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REPORTS epidemic; cholera W HICH HAS RA C I TBRUttKOCT 'DOSTAN AND THE PENINSULA OF INDIA; 

SINCE AUGUST 1817 



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ERRATA. 

Ige .'JO line 7 from bottom, for every read very 35 line 6 — top, fo 1 " against read again 60 Signature f for Milwood read Mi/ward 

I,'JO line 12 from bottom, for as read «£ 

Letter No. 34 insert Signature R. Wallace 

141 line 7 from top, for parvagum read yjflr vagutn 

155 Signature, for S. Coats read T. Coat? 156 line 5 from top, for is read in 

J175 first line, for September read August. IN DEDICATION, i, line 6, for extends read eatf#tc?eeJ. 



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0 



TO THE RIGHT HOSORABLE 

Sir EVAN NEPEAN,bart, 

GOVERNOR OF BOMBAY, 

One of His Majesty't most Honorable 

Privy Council, $c. &c. <s>'C 

Sm, 

ifcVE take the liberty of prefixing* your name to the following 8 reports, because they belong* to you by a double title. They relate to the 

measures 



2 

Dfc.DICATIO,^» 

neasures taken, under your anction, to check amostsing-ular and alarming' disease, vhich after sweeping* the provinces of Hindostan, exends into those under your government ; and w ithout the irompt, liberal and, we may ay, unlimited powers which ou bestowed on the Medical Joanl, for the purpose of arpstin 1 the progress of the fyil, the best exertions of the nedical establishment, must 

have been comparaiiv ely feeble and inefficient. The 

many 



DEDICATION. 

3 

many thousands who owe their lives to the extent and efficacy of those measures, owe them to you. 

You have seen the British dominions in this country enlarged in territory, in revenue, in wealth and in power far beyond the most sanguine hopes that could have been entertained, when you landed in India: and in accomplishing* these objects, the aid derived from your government has confessedly? most essentially contributed. These are noble and generous sources of 



pride, even though necessarily attended with much immediate misery and bloodshed. But splendid as they are, they will not, we think, lessen the feeling's of pure and unmingled gratification which you will derive from having* been the means of saving* so many human lives, of alleviating* so much human suffering*. These local and domestic occurrences may find no place in the pag*e of history: but you will find a humbler thoug*h a rich reward in 



4 





DEDICATION, 

5 

I lie pleasing* consciousness of aving 1 done g-ood, 

We have the honour to remain, 

Sir, 

Your most Obdt. Servants, 

R. STEUART, 

B. PHILIPPS. 

Bombay, 2ith March 1819. 









J_ IT E fullowing reports contain an account of one of the most formidable and fatal diseases that lias visited India in modern times, and which has raged with unabated fury in one part or another of Bengal, Hindustan and the Peninsula ever since the middle of August 1817, and still continues its progress as if every province were destined to experience its baneful influence. 

It is proper to state the circumstances under which these reports have been offered to the public, and it is hoped that it. will be accepted as a sufficient apology to the gentlemen who contributed to give the information they contain, for publishing what they may consider crude and hastily prepared notices, to assure them that had the delay which has taken place in their 

progress 



progress through the press been foreseen, they should have had an opportunity of revising them ; this circumstance however it is believed, does in no degree diminish their value; they may be considered as notes taken at the side of the sick-bed, containin"' a faithful record of every occurrence as it took pltce, and in a stale of mind anxiously watching the chain of symptoms and the effect of remedies employed, hi a disease of which little was known, and the changes so rapid a^ to require the utmost vigilance on the part of the practitioner. That this has been generally well performed, wo presume, will be readily acknowledged, and it will constitute the most acceptable reward of their labours. 

ihen the disease had advanced to the raid as far as Jaulnah, nearly four de. to the eastward of this place, it bepretty evident that it would continue urse all over the western side of the isula. ft (hen became the duty ot Iho :al board to take such measures as id best calculated to resist as far as 

possible 

2 





possible its fatal effect*, and amongst others they directed all the medical gentlemen immediately under their control to communicate whatever information they might bo ably to obtain cither by their own experience ©r otherwise, in regard both to its history and treatment. The mass of inibrnialion thus collected soon appeared of a nature too interesting both to the medical 

s 

profession and to the public, to be laid aside as mere official papers; application was therefore made to government for permission to publish it at the public expense, this as might be expected, was immediately complied with in the most liberal manner. It is true that an abridgment of the principal matter contained in these reports might, have been easily prepared, but it was judge 1 but fairness to the contributors to adopt the mode that has been pursued, and to arrange them as nearly as possible in the order of their respective dates. And as an able letter written by Mr. Corbyn of the Bengal Establishment, who was in charge of the native general hospital of one of the divisions of the Bengal army, when the disease 



3 





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. 

ictioun v lew 

tain ol KytnploiiH and Hullenng^ 

in Una singular d it is indeed to 

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!)p regretUgd thai the dates of th* appear* unci? of the diltafi at 1 1 k - dillercnt places in Bengal ait not mentioned, which would enable im |<> compare flic* progress of the ribeftte in NtpfcCt to lime and distance, in thote provinces with what wo have observed pretty uniformly to take place on this wide of India ; it is however to be hoped that (his Information will yet be supplied by those gentlemen who have had opportunities of making observations and collectting facts at the stations alluded to. It seems however suflieiently evident from this extract that the appearance of the disease at distant stations was by no means simultaneous, and it is most likely that it will be found that the times will be in some regular ratio to the distance; thus it appears to have taken nearly ten days to reach Calcutta from Jessore, a distance about 100 

Brh.ilor.l first appeared in August of l«t>t year ( 1817) Jessore ; Nituuled übouta hundred milci uorth rant utta. There had bern n<> pr<Vou« narked peculithe weathrr. The preceding cold and hot montb« wkie diifcrrat from those of former year* ; Jt U?e rainy 

0 





Ens raging with great violence, lias bc?h equently mentioned in the reports, it lias ?en thought proper to subjoin it as an apuidix. 

As the progress of this disease throughout India forms a very important part of its history, we .shall as far as we are enabled, by our information, which is far from complete, trace it from the place where it seems first to have broken out, to this Island, where it first appeared in August last, comprising a period of about one year from its commencement. In doing this we are happy to avail ourselves of a Utter from the medical Board of Bengal * dated 4th of Sept. last, from which we shall lake the liberty to quote largely, as it contains much information on this part of the subject ami also a comprehensive and perspicuous view of the chain of symptoms and sufferings* in this singular disease. It is indeed to 

be 

* When tlio disease had reached Bombiv, Dr. Mock, Super. Intending Burgeon of Clu/crat, fron a laudable desira of obtain* lag all the information possible with regard to its treatment, :i|>- plicil to t lie Medical board of Bengali the answer to tin's contains tUf. information alluded *.o. which appeared so interesting tliat «• are confident we need uti'c'r nu apolu \ lor ill nubJii af'oiu 

4 





be regretted that the dates of the appearance of the disease at the different places in Bengal are not mentioned, which would enable us to compare the progress of the disease in respect to time and distance, in those provinces, with what we have observed pretty uniformly to take place on this side of India ; it is however to be hoped that this information will yet be supplied by those gentlemen who have had opportunities of making observations and collectting facts at the stations alluded to. It seems however sufficiently evident from this extract that the appearance of the disease at distant stations was by no means simultaneous, and it is most likely that it will be found that the times will be in some regular ratio to the distance; thus it appears to taken nearly ten days to reach Calfrom Jessore, a distance about 100 

B Cholera first appeared in August of last year ( 1817) Jessore; situated about a hundred miles north east jtta. There had been no prcrous marked peculithe weather. The preceding cold and hot montbf wise different from those of furmrr years ; -4c the rainy 



5 





6 

PREFACE. 

•eason was proceeding -with iti wonted regularity. To the authorities on the spot there, the disorder seemed at first to be of a purely local description ; and attributable to the intemperate use of rank fish, and bad rice. They were soon undeceived, after nearly depopulating the town of J-essore, it rapidly spread through the adjoining villages ; and ran from district to district, until it brought the whole province of Bengal under its influence. It next extended to Behar > and having visited the principal cities west and east of the Ganges, reached the upper provinces. There its progress was more irregular. Benares, Allahabad, Goruckpore, Lucknow, Cawnpore, and the -more populous towns in their vicinity, were affected nearly in the regular course of time. But it was otherwise in more thinly peopled portions of tl € country. The disease would sometimes take a complete circle round a village, and leaving it untouched, pass on, as if it were about wholly to depart from the district. Then, after a lapse of weeks, or even months, it would suddenly return and, scarcely reappearing in the parts which had already undergone its ravages, would nearly depopulate the hpot» that had so lately congratulated itself on its escape. Some* times after running a long course on one side of the Ganges, it would, as if arrested by some unknown agent, at once stop; and taking a rapid sweep across the river, lay all waste on the opposite bank. It rarely, however, failed to to return to the tract, which it had previously left. After leaving a district or town, it sometimes revisited it, but in ruch cases the second attacks were milder ; and more readily subdued by medicine; than those in the primary Mutation. 

The disorder shewed itself in Calcutta in the first week 

of 



of September. Few were seized in the beginning; but of those few scarcely one survived. Each successive week added strength to the malady ; and more extended influence to its operation. From January to the end of May, ifc may be said to have been at its full height; and during the whole of that period, the deaths in the city seldom by the police returns fell short of 200 a week. 

It in turn, attacked every division, and almost every coq-t in the army. Of its fatal effects amongst the troops, a melancholy ami signal instance is afforded in the history of its appearance in the centre divis'on of the field army, under the personal command of the Most Noble the Commander in Chief. There it commenced its attack on the 18th or 19th of November ; was at its utmost violeuce for four or five days; and finally withdrew in the first days of December. The division consisted of less than ten thousand fighting men » and the deaths within twelve days amounted, at the very 'owest estimate, to three thousand ; according to others to five, and even tight thousand. The average loss of rank and file was between eighty and ninety men a battalion. 

The Epidciuick was long in crossing the Bundlekund anil Rewa Hills. It began to shew itself at Jubbulpore on the 10th of April ; prevailed generally amidst the corps posted there, at Mundelah, Saugor, and other subordinate stations* to the 2 1st; and nearly disappeared before the end of the month. Hire its influence was singularly irregular. In the name camp and under circumstances precisely similar- some corps were entirely exempt ; others had a few oiild case* only : and others again suffered very severely The same irregularity held in different descriptions and classes of tioops. The disease did not reach Colonel Adams's camp 



7 





8 

PREFACE. 

till the 20lb of May. It raged very violently during four or five days; and continued its opt rations in a desultory manner till the middle of the succeeding month. In Bengal, and the middle province*, it may now perhaps be considered as nearly at an end. Cases no doubt still now and then occur in Calcutta, and its vicinity; but these arc rare; and should rather be reckoned sporadic, than as proofs of the subsistence of the epidemic. The returns from the different divisions of the army, now leave the head of Cholera Morbus, in most cases, blank ; and the reports of the civil Surgeons are equally decisive of its general disappearance* At Delhi, Futtigur, and others of the more northern stations, whither the disease was long in spreading, it is still, the board believe, in full force, and producing the most alaiming mortality.** 

Colonel Adams's force was on the 29th or 30th of May in the neighbourhood of Nagpour, where the disease had raged for some days. We do not know the exact period at which it appeared at Jaulnah, but believe it to have been the latter end of June or beginning 1 of July, immediately after the arrival of a detachment from Nagpour. After pushing over a space of 200 or 220 miles, after visiting- Aurangabad and Amedniiggur in its course, it reached Seroor, a distance of 150 miles, on the 18th or 19th of July. Towards the latter 





? 

end of the same month it appeared in the city of Poona, although the troop 9 encamped in its neighbourhood continued healthy for some time after. On the 6th of August it broke out with great violence at Panwell, a considerable village on the main line of communication between Poona and Bombay, separated from the latter by an arm of the sea, and distant about 15 or 20 miles; but between which a pretty constant communication is kept up by means of boats. On 9th or 10th of the same month the first case appeared on this Island, and, as appears by Doctor Taylor's report, could be traced to a man who had arrived from Panwell the same day ; it is also evident by Dr. Jukes's report that it spread north and south along the sea coast from the same place, and that it was imported to a village in the neighbourhood of Tannali on the island of Salsett, distant from this place about 20 miles, by a detachment of troops that escorted a state prisoner to that garrison from Panwell. The diarase did not break out at Mahim, on the extremity of this island ditt* 



9 





PREFACE 

10 

tant only 5 or 6 miles from the principal native town of Bombay, until it had been established in the latter : it then gradually spread over the western side of the island of Salsett, through which the road from Bombay to Surat and the northern contries lies, and by which during the south west monsoon, is the principal line of communication. By the observation of some individuals * who, aware of the danger of the malady, and with the humane view of relieving the sufferings which it inevitably produced, care full v watched its progress, we are enabled to trace the disease a3 if creeping along from village to village on that island precisely in the same way, that is, by the arrival of people affected with the disease from places where it was known to prevail ; and we are assured that there are some small v liages on that island, which from want of this sort of communication, or from some other cause, have after a lapse 

of 

i> Amongst those, wo have great pleasure in mentioning tb« ne ol'Ensign VV. A. Tato ol the corps of Engineers, stationed Satsctt ; who, among other arduous duties, paid the must remitting attention to alleviate the sufferings of a largo pof- nof t tie population, and to whose humane exertion*) souio >u»ands ol' the inhabitants owe their preservation. 



of four months, hitherto escaped entirely. 

From the foregoing detail, which to some may appear too minute, we are disposed to conclude that this epidemic is not only different in its nature from those that have hitherto been observed, but that it may be said to stand alone, in regard to some of the more essential characters which usually distinguish those diseases. 

Pthe first place., it has prevailed in de, equally violent at all seasons of the ; in regard to temperature, from 40 0 degrees of Fharenheit to 90 or 100 ; in regard to moisture, during the con- P ice of almost incessant rain for month?, t dry state of the atmosphere winch ly leaves a vestige of vegitation on rface of the earth. Secondly, although lias been adduced may not appear to to be sufficient evidence of the fad 

» 

it appears to us incontrovertible, that it is capable of being transported from one place to another as in cases of ordinary contagi. on or infection, and also to possess the power of propagating itself by the same 



11 





Ks that acknowledged contagions do, s, by the acquisition of fresh materials which to assimilate, at the same time ps, subject to particular laws, with i we may never become acquainted, c however of the doubtful nature of round which we tread, amidst the contrary opinions that have bejen advanced on this subject, we shall content ourselves with stating a few facts, which have been supplied by gentlemen whose reports have been already printed, and which might be encreased far beyond the limits to which we think it necessary to confine ourselves. In October last, when the disease had almost disappeared at Tannah, the attention of Mr* Jukes was called to a case that had appeared in one of the apartments of the barracks of that fort appropriated to European troops ; this owing to too late application for medical aid, soon terminated fatally ; another case occurred a few hours afterwards, the subject of which was saved with much difficulty and danger, and in the course of ti succeeding* days no less than 9 cases oc- 

curred 

12 





curred in the same apartment. The curiosity of Mr. Jukes was naturally excited to ascertain under what circumstances so much disease was produced, and on examination, the ward appeared to be both badly ventilated and too mudi crouded with men; the place was immediately emptied, scoured and fumigated, after which no oilier case occurred. Since the middle of December when we had flattered ourselves that the disease was vanishing, as the cold season advanced, the number of cases considerably encreased in this Island, Salselt & the Conkan, & consequently excited much alarm; in some instances these cases have been confined to particular spots, and sometimes to particular houses, where the disease has attacked and destroyed in succession whole families, consisting of three, four, and five persons, while in others only a single case or at most very few have occurred. We are utterly ignorant of any local circumstances to which such a change can be ascribed, unless by supposing that a diminution of temperature, together with ex- 



13 





14 

PREFACE. 

posure, may have called into action some latent remains of an active poison ; otherwise it seems difficult to reconcile those facts with what 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 lias 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. 

We shall now 1 proceed to describe the disease and the symptoms that accompany it, which we cannot do better than in the words of the medical board of Bengal ; after which we shall state the few discrepancies that have been remarked there, compared to the general appearance of the 





PREFACE. 

15 

disease on this side of India, and which seem to be connected with local causes, rather than establishing any difference in its nature: we may premise that the names Cholera Morbus, Cholera Spasmodica and Mort de Chien which it has received, apparently by common consent, seem equally inapplicable, in so far as a name can couvey any idea of a disease. 

"Having thus given a rapid, and imperfect sketch of the history of the epidemic, the board should now proceed to detail the symptoms, which attended its attack. This part of their task they will not find it difficult to accomplish The leading appearances of this most fatal malady were but too well marked on their approach, and subsequent progress; and amongst the myriads, who were attacked, exhibited perhaps less variety and fewer discrepances, than characterise Ihe operation of almost any other disease to which the human body is subject. The healthy and unhealthy ; Hit strong and feeble; Europeans and Natives; the Mussulman and Hindoo ; the old and young of both sexes, and of every temperament and condition; were alike within its influence. 

The attack was generally ushered in by sense of weakness, trembling, giddiness, nausea, violent retching, vomiting and purging of a watery, starchy, whey coloured, or greenish fluic!. These symptoms were accompanied, or quickly followed by severe cramps; generally beginning in the fingers and toes, and Ihcnco extending to the wrists and fore ;;;ns, calves of the legs, thighs, abdomen, and lov.er part of the 

thorax. 



and oppression of stomach, and pericardium ; great sense of internal heat ; inordinate thirst ; and incessant calls for cold water, which wag no sooner swallowed, than rejected, together with a quantity of phlegm, or whitish fluid, like teethings of oatmeal. The action of the heart and arteries now nearly ceased ; the pulse either became altogether imperceptible at the wrists, and temples ; or so weak as to give to the finger only an indistinct feeling of fluttering. The ' aspiration was laborious and hurried ; sometimes with long and frequently broken inspirations. The skin grew cold ; clammy ; covered witii large drops of sweat ; clank and dis« agreeable to the feel; and discoloured of a bluish, purple, or livid hue. There was great and sudden prostration of strength; fjish ; and agitation. The couutenance became collapsthe eyes suffused, fixed, and glassy ; or heavy, and ; sunk in their sockets, and surrounded by dark es ; the cheeks and lips livid and blood-less ; and the le surface of the body nearly devoid of feeling. In feehabits, where the attack was exceedingly violent, and sis fed by medicine, the scene was soon closed. The ilation and animal heat never returned ; the vomiting and purging continued, with thirst and restlessness; the patient because delirious or insensible, with his eyes fixed in tcant stare ; and sunk down in the bed ; the spasms ined, generally within four or five hours. 

The disease sometimes at once, and as if it were momentarily, seized persons in perfect health ; at other times those who had been debilitated by previous bodily ailment; and individuals iv the latter predicament generally sunk under the attack. Sometimes, the stomach and bowels were dis- 



16 





ordered for some days before the attack ; which would then, in a moment come on in full force, and speedily reduce the patients to extremities. 

Such was the general appearance of the diseaße where it tut off the patient in its earlier stages. The primary symptoms however, in many cases admitted of considerable variety. Sometimes, the sickness and looseness were preceded by spasms. Sometimes, the patient sunk at once after passing off a small quantity of colourless fluid by vomiting and stool. The matter vomited in the early stages was in most cases colourless, or milky ; sometimes it was green. In like manner, the dejections were Usually watery and muddy ; sometimes red and bloody ; and in a few cases they consisted of 

a greenish pulp, like half digested vegetables. Iv no instance, was feculent matter passed in the commencement of the disease. The cramps usually began in the extremities; and thence gradually crept to the trunk ; sometimes they were simultaneous in both ; and somelimes the order of succession was reversed ; the abdomen being first affected, and then the hands and feet. These spasms hardly amounted to general convulsion. They seemed rather affections of individual muscles, and of particular sets of fibres of those muscles: causing thrilling and quivering in the affected parts like the flesh of crimped salmon ; and firmly stiffening and contorting the toes and fingers. The patient ajways complained of pain across the belly; which was generally painful to the touch* and sometimes hard and drawn back towards the spine. The burning sensation in the stomach and bowel* was always pre•eutj and at times extended along the cardia and cesophagu» to the throat. The powers of voluntary motion were in every instance impaired ; and the mind obscured. The patient stag- 



17 





jeered like & ctrunK^ti truin or toil down iikc ft npinicss oiuicl. Headach, over one or both eyes, sometimes, but rarely occurred. The pulse, when to be felt, was generally regular* and extremely feeble, sometimes soft; not very quick; usually ranging from 80 to JOO. In a few instances, it rose to 140 or 150, shortly before death. Then it was distinct, small, feeble, and irregular. Sometimes very rapid, then slow for one or two beats. The mouth was hot and dry ; the tongu* parched, aud deeply furred, white, yellow, red or brown. The urine at first generally limpid, and freely passed ; soiuctimas Scanty, with such difficulty as almost to amount lo strangury; and sometimes hardly secreted ia any quantity ; as if ths "kidnies had ceased to perform their office. In a few caw.*, the hands were tremulous. In others the patient declared himnt-lf free from pain aiid uneasiness; m hen want of pulse, cohj •kin, and anxiety of features, porteuded speedy death. The cramp was invariably increased upon moving. 

Where the strength of the patient's coiistiLutian, or of th« curative means administered, were, although inadequate wholly to subdue the disease, sufficient to resist the violence of its onset; nature made various efforts to rally; and held out strong, but fallacious promises of returning health. Iv such cases, the heat was sometimes wholly, at others partially restored; the chest and abdomen ia the latter ca.se becoming warm, whilst the limbs kept deadly cold. The pulse would return; grow moderate and full; the vomiting and cramps d is* appear; the nausea diminish; and the stools become green, pitchy, and even feculent, and with all these favorable appear* anres, the patient would suddenly rtlaspej chills, hiccup, want of sleep, and anxiety woukl arise; the vomiting, oppres* sion, and insensibility return, and iv a few hoars terminate in 



18 





*>hen the disorder ran it* full course, the following appearatictt presented themselves. — What may he termed the cold atage, or the (state of collapse; usually lasted from twenty four to forty eight hours; and was seldom of njore than three complete days' duration. Throughout the first twenty four hours' nearly all the symptonn of deadly oppression, the cold skin, feeble pulsr, vomiting and purging, cramps, thirst and anguish continued undiruiuished. When the system shewed symptoms of revival; the vital powers btgjfl to rally; the circulation, and heat to be restored ; and the spasms and sickness to he considerably diminished. The warmth gradually returned; the pulse rose in strength, and fulness; and then became sharp and sometimes hard. The tongue grew more deeply furred ; the thirst eontiuued, with less nausea. The stools were no lowger like water \ they became first brown and watery ; then tk:k, black, and pitchy ; and the bowels during many Jays continued to discharge immense lqads of vitiated bile, until, with returning health, the secretions of the liver and other vwßlra gradually put on a natural appearance. The fever, which invariably atteuded this second stage of ihe disease, way be considered to have been rather the result of nature's effort t« recover herself from the rude shock which she had sustained; than as forming any integrant and necessary part of the disorder it* elf. it partook, much of the nature of the common bilious attacks prevalent in these latitudes. There win the hot dry skin ; foul, deeply furred, dry, tongue ; parched mouth; sick stomach; depraved secretions, and (juick variable pulse; sometimes with stupor, delirium, and other marked ai&ctious of the brain. When the disorder proved it Ul after reaching this stage; the tongue from being cream coloured, grew brown, and sometimes dark ; hard, and more deeply furred ; the teeth and lips were covered with sordes \ 



19 





the state of the akin varied, chills alternating -with flushes of heat ; the pnlse became weak and tremulous ; catching of the breath; great restlessness, and deep moaning succeeded; and the patieut soon sunk, insensible, under the debilitating effect* of frequent dark, pitchy, alvine discharges. 

Of those who died, it was believed, perhaps rather fancifully, that the budiea sooner underwent putrefaction, than those of persons dying under the ordinary circumstances of mortality. The bodies of those, who had sunk in the earlier stage* of the malady, exhibited hardly any unhealthy appearance. Even in them, however, it was observed, that the intestines were paler & more distended with air, than usual; & that the abdomen, upon being laid open, emitted offensive odour, wholly different from the usual smell of dead subjects. Id the bodies of those, who had lived sometime after the commencement of the attack, the stomach was generally of natural appearance externally. The colour of the intestines varied from deep rose to a dark hue ; according as the increased vascular action had ben arterial or venous. The stomach on being cut into, was found filled, sometimes with a transparent, a green, or dark flaky fluid. On removing this, it'a iiiUrnal coats in some cases wt;re perfectly healthy; in others, and more generally they were crossed by streaks of a deep no; ii tfTfpna«d with spots of inflammation, made up of tia-3'vs of charged vtrssf-ln. This appearance was frequently confiniud to the duodenum. In « very few cases the whole internal surface of the stomach wasco\ered with coagulable lymph i od removing which, a bloody gelatine was found laid on the interior coat in ridges or tlevated streaks. Tl»e large inttstinttf wtre sometimes filled with muddy fluid, sometimes fnhii with dark bile, like tur ; just a* the individual had died 

» 

20 







iii the earlier or later periods of the attack. In most Cdsct, tht* liver was enlarged, and gorged with blood. In a ft\r, it was large, soft, light coloured, with greyish spots, and not very turbid. In others again it was collapsed and flaccid. The gall bladder -was, without exception, full of dark green or black bile. The spleen and thoracic viscera were in general healthy. The great venous vessels were usually gorged ; and in oue case the left ventricle of the heart was extremely i turgid. The brain was generally of natural appearance. In one or two instances, lymph was effused between it's membrances, near the coronal suture, so as to cause extensive adhesions. In other cases, the sinuses, and the veins leading to them, were stuffed with very dark blood." 

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 owin^ 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; 

21 





Peninsula; fur 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. 

I This disease seems to have been known to r. Sydenham, and to have be.n accutely described by him as a prevailing )idemic in England in IGO9 under the title ¦ Cholera Morbus ; and as he nowhere entions bile as forming any part of the scharges from the stomach or bowels it lay be justly inferred that if it had, it could ot have escaped the notice of so accurate 

an observer. lie says 

" Morbus hie, gui, ut antea diximus, Anno 1G(!9, " se latins difl'uderat, guam alio quovis anno, quantum ri;<> 

" observaveram, earn anni pattern, quae acstatcm fugienlwn 

atque autiiinnum imminentem complectitur, unice ac endcm prorsus fide, qua veris pririiordia Hirudines, aut inscquontis ' tempestatis ftrvorem Cucullus, amare consuevit : Qui ab in , gluvie ac cropula nullo temporis discrimine passim exdtntnr ' aflcctus, ratione s\mptomatum nou absimilis, nee t andem ' curationis methodum rrsptiens, tameu allerius cst subscllii 



22 





" Maluin ipsnm facile co»noscitur, adsnnt mini vomilus enor* " nics, arpravoruin humorum cum maxima diHicultate etaiigustict " alvmn deje.Qticij cardialgiu, sills. Pulsus color ac frequens, " cum u'siu ct anxietate, non Varb etiatn parvus ct inxHjualis, *' iusuper et nausea niokstissima, sudor iutenfum diaphorclicus, " ¦ciuriun tt bnu'hioruin coutractura, animi doliquium, par" tinm extrem truin iiiyiditas, cum aliia vo\x symptonmlibus, " qu.e arit.mitvS liiayixipere perteircfaciant, atque ctiani arigusto " viflgipti qiiiituoi horaium spatio ivgrum intcriniant." 

Ik ml again in his letter to Dv. Brady debingthe Epidemics of 1 0 7 4 , 5 and 0, he 

" Exnnitc restate Chokra Morhus opiilemice jam sacvi<r * h;it, et itisnoto tcmpestatis calore evectus, atrociora cou" vulsiomnn symptomata, eaqtie diuturniora secum truliclnit, " qiiani mihi prius uncjuam videre contigerat. Neque cniin so* him abdomen, uti alias in hoc nialo, sed uuiversi jam cor" poris musciili, brachiorum crurutnqne ptv re-li :uis, spasmis " ti:ilabajitnr dinssimis, ita ut tttjer c lccto subiude exiliret, " si forte cxtenso quaquaversuin corpore eorura vim posset " eludeie." 

IFhe first of these extracts describes the ease with great accuracy as it, very ge•olly, affected the Natives — the second is 11 exemplified in Dr. Durrell's report as ittacked the Europeans of the 05th Regt. Seroor. As an example of that form of I disease, it may not be uninteresting to 



23 





t re the outlines of a case communicated by rgeon Craw taken in the presence, and th the permission of Dr. Burrell. 

Joseph Smith H. M. 05th Regiment. 

A stout muscular man of a sanguineous temperament. — August 15th 1818. 9 o'clock a. m. — Was just now brought into hospital affected with universal spasms ; those of the inferior and superior extremities, and of the thorax and abdomen being in particular very violent; but the head and trunk are alternately and involuntarily thrown backward and forward- These spasms remit, and increase in severe parxoysnis, and are accompanied with great distortion of the features— strong slndor or gnashing of the teeth — foaming at the month — and the most urgent and incessant calls for cold water, with an acute burning and dragging pain at the epigastrium. The pulse is scarce* ly perceptible at the wrist — the hands and arms are covered with a cold moisture I—the1 — the feet and leg 3 cold — but the face Hushed and bathed in sweat. The pulsations in the temporal artery are small, frequent, fluttering and easily compressed, and he complains of severe headache and of in* ability t't void his urine. The spasms are so violent as to r«-quire four B»en to restrain him and he is more unmanageable and outrageous in his attempts to obtain wattf from the bathing tub, the sight of which greatly tocreated bit d< sire to drink. He has been affected, he says, with .» watery porgiug for two days past, and thin morning at "2 fr'docb wan leittd with vomitings, arid iqofl after had six watery motions — but LlieM symptom* having sonic what subsided lit. i*tlt§4i/l the i« mi .it moth\t\g parade, wbitfc howcVet hi #aa soon ofcli^r <1 to 



24 





PREFACE, 

25 

Jeavf from a return of the purging with the most importunate desire for water and burning pain at the scrobiculus cordis. The great thirst and pain at the stomach and the previous symptoms of purging and vomiting, were the cause <¦>( Ins being scut to the hospital; and on his way from the camp (which is more than a mile distant from the hospital, the spasms at* tacked him. Has used no remedies. 

A vein was immediately npdied on liis admission into hospital but bled with difficulty, and after about. 10 ounces ha J been obtained he was immersed in the hot bath witii the vein stilt open. Wh.u about 13 ounces hud flawed the spasms abated, the pulse became quite perceptible at the wrist, tho' small and quick and the blood now flowed from the arm in a full stif ;ini. Twenty eight ounces having Wen drawn, and the apasms and pain at the epigastrium having entirety ceased* the arm was bound up, the patient was carried to his cot and 20 grains of calomel with 40 drops of laudanum were now administered. It would be tedious and unnecessary to relate the fuither particulars of this case It will be sufficient merely to observe that in consequence of a return of tlie s\rn| turns 60 ounces of blood were taken in tess than 12 hours, before they could be finally subdued. A blister was also applied to the epigastrium, vJiicb, without any other rfraedies than * cathartic on the evening of the "2d day, accomplished the cure. 

Eie disease is also accurately described by lestone as quoted by Dr. Clafk, and by Curtis of Madras in 1 782 when it ragi the southern provinces of the Peninto a considerable degree, and according 





0 

¦insula ; 

in its coitself in any the agency i entirely be fairly 

I 



PREFACE, n of the purging with the 

0 

desire for water tad burning pain at Ihe The great thlrsit aud pain at the ntoaach 

symptoms of purging aud vomit ia^, itut te the hospital; and ou bn b more than a mile distant from tl tacked him. Has used do rrfuedii A vriu waa irnmi i!u(eiy np*ti <l i hit bled with difficulty, and after 

obtained he Was ionm-ersed 

qxn Whca about tect had flwed ' 41M 



to Bartolomeo* " sometimes carried off 3O or 40 persons in the s^me place in one day." The latter author gives the Indian narrtes *' Ntrtiripa or Ni) coiubcn, an intestinal colic, which proceeds from cold. This disease is com nonly calltd Mortteiim, of which Sonnerat drolly enough makes, mort de chien, dog's death.'' Or the two fitst terms we are unable to obtain any translation among any of the languages understood here, probably from the manner of spelling intended to illustrate the pronunciation, and that by a foreigner. If" the latter term Mordexim be derived from the Sanscrit, Dv. Taylor, who is intimately acquainted v\i:h that language, offers the following etviuo- Jogv, making allowance for the orilu'gru];ljy. HJoxif.rim may be Mrifjjoo/ishtnr, coinpdunded of two words, J\Jrif yoo signifying death, and Kshun a moment, f which al- 

though 



• Scfj voyag.es to %\re LaU Luiies, by F. \\. Da Sa*a B«rto!om<»o, Iranslattd by Pr>»t*r. t" .^?uaiy i*f tbe u^tivoj;/' s.iys Dr. Tav'er, " il pronouiK 

ring this- word, wouM •epapgtw the eotpu^|iiid Icttef nn mlo fvro Ifctfeti; with a.) inlicTt-nt voa'c! between, ©id wMlPcf c*fl tut !«tttrt i tad, thus converting liie word n:ti< Mv ul t/i^/l >;n t iTid bi!pjio»iiig the long- vff^cl 00 to be KUorUinedj as • ' v 



26 





though not the name of a disease, mar, ac-' cording to the figurative manner of expres-" sion universal in these countries, be naturally enough, used as such, in the same mariner as the words Jurree Murree, which signify sudden death, are at the present time in use here, to designate the disease m question. Dr. Taylor has also furnished U9 with the account of a disease taken from a Sanscrit medical work, the Madhow Nidan, 

lu|)[)ci)s in rnmmon pronunciation, the sound would tlitn be v< r\ lik<j tlr.it of the word given by Btrtoloaieo." On tiie etymology of Jiu-rce Murct, "which inny be translated prstiiChtiiil diswisfc" llie sunc exc< llent oriental |obe4ar observes," the | 

" deriwitiou of lite word juree in iu»t vtry clear. Perhaps it " is a conii|»!ion from ihura. a stream, or jhutva to flow, to " drop— or liomjicur lover : murct is from murvn dtalh. Ju" rce mune is a trrm nstd oil any oCcatibu ofgreat inni f.;-" lify, wlittlitr arising from fever, small pox, uiyaslcs, or v* " in the pr< sent instance, from Cholerj. Auion^ the iffiioraul 

" and lower clhssc'.s it def(4t«i tfot cnlv thcdiscoi.c, but it at.o " the nauoe of a Goddess from whoui this ptstiUMitjal ov quo* " tagiotii disorder is B:i(>j)ostd to arise. In HtnJootthtnea " and Guzerattee the preittiit disease is tiamed litre either 

Murgtc, o: Mir/jrc, the formrr is from the Persian word 

" Murg, dtath, QM lattfr siguifies fpilcpsy. The Winrticn " Cholera je named ia Mahratta Tural at Mmsluc, the r in " the last word bting tlu: har&h or Noi tlnnnhailand r. Turral " is a word found in Mahratta wotics, and us thus de*ciib&i. " ' Vomit iug and purging, gnat tints', and piercing pain :n " thchvwels.' '\ h.^ word Mui slice we h;ive never met with i;i " any book, and ftow native Vaidyas or Doctors of our ac" aoaiatauee (inspect that it is a foreign wuru." 

which' 



27 





aocvin 

PREFACE. 

Which leaves very little doubt that it ha* not only been long known to the natives. but proves its identity : it is as follows. 

. Symptom* of the disease named Visoochi. Faintnoss, purging, vomiting, tliir&f, piercing pains in the bowels (as if thrust thro' by a spear, ) vertigo, spasms or knots, yawning, senbulion of internal heat, tron ors, pain at pit of the stomach, violent huadad c, retention of urine, coma, rcsiless* UCfut, pi ickiug- pains in the body." 

It is obviously unnecessary to prosecute this enquiry further, and we shall only add that Dr. James Johnson of the Royal Navy is the latest author, so far as we know, who has treated this subject, and who has also the merit of having been the first who has generally pointed out the best method ot cure, from a few cases he met with on the eastern coast of Ceylon, where the disease seems to be more prevalent than in any other part of India. 

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, v at/a caligine merscer Great difference ofopf- 





t 

nion exists among practitioners, as to its contagious or non-contagious influence, and this difference very naturally arises oat 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 1803,1 803, 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 it's marked anomaly from all hitherto known simple epidemics, would seem to favor tha 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 necesiary 



29 





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 pos- 

The predisposing causes are more obvious, and on this point practitioners are unanimous. 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, Jow 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, otlcr a more unlimited 

ran^c 

30 





range to the oDer&tion of the orijnna 1 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. 

Concealed from our view as the exciting or proximate cause of this formidable disease may ever remain, we have only to observe its effects, and the united testimony of all who have witnessed it seems to show, that there is a somcivhat which presses heavily and suddenly upon the vital functions, and on many occasions, resembles the effects of a poison taken into the stomach or applied to the blood ; but whether it acts more immediately upon the circulating system or the nervous, we cannot determine ; the various modes of attack, which have given rise to the division of the disease 



31 





into species and varieties, would lead to the supposition that sometimes the one and sometimes the other may be the case. The m st 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 tliseasr\ which quickly extending through the whole intestinal canal, discharges its contents ; for it has often been observed that the purging mure 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 set-ms evident from the numerous cases in which reiiher vomiting nor purging are preterit, ard i-i which the first appearance of disease is the almost total suspension ot 



32 





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 diseases 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 Plly dnaccompanied with any alarm - mptoms, but more particularly when nsider the nature and circumstances c subjects who have been chiefly preto our view. They are composed poor and labouring classes who are 

occupied 

33 





occupied in obtaining subsistence for tne Gay 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. These circumstances seem to have given rise to a doubt whether the disease among natives i-s ever ushered io. 

I* a stage or' excitement connected with -actfen,* and to have suggested the judious queries, "Is this disease ever attended in the beginning with encreased heat and quickness of pulse ? and, Does this form ever run into the other with cold extremities and sinking of pulse or total want of it ?" 

So fjr as Europeans are concerned, Dr. Burcll's report answers the first decidedly in the affirmative; but even among them this stage, under particular circumstances, is not per- 

ceptible, 



34 





ceptible, — that is, <*-h«?n the patients have been exposed to a draft of cold air in a state of intoxication, a common circumstance aniong European soldiers. 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 readyto 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 erpployeis. 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, 



35 





II 11 •1 ¦ /- » t mely, coldness, sinking of the pulse, asms and death. It must however be knowledged that this stage of excitement by no means so distinctly unfolded among c natives as among Europeans, and this ay depend upon constitutional causes. 

I Dissections abundantly prove that venous ngestion constitutes the principal change at has taken place during life, and there sufficient reason to believe that this takes ace in its early stages. This part of the bject is so well illustrated by Dr. Armong in his elegant treatise of typhus fer, that we are induced to insert the followl extract, as this valuable book may •t yet be much known in this country. It his description of the attack of congestive 

ITheHtage of excitement without ths interference of art, ?er emerges at all, or only dues so very imperfectly : the ergiesof the system either being nearly extinguished by (visceral congestions, or so much oppressed, as to be able to create au universal reaction. In congestive cases, c local accumulations obstruct from the beginning tlie nmon series of febrile phenomena, and there is in conseeoce either a total want of morbid heat, or concentration 

of 

36 





« «f it, from partial reactions, in some parts of the body, whilst «• others are considerably beneath fte natural temperature. ¦ It is the entire absence or the partial presence of excite " ment, which constitutes the chief external distinction be" twecn the severest forms of the congestive typhus, as they all " coincide in suppressing the functions, or in deranging the ¦ structure of some important organ, by an almost stagnant " accumulation of blood in some part of the venous system. 

I" The attacks of the most dangerous forms of the congestive typhus are generally sudden, and marked by an overpowering lassitude ; feebleness of the lower limbs ; deep pain, 

I giddiness, or sense of weight in the encephalon, a dingy pallidness of the face ; anxious breathing ; damp-relaxed, or dry withered skin ; and those peculiar conditions of the temperature which have been noticed above. The pulse is low, struggling, and variable ; the stomach irritable ; frequeqtly there is an inability from the first to hold up the head ; and the mind is more often affected with dulness, apprehension or confusion, than with delirium. The whole appearance of the sick impresses the attentive practitioner ¦with the idea, that the system in general, and tlie brain iv particular, are oppressed by some extraordinary load." 

I Those who are most intimate with the isease in question in all its various modes f attack, will be struck with the great sililarity between the two diseases at their rst appearance ; the circumstances of r-hich seem clearly to point out that chan;cs somewhat simitar, if not the same, take 

piker 

37 

p 





place in both, especially in this stage. Fxperience has also proved tliac those morbid changes are to be best counteracted by the same remedies. 

On the subject of the cure of the disease we need say but little. The practice so judiciously and speedily adopted by Dr. Burrellin the 65th regiment, clearly prove* that at the commencement of the disease in Europeans, blood letting is the sheet anchor of successful practice ; and perhaps al- o with natives, provided it be had recourse to sufficiently early in the disease ; and as long as the vital powers remain so as to he able to produce a full stream it ought perhaps never to be neglected, it having been sufficiently proved that the great debility so much complained of is merely apparent. Calomel as a remedy certainly comes next in order, and when employed in proper doses with the assistance of opium, and more particularly in the early stage of the disease, seems to be equally effectual among natives, as venesection among Europeans, in arresting its progress. In all the cases 



38 





formerly alluded to, when we met the disease on its first attack, a single scruple dose of calomel with Oo minims of laudanum, and an ounce of castor oil seven or eight hours afterwards, was sufficient to complete the cure.* The practice of this place, aft sufficiently appears by Dr. Taylor's report, bears ample testimony to the controul which calomel possesses over the disease, in as much as it has often preserved life when bloodletting could not be put in practice. 

All other remedies must in our opinion be considered as mere auxiliaries, no doubt ertremely useful as such, and ought never to be neglected ; but particularly the warm bath and stimulating frictions. Even wherte 



• W« are aware that it may be objected by tome that the symptoms there stated are not sufficient to constitute the disease. This objection we have often heard ; and in reply shall only say that we have ourselves entertained simitar doubt wlifn thr symptoms were more equivocal, and have h«ard of many other cases of the same nature, in which by ne- glecting to administer the remedies, or trusting tfiem to the discretion of the patient, death has followed id a few hours. Such fastidiousness therefore, is certainly not warrantable at a time when a single disease is daily carrying off 40 or 50 people. 

39 

r 





40 

PACE 

the disease appears to have given way to bleeding, we think it highly necessary con•tantly to administer calomel. The powerful effect of this remedy in allaying irritability of the stomach and intestines when given in large doses is generally acknowledged by practitioners, in the severer attacks of dyseutery: as a great and permanent stimulus to the vascular system it will be readily acknowledged by every one who has suffered for any length of time under its effect in ptyalism, where the bounding pulsations of thearteries of the temples and neck produce ¦very disagreeable sensations, and even preclude sleep. Its powers over inflammation of the abdominal viscera, the liver in particular, and indeed in membranous and glandular inflammation generally, are now universally acknowledged.* 

lln a disease therefore in which we have cry reason to believe that venoua conges- 

tied 

* We read with tome surprise the declared opinion *>f Dr. Armstrong in bit treatise as Puerperal lever, that the good «fftcts of vftiuiiiel were , solely owing ta its purgative quality, *hil« at th« iam» time be ackawwl«Jg«» that th« due.ua ww 



PREFACE, 

41 



\wn Vas 'taken pi; cc to a great extent, we conclude that the liver from its peculiar circulation and structure is more immedia- Iy liable to become seriously and permantly injured, it should not be omitted. We ye before mentioned that Dr. James hnson of the Royal Navy seems to have en the first to have pointed out the best method of cure ; since most of the foregoing Temarks 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 bloodletting^ 

Ih more spec.lily and perfectly overcome in those rases ere ptyalism was produced. He has however made ample end\s in the treatise now before us, acknowledges that its ue is to be attributed to its specific qualities as a mercurial. is by the acknowledged errors of such men that medical ctice is stored with- its most valuable facts. Puerperal er is hot a very common occurrence in this country, al- iugh it occasionally tokos place; and it is but an act of tice due to Dr. Helenus Scott, formerly of this place, now of issell Square, to state, that for more than thirty years back, was in the constant practice of treating this fever with calomtl ao C 9 to affect the system ; and that to the best of our recollection he never lost a patient. We are led to make this observation from another motive, as we have reason to believe, that thisaalntary practice i< but little known in this country, and it may serve at a hint which may save some valuable live*. 



Ps disease, or one somewhat similar to it, 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 lisease was producing the most dreadful ivages : the early communication of his ractice has been the means of saving thoulnds of lives in situations where Dr. Johnjn's work might not be known. 

In conclusion, we shall only add, that, whatever place may hereafter be assigned to this disease in nosological arrangement, we cannot help thinking 'that its present appellation of cholera must be discontinued. If true cholera morbus be, as we have been taught by nosologists to conclude, a morbid flow of bile, the present disease surely cannot be ranked with it ; and we agree entirely with Sydenham (if the quotation we have formerly made from him be allowed to be applicable to our present purpose), that though possessing many symptoms in com- 

mon, 

42 







PREFACE. 

XLIII 



mon, the diseases are yet toto cctlo of a different nature. v Quisquis autem cholera 

" morbi legitimi phacnomena studiose col" legerit, fatebitur morbum istum,quamvis •' eorundern symptomatum nonnullis stipa* " tum,ab hoc nostro toto coelo distarc.'' 

43 













JV vvUll'tv* AVljIVViv 

RELATIVE TO THE 

CHOLERA MORBUS. 

No. 1, 

Extract of a Letter from Assistant Surgeon Ro- 

Bert Wallace, Deputy Medical Storekeeper in the Deckan, to George Ogihy Esq. Secreta- 

ry to the Medical Board. 

Seroor, 22d July 1818. 

{, HE Cholera Morbus made its appearance in our cantonments yesterday and has to day attacked both Europeans and Natives. The disease is most formidable: we have found the large doses of calomel, oil of peppermint and laudanum generally succeed in checking the vomiting- and purging; but the most formidable symptom is the sudden debility and coldness, whict> seem to mdi 





cate the use of the most powerful stimulants : the hot bath has been found very useful. 

I never yet saw a disease where the debility came on so suddenly and with such violence, it i« common to find patients one hour after the first attack perfectly cold with no pulsation whatever in the arteries of the wrist. 

I have had about sixty cases amongst the Bazar people and followers : four of these died last night^but the number of cases is increasing every 



No. 2. 

Extract of a Letter from Mr. Wallace to 

John Milne Esq. M. D. Actg. Superintending 

Surgeon with the Deckan Force. 

Seroor, 22d July 1818. 

Since I wrote yesterday, the Cholera has gradually increased. I have had about sixty cases amongst the Bazar people and followers; of these four have died ; and there must, 1 fear, be more casualties in the course of the day. The disease is ushered in with purging, succeeded by vomiting ; and both discharges are of a dark colored watery nature. These symptoms are quick- 



2 





Jy succeeded by spasmodic cramps, chiefly of the extremities; at this period sometimes within an hour after the first attack, the alarming debility, attended with universal coldness, sinking of the features, and indistinct pulse, come on. 

I have in most cases succeeded in arresting* the vomiting and purging by large doses of calomel and laudanum ; but it has been necessary in almost all the cases to repeat the laudanum and peppermint, to allay the spasms and pain in the abdomen. After all this has been done, the debility and coldness remain to be conquered ; and I think the most active stimulants are now required. 1 have begun to day to give arrack in hot water and congee to the Natives ( for they are too numerous to be supplied with ammonia, ether &c). The coldness and debility have in some cases continued for twelve hours, when heat and subsequent moisture of the skin are the favorable prognostics. 

The disease has attacked the European soldiers, both in the 65th regiment and the artillery: five of the former and ten of the latter are affected to day. The symptoms are extremely formidable; the alarming debility is here also the prominent symptom ; it is fully as remarkable, as in the Native patients. The same treatment 



3 





lieen found applicable to both. The Euns have found great benefit from the hot and I shall endeavor in the course of the o give the Natives the advantage of the We are engaged in a very melancholy and I fear that the disease will spread all he western provinces. 

( Signed ) ROBT. WALLACE. 

No. 3. 

Extract of a Letter from Mr. Wallace, To Z)r # 

Milne. 

Seroor, 25* July 1818. 

As far as my experience goes, the cholera is already abating; my admissions of Natives decreased considerably yesterday, and they are still less to day. The symptoms, however, are still very violent, and unremitting care and activity is required to arrest their progress. I believe Mr. Corbyn's practice to be very efficacious, when adopted early : the majority, however, of my cases did not apply for relief, until they had been attacked for some hours, and the medicine was almost invariably rejected, in common with every liquid. I determined to exhibit the remedy in a- 



4 





notlicr form, and rubbed up two grains of soft opium, fifteen grains of calomel, with about two drams of honey. This was gradually swallowed, and dropped into the patient's mouth by the finger. After this, he was placed in the hot-bath, and small quantities of hot arrack and water, mixed with spices and sugar, given to drink. The patient commonly fell asleep; and in favorable cases awoke free from danger. In others, the coldness and spasms recurred, when recourse was again had to the hot-bath, and opium, administered in various forms. Twenty two cases only were admitted yesterday, and all of these, except two, recovered. 

The disease is now diffused all over the cantonments. Fifteen fresh cases were received to day into the Csth hospital: two men died in the night ; but I think their practice has been very 

The cholera has made it's appearance at Ahmednuggur; but from what 1 can learn, it is not so violent in it's symptoms, as it has been here. 

(Signed) ROBT. WALLACE. 



5 





6 

MEDICAL REPORT OF THE 

No. 4. 

Copy of a Letter from Doctor Win. G. BurreL Surgeon of H. M. 6oth Regiment, to Doctor Milne. 

Serror, 27th July 1818. 

My Dear Sir, 

P'he Cholera Morbus has been in these cannents since the 18th instant. In the 65th reent it commenced on the2lst, the admissions as follow — 

21st 1 22d 6 23d G 24th IS 25th 22 26th 7 Total 7. 60 Deceased 4 

I he soldiers of the regiment not aware of the ;er of the disease., did not report themselves he few days they felt unwell, these ewes prized the admissions of the 21st and 22d nt; when admitted into regimental hospital ltmost debility was apparent, consisting of le pulse, cold extremities, nausea, and can; vomiting with spasms, these were followed nivcrsal sinking and coldness of the body, and 





Eh ensued in the spare of VI, 1 ie t and 21 hours • admission; the wtfrm I r';j, calomel and m were tried, along writh the most powerful ulants, with little success. 

On the 22d instant, when the men had been 

Ey warned of danger from not reporting- themfes sooner, I got into hospital a different desition of cases, viz. men with a full pulse, hot 

skin, constant vomiting- of white matter, like thick 

conjee, seldom any purging-; if it existed, it was 

like the matter vt>rriitcd. Bleeding- was used in every case with so much success, that I have no 

Ritation in recommending its adoption. Hie first svmplons in the attack, were languor 

• 

with occasional pains and sense of numbness in the 

extremities, violent headache and thirst; short- 

ly there ensued nan: on, vomiting- of slimy matter, 

weight over the prccordia. with griping- in the 

bowels, small stools of white slimy matter, no 

appearance of bile from the stomach or bowels ; 

the spasms followed, in many cases so violent. 

as t> . Jo hold the patient: if relief 

ivas not immcdiatly .';ivcn, it is astonishing ho# 

soon the system sinks' under the attack, marked by 

the eftds oi the finger • arid toes getting- cold, pulse 

and motion ofthe heart ceisihg*, with a livid mark 

rsund the eye.*. Frofti ihi* 6ttde, some men rc_ 

covered under the stimulating- plan ; a!thoui;h 



7 





ihcy had lain in that condition from six to twe'vs lours, but, it is to be looked upon as one of the nost dangerous symptoms of the disease. 

On admission 1 bled in every instance, in general to a good extent; where universal spasms tilted, venesection was carried on addeliquium, I.c patients at the same lime in the hot bath at 10 degrees, the spasms were invariably relieved, ausca and vomiting- alleviated, so that the stomach )ore the exhibition of the calomel in scruple oses, combined with laudanum; which doses vere frequently repeated : in short, opium was ;iven under every combination with calomel ; nd I believe the calomel will be found to rest on nost stomachs per se. 

The application of blisters was not attended vith much advantage; although they might do ood in some cases : every dependence is to be )laced on the hot bath with the means above icntioned. Frictions with stimulants to relieve .c cramps, are never to be depended upon when le patient comes under treatment in the first ta<i % e, as bleeding relieves the congestion of the iver and internal parts, and the patient falls nto a refreshing sleep. The next day his gums vill likely be affected, stomach quiet, and capa>le of bearing some of the commtm cathartics, ie exhibition of which is followed by dark bilious 

stools. IVom 

8 





From having so much duty at present, I am sorry I cannot enlarge upon this topic ; but have only to mention my full confidence of bleeding in Europeans : the result is most striking in our hospital, as it in every case lessens the irritation of the stomach, one of the most dangerous symptoms in this disease. Bleeding has been tried on the Native attendants with the same good success. 

I As every epidemic by accumulation of subject, as a tendency to propagate its virus, lam cauous in reporting this disease not infectious: allost every attendant in the hospital in the short >ace of six days has had the disease; there are )out thirty attendants in hospital. 

I The regiment is about 800 strong, the admisons from the regiment bear no proportion to c attendants who have been taken sick. The ercurial influence in a small degree does not lard the patient from attack, as has be.en clearly oved in our wards; full mercurial influence ight prevent it. 

I remain, Dear Sir, Your very Obedient Servant, 

G. BURRELL, M. D. 

Surgeon H. M. teth Regt. J. MILNE Esq. M. D. 

Act. Superintg. Surgeon 

I'uONAII. 



9 





1 No. 5. 

Extract of a Letter from Mr. Assistant Surgeon 

Richards, to Dr. Milne. 

Funderpoor, 28th July 1819. 

EThe weather still continues very sultry. Up this afternoon, we have lost twenty five tients, out of one hundred and ten. Capt. kes'g detachment arrived here this morn* ;; they have suffered severely from the olera Morbus, and have brought in twenty cc cases." 

• In many instances the patients have voided " the round worm from 6 to IS inches in length ; ¦ but this peculiarity has been chiefly confined " to the 6epoys of the 2d battalion 15th regf ment." 

Xi a few instances the spasms had been so re, as to produce lock-jaw; and in these s, I have used the lancet with much sue- 

ft p_.. >» 

True Extract, 

J. MILNE, M. D. 

Act. Sup. Surgeon D. F. 



10 





No. 6. 

Copy of a Letter from Assistant Surgeon Thomas 

Whyte, to Dr. Milne. 

Seroor,2Bth July 1318. 

Dear Sir, 

1 duly received your note requesting from me any practical remarks I might have in.de upon ttie prevailing epidemic. 

The Cholera Morbus made its first appearance here in the lines of the foot artillery, ft lid attack* ed in succession every other corps, except the 4th light cavalry and 22d dragoons, which fitom situation *r*ome other cause have hitherto escaped. I WtA the more inclined to think, that these corps owe their exemption to locality, from the following circumstance — The Madras dooly bearers were encamped at the W. end of cautonment hill, between it and the nulla which separates the cavalry from the infantry lines; and while in that situation, several were attacked by the disease, and 3or 4 died. At the request of the Assistant Surgeon of the 22d dragoons, whose duty it was to attend them, they were removed to a situation near the lines of that corps, that he might be at hand to afford them the most speedy aid ; and since their removal, I understand no fresh cases of Cholera have occurred, Since 



11 





12 

MEDICAL REPORT OF THE 

the epidemic showed itself here, the day 9 hare been exceedingly close and sultry, and about sunset a piercing cold wind has set in from the S. W. : this wind blows down the channel of the nulla mentioned above, turns the corner of Cantonment hill, and blows over the cantonments. From want of a thermometer, I could not judge accurately of the decree of heat; but from my 

sensations, I think it's range must have been extensive. The class of people which has principally suffered from this disease, is composed of the poor, badly clothed, or fed, and those of a debilitated constitution ; or else of men, in whom the perspiratory process has been highly excited during the day, whether by violent exercise or exposure to the sun ; and in this way sometimes the stoutest and healthiest men suffer. While this disease bears all the characters of an epidemic, undoubtedly depending upon some peculiar and unknown properties in the atmosphere, it appears to be more readily caused by currents of that atmosphere blowing from particular quarters ; and what is of great practical importance, a situation sheltered from these currents, a situati* on for example, in the lee of a hill, is particularly free from the influence of this epidemic. It appears to me that, In some constitutions, this cold wind, instead of producing Cholera, causes a re. 





gular attack of ague and fever. You will observe by the abstract of the ?th, that 18 case* of fever were admitted lust week, although the period of their admission was not the springs, when that disease commonly shews itself: in few of these men did more than one fit occur. The above impression was made stronger on my mind, from what took place in my own person. After all my perspiratory pores had been kept open some lime, in a crouded hospital, on going acros9 the parade, I was suddenly seized with a cold shivering aid trembling lit, which lasted some time after my return home. All my thoughts were fixed on Cholera. By means of the pediluvium and mulled port wine, however, I restored warmth and comfortable feelings, trnt suffered a smart febrile attack after going to bed, which kept me hot and restless during the night; but from which I, in the morning, arose free tho' languid. I think* that had my constitution been 60 predisposed, the same cause which produced fever, would have brought on cholera moibus. From observation, as well as analogy, 1 think there is no ground for the belief of some, that this disease is contagious. The opinion 1 learn is entertained and acted upon at Punderpoor ; and if erroneous, 1 need not remark, what ills it is calculated to produce, in as much as it withdraws attention 



13 





14 

MEDICAL REPORT Op THE 

front the true means of prevention ; and perhaps in some instances may deprive the afflicted of that kindness and attention, they have a right to Expect, and otherwise would be sure to receive from their friends and relations. After the mistake, which the accurate Cleghorn was led into regarding intermittent fever, and a similar mistake prevailing- so long, but which is now generally given up, regarding yellow fever, and particularly in consequence of the many evils, which an erroneous opinion of this kind must give rise to, something more than ambiguous evidence should be required to establish a point of so much importance. 

From being without a native assistant in thelight battalion, I was obliged, us the only alternative, to get those men of that corps who were attacked with this disease, carried to tlie general hospital, where I at first attended pretty constantly throughout the da y; and the consequence was that my observation was extended to every case that was admitted into the hospital. The symptoms in every cusc, were much alike ; at firtt, the disease was of the most violent form, and what was worse, in the most advanced stage before the paticnl applied for relief; most having been attacked from S to 10 hours before, so that you may imagine many came then with no prospect, but to 





die, and the scene, by this, was rendered most distressing. The first seapoy who came, had been attacked at 12 the night before, and was brought at 10 in the morning: the spasms had extended to the muscles of the chest and arms; and the first dose of medicine immediately rejected; his countenance expressed the greatest distress, and frequently the pain from spasm was so great, that he roared out in the most piteous manner: temporary relief was procured from the warm bath: but nothing could controul the disease, and be died at 12 o'clock the following night, £4 houfl from the first attack. The day before, a seapoy of the 7th had died of the disease; he was attacked at 5 o'clock the night preceding-; I saw him at ? the following morning 1 in the lust stage; he was perfectly s>ensib!e, the spasms had ceased, no pulse was perceptible, coldness like that of deat.li extended over the whole body, all voluntary contractile power of the muscles was gone, and in this state he died at 12 o'clock at noon. 

The account, which Curtis, in his diseases of India, has given of cholera spasmodica, accords very exactly with the symptoms of this disease in its most violent form, in which it first displayed itself; and the practice recommended by Johnson is that which I have pursued, and I may add with almost invariable success, where the patient 



15 





has complained in time ; but, alas ! the disease in its commencement, and often for a few hours of its progress, is most insidious, by yrliteh means the patient is seldom alarmed, until considerable danger has arisen. The statement, which Mr. Corbyn has given of 108 successful cases, treated out of 110, seems to me calculated to mislead, and raise expectations that must be disappointed. However, the remark which lie makes shortly after, that after a lapse of 6 hours from the attack, the remedies he recommends, will seldom produce any benefit, seems fair and candid; and I have to lament that very few of the cases, that presented themselves at the general hospital, were admitted so soon, most of them considerably later. The disease generally begins with a watery purging unattended with grr.ing, or any pain, which i 8 followed, at an uncertain period of from half am hour, to sor 6, by vomiting of a white colored fluid; but sometimes, the attacks of both are simultaneous. I will here add my testimony, to the heap of evidence before accumulated, that in this form of the disease I have ne\cr observed any thing' resembling- bile discharged rpwards or downwards. The vomiting and pinging is soon followed by great debility, and sinking of the pulse, the extremities be* come cold, the eye sinks into the socket, the 



16 





vessels of the tunica adnataare injected with blood, from which, if the disease advances, a film is in a few hours formed, the features express the deepest distress and the eyelids are either wholly or half closed. The patient invariably complains of great heat and thirst, and the calls for cold drink, although he is told of the danger attending it, are incessant: indeed the only way to prevent its being given to him, is to place a sentry at the door for tlie purpose of preventing any being- curried into the hospital; otherwise some are siuc to sulVer from the mistaken kindness or easy compliance of, their friends. The tenesmus now, becomes constant ; although nothing- is discharged, but <he iluid above mentioned, and a substance like the congealed white of an egg : the uneasiness and jactation are so great that it is with the utmost difficulty we can get an opportunity of feeling the pulse, which by this time is not always percrpiible, although it is generally so until the spasms come on. These attack at no fixed or determinate period of the disease ; but in general not for many hours after the vomiting and purging; and medicines given before their appearance will in general be attended with success. The spasms me always of the tonic kind; attack first the toes and legs, and extend up to the thighs, muscles of the abdomen, chest and arms. When they reach the 



i 

17 





18 

MEDICAL REPORT OF THE 

chest, the difficulty of breathing becomes so urgent, the sense of suffocation so great, that I think the diaphragm must be spasmodically affected at the same time The patient frequently is heard to call out that he is dead, feeling I suppose as if he had resigned his last breath, while the diaphragm is fixed. All this while, unless checked by medicine, the vomiting and purging continue, and very commonly worms of the lumbrici andteniae kinds are discharged. They are so common, that some have thought them connected, in some measure, with the cause of the disease ; however I look upon them as purely accidental. The vomiting and purging are usually checked by medicine, and always greatly alleviated, a considerable while before the spasms disappear ; indeed I have often observed the spasms of the arms come on, after these had been stopped, and while arterial action was encreasing, so that I have been led to believe, that, after the spasms have formed, the disease will run through it's course, mitigated in degree, although regular as to the order of muscles affected in succession. The first signs of amendment, after the vomiting and purging are checked, arc a warm sweat on the forehead ; the tongue, which before was white, dry and cold, becoming warm ; less uneasiness and jactation ; an inclination to bleep, and often, 





with care, a small firm beat of the pulse at the wrist may be discovered. Whenever heat is restored for any time to the extremities, or a -warm sweat becomes general, or bile appears in the stools or in what is vomited, the patient is out of danger. In two favorable cases, both old men, there appeared in the stool a copious red colored fluid, apparently blood slighly diluted with water. The patient, after a severe attack, in general continues so weak, as to be unable to stand for several- days, and in a few cases, 1 have observed afterwards, great heat of the surface, with a bilious vomiting and purging". The most unfavorable and dangerous signs are, the coldness extending to the region of the heart & stomach, the skin under the nails appearing pale, the nails becoming inverted towards the skin, the tongue continuing icy cold, an universal cold colliquativc sweat, shrivelling of the cuticle of the palms of the hands and soles of the feet, the spasms disappearing while these symptoms continue to increase. In general, all pain and spasm leave the patient before death, and although the heart cannot be felt to beat, he expresses himself easy, and says he is better; but I sometimes have seen him in the greatest agony shortly before, rolling himself on the ground and groaning, sometimes bellowing most piteoulfy. The latter symptoms I have oh- 



19 





I 

served, I believe are confined to patients who linger S or 4 days, before death comes to their relief, in whom the disease appears at first to be vanquished; but whose vis medicatrix naturae is not sufficiently strong- (o excite that reaction of the system, in which the return of health consists. lat first thought, that in a disease of so much violence, there was no such thing- as a spontaneous cure; but a man who had been affected 3 days, \vas brought to the hospital this morning, in whom the spusms had almost entirely gone off, and whose pulse could be felt at the wrist, although from the description he must have sustained a violent attack, and he had taken no medicine. 

1 remarked before, that the practice I had followed, was that first recommended by Johnson, und since by Mr. Corbyu, in which the corner stone and sheet anchor is calomel in a large dose of \o or 20 grains to an adult, according to his strength. 1 have had the most manifest proof, both in this disease, and formerly in severe fever and dysentery, that calomel in this quantity, acts us a powerful sedative, often allaying vomiting and soothing uneasy sensations, when no other medicine will produce such beneficial results. I have in no case left the cure alone to the usual anodynes andantispasmodics; so that I am not able to 



20 





say from my own observation what would be the result in such a case ; and I have felt little inclined to do so, in consequence of the indifferent success Mr. Curtis met with, from the use of these medicines. I have always combined the calomel with opium, sometimes the extract, sometimes the tincture, and usually with a few drops of the essential oil of menth pip. but very often both the latter and the tincture appeared to excite vomiting;, in which case, after resting- a little, or ai;< r the warm bath, the dose of calomel has been repeated, combined with the extracts and a little honey or conserve. The orgasm of the stomach and intestines by this means is generally speedily allayed; but often the spasms and coldness continue sometime; to remove which, I have seen nothing act so surely, as the warm or rather the tepid bath ; if too hot, the bath will do more harm than good: after 15 or 20 minutes in the bath, the spasms in every case disappear, heat is restored, and the pulse returns to the wrisf. But after the disease has advanced too far, these eiVects, although always produced, are but of short duration, the puise disappears again, the coldness returns : as auxiliaries, strong stimulating and anodyne liniments, aether, or hot brandy ami water, in small doses, repeated frequently, 



21 





heat of the epigastrium, warm clothing, and o« piate injections, are almost all that I have used; tin these cases will always produce the best ef:ts, although, they ought in no case to be omit-1. The p;tin'» calls for cold drink are con - .nt, and it indulged, will counteract the effects every remedy, causing the vomiting, spasms, d other bad symptoms to return, with as much violence as before. The less his desires for drink of any kind arc complied with, the better, as they never relieve the sense of burning heat and thirst ; and when accumulated in any quantity must I discharged ; thus Increasing the irritability of c stomach to such a degree, that at last whatcr enters the oesaphagus is immediately spouted up. If the calomel and laudanum are vomited sooft after administration, without having produced any benefit, we mustalways repeat them after waiting a short time ; the. quantify taken is of vo importance until beneficial results are produced; for the production of which we must give sufficient time, and in the mean time it will be proper to forbid any thing being taken into the stomach. If s-leep or warmth succeed, we may conclude the remedy bath effected ail we want, and if no check is given by cold air, cold drink, or c drink for sometime, health is sure to follow, much laudanum without a combination of 



22 





calomel to counteract its constipating effects, is attended with danger, as it checks the vomiting and produces stupor without encouraging this secretion of bile and flow of perspiration, in cither words, restoring 1 the balance of circulation, a derangement of which appears tobe the whole of this disease, and to the restoration of which I think all our efforts should be applied. A »v;an cured by doses of opium every hour, or half hour, without the combination of calomel, is never secure from danger. Three or even four days afterwards, he may have a relapse, differing from the former, In as much as the pain is generally fixed, and most probably depends upon inflammation of some of the viscera of the abdomen, and these relapses ace pregnant with danger. I have mentioned what I think the only true theory of the disease, the only one which will account, satisfactorily, for every symptom of it; an I the modus operandi of those medicines whic'i are found to cure it. I ought rather to ft y I E hinted at, and it is not my intention to ;e upon it. It accounts too for the utility i has arisen from bloodletting, a remedy I not mentioned ; although, in many car,* s, ik it must be powerful in doing good, but of the cases [ have seen have appeared to nfavorable to its use. In conclusion, lam 



23 





happy to inform you that for the last three days, the disease has evidently been on the decline, and during that period most of the cases have assumed a different and much milder type ; and comparatively are little dangerous. It approaches somewhat to fever, the patient complains generally of severe pain in the abdomen from the first, spasmodic pain of the legs, sometimes vomiting a watery fluid and sometimes bile ; but in every case the hV'at, so far from being diminished, i 9 increased, and the pulse is full, tho' little increased in frequency. The disease is attended with this advantage, that in it's first appearance it is alarming; the pain in the abdomen and the spasms of the legs are pretty severe, but besides he is possessed with emotions of fear and alarm i greater than the symptoms ought to give rise to, and for which he, when asked the reason, is totally at a loss to accoant. A large dose of calomel and opium, in every case, has been sufficient, and generally in a few hours he goes home quite 

(Signed) TIIOS. WHYTE. 



v 

24 





No. 7. 

Copy of a Letter from Assist. Surgeon Charles 

Daiv, to Dr. And. Jukes, Tannah. 

My Dear Sik, 

I received your letter of the 19th instant yesterday, requesting me to give you some account of the Cholera Morbus, as it has prevailed here, and the mode of treatment which has been found most successful ; and as the disease appears to be extending' very rapidly towards the coast, which induces me to fear that even your insulated situation may not be exempt from its ravages, I lose no time in acceding to your wish, though 1 must in the first instance bespeak your candour in favour of observations so very hastily drawn 

As I presume you have seen the letter written by Mr. Corbyn, who had charge of the Native hospital, centre division of the army a*. Eritchj to Captain Franklin, Assistant Quarter Master General of the same division, on this subject, perhaps 1^ could not do better than recommend you to pursue the plan of treatment therein laid down, as it is the same with very little variation that I have adopted ; but as I know you will be glad to hear that success in my own 

practice 

25 





happy to alarm job tint 

Editease has eridenriy bee I during that period most am t d a diflerent and much 

coapaßuivety are liuie 

Hwewhai to fener, 

nan moil ir pain of 



a watery fluid and rataetimes bile ; cue (he ifcal, to &r from being d 

¦¦ad hml OM 



t 

ail, th«. iianp - disease ¦ attended w 

thif adranta^e, that in it's ftm appearance itia aianntcz; the pain in Mie aoaVoneii and r he •pasosof the !egs are pretty awrere, but jesides greater than the s^-nptomt <m^it to gtre n«e to. 

aad for which he, when asked the reason, is to- 

i 



it a km* to ac 



and 

*> 

0 







practice tends to corroborate his, I shall make no apology for mentioning* the history and treatment of this disease, though I should thereby have occasion to repeat in nearly similar words much of what he has related, as well as those circumstances where any difference has occurred either in the symptoms or plan of cure, in order that you may have at one view, as complete a knowledge of the subject as it is in my power to give you. I sincerely wish that we could receive a second letter from Mr Corbyn on a subject, that his extensive practice so well enables him to speak on, and which he almost promised to do, in his first letter, or as he modestly expresses it M correct the errors that from pressure of business mi^ht therein occur." 

Some of the symptoms of Cholera Morbus, or rather I should prefer the French term of mort de chien, as it has occur red here, are as follow. 

The patient is suddenly seized with violent and frequent vomiting- and purging, which is attended with immediate coldness of the extremities, anxiety of countenance, and gfeat prostration of strength. The stools consist principally of mucus and water, or muddy looking •water, and seldom shew any appearance of bile 



26 





mixed with them. The vomiting- is also not bilious, which in a great measure distinguishes it, from the commencement, from common Cholera (1 have made it a rule, when the stools and matter vomited were bilious, to moderate the doses very much, but still act upon the same plan, and the result has been very satisfactory ). The pulse is very feeble and small, but in most cases it is scarcely perceptible, and frequently from the first attack is not to be felt at the wrist. There is often great pain and sensation of burning heat at tiie pit of the .stomach, the skin breaks out into cold clammy sweats, the eyes sink, the breathing becomes oppressed ; in some cases there is great restlessness and anxiety ; in others the diminution of strength is such that they are unable to move, and lie on the cot as if dead or insensible ; if roused however, they speak, and seem to retain their senses as long as the tongue can give utterance, and shew by signs, sometimes even when past articulation, tha,t the senses are Hot impaired. At an early period, a most distressing thirst prevails, and the patients are particularly anxious for cold water in preference to any thing else, in which, should they be indulged, all attempts at recovery afterwards seem almost useless. In many cases there is present 

on their fust arrival at the hospital an extreme 

V i*\ 1 ? iwj j 

27 





no apology for meiitkming »W« »,». iHMC ttCfMM) t* rrj>» orach of wlmt Ji« ha* nktUni afcam*l*ui** wif«re any dHforwv ttrtJMT in the *- that y«»u ma v bbn -' " upJuie a gpre v<»u. \.¦¦ t ¦ t . v t •¦ , aemtm lecopd letter from Mr ¦1 hi* extern • ;,•.-.'• ird MM bun to apeak on, * I r *e »lm<> nt*- fi-"* I- ¦:.«:• " • |iifwji I nin thu' iroMi )>reMure 

E' pt ] Mhouid prefer 'II!'! ;:¦ low. 

•odd* i r i !mrr»' ' «tn» . Trir I ¦' firn> rind yr»' irHter, ami ifll 



0 





iiiix«m| wild them The vomiting ii uUo noi bi liohm win* ii in si grail iimjihui <• dittinguUnei •', from thf « Miiini'ii' • iim vi , from common Cholera ( I httV€ Itiadfi i ( I Milr, when the itooit and in i' iii vomited were bilious, lo moderate Ihe do \.i, iniuii. but •till id upon tbt same pi.m, and the result ii« been vm\ talisfkctor) ) Thei (i'il • i \<iv feeble smml '•iikill, hut in Mot! en ii \n icarccl) [>crceptiblf/ snni freo^uentljf from flic lust .ii f.n Uis noi U) br felt tl I Ji<* wri 1-.1 -'. Tlmic i ol ell ;m.il |i;iim iiml Hc.nHiitioii of Ijuruiitg heal ;•! the i"f of the itontachj tin? tkiu breaks oul into cold clammy iwenttj Hu* Rjcti Mitk, the breathing bccbmci opprcstcd ; in tomfl <.1 ci theif In greal retUcmtteM nnd iniietyj i»» Oitiefl UIC flimnnition ot Httnglh If Ittcll 'lii' l - v ire unable <•> mrtve, and lie on tho cot i«^ If d< ad «»i inietifible , ii routed however, they k j)«'<'-. ;ind ItfCIII •<» mlhiii their |tnt€f :ih loifg »* 1 lie Umgueoa.ii give attefa>nee # Mjd ihcw l>y ii| ¦omeiitnM efeti when |>i»M ¦rticuuition J tba^ the ieinei are acH impaired At in eaHy period, a most diiiftf#ing thir*( pftvuib, and Mir- paiicnti are pputiculaiiy afisioui fof cold water in pfe£ i rnre (o ;m\ Mling «'I k <', in whirh, ihoUld H)f y e indulged, attaiUtmpti ;it rtcoretf •fterwatdi leem aliflOiJ ttieWsi In ninny vi\Hi'H there i-, pre-f n( 

on their iirst arrival si the hospital an extreme 



0 





lillowness of the eyes, and if the skin is clear enigh to shew it, a sallowness of countenance, once denoting; the state of jaundice that imediately preceded, and, I think I may add t ought on the attack. In almost all instances, ther sooner or later, the legs and arms are afcted with rigid spasms, which soon extend to ie abdominal muscles, and those of the chest, Inch occasions hiccup, and most violent pain >out the diaphragm. The urine is very scantily creted throughout! These symptoms rapidly incase in violence, the strength abates, the whole :>dy grows cold, and in a very few hours the ene is terminated by death. 

II have noticed in more than half the cases of atives that I have attended, that the tongue is lite clean, and I have always found it a very vorable symptom. 

I Such is the disease as lms appeared among Naft t and my own practice is too limited with uropeans to speak much on the subject. In 1 cases however that I have seen, Europeans )mplain a great deal more of the violent burn£ sensation and pain at the pit of the stomach, take the liberty of making an extract from a ter of a Medical officer whose practice has been liefly among Europeans, and who I am sure 



28 





29 

CHOLERA MORBUS, 



will extuse my doing so without waiting for his permission, which describes the dreadful rapidity of the course of this complaint, which will shew you in how much it resembles the description of it as it exists amongst the natives. He cays " the patients sometimes walk to me, but are more frequently brought in a dooly, they complain of cramps in the legs, the countenance, skin, and pulse indicate immediately the nature of the disorder. The face, to make use of a common expression, is fallen in, collapsed, and eyes sunk. Skin cold; no pulse, or if any, feeble and scarcely to be felt. In half an hour the body becomes clammy, and cold sweats pervade, the pulse sinks, the eyes become fixed, spasms become genera), and the patient dies in a few hours, not less than five, and few exceed twelve or fourteen." 

The exciting causes of mort de chien, in that violent degree that it has prevailed over so large a portion of India, and still continues to do, seem unknown. Ido not think it is an infectious disease. But there are certainly many circumstances which favor a different belief. If it be not infectious, it is strange that it should for the most part have been regularly progressive from place to place, and equally violent under the varieties of temperature and seasons, without 

regard 



!;ard to age or sex. It has never appeared, as as I remember, at distant stations at one and ; same time ; and till we obtain farther infortion on the subject, it is not possible to demine either that it is, or is not an epidemic, infectious disease. Perhaps endemic is at pert the better appellation. 

Of the predisposing causes among Europeans, excess and intemperance, whereby men expose themselves to the night air by falling asleep in a state of intoxication, are the most decided. And the fatigue and exposure which native followers are subject to, together with want of clothing, bad food, eating the colder kind of fruits, such as melons, cucumbers, raw vegetables and grain, are sufficiently obvious causes of disease, and never fail of producing more or less of fevers and bowel complaints at this season of the year. During this monsoon however these complaints have been much fewer than is usual, and the Cholera Morbus has instead been the prevailing disease. There is an illustration which is very striking; of what care and temperance will do to preserve Euro-? peans from tiis disease, whic'.i I will give you — Two bodies of men, one of nearly three hundred and the other about one hundred (this is very nearly the numbers but not exact), were in adjoining situations, when the disease broke out in 

the 

30 





(he place where these troop.s were. The 100, men immediately determined, that, by great temperance and care, arid, by not exposing themselves. Innecessarily, and in particular by avoiding the ight air, to endeavour to escape the disease* ; succeeded so well thai only one man had an tack of" it ; while the other body of men, the 300 ho took, cio such precaution, los.t one tenth of their whole number. You may think from the ianner in which I have written this, that I have no stinct information as to numbers; but had I time, could easily procure the e^act statement, which am quite certain would very nearly dgree with iiat I have said horn memory. 

tWith all this however the real and essential ¦ . jse is as much concealed as ever. 

I The proximate cause I consider to be spasm the finer vessels of the liver, and particularly those which, from their minuteness and ar« igement resembling the huirs of a pencil brush, i called peucijU. 

As to the treatment of this disease when the patient is first brought (and the greatest care and attention is necessary that no delay take place after the attack), I put twenty grains of calomel upon the tongue and, wash it down with sixty minims or (120) one hundred and twenty drops 

of 

31 





t laudanum, twenty minims or (4o) forty dropj Essence of peppermint, and two ounces of ter.* 

In cases where Europeans are attacked, copious bleedings are said to be attended with success, as well as is also the application of the most violent blister.f I have bled Natives, but without benefit ; and I have known the lancet equally unfortunate where employed with Europeans : still it has been so strongly recommended, that I should irot hesitate to bleed any whose pulse was strong enough to warrant it ; and if I did so, I should 

think 30 or ao ounces was not carrying the plan 

* To those win* are not medical it may be proper to observe, that the college of physicians of L ndon have, in their last pharmacoper-ia, introduced a small glass measure, which is (graduated to ( 60 ) sixty divisions of a fluid dram (the Btit jmrt of an ounce ), which are called minims, in order to give security to the dose ordered, which was never the case with dropping; as one bottle will make the drop twice as large as another; and in common, 120 drops are only equal to a dram or 60 minimi : au<l ax Mr. t 'orb) n says 60 drops, when writing to Captuin Franklin, I imagine he can only mean half the quantity which 1 in in the habit of giving 1 . 

f It' you should not have noticed the effects of the pure armmtic vinegar ( Henry's is in general the best), it will be useful to know that it instantly raises a blister, if rubbed on tlie purt where rcqnirnd, and is pure: but in a case ofthij kind, where nil )uur efforts are to be confined to a i'evr hours, 1 should not hesitate about using even boiling water, the most violent caustic, or any of the violent applications of butter of auuuicu), ip.. lk hush, or fuphorbiura. 



32 





I) far. If the first dose of calomel and the night should be immediately rejected from the imach, the dose should be repeated ; but if rened for a short time, half the quantity Will be ite sufficient both of the calomel and the opiate, ofn this time till the symptoms are relieved, or c patient falls asleep, during which probably c extremities will grow warm, and on awaking will appear to be nearly recovered, let the folding draught be given every hour — of laudaim 30 minims, peppermint 10 minims and war two ounces. 

For the coldness of tlie hands and feet, it is necessary to have recourse to anodyne fomentations, hot cloths, I ott'es filled with hot water frictions with flannel, and the like, constantly ap- 

IThe contraction and spasms of the extremities nd musc'es are relieved in a great measure by hampoing, and friction with stimulating oils and he ammoniacal liniment. 

If the vomiting continues, I have seen the most beneficial effects arise from a tea-spoonful of the eau de Cologne, or tether, given with the opiate ; medicines are also often retained by givng them the instant that the stomach is a little composed after vomiting. 



33 





For the jaundiced appearance which I have no* ticed as a common symptom present on the first attack, I always give a pill, compo-ed of two grains of rhubarb, one grain of calomel and two grains of Castile soap ( if too large they may be divided to form middling sized pills ;) this serves to assist the bowels as a sort of artificial bile, as well as to stimulate the liver to its natural and healthy ac- 

As soon as the common symptoms of Cholera Morbus are relieved, it is necessary to give some opening medicine, of which, castor oil is decidedly the best, to endeavour to obviate as much as possible the effects likely to be produced by such large doses of calomel and laudanum as have already been exhibited. The use also of enemas composed of half a pint of congee with a tablespoonful of common salt, is remarkably serviceable at this period. 

I often happens, although the patient is enrelieved from the symptoms of mort de chien still other complaints remain, induced proeither by the severity of the disease, or the administered ; of these one of the most cornis suppression of urine : when this is the let the patient be immediately put into the i bath, and have fomentations constantly id to the abdomen. Let about 15 or 20 grains 

of 

34 





of nitre be dissolved in a point of conjee, and given as common drink : should the case be suppression, this will for the most part be efficacious ; should it be only a case of retention, the catheter is alone necessary. 

Against I hint, in every period of this disease, warm conjee is the only proper beverage. 

Another complaint succeeding mort de chien, is, where the liver is deficient in action and the bile is not secreted in healthy quality or sufficient quantity : in such cases, the rhubarb and soap pill, or if necessary, 5 grains of the blue pill, every night, will speedily restore its natural action. 

The extract of Taraxacum is a most excellent remedy to give in completion of the cure, and to assist in restoring the natural secretions and evacuations. When debility alone exists, the usual bitters and stomachics are to be administered ; such as camomile, columbo, gentian, bark &c— ~ But I have found that a weak infusion of create (gentiana chirayita), gradually made stronger as the patient recovers, exceedingly useful (arid indeed I think it is a medicine most deserving of every attention, in other diseases as well as this, where tonics are required). 

This will in general complete the cure, unless some internal obstructions prevent it ; in which 



35 





I! the usual remedies are to be employed, as If" It c an original disease wholly unconnected with, cholera morbus. 

I You. will perhaps think it strange that I should ' nothing about dissections, and appearances er death* The truth is, I cannot imagine that jch is to be discovered thereby ; and I may ven~ re to say, that not one half of the diseases which ye appeared upon dissection can belong to or ise from Cholera Morbus. Let me recite part the list now before me in print and manuript. The intestines were inflamed, corrugated id flattened, the stomach inflated, and liver not 

luch altered, the gall bladder distended. Another is the stomach highly inflamed, and corruga-3ns as from spasms, the intestines contracted ngitudinally, great accumulation of bile of dark, ¦cen colour. In others, inflamatioi^pf the heart ith the pericardium, congestion of the small inistines and mesentery, no disease about the lisr, the gall bladder filled with healthy bile, the }leen enlarged and turgid &c &c. Now when it ; to be considered, that a man is so violently ttacked as to fall down as if shot, when previulsy ha perfect health, I consider that it would be ¦npossible such effects should be produced as hose mentioned above in the course of six or 



36 





even twelve hours, and few live longer, more especially when not only the sanguineous but the nervous system seem almost destroyed, or to say the least are so languid and feeble as only just to shew signs of life. The pulse, you recollect, scarcely perceptible and the extremities cold. Surely it is impossible that secretion and inflammation could go on to any extent under such «i stagnation of the whole fabric. It is true that at present neither inflammation or secretion either may.be thoroughly understood ; but T imagine no one will like to support such an opinion as that either of them, particularly the latter, could happen without some extraordinary action of arteries or nerves ; and I cannot believe that we can therefore consider dissection likely to throw much light on the disease. 

II have now mentioned the principal facts and iservations which occur to me either as to the mptoms or treatment of mort de chief] ; and if, ifortunately, any cases of this disease should apar and come under your care, I hope you may perience some advantage from them. 

tAs to the kind partiality which induces you to sh me to make these observations public, I will nfess to you that I should be most happy if I uld thereby render any service, either to the 

profession, 

37 





profession, or the melancholy sufferers who may be affected with this disease ; and I leave it entirely to yourself to judge if there is aught in what I have said that can make it worth while publishing after Mr. Corbyn's letter ; if you think there is you have my full permission for doing so. 

With the best wishes for your success, I remain, my dear Sir, your most faithful friend and servant. 

CHARLES DAW, 

Aasist. Surg. B. E. in Med. 

charge of H. H. the Nizam's 

Regular Infantry in Bcrar. AURIMGABAD, JULY 29th 1818. 

No. 8. 

Extract of a letter from Assistant Surgeon Wallace, to George Ogilvy Esq. Secretary to the Medical Board. 

Seroor, 29th July 1818. 

Sir, 

I am happy to state for the information of the Board, that the number of people attacked by Cholera has decreased for the last three days ; and that in the majority of cases where the disease is combated at its commencement, the prac- 



38 





39 

CHOLERA O R B L S« 

tice has been very successful : in the worst cases it is necessary to conquer the spasm before the calomel and laudanum can be retained on the stomach : this has generally been done by immersing the patient in the hot bath and bleeding him, feting the blood flow till the contractions of the muscles subside; at this period the stomach usually retained the medicine and often fiduced favorable effect before the spasm rerred, when recourse must again be had to the hot bath &c. Second bleeding is sometimes necessary. 

In administering Mr. Corbyn'i remedy to natives, I have found is very advantageous to mix it with as small a quantity of water as possible, and to restrain them (if possible) from swallowing any thing for two hours after it has been taken. 

No. 9. 

Extract of a letter from Surgeon David Craw, to 

Dr. And. Jukes. 

Seroor, 30th July 1818. 

I have only this moment received your very agreeable letter of the 25th. It would have given me very great pleasure to have given 





|>v the most ample reply to your laudable enqu*?s respecting the present highly alarming- and lomalous epidemic ; buc the combined causes of int of health and want of employment have very uch contracted the sphere of my own personal iservation on the subject. Such information nvever as an occasional v sit to the hospital of . M. Goth regiment, a few cases amongst my vn domestics, and a constant conversation on ie disease with all of my professional friends at >roor, can afford, is very much at your service. 

In the first place, it will be necessary to premise iat the disease is of a most multiform nature, and jarticularly tb:?t there appears to be a very rnark-1 difference, generally, as affecting the Native id the European. Curtis gives the best descripon of it, and Johnson I think has copied him erbatifl). Girdlestone, Clarke and Bontius may so be perused with advantage. Curtis describes ie disease precisely as it made its appear. .<•<> hue at first amongst the Natives : as affect)g the Europeans it is somewhat different ; and ¦ay it has charged its type in the fo'mer class* ringing it nearer to that as exhibited in the latter. p a 'he Natives of all casts and temperaments, young ml old, and strong and weak (and tie same 

may te *aid of the Europeans) are equa''y 1 able 

to 

40 





to the attack of the disease. After a few watery clay colored evacuations from the stomach and bowels, with acute burning pain at the epigastrium, and considerable tenesmus ; spasms of the muscles of the legs, thighs and abdomen ensue, and these are speedily followed by a weak, fluttering imperceptible pulse, and deadly coldness of the extremities and indeed of the whole body, the vital powers sink rapidly, the patient is drenched with cold sweat, the palms of the hands become corrugated, the cuticle being raised into folds as' if it had been a long while immersed in hot water, the eyes are sunk in the orbits and are surrounded hy a very ominous livid circle, and death closes the scene. With the Natives therefore the rapid approach of great debility is alone to be feared. The calomel and laudanum plan, with the most powerful diffusible stimuli and the hot bath, haye 1 been eminently successful ; and if application is made within 4 or 6 hours from the first appearance of the disease, the cure is almost certainly effected. It does not appear very difficult to allay the stomach and bowels ; and it is seldom necessary to repeat the calomel more than two or three times, provided the first dose has been rejected : but where the stomach is more irritable* ¦ the calomel and solid opium with confectio rossefprrna boli, is found to answer better than the fluid laudanum 

41 





kudanum. The bath after the exhibition of this medicine ha 9 the most beneficial effect, and quiets all the symptoms in awondeiful manner. Notwithstanding the early exhibition of the remedies, the disease yet appears to run through a kind of course, for the symptoms of coldness and total absence of pulse frequently take place where there appears to have been but little disturbance in the primes viae. Wine, aether, hot spirits and water, compound spirits of ammonia, and oil of cinnamon, with a repetition of the bath and constant friction of the limbs are all in their turn necessary when the alarming symptoms have come on. Notwithstanding the unremitted application of these remedies, the patient may become comatose, indicating blisters and sinapisms ; but this is almost invariably a fatal symptom, tho' I have my doubts whether this is not sometimes induced by the too liberal use of the stimuli. Ischuria or Dysuria is also a constant symptom, but generally relieved by the bath, and certainly by the catheter. 

I The disease as affecting many of the Eurojans appears to me to be a true Tetanus, and o' my professional friends (as it appears to me isled by the irritability of the stomach and >\vels) will not at all accord with u>e in wy pwi| I regard our present epidemic in all clas-5 to he more nearly allied to Tetanus than to 

Cholera, 

42 





iolera. The last is surely a misnomer as ap»d to a disease the principal characteristic of ich is an entire want of xoah in the evaitions, and should it be your lot to see the aftion amongst Europeans, I request your attion to this subject. There have been I think iut 70 or 80 of the 65 th already attacked, I perhaps 30 or 40 in the horse and foot llery ; the former corps has lost I think 6 men, Ii the two latter combined 4or 5. Within ; last few days it has made its appearance in » 22d dragoons ; 10 or 12 have been attackand two I think died. In these corps the ease makes its appearance sometimes by the ne affection of the stomach and bowels as in 5 Natives, frequently with spasm in the feet, s, abdominal muscles or arms ; but in all, the ismodic affection is the preeminent one, headle, pain in the eyes, excruciating pain at th© obieulus cordis ( a pathognomic symptom of Tetanus), quick-full-hard pulse ( but labouring [oppressed according to the violence of the sms), retention or difficulty of voiding the ie, strong and violent spasm drawing up the ;, rigidly contracting the arms and fingers, ding the body forwards or backwards, or lally, the patient at the same time exerting snch sical strength as requires half a dozen of 



43 





44 

Medical report op thb 

|»en to hold him on his cot. I have already sakl lat the intestinal evacuations are watery and clay >lonred, this must not be lost sight of as indiiting a want of bile, the vomitings aie somehat of the same kind, attended with eructations hile the Lowels are distended with flatus. These >mbined with a very distressing tenesmus, not be allayed by Anodyne Enemas, strongly )int out that nature requires relief by the bowels, fter the Id day that the disease made its appearice in the 65th, Dr. Burrell commenced blood tting with the most decided advantage, this has eretbre become the first grand remedy amongst c Europeans, and in which he has been follow- II by the practitioners in other European corps, d with the same result. Bleeding quoad vires, c calomel and opiate, the hot bath, warm cloth, g and frictions spirituous or anodyne, form c chain of treatment in the European ' hospitals re; and these are repeated again and again as the mptoms may seem to demand. Under this system, d early application for relief, I think the disease, not fatal in a greater proportion than 1. in 100 ses. lam convinced that after bleeding and c bath, a powerful purgative and a strong caartic enema would have a much better effect an narcotics ; the difficulty would be in getting c medicine to stay on the stomach, but this 

surely 



Surely might be managed without powerful opiates; for in all cases after the patient has been dosed into a state of stupor, it is necessary to open the bowels, and a bilious motion is in my opinion the best criterion of his safety. The calomel alone would answer the purpose, I have no doubt, while it rapidly mercurializes the system. 

One dose of 15 grains often brings on ptyalism in 24 hours, and all the patients complain of their mouths being affected on the 2d day. On the state of the atmosphere and the immediate exciting cause or causes of this disease, it would perhaps be unavailing to form any con» jecture. On the former, as in all other epidemics, certainly so ; tho' I have little doubt that any check given to perspiration, and particularly exposure to a current of air, especially the cold air of the night, is a powerfully exciting cause. Warm clothing and excluding the chill breeze after sunset form our principal plan of preservation. The natives and soldiers you know are not over cautious in these particulars. There is amongst us all at this station, however, a wonderful predisposition to disease ; some are affected with severe headache, pains of the eyes, rheumatism, and spasmodic affection of the neck and loins and legs ; others with pains at the stomach, nausea, graping pains or twitchings in the ab- 



45 





dominal muscles, want of appetite, and irregularity 

in the alvine discharge ; and some with sudden catchings in the muscles of the legs when walking, or a subsultus tendinum in the arms and fingers. 

It is yet a doubtful matter whether the disease is contagions. At Poona they allege, that the few cases which have yet been seen there are strangers who have brought the disease with them : but what I am now going to relate may seem to prove strongly its contagious nature. Every one of the native attendants in the fi.ith hospital, and they are 30 in number, have been attacked with the disease. Now on any other supposition this is perfectly unaccountable. Could the effluvia arising; from a number of patients condensed into a small space have excited the disease in the attendants ? I have little doubt of it. Ido not think that more than two or three bodies have been opened after death ; and thu* these died in a comatose state, inspection of the brain was neglected as being too troublesome ! la all, the appearances in the abdomen were pretty much alike, the bowels extremely distended with air, the gall bladder and ducts tinged with bile, and marks of congestion of blood in the he~ patic system, the lower bowels coated with a pasty, clay coloured, ad/iesive, slightly feculent mat- 



46 





ter* I put very little faith however in the caretesl and hurried inspection of these bodies j a morfc minute dissection will be requisite to enable u» to dr aw any useful inferences. That there is such a spasm however of the duodenum, as closes up the common duct, there can be no doubt; and in removing this, I know nothing so useful as cathar* tics, particularly the mercurial. You will observe that the flatulency and real obstipation (notwitru standing the apparent purging), and want of bile in the bowels, form exactly the Cholera sicca of Sydenham ; but such diseases have not the slightest connection with cholera, secundum €< summan doctoris auctoritatem et urbis." if I have been successful in conveying intelligibly (tho' hastily) to you what I myself have seen Kd heard, you will draw the following condu* '113. 

KThat the epidemic amongst the Natives en attended with alarming debility rapidly ening to the affection of the stomach and ; and has been successfully treated as almentioned. 

E2d That amongst the Europeans it has varied nsidcrably m its appearances and that bleeding s been highly useful 

3d That in the former class the type is now so 



47 





far changed as to require, or at least to indicate blood letting — and 

4th That all ages and all sexes, the young and the old, the stoat and plethoric, the puny and debilitated, are alike liable to the disease. 

You have seen that I think the disease, as it has exhibited itself in the European corps, is nearly allied to tetanus ; I may be mistaken, but I extend the same observation to the class of Natives. Various symptoms in different classes of men must be expected; all diseases afford them. Read carefully the cases of tetanus in Dr. Hamilton's work or purgatives, and you will have a good idea of some of those in this extraordinary epidemic. But I must tell you that we have, too, cases of the common cholera; and should we not have had them, tho* free from this wide ¦^reading disease? I had two or three hundred cases last rains at Caranja. 

I have now endeavoured to comply (as fully as I am able) with your request, and if you are disappointed, you must attribute the disappointment entirely to my »vant of opportunity, and receive my desire to give information as an equivalent to its being amply bestowed if it were in my power ; this lam sure you wifl kindly do. Laying aside theory, you may rest assured in the 



48 





49 

CHOLERA MOR3 U & " 



plan of cure, and at ease in your mind on this head, you may call the disease by any name you please. Tetanus epidemicus ©r indicus, convulsio indica ; Cholera sicca, indica, spasmodica vel ilatulenta, &c. 

You must not be surprised at the variety of the descriptions you may receive from various individuals ; the epidemic will comprehend them all, however different. We have had but a fevr slight showers here this monsoon ; and it remains to be seen, whether the disease can be washed away by a deluge, or whether cold and moisture may prove more powerful exciting causes. Its commencement in Bengal last rains, and its duraration through the cold and hot seasons, would appear to deprive us of any rational hope of the first event. " There are more things in heaven and earth, than are dreamt of in our philosophy.'* 

P. S. I must not omit, that in a few oases the muscles of the face have also been spasmodically affected ; and in one woman the jaw was for a time firmly locked. Amongst the officers at this station, only two or three of the 65th have been affected. The disease I think is evidently on the 





50 

KKPICAL REPORT OF THS 

No, ia 

Remarks and observations on cases of Cholera 

that occurred in H. M. 22d Dragoons at Seroor; by A. S. Campbell Esq. Assistant Swr- 

geon in charge. 

The 22d Dragoons were remarkably healthy during the greater part of last month : towards the close of it a great increase in the number of the sick took place, from the prevalence of the Cholera Morbus, three cases of which in our hospital have proved fatal. These men however were admitted in a state which rendered bloodletting ( the most effectual remedy in this complaint) quite inadmissible ; as they were several hours sick before they reported themselves to me ; and were of weak relaxed habits of body. The following were the symptoms in the course of the disease in the fatal cases. A sunk pulse, universal coldness of the body, with profuse sweating, violent spasms in the extremities, extending to the abdominal muscles, severe vomiting and purging of matter like conjee water, a desire for cold Ink and an aversion to warm: in two or three urs after admission the spasms and vomiting appeared, and the patients sunk into a state in which no stimulants could rouse them. m hands then got a bleached appearance and 





he nails became blue, the eyes sunk in the orjits, and the eyelids became of a livid appearance. The pulse now could not be felt at the wrist, he countenance was expressive of the greatest nguish, and the breathing very laborious : in this tate the patient continued till relieved by death. )ne of the patients fell frequently into fainting its before he died, and two were attacked with liccough. 

I The following treatment in these cases was nployed. The patient was frequently immersed the hot bath, which never failed to have a mporary good effect, as the pulse was always ised after be was brought out. This was mor2 after the pulse had disappeared at the rist before immersion, which became quite periptible afterwards. The effect however was very temporary, as the pulse* again disappeared in a ew minutes, notwithstanding all that could be one by frictions with hot arrack and the interal use of the most powerful stimulants to estore and keep up the circulation. The scruple ose of calomel, with Corbyn's anodyne draught", was given every two hours ; but when the sjpasmj and vomiting had ceased, the laudanum was Citted, the calomel continued and the stimuts more frequently given, Bloodletting, as 

i 

51 





52 

MKDtCAL REPORT Chf THS 

Eid before, could not be employed from th£ c in which these three men were brought ic. 

On the dissection of the first fatal case, the following were the appearances. In the liver a considerably congestion had take place, which was apparent from its unusually dark color and the tenseness of it coat. The stomach was filled with a thick whiteish matter like conjee water, similar to what had been vomiied before death. V\ry slight marks of inflammation existed on the inner coat of the st >mach, but so very slight that they could hardly be observed. Ti.e small intes* tines were of a lighter color than in the healthy etaie, and distended with air. 

I had time to examine only one of the remainbodies from my having to be so much in the pital to superintend the management of the other cases of the disease. In the other subject I same marks of congestion were not present, gall bladder was however in the same mandistended with healthy bile, none was found the biliary ducts as was the case in the former subject, although I forgot to mention it when speaking of the morbid appearances. The stomach and intestines were in the same state, with the exception of the colon, which in this 







fctabject was contracted, to an unusually small size (in circumference). 

The lungs were unsound, in this case having tubercles upon them, in the former no morbid appearance was found in the chest. 

The cases which terminated favourably presented very diffeient symptoms, as I had seen the whole of the men immediately after they had been attacked. They came in with the following Imptoms. A quick full pulse, much thirst, and, one or two instances, much pain in the head, lere was no sweating ; they in general complainof a numbness in some part of the exlremis, before the spasms came on. Vomiting and rging of the whitish matter next made its aparance, and the cramps became general, hi c. case only had the egesla any appearance having bile upon them, and this teas a very 

The patients were immediately bled nearly ac deliqnium, and afterwards put into the warm bath and,the calomel and opium given (latterly I pre~ ferred giving the opium in the solid form ; as in every case I found ihat it remained better on t stomach, and with the best effect). If the s was vomited, it was immediately repeated, i£ the spasms were very severe an anodyne 

clyster 

53 









clyster was given, and the blister applied to theah* dominal region. On putting; the patient to bed, he invariably expressed himself as being much relieved, and generally fell asleep if not prevented by the violence of the spasms. In two or three hours, the bolus was repeated, which always induced bleep. The pulse became always fuller after venesection, although in one case I took, forty eight ounces of biood. 

I After the patient awoke, he invariably said he ad no complaint, excepting pei hups a little pain i the head and now and then slight spasms. Pure ile was brought up by vomiting, and on the \hibition of a purge passed by stool. I have not >und that the patients have recovered the effects f the complaint so soon as has been represented, 'hey are all at present in hospital convalescent. 

Numbers of the dooly bearers and other camp KHoven were attacked with the disease : I lost together about ten natives, and cured a propor- Lnjate number. 

ALLCOURT CAMPBELL, 

Assistant Surgton, 

in Medical charge. 

TV" » % 

54 











No. 11. 

Extract of a Letter from Mr. Assistant Surgeon 

Tod, to Dr. Milne. 

Camp at Cliumargoodee, Ist August 1818 

<c I had the pleasure to receive your's of the 26th ultimo, two days ago, regarding the Cholera Morbus, which h^s been committing such havock in some parts of the country. 

It has been in our camp ; but the number of cases, I am happy to say, have been less numerous, than could have been anticipated ; and those, who have been attacked, have invariably been such, as were least comfoitably sheltered from the weather. In our detachment, only three have had the disease, two of whom recovered, and the third (a very old Beastie) died ; although he was brought to the hospital in less than an hour after the attack. 

Amongst the auxiliary horse, the cases have been more numerous ; but the town's people have suffered more than either. 

IA great peculiarity in this disease, is the sudi manner, in which it commences. In several tances, the patient has dropt down quite insenle, without any previous warning ; and in less 



55 



56 

56 .medical report op thb 

. 

I hen fifteen minutes (although he has recover- I d a little from the first shock), the extremities I aye been as cold as those of a dead body: tinolher circumstance is equally remarkable, as it is entirely at variance with the description of the disease, as it is seen in Europe, that is, the vomiting has in many cases not been present at all, end in all those, where it did take place, th<3 matter vomited, as well as that passed by stool, has not been in the least bilious, but a thin whitish fluid resembling congee. The principal symptoms have been violent pain in the bowels^, and spasmodic contractions, attended with great pain in the extremities, which have required an almost incredible quantity of medicine to remove them. 

lln a number of those, that came first under y care, very large worms were passed, both by >mit and stool ; and as their being discharged emed to give great relief, I was in doubt for me time, whether they were not in part a cause the disease ; but from further experience F am 3\v convinced, they were entirely acciden-1 ; and were brought off by the large doses of lomel necessary to cure the disease. The way in rfich I have administered the medicine is by giving lomel, one scruple,, and washing it down with 

Tinct. 





57 

CHOLERA M O. RB U $ 

Tinct, Gpii, one dram, and vvnter, two ounces ; and when th.c first dose has been rejected, I have re-, peated the dose at an hour's interval, which generally has succeeded, although, in a few cases I have been under the necessity of giving it three or four times. Frequently when the disease was unattended with vomiting, or where that has been easily checked,, the spasmodic pains in tlie bowels and extremities have remained and then I gave Tinct. Opii and aether, each half a dram every hour, until they produce,! relief. I have had altogether about 100 cases, in which the calomel and opium have been given ; and I may add with complete success ; for, although 10 or 12 have died, they have either been such old men, that no reasonable hope could be entertained of their recovery from the commencement ; or if young have been brought from the town with the disease in so advanced a. stage, as to be beyond the power of any medicine. The disease appears to be leaving us now, as we have seldom more than one instance of it in the course of the day, and the symptoms are much milder than when it first commenced. 

I am, my dear ' ir, 

Your very truly 

(Signed) J. TOD, 

No. it 



No. 12. 

ret of a letter from Mr. Assistant Surgeon Milliard, to Dr. Milne, 

Abmednuggnr, 2d August 1818. 

" Since 1 had the p^asure to receive your last letter, a great number of cases of Cholera Morbus come daily under my observation ; to relate all the symptoms would be mere'y repealing what we have heard so often, with the exception of the worms, which 8 out of 10 patients have passed. 1, 2, 3, and sometimes four have come from one person, and generally per ano. One patient threw 3 off her stomach in the course of one hour. The instant these creatures are voided the sufferer is relieved frjm the strong burning sensation in the abdomen. I will ventuie now to give my treatment, with my object for making the addition to Mr. Corbyn's. There are two great objects to be obtained, necessary for the recovery of the patient ; first, to allay the vomiting and purging : 2ndiy, to restore the pulse and heat to the extremities, and produce sleep. la order to effect these, I have, in addition to one scruple of culo.uel, put antimon, powder gr. v. and added to the draught laid down, Sp. aether, Nitr. one dram. In the course of 2 hours give calomel 



58 





gr. x, James's powder gr. v, with half the draught 

and camphor mixture instead of plain water, and repeat this, as it m.iy be required. By this treatment, I do assure you, that my loss, since it's commencement, only amounts to five ; and when you consider the villagers never apply, till the case is desperate, I trust you will not think. the number great. The best laxative to be used, I have found to be magnes. carb , four scruples. It remains on the stomach, and generally causes two or three plentiful evacuations. I really should not have presumed so far as to offer my practice to you without your encouragement and request to let you know how I succeeded. I will now give you a case of a sepoy of my battalion, who on returning from Seroor was attacked at Ranjangaum On the nifflit o( the 30ih of July. He was brought to me in a senseless state about 12 o'clock, August Ist noon. His extremities quite cold, pulse not to be felt, and groaned as if in violent pain, with vomiting, his eyes sunk in their orbits; and he was altogether in a dangerous state. I immediately gave my powder wilh x the draught, which made him drowsy (but the heat did not return) and allayed the vomiting. At 4 p.m. I gave him calomel x gr. and James's powder gr. v, with the draught, camphor mixture instead of vVater 

t 



59 





60 

MEDICAL REPORT Op THE 

and continually applied hot bottles to every part of the body (having no convenience for bathing) till 8 p. m. when I found him in statu quo. I knew there was no time to be lo.^t, and immediately gave him calomel one scruple, James powder gr. x, five more than usual, with camphor mixture draught, with the hot bottles, and remained with him till 12 o'clock, midn ght ; when the heat and pulse slightly returned, and perspiration diffused all over the body. On the 2d, I give him 4 scruples magnesia, and he is now in a fair way to recover^ I attribute a great deal to the pulv. antim. in producing moisture and heat ; and certainly it is the cause of the worms being voided so soon. 

I am, Sir, 

Yours very faithfully 

EDVV. MILWOOD, 

No. 13. 

Extract of a letter from Mr. Assistant Sur- 

geon Moi/le, to Dr. Milne. 

3d August 1818. 

" The disease I am happy to say, is disappearing rapidly : and the rain, which has fallen in great abundance, has been attended with the 

beneficial 



• 

beneficial effects of rendering the atmosphere more pure. 

I purpose in the course of a few days to transmit a statement of the numbers where bloodletting was had recourse to, as well as of those* that recovered under the means recommended fey Johnson. In stich cases of the existing Cholera, where the pulse is not much below the natural one and where the spasms are frequent and severe, I conceive venesec ion the most active remedy. The expressions from the sufferers under the operation justify the assertion, the the instant the vein is opened the pulse invnriably rises, and the spasms frequently cease altogether. From the variety of cases I have met with, since it's commencement, I cannot help thinking the disease in question intimately Connected with tetanus. 

No. 14. 

rract of a letter from Dr. Milne, to George, Ogilvj/ Esq. Sec. to the Medical Board. 

Camp near Poona stli August 1818. 

The troops at Poonah and at Satara remain Jiealthy; but the inhabitants of the former 



61 





city continue to suffer : from 20 to 30 daily are seized, but the casualties are few ; and the disease is much milder than when it commenced. 

No 15. 

Extract of a letter from Mr. Assistant Surgeon 

Wallace, to Dr. Milne. 

Seroor, 3d August 1818. 

The Cholera has nearly left us. They have Still a few cases amongst the Europeans, and one or two daily amongst the bazar people ; but those, that I have seen, are slighter than they were. 

The state of the atmosphere is however, certainly not salutary tit present ; most people are complaining, either of febrile symptoms or a derangement of the bowels. 

No. 16. 

ract of a letter from Mr. Assistant Surgeon Richards, to Dr. Milne. 

Puuilerpoor, 3d August I8!S. 

The Cholera Morbus still continues to make 



62 





Is appeal ance here, but within the last few days certainly has assumed a milder form. Up to iis morning, the number of admissions amounts > one hundred and seventy, out of which number ght casualties have occurred. 

I The extent of my assistance is limited, in con:quence of three of my hospital attendants, inuding my first dresser, being attacked with the holera Morbus ; but lam happy to say that bc>nd our encampment, there is now but little :casion for medicines. In the town of Punder)or, there has not been a casualty from the holera, the lasi three days ; and we have had it two within the last five. 

I Four Europeans of the detachment of Artillery ive been attacked with the disease; the first died in few hours after I saw him. I examined his bodyid found a very considerable congestion of ood in the whole of the abdominal viscera, no flamrnation; the stomach partly filled with the me* cities he had taken; the bowels empty, but conierably inflated; the spleen somewhat enlarged id of a very dark colour; the gali bladder distended ith dark coloured viscid bile, none in the ducts ; m urinary bladder so much contracted as to >mpletely obliterate its cavity. The other three en, fully aware of the danger of neglecting them- 



63 





fcelves applied to me in the early stage of the dis* ease; they were immediately bled, and the calomel and laudanum administered, and are all doing well. We have had seme heavy rain, which has cooled the atmosphere. 

No, 17. 

Extract of a letter from Mr. Assistant Surgeort 

White, to Dr. Milne. 

Seroor, 4th August 1813. 

In my last I omitted to mention, that I had been present at the dissection of two patients, who died of Cholera Morbus ; one an Euiopean of the foot artillery who had been Mr. Moyle's patient ; the other, a senpoy of the light battalion, consequently a patient of my own. I shall now present you with a short account of the appearances in both cases; but in the first place premise, that I do not think, ita either of them, we meet with a fair picture of what is to be expected in cases of acute cholera Spasmodica; wherein the life of the patient is terminated within 18 hours (considerably sooner in general) ; in which no favorable change in the disease has been observed; but in which the cold- 



64 





CHOLERA MORBUS, 

65 

tiess and want of pulse have continued uniform. For in both of these cases had a favorable change been observed. 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, coolness having reappeared. The seapoy was attacked at day light, admitted at 1 1 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 tenesrnus urged him to remain almost continually upon the stool. However, I thought him in fair way to recover, and was astonished a few hours after to receive a report of his death. 

IJpon opening the abdomen, the most striking ?earance was the enormous distension of the mach and bowels, not with air, for they were v\y throughout filled with something of a isistence intermediate between that of a fluid I solid; there was not much of bloody turcence upon their surface, but they wanted moisture and glossy appearance of health* c liver was much enlarged, apparently from the antity of blood contained in its vessels ; and in 

one 



<*ne part of its convex surface there was a cooi 

fciderable extravasation of blood. The gaU ; bladu der was 6He£ with bile, and, projecting beyond the edge of the liver; the bije was a very dark colour, and the, gall ducts wece pervious. Oa cutting into the stomach and intestines tJie sto-_ 

roach was filled, with an immense quantity of half digested rice and meat ; the contents of the small intestines were dark coloured, apparently from an admixture of bile. The contents of the. large resembled in colour what had been evacuated per anum before death, i. c. of a whitish colour ; and parts of a tape worm were found, joints of which had been discharged, while the patient Was alive. The bladder was quite empty and wholly sunk into the pelvis ; T thought the kidneys were of a diminutive size. In the chest, the lungs were collapsed so much, that they hardly appeared to 611 one third of the cavity. The left portion of them were marked with several black spots; but whether these were recent, I could not determine. There was no water in the pericar-* dium. In the European, the appearances of the chest were exactly similar to the above, with the exception of the black coloured spots. The stomach and intestines too, were much distended, but with wind only, as appeared from their collapsing the moment a puncture was made into them; but the 



66 





Terns on the outside of both, as well as those of 

the mesentery and mesicolon were turgid with 

blood, so was the liver, and the gall bladder was, as in the other case, full of bile. The urinary 

bladder was completely empty, f shaft conclude with remarking, that from the contents, of the small 

Etestines in the seapoy being darkcol.mired, while ose of the large retained the light colour which arks all the discharges in this, disease, it appears 

to me, that in this case the disease was proceeding to a favourable termjnajtion, which would have been completed had the patient's strength been sufficient ; but tint while these changes were going forward, hjs friends had indulged him witli an immoderate quantity of food; which, overloading the stomach, caused such debility, as arrested this progress, and was the immediate cause of death. It is impossible to account otherwise for the quantity of food found in the stomach; as' this would have been evacuated by the free vomiting that took place in the early stages of the disease, had it been introduced before the commencement of the disease; and art opportunity was. given to the friends for exercising such imprudence, by the native Doctor having gone to a grand, festival, at the time, instituted for the appeasing of the Deity and averting "the then existing 

Tlw 

67 





- 



The disease continues to present a milder aspect, and occurs now but rarely : loss of pulse end coldness are seldom observed; and often it first shews itself by severe pain of the abdoman attend* cd with cramps of the lower extremities, some* times by a sudden giddiness and confusion, loss of memory and vomit'ng, attended also with cramps : indeed but for these cramps, I think it would be impossible to distinguish this stage from fever, at the beginning : and these cases are attended with hardly any danger. The only bad cases that are now brought to the hospital are men who have been ill in the Bazar and neglect* ed for two, three, or four days. 

No. 18. 

rofa letter from Dr Burrell, of H. Ms* 6hth Regiment, to Dr. Milne. 

S#roor, lOtb August 1818. 

To 

J. MILNE Esq. Acting S. Surgeon. 

Dear Sir, 

lAs dissections of cases of Cholera Morbus :rc not sent along with my statement of the 



68 









69 

CHOLERA MORBU9 



26th ultimo, I beg to send you a few remarks 

on this subject. 

As congest on has been found in all our former fatal causes, 1 yesterday had another demonstrative instance of the eligibility of bleeding in Cholera. 

John Stokes, of the 65th regiment, a man recovered from chronic syphilis, was attacked in our wards, with vomiting and purging at 8 P. M. of the Bth instant. When seen, his hands and feet were cold, with some rigidity; under these circumstances, and he bei-.ig of a weakly habit, bleeding ( I may say unfortunate')' ) was not used. The usual remedies, with the h.t ba!h, were tried. He died on the gth inst. at 2. P. M. 

In company with Dr. Whyte of the 2d N. I. and Assistant Surgeon O'Reilly (55th regiment, \ opened the body. The liver was found of a dark colour, distended with blood, and the gall bladder full of bile. The sp!ecn of an extremely blue colour. The omentum inflamed, and veins filled in every part. The small arteries of the intestines of a lively red : and the colon contracted, through its length, to the size of the mid. die finger ; and its calibre so small, as hardly to allow a scalpel handle to be introduced. 

The veins of th« stomach more particularly * J 





70 

MEDICAL REPORT Op THE 

arrested our attention : on the great curvature they were of an intermediate size between a crow's and a common u/.i 11 ; the.c turgid vei;is were more apparent internal v, ami the most forcible injection could not have more comp'etelv filled the vessels. The mesenteric vessels, as we 1 as the vessels of every other internal membrane, partook of this appearance of formerv ii:crea«>ed action. The lv gs were dark and suttued witu blood, this mos£ probably is the cause of tne stertorous and laboured breathing pie&ent in almost every fatal case. 

From former dissection*?, and the appearances in this case, little doubt ought *o arise reg.m!-ing the exigence of bleeding in almost every case; but irore especially in the firsst hours of attack. If even during* the cold and rgid sta'e of the limbs, should the pulse rise in the h<>t bath, which it grneraly does, we ought not to hesitate in opening a vicn ; as recovery from this stage is most precarious, and every experiment may, therefore, be tried. 

As dissection in this disease hns shown, and will in every case show turbidity, if not inflam* mation, of the vessels of the internal parts, no hesitation as to what line of practice is best, should harbour in the minds of medical men duriu" tlic DrcVtilcnc£ 01 so tlrciiilf ql a ci'siiti^o 

.Under 







Under this idea of merea ccc c of action internally, and consequent want of balance in the circulation, fro.n which arises the culdness and shrink. big of the external parts, I commenced the bleeding sytcm ; and of the cases admitted of Cholera, since the 2 1st ultimo, up to the lOtb August, the casualties run thus. 

Bled 88 Dead. . 2. Not bled 12.... dead.. 8. — — — Total admissions, . . 100 deaths 10. 

Our cases of dysentery in the chronic stage 

in the hospital, have been aggravated in many 

instances ; appearing as if the epidemic gave 

peculiar character ot symptoms to the usual endemial 

diseases. 

Rclipses of cholera have not been unfrequent; and the regularity of the bowels must be strict. 

ly attended to in the stages of convalescence. Some of these relapses require the same treat* 

went, as the original attacks. 

In one European woman the attack proved fa- 

tal. 



71 

CHOLERA MORSUS. 





72 

MEDICAL REPORT OF TH« 

No 1 2. 

Extract of a letter from Mr. Assistant Surgeon 

White, to Dr. Milne, 

Bcroor, 11th August 1819. 

Tt was my fortune to be present at the dis. fiectior* of two Europeans, who died fom. cholera ; one a private ofthe(Lth, the others foot artillery man. 

The man of (he 65th had b^en in the he?pi- 

. 

tal for some time on account of a (hron c syphilitic corr.p'a'nt. J-Je was attacked at 8 o'ciOck. P. M. with cholera spasmodica, attended with great debility, coldne?s, and want of pulse; was not bled, and died at 3 P.M. the following day, i£ hours after the first attack. 

In tlie abdomen, the omentum was nicely spread over its contents, free from fat, and of a dark colour. The liver increased in size ; on cutting into il's substance, the mouths of it's vessels were seen distended, wide^ and poured out a considerable q.ia;itity of blood. Vesica ftllit pretty full ; stomach very much so, and of so dark* a colour, that on a superficial examination it might 1 c thorght in a state of gangrene. The small inte tines too presented a similar appearame, and might easily give rise to a similar mis* 

take ; 









[cc ; but both were perfectly adhesive and firm j d by drawing the finger over their surface, innuirable small veins might be seen, running ift directions, as in a preparation nicely i- jected th wax. The intestines were moderately disced with some fluid, and a worm could bt t. What surprised us greatly was the appearance of the colon, contracted throughout it*6 whole extent, from the caput ccecum to the sigmoid flexure, so much as to bring the sides of it's internal surface in close contact, from this contraction of it's fibres feeling thick and solid, not exceeding in circumference my middle finger ; this could only have been caused by a violent spasm before death. 

% 

II must now revert to the stomach and meitery, and describe a most extraordinary and autiful appearance; one which I imagine will inriably be found, irt a greater or less degree, hi sry case of cholera, where the patient has :d soon after the first attack of that disease, i. c. lere death can be considered the consequence its first attack. Besides the small veins, be^ •c taken notice of, and which I supposed to part the dark colour of the stomach, all it's ger veins were distended with blood to a realljr ormous size ; the circumference of the v&ieb sees, being fully at large as crow quills, run- 



73 





/ 

ning upon the upper and lower, or concave ani 

convex surfaces in a pretty straight direction ; and in the other parts, by their convolutions resembling a closely woven network, particularly whea held up to the light. The veins of the mesentery were turgid in the same manner, the circumference of many of them being nearly equal to that of the vena breves. No injection, however successful, could have represented more correctly the course of the veins in these parts. The mesocolon was pale, resembling in this the contracted colon. On cutting into the stomach, a large quantity of a dark, looking fluid was found ; and on emptying it, we discovered a considerable quantity of calomel, lying amongst it's rugae, near the pylorus, quite undissolved ; from which it would appear, that the above fluid is of a nature totally different from the gastric juice. The pericardium contained no fluid. The bladder was empty. Indeed all the secretions seem almost wholly suppressed in this disease ; excepting those into the stomach and intestines, which are much altered in quality. The lungs were much, darker in colour than natural, approaching to that of the liver; and by drawing the finger over any portion of them, the veins were made apparent, distended with black blood. 



74 





75 

CHOLERA M ORB »S, 

* The artillery man had been attacked at 2 a. m. admitted at 6, with symptoms like those of the above patient ; was not bled : and died at 4 p. m. the fallowing day. He had been comatose for about 24 hours before his death. 

In the thorax, the pericardium was empty ; there were several old adhesions of the lungs to the pleura ; the lungs themselves were of a dark colour, as in the above case. 

Abdomen— liver increased in size ; vesica fellis containing a little bile ; stomach distended with fluid, and of a dark colour, but none of it's large veins distended, like those in the former case, although all the small veins were turgid in a similar manner. The small intestines were dark coloured, and dr } er than natural. The mesentery not strikingly altered in appearance, but a portion of the ileum, to the extent of about 18 inches, above it's insertion into the aecum caput, with it's corresponding mesentery, was perjectly black and gangrenous in appearance. We pronounced them so at the time ; but, upon after reflection, I think the gut possessed too much tenacity of texture; and this appearance might have been given by extravasation, which I believe, is difficult to be distinguished all the times from the former state. The colon throughout was much 

more 



more diseased than either the stomach or upper portion of the small intestines, although not 50 much so as the portion of the ileum just taken notice of. It appeared in a state intermediate between venous congestion and arterial inflammation, indeed it's colour and whole appearance as well as that of the mesocolon, was of that mixed nature, that I do not know a better method or mode of expression, whereby to convey an idea of it ; and here I may remark, that in this disease, I think the former state runs frequently into the latter. The bladder was almost empty, the fluid contained in the stomach was of a still darker colour, than was that of the former patient. 

On examining the upper part of the cranium, we thought the dura mater inflamed ; the trunks of large blood vessels were distinctly seen through it, and on removing this membrane, we were presented with a beautiful sight — the veins of the pki mater distended, as if ready to brust, and runnino in all directions amongst the convolutions of the upper hemisphere. The increase of size was perfectly sufficient to account for the coma which had taken place. Several small arteries were seen ; but I think not more than are usually found ; certainly not enough for us to infer, that 



76 





BH^^' 111' the membrane had been inflamed. No serum was found in the ventricles. The above appearances seem tome strongly indicative of the propriety of blood-letting. I have not yet tried it ; and I believe it has not yet been used by any practitioner here in cholera, attended with constant vomiting and purging of a white coloured watery fluid, coldness of the surface, and want of pulse In the proximate cause it appears to resemble strongly what Dr. Armstrong in a late publication has designed " Congestive Typhus** •' attended with an enfeebled action of the heart and arteries, an accumulation of blood in the venous system", distinguished by the " hot stage being not at all or only imperfectly developed, and by signs of congestion in the internal organs**, which state, he says, is attended with " great apparent debility." But instead of considering this debility as real, owing to the direct influence of contagion as a sedative; instead of using stimulants, he recommends " venesection, after which the pulse generally rises, the warm bath and calomel in a scruple dose, repeating smaller doses, three or four times, the first day**. He gives great praise to calomel, as an " equalizer of the circulation*' ; says, that when the skin was even cold and shrunk, it made the skin warm and reddish, the pulse soft, full and strong. From the great resemblance 

77 









73 MEDICAL REPORT OF THE between some of the symptoms of these two 

diseases ; from the great success, which attended Dr. Armstrong's treatment of a disease in which debility has hitherto been considered the most pro- Snent symptom, and stimulants the only cure, well as from the appearances on dissection, related above, there is every reason, I think, to expect beneficial effects from blood-lettirg, even in the cold cases of this disease ; and nis my intention 

to give it a trial soon. 

The only alteration I have yet tried, in the treatment or cholera, is to give every half hour niter the first large dose of calomel retained in the stoirarh, a pill containing, cal. 2 gr. opium I^gr., until heat, a pulse, ot natural stool is procured. Very often after the return of beat or a pulse, from 24 to 48 hours elapse; and before a red or yellow coloured stool is seen; although the disease is evidently conquered, and the patient improving, in these cases the pills are repeated at the interval of 3or 4 hours. From the short trial 1 have given the above plan, I possess a very high opinion of it's mility. To prevent relapses, it ap- . pears necessary to continue some tune the influence of mercury in a regular, constant, and steady manner, giving by this means a stimulus to the action of the heart and arteiies, keeping up a de- 

teruunutio;! 

I 



termination to the surface, as well as the regular circulation through the liver. Many of the dif- 

circulation through the liver. Many of the dif- 

fusiye stimuli will produce the same effects in a quicker apparent manner, as for instance spirit. , ammoniac arom., or cefher reciif.; but I am convinced, that none of them will produce such lasting and truly beneficial effects 



No. 20. 

r Copy of a letter from Mr. Surgeon Longdill of theAth regiment Madras Lt. Cavalry to Dr. 

Milne. To 

JOHN MILNE, E«q. 

Acting Superintending Surgeon, 

DECC A I* 

Sir, 

I have the honour to forward you a general Return of all cases of spasmodic cholera which have come under my care, since it first appeared at this place. 

The iata! cases were those, in which the patients were brought to me with* cold extremities, and no pulse to be felt at the wrist ; and although the calomel and opium stopt the vomiting, yet I never could restore the pulse or procure warmth in the hands and feet, altho' the warm bath, and frictions with hot spirits over the whole body. 

and warm drinks were given. In all the other 















Eses, there was some warmth in feet and hand% d a little pulse to be felt ; and they did well. In only two cases, and those of dooly bearers, whom I got on the immediate attack, did I use the lancet, and that with considerable benefit, as it diminished very much the spasms of the stomach, and the calomel and opium remained : in a short time the patients fell asleep and into a !ntle perspiration, and hardly any thing else was juired but a little mild cordial, such as warm indy and water. On the 3d day, I, in gene, gave all the patients a dose of castor oil, as i laudanum had produced constipation ; and :y all complained of the mouth being affected. 

IMy general plan of treatment was to give the >se recommended by Mr. Corbyn ; sometimes it is immediately thrown up, I then waited for an >ur and gave another, with the warm bath; which general relieved the patients ; after whi«h they quired little else than cordials, and a gentle lax- 

I have the honor to be 

Sir, 

your very obedient Servant, 

B. P. LONGDILL, 

Sttrg. lih Cavalry. 

SEROOR, 

17th August 1813 





80 





No, 21, 

Mxtract of a letter from, Mr. Surgeon Gordon to Geo. Ogiliy Esq. Sec. Med. Board. 

S.dura, 21) ill August 1818. 

To 

GEORGE OGILVY Es«. 

Secretary to the Medical Board. 

BOMBAY, 

Sir, 

»It appears to me that this epidemic as it ha jwn itself at Satara, is much modified am very different from that which Mr. Corbyn ha M ascribed in his letter, and from common cho ra morbus. I pretend not to say how it ha been modified, but it does appear to me that the epidemic now prevalent here, generally attacks in the first place the brain, and that the stomach is in most cases only secondarily affected. Thif « consider the nature of the disease in genera!, ho' there certainly are cases in which the stomach is primarily and principally concerned ; but even when this is the case, I think we have Efly to dread acute inflammation of that visand not the continuance of vomiting and ;ing. 

The following are the circumstances which have led me fo> form this opinion. 

w 

81 





Ist The symptoms and general history of th* disease. 

In all the cases I have seen, neither the vomiting nor purging have been very violent ; they have generally been easily subdued, and often ceased of themselves ; and the spasma have never been very severe. Altho* however the evacuations have ceased, and the spasms have not been violent, yet the pain at the scrobiculus cordison pressure, the burning heat in the stomach and esophagus, and the violent thirst still continue. The patient sinks rapidly, the pulse fails at the wrist, the extremities become old, he lies in a kind of stupor, but sensible to the last when roused, and generally dies in "from 18 to 36 hours without any spasm or struggle. 

Several people in the bazar and fields have suddenly become giddy, fallen down, and after one or two slight efforts to vomit, have expired in a few minutes ; and almost all who have been attacked, have had some giddiness and pain in the head, have had a tendency to stupor, and have often become a little deaf. In two cases which I have seen, the jaw became locked for a time, but soon relaxed. 

2dly. The result of different modes of treatment. 

In seven casei which I considered fair trials and 



82 



JkfBOICAL 



in which Mr. Corbyn'* treatment was adopted, altho* the evacuations were soon cheeked, yet tour of the patients gradually sunk and died in from 24 to 36 hours ; and of"four other cases brought when too late, and very much exhausted, i lost the whole, altho' Mr. C's. dose was exhibited and afterwards as.-isted by the strongest stimulants both internally and externally. Nothing however could rouse the circulation or restore heat to the extremities. 

Whereas of three cases which I have lately seen, all of whom have been early, freely, and repeatedly bled, two have completely recovered, and I consider the third out of all danger. In the two first, the pulse rose under the bleeding, the burning heat of the stomach disappeared, and they expressed themselves completely relieved. 

They had still however a great inclination to sleep, and the pit of the stomach was still a little painful on pressure ; but these symptoms were soon removed by a dose of jalap and calomel. 

F^he third was very low when brought to me, I with difficulty obtained a sufficient quantity blood, but his pulse also rose as the blood flowed. The vomiting however still continued in a slight degree, but was stopped by a full dose of laudanum and the application of a blister over the stomach. He now complains only of a little debility. 



83 







The man from whom I took the greatest quantity of .blood in the shortest space of time, was the quickest and most perfect recovery. The blood, however, did not in any of these three cases assume the buff/ or inflammatory appearance. 

3dty. The appearances on inspection of dead 

I was allowed to inspect the body of one of my first patients who died after 20 hours' illness. The stomach and bowels were quite empty, and all the viscera of the abdomen were perfectly sound and natural, except the stomach which was much inflamed, but not in my opinion sufficient to account for the fcuddeness of the event. Its inner coat was much corrugated, in some places reddened by inflammation, and generally covered with a coat of coagulable lymph, or something 1 like thickened mucus, of a slighly yellowish colour; but there were no appearances of gangrene orulceration. I did not at this time suspect the brain, and unfortunately neglected to inspect the head* 

Itve also inspected the body of a man who t a vil'cge, about a mile from Satara, and as dead before I saw him. A native practihad given him two pills containing three of opium in each. -The evacuations ceasibout "8 hours, but he died in 24. The 





stomach and bowels were quite empty ; the bowels perteci.lv sound, but the stomach exhibited slight marks of inflammation or rather of venous congestion. The liver was quite sound, and the g-ail bladder contained the usual quantity of healthy bile. In the head however there was every np» pearance of extreme venous congestion, fVr all the vessels of the coats of the brain were much dilated and quite turgid with blood; but there was no rupture nor effusion, nor were there marks of active arterial inflammation in the substance of the brain. 

Mr. Sheppee vviil have probably communicated an account of the appearances in the body of a dooley bearer which he inspected. Thc?v are exactly similar to my last case, and it also struck him that the dura mater was pretcrnaturally tense, as if from the pressure of the dilated rvttffl within. Mr. Corbyn also mentions murks of general inflammation of the viscera of the abdomen in the case which he inspected, but he does not say that he examined the head. 

E:h then are the reasons wliich have induced • suspect that in the epidemic now prevalent s vicinity, the brain is often, if not generally, rgan principally affected. It also appears to that the sudden crisis of the disease is :ly to be accounted for, looking only or prin- 

ciHiy 

85 





cipally to the stomach, for I have not seen the evacuations so violent or so long continued as to occasion death from exhaustion ; the spasms have never been so severe as to cause it, and the event has in my opinion often been too rapid to be accounted for from the common course of inflammation. Biit evtn if the idea of the brain being affected is erroneous, yet, as inflammation of the stomach does appear to arise in many cases, bleeding, early, freely and repeatedly cannot but be highly beneficial. 

Mr. Cbrbyn indeed recommends it in Europeans, but 1 think if he had seen the disease in the form it has assumed in this quarter, he would have insisted much more on the necessity of it. It must be done early in the disease, for in the latter stages it will not flow in any quantity even from the jugular veins or temporal artery. Indeed after the pulse has, failed at the wrist and the extremities have become cold, I consider the palicnt as almost irrecoverable. 

Imy idea is correct, the auxiliary points of lent will be obvious. I have not seen instimulants of any use, and I suspect thej eiierally prejudicial ; but blisters to the stoand head promise to be useful. 

P. S. I have this forenoon had another case in 



86 





B bleeding has completely cured the df» It was a decided case of the epidemic, le blood put on a highly inflammatory apce. 

A. O. 

" ¦¦¦ ¦Will fi 

No. 22 

Extract of a letter from Mr. Wallace to Dr. 

Milne. 

Seroor 23d Aigust 1818. 

Sir, 

The cholera has, I regret to say, attacked several people yesterday and to day, with symptoms of extreme violence. In two cases the coldness and loss of pulse, with the collapse of the features, came on four hours after the first symptoms of purging ; this was quickly succeeded by vomiting-, but the patients had no spasms and suffered no pain whatever in three of these cases. I was induced to bleed ; but thoagh the veins in both arms were freely opened, and the patient immersed in a tub of hot water, very small quantities of blood could be obtained, and no benefit received to the patient. Indeed three fourths of my patients would, I am of opinion, have furnished the same results, 



87 





will not infer from this observation, thut I am hostile to the practice, I have always practiced it with Europeans; but, these cases had neither lost their pulse nor altogether the warmth of their extremities, and the spasms were often violent. My opinion is, that any remedies likely to restore the balance of the circulation are applicable ; and it is with this view, that I have given calomel in large ;md repeated doses, which I think not only powerfully determine to the surface, but excite the actions of the secretory organs, whose functions are for a time completely sus- 

Se shall have no want of facts, and I trust i reasonable and successful practice will rerom them : but I confess the more I see of ital disease, the less sanguine I am in it's 

No. 23. 

Extract of a kller from Lieutenant Colonel 

Cunningham, to Dr. Milne 

Xxirrar, Cstb August 1818. 

We have certainly Rot the disease under, although we have not got rid of it altogether; 

»nd 

88 





lit is still doing much mischief in several of illages. It is rather a remarkable circume, that the Natives in some piaces have had rse to bleeding- of their own accord, and the best effect. 

No. 24- 

Extract of a letter from Mr. Wallace to Dr. 

Milne. 

Seroor, 31st August 1818. 

t have the pleasure to return you 

's letter, which by no means convinces 

me, that the epidemic is contagious. I believe the first man attacked in our cantonments, was a bazar peon, a very old man, who lived in the centre of the bazar; this man was not removed from iiis hut, he recovered, and not one of his numerous family was attacked. The second case was in an old Mussulman, who lived m a small routce, pitched in an open space before Mr. Griffiths':* house. He also recovered. This disease was never confined to a particular spot in the bazar, nor did it appear to rage in one quarter, more than another. The sick were al- •ways accompanied to the hospital by their fa- milies, and I have never been able to truce any 



89 





tiling- like contagion amongst them ; though a* particular circumstance led me to have this ob* ject in view, soon after the disease first appear* cd. A- great proportion of the cases have late- ly occurred in grass-cutters, and people who liave been much exposed to cold and damp; in- deed Lhave in many cases traced the commence. incut of the attack to a check to the - perspwra- tion. Not one of the medical attendants in the iiospital has been attacked, and some of them, particularly Ragoba ( whom you know ) has been unremitting in his care and attention. There have been also lying in the hospital, three con- valescent wounded Madras troopers and one follower with a bad wound in his thigh. These men have slept dtirmg the last six weeKs in the midst of people affected with cholera, and they Lave all escaped the disease. The follower, it is true, was attacked the other day with violent cholic and coldness of the extremities, but these symptoms gave way to a warm purgative and friction, though Lam incHned 1 to* believe lome of my medical friends might Have Wed* him, and thus cured, an Epidemic Cholera. 

's letter induces me to think. 

t there must have been some unusual symp- of this disease to the southward. In a! 



90 





most all the cases I have had, and particularly during the present month, the disease was ushered in by purging, and the symptoms were progressive, thougb they varied in their rapidity. I am happy to say I have had no case during the last forty eight hours 

No. 2.5, 

Copy of, a letter froivb Mr. Surgeon Robertson, 

of the Bombay, European repment, to Dr 

MUnc. 

Camp al Keerky, SUt August 1818. 



JOHN MILNE M. D. Eso 

fOOIf A B r 

My Dear DbcTOßy 

(You have had daily information regarding the pcarance and the progress of the epidemic in the ?nibay regiment* But, agreeably to your desire, and to* the example set by our Medical brethren at Seroor and the other stations under your superintendence, who have hail an earlier opportunity of witnessing the effects, and describing the various symptoms, and detailing the irieet successful practice, and indeed, who have written upon this disease in such a masterly manner, that nothing appears, to have escaped them, I have 



91 





tf the pleasure, tho' with considerable diflice, to offer these few remarks, accompanying weekly report. 

We had been upon the look-out for this attack upwards of a month, and altho' every precaution wai used, and strict orders given, that the moment a man was taken ill in the lines, he should be brought to me at any hour in the day or night, yet our two first patients, who were both seized at night, were unfortunately, thro' their own obstinacy allowed to remain in the lines 'till next morning-, when every cflbrt to save them proved ineffectual. From the mild nature of the incipient symptoms in one of them, an old man, the complaint had failed to attract the notice of those in his tent, and the other patient, who was indined to be sickly and subject to occasional attacks of fever, succeeded in deceiving 1 his Serjeant, who was about to bring* him to me, by saying that he was getting well fast, and that nothing was then the matter with him. 

The commanding officer immediately adopted E which, together with some afarm occathese two cases, have effectually presimilar occurrence, and we have lost 

The disease displays great variety in its mode 

of 

92 





of attack, which is certainly influenced by the constitution of the subject; and generally affects parts which had been weakened or had sustained injury from previous bad health. Thus, amongst our admissions into hospital, I observed that men, who had been exposed to the remote or exciting causes of fever, were seized with a cold chill and shivering-, and a great weakness, they said, such as they never felt before, with sometimes a loss of sight; these were succeeded in a short time by a hot skin, quick and tolerably full pulse, acute headach, intense thirst, sickness, and sometimes vomiting, great oppressions in the chest and a tendency to spasmodic twitchings there, without much affection of their bowels. 

(n, who have kad bowel complaints, (I speak i knowledge of their constitution) have felt ime weakness come over them, with treof the whole frame, a griping and purging ite and slimy matter, while the affection of omach and head did not appear to be in rtion to that of the bowels. 

A man, who has had epilepsy, was heard at night by the Serjeant to be moaning and grinding his teeth in his sleep; the Serjeant awoke him, and he instantly began to vomit. He was brought to me quite insensible, and on being 



93 





11 ll* 1 ¦* 1 • V roused by smelling salts; was again immediately seized with vomiting, after which he fell into tears, and he felt an unaccountable oppressionupon his '-hest, with- great headach and thirst. He took a dose of calomel and laudanum, fell fast asleep, and was quite well next morning. A man, who formerly had hemiplegia, from which he completely recovered, fell down while going from htf tent to the cook-room to order his suppor. lie was immediately brought to the hospital with total paralysis of his left side (the same which raid formerly been affected); he was bled, until he regained the use of his arm and leg, and was well next day. 

Worm. I*,1 *, by their irritation, induce a predisposition to the attack. We have had two cases, one of the tdMiia, and one of the tercs kind. In both, when first attacked, the pain in the bowels was excruciating, with headach, thirst, vomiting and purging; skin cold, pulse a little quickened and oppressed, and the patients (altho 1 m ordinary health just before) gave themselves up, and said they had but a few- hours to live. Bleeding relieved them, and the oil'miel & laudanum brought them quite round. The worms made thetf appearance next morning. 

The diaphragm is affected in many instances. 



94 





and two cases have occurred here, in vvhich a violent spasm of this muscle appeared to be (he prominent symptom of the disease. The patients were struck down perfectly insensible, with the pupils dilated, pulse slow and oppressed, great headach, and thirst, a cold sweat, purging, retching (without any effect), and at intervals the most violent contortions of the whole body, so that the assistance of several people was required to hold them upon their cots. Copious venesection, with anodyne injections, and the warm-bath, subdued the spasm, and relieved the head; and at the sametime, when swallowing- became practicable, admitted the exhibition of calomel and laudanum. 

¦large blister over the diaphragm secured had been gained, and confirmed their conencc. 

The following is the number of patients, with the dates of their admission &c. 

Abstract of patients with Epidemic Cholera. 

When admitted No. Cured I)j.< i:askd Remaining 

August 241h 

1 

1 I 

¦ 2oth 26th 

7 I 

;{ S l 

7 4 

27th 

4 1 



„ '.'Mil, 

4 1 

„ 2SHIi 

1 

Total, j 24 [ 12 

2 

!•» 



95 





Dr. Dalgairns and myself had an opportunity of inspecting one of the bodies only; and the dissection (which took place late in the afternoon) was, from want of light, unfortunately confined to the abdominal viscera. We traced the appearances, so beautifully and correctly described by Mr. Whyte of the light battalion. The veins of the omentum, as if injected with wax, first arrested our attention. The small intestines were considerably inflated with air, and their veins were also turgid; the colon, throughout it's whole extent, was wonderfully contracted in diameter, and it's cavity entirely obliterated; the intestines were quite empty. In the stomach we found the medicines he had taken, the coats of it were sound, and the veins full of blood. The liver was sound. The gall bladder full of bile; and the spleen in a state of health. 

Cc perceive nothing' of a contagious nature » disease. 

No. 26. 

Extract of a letter from Mr. Surgeon Gordon to George Ogilvj/ Esq. Secretary Medical Board. 

jSatara, 6th September 1818. 

I some time ago s«nt you a report for the 

Medical 

96 





Medical Board, which I hope you received,, regarding what 1 had seen of the Cholera Morbut in this vicinity, and in which I laid considerable stress on the importance of free and early blood- 

Since then I have had eleven cases, bled the whole of them, some very largely, gave Dr. Corbyn's dose, and then opened the bowels, and they are all quite well. lam perfectly convinced that nothing but the bleeding could have saved the lives of three of them, and it certainly has not done harm in any one of these cases. It was quite pleasing to hear some of them, whilst the blood was flowing, first say, " the pain in my head is gone," then, " the burning heat in the belly is also gone," and next, " the cramps have also ceased." If the patient is not brought very soon after the attack, the blood often flows at first only by drops and very black coloured, but after a little has escaped, the patient yawns, or takes two or three full inspiration^ and then the blood flows in a full stream. 

In one case I opened a vein in the arm, but the blood would not flow ; I then triec^ the jugular vein, also without much effect, vein merely emptying itself and then ceasing 1 . I then opened the temporal artery which bled tolera- 

Wy 

97 





bly freely ; after a few ounces had escaped, the circulation so far recovered itself that the blood began to flow from the jugular vein, and on putting the ligature again on the arm the blood now came in a full stream. The pulse always rises under the loss of blood, and the heat returns to the extremities as the circulation returns. In those cases therefore where the head is the organ principally concerned, by taking blood, we remove the venous congestion in the head, thereby restore the energy of the brain and enable it to re-assume its controul over the circulating system; and in those cases where the stomach is principally concerned, we remove the danger of inflammation taking place, and thus reduce the disease to a case of miid common cholera morbus. 

If the patient is so far gone that the blood will not flow even when in the hot bath, I consider the case as desperate; altho' life may continue for many hours: for altho' every other bad symptom has disappeared, yet nothing will rouse the circulation again. In several cases altho' Dr. Corbyn's dose was immediately rejected from the stomach, yet the draught given without the calomel was retained: and in some cases blisters to the pit of the stomach and neck were very use- 

98 





99 

CHOLERA JIORBUS. 

No. 27- 

Extracts of a letter from Mr. Assistant Surgeon Henderson to Dr. Milne. 

Knrrar, 14th Auprjst 1618. 

In these cases the primary symptoms did not appear to be uniform : in several the vomiting and purging did not commence for some time ; and in two cases which came under my notice there was neither vomiting nor purging; tho' the spasms, pain in the abdomen, and great prostration of strength, which invariably marked this disease, were very severe. Syncope was sometimes a primary symptom ; and in one case the sudden debilitating effects of this disease were so severe, that a carpenter, while at work, fell down in a state of asphyxia, from which, when he was in some manner roused, he was seized with the other symptoms of the disease in so violent a manner, that he died, notwithstanding medical aid was immediately obtained. Sometimes there was vomiting without purging, and trice ve rsa. Generally, however, watery stools were the first symptom ; the irritation then appeared to spread to the stomachy and produced vomiting, and inverted action of the intestines, often causing- a vomiting of large 

worms 

* # * 



100 

MEDICAL REPORT OF THE 

worms in considerable numbers. The purging of 

t'atery matter was found the symptom most difcult to be allayed, and the disease in those cases, seemed to run its course much faster, producing the cold sweat and coldness of the extremities ; from which symptoms few, if any recovered. Pain in the region of the abdomen, as well as burning heat and spasms, were constant symptoms. I only observed hiccup in one patient, who was dying ; and Mr. Radford m two other cases, both of which likewise were fatal. In no case, was there any swelling of the abdomen, nor any reason to suspect a collection of wind in the intestines. 

? ****¦*****#***#*****$ 

Having lost one or two patients, who received medicines from me in an early stage of the disease, while I trusted to the calomel and opium ; and observing that in these, the symptoms most distressing and permanent, were the pain and heat in the abdomen, and the violent spasms of the legs and arms, I derer mined on trying bloodletting on the next favorable subject, conceiving that the disease was purely inflainatory ; and the result exceeded my most sanguine expectation. In short, every case recovered, which arrived etrly; and several recovered, who had been 8 hours and upwards labouring under this disease ; and 





who, I have no doubt, would have fallen victims to it, had not the lancet been used. 11l every c:ise venesection has been adopted latterly, without regaod to age or constitution ; and in my opinion neither the state of the skin nor the pulse; ought to dissuade us from bleeding. The effects oi it were almost instantaneous in relieving the pam of the abdomen and spasms; and where enougli of blood was drawn, they never returned. It checked vomiting at the same time, and what nrirked the similarity of the disease to inter, tis, was that the pulse became fuller and softer with the bleeding;, tho' it was before almost imperceptible ; and the blood, which flowed at first guttatim, gradually run in a fair stream : eighteen ounces was a common bleeding, and in no case did I observe that the patient was weakened by 

it 

#«•?•*««??? 

No 28. 

Extract of a Letter from Mr. Assistant Surgeon 

Whyte to Dr. Milne. 

Seroor, 17th August 1818 

¦:e I last wrote you, I have hardly seen se of cholera, consequently have had no 



101 





¦ unify of making further observations on the t; but should it again recur, I will continue uaiat you with my progress. 

E understand Mr. Moylc opened the thorax and Mnen of an artillery man, who died the day the mail of whose dissection I formerly gave an account ; and he found the appearances in ral the same as we had found in his former 

I was present likewise at a dissectiori made yesterday morning by Dr. Wallace; and in geneial the appearances corresponded very exactly with those, of which I gave you an account in my last letter, so that I regard the fact of venous congeslion, as now indisputably established. I am wry anxious to learn the result in a more particular itiannct of venesection in this disease. But as the disease appears to have assumed different types, according as it attacked men of different habits, more especially Europeans and natives ; us it has likewise been observed to take on different degrees of violence at different periods. being generally most violent at first, and pretty constantly becoming milder in a short time after; it appears to me necessary, in order to establish clearly the superior advantages of this practice, that the prominent symptoms, in those case- 



102 





wherein it has been used, should be described, and its apparent effects regularly noted down :else this, or any other remedies may, in time, acquire an undue degree of credit, from having been employed in cases of comparatively little danger ; and at periods, when the epidemic has assumed its mildest type. I fear, that it has happened, that bleeding has been refrained from entirely, while the epi-.lemic assumed its worst form, as wholly inapplicable; afterwards used during it's milder attacks, and regretted then, that it had not been used sooner; occasioning the greatest confusion by this means in the general result and proper indications of cure. 

No. 29. 

Extract of a Letter from Mr. Assistant Surgeon 

Whyle to Dr. Milne. 

Seroor, 7th September 1818. 

ionvinced, as I am, of the total absence of conm in this disease, I have observed the late ral in some measure of this opinion with some cc.of pain. Surely, if it was at all contagious, fact of it's brirg so could not long remain btful. In the general hospital here, there were c sepoys, who resided continually from the 



103 





first appearance of the epidemic, inhaling at every inspiration by da) and night, mouthiuls of infection. If the atmosphere was really loaded with contagious effluvia, arising from the bodies of the numerous inhabitant! 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 .o 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 ; (hereby exposed to be infected with the disease, whether it is conveyed through the medium of the atmosphere, or by touch : and vet I I have not known one instance of dooly bearers, friends, and attendants of the sick being so infected ; nor have any of our hallalchorcs, or hospital assistants suffered. One of your correspondents supposes, that the disease has travelled in a direct route at the easy rate of 15 miles a cliy, and believes, if it coubl be proved, that it has not shewn itself in any village, that had remained insulated or unconnected with other villages, where the disease was. Lhilil this is proved, it is 



104 





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 tip between these parts all the while. The only disease resembling in the extent of it's ravages this disease (and it has exceeded it) is the influenza ; which, although many have supposed the contrary (as will be always supposed by some of every epidemic), is now generally allowed by the best judges to be propagated without contagion. In one of these epidemics (I forget in what year) which, I remember, I have heard Dr. Gregory describe, this disease first appeared in America, came across the Atlantic, shewing itself in it's progress in different longitudes at sea, in ships that had departed from a port free from the disease, appeared first in the most westerly parts, and gradually proceeded to the most easterly of Europe, and from these into Asia, sometimes in the wind's eye, sometimes not, as happened. Nothing is so apt to impose upon advocates for contagion, as th« disease attacking in succession the houses next to each other, us cholera is said to have done in Bombay. The yellow fever, when it first shewed itself in Philadelphia {I believe 1799), deceived Dr. Kush, 

• 

in 

105 





in this iftarmer, and be hacf afterwards the meritorious earidourto acknowledge it. 

No. 30. 

Extract of a Letter from Mr. Assistant Surgeon Henderson, to Dr. Milne. 

Kurrar, 13th September 1816. 

With respect to it's contagious appearances, I have observed nothing here, which indicated such a quality in the disease. Certain classes of people, as also certain modes and conditions of living seem to [me to predispose to it's attack. Hindoos ap* pear more subject than Mussulmans ; the poor and the old, more than the rich and the robust ; and exposure to cold and damp seem also to be predisposing causes. For these reasons, I can conceive the disease to assume strong marks of contagion in some instances ; as in a corps composed of one cast of Hindoo?, all subject to the same predisposing causes, while they adopt the same mode of life ; or in a village, whose inhabitants are generally poor, and the viltage rll situated : this last I have certainly remarked in this neighbourhood ; and I think, that, in such circumstances, it may sometimes give rise to an idea of it's contagious quality. To ascertain this point, 

however. 

106 





107 

CHOLERA MORBUS, 

however, is a subject of no mean importance, even more so than it's cause ; and I should be extremely glad to be favoured with your idea of 

No. 31. 

Extract nf a letter from Mr. Surgeon Cray.; 

to Mr. Juki's, Garrison Surgeon, TannaK. 

Seroor, August 181». 

As the cholera is still prevalent here, I think it may be acceptable to you to learn how matters are going on, and particularly as I have it now in my power to afford you the most convincing proof of the decided superiority of bleeding in European subjects. I think I mentioned to you in my former letter on this subject, that there was some apparent difference in the symptoms and state of the system as the disease is, on its first onset, observed in the European and native; and particularly, that in the former there is a first stage in which the pulse is quickened and the heat of the skin somewhat augmented ; or at least that the first does not so rapidly sink nor the latter diminish in a great degree. It is in this early btage in which venesection most certainly conquers the disease, and if notwithstanding the use of this 

remedy 



remedy symptoms of apparent debility ensue, these are still in a very minor degree, and strongly evince the great power of blood letting in rendering the morbid chain of symptoms less threatening and fatal. Since the 2 1 st of last month (when the disease appeared in the o*s th regt.) to the JOth of this month inclusive, 100 cases of the disease have been admitted into hospital. Of that number 88 were bled freely on their admission, md only 2 have died; while of the remaining 1 2 who were not bled, no less thon S have fallen a sacrifice to the disease. This simple statement speaks volumes. For the two first days, Dr. Burrell did not employ the lancet, but he speedily found out the inefficacy of the common treatment. Of the J2 patients who were not bled therefore, the greatest pnrt were admitted on the Ist or 2d day, and about ;) or -1 since, with such symptoms of smkinjfr'fis did not appear to him to render bleeding admissible. He now lamen s extremely that the scare-crow of iihagiriarij debility, should have deterred him from employing the only remedy which could have promised a successful result; as the i(upenrancc i s on direction have but too well proved the necessity of such treatment. One of \\\o*r cases I shall shortly relate to you. A patient in hospital convalescent from ob^tin^te and lon* continued symptoms of a svnhllitlc riatiWj 



108 





Was attacked on the Bth inst. with the usual symptoms of cholera. Being supposed to be debilitated by the protracted nature of his former disease, he was not bled, but had the calomel and laudanum, the warm bath &c. according to the common plan. These however were of no avail, and be died, about 1 8 hours after lie was attacked. On dissection, the vessels of the stomach, duodenum, and the whole of the alimentary canal, with thoseof the mesentery, liver, and lungs, were found amazingly gorged and distended with blood ; many of the veins, particularly of the stomach and mesentery, were as large as crow quills ; and the smaller ramifications of the arteries were also distended with every appearance of general inflammation as well as of venous congestion. The transverse arch of the colon seemed as if death had not liberated it from the violent spasm with which it had been affected, for it was contracted to a very small size and almost impervious. I had last night an opportunity of seeing the dissection of a still more important case. A man of the foot artillery died about 30 hours after the ittack of the disease. This patient I saw twice during his illness. Moyle opened a vein whfQ the man applied at the hospital, but as there was not a drop of blood discharged from it, the arm was tn«d up and th<* cure trusted to the 



109 





> 

other means. Symptoms of coma and great derangement in the head, with great anxiety, and oppressed and laborious respiration speedily came on, and the hands, arms, and lower extremities wvre cold, while the rest of the body retained its natural temperature. Powerful stimuli were administered, and blisters applied to the epigastrium, head and back of the neck, and leeches to the forehead, but these were not successful in drawing blood, and the man sunk. On dissection, we found the same congestion of blood in the abdominal and thoracic viscera as in the former ense; but there were also large spots of extravasated blood found in different parts of the intestinal canal, and in other places decided appearances of increased arterial action while a large portion of the ilium and colon was in a complete gangrenous state. I felt certain, from the symptoms, that the brain would indicate disease, and nothing could be more convincing than the appearances when the calvarium was rerrtoved. The most expert anatomist could r.ot have injected the ten millionth part of 0e vessels which now covered the membranes and surface of the brain. It appeared indeed as if the whole was nothing but a mass of blood vessels, and every little branch seemed so entirely distended and glutted as if one drop more must have ruptured it. There was no effusion of fluid in 



110 





the surface nor in the ventricles; but if the patient had hved a tew hours longer, either this or an effusion of blood must have inevitably happened. In the space of 20 or 30 hours, therefore, you see there is not only formed a true congestive disease^but inflammation and even gangrene has taken place ; and how these are to be better remedied or prevented than by blood letting, I cannot conjecture. When I saw the last patient, I was firm- Jy of opinion that nothing else would save him • the difficulty appeared to be that blood could not be drawn from the surface ; but by immersing him in the hot bath and opening the temporal artery, or jugular vein, this difficulty might probably have been obviated. In the mean time all these comatose patients uniformly die. The other symptoms which have constantly prognosticated a fatal termination, are, tfce long continued ab-r sence of the pulse at the wrist, the great coldness of the legs, arms and hands, the lividity of the skin and nails, and the contraction of the fingers, with, the sodden appearance of the cuticle on the fingers and palms, and sunk eye surrounded with a livid circle. Yet there is a patient in the foot artillery hospital with all these symptoms : he has lain in this state for two days, extremities as cold as death, and pulse either in the radial or brachial artery quite imperceptible ; tut heat is very gra^ 

dually 

111 





Tilly returning, he is free from all uneasiness, aks with considerable strength, and notwithstanding appearances, will, I think, ultimately recover. We ought to be cautious therefore in drawing our prognosis: but I must remark, that in this case ¦there has been none of that profuse cold sweat which invariably marks the fatality of the disease?. From this patient not more than ]O ounces of blood could be obtained, but this small abstraction, in my Opinion, has had a favourable influence. Moyle's practice in the horse and foot artillery, and Mr. Campbell's in the 17th dragoons, piove equally illustrative of the grand effects of depletion; and I shall attempt to show that the same plan, would be fully as efficacious with the natives* Wallace in the general hospital, and Whyte in the sepoy hospitals, do not get their patients till the disease is of some Handing ; they lose the first stage, when the powers of life seem to make a struggle against the disease, and when the lancet is so sure of obtaining the i( victorUi Icela." Hence their patient! are admitted with want of pulse, coldness of the extremities, and great debility ; and many of them in articulo mortis. If one out o( 5 or 6of these die, we cannot wonder at it ; but rather how so many should live. Their dissections however have presented the same appearances as I have already described. The more 



112 





irritable and mobile fibre of the Indian will well account for the greater rapidity with which symptoms of exhaustion take place; and therefore i here i« the greater necessity for checking the disease in the very bud, if the patient can be had at this early stage. Dr. UurrreH's la-ncet has clone this with great success. He has bled all the native patients belonging to the regiment, and the cases have been at least as numerous as those of the Europeans, and exactly with the same result; but he gets them while there is yet a little vitality in the pulse and surface ; and however short this stage may be, it is a certain one, and the cure nearly as certain. Upon the whole, this is his rule — In all cases where the stomach and bowels are affected, or while there are any spasms, even tho' the pulse is obscure and the extremities cold, Open a vein an I draw blood till an abatement or relief is procured. But in many cases it is necessary to blued once and again ; particularly if the spasms are violent, or the breathing oppressed, or the head affected. There can be no doubt, that death in many cases takes place rapidly from the spasms extending to the large blood vessels, and heart itself. Such case* must exhibit an almost instantaneous appearance of sinking and debility: but as HI this tasc ths powers of life are oppressed and not exhausted, I am confident that taking blood would 

reiuovo 

113 





114 

MEDICAL REPORT Op THE 

remove the alarming symptoms. In many eases, in affections of the head particularly, great oppression in the chest, and where the abdomen is tender and painful to the touch, blisters prove useful ; but there is a considerable difficulty in exciting vesication, and the object is to do this effectually in a very short time. It is therefore a great improvement on the process, to apply to the place intended to be vesicated, the nitric acid by means of a little lint, and then applying the blister in the common way. Opium is the most injurious medicine that can be employed, the calomel alone will quiet the stomach, particularly if combined with previous bleeding and the warm bath, and that is the only apparent use of opium. It increases the congestion, the constipation, and tendency to inflamation, and materially deranges the head. My plan would be bleeding, warm bath, and a bolus of musk and sub-carbonate 

of ammonia. I have made extensive trials of the latter medicines in spasmodic diseases, gastric irritability, and congestions in the head and viscera, and found them most powerful in allaying 

spasm and irritability, in allaying coma and exciting sensation, and in quickly and safely determining to the surface. They must be given however in large doses, and repeated frequently. In the cold stages they would produce a most beneficial effect. 

i 



lobserve inalate number of the Edinburgh medical and surgical journal, the review of a work, by a Dr # Armstrong on typhus. He particularly mentions a congestive typhus with all the appearances on dissection which our epidemic exhibits, and strong ¦ ly recommends copious bleeding, warm bath, and simple doses of calomel. It is an interesting work which you may perhaps find in Bombay. Indeed the lancet is now the grand remedy pjt home iti fevers of all types, at least continued fevers. We have had for the last week a great deal of rain, but I do not observe that it has had any effect in diminishing our disease ; at least the Europeans continue to suffer nearly as much as ever, though it is certainly on the wane amongst the natives. In fact, cold and moisture are the most powerful predisposing causes, but as most of the natives have had their visitation, the occasional or exciting cause must have frlsh pabulum at another station. What this cause may be, we can never hope to know, for I hold it as proved, that in all epidemics the chemical constitution of the atmosphere remains unchanged. The proximate cause, 

tho' not quite so much obscured, is yet greatly in the dark. We can discern, it is true, nearly the whole of the morbid chain, but what is primary 

and what secondary we cannot tell. 



115 





Jhc Joltowmg letter, tho not from a medical gentleman, is inserted as containing some in" tercsting- facts and observutioiis. A liberty ichich the writer icill, no doubt, excuse. 

No. 32. 

Copy of a letter from Capt Si/hcs to Di\ Milne- 

Punderpoor 15th August 1818. 

tn Loppy to meet your wishes in communi* the result of my observations on the cholorbus; but you must be satisfied with fling- information, 1 can afford you, being ised in a meagre detail of facts. 

I have seen the malady under three distinct shapes — Ist. Where the victim, in previous ro* bust health, is struck senseless, of this 1 had five cases in my camp. In three cases, bleeding-, with a subsequent emetic and cathartic, restored the patient in two days. In one case, the blood could not be made to flow although violent friction was used to rouse the circulation ; nor could any remedy be got down the throat, and the man died in eight hours. In the other, bleeding was not tried* and death ensued in a few hours. When the disease first commenced it's ra\agcs in Punderpoor, it must have been under this form, for 350 people are described to have died in One day, tumbling 



116 





r over each other lifeless in the public streets. The 2d form of it was under violent and incessant purging' of watery matter. Many attacked in this way throw up from the stomach one or two long brown worms. Most of those who retained the calomel and laudanum in their stomachs, recovered. In one instance, I am induced to believe an old woman died from weakness, four days after the disease had been stopped. It does not appear to me, that calomel and laudanum may be relied upon as -a. certain means of arresting the progress of the disease, for some died unexpectedly after having kept the medicines on their stomachs; and one or two were so violently attacked, as to resist every eifort to keep down the repeated doses of laudanum. These of course died. The 3d form is that of violent purging of watery matter, with little or no vomiting at first. In the cases of two of my servants, the attack was preceded by a cold inflated sensation in the stomach for some previous days, with total loss of appetite, and violent eructations. In this form the spasms were weaker, and the disease evidently less severe than in the other kinds. The usual remedies put an effectual stop to it in two or three days. 

Bth respect to the origin and nature of the y, lam incompetent to give an opinion. But ,'s progress is independent of the air, I think 



117 





118 

MEDICAL REPORT OP THE 

there are many circumstances to justify the belief in. In the first place, we see that it has made it's way against a permanent S. W. wind, from Jaulna down to Punderpoor. It's effects were not instantaneous in the country ; but it's progress may be traced by a slow advance of 15 or 20 miles a duy, as if it has been communicating- gradually by persons travelling- from town to town. It's principal ravages about here appear to have been confined to the high roads from Punderpoor, and the large villages in the neighbourhood; and I dare gay it might be proved, that it did not break out in any village, until that village had communication with a neighbouring place, in which the disease existed. Corroborative of this, are the observations I made at Nalapoota on the 17th July. That day, 1 descended the Mahadoo gt&llt from tbe town of Singnapoor, in which the disease was unknown, and marched si\ miles to Natapoota ; where the plague had that very day made it's first appearance. It first appeared in Ptinderptor on the Hth, so that it had taken three days to travel 40, or 50, miles to Natapoota. There are other circumstances also to justify the belief, iimt it is contagious. In my light company, there were three or four men taken at once, of course there were attendants from the same company upon these men. The disease went on increas- 

in S 



ing in that company : and there have been moiy cases of cholera in it than any other. One of my servants was attacked, it gradually spread to five. An officer at Punderpoor had seven servants attacked, one after the other. The gentleman in the next tent had not one. I have seen asimilar instance in our corps. I should infer, therefore, from it's running- in particular companies of a corps, or sets of servants, that as they attend on each other, and constantly sit or sleep in the confined space of a small tent, that the disease is communicated by absolute contact, or from respiring the same air that a diseased person has done. I am aware, that there are very strong arguments against it's being infectious, persons escaping who have been in constant habits of handling the sick & breathing the air of the cholera hospitals- But Ido not think I can cite myself as an instance of it. for I feel a strong 'conviction, that had I not taken timely remedies, I should have bee.i attacked. How far the disease exists in the air 

y 

might at any time, I should think, be ascertained by a chemical analysis of it's component parts in some place, where the disease may be committing it's greatest ravages. The above observations, I fear, will not prove either novel or useful; but you are welcome to them. 

No. 33. 

119 





No. 33.- 

Extracts of a letter from Mr, tVhyte, to Dr* Milne. 

Se*-oor24th August 1818." 

i return you, with many thanks for your a(-tion in sending them, the letters on the subt of cholera from Messrs Jukes and Henson ; and be£ at the same time to inform you, 1 1 lost no time in circulating them, agreeably the mode you pointed out. 

Should the disease stay long at Tannah, I anticipate that considerable light will yet b(t thrown upon the different plans of cure by Mr. Jukes's well known zeal and ingenuity in research. As far as general conclusions can be drawn from a single case, his experience is satisfactory in favor of blood letting. But it appears to me, that it is only in a particular class of cholera, that it will be found to be favorable; & that the nature & extent of that class remains yet undefined. It appears to me further, that in the severest forms, it will be found totally inapplicable as a remedy. When the pulse has left the- wrist, and the extremities are cold, it is impossible to draw blood, even by the aid of the warm bath; or at most, only a small quantity, 



120 





when, instead of the pulse reappearing', the flow of blood ceases entirely, and faintness or actml syncope comes on. This has been the case in three*patients belonging to Mr. Wallace, of whom you will receive from him a more detailed account. The first man died ; the other two, bled yesterday morning-, were in the greatest danger afterwards. I am happy to say, they are both alive yet, and one appears likely to recover, the other's fate is still uncertain ; but if either or both recover, they will owe their lives entirely to small doses of caiomd and opium ; of the former grains 2, and the latter 4 grain, given every half hour after the first large dose of these remedies which stayed upon the stomach. lam happy to confirm, by what I have since observed, my former recommendation of this remedy, given in the above manner. I believe that the stimulant effect of this quantity of calomel, lasts about half an hour; and is then followed by a corresponding sedative effect, so that it requires to be repeated after that lapse of time. In both of tlsc.se men, it has restored some pulse, some heat of the surface, and produced high col; mred stools; so that it has certainly prolonged their lives ; allowing them still to be in some danger. One man had been ill eleven hours before his admission, the other three; but in neither could any quantity of blood be drawn, and in both 



121 





122 

wwr^Tr at TIFPOPT OTT TPWtr 

(fid it produce a bad effect. Nor is a number of hours, in the worst cases, necessary to induce such unfavorable symptoms. In some of my patients, now alive, I have ascertained, by the* clearest evidence, that these symptoms supervened in one hour from the attack ; and that they were brought to the hospital in that space of time. These men have not the smallest recollection of any thing that occurred to them, for two or three days afterwards; and their recovery was very tedious; so great was the debility, and so suddenly induced by this disease. 

Whenever the pulse rises as it did in Mr. Jukes's case, and the heat is restored by the warm bath (often it is increased), in these, I have no doubt, that bleeding will always be found the most successful remedy : and whenever the pulse, however small, remains at the wrist, while the heat is little or nothing diminished, and the spasms arc violent, bleeding will always be a useful and powerful remedy. It was in such cases, that it was found successful here, and these were the most common cases amongst Europeans. Indeed 1 have been told, that in many, the heat was much increased. It has not occurred to me to meet with any such case ; and in those where the pulse remained, and the coldness had not come on, ooru r success was invariable with the usual remedy. 





But by far the greatest proportion of cases among the natives here, were of the worst form, or what, we distinguish by the appellation, in common conversation, of cold cases ;.aud latlerh/, in these, spasm was not a striking symptom. In many, nothing but a tenderness of the muscles occurred; and in some of the fatal cases, attended with the greatest sinking of the vis vitoe, no heat, or pain on pressure of the abdomen, occurred. In one of these cases, a man who accompanied Captain Montresor from Poona, brought to the hospital after the disappearance of spasm, we found the mucous coat of the stomach studded with little red spots, either from extravasation, or the ramifications of minute arteries prcternaturally injected with blood, while at the same time it was so soft and pulpy, that I could easily scrape it off with my nail. 

The small intestines were full of a matter like the ill digested pus of a scrophulous. abscess ; & yet this man complained of no heat or pain of his abdomen before death. 

*##¦*###*#?********•** 

Im the very nature of the disease, the sudannerof its assuming the worst symptoms te cases, the insidious mode of its attack ers, there wijl always be a large proportion 

of 

123 





ofcases which will be little benefited by any remedy, and prove fatal at every station where it appears; and in the worst form of this disease, I much fear that blood letting will be found to exert little power, if not a deleterious one. There are certainly cases in which it is inapplicable: it becomes, therefore, a desideratum to distinguish these. Is this disease ever attended in the beginning with increased heat and quickness of pulse? And does this form ever run into the other, with cold extremites and sinking pulse, or total want of it? 1 have never seen it in this shape, althofigh I have heard it contended, that it does, or may do so. It appears necessary to ascertain the correctness of this position ; as if erroneous, it must be a fertile'souree of error, in as much as probably cases of fever with pains in different parts of the body, or even spasms, may be classed with cholera. You will understand, however, that from what I have observed in three cases of that kind, in which I wished for a more powerful remedy, as being composed of the cases we found here so dangerous, bleeding has failed, or appeared to be injurious ; and thai we were, after giving it a trial in such cases, obliged to resort to tlj« remedies we formerly found most successful ; au(,l that these again appeared to do good. 



124 





No. 34. 

Cases of Cholera Morbus in the Native General 

Hospital at Seroer during the month of August 

1818. 

Hybuttee Ravee was admitted into the general hospital at Seroor, on the Bth August at 8. a. m. He had been attacked with purging about seven a.m. on the preceding day;- the discharge was said to be of a brown colour, watery, with very little griping: about four hours after, he was seized with ¦nausea and vomiting, which were quickly succeeded by spasmodic contractions of the upper and lower extremities. I wa3 at the hospital when he was brought there, at which time the whole body was cold, his features and eyes sunk, and no pulsation could be felt in the arteries: his evacuations by vomit and stool, were frequent, watery, and of a dirty brown colour : he complained of pain in the stomach, this was not encreased by external pressure on the abdomen, nor was there any tension or fulness in the part: the muscles of the upper, lower extremities, and the abdomen, were contracted and painful. He was ordered to take fifteen grains of calomel in a draught containing sixty drops of laudanum, twenty of 01. menthec and one ounce of water. This was almost instantly spouted out of the stomach : the patient was im- 



125 





mediately placed in the hot bath, and five minutes 

after, 15 grains of calomel, three grains of opium and a little honey were swallowed, and re w tamed : he was kept in the bath twenty minutes, and expressed himself relieved : no pulsation to be felt in the arteries, the body has acquired general warmth from the hot water, and he appears disposed to sleep : he was quickly roused by a return of the spasms, when a draught containing one drain of sp. ammon. arom., forty drops of tinct. opii and one ounce of water, was given and retained : the vomiting and purging are checked, but the spasms and pain are violent; he was rubbed all over with hot arrack and wrapped up in cumlies. 

At twelve a. m. he was a second time placed in the hot bath, and a second dose of calomel with 30 drops of Line, opii administered; he now dose/1 a little, and appeared more composed till one o'clock p. m., when he became extremely restless, complained of oppression about the hypocondria ; the spasms hnd now nearly subsidea 1 , but the body again cold, became covered with a clammy sweat ; this was soon succeeded by the peculiar appearance in the hands and feet, the skin of which became corrugated and folded up; repeated small doses of arrack and congie were ordered to be given. 

i 

126 





I saw him again at six in the evening, when 

Ewas evidently dying ; he was free from .pain d perfectly sensible, and expressed a wish to be lin put into the bath. The wish was complied 

with. He died at 7 p. m. 

The body was opened the following morning 

at day light : all the abdominal viscera were found gorged with venous blood, the large veins having the appearance of being injected ; the liver was dark coloured, slighly enlarged, and on cutting into its substance, appeared loaded with blood ; the gall bladder was distended with dark, coloured ropy bile, and ihere was not the least appearance of this fluid in any part of the stomach and intestinal canal. The stomach was about half filled with a dirty coloured fluid, the vessels on its surface were distended with blood, but the inner membranes was neither inflamed, nor discoloured; nor was the substance of this viscus thicker than usual. Numerous loaded veins were perceptible on the mesentery and small intestines, but on dividing and tracing these latter, no marks of inflammation were apparent on their inner membranes: the large intestines did not exhibit the same marks of congestion ; the colon was contracted, the urinary bladder was empty. 

The vessels of the lungs were turgid, and load- 

Ed 

127 





fvvith blood, the quantity of water in the penrdium was not gieater than is usual. 

Goonjamae was admitted into the hospital oft the 10th August at 6 a. m. He had been attacked with purging on the 9th at 4 a. m.-, which had been succeeded in a few hours by vomiting and spasm, these symptoms had all subsided when he was brought to the hospital. His whole body and extremities were cold, tongue furred, white, and cold, he was perfectly sensible, complained of restlessness and oppression, but was free from spasm or pain ; his eyes and features were sunk, pulse not to be felt. He was placed in the hot bath, and the usual dose of calomel and opium administered: on being taken out, a blister was applied across the hypochondrium, and the extremities well rubbed with hot arrack, and equal quantities of this spirit and hot congee given in small quantities for common drink. The stomach rejected nothing, but it was evident that the disease had gone too far, and that reaction was not likely to take place. This man died at noon without a groan or struggle. The body was opened at five p. m. the same day. 

¦his case the venous congestion was more g than in the former ; the liver exhibited surface large distinct dark ontches, the pall 

bladder 

128 





bladder was distended with dark green bile, and no appearance of this fluid was to be discovered in the intestinal canal ; the stomach was half filled with a brown dirty coloured fluid, and the remedies swallowed in the morning were found in it unchanged, its external surface was covered with numerons vessels loaded with red blood, while its inner coat was so pulpy and softened that it was easily divided from the nervous coat, by the back of the nail of the thumb ; the small intestines exhibited marks of inflammation, the veins on the mesentery were loaded with blood, the ileum contained a large quantity of half digested rice not having the least tinge of bile, and amongst this were found three large lumbrici, dead. 

The colon was contracted through its whole course, but shewed no marks of inflammation except the turgid veins on the mesentery and its external coat. The bladder was empty. 

The thoracic viscera exhibited the same marks of venous congestion, and an unusually large quantity of .water was found in the pericardium. 

The head was not opened. 

Three other bodies were inspected, in all of which, congestion of blood, more particularly in the liver, was the most remarkable appearance : 



129 





130 

MEDICAL REPORT Or THE 

the vessels on the stomach and intestines were loaded with blood, and the non-appearance of bile in their canal was a constant occurence. These appearances, and an account that reached us at this time, that bleeding had been attended with remarkable good effects to the southward, induced me to give the practice a trial : the result is recorded in the three following cases. 

Case. Ist. — padoo, a servant of B. Gen. Smith, aged twenty, of a weekly habit, was attacked on the 23d of August at 4 a. in. with purging of watery matter, unaccoinpauied with griping. On the 3d evacuation, about 5 o'clock, he fell to the ground fainting from debiijt) : as six a m. he was seized with vomiting and spasmodic contractions of the upper and lower extremities. I was called to see him at halt* past seven ; as this time his extremities were becoming cold, his pulse feeble but 1 regular, vomiting and purging frequent, the discharge a dirty brown coloured fluid, he complained of no pain whatever and the spasms had subsided : fifteen grains of calomel was given in the usual quantity of laudanum and immediately vomited, he soon after had a discharge by stool. J now opened a vein in the right arm, when the blood flowing by drops, ft larger Opening ua* made in the vein of the left arm, and the patient put in (he hot bath ; he soon became faint, but by 





the aid of volatile salts was kept in the tub for twenty minutes. During this time, notwithstanding every exertion by friction &c, six ounce? only of blood could he obtained; on removing him from the tub, he fainted : on his recovery, the dose of calomel and laudanum was again given, and retained : at this time the pulse could no longer be felt nt the wrist, but the temporal artery could be indistinctly perceived. 

f; 10 a.m. he continued free from pain, the ting hnd ceased, but the purging was fret, his extremities were cold, pulse not to be lie was again placed in the hot bath, and on j taken out, an enema containing half an ?of tine, opii and two ounces of congoe was :ed, and pills containing two grains of calomel half a grain of opium directed to be given half hour. 

X twelve a. m., he seemed disposed to sleep, ing and purging were checked, extremities no pulsation to be felt in the arteries: his and feet were well rubbed with arrack. 

Sfivc p. m., he appeared better, he had kept tills oi'i his stomach, hands and feet continue but the pulsation of the temporal artery is erceptible, the head and trunk of the body covered with a warm perspiration: the pills 



131 





R discontinued and a draught containing forty ;. of line, opii. and two drams of sp. ammon. . ordered at seven o'clock: some tea was given in small quantities, for he refuses or 'spirits in any shape. 

August 24th 6 a. m., the patient is better, has evidently slept at intervals during the night, hands and feet continue cold, but the trunk and upper parts of the extremities warm and moist, his pulse can now be felt at the wrist but is very feeble and indistinct, complains of extreme debility, and says that he is hungry : a small quantity of rolong congee with nutmeg was given, and easily retained ; as he had no evacuation by stool, fifteen grains of rhubarb and the same quantity of magnesia was given in peppermint 

9 a. m., he continues better, has had two evacuations of a feculent smell and tinged with bile: pills containing 2 grains of calomel and half a grain ot opium directed to be taken every two 

J2 a 4> m., her has taken come broth and appears improving in all respects, his extremities have regained some degree of heat, the pulsation at the wrist can be felt, is free from all pain. 

I was called to him at five p. m,, the purging 



132 





fmd returned with violence, and he complained of difficulty of breathing*, an opiate clyster Was administered, and a cordial dm tight given; this was swallowed with difficulty. He died in a few minutes. I was very desirous to open the body of this man; the unfavorable change that occurred about five o'clock being unexpected, for hi? symptoms were all those which I had observed to take place progressively in those cases of the disease where the result was favourable. 

Case 2cl. Linoo was admitted into the hospital on the 23d August at 10 a. m. He had been attacked with purging on the r 22d. at 12 p. m. f succeeded by vomiting, spasms and coldness of the body ; his evacuations were frequent, of a dirty brown colour, his extremities cold, pulse at the wrist regular but feeble, spasms of the extremities and abdominal muscles violent, tongue white, cold and furred; he complains also of violent pain in the stomach ; the usual dose of calomel and laudanum had been administered and rejected before I saw him. I directed him to te put into the hot bath, and bled him, sixteen ounces were procured with some difficulty, when he fainted, but was recovered by the usual means, the bath had diffused temporary warmth over his body, but tlie pulse could no longer be felt nt the wrist, I counted seventy pulsations in the temporal artery m 

133 





a minute, they were feeble.: 20 grains of calomel, and sixty drops of laudanum were again given and retained. 



* ] p. m., The vomiting and purging had ceased, but the extremities have again become cold, no pulsation can now be felt in the temporal artery, complains greatly of oppression in breathing, spasms have abated: he was again put into the bath ; and pills, each containing 1 grains calomel and tine, of opium, directed to be given every hour- 

6 p. m., Rethinks himself better; but his features aresunk, and extremities cold and shrivelled: an opiate draught and hot arrack and conjee with spice and sugar ordered ; and the whole body to be well rubbed. 

24th. He continues sinking, is extremely restless and uneasy : having had no evacuation by stool, ten grains of rhubarb was given in an ounce of the tincture. This produced several brown watery evacuations, but they had no appearance of bile. 

JO a. in., Fifteen grains of calomel, 30 drops of ti.ic. opii and 1 5 of 01. inenthae were again given and retained. 

\'i p. in. Complains of tenesmus, passes small mucous stools tinged with blood : a clyster of 100 drops of laudanum and two ounces of congee in- 

8 

134 





(5 a. m. He is now free from pain, his -whole body cold, and complains ofanxiety and restlessness. He died at 9 p. m. without a struggle. 

Dhurme Chetoor was attacked at Q a. m. on the 24th of August, with a purging, he began to vomit at 1 p. m. when he was brought to my house. His pulse is 75, rather small, complains of spasm in his legs, thighs aad fingers, is purged and vomited every ten minutes, his extremities are not cold. The usual dose of calomel and laudanum was administered, and I opened a vein in his arm, four ounces of blood flowed quickly, when he was seized with a violent spasm, this soon went off; after twelve ounces had been taken, he fainted, but soon recovered ; four more were removed, when he again fainted ; the arm was tied up, and he lav down apparently exhausted. The pulse had become more feeble. 

2 p. m. He is now cold, and the spasms have returned, at half past two he vomited the medicines; at three he was sent to the hospital, and put in the warm bath ; on being taken out, the calomel and opiate was repeated and retained. 

Kp. m. The purging and vomiting have ceashands and feet cold, he has spasms in the minal muscles, pulse feeble, tongue white, :d, and cold: pills containing '2 groins of calo- 



135 





tflel and half a grain of opium directed "to be given every hour, find an opiate draught at night. 

25th 6 a. m. He is now free from pain, but complains of slight spasms in his thighs, his pulse can be felt at the wrist, but is very "feeble ; hands and feet cold: the calomel & opium to be continued, and the whole body well rubbed with arrack. 

12 a. m. He is now free from pain or spasm?, but the extremities are cold and pulse very feeble: amall quantities of congee and arrack frequently 

¦/f 

I. m. He is not so well ; there is great )r and encreased debility as well as coldness # red him to be put in the hot bath and a I draught with 40 drops of laudanum to be the pills to be continued. 

Pi 6 a. m. Hehas slept during the night, and er in all respects, hands and feet warm, pulse :ble, his gums are affected with the mercury: pie of rhubarb was given in peppermint and the pills discontinued. r 

12 a. m. He continued better ; he had several evacuations, the first watery, the last black and slimy: pills containing 2 grains of calomel and the same quantity of rhubarb to be taken every hour. 

6 p. m. His stools are now more natural and of 

136 





a deep yellow colour he is improved in all respects: 

an opiate ordered at eight o'clock. 27 th. He is now convalescent, 

II think these cases show that blood letting is )t to be relied on for the cure of this epidemic. , the first case, so small a quantity of blood could obtained, that no fair inferences can be drawn » it I may here be allowed to observe, that nearly ree fourths of the cases that have lately occur- J, would probably afford the same results. 

In the 2d case the disease had probably too far advanced to be checked by any remedy, but here, no favourable changes^ such as return of warmth, rising of the pulse, or suspension of the spasms were produced by bleeding. 

lln the 3d case, no advantages accrued. Though jod was drawn ad dellquiwn, the pulse became )re feeble, the extremities gained no warmth, r was the violence of the spasms mitigated, tile the patient certainly suffered from debility, lad an opportunity of contrasting this case with it of Sumboo Savoojee who was attacked on ; same day; this man was not bled, his sympns exactly resembled those of the other : he a vomited the first dose of calomel, which was : retained till he had been put into the bath, 1 he was discharged convalescent on the evening the 25th, the doy following. 

I 

137 





IT wish to observe that I have always dated the immencement of the disease from the first time c patient was purged, for this was the first arked symptom in all the cases that were admitd in August: the next was vomiting, at inter- Is, varying from two to eight hours, and this mptom was quickly followed by cramps and spasm, which in the worst cases were of very short duration, and succeeded by atony, and death. 

The result of my experience in this disease is, that previous to, or during the existence of the spasms, the following mode of treatment will be attended with success: the stomach and bowels should be first quieted with an opiate, and the spasms allayed by the use of the warm bath, large doses of calomel and opium followed speedily up, with smaller quantities in repeated doses, will excite the suspended secretion in the abdominal viscera, will, above all, relieve the liver loaded with blood and bile, and thus determine speedily and powerfully to the skin, restoring gradually the lost balance of the circulation. lam of opinion that the total absence of bile which I have invariably observed (at that early period of the disease, before the cramps and vomiting appear), as well as the loaded state of the gall bladder and iiver which appear on dissection, affdfd just 

grounds 

138 





grounds for suppling that a deranged state of this viscus is a predisposing cause to an attack of this epidemic: for it is very certain that an appearance of bile in the feces is the most favourable symptom towards recovery. 

In the more advanced periods of this disease, when the pulse cannot be felt, the body universally cold, when the spasms have subsided, and atony prevails, the chances are of course greatly against the recovery of the patient ; but several of these apparently desperate cases have cpme round, by adding tv the above mentioned treatment the most powerful stimuli externally and internally. 

I could adduce many facts in support of my opinion that this epidemic is not propagated by contagion, but will content myself with the following. Three convalescent wounded sepoys and a follower have been in the hospital appropriated for the reception of patients suffering from the disease, they always slept in the hospital surrounded by the sick, and not one of them has been attacked up to this day, and the disease broke out on the 2Ut July. 



139 





140 

MEDICAL REPORT OF TUZ 

No. 35. 

Copy ofn letter from Mr. Assistant Surgeon An* 

derson to Dr. Milne. 

Poonab, 14th August 18J8. 

To 

JOHN MILNE M. D. Esq 

Act. Sup. Surgeon, 

DECCANi 

Dear Sir, 

I have been visiting the hospitals in the city fof the reception of patients labouring under the prevailing epidemic during the last week, and now beg to offer my, observations on the subject. It is unnecessary to trouble you with a repetition of the symptoms of a disease so well known and so often described as the cholera morbus^ suffice it to say, that it exactly agrees with the description of Celsus, and the history given by Sydenham of a similar epidemic which prevailed in England in 1669. There is indeed a variation in the symptoms, as they do not all appear in every case, and in some they are much milder than in others. It would seem also, that the disease has hitherto been less virulent here, than it is described to have been at other stations. With regard to the cause, we ought at once to acknowledge our ignorance. It is supposed to exist in the atmosphere, from it's pervading €very where so extensively ; but how comes it to spread in opposition to a 

continued 



Inued current of air like the S. W. monsoon, idea that it is of a contagious nature is enned by so few, and with so little reason, that rce merits notice. 

The disease is spasmodic, and it's unknown and imperceptible cause appears primarily to affect the nervous system of the parvagum which supplies those organs whose action is independent of volition, viz. the organs of digestion, circulation and secretion. It is true the muscles of the limbs &c. are often affected with spasms, but this is to be considered as a secondary affection, it has seldom been the case among the patients I have seen, and many have proceeded to a fatal termination without these spasms having occurred. 

I consider the principal cause of death to be the affection of the heart, through which the circulation is obstructed, impeded, and at last ceases. This affection of the heart is probably a spasmodic contraction more or les^s permanent, obstructing the flow of blood thro' its cavities, and causing the venous congestion so obvious on dissection, and so well described by Mr. Whyte, which in fact seems to be the sum of all the morbid appearances. 

I have found no great difficulty, in any case, in checking the vomiting and purging ; and lam sa- 



141 





142 

MEDICAL REPORT OF THE 

lisfied that this can always be done by opium, if iven with a liberal hand, repeated, and varied in irmula, as circumstances require. In general, alomel in a large dose was given with the lauanum; but I am convinced that the principal enefit is derived from the anodyne, altho' the 

tlome! has hitherto received the greatest credit, a recent case, when the vomiting and purging 

are checked, we may consider the patient safe; and all tjiat is necessary is to administer some laxative. Numerous cases, however, do not apply for relief till the body has become cold, no pulse is to be felt at the wrist, nor even a thrill of the heart is perceptible. In this deplorable case, * nothing but the most assiduous, constant, and unremitted exertion, will prove successful in excitin 1 the motion of the heart, and renewing the circulation of the blood. The most powerful stimuli are called for ; alcohol, ammonia, camphor, hot fomentations and frictions; but above all, strong sinapisms to the stomach, are, I think, the most useful. One man I saw to day, who was rescued from the state above described, by his friend applying the actual cautery on the scrobiculus cordis. Nothing, I think, would have so powerful an effect to renew the action of the heart as galvanism ; lam sorry I have it not in my 

la 



143 

CHOLERA MORBU9. 

In the cases that I have seen prove fatal, the cause of death has uniformly been this obstruction of circulation. Bleeding- might relieve it, as it, removes the mechanical weight and pressure of the mass of blood, but in the cases which I saw prove fatal, it would have been difficult to procirre any quantity by the usual means of venesection, as there seemed to be no blood in the veins of the extremities, so that it would be necessary to open the jugular. 

I have not seen any indication for bleeding- in the early stages, and all the cases that applied early, have been cured without bleeding. I should think the benefits, said to be derived from that practice, must be from it's acting chiefly as an antispasmodic. 

I bled only one patient in the early stage, in whom there was a good deal of febrile heat and a sharp thready pulse; this man received relief during the operation, and recovered. 

The practice all along has been peculiarly successful in these hospitals, which must be attributed to the assiduous attentions of the native servants at all hours. 





No. 3(5. 

Pof a letter from Mr. Surgeon Coats to fort Sleuart Esq. President Medical Board. 

I am sorry I cannot add much to your stock of information respecting this singular and interesting epidemic, with which India-is visited, as I was absent on a tour into Candeish with Mr, Elphinstone during its prevalence here, and my experience is confined to the few cases that occurred in our camp. I have however applied to the medical gentlemen attached to the auxiliary troops, for the result of their observations and practice, which has been considerable, and which I shall have great pleasure in sending you as soon as I receive it. Our escort consisted of 4 com- S* ss of sepoys, and about 50 irregular horse, several native gentlemen with their followiccompanied us, which increased our party >out 1,200 persons. 

E^e left Poona towards the end of June, and halting; about 10 days at Ahnaednus:-which we found quite healthy, we arrived at aon the 13th of July. During this part of journey the wind blew an almost constant from the westward, and beyond a shower vo, no rain fell. The thermometer in our i was generally about 83^ or Si 0 , at noon; 



144 





78° or 79° in the evening and morning-. We were visited at Tokaby a gentleman from Aurungab.-ul, who brought us accounts of the epidemic raging in that city, that the idea was, that it had been brought from Jaulna, where it now also raged, and that its progress through the villages on the post road from Nagpore to that station, could be distinctly (raced. The practice followed in the treatment of this disease at Aurangubad, was that recommended by Mr. Corbyn, and had been particularly successful; indeed if the patient applied in time, it was considered infallible. We arrived in Colonel M'Dowall's camp, a march beyond the Casserborra ghaut, in Gandeish, on the 19th, where the disease prevailed, and the gentlemen generally believed that it had been introduced amongst them from Jaulna, with which place, they had a constant communication. It did not appear that the disease existed in any of the villages in the neighbourhood. Four out of five Europeans attacked, had died; and about \ c l natives ; but a large proportion of natives had recovered. Mr. Corbyn's practice was fully tried on the Europeans, and in the opinion of the gentlemen who adopted it, it rather seemed to aggravate than do good. Ido not recollect whether the patieuW were bled, but I think not. We were pitched in the centre of Colonel McDowall's camp, and staid 



145 





one day; exclusive of that of our arrival, and our people and his must have mixed with each other. The day after leaving Colo .id ftlcDowmll'fl camp, one of our sepoys was attacked 0:1 the inarch with the usual symptoms of the epidemic ; hz was in the rear, and I did not see him till we cane to our ground, but the native assistant gave, hini'a dose of 50 drops of laudanum, and put him into a dooly. VlTUen I saw lira', his extremities wc:'3 cold, his pulse Wan scarcely to be felt at the wrist, his countenance had the peculiar nppearance so expressive of the disease, and although he did not complain much, he was very resllcss and rolled about in his bed. I gave him 20 grains of calomel and 5& drops of laudanum with peppermint, and ordered him Warm fomentations and frictions, and warm conjee. Although he now became quite quiet, he did not sleep, and the puiie did not improve for several hours, it at lengi* begun to recover, when a dose of castor oil a. id laudanum was given, which operated well, and removed th? danger. It was several days before he recovered his strength. We continued our journey through Candcish by Mullygom, Julna, Songeer (when we halted a few days) to the Taptee, at llopriel, and returned by Nunderbar and 13a main to C'handore, without haying- had any other patlenti, or meeting with the disease in any 

of 

146 





of the villages. A few d;«vs before we left Songeer, the epidemic had readied some villages f o the eastward, but I was not able to trace by what route. It also raged in Sir John Malcolm's camp at Mow fn thcsNerbudda : I did not hear any aftcount f/f the treatment that was pursued, but u;i-dersstood that the calomel and laudanum had failed in several cases. The weather during our stay in Candeish was very warm, the air (fad the salt* moist feel of that on the Cbast, the thermometer was often 92° at 3 p. in , and it seldom fell tc!o\v So°; very little rain fell till we readied theTapU- , from whence toChandore we had constant show* ers, but they were not heavy r.or of Ibhff continuance. We arrived at Cliandore on the 16th of August, halted the 17th and JSth, and marched on the 19th by Nassick, Akola, Nursaun^auai and Coryg-aum to PoOna, which we reached oa the 7th instant. We experienced a great change of climate on passing 1 the ghaut at Chandorc, the thermometer fell 1O and 'die air had t!.e coolness and elasticity of that of Poona, instead of the moist feel of that of Candeish ; we had daily showers during the remainder of our journey, and on some days the rain was heavy, and (ravelling became harrassin « to our followers. The epidemic had reached Chandore before us, and there were a few cases ia the town while we were there, but it had 



147 





not been violent or excited much alarm. A communication had been kept up between this post and Colonel McDowall's camp. The day after leaving Chandore, a servant of one of the bramins of our camp was attacked in the evening 1 , and brought to me at 3 o'clock in the morning". A dose of opium had been given him by his master, and he was not suffering much from spasms or retching. I gave him 20 grains of calomel and 40 drops of laudanum, and ordered warmth &c. A report was brought to me at daylight that he was better, and had been sent on in front on a camel. When we came to our ground, his pulse was scarcely to be felt, and his extremities were cold, ano" ther dose of medicine was given, and friction and "warm fomentations were had resource to ; but notwithstanding he appeared to recover a little, he died in the evening. We arrived at Nassick on the 21st, halted on the 22d and left it on the 23d. The disecse had been rasnn"; there with great violence, and it was supposed had destroyed 2 or 000 of the inhabitants. It was on the decline, but fresh cases were hourly occurring during our stay. Some of the bramins, without my making any particular inquiry on the subject, told me that the disease had been brought from Ahmednugur, by some Sebundee peons. Nassick perhaps contains 25 000 inhabitants it is situated rather low and 

b 

148 





is sheltered from strong winds, the streets arc narroAv and filthy, and generally slope towards the 

Godavery on which the tank is built. Our troops are cantoned to the N. W. of the tank, at a distance of a few hundred yards, on an elevated, dry, and exposed spot. No case had occurred amongst them, or the followers, although they had a free communication with the town. Mr- Warner, the surgeon of the troops at Nassick, extended his service with great zeal and humanity to the inhabitants, and I understood that almost all the cases that were brought to him early, were recovered. He did not seem to place much confidence in calomel, he gave laudanum, camphorated mixture and cordials, and recommended the patient to be put into a warm room with a fire, and the thirst to be allayed by warm conjee, a laxative was given as early as possible. The weather was raw and wet during- our stay at Nassick, and all the bramins with their followers, and many of our own, visited houses in the town. On the 23d, the day after we left Nassick, a follower of one of the vakeels was seized with the epidemic, the next day 2 more were taken ill, and the number of cases daily increased till the 28th, from which time they gradually decreased till the 3d instant, after which we had no more taken ill. The number that had the disease amounted 



149 





to about 32 or .33, besides which there were some anomalous cases, of these, 3 were sepoys, 1 nn auxiliary horseman, 2 gentlemen's servants, 2 palanquin bearers, 1 dooly bearer and 2 josfoosos, the rest were beggars attendant on the vakeels. The proportion of deaths was 7. The case of (ne of the number has been mentioned ; two died before 1 could see them, but had each a dose of calomel and laudanum; three had the usual remedies given to them, and one of these was bled, but they had not the benefit of warm lodging and good nursing-; the other patient died on the 3d day after the attack, after I had considered liim out of danger ; but I attribute his deatli to debility, and having been overcome by a. long march, rather than to the disease. 

From the above facts, and Qthers which have been related, I consider the disease infectious, but if this opinion is well founded, it ought to ocratiog no alarm, for it is only under some peculiarity of constitution, and that fortunately vtry limited, that the poison arts • about 1 in 40 in our camp was attacked, but 1 should think this is above the usual proportion. If the disease was occasioned merel\ by a distempered state of the atmosphere it would have spread over the country with some regularity, but the epidemic seems generally to have travelled in lines along- the post 



150 





151 

CHOI.F.IIA MOBBUS. 

roads, and always to have required a succession of subjects for its propagation. In Candeish where there is not sufficient population and but littleinterrourse between the villages, its progress was slow. At Punderpoor it made its appearance at the time of the great Jatra, and was spreadator.ee in all directions by the pilgrims returning to their homes. The poison would seem also to have been more concentrated there from there being so many source* of production ; the number of deaths in a few days were estimated at 3000, and the patients are drfcribed as having been knocked down dead, as if by lightening. We know nothing of the state of body that predisposes to the disease. Persons of all classes and both sexes, are equally liable to it. In our camps, the sepoys and our servants who were well fed and clothed, seemed to suffer less tjian the beggars and servants of the bramins. It has been suggested by Philo medicus, in his ahle letter, that deficiency of bile may be the predisposing cause, but dissection has proved that the gall bladder and its ducts, are stuffed with this, and found like the other secretions and excretions, as the urine, pus, saliva &c. ; it is merely pent up by the general spasmodic nffection that prevails, and is evacuated in abundance when this gives way. If I were to pretend an opinion, I should say, that the disease consisted in a peculiar state of the ncr- 





152 

MEDICAL REPORT OF THE 

vous system acted on by a peculiar poison producing a deranged state of the muscles, both of voluntary and involuntary motion ; but this amounts to no more than a confession of ignorance, for we know very little more of the nervous system than of this supposed invasion. The symptoms you are already well acquainted with, although there seems to have been some modifications of them at different places. The small and oppressed pulse, coldness of the extremities, and tint expression of countenance denoting 1 something pressing heavily on the energies of life, showed in every case I saw ; and these symptoms were followed in every case that did well, after an interval of from 12 to 24 hours, with a feverish reaction, that is, the skin became hot, the face flushed, and the pulse quicker and rather full. The thirst and call for cold water was always urjrent, the toninie in some cases was clean and to ' o florid, in others furred, and of a deadly white The muscular system was always affected. In old men and the healthy, these affections of the mus!of voluntary motion amounted to no more 1 what was termed a puffing ; in the young & jst, these are sometimes drawn into hard lumps nded with the most excruciating pains. The jms of the stomach and muscles of the rectum c marked by the water being; often ejected' in a 





small stream, as if from a syringe. I should have pronounced that some of thecascs I had were labouring under snake bites, had I not been better informed. I generally followed the practice recom* mended by Mr. Corbyn. In two cases, the calomel was not given, in 2 or 3 it was rejected, and not repeated, these all recovered. I thought the calomel when given with the first dose oflaudanum seemed rather to increase the irritability of the stomach, and suspected it good effects are rather to be attributed to its cleobstruent and laxative properties than as an antispasmodic. I think, it ought to be generally administered, but in Euiopeans not till the patient has been freely bled, and in both Europeans and Natives, not till the irritability of the stomach has been removed by laudanum ; no time is lost by this. It does not appear to me either, that there is any necessity for such large doses as 20 grains; the laudanum and opium should not be pushed further than to stop the vomiting and purging, and to allay the cramps and pains. It did not produce healthy sleep in any of my patients, although I gave it in large doses, but only a stupor and lethargy. It soon occurred to me that the small oppressed pulse could not proceed from debility, but mustarise from temporary interruption of the flow of blood through the heart. I therefore early had recourse to bleeding, and with the most 



153 





narked good effects. The propriety of bleeding is now further manifested by Mr. White's accurate ami well described dissection, and I am decidedly of opinion that it ought to be had recourse to in all Kuropeans and young and robust Natives ; and indeed to patients generally, unless they are very old, or very late in the disease. In many of the cases, notwithstanding the above remedies, there was a considerable struggle, and it was some time before the healthy reaction took place. In this instance, I alwnys employed friction, warm fomentations and warm conjee; and if the patient was not to be roused, a little brandy in it, or draughts with volatile alkali. The instant the skin became warm, I gave a dose of castor oil and laudanum, which generally operated, when I considered all danger removed. Excepting in one case, there was, apparently, not much suffering ; this was a young, robust Mussulman belonging to the auxiliary horse,* he was quite frantic with pain, and there seemed to be some delirium. A large dose of laudanum, and calomel produced no relief, when 30 ounces of blood was taken from him. and he was immediately relieved and fell asleep. No disease I have seen, requires more attention on the part of the physician and attendants than this, and on a faint ac* quaintance with it none seems more formidable, but if fairly understood, with our present expe- 



154 





155 

CHOLERA MORBtfS. 

CI do not think more than 1 in 20 would it, as appeared in our camp. I hope you rdon these hurried and desultory remarks. 

Believe me, 

Yours very faithfully 

S. COATS. 

I might have mentioned that all the subjects predisposed to the disease seemed to have been attacked at the places where it has appeared within JO or 12 days. After which there arose, at some of the stations, some anomalous and dangerous casea, some time after the epidemic had apparently 

No. 37.- 

C'ft.y of a letter from Mr. Surgeon Jukes, to Robert Stcuart, Esq. President Medical Board 

To 

ROBERT STEUAUT, Esq. 

FULSIDENT 

Medical Board, 

BOMBAY. 

Sir, 

Although I have given you almost daily reports of the progress of the prevailing epidemic (commonly, though I believe erroneously called cholera morbus) at this station, and generally, all over this 

Island, 



Island, and the North Concan, yet as you have expressed a wish that I should concentrate those scattered reports in the form of a letter, I have much plensure is doing it. 

¦The epidemic has been now so generally deibed and its symptoms are for the most part so well characterized, that it is unnecessary to enter into a particular detail of them. lam not aware that the disease as it has appeared here, at all differs from that disease which has now extended itself from the banks of the Ganges to the western ocean, and still seems to be extending its ravages; but it does in some instances assume an aggravated form, and attacks with so milch severity, that «ime appear to have fallen down suddenly and cd. I shall have occasion to report one or two very severe cases, which fell under my own care, Ii where I feel satisfied that nothing but the y prompt assistance that was offered, saved the 2S of several individuals. You no doubt in ur official capacity as member of the Medical ard, have seen several such cases recorded, and rhaps the late prevalence of the disease in Bomy has given you opportunities of seeing them rsonally. By the correspondence I had kept up th some of my medical friends in the Dcckun, I is informed of the progress and nature of the 



156 





disease as it appeared in our cantonments at Scroor, and my friend Mr. Craw's excellent letters, established at once the basis of my practice here. It is not wholly to this however that our success is to be attributed, for the rules established by our magistrate!, for the early application of the usual remedies, aided by their own zeal and [industry, contributed most essentially to the success of our exertions. Before I had to combat with the disease, I was very sanguine, and thought that the early application of caloric externally and intenuilh , while I abstracted blood largely to relieve the congestion of the internal parts, which I believed to exist, would be attended with the happiest effects, and I almost fancied might supercide even the use of calomel and opium. I soon had opportunities of applying my tfTeory to practice, and I think, that in most ca?e«, success would attend it, when applied early. It is very true, and very fortunate, that calomel and opium in large doses cure a very large proportion of those attacked with thedisease, for it would be absolutely impossible,, where so many are affected, to have recourse to the hot bath and bleeding, even if they were found more successful. Some cases however do now and then occur, where notwithstanding the calomel and opium have been given early, success has not attended their use, and I air. inclined to think that many lives 



157 





MEDICAL REPORT OF THE 

158 

have been saved by the use of the lancet, which u'ould otherwise have terminated fatally. 

Without at all adverting to the origin or immediate exciting cause of this very formidable disease, it must be quite evident to every common observer, that if the blood which now fills the vessels and warms the extremities, should from any cause be suddenly withdrawn from them, that that same blood must be still somewhere in the system; it has not been withdrawn, it is not annihilated. It is not now in the superficial veins, for they are all collapsed; the pulses at the wrist have ceased to beat, or beat vcy languidly ; and in short, the sodden appearance of the hands and feet at once bespeaks the abstraction of the vital fluid iron) all those parts. It must be quite evident then that some ot the internal vessels must contain a very undue proportion of blood; and aisseccions have proved this to be the case \v. the most satisfactory manner. What then, I would ask, are the inferences which such theory, and such facts oblige us to draw? surely, in the first place, to relieve the congestion of the internal vessels by copious bleeding; and in the next place, to stimulate the heart and the vital powers into action. There is nothing more immediately stimulating tothearterial system than heat, and hence the hot bath is strongly in- 





CHOLERA MORBUS. 

159 

dicated, and my own practice substantiates the truth of the theory. 

In some cases however, the attacks have been E sudden, and I shall briefly relate a case or illustrative ot this aggravated form of the dis- 

A stout and apparently healthy humaul of Mr. Marriott's was suddenly attacked with the disease, and, from the accounts we received, almost immediately became insensible. It is difficult to obtain correct information, as to time, from a native, but from all I can leafn, it appears that he had been attacked about two or three hours before he was brought to Mr. Marriott's house ; his hands and arms and feet were then cold, he had no pulsation at the wrist, but he faintly replied to questions put to him. Mr. Marriott had him put into a hot bath immediately, and had opened a vein in the arm, which only poured out a small quantity of black blood. It was now I first saw him, he was in the bath, I opened other veins and divided both temporal arteries, but in vain. No blood ilowed, & he died fri another hour: brandy, laudanum and aether &c. were poured down his throat. 

I have great pleasure in briefly relating another case, which occurred very shortly after this at Mr. 





160 

MEDICAL REPORT OF THE 

Marriott's house, and where the most complete success attended our exertions. 

I A stout healthy peon of the collector's, while sansing his gun in the chokey, was seized with sudden giddiness, and fell down insensible; he was carried instantly to Mr. Marriott's house. He describes him to have been without pulse, and quite insensible, he had opened a vein before Jarrived, which now bled very languidly; he was perfectly insensible, but there was a trifling degree of warmth yet in the extremities, and a very obscure pulsation could be just felt at the wrist. I instantly opened a vein in the other arm, and as the blood flowed from this, the vein which had ceased to bleed in the other arm began to flow afresh ; finding however that the blood still flowed slowly, a third vein was opened, and it was most gratifying to see the regenerated powers, as it were, coming into action as the blood now flowed in full streams from all three veins. He was perfectly insensible when I first saw him, and a slow and oppressed breathing was carrying on; but as the blood flowed from his arms, his breathing freshened, his lungs felt relief, he could now move his eyelids, comprehended when spoken to, and though he could not articulate he made signs that he was re. Jieved. I allowed the blood to flow till I think 40 ounces had been abstracted, when his pulse hay. 





ing become quick, and he a little restless, the ar ms were tied up, lie was put into a hot bath for a few minuies, when a copious perspiration was produced, and he was placed between warm and dry cumblies. I confess I have my doubts whether any thing more would have been necessary to secure this man's recovery, but as it was a severe case, I did not like to trust to the bleeding and the bath alone, and he therefore took. 1 5 grains of calomel, with about 50 drops of laudanum and a proportion, of ammonia and peppermint. Three hours after- WitflS, the skin was warm and moist; but as he complained of some uneasiness in his Stomach, although generally speaking lie was quite relieved, a few more drops of laudanum and peppermint were administered. 

Jt may perhaps be objected to this case, that it may not have been one of the prevailing epidemic, and therefore may admit of a doubt, whether bleeding is required in that disease. I believe however th.it most medical men who have seen much of the disease, as it has appeared on this side of India, have had too many opportunities of seeing such cases, and must have had many more reported to them by the native doctors; tor my o\yn part, I have no doubt but that this was really an attack of the prevailing epidemic under an ag&ra- 



161 





vated form, and that nothing but the early and copious abstraction of blood saved his life. 

T could relate many other instances of a simi- t nature that fell under my care, where the c measures were followed, with the same :ess. 

From what I have said above, it will naturally [inferred, that I should try the effect of blood ting and the hot bath alone. The first case the prevailing epidemic which occurred here, wever, so strikingly exemplifies the advantages bleeding and the hot bath, after calomel and lium had been given without any apparent ef:t, that I will shortly detail it. 

A stout healthy naig, of the detachment which escorted TrimhuckjeeDainglia, state prisoner, from the Deckun to this garrison, was the first person seized with the disease at Tannah. He was attacked about 7 a. m., and was sent to the hospital about 9 a. m., where my native assistants had already given him 13 grains of calomel and 10 drops o( laudanum with peppermint. I saw im about half an hour after he had taken this ose, he still complained of great pain about the ;robiculuscordis, and generally over the wholeabomen; he was '.ent forward with pain, his hands & eet were cold, with strung tendency to cramps in 



162 





his legs, and there was a general restlessness and anxiety about him ; he hud vomited some colourless fluid, his pulse was very slow and qppressccfj only 45 in a minute; he had not vomited since taking the calomel and opium, but as it had not afforded him the least relief, and the dose appeared smaller than had been usually administered, I immediately gave him 5 grains more of calomel and 20 miniums of laudanum, making altogether ) 7 grains of calomel and 80 drops of laudanum, with a proportion of ammonia and peppermint. Hot fomentations were applied as early as possible, and I ordered a hot bath to be prepared for him. While visiting my European sick in an adjoining hospUal, the bath had been prepared, fd my assistants had got him into it ; it was hot as he could bear it, and when I arrived 

a few minutes afterwards (about 1 l£- a m), the bath was then 112°. In a few minutes after being in the bath, the pain in the stomach and abdomen had left him and he felt much relieved, his pulse was now full and strong, and 110 in a minute, but intermitting irregularly. Notwithstanding the pain about the scrobiculus cordis had ceased, there was still a strong tendency to cramps in his leg. I bled him while in the bath to 30 ounces, the pulse no longer intermitted and the tendency to cramps was quite removed ; He 



163 





164 

MEDICAL REPORT OF THE 

felt, he said, quite free from pain. He was now put to bed and covered with cumblies. 1 p. m., a general glow of heat upon his akin, which was moist ; but as he complained of some little pain about the scrobiculus cordis, 40 drops of laudanum were repeated. sp. m., feels quite well ; but having had no discharge fr»m his bowels, I gave him a purging draught, which completely relieved him. This man remained in hospital for a day or two, on account of some irregularity in his bowels ; his mouth became sore from the calomel he had taken, but he required only a little laxative medicine. It is worthy of remark perhaps that no relief was in this case obtained from the calomel and opium, though it had "been taken two hours and a half ; and he was relieved considerably, in less than 10 minutes, after he had been in the hot bath ; and the tendency to cramps which still remained in his legs, as also the intermission of the pulse, was quite removed by bleeding. I cannot therefore lut think that 1 12 degrees of caloric applied to the body, whereby the circulation was restored to the extreme vessels, was of the most essential service, and the entire relief which followed the blood letting indicates its utility in removing the tendency to spams. It is true the disease being attacked early, might possibly have 





165 

CHOLERA MORB U S. 

turs ; but the first apparent good was undoubted* from the application of caloric. 

lAs I am of opinion that cases illustrate facts in s clearest point of view, I cannot deny myself the pleasure of relating one case of the prevailing epidemic, which was cured in a very short time by bleeding and the hot bath alone, and as far as I know, it is the first case that has been so cured. 

Colonel Boye's hookaburdar, a middle aged man, was attacked with the disease about 1 p. m. ; he walked with great difficulty to the hospital supported by two other men, he complained of excrutitttng burning pain about the scrobiculus cordis, he was bent double with pain, but he had not yet vomited or purged, his pulse was small and rather frequent, and the disease appeared to be making rapid strides. I happened to be at the hospital when he arrived, a hot bath was immediately prepared, and he was placed in it without delay ; it was as hot as it could be borne, and indeed it was some little time before he could bear it to be applied to his body; measured by a thermometer it was 1 14°. The bath alone relieved the pain considerably about the epigastric region, but not immediately. I opened a vein while he was yet in the bath, and the orifice being large, the blood flowed very rapidly ; I allowed it to do so, till the burning pain 





about the scrobiculus cordis had entirely ceased, at this time about 26 ounces of blood had been abstracted ; taking him out of the bath, he could scarcely be supported to a cot within 5 paces of it, when he fell senseless upon it. It was indeed a most complete fainting fit ; he was covered with warm cumblies, and 1 gave iiim a few drops of ammonia, but it was some little lime before he recovered his perfect warmth ; in 5 hours, he was so perfectly recovered, that he left the hospital and went home contrary to my advice, and without my knowledge. I have seen this man repeatedly since, and he has not had the slightest return of 

II could give you many more cases wherein the vantages of bleeding have been very marked, but thosfc I have detailed I think are sufficiently conclusive; and I will not multiply examples. Experience has now taught us that a very large proportion of those attacked with the disease recover by the calomel and laudanum alone, but I feel satisfied there are many aggravated cases wherein nothing but the most prompt and decided use of the lancet, could possibly save the patient ; for in a little time, the extremities become so cold, and the arterial action so weak, that it is impossible to abstract blood. I have repeatedly opened the 

temporal 

166 





temporal arteries, with several veins in the arms, without being able to get more than a few ounce* of very black, blood, which could only be obtained by mechanical pressure, and this, as far as my own observations go, affords no relief. In such cases a hot bath is frequently quite unavailing, its stimulus very often fails to excite the action of the heart and arteries, no increase of circulation takes place through the extreme vessels; the vital powers, in fact, seem insensible to the action of any stimuli, and the hands and arms of such patients become heated in the bath, just as any other animal substances would do, not possessing vital powers. Such cases however are not necessarily fatal, and I have hnd the pleasure of witnessing several recoveries from such apparently hopeless conditions of the human system. 

Although the prevailing epidemic is liable to attack people of all ages and conditions ; the weak and the infirm, whether from age or poverty or other causes, seem most liable to be attacked; and when attacked, undoubtedly suffer most. Travellers and those exposed to the inclemencies of the weather, as people at work in- the rice fields &c. seem to have been very liable to the disease. The vomiting and purging appear invariably to have been without bile, and I think resemble their rice 



167 





conjee more than any thing else. In some instance! the disease has been attended with extreme flatulency, sometimes the head aches very much, attended with considerable giddiness, but this is by no means universal; and the pulse is extremely various, spasmodic affections of the muscles do not generally occur early, and sometimes scarcely at all, I have seen the jaw locked in one instance, for a short time ; it was a female, and she recovered, after bleeding. In one or two instances, the blood drawn has had a slight buff upon it, but it ii by no means general. There has been a suppression of urine in a few cases; in one where I introduced the catheter, there was no urine in the bladder: this symptom only came on a few hours before death. The Europeans have been much less liable to attacks of the disease than the natives ; and considering the dissipated lives our invalids and veterans generally lead now, we have had but very few cases, and none yet fatal. Two European women have died of the disease ; both of them were rather advanced in age, ami had had the disease upon them for some hours before medical assistance was obtained. One of them was extremely dissipated ; but my letter has already become so long thitt I cannot detail her case: we examined the body after death; there was no particular congestion about the liver, stomach, or intestines ; the 



168 





Ss of the piamater were rather too turgid, en this was not particularly to be remarked ; entricles contained no unusual quantity of but upon cutting down through the right phere of the brain, towards the basis of the there was a considerable gush of serous fluid, appeared to have been extravasated there. 

A stout healthy soldier of the 69th, who was in the hospital fot a contusion of the foot, was attacked with the disease during the night, apparently from sleeping in a current of air between two open windows. This man's case is interesting, but for the reasons just before stated, I cannot here relate it ; he recovered, though we gave him over for some hours. Blood letting was had recourse to, but not till 7 hours after the attack, when the sunken eyes, con. tracted features, coldness of the extremities and constant vomiting and purgingof conjee like fluid, indicated the formidable progress the disease had made; powerfully stimulating injections, composed of assafcetida, tincture of castor, laudanum and salts, and a large blister over the abdomen, with brandy, aether, ammonia &c. seemed to save him. 

I A disease like the prevailing epidemic, which 9 now spread itself like a pestilence, from the inges almost to the Indus, and from the nor- 



169 





170 

• * - *^ 

them parts of Bengal over the greater part of the peninsula of India, assuredly demands very particular inquiry to endeavour to ascertain its origin, and the laws which have since directed its progress. I confess myself to be quite ignorant of almost every thing- that has be*Mi written upon the subject in Bengal, and indeed I, with others on this side of India have had occasion to lament that we have been so little informed on the subject. It has been a general remark, however, that the disease is not contagious ; and if to the present time, medical men should continue to entertain any doubts on the subject, there must be something still very obscure and very inexplicable in the nature of the disease. Others better qualified and better informed may trace its early progress ; I shall briefly here call your attention to its progress on the western side of the peninsula, and more especially as it approached our •wn territories. 

lam informed by a very intelligent officer, was at Jaulnah during the time that the se made its appearance there, and who himifterwards sustained ah attack of it, that the tinic appeared in those cantonments early in and immediately after the arrival of a denent from Nagpoor, where it seems to have prevalent a month earlier. It had got \o Se- 





roor I believe by the 18th of July; as yet they had had very little rain there, and I believe it was generally imagined that more seasonable weather, viz. some rain, might have a tendency to check the disease. It was hoped here that as the disease had for some months been moving gradually S. West, and borne along, as it were, by the N. E. Monsoon, that it might be checked by the violent S. W. gales which blow on our coast during that season of the year. 

SiVe were not long kept in doubts : on the 6th August it made its appearance at Panwell, very shortly after, we heard of its radiating th and south from that point, and it is now jnding itself through the Concan. 

It will not have escaped your observation that the disease travelled along the high-road from the Deckun to Panwcll; and I have not yet heard of any village in the Conkan that has had the disr ease, but by intercourse with places alread> labouring under the disease, It is worthy of remark perhaps, that the first person attacked with it here on the 13th of August, was a naig belonging to a detachment which left Seroor on the 28th of July, when the disease was very general there; and several men of the detachment fell ill on the inarch with it, and were sent into Poona. Thii 

detachment, 

171 





172 

MEDICAL REPORT OF THE 

detachment, which escorted the state prisoner Trimbuckjee to Tannah, came by water from Panwell, and landed at Chundnee on the evening of the 12th August. It was at Chundnee where the disease first appeared on this island. A man died there on the 15th, and from the account given me, 1 have no doubt it was a case of the same disease. On the 16th, however, se» veral were affected there, and it very soon be* came general in Tannah. 

I have had no reason to think it lias been contagious here, neither myself nor any of my assistants who have been constantly amongst the sick, nor any of the hospital attendants have had the disease. It has not gone through families, when one has become affected. It is very unlike contagion too in many particulars. In general I think it has been remarked, that the greatest number of people are affected in any place during the first few days the disease has appeared there; whereas contagion would be quite the reverse. There is undoubtedly considerable obscurity, however, at present belonging to this very singular disease; and the laws by which it has lately been moving from place to place, are very unlike those of common epidemic diseases. 

If the exciting cause be something in the at- 

mosphere. 



•nosphere, which has had its influence from Ben* gal to the Deckan, how did it come down directly against the S. W. wind that has been blowing upon this coast since June? How does it happen that the winds from the ocean still spread the disease? and if it be something general in the atmosphere, why has it not hitherto made its appearance in some two distant parts of the province at the same time? Nothing of this kind has I believe been observed; it still seems to be creeping from village to village, rages for a few days, and then begins to decline. 

It is generally reported that a similar disease prevailed here about 25 or 30 years ago, and that like this, it was imported from the* Mahratta country; perhaps the records of the Medical Board, or of the Government, would afford some elucidation upon this very interesting subject. 

In order to afford you every information: in my power, I will just add, that to common observation, there has been nothing very particular m the weather. The barometer has neither been particularly high nor low. The thermometeF for the last month ha 9 scarcely ranged more than from 76° to 82° and many days nearly stationary at 78° or 79°. Leslie's hygrometer according to the days, has ranged from- 8 to 20: the fall of rain 

fa 

173 





174 

MEDICAL REPORT OF THE 

* 

fa August was unusually great; measured by Howard's pluviometer, we had upwards of 48 inches. 

I have now only to entreat your indulgence to report ; lam fully conscious of its imperons, more licsure and more experience would ! enabled me perhaps to make it more worthy • acceptance ; but if any observations I have c, can tend to throw any additional light, ;rupon the nature of a disease or cure, which 

» 

ir as I know, is almost unprecedented in our ical history, whether we regard it as to the gcs it has made, or the Igreat extent of count has now travelled over, I shall rejoice in the >rtunity I have had of presenting them to 

No. 38. 

tof a letter from Dr. Taylor, to the Prcsl* dent of the Medical Board. 

To 

ROBERT STEUART, Esq 

PRESIDENT 

M> dica! Boar 'l. 

Sin, 

The twi> first cases of the present prevalent disease which,l believe, were observed in Bombay, oo 





curred on the 14th September in a narrow street or lane of the native town named Gunesa Wara, and were brought to my notice by a Brahman physician, who had heard me describe the disorder, and mention that, having raged from sometime in Bengal and Hindosthan, it was now travelling westwards in the direction of Bombay. On visiting the two persons thus reported to me, I found that they had the most decided characteristic symptoms of the disease. 

The first was a woman aged about 40 yenrs, of the Combhee cast. She had been taken ill the preceding evening, after sunset, with vomit'ifH? mid purging of a whitish watery fluid, accompanied with severe pain at the pit of the stomach, and general spasms. When I saw her, the vomiting and purging had ceased for about two hours, and she complained only of what she termed goleor knots in the muscles of the legs, arms, and abdomen, find of pain at the scrobicuHs cordis, which, however, was less violent than at the commencement of the attack. There was great prostration of strength, and the pulse at the wrists and temples was imperceptible. Her mouth felt excessively parched, her tongtye was foul, ana her desire to drink cold water was vr.rv urgent. Her extremities were quite cold, and her countenance bore a deadly ap- 



175 







176 

MEDICAL REPORT OP THE 

pearance. During the night she had taken some ginger and opium mixed up with honey, and frictions with warm spirits had been used, which afforded considerable relief from the pain occasioned by the spasms. I gave her 20 grains of calomel and 80 drops of laudanum, and directed fomentations to be used ; but she died in an hour and a half after I saw her. 

The second patient was a man who lived within two or three doors of the first. He had been ill upwards of 1 8 hours. At first he had only parging of a watery fluid, but 6 or 8 hours afterwards he was seized also with vomiting. He complained of violent heat at the stomach, and said that his fiver was burnt and dried up. The pulse at the wrist was feeble and indistinct. The day before I saw him he had vomited two or three worms. His tongue was not foul, neither did his mouth feel parched, tho' his thirst and desire todrink cold water were excessive. He perspired profusely, and there had been considerable retention of urine from the commencement of the disease. Be also, as well as the first patient, had taken ginger and opium, and used frictions with warm spirits. Calomel, and a laudanum draught, were given, him,, which were not retained on the stomach. 1 then proposed bkeding r but he would not sub- 





mittoit; he also refused to take anymore medicine; a short time afterwards, however, he consented, in consequence I believe of seeing the good effects produced on some other individuals. In the interval fomentations had been used. This man at last recovered. 

Aware of the desire manifested by your Board to ascertain, if possible, the manner in which the disease had originated in Bombay, I directed some enquiries on the subject ; in reply to which I was informed, that an inhabitant of Gunesa Wara, had, immediately on returning from a visit to Poona*, four or five days before, been attacked with cholera, and died ; that on the following day, his wife, and the wife of a man who lived next door, had also been seized with the same complaint, of which they both died ; and that almost immediately afterwards, two other neighbours, an old woman and her grand-daughter, had also fallen victims to the same disease. 

In this lane the disease continued to spread for five or six days following my first visit, after which it nearly subsided, and appeared only occasionally in one or two individuals. 

Seven other cases occurred on the lGth n dif- 

ferent 

* The dis.;u»e at Ulil time rayed at Pamveli 

177 





» 

ferent parts of the native town ; bat the next fatal case, which came to my knowledge, happened on the 17th: the man had been taken ill during the night, and in the morning one of my assistants was sent for, but it was too late, for the patient died in five minuses after the assistant arrived. This occurred in a pretty populous place above the jail. A considerable number of people residing in the neighbourhood were attacked immediately afterwards, and two or three of them who did not apply for medicine, died. 

It broke out almost at the same instant it) a place below the jail, where great numbers were taken ill in rapid succession ; and several to whom medicine had been administered, tho' not at a very early period, fell victims to this formidable disorder. 

At this time the disease had probably spread considerably throughout the island, for tho' only 26 cases were reported to me on the 1 Bth, and 22 on the 19th, this may have arisen from there being only 3 or 4 assistants employed in visiting the different parts of the town ; for on the 20th, when, under your orders, I obtained a large establishment of assistants, the number of reported cases amounted to no less than 10p. 



178 





Its progress during the next six days, as you will bserve from the daily reports submitted to you, vas extremely rapid. On the 25 th, the cases seen jf my assistants were 318, and on the 26th, 293. sut from this lime you will perceive that it be£an to abate almost as rapidly as it had commenced. )n the Ist September the number in my reports as 137, on the 15th, 97, on the Ist October 75» id on the 15th, 55. It continued decreasing till le Bth Nov. on which day only it) were contained 1 my reports; hut the number has again increasd. and for the last few days has fluctuated bevecn 20 and 30. A day or two of hard rain?emed to increase, in a small degree, the number f cases; but in other respects I have not percejvd that the disorder has been much influenced by le state of the weatlicr. 

The description of the two first cases which I aw, exhibits the most usual and general symptoms f the disease ', but in the numerous cases which uive fallen under my observation, a variety of ther symptoms have presented themselves. Noling indeed excites greater surprise, or perplexes le practitioner more, than the diversified sympoms of this disease. From the name of cholera norbtis which has been given to it, we should lave supposed that vomiting and purging, and es)t;cially of bile, were the invariable and most dis- 



179 





180 

MEDICAL REPORT OF THE 

tressing symptoms. In a number of cases, however, there was neither vomiting nor purging, while in others there was vomiting without purging, or vice versa; hut in none was there the smallest appearance of bile. Besides, when vomiting and purging did occur, they were, in the majority of instances, by no means frequent or severe, and were in general easily checked by calomel and laudanum. The most distressing symptoms, and those which most decidedly marked the disease, were spasms, frequently affecting every part of the body, and a twisting, piercing pain, or burning 1 heat in the abdomen, either at the scrobiculus cordis, or around the navel. The patients also frequently complained of burning pain in the region of the liver. Except in two or three cases, however, I never found that, unless in a very slight degree, the pain in the liver or abdomen was increased by pressure. The spasms which, with a very few exceptions, were a constant concomitant in this disease, were sometimes such as to produce the utmost distress and agony, the patients tossing themselves violently in every direction, and calling out to the by-standers to lay hold of their limbs or to sit down upon them. In one case, the patient screamed out in dreadful a£ony that his leers and arms were breaking. The?<* 

i-oT-ii): were couGo/ri sorttetimw to the bellies of 







the muscles, and sometimes extended throughout their whole length. They frequently affected the P 1 ;s of the chest and diaphragm so as to render ing difficult and laborious, and to produce sof suffocation. In some cases, the throat pecially affected, tho* without any great def pain, and the patient was rendered incapable of utterance. Trismus also occurred in several instances. Some individuals were seized with general tremors, while others complained of a sensation as if their bodies were pricked with. 

Eree different forms of this disorder have marked by several accurate observers, and ild conceive, frooa-wjiat has fallen under my observation, with much judgment and propriety. In the first form, the patient is attacked with slight pain in the abdomen, which gradually increases, and is succeeded by vomiting, purging, and spasms, after which coldnes of the extremities, loss of pulse, and clammy sweat gradually supervene. Of this form, many cases occurred where the patients after allowing six, eight, or even ten hours to elapse without applying for medical assistance, ultimately recovered by means of calomel and laudanum, with stimulants and fomentations. Among the first cases I saw, one was of this kind. It indeed proved fatal, but as 

it 

181 









182 

MKD.ICAL- HEPGRT : OF THE 

Bed as a salutary example of the promptitude , hich tht? proper doses of" medicine ought to ninistered, it may not be improper to notice lia place. 

A stout healthy looking lad of about 15 or 1 6 rears of age, came to me complaining of a slight uneasiness in his bowels, which he said did not amount to pain, and requesting that medicine should be given to him. Supposing it merely one of those OMCfI which are daily met with among the natives, especially at this season of the year, I only gave him 0 grains of calomel, at the same time leaving particular instructions that, in the event of his becoming worse, I should be sent for immediately. His complaint increased in the afternoon and evening, but unluckily the person to whom my orders were directed, instead of calling me, rested satisfied with giving him 6 grains more of calomel. At 10 o'clock next day, when I went to see the other patients, this lad was dead- 

In the second form of the disease, pain in the abdomen, vomiting and purging, are rapidly succeeded, by great prostration of strength, extreme coldness in the extremities, and an imperceptible pulse at the wrist and temporal arteries. The eyes nr e yellow, fixed, nnd sunk ; the face and breast are covered with a cold, clammy perspira* 

tion ; 





tion; the patient frequently lies in a state of coma, and when roused, usually makes no complaint, except perhaps of spasms in the extremities, and of feeling that hu is about to expire. These symptoms occur often within an hour, or an hour and a half, after the first attack of the disease. Almost all of these cases, which came under my observation, proved fatal. In them the calomel and the large doses of laudanum, combined with the most powerful stimuli, produced no sensible effect; and when a vein or the temporal artery was opened, the blood either refused to flow at all, or only trickled down slowly in drops. I seldom had an opportunity in such cases of trying the warm bath, but in one instance where it was used, it seemed totally to fail in rousing the powers of the system, or in relieving the symptoms. 

Four or five cases of this form of the disease occurred at my house. I shall only notice two of them. The first was that of a Kamati girl about 11 or 12 years of age. She was brought tome about 6 in the morning, and was said to have been taken ill three hours before. Her ex¦ tremities were perfectly cold, the pulse was imperceptible, and her eyes were sunk in their orbits. As no blood could be obtained, I gave her some calomel, with a laudanum mid stimulant draught. By these means she was somewhat relieved for a 

183 





short time, but she soon again became worse. The warm bath was then used, and stimulant draughts were repeated at short intervals, but without avail. Sheexpiredin 3or 4 hours after I first saw her. 

The second case was that of a fuqe r, who while attending a sacrificial festival made by his cast to avert the direful attacks of the juree muree, or fatal disease, was suddenly seized with severe pain in the abdomen, which was immediately followed by slight vomiting and purging. When brought to me within an hour and a half afterwards, he had most severe spasms, his eyes were yellow and sunk, his extremities cold, the pulse could not be felt, and he was covered with cold perspiration. Veins were opened in both arms, but scarcely any blood flowed. Cnlomel and laudanum were then given him, and were followed by stimulant draughts and fomentations, and applications of bottles of warm water to his extremities and abdomen ; but no relief was obtained. He rapidly sunk, and died in the course of three hours from the time of his being brought to mv house. I had not an opportunity of using the warm bath. 

Of the third form of the disease, I have also seen several instances. The patients fall down suddenly deprived of sense, the pulse is often feeble 



184 





and indistinct, but sometimes rather full and strong 1 . When he recovers a little he complains of great pain in the head and giddiness, and frequently of pain in the abdomen. Trismus occurred iv two or three of these cases. 

It will be sufficient to mention only one case of this description. A woman who lived close to the Bendy bazar went out about 7 o'clock in the morning to purchase some articles. While in the bazar she fell down senseless, and in that sate was carried to her home. One of my assistants was immediately sent for, and he gave her an ounce of the mixture. Alarmed however at this appearance of this disease, he instantly came to inform me. When I saw her, she had recovered a little from her state of insensibility, and her pulse was good, but she had a considerable degree of trismus. I bled her to the extent of u»-wards of '24 ounces ; and as she complained before I came away of pain iv the abdomen, I ordered her a scruple of calomel, and directed that in the event of her bowels not being moved, she should have a dose of castor oil. These measures were attended with good effects, and she speedily recovered. 

These different forms of the disease, however^ arc not to be regarded as distinct species Lut mere- 

iy 

185 





\y as varieties produced by the same cause operating on peculiar constitutions, and on persons of diversified habits and situations in life. That in many cases of the second form the patient had laboured under slight symptoms of the disease for sometime before he actually complained, is a circumstance extremely probable, and was most likely to occur amongst the poorer and more laborious classes; and accordingly it was found that, in agreat many instances, the first complaint was made in the evening after the person had returned from his labourduring the day. In such cases, theprevious exhaustion from bodily fatigue would aggravate the disorder, and render it more rapid in its progress. 

Should these details regarding the character of the disease be deemed, at the present period, te» Pand unnecessary, it is hoped that some acof the medical practice adopted at this carried on under circumstances, as far as cnv, new and peculiar, and of the sucwhich hate attended it, will be considered more novel and important. The practice, in al| the reports I have seen, was conducted in hospitals, under the immediate eye of the surgeon, who had proper native assistants under him, and was amply provided with every convenience for employing with promptitude the various rcmediej 



186 









required. It was soon ascertained by your board* 

iowever, that the circumstances under which reef would be afforded to the immense population fthis island, were very different, and that the rejudices of the natives would, in scarcely any instance, 

allow them to receive medical assistance in hospitals or places where numbers could be attended together. As the only course then left was to administer medicines at their own houses, you were compelled to employ a numerous establishment of native assistants ; and in the immediate pressing urgency of the occasion, many were necessarily engaged who had not the slightest know^ ledge of medical practice: I have however, much pleasure in reporting to you, thatsuchof ihe assistants as were placed under my orders, have been, in general, very attentive and assiduous in the discharge of their duty, and that, judging from the numerous opportunities I have had of observing their practice, they seem, from the instructions which they received, to have been enabled to distinguish the disease with a good deal of accuracy. 

I For their information and guidance, a general jcription of the disease, & of the method of cure be observed, were translated into the Hindoostha?, Mahratta, andGuzerattee languages, and each them was furnished with a copy of these instruc. us in the language which he best understood. 





188 

MEDICAL R.bPORI' Of TKB 

The method of cure which, after consulting with 

you, I ordered to be used by the native assistants, was extremely simple. They were supplied with scruple 

doses of calomel, and a mixture composed of laudanum, essence of peppermint, brandy, and water; each ounce of which contained .0 minims of laudanum, 10 minims of essence of peppermint, three drachms of brandy, and four drachms of water- The calomel was first given in powder on the tongue, and then washed down with an ounce of the mixture. A similar dose was ordered t« be repeated in two or three hours, if the patient derived no material relief from the former; or to be repeated immediately should the first be rejected, a circumstance, however, which very seldom happened. Besides giving these medicines, the assistants were directed, in all cases where it was practicable, to use the warm bath ; and when, as it generally happened, this could not be done, to endeavour to alleviate the spasms and the pain in the aldomen by fomentations with cloth wrung out of warm water, or by fomentations with warm bricks or tiles, or salt wrapped upincloth.s. Frictions With warm spirits were also directed, which almost uniformly afforded great relief. The patients were ordered to be laid on a cot, underneath which* ihigraf filled with warm ashes were placed when it wal necessary ; vessels tilled with warm water were 





189 

CHCUUA MOXBUi. 

also appriedfo the extremities. When by the use of these remedies the more violent symptoms wene removed, but some pain or uneasiness in the übdomen still continued, and the bowels were not moved, an ounce or an ounce and a half of castor oil was rriven. In addition to the other stimuhints already mentioned, I sometimes directed doves and cardamoms to be taken, when the extremities were cold and the pulse feeble. Particular injunctions were given not to allow the patient to drink cold water ; but to allay in some measure his urgent thirst, he was permitted sparingly the use of warm congee. The assistants were also enjoined not to suffer anyone to be disturbed who felt a disposition to sleep. 

|\s the majority of cases were seen onh by the ive assistant?, I have judged it proper to gi yev c » account of the general plan of practice they •c directed to pursue. Considering every cir- DfUnctj the success attending it has been eh greater than could have been expected. 

Iriie same practice was adopted by myself, with > exception, that usually I had recourse in the t place to bleeding. The accounts I had read the disease, and of some dissections which wed a great congestion of blood in the abninal and thoracic vessels, led me to conde that bleeding, in many cases, would be 

the 



the most efficacious remedy. Accordingly it will be observed that I wished to try the effect of blood letting in one of the first cases, but was prevented by the unwillingness of the patient. A day or two afterwards I was called to see a person who had been ill 18 hours, and had received from one of my assistants two closes of calomel, and two laudanum draughts* At the time I saw him, tho' his mouth was affected, he had excruciating burning pain in the abdomen, with tormenting thirst and spasms. With some difficulty I prevailed on him to submit to bleeding) and took from him at least 24 ounces. During the bleeding* the pain in the abdomen entirely ceased ; and what is a little singular, on his arm being tied up, he lay dowa on his left side, which the people of the house said he had not been able to do before, tho* he did riot complain of any uneasiness in the region of the liver. As slight spasms still continued, I ordered him to be put into the warm bath. By these means, and the exhibition afterwards of a dose of castor oil, he entirely recovered. 

The next patient whom I bled, had taken calomel ami the laudanum draught, which had put a stop to the vomiting and purging ; but when I saw hi ip he had mo^t dreadful spasms, was perfectly cold, and no'pulsatinn could be felt at the wrist or in the •-.¦.•¦;•=•,: aru-y. lopencd vein* in boll. 



190 





191 

CHOLERA MORBUS, 

Rut not more than 2 or 3 ounces of blood Circumstances rendered it impossible to warm bath. He died in a short time afs, 

The two next cases in which blood letting wai employed, were relapses. They were both females. Calomel and laudanum had removed entirely for two or three days all the symptoms of the complaint, and at the time I saw them their mouths were affected. The first of them complained of dreadful burning pain in the abdomen, which was increased on pressure, and of much headach and thirst. The other, besides a severe twisting pain in the abdomen, accompanied with a sensation of heat, had also great thirst and spasms. In both cases the pain in the abdomen was instantly relieved by bleeding. The warm bath was used in the second case with the best effect. One or two doses of castor oil were afterwards given, and both persons 

From this time, bleeding was very generally adopted in the cases which I had an opportunity of seeing : latterly also it was had recourse to by such of the assistants as had learnt to bleed, and was sometimes even urged by the patients themselves and their friends. In almost every case it relieved the pain in the abdomen, and the 





spasms; nnd when the principal symptoms v»tM 

great oppression at the brenst, laborious breath, jug, and a sense of suffocation, or when the patient had trismus, or general tremors with giddiness bleeding was the only remedy which afforded effectual 

relief. 

When it could be obtained, the usual quantity 

of blood taken nway was '24 ounces, nnd no case occurred to me of the disease after such copious bleeding (for in a native it may be called copious) proving fatal. In two or three instances, however, it was found expedient to repeat the bleeding. 

But while bleeding in an early stage of the disease, and under certain circumstances, almost uniformly produced the most decided and sakitary effects, it was in genera! unavailing in the latter stages, or in the worst forms of the disease, when the extremities were cold, the pulse could not he felt, and the eyes fixed and sunk. In such cases indeed it was impossible, as has been already observed, to procure a proper discharge of blood, which merely trickled down in small drops; and opening the temporal artery was attended with no advantage, for by this means I never obtained more than 2or 3 ounces of blood. Under such circumstances, no pulsation could be felt in the artery, and uV .An» Jr» /\r\oi r\r tu'rt in^*Jinr<*' th^ hiOOfl floui^H trXCrpi ul one vi iww i**»»»i**»v*| win. uiwv* a wvu 



192 





out of it without any pulsatory motion. Almost the whole of theee cases proved fatal. A few however, in which thedischarge of blood, tho' small, was followed by faint ness and prefuse perspiration, terminated favoiirablv. 

Aindngst these almost hopeless crises, I met also with a few who recovered, tho' not the smallest discharge of blood could be obtained. I bhitll briefly notice one of them. Me was a boy of about I" or 13 years of age, who complained of excruciating pain in the liver, with spasms ; his pul*e coilld not be felt, and his extremities were quite cold. In puncturing a vein, I had little hopes ot procuring a flow of blood, tho' I expected that, as in other former cases, an ounce or two might issue by drops. I was therelore somevfb.it surprised to find that the incision, tho' pretty large, was not even tinged with blood, but bore the same appearance as it' it had been made OB a dead bodr. The boy was saved, however, by the free use. of calomel and laudanum, with powerful stimulant draughts formed of aqua aimnuni;i, ether, and brandy. In the three oilier ca*es the incision prrsentcd the same appearance I have mentioned. One of the patients however died. 

The cases in which their wa<? ah oppnrfimitv <»f using :he warm bath were very few, but wiieurref 

« 

193 





194 

JVI C* LJ 1 j\ 111 1 *\ 1 . fc L^ 1\ X v/ j* AII HU 

it was used, it proved the most powerful means of quieting the patient and relieving the spasms. 

After the most violent symptoms were remov* ed, small doses of calomel combined with opium, were sometimes given with great benefit. Jalap or castor oil were given to procure a free discharge from the bowels. 

To enter upon a discussion on the nature of this disease, concerning which a variety of opinions have been expressed, would be inadmissible in a report which has already exceeded its proper limits. The uneasiness or pain in the liver which often occurs, the yellowness of the eyes, the to t;il absence of bile in what is vomited or passed by stool during the continuance of the disorder, and the discharge of bile, frequently vitiated, which takes place after it has been subdued, may be adduced in support of the opinion which attributes the disease to some derangement in the biliary system; while the almost constant occurrence of spasms shews that the nervous system is greatly arfu'cted. 

IVhether the disease be contagious, or a simple lemic produced by some peculiar state of the Qsuhere. is a question which has been a good I agitated. The course which it lias pursued l) one extremity of India to the other, uncheck- 

Ed 



Ted by different states of temperature, and by great variations of the seasons ; its proceeding even against the powerful monsoon winds, and its having been traced moving along the high road from place to place, have been urged as proofs of its contagious nature. The manner in which it was found to have originated and to spread at this place, lends some probability to the same opinion. Its introduction to Bombay has been clearly traced to a person who came from the Deccan and passed thro' Panwell when the disorder was raging there; and it has been observed here, that whenever it appeared in any particular spot or family, a considerable proportion of the family, or of the neighbours, were attacked within a very short period of each other: on many occasions I have seen 3 or 4 of a family lying sick, at once. In bringing forward these facts however, it may be proper at the same time to state, that of the 44 assistants employed under me, only three were seized with this complaint. 

Whatever may be the origin of this disease, the most powerful predisposing causes are circumstances which induce debility. Those who have suffered most severely in Bombay are the very poorest classes who live on meagre food, undergo considerable fatigue, inhabit wretched huts, and who often not possessed even of a cot are oblic^d 



195 





196 

MEDICAL REPORT OF THE 

to sleep on the mud floor with scarcely a cloth to spread underneath them At the season it appeared here> cold and moisture peculiarly predisposed to its attacks. In the Kamati village which lies low, and, during the rains, is surrounded with water, and the inhabitants of which are chiefly hnmals who are much exposed both day and night, the cases were the most rapid in their progress, and in proportion were attended with the greatest moi ta- 

Amongst the better classes many individuals have also been attacked, but a very small proportion of fatal cases have occurred where assistance was called in time. 

Ejroportion to i»s number the Musselman tion seems to have suffered as much as the d. In those parts of the native town which abited chiefly by the lower classes of Muss, and of that particular description of them Memons, the cases on different occasions were very numerous, and the mortality cdnsiderable. The diet and habitations of these Musselmans differ very little from those of Hindoos in similar situations in life. 

¦: preceding remarks will Se considered wholly ible to the native population. With the ion of five or six instances amongst the com- 





197 

CHOLERA MORBUS. 

tnon soldiers, no European I believe has suffered from the disorder at this place. 

From the first appearance of the disease at Bombay on the 14th of August, up to the present date, medicine has been administered, in the districts under my charge, to /45y patients, out of which number there have occurred 44] deaths, being in the proportion of nearly six to a hundred. Two or three hundred cases, however, which have been attended by myself without any assistant, but of which the pressure of my occupations prevented me from keeping an exact register, are not included in the above number. 

It will afford me the highest satisfaction should you consider this as a favourable result of measures which were conducted agreeably to the orders of your Board, and under its active superintendence. 

JOHN TAYLOR, M. D. 

Jttistamt Surgtom* 

Bombay, 16f/i November 1818 O 

No. 3& 



198 

MEDICAL REPORT OF TKI 

No. 3<J, 

Letter from George Ogilty, Esq. to the Preri* 

dent of the Medical Board: 

To 

ROBERT STEUART, Esa. 

PRESIDENT MEDICAL LU\UV, 

Si*, 

In compliance with your desire, I have now the pleasure to submit to you such observations as have occurred to me on the prevailing epidemic as it has appeared at this presidency. 

I shall not enter into a detail of its various symptoms, as these have been repeatedly described in the numerous reports that have been aU ready submitted to you. Different degrees of severity may, no doubt, have marked this disease at different stations, and sometimes one svinptom have predominated, sometimes another, but its characteristic features appear to have been generally and essentially the same. A few desultory observations, therefore, are all I can piesume to offer. 

Neither the strong contrary monsoon winds then prevailing, nor the insular situation of Bombay itself appear to have had any influence iv exempting it from the attack of this singular dis- 



# 



order; which, advancing from the eastward, made its appearance on this island about the middle of August, and soon spread with astonishing rapidity frcrn one end of it to the other. It appear* to have attained its height about the end of that month or beginning of September, when 300 or 4uO cases occurred. daily. Alter which it began to decline, at t'rst rapidly, and subsequently it lias continued to exist in a varying tho* much diminished degree. 

The epidemic has been here chiefly confined to the natives, very few Europeans having been aU lacked by it, and of these, the higher orders seem to have been almost entirely exempted,, tho* some have complained of symptoms that led to a belief that an unhealthy state of the atmosphere prevailed. I have, however, observed that the Parsees, who approach nearer to Europeans in constitution and habits of life than many of the other classes of natives, have suffered considerably. In the Fort many were attacked, and the disease was sometimes extremely rapid and formidable. 

As the first symptoms of this epidemic are fre* quently slight, it has been remarked that the remedies employed have had the credit of curing cases of cholera that would have merely proved attacks of simple ciiolic or any tiling else, and 



199 





- 

200 

MEDICAL REPORT Or- THE 

that too favorable an opinion of the had hi' Consequence been formed. That this may have j occurred now and then 'is not improbable, but in i far as my observations go, certainly not to any extent. In some instances, where I had au opportunity of watching the patients, I delayed giving medicine as long as I possibly could with safet\, for the purpose of ascertaining whether they were actually cases of this complaint in its early stages or otherwise, and in almost every one of these I was compelled to have recourse to vigorous measures in the end. The success which has attended the measures adopted here, and the small proportion of deaths that have occurred when compared with the thousands attacked, are, I think, chiefly to be attributed to the great alarm which the disease excited on its first appearance on the island, and the consequent promptitude with which the natives applied at the numerous stations for assistance, every thing depending on the early administration of the re- Ul CU 1 wo • 

An instance of the insidious manner in which this disease not unfrequently commences, occurred in a horse-keeper of my own. While I was absent on a short visit he had been twice slightly purged, and on my return complained of a trifling 

uneasiness 



' 

uneasiness in his bowels. He appeared to have passed nothing but a little dark watery fluid perfectly destitute of bile ; and on questioning him, I found that he had felt a little griping about two hours before. He looked dark round the eyes and his pulse was somewhat small ; but had the epidemic not been prevalent, I doubt if I should have thought any thing of the symptoms. It was now about 10 a. m., and I gave him as soon as the medicine could be procured, 20 grains of calomel together with a dose of the mixture which is kept ready prepared at the different stations, and which contained a drachm of laudanum with some brandy and peppermint. These were retained, but did not entirely check the symptoms, he had occasional sickness and pain at the stomach, and a smaller dose with fomentations were administered about 12 o'clock. He was allowed to remain in his own hut, and now appeared to be doing well ; towards evening, some fluid he had incautiously taken brought on a return of the symptoms in the most aggravated form. I found him at 1 1 o'clock at night, lying exhausted on his cot, with the most violent retching and purging recurring incessantly, tho' in small quantities and without any appearance of bile. He was bathed in profuse cold perspirations, his pulse was almost gone, his countenance shrunk and ghastly, burning heat and 

pa,n 

201 





pain at his stomach with cramps and twichings in all his lirabs. I gave him immediately 4 grains of extract of opiu.m soaked in oil of peppermint, which he fortunately retained, and I had him instantly conveyed to the hospital. The hot bath was ordered, and while getting ready, a glyster was exhibited with half an ounce of laudanum. He remained in the bath, which was as hot as it could be borne, for a full quarter of an hour, when he became languid and sleepy. He was then well dried, placed between warm cumblies, and soon fell asleep. A gentle and warm moisture broke out almost immediately afterwards ; orders were given that he should not be disturbed by unnecessary interference, and he awoke in a few hours free from all immediate danger. Some days elapsed, however, before the biliary secretion was perfectly restored, and it was necessary to give him small doses of calomel occasionally, with purgatives, which, together with camphor mixture and cordials, and light nourishing diet with a small proportion of wine, gradually brought him round. Had this man been more under observation in the first 

instance, all the latter symptoms might have leen prevented. 

* 

Bis wife, who was in a bad state of health at the time, and who attended him during his iliues', W2S uttiickcd with cholera about three weeks af- 

terwards ; 

202 





terwards; her case was not reported and she died. 

I have not personally met with any well authenticated case of recovery without medicine. 

The treatment which I have generally adopted with the natives when the disease is encountered in its early stages and milder form, is to give a large dose of calomel and landanum in the proportions already mentioned, with a little brandy and peppermint, which is generally retained; if not, it is repeated as soon as the stomach gets a little composed, and in the meantime hot fomentations, or the warm bath if procurable, are employed. If the patient is not decidedly better in less than two hours, or even in a much shorter period if the symptoms 'are urgent, the dose is repeated again, and again if necessary, either in. full or diminished proportions. The spasms and irritation are allayed, the balance of the circulation restored, and the patient speedily recovers, requiring little more perhapa than a gentle cathartic or two afterwards ; and in a large proportion of these cases, I have found it unnecessary to employ ether, ammonia, or any of these active stimulants. The disease appears to be cut short, the morbid chain is broken, and the cold stage in which they are more particularly required, is prevented. 

I have seen the medicines given in double doses 

by 

203 





• 

by mistake: an instance occurred to myself. I was called to a sepoy who was repoited to have fallen down in a kind of fit, I found him recovering from a state of insensibility and complaining of a most excruciating pain at the stomach, with sickness, giddiness and slight spasms or twitching! in the calves of the legs and arms. His countenance was shrunk, his pulse small, and no time was to be lost. The usual medicines, which were to be found in almost every house, were administered. He was carried to the hospital with orders that the warm bath should be got ready, but nothing done until my arrival. I followed immediately afterwards with the intention of placing him in the bath and of bleeding him ; the note which I had sent with him, had miscarried, and I found that the dose had been instantly repeated. This man took therefore 40 grains of calomel and upwards of 200 drops, of laudanum in less than half an hour. I found him inclined to sleep ; nothing more was done, and in two or three hours he was as well as ever he Was in his life. The medicine seemed to have no other effect, th in that of arresting the symptoms which were making rapid Strides. 

Altho' purging and vomiting are generally among the first evident symptoms of this disease, yet I have never found thorn prove the most formidable. One ©r other of them is not unfrequently 



204 





Snt, sometimes both, and they usually yield to icine without any. great difficulty even in ; which prove fatal. The name which the ise has commonly received with reference to i symptoms, would convey a very erroneous 

Pains or burning heat at the stomach, and spasms, in some degree or other, have been rarely, if ever entirely, absent in the cases which have fallen u\w der my observation. In some, the latter have been so extremely violent as to render it requisite to have the patient held down ; in others, and much moreger^erally, they have been confined to cramps in the limbs, sometimes severe, but very often amounting only to a kind of gnawing, or creeping sensation, so slight indeed that the patient will not mention them, unless he is questioned. 

In a great majority of the cases that have come under my notice, ™ head has not been materially affected ; the patients have frequently retained their senses to the last, and have answered questions rationally within a few minutes of death. 

In some instances however, the coma and stupor have been very great. 

Although the disease is much more under the influence of medicine \fhen the symptoms com- 



205 





Ie with slight purging, or vomiting, and follow other in gradual succession, yet it does not r to me to be less certainly fatal under these :n stances if left to itself than when the pais attacked suddenly with giddiness, coldloss of pulse, and all the most formidable toms at once. 

If the calomel and laudanum with the warm bath do not speedily obtain relief; if the medicines are obstinately rejected in th^ir various forms, which is seldom the case ; or if the symptoms arc urgent and rapid from the commencement, I have recourse to venesection, and often with the happiest effects : but this remedy among natives, to whom my experience has been chiefly confined, is perhaps not requisite in Q cases out of 10. This is extremely fortunate, as the lancet cannot always bo had recourse to among an extensive population, where the disease has been so extremely prevalent as it has been here, even had its necessity been more generally apparent than I have found it to 

Kxcruciating pain or burning at the stomach, re spasms or affection of the head, appear to :ate the immediate use of the lancet; and in t cases I have deemed it prudent to have rese to it without delay, and generally with 



206 





the most decided advantage. Where along with the spasms there is some heat of skin and quickness of^pulse(asl have occasionally met with in the commencement of this disease), I have thought it preferable not to use the bath so hot as in the latter stages when the stronger stimulants are required. A moderate warmth seems at this period to relax the surface better, and proves more soothing. In some of these instances, particularly when there is much determination to the head, I have been cautious in pushing the laudanum; and indeed in all cases when the symptoms appear to give way I discontinue it as soon as possible. Other measures then become requisite: but under the general circumstances already mentioned, opiates when used with care, have proved invaluable. 

The mouth becomes not unfrequently affected from the calomel that is given within the first few hours, and in all these cases the secretions afterwards appear to come round more speedily to their natural state ; but I have not givun the medicine with this intention in the first instance, as the patient is generally either dead, or out of danger, before it could be effected, and as the prejudices of the natives seem so much against the u»e of mercury, as to render it advisable to prevent this result as much as possible, from the tendency 

it 

207 





¦ild have in checking their ready application lief. 

When this disease is far advanced in its symptoms, altho* possibly but a very short time may have elapsed since its commencement, when the skin is cold and the pulse gone, the most active measures and unremitting exertions become requisite. The external application of heat in every convenient form, warm and stimulating frictions, large doses of calomel, hot brandy and water with, spices, ether, ammonia &c, become absolutely necessary ; and under these circumstances all are but too often unavailing. There is frequently at this period much oppression at the chest with great restlessness, and anguish ; and these prove* not uncommonly, most distressing symptoms. 

By far the most formidable symptom in this extraordinary disease, both in appearance and re-» ality, is the remarkable coldness of the skin, depending on the diminished energy of the circulation which seems almost entirely to desert the surface. Many recover from this state by an assiduous and unremitting perseverance in the measures already mentioned ; but it notunfrequently happens that every thing we can do, proves alike unavailing. The case is indeed desperate. 

Pissections have shewn that there is a great 

accumulation 

208 





!:cu munition of blood in the large vessels and ternal viscera ; they are apparently gorged and •pressed, and every measure that tends to restore c equilibrium of the circulation, one would narally suppose must be useful. Bloodletting pears to have this tendency by removing part of c oppressing fluid, and drawing the remainder into circulation, and thereby, if I may be allowed ie expression, mechanically relieving the oppressed gans, which may then, perhaps, admit of being ore readily roused into action. Advantageous suits may possibly be anticipated from it on other indples, but I shall not attempt to theorise. 

II have tried it in this stage of the di sense freicntly ; it has very often happened that I could )t get the blood to flow by any means whater; when I have succeeded in this, it has often led, ns well as .ill other remedies, in doing any »od ; but several cases have occurred in which [jave derived advantage from it even under the ott discofiraging appearances, and I am not aire that I have seen it do harm. 

Ilt is chiefly, however, in the early period of this case, to meet particular symptoms when urgent, jh as formerly mentioned, that I have resorted to and then with the most unequivocal success; but ntralhf speaking (with reference to natives) it is t requisite; and the other remedies, when adn.i- 



209 





Kitered in time, overcome the disease and accomsh with safety aH that can be wished for. 

I Internal inflammation may sometimes occur, and 2n gangrene, but I feel convinced, that death is t seldom to be attributed to these causes. The ilady is far too rapid in its progress, and the tient is too generally overtaken before these :al affections run so far, as in themselves to dcs- 

I Unless in some few instances 'vhich may prove 'y suddenly fatal, or in those cases where the readies are had recourse to so early in the disease to arrest the further progress ol the symptoms, uve always found the remarkable coldness of • surface and partial suspension of the circulan, to ensue, sooner or later; and I am induced consider them as the most prominent features this truly singular disease. Indeed they may nerally be perceived to accompany it from its ¦y commencement and they are sometimes exidingly rapid in their progress. 

II have seen several instances of this disease, in iich, after the violent symptoms have been reived, the patient has continued in a kind of low ctive state, with a distinct, though contracted Ise, and death like coldness of the skin, the eyes low, and the countenance pallid. This, if notdeiding upon, is generally connected with a dis- 



210 





I state of the biliary functions, which do not *to recover from the shock, they have sus-» : but I have never remarked this state to continued, where the system has happened c been affected by the calomel. 

One patient died suddenly in this way on the 3d or 4th day after he had got over the violence of the attack ; and my attention was, in consequence, particularly directed to its future occurrence. I have always found it removed by calomel, in large or small doses according to circumstances, followed up by purgatives, together with camphor mixture, and perhaps the spt. ammon. aromat. with mild cordials and light nourishing diet. 

In two or three cases I have observed very extraordinary convulsive motions of the extremities and head recurring at short intervals; and in two instances (both women), these were very remarkable in the muscles of the abdomen, and seemed to depend on the augmented irritation arising from worms. They were both Parsees, and in one of them, the pain & burning heat at the stomach were so excessive, as to induce me to bleed her twice, though of a weakly habit. The calomel, followde up by compound powder of jalap and castor oil, dislodged and brought away a nest of worms matted together, to the number of a dozen at least. The relief was immediate. These are common 



» 

211 





212 

MFDICAL REPORT Of THE 

with the natives, and have no connection with this disease in particular, further than hy aggravating or modifying some of its symptoms, and it is no unusual occurrence for the powerful medicines which are given, or even the symptoms themselves, to disturb and bring away great numbers of them. 

I have seldom used blisters, excepting when the head has been particularly affected, and the patient comatose ; or to remove local symptoms consequent to the disease. When the patient is seen in the commencement, I have found the remedies already mentioned prove very generally successful; and in the latter stages, when the pulse is gone and the patient cold, I have been induced to rely more on the hot bath, stimulants, frictions, and remedies of a more general nature. When blisters are employed, in order to ensure their acting, the best plan, perhaps, is that which has been recommended of destroying the cuticle by nitric acid, and then neutralizing it by means of salt of tartar, and afterwards applying the blister to the part. 

The sooner medicine is had recourse to in this disease tfle greater is the chance of recovery. Its awfully rapid progress admits of no delay, and we find that calomel and opiates, the warm bath, bloodletting, frictions Syith stimulants, and the external application of heat in all its various forms, blisters, together with ether, ammonia, brandy 





. 

urnl other powerful stimuli internally, glysters, anodyne, stimulant, and laxative, and cathartics, form the principal means of cure. The whole m.iy become requisite in one individual case in its cfinerertt stages, but all of them are nor. always necessary, and some of them are no doubt at times decidedly injurious. Euch remedy is to a certain extent useful, and much may depend on their judicious selection and combination in the various cases which present themselves. Sometimes patients shculd.not be disturbed; sometimes the remedies, particularly heat, cannot be too assiduously employed. 

Phe continuance of this epidemic, through all the ms of India, and the extraordinary mnnner in h it appears to travel, have occasioned diffvropinions with regard to its being of a contagfous nature or otherwise. So much doubt indeed exists on this point, that it might be presumption in me to offer an opinion. Of the two iimuvc corps Ehere, aii;d of which I held temporary charge ng the indisposition of the medical officer :hed to them, the cholera was much more alent in one than in the other, and in a much c aggravated form. From this circumsunce, ever, I can draw no positive inference that nncontagion; as the former is a newly raised 

corps 

213 





214 

MEDICAL REPORT OF THE 

corps consisting chiefly of recruits, who have been more drilled, and are possessed of much fewer comforts than the old sepoys. Many of them were also destitute of sufficient clothing, and consequently suffered from being unable to change after returning exhausted from parade, and (as it was during the monsoon) not unfrequently wet also. That the corps in question was more predisposed to disease^ from some particular cause or other Uheir local situation being the same), is very evident from the great number of cases of severe bilious remittent fever which have occurred in it, and which are certainly not infectious. Neither have any one of the hospital attendants been attacked with the epidemic, although they were in the habit of assisting the patients day & night. Hammauls, it has been observed, have suffered more on this island than many of the other castes, so have fishermen ; and it has been, I think, justly remarked, that fatigue, poor diet, bad clothing and exposure to cold and moisture, particularly predispose to this disease. 

I have the honor to be 

&c. &c. 

GEO. OGILVY, 





' 



Copy of a letter firom Frederick Corhr/n, JBff; 

the medical officer in charge of the. native field 

hospital with the centre division of the. grand ar?tu/, I'flatire to the treatment which had been found most efficacious during tlw prevalence of the alarming epidemic that lately visited the armi/ in it's course thro' the province* iub- 

jf-cl to the presidency <<f Fort William. 

I In compliance with your request to give you structions for the treatment of the disease which prevails in camp, from the circumstance of your being frequently detached •from the army without medical assistance, I give you a statement wilh much pleasure. 

I The s.mptoms are as follows : Violent vomiting id purging of watery matter, spasmodic cramp i the extremities extending to the abdominal id muscles of the chest, a collapsed countenice, the pupil and the white of the eye covered ith a thick film, a suffusion of blood and turgity of tlieir vessel*, the eve atkngth sinks into 5 socket and iaunediiiUftlv becomes fixed. — The 

extremities 



extremities now become cold, and the pulse is not: » be felt, and indeed the energy and action of : heart are considerably diminished.. 

I The first man,' I saw thus affected, was treated i th three grains of calomel and a quarter o('a , am of opium every two hours with frequent lughts of- brandy and water, and other stimuits; the man. died and .l opened him on theme evening. 

[[found the itnmaah partly . filled wit l i muddy ter, the: bowels were empty .and considerably, lated with air, hardly any bile in the gall blad', none in the biliary ducts, there was general lamination of the bowels., liver, stomach, .and , 

These were indications to follow a directly opposite mode of treatment. Consequently, on assuming chargeof the, native hospital for the reception of camp followers, and public establishments, on the l(3tb of this month, one hundred and tin patients were admitted with tljes)mptoms I have described.. 

I immediately gave to each patient I 5 grains of calomel, which I dropped on the tongue awd , washed it down with 60 drops of laudanum and 20 i drops of peppermint in 'I ounce* of water. 

Before . 

2 





3 

A P P E NT D I X. 

Before I go further, it will be necessary to mention to you, that laudanum in a large dose of (it) ilrops is not a stimulant but a sedative, whereafc laudanum from Id 4trops to 20 and 30 is a stimulant, the former produces sound sleep, removes spasm and irritability, whilst the latter excites considerable uneasiness and convulsive starting. 

I, 'ill appear the, more remarkable to you when . mention that the variation ot a. dose of caloas the same effects. 

|)mel in a dose from 5, 8, to 10 grains, excites lie, sickness, irritation of the bowels, and, ount of. it's being a stimulant, acts as a good ivc, but calomel in a do^e from 15 grains- to sedative, allays vomiting, removes spasm, ., the patient to sleep, and produces one. or, oiionSis. * 

|.i will now observe on what principle I treats y patients; not on a plan of giving powerful i ants, Lut on one which at once removes the ility and spasm, composes the stomach and , >wels, produces sk-ep and tranquillity of the excites the secretion of the liver, and nethe progress of inflammation^ 

On the second day it was indeed a consolatory light to observe the wonderful change. 

i'he vomiting and the purging had stopped, the 





Spasms removed with general moisture on the skin, they had experienced soi.no. sltcp, ai.d ihe j,ul»e had returned lo the wrist. 

mow gave 30 grains of jalap which effected or two bilious motions. — Of one hundred and men 1 Olil) lost two, and those were dcc Tepid men, in whom the vital energies were at i extinguished, — the remaining one hundred eight 1 had the good fortune to see all reco- 

il! the treatment of Europeans, however, I should strongly recommend copious bleeding, and never less than twenty grains of calomel with (JO drops of laudanum and 20 drops of peppermint ill 2 ounces of water, and, on the spasm attacking the abdomen, the application of a large blister. 

(ild the blister fail in drawing and the blood v from the veins, immersion in the warm 11 have the most beneficial effects. Should m bath not be procurable, warm frictions I of warm water thrown over the patient iduce an equally favorable result in bringut the reaction of the circulating system. 

When the purging and vomiting are incessant, as well as violent, we ought never to be alarmed in giving as far as 80 drops »>f laudanum with '20 drops of peppermint, and '20 grains erf calomel, 



4 





and injecting 40 drops of laudanum in conjee by enema. 

A few hours determines the safety of the patient, therefore triese few hours must not be lost in an undetermined manner and by small and useless doses. 

After the fiist shock is over, that is, after three or four hours, if there is much spasm and irritably lity remaining, the dose of calomel and draught, must be repeated, the patient will then fall into sound sleep and awaken nearly recovered. 

The after treatment will only be to keep the bowels regularly open with calomel and jalap, and to give occasionally 60 drops of laudanum to promote sleep. It is howevur to be remembered, that it would be an error and do considerable harm to bleed in persons who are weak, worn down by disease, and aged. 

The most urgent symptoms in this disease are violent thirst and dreadful sensations of burning heat n the bowels and pit of the stomach ; the frequent & lamentable calls for cold water should never be satisfied, for I observed many unfortunate camp followers who had died in the act of drinking. I. therefore gave warm conjee, and by the means of sentries, prevented any water being taken into the , 

Hiccough 

5 





* 

Enough is not a dangerous symptom in this , for there was hardly a patient recovered t suffering this spasmodic irritability. 

II am of opinion that unless a patient takes these medics within 6 hours after the attack, the case hopeless, at least I only recovered ten patients th the regular form of the disease, after a greatlapse of time ; and in those the symptoms 

Ift is of the greatest importance to bear in mind \ necessity of giving calomel in powder instead pills, for I have known many instances where Is were passed through the patient in thesume te and form they were taken into the stomach, is point therefore is of such high importance, it, in fever, dysentery, but above all, in this nplaint by which a patient is carried off in 12, farthest 30 hours after the attack, firm which :umstance it becomes necessary to affect the tern immediately, otherwise if this point should overlooked, the chief object in the operation of I medicine may be frustrated and the- patient t. 

iltispn this principle I recommend laudanum preference to opium, one is directly active in it's sraiion, but the other has to undergo the proi of or perhaps never dissolving 



6 





¦ through the system in the S3me state it was into the stomach without producing any whatever. 

I am so convinced of what I now assert and recommend, that for these last three years I have never once used any medicine in the form of pills And I look back to the day when 1 first discovered this error in practice as one great improvement in the treatment of acute diseases. 

I ding over the foregoing I find I have neg. to mention the use of peppermint in co-ope- with laudanum, the reason I prescribed it 'om its known good qualities in expelling air inflated bowels and stomach, and I have found it have that effect in the most de&ira- 

lat this disease is not infectious, lam perfect- ivinoed. All my attendants upon the sick. escaped the disease, and I have more parti- \j at all hours of the day and night respired nosphere of a crowded hospital with impunity. 

XI fancy there have been a combination of , perhaps ene of the principal was the sud- tanget of atmospherical temperature, for [ knew the thermometer vary so much as it ib season. 

In 

7 





E morning at day break it stood at 52° and clock 96 ° — a variation of 44 degrees in 6 id a half. 

I must beg leave however to decline at present entering into the causes of this disease, from recent investigation and circumstances it has put on more the appearance of being epidemic, than it did on the commencement ; but as I have leisure I trust I shall be able to correct any errors in this letter, which is written during the pressure o* other business. 

Believe me, 

My Dear Sir, 

Your's Faithfully, 

(Signed) FREDERICK CORBYN, 

Assistant Surgeon, in charge of the Native 

Hospital, Centre Division of the Armj, Camp Eritch, Not. 

26, 1817. 

8 





'appendix, & The following; tables contain the number of cases and deaths from Cholera within the Island of Bombay which have been ascertained. The first and second columns of each month contain the cases and deaths where medicine was administered. The third column the number of deaths ascertained by the Police without medical astistance. As the numbers in the third column are formed from reports of only a particular part of the Island, they are necessarily under the actual v numbers, and it is probable that one third or one fourth may be added to them. 



10 APPENDIX. Accost I*lB. ~ ' September. t JJai/i\ to^.J L>fnthr\ Polux Oao \ Co.; | lscaths\l J olti-e~ 1 ] ' ' '"" I z | " ' 1^ o 2 191 1 S5 o C ltv * 37 4 | •' 23° 2f 22 5 5 2ie 1; '^3 6 « 22- l- 3^ 7 ! 7 202 1 11 g 8 174 11 19 9 9, 194 12 19 1( 10 187 9 IS) j, 11 168 '« 13 ,2, 2 12 I<>3 I*- 8 l; 13 170 10 U j! 14 178 6 7 ' 10 3 1 15 168 3 19 lt> 10 1 I lfc l^ l ' 12 17 13 2 2 1? 17 ° 7 a 18 26 2 7 18 152 3 6 19 64 3 *0 ld 15 ° 9 J0 20 213 14 22 20 , 164 13 12 21 312 17 33 21 1 26 2 21 22 340 22 21 22 "9 6 12 *>3 361 2*> 27 2.9 131 6 14 24i 448 30 35 24 100 8 10 25 21 C9| 25 I 0 * 1 10 W 2G 1 483 25 46 2' 92 7 17 07 . 377 13j 42 27 183 10 12 28 381 09 15] 28 H' s 8 7 29 3291 23 18 29 Ub 8 10 30 2*o 11 28 30 I° 9 6 17 •M 200 16 2 I | |__ ¦"XiOJJ 25b] 40<jJ "4804J 557| 647 



APPENDIX. 11 "October! |j November j)w| Casi-'s'lhaihs Pbfavj' D"y>\ Cases \JDt'(Uhs\ Police ' 1 107 ~ ~~7 ll|| 1 28 0 2 2 121 10 91 2 24 0 2 3 112 ft 8 3 SI 0 1 4 87 5 14 4 25 I 2 0 103 4 14 6 21 1 3 6 91 II 10 6 32 1 I 7 107 7 Pi 7 25 0 2 8 '102 9 lt»j 8 19 0 0 9 100 5 13 9 2<» 4 10 89 G 616 1 10 21 0 0 11 89 4 s! 11 29 0 O 12 84 7 3, 1 12 20 O 2 13 83 9 11 13 26 3 0 14 77 G C 14 Ul 2 4 15 85 4 13 MS 40 4 1 lb 76 2 Si <> 40 0 2 17 tiS 4 4 1? 31 0,0 18 82 9 18 28 . 0 0 19 70 3 3 19 26 1 0 20 74 6 4J 20 M 0 6 2J 65 1 0\ 21 N 2 d 22 60! 6 ' 3j 22 30 3 0 23 73! 3 6j 23 34 3 24 731 3 2h 33 2 25 52 4 25 21 3 26 69 3 2; 20 25 3 0 27 40 1 1 27 2b 3 28 49 3 2 & 2b 1 29 43 3 3 29 32 2 30 52 2 2 3° 2 4 5 311 25 1 4\ 2411 146 101 l 82 1 44J 29 



12 APPENDIX. December. January Ibl9. /><ry* Ca*e* Deaths Police Days Cases Deaths Holic* J 36 4 1 29 { 1 ~~ " ~3 2 26 ] 1 2 21 3 4 3 22 3 8 20 2 6 4 26 2 4 33 6 $ » 5 . 29 1 2 fi 40 11 2 6 25 3 5 c 38 I * 10 7 25 3 2' 7 35 6 12 8 2.3 0 7 £ 44 5 3 9 27 0 2 9 30 6 6 10 18 0 1 1( 81 0 8 11 14 0 3 ii 32 2 4 12 22 1 2 12 27 3 4 13 23 3 13 25 6 7 14 34 1 3 14 2 4 6 15 37 6 X 3( 7 9 16 27 2 4 16 34 6 13 17 23 1 1 I? 30 5 2 16 32 6 18 29 2 2 19 29 0 4 19 31 6 1 2(i 40 6 0 2(J 2' 3 2 21 23 3 21 29 2 2 83 25 C 3 22, 31 6 0 $3 26 3 83 i>i 1 G »4 1 4 B4 2(. 2 2 «s 23 2 8 26 25 0 2 8« 1 G 2€ |9 0 l fc 9 2 27 35 3 1 2(, 3 4 2 fc 20 2 -¦' U 9 C| 29 23 0 1 » (> 22 j g 6J 30 28 1 31 26] 3 9jf 31 2f> 1 c*o6; C4~ ~foll*~ ' bh9l H4J ° 125 



13 

APPENDIX. 

l'l BIUAIJY. I'V.BKLM Duii* Cases 1 Deaths l'mitt \ ¦ j>s Coats Dc.it hs Police 1 22 / \ l§ Ijjlj 4 2 26 2 lti| 19] 2 3 88 1 17 17 2 4 18 2 1 I 17 0 5 1G 1 K> 18 0 C 96 0 SioJ 16 1 7 23 1 21 14 8 2? 2 'J2 16 1 9 23 0 23 16 > 0 10 lo 1 24 IS 1 11 17 3 2u 1> 1 1* 9i) 0 l>f\ 7 6 13 20 2 27 ) 6 6 14 16 J_ 2J I ABSTRACT of CASES. 

1817. Cases. 

Deaths. Police. 

August, 4400 256 409 

September, 4804 .... 257 478 

October,... 2411.... 146. 181 

November,. 824 44 29 

December,.- 806.... 64 Tl 

1819. 

January,. ... 889 .... 114 125 

February,.... 517 27 

14651 938 1294 

1 Proportion of Deaths in those cases where itUciue was administered, 6.4 per cent. 





APPENDIX. 

14 

The population of the Island mny amount to between 200 and 220 thousand, say 210000. The number of ascertained cases 15945, which givea the proportion of attacks of the disease for the population 7£ per cent. 

P. S. 7he disease still continues in the Island at the rate of about 10 cases daily. There are few deaths. After having disappeared for two months on the Island of Salsett, it lia9 recently broken out • »nd in one of the villages alluded to in the preface, which had entirely escaped during the greatest prevalence of the disease, no less than 23 of a population of 80 have died. April 6th 1819.