel and lauda-num doses.

To evince how essentially necessary bleeding is,Dr. Burrell sends the following return:

Bled . 88 Died . 2Notbled . 12 . 8

Total admitted loo - 10

I now come ,to Mr. Surgeon Longdill's report,dated Seroor, 17th of August, 1818. " My generalplan of treatment was to give the dose recommend.ed by Mr. Corbyn. If it was rejected, anotherwas given, after waiting an hour, with the warmbath, which generaljy relieves the patients. Afterwhich they required little else but cordials and agentle laxative."

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Mr. Surgeon Robertson, of the European regi-ment, on the Bombay establishment, dates his re-port from Keerky, and states that bleeding relievedthem, and that calomel and opium brought themquite round.

The report which succeeds is from Mr. SurgeonGordon, dated Satara, 5th of September, 1818." I sent you a report in which I stated that I laidconsiderable stress on free and early blood-letting.Since then I have had eleven cases, bled the wholeof them, then opened the bowels, and they are allquite well.

Mr. Surgeon Coats reports to the President ofthe Medical Board, that " the practice followed inthe treatment of this disease at Aurangabad wasthat recommended by Mr. Corbyn, and had beenparticularly successful; indeed, if the patient ap-plied in time, it was considered as infallible.

Mr. Surgeon Jukes next reports, that "expe-rience has now taught us that a very large propor-tion of those attacked by the disease,.recover by thecalomel and laudanum alone; but I feel satisfiedthat there are many aggravated cases wherein no-thing but the most prompt and decided use of thelancet could possibly save the patient."

The next report comes from Dr. Taylor,- a gen-

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SPASMODIC CHOLERA OF INDIL.

tleman who had the principal practice in the diseaseat Bombay. This practice is precisely similar tothe foregoing; he gives the following return:

Medicine administered to . . 7459Of whom died . . . . 441

being a proportion of nearly six to an hundred.

The last report is from George Ogilvy, Esq.Secretary to the Medical Board, confirming thetreatment already mentioned, and the reports areconcluded with the following abstract of caseswhich occurred in the island of Bombay.

1817. Cases. Deaths.August 4400 456September 4804 287October 2411 146November 824 44December 806 641819.

January 889 114February 517 27

14651 1138

Proportion of deaths in those cases in whichmedicine was administered, 6.6 per cent. In thesame space of time 1294 cases were reported bythe police, in none of which medicine was admi.nistered, and it is a most important remark by

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Mr. Ogilvy, Secretary to the Medical Board, thatit was not ascertained that any case had recoveredin which medicine had not been administered.

The population may amount to between 200,000and 220,000. The number of ascertained caseswas 15,945, which gives the proportion of the at-tacks of the disease to the populatiQn 7j percent.

I believe I have now satisfactorily proved toyou the efficacy of the treatment I recommended.I shall add the remarks of the Medical Board ofBombay, made after summing up the whole of theopinions regarding the proper mode of treatmentto be adopted.

" On the subject of thle cure of the disease weneed say but little. The practice so judiciouslyand speedily adopted by Dr. Burrell in the 65thregiment clearly proves, that in the commence-ment of the disease in Europeans, blood-letting isthe sheet-anchor of successful practice, and per-haps also with the natives; in this I have en-tirely concurred in my printed report, but havethere said nothing of this practice among the na-tives. I tried bleeding with the natives, butcould get no blood fiom the arm, and finding everyefficacy from the medicine I prescribed, I had nooccasion to make a second attempt; but I haveno doubt you will perceive from the principles on

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which I ground the cure, that the venesection isadvisable in all cases where blood can be obtained;;"to proceed-" provided it can be had recourse tosufficiently early in the disease, and as long as thevital powers remain so as to be able to produce afull stream, it ought never to be neglected, itbeing sufficiently proved that the debility so muchcomplained of is merely apparent. Calomel as aremedy certainly comes next in order, and whenemployed in proper doses with the assistance ofopium, more particularly in the early stage of thedisease, seems to be equally effectual among thenatives, as venesection among the Europeans, inarresting its progress. In all the cases formerlyalluded to, when we met with the disease in itsfirst attack, a single scruple of calomel with 60minims of laudanum, and an ounce of castor oilseven or eight hours afterwards, was sufficient tocomplete the cure. The practice of this place, assufficiently appears from Dr. Taylor's report, bearsample testimony to the controul which calomelpossesses over this disease. All other remediesmust in our opinion be considered as mere auxi-liaries, no doubt extremely useful as such,, andought never to be neglected, particplarly the warmbath and stimulating frictions."

I trust, Sir, I have now performed my duity ingiving you a full and accurate account -of the na-ture and treatment of this alarming epidemic. Iam still accumulating information, but in the mean

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time as my object is utility and not emolument, Ibeg you will give publicity to this letter, by pro-curing the insertiotn of it in that excellent work,the Transactions of the Medico-Chirurgical So-ciety.

I am, my dear Sir,Your very obedient Servant,

FREDERICK CORBYN.

To Sir Gilbert Blane, Bart.

Such is the account, for which we are much in-debted to Mr. Corbyn, of a malady, which,viewed in all its bearings, is without a parallelin the annals of physic. Whether considered inthe tragical details of its sufferings and fatality,the obscurity of its origin, the sagacious, energe.tic and successful practice by which it was opposed,or the singular circumstances of its rapid progressand its diffusion-over so large a portion of the ia-Nitable globe, it is one of the most interesting andaffecting objects that can engage the attention ofmanikind, particularly of the medical world.

Some conception may be formed of the intensityof the sufferings from wlhat is commonly expe.rienced of the torture from the cramp of a singlem-uscle in the leg; for what must be the agoniesof those in whom the whole muscles of the extre-miities and trunk are so affected, and what -the su.peradded anguish of those in whom the breathing

S2


is impeded by a like affection of the muscles ofrespiration, including the diaphragm, not to men-tion the stomach witlh other muscular and vitalorgans, all thrown into the like excruciating con-tractions ! When to these are added the attendantsymptoms of despair and prostration of mind, itwill be difflicult for imagination to conceive a moreexquisite picture of human misery.

There is therefore great cause of gratulation tohumanity, as well as mtlch matter of triu'mph tothe medical art, in means having been devised forstripping this disease, almost invariably fatal whenleft to nature, in a great measure of its terrors anddanger, by the bold and combined administrationof two potent remedies; the one possessing, alongwith an active evacuating quality, a powerful spe-cificinfluence on the secretions; theotherdisplayingthose anodyne antispasmodic stimulating and ex-hilarating virtues, which render it one of the mostindispensable instruments in the hands of the me-dical practitioner.

One of the first circumstances wlhich strikes usin the history of this disorder, is the name it hasacquired, the term cholera seeming to imply thatit consists of a redundancy or depravity of the bile;whereas it appears that the secretion and excretionof the bile are entirely suspended, and that themattet evacuated by vomiting and purging is quiteof a different character. This is an inaccuracyhowever, into which the ancients, as well as the

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moderns, have fallen, and is best elucidated byAlexander,Trallian*. This ancient author describesthree species of cholera. In the most intense,there is no evacuation of bile, and he thinks thename might more properly be derived fromXoXaoae;,an old Greek word used by Homer, to signify thebowels, than from Xx', bile, In the species nextin degree, however, he says there is a great dis.charge of bile, and being attended with excrucia-ting spasms like the former, obtains the same name.The third species is a simple bilious diarrhoea with.out the spasms. In the disease, as it occurs in or.dinary practice, in this country, most commonlyin the month of August, after the canicular heats,one of the most prominent symptoms is certainlythe discharge of a large quantity of bile, and seemsto be the middle species of Trallian. Hippocratessays little of the nature of the evacuations, onlythat green bile forms part of them. Aretaeus, inhis description, says, that the evacuations are atfirst pituitous, and then of pure yellow bile.Celsus says, that matter of a white color isevacuiated, sometimes black arid of various colors;but he does not describe it with his usual precision,for he calls the white matter bile, using the termin the same vague sense as many persons out ofthe profession in our times, applying it to everymorbid humor of the stomach. In the works ofSauvages, Cullen, and most modern authors, thereseems to be a want of due precision and care in

* Lib. VII. Cap. 14, 15, and 16.

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specifying bile as the only or chief matter eva-cuated. The cholera of Sydenham seems to comenearer to the intense species of Trallian and to theIndian epidemic than any other modern before Mr.Curtis*, and it seemed to prevail, epidemically, inEngland in 1669, and still more severely in 1676.He says nothing ofbile, and characterizes the eva.cuated matters by the name of pravi humores.There seems, however, in all cases to be a pro-pensity to a redundant and vitiated secretion ofbile, for sooner or later it makes its appearance,though in the intense species of the disease the se-cretion of it is suspended in common with theurine and other secreted fluids ; but on the disordergiving way, and the secretions being restored,large quantities of dark colored bile are immediate-ly observable in the discharges from the bowels,the tendency to its redundant and vitiated produc-tion having then scope.

Some of the Indian practitioners have been somuch struck with the impropriety of calling thisdisease cholera, that they have studiously abstainedfrom giving it this name. As a matter of philology,we certainly, by retaining this name, run the riskof falling into the same absurdity as the scholiast,who so preposterously derived lucus a non lucendo;but, on the other hand, we have the highest, cri-

See Account of the Diseases of India, as they appeared in theFleet, in 1782.

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tical and classical authority in points like this, forimplicitly submitting to established usage as thesole arbiter of speech, without regard to etymology.We will do well then to retain the old name, parti-cularly as no other or better has been proposed bythose who have laid aside the old one. Underthis explanation it can lead to no mistake, ambi-guity, nor error of practice,; and as the most prowminent character, next to the bowel affection, isthe cruel muscular cramps, the epithet spasmodicis here added to it, omitting the word morbus,which was first employed to distinguish it from themetaphorical sense of the word as applied to apassion of the mind. Ifno name had hitherto beenaffixed to it, it might be denominated the colicaspasmodica maligna.

Beside what has been extracted from the Bom-bay communications by Mr. Corbyu, there is littleof importance, either in the description or practice.In some of the dissections there is more mentionof congested blood in the veins of the intestines,and of the appearance of inflammation on the stowmach, even to the effusion of coagulable lymph onits surface, in some subjects. This is what mightnaturally be expected, from the bloodless state ofthe extremities, and surface of the body; the cir-culation there seeming almost suspended, as ap-peared by the absence or weakness of the pulse,the extreme cold and shrinkinig, the mass of bloodbeing determined to the bowels; and this seems to

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account for the burning pain at the stomach, andthe success of blood-letting. Some of the gentle-men in their descriptions seem to labor as if at aloss for language to convey an adequate idea ofthe shrinking of the limbs and trunk of the body,the shrivelling of the skin, the collapse of thecountenance, and the sinking of the eyeballs. Itwould appear, that the total absorption of the adepshad also contributed to this, so great and rapid wasthe emaciation; and might not the thick whitematter, so constantly described as discharged fromthe bowels, have been the contents of the adiposemembrane, thrown on the bowels in the same man-ner as serous fluids are thrown on them fromdisease, or the operation of medicine ?

We. find in these documents also a very inte-resting and instructive observation regarding the-comparative susceptibility of the Europeans andthe natives. While thousands of the latter wereperishing by the epidemic in a district near Bom-bay, only six European soldiers died of it. Thisforms a guide to the prophylaxis, namely, goodnourishment, good clothing, shelter from theweather, and the avoiding of fatigue; thesebeing the circumstances in which the -natives-and Europeans differ.

There also occurs an incidental remark, wellworth recording, with regard to the dose of calob-mel and laudanum, which may be safely and even

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beneficially administered. "By mistake twentygrains ofthe former, and sixty minims of the latter,were given at the interval of less than half an hour.The patient was inclined to sleep; nothing morewas done, and in two hours and a half he was aswell as ever he was in his life."

The farther remarks on the question of contagionare also deserving of notice. The following ex-tract contains the opinion of the Bombay MedicalBoard on this subject. " On the 6th of August,1818, it broke out with great violence at Panwell,a considerable village in the main line of commu-nication betweeni Poona and Bombay, separatedfrom the latter by an arm of the sea, and distantfrom fifteen to twenty miles; but between which apretty constant communication is kept up bymeans of boats. On the 9th or loth of the samemonth, the first case appeared in this island, and,as is mentioned in Dr. Taylor's report, could betraced to a man who had arrived from Panwell thesame day. It is also evident from Dr. Jukes'sreport, that it spread north and south along thesea coast from the same place, and that it was im-ported to a village in the neighbourhood of Tan-nah in the island of Salsette, distant from thisplace about twenty miles, by a detachment thatescorted a prisoner from that garrison to Panwell.The disease did not break out at Muhim, on theextremity of this island, distant only five or sixmiles from the principal native town of Bombay,

7

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SrASMODIC CHOLZRA OF INDIA.

until it had been established in the latter; it thengradually spread over the western side of the islandto Salsette, through which the road from Bombayto Surat and the northern countries lies; and bywhich during the south-west monsoon, is the principal line of communication. By the observationof some individuals', who, aware of the danger ofthe malady, and with the humane view of relievingthe sufferings which it inevitably produced, care-fully watclied its progress, we are enabled to tracethe disease as if creeping along from villag,e to vil-lage on that island precisely in the same way, thatis, by the arrival of people affected with diseasefrom places where it was known to prevail; and weare assured that there are some villages in thatisland, which from want of this sort of communica-tion, or from some other cause, have, after a lapseof four months, hitherto entirely escaped.

From the foregointg detail, wbiclh, to some, mayappear too minute, we are disposed to concludethat this epidemic is not only different in its naturefrom those that have hitherto been observed; butthat it may be said to stand alone, in regard to

* Amongst those, we have great pleasure in mentioning thename of ensign W. A. Tate of the corps of engineers, stationed on

Salsette; who, among other arduous duties, paid the most utiremit-tincr attention to alleviate the suffering- ofa large porLion ofthe po-pulation, and to whose bumane exertions, some thousand of thein,habitants owe thteir preservation.

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some of the mnore essential characters which usuallydistinguish those diseases.

In the first place, it his prevailed to a degreeequally violent at all seasons ofthe year ; in regardto temperature, from 40 to 50 degrees of Fahren-heit to 90 or 100; in regard to moisture, duringthe continuance ofalmost incessant rain for months,to that dry state of the atmosphere which scarcelyleaves a vestige of vegetation on the surface of theearth.

Secondly. Altbough what has been adducedmay not appear to some to be sufficient evidenceof the fact, it appears to us incontrovertible, thatit is capable of being transported from one placeto another, as in cases of ordinary contagion orinfection, and also to possess the power of propa-gating itself by the same means that acknowledgedcontagions do, that is, by the acquisition of freshmaterials with which to assimilate, at the same timeperhaps, subject to particular laws, with which wemay never become acquainted. Aware, however,of the doubtful nature of the ground wvhich wetread, amidst the contrary opinions that have beenadvanced on this subject, we shall content ourselveswith stating a few facts, which have been suppliedby gentlemen? whose reports have been alreadyprinted, and which might be increased muchbeyond the limits to which we think it necessaryto confine ourselves. In October last, when the

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disease had almost disappeared at Tannah, the at-tention of Mr. Jukes was called to a case that hadoccurred in one of the apartments of the barracksof that fort appropriated to European troops; this,owing to too late application for medical aid, soonterminated fatally; another case occurred a fewhours afterwards, the subject of which was savedwith much difficulty and after much danger, and inthe course of six succeeding days, no less than ninecases occurred in the same apartment. The cu-riosity of Mr. Jukes was naturally excited to as-certain under what circumstances so much diseasewas produced, and on examination, the ward ap-peared to be both badly ventilated and too muchcrowded with men; the place was immediatelyemptied, scoured, and fumigated, after which noother case occurred. Since the middle of Decem-ber, when we had flattered ourselves that tlledisease was vanishing as the cold season advanced,the number of cases considerably increased in thisisland, Salsette and the Conkan, and consequentlyexcited much alarm; in some instances these caseshave been confined to particular spots, and some-times to particular houses, where the disease hasattacked and destroyed, in succession, whole fa-milies, consisting of three, four and five persons,while, in others, only a single case, or at most, veryfew have occurred. We are utterly ignorant ofany local circumstances to which such a changecan be -ascribed; unless by supposing that a dimi-naLtion of temperature, together with exposure,

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may have called into action some latent remains ofaniactive poison; otherwise it seems -difficult to re-concile those facts witlh -what is observed in or.dinary epidemics. It will be observed that MIr.Jukes, in his report, remarks that the disease, as it atfirst appeared at Tannah, did not go through fanii-lies when one had become affected. He has sinceseen sufficient reason to alter his opi-nion in regardto that particular; and we think that we observedin several instances, that the disease has shewn agreater tendency to spread, where the first attackshave proceeded in their -course to a fatal termina-tion, which they invariably do when not counter-acted by medicine. How far the same thing hasbeen observed to happen in other -epidemics wecannot determine.

The next-testimony on this side of the questionis that of Dr. Burrell, who says, in his report -datedSeroor, July 27, 1818: "-As every epidemic, byaccumulation of subjects, has a tendency to propa-gate its virus, I am cautious in reporting thisdisease not infectious. Almost every attendant inthe Hospital, in. the short space of-- six days, hashad the disease. There are about thirty attendantsin the Hospital."

In proof of the contrary opinion, the authorityof Mr. Assistant Surgeon Whyte may be cited,who, in his report dated Seroor, Sept. 7, 1818,says, " Convinced as I am of the total absence of

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SPASMODIC CHOLERA OF IND1A 1

contagion in this disease, I have observed thelate revival of this opinion with some degree ofpain. Surely, if it was at all contagious, the factof its being so could not remain long doubtful.In the general hospital here, there were threeSepoys, who resided continually from the first ap-pearance ofthe epidemic,inhaling by day and nightat every inspiration, mouthfuls of the infection. Ifthe atmosphere was really loaded with contagiouseffluvia arising from the bodies of the patientsin the hospital, the escape of these men (whichhas been complete) would be miraculous, indeed;living, as they were, in the very midst of these ef-fluvia, and so near their source. Allowing that theconstant habit of doing so procured them an ex-emption from the influence of contagion, the samething cannot be said of the friends and relationswho were attending upon the patients, and of sixdooly bearers, changed daily, and who used toassist the sick into and out of the bath, and inevery other way; thereby exposed to be infected.by the disease, whether it is conveyed. through themedium of the atmosphere or by touch; yet Ihave not known one instance of dooly bearers,friends and attendants of the sick being so infect.ed, nor have any of our hollalchones or hospitalassistants suffered."

The next extract shall be-from the letter of Cap-tain Sykes to Dr. Milne, dated Punderpoor, 15thof August 1818; and as this is mere matter of

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evidence, upon which persons, of good sense outofthe profession are competent to decide, (perlhapsnot the less so that they are not biassed by aniytheory or preconceived opinion) some weight isdue to it. " With respect to the origin and natureof the malady, I am incompetent to give an opi.nion; but that its progress is independent of theair, I think there are many circumstances to jus-tify the belief. In the first place, we see that ithas made its way independent of a permanentS.W. wind from Jaulna down to Punderpoor. Itseffects were not instantaneous in the country; butits progress may be traced, by a slow advance, tofrom 15 to 29 miles a day, as if it had been-om-municating gradually by persons travelling fromtown to town. Its principal ravages about hereappear to have been confined to the high roadsleading from Punderpoor and the large villages inthe neighbourhood, and I dare say it might beproved that it did not break out in any village,until that village had communicated with a neigh-bouring place in which the disease existed. Cor-roborative of this, are the observations I made atNatapoota of the 17th of July. That day I de-scended thie Mahadoo ghaut from 'the town ofSingnapoor, in which the disease was- unknown,and marched six miles to Natapoota ; where theplague had that very day made its first appear-ance. It first appeared in Punderpoor on the 14th,so that it had taken three days to travel 40 or 50miles to Natapoota. There are other circum-

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stances also to justify the belief that it is conta-gious. In my light comnpany there were three orfour men taken ill at once; of course there wercattendants front the same company upon thesemen. The disease went on increasing in thatcompany, and there have been more cases of cho.lera in it than any other. One of my servantswas attacked: it gradually extended to five. Anofficer at Pundeerpoor had seven servants attackedone after the other, the gentleman i-n the nexttent had not one. I have seen a similar instancein our cor'ps. I should infer therefore,- from itsrunning in particular companies of a corps, or setsof servants, that, as theyattend on each other,and constantly sit or sleep in the confined spaceof a small tent, the disease is communicated byabsolute contact, or from respiring the same airthat a diseased person has done. I am aware thatthere are very strong arguments against its beinginfectious, persons escaping who have been in con-stant habits of handling the sick and breathingthe air of the cholera hospitals."

Mr. Surgeon Coates, in a letter to the President-of the Medical Board at Bombay, says, "c AtTokah we were visited by a gentleman from Au-rungabad, whlo brought us accounts of the diseaseraging in that city; -but the idea was, that it hadbeen brought from Jaulnah where it now alsoraged, and that its progress through the villages inthe post road from Nagpore to that station could

VOL. XI. L

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be distinctly traced." In anotlher part of his re-port he says, " From the above facts and otherswhich have been related, I consider the diseaseinfectious; but though this opinion should be wellfounded, it ought to occasion no alarm, for it isonly under some peculiarity of constitution, andthat fortunately very limited, that the poison acts.About 1 in 40 in our camp was attacked, and Isliould think this is above the usual proportion.If the disease were occasioned by a distemperedstate of the atmosphere, it would have spread overthe country with some sort of regularity, but itseems generally to have travelled in lines along-thepost roads, and-always to have required a succes-sion of subjects for its propagation. In Candeish,where there is not sufficient population, and butlittle intercourse between the villages, its progresswas slow. At Punderpoor it made its appearance atthe time of the great Jatra, and was spread at oncein all directions by the pilgrims returning to theirhomes; the number of deaths here was so00 in afew days. The patients are described as beingknocked down as if by lightning. We know no.thing of the state of the body which predisposes tothe disease. " Mr. Coates mentions a circumstanceat the conclusion of his letter, which leads to theidea of the infection lying dormant for some timeas in the case of small-pox. He says, I might havementioned that all the subjects predisposed to thedisease, seemed to have been attacked at the placeswhere it appeared within ten or twelve days."

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SPASMODIC CHOLF.RA OF INDIA.

The last extract relating to this subject, shall betaken from the report of Dr. Taylor to the Me-dical Board of Bombay, dated 16th of Nov. 1818."Whether the disease be contagious, or a simpleepidemic produced by some peculiar state of theatmosphere, is a question whiclh has been a gooddeal agitated. The course which it has pursuedfirom one extremity of India to the other, un-checked by diffierent states of temperature, and bygreat variations of seasons; its proceeding evenagainst the powerful monsoon winds, and its hav-ing been traced moving along, the high roads fromplace to place, have been urged as proofs of itscontagious nature. The manner in which it wasfound to have originated and to spread at thisplace, lends some probability to the same opinion.Its introduction to Bombay has been clearly tracedto a person who came from the Deccan, and passedthrough Panwell when this disorder was ragingthere; and it has been observed here, that when-ever it appeared in any particular spot or family, aconsiderable proportion of the family, or of theneighbours, were attacked within a very slhort pe-riod of each other; on many occasions I haveseen three or four of a family lying sick at once.In bringing forward these facts, however, it may beproper at the same time to state, that of the 44assistants employed under me, only three wereseized with the complaint.

L 2

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The communications from the Mauritius, comenext to be considered: It appears by a reportmade by the principal medical officer there to thePresident of the Medical Board of the Army,that the disea3e first shewed itself here on the 20thof November, 1818, and continued to prevail,though with considerable abatement, till the 18thof December, when the last accounts came away.In that time sixty-nine cases hadoccurred in anarmy consisting of 1472 men, of whom fourteenhad died. It appears by a communication madeto the writer of this, by a gentleman high in theCivil Service of the Government, that from the timeof its breaking out till the date of his letter, De-cember 18th, the number of burials during thesame period was 700. The ordinary average wasfrom 90 to 120 in the same space of time. This isindependent of the deaths in the country districts,which have been very numerous. By stil morerecent accounts it appears that the total mortalityin the island amounted to several thousands, an-dthat the number of cases in the army, from the19th of NTovember, 1818, to the 4th of February,1819, was 269 ; of whom, 235 were discharged;31 died; and 3 remained. Here, as in India, byfar the greatest proportion of seizures took placein the laborious classes of the population. Onlytwelve of the white inhabitants had died of it; butthis class of the population lost not a moment in re-moving from the town on the first alarm, and every

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precaution was taken as ifthe disease had been con-tagious,

With regard to the practice, opium and calometwere administered to the cases in the army, butin smaller doses than in India. Little is said ofthe civil practice, except that one of the Frenchpractitioners stated that he found great benefitfrom the administration of repeated doses of twodrachms of the sulphate of magnesia. It hasbeen already mentioned that the mortality in thecivil hospital was 94 in 133 admitted. The deathsin the town by the report of the French practi-tioners were 194 in 440 admitted. By comparingthese statements with those in India, it will beseen that the success was much greater in thelatter.

There was here the like difference of opinionreprding the contagious nature as in India. Theprincipal medical officer denies its being conta-gious, and ascribes the appearance of the diseaseto the unusual degree of atmospheric heat. Ano-ther medical officer is of opinion that it is con-

tagious, and that it fell most heavily on the at-tendants of the sick. From the great alarm ofthe inhabitants, it is evident that they were im-pressed with the same belief, and did not doubtthat it had been imported by the Topaze frigate,which arrived at Port Louis on the 29th of Octo-ber from Ceylon, where it prevailed. Of 17 who

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were taken ill of this disease on the passage, 3died, by the rer ort of the surgeon, beside twopreviously; the whole number of deaths by thatdisease being stated at 5 on board for the preced-ing 18 months.

It is of the utmost importance that the questionregarding the infectious nature of this malady bedecided. The facts and the arguments on both sidesof the question have been fully detailed. It- hasbeen already observed, that if it is not contagious,and that the general belief should prevail of itsbeing so, the most serious distress and inconve-nience would arise, from the dereliction of thesick, to which it would give occasion. But onthe other hand, the mischief would be infinitelygreater, should it be really infectious, and thecontrary opinion prevail. It is evident that thesettling of this question must be of the mostgrave, serious and vital moment to the community,and to the character and feelings of the medicalpractitioner, to whose opinion the world at largenaturally look up, and from whose decision, if er-roneous, the most direful calamities must ensue.It is indeed hardly possible to conceive a higherand more sacred responsibility to exist, for uponsuch decision hangs the fate of thousands, who may,by a mistaken opinion, perish of a disease perhapsthe most excruciating in the whole catalogue ofhuman maladies, not to mention that the peace ofmind of the individual who pronounces the senr

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tence, as well as the credit of the profession atlarge, is deeply involved in the opinion he maydeliver.

The main argument of those who maintainnon-contagion is the exemption of the great num-bers who are exposed to breathe the egluvia, and tothe contact of the affected subjects. To. those whoemploy this mode of reasoning, there are two con-siderations which seem to have escaped their at-tention. The one is, that the same principle willapply still more strongly against its being derivedfrom a general atmospheric cause, whether this ismade to consist in a higher degree of temperature,or in some contamination from the exhalations ofthe soil or other cause. For it is evident, that asall must breathe the same air, all ought to' be seized;whereas it is possible that many may avoid inhalingthe morbid effluvia of the sick, which is so muchmore partially diffused. Those who have remainedexempt, must have been equally exposed to thecause as those who are taken ill, if that cause pro-ceeds from the soil or the atmosphere, or anyother universally diffused cause, such as must existif contagion is denied.-The other circumstanicenot adverted to, is, that in no case of epidemicdisease, however distinctly depending on the mor-bid poison of the sick, is the whole population af-fected in the same manner. If this were not thecase, the plague or small-pox would long ago haveextinguished the human species, whereas great

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numbers who are taken ill of both, escape withtheir lives, and others entirely resist the infection.It is clearly stated insome of the testimonies alreadyrecited that, except in the hard-living part of thecommunity, only a small proportion of those ex-posed, were susceptible, from some inscrutable mo-dification in their constitutions, and it appears thatafter all the susceptible had been affected, thedisease abated, and speedily disappeared.

The circumstance which most obviously discri-minates an epidemic arising from the morbid poi-son engendered in the human body, that is con-tagion, from those wlhichi arise from affections oftheatmosphere, whether consisting in alterations oftemperature or in contaminations from the soil, isthat the progress of the former will necessarily beprogressive and traceable to human intercourse,whereas the influence of the latter will as certainlybe contemporaneous in situations more or less dis-tant. It will be clearly perceived,, by a careful pe-rusal of the preceding history, that the spread ofthis malady has been strictly progressive, and evi-dently carried by human beings from one districtto another; nor is it conceivable that those requi-sites of temperature and contamination of the at?mosphere, could have occurred by mere accidentat those spots and periods in which the diseaseshewed itself in its progress by sea and land, as his-torically ascertained in the preceding narrative.This is no where more striking than, at the Mauri.

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tiuS. This island is near 000 miles from the otherplaces at which the epidemic raged; and can anymind be so constituted as to believe that a newdisease of the identical nature with that which hadravaged all India, should have shewn itself by mereaccident at the very time when its appearance wasin exact conformity with the supposition of itsbeing imported by the frigate ? For let us supposethat the inhabitants of the Mauritius were all, ormost of them, susceptible of the small-pox from thelong absence of that epidemic, and that a -shipshould arrive in which several cases had recentlyoccurred, and from which thirty of the sick werelanded, and a free intercourse admitted, as statedin the transmitted accounts, it would break outabout the same distance of time, that is about threeweeks after the arrival of the ship, for no subjectmight be exposed to the morbidfomites for a weekor two, and the infection would remain in the sys-tem for ten or twelve days, a circumstance commonto these two epidemics, and which took place withregard to the cholera after the arrival of the Topaze.This subject indeed cannot be better illustratedthan by running a parallel between the actual pro-gress ofthis epidemic and the usual course of small-pox. Let us put the case that small-pox had beenintroduced into Calcutta in August, 1817, andthat the whole of India had been so long a stran-ger to it that all the inhabitants were in a suscep.tible states would it not take exactly the same di-

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rection and propagate itself in the same manner aswe have seen the cholera to do ? It would extenditself to that quarter in preference to any other inwhich the greatest human intercourse was goingon, that is towards the North-West, where the af-fairs of government and commerce, and above all,at that period, to the quarter where the GrandArmy was assembling, on the banks of the Jumna.This was the route which it actually did take, andthe like causes carried it into the Deccan, andfrom thence to each side of the Peninsula of India,where the communication of human beings wasgoing on, and advancing most rapidly where thiscommunication was most frequent, reaching at lastthe sea-port towns on the Coromandel coast and theisland of Ceylon, where having got on board ofships it-- was transported over seas and oceans tothe continents and islands to which these shipswere destined.

It farther resembles the small-pox in tthe subtle-ness of its communication, the infectious matter ofboth seeming more volatile than that ofthe plague;for though we have been able to trace it on thegreat scale, it has been found occasionally like thesmall-pox to break out in spots a few miles distancefrom the known seat of contagion without its beingpossible to trace it. It is to be regretted that thesame circumstance renders it extremely difficult inth4 case of both diseases, tQ take measures however

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judiciously framed and vigilantly executed, whichshall be effectual in preventing their introduction.

The only other hypothesis that has been devisedto account for the remote cause of epidemics ingeneral, besides the exhalations of the soil and theinfectious effluvia of the living body is that whichwas suggested by Sydenham, of subterraneous mi.neral effluvia arising from time to time. This hasbeen actually alluded to by one of the medical of-ficers of India as a probable conjecture ; but not tomention the untenable ground of an assumptionpurely gratuitous, and neither supported by factnor countenanced by analogy, it may be askedhow it is conceivable that these effluvia could ex-hale from the earth in the progressive manner inwhich this disease extended itself, and how will itaccount for its appearing on board of ships at sea,or at remote spots where these ships arrived, theMauritius for instance, 3000 miles distant fromIndia, while it was unknown at the Isle of Bourbon,a small neighbouring island in the middle of thesame ocean, in the same atmospheric stream ofair, being situated about thirty leagues to leewardof it? And we may here take occasion to mentionthat intelligence has just been received in Englandthrough the French journals, that a ship arrived atone of the ports of France on the 9th of May, inninety days from Bourbon, which she must haveleft therefore on the loth of February, at whichtime the disease had not appeared in that island,

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and that a strict quarantine had been institutedfrom the moment it was known to have shewn itselfat the Mauritius about three months before*.

* Since this sheet was sent to the printer, intelligence lhas beenreceived from the Mauritius, dated the 21st of March, fromwhich it appears that the epidemic had then entirely ceasedthere, and that a ship had arrived the day before from Bourbon,with accounts of its having appeared there in spite of the pre-cautions, but had been confined to the town, and had ceased whenthe ship sailed.

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