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ANNALS OF CHOLERA : 
 
 FUOil I'HK 
 
 EAUIIEST PERIODS TO THE YEAH 1817, 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/annalsofcholeraOOmacp 
 
ANNALS OF CHOLERA 
 
 THE EAELIEST PEEIODS TO THE YEAK 181T 
 
 JOHN MACPHERSON, M.D. 
 
 INSPECTOR-GENERAL OF HOSPITALS H.M. BENGAL ARMY (RETIRED). 
 AUTHOR OP " CHOLERA IN ITS HOME." ETC. 
 
 WITH A MAP. 
 
 UNDIQUE DECERPTA. 
 
 LONDON 
 
 H. K. LEWIS, 136 GOWER STREET, W.C. 
 
 1884 
 
 lAll Rights Reserved.'] 
 

 /V\ ^^ 
 
Ithit^tth io 
 
 PROFESSOR 
 
 DR. MARX VON PETTENKOFER, OF MUNICH, 
 
 AND TO THE MEMORY OF 
 
 THE LATE PROFESSORS 
 
 DR. C. A. WUNDERLICH, OF LEIPZIG, 
 
 AND 
 
 DR. W. GRIESINGER, OF BERLIN, 
 
 IN APPRECIATION OF THEIR LABOURS IN PROMOTING THE STUDY OF 
 
 THE .ETIOLOGY OF CHOLERA, 
 
 AND IN REMEMBRANCE OF OUR MEETING IN LEIPZIG AT 
 
 THE CLOSE OF THE YEAR l865. 
 
PEEFACE. 
 
 The appearance of Cholera in Egypt during tHe pre- 
 sent year, and its continued prevalence there, have 
 excited fresh interest in that disease. A re-issue of 
 this workj which appeared originally in 1872, may 
 therefore perhaps prove acceptable now, especially 
 while so many problems respecting the aetiology and 
 the treatment of Cholera remain unsolved. 
 
 The book treats of only one portion of the subject 
 of cholera : it is merely a collection of facts gathered 
 from all available sources, and is not written in sup- 
 port of any particular theoretical views or opinions. 
 Yet, as the study of its past history ought to throw 
 some light on the present of the disease, it may 
 possibly, from the large amount of ground which it 
 goes over, help to give a breadth of view in consider- 
 ing the questions connected with the subject, which 
 is at present rather wanting in our discussions. 
 
 We have abundance of opinions respecting Cholera 
 
U PREFACE. 
 
 and the modes of its diffusion^ but certain views may 
 appear to explain the phenomena of particular out- 
 breaks^ yet may not be found to bear the test of 
 general application. These annals of Cholera appear 
 to show, that its malignant form may prevail al- 
 most anywhere, and under any circumstances, although 
 the disease has its favorite habitats and its favorable 
 accompanying circumstances. 
 
 The mere facts of this book have not been called 
 in question ; but all of them have not been very 
 heartily received, even by some weighty authorities. 
 Some of these have remarked, that after all, the dis- 
 ease since 1817 must be considered a difierent one 
 from what it was before that period, because authors 
 before 1817 did not seem to think that the disease 
 was transmissible from man to man. It is true, that 
 the first author who alludes to the question, in his 
 account of Cholera at Goa more than 800 years ago, 
 remarks that ^''the poison does not seem to be catch- 
 ing," an opinion in which most writers before 1817 
 seem to have been agreed. But was not this the 
 common opinion of medical men in India for at least 
 two decades, after the outbreak of 1817 had made 
 
PREFACE. Ill 
 
 most of them familiar with the disease ? The epi- 
 demics of that and of subsequent years, do not 
 seem to have produced any change of opinion re- 
 specting the transmissibihty of the disease. The 
 same authorities, although accepting the account 
 by Bontius of malignant Cholera in Java in 1629, 
 are inclined to ignore the equally clear Portuguese 
 accounts of the disease in India, a century earher. 
 
 As this book treats solely of Cholera before 
 1817, the only change that might be expected in 
 a new edition of it, would be the incorporation of 
 any new facts which had come to light respecting 
 the history of Cholera before that date. Such new 
 facts would, almost of necessity, be merely confirma- 
 tions of what was already abundantly evident ; but, 
 in truth, I have not been searching for more evi- 
 dence, and I owe to the kindness of Professor 
 Dowson the only addition I have to make. He says, 
 that Jehan Gir, in his authentic biography, men- 
 tions '^ that one of his nobles died of the cholera 
 (Haiza) in the Deccan in 1616." He goes on to 
 say, " that in that year a dreadful plague (ivaba or 
 ouha) broke out in many parts of Hindostan. It 
 
IV PEEPACE. 
 
 first appeared in districts of the Punjab, and gradu- 
 ally came to Lahore. It spread through Sirhind 
 and the Doab to Delhi and its dependent districts, 
 and reduced them and their villages to a miserable 
 condition. It had now wholly subsided. The dis- 
 ease was considered a new one, and its most pro- 
 bable cause was, that for two years in succession, the 
 country had suffered from famine, and there had 
 been a deficiency of rain." 
 
 Haiza undoubtedly means Cholera, and it is well 
 to have thus a distinct notice of it in the interior of the 
 Continent of India at^this time, as there is rather a 
 want of notices of the disease in India proper be- 
 tween 1577 and 1639. As to the nature of the 
 epidemic, any form of fever would certainly not have 
 been considered as something new. Still I do not like 
 to pronounce that this plague was Cholera, because 
 the word waha, although used by Arabs at this day 
 for Cholera, is not so specific a word as haiza. It 
 certainly would have been interesting, to have found 
 a positive record of Cholera pursuing its course 
 down, instead, as is usual, up country in India. 
 
 I shall now make a remark or two on some of the 
 
PREFACE. T 
 
 subjects alluded to in the Appendix. It contains a 
 note^ whicli points out what seem to be rather far- 
 fetched conclusions of Dr. Bryden^ respecting the- 
 connexion of European and of Indian epidemics be- 
 fore 1817. Dr. Bryden has since died^ to the great 
 regret of all interested in Indian medical subjects,. 
 No one has ever contributed so much to a know- 
 ledge of the vital statistics of India, or has studied 
 the laws of the diffasion of Cholera more deeply. It 
 is unfortunate,, that there has always been a certain 
 want of clearness in his language. But there are- 
 few authors who can enter on the complicated sub- 
 ject of epidemics, without involving themselves in 
 obscurity. Nevertheless, as long as we continue ta 
 see diseases such as Cholera, or even Small-pox, 
 (which differs from it so much in transmissibihty 
 and in all respects), or their germs, if it is preferred 
 to use that expression, spread at one time with im- 
 mense rapidity, and at another shew no tendency ta 
 spread, it may be fairly assumed that there is some 
 cause for this, although we can at present offer no 
 adequate explanation of its nature. Cholera has been 
 thought to spread by direct contact or communica- 
 
VI PREFACE. 
 
 tion; or by means of a poison believed to reside 
 in cholera dejections^ and conveyed througli drink- 
 ing water, or by soiled clotbing, or as an emanation 
 from the soil after the excreta have lain in it for 
 some time, or as an impalpable substance borne 
 by winds. These modes of transmission in their 
 fullest operation, (and aided by individual or by 
 local predispositions, which are much less simple 
 and definite influences than they are usually as- 
 sumed to be), are insuflBcient to explain the sudden 
 spread of an epidemic. Some undiscovered addi- 
 tional agency is required. 
 
 In the Appendix there is a short paper on the 
 analogies of Cholera nostras and of malignant 
 Cholera. It may be of some use now, at a time 
 when the question has been raised again, as to what 
 clinically distinguishes the two diseases; and when 
 some physicians even doubt whether the recent epi- 
 demic in Egypt was the malignant disease ; when it 
 is mooted, whether Cholera ever originates de novo 
 in other countries, besides in India ; and whether it 
 may not originate in India, in other parts of the 
 country, besides in those which are considered to be 
 its especial homes. 
 
PREFACE. VII 
 
 Curiously enough, viewing the matter historically, 
 there appear to be few early notices of Choleraic 
 disease in Egypt, although the delta of the Nile is 
 well suited to be its cradle, but this is also the case 
 with regard to Lower Bengal, which is now regarded 
 as the chief seat of mahgnant Cholera. 
 
 I would add, that I regret that I did not notice 
 more fully in the body of the work, the subject of 
 Cholera Infantum, as that disease in its most acute 
 forms very closely resembles malignant Cholera, and 
 as it resembles it in this other respect, that it has 
 particular seasons for making its appearance in dif- 
 ferent parts of America, and probably in other coun- 
 tries, just as Cholera has in India. It seems to me, 
 further, a remarkable fact, that while Cholera Infan- 
 tum is not infrequent, and when it does occur, is 
 very fatal in India, yet deaths of infants from 
 malignant epidemic Cholera are comparatively speak- 
 ing rare, both in India and in Europe. 
 
 This brings me to remark, that a Berlin observer 
 has recently discovered low forms of life in the in- 
 testines of children who have died of Cholera nostras, 
 just as Dr. Koch has made somewhat similar obser- 
 
Till PREFACE. 
 
 vations in some Cholera cases iu Egypt. One must 
 welcome the discovery and the establishment of any 
 fact connected with the pathology of Cholera^ such 
 as that of the constant presence of a form of bacillus 
 in it. But it does not seem at all likely that the 
 ascertained presence of such low organisms in cases 
 of the disease^ will in any way affect the general or 
 the special treatment of malignant Cholera. 
 
 Some friends have asked me_, why I have not con- 
 tinued these annals down to the present period. In 
 reality, I have no new facts to contribute to the re- 
 cent history of the disease. Besides it is to be found 
 in many works, and it has been treated of with con- 
 considerable fulness by my friend Mr. Charles 
 Macnamara in his " Treatise on Asiatic Cholera." 
 
 JOHN MACPHEESON. 
 CuEzoN Steeet, W. 
 December, 1883. 
 
TABLE OF CONTENTS. 
 
 CHAPTEE. PAGE 
 
 I. — LiTEEATTmE OF THE SUBJECT .... 1 
 
 II. — NOMEXCLAXrEE 6 
 
 III. — ChOLEEA FEOM THE AgE OF HiPPOCEATES TO 
 THE CouniENCEMENT OF THE SIXTEENTH 
 
 Centtjey 15 
 
 IV. — Choleea in THE West FEOJI A.D. 1500 TO 
 
 A.D. 1817 43 
 
 V. — Choleea in the East feo:m: a.d. 1600 to 
 
 A.D. 1750 79 
 
 VI. — Choleea in the East feom a.d. 1750 to 
 
 A.D. 1817 124 
 
 VII. — Rejiaeks on the (Jutbeeak of 1817 . . 159 
 
 VIII. — Gfneeal IIeview of Choleea in the East . 17G 
 
 IX. — Geneeal Summaey 200 
 
 APPENDIX. 
 
 1. — On the Analogies between Choleea Kosteas 
 
 AND Choleea Indica ...... 207 
 
 2. — On ENDEiiic AND Epidemic Colics . . . 225 
 
 3. — SUPPLEMENTAET NOTE 231 
 
ANiNALS OF CHOLERA. 
 
 CHAPTER I. 
 
 LITERATURE OF THE SUBJECT. 
 
 Cholera is one of the most ancient diseases of 
 whicli distinct descriptions exist. It is a disease 
 that varies a good deal in its manifestations, and it 
 has been variously defined in consequence. Its 
 general characteristics are so well known, that it is 
 unnecessary to offer a fresh definition of it, especially 
 as I am not going to write a treatise on its theory 
 or treatment. 
 
 When we consider the enormous bulk of the 
 literature to which cholera has given rise, par- 
 ticularly within the last forty years, it is surprising 
 to find how little has been written concerning its 
 early history. Yet it so happens, that there are 
 few diseases respecting which such an uninterrupted 
 chain of evidence exists ; and it is, on the whole, 
 not creditable to the English, who are so directly 
 interested in India, that they have added little to 
 the accounts of the early history of the disease in 
 that country to be found in the admirable reports 
 of Messrs. Jameson and Scott, of the Bengal and 
 of the Madras Medical Boards, now fifty years old. 
 
 a 
 
 ^; 
 
Z ANNALS OF CHOLERA. 
 
 It is the object of tliese pages to supply sucli addi- 
 tional information,* and if these records do not aspire 
 to completeness or to the dignity of history, I have at 
 least striven to write them in the impartial spirit of 
 an historian. This is the more necessary, as it is 
 very mmsual to find any writings on the subject of 
 cholera, even ofl&cial reports, in which the author 
 does not show a very distinct bias for some one 
 theory as to its eetiology, pathology, or treatment ; 
 and unfortunately no theory that has been hitherto 
 brought forward on any one of these points, can be 
 considered to have advanced further than the stage 
 of being under probation. I shall therefore give, 
 as far as possible, the accounts of authors in their 
 own words, so that every one may have it in his 
 power to di'aw inferences for himself. IMy com- 
 mentary on them shall be very brief, and my 
 observations, as far as possible, only such as seem 
 in a manner to force themselves on us. Some 
 further consequences, which appear to me to flow 
 naturally from the history of cholera, I have placed 
 in an appendix, as all may not assent to them. 
 
 I had intended, in the first instance, to limit myself 
 to notices of the disease in the East ; but I soon 
 found that the subject must be handled very im- 
 perfectly, especially with reference to dogma and 
 treatment, if the history of the disease in other 
 
 *I had already done so partially in the "Quarterly Re- 
 view," January, 1867, in the translation of "Cholera in its 
 Home," by Dr. R. Velten, Erlangen, 1867, and in the Epidemi- 
 ological Society's Journal, 1869. 
 
LITERATURE. 6 
 
 parts of tlie world were overlooked. I tlierefore 
 resolved to attempt to draw, wliat has not liitlierto 
 been done, a sketch of the history of cholera in all 
 times. The sketch is imperfect ; still it fills up in 
 a measure a blank in the history of cholera. In 
 this part of the subject I have derived much assist- 
 ance from Dr. Short's* useful but now forgotten 
 work. 
 
 For the early history of the disease, and for 
 accounts of it by the Greek and Arab authors, I 
 have found Dr. Adams, in his translation of Paulus 
 .i^gineta, a learned and useful guide. 
 
 Dr. "W". F. Chambersf furnished a masterly review 
 of the whole subject, especially noticing Gfreek and 
 Roman authors, and some of the earher European 
 ones, but like Dr. Grraves and Sir E, Martin, in 
 their standard works, had nothing to add to what 
 was already known respecting the older history of 
 cholera in the East. Hirseh,* in his very impor- 
 tant work, has supplied a number of useful refer- 
 ences to old travellers, and has taken a broader 
 view of the outbreak of 1817, than is usual with 
 most writers. 
 
 Mr. Graskoin § has produced some most valuable 
 translations from the Portuguese. 
 
 Mr. Macnamara, of Calcutta, has furnished me 
 with a very interesting account of the cholera temple 
 
 * On A.ir, "Weather, Storms, &c. London, 1749. 
 
 t Medical Gazette, 1849. J iledicinische Geographie. 
 
 §B. and F. Med. Chir. Eeview, Julv, 1867. 
 
 B 2 
 
4 AXNALS OF CHOLEEA. 
 
 in Calcutta, and he* and Dr. Baird Smith f have 
 collected a good deal of curious matter connected 
 with the outbreak of 1817. 
 
 Dr. James Wise, of Dacca, has supplied me with 
 some useful references to books of trareL 
 
 Several Grerman and Dutch physicians have ex- 
 pressed an interest in the subject, but have been 
 unable to furnish me with fresh materials. Yarious 
 kind friends have, I hope, prevented me, in spite of 
 my non-acquaintance with Eastern languages, from 
 falling into any very grave philological blunders in 
 the chapter on the nomenclature of cholera. 
 
 The work, however, to which I am particularly 
 indebted, is that of Dr. Scoutetten.J of Metz, a 
 veteran in the field of cholera literature^ who, after 
 undergoing the siege of that city, died soon after its 
 occupation by the Grermans. 
 
 He has produced a work which, in spite of a few 
 inaccm-acies, leaves little or nothing to be desired on 
 the subject of early Grreek and Latin, and of early 
 Hindoo literature. Had he been equally full about 
 later Em-opean and Indian periods, there would have 
 been no occasion for the present work. Though 
 following him in many things, I hope to be warned 
 by his example, and avoid the mistake which he com- 
 mitted, of combining an excellent liistorical sketch 
 with one of the recent theories of the disease, which 
 is already abandoned by many of its followers. 
 
 * On Asiatic Cholera, 1870. f Indian Annals, 1870, 
 
 X Histoire Chronologique du Cholera. Paris, 1870, 
 
LITERATURE. 5 
 
 I thoiiglit at one time of adding a list of early 
 writings on cholera. But really the separate works 
 on the subject referring to the period of which I 
 treat, are not very numerous, nor very important, 
 nor very accessible. I have chiefly had to consult 
 the systematic writers on medicine and the works of 
 travellers ; and the references to them in the body 
 of the work, seem to be all that is required in the 
 way of bibliography. I have, in most practicable 
 instances, verified references by consulting the 
 original authorities. 
 
ANNALS OF CHOLERA. 
 
 CHAPTER II. 
 
 NOMENCLATURE. 
 
 Cholera has been described under such a variety 
 of names, tbat a knowledge of them is absolutely 
 necessary to anyone who wishes to investigate its 
 history. They may be classed thus : — 
 
 1. Names common to it and to other pestilences ; 
 and such names are naturally commonest in the 
 East, where epidemics of the disease have been so 
 freqiient. 
 
 (a.) The Hindostanee name is murree, or deadly 
 disease, a word evidently from the same root as the 
 Latin mo7i; mors, or our own murrain. Cholera in 
 many parts of India is called murree, or jurree 
 murree, that is, the sudden pestilence, or maha 
 murree, that is, the great pestilence. The latter 
 term has of late years been applied also to a disease 
 in certain parts of India, resembling the Levantine 
 plague, which has occurred occasionally during the 
 last forty years, although all early authors comment 
 on the fact that India is free from the plague 
 proper. 
 
 (6.) The Arabic names for pestilence are iaoun, 
 and still more wuha, or El ouha, and by such names 
 is epidemic cholera occasionally described in India at 
 the present day. Ouha is a common name in Arabia 
 
NOMENCLATURE. 7 
 
 for ctiolera, as well as for the plague. An illustration 
 of this is afforded by Scoutetten,* who found that 
 the Arabs in Algiers had no specific name for 
 cholera, but applied to it that of El oitba, the name 
 usually employed by them for the plague. 
 
 Hindostanee or Arabic names, such as murree, 
 or taoun, or ouba,f cannot, therefore, be accepted, 
 without collateral evidence, as necessarily meaning 
 cholera. 
 
 (c.) The Chinese name for cholera. Mo louaii, is 
 probably a name of this class, as it is said by Chinese 
 scholars^ to consist of two characters, the first de- 
 noting a sudden start, as of a bird taking flight, 
 the second meaning confusion or disorder. It, there- 
 fore, seems to indicate a sudden and violent attack, 
 and nothing more. 
 
 (d.) The French name of froiisse galanf, or tuck- 
 t(p sjxirk, must be considered to oome under the 
 same head, and merely indicates the sudden death 
 of the robust. 
 
 (e.) It is scarcely worth while to allude to a far- 
 fetched derivation of cholera from the Hebrew. 
 However, it appears that in Eeelesiasticus, chap. 
 xxi., v. 22, and in some texts of the Bible, the 
 words cliolaim raim, literally bad disease, in the 
 plural choU ra, occur. This was erroneously trans- 
 
 * Op. eit. p. 45, Note. 
 
 t It has been said that the Arabs in the East have called 
 ■cholera the air, el ouwa. This is an error that has arisen from 
 confounding el ouha with el haiva : the latter word means air. 
 
 J Transact. Med. and Phy. Soo., Calcutta, Vol. I., p, 204. 
 
ANNALS OF CHOLERA, 
 
 lated ill the Septuagiut version, x°^'F'^ "'" <^rpopos, wliicli 
 was rendered cholera et tortura by St. Jerome. 
 I rather think this version passed into the Ynlgate. 
 However, Luther tra,nslated it rightly, and in Cover- 
 dale's Bible, in 1535, it is merely rendered " aike 
 and pain of the body." This derivation is now 
 generally given up. 
 
 2. The great majority of the names that are 
 specific for cholera, are derived from its first and 
 most prominent symptom, derangement of the 
 alimentary canal. As much doubt exists respect- 
 ing the actual date of Sanscrit and of Chinese 
 writings which describe cholera, the name which 
 occurs first in the writings of the father of medicine, 
 and which to this day continues to be the popular 
 name for the disease in^all except Eastern countries, 
 namely cholera, must be considered the most ancient. 
 
 {a.) There has been considerable difference of 
 opinion regarding the exact etj^mology of the word 
 xoxtjja. It has been supposed to be a contraction 
 of x"'^", and for, or (ota, flux, thus meaning flow of 
 bile. It has been derived from ^oxar, j/oxaSor, intes- 
 tine. Others have imagined that it was the same 
 word as x"^*/"*. the gutter of a roof, because the 
 discharges in cholera flow as from a si3out. I shall 
 not enter into any oritioism on those derivations,* 
 none of which will stand the test of much examina- 
 tion. On the whole, the most satisfactory derivation 
 is from x^xoi, the old form of xoxr, bile, and xoxipr, is 
 
 " For fmtlier criticism on liiese, vide Scoutetten, p. 41-43, 
 
KOMENCLATrRE. 9 
 
 ^ xoupr, Moaoi, tlie bilious disease, or disease of bile, tlie 
 word x<=^of not being exclusively confined to bile in 
 the tecbnical sense of the word. But even from an 
 early date the word cholera must have had an 
 extended meaning. Had cholera meant only flow 
 of bile, Hippocrates could not have contradicted 
 himself by describing a dry form of the disease. 
 
 Besides cholera, Hippocrates talks of naOea xoXipiKx, 
 or bilious affections, and says that pork is xoXaUs, 
 which Gralen understands as meaning productive of 
 cholera. There was also the word xcupt^o-ni, of the 
 nature of cholera. Two Grreek phrases for cholera 
 seizures may be added, as they are characteristic of 
 the suddenness of the disease — xoUfa Ixx&t, cholera 
 seized a patient, and x°^E/"'"^f >'^?9'-<>'«', to be seized 
 with cholera. Patients labouring under the disease 
 were called y^oXiptxoi, or x'^'-ef'^vte?. 
 
 (&.) The Sanscrit name usually believed to denote 
 cholera, is visuchiJca. T understand that originally it 
 means a disturbance of the stomach and intestines 
 generally. Dr. llessler* says it is certainly Ileus, or 
 spasm of the intestines, with retention of faeces, 
 while Dr. H. H. "Wilsonf translates it spasmodic 
 cholera. Dr. Martin Haug,:J: probably %vith over 
 refinement, tliinks that there were in Sanscrit dif- 
 ferent names distinctly descriptive of different stages 
 of the disease : — 1. visiic/iika, vomiting and purging ; 
 
 * Commentar. in Ayurvedam Fascic II. p. 101. 
 
 + Sanscrit Dictionary. 
 X Pettenkofer Terbieitiing's Art, &c., 1S71. 
 
10 ANMALS OF CHOLERA. 
 
 2. alavha, cramps ; 3. vilamhiTia, collapse ; besides 
 still another name, 4, dandasalika, applied to rigi- 
 dity. In Soutliern India the spasmodic form of 
 vmichika has been named sitanga soniput. But it 
 does not aj)pear to me that such terms are really 
 defined in Sanscrit with any approach to accuracy. 
 Practically, this is of little importance, as Sanscrit 
 names are only known to the learned, have not been 
 in general use for centuries, and, therefore, help us 
 little in tracing the history of cholera. 
 
 (c.) The next oldest specific name of cholera, 
 haidsa* is the term by which it is generally recog- 
 nised at the present day in India, and by which it 
 has always been known to Mahommedans. It has 
 been known to the Arabs at least since the time of 
 Ehazes, who, about a.d. 900, described the malady 
 as el haida. It does not appear to be certainly 
 ascertained what the origin of the name is. It 
 seems to mean relapse or lethargy, but this is 
 uncertain. 
 
 {d.) Far our most important guide in tracing the 
 course of cholera within the period of European 
 connection with India, is movdeshee, or morshee, the 
 word found by the Portuguese in use at Groa, where 
 the Mahratta dialect prevailed. The word in the 
 Mahratta language still means cholera, but in 
 
 * Sometimes corruptly read saida and almeida, or haisa. 
 Its various forms, I am told, can be easily explained by the 
 placing or omitting tbe dot over the Arabic letters, and by 
 the mode of writiug the first letter, which may easily be 
 mistaken for an m. 
 
NOMENCLATURE. 
 
 11 
 
 Guzerattee it only means pain of the stomach. 
 The word is, I believe, never used now by Euro- 
 peans. As early as the year 1702, Pere Martin 
 observes that the French had corrupted the word 
 mordeshin into 7nort de chien. Cholera was in early 
 times always termed ^nordesld by Europeans, and 
 affections analagous to cholera were also described 
 under that name. 
 
 The following are some of the forms under which 
 the name occurs in works of European travellers : — 
 Mordshi, morshi, morexi, morexin,mo)'dcxin, mordeshin, 
 mort de cJiien. Scholars consider the derivation from 
 the Mahratta word modna, to tear or twist, the most 
 satisfactory. 
 
 (e.) The names locally employed in the East to 
 designate cholera, are most of them more or less 
 descriptive of vomiting and purging, or, put in its 
 simplest form, of motion up and down : — 
 
 Hindostanee 
 Mahratta 
 
 Guzerattee 
 
 Deccanee 
 
 Cashmeree 
 
 Bengalee 
 
 Chittagong 
 
 Tamiil 
 
 Teloogoo 
 
 Malabaree 
 
 Malay 
 
 C Upurwai turwai. 
 
 I Sweta Rasa, white fluid. 
 
 f Morshi, Modsi, Modavasi. 
 
 I Tural. 
 
 f Hagok. 
 
 I Koganla. 
 
 Dank lugna. 
 
 Dakee. 
 
 Ooola, oota. 
 
 MoTi-pet, mouth and belly. 
 
 Enerum Vandee, vomiting and purging. 
 
 Vantee. 
 [ Kiritiripa. 
 
 \ Xicumber, gush of water. 
 I Shani. 
 ' Yisuchika. 
 
 Moontaan. 
 
12 ANNALS OF CHOLERA. 
 
 Similarly in Europe : — 
 
 German Brech-ruhr, vomiting and purging. 
 
 Dutch Brak-loup. 
 
 i Unbloody dysentery. 
 Plague in the guts. 
 Cramps. 
 Spasms. 
 
 Turkish and Russian names, calling cholera the 
 black disease, are, I suspect, more recent than the 
 period now treated of. 
 
 3. Another set of names expressed more or less 
 theoretical views respecting the nature of the disease, 
 or described some of its leading features. I give 
 only such as have been used before 1817; most of 
 them had indeed been employed before 1770. 
 
 (a.) Such symptoms as referred to the nervous 
 system attracted attention. Cholera has been at 
 times classed in Indian as well as in European 
 medicine among spasmodic or nervous affections, 
 and has, in consequence, been sometimes termed in 
 India sitanga som'puf. It has been called a tetanus ; 
 it has been even named mirgee, the common Hindo- 
 stanee word for giddiness or epilepsy. It has been 
 called cramps, spiasms, syncope. 
 
 (b.) It has often been confounded with diseases of 
 the digestive organs, such as diarrhoea, colic, ileus, 
 dysentery, and with fever. Hence we have such 
 names as dysenteria incruenta, colica ?niseraica, cholera 
 intermittens, and fehris cacatoria. 
 
 Cholera has also been confounded at times with 
 ileus Tndicus, and with diarrhren chokroide^. 
 
 {c.) As long ago as 1763, Sauvages established no 
 
NOMENCLATU RE. 13 
 
 fewer than eleven varieties, and lie explains that 
 the disease is called cholera morbus, to distinguish 
 it from cholera ira, that bile, and choler or anger, 
 may not be confounded : — 
 
 1. Spontanea. 6. Intermittens. 
 
 2. Sicca, or Iv-/^". 7. Indica. 
 
 3. ^ruginosa, e fungis. 8 Verminosa. 
 . ^a. venenis fossil. 9. Arthritica. 
 
 " lb. ,, animal. 10. Crapulosa. 
 
 5. Dysenterica ^ruginosa. 11. Serosa, ay^oXos. 
 
 Other names given to it, most of them also long 
 before 1817, were — 
 
 Passio cholerica. 
 Cholera legitima. 
 
 illegitima, or notha, 
 
 humida, t-^^Ti. 
 
 Hatulenta. 
 
 spasmodica. 
 
 maligna. 
 
 infantum. 
 
 To enter into any minute criticism on all those 
 names would occupy no small space, and I trust 
 that, without doing so, the reason for bringing so 
 many of them together, mil be apparent in the 
 sequel. Dry though this enumeration of teims 
 must be to most readers, a knowledge of them is of 
 much importance, both as affording a clue to many 
 notices of cholera in the writings of professional 
 and of unprofessional men, which have hitherto 
 escaped noticej and also as affording many curious 
 indications of the diffusion of the disease, and of 
 the theoretical views tliat have been entertained 
 
14 ANNALS OF CHOLERA. 
 
 from time to time respecting the nature of the 
 malady. 
 
 As comparative grammar throws much light on 
 the history of races, so does comparative nomen- 
 clature on the history of a disease. 
 
 I shall at present only remark, that one or two 
 conclusions flow irresistibly from the preceding list, 
 such as, that the diagnosis of cholera from colic and 
 ileus and dysentery, must have been in former times 
 most inaccurate ; and, indeed, this is not surprising, 
 while to this day colic and ileus continue to be very 
 vague and uncertain terms : that, having such a 
 variety of names, cholera must have been a disease 
 presenting much variety of symptoms : and, further, 
 that cholera must have^been a disease very familiarly 
 known, for in Europe almost every country had a 
 popular name for it, and in India there was not a 
 district or a language, that had not its local name 
 for the complaint. 
 
 In one shape or another cholera may, therefore, 
 be said to have been in all ages a world-wide 
 malady. 
 
UP TO THE SIXTEENTH CENTURY. 15 
 
 CHAPTER III. 
 
 CHOLERA FROM THE AGE OF HIPPOCRATES TO THE 
 COMMENCEMENT OF THE SIXTEENTH CENTURY. 
 
 Cholera is made mention of in the earliest medical 
 writings tliat are in existence. It is in the works 
 of Hippocrates that we first find the word xox'tp-n. It 
 is repeated frequently by him, as well as the phrase, 
 choleric affections. No systematic description is 
 given of the ordinary form of the disease, though 
 several cases of it are recounted.* For instance : — 
 
 " At Athens a man was seized with cholera. He 
 vomited, and was purged and was in pain, and 
 neither the vomiting nor the purging could be 
 stopped ; and his voice failed him, and he could not 
 be moved from his bed, and his eyes were dark and 
 hollow, and spasms from the stomach held him, and 
 hiccup from the bowels. But the purging was 
 much more than the vomiting. This man drank 
 hellebore with juice of lentils ; and he again drank 
 juice of lentils, as much as he could, and after that 
 he vomited. He was forced again to drink, and the 
 two (vomiting and purging) were stopped ; but he 
 became cold. He was washed with plenty of (hot) 
 water down to the genital organs, until the upper 
 
 * Epidem., book v., 4, 29, 27. 
 
16 AXXALS OF CHOLERA. 
 
 parts also grew warm, and he lived ; and next day 
 lie took some gruel (meal with water)." 
 
 Here is another case : — 
 
 "Eutychides had a choleric affection, which ended 
 in a tetanic seizure of his legs, along with purging. 
 He vomited for three days and nights a quantity of 
 coloured and very red bile, and he became powerless 
 and oppressed with nausea, and he could retain 
 nothing — -neither drink nor food ; and there was 
 complete retention of urine {tov oipov ttoxx-o o-x£a-<s), and 
 there was no passage downwards. By vomiting 
 soft dregs were evacuated, and they also passed 
 downwards." Again : — 
 
 " It happened to Bias, the pugilist, who was a 
 great feeder, to have a choleric attack from eating 
 flesh. ... In summer reign choleric affections 
 and intermittents." 
 
 The two first of these cases are descriptions of 
 sporadic cholera of some intensity ; the last is only a 
 case of indigestion. 
 
 We have seen something of the treatment of the 
 first of these cases, but Hippocrates says more on the 
 subject of treatment.* 
 
 *' In cholera, for the pain, it is proper to give 
 what is ordered among the remedies for relieving 
 pain, and to take care of the belly, moistening it 
 with drinks (internally), and relaxing the whole 
 body except the head, with warm baths. In this 
 way, some fluid being introduced, the vomiting is 
 
 * On Affections. 
 
UP TO THE SIXTEENTH CENTURY. 17 
 
 easier, and any adhering matters are expelled up- 
 wards, while the alvine evacuation is facilitated ; 
 but if the patient is empty, he vomits and purges 
 with greater difficulty. In the evening he should 
 get what is prescribed for persons over purged by an 
 evacuant." 
 
 Hippocrates mainly assigned disordered bile (pro- 
 bably using that word in an extended sense) as the 
 cause of cholera and kindred affections, and the 
 disorder was induced by indigestible articles of diet 
 and by excesses at table. He thought men of middle 
 age most subject to these attacks, and the summer 
 season most favourable to their occurrence. In his 
 Aphorisms* he places chronic diarrhoea, cholera, and 
 dysentery next each other. 
 
 It would thus seem that sporadic cholera was 
 common enough in the days of Hippocrates ; but 
 there is no hint of the disease being epidemic, 
 although it was more frequent at a particular season. 
 Hippocrates gives most of the symptoms of cholera, 
 including suppression of urine, but expresses no 
 opinion as to the gravity of the disease. His treat- 
 ment was mainly diluent, with the external use of 
 warm water. Though in one case he mentions giving 
 hellebore, he gave very little active medicine ; and it 
 was only in later stage.3 that he ordered medicines 
 to suppress purging. 
 
 But Hippocrates described another kind of cholera, f 
 " In x"'-^;'* ?^p«, the stomach is distended with air, 
 borborygmi are heard, there is pain in the sides and 
 
 * 3 Sect., 30. t De Vietu. 
 
18 ANNALS OF CHOLERA, 
 
 in the loins. The patient, unable to pass anything 
 downwards, is constipated. In order to quiet 
 vomiting, we must produce action of the bowels. 
 The patient must have immediately a clyster, hot 
 and as oily as possible. He must be anointed freely 
 with oil ; he must be extended in a bath, and cold 
 affusions must be used slowly. If, when he is re- 
 vived, alvine evacuations follow, he is cured. . . 
 If the pain does not abate, give him asses' milk to 
 di'ink until he is purged. If the stomach is relaxed 
 and he has bilious motions — if he has griping, vomi- 
 ting, oppression, or gnawing feeling, it is best to keep 
 him quiet and give him oxymel to drink, &c." He 
 attributed this affection to indigestible substances, 
 especially to eating assafoetida with a quantity of 
 cheese. 
 
 I think that all must frankly admit that the above 
 account does not describe any known form of cholera. 
 There are, indeed, rare cases of cholera with a very 
 small amount of evacuation, but never characterised 
 at the onset by flatulence and constipation. This 
 division of Hippocrates has been followed by many of 
 the early authors, but by no means by most of them. 
 The disease was evidently a flatulent colic, such as 
 is not very unfrequent in any country, and some 
 forms of which, occurring in the East, have been 
 described by such terms as Ileus Indicus or Colica 
 Japonica. 
 
 We have evidence that the successors of Hippo- 
 crates were acquainted with cholera, as we know 
 something of their mode of treatment. For in- 
 
rP TO THT2 SIXTEENTH CENTURY. 19 
 
 stance, Erasistratus ordered wine, but in very small 
 quantity; and Asclepiades (•wlio tkought tlie de- 
 finition of flow of Lile too naiTOw, and called it a 
 flow of tumour; gave his patients tke first day wine 
 and polenta. Tkey add, liowever, but little to our 
 knowledge of cliolera. 
 
 At tbe commencement of the present sera Celsus* 
 wrote tbe following account of tbe disease : — 
 
 " Cliolera simul et dejectio et Tomitus est : pree- 
 terque bsec inflatio est ; intestina torquentur, bills 
 supra infraque erumpit, primum aquse similis, deinde 
 ut in ea recens caro lota esse videatur, interdum 
 alba, nonnunquam nigra vel yaria. Ergo eo nomine 
 morbum bunc ^o/.i^ay Grrgeci nominarunt. Prseter ea 
 vero, quEe supra comprebensa sunt, stepe etiam cr-ura 
 manusque contrabuntur : urget sitis, anima deficit : 
 quibus concurrentibus non minim est si subito quis 
 moritur. Neque tamen ulli morbo minori momento 
 succurritur. 
 
 " Protinus ergo ubi ista cceperunt, aquae tepid83 
 quam plurimum bibere oportet et vomere. Vis 
 imquam ea sine vomitu sumitur ; sed etiamsi non 
 incidit, tamen corrupta3 miseuisse novam materiam 
 prodest, parsque sanitatis est vomitum esse suppres- 
 sum. Si id incidit, protinus ab omni potione absti- 
 nendum est. Si vero tormina sunt, oportet frigidis 
 et bumidis fomentLs stomacbum fovere, vel, si venter 
 dolet, iisdem egelidis, simul venter ipse mediocriter 
 calentibus juvetur. Quod si vebementer et vomitus 
 et dejectio et sitis vexant, et adhue subcruda sunt 
 
 * De Medicina, lib, iv., cap. 11. 
 
 c 2 
 
20 ANNALS OF CHOLERA, 
 
 qvLse vomuntur, nondum vino maturum tempus est : 
 aqua, neque ea ipsa frigida sed potius egelida, danda 
 est. Admovendumque naribus est pulegium ex 
 aceto, vel polenta vino aspersa, vel mentlia, vel quod 
 secundum naturam est. 
 
 " At cum discussa cruditas est, tum magis veren- 
 dum est ne anima deficiat. Ergo tum confugiendum 
 est ad vinum. Id esse oportet tenue odoratimi, et 
 cum aqua frigida mixtum, vel polenta adjecta, vel 
 infracto pane : quem ipsum quoque assumere expedit : 
 quotiesque aliquid aut stomaclius aut venter eflPudit, 
 toties per lisec vires restituere. . . . At si inanis 
 est homo, et crura ejus contraliuntuT; interponenda 
 potio absintliii est. Si extremse partes corporis £ri- 
 gent, ungendse sunt calido oleo, cui cerse paulum sit 
 adjectum : calidisque fomentis nutriendse. Si ne sub 
 bis quidem quies facta est, extrinsecus contra ventri- 
 culum ipsum cucui^bitula admovenda est, aut sinapi 
 superimponendum. TJbi id constitit dormire oportet : 
 postero die utique a potione abstinere : die tertio in 
 balneum ire : paulatim se cibo reficere somnoque 
 quisquis facile acquiescit : vitetque lassitudinem et 
 frigora. Si post suppressam cboleram febrieula 
 manet, alvum duci necessarium est : tum cibis vinoque 
 Titendum est. Sed bic quidem morbus et acutus est, 
 et inter intestina stomacbumque versatur sic ut cujus 
 potissimum partis sit, non facile dici possit." 
 
 In tbe foregoing sentences, Celsus gives a clear 
 account of a very decided cbolera, a disease in wbicb 
 be is not sure wbetber tbe stomacb or tbe intestines 
 are most involved. He s&ys little or notbing 
 
UP TO THE SIXTEENTH CEN-TURY. 21 
 
 of the causation of the malady, but he gives a good 
 idea of the practice of the period. He began 
 "svith ordering water as an emetic, with the object of 
 stopping the vomiting by clearing the stomach, and 
 considering, that the water would be useful by dilu- 
 tion, even if it did not produce vomiting. He recom- 
 mends externally frictions with oil, sinapisms, and 
 dry cupping. He also recommended wine pretty 
 early. Every practical man will recognise the sound- 
 ness of his advice in being cautious not to induce 
 relapses by giving too much drink or food. 
 
 The descri23tion of the disease given by Coelius 
 Aurelianus,* about eighty years after Celsus, was 
 admirable. He considers cholera to be closely 
 allied to diarrhoea. He mentions many symptoms 
 of much importance. For instance, he enumerates 
 as precursors of cholera, heaviness and tension of the 
 stomach, feeling of discomfort, restlessness, flatulence, 
 nausea. He notices blackness of the coimtenance and 
 sharpening of the features, egestion of thin, watery 
 fluid, the eyes growing red towards the close, re- 
 covery by gradual relaxation of the symptoms, 
 especially the discharges taking place at longer 
 intervals. He uses the very phrase of consecutive 
 fever, now so much employed. His allusion to it is 
 more distinct than that of Celsus, and he discusses how 
 it can be best kept off, recommending abstinence. 
 
 He says little of the pathology of the disease. It 
 is usually "caused by some variety of indigestible 
 food, and^he alludes to the analogy of sea- sickness. 
 * Acut. Morb., lib. III., cap. 19, 20, 21. 
 
22 ANNALS OF CHOLERA, 
 
 In his chapter on treatment he criticises severely the 
 practice of others, especially that of giving emetics — a 
 measure, he says, like bleeding a man suffering from 
 haemorrhage or from profuse perspiration. He also 
 mentions that Heraclitus Tarentinus used opium 
 and henbane, and other remedies to restrain the 
 discharges ; but his own practice is essentially the 
 same as that of Celsus. He recommends ligatures 
 to the limbs, but that they should be frequently 
 changed, lest the pressure should be too continued. 
 This practice is of interest, as being so common in 
 Eastern countries. He gave wine, and in the decline 
 of the disease he gave drinks made of the juice 
 of quinces, pomegranates, and autumn fruits, a 
 practice in which he was followed by all the later 
 authors. He was cautious to prevent relapses, 
 and was quite aware of the gravity and of the 
 antiquity of the disease, for he says that the ancients 
 described it as acute and very swift, being rarely 
 protracted to the second day. 
 
 I have not quoted Aurelianus at length, as I sub- 
 join a very similar account of the disease by one who 
 was nearly his contemporary, and one of the most 
 valuable early writers on medicine, Aretseus of Oap- 
 dadocia* : — 
 
 " Cholera is an inverted movement of everything 
 in the whole body to the stomach, to the belly, and 
 to the intestines — a very sharp malady. For the 
 matters collected in the stomach escape by vomiting, 
 and the fluid matters in the belly and intestines run 
 * Morb. acut., lib. II., c. 5 ; Morb. acut. curat., lib. II., c. 4. 
 
UP TO THE SIXTEENTH CENTURY. 23 
 
 through by the lower passage. What is first vomited 
 is like water, but what passes by stool is stercoraceous 
 fluid and of ill odour. For continued bad digestion 
 has been the cause of this. But what is washed 
 away is first like phlegm, afterwards like bile. At 
 the beginning the disease is free from pain, but 
 after that, there are tension of the stomach and 
 tormina of the belly ; but if the disease increases, 
 the tormina are augmented, there is syncope, the 
 limbs are unknit, there is helplessness, loathing of 
 food ; and if they swallow anything, yellow bile 
 rushes out unceasingly by vomiting with sickness, 
 and the dejections are like. There are spasms, and 
 drawing together of the muscles of the calves of the 
 legs and of the arms. The fingers are twisted ; there 
 is vertigo and hiccup ; the nails are livid ; there is 
 cold refrigeration of the extremities, and the whole 
 body becomes rigid ; but if the malady runs on to 
 its end, then the man is covered with perspiration ; 
 black bile bursts out upwards and downwards. There 
 is retention of urine from spasm of the bladder ; but, 
 indeed, much water is not collected in it, owing to 
 the pouring out of the fluids into the intestines. 
 There is loss of voice ; the pulse becomes very small 
 and frequent, as in syncope ; there are constant 
 fruitless attempts at vomiting, desire to evacuate 
 with tenesmus, but dry and without fluid ; death, 
 full of pains and miserable, with spasms and suf- 
 focation, and fruitless vomiting. . . . But if he 
 rejects everything by vomiting, and a perpetual 
 perspiration flows, and the patient becomes cold and 
 
24 ANNALS OF CHOLERA, 
 
 ash- coloured, and the pulse approaches extinction, 
 and the patient becomes speechless, it is well, under 
 such circumstances, (for the physician) to make a 
 graceful (becoming) retreat." We shall have occa- 
 sion to notice this singular remark afterwards. 
 
 Aretseus devotes a very full chapter to the internal 
 treatment of the disease, and to the application of 
 local remedies. These, however, need not be detailed 
 here. The principle of his treatment was that 
 it was bad to suppress excretions which ought to be 
 removed. He used, therefore, diluents chiefly, and 
 water in small quantities. He remarks, what is very 
 characteristic of the disease, that patients always 
 preferred cold drinks, but sometimes he gave them 
 hot ones. If there were signs of the patient's strength 
 failing, he gave wine and the juice of fruits^ 
 
 Aretseus, while he describes the symptoms of the 
 disease so well, does not enter into its pathology ; 
 but as to its setiology, he observes that the disease 
 prevails most in summer, next most in autumn, less 
 in spring, and least in winter : and as to age, that 
 young men and men at their prime are attacked 
 most, old men least, boys more than old men, but 
 not very fatally. 
 
 We must now turn to accounts of cholera by 
 another class of authors. 
 
 There is much variety of opinion as to the com- 
 parative antiquity of Hindoo and Chinese and of 
 Greek medicine. As some claim a far greater anti- 
 quity for the two first than for the last, I might have 
 commenced this sketch of the history of cholera with 
 
UP TO THE SIXTEEoMTH CENTURY. 25 
 
 extracts from the Shastras and from tlie earliest 
 Chinese books; but I have thought it most con- 
 venient to introduce the Sanscrit accounts of cholera 
 here, as they are probably not earlier than the latter 
 half of the second century ; not that I presume to 
 settle a question on which scholars are much divided. 
 
 " Visuchika chiefly attacks those who are timid or 
 immoderate in their living. . . . Along with 
 convulsions, the patient has intellectual torpor, 
 diarrhoea, vomiting, thirst, giddiness, restlessness, 
 tenesmus, yawning, feeling of heat, lividity, shiver- 
 ing, pain in the head and at the prsecordia. The 
 belly is retracted : the patient, whose voice is lost, 
 is in a state of extreme agitation. The gases con- 
 tained in the belly rise. When the faeces and the 
 air remain shut up in the belly, the patient grows 
 weak, loses power of moving, then come hiccup and 
 eructations. . . . When the patient's gums are 
 livid, his nails and lips pale, when he vomits abun- 
 dantly, and loses consciousness of his acts, when 
 his eyes become hollow, when his voice is lost, 
 when his joints are all relaxed, one ought to have 
 recourse to the instructions of the sacred books,"* 
 or, as Dr. Wise translates it, " such a person may 
 be taken out to be burnt, he will not recover." 
 
 With respect to treatment, Dr. Wise tells usf that 
 besides commencing with an emetic, and the appli- 
 
 * Ayurveda of Su^ruta. Calcutta, 1835, Vol. II. p. 518. 
 The chapter is in verse. I follow a translation by Dr. Lietard, 
 given by Scoutetten, 
 
 t On Hindoo Medicine, 1845, p. 330, 
 
26 ANNALS OF CHOLERA, 
 
 cation of the actual cautery to the ancles, Su9ruta 
 recommended a compound of myrobalan, orris root, 
 assafoetida, the seeds of the "Wrightia anti-dysenterica, 
 red garlic, rock-salt, and atee^, of each equal parts. 
 These were reduced to powder, and mixed with 
 warm water for use, 
 
 Charaka, a later writer, added opium and black 
 pepper to the mixture. This receipt is said to cure 
 cholera when the eyes are sunk, the pulse is imper- 
 ceptible, and the extremities are cold. 
 
 In addition to these prescriptions,* Dr. Wise also 
 mentions a potion, the chief ingredients of which 
 were Sinda salt and hutcli infused in water. The 
 hutch is a warm stomachic like ginger. 
 
 In the preceding description of cholera, which is, 
 I believe, treated under the head of indigestions, we 
 have a very fair account of cholera, but by no means 
 so complete as some of those already quoted. It 
 gives us no idea of what was the degree of fre- 
 quency of cholera in India, but it shows that there 
 was a very acute form of it to be met with, of so 
 severe a nature, that in the end it was usual to 
 abandon all attempts to save the patient. 
 
 I think the reader cannot fail to be struck with 
 the very close resemblance between the concluding 
 sentences in Aretseus and Su9ruta. Their structure 
 is similar ; they occur in both at some interval 
 
 * It is curious to find in these prescriptions the prototype of 
 all the opium and assafoetida and black pepper cholera pills, 
 which always have been employed in Bengal, and are at the pre- 
 sent day popular with the natives of India, and much used in 
 European practice. 
 
UP TO THE SIXTEENTH CENTURY. 27 
 
 from the description of the disease. They both 
 consider what should be done when the case 
 becomes hopeless, and both agree that the patient 
 may be abandoned by the physician. I cannot but 
 think that the Sanscrit author, having Ai-etseus before 
 him, was shocked at the suggestion of the phy- 
 sician's simply beating a retreat, and therefore 
 recommends recourse to the last rites of religion. 
 Others may think Areteeus borrowed from the 
 Sanscrit. But, for the history of cholera, this chrono- 
 logical question is of no very great imj)ortance. 
 
 "We are able to see these Sanscrit accounts, as they 
 appeared in a somewhat altered form, in Southern 
 India, in the books of the Tamul physicians. Theii- 
 present form is of uncertain date.* 
 
 " The Vidhuman Visuchi (the third species of 
 ajerna, or indigestion) is most rapid in its effects : 
 its symptoms are dimness of the sight, persj^iration, 
 sudden swooning, loss of consciousness, derangement 
 of external and internal senses, pains in knees and 
 calves of legs, griping pains in belly, extreme thirst, 
 lowness of the windy and bilious pulses, coldness in 
 the hands, feet, and whole body." 
 
 The more spasmodic form, sitanga soniput, was 
 thus described : — " Chilliness, like coldness of the 
 moon, over the whole body, cough, and difficulty 
 of breathing, hiccup, pains all over the body, 
 vomiting, thirst, fainting, great looseness of the 
 bowels, trembling of all the limbs." 
 
 Sitanga soniput was said to be simply spasmodic, 
 * Madras Courier, January, 1819. Quoted by Scott. 
 
28 ANNALS or CHOLERA, 
 
 and tliough usually yet not suddenly fatal. The 
 visuchi is most rapid in its progress, and at times 
 epidemic. 
 
 In the preceding extracts from the Tamul there 
 appears to be a mixture of what is of extreme an- 
 tiquity with what is comparatively modern. 
 
 On the whole, the ancient writers on Indian 
 medicine do not give nearly so clear and distinct 
 an account of cholera as the Grreek and Roman 
 ones, and they afford no indication of any parti- 
 cularly virulent or epidemic form of the disease being 
 known to them. 
 
 There are accounts of cholera that profess to be of 
 very early date in another Eastern country. It is 
 unnecessary to discuss the question of the antiquity 
 of Chinese medicine]" There seems to be no reason 
 to doubt that it is at least as old as Hippocrates, 
 but the age of such notices of cholera as we have, is 
 very uncertain. 
 
 Cleyer* gives some account of ordinary and not very 
 severe forms of cholera, on which much need not be 
 remarked, but it is of interest, as being written in 
 1669, long anterior to questions arising about the 
 prevalence of cholera in China. The disease Ho 
 louan is described as " perturbatio supra et infra, ut 
 cum fluxu alvi et vomitu eeger laboret." 
 
 In the Chinese book, Ching-che-chin-shing, j^rinted 
 about 1790, there is an account of Ho louan.f 
 Most of the usual symptoms are mentioned, and 
 
 * Specimen Medicinae SinicEe, 1682, p. 80. 
 t Transact. Med. and Phy. Socy. Calcutta., Vol. I., p. 208. 
 
UP TO THE SIXTEENTH CENTURY. 29 
 
 some veiy characteristic ones : — " Sometimes the 
 patient is hot and restless, and desires to throw off 
 every covering. Wlien there are spasms, vomiting 
 and purging, cold perspiration, giddiness in the 
 head, and confused vision, the disease becomes in- 
 curable."* The disease was attributed to neglect 
 of diet, to exposure to changes of temjoeratui^e, to 
 extreme heat — although it might also occur in winter. 
 These points in the sequence of symptoms may be 
 noticed. " When the pain attacks the head first, 
 vomiting comes first ; when the pain commences in 
 the abdomen, purging comes first. If the pain in 
 the head and in the abdomen come on together, so 
 do the vomiting and purging." 
 
 These notices seem scarcely to afford proof that in 
 very early times cholera was known in China as an 
 epidemic. However, such full and positive accounts, 
 professing to describe a cholera of great antiquity, 
 have been published, that I give their substance, f 
 ^ '' This malady is due to a mdasmatic poisoning. 
 Bad nourishment, too cold food, watery and green 
 fruit, develop the germs of tliis plague, which is 
 often epidemic." 
 
 " Cholera 8icca. The prodromi are malaise, lassi- 
 tude, loss of appetite, pain in the abdomen, diarrhoea. 
 The duration of these symptoms is very various, 
 they sometimes occur ten days before the attack. 
 They requii-e to be watched, especially the diar- 
 rhoea." Then there is the usual description of 
 
 * This sentence reminds one of Aretseus and Su^nita. 
 t La Medecine ehez les Chinois. Paris, 1863. 
 
30 ANNALS OF CHOLERA, 
 
 symptoms, in which I may observe the mention 
 of vomiting matters white and like rice-water, and 
 of suppression of urine. The mortality of this 
 disease is great, about 20 per cent. ; its duration 
 from two to ten days. 
 
 The description of the humid form differs from 
 that of the dry mainly in saying that " the pro- 
 dronii are less marked. Sometimes the attack is 
 sudden, without any notice whatever. Retraction 
 of the testicles is also mentioned as a symptom. 
 The same treatment as for the other kind. The 
 mortality is 50 per cent, if the patient is not early 
 seen to ; if he is attended to, you scarcely lose 10 in 
 a 100. The disease lasts four or five days." 
 
 The important point in treatment was to practice 
 acupuncture in eight or ten points of the body, in- 
 cluding the tongue, applying heated salt to the 
 stomach, and giving warm drinks, especially an 
 infusion of ginger. 
 
 The symptoms here recounted do not in them- 
 selves require much remark, but some of them seem 
 to apply to nephritic colic, and there is to me evi- 
 dently an appearance of their having been gathered 
 from many sources. They have a half modern 
 cast — for instance, the phrases miasmatic poisoning 
 and ricelike evacuations — as if they were meant to 
 bear on questions agitated at the present day. If 
 really old, the Hippocratic division into humid and 
 dry would be very curious, but the symjotoms as- 
 signed to humida apply just as well to sicca ; in fact, 
 a disease cannot be called fiicca, when it is said that 
 
UP TO THE SIXTEENTH CENTURY. 31 
 
 there are evacuations both, upwards and downwards. 
 I cannot regard tlie statements of tlie comparative 
 mortality of either disease as of much importance, 
 except as showing that the disease meant to he 
 described must have been a severe one. 
 
 It is extremely interesting to find that acupunc- 
 ture was the main feature of the treatment — a 
 practice widely adopted in Java, China, and Japan, 
 in all spasmodic diseases, and especially in Colica 
 Japonica. 
 
 Returning to Europe, it is a matter of surprise, that 
 the great monarch of medicine for so many centuries 
 after the close of the second one, says little of cholera. 
 Scoutetten finds, indeed, that Gralen has used the word 
 thirty-three times ; but he does not say much more of 
 the disease than that he had seen cholera caused by 
 eating raw mushrooms. He had a remedy, the 
 Theriacum, which had restored new life to patients 
 in the collapse of cholera ; and he observed that 
 cholera humida was caused by indigestible acrid 
 articles of food, and cholera sicca by acrid flatu- 
 lencies. He also mentions spasms of the gastroc- 
 nemius muscle, and the state of the pulse in the 
 disease. 
 
 The later Greek writers are chiefly of importance 
 to us as carrying on the thread of the history of the 
 disease : they describe nothing fresh. Aetius,* about 
 A.D. 360, gives a poor description of cholera. He 
 however puts the theory of the evacuation of morbid 
 matter (in modern phrase, the eliminating treatment 
 * Lib. III., Sect, prim., cap xii. 
 
82 ANNALS OF CHOLERA, 
 
 of the disease) in so strong a point of view, that his 
 remarks must not be omitted : — 
 
 "Adjuvare etiam oportet per sedem excretionem. 
 Alvum enim velut venenum insidens et ventrem et 
 intestina rodit, et humores ex universo corj)ore adtra- 
 hit. Per vomitus itaque opportunam provocationem 
 vomitus ipse solvitur et cessat. Quum vero humorum 
 excretio quieverit," etc. 
 
 No one can condemn more strongly than he does 
 the use of astringents : — " Si quis igitur mox in 
 principio ea qu.se efferuntur cohihere aggreditur, is 
 majoris mali auctor est." 
 
 Aetius had, therefore, very distinct notions about 
 the presence of a poison, which irritated the intes- 
 tines and drew all the fluids of the body to them, 
 and which ought to be eliminated. He thought 
 the vomiting might be cured by the use of emetics, 
 and did not hesitate to accuse those who used astrin- 
 gents of injuring theu' patients. 
 
 Alexander of Tralles,* a century later, dissatisfied 
 with the ordinary derivation of the word cholera, 
 because the evacuations were often serous and not 
 bilious, suggested a new derivation of the word 
 from KoxaSis or xo^^Ses intestines ; he also ado23ted the 
 division of Hippocrates into u^ypr, and fnpa, and insists 
 with great earnestness on the patient being seen at 
 the commencement of the attack. 
 
 Paulus -^gineta, about a.d. 700, the last Greek 
 writer I shall quote, gives pretty full accounts of the 
 disease, and fuller of its treatment, but adds nothing 
 * Medicina Practica, Francft. 1622, p. 345. 
 
UP TO THE SIXTEENTH CENTURY. 33 
 
 to what was known. He recommends the use of 
 mixtures of juices of fruit, and of various wines. He 
 however alludes to a frightful epidemic and conta- 
 gious colic in his day,* which had ran all over Europe, 
 and which suggests the idea of cholera, but for the 
 prominence given to some of its sequelae, that is, to 
 epilepsy, paralysis, and other affections of the nervous 
 system. Nevertheless, although in modern days such 
 sequelsB are not very common, undoubtedly epilepsy, 
 partial paralysis, loss of power in fingers, anaesthesias, 
 paraplegias, neuralgias, insanity, have been recorded 
 as the consequences of malignant and sometimes of 
 ordinary cholera; and in India cholera has actually 
 been described by the names of epilepsy and of tetanus. 
 I have looked through a great many Arab writers, 
 the successors of the Glreek ones, in Latin trans- 
 lations, as others have done ; but they add nothing 
 to the Greek accounts, from which they are mainly 
 borrowed, and to which they are inferior in accuracy. 
 Their notices, however, are so far important, that 
 they show how cholera continued to be a well- 
 marked and recognised affection. Rhazes, who 
 flourished at Bagdad about a.d. 900, gives f in a 
 
 * Mercurialis (book vii., cap. iv.) was much puzzled at the 
 account by Paulus of this colic being contagious, and he cannot 
 understand a colic being epidemic. Still he thinks it may 
 sometimes arise from pestilential air ; and he remarks that the 
 word colic was used for almost any pain of the bowels. As to 
 ileus, most of us have had occasion to observe the facies cholerica 
 in cases of obstinate obstruction, or in perforation of the small 
 intestines, and can understand ileus being taken for cholera. 
 
 t Continecs, lib. v., cap, 2, A most laborious compilation 
 
 D 
 
34 ANNALS OF CHOLERA, 
 
 chapter, the heading of which is " De fluxu ventris s. 
 el Seyda,^' the following description : — " It begins 
 with nausea and diarrhoea, or one of the two, and 
 when it reaches the stomach it goes on multiplying 
 itself. The pulse fails, and the breathing is at- 
 tenuated ; the face and the nose become thin ; the 
 colour of the skin of the face is changed, and the 
 countenance of the dead succeeds. The extremities 
 become cold, and there is cold perspiration, and there 
 are spasms in the hands and feet and legs. There is 
 urgent thirst, which cannot be satisfied, as the patient 
 immediately rejects what he drinks." His notions 
 of causation are these : — Cholera is produced by some 
 external cause, as too great a quantity of food, or by 
 some internal cause, such as bad humours in the 
 body. As to influence of weather, he says that hot 
 weather produces it, and that it is worst in summer ; 
 that it often occurs in autumn, and sometimes in 
 winter. As to mortality, he observes that the young 
 and men in the vigour of life usually recover, but that 
 there are few of the old a.nd decrepid who get over 
 an attack — few of them that do not perish. With 
 respect to analogies with other diseases, he seems 
 to regard it as resembling spasms from excessive 
 evacuation, or the effects of poisoning, and observes 
 its association with tertian fever, and its occurrence 
 in the coui'se of fevers. 
 
 The treatment was essentially that of the Grreeks, 
 and the same as that recommended for syncope from 
 
 of the opinions of others, each opinion prefixed in the Latin 
 translation with the monotonous word " Dixit." 
 
UP TO THE SIXTEEJSTH CENTURY. 35 
 
 excessive evacuation. He used the word syncope as 
 synonymous with, collapse. He repeats the usual 
 caution, that the physician must not be negligent, 
 but be constant in his attentions and his endeavours to 
 get something to stay on the stomach. For vomiting, 
 ligatures of the legs were preferable ; for purging, 
 those of the hands. This had been said by Alex- 
 ander of Tralles before him. If there was great 
 debility, the more styptic wines, and ones of good 
 odour, were given. The use of wine was to be limited, 
 or as ordered in the chapter on syncope ; for excessive 
 burning of the stomach, cold water, or even snow or 
 ice, were recommended. 
 
 In the first place, if debility was not great, the 
 patient should be vomited and purged, not nourished, 
 and warm water was often given. To procure sleep 
 was a great object, and opiates in moderate quantities 
 were employed. 
 
 These slight notes of his practice are sufficient to 
 show, that many of the questions on which there is 
 such variety of opinion in modern days, continued 
 to be frequently discussed — the use of wine and 
 of opium, and how far the evacuations were to be 
 repressed or encouraged. Apparently the only allu- 
 sion to what was called cholera sicca, is to be found 
 in the recommendation to use clysters, if constipation 
 be present. 
 
 Avicenna,* about a century afterwards, mainly re- 
 peats Rhazes, and also employs the word haida for 
 cholera, which evidently continued to be a common 
 
 * Ayicennfe opera. Tenet, 1608. 
 
 d2 
 
 y 
 
36 ANNALS OF CHOLERA, 
 
 disease. There is, however, no trace of its being 
 epidemic beyond the statement of his predecessors, 
 which he repeats, about heat and summer and autumn 
 producing the affection. It is said that he remarks 
 on the greater prevalence of the disease during the 
 Ramzan, the fasting period of the Mahommedans, 
 but I have not been able to verify this. He observes 
 that the disease is particularly fatal in children ; 
 and, like many writers before and after him, says 
 that the disease is least fatal in those who have had 
 previous attacks of it. There was therefore no ques- 
 tion that this form of cholera might recur in the 
 same person. 
 
 He is also of interest to us because he has been 
 more particular than other Arab authors in specify- 
 ing the nature of the evacuations. He says : — 
 " Cholera incipit "cum fluxu ventris cholerico, delude 
 aquoso puro et foetido, delude perducit ad fluxum 
 ventris, qui est sicut lotura carnis recentis, habentem 
 odorem pinguedinis, et ad curafhium.''* This last is 
 an Arabic term, having a close relation to milky or 
 rice-water evacuations. 
 
 Again, he is very judicious in directing the treat- 
 ment, i.e., the favouring or suppression of discharges, 
 according to the character of the evacuations. Thus 
 
 * My friend, Dr. Sprenger, author of "The Life of Mahomet," 
 called my attention to this word, which he believes to be an 
 altered form of an Arabic word applied to a disease of camel 
 and sheep, in which the milk coagulates in the udder. Cura- 
 thium, therefore, may mean a milky or flocculent substance. 
 Dr. Greenhill tells me he thinks this doubtful. 
 
UP TO THE SIXTEENTH CENTURY. 37 
 
 he says : — '' Amplius oportet ut consideres illud quod 
 egreditur. Dum enim perseverat exeundo clijlus et 
 aliquid homogeneum ei et oibus, non concedatis ejus 
 retentionem omnino. Sed quum illud quod egreditur 
 est res curathia viscosa aut cholerica, aut alia ex his 
 quse debilitant corpus, oportet ut adjuvetur in ejus 
 retentione cum stjpticis."* Probably the Latin 
 translation is very imperfect, but the important 
 point is that Avicenna recommended the treat- 
 ment to vary according to the evacuations. Every 
 practical man in treating the disease knows what 
 important indications the evacuations afford in the 
 worst forms of cholera, and therefore this looks as if 
 Avicenna was well acquainted with them. 
 
 Though Avicenna says nothing of cholera being 
 epidemic, he takes occasion, under the head of colic, 
 and when mentioning the epidemic colic spoken of 
 by Paulus ^gineta,t to say: — " Et quandoque 
 accidunt colica et ileos secundimi semitam accidentia 
 eegritudinum pestilentialium advenientium, et per- 
 veniunt de regione ad regionem, et de homine ad 
 hominem."J 
 
 Avicenna thus appears to believe in epidemic 
 colics and ileus sometimes prevailing in the East. 
 Notwithstanding the very full chapter he gives on 
 colic, he must have used the above expressions 
 hastily, for ileus can never be epidemic, and it is 
 questionable whether true colic can be so, as I shall 
 have occasion afterwards to show. 
 
 * Avicennse, edit, cit., p. 812. Ibid. p. 828. 
 t Supra p. 83. % Lib. III., Ten. 16, tr. 3. 
 
38 ANNALS OF CHOLERA, 
 
 Without pressing the matter too far, I think it 
 may be fairly inferred that epidemics akin to cholera 
 were not entirely unknown in the days of Avi- 
 cenna, 
 
 Averrhoes, in the twelfth century, is of value, as he 
 wrote in Spain and knew something of Morocco, where 
 indeed he died after a short residence. He continues 
 the use of the word haida or el haida — written cor- 
 ruptly by his translators almaida. In his chapter on 
 syncope coming from excessive evacuation, occurs 
 this passage* : — " Siout fit in ilia passione, quse 
 cholerica nominatur, et in Arabico dicitur almeida, in 
 qua vomitus et secessus simul fiunt, quae curatur 
 stringendo et ligando crura et brachia." Such 
 patients were to be placed in a hot bath. 
 
 I do not suppose that a further examination of 
 Arabian writers would elicit much of value. It 
 is said that some account of cholera is to be found 
 in the works of Ali Ben Hossein, of Bokhara, in 
 136-i ; in the writings of Mohammed Ishah, and of 
 Abdoul Curvy Ben Shahad, about the same period. 
 This is only so far interesting as bearing testi- 
 mony to the existence of a form of cholera in the 
 East. 
 
 To show that cholera continued to be a well- 
 known disease in Europe, it may be sufficient to 
 refer to Bernard Grordon, John of Gradesden, and 
 Grilbertus Anglicus. They all give some account of 
 it, yet they are little better than copyists of Ehazes 
 and Avicenna. It may, however, be worth while to 
 * De Medicina, lib. YII., c. 19. 
 
UP TO THE SIXTEENTH CENTURY. 39 
 
 say that Bernard Grordon of Montpellier's theory of 
 the disease, was shortly this* : — "The choleric passion 
 is a combination of anastrophe and of catastrophe, 
 an expulsion of food upwards and downwards. The 
 cause is a corrupt humour in the stomach, which 
 passes to the members and then again returns to the 
 stomach ; and being now fully formed, expels with 
 immense impetus both up and down. Spasms and 
 similar accidents occur, therefore you must be careful 
 to watch them." Bernard Gordon seems to have 
 lived in the thirteenth century. There appears to be 
 nothing of interest on this subject in John of Grades- 
 den, who was nearly a contemporary of Grilbertus 
 Anglious,t who lived about the commencement of the 
 fourteenth century. Of the latter it is sufficient to say, 
 that he treats of Colerica or Colerides ; that he used 
 the word syncope as synonymous with collapse ; that 
 he says that excessive evacuation and spasms accele- 
 rate death by inducing syncope. He considers it a 
 most acute disease. Bad cases terminate in the 
 course of a day, and he thinks that unless the patient 
 is strong, evacuants must not be used. 
 
 These extracts may be taken as representing the 
 views entertained in the thirteenth and fourteenth 
 centuries. I have not consulted any medical authors 
 of the fifteenth century, but nothing is likely to be 
 discovered among them, the period immediately pre- 
 ceding the revival of letters, and, indeed, the three 
 centuries from the thirteenth to the sixteenth being 
 
 * Lilium Medicinpo Lugdun., 1573, p. 481. 
 t Compend. Medicinse Lugdun., 1510. 
 
40 ANNALS OF CHOLERA, 
 
 perhaps the most barren and uninteresting in the 
 whole history of medicine. 
 
 The general notions of the fifteenth century may, 
 however, be considered to be fairly enough repre- 
 sented by Raphael of Volterra,* in a sort of encyclo- 
 paDdia of human knowledge published by him in 
 1507. He enumerates colic, ileus, cholera, dysen- 
 tery, in succession, setting down the two first as 
 diseases of the intestines, the two last of the stomach. 
 Of cholera, he says : — " Cholera, numero plurali, 
 ventris turbatio facta et per infema et per vomitum 
 ob cruditaiem et pravos humores aggestos. Cholera 
 vero numero singulari pro bile ponitur," &o., &o. 
 This strange but erroneous notion, of there being a 
 singular and a plural word, cholera, I have not met 
 with before this period^ but it has been repeated by 
 some authors. 
 
 With this extract these tracings of cholera from 
 the earliest ages to the year 1500 may close. 
 
 If we review the history of cholera up to this date, 
 we find that almost every writer on medicine in 
 Europe or in Asia has described a disease, the pro- 
 minent symptoms of which were violent vomiting and 
 purging. Different writers have dwelt on different 
 symptoms of the disease more particularly. But 
 serous evacuations, suppression of urine, loss of fluid 
 to the system, lividity of countenance, collapse, rapid 
 recovery, protracted recovery with secondary fever, 
 relapses, have all been described from the earliest 
 periods. The disease was counted a very grave one. 
 * Commentaria Urbana, Basil., 1543. 
 
TIP TO THE SIXTEENTH CENTURY. 
 
 41 
 
 The prevailing idea of the pathology of the disease 
 was that some foreign matter, such as indigestible 
 food or some morhid secretion of the system, acting 
 as a poison, irritated the stomach, and stimulated it 
 and the intestines to evacuation, and that the system 
 suffered in sympathy. 
 
 The ordinary treatment '^as in the first instance 
 to aid in clearing the stomach of irritating matter 
 by gentle emetics or aperients, or frequently to be 
 satisfied Tvith diluting the contents of the stomach 
 with water. There was a great dread of debility, 
 and wine was used as early as it was considered 
 safe. Opium, from a very early date, was em- 
 ployed by some. A great variety of measures 
 were used externally to restore heat and relieve 
 cramps. 
 
 There is no reliable account of epidemics, but the 
 disease prevailed most in warm weather. 
 
 We have indeed seen that Paulus ^gineta de- 
 scribed an epidemic bearing much resemblance to 
 cholera, and that Avieenna mentioned epidemics of 
 colic and ileus. Some of the sudden pestilences 
 recorded in the Bible have been conjectured, on no 
 sufficient grounds, to have been cholera; and 
 Josephus, the Jewish historian,* recorded a pesti- 
 lence in which the patients died with pains in the 
 intestines and vomiting, but he adds that they 
 evacuated the bowels corroded in every way, a de- 
 scription that could not apply to cholera. 
 
 Although we have a great aid in its identification 
 * Lib. I., cap. Y., y. 6. 
 
42 A>-NALS OF CHOLERA, 
 
 from the fact that it has been wonderfully constant 
 in its sjrmptoms for 2000 years, it would have been 
 very surprising indeed, if it had been possible to 
 identify with certainty any epidemics of cholera at 
 80 early a period. 
 
 The names applied to it by the earliest Grreek and 
 Arabic authors, cholera and haidsa, are at this day 
 its popular designations in Europe and in the East, 
 
 Erom the history that has just been traced, we 
 are warranted in drawing the conclusion, that up to 
 this time no Eastern writers have described a form 
 of cholera more acute than that of which the Greek 
 and Eoman authors have given full accounts. 
 
 But after this period, we find that European 
 travellers on reaching India were at once struck 
 with the existence in '"that country of a more acute 
 form of the disease than was common in Europe ; 
 and, therefore, from this date we can conveniently 
 treat of cholera in the East and of cholera in Europe 
 separately, always recollecting that in all parts of 
 the world it was a disease of varying intensity, and 
 that varied in its symptoms within certain limits. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 43 
 
 CHAPTER IV. 
 
 CHOLERA IN THE WEST FROM A.D. 1500 TO A.D. 1817. 
 
 The chief difference wMcli strikes us between the 
 period we have just surveyed, and that on which we 
 are now entering, is this, that from the commencement 
 of the sixteenth century we begin to have notices of 
 epidemics of bowel affections of considerable magni- 
 tude. They have rarely been described with sufficient 
 accuracy to make it possible to determine actually 
 what they were. They have been usually called colics 
 or dysenteries. But in modern times almost all epi- 
 demic colics are referred to lead poisoning, and 
 attributed to the consumption of unwholesome 
 wine. Many of these coKcs appear to have been 
 too widely spread to be so accounted for. Again, 
 dysenteries are usually confined to comparatively 
 limited areas, but Fernelius tells us* that in 1538, 
 " violent dysenteries ravaged the whole of Europe 
 with such ferocity, that scarcely any state escaped 
 unscathed." For these and other reasons it seems 
 probable that such epidemics may have been some- 
 what of a choleraic nature. 
 
 In the history of choleraf in Europe in the 
 
 * De abditis rerum causis, lib. II., cap 13. 
 t Where I do not give authorities, I have found the state- 
 ment in Short, op. cit. supra p. 3. 
 
44 ANNALS OF CHOLERA, 
 
 sixteenth oenturj, a great deal turns on the inter- 
 pretation of the French term trousse galant* now the 
 popular name for the disease in France. A century 
 later, or by the year 1643, it is used by Yan der 
 Heyden as synonymous with cholera ; but P. 
 Forestus, writing indeed only what he had heard, 
 in giving an account of trousse galant, which ravaged 
 all France and England in 1545, describes it as 
 a malignant fever with putridity and vomiting of 
 worms ; and though he writes at some length about 
 cholera, he in no way hints that it resembles trousse 
 galant in any respect. 
 
 Mezeray, the French historian, after saying that 
 a famine had desolated Italy and France for five 
 years, and was followed, in 1529, by the disease of 
 which he gives this descriptionf; — 
 
 "De cette mauvaise nourriture s'engendra une 
 nouvelle maladie qui etoit si contagieuse qu'elle 
 eaississit incontinent quiconque approchoit de ceux 
 qui en etoient frappes. Elle portoit aveo soi une 
 grosse fievre continue qui faisit mourir un homme en 
 peu d'heures, d'ou elle fut dit trousse galant. Que si 
 
 * We find the earliest notice of this disease with its name 
 slightly altered in the remote kingdom of Scotland, which 
 was, however, closely connected with France. Holinshed 
 says : *' In the month of September, 1510, an universal 
 sickness ruled through aU Scotland, whereof many died. 
 It was very contagious, and they called it stowpe galant.'''' 
 Unfortunately, he says no more. September has always been 
 a cholera month in these islands. The name indicates a disease 
 sudden and severe. — History of Scotland, p. 194. 
 
 t Mezeray, Histoire de France, torn, ii., p. 966, quoted by 
 Anglada, Etude, &c., 1869. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 45 
 
 quelqu'un en echappoit, elle lui arraohoit tous les polls 
 et les ongles, et lui faisoit une langoureuse foiblesse 
 six semaines durant aveo un si grand dugout de 
 toutes Bortes de viandes, qu'il ne pouvoit en avaler 
 que par force." 
 
 I quite agree witli Anglada that no one can pre- 
 tend to recognise liere a description of cliolera. The 
 most characteristic symptoms of all, vomiting and 
 purging, are not once mentioned. Grreat continued 
 fever, excessive contagiousness, and loss of hair and 
 nails, are no signs of cholera. I think, therefore, it 
 must be admitted that the trousse galant of that 
 period in France was not cholera, for neither the 
 non-medical description of the disease in 1529, nor 
 the medical one of it in 1545, point to that affec- 
 tion. 
 
 But leaving these uncertain descriptions, we come 
 very soon to something very closely resembling 
 autumnal cholera, although it is termed a colic 
 or Ueus. Moyses Alatius* writes thus : — " Golicam 
 iliacamque memini me vidisse in civitate Mantuae 
 anno 1560 mensibus nimirum August! et Septem- 
 bris, qui pubilce turn temporis ejusmodi passionis 
 contagione per universam civitatem grassabantur, 
 cum ssevis symptomatibus, assiduo nempe ac urgente 
 vomitu bills porrace89 in magna copia, necnon etiam 
 aeruginosae, lipothymia, assidua febre malignitatis 
 non experte, ac siti immensa, ac in eadem familia 
 plurimi eo morbo oppressi inveniebantur." With 
 the violent vomiting, immense thirst, and collapse, 
 
 * Mareia3 Prtelect., p. 276, 26. 
 
46 ANNALS OF CHOLERA, 
 
 doubtless many other symptomB were associated, 
 though they are not enumerated ; undoubtedly, this 
 looks very much like a local epidemic of cholera. 
 
 In 1564, however, we have the disease described 
 by name in an appendix to the works of Riverius. 
 The unknown author writes thus in substance : — 
 " In the year preceding the plague at Nismes, if I 
 recollect rightly, the disease called cholera was pre- 
 valent, killing many within foui' days ; but nearly 
 all recovered who sought aid on the first onset of 
 the disease. The treatment was of this sort. The 
 smallest possible quantity of liquid was given, 
 although the patients were tortured with inex- 
 haustible thirst, because vomiting and purging were 
 increased whenever they drank, and death followed 
 inevitably from them. Warm oil was used against 
 the torpor and the convulsions of the legs. The 
 vomiting and alvine flux were combated by all sorts 
 of warm powders and cordial epithems applied to the 
 abdomen. They also got opiates, and sometimes, if 
 the strength had not yet failed at the commence- 
 ment of the disease, rhubarb was given. Strength- 
 ening clysters were also used, especially in boys 
 reduced by the disease. Under such measures nearly 
 all the patients recovered." 
 
 I think it is worth while to quote here the descrip- 
 tion of cholera given about this time by Lommius,* 
 as it is concise, and his writings remained classical 
 in medicine for nearly two centuries : — 
 
 " Omnium id penc atrocissimum est quod x°^''P<*^ 
 * Medicinal. Observation, lib. III. Antwerp, 1560. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 47 
 
 Grasci dicunt. Bills supra infi-aque magno impetu 
 prorumpit, acuti in intestinum superum dolores et 
 torsiones et inflationes incidunt : ingens afficit 
 bibendi cupiditas ; pulsus celer, frequens, parvus 
 atque concisus est : sgepe sudores toto corpore 
 moventur ; ubi gravius malum est, pulsus prope 
 totus concidit, crura manusque contraliuntur, frigidse 
 sudationes fiunt, anima deficit, et quum ad ex- 
 tremum ventum est, syncope accidit, quibus con- 
 currentibus omnibus, mirum non est aliquem subito 
 extingui." 
 
 "With all this good description, Lommius hints only 
 at ardor urinse instead of suppression, and at sterco- 
 raceus vomiting, a tbing unknown in cholera. He 
 says, " The disease is commonest in summer and 
 autumn : common among the young, rarer and more 
 fatal in old men." 
 
 About the same time, or near the year 1575, the 
 celebrated Paduan Professor Mercuiialis gave a full 
 account of cholera ; and although it is mainly based 
 on the histories of previous writers, some of his 
 observations are well worthy of being remembered. 
 As to the Protean nature of the malady, and its 
 varying mortality, he says* : — " lUud notandum, 
 non ita varium esse Proteum a poetis descriptum, 
 uti morbus ille varius videtur: quondam interdum 
 ita mitis esse videtur ut tutus censeatur, et tamen 
 jugulat ; interdum gravissimus incidit, ut statim vide- 
 atur jugulare velle, et tamen in bonum vertitur." As 
 to the diseases with which it is associated, and as to 
 * Lib. III., cap. 25. 
 
■io ANNALS OF CHOLERA, 
 
 its fatality* : — " Yidentur enim in cliolera con venire 
 singultus, nausea, inappetentia, (diarrhoea) dysen- 
 teria, vomitus, morsus, cardialgia, tremor (convul- 
 siones), et tandem omnes morbi qui infestant 
 ventriculum, ut non sit mirum ei ab omnibus et 
 lethalis et acutissimus sit existimatus." And then 
 he comments on the retreat of the doctor recom- 
 mended by Aretseus, and says, that under such cir- 
 cumstances the priest is of more avail. 
 
 About treatment he lays down some golden 
 precepts, the neglect of which has contributed not 
 a little to our knowledge of the relative value of 
 different modes of treatment being so imperfect f : — 
 " Est tamen in perficiendis his scopis aliqua differ- 
 entia, quoniam alia conveniunt in principio, alia in 
 augmento, alia in declinatione morbi." The treat- 
 ment of the different stages of the disease is seldom 
 with us sufficiently varied. 
 
 Towards the end of this century, Prosper 
 AlpinuSjJ though he did not see any cholera in 
 Egypt, the diseases of which country he described, 
 remarks that he had frequently witnessed deaths 
 from cholera, usually connected with double tertian. 
 
 Piso§ has less freshness than Mercurialis. He is 
 very much of a compiler from former authors, but he 
 bears testimony to the violence of the disease, which 
 was such " ut ea perculsi tosicum se bibisse putent," 
 a forcible expression of the old belief that its effects 
 
 * Loc. cit. t Loc. cit. 
 
 X De Medicina Methodica. 
 § N. Piso, de cognoscendis et curandis morbis, lib. III. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 49 
 
 were akin to those of poison. He insists on cholera 
 being sometimes the result of the abuse of purgative 
 medicines ; in fact, the three causes for the disease 
 which he assigns, are depraved humours, food, and 
 medicines, and he says that the most recent theory 
 of the disease in his day was that bile having accu- 
 mulated becomes irritating, and is expelled hither 
 and thither. 
 
 He was inclined to use both gentle emetics and 
 mild purgatives. The vomiting is cured by an 
 emetic, but after a time, if the powers were failing, 
 he gave wine. 
 
 We come next on a notice of a contagious epidemic 
 colic, which prevailed with great violence, and spread 
 all over Europe. An account of it was given some 
 thirty years afterwards by Zacutus Lusitanus, but he 
 treats the disease quite apart from the description of 
 cholera which he gave at that time, while making the 
 statement, that the Indian form was much more 
 acute than the European one, to which we shall 
 afterwards have to refer. He makes a remark, 
 which many other writers do, that those who have 
 had previous attacks of cholera are most likely to 
 recover. This indicates a mild form of the disease. 
 
 "We have every reason to believe that fluxes (no 
 doubt mainly true dysentery) were common in 
 Europe in the beginning of the seventeenth century, 
 if we are to judge by the literature of the period. 
 In 1607, two treatises were published at Strasburg 
 and at Ereiberg, on the Pestis et Dysenteria, then 
 commonly epidemic. 
 
 E 
 
50 A^^NALS OF CHOLERA, 
 
 In 1610, Grardiner* tells us that in England 
 summer brought tertian ague, yellow cholera, and 
 choleric fluxes. In 1617, Grramann published at 
 Halberstadt an account of the white and the red 
 flu5,t a distinction somewhat resembling that which 
 was at a later period taken up in England by 
 Claremont,J who divided fluxes into Jecoraeise and 
 Eheumaticee, and by WiUis. In 1623 and 1626, there 
 were epidemics of flux at Pont-a-Mousson, and at 
 Lyons ; and what shows that some of those fluxes 
 were probably of a choleraic character, Pietre, in 
 1624, published a treatise in Paris on the expe- 
 diency of blood-letting in cholera. Unless some 
 form of the disease was prevalent, a monograph on 
 a single point of treatment would surely not have 
 appeared. 
 
 It is worthy of remark that about the year 1636, 
 " rising of the stomach " or vomiting became a new 
 heading in the London bills of mortality ; also that 
 the deaths from convulsions increased very rapidly 
 
 * Trial of Tobacco. London, 1610. 
 
 t As early as 1583, Schonheid gave an account of the red flux. 
 This term is enough to show that a fliix not red was then recog- 
 nised. I am aware that up to the present day the uneducated 
 in Germany sometimes make a distinction between white and 
 red dysentery. There is no doubt occasionally a good deal 
 of white mucus in dysentery, and the dejections are some- 
 times nearly colourless, though free from mucus, in cases which 
 have been described as dysentery ; but I know of no form of 
 true dysentery in which a white discharge is characteristic of 
 the whole course of the disease. Still, it does not follow that 
 white dysentery was cholera. 
 
 X De aere et locis Anglise, 1672. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 51 
 
 after tliat period up to tlie end of the centiuy. So 
 did the deaths from cholera raorhus (so specified) 
 considerably, and proportionate to the increase of 
 deaths by cholera morbus was that of deaths by 
 colic and ileus. This statement does not refer to 
 the epidemics of cholera. Thus, according to the 
 London bills of mortality, the deaths were in these 
 proportions : — 
 
 1629-36 1695-1712 1754-67 
 
 Cholera Morbus 23 78 79 
 
 Colic and Ileus 192 640 546 
 
 A very lively description of the " trousse-galant, 
 called cholera morbus," was given in 1643 by a 
 Belgian physician, Van der Heyden,* a great advo- 
 cate of the water cure in gout and in some other 
 diseases : — *' The fimous onset of trousse-galant in 
 a short time takes away from the body so much of 
 its substance and of its force, and occasions in it so 
 much mischief and change, that in seven hours 
 their domestics would not recognise in such a sufferer 
 a master or a relative, unless they knew it could be 
 none else, for they encounter the true Hippocratic 
 expression, which indicates the extreme of debility 
 and the image of death. Once when I was called 
 to see a patient, only five hours after his attack, I 
 found him in a condition giving the most ui] favour- 
 able prognosis, to wit, without pulse or speech, 
 passing in his evacuations only a fluid resembling 
 
 * Discours et advis sur les liux de yentre, &e. Ghent, 
 1643-45. 
 
 E 2 
 
52 ANNALS OF CHOLERA, 
 
 clear milk. Along with this, his eyes were so sunk 
 that one could scarcely see them, and his legs and 
 arms so drawn back by convulsions, that one saw no 
 movement in them, and so cold from the moisture of 
 a cold and clammy perspiration adhering to them, 
 that the patient seemed more dead than alive." 
 
 The chief treatment of this malady was by the 
 laudanum of Theophrastus. It is well to remark in 
 this admirable picture of cholera the precise state- 
 ment about the nature of the evacuations. 
 
 At this time it was believed that excesses and 
 imprudences contributed to the development of cho- 
 lera, and doctors laid down hygienic rules for 
 avoiding attacks of it. The popular rhyme which 
 will be found in the note,* while it embodies some 
 such advice, recommending abstinence from excess, 
 and keeping the feet warm, shows at the same time 
 that the malady which gave rise to it must have 
 been a widely-spread one. The precise date of the 
 rhyme is not ascertained. 
 
 About the same period, or in 1649, Rivierus, of 
 Montpellier, gives a full account of a cholera, 
 chiefly sporadic, but of very considerable intensity. 
 It was sometimes followed by secondary fever, and 
 he gives also some cases of intermittent terminating 
 in cholera. As there is more of freshness and origin- 
 ality in his remarks than in those of many other 
 
 * Tiens tes pattes (feet) en chaud, 
 Tiens vides tes boyaux (bowels), 
 Ne voyez pas Mai'guerite, 
 Du cholera tu seras qtiitte. 
 
IN THE WEST FROM A.D. 1500 TO A.D, 1817. 53 
 
 systematic writers, I do not scruple to make a few- 
 extracts *: — 
 
 " It is worth while to consider whence the enor- 
 mous quantity of fluid expelled in this disease by 
 vomiting and purging can be derived. It is usually 
 said that this fluid comes both from the mesentery 
 and the parts near it, and also flows into the intes- 
 tine from the whole body. This is probably occa- 
 sioned by the malignant matter in the intestines 
 poisoning the whole fluids of the body, as the irritat- 
 ing medicines, antimony and elaterium, by poisoning 
 the healthy humours, cause hypercatharsis. 
 
 "As to its prognosis, this disease must be con- 
 sidered a very acute one, usually bringing sudden 
 death with it, but if there be any palpable cause for 
 it in what has been eaten, recovery is probable. The 
 more acute the symptoms in cholera are, as syncope, 
 convulsions, coldness of the extremities, the shorter 
 history we have, and death is the nearer. 
 
 " If the vomiting begins to abate, if the cadaverous 
 hue of the face begins to disappear, there is good 
 hope ; but patients are often carried off hj a relapse 
 after not only bystanders, but the physicians them- 
 selves have thought the danger over." 
 
 As to treatment, he would allow a little evacua- 
 tion in the commencement of the disease, until the 
 depraved humours were gone. But his main remedy 
 evidently was opium, and when the discharges were 
 somewhat checked, the use of cordials. 
 
 Some practitioners bled at the commencement of 
 * Prax. Medic, lib. ix,, cap. ix. 
 
54 ANNALS OF CHOLERA, 
 
 the attack, when they said the vital powers were 
 oppressed, not exhausted. This he did not approve 
 of, but recommended bleeding once or more in the 
 secondary stage, when it was necessary. 
 
 He considered cholera sicca a very rare disease, 
 and his treatment is not meant to apply to it. 
 Eivierus believed in the existence of contagious and 
 pestilent epidemics of coHc, which were most deadly. 
 
 There is much in Eivierus that applies to the 
 disputed questions in the theory and treatment of 
 the disease at the present day. 
 
 After this we do not for a time find much mention 
 of cholera in Europe. But Piso,* in his account of 
 South America, observes in the year 1658 that 
 cholera was a severe disease among the natives of 
 Brazil, often killing in twenty-four hours. 
 
 There was an epidemic of cholera again in Grhent, 
 in 1665. 
 
 We now come to the famous English epidemics, 
 which have been illustrated by Sydenham, by Willis, 
 and by Morton. Short tells us that in England, 
 owing to the heat in 1669, came cholera morbus, 
 which reigned till 1672. In 1676, the convulsions 
 were more violent and more continued than Syden- 
 ham had ever seen before, and required stronger 
 anodynes. Notwithstanding that they are well 
 known, Sydenham's accounts of the cholera of those 
 days are so valuable that I shall extract their principal 
 portions : — 
 
 Cholera morbus occurring in autumn is very 
 * Historia, &c., Indife utriusi^ue. Amstelodam. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. OO 
 
 different from the ordinary cholera induced by in- 
 digestible food. The disease is easily recognised. 
 " Adsnnt enini vomitus enormia, ac pravorum 
 humorum cum maxima difficultate et angustia per 
 alvmn dejectio : cardialgia, sitis, pulsus celer ac 
 frequens, cum eestu et ansietate, non raro etiam 
 parvus et insequalis : insuper et nausea molestissima : 
 sudor interdum diaphoreticus : crurum et brachio- 
 rum contractura, animi deliquium, partium extre- 
 marum Mgiditas, cum aliis consimilis notae symp- 
 tomatibus, qu.se astantes magnopere perterrefaciunt, 
 atque angusto viginti quatuor horarum spatio eegrum 
 interimunt."* The disease varied in its symptoms. 
 Cholera occurring at any other season of the year 
 differed " toto coelo " from that in August, f Some- 
 times the cramps were particularly violent. " Exe- 
 unte eestate cholera morbus epidemice jam sseviebat, 
 et insueto tempestatis calore evectus atroeiora con- 
 vulsionum symptomata, eaque diutumiora, secum 
 trahebat, quam mihi prius usquam videre contigerat. 
 Neque enim solum abdomen, uti alias in hoc malo, 
 sed imiversi jam corporis musculi, brachiorum 
 erurumque prse reliquis, spasmis tentabantur dirissi- 
 mis, ita ut aeger ex lecto subinde exiliret."J Re- 
 specting the causation of the disease, Sydenham's 
 opinions are chiefly remarkable for the weight he 
 attached to the epidemic constitution of the year and 
 to season, as if there was " something hidden and 
 peculiar to the air of the particular month that 
 
 * Obseryat. Medic, sect, iv., cap. 2. t Loc. cit. 
 
 X Epistol. R., I., 7. 
 
56 ANNALS OF CHOLERA, 
 
 impressed a sijeciiic alteration on the blood or on 
 the ferment of the ventricle." As to his practice, 
 he considered that " to attempt to remove the acrid 
 humours, the cause of the disease, by cathartics, was 
 as throwing oil into the fire, or to retain the 
 secretions by astringents, was to subject the patient 
 to an intestinal war/' He hit on a middle plan, 
 and, preferring dilution to evacuation in the first 
 instance, gave chicken soup, but after three or 
 four hours, if the patient had not improved, 
 " Hoc, inquam, oasu, omissis aliis quibuscumque 
 auxiliis, recto oursu ad saoram hujus morbi anchoram, 
 laudanum intelligo, confugiendum est ; quod non 
 tantum exhibendum est urgentibus symptomatibus, 
 sed etiam cessantibus vomitu ac diarrhcBa, mane et 
 sero quotidie repeten3.um, donee pristinas vires 
 seger ao sanitatem tandem receperit."* He therefore 
 gave laudanum very freely, and continued its use 
 much longer than has been usual in more modern 
 practice. Sydenham had only seen one case of 
 cholera sicca. 
 
 It is, perhaps, not too much to say that the 
 account of the same disease given by his con- 
 temporary Willis, is, in many respects, as interest- 
 ing as that of Sydenham. He has not omitted 
 the leading sj^mptom of white or watery evacuations. 
 Willis, like many other writers, considered cholera 
 to be a kind of dysentery, or, as it was vulgarly 
 called in England, "griping of the guts." The 
 
 * Observat. Medic, sec. iv., cap. 2. 
 
IN THE WEST FUOM A.D. 1500 TO A.D. 1817. 57 
 
 fallowing is Willis's description of the unbloody 
 flux — dysenteria inoruenta* : — 
 
 " In the year 1670, about the autumnal equinox, 
 a great many were sick of an unbloody but very 
 sharp and dangerous dysentery. The disease in- 
 vading suddenly and frequently without any mani- 
 fest occasion, did reduce those labouring with it by 
 great vomiting, frequent and watery stools (excre- 
 tory convulsions, with tormenting perturbation of 
 the whole body), quickly to a very great debility, to 
 horrid failure of the spirits, and loss of all strength, 
 I knew some, the day before well enough, and very 
 strong, in twelve hours' space so miserably cast down 
 by the tyranny of this disease, that with a weak and 
 small pulse, cold sweat, short and quick breath, they 
 seemed just ready to die ; and truly not a few to 
 whom fit remedies or opportunity of cure were want- 
 ing, were suddenly killed by it. This sickness, 
 raging for a whole month, began to decrease about 
 the middle of October, and before the beginning of 
 November was almost wholly vanished. Yery few 
 in that time had bloody stools, and not many bilious, 
 but very many had vomits, and watery, almost clear, 
 and plentiful stools. Whilst that popular dysentery 
 raged in the city so cruelly, in the country, or at 
 least three miles beyond the city, almost none was 
 sick of it. Besides here, although very many were 
 sick, the disease did not seem to be propagated by 
 contagion, but to affect those only that were pre- 
 disposed. For it did not take those who were 
 * Pharmaceutica Rationalis, sect, iii., c. 3. 
 
58 ANNALS OF CHOLERA, 
 
 conversant in the same family witli the sick any 
 sooner than those who shunned their houses." 
 
 Next come his views of treatment. " For the 
 cure of this disease no evacuation did help ; yea, 
 phlebotomie vomiting and purging sometimes did 
 hurt ; but for the most part the remedies were only 
 cordials, in so much that spirits of wine, with sugar 
 a little burnt, became a popular remedy and for the 
 most part profitable, though in the bloody flux it 
 was often found hurtful." If the pulse and breathing 
 were strong enough in the evening, he gave some 
 laudanum. 
 
 As to the aetiology of the disease, he did not 
 think its symptoms proceeded merely from the acrid 
 contents of the intestines. To account for the sudden 
 prostration of strength, he thought that a degenera- 
 tion of the nervous liquor and nervous juice over- 
 flowed into the mass of the blood, which, as the 
 nervous liquor is incongruous with it, rejects it by 
 the stomach and intestines. 
 
 Willis's views were tinctured by his opinions on 
 the nervous system, but here we have the germ of 
 the well-known theory which attributes the phe- 
 nomena of cholera to a sudden impression on the 
 nervous system. The main cause of the disease was 
 the evil influence of the air, which was naturally 
 increased by errors of living, but he could not connect 
 the disease with over-eating of fruit. Willis did not 
 describe secondary fever. 
 
 Another great physician of those times, Morton, 
 speaks of epidemic diarrhoeas and dysenteries, accom- 
 
IX THE "WEST FROM A.D. 1500 TO A.U. 1817. 59 
 
 panied by awful twitcHng cramps, as prevailing 
 annually from 1666 to 1672 to such, an extent as to 
 occasion a weekly mortality of from three to five 
 hundred. The diarrhoea consisted of a copious 
 purging of colliquative and virulent serum. Dr. 
 Morton's account is particularly valuable as showing 
 the connection between cholera and the fevers of 
 those days. He also gives one of the best marked 
 descriptions of the livor produced by the disease : — 
 " Totum corpus instar glebse frigidum et madore 
 perfasum, cutem, prse sanguinis congelatione, nigri- 
 dine tinctam."* 
 
 These statements respecting the prevalence of an 
 annual form of abdominal flux at this time by pro- 
 fessional writers, are confirmed by Mr. Chapman, of 
 Bath, in 1673, who, in a pamphlet written in praise 
 of the waters of his own city, propounds the question, 
 whether it may not be owing to the fashion of 
 drinking purgative mineral waters in the neighbour- 
 hood, that " a not only painfully torturing but 
 mortal malady, as the bills of mortality show, that 
 doleful disease, griping of the guts, had caused more 
 deaths in London about that period than ever in 
 former ages." 
 
 With respect to this griping of the guts, as we have 
 already seen, Willis appears to include under the 
 term both bloody and unbloody fluxes. Never-- 
 theless the great majority of those who have con- 
 sidered the question, are of opinion, that the griping 
 of the guts usually referred to the cholera described 
 * Pyretologia, &c., hist or, prim. 
 
60 ANNALS OF CHOLERA, 
 
 hj Sydenliain, doubtless including cholera infantum, 
 a very fatal form of the disease. Dr. Grreenhow 
 writes* that "an examination of the bills of mor- 
 tality shows a great increase of diseases of the flux 
 family after the great plague of 1655. This mor- 
 tality is chiefly assigned to the disease styled griping 
 in the guts, sometimes also called plague in the guts, 
 between which, bloody flux, flux and colic, a dis- 
 tinction is uniformly maintained. In the year 
 immediately preceding that of the great fire, the 
 number of deaths from this one form of flux exceeded 
 two thousand. Below that it never fell until near 
 the close of the century, although in some years it 
 exceeded three thousand ; and in one or two, four 
 thousand. Making allowance for the increase of 
 population, the mortality for this single disease in 
 ordinary seasons equalled that occasioned by the 
 cholera epidemic in London in 1854." f 
 
 Ettmuller,+ the standard author of his day, does 
 not say anything of much importance on cholera 
 itseK, but his remarks on diarrhoea and dysentery 
 
 * B. and F. Med. Chir. Review, April, 1856. 
 
 t Dr. Black (a) reckoned that during the last thirty years 
 of the seventeenth century, the deaths from gripes and colic 
 in London amounted to the large number of 69,979. 
 With respect to the diffusion of disease of the nature of liux in 
 Europe at this time, I find that there were diarrhoea and 
 dysentery in Denmark in 1660, great dysentery over all 
 Europe in 1666, dysentery at Breslaw in 1680, dysentery in 
 most parts of Europe in 1684, dysentery in Augsburg in 1688. 
 (a) Comparative Yiew, &c., London, 1788. 
 
 X Opera Theoret, et Pract, Lugdun,, 1686. 
 
IIS THE WE^T FROM A.D. 1500 TO A.T). 1817. 61 
 
 are instructive in tiieir bearing on cholera. He con- 
 sidered cholera to be only an excessive and unusually 
 malignant form of diarrhoea, and he is loud in the 
 praise of opiates for its cure. Diarrhoea, he said, was at 
 times more or less epidemic, and was at such periods 
 contagious. He believed it to arise from a ferment 
 either inspired with the air or taken in with the 
 food, or arising from the excreta of the sick, which 
 multiplied itself after being introduced into the 
 body. Of dysentery, he said that it might be spor- 
 adic or common, endemic or epidemic, mild or 
 malignant, with fever or without it. Every epi- 
 demic of it was contagious. The disease was caused 
 by the air, by bad water, and by bad fruit. The 
 contagion was propagated by the latiines, and some- 
 times even by injection syringes. Rivierus before 
 him had pointed out how in contagious dysentery 
 all the members of a family got it from the use of 
 common latrines. 
 
 Pechlin deserves mention as having described a 
 cholera about this time, which he expressly describes 
 as serosa and axo><i, or without bile, and says that 
 the cause of cholera had been erroneously assigned 
 to the bile. 
 
 In 1689 there were cholera and dysentery in Nurem- 
 berg. In 1691, in London, the third fit of inter- 
 mittent was sometimes accompanied with convul- 
 sions or a cholera. In 1695, in Ulm, there was an 
 epidemic convulsive colic, with fearful cramps, and 
 often with vomiting. I mention this epidemic, not 
 as necessarily having been cholera, but certainly 
 
62 a:nnals of cholera, 
 
 having close analogies with that disease. I might 
 enumerate more epidemics, such as one in Switzer- 
 land in 1696, commonly attrihuted to wine. Such 
 epidemics are usually set down to lead colic, and no 
 doubt often so with justice ; but they appear to have 
 spread from district to district in a way that it is 
 difficult to account for by the lead theory alone, and 
 the symptoms were much more acute than it is usual 
 to witness in ordinary lead poisoning. 
 
 The celebrated Hoffmann's* account of cholera is 
 chiefly interesting from the close parallel which he 
 draws between that disease and the effects of poison, 
 esj^ecially of arsenic. f 
 
 We now enter on a new century, and the notices 
 of cholera become less frequent. This coincides 
 mth what happened in the East. There is no 
 question whatever of the decay of the disease in 
 the East, as I have examined most of the available 
 authorities. I cannot say that I have examined the 
 question as regards Europe as thoroughly. 
 
 In 1701 there was an epidemic of cholera at 
 Breslaw, which was described by Helwig. He 
 observes that the disease occurs annually, and is 
 worst in the hottest years. In 1711, according to 
 Lentilius, J cholera was almost epidemic in Tubingen 
 
 * Opera, Vol. III., p. 1 74. 
 
 t It is curious to find another Hoffmann only last year 
 describing the post-mortems of some eases of arsenical poison- 
 ing, in which, like Virchow, he found the shedding of 
 epithelium, and the very sporules said to be distinctive of 
 Indian cholera. 
 
 I Eteodromus, p. 568. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 63 
 
 in June and July. In 1712 Augsburg had a cholera, 
 in the month of August. About the same date 
 Torti remarked on the supervention of choleraic 
 attacks in intermittents. In England, from the 
 beginning of the century, the moi^tality from the 
 various forms of alvine flux began to fall. Dr. W. 
 Heberden states that the mortality from flux, which 
 for many years in the end of the last century 
 annually exceeded two thousand, amounted to on© 
 thousand and upwards in the early part of the 
 eighteenth century, (others have calculated the deaths 
 from colics and gripes of the guts in the first fifteen 
 years of this century at 13,668), decreased to one 
 hundred and fifty by the middle of it. 
 
 As a specimen of the physico-mechanical medicine 
 that prevailed at that period. Dr. Pitcairn's* views on 
 cholera may be given in abstract. He was a great 
 authority in his day, not only in Holland, but 
 throughout Europe. He cannot admit that there 
 is any foreign ferment mingled with the blood. 
 Cholera was caused simply by the putrefaction of 
 some article of food in the stomach. This cause 
 exercised its force before it could get into the blood, 
 by exciting convulsive movements in the fibres of 
 the stomach. 
 
 All the phenomena of cholera were merely symp- 
 tomatic of the stomach afiection, not of any ferment 
 ' in the mass of blood. As the corrupt substance 
 irritates the stomach and intestines to excretion, 
 there is no need of artificial purging upwards or 
 * Philosoph. Mechan. Elements of Medicine, 1717. 
 
64 ANNALS OF CHOLERA, 
 
 downwards ; and as there is a necessity for excretion, 
 no astringents will be wanted, so long as any portion 
 of the morbid matter remains. As when a person 
 has taken a strong emetic, no one in his senses will 
 give another emetic or purge, or anything to stop 
 vomiting, so in this distemper we must proceed on 
 the same considerations. 
 
 His treatment was therefore mainly by dilution. 
 In the later stages he gave opiates, but warily and 
 in divided doses, and in a liquid form. He was 
 thus quite aware, as practical men commonly are, 
 that the system is usually sufficiently active of itself 
 in its efforts at evacuation. 
 
 Cholera was not unusual at this time in towns in 
 the north of Grermany, for returns show that in the 
 years 1722-3-4 there were 113 deaths from cholera 
 morbus in BerKn, and 208 in Breslaw. 
 
 In 1726, according to Dr. Short, there came in Eng- 
 land in July looseness and cholera morbus, in August 
 mild choleras. This seems to have gone on more or 
 less every year till 1737, the disease never being very 
 violent or epidemic. About 1736, Dr. Douglas, of 
 Fife,* described cholera in that part of the world 
 as occurring occasionally, and frequently killing in 
 twenty-four hours if it were neglected. His treat- 
 ment is perhaps worth quoting. In the first place, 
 he gave copious draughts of warm water, to make 
 the patient empty the contents of his stomach : then 
 he gave them toast-and-water made with oat cake 
 ad libitum. This was his grand remedy. But if 
 * Edinbiirgli Medical Essays, v. iv., p. 140, 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 65 
 
 the patient was convulsed or exhausted, or near the 
 jaws of death, then he gave laudanum freely and 
 wine. 
 
 In 1736, there was a contagious dysentery at Nim- 
 uegen, of which Degner has given a very careful 
 history.* From his description of the disease it 
 would seem undoubtedly' that a certain number of the 
 eases were true cholera. He did not at first think 
 the disease contagious, but became convinced that it 
 was so, when a fair took place, and when the country 
 people evidently carried back with them the con- 
 tagion to their homes. He thought cholera to be 
 alKed to dysentery, but to differ from it in not being 
 contagious. 
 
 Van Swieten, who produced his commentaries on 
 Boerhavef from 1742 to 1747, speaks very shortly of 
 cholera, and nowhere gives a complete history of the 
 disease ; yet the impressions of so great an authority 
 in medicine must always be of value. He says: — "In 
 cholera morbus, of a sudden and in a few hours' time, 
 there is so great a discharge of the humors both by 
 vomiting and by stool, that the whole body is ex- 
 hausted, the face is pale and collapsed. All the 
 strength is destroyed, and even convulsions are 
 observed from so profuse and sudden an inanition, 
 even though not so much as a drop of blood is 
 discharged either upwards or downwards This I 
 have often observed with great astonishment, and 
 especially in the case of a strong girl, who in the 
 
 * De Dysenter. Bil. Contag., 1738. 
 t Commentaries, Edinburgh, 1776, Vol. vi., p. 299. 
 
 F 
 
66 ANNALS OF CHOLERA, 
 
 space of three hours had her face so altered and col- 
 lapsed, that her most intimate acquaintances could 
 not know her, all the humors being dissolved as it 
 ■were by a poisonous force, and violently expelled by 
 vomiting and purging." 
 
 Our next accounts of the disease take us to the 
 South. In the period from 1742 to 1750, Dr. Cleg- 
 horn* describes cholera morbus in the island of 
 Minorca, and especially as occurring in the cold 
 stage of intermittents. 
 
 About the same period another army surgeon. Sir 
 John Pringle,t tells us of cholera, dysentery, and fever 
 prevailing in the Low Countries and about Grhent, 
 associated very much as we find them in such locali- 
 ties in the tropics. He believes fever, dysentery, 
 and cholera to be produced by the same cause — a 
 view often held by those who have had experience 
 of tropical disease. He propounds the view, nearly 
 as old as anything in medicine, that noxious vapours 
 may exhale from the porous surface of the earth ; and 
 what is more interesting with reference to recent 
 theories, although the remark is made when he is 
 speaking merely of intermittents, and he does not 
 indeed seem to have seen very much cholera, he 
 writes : — " By looking into their wells, it is easy to 
 determine the healthiness of their villages. These 
 wells being fed by the underground water, and being 
 observed to sink proportionally to the drought in 
 summer, are at once a proof and a measure of the 
 
 * Observations on Diseases of Minorca, 
 t On Diseases of the Army. 
 
IN THE AVEST FROM A.D. 1500 TO A.D. 1817. 67 
 
 constant exiialation of tliis concealed water tkrongli 
 the pores of the earth, occasioned bj the heat of the 
 sun." 
 
 In 1751* there was an epidemic of cholera in 
 Paris, witnessed by Malouin in the month of July, 
 and treated successfollj with opium. 
 
 About this date Cocchi,t an Italian physician, 
 mentions that acute and dangerous disease with the 
 ancient name of cholera. I merely make this re- 
 ference to show, that the disease continued to be 
 known in that part of Europe in which it has always 
 been most prevalent. 
 
 In 1753 a certain Dr. Tralles+ published a work 
 of very considerable importance in the history of 
 cholera — not for anything new in the way of facts 
 that it contains, nor for the very elaborate detail of 
 his own symptoms, but as an excellent digest of what 
 had been written on the disease up to that time. 
 He has very good remarks on the analogies of the 
 phenomena of cholera with those of poisoning. 
 Perhaps he is the first writer who expressly refers 
 the oppression of the circulation to the blood being 
 drained of its serum. " Ita emunctum esse liquidum 
 ut circulatio desinere incipiat." Aretasus had given 
 a similar reason for suppression of the urine. He 
 has a special chapter on secondary fever, which most 
 previous authors — I mean of those who mentioned it 
 at all — did not discuss at length. As to the causation 
 
 * Quoted in Anglada, Etudes, &c., 1869, p. 620. 
 
 t Bagni di Pisa, 1750. 
 
 X Historia, &c., Vratislayiae, 1753. 
 
 f2 
 
68 ANNALS OF CHOLERA, 
 
 of the disease, lie did not believe with Sydenham 
 and Willis in an occult atmospheric influence, but 
 attributed more to sudden refrigeration of the body 
 during great heat. As to the gravity of the disease, 
 he gives a long list of authors who have pronounced it 
 deadly, and he says for himself : — " Inter eas auteni 
 et choleram morbum quandoquam se efferre, tyranni- 
 camque stragem longe lateque edere solere, nimis 
 eheu ! rerum usu. compertum est." But he is most 
 valuable in his comments and criticisms on the 
 various means applied to the cure of cholera, namely, 
 bleeding, emetics, purgatives, clysters, especially on 
 turpentine, acids, absorbents, demulcents, salts, 
 volatile aromatics, tonic astringents, anodynes, opi- 
 ates, wine, drinks, cold water, topical applications, 
 baths. It is impossible to follow him in all his 
 details, but I may say shortly, that he uses the phrase 
 " eliminative," even then not a new one; that he 
 is very severe on the use of emetics ; is averse to 
 the use of purgatives ; rather likes demulcents and 
 diluents, on the analogy of the presence of an irri- 
 tating poison in the intestines. He thinks absorbents 
 useless, but many have faith in them, as in many 
 remedies, bi^-cause if they do no good they at least 
 do no harm. He approved of venesection in the 
 plethoric at the commencement. But his chief faith 
 was in opium, though he admitted that it should be 
 used with some caution. He approved of wine, but 
 gave some hints as to the risk of its causing con- 
 gestion of the head. 
 
 He winds up with the practical reflection that 
 
IN THE WEST FROM A.D, 1500 TO A.D. 1817. 69 
 
 there is no universal method of cure, and that he 
 really cannot recommend much more than the simple 
 remedies which were useful in his own case — vene- 
 section, diluents, demulcent tepid drinks and clysters, 
 fomentations and emollient ointments, and opium- 
 He hopes that some one article of the huge appa- 
 ratus of medicines he has enumerated, may detract 
 from the savage cruelty of cholera morbus, which 
 suddenly cuts oif so many lives. So much for the 
 treatment of cholera and for its fatality in Europe in 
 the middle of the last century. 
 
 Bissett,* in 1762, writes : — " The true malig- 
 nant cholera morbus seldom appears in Great 
 Britain, at least in the northern parts of the island. 
 I have not met with more than four cases of it in 
 seven years' practice, yet several cases of an uu- 
 malignant cholera have fallen under my observation, 
 particularly in August, 1759." This is merely 
 interesting as recognising the existence of a viru- 
 lent form of the disease. Sauvages, as we have 
 already seen,t describes, in 1763, a great variety of 
 forms of the disease, including the Indian one. In 
 1765 there was a choleraic form of intermittent at 
 Montpellier.l 
 
 In 1766 Sims§ described a bilious colic in London. 
 We are carried by Eouppe|| to quite another area, to 
 
 * Essay on the Medical Coastitution of the Air, &c. 
 
 t Supra p. 13. 
 
 X Anglada, Etudes, &c., p. 397. 
 
 § Observations on Epidemic Disorders in London, 1773. 
 
 II De morbis navigantium, 1762. 
 
70 ANNALS OF CHOLERA, 
 
 naval life and to sailors, among whom, owing to 
 their diet, coKeky attacks are in all ages frequent. 
 Of specific facts he does not give many. One is a 
 remarkable one of a whole ship's crew being stricken 
 down with cholera, off the Mediterranean shores of 
 Spain. Seventy men were attacked in one day, and 
 the epidemic lasted two or three days. This is what 
 we might now read of in cholera times —but mark 
 the difference, all the cases recovered ! 
 
 Eouppe was quite aware of the prevalence of 
 choleraic attacks in tropical regions (he did not 
 visit the East), yielding in no degree in violence to 
 the effects of the most keen poisons, and says that 
 those attacks are sometimes sporadic, sometimes 
 epidemic. He describes a fever complicated with a 
 choleraic access, and treated such an access in yellow 
 fever with warm drinks, poultices, and opium. 
 
 In 1767 Dr. Short mentions cholera morbus as 
 one of the diseases that made havoc among men. 
 Holmes, the President of the London Medical 
 Society, in his address to it in 1777, remarked 
 that cholera morbus came round every year as 
 regularly as autumn. 
 
 In 1782, Dr. Currie,* of Philadelphia, described a 
 fever that frequently terminated in cholera. There 
 was immense mortality of children from cholera 
 infantum, as there always has been in America. In 
 July, 1791, attacks of cholera were common in 
 Philadelphia. 
 
 * Account of Climate and Diseases of America. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 71 
 
 The ordinary views prevailing respecting cholera 
 morbus are fairly represented by Dr. Black* in 
 1788 :— 
 
 " Cholera morbus is much more frequent in 
 tropical and warm climates, and in northern regions 
 in the summer and autumnal seasons, especially in 
 unusually hot seasons. The disease is not infre- 
 quent in this island and metropoKs ; nor is it con- 
 fined to the warm season only. The symptoms are 
 sickness and nausea, succeeded by violent vomiting 
 and purging of a bilious nature, with gripes, 
 tenesmus, tension of the abdomen, anxiety, great 
 prostration of strength, intense thirst, eardialgy, 
 and sometimes muscular spasms of the lower extremi- 
 ties. In cases of ordinary violence it may continue 
 a day, and then cease. In more tremendous assaults 
 it sometimes proves fatal in twenty-four hours, 
 portentous omens of which are violent vomiting and 
 purging, sudden prostration of strength, quick, weak 
 pulse, hiccup, fainting, cold sweats, and cramps of 
 the extremities." 
 
 Am ong its causes he enumerates hot climate 
 and seasons, and in the tropics extreme heat and 
 dry weather, succeeded by fall of rain and coolness 
 of temperature, sudden changes of weather, cor- 
 rupt bile, excesses, &c. ; adding that " the disease 
 is symptomatic in intermittent and remittent 
 fevers." 
 
 Dr. Tallman described an epidemic of cholera at 
 
 * "View of Mortality," London, 1788. 
 
72 ANNALS OF CHOLERA, 
 
 Piillna in 1790.* Dr. Chambers gives the foUowing 
 abstract of his more important observations : — 
 
 " He is, perhaps, the earliest author who has 
 recorded as a premonitory symptom uneasiness of 
 the throat, accompanied by eructation. This is 
 followed by heat alternating with rigors, by uni- 
 versal languor, lassitude, gripings, constriction of 
 the prsecordia, nausea, on which supervene suddenly 
 vomiting and the most violent purging. In a short 
 time the pain in the abdomen becomes more intense ; 
 an incredible anxiety and painful thirst come on, 
 while the nausea and tenesmus, even in the intervals 
 of vomiting and purging, is most distressing. 
 The patient is sleepless ; the pulse grows very 
 frequent, small, and unequal ; the urine is often sup- 
 pressed, the mind -Unsteady." There is not much 
 more to be gathered from him, that has not been 
 often repeated in these pages ; but the description 
 of the more advanced stage is good : — " The body 
 has a shrunken, corpse-like look (cadaverosum, 
 macilentum) ; there is constant inquietude and rest- 
 lessness ; the eyes become sunken and hollow ; the 
 spasms of the various parts are most excruciating ; 
 the nails become blue ; the extremities cold ; cold 
 sweats break out, especially on the forehead." 
 
 Towards the close of this century Foderef saw 
 cholera epidemic in the neighbourhood of Nice, and 
 in the canton of Martignes. He disliked the delays 
 
 * Tallman in Stoll, Dissert. iMedic, v. ii., p. 247. 
 t Sur les Epidemies, vol, ii. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 73 
 
 of laxatives and clysters, and found opium the only 
 remedy. 
 
 Drs. Chisliolm* and Clark,! in 1795 and 1797, 
 mention cholera morbus in the "West Indies. It was, 
 however, a mild disease, although the latter observes 
 that instances have occurred of its being quickly 
 fatal when neglected. Cholera continued to show 
 its old liking for ships. A cholera morbus appeared 
 in 1800 among troops on board ship in Port Mahon 
 in an alarming form, though with no fatal con- 
 sequences. J 
 
 A notice by Dr. "Willan§ may conveniently wind 
 up the century. 
 
 " In 1800 the cholera was a frequent disease in 
 London in September, but particularly so after the 
 rains on the 19th and the 20th of August. To a 
 profuse discharge of green bile fi'om the stomach and 
 intestines, cold sweats, fainting, and hiccough, were 
 superadded most painful cramps of the muscles of 
 the lower extremities. The trunk of the body was 
 similarly affected, being j erked from side to side by 
 sudden and violent convulsions." 
 
 I shall be very brief in what I say of the com- 
 mencement of the nineteenth century. 
 
 I observe that Mr. White, of Bath, pubhshed a 
 book on cholera in 1808. Mr. Curtis, in his book 
 published in 1808, says that he has observed many 
 
 * On Yellow Fever. 
 
 t On ditto. 
 
 X Currie Medical Reports, vol. ii., p. 548. 
 
 § Miscellaneous Works, p. 375. 
 
74 ANNALS OF CHOLERA, 
 
 cases of cliolera near Edinburgh, nearly identical with 
 the mort de chien he had seen in the East Indies ; but 
 there was this difference, that only one of these cases 
 was fatal. 
 
 Saunders, in his treatise on Liver, in the edition 
 of 1809, continued his statement that cholera morbus 
 was extremely frequent in England in the months of 
 August and September, so as to be considered the 
 autumn epidemic. 
 
 According to the bills of mortality, diarrhoea, 
 summer cholera, and other diseases of the nature of 
 flux, were unusually fatal in most of the early years 
 of the century, for instance, in 1802 and 1803, and 
 again in 1811, 1814, and 1815. 
 
 Dr. Armstrong* described cases resembling cholera, 
 which occurred at Shields and in the neighbouring 
 districts in 1817, under the head of congestive 
 typhus ; and Mr. Hennenf recorded the prevalence 
 of a most fatal cholera at Cephalonia, in the years 
 1816 and 1817. It does not seem to have spread 
 widely, but it destroyed three oiit of the four attacked 
 by it, and was therefore proportionately more fatal 
 than ordinary Indian severe epidemics. | 
 
 Looking back now at those three centuries, we find 
 
 * Armstrong on Typhus Fever, 1819. 
 
 t Medical Topography of the Mediterranean, 1830. 
 
 X Many of the medical officers insist, in their letters in the 
 Bombay Report on Cholera, on the close resemblance between 
 what they saw and what was described by Armstrong. For 
 myself the fievre pernicieuse, or algide, has always appeared 
 to me to resemble cholera much more closely than any other 
 phase of fever does. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 75 
 
 that varieties of the disease were recognised at a very- 
 early period, and that by the middle of the eighteenth 
 century it had been subdivided into more than a 
 dozen species. 
 
 Perhaps the most remarkable point in those sub- 
 divisions* is, that they indicate the close connection 
 of cholera with dysentery, and with intermittent 
 fever ; that the worst Indian form of the disease was 
 even then recognised. Ftirther, a spontaneous, a 
 dry, a verminous form, the rlieumatic form (which 
 merely meant flux), were admitted, besides cases the 
 result of poisoning, whether vegetable or metallic. 
 In this long list of allied affections various forms 
 of colic, and possibly of ileus, were in all probability 
 included, as well as acute colliquative diarrhoea. 
 
 This multiplication of species can be considered 
 no advance in medicine, and is in strong contrast 
 with the late classification of the London College 
 of Physicians,! which lays down only two varieties, 
 cholera simplex and cholera pestifera. 
 
 Nor is the advance of this period to be found in 
 any more complete description of the symptoms of 
 the disease, unless perhaps in so far that secondary 
 fever was more distinctly recognised. Suppression 
 of urine, and rice-water evacuations, usually con- 
 sidered the characteristics of Indian cholera, had 
 been already described, but were noticed again 
 in Europe. Various questions were raised as to 
 
 * See Chapter I. supra, 
 t Diarrhoea, cholera, paralysis, and colic succeed each other 
 in their general list. 
 
/b ANNALS OF CHOLERA, 
 
 the pathology of the malady. The condition of the 
 circulation was more fully considered, and how far it 
 was dependent solely on the mere drain of fluid 
 from the intestines. Although much was still 
 ascribed to articles of food as exciting causes, there 
 were questions of its not being simply a disease of 
 the stomach and small intestines, of its being a more 
 general affection of the system, of spontaneous 
 blood poisoning, and of a primary impression on the 
 nervous system. The connection of cholera with 
 dysentery, with fever, and especially with inter- 
 mittent fever, was studied. 
 
 The difficulties attending the discrimination of two 
 forms of dysentery, which were early observed, can 
 not now be entirely^ cleared up ; but there seems to 
 me to be a strong presumption that in many in- 
 stances, and a hundred years before Willis, white 
 dysentery meant cholera. 
 
 As to treatment during this period, emetics and 
 purgatives seem to have been going out of fashion, 
 and the old diluent treatment was frequently adopted 
 in the beginning, although a few practitioners 
 would not allow any liquid at all to be given. 
 Opium and cordials became latterly the favourite 
 medicines. Greneral blood-letting was recommended 
 and practised in the first half of the seventeenth 
 century ; but I doubt whether it was ever very 
 popular, especially in the commencement of the 
 attack. As to other treatment, hot baths were used ; 
 blisters and sinapisms were applied to the stomach 
 and to the extremities. 
 
IN THE WEST FROM A.D. 1500 TO A.D. 1817. 77 
 
 As to the aetiology of the disease, a great deal 
 was attributed to a certain epidemic constitution 
 of tke air, to season, to miasms generated in the 
 soil, and depending on its moisture and the heat 
 of the sun. As regards contagion, cholera was 
 undoubtedly reckoned non-contagious. The con- 
 tagion of the cognate diseases, epidemic diarrhoea 
 and dysentery, was acknowledged, and the idea 
 at least of cholera being contagious had been 
 suggested, though settled in the negative by such 
 authorities as "Wniis and Degner. Although the 
 contagious natui'e of the cholera excretions does not 
 seem to have been hinted at, the contagious nature 
 of the excreta in what were considered diseases of 
 a kindred nature, diarrhoea and dysentery, was freely 
 admitted, as also the influence of bad water in their 
 production. 
 
 But what marks this period most distinctly is 
 the repeated occurrence of epidemics of the disease, 
 among which the comparatively limited ones of 
 London hold a prominent place, owing to their 
 having been so fully described. Imperfect though 
 our information is, there are strong indications that 
 there were epidemics of the disease of considerable 
 magnitude in France and other parts of Europe. 
 
 But the disease, at least in the eighteenth 
 century, seems never to have produced a very 
 startling mortality, nor were its epidemics so appal- 
 ling as those we shall find described in India 
 during the same period. All the physicians, indeed, 
 seem to have spoken very confidently of being able 
 
78 ANNALS OF CHOLERA, 
 
 to cure cholera, if they were only called in early 
 enough. As we shall find that this confidence was 
 often entertained in India in the presence of the worst 
 forms of the disease, I should not trust to this mere 
 tone of assurance as a proof that they could cure the 
 disease, did not the narratives of the period of par- 
 ticular cases show, along with many sudden deaths, 
 a very great proportion of recoveries. 
 
IN THE EAST FKOM A.D. 1500 TO A.D. 1750. 79 
 
 CHAPTER V. 
 
 CHOLERA IN THE EAST FROM A.D. 1500 TO A.D. 
 1750. 
 
 As the Portuguese found cholera in India on tiieir first 
 arrival, it is only reasonable to suppose th.at it existed 
 there before that period. The words by which pesti- 
 lences have been described by Mussulman historians 
 are, unfortunately for our purpose, applicable to other 
 diseases besides cholera. However, Mr. Dowson, in 
 his learned edition of Sir Henry Elliot's "■ History 
 of India,"* gives an instance of what very possibly 
 was cholera in the neighbourhood of Delhi, as early 
 as the year 1325. At that time the Sultan Ma- 
 homed Ben Tugliik Shah arrived at Arangal, where 
 cholera (ivaba) was prevalent. Several of the nobihty 
 and many other persons died of it. The sultan him- 
 seK had an attack, and his recovery was tedious. 
 There appears to have been in that season a scanty 
 fall of rain : there was famine and great distress, 
 and the people perished in great numbers. This is 
 doubtless no solitary instance of what happened 
 before the year 1500, and sometimes such pestilences 
 were fevers, sometimes cholera ; but it is pleasanter 
 
 * Vol. III. 
 
80 ANNALS OF CHOLERA, 
 
 to deal witli indisputable facts, as we are able to do 
 bencefortli. 
 
 "We now reacb the period of direct intercourse with 
 India and the Islands of the Indian Ocean, by the 
 voyage round the Cape, and of the settlements of 
 Europeans in the East which naturally followed. 
 From this date we have an almost unbroken chain of 
 evidence, usually direct, in some few oases circum- 
 stantial, of the prevalence of cholera in India, not 
 only in its milder, but also in its most malignant 
 forms — evidence quite sufficient to satisfy anyone 
 having a practical knowledge of the disease in India. 
 Although the description given of the symptoms is 
 often incomplete, as was to be expected in the 
 accounts of ordinary travellers, and as is the case 
 when they mention other maladies, yet, taken in con- 
 nection with what we know of the native names for 
 cholera and of the habits of the disease, a few points 
 which are alwaj^s noted are quite sufficient to identify 
 cholera. Eor instance, sudden attacks of vomit- 
 ing and purging, followed by cramps and collapse, 
 and causing death within twelve or twenty-four 
 hours — attacks so sudden that they were often attri- 
 buted to poisoning, and for which Europeans had no 
 remedy — a disease occurring sporadically at one 
 time, as an epidemic at another. No other Indian 
 malady, whether epidemic or sporadic, was so sudden 
 in its onset and in its progress, or excited the sus- 
 picion of poisoning. The native treatment by 
 cautery, recommended in old days in Sanscrit writ- 
 ings, although it was used in other complaints, also 
 
IN THE EAST FROM A.D. 1500 TO A.U. 1750. 81 
 
 affords a valuable clue in tracing out cholera.* I 
 am satisfied that evidence of this kind — many little 
 facts, not in themselves sufficient, but when taken 
 together irresistible — will make most impression 
 on those who are most familiar with the disease. 
 They are (pu^iwra avvirom — that is, they speak to such. 
 Such experts cannot, of course, pretend to define 
 with certainty what form of cholera each mention 
 made of it was, whether sporadic, endemic, or epi- 
 demic ; but the existence of a bad form of cholera is 
 always recognisable. Indeed, considering how small 
 the total number of Europeans in India was, how few 
 parts of the country they had visited, except as pass- 
 in g travellers, bearing in mind that even at the 
 present day it is only in exceptional years that 
 cholera is one of the principal, that is, most destructive 
 maladies ; that fever, and dysentery and diarrhoea, 
 whether original or as sequelge of fever, are the 
 
 * 1 think it may be said that, as a rule, the cautery to the 
 ankles was chiefly employed in the East in violent spasmodic 
 diseases and affections of a general nature, as in mordshi, in 
 the last stage of fever, and in calentures. In more local 
 affections it was applied topically, as over the spleen in diseases 
 of that organ, for instance, in the Maldives in 1604, according 
 to Pyard, or at this day in Bengal, or over the colon in an 
 affection of it called null in Bombay, which seems to be the 
 colic alluded to by Carreri in 1696. I believe that applications 
 of the cautery to the abdomen or to the ankles were not often 
 nsed indiaiThoea or dysentery. The moxa was also a favourite 
 application in the East, especially characteristic of Chinese and 
 Japanese medicine. Apparently the acupuncture of China and 
 Japan did not reach India. The Greeks applied the cautery 
 lightly in colic, but not in cholera. 
 
 G 
 
82 ANNALS OF CHOLERA, 
 
 diseases whicli always have destroyed the greatest 
 number of lives in India — it is surprising that we 
 have so many notices of cholera, and it is cei-tain 
 that it must have been very widely spread to have 
 attracted so much observation. Undoubtedly far the 
 greater number of cases that have been formerly 
 described as mordshi or cholera, or cholera morbus, 
 would in these days be considered cases of true 
 malignant cholera. 
 
 Yasco de Gramez first reached the south-western 
 coast of India in the year 1497. The Portuguese 
 began to form settlements about the year 1502, and 
 they took Goa, which continues to this day to be their 
 seat of government, in 1510. 
 
 Their first proceedings in India soon involved them 
 in a war with the Sumorin, the ruler at Calicut, and 
 in 1503, during a campaign against him, there is an 
 unmistakable notice of cholera, as v/ell as of small- 
 pox, having proved fatal.* " The loss of the Samorin 
 could not have been less than 20,000 men, to which, 
 besides the wounded, greatly contributed the current 
 spring disorders, and also smallpox ; besides which 
 there was another disease, sudden like, which struck 
 with pain in the belly, so that a man did not last out 
 eight hours' time." 
 
 Some years afterwards, or in 1513, an e23idemic 
 of frightful intensity at Groa, and a graphic 
 account of it and of the distress and consternation it 
 
 * Lendes da India, vol. I., book It., p. 489. et seq. This 
 and tlie next extract are translated by Mr. Gaskoin in the 
 British and Foreign for Jiily, 1867. 
 
IN THE EAST FKOM A.D. 1500 TO A.D. 1750. 83 
 
 occasioned, lias been left us. " In tlie spring of this 
 year there appeared a mortal throe, which those of 
 the coTintrj call moryxy, common in all classes of 
 people, no less to the child at the breast than to the 
 octogenarian — to the stalled beast and the domestic 
 fowls also, for it was common to all things living ; 
 nor could any reason be assigned for this agonising 
 infliction. The sound as well as the sick fell victims 
 to it, and nothing did it respect. This dolour 
 struck on the stomach : so grievous was the throe, 
 and of so bad a sort, that the very worst kind of 
 poison seemed to be taking effect, as proved by 
 vomiting, with excessive thirst for water accompany- 
 ing it, as if the stomach were parched up, and by 
 cramps that were fixed in the sinews of the joints 
 and in the soles of the feet, with pain so extreme 
 that the sufferer seemed at the point of death. The 
 eyes were dimmed to the sense, and the nails of the 
 hands and of the feet black and curved. For this 
 disease none of our physicians found a cure. The 
 patient barely lived the day, or at most the night 
 through, in such sort that of one hundred attacked 
 scarcely ten escaped, and they used native remedies. 
 So great was the mortality, that the bells tolled all 
 day long. There were twelve, fifteen, or twenty 
 burials daily. At last the Grovernor ordered that the 
 bells should be tolled no more, as their tolling in- 
 creased the alarm. The Grovernor ordered the 
 physicians to examine a dead body ; but they found 
 nothing in the body, but the stomach shrivelled up 
 like a piece of leather." 
 
 G 2 
 
84 _ ANNALS OF CHOLERA, 
 
 As this is the first notice of an epidemic of cholera 
 in India, so also is it of a post-mortem examination 
 of a case of the disease, with the usual negative 
 result of a superficial examination. It proves 
 beyond question that the Portuguese applied the 
 word nioryxy to malignant cholera from the very 
 commencement. 
 
 The points of most interest in the preceding- 
 account are the occurrence at that early date of so 
 violent an epidemic, and the statement that domestic 
 animals suff'ered at the same time from the disease. 
 Similar statements have frequently been made, but 
 it is very difficult to admit their accuracy without 
 more complete evidence. 
 
 This pestilence came after a time, like other epi- 
 demic invasions, to be forgotten ; for D'Orta, writing 
 at Groa a few years afterwards, does not mention the 
 epidemic of 1543. 
 
 Grar9ia D'Orta, who had resided at least a quarter 
 of a century at Goa, published in that place, in 
 1563,* the earliest European work on Indian mecli- 
 
 * WMle giving the Portuguese all praise for the printing of 
 this book at Goa, I may go a little out of the way to give them 
 credit for their great hospital, a royal foundation at that place. 
 All travellers are loud in its praises. The building is described 
 as being more like a palace than a hospital, and it had beau- 
 tiful gardens attached to it. It had accommodation for from 
 1000 to 1500 patients. The cleanness of the beds and bedding, 
 and the excellence of the diet, were the theme of admiration 
 with all, and no doubt the change to it from on board ship 
 must have been most grateful. Patients on admission had the 
 hair shaved from every portion of the person, and were well 
 washed. The gentlemen of Groa used to go into the hospital for 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 85 
 
 cine, and the first book printed in India. Notwith- 
 standing its numberless typographical errors, the 
 production of the work is very creditable to the 
 Portuguese. The book is in the form of colloquies, 
 and his account of cholera occurs in the colloquy on 
 the drug Cosfas. As it is the first full account of 
 the disease given by a European physician, I have 
 attempted a condensed translation of it : — 
 . " Let us approach the choleric passion, which the 
 Indians call morxi, or disease from eating too much, 
 and which we corrupt into mordeshi. The Arabs 
 call it hachaiza, which has been corruptly read by 
 Erhazes as saida. 
 
 " It is a malady which kills very quickly, and from 
 which few recover. It is more acute than in our 
 lands, for it commonly kills in twenty-four hours. 
 I have seen cases in which it did not last more than 
 ten ; persons in whom it lasted four days ; and as there 
 is no rule without an exception, I have seen a man 
 
 treatment for all serious illnesses. The establishment was 
 Tinder the management of the Jesuits. There were other 
 hospitals for women and for natives. The hospital at Diuwas 
 only second to the great one at Goa. But Goa began to decay 
 early. Tavernier («) tells us, in 1648, that the management of 
 the hospital was changed, and its credit gone. The patients 
 complained of the want of all nourishing food. Tavernier says 
 that the credit of the hospital was somewhat revived by the 
 successful use of profuse blood-letting, sometimes repeated 
 from twenty to thirty times ! The patients were often made 
 to drink a glass three times daily of the urine of the cow, a 
 practice borrowed from the natives ! 
 
 («) Suite des Voyages, 1713, vol. iii., p. 163. 
 
86 ANNALS OF CHOLERA, 
 
 of strong constitution that lived for twenty days, and 
 went on vomiting bile incessantly, and in tlie end 
 died. I knew an excellent gentleman wlio suffered 
 thii'ty hours from this complaint, and who said that 
 he had neither vomiting nor purging, nor cramp, 
 but was entirely prostrated by inability to breathe 
 fi-eely. The natives call this kind, got by excessive 
 venery, the dry or secco. 
 
 " Those who eat much, particularly of cucumbers or 
 shell-fish, and those who have too much converse with 
 women, suffer most. The disease is most common in 
 June and July. Symptoms : the pulse is very weak ; 
 in a short time there is a feeling of great cold, along 
 with cold perspiration ; the surface cold is very great, 
 while the patient complains that he is burning ; the 
 thirst is clamorous ; tfie eyes are very weak ; there 
 is inability to sleep, much vomiting and purging, 
 until the powers are so exhausted that nothing more 
 can be expelled ; cramps in the legs follow ; the 
 patient turns and twists from suffering, and cannot 
 remain quiet. After the patient may have been vomit- 
 ing and purging a couple of hours, at last he brings 
 up only water, with no bitter or acid taste." He 
 further adds that " the poison, bad though it be, does 
 not seem to be of a catching kind." 
 
 " The malady was not one that could be neglected 
 either by the physician or by the hosj^ital attendants. 
 As to treatment, there is a poisonous humour and 
 infection which ought to' be expelled and evacuated. 
 The native treatment was to give a decoction of rice 
 with pepper and cinnamon, but above all to apply 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 87 
 
 the actual caut^y to the feet and ankles, and to tie 
 ligatures round the limbs. They also pushed long 
 pepper into the ejes in collapse, as they did in 
 lethargy. He himself gave no water to drink, except 
 a little in which gold had been extinguished. He 
 used a variety of astringent vegetable medicines. 
 He thought there was much virtue in three grains of 
 Bezoar, a remedy with which he cured the Bishop of 
 Malacca. He rubbed the whole body with hot 
 cloths and warm oils, and when the vomiting stopped 
 gave a little chicken soup." 
 
 Thus D'Orta points distinctly at the varied 
 forms of the disease — the ordinary one with violent 
 vomiting and purging, the other with nearly an 
 absence of those symptoms. He does not mention 
 the usual crucial tests for malignant cholera : 
 watery dejections and suppression of urine. He 
 mentions a case of partial convalescence, yet which 
 ended fatally, after many days of bilious vomiting. 
 One case is described as being mainly one of asphyxia. 
 He says the disease is one of season, prevailing 
 chiefly in June and July, and does not allude to 
 any former epidemics. He does not for a moment 
 believe the affection to be a new one, although he 
 knew it was more severe than the ordinary disease 
 in Eiu-ope. 
 
 In D'Orta' 8 account the influence of ancient authors, 
 and especially of Ehazes, is very plain. He pursued 
 his mode of treatment mainly. He follows the 
 Greek and Ai-ab practice of applying ligatures to 
 the limbs, and also the Indian treatment by cautery. 
 
bb ANNALS OF CHOLERA, 
 
 The next author who mentions cholera is Christo- 
 pher A' Costa, who surnames himself Africanus. He 
 made much use of D'Orta in his treatise on " Drugs 
 and Simples,"* and thus expresses himself (I have 
 used the Italian translation) : — " The Brahmins and 
 the Canarese doctors use the Canarese pepper for the 
 passio cholerica, a malady called morxi, which malady 
 is so acute that it kills in twenty-four hours, or less. 
 It is called by the Arabs hachaiza, and is to be 
 regarded as a particular pestilence. Of which 
 poisonous malady Grod has cured many by my 
 hands in these Eastern parts. And I have in hand 
 a treatise on this and on many other common Indian 
 maladies, to be published if God will." 
 
 "We also learn from his translator " Clusius " f 
 that the Malabar doctors consider the jack-fruit to be 
 injurious : " Qui frequentius Jacca vescuntur, facile 
 in pestilentem ilium et pessimum morbum mordshi 
 appellatum incidunt." 
 
 We thus learn that cholera morbus and mordshi 
 were considered the same by A' Costa as well as by 
 D'Orta, and that it was one of the common diseases 
 of that part of India, namely, Canara — that is, ac- 
 cording to the usual acceptation of the term, that 
 cholera was endemic there. 
 
 We may set down to about this period, or from 
 1570 to 1580, a notice of cholera in Goa by the 
 Sieur Vincent le Blanc.:}: Apparently his account 
 
 * Burgos, 1678. t Antwerp, 1582. 
 
 X Le Blanc is one of the early describers of Bengal, and, 
 like most writers, he praises its wealth and salubriousness, and 
 
IIS THE EAST FROM A.D. 1500 TO A.D. 1750. 89 
 
 of travels in the East (part of which, I Buspect, is 
 a compilation) was not put together till 1631, when 
 he was of the age of seventy-four. But by his own 
 account he started from Europe in 1567, and must 
 in two or three years have reached India. He says 
 of Groa : — " Tout ce peuple est fort Bujet a la verole, 
 et a une autre maladie qu'ils appellent mordesin, qui 
 commence par des vomissements et des maus de 
 tete, et est pestilentielle, dont plusieurs meurent." 
 He then goes on to talk of scurvy.* 
 
 Linschott, a Dutchman, who spent many years in 
 Groa, and who published a book of travels, writes in 
 1589, according to his French translators : — " Les 
 maladies que ces changements de temps apportent 
 aux habitants de Groa sont divers, entre les quelles 
 a la vogue celle qu'ils appellent mordesJiin, qui sur- 
 vient en un instant et a I'improviste, avec souleve- 
 ment de I'estomac et vomissement continual jusques 
 a tomber dans defaillance : cette maladie est com- 
 mune et mortiiere a plusieurs." After talking of the 
 two next most fatal diseases, dysentery and fever, he 
 
 says its iiihabitants enjoy great longevity. Like others, he de- 
 clares the Ganges water to be excellent. Tavernier, sixty 
 years afterwards, is an exception to the general rule. He tells 
 us that, notwithstanding that the water is salubrious to the 
 natives of the country, and that it is sent to the Great Mogul 
 for his personal use, the Dutch in their settlements are obliged 
 to boil it before drinking. He and his companions, somewhere 
 near Allahabad, tasted a little mixed with wine, and only did 
 themselves a little harm ; but their servants suflfered severely 
 from the incautious use of it. 
 
 * Les Voyages, &c., Troyes, 1658. 
 
90 ANNALS OF CHOLERA, 
 
 adds of tliem all : — " Ces maladies font mourii" 
 annuellement grand nombre de Portugais " ; just as 
 one migh-t write at the present date of the three 
 diseases. 
 
 "We thus have six distinct, entirely unmistakable 
 accounts of the common prevalence of cholera at 
 Groa, and in the regions near it, in the sixteenth 
 century — one of them a graphic account of a bad 
 epidemic, of a type as fatal as has ever been known. 
 Taking, therefore, the most limited view of the case, 
 the disease must have been common on the coast of 
 Malabar and of Canara. As the word mordshee is 
 a Mahratta one, and as the Mahrattas had come 
 from the interior to Goa, it seems probable that 
 they had brought with them to that place a' know- 
 ledge of the disease^ to which they attached that 
 name. The Arabs, too, described the malady by the 
 old name in their language for it ; and I can find no 
 hint in. any dii'eotion of the affection being regarded 
 as a new one. 
 
 In the sixteenth century we have thus found 
 cholera to have been present in "Western India 
 only, but, be it remarked, in the only jolaces where 
 Europeans had any opportunity of observing the 
 diseases of the country. If we have no notice of 
 cholera before the arrival of Europeans, and then 
 only of its prevalence in the parts \dsited by them, 
 it is surely probable, not only that the disease was 
 to be found in India before their arrival, but also 
 that it was not limited merely to the districts with 
 which they communicated. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 91 
 
 With tlie next century we find abundant traces of 
 tlie disease, not only in India, but in the adjoining- 
 countries and islands ; and this gives me occasion to 
 say, that when one looks into the question, there 
 appears to have been a wonderful amount of inter- 
 course throughout the East in those days. Every 
 ship, whether Portuguese, Dutch, French, or EngHsh, 
 seems in the earliest days to have touched at Zanzi- 
 bar, at Aden, or Muscat, or at some port on that 
 coast, on its voyage from Europe to Surat, Groa, or 
 Calicut. From the western coast of India the 
 voyage was usually extended, especially by the Por- 
 tuguese and Dutch, to the Moluccas ; some ships, 
 too, found their way up the bay to the kingdom of 
 Bengala. Then the Portuguese on the west coast of 
 India were in close communication with Ormuz. 
 Ships sailed from Surat, conveying merchandise, 
 brought from upper India and from Bengal, to be 
 shipped for the Persian Grulf, and to go on by 
 caravan to Aleppo, the overland route of those days. 
 In the earliest times of the Portuguese, the fleet of 
 the Caliph of Egypt even issued from the Eed Sea 
 to attack them and besiege Diu. European vessels 
 often went up the Eed Sea. I need hardly add that 
 from the earliest periods, long before the Portuguese 
 reached India, Mahommedan pilgrims sailed annually 
 from Surat and other ports, bound for Arabia, 
 November was the month in which the ships usually 
 started. There was, therefore, an immense deal of 
 communication among the different parts of Asia 
 with India, mainly by ships and also by caravans. 
 
92 ANNALS OF CHOLERA, 
 
 General Beanlieu* wlio commanded an expedition 
 of a few sliips sent out by the Freneh, on arriving 
 at Sumatra, in 1620, lieard that there had been a 
 very fatal epidemic among the natives, which had 
 also destroyed a good many Europeans, especially 
 Frenchmen, and that it was of so sudden a nature, 
 that the Dutch and English were accused of poison- 
 ing their rivals, and Beaulieu was cautioned on the 
 subject. Nevertheless, Beaulieu himself had an 
 attack of the most violent vomiting and purging, 
 for which he was treated with Bezoar, a remedy 
 known to be used in cholera. He afterwards lost 
 forty of his men of " dysenteric et des grandes vomis- 
 sements, auquel on n'a pu trouver remede." He 
 talks of " les dysenteries " and of " comme je crois 
 les vomissements " separately. He attributed the 
 disease to the sailors drinking a great deal of water, 
 and then sleeping in the open air with their bellies 
 exposed. He said that living moderately, if it would 
 not ward off an attack, at least increased the chance 
 of recovery. Here, as elsewhere, we find cholera 
 and dysentery associated. 
 
 A very clear light is thrown on these imperfect 
 notices by Bontius, who in 1629 gives a full account 
 of the disease, which would have been unmistakable, 
 even if he had not identified it by mentioning more 
 than once that the Malays called it mordeshi. Now 
 we know that the Dutch had been preceded by the 
 Portuguese in Java, that the word mordeshi is not a 
 
 * Recueil de Theyenot, vol. ii. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 93 
 
 Malay word : it must therefore liave been imported 
 from India, and it must have been applied by the 
 Portuguese to a form of cholera which they either 
 brought with them or found already existing in the 
 island.* Bontius has been often er quoted than any 
 other authority for the early existence of cholera in 
 the East ; still, he is so important, that his account 
 of the disease must be reproduced here. Before 
 giving it, I shall merely remark that he talks of the 
 disease as a common endemic one, says it is as much 
 dreaded as is the plague in Holland, and that he 
 mentions it over and over again, under the heads of 
 several native remedies for it. "We learn that Bon- 
 tius had the misfortune of losing his wife in Batavia, 
 in 1631, from an attack of cholera, and he had this 
 loss probably before his mind when he says how 
 much cholera is dreaded, and how it is only too 
 familiar in those regions. " Proh dolor ! " Bontius 
 was well acc|uainted with the works of D'Orta, and 
 therefore with that writer's account of the disease, 
 as they both were with the writings of Grreek and 
 Arab authors, some of whose phrases and treatment 
 they repeat. 
 
 " Cap. YI. — De Cholera. Prseter jam dicta alvi 
 profluvia, etiam cholerica hie familiariter eegros in- 
 festat, cujus causam signa ao symptomata, curam 
 denique hoc capite absolvere animus est. Fit itaque 
 cholera, cum materia biliosa ac preetorrida ventriculum 
 ac intestina infestans per gulam simul ac per anum 
 
 * Besides tMs there was much, intercourse between Java 
 and India before the European period. / 
 
94 ANNALS OF CHOLERA, 
 
 . continuo ferme ac cum magna copia rejicitur. Morbus 
 est acutissimus, ideoqueprsesenti eget remedio. Causa 
 prsecipuahujus mali, prseteraeris calidam et humidam 
 temperaturam, est nimia fructus hie edendi licentia, 
 qui quod plerumque sint liorarii ac putredini obnoxii, 
 tum humiditate sua superflua ventriculo infesti sunt 
 ac insueti etiam, ac bilem seruginosam hanc gignunt : 
 lisec excretio et non sine causa alicui videretur salu- 
 bris, quod talia ]Durgentur qualia oportet : tamen quia 
 cum tanta quantitate simul effunduntur spiritus 
 vitales ac naturales, debilitato quoque per foedos 
 balitus corde, caloris omnis ac vitse fonte, ut pluri- 
 mum commoriuntur aegri, idque celerrime, utpote qui 
 intra viginti quatuor boras, vel etiam pauoiores, ex- 
 pii^ent, ut accidit in^er plurimos Cornelio van Eoyen 
 segrorum in nosocomio ceconomo, c[ui bora sexta ves- 
 pertina adbuo valens subito cbolera corripitur, et ante 
 duodecimam noctis boram vomendo simul ac per 
 alvum dejiciendo, cum diris cruciatibus ac convul- 
 sionibus miserrime expiravit, vincente morbi vio- 
 lentia ac celeritate omne remediorum genus : 
 si tamen ultra prsedictum spatium, pernicies ista 
 protrabitur, magna curee spes est : pulsus bic 
 admodum debilis est, respiratio molesta, membra 
 externe frigent. Calor vebemens ac sitis interne 
 urgent, vigilise adsunt perpetuse. Jactatio corporis 
 inquietissima, quse si comitatur frigidus ac foetidus 
 sudor, mortem in propinquo esse certissimum 
 est. 
 
 " Danda in boc affectu primum opera, ut acerri- 
 mus iste bumor, qui tanto furore ac orgasmo fertur, 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 95 
 
 mitigetur. Quod fieri potest maxime per adstrin- 
 gentia medicamenta, ao ventriculiun et intestina 
 corroborantia, et simul modico frigore furorem 
 materise morbificse refrsenantia. In his prsestan- 
 tissimus est sirupus ex Billingbing, turn fructus 
 ejus saccharo conditi, adjecto croco : sirupus prse- 
 terea e succo limonum recentium. In Java nas- 
 citur preeterea ad liunc affectum pseudo-Myro- 
 balanus qui forma Bellericos refert. Et magna 
 copia a nigris in urbem venalis adfertur. Et sola 
 astriotoria vi prsestat, cum ceterse Myrobalanorum 
 species etiam laxativi aliquid habeant : bine conditus 
 bic fructus utilissimus, ad cboleram non solum, sed 
 ad cseteros omnes alvi fluores nimios : cum cornu 
 cervi usto, lapide Bezoar, rasura cornu rbinocerosis, 
 vel margaritis prseparatis. 
 
 " Sed bis non adferentibus juvamen, confestim 
 ad extractum croci deveniendum est, tum ut vigilise 
 arceantur, ac somnus concilietur : qui propter sum- 
 mam virium dejectionem bic necessarius est : tum 
 ut, tantisper mitigato atroci isto bumore, natura 
 fortior denuo ad vincendum bostem insurgat : cbole- 
 rici (ut fere semper) convulsi luoriuntur." 
 
 Bontius tbus says tbat tbe disease is a common 
 one ; tbat it is caused by bot and bumid air, and by 
 eating too mucb fruit ; tbat altbougb vomiting and 
 purging are efforts of nature to get rid of wbat is 
 noxious, yet tbey produce sucb a degree of alarming 
 weakness and sucb sudden deatb, tbat tbey must be 
 cbecked. He does not mention tbe nature of tbe 
 evacuations, nor suppression of urine, but be paints 
 
96 ANNALS OF CHOLERA, 
 
 tlie disease unmistakably. He says, what tliere is 
 much truth in, that if life can be protracted beyond 
 twenty-four hours, there is considerable chance of 
 living, and he saw how much recovery depended on 
 the powers of reaction of the constitution. 
 
 As to his treatment much need not be noticed ; 
 he proceeded at once to vegetable astringents, ^fy- 
 robalanus, I believe, continues to be used in Java for 
 dysenteries, for which one would be more inclined to 
 use it than for cholera. The mention of the use of 
 lime-juice is interesting.* Like D'Orta, Bontius has 
 faith in Bezoar. 
 
 But his great remedy was extract of crocus, and, 
 like the Arab writers, he had a strong sense of the 
 necessity of inducing sleep, if possible. Saffron was 
 in those days used as a hypnotic, but in his prepara- 
 tion of it there was a very large proportion of opium. 
 
 We come nest to a very important notice of 
 cholera, which very probably was published before 
 Bontius' account of the disease in Java, if not 
 written earlier. Zacutus Lusitanus was a celebrated 
 Jewish physician, banished along with the rest of his 
 countrymen from Lisbon by Philip IV. He retired 
 to Amsterdam, where he published what was perhaps 
 the great systematic work on medicine of the day. He 
 had opportunities of communicating with the Dutch, as 
 well as with the Portuguese, the two nations in those 
 days most closely connected with the East. Letters 
 
 * This remedy for diarrhoea, now popular in many parts of 
 Europe, was about that time a favourite remedy of the negroes 
 on the west coast of Africa for colic. 
 
IX THE EAST FROM A.D. 1500 TO A.D. 1750. 97 
 
 addressed to Mm from the tropics, and especially 
 from Dr. Pereira, of Groa, sliow that he was in close 
 communication with physicians abroad. The story 
 about the cake from which the Arabs suffered is 
 quite new, and was not borrowed from preceding 
 authors. The statement therefore which he makes 
 in 1632 is entitled to much consideration; it is very 
 distinct and positive : — " Ne ergo contemnas hunc 
 affectum, qui etsi in Lusitania nostra et Amstelodami 
 paucos jugulet, in Oriente, ubi vocatur patrio sermone 
 mordeshi, plures quos corripit extemplo jugulat, et in 
 Mauritania et Arabia est lethalis fere ; in quem affec- 
 tum incidunt Arabes frequenter, qui continuo juscu- 
 lum esitant frigidum . . quod Cuscus vocatur."* 
 The notice by Zaoutus of the prevalence of the dis- 
 ease in Arabia is very important. We know, indeed, 
 that the Portuguese troops in various expeditions from 
 Ormuz suffered from sudden sickness, which com- 
 pelled them to retire ; but the nature of such attacks 
 does not seem to have been specified. A Russian 
 physician. Dr. Pehman, learnt in 1832, that there 
 was a tradition that cholera had been introduced 
 into Arabia some centuries before, that it travelled 
 over Persia, Syria, and Egypt, and finally dis- 
 appeared in the Afi-ican desert, f "We also know that 
 all Arab writers described cholera (of one kind at 
 
 * Prax. Histor. lib. ultim., observat. iii. 
 
 t Diseases are often mentioned as occurring in ships in the 
 Mozambique Channel, but they were chiefly fevers, dysenteries, 
 calentures, and scurvy. Rowles tells us of seven seamen dying 
 almost instantaneously in Madagascar in 1607 ; but this was 
 set down to poisoning by the natives. 
 
 H 
 
98 ANNALS OF CHOLERA, 
 
 least) as an ordinary disease ; and a little later we 
 shall find Then Rhjne stating that choleraic 
 colic prevailed universally through the East. But 
 though none of these statements are in themselves 
 sufficient to prove the existence of malignant cholera 
 in Arabia, they tend greatly to confirm what Zacutus 
 has said. He was perfectly aware that the tropical 
 disease was more violent than the ordinary European 
 one ; he knew that mordeshi was the name given to 
 the disease in the East ; and when he expressly 
 names the cake they eat, to which he attributes the 
 attacks of cholera to which the Arabs are subject, he 
 must have been using the information given him by 
 some local informant. 
 
 "With reference ia- the prevalence of the disease 
 in Mauritania, its mention as a violent illness by 
 Averrhoes, who practised in Spain about the year 
 1200, shows that at one time, at all events, it was not 
 unknown ; and Zacutus, being a native of Lisbon, 
 was likely enough to have good information respect- 
 ing a coimtry but little removed from Portugal, and 
 with which there was probably as much communica- 
 tion in those as in modern days. 
 
 We now return to India proper, and find an in- 
 telligent German traveller, Mandelsloe, who travelled 
 all over the world, giving the following account of 
 the maladies of Groa in 1639 : — 
 
 " Ce dereglement des saisons et ce changement 
 subited'une extremiteal'autresont causes de plusieurs 
 grandes maladies parmi les Portugais. Mais celles 
 qui y regnent le plus sont celles qu'ils appellent 
 
IN THE EAST FROM A.D. 1500 TO A.U. 1750. 99 
 
 Morclexin qui tuent subitement, les fievres chaudes et 
 la dysenterie, contre lesquelles ils ont presque point 
 d'autre remede que la saignee." 
 
 He then goes on to say that true plague is entirely 
 unknown in India. Although Mandelsloe may appear 
 to a certain extent to be repeating what Linschott 
 had already said about the diseases of Goa, he knew 
 that place and Surat well, and could scarcely make a 
 mistake. He is quite precise, and there is no possi- 
 bility of confounding the morclexin with dysentery 
 or with any other disease. ^ He also talks of the 
 morclexin in the plural, as if there were varieties of 
 it, and as if it were a commonly prevalent disease. 
 It is the first, he tells us, of the fatal maladies which 
 reign there. 
 
 Although there is abundant evidence of the pre- 
 valence of cholera in India about this time, a slight 
 notice by Baldseus, a Dutch clergyman, who gave 
 very full accounts of Ceylon and of the Malabar 
 coast, need not be overlooked. He enters very little 
 into the diseases of the country, but the following 
 casual observation was made by him in his account 
 of the coasts of India in 1611 : — " Care must be 
 taken to cover well your belly, hips, and legs, for 
 fear of the cramp, especially if you lie exposed to the 
 air in moonshiny nights, the neglect of which j)re- 
 caution often proves fatal to soldiers and sailors, after 
 they have treated themselves with arrack or with 
 other strong liquors."* 
 
 * Collect, of Voyages, vol. iii., p. 661. 
 
 h2 
 
100 ANNALS OF CHOLERA, 
 
 Now, what cramps could these have been ? The 
 tetanic attacks described about that period seldom 
 proved fatal, still less the facial paralysis which to 
 this day is commonly ascribed to sleeping in moon- 
 light. We know of no cramps that were often fatal, 
 save those of cholera. 
 
 We now begin to hear again of cholera in its 
 epidemic form. Some very extensive epidemics 
 are alluded to by native writers, who are quoted 
 by Colonel Tod.* The name applied by them to 
 the disease is murree, the generic term, as we have 
 already seen, for any deadly pestilence, and, Colonel 
 Tod tells us, the name commonly applied in Eajpoo- 
 tana to the choleraic pestilence. Unfortunately, very 
 incomplete accounts are given of those, as of all other 
 epidemics, which were seldom described in detail by 
 native historians. But when we know how common 
 cholera was in India at this time, and that it had 
 prevailed epidemically in a former century, the pre- 
 sumption is very much stronger that epidemics of 
 the disease did occur, than that they did not. I 
 have also observed some confirmation in entirely 
 opposite quarters of at least two of the epidemics 
 mentioned by Colonel Tod, as will appear in the 
 sequel. 
 
 According to him, native historians give accounts 
 of epidemics of cholera in Me war in 1661, in Mar war 
 in 1681, and in camp before Groa in 1684, when as 
 many as 500 men a day are said to have perished. 
 
 * Annals of Rajpootana, vol. ii. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 101 
 
 Colonel Tod, wIlo was an officer of great intelli- 
 gence, remarks very sensibly (and it is often useful 
 to hear tlie opinion of independent non-medical 
 observers, who have no theory to support) : — " Thus, 
 in the space of twenty years, we have cholera 
 described in the Peninsula, in the deserts of India, 
 and in the plains of Central India. I have no doubt 
 that other traces of the disorder may appear in the 
 chronicles of the bards, or in Mahommedan writers, 
 judging from those incidental notices which might 
 never have attracted attention, had not murree come 
 to our own doors." 
 
 Unfortunately, those fui^ther traces have not yet 
 been discovered, but I am glad to be able to support 
 Colonel Tod's opinion respecting the former preva- 
 lence of cholera in the part of India of which he 
 treats, by that of another eminent man, Sir John 
 Malcolm, who seems to have believed that cholera 
 has always been endemic in some portions of Mal- 
 wah.* His words are : — " It has been ascertained 
 that cholera morbus, which has so lately spread over 
 India as an epidemic, always exists as a disease in 
 this province." 
 
 De Thevenot, a French traveller, in his account of 
 his wanderings in the East, mentions that in 1666 
 he had a slight attack of cholera in travelling from* 
 Boorhampore to Surat, and gives the following 
 account of the disease : — 
 
 " Les Portugais appellent Mordechm les quatre 
 
 * Report on Malwah 1821, p. 5, note. 
 
102 A>'NALS OF CHOLERA, 
 
 sortes de coliques qu'on souifi-e dans le Indes, ou elles 
 sont freqiientes. La premiere est une simple colique, 
 mais qui cause de grandes douleurs : la seconde est 
 celle qui outre la douleur cause le cours de ventre. 
 Ceux qui sont affliges de la troisieme ont de grands 
 vomissements avec les douleurs ; et ceux qui ont la 
 quatrieme souffrent les trois maux ensemble : a savoir, 
 le vomissement, le flux de ventre et les extremes 
 douleurs ; et je crois que cette derniere est le Cholera 
 Morbus. Ces maladies viennent le plus souvent 
 d'indigestion, et se font sentir quelquefois avec des 
 douleurs si pressantes, qu' elles tuent un bomme en 
 vingt-quatre beures. Le remede que Ton a aux 
 Indes pour s'en delivrer est de faii-e rougir une 
 broebette de fer grosse^ comme la moitie des doigts, 
 I'appliquer sur la plante du talon du malade, et Vj 
 tenir jusqu'a ce qu'il ne la puisse plus souffrir. II 
 faut faire la meme cbose a I'autre talon ; et ce remede 
 est pour I'ordinaire si efficace que les douleurs cessent 
 en meme temps. Si Ton saigne le malade avant 
 cette ustion, il serait en peril evident de la vie. . . 
 . Mais la saignee n'est pas dangereuse deux 
 jours apres I'operation. II y en a qui se servent de 
 ligatui'es pour ce mal, a la tete, au dos, aux reins, 
 aux cuisses et aux jambes ; et quand le malade ne 
 'sent pas la force de cette ligature, on juge qu'il ne 
 pent guerir. 
 
 " Le cours de ventre seul est aussi fort ordinaire, 
 et tres dangereux."* 
 
 * Thevenot, Relation des Voyages, vol. ii., chap. 10. Paris, 1673. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 103 
 
 This account is of much interest, especially as 
 showing that different degrees of mordshi were 
 observed. They continued to he recognised by 
 the Portuguese, as they had been pointed out in 
 early Hindoo medicine. Thevenot records the use 
 both of the cautery and of ligatures, and is remark- 
 able as recommending blood-letting, in convalescence, 
 as Rivierus did. 
 
 Cleyer* noticed ordinary cholera in China in 1669. 
 
 Our next notice, a brief one, contains, I believe, 
 the first specific statement about cholera by an 
 Englishman. Dr. Fryerf made more than one 
 voyage to the East, and in his account of Surat 
 and of the Western Coast, about 1674, he speaks 
 of cholera morbus as occurring in extreme heat ; 
 also of there being a vomiting and purging, called 
 by the Portuguese mo7'desheen, and treated most 
 unmercifully by them with the actual cautery. 
 He does not seem to regard cholera morbus and 
 mordesJieen as identical. 
 
 A certain Dutch Professor, Then Rhyne,J wi^iting 
 in 1679, affords very important information respecting 
 cholera in the East. It is all the more valuable, as he 
 had resided some years in Java, and had also made a 
 voyage to Japan. He, therefore, must have been 
 familiar with the condition of Oriental countries. 
 
 Although Then Rhyne only makes one precise 
 statement about cholera — that it was common on 
 
 * Supra p. 28. 
 
 t A new accoTint of East India, &c., 1698. 
 
 \ Then Rhyne de Arthritide, &c., 1683. 
 
104 ANNALS OF CHOLERA, 
 
 the coasts of India, and treated with the cautery — 
 I have thought it best to give the whole passage at 
 full length, both because others may wish to be able 
 to judge of it for themselves, and because colic is in- 
 timately connected with cholera, at least historically. 
 It seems quite possible that he may have confounded 
 colic with cholera. 
 
 " In vehementissimo dolore colico (qualis per 
 Asiam passim horrendum in modum soevit, segrosque 
 nefandis cruciatibus ssepe necat, vel saltem paralysin 
 in manibus pedibusque post se multotiens relinquit) 
 hoc remedii genus adhibent Lusitani : — 
 
 " Candente ferro pedibus insistunt nudis, donee 
 sibilum edat adusta pars persentiatque dolorem, unde 
 ilico levamen solet sequi, sin minus incurabilis habe- 
 tur. Inde arguit flatus esse hujus efficientem causam 
 mali. Qui contra sensuum fidem de flatuum 
 preesentia dubitat, hoc Bengalensium facile convin- 
 cetur experimento, qui in hoc atrocissimo morbo 
 abdomen ita fricare ac premere norunt, ut flatus per 
 ipsum umbilicum sensibiliter exeat cum sibilo : quod 
 si non succedat, umbilico magnam oUam {Cojang 
 vocant) aqua repletam imponunt,* quae tum flatuum 
 impulsu ac impetu movetur et evidenter subsilit. In 
 eodem porro affeetu milites nostri Cselonenses cremati 
 
 * Fryer mentions tliat in bloody flux an earthen pot filled 
 with earth was made fast over the navel by a string. Then 
 Rhyne was so carried away by his belief in flatus being the 
 cause of spasm, that he believed that the Bengalees actually 
 squeezed flatus through the umbilicus, and that the sound of 
 the skin when the cautery was applied violently, was caused by 
 the escape of flatus I 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 105 
 
 ligni cineres de foco toUere, et aqua mixtos bibere 
 sclent, uncle subitum solamen persentiunt. 
 
 " Multi prseterea Indicae orse incolse pedum 
 inustionem in Cholera Morbo optato cum eventu 
 instituunt." 
 
 Then Rhyne, therefore, thus describes a very fatal 
 colic as prevailing everywhere through Asia, and 
 specially among the Dutch soldiers in Ceylon, and in 
 the natives of Bengal, which often left paralysis 
 behind it. It would seem to me that various forms 
 of endemic colic, and possibly of cholera, have been 
 mixed up in one general description, and it is scarcely 
 probable that any true colic would have been either 
 so widely diffused or so fatal. 
 
 Without, however, pretending to determine what 
 this colic was, I think Then Rhyne might have 
 added that cholera prevailed in Java as well as on 
 the shores of India, for elsewhere in his account of 
 acupuncture he mentions that it is sometimes em- 
 ployed in Japan in cholera. 
 
 This period is undoubtedly referred to in a state- 
 ment made some years afterwards by the celebrated 
 chemist Homberg, a native of Java.* 
 
 " M. Homberg t ne dans I'isle de Java, souvient 
 que quand les Javanais ont une certain colique, ou 
 un cours du ventre doloureux, qui est ordinairement 
 mortel, ils s'en guerissent en se brulant les plantes 
 
 * Histoire d'Academie, &c., 1708, p. 47. 
 
 t Homberg's father was Dutch. He himself makes the ex- 
 traordinary statement that his sister was married at the age 
 of eight, and was a mother at nine ! 
 
106 ANNALS OF CHOLERA, 
 
 des pieds avec un fer cliaud." A real colic is not a 
 " cours du ventre," nor is any alvine flux but cholera 
 usually mortal. This confirms a French, statement, 
 given without assigning any authority for it, that 
 cholera continued to prevail in Java in 1689. 
 
 All this history of choleraic affections is strongly 
 confirmatory of the statement by Zacutus respecting 
 the extended prevalence of cholera in the East. 
 
 Returning to India and the country about Goa, 
 we are next met by a certain Dr. Dellon, who seems 
 to have left France in 1667, and to have returned 
 home in 1677. He is apparently author of a real or 
 fictitious history of a prisoner in the hands of the 
 Inquisition at Goa,* and he makes the prisoner 
 attribute his escape^ from the cruel Indian malady 
 called mordshin to his having been well fed. In an 
 appendix to his book of travels,! there is, with his 
 initials attached, an account of the diseases of India, 
 and the subjoined one of cholera. It is a poor one 
 to be given by a medical man, still it cannot be mis- 
 taken, as he elsewhere speaks of its great mortality, 
 and says that, after trying all European remedies, he 
 had finally to fall back on the treatment by cau- 
 tery. It will be observed how writers repeat each 
 others words : — 
 
 " La maladie que les Orientaux appellent mordechi 
 n'est proprement qu'une indigestion ; elle est fre- 
 quente dans les Indes, oii les chaleurs et les sueurs 
 
 * Relation de I'Inquisition. 
 
 t Relation d'un Voyage, Paris, 1686. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 107 
 
 continuelles rendent les estomacs debiles ; elle n'est 
 pas pour cela moins dangereuse, et Ton voit tres 
 souvent moiirir des personnes en pen d'heures, si 
 elles ne sont pas promptement secourues. Les exces 
 du boire et du manger, et les aliments de difficile 
 digestion pris particulierement le soir, sont les causes 
 ordinaires de ce mal. Ses signes sont : grande 
 alteration, douleur de tete, inquietudes, fievres, delire, 
 flux de ventre et vomissents ; le pouls est fort et 
 inegal, les urines rouges ou blanclies mais toujours 
 claires : tous ces signes ne se rencontrent pas tou- 
 jours dans un meme sujet ; mais comme le mal est 
 dangereus, il ne faut pas rien negliger aussitot qu'on 
 a lieu de le soup9onner." 
 
 Here, if we were merely to go by the mention of 
 some symptoms and tbe non-mention of others, we 
 might easily doubt whether this was cholera. Pain 
 in the head, delirum, pulse strong and unequal, 
 urine red or white — these are not symptoms of 
 cholera. Neither rice-coloured eyacuations nor sup- 
 pression of urine are mentioned. Yet no one, even 
 without the help of the name mordesJii, could fail to 
 suspect the real nature of the malady. Dellon 
 further confirms this impression by the treatment, 
 of which he gives an account : — 
 
 " Le premier et le principal remede que I'on fait k 
 ceus que I'on croit ou que Ton craint etre attaquez du 
 Mordechi, est de leur bruler les pieds, en appliquant un 
 fer rouge et delie comme une broche, en travers sous 
 le talon a I'endroit le plus calleux, I'y laissant seule- 
 ment jusques a ce que le malade ait temoigne par 
 
108 ANNALS OF CHOLERA, 
 
 ses oris qn'il I'a senti, on I'ote d'abord, frappant 
 quelques coups sur le lieu brule, aveo une pantoufle 
 pour empeclier qu'il ne s'eleve des vessies, sans y rien 
 mettre da vantage. 
 
 " L'application de ce fer ne fait pas un grand mal, 
 et pourveu qu'on ne soit pas empesclie par d'autres 
 raisons, I'on pent marclier apres, aussi librement 
 qu'auparavant ; neantmoins elle arreste la violence du 
 Mordechi, en dissipe souvent tous les accidens sur 
 le chainp, et s'il arrive que la fievre continue encore, 
 elle pent estre traiter sans danger avec les remedes 
 ordinaires. 
 
 " C'est encore dans ces sortes de fievres que les 
 Indiens mettent beaucoup de poivre dans la Cangez 
 (ou Conge) des malades aussi bien que sur leurs 
 testes, et ceci est ordinairement que par ce regime et 
 par la bruleur qu'ils la guerissent sans y employer 
 la saignee, qui seroit infailliblement mortelle dans 
 les commencemens, et la purgation n'est mise en 
 usage, s'il arrive qu'elle soit necessaire, qu'appres 
 que la violence du mal est dissipee et qu'il n'y a plus 
 du tout de fievre." 
 
 If Dellon is not very distinct or very accurate in 
 his descriptions, we are at all events obliged to bim 
 for this account of the association of the disease with 
 fever. He follows Eivierus in considering blood- 
 letting in the commencement of the disease bad 
 practice, though it may be required at a later stage. 
 
 About this period Kaempfer* tells us that cholera 
 
 * Ameenitat. Exotic, fascic. iii., observat. 11. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 109 
 
 was frequent and fatal in Japan : — " Cholera admo- 
 dum in liac regione frequenti et fanesta " — expres- 
 sions wMcli would not apply to occasional cases of 
 sporadic cholera. He further tells us that a family 
 had grown rich on the sale of a Nostrum for cholera. 
 It was as bitter as gall, but when brought to Europe 
 did not seem to have the same effect on German as 
 on Japanese stomachs. 
 
 We have already seen that Colonel Tod believed 
 from native sources, that cholera was epidemic in 
 Marwar in 1681-2, and before Groa in 1684. 
 
 That there was much epidemic disease diffused in 
 India about this time is very certain, and I think I 
 am scarcely wandering from the subject of these 
 annals, in entering into a short investigation of the 
 subject. 
 
 In 1687, after a prosperous voyage in the S.W. 
 monsoon, from Pondichery, Commander Forbin* 
 put into the port of Masulipatam. They had been 
 astonished at passing through thick clouds of insectsf 
 
 * Histoire Grenerale des Voyages, vol. xii., p. 150-51. 
 
 t This is one of the many instances in which there has 
 appeared to he a connection between epidemics and nnusnal 
 swarms of insects. The idea that lower organisms were the 
 causes of epidemics is very old. It is nearly 2000 years since 
 Varro wrote, " If there are any marshy places, and they dry 
 up, certain minute animalcules are hatched, so small as to 
 escape the sight, which enter the body with the air through the 
 mouth and nostrils, and cause serious distempers." Varro has 
 had many followers down to the present day. In these days of 
 microscopic research, however, the discovery of various kinds 
 of microphytes in diflferent diseases has led to the theory of 
 lower forms of animal life, being very generally supplanted by 
 
110 ANNALS OF CHOLERA, 
 
 just before arriving there, and when approacliing 
 the land, the air was so obscured by them, that they 
 had to make their way by sounding. When by the 
 aid of a pilot a boat of theirs reached the shore, they 
 were surprised on landing, to find most of the factories 
 shut, and the town nearly deserted. The cause of 
 this was a pestilence, or rather the plague, la pede. 
 Unfortunately, Forbin says nothing of its nature. 
 One may guess, from his account of a disease on board 
 his ship after leaving Masulipatam, that he supposed 
 it to be a pestilential fever. But fevers seldom cause 
 either so much alarm or so much mortality. True 
 plague, all travellers say, was unknown in India. It 
 would have been very satisfactory to have been able 
 to identify this epidemic as one of cholera, as hitherto 
 we have no notice of it so far north along the Madras 
 coast. But the proof of its being cholera, is in- 
 sufficient. 
 
 Another epidemic of uncertain nature has been 
 sometimes assumed to have been cholera, that before 
 Beejapore, in the year 1689, described by Kafee 
 Khan.* His history of it does certainly not accord 
 with the usual accounts of that disease. He uses the 
 very general appellations of taotin and ouha, and 
 
 that of lower forms of vegetable life, being the active agents 
 in the production of disease. Apparently, the latter theory 
 has not been found very happy in its application to cholera 
 either Lq Europe or in India. However, these minute fungi or 
 sporules are very convenient supports for the zymotic or ferment 
 theory of disease, which, too, is one of great antiquity. 
 * Grant Duff's History of the Mahrattas, vol. i. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. Ill 
 
 friends who have examined Kafee Khan for me, have 
 not been able to show that the disease was really 
 cholera. However, now that we have such abundant 
 evidence of the general diffusion of cholera at that 
 period, the question whether there was cholera at 
 Beejapore is of less importance than it once was. 
 
 Ovington also tells us of a pestilence which had 
 raged at Surat, off and on, from 1684 to 1690* : — 
 " It had some time of interval in the season that 
 cooled the aii\ The greatest paroxysms were always 
 before the rains and after them. As many as 300 
 have died in a day. The Eui-opeans escaped, but 
 their servants sometimes were dead within a few 
 hours of leaving their presence. In 1691 a sweep- 
 ing pestilence prevailed at Balsora." 
 
 On this it may be remarked, that we know of no 
 disease in India, except cholera, that produces such 
 sudden deaths ; that its being more or less under 
 the influence of seasons is characteristic of that 
 disease ; and that the period assigned exactly agrees 
 with Tod's account of cholera at Groa in 1684. 
 
 As for the apparent immunity of Europeans 
 where natives suffer, that and the reverse are facts 
 of no rare occurrence in epidemics of cholera. Nor, 
 after what we have seen, and shall see, is Ovington's 
 not being able to identify the pestilence and mor- 
 dechin of much importance. 
 
 However, the only reliable guide we have to the 
 nature of the disease which showed itself at Groa 
 
 * A Voyage to Surat, by I. Ovington, M.A. London, 1696. 
 
112 ANNALS OF CHOLERA, 
 
 and Surat, and at Masulipatam and Beejapore, is 
 what Grrant Duff reports of tlie illness at Beeja- 
 pore, on the authority of Kafee Khan : — " A 
 fever had prevailed for some years both in the 
 Deccan and in Gruzerat. It consisted of a slight 
 sweUing under the ears, or in the armpit or 
 groin, attended with inflamed eyes and severe fever. 
 It generally proved fatal in a few hours, and those 
 who did recover became whoUy, or in part, blind or 
 deaf." 
 
 The rapidity with which death ensued would be 
 characteristic of cholera, and sloughing of the cornea 
 is not infrequent in that disease ; but both symptoms 
 occur also in Pali plague, or maJia murree. 
 
 Its extending from coast to coast looks, therefore, 
 as if this plague might have been cholera. 
 
 Maha murree has, in modern times, been limited 
 to districts in the west and north-west of India ; it 
 has never been known in Southern India or in Bengal. 
 The greatest difference in their extent has always 
 prevailed between epidemics of fever and of cholera. 
 The bad fevers of Bengal in 1757 and 1762, and the 
 one prevailing now for some years in Bengal, have 
 never quitted the limits of that province. The bad 
 fever of 1809-10-11, in Southern India, remained 
 limited to that district. Epidemics of dysentery do 
 not run from one end of India to another. Cholera 
 is the only epidemic that has shown itself in every 
 corner of India before 1817. 
 
 On the whole, nevertheless, after balancing all 
 considerations, I am inclined to believe that the 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 113 
 
 malady wHich prevailed so extensively at this time 
 over India was a fever approaching in character to 
 the Levantine plague, probably resembling the Pali 
 plague of 1837, and the maha murree of more recent 
 times. 
 
 The second Englishman who mentions cholera in 
 India is Ovington, Chaplain to the King. In his 
 account of Surat, in 1690, he tells us that the three 
 chief diseases are fever, mordechin, and barbiers : — 
 " The mordechin is another disease of which some 
 die, which is violent vomiting and looseness, caused 
 most frequently by excess in eating, especially a 
 mixing of flesh and fish, and which is cured by a 
 hot iron clapt to the heel of him that is sick," and 
 which often made him lame for some time after he 
 was cured. 
 
 With one other notice, we conclude the history of 
 cholera during this century. Dr. Gremelli Carreri, 
 in his voyage round the world, mentions mordazin 
 as prevailing at Damaun, near Bombay, in 1695, 
 and its treatment by cautery. 
 
 His account of it is worth quoting on several 
 accounts : — " The disease th6_y call mordazin is a ' 
 complication of fever, vomiting, weakness of the 
 limbs, and headache. It always proceeds from too 
 much eating, and is cured by burning into the 
 heels with a red hot spit, till the patient cries out. 
 That which they call bombaraki and naricut swells 
 and causes a violent pain in the belly, and to 
 cure it fire also is applied to the swelling, so that 
 those who have the good fortune to recover, carry 
 
 I 
 
114 ANJvALS OF CHOLERA, 
 
 the signs of the fire after on their belly. For this 
 reason the physicians that go out of Portugal into 
 these parts, must at first keep company with the 
 Indian surgeons, to he fit for practice. Otherwise 
 they go about to cure these maladies, so different 
 from ours, after the European fashion, and may 
 chance to kill more than they cure. For fear of 
 these diseases, on flesh days they only eat flesh at 
 dinner, and generally fish at night."* 
 
 Here, again, we have cholera and a form of colic 
 associated. We have already had ample evidence 
 that the Portuguese adopted the native treatment 
 by cautery for cholera — a sufficient proof of the 
 gravity of the disease, and of their sense of their 
 inability to cure it. Some may wonder how such a 
 remedy ever enjoyed so great a repute. But we must 
 remember that Bezoar, dissolved pearls, and a host 
 of similar remedies, were in those days in vogue in 
 the treatment of the disease. Besides, the cautery 
 is not talked of as infallible. It did not cure, if the 
 patient did not feel it — that is, if the case was very 
 far advanced. 
 
 In pursuing the history of mordeshin, we now 
 hear of it in a quarter in which we have as yet had 
 no notice of its presence, unless Then Rhyne's 
 account of flatulent colic be accepted as such, in its 
 great modern seat. Lower Bengal. 
 
 We have already had occasion to believe that 
 cholera is mentioned in ancient Sanscrit writings. 
 
 * Collectiou of Yoyages, vol. iv., book i,, chap. 2, p. 199. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 115 
 
 From a very early period the Deity was propitiated 
 in various forms to avert certain maladies. One of 
 the best known forms was that of Fheetola, or of the 
 goddess of small-pox. Some years ago it was stated 
 that there existed an inscription in front of a temple 
 at Vizianuggur, which described the symptoms of 
 cholera. I have never been able to ascertain on 
 what authority this statement was made ; but it is 
 not very important, as Sir W. Jones is said to have 
 pronounced, that the inscription did not date from a 
 period anterior to the Mahrattas. We know that at 
 the date of the outbreak of 1817 the cholera goddess 
 was worshipped in various parts of India, as 3Iaree, 
 or "the destructive;" and in Lower Bengal as Oola 
 Beebee, or goddess of cholera; but it is also certain, 
 that she was worshipped in various parts of India 
 long before the year 1817. 
 
 Mr. 0. Macnamara has recently made out the his- 
 tory of the temple of the goddess at Calcutta, which 
 is shortly this : — At an early period, the date of 
 which cannot be ascertained, an old woman went 
 into the jungle, and discovered, by what process is 
 unknown, a stone which was believed to be the idol 
 of the cholera goddess. She assured her friends that 
 whoever worshipped the stone with due reverence 
 would, with his whole family, enjoy an immunity 
 from cholera. The fame of the goddess gradually 
 spread, and people flocked from a distance and 
 worshipped her with great devotion. 
 
 As is usual in such cases, the idol became the pro- 
 perty of a priestly family, and a source of income. 
 
 I 2 
 
116 ANNALS OF CHOLERA, 
 
 Originally the idol was kept merely under a 
 bamboo sbed ; but early in the eighteenth century, 
 probably about the year 1720, an English'merchant, 
 to please his Hindoo friends, built a temple to the 
 goddess, which still exists in a ruinous state,* 
 
 Of the rites performed at the shrine we know 
 that, besides presenting offerings, the votaries of the 
 goddess fasted in the morning, and at two o'clock in 
 the afternoon dined upon crushed rice and dhahee, a 
 preparation of milk, taking nothing after that until 
 next day. Every Tuesday and Saturday some three 
 or four hundred females used to worship after this 
 fashion, and return to their respective homes in the 
 evening. The pilgrimage was especially common 
 from April to June, or during the cholera season- 
 In process of time the temple became inconvenient, 
 from its situation, and Mr. Duncan, the merchant 
 who built the first temple, supplied 6000 rupees for 
 the erection of the building which is now in use. It 
 was built probably about the year 1750. 
 
 The old rude stone was transferred to the new 
 abode, and a somewhat elaborate idol constructed. 
 It represents in the centre a carcass, with a vulture 
 preying on it, and on the back of the latter the 
 goddess is represented with four hands, and in 
 a sitting posture. On her right is Munsha, the 
 
 * I have seen a photograph of the ruin. It has a tower or 
 minaret copied from the tower of Pandoah, some thirty miles 
 distant. Its pillared verandah is in the usual debased style 
 of Italian architecture introduced into India by the first 
 Europeans. 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 117 
 
 goddess of serpents ; next to her is SMva, the destroy- 
 ing principle ; next comes a female in a suppliant 
 posture, and a male afflicted with the disease. The 
 female is supposed to be praying to Shiva for the 
 recovery of her husband. On the left of the goddess 
 are the idols of Sheetola, the goddess of small-pox, 
 and of Shusthee, the goddess presiding over infants 
 and children. 
 
 This piece of sculpture for some time attracted 
 many votaries, and the revenue of the temple 
 amounted to about 4000 rupees a-year; even the 
 rice collected from the offerings amounted annually 
 to 200 or 250 maunds (nearly nine tons). 
 
 The temple continues to be the property of the 
 family that originally jDossessed it, but it is by no 
 means so lucrative now, producing hardly an income 
 of 300 or 400 rupees a-year.. 
 
 From this curious history we are entitled to infer 
 that, although cholera was not so prevalent in India 
 in the commencement of the eighteenth as it was in. 
 the seventeenth century, yet it was a common disease 
 at that period in Bengal. It seems also certain that 
 the disease must have raged at times with violence, 
 or it would not have been found necessary to pro- 
 pitiate the Deity specially for it. 
 
 Accounts of cholera in Southern India about this 
 time are supplied by the Jesuit missionaries.* Pere 
 Martin met with the disease between Madura and 
 
 * Travels of several learned Missionaries of the S. Jesus. 
 From the French, 1713. 
 
118 ANNALS OF CHOLERA, 
 
 Tricliinopoly. In a letter dated 1702 lie mentions 
 an attack of violent gastric disturbance with convul- 
 sions, and records its cure by the application of the 
 actual cautery to the soles of the feet, followed by 
 violent slippering — an invaluable remedy, he says, 
 much used along the coasts, but little known inland, 
 or at Aour, where this case occurred. Martin is the 
 first author, I believe, who uses the name of mort de 
 chien. He describes that extraordinary indigestion 
 which they call in India mordesJii, and to which 
 some of the French have given the name of mort de 
 chien, as it causes a cruel and violent death ; it was 
 an " espeee de colique de miserere," and a distemper 
 far commoner in India than in Europe, and it was 
 rare for a patient not to succumb to it. This was 
 his theory of the disease : — " La continuelle dis- 
 sipation des esprits aflFoiblit si fort la chaleur 
 naturelle, que I'estomac est souvent hors d'etat 
 de faire la coction des alimens." Another French 
 missionary mentions at this time a marvellous 
 case, but not more marvellous than many a 
 cure of cholera reported at the present day : — " Les 
 jours passes un paien etait attaque d'une maladie 
 qu'on appelle mordechin. Son frere qui est Chretien, 
 lui donna un peu d'eau benite et se mit a reciter 
 avec foi quelques prieres : le malade guerit subite- 
 ment." 
 
 The Sieur LuilHer* made a voyage to India, and 
 arrived in Malabar in June, 1702. He visited 
 
 * I^ouveau Voyage aux Grandes Indes, &c. Rotterdam, 1726. 
 
IN THE EAST FKOM A.D. 1500 TO A.D. 1750. 119 
 
 Bengal in 1703, and on his return published an 
 account of his voyage, to which he appended the 
 account of the diseases special to India, which had 
 been already published by Dellon. Luillier visited 
 Hooghly in 1703, and gives the following account 
 of mordeshin : — 
 
 " Comme la chaleur excessive empeche la circulation 
 du sang, les Europeens et les Mistis se font frotter, 
 tirer et masser les bras, les jambes et toutes les 
 parties du corps, afin d'aider a la circulation, et c'est 
 ce qu'ils appellent se faire masser, autrement ils tom- 
 beroient dans des assoupissemens leta"rgiques, dont 
 ou meurt souvent, si Ton n'est pas promptement 
 secouru ; ce mal s'appelle mort-de-chien, I'esperience 
 a fait trouver un remede qui est unique et tres-assure : 
 c'est appliquer un fer chaud sous la plante des pieds, 
 et ensuite les battre avec un baton ou autres choses 
 plates" (p. 83). 
 
 There is no novelty in this account, but the reason 
 assigned for the practice of mulling and shampooing 
 the lim bs which Luillier found in use, is a curious 
 one. It is the first time I have heard of it as a 
 prophylactic against cholera ; but its being regarded 
 by anyone as such, shows how common the disease 
 must have been. For the present, Luillier's notice 
 is the earliest one we have by any European of 
 mordeshin being a disease known in Bengal. 
 
 In the end of the year 1709 another of the Jesuit 
 brotherhood, Frere Papin,* who had sailed up to 
 
 * Lcttres Curieuses, &c., Paris, 1781, vol. xi., p. 258. 
 
120 
 
 ANNALS OF CHOLERA, 
 
 Bengal, writes from Chandernagore an account of 
 the diseases of the country. Among them he enu- 
 merates mordshi, or cholera morbus, but gives no 
 hint whatever as to its degree of prevalence, beyond 
 placing it as first of the principal distempers. The 
 native treatment, he tells us, is to withhold fluids from 
 the patient and to cauterise his feet. 
 
 A Dutchman, Yalentyn, compiled an elaborate 
 description of Eastern settlements, which appeared 
 in several folio volumes about the year 1726. He 
 makes little or no mention of cholera, but incident- 
 ally observesT:hat it is a common disease in Groa. 
 
 The existence of a bad form of cholera in the 
 East was at this time generally recognised in 
 Europe. The well-known Dr. Arbuthnott, in his 
 book on Air, published in 1733, although he gives 
 no authority for the statement, tells us that the 
 cholera morbus, and beriberi, and fevers are the 
 prevailing diseases at Fort St. George, or Madras, 
 fi-om April to the end of July. In the year 1736, 
 Paxman pubHshed a short sketch of the diseases of 
 India.* He observes that the mordesMn and mordshie 
 occur fr'equently in India, and says that mordshi 
 denotes a disturbance of the stomach ; mordeshin 
 nausea and vomiting, a distinction of no value, except 
 as showing that there were various forms of cholera. 
 He says that he was nine years in Bengal, and that 
 he also visited the coast of Coromandel. He men- 
 tions very bad fevers as occurring in Bengal in 
 
 * Specilegium de Indorum Morbis, 1735. 
 
IN THE EAST FKOM A.D. 1500 TO A.D. 1750. 121 
 
 August, but says notHng special of mordshi, or of 
 epidemics of it, in ttat part of India. 
 
 For tlie next fourteen years our accounts of cholera 
 in India continue to be very scanty, and we learn, 
 cbiefly from systematic works and from Theses, 
 wbich seldom give any original information, that 
 the Indian form of cholera was still recognised 
 in Europe, although little was heard of it in India. 
 
 Perhaps the main points in the long history of 
 250 years which we have just gone through, are the 
 following : — We are told that there were several 
 kinds of mordeshi, but the descriptions of them are 
 imperfect. The earliest notices are much the 
 fullest. The Portuguese in the sixteenth century, 
 and Bontius in the early part of the seventeenth, 
 give the only tolerably complete accounts ; yet, 
 notwithstanding the constant mention of mordesJii 
 in India in those days, quite as lively pictures of 
 cholera were drawn in Europe. 
 
 In the causation of the disease a great deal was 
 attributed to moist heat and to season, to repressed 
 perspiration and to exposure of the abdomen to 
 chills; a great deal also to indigestible articles of 
 food, chiefly to vegetable ones, though occasionally 
 to flesh and fish. 
 
 With respect to its pathology, there was not a 
 novel idea. The prevailing one was, that it was an 
 affection of the stomach and of the intestines, while 
 there are sometimes indications that it was occasion- 
 ally considered to be a fever, or an ileus, or an 
 indigestion. There was little speculation on the 
 
122 ANNALS OF CHOLERA, 
 
 nature of the disease, the old notion that there were 
 morbid secretions to he removed being the ordinary 
 one, and little which, as the discussions in Europe at 
 the same time have, has much bearing on the questions 
 agitated in modern times respecting the essence of 
 the disease. It is, however, to be remembered that 
 for the last fifty years of the period, European phy- 
 sicians had not the constant opportunities of studying 
 the disease in India, which they had before that 
 time. The disease does not seem to have been con- 
 sidered contagious ; still it is probable that some 
 considered it so, when we find A' Costa calling it a 
 peste particulare, and Bontius declaring that it was 
 dreaded as much as the plague was in Holland. 
 
 "With regard to treatment, the Portuguese, in the 
 first instance, followed the practice of the Arabians, 
 but after a time were content to follow the lead of 
 the natives, especially in the universal adoption of 
 cautery as a strong revulsive. Bontius treated the 
 disease with vegetable astringents, and with saflfron 
 and opium. He had the faith of the day in Bezoar, 
 in solutions of Hog Stone, and in prepared pearls. 
 In the way of diffusible stimulants he does not 
 appear to have employed anything more than 
 shavings of rhinoceros or hart's horn, if they may 
 be regarded as such. In some of the later stages 
 blood-letting was practised. 
 
 We have distinct and positive accounts of epi- 
 demics of the greatest malignity. 
 
 We have traces of the disease attacking European 
 and native soldiers, and of its occurrinsr on board 
 
IN THE EAST FROM A.D. 1500 TO A.D. 1750. 123 
 
 ship. But the most striking feature of the period 
 is the wide extent to which cholera prevailed 
 throughout the East during the seventeenth cen- 
 tury — a difPasion of it, which was followed by a 
 period of decline of about fifty years. 
 
 We shall in the next period have more complete 
 descriptions of the disease, and accounts of epidemics 
 of it, in India. Whether these epidemics were more 
 extensive may be a matter of question ; but we shall 
 hear somewhat less of the prevalence of cholera in 
 other parts of the East. 
 
124 ANNALS OF CHOLERA, 
 
 CHAPTER YI. 
 
 CHOLERA IN THE EAST FROM A.D. 1760 TO A.D. 
 1817. 
 
 About 1750 we begin again to have fuller accounts 
 of the malady. Mr. John Henry Grrose, in 1766,* 
 in his observations on the East Indies, says : — 
 " There is likewise known, on the Malabar coast 
 chiefly, a most violent disorder, being called morde- 
 shin, which seizes the patient with such fury of 
 purging and vomiting, and tormina of the intesthies, 
 that it will often carry him off in thirty hours. For 
 this the physicians among the natives know no more 
 effectual remedy than the actual cautery to the soles 
 of the feet, the powerful revulsion of which seldom 
 fails to have a wholesome efficacy." But, what is 
 much more important than this repetition of the old 
 story, Mr. Grrose tells us, in his account of the island 
 of Bombay, which immediately follows his account 
 of his arrival in 1750, that mordeshin was hardly now 
 known there, thus showing that the disease had been 
 formerly well known, and that it had its periods of 
 increase and of decrease in the island then as now. 
 
 * A Yoyage to the East Indies, &c., by John Henry Grose. 
 London, 1766. 
 
IN THE EAST FROM A.D. 1750 TO A.U. 1817. 125 
 
 Tke healthiness of the island must have been im- 
 proved since the time of Ovington, when a man's 
 life in Bombay was supposed to he worth two mon- 
 soons ! A suggestion of those days for diminishing 
 the unhealthiness of the place was, that the houses 
 should be better raised. 
 
 Cholera is next found on board ship. Mr. John- 
 son, of Chester,* mentions that the English fleet in 
 India suffered much from cholera in the year 1756, 
 Mr. Johnson had the care of a hospital ship, and 
 gave the Calumba root to a great many patients — 
 often to twenty in a day — attacked with the cholera 
 morbus. He seldom employed any other means 
 previous to its exhibition ; and he generally found 
 that it soon stopped the vomiting, which was the 
 most fatal symptom, and that the purging and 
 remaining complaints quickly yielded to the same 
 remedy. The mortality on board his ship, after he 
 used this medicine, was remarkably less than in the 
 other ships of the same fleet, in this fatal disorder. 
 
 In this year the Madras Eeport on Cholera says, 
 that the malady prevailed at Arcot, about fifty miles 
 inland from the Presidency town. That neighbour- 
 hood seems to have been a district to which the 
 disease adhered for a long time, for in it, or in 
 Yellore, or in the adjoining valley of Amburpet, 
 there are notices of it for a series of years. 
 
 There can be little doubt that the affection 
 mentioned by the historian Ormef as prevailing 
 
 * Percival's Essays, 1783, vol. iii. f Vol. ii., p. 208. 
 
126 ANNALS OF CHOLERA, 
 
 epidemically in Southern India, and causing great 
 and sudden mortality, in 1757, was cholera, especially 
 as its date would agree with, what Dr. Paisley writes, 
 that the disease was horribly fatal in our first cam- 
 paign in the country to the blacks, and that fifty 
 Europeans of the line were seized with it, and that 
 the disease was seen at Trincomalee. 
 
 We have so few notices of cholera at this 
 period in other countries of the East besides India, 
 that we are glad to find that the existence of a 
 tolerably acute form of cholera in Arabia did not 
 escape the observation of Karsten Niebuhr in 
 1761-63,* although it was overlooked by the Con- 
 stantinople Conference. He remarks that cassia 
 fistula, or black cassia, mixed with a little rhubarb, 
 is the best remedy known to the Arabian physicians 
 for the cure of the cholera morbus and of diarrhoea, 
 which are in hot countries particularly dangerous. f 
 
 * Travels in Arabia. 
 
 t A good deal has been made, especially by French authors 
 (anxious to localise the origin of the disease in the Delta of 
 the Ganges, and to ascribe its outbreaks to English neglect), of 
 the fact reported, that 30,000 natives and 800 Europeans died 
 of the disease in Bengal, in 1762. But Lind, a relative of the 
 better known author of that name, the authority quoted for 
 this, expressly calls the disease a putrid and remitting fever, 
 which was cured by bark. Ives, Lind, and Bogue describe the 
 diseases of seamen on the river Hooghly for a period which may 
 be said to extend from 1756 to 1773 ; but they make no 
 mention of any disease like cholera (the nearest to it is Ives' 
 account of twenty-seven cases, in 1756, of convulsions of the 
 intestines from a scorbutic state and muddy river water), though 
 we know that it remained in Bengal as an endemic, and 
 
IN THE EAST FROM A.D, 1750 TO A.D. 1817. 127 
 
 M. de Gentil,* in his travels to India on tlie 
 occasion of the transit of Venus on the 6th June, 
 1761, and 3rd June, 1769, informs us that the mort 
 de chien is considered to be more dangerous than the 
 flux of blood, and that the Indians are less subject 
 to it than Europeans. As Grrose mentions the 
 disease as common on the Malabar coast, so Grentil 
 found it on the Coromandel shore. His letter is 
 dated at Pondichery, 1769, and it evidently refers 
 to the important epidemics, to the full account of 
 which, by Sonnerat, we shall presently have to turn ; 
 first, however, quoting Grentil's letter in the original, 
 and a notice of cholera in India and China, usually 
 attributed to Linnaeus : — 
 
 " Le mort de chien, ou 7no7rleschin, comme I'ap- 
 pelle Henri Grrose, est une maladie terrible et plus 
 dangereuse que le flux du sang. EUe fait mourir 
 
 though, most writers were familiar with the existence of the 
 acute mordesMn in other parts of India. There is no doubt 
 that the disease of 1762 was a fever, yet it is worthy of notice, 
 how suddenly a boat's crew would be knocked down by it, also, 
 that " what they vomited and voided by stool was most com- 
 monly a whitish matter resembling chalk and water, or curdled 
 milk which is vomited by sucking children, when the curd is 
 much broken down, "(a) as happens in Jievre pernicieuse algide. 
 Stavorinus, a Dutchman who visited Bengal in 1768-71, 
 describes a very fatal disorder peculiar to the country, called 
 Juunibaad, which swept away multitudes in three days, or, if 
 there was recovery, left blindness, deafness, or paralysis. I 
 can find no other account of this disease. It was somewhat 
 like the disease of Beejapore meationed above. 
 * Voyage dans les mers de I'lnde, 1779. 
 
 (a) Lind ou a Putrid and Hemitteut Fover, p. 25. 
 
128 ANNALS OF CHOLERA, 
 
 souvent en moins de trente heures : je la regarde 
 comme une sorte d'indigestion, qui occasionne la 
 plus violente revolution dans tout le corps. Les 
 Indiens sont encore beaucoup moins sujets a cette 
 maladie que ne le sont les Europeens. 
 
 " Le nialade est pris de vomissements terribles, de 
 douleurs considerables dans le sintestins, et d'evacua- 
 tions inconcevables ; il perd peu a pen ses forces, et 
 tombe dans des defaillances continuelles. A la cote 
 de Coromandel, on emploie des lavages et des cor- 
 diaux : Grrose dit qu'a la cote du Malabar on applique 
 des cauteres sous la plante des pieds et que leur 
 revulsion puissante opere presque toujours un efFet 
 salutaire."* The pbrase " evacuations inconcevables " 
 is a strikingly characteristic one. 
 
 Shortly after this we have another notice of 
 cholera in the East, and of its occurrence in China, 
 as well as in India. Dr. Wanmann,t in his 
 inaugural thesis, which appeared under the auspices 
 of Linnseus, mentions that he had made at least one 
 voyage to the East. He observes that cholera 
 Indica is a most frequent disease of sailors, especially 
 on their first arrival in India. He attributes this to 
 change of diet, eating turtle and fruits, especially 
 acid ones, and the fruit lemties, sold to them in such 
 quantity in China. The disease was to be cured by 
 opium, and by drinking decoction of rice or of 
 mallows. 
 
 * Vol. i., p. 676. In a letter dated " Pondichery le ler 
 Mars, 1Y69." 
 
 t Linnaeus de Morbis Nautarum, 1768. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817» 129 
 
 Whatever form of cholera this may have been, 
 there is no doubt that sailors and passengers are 
 especially subject to the worst forms of the malady 
 on arrival in Eastern ports ; the change of diet, no 
 doubt, predisposing them to its attacks, as well as to 
 those of the milder alvine fluxes. 
 
 Sonnerat's travels were not published till 1782, 
 and in a general way extend over the period from 
 1774 to 1781, but his allusions to cholera appear 
 to include the epidemics about Pondichery in 1769, 
 just alluded to by GrentiL Sonnerat has got the 
 credit of having converted the native name of mor- 
 deshin into the similarly sounding French term mort 
 de chien, but we have already seen that this trans- 
 mutation had taken place by the commencement of 
 the century. His statements about cholera are so 
 full and important, that I introduce them at length. 
 He says that an epidemic malady prevails, which 
 sometimes kills those attacked by it in twenty-four 
 hours, or less. It prevails only during the cold 
 season : — 
 
 " Les debauches et ceux qui ont des indigestions 
 sont attaques d'un devoiement ou plutot d'une 
 ecoulement involontaire de la matiere fecale de venue 
 liquide, mais sans aucun melange de sang. lis n'ont 
 point de remede pour ce cours de ventre, qu'ils appel- 
 lent flux aigu, et dont ils laissent la guerison aux 
 soins de la nature. 
 
 " Le flux de cette espece qui regna il y a quelques 
 annees se repandit dans tout le pays, fit de grands 
 ravages, et depuis Cheriugam jusqu'k Pondichery 
 
 K 
 
130 ANNALS OF CHOLERA, 
 
 emporta soixante mille personnes. Diverses causes 
 roccasionnerent. Les uns en furent affliges pour 
 avoir passe les nuits et dormi en plein air ; d'autres 
 poTir avoir mange du riz froid aveo du tair (lait 
 caille) ; mais la plupart le furent pour avoir mange 
 apres s'etre baignes ou laves avec de I'eau froide, ce 
 qui leur causait une indigestion, un spasme universel 
 du genre nerveux, Buivi de I'atonie et de la mort, si 
 les malades n'etaient promptement secourus. Cette 
 epidemie arriva pendant que les vents soufflaient du 
 nord en Decembre, Janvier, Fevrier : quand ils ces- 
 sferent, la maladie disparut. 
 
 " Elle etait caracterisee par un cours de ventre 
 aqueux accompagne de vomissements, d'une faiblesse 
 extreme, d'une soi£ ardente, d'une oppression de 
 poitrine, et d'une suppression d'urine. Quelquefois 
 le ma,lade sentait de vives douleurs de coliques. II 
 perdait souvent connaissance et la parole, ou il 
 devenait sourd : le pouls etait petit et concentre, et 
 le seul sp^cifique que trouva le frere du Choisel, de 
 la mission etrangere, fut la tlieriaque et la drogue 
 amere. Les medecins Indieas ne purent sauver un 
 seul malade. II y a lieu de penser que la transpira- 
 tion arretee refluant dans la masse du sang et se 
 portant a I'estomac et aux intestins, occasionnait des 
 vomissements, qui se terminaient par ce cours de 
 ventre. 
 
 " Celui qui le suivit deux ans apres fut des plus 
 terribles. II ne provenait point de la meme cause 
 que le premier, puisqu'il commen^a en Juillet et 
 Aoiit, s'annoncait d'abord par un cours de ventre 
 
IN THE EAST FBOM A.D. 1750 TO A.D. 1817. 131 
 
 aqueux, qui survenait tout a coup, et quelquefois eu- 
 levait le malade en moins de vingt-quatre heui*es. 
 Ceux qui en etaient attaques evacuaient jusqu'k 
 trente fois en cinq ou six lieures, ce qui les reduisait 
 a un tel etat de faiblesse qu'ils ne pouvaient ni parler 
 ni se remuer : souvent ils n'avaient point de pouls. 
 Les mains etaient froides ainsi que les oreilles : le 
 visage etait allonge, I'enfoncement de la cavite de 
 I'orbite etait le signe de mort : ils ne sentaient ni 
 mal de ventre, ni coliques, ni trancliees. Ce qui 
 les faisait le plus soulErii', etait une soif ardent«. 
 Quelques uns rendirent des vers par les selles, 
 d'autres par les vomissements. Ce cruel fleau frappa 
 generalement toutes les castes mais surtout celles qui 
 mangent de la viande, comme les parias, Les 
 medeoins nationaux ne reussirent pas mieux k traiter 
 cette maladie, qui se renouvela dans le temps des 
 vents du nord. 
 
 " Les Indiens sont encore sujets a des cours de 
 ventre sereux et a des vomissements occasionnes par 
 la transpiration interceptee et par leur excessive 
 mis^re, qui est telle que le plus souvent ils n'ont pas 
 assez a manger pour entretenir I'equilibre de la cir- 
 culation. A ces deux causes se joint le defaut de 
 linge pour se couvrir dans les temps froids. lis 
 couchent sur une terre humide, dans des cabanes ou 
 ils ne sont pas a I'abri de la pluie et du vent. Le 
 manque de toutes les cboses necessaires a la vie de 
 I'homme attire a ces malbeureux des maladies qui 
 les font perir en grand nombre. 
 
 " Les indigestions, appelees dans I'lnde mort de 
 
 k2 
 
132 ANNALS OF CHOLERA, 
 
 cMen, sont fr^quentes. Les castes qui mangent de 
 la viande, nourriture trop pesante pour un climat 
 si ch.aud, en sont attaquees. Les Brames, quoiqu'ils 
 ne mangent ni viande ni poisson, ont souvent de oes 
 indigestions, produites par la grande quantite de 
 beurre qu'ils mangent aveo leur riz : plusieurs en 
 sont morts subitement. 
 
 " Ces indigestions frequentes n'ont pas toujours 
 pour cause une nourriture trop abondante. L'air 
 frais auquel on s'expose avec tant de plaisir cause 
 une indigestion, s'il a trop refraicbi le ventre, la 
 tete, ou quelqu' autre partie du corps, en supprimant 
 la transpiration : plusieurs personnes sont mortes 
 pour avoir coucbe imprudemment en plein air." 
 
 Lengtby though Tihis account is, it is, in very- 
 many respects, worth studying. 
 
 Sonnerat appears to describe sporadic cholera as 
 7nort de chien, endemic as the serous flux, and 
 epidemic as the acute flux. He seems indeed to have 
 been but half aware, that they were merely different 
 forms of the same disease. 
 
 In his description cramps were not a very promi- 
 nent symptom ; the epidemic disease which he paints 
 appears to have had little spasmodic reaction. Oppres- 
 sion of the chest and suppression of urine are recorded, 
 and occasional deafness and vomiting of worms. 
 
 The epidemics lasted a long time, for one suc- 
 ceeded another in two years, and the latter one broke 
 out a second time within the year, before its whole 
 force was spent. 
 
 December, January, and February seem to have 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817, 133 
 
 been the chief cholera months, and although one 
 epidemic commenced in July and August, it broke 
 out afresh in the cold season. 
 
 His theory of the disease is, that suppressed per- 
 spiration enters the blood, and then acts on the 
 stomach and intestines. He accuses rice, but not 
 fruit, also eating meat, of causing the disease. He 
 attributes attacks of cholera to catching cold after 
 bathing, to imperfect clothing, deficiency of food, 
 and to general misery, humid soil, and want of pro- 
 tection from the weather. 
 
 But the disease mort de chien, a dangerous in- 
 digestion, was caused by eating too much either 
 of animal meat, or too much butter with rice. 
 It was also caused by exposure of the body to 
 the air. 
 
 He says little of the treatment of the disease ; for 
 neither form of it did the natives appear to have 
 efficient remedies. The great loss of life, called 
 60,000 men, in the small space between Cheringam 
 and Pondiohery, shows the virulence of the epi- 
 demic- 
 
 On the whole, no author before the time of Son- 
 nerat gives us so distinct an account of the epidemic 
 prevalence of cholera, so full a description of its 
 varieties, or has attribated it so positively to the 
 physical misery of the natives of the country. 
 
 During the period which may be said to be 
 covered by Sonnerat's histories, we learn from the 
 Madras Report that cholera prevailed at Amburpet 
 and Ai"cot in 1769-71. 
 
134 ANNALS OF CHOLERA, 
 
 Dr. Clark* tells us that cholera was a very frequent 
 disease at Bombay in 1772. f 
 
 The prevalence of cholera at Madras in 1774 led 
 to Dr. Paisley's communication respecting his know- 
 ledge of the occurrence of the disease at an earlier 
 period, which communication, strange to say, did 
 not see light till some thirty years afterwards.^ 
 Dr. Paisley approved of the troops changing ground, 
 in hopes of getting rid of the disease. 
 
 There seems to be no reason to doubt that cholera 
 reached the Isle of France in 1775. The accounts 
 of this event, collected afterwards by Dr. Burke, 
 appear to be quite convincing, and Tholozan§ tells 
 us that he is informed that old people who saw the 
 disease in 1819 recognised it as the old malady 
 of 1775. 
 
 The chief epidemic described by Sonnerat on the 
 Coromandel coast must probably have occurred from 
 the year 1776 to 1778. 
 
 Fontana,|| writing in 1776 an account of the 
 
 * On Diseases of Voyages to Hot Countries, 1773. 
 
 t Dr. Clark, speaking of Calcutta at this period, says: — 
 " There have been several melancholy instances of persons who 
 have returned home in a state of perfect health from perform- 
 ing the last duties to a deceased friend, and have next day 
 been numbered with the dead." Dr. Clark is writing of fever 
 and fluxes. Such cases have occurred within my own know- 
 ledge ; but they have always been cases of cholera. Fevers of 
 such rapid malignity are scarcely known in Calcutta. 
 
 X Curtis' Account of the Diseases of India, 1807. 
 
 § « Gazette Medicale," 1868. 
 
 II Osservazioni, &c., Livorno> 1781. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 135 
 
 diseases of sailors in India, mentions that during his 
 voyage he had no opportunity of seeing a case of 
 that terrible and fatal malady, cholera morbus or 
 mordeshi, because the disease, he believed, was 
 more common on land than in ships. He was, 
 however, perfectly aware of the existence of the 
 affection. 
 
 The Medical Board of Calcutta had reason to 
 believe that the disease was epidemic in Bundlecund 
 about the year 1779.* 
 
 In that year Sir Elijah Impeyf writes thus of the 
 malady, as it prevailed in a mild form in Calcutta : — - 
 " I am subject once or twice a year to violent attacks 
 of the cholera morbus, here called the mort de cMenP 
 
 Folly + saw cholera at Tranquebar in 1780. 
 
 Lind, in the second edition of his book in 1780, 
 remarks generally, that the mordeschin is very fre- 
 quent and very fatal in the East Indies. Opium 
 was the great remedy. 
 
 From this period onwards there is not much to be 
 said of the march of cholera in India, which is not 
 to be gathered from the Indian Reports, especially 
 those of the Medical Boards of Bengal and of 
 Madras. My task will henceforth be chiefly con- 
 fined to a chronological re-arrangement of facts, 
 with the addition of a few new ones which illustrate 
 what was abeady known ; and which show very 
 clearly that, however it might slumber, cholera, 
 
 * Bengal Report. 
 
 t Life by Ms Son. 
 
 X Tode. Med. Ching. Bibliotb. x., p. 409, quoted by Hirscb. 
 
136 AISJNALS OF CHOLERA, 
 
 even in its malignant form, never ceased to exist in 
 India. 
 
 After the history which we have just gone through, 
 and more especially after the constant notice for the 
 previous ten years of the prevalence of cholera along 
 the Madras Coast and in Southern India, it appears 
 to us almost inconceivable, how the outbreak now to 
 be recorded, should have been the cause of so much 
 astonishment. It shows, at least, how very little was 
 known in those days of what was going on in dif- 
 ferent parts of India, and that cholera, in its malig- 
 nant form, could have been little known in Ben- 
 gal at that time, although the cholera goddess had 
 not been installed in her new temple more than 
 ten or twenty year^. The nature of the ordinary 
 cholera of the period may be guessed from the letter 
 of Sir Elijah Impey, just quoted, in which he 
 speaks of the frequency of his attacks. 
 
 This is Jameson's account of the Granjam out- 
 break : — " A division of Bengal troops, of about 
 5000 men, was proceeding down the coast towards 
 Madras in the spring of 1781. A disease resem- 
 bling cholera had been prevalent in that part of the 
 country for some time before the arrival of the 
 column. On the 22nd of March, at Granjam, it 
 assailed the troops with almost inconceivable fury. 
 Men in perfect health dropt down by dozens, 
 and others, less severely affected, were dead, or past 
 recovery, within an hour. The spasr^s of the 
 extremities and trunk were dreadful, and distressing 
 vomiting and purging were present in all. About 
 
IX THE EAST FROM A.D. 1750 TO A.U. 1817. 137 
 
 500 were admitted into hospital that day, and for 
 the two following days the disease continued 
 unabated — more than one-haK of the army was sick, 
 and it was found impossible to proceed further. It 
 was, therefore, resolved to halt at Itchapore. The 
 good results of this measure were immediately appa- 
 rent. By the 29th of the month the sick were 
 diminished to 908, and on the 1st of April the army 
 was able to recommence its march, leaving the con- 
 valescents behind. The deaths, probably, did not 
 fall ghort of 700. The camp-foUowers were first 
 attacked, then the Sepoys, and then the Europeans. 
 Few officers were affected, and only one died. The 
 disease was at first attributed to poison, and espe- 
 cially to the drinking water, but afterwards to vicis- 
 situdes of weather, and to exposure of the troops." 
 Mr. Jameson adds, that in the treatment no opium 
 was employed, and that there is reason to believe 
 that tartar emetic was too freely used. 
 
 " The disease found its way up to Calcutta," writes 
 AVarren Hastings, 27th April, 1781, " and after chiefly 
 affecting the native inhabitants, so as to cause a 
 great mortality during the period of a fortnight, it 
 is now greatly abated, and is pursuing its course to 
 the northward." Unfortunately the course of the 
 disease to the north was not traced ; but Mr. Lind- 
 say, of Sylhet, writing in September of the same 
 year, affords some slight clue to it : — " The malig- 
 nant distemper, after having carried off a number of 
 the inhabitants of Calcutta, is now raging with the 
 greatest fury at Sylhet. Many of the Zemindars 
 
138 ANXALS OF CHOLERA, 
 
 and Naibs liaving fallen victims to it, the others in 
 a body have deserted the town." "* Another letter 
 of Mr. Hastings', of the 28th, to Major Scott, gives 
 his further impressions regarding the disease : — " A 
 contagious distemper seized the detachment at 
 Granjam, and threatened to annihilate it. It partly- 
 resembled the disease called mordeshi, or mordeshin, 
 in Europe cholera morbus, but seems to be a species 
 of the plague, and to have been caused by exhala- 
 tions from the rains, which have fallen almost in- 
 cessantly and with great violence during two months. 
 It has travelled since to Calcutta, where it made an 
 alarming havoc for about ten days. By a rex3ort 
 which I ordered to be made me, of the number and 
 names of the inhabitants who perished by the dis- 
 temper between the 11th and 21st of the month, 
 there appear to have died in all 879, multiplied by 
 reports into many thousands. The weather has 
 cleared, and the mortality abated. I do not recollect 
 whether Colonel Pearse's letters mentioned the 
 number that he has lost, but I fear that of Sepoys 
 alone it has not fallen much short of a thousand. 
 By the last advices, he was near Yizagapatam, and 
 his men fast recovering." f The mortality here 
 mentioned was far greater, for the time the plague 
 lasted, than what took place in Calcutta in 1817. 
 
 This visitation of Bengal cannot have lasted long, 
 for Balfour, in 1784,:}: in talking of the diseases of 
 
 * Taj'lor's Medical Topography of Dacca. 
 
 t Gleig's Life of "Warren Hastings, vol. ii. 
 
 X Influence of the Moon on Fevers. Calcutta, 1789. 
 
IN THE EAST FROM A.D, 1750 TO A.D. 1817. 139 
 
 the district, only mentions incidentally " fluxes and 
 spasms." 
 
 According to tlie accounts of French, writers, 
 which I have not been ahle to verify, cholera in this 
 year attacked the army of the French commander 
 Andeme in the south. In the year 1782 cholera 
 was largely diffused in Southern India. The mort 
 de chien or cramp prevailed in Sir Edward Hughes' 
 fleet, both off Madras and Trinoomalee, at the latter 
 place in May and April. 
 
 Curtis* tells us of that fatal and intractable Indian 
 disease, which from July to September of this year 
 occurred in the Madras hospital and in the fleet. 
 He thought he could make out two sets of cases : one, 
 when the disease was of a more bilious nature, the 
 other, with sudden depression which was not pro- 
 portionate to the spasms or to the amount of fluid 
 lost. This last observation may be noted. This 
 sudden depression he considered to be the great 
 characteristic of the disease. He could not satisfy 
 himself, as others did, that the orderly and well- 
 clothed man suffered less from the disease than 
 the disorderly and ill-clothed. He at first for 
 treatment made use of small doses of glauber salts 
 
 * Op. cit. Curtis's satisfactory account of cholera is remark- 
 able as not having been published till twenty-five years after 
 the events it relates. He does not onoe allude to Girdlestone, 
 who described the same occurrences twenty years before him. 
 It is strange, that although they must have been in Madias 
 at the same time, and though Curtis must have seen the book 
 of G-irdlestone, who described the same occurrences twenty 
 years before him, he does not once allude to his name. 
 
140 ANNALS OF CHOLERA, 
 
 with one- eighth of a grain of antimony, and also 
 used other purgatives and castor-oil. When there 
 was bilious colluvies in the primes vise, he found 
 them admissible, at least gentle purgatives ; but in 
 cases of depression he found the evacuants only 
 increased the weakness. His treatment in the main 
 became the use of strong ammonia and stimulants, 
 with some opium. 
 
 Mr. Girdlestone,* at the same time, October, 1782, 
 on landing at Madras, found spasms the first disease. 
 Though there can be no doubt as to the nature of the 
 affection, he does not mention purging or suppression 
 of urine. More than fifty of the newly-arrived troops 
 were carried off within three days of their landing, 
 and 300 men of the 101st regiment were attacked 
 within the month. All the worst cases were brought 
 in about four o'clock in the morning. The faculty 
 at Madras prescribed chiefly hot Madeira wine. 
 Grirdlestone, who never calls the disease cholera, 
 indeed, says, " in spasmodic affections, and in 
 cholera morbus," thought giving forty drops of 
 laudanum with a cordial, repeating the cordial with- 
 out the laudanum if it was retained, most successful 
 treatment. He also used injections of warm broth, 
 and friction to the surface. He was much pleased 
 with the result of his own practice, while he did not 
 judge as favourably of the effect of the treatment of 
 the disease by the faculty. 
 
 Curtis and Grirdlestone are pretty well in accord 
 as to the morbid appearances to be found after 
 * Essay on Hepatitis and Spasmodic Affections of India, 1787. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. Ill 
 
 death. Both, were agreed that there was no injury 
 sustained by the brain, liver, gaU, bladder, stomach, 
 or heart ; but Curtis observed in two of his cases 
 that there was more water then natural in the peri- 
 cardium, and the vessels of the lungs, liver, and 
 pericardium appeared to be very turgid and full 
 of blood. 
 
 In the same year Konig, the botanist, gave the 
 following admirable account of the disease : — 
 
 " Nuper iterum morti proximus fui, morbo enim 
 diro, quern Dysenteria apoplectica appellare fas est 
 tenebar. Sanitatem reddidit clementissimus Deus. 
 Integer tamen mensis ante periectam restitutionem 
 transiit. Morbi cursus hie est : Diarrhoea corripitur 
 seger cum elastica quasi excrementorum ejeetione ; 
 dein sequuntur ejusmodi dejectiones, quee nihil nisi 
 humorem lymphaticum clarum continent. Manus 
 mox frigent cum pedibus. Manuum musculi con- 
 trahuntur, et hse seque ac faoies flavidum glutinosum 
 muoum transsudant. Pulmones angastantur, vox 
 rauca vix.adstantibus percipienda. Alii timore per- 
 cutiuntur, alii indolentes videntur. PulsuiB in 
 omnibus extremitatibus deficit, et tantum ad caroti- 
 dem artcriam observatur, quamvis irregularis. Non- 
 nuUi jam vomunt. Ungues lividi sunt ; et diri 
 spasmi brachia et suras corripiunt, cum clamore 
 segroti. Hsec mors sequitur sine insigni convulsive 
 motu. Cursum huno sequitur morbus, qui stepe 
 intra semihorium terminatur : nonnunquam sex 
 ad octo horarum spatio absolvitor. Qui remediis 
 sublevantur idoneis, ad n'^cthemor spatium ilium 
 
142 ANNALS OF CHOLERA, 
 
 protrahere possunt. Pauci sibi relicti convalescunt. 
 Huno ego morbum perioulosissimum vioi, et sospes 
 liodie descripsi."® 
 
 Konig had thus a narrow escape of his life, and 
 was able to give us this lively picture of what I 
 suppose may be called the endemic of the country, 
 which he experienced at Tranquebar. There is 
 nothing overlooked in this description, except the 
 suppression of urine. His tardy convalescence makes 
 it probable that he may have had consecutive fever. 
 The case is as it were an average one, the. diarrhoea 
 being as usual the most prominent symptom. The 
 sudden failure of his powers must have suggested 
 the phrase of apoplectic dysentery. The disease 
 must have been acute enough, as it was said to kill 
 perhaps in half an hour, or in six or eight hours. 
 Ho believed that none recovered who did not receive 
 treatment. 
 
 In the same year, according to Dr. Clark,t troops 
 fresh from England, although coming off an unfor- 
 tunate voyage, died in Bombay harbour on landing 
 of cholera and of couj:) de soleil. He adds that 
 cholera there is a disease of the dry months. 
 
 Fra Paolino Bartolomeo, a Capuchin brother, 
 who spent thirteen years in Southern India, and 
 who published, in 1796, his travels, which contain 
 much useful matter, desciibes an epidemic of the 
 disease in Malabar in this year. His account of 
 
 * Retzius, Observat. Botaii., 1786, Fascic. iii., Preface. 
 t Op. cit. 2ud edit., 1792. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 143 
 
 cholera may therefore be conveniently introduced 
 here : — 
 
 *' Far more dreadful are the consequences of the 
 intestinal colic, called by the Indians Shani, Mordexin, 
 and also Nicomher and Nirtiripa. It is occasioned by 
 the winds blowing from the mountains, which carry 
 with them a great many nitrous particles, and which 
 commonly commence immediately after the rainy 
 season, when the wet weather is succeeded by a 
 great heat or a continued drought. On the coast of 
 Malabar this is the case from the beginning of 
 October till the 20th of December, and on the coast 
 of Coromandel in April and May. People are then 
 liable to catch colds, and the consequence is that 
 malignant and bilious slimy matter adheres to the 
 bowels, and occasions violent pains, vomiting, fever, 
 and stupefaction, so that persons attacked with the 
 disease die very often in a few liours. It sometimes 
 happens that thirty or forty persons die in this 
 manner in one place in the course of a day, unless 
 speedy relief be administered. The bitter essence — 
 the drogue amere — is the best remedy for this colic. 
 In the year 1782 this disease raged with so much 
 fury, that a great many persons died of it. The 
 above essence is very dear, and it was not possible 
 to procure it in such quantities as to supply all the 
 patients. In its stead, therefore, we employed 
 togora — coooanut brandy, distilled over horse dung. 
 All those recovered to whom this beverage was 
 given, but the rest died in three or four hours. The 
 fame of our medicine was spread as far as Cochin. 
 
144 ANNALS OF CHOLERA, 
 
 When the Dutch physicians at that place were 
 informed of this circumstance, they not only gave 
 our medicine their approbation, but even employed 
 it in their practice." * 
 
 In the preceding account the chief noteworthy 
 points are, the immense importance in the causation 
 of the disease which Bartolomeo attributes to season ; 
 also his finding the use of spirits exceedingly valu- 
 able, as I imagine those who have had much practice 
 among the natives of India, have usually done. 
 
 Next year, or in 1783, the Madras Eeport describes 
 tlie malady as epidemic along the whole coast. We 
 hea.r from Hay of its having been at Travancore in 
 tlie South, and it showed itself in the army of ob- 
 servation. 
 
 An outbreak which took place this yearf has 
 always excited much interest, and especially since 
 the influence of pilgrimages in diffusing the disease 
 has come to be studied. It also seemed to stand 
 alone as an isolated example of cholera occurring 
 in the north-west of India. But now that we know 
 of previous outbreaks in Hajpootana and Bundle- 
 cund, and when we find that the opinion has been 
 entertained that cholera has always been endemic 
 in Malwah, the epidemic is less surprising. 
 
 Hurdwar, where the waters of the G-anges first 
 issue into the plains, is held very sacred by the 
 Hindoos, and every year, at the full moon of April, 
 
 * Travels, &c., p. 409, English edit., 1800. 
 t Vide Bengal Report, &e. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 145 
 
 and more especially every twelfth year, an immense 
 concourse of people assembles near it to hold a fair, 
 and for the purpose of bathing in the holy stream. 
 The year 1783 was one of the propitious years, and 
 the concourse of pilgrims was very great (it has been 
 stated at one or two millions !) . It is the custom of 
 the pilgrims to repair to the bed of the river, where 
 they pass the night with little, if any, shelter — many 
 persons being crowded under the cover of a single 
 blanket, thrown out as an awning. The tempera^ 
 ture is very variable, the days being hot and the 
 nights cold. Whatever influence this may have had, 
 or an easterly wind springing up during a hot night, 
 it is certain that cholera broke out soon after the 
 commencement of the ceremonies, and raged with 
 such fury that in less than eight days it is said to 
 have cut off more than 20,000 victims. But so con- 
 fined was its influence, that it did not reach the 
 village of Juwalapore, only seven miles distant, and 
 ceased immediately upon the concourse breaking up, 
 on the last day of the ceremony. 
 
 After this year the epidemic diffusion of cholera 
 diminished, although the disease every now and then 
 cropped up. It was at Yellore and Arcot, which are 
 close to each other, in the years 1787-88, and 1789. 
 At Yellore it was a disease so rapid in its progress, 
 that many of the men were carried off in twelve 
 hours' illness. Mr. Davis's account of it at Arcot in 
 November, 1787,* is singularly interesting, as he 
 
 * Madras Report. 
 
146 ANNALS OF CHOLERA, 
 
 describes three varieties of the disease in hospital, 
 
 namely, cholera morbus, an inflammatory fever with 
 cramps, and a spasmodic affection of the nervous 
 system distinct from cholera ; he adds, that the last 
 disease was more fatal than the other two, destroy- 
 ing all that were attacked by it. 
 
 This disease, which was the true malignant cholera, 
 Mr. Duffin treated with castor-oil successfully ; in- 
 deed, he was happy to say, he scarcely lost a man. 
 
 Mr. Thompson* has given us an account of the 
 post-mortem appearances, which, such as it is, is far 
 more satisfactory than those usually furnished. 
 
 The gall bladder was exceedingly distended with 
 bile, extending an inch or more beyond the edge of 
 the liver. There were no marks of putrescence in 
 any of the abdominal viscera ; the kidneys and the 
 intestines were healthy ; the urinary bladder quite 
 empty, and contracted to the size of a walnut. The 
 stomach and duodenum both empty of bile, and no 
 appearance of inflammation in any part of the intes- 
 tinal canal or peritoneum. 
 
 Here we have the gorged gall bladder, and con- 
 tracted urinary bladder, so characteristic of cholera. 
 The minuter changes occurring in the surface of the 
 intestines and in the kidneys were not matter of 
 observation until a much later period. 
 
 In one of these years, about 1788, according to 
 native report, we learn, through Superintending-Sur- 
 geon Duncan, that cholera prevailed epidemically at 
 
 * Madras Report. 
 
IN THE EAST FROM A.D, 1750 TO A.D. 1817. 147 
 
 Bellary. This is of interest as affording an instance 
 of a place at a considerable distance from tlie sea 
 being attacked. 
 
 The oj^inion expressed at this time by the Madras 
 Medical Board, in November, 1787, is an important 
 contribution to the history of the disease : — 
 
 " A disease had in October last prevailed at 
 Arcot similar to an endemic that raged among the 
 natives at Paliconda, in Amboor Valley, in 1769-70, 
 in the Bengal detachment at Granjam, in 1781, in 
 the army of observation in 1783, and in several other 
 places at different times, and as epidemic over the 
 whole coast in 1783, under the appearance of dysen- 
 tery, cholera morbus, or mordezin, but attended 
 with spasms at the prsecordia, and sudden prostra- 
 tion of strength, as characteristic marks." 
 
 Here we see that the Board recognised an old 
 disease, merely intensified by its being epidemic ; the 
 old resemblance to dysentery comes out again. 
 
 If we hear less of cholera in India proper at this 
 time, yet it seems to have been in Batavia in 1789, 
 where it was treated mainly with large doses of 
 opium.* 
 
 Singularly enough, another Bengal column was 
 attacked in 179 Of in much the same way as that of 
 Colonel Pearse, and in the same country, at the same 
 season. The cholera commenced late in March, but 
 was not general till the 15th of April, when its 
 activity was heightened by a heavy squall of wind 
 
 * Journal de Marine, La Haye, 1868. f Bengal Report. 
 
 L 2 
 
148 ANNALS OF CHOLERA, 
 
 and rain, wliich overtook tlie detachment on the 
 north side of the Chilka Lake. From this time till 
 the middle of June, when the detachment reached 
 EUore, and the weather had become more moderate 
 owing to frequent falls of rain, the disease proved 
 verj fatal. But although the disease accompanied 
 the column much longer than it did that of Colonel 
 Pearse, it did less mischief. Luckily, says Mr. Jame- 
 son, laudanum and cordials were resorted to for its 
 cure. 
 
 Clark, in the new chapter of the edition of his 
 work in 1792, says that cholera is common in Ma- 
 labar and in Canara, and, according to Mr. Hay, 
 writing from Uuillon in 1818,* " The endemic, if 
 not of the ISIalabars, certainly of the Travancorians, 
 devastated the country twenty-five years ago," which 
 would be about 1793, " destroying thousands." At 
 this time, be it observed, according to Hay, the 
 native doctors abandoned theii' charges and fled, 
 thinking the disease contagious. 
 
 The rumour mentioned by Mr. Jukes, in the 
 Bombay Medical Report, that the disease had pre- 
 vailed in the Mahratta country about this time, 
 and had reached Tannah, is confirmed by the more 
 precise statement of Colonel Tod, that it was 
 epidemic in Marwar in the year 1794. f 
 
 * INIadras Report. 
 
 + The disease which occurred this year at Ellore, and which 
 is described in the Madras Report, was a variety of heat 
 apoplexy, or coup de soleil. Some of its nervous symptoms 
 approximated to those of cholera. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 149 
 
 I am able to conclude this century witli a confirm- 
 ation of the report mentioned by the Bengal Medi- 
 cal Board, that the disease prevailed epidemically in 
 Lower Bengal in the end of the century, although 
 when it re-appeared there only twenty years after- 
 wards, it was regarded by the great majority of 
 observers as an unheard-of pestilence. In 1797 a 
 collector, in one of his reports,* alluding to the 
 sickness and mortality in a pergunnah of Backer- 
 gunge (and Backergunge and Burisal may be taken 
 as synonymous), says: — "In one house, that of a 
 grain dealer, seventeen lives have been lost in eleven 
 days ; and I consider that from four to five hundred 
 lives have been sacrificed to this plague, which has 
 not yet been subdued." This plague can only have 
 been cholera. There is no other Indian complaint 
 to which the description would apply. 
 
 As we get nearer the great outbreak of 1817, or 
 for the next nineteen or twenty years, our notices 
 become scanty in the extreme. There was evidently 
 a period of comparative quiescence of the disease, 
 although every now and then it gave evidence of its 
 existence. Dr. Jameson, of Cheltenham, in a note 
 to his work on that place, observes, in 1802, that 
 hepatitis and cholera morbus were the chief diseases 
 of India in the hot season, according to the statement 
 of officers to him. Dr. J. Johnsonf saw some cases of 
 the disease in the harbour of Trincomalee in 1804. 
 
 * Taylor's Topography of Dacca. 
 
 t Iiilluence of Tropical Climates, 1813. 
 
150 ANNALS OF CHOLERA, 
 
 He insists — it does not appear on what autliority — 
 that cholera, or niort de chien, existed in its most con- 
 centrated state on the east coast of Ceylon, where 
 it was more prevalent than in other parts of India. 
 He recommended the use of blood-letting and of 
 Calomel. Mr. Barnes, of Jessore, tells us that on 
 two occasions previously to 1817, the Court at that 
 place had been broken up owing to outbreaks of the 
 disease, and that he remembered having seen cases 
 of cholera. Recently, Mr. C. Macnamara* has ex- 
 humed from the records of the Bengal Medical 
 Board a few notices which show that some stray 
 cases of the disease, so named in the returns, oc- 
 curred in the years 1808-9-11-12-13 and 14, most 
 of them in Chunar, near Benares, and some of them 
 in Fort William, Calcutta — in this last place, in 
 1814, in a crowded barrack, among newly-arrived 
 troops. 
 
 In this year, too, we have clear and distinct 
 accounts from two medical officers of an outbreak of 
 the disease among native troops near Jaulnah.f That 
 in the 9th Regiment, recorded by Mr. Cruikshank, 
 was of considerable severity. Mr. Cruikshank, on 
 referring to his notes some years afterwards, found 
 that, in consideration of the great amount of vascular 
 collapse, he had denominated the disease, asphyxia. 
 Mr. Cruikshank' s account is also interesting, as giving 
 an example of two corps of the same brigade being 
 apparently situated alike, yet one suffering from the 
 
 * Treatise on Cholera. f Madras Report. 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 151 
 
 disease, and the otlier escaping it, for no assignable 
 cause. 
 
 Furtlier, says Mr. Scott, in tlie Madras Report, 
 tliis paper of Mr. Cruiksliank's is important, inas- 
 much, as it evinces that cholera did exist at that time 
 to an extent not hitherto suspected, and yet that no 
 trace of it is found in the public records.* 
 
 We are indebted to a Calcutta news]3aper in 1831 
 for an account of a small outbreak of cholera in 
 Lower Bengal in 1816. It appears that a band of 
 bird and fruit sellers called Kooroorcheas (from 
 whence they had come is not known) were at a 
 village called Saifgunge, in the district of Purneah, 
 north of the Ganges, in 1816, and that in the months 
 of April and May they suffered from a pestilence for 
 which they then had no name, but to which they 
 gave the name of oola next season ; that it killed 
 eight or ten of them daily, and that in consequence 
 they broke up their encampment, and scattered 
 themselves in the neighbouring villages. There 
 is no improbability about this story, and if it be 
 accepted, it shows that, if we had fuller evidence, it 
 might probably turn out that cholera of the malig- 
 nant kind was present in more than one locality in 
 Bengal the year before the outbreak of the great 
 
 * Corbyn's very extraordinary statement that he saw the 
 disease on board the Mangles East Indiaman, in 1814, 
 among the Lascars, on the voyage from England to the Cape, 
 has never been accepted. The men's legs were oedematoiis ; 
 it was evidently some acute form of choleraic diarrhcea, super- 
 vening on scurvy. 
 
152 ANNALS OF CHOLERA, »• 
 
 epidemic. That what was called cholera morbus 
 was not unusual in Calcutta itself, is shown by the 
 police reports,* if they are to be at all credited. For, 
 counting Mahommedans, they assign a mortality of 
 about 200 by this disease, in each of the years 1815 
 and 1816, to the population of Calcutta. 
 
 The great epidemic of 1817 is usually described 
 as having commenced at Jessore ; but in that year 
 there was a fatal case of cholera in Fort William in 
 the month of March, which attracted no attention. 
 In May and June the disease was raging epidemi- 
 cally in Kishnaghur and Mymensing. In July it 
 was at Sonergong in the Dacca district, and as high 
 up the river as the large city of Patna, and it did not 
 reach Jessore till August, and not till after the middle 
 of the month. It broke out in Calcutta at much the 
 same date, or a few days earlier. In both places it 
 caused great consternation, but the greatest in Jessore. 
 
 As the old temple of Oola heehee (Lady of the 
 Flux) was in an out-of-the-way suburb of Calcutta, 
 a new temple to her was opened at Kidderpore, and 
 at Sulkea a young woman sat for some days in a 
 temple as an incarnation of her, till removed by 
 order of the magistrate. The priests of the old- 
 established deity of Kali Grhat issued a proclama- 
 tion, and sent cowries round in a mysterious way, 
 threatening those who did not resort to her shrine, 
 an4 the road to her temple was crowded with 
 pilgrims, t 
 
 * Bengal Report. + Asiatic Journal, 1818. 
 
IN THE EAST FROM A.D. 1760 TO A.D. 1817. 153 
 
 This shows at once the intensity of the alarm, and 
 that in reviving the worship of Oola beebee, the anti- 
 quity of the disease was recognised. 
 
 In Jessore, which is sometimes mentioned by 
 the old name of Morley, although there was great 
 mortality in the district, and cholera undoubtedly 
 showed itself with much malignancy, the disease 
 broke out on the 19th of August in the part of it 
 called Yeramdah ; it was gone from the Jail by 
 September 2nd, and the mortality in the station 
 was almost over by the 20th of September. So 
 much was this the case, that the civil surgeon. 
 Dr. Tytler,* reported that it was unnecessary to 
 carry out the hygienic measures recommended by 
 the Medical Board of Calcutta, such as clearing 
 away trees and overgrown jungle, and collections of 
 filth, and filling up pools of stagnant water. The 
 treatment recommended by the Board, as carried 
 out by him with no instance of failure, if adopted 
 at once, had been sufl&cient to overcome the disease ! 
 That treatment was mainly, the use of large doses of 
 calomel in the first instance, and of opium in small 
 doses, if the vomiting was protracted. 
 
 The practice oflicially recommended by the Medi- 
 cal Board, and carried out by the aid of native 
 doctors in Calcutta and its suburbs, was founded on 
 the principle, that the administration of diluents 
 only led to waste of time ; that nothing could be 
 more dangerous than any delay in supporting the 
 
 * Dr. Baird Smith, in Indian Annals, 1870. 
 
154 ANNALS OF CHOLERA, 
 
 patient ; that by giving aperients or emetics in tlie com- 
 mencement, you increase the virulence of the disease, 
 which it should be your object to quiet. The treat- 
 ment, therefore, was in the first place to give about 
 a Madeira glassful of brandy, plain, or with water, 
 according to the degree of depression of the patient. 
 When the patient was a little revived, and his 
 stomach was quieted for a time, you were to give 
 fifteen drops of laudanum in water ; if that was not 
 kept down, or until a dose was retained, you were to 
 go on repeating the laudanum, increasing the dose 
 to about forty drops. Opium dissolved in water was 
 to be applied to the pit of the stomach, and hot 
 brick-bats applied to restore warmth. 
 
 When the stomach was quieted, and brought into 
 a fit state to retain purgative medicines (given with 
 a view of expelling the morbid secretions of the 
 intestines), calomel, owing to its action on the liver, 
 was thought an appropriate medicine, and was given 
 in pills of 3 grs. each every half hour or forty 
 minutes. But care must be taken not to give a 
 large dose at once, which would infallibly bring 
 back the vomiting. During the exhibition and 
 operation of calomel or other purgatives, the patient's 
 strength should be constantly attended to, and be 
 supported by small quantities of brandy-and-water, 
 given from time to time. After a space tonics were 
 administered to restore vigour to the stomach.* 
 
 * We have no distinct account of the treatment adopted by 
 the native doctors. The Medical Board borrowed the use of 
 decoctions of black pepper, of ginger, and other stimulant 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 155 
 
 This treatment was considered to be very effi- 
 cacious. " In a very eminent degree successful." 
 " It is fortunately," writes the Medical Board,* " a 
 disease which in most instances admits of a speedy 
 remedy." This of the great choleraic pestilence! 
 
 Nothing is at the present day more surprising to 
 us — at least to such as are really familiar with the 
 disease in Europe or in India — than the confidence 
 with which medical men talked of the result, if they 
 were only called in in time. Yet nothing could be 
 more acute than the malignant forms of the disease 
 described at the time. There are, indeed, some 
 tables of the cases treated in Calcutta, and of the 
 number of deaths. f If we could have the slightest 
 confidence in them (and they would show that only 
 about ten per cent, of those who were treated died) , we 
 must believe that the disease could be handled far 
 more successfully then, than in modern times. But 
 we know that such results could not have been really 
 obtained during a virulent epidemic. 
 
 The following extract^ from a memorandum 
 circulated at the time by G-overnment, gives a 
 sufficient idea of the intensity of the epidemic : — 
 " The most alarming symptom of the disease is the 
 sudden prostration of strength at the very com- 
 mencement. The patient while walking or engaged 
 
 medicines in common use among them. Had the natiyes for- 
 gotten the use of the cautery, the universal remedy in former 
 cholera times ? 
 
 * Indian Annals. f Bengal Report. 
 
 X Indian Annals, 1870. 
 
156 ANNAI.S OF CHOLERA, 
 
 in his usual occupation, without any previous warn- 
 ing symptom, falls down, and is immediately seized 
 with vomiting, at the same time that a cold and 
 clammy sweat breaks out over his body. His pulse 
 can scarcely be felt, and his debility is such, that he 
 is unable to move from the spot without support. 
 In some cases the patient has died within half an 
 hour of his first attack ; but in general, where no 
 remedies are used, it proves fatal in ten or twelve 
 hours. ... In recovery a relapse is frequently 
 produced by loading the stomach with food, and 
 this is generally very speedily fatal." 
 
 The intensity of disease described above, is no 
 greater than what we have read of at Groa, in Ma- 
 labar, in the Delta "of the Cauvery, in Granjam, and 
 at Hurdwar. Similar malignity prevails at the 
 commencement of all bad epidemics, although the 
 accounts of it are sometimes exaggerated by such 
 panic, as manifested itself at Jessore on this occa- 
 sion, 
 
 I think it unnecessary to load my pages with a 
 full account of the symptoms of the disease as it 
 showed itself at this time, for they differ in no 
 respect from other accounts of Indian epidemics of 
 cholera, of which so many specimens have been 
 already given. 
 
 It is not my intention to pursue the history of 
 cholera beyond the point now reached — the com- 
 mencement of the outbreak of 1817 — and I shall 
 conclude by giving the ideas of the Medical Board, 
 expressed within a fortnight after Jessore was 
 
IN THE EAST FROM A.D. 1750 TO A.D. 1817. 157 
 
 attacked.* They refer to the extent of the disease, 
 to the local circumstances which favoured its spread, 
 and to the condition of the people, which pre- 
 disposed them to its ravages. They are in spirit 
 much the same as the reflections of Sonneratf : — 
 
 "It is prohahle that there is no considerable town 
 in the low and humid climate of Bengal that is at 
 present entirely exempted from the operation of the 
 disease. The obstruction to ventilation in native 
 towns from rank and luxuriant vegetation powerfully 
 aids the influence of the season ; and, according to 
 the degree of the operation of this cause, will the 
 prevalence and fatality of the epidemic be probably 
 increased or diminished. 
 
 "The sudden alternations of heat and cold, acting 
 on the constitution of natives, which are extremely 
 susceptible of those impressions, no doubt influence 
 the prevalence of the present epidemic ; and the same 
 observation is perhaps applicable to unwholesome or 
 insufficient diet, and to the miserable accommodation 
 afforded by the low and damp huts of the lower and 
 more indigent natives." 
 
 Such were the impressions created in Lower 
 Bengal, when the existence of the epidemic was first 
 recognised. 
 
 It should not be forgotten that Mr. CrawJ treated 
 200 or 300 cases of common cholera during the rains 
 at Caranja, near Bombay. We learn this merely 
 
 * Indian Annals, 1870. t Supra p. 131. 
 
 X Bombay Reports. 
 
158 ANNALS OF CHOLERA. 
 
 incidentally, but it is sufficient to show, tliat choleraic 
 affections were common in at least one other part of 
 India, at the date of the Bengal outbreak, although 
 having no connection with it. The presumption 
 arises naturally, that Caranja was not the only place 
 where such affections were occurring. 
 
REMARKS ON THE OUTBREAK OF 1817. 159 
 
 CHAPTEE YIL 
 
 REMARKS ON THE OUTBREAK OF 1817. 
 
 When cholera reached Jessore and Calcutta, and 
 caused such alarm, the medical authorities reported, 
 in the first instance, that it was the usual epidemic 
 of the season in an aggravated form. It was some 
 little time before the term cholera was applied 
 to it. 
 
 (1.) Not raising just yet the question, what was 
 the usual season for such an epidemic, I shall first 
 inquire what collateral evidence there is of there 
 being a sort of annual cholera in Bengal, otherwise 
 an endemic cholera. The fact of there being a 
 temple at Calcutta dedicated to the goddess of the 
 disease, limited even though her worshippers may 
 have been in numbers of late years, is a tolerably 
 satisfactory proof that the disease was always recog- 
 nised in Bengal ; but we have further notices of its 
 existence from English witnesses. 
 
 Dr. Young, of AUipore,* for a long series of years 
 used to have a few cases of cholera, but not of much 
 virulence, among the prisoners in his jail every 
 season. Dr. Barnes, of Jessore,t said, that he had 
 
 ♦ Ou Cholera, 1831. 
 
 t Rouppell, Lumleian Lectures, 1832. 
 
160 ANNALS or CHOLERA. 
 
 been accustomed to cases of tlie identical disease, 
 althougli he had not called them by the name of 
 cholera ; that he thought the disease was a new 
 one, suj^erseding the periodical remittent of the 
 season ; and that it had repeatedly been the subject 
 of correspondence between him and the Medical 
 Board. Dr. Tytler, again, who was the officer 
 present at Jessore at the time of the outbreak of 
 1817, considered the disease to be the usual epi- 
 demic. This was before he had stumbled by hap- 
 hazard on his rice theory, which, indeed, had been 
 previously indicated by Sonnerat. Dr. Tytler* 
 afterwards wrote, that he had proof from official 
 records, that cholera had formerly occurred at Jes- 
 sore. " 
 
 Dr. Macrae, of Chittagong,t who furnished the 
 report of the outbreak of the disease in the Bengal 
 column in 1791, which has already been quoted, 
 and whose evidence is very valuable, as he had 
 undoubtedly witnessed a sharp epidemic of the 
 disease among soldiers, said that he was familiar 
 with the disease every hot season since 1794, the 
 date of his settling at Chittagong. 
 
 Mr. Jameson tells us that such epidemics occurred 
 in Calcutta in the sultry season, of which, indeed, the 
 death of a soldier in the Fort, in March of the year 
 1817, was an illustration ; and in the appendix to his 
 report, the return already quoted^ shows, that about 
 
 * On Cholera, p. 41. 
 
 t Macnamara's Treatise on Cholera, Appendix. 
 
 \ Supra p. 152. 
 
REMARKS 0:S THE OUTBREAK OF 1817. 161 
 
 200 deaths annually were occasioned by cholera 
 morbus in the whole population of Calcutta. 
 
 Dr. Clark, too, had long before this said, that 
 cholera occurred in Bengal in the hot season, though 
 less common there than on the Malabar and Coro- 
 mandel coasts. 
 
 The Medical Board was, therefore, not without 
 grounds for the view which it at first entertained. 
 But whatever its first opinion was, it soon came to 
 acknowledge that the disease was a wide- spreading 
 pestilence, of far greater severity than any annual 
 epidemic that they had been accustomed to. 
 
 (2.) With respect to the season considered to be 
 the normal one for the endemic cholera in Calcutta, 
 Mr. Jameson's statements are a little conflicting, 
 and I think I can trace very plain signs that, fair 
 though he generally is, like other writers on the sub- 
 ject, he has his views somewhat tinged by the conclu- 
 sion at which he had arrived ; this was, in fact, the 
 ancient doctrine about pestilences, that not merely 
 hot, but hot moist air, as well as vicissitudes of tem- 
 perature, were necessary for the production of cholera. 
 His first observation is, that the disease rarely 
 occurred in the equable months of the dry 
 and hot weather, but acquired vigour towards the 
 autumnal equinox. Further on in his Eeport he 
 makes the statement, that the disease is endemic in 
 sultry periods of the year, which I suppose would 
 bring us back to the hot season. 
 
 If we come to facts bearing on Calcutta and its 
 neighbourhood, we learn from his Report that there 
 
 M 
 
162 ANNALS OF CHOLERA. 
 
 was a deatli from cholera in Fort William in MarcH, 
 1817, and that cholera prevailed in Nuddea in May. 
 Reverting to older evidence, we find that the chief 
 season of pilgrimage to the cholera goddess was 
 from April to June, and that the epidemic of 1781 
 raged in Calcutta in April. Clark, in the edition 
 of his work published in 1792, says that the hot 
 months are the season for cholera in Bengal, and 
 Dr. Macrae used to observe it annually in Chitta- 
 gong in the hot season. 
 
 Still, the fact remains, that the first great out- 
 break of 1817 in Calcutta was in the month of 
 August (and I have myself seen, during the rains 
 in Calcutta, in September, 1859, the worst epidemic 
 I have ever witne^ssed among Europeans) ; but the 
 disease very soon resumed its old habits — may be 
 said to have righted itself. After having almost 
 died out by the end of the year 1817, it suddenly 
 broke out again in the end of February, 1818, and 
 raged during the hot-weather months. The two 
 worst months of the rains in 1817 produced only 
 727 deaths, while the two worst ones of the hot 
 weather of 1818 produced 2454 deaths, or consider- 
 ably more than three times as many. Cholera was 
 thus very much worse in Calcutta in the second 
 than in the first year of the outbreak. Its course 
 was similar in other places near Calcutta. It recurred 
 at Nuddea in the end of February, 1818. In 
 Burdwan it was particularly violent in the hot 
 weather of 1818. It probably followed a similar 
 course in Jessore, says Mr. Jameson, although 
 
REMARKS ON THE OUTBREAK OF 1817. 163 
 
 reports are wanting. In all those places the disease 
 showed itself again in the hot weather of 1819. 
 
 Reviewing thus what evidence we have of the 
 season for cholera in Calcutta before and immediately 
 after 1817, I think there is a very decided presump- 
 tion that the hot weather has always been the chief 
 cholera season in Calcutta, although its period was 
 deranged for a time in 1817. 
 
 (3.) The outbreak of 1817 was of such magnitude, 
 and has had such lasting effects, there has also been, 
 in my opinion, so much misapprehension about its 
 source, that I hope a few words on its origin 
 will not be thrown away, even if they do not profess 
 to solve the cause of the outburst. 
 
 In inquiring into the origin of the outbreak of 
 1817, it may be well to determine some of the dates 
 when, and the localities in which it showed itself 
 first, a part of the question which seems to have 
 been somewhat overlooked ; and a few facts are of 
 more value, than much speculation on the subject. 
 
 The disease is represented as prevailing in May 
 and June in Kishnaghur (of which another name 
 is Nuddea) , sixty miles north of Calcutta ; and in 
 Mymensing, 250 miles north-east. On July the 
 11th it broke out in the large city of Patna, 
 300 miles north-west of Calcutta. It was at 
 Sonergong, in the Dacca district, in July, about 150 
 miles east of it. Early in August cases of the 
 disease occurred in Calcutta and Jessore, but did not 
 cause much alarm till about the 15th and 19th of 
 the month respectively. 
 
 M 2 
 
164 ANNALS OF CHOLERA. 
 
 On the 13tli of August cliolera was at Sjiliet, 
 nearly 300 miles north-east. Nay, by the 18th it 
 had reached Grhazeepore, almost 400 miles north- 
 west of Calcutta. "We know that the disease was 
 raging in Chittagong, 250 miles south-east of Cal- 
 cutta, by the 23rd of August. 
 
 It is, therefore, very surprising, how Jessore ever 
 came to be considered the centre from which the 
 disease spread in 1817,* and still more how the 
 Sunderbunds, a district south of it, equivalent to the 
 mouths of the Granges, have been specially fixed on. 
 Notwithstanding the declaration of the Constanti- 
 nople Cholera Conference, that Jessore could not be 
 considered to be a particular centre of diffusion, the 
 statement that cholera dates its origin from Jessore, 
 or from the Sunderbunds, is repeated in almost 
 every work — has, in fact, become stereotyped. 
 
 We have already seen that cholera was spread 
 over a large area in almost every direction from Jes- 
 sore except the direct south, before its outbreak in 
 that place. 
 
 The districts south of Calcutta and of Jessore 
 were not attacked until after those places. Diamond 
 Harbour, for instance, forty miles south of Calcutta, 
 was attacked on the 20th of September, or a month 
 
 * Until the J were better informed, the Bengal Medical 
 Board seem to have shared the popular belief about the local 
 origin of cholera at Jessore, and that it spread from that 
 centre. This belief they entertained up to the latter half of 
 the year 1818, See their letter in the Bombay Keports on 
 Cholera of 1819. 
 
REMARKS ON THE OUTBREAK OF 1817. 165 
 
 later. The Sunderbunds are not once mentioned 
 by name by Mr. Jameson, but he does remark 
 that the mouths of the Granges did not suffer till a 
 month after Calcutta. Indeed, it may be doubted 
 whether they suffered at all in 1817. Mr. Jame- 
 son's only positive fact is, that cholera reached Buri- 
 sal, which is situated at the eastern border of the 
 Sunderbunds, on September 14th ; but further on in 
 his Eeport he says, that in Bullooah, and tracts near 
 the mouth of the Granges, the disease began in Feb- 
 ruary, and ended in June, 1818. In any case the 
 mouths of the Granges were attacked after Calcutta 
 and Jessore. As to other places situated south-west 
 of Calcutta, Balasore, on the coast, 180 miles distant, 
 was attacked on September loth ; Midnapore and 
 Cuttaek are said to have been almost spared during 
 the first year of the epidemic. 
 
 On the whole, therefore, all our evidence goes to 
 show that in 1817 cholera was, in the first instance, 
 diffused to the north of Calcutta and Jessore ; that it 
 was first in the upper, or rather the outside part of 
 the Grangetic Delta, and certainly not in its lower 
 portion. The disease had no special connection 
 with Jessore, and still less with the Sunderbunds. 
 
 The disease, however, when it did reach Jessore, 
 was of a high degree of intensity. But, neither did 
 it begin there, nor can it be said that it showed itself 
 there first in a small way. 
 
 I have been unable to discover the source even of 
 the report that cholera originated in the Sunder- 
 bunds. 
 
166 ANNALS OF CHOLERA. 
 
 (4.) Did the disease spread from any centre ? 
 Jameson, wlien the facts were all before him, was 
 able to say it did not spread from a centre, and he is 
 probably quite right. I am far from meaning to 
 assert that there is sufScient proof that there was 
 any centre. Yet I cannot but remark that, if 
 there was one, the district in which the gipsies had 
 cholera the year before, was as probable a centre as 
 any — Saifgunge, in the Purneah district, lying about 
 150 miles west of Mymensing, north of Kishnaghur, 
 and east of Patna, the places where cholera was first 
 observed in 1817. 
 
 (5.) Is there any ground to believe that the 
 disease in that year came to Bengal from any other 
 quarter ? We know that in 1781 epidemic cholera 
 was believed to have reached Calcutta from Ganjam, 
 and then passed off to the north ; but in this year 
 there is not the slightest indication of there having 
 been cholera in Ganjam, or among the pilgrims at 
 Juggernath, or, indeed, of the malignant kind in 
 any part of India. The last we have heard of it in 
 the Gangetic Yalley was at Chunar, where there 
 were seventy-nine cases in 1811-12-13, and the local 
 epidemic in Purneah in 1816, already alluded to. 
 
 In more distant parts of India we only know of 
 the small outbreak near Jaulnah, in 1814. On the 
 whole, there is no other quarter of India from which 
 we can conjecture that cholera came to Bengal in 
 1817 ; there is no trace of its importation in that 
 year. 
 
 (6.) When we undertake the investigation of 
 
REMARKS ON THE OUTBREAK OF 1817. 167 
 
 questions concerning the propagation of disease, 
 except wlien it passes direct from man to man, we 
 enter on very perplexed paths. "WTien we engage 
 in inquiries as to the origin of a new disease, a wider 
 sea of difficulties opens "before us. A good deal is 
 known, although more is assumed, of the causes that 
 have led to local outbreaks of disease, and that favour 
 the spread of a malady that is once in existence ; but 
 of the causes which produce world-wide pestilences 
 we virtually know nothing. Neveii;heless, we may 
 pass in review some of the causes that have been 
 assigned for pestilences in general, and for the out- 
 break of 1817 in particular.* 
 
 * There is so mueli tliat is assumed and so muoli that is 
 vague in fetiologv, that I may be excused for endeavouring to 
 state a few elementary considerations. Many, I believe, have 
 positive opinions on points considered doubtful by others. 
 
 A distinction must be drawn between the origination and the 
 propagation of an epidemic disease. 
 
 As to its commencement, we may conjecture it to be some 
 morbid process originating within the system, or excited in it 
 by bodies organic or inorganic, solid or gaseous, however gene- 
 rated, coming from without. 
 
 The morbid process, when once set up, has periods of activity 
 and of rest. (The cause of this has been conjectured to be 
 the periodical birth and death of animal or vegetable germs.) 
 Whether such process ever arises afresh, either from within or 
 from without, in a disease like cholera, or it is only revivified 
 — in short, whether there is spontaneous generation of cholera 
 — remains undetermined. 
 
 The morbid process once having been set in action, it is ascer- 
 tained that in some diseases, and it is probable that in others, 
 the system gives off particles capable of propagating it. These 
 particles may be transferred from man to man in various ways : — 
 
168 A]SljSrALS OF CHOLERA. 
 
 Quintilian,* in his chapter De Conjectura, says 
 that pestilences may arise from " ira deum, aut in- 
 temperie coeli, aut corruptis aquis, aut noxio terrse 
 halitu." There could not be a more concise expres- 
 sion than this, of the views of the ancients on the 
 subject, and one might almost suspect that there 
 
 1. By contagion, direct or indirect. — To many minds the 
 explanation of the propagation of cholera by contagion alone 
 is quite satisfactory. 
 
 2. £t/ air. — The theory of cholera being an air-born pesti- 
 lence has always been the popular one in India, and has, if I 
 may use the expression, been revitalised of late years by Dr. 
 Bryden with much ingenuity and ability. 
 
 3. J5y water. — The school that believes in the propagation 
 of cholera mainly by water polluted with its germs, is essen- 
 tially English. ^ 
 
 4. By soil. — Under this head come all the old popular 
 notions of emanations from the soil, malaria, drain, and 
 privy emanations, gases, such as sulphuretted hydrogen or 
 carbonic acid. Pettenkofer must be considered the great modern 
 investigator of these terrene miasms. I would venture to say, 
 that in his views, as he now expresses them, it appears 
 to me that the presence of the dejections of cholera 
 occupies a less prominent place than formerly. His great 
 factors are, soil and subsoil in various conditions of heat, 
 porosity, and moisture (including grund wasser, to which he 
 seems now to attach a wider meaning^, and the extrication of 
 gases. In his most recent researches he has obtained some very 
 remarkable results as to the great and sudden increase of the 
 amount of caibonic acid given off by the soil in the months of 
 August and September. It remains to be seen whether this 
 phenomenon will prove a constant one, and to discover a satis- 
 factory explanation of it, if it be so. 
 
 5. Seasons and weather. — These undoubtedly influence the 
 
 * Lib, vii. 
 
REMARKS ON THE OUTBREAK OF 1817. 169 
 
 was a little quiet irony, in its being introduced in 
 tlie chapter on Conjecture. 
 
 Purtlier agencies, such as earthquakes, sidereal in- 
 fluences, electrical currents, newly-developed animal- 
 culsB, or fungi, are things of which we practically know 
 nothing as generators of disease, and very little that 
 is positive of any of them as propagators of it ; but 
 men groping in the dark have attributed pestilences 
 to their influence, and cholera among others. Such 
 theories allow so wide a scope to the imagination, 
 that they will always be popular with many ; for, as 
 man is constituted, he is better pleased to have any 
 explanation of a phenomenon than none. They are 
 in their nature extremely attractive, but until some 
 mode is discovered of submitting them to the rigid 
 test of observation, they must not be allowed to 
 usurp the place of facts. 
 
 Still more imaginary or fanciful causes, such as 
 cerebral degeneracy of the Hindoos under the rule 
 of foreign masters, influenced solely by a mercantile 
 spirit, or combinations of moral and cosmical causes, 
 have been sometimes advanced by the French, 
 
 propagation of cholera. In one sense they may be considered 
 as the aggregate results produced by the last three agents — 
 air, water, and soil — as influenced by light, heat, and elec- 
 tricity. 
 
 It appears to me that all writers on aetiology insist too much 
 on some one of the foregoing modes of propagation. 
 
 There is a further side of the question, and one with which 
 hygiene has much to do — how far individuals or localities are 
 predisposed to receive the disease, when it is brought to them, 
 through whatever channel. 
 
170 ANNAL6 OF CHOLERA. 
 
 and by others, who have doubtless supposed that 
 they have been explaining something by the use of 
 this vain and mystic phraseology ; but I pass on to 
 causes of which somewhat more is known — sequence 
 in time seeming to point to cause and effect, even 
 though it may not explain the mode of operation, 
 - (a) Pestilences have been attributed, at times, to 
 the crowding together of large congregations of 
 human beings, and local outbreaks of disease have 
 been traced to such causes. But no cause of such a 
 nature existed in Bengal in 1817. We know of no 
 great pilgrimages or assemblages there in that year. 
 Besides, the pilgrims to Juggernath only skirt the 
 Delta of the Granges ; and the pilgrimage to Saugor 
 Island, at the mouth of the Hooghly, is compara- 
 tively a small one. Cholera did not become epidemic 
 till some months after the season of pilgrimage ; and 
 there is no evidence to show, that in the early part of 
 the year there was cholera at either of these places. 
 In fact, those places which lay to their south, were 
 not attacked till after Jessore and Calcutta. Lord 
 Hastings's large army was also in an entirely dif- 
 ferent part of India, from that which was the scene 
 of the first outbreak. 
 
 (b) We know that bad food predisposes to many 
 diseases, and that some kinds of it are the exciting 
 causes in India, as in Europe, of attacks, often fatal 
 ones, that closely resemble cholera. We have seen 
 how often, in all ages, cholera has been attributed to 
 irregularity of diet. At the time of the outbreak, 
 much was attributed to the consumption of bad rice 
 
REMARKS ON THE OUTBREAK OF 1817. 171 
 
 and of decayed fish. Nev/ rice is always unwhole- 
 some, and bad fish has often acted like a violent 
 poison ; but there is not the slightest evidence that 
 there was anything unusual as regards the quality 
 of the supply of food in Bengal in 1817. 
 
 (c) Famine is another cause that has been assigned 
 for pestilences, but though there have often been 
 famines in India, and there was scarcity of grain in 
 some parts of India in the preceding year, there was 
 no scarcity of food in Bengal, or in any other part 
 of India, in 1817. 
 
 (d) Experience shows us that various conditions 
 of poverty, with its close attendant, filth, along with 
 bad drainage, and bad water, and rank vegetation, 
 are inimical to health, and favour local outbreaks 
 of disease. Such sources of disease were pointed out 
 by Sonnerat as accounting for the cholera on the 
 Coromandel coast, and such conditions of unhealthi- 
 ness existed in Bengal abundantly at all times. It 
 can scarcely be said that there was anything peculiar 
 in this respect, in the state of Bengal at the time we 
 allude to. 
 
 Even if it were certain, as some believe, that large 
 tracts of land, in Lower Bengal and in the Sunder- 
 bunds, which were formerly under cultivation, are 
 now waste, owing to the silting up of rivers, and 
 other changes, such causes had been in progress for 
 long periods before the year 1817, and there is no 
 evidence that they were intensified about that time. 
 
 {e) It has been a favourite notion of the French, 
 to throw the onus of the production of cholera on 
 
172 ANNALS OF (IIOLERA. 
 
 English dommation, and on the neglect by Govern- 
 ment of the great public works of the Mussulman 
 Emperors.* I need not inquire where those great 
 works were situated — certainly not in Lower Bengal 
 — or at what period they fell into decay. It seems 
 sufficient to observe, that cholera was first known to 
 us in districts where no such works ever existed, 
 that is, along the shores of India. 
 
 (/) Seasons may be regarded as the aggregate 
 result of the temperature, moisture, and movement 
 of the ail", and of its action on soil and vegetation ; 
 and their operation on disease, both in the produc- 
 tion and in the propagation of it, is one of the best 
 established facts of ajtiology, although the theory of 
 this is very imperfectly known. 
 
 A great deal of influence in the production of the 
 cholera of 1817 has been attributed to the irregu- 
 larity of the season in Lower Bengal. There seems 
 to be no question that the season was an unusual 
 one,t that in 1817 there was an extensive inundation 
 
 * See Dr. E. Groodeve's Reply in Proceedings of Constan- 
 tinople Conference. 
 
 t On this, as on many other points, the Bengal Medical 
 Board had, in the first instance, very imperfect information. 
 It wrote to Bombay in the latter half of 1818(n) : — " The pre- 
 ceding cold and hot months were in no way diflerent from those 
 of former years, and the rainy season was progressing with its 
 wonted regularity, when cholera appeared." Yet the same 
 Board, on 23rd September, 1817, had thought the disease 
 " chiefly referable to the long-continued and incessant rains of 
 this present season. "(6) 
 
 (a) Vide Bombay Reports. 
 
 (6) Baird Smith's ludian Auiials, 1870. 
 
REMARKS ON THE OUTBREAK OF 1817, 173 
 
 in Lower Bengal. In the preceding year tlie scan- 
 tiness of the rains, and the short supply of grain, 
 were believed to have generated in the Upper Pro- 
 vinces a bad epidemic of a bilious remittent fever. 
 
 In 1817 there were singular deviations in Lower 
 Bengal from the ordinary course of the seasons. In 
 the lower and western portion of the Gangetic 
 Yalley there was a long protraction of heavy rain 
 (120 inches, or nearly double the usual amount of 
 rain, are reported to have fallen during the year), 
 while in the eastern part of Bengal things wore a 
 different appearance. In that quarter, there was a 
 deficiency of rain, and the rise of the river was 
 four feet short of its usual height. There was, 
 therefore, undoubtedly the influence of unusual 
 weather at work. We have abeady said, that it is 
 known to induce attacks of illness in individuals, 
 and also to influence the course of epidemic dis- 
 eases. What further power over disease it has, no 
 one can pretend to lay down positively. Incapable 
 though it may be of producing a new disease, yet it 
 may possibly be able to intensify an old one, and 
 cholera was an old malady in Bengal, though lat- 
 terly quiescent. 
 
 It seems at least certain, that the influence of 
 weather was sufiiciently powerful to alter the period 
 of the old endemic disease, for the first ejiidemic 
 of its aggravated form in Calcutta took place in 
 September ; although even in the very next year the 
 old epidemic season of the dry weather resumed its 
 sway. The old season for the disease returned ; but, 
 
174 Al^NALS OF CHOLERA. 
 
 unfortunately, not the comparative mildness which 
 had characterised the affection of late years. 
 
 As to the origin of the disease in 1817, it seems, 
 therefore, pretty certain that it was the old endemic 
 complaint which became intensified in that year, and 
 the most reasonable conjecture is, that the disease 
 was intensified by the unusual weather. 
 
 " Intempestivis pluviisque et solibus icta." 
 
 Whatever may be the value of this conclusion, which 
 has no pretension to novelty, a careful examination of 
 all the circumstances connected with the origin of 
 the disease makes it certain, that no great change of 
 any kind, no new palpable cause or clasg of causes, 
 came into operation about the year 1817, as has 
 been inferred to have been the case by the Constan- 
 tinople Cholera Conference. Such new causes of 
 any tangible nature never have been, and never are 
 likely to be, detected, as far as I am enabled to form 
 an opinion. 
 
 If I cannot pretend to have thrown much new 
 light on the causation of the outbreak of 1817, still 
 it is to be remembered that the origin of all great 
 pestilences is buried in obscurity ; and that, if it has 
 been ascertained that the cholera of 1817 was only 
 the old cholera intensified, more has been learnt of 
 its origin, than of that of most of the great epidemics 
 or world-wide pestilences. 
 
 It would be beyond the scope of these historical 
 notices to inquire, why the last outbreak of cholera 
 has remained so long in force — why, unlike former 
 
REMARKS ON THE OUTBREAK OF 1817. 175 
 
 ones, it has not yet readied a period of quiescence — 
 and further, why this last outbreak has been so ex- 
 tensively diffused. 
 
 I shall content myself with merely remarking on 
 the latter question, that it has been often attempted 
 to explain the spread of the disease, by saying that 
 the year 1817 is a period from which increased com- 
 munication throughout India commences. There is, 
 however, no ground for this assumption, as far as I 
 have been able to ascertain. I cannot attach the 
 importance that some do to the attack of the large 
 army under Lord Hastings by the epidemic. In- 
 creased facilities of communication sprang up very 
 gradually in India, and their commencement can be 
 referred to no particular date, and certainly not to 
 so early a period as the year 1817. 
 
176 a>;nals of cholera. 
 
 CHAPTEE YIII. 
 
 GENERAL REVIEW OF CHOLERA IN THE EAST. 
 
 1. The word mordeshi and its modifications have 
 "been used, like the word cholera, somewhat loosely, 
 and applied to various forms of the disease in the 
 East. This has been already apparent, but will 
 come out more clearly by a summary of its use by 
 authors. ^ 
 
 D'Orta talked mainly of only one morxi — the 
 Arab Haida — but also mentioned a dry form. Bou- 
 tins mentions only one cholera, or morxi ; he almost 
 always associates it with dysentery, but on one 
 occasion with spasms. De Thevenot, again, de- 
 scribed generally four varieties of morxi, ono of 
 which he thought was the true cholera morbus. 
 Dellon, although he alludes to its fatality and to its 
 connection with fever, says morxi is an indigestion. 
 Fryer seems to speak of cholera morbus and of 
 mordeshin separately. Mandelsloe talked of the mor- 
 dexins in the plural. Martin ^called morxi a sort of 
 ileus miserere. Sonnerat seems to describe three 
 diseases — first, epidemic cholera, which he calls a 
 flux aigu ; next, serous fluxes with vomitings, to 
 which the natives of India are subject ; and lastly, 
 an indigestion which is called mort de chien. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 177 
 
 Lind treats of dysentery and cholera morbus in 
 tlie same chapter, and knows that mordesJun is the 
 Indian name for the latter. Sir R. Chambers tells 
 us that he used to have several attacks of mordeshi 
 during the year. 
 
 Curtis mentions that cholera may be bilious or 
 spasmodic ; and Grirdlestone seems mainly to have 
 regarded the spasms. Curtis and Clark were aware 
 that they were called morxi, or rather mort de chien. 
 Fra Bartolomeo calls mordeshm an intestinal colic, 
 though describing the true features of cholera. 
 Konig thought cholera an apoplectic dysentery. 
 
 This analysis might easily be carried further, but 
 enough has been said to show that the diagnosis and 
 nomenclature of cholera were scarcely a shade more 
 accurate in the East than in Europe. Nor is this sur- 
 prising. Many of the authors just quoted were un- 
 professional men, from whom technical exactness 
 could not have been expected. Still, the existence of 
 a violent form of cholera caUed morxi comes out 
 everywhere very distinctly. Doubtless the disease 
 itself varied in its character then as it does now, and 
 authors naturally described drfferently a disease of 
 varying intensity. 
 
 I suppose there are few who will not admit that 
 cholera varies, but I shall, nevertheless, give my own 
 general experience of cholera attacks in India. 
 
 You meet with an ordinary bilious attack, often 
 colicky, but of unusual severity. 
 
 You have an attack closely simulating cholera in 
 all its symptoms (and which an experienced physician 
 
178 ANNALS OF CHOLERA, 
 
 may in the first instance take for and treat as cholera), 
 sometimes ending fatally, wliich may be traced to 
 the use of a positively poisonous article of diet. A 
 familiar example of this is offered by copper poison- 
 ing, sometimes erroneously called copper colic — erro- 
 neously, for I have never seen constipation in it. 
 
 Then you have occasional sporadic cases of 
 cholera, or you have the disease bursting out with 
 epidemic violence, and spreading on every side. 
 
 If this or any similar classification at all approaches 
 the truth, it is not surprising that various forms of 
 disease were described by the term mordeshin. 
 
 But a further source of confusion is, that cholera, 
 even in its epidemic form, although retaining its cha- 
 racteristic features, varies in its symptoms, not only in 
 difi'erent seasons, but during different periods of the 
 same outbreak. The variety is shown in the presence 
 or absence of premonitory diarrhoea, the amount of 
 vomiting and purging, the violence of the spasms, 
 the lividity of the countenance, the period of the 
 supervention of collapse, the frequency of the occur- 
 rence of secondary fever. It was the predomiuance 
 of particular symptoms that led to many of its names 
 — as bilious, spasmodic, asphyxia, syncope, black 
 cholera, dry cholera. Three varieties in different 
 epidemics were well observed by Sonnerat, and we 
 have seen that the violence of the spasms led occa- 
 sionally to the disease being confounded with tetanus. 
 True tetanus has undoubtedly occurred in cholera, 
 in Europe as well as in Asia, though it is not 
 frequent. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 179 
 
 The general result at wMcli we arrive, from a 
 consideration of the use of the word mordeshi, is, 
 that there was always cholera of varying intensity 
 in India, from the date of European connection with 
 it, and that mordeshin was a general name for the 
 disease, although often loosely applied. It would be 
 a vain attempt to endeavour to determine, in every 
 instance where the word mordshi has been used, 
 whether true cholera was meant to be indicated by 
 it, as the writers who used the two phrases had often 
 no very definite ideas on the subject ; but it is abso- 
 lutely certain that a disease identical with modem 
 malignant cholera, both in its sporadic and its epi- 
 demic form, was usually meant by mordeshin. 
 
 2. It is unnecessary, I think, to enter into ques- 
 tions as to what constitutes the endemicity of a 
 disease. I shall use the word in the sense of a 
 disease prevailing in a district for a series of years. 
 
 With respect, then, to the endemicity of cholera in 
 various parts of India, especially from Surat to Cape 
 Comorin, and along portions of the Coromandel 
 coast, our early travellers had no doubts on the 
 subject. Even Bontius regarded cholera as a disease 
 of Java — he expressly calls dysentery, cholera, and 
 spasms endemic ; and Then Ehyne described it as 
 prevailing on all the coasts of India. It is un- 
 necessary to recapitulate all that authors have said 
 on the subject of its prevalence in the north and 
 west of India ; but some of the more valuable infor- 
 mation is, what Sonnerat gives about the coast near 
 Pondichery, in 1770 ; Bartolomeo, in 1782, about 
 
 N 2 
 
180 AN>fALS or CHOLERA. 
 
 the coasts of Malabar and Coromandel ; and their 
 accounts are in a general way confirmed by Clark, 
 in 1792. 
 
 But was cholera an endemic in India at the time 
 of the outbreak ? * We have already seen that Drs. 
 Barnes and Tytler, and Dr. Young, also Dr. Macrae, 
 of Chittagong, say they were acquainted with the 
 disease, though usually in a milder form. Dr. "W. 
 AinsHef informs us, that he had long known sporadic 
 cholera to be common on the Malabar coast. 
 
 For fiu'ther evidence we must travel a little beyond 
 the year 1817, although I am anxious not to exceed 
 that limit. The Madras newspapers, in 1818, said 
 that the disease was occasionally known as an endemic 
 in that Presidency ; but we have nothing more im- 
 portant or interesting in the whole history of the 
 disease, than what Mr. Hay wrote from Quillon, Nov. 
 19th, 1818 :— 
 
 " The spasmodic cholera, which caused great 
 mortality in Trevandi'um, in last May, I am happy 
 to say, abates, the last seven days having only 
 afforded thii'ty-six cases and one death. But the 
 Pythians (native doctors) report the death of almost 
 all attacked. I hold this to be the endemic of the 
 
 * Orton, one of our most intelligent writers on cholera, said : 
 — " Sporadic cholera is rarely met with, except in certain tracts 
 of country, as the lower provinces of Bengal, Chittagong, the 
 east coast of Ceylon, the province of Travancore, and, according 
 to Sir J. Malcolm, certain woods and highly malarious tracts 
 of Malwah."— On Cholera, 2nd edit., 1832, p. 351. 
 
 t Observations on Cholera, 1825. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 181 
 
 Malabars, wMcli is perfectly familiar to us all. I 
 trust to be able to make a noble stand, when the 
 epidemic does arrive." No new disease, bowever, was 
 reported to have reached him that season, and Mr. 
 Scott, the author of the Madras Eeport, remarks that 
 there can be no doubt, that the endemic of Malabar was 
 the epidemic of other parts of India, It is strongly 
 in favour of its having been really the epidemic, that 
 it occurred exactly at the usual season for its preva- 
 lence, according to Era Bartolomeo. Whether this 
 conclusion be accepted or not, I think it is impossible 
 for anyone, after making all allowances for native 
 exaggeration, to doubt that at this time a severe 
 form of cholera prevailed near Quillon. If Mr. Hay 
 and the Pythians mistook the new cholera for the 
 old endemic one, with which they were so familiar, 
 it only shows, how very closely the diseases must 
 have been allied. It is extremely to be regretted 
 that Mr. Scott did not push the inquiry further at 
 the time. Of no subject is less known, than of the 
 meeting of an endemic and an epidemic of the same 
 disease. 
 
 But perhaps as striking a case as that of Mr. Hay, 
 is afforded us by Mr. Craw. He writes from Seroor,* 
 30th July, 1818 :—" You have seen that I think the 
 disease, as it has exhibited itself in the European 
 corps, is allied to tetanus. But I must tell you that 
 we have, too, cases of common cholera ; and should 
 we not have had them, though free from this wide- 
 
 * Reports on the Epidemic Cholera, Bombay, 1819. 
 
182 ANNALS OF CHOLERA. 
 
 spreading disease ? I had two or tkree hundred 
 cases last rains at Caranja." Mr. Craw further 
 ohserves that the disease is of a most miiltiform 
 character. Both common and tetanic cholera were 
 occurring at the same time. 
 
 Are we not fairly entitled to conclude that cholera 
 morbus was endemic in that district, in Mr. Craw's 
 opinion, and that the chief difference he perceived 
 between it and the epidemic disease, was the com- 
 parative violence of tetanic sj)asms, which symptom, 
 too, he observed mainly in Europeans ? In short, 
 we find that Mr. Hay took what was consi- 
 dered to be the new disease for the old one, with 
 which he was perfectly familiar ; and that Mr. Craw 
 considered a portion of the cases occurring during 
 the epidemic, which reached him in 1818, to be of 
 the same nature as cases of the disease he had treated 
 in the previous year. 
 
 We are strongly reminded, by this mixture of 
 different forms of cholera, of the cases with 
 tetanic spasms which Grirdlestone gave an account 
 of, without any mention of pui'ging, and of Dr. 
 Clark's very sensible remarks on the subject* : — "The 
 spasmodic affections which appear on the Coromandel 
 coast seem to have a close analogy to cholera. With 
 respect to their cure, according to the united consent 
 of all the gentlemen with whom I have conversed, 
 they are to be treated exactly like cholera." 
 
 On the whole, then, without endeavouring to push 
 
 * On Diseases in Hot Countries, &c. London, 1792. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 183 
 
 any conclusion too far, I think we liave sufficient 
 evidence, that about the time of the outbreak of 1817, 
 a certain form of cholera prevailed in various parts of 
 India, and in some extremely remote from Bengal — 
 a form so closely resembling ej^idemic cholera, that 
 it was difficult to distinguish the one from the other. 
 
 3. But cholera at times prevailed epidemically as 
 well as endemically. The Groa epidemic of 1543 
 seems to have been one of great intensity. It would 
 be interesting to learn whether cholera prevailed in 
 other parts of India at that time ; but on this, and on 
 other early epidemics, no complete information is to 
 be obtained. There is strong reason to believe that 
 there were several epidemics of cholera in the seven- 
 teenth century, especially in its latter half, in Marwar 
 and Mewar, and possibly at Groa, Surat, and Balsora, 
 If we come to later ones, we find that there were 
 many epidemics in the south, near Madras, from 1757 
 to 1780 ; but we have no traces at that time of cholera 
 on an extensive scale in any other part of India. 
 
 Dr. Clark expressly tells us that cholera was more 
 prevalent on the Malabar and Coromandel coasts 
 than elsewhere. 
 
 "We know the medical history of Lower Bengal 
 for that period tolerably well, and that during the 
 last haK of the eighteenth century there was little 
 cholera in Bengal, and therefore it is highly impro- 
 bable that the epidemics of cholera of that period on 
 the Madras or Malabar coast, had come from Bengal 
 or any other part of India. 
 
 In those days they knew that cholera travelled 
 
184 ANXALS OF CHOLERA. 
 
 considerable distances, but do not seem to bave en- 
 tertained tbe idea of its source being in an entirely 
 diflFerent part of India, from that in which it occurred. 
 And there is no evidence to show that it was — not 
 even enough to excite the suspicion of it. 
 
 Within the period of his stay in India, or from 
 1774 to 1781, Sonnerat records one epidemic fol- 
 lowed by another in two years. 
 
 In 1781, what was called the Granjam epidemic 
 reached Calcutta, where the disease seems to have 
 been quite unknown. 
 
 Again, in 1790, the Bengal column, marching 
 south, was astonished at the outbreak of the disease, 
 which they thought they picked up on the Ganjam 
 coast. This was tjbe last considerable epidemic 
 before 1817. 
 
 It appears to me perfectly marvellous that, for 
 more than two years after the outbreak of 1817, the 
 Medical Board of Calcutta remained in ignorance of 
 the invasion of Bengal in April, 1781. Yet in ten 
 days of that month it killed more of the inhabitants 
 of Calcutta, than were carried off by the epidemic of 
 1817 during the three first months of its prevalence. 
 Of officers who made reports to the Bengal Board, 
 Dr. Macrae appears to be the only one who had seen 
 anything like a real epidemic. 
 
 In like manner, as already observed, D'Orta, writ- 
 ing in Goa, makes no allusion to the great epidemic 
 of the disease, which had occurred in that city twenty 
 years before. Apparently, the memory of such things 
 is soon lost. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 185 
 
 4. Intimately connected witli endemicity and epi- 
 demicity is the tendency of cliolera to preyail in 
 particular districts at particular seasons. The disease, 
 though it is capable of appearing at any period of 
 the year, yet seems to have a preference for one* or 
 even more periods of it. 
 
 Thus we have seen that on the Malabar coast the 
 last months of the year were its favourite period ; in 
 Ganjam and Calcutta, again, the hot season ; while 
 from Surat to Bombay and Groa the season was 
 earlier than farther down the coast. 
 
 It would be unwise to pretend to push this subject 
 further, or to be more precise, as it is only now by 
 the results of a whole series of statistical returns 
 that we are making out the seasons of the present 
 prevalence of cholera; and undoubtedly, so far as 
 we can see, the old and the new seasons coincide. I 
 merely insist on the fact of seasonal prevalence ; its 
 theoretical or setiological explanation may vary ac- 
 cording to the theories held by different observers. 
 
 * TMs was indicated ia some tabular statements by Sir R. 
 Martin and Dr. D. Stewart, but was first pointed out on a 
 large scale by ]\Ir. H. M. Macpberson, Inspector-General 
 (retired), in Ms valuable statistics of Calcutta (a). The 
 question was gone further into in " Cholera in its Home," 
 and the remarkable influence of Indian season on small- 
 pox, as well as on cholera, was pointed out. These 
 subjects have been since illustrated on a vastly wider 
 scale by Dr. Bryden, in his exhaustive report, and by Dr. Cor- 
 nish, in his recent lucid examination of the diffusion of cholera 
 
 (a) Indian Annals, 1863. 
 
186 ANNALS OF CHOLERA. 
 
 5. If we consider our knowledge of the diffusion of 
 cholera in India chronologically and geographically, 
 we shall find that in early times it was mainly pro- 
 portionate to our knowledge of the country. 
 
 During the sixteenth century Europeans had little 
 intercourse with any part of India except its western 
 coast. In this period, accordingly, we find cholera 
 at Calicut, at Groa, and the country round, and we 
 have an account of a frightful epidemic of it at G-oa. 
 In the next century we hear of cholera over a wider 
 area. It was, in the first half of the seventeenth cen- 
 tury, in Sumatra and Java ; it is said that it was also 
 in Arabia, and we have further accounts of it at 
 Groa. In the last half of the century we have 
 accounts of its coiltinued prevalence in Java, also 
 in Ceylon, and on all the coasts of India ; indeed, 
 if we take Then Rhyne's statement in its widest 
 sense, in Bengal also, and throughout the whole 
 of Asia. We have special notices of the disease 
 at Groa, Damaun, Surat; and a very probable 
 account of epidemics in Marwar and Mewar, and 
 at Groa. 
 
 For the first half of the eighteenth century we 
 
 in the Madras Presidency. Professor Von Pettenkofer has 
 done much to spread in Europe the knowledge of the latest 
 ohseryations in India, and of the fact of the periodicity of 
 cholera in that country. But it must be remembered, with 
 reference to most of our Indian Reports, that they chiefly illus- 
 trate cholera as it occurs under peculiar conditions, that is, 
 among men massed together, as soldiers or prisoners, and that 
 as yet we have little information respecting the diffusion of the 
 disease throughout the general population. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 187 
 
 have few accounts of cholera ; yet we have traces 
 of it at Madura, at Calcutta, at Madras, at Groa, and 
 generally as an Indian disease. In the latter haK 
 of the eighteenth century it was constantly prevail- 
 ing, often with epidemic violence, especially from 
 the year 1768 to 1783, almost uninterruptedly, espe- 
 cially along the Madras coast. It was at Bombay 
 and on the Malabar coast, in the English fleet in 
 those seas, at Trincomalee, Tinnevelly, Pondichery, 
 Cheringam, Arcot, Yellore, on the Coromandel coast 
 generally, and at Granjam, whence it travelled to Cal- 
 cutta and Sylhet ; at Bombay, on the Malabar coast, 
 at Tranquebar, high up in the north-west at Hurdwar ; 
 again at Vellore and Arcot, again near Granjam and 
 at Travancore, besides being very probably epidemic 
 in Mewar and Bundlecund. It seems to have been 
 last heard of in this century at Burisal, near one of 
 the mouths of the Granges. It had by this time 
 visited almost every comer of India. 
 
 In the first years of the nineteenth century 
 we hear of a few cases of the disease in very opposite 
 parts of India ; none of them, except the outbreak 
 near Jaulnah, approaching to the nature of a violent 
 epidemic. Some of those places were Trincomalee, 
 Chunar, Jaulnah, Fort William, Purneah. Besides 
 this, there was a comparatively mild form of the 
 disease, but varying in intensity and the degree of 
 its prevalence, known in many parts of India as an 
 endemic. This was the state of things before the 
 great outbreak of 1817. 
 
 6. If we next consider the configuration of the 
 
188 ANNALS OF CHOLERA. 
 
 districts througli whicli cliolera was diffused,* we are 
 struck bj its prevalence along sea-coasts ; but tbis 
 may be in a great measure attributed to European 
 intercourse, and to our knowledge, consequently, 
 baving been limited in tbe first instance to the coasts, 
 and to moutbs of rivers. "We bave it along tbe two 
 sbores of India — tbe western, remarkable for its 
 luxuriant vegetation, and for its periodical beavy 
 rains ; and tbe eastern, wbicb may be almost cbarao- 
 terised as being its opposite in tbese respects. In 
 modern times cbolera bas been observed to follow 
 tbe course of rivers. In bow far are tbere any traces 
 of its doing so in olden times ? We bave none on 
 any of tbe large rivers, sucb as tbe Granges, tbe 
 Grodavery, or tbe Nerbudda ; but we bave cbolera 
 prevailing at Arcot, Vellore, and Amburpet, up tbe 
 Paliar river from Madras. We find cbolera frequent 
 at tbe emboucbures of rivers, as at Sui^at, Groa, and 
 Cocbin. 
 
 It seems to bave flourisbed in tbe dense verdure of 
 Groa, and in tbe back waters furtber do^vn tbe coast. 
 On tbe otber side it visited tbe deltas of tbe Cauvery 
 and tbe Granges, and perbaps tbat of tbe Mabanuddy, 
 for troops appear to bave twice suffered from tbe 
 disease, just after passing tbrougb it. But it also 
 visited tbe plains of tbe Carnatic, tbe bigb land of 
 Malwab, 2000 feet above tbe sea, tbe central district 
 
 * This subject is, I hope, sufllciently illustrated by tbe map 
 prefixed to the work, although its scale is small. The object 
 haa been more to indicate districts, than to insert every spot 
 where cholera had been noted. 
 
GENERAL EEVIEW OF CHOLERA IN THE EAST. 189 
 
 of Bundlecund, and occmTed as higli up tlie Gran- 
 getic valley as Hurdwar — districts in their climate 
 and physical characteristics as remote as possible 
 from the deltas of rivers. 
 
 It also reached islands : Ceylon (which may be 
 counted part of India), Java, Sumatra, and the Mau- 
 ritius. It seems to have visited Arabia, and possibly 
 Africa; but respecting this, and its prevalence in 
 China or Japan, at least in an epidemic form, we must 
 speak with reserve. It has existed on coasts and 
 islands, on deltas of rivers, on plains a thousand 
 miles distant from the nearest sea-coast ; in 
 districts of as different configuration, as the delta 
 of an Indian river, and the volcanic formations of 
 the Mauritius. Nevertheless, the disease has, on the 
 whole, shown a preference for low, damp districts with 
 abundant vegetation ; in early times, as was indeed 
 to be exjpected, there are no accounts of its invading 
 hills approaching in height to mountains. 
 
 Cholera has manifested itself on soils and rocks of 
 the most opposite nature — on alluvium, on laterite, 
 on sandstone, on trap, and on primary formations. 
 
 7. Our knowledge of the chronological and geo- 
 graphical distribution of cholera is summarised in 
 the following table of notices of mordeshi, or mort de 
 chien, of cholera, or of cholera morbus, in the East, 
 chronologically arranged. Epidemics are marked 
 with an asterisk: — 
 
 Adthok. Year, Locality. 
 
 Correa 1503 . Near Calicut. 
 
 Do 1543 . Goa. 
 
 D'Orta 1563 . Goa. 
 
190 
 
 ANNALS OF CHOLERA. 
 
 AUTHOE. YeAE. 
 
 A'Costa 1577 . 
 
 Le Blanc 1580 . 
 
 Linschott ..... 1589 . 
 
 Beaulieu 1621 . 
 
 Bontius 1629 . 
 
 Do 1631 . 
 
 Zacutus 1632 . 
 
 Mandelsloe 1639 . 
 
 Bald^iis 1641 . 
 
 *ColonelTod .... 1661 . 
 
 De Thevenot .... 1666 . 
 
 Fryer 1674 . 
 
 Dellon 1676 . 
 
 ThenRhyne .... 1679 . 
 
 Cleyer 1680 . 
 
 *ColonelTod . . ." . 1681-2 . 
 
 * Do 1683-4 
 
 Kaempfer 1684 . 
 
 Homberg ..... 1689 . 
 
 OvingtoQ 1690 . 
 
 Carreri 1695 . 
 
 Pere Martin .... 1703 . 
 
 LuiUier 1703 . 
 
 Pere Papin 1709 . 
 
 Valentyn 1726 . 
 
 Arbuthnott 1733 . 
 
 Paxman 1736 . 
 
 Grose 1750-64 
 
 Jolinson 1756 . 
 
 Madras Report .... 1756 . 
 
 *Orme 1757 . 
 
 Paisley 1757 . 
 
 Mebuhr 1761-3 . 
 
 Wanmann ...... 1766 . 
 
 Gentil 1769 . 
 
 Locality. 
 Canara. 
 Goa. 
 Goa. 
 
 Sumatra. 
 Java. 
 Batavia. 
 India, Arabia, and 
 
 Mauritania. 
 Goa. 
 
 At sea in the East. 
 Mewar. 
 Between Surat and 
 
 Boorhampore. 
 Surat. 
 
 Goa and Western India. 
 Coasts of India.. 
 China. 
 Marwar. 
 Goa, Surat. 
 Japan. 
 Java. 
 Surat. 
 Damaun. 
 Madura. Coasts of India. 
 
 Bengal. 
 
 Goa. 
 
 Madras. 
 
 India. 
 
 Bombay and Malabar 
 
 Coast. 
 English Fleet in India. 
 Areot. 
 Tinnevelly. 
 First campaign. 
 Arabia. 
 
 India and China. 
 Pondicherv. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 191 
 
 Author. Year. 
 
 *Sonnerat 1768-9 . 
 
 Madras Report , . . 1769-71 
 
 Clark 1772 . 
 
 Paisley 1774 . 
 
 Burke 1775 . 
 
 Fontana 1776 . 
 
 Fra Bartolomeo ... 1778 . 
 
 Sonnerat .... 1778-79 
 
 Bengal Report .... 1779 . 
 
 Sir Elijah Impey . . . 1779 . 
 
 Lind 1780 . 
 
 FoUy 1780 . 
 
 *W. Hastings .... 1781 . 
 
 Hirscli 1781 . 
 
 Curtis and Girdlestone . 1782 . 
 
 Eonig 1782 . 
 
 *Bartolomeo 1782 . 
 
 Do 1782 . 
 
 Clark ....... 1782 . 
 
 *Madras Report . . . 1783 . 
 
 Do 1783 . 
 
 Hay 1783 . 
 
 *Bengal Report .... 1783 . 
 
 Madras Report . . 1787-8-9 
 
 Do 1789 . 
 
 Dutch Accounts . . . 1789 . 
 
 Bengal Report .... 1790 . 
 
 *Hay 1792 . 
 
 *Jukes, Tod 1794 . 
 
 Jukes 1794 . 
 
 Taylor 1797 . 
 
 Jameson, T. . . . . . 1802 . 
 
 Johnson, J 1804 . 
 
 Macnamara . . . 1808-9-11-12-13 
 
 Locality, 
 
 Do., and whole coast. 
 
 Amburpet and Arcot. 
 
 Bombay. 
 
 Madras . 
 
 Mauritius. 
 
 Malabar Coast. 
 
 Malabar Coast. 
 
 Coromandel Coast. 
 
 Bundlecund. 
 
 Calcutta. 
 
 Common in India. 
 
 Tranquebar. 
 
 Ganjam and Calcutta. 
 
 Andeme'sArmy inSouth 
 
 Madras, Fleet, Trin- 
 comalee. 
 
 Tranquebar. 
 
 Malabar Coast. 
 
 Cochin. 
 
 Bombay. 
 
 Whole Madras Coast. 
 
 Army of Observation. 
 
 Travancore Country. 
 
 Hurdwar. 
 
 Yellore and Arcot. 
 
 Bellary. 
 
 Batavia. 
 
 Near Chilka Lake. 
 
 Travancore. 
 
 Mewar and Mahratta 
 Country. 
 
 Thanah. 
 
 Backergunge, or Buri- 
 sal. 
 
 India. 
 
 TriQComalee. 
 
 Various places in Ben- 
 gal, Chunar. 
 
192 
 
 ANNALS OF CHOLERA, 
 
 Author. 
 
 Yeah. 
 
 Locality. 
 
 Madras Report 
 
 . . 1814 . 
 
 Jaiilnah. 
 
 Bengal Eeport 
 
 1815-16 
 
 Calcutta. 
 
 Calcutta Newspaper 
 
 . . 1816 . 
 
 Pui-neali. 
 
 Bengal Report . . 
 
 . March, 1817 
 
 Fort William. 
 
 Do. . . 
 
 . May and June Kislinaghur, Mym 
 
 eincr 
 
 Po. . . 
 
 . . July . 
 
 Patna. 
 
 Do. . . 
 
 . . July . 
 
 Sonergong in Dacca 
 
 Craw 
 
 . 1817 . 
 
 Caranja, in rains. 
 
 Bengal Report 
 
 . August 13 
 
 Calcutta. 
 
 Do. . . 
 
 August 19 
 
 Jessore. 
 
 8. As to what may be called tlie habits of the 
 disease, when it became epidemic, it attacked the 
 natives over large areas ; it showed little respect for 
 persons, although the poor and feeble were supposed 
 to suffer most. It sometimes attacked them in their 
 religious pilgrimages, of which we have a striking 
 instance at Hurdwar. Europeans were as Kable to 
 its attacks as natives. 
 
 The disease attacked camps. It was picked up, 
 so to say, by troops passing through districts where 
 the malady prevailed. The disease would either 
 reach its maximum in a few days, and then leave the 
 column, or it might adhere to it for weeks in the 
 shape of sporadic cases. Of two bodies of soldiers, 
 apparently under exactly the same conditions, it 
 would attack the one, and spare the other. It is 
 difficult to say whether European troops suffered 
 more than natives ; the men certainly suffered much 
 more than the officers. The robust and the weak 
 seem to have suffered nearly alike. The great 
 majority of attacks were just before daybreak. 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 193 
 
 There are indications of travellers having suffered 
 particularly, and positive proof of European soldiers 
 suffering at the time of their disembarkation, from 
 the ships that had brought them to India. 
 
 The disease often attacked ships, and, indeed, was 
 particularly common among sailors, although often 
 confounded with colicky affections.* Dr. H. H. 
 Groodevef observed long ago that cholera, though 
 not perhaps existing to so great an extent through- 
 out India generally, was, in 1782, as destructive on 
 board our ships, as it has been at any later period. 
 
 There is the strongest presumption, that cholera 
 was conveyed from place to place by ships as much 
 in those, as in later periods. 
 
 With reference to the history of the disease after 
 1817, a knowledge of the travelling habits of the 
 malady before that time is a desideratum. But it 
 is not safe to aflSrm much positively. It seems to 
 have been believed, that the disease readily travelled 
 up or down either coast of India, when it was 
 epidemic. In 1781 it travelled from Granjam to 
 
 * Mr. Jameson, p. 92, makes tlie very important statement, 
 that the epidemic has again and again visited the sailors of 
 European ships just entering the river, and previously to their 
 having any communication with the shore. Surely it might 
 he easily ascertained whether this is really ever the case in 
 the river Hooghly. I have had eases reported to me of sailors 
 dying without having touched the shores of India, hut not 
 before their ships had communicated with the land. 
 
 t Transact. Med. and Phy. Society, Calcutta, vol. viii., 
 part 2nd, 1842, in an excellent sketch, I believe the only 
 one extant, of the history of European practice in India. 
 
 o 
 
194 AMKALS OF CHOLERA. 
 
 Sylhet, wliicli was north-east, and in 1794 nearly 
 south, from Mewar to Thanah ; in the one case, 
 going from the coast to the interior — in the other, 
 from the interior to the coast. 
 
 With respect to the supposed rate of travelling of 
 the disease we know very little, but it is worth 
 observing, that it attacked Colonel Pearse's force 
 near Granjam, on the 22nd of March. On the 27th 
 of April, "Warren Hastings remarks that it had 
 visited Calcutta about the 13th of March, and after 
 a fortnight's prevalence was passing off to the 
 north. 
 
 9. We have not many data to throw light on the 
 period of incubation of the disease ; but two cases 
 show as well as airy instances have done so since, 
 how short the period of incubation commonly is. 
 Dr. Clark tells of soldiers getting cholera on land- 
 ing at Bombay the day after their coming into 
 harbour ; and in like manner Grirdlestone tells us of 
 troops being attacked at Madras within three days 
 of their arrival. The period of incubation was 
 therefore just as short in those days, as it is usually 
 now. 
 
 10. Eespecting the causation of the disease, we 
 find no ideas that were not familiar to the 
 ancients. The prime factor was always heat, 
 next vicissitudes of temperature, sometimes rain 
 and damp heat, and generally locality and climate, 
 as the disease was believed to be an endemic 
 in particular places, and common on board ship, and 
 most prevalent at particular seasons. Filthy and 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 195 
 
 ill-aired places were acknowledged to present a field 
 very favourable for cholera. On the part of the 
 patient, (as has been abeadj observed in the sum- 
 mary of an earlier period in Chapter V.) much 
 was generally attributed to some imprudence on his 
 part ; for instance, to exposing himself when over- 
 heated to cold air, especially to sleeping with the abdo- 
 men uncovered. A great deal was also ascribed to 
 the use of unwholesome articles of diet, especially of 
 some kinds of fish, and fruit, and rice, and of bad 
 drinking water. Fatigue and excess of any nature, 
 imperfect clothing and poor diet, and general low 
 condition, were also assigned as causes, but in the 
 middle of epidemics were less observed, as then there 
 was little distinction of persons. 
 
 Although contagion was commonly admitted in the 
 case of dysentery, and mainly through the medium 
 of the evacuations, it seems only to have been just 
 thought of in cholera, and the first expression of a 
 suspicion that the evacuations might propagate the 
 disease, occurs in Jameson's mention in the supple- 
 ment to his Beport of the state of the privies at 
 Meerut. The non-mention of contagion, however, 
 does not in itself prove anything, for in former times 
 smallpox and scarlatina have often been treated of, 
 without any allusion to their contagiousness being 
 made. 
 
 11. There is nothing very new to be gathered con- 
 cerning the pathology of the disease duiing this 
 period. The disease was supposed by some to be 
 excited by putrescent food or corrupted bile acting on 
 
 o 2 
 
196 ANNALS OF CHOLERA. 
 
 the stomacli and intestines. Sonnerat suggested sup- 
 pressed perspiration getting into tlie blood and poison- 
 ing it. Then the violence of the spasms led to the 
 disease being considered a form of tetanus. Others 
 regarded the disease as a sort of dysentery or colic, 
 or ileus. Its connection with fever was less insisted 
 on in India than in Europe. On the whole, perhaps, 
 it may be said that a distinction between bilious and 
 spasmodic cholera was pretty generally accepted, and 
 that, although blood-poisoning and a sudden impres- 
 sion on the nervous system found advocates, yet the 
 general feeling was, that the disease was caused by 
 irritating matter applied to the stomach and the 
 intestines. Towards the end of this period the 
 suggestion was thrown out that the disease was an 
 asphyxia. I need not pursue this subject further, as 
 it is not my object to enter on any discussion on 
 the theory of the disease. 
 
 Little advance was made in the study of morbid 
 changes observable after death. The facts of the 
 distension of the gall-bladder with bile, and of the 
 contraction of the bladder, were noticed, while the 
 stomach and intestines, and the viscera generally, 
 were usually, according to the superficial examina- 
 tions of those days, declared to be healthy, or at most 
 to contain flatulence, have their mucous sui'faces in 
 a state of irritation, or some of the mucous glands 
 enlarged. 
 
 12. As to treatment, there was not much novelty. 
 The old cjuestion whether to commence the treat- 
 ment with the removal of morbid secretions by 
 
GENERAL REVIEW OF CHOLERA IN THE EAST. 197 
 
 means of emetics, purgatives, diluents (or, in modern 
 phrase, eliniinants, if you will), or not, continued to 
 engage atttention, as in tlie days of Hippocrates. 
 Many used them in the first instance in the treatment 
 of the beginning of an epidemic ; hut then, after a 
 time, they were struck with the prostration of the 
 nervous system and the sudden depression of the 
 powers. They felt that a patient might die, while 
 they were occupied with their preliminary measures, 
 and as a rule, whether rightly or wrongly, they 
 usually became advocates for the early use of stimu- 
 lants and opiates. It was mainly with those remedies 
 that the outbreak of 1817 was in the first instance 
 combated. 
 
 The chief thing to be remarked as to local treat- 
 ment, is the universal adoption by the Portuguese of 
 the native treatment by the actual cautery, which 
 we found referred to in Sanscrit medicine. This 
 usage appears to have died out, at least in European 
 practice, after the middle of the eighteenth century. 
 The analogous one by the moxa was made use of 
 by Mr. Moorcroft,* in 1817. The native treatment 
 by ligature does not seem to have found much 
 favour with Europeans — indeed, is scarcely men- 
 tioned. 
 
 13. There are a few indications of the hygiene of 
 the day. People were cautioned against indigestible 
 articles of food, and against bad water (it was 
 believed that some families had remained weU 
 
 * Asiat. Journal, 1818. 
 
198 A^^NALS OF CHOLERA. 
 
 owing to having their drinking water boiled), 
 against exposure to the air, and to change of tem- 
 perature. Warm clothing, and especially protection 
 to the abdomen on board ship, were recommended. 
 There were no precautions used against a contagion 
 which was not believed to exist. 
 
 Not a word seems to have been said on the use of 
 disinfectants, although before that period they had 
 been applied to the excreta of dysentery. 
 
 Changing ground was recommended for camps, 
 and occasionally also a halt, when troops on the 
 march were attacked. 
 
 On the outbreak of the disease in Jessore, the 
 Medical Board sent orders to have jungle cleared 
 away, stagnant pools filled up, and everything done 
 to procure free ventilation. These very measures 
 are the ones recently adopted in Bengal, against the 
 epidemic fever. Their Report recommended widen- 
 ing the streets, improving the drainage, and making 
 various other changes, such as closing the European 
 and Mohammedan burial-grounds, with a view to 
 improving the sanitary condition of Calcutta.* 
 When writing of the new epidemic, Lir. Moorcroft,t 
 of Chuprah, suggested, in 1817, at all events 
 in principle, the system of drainage in Cal- 
 cutta, one section of which has just been success- 
 fully accomplished. He wrote that perhaps two 
 steam-engines on the river, with a system of open 
 
 * In 1753, before the era of the Black Hole, a committee 
 was assembled to report on the drainage of the place. 
 t Op. cit. 
 
GENEEAL REVIEW OF CHOLERA IN THE EAST. 199 
 
 and gun drains beginning at the engines, lead- 
 'ing througli streets, and disemboguing into the Salt 
 Water Lake, might suffice to drain the city, and 
 that the expense, however large, would be abundantly 
 repaid by the increased salubrity of the place. 
 
 I must not leave the subject of treatment and of 
 hygiene, without remarking on the mistake which 
 has so commonly been made in all ages. Because 
 an epideraio in the natural course of things becomes 
 milder towards its termination, and at last ceases, 
 the lessened mortality, and final disappearance of 
 the disease, are ascribed to our improved practice^ or 
 to our better arrangements. 
 
200 ANNALS OF CHOLERA. 
 
 CHAPTER IX. 
 
 GENERAL SUMMARY. 
 
 I SHALL conclude these annals with an enumeration 
 of some of the results, which have been obtained 
 by this survey of the history of cholera. 
 
 (1.) Cholera of various degrees of intensity has 
 existed in all parts of the world, in varying extent, 
 as long as there have been any records of the healing 
 art. 
 
 The general laws and habits of cholera have 
 remained wonderfully constant. 
 
 The great characteristics of cholera have from the 
 earliest ages been sudden attacks of excessive vomit- 
 ing and purging, with rapid failure of the powers 
 of the system. 
 
 From an equally early period physicians have 
 always had the problem before them, how far it 
 is better to encourage or endeavour to restrain the 
 evacuations, and how early it is necessary to sup- 
 port the strength of the patient. 
 
 The Grreek and Roman authors describe a disease 
 of quite as great intensity as the early Indian or 
 Chinese ones do. 
 
 Although it was always remarked that cholera 
 was influenced by season, there is no positive evidence 
 
GENERAL SUMMARY. 201 
 
 of there having been epidemics of the disease either 
 in Europe or in Asia before the sixteenth century, 
 unless some of the epidemics of colic and of ileus 
 be accepted as outbreaks of cholera. 
 
 In Europe we have had a good many epidemics of 
 cholera, the earliest of which, that has been described 
 by name, occurred at Nismes, in 1564. 
 
 Cholera was first observed by Europeans in India, 
 in 1503, and the first epidemic of it that has been 
 described, took place in Goa in 1543. 
 
 The disease in India was at once recognised to be 
 more violent than the cholera of Europe. 
 
 Cholera was first observed in India, on the coasts of 
 Malabar and Canara, in the sixteenth century, and 
 continued to prevail there almost uninterruptedly up 
 to 1817. 
 
 In the seventeenth century cholera was known at 
 Sumatra, in Java, in Japan and China, in Arabia 
 and Mauritania, at Gloa and Surat, and on the shores 
 of India generally, and it is tolerably certain that 
 there were several epidemics in the interior of India. 
 
 In the seventeenth century cholera was a common 
 sporadic disease in Europe, and there were bad 
 epidemics of it in the first half of the century, 
 known as trousse galant in France and Belgium, 
 and also bad outbreaks of it in the latter half of the 
 century, particularly in London. 
 
 None of the European epidemics of cholera, so 
 far at least as we have reliable accounts of them, 
 nearly equalled the Indian ones in malignity or in 
 extent. 
 
202 ANNALS OF CHOLERA. 
 
 In the first lialf of the eighteenth century there 
 was comparatively little cholera in India, and no 
 epidemic of importance in Europe. 
 
 In the last half of the eighteenth century cholera 
 continued to prevail on the Malabar, and was espe- 
 cially common on the Coromandel coast. It was 
 constantly at Yellore and Arcot, visited Bellary, 
 Granjam, and Calcutta as an epidemic. There was 
 also probably more than one outbreak in Upper 
 India. The disease appeared in Java and China, 
 and visited the Mauritius. 
 
 There was no cholera in the last half of the 
 eighteenth century in Europe, in America, or in the 
 West Indies, at all. comparable in virulence with 
 what occurred during the same period in India. 
 
 Cholera died away in the end of the eighteenth 
 centmy, and remained quiescent in the first few years 
 of the nineteenth. It occurred sporadically in 
 Europe, was endemic in India, but scarcely mani- 
 fested itself as an epidemic. 
 
 Cholera in India was an endemic disease, every 
 now and then breaking out as an epidemic. 
 Our information about epidemics is very incom- 
 plete ; still there is enough to show, that some- 
 times an epidemic passed over after one visita- 
 tion, sometimes it repeated itself during the same 
 year, sometimes one succeeded another at an interval 
 of two or three years. Occasionally an epidemic 
 was more fatal in its second, than in its first year, 
 {i.e., in what has been termed the second year of 
 invasion). 
 
GENERAL SUMMARY. 203 
 
 Haying obtained these more general results, we 
 may next consider the periods of increase and of 
 decrease of cholera in more limited areas. 
 
 (2.) In India, it is certain that there was little 
 cholera in the Delta of the Cauvery in the beginning 
 of the eighteenth century; that after the middle of 
 the century there were very extended epidemics; 
 and that towards the end of the century the disease 
 had died out very much. 
 
 Again, it is certain that there was little cholera in 
 Lower Bengal during the last half of the eighteenth, 
 and very little in the commencement of the nine- 
 teenth, although it broke out with such virulence in 
 the year 1817. 
 
 Or out of India, whether it was introduced into 
 Java or not, it was for a long period in the seven- 
 teenth century regarded as an endemic of that island, 
 but ceased to be so in the eighteenth century. 
 
 Again, as an epidemic, the disease visited the 
 Mamitius in 1775, and died out. It visited Bengal 
 in 1781, but was extinguished. It visited or broke 
 out in Bengal again in 1817, and has never ceased 
 to exist there. 
 
 "We thus learn that a district nearly free from 
 cholera may become its favourite seat, and then, 
 after a longer or shorter period, cease to be so. 
 
 We learn that out of India, as in Java, the 
 disease, after appearing to be endemic, may cease to 
 be so. 
 
 Thus, generally, it is clear that an epidemic may 
 pass o£F, or may take root in a district. 
 
204 ANNALS OF CHOLERA. 
 
 Of the causes of such phenomena we practically 
 know very little ; we cannot pronounce why a coun- 
 try should at one time seem to nourish the disease, 
 at another time not. It is not a case of di^ainage, 
 as with malarious fevers. These changes have taken 
 place without any alteration in the condition of the 
 people or of the country — at least, alterations that 
 anyone has been able to indicate. 
 
 The same applies very much to the London 
 epidemics, and to European ones generally. We 
 can only say, that as the general health of districts 
 has improved, sporadic cholera has been less fre- 
 quent. European epidemics bore a more distinct 
 relation to the prevalence of dysenteric affections, 
 and of aguish fevers, than has been recorded of 
 Indian ones. 
 
 I come next to some propositions more imme- 
 diately connected with the outbreak of 1817. 
 
 (3.) As far as can be ascertained, while cholera 
 was so prevalent on the Malabar, and still more on 
 the Coromandel coast, in the latter half of the 
 eighteenth century, it was little known in any other 
 parts of India. 
 
 Although there are a few occasional notices of 
 cholera in Bengal, and the existence of the cholera 
 temple shows that the disease must have been at 
 times very well known. Lower Bengal is the portion 
 of India, in which we hear least of cholera in early 
 times, and it could not have been a common disease 
 in its worst form in the last half of the eighteenth 
 century, or its appearance in Calcutta in 1781 could 
 
GEKEE.AL SUMMARY. 205 
 
 not liaye occasioned sucli panic and astonishment. 
 The same remark applies to the outbreak of 1817. 
 
 With reference to the place of origin of the 
 epidemic of 1817, there is not the slightest reason 
 for connecting it with Jessore in particular, and still 
 less with the Sunderbunds. 
 
 No disease appeared in India in 1817, tha.t had 
 not often appeared there before — no symptom mani- 
 fested itself, that had not often been witnessed before 
 — ^no new habits of the disease were developed. 
 
 The natives of India invented no new name, and 
 worshipped no new goddess, for the disease of 1817. 
 A j^retty sure sign, that they did not think the 
 malady a new one. 
 
 Two nev/ attributes, however, have been some- 
 times ascribed to the disease of 1817, contagiousness, 
 and power of spreading. As regards the first, there 
 is no reason to believe, that the disease in that year 
 was either more or less contagious, than in similar 
 outbreaks in former years. As regards the second, 
 the disease had often spread widely before, and it 
 can at most be said, that this power of spreading was 
 intensified. 
 
APPENDIX. 
 
 ON THE ANALOGIES OF CHOLERA NOS= 
 TEAS AND CHOLERA INDICA.* 
 
 The suryey of tlie history of cholera in its various 
 forms wMch lias been taken in tlie preceding pages, 
 suggests an inquiry into the points of accordance 
 and points of difference, which exist between what is 
 called cholera nostras, and cholera Indica. I do not 
 mean between the sKght attacks of summer cholera, 
 with which term many attacks of bilious derange- 
 ment are dignified, but between the graver forms 
 of cholera, which were known in Europe for 2000 
 years, and that which was recognised in Europe in 
 1831 as the Indian disease. I do not take either 
 disease at any one particular date, but as they have 
 both shown themselves during the course of the 
 three last centuries. 
 
 An ordinary case of cholera nostras, by common 
 consent, differs widely enough from one of cholera 
 Indica. Many will say they cannot be possibly 
 mistaken for each other. 
 
 * Read before the Medical Society of London in 1870 ; its 
 substance appeared in 3Iedical Times, December, 1870. 
 
208 APPENDIX. 
 
 But wlien. an attempt is made to sliow in detail in 
 what tlie difference consists, many difficulties spring 
 up in our way, as will appear from the following 
 comparative view of some of the phenomena of the 
 two diseases. 
 
 1. It is unnecessary to enter on an enumeration of 
 the symptoms of either disease. For our purpose, it 
 is sufficient to look at the late nomenclature of the 
 College of Physicians. Cholera has wisely received 
 a wide definition. It is set down among general 
 diseases. Two forms are mentioned, simple and 
 malignant, which may be considered equivalent to 
 cholera nostras and Indica. The first is not de- 
 scribed, but the la,ttpr is termed an epidemic disease, 
 characterised by vomiting and purging, with evacu- 
 ations like rice-water, accompanied by cramps, and 
 resulting in suppression of urine and collapse. I 
 have no occasion to find fault with this enumeration 
 of symptoms. But there is no one symptom laid 
 down here, or that ever has been attributed to 
 cholera Indica, that has not occurred in cholera nos- 
 tras. Suppression of urine and rice-water evacuations 
 have been ordinarily considered to be the distinctive 
 characteristics of cholera Indica ; but the first of 
 these was mentioned by Hippocrates, and has been 
 noticed over and over again, by those who described 
 with care cholera nostras of any intensity. An 
 enormous serous discharge has always been charac- 
 teristic of cholera nostras. Celsus described this 
 as often being white, or like water. Without going 
 over the long list of authors already quoted, I may 
 
APPENDIX. 209 
 
 mention that Morgagni, in 1738, and Tralles, in 
 1753, described it in their own persons, and, like 
 many of their predecessors, said that it was clear 
 and in ineffable quantity ; and Short, in 1749, in 
 describing fluxes, besides talking of a milky and 
 chylous one, mentions " a clear watery serous, or 
 lymphatic looseness, which is either clear as water, 
 yellowish, or ash -coloured." The cramps are often 
 just as marked in cholera nostras as in Indica ; and 
 the same is true of collapse. How many pictures of 
 it have been quoted above ! Another symptom is 
 secondary fever. Celsus hinted at it, and 0. 
 Aurelianus calls it consecutive. Rivierus and others 
 of his time mention it, and there are full accounts of 
 it in the middle of the eighteenth century. 
 
 Among the sequelae, affections of the nervous 
 system seem to have been just as common after 
 nostras as after Indica.* 
 
 Temporary albuminuria has been observed in 
 both. Even the not very common sequela of a 
 rash is to be found in cholera infantum, a very 
 severe form of cholera nostras. The out-of-the-way 
 symptom of vomiting worms has been described 
 occasionally in both diseases. It might have been 
 imagined that certain changes in the temperature of 
 the body were characteristic of cholera Indica. They 
 have not been sought for much in nostras ; yet 
 they have been detected in it by Dr. Sutton, of the 
 
 * Dr. Aquilla Smith has communicated to me a case of 
 paralysis occurring after cholera nostras, which was cured by 
 electricity. 
 
210 APPENDIX. 
 
 London Hospital. It is more than doubtful wliether 
 there are any chemical or other tests by which the 
 evacuations of the one disease can be positively dis- 
 tinguished from those of the other. In both diseases 
 the intelligence is not obscured until unconsciousness 
 supervenes, although it has sometimes been de- 
 scribed in both as being disturbed. 
 
 2. The appearances after death have not been in- 
 vestigated in a disease of less fatality like cholera nos- 
 tras, as carefully and as frequently as in Indica. Yet 
 no distinctive difference has hitherto been pointed out. 
 Staff-surgeon Hunter, who had experience of cholera 
 in the East, gives the results of a post-mortem at 
 Chatham in a case of cholera nostras, which, he 
 observes, would do for the banks of the Ganges. 
 That excellent observer, Grriesinger,* made some care- 
 ful examinations, but could discover no difference. 
 Scoutetten, who had seen cholera in every part of 
 Europe and in Africa, had occasion to examine the 
 bodies of some patients who died at Metz, in 1869, 
 of cholera nostras. He could find no difference 
 except in the absence under the microscope of the 
 so-called cholera sporules, a matter now becoming one 
 of very little importance. Since then Uuinquaud,t 
 in Paris, has examined the bodies of two cases of 
 cholera nostras with the same result. Masses of 
 detached epithelium have been found in the intestines 
 in nostras as well as in Indica. Grriesinger observed 
 
 * Infections Krankheiten. 
 
 t Archives Generales de Medicine. March, 1869. 
 
APPENDIX. 211 
 
 that one of the bodies in his fatal cases of cholera 
 nostras was verj distinctly warmer than natural 
 twenty-four hours after death. Muscular move- 
 ments do not appear to have been witnessed after 
 death by cholera nostras, but the opportunity for 
 observing it is not often offered in a disease of bo 
 small mortality. 
 
 3. The same general views have been entertained 
 during a long series of years as to the nature of the 
 two complaints : — 
 
 {a) That they were the manifestations of the 
 action of a poison, whether depraved 
 humours of the body, or articles intro- 
 duced from outside ; in short, in one 
 shape or other, manifestations of blood 
 poisoning. 
 
 (h) That they were affections of the nervous 
 system, of a more or less spasmodic 
 character. 
 
 (c) That they were forms of fever, or diarrhoea, 
 
 or dysentery, or colic. 
 
 (d) That they were attacks of acute or subacute 
 
 inflammation of the bowels and intes- 
 tines. 
 
 Theoretic explanations of the mode of operation 
 of the poison apply equally well to either form. 
 
 4. If we turn to treatment, we find that for 2000 
 years physicians have been considering which indi- 
 cation it is best to follow — to encourage the dis- 
 charges, or to restrain them. The earliest indication 
 
 p 2 
 
212 APPENDIX. 
 
 usually followed in nostras was to remove, besides 
 crudities of food, altered phlegm or bile, or an 
 unknown poison, just as with, many of the present 
 day it is the object in treating cholera Indica, to 
 eliminate or evacuate a specific poison. Others have 
 thought it best in both diseases to endeavoiu' to check 
 the evacuations, and to support the strength of the 
 patient. We find that the treatment of cholera nos- 
 tras was a mixture of the diluent, the evacuant, the 
 astringent, the cordial, or stimulant, just as that of 
 cholera Indica. Opium has frequently been con- 
 sidered the sheet anchor in both, although some have 
 thought that its less efficacy in Indica, affords a 
 ground of distinction between it and nostras. 
 
 The spasms of the extremities have been treated 
 alike — ligatures, and even the actual cautery have 
 been used in both ; friction, with aromatic sub- 
 stances and oils, and the application of heat and 
 of baths, have been practised in both forms. 
 
 5. It is admitted that the prognosis in the two 
 diseases is very different. Nevertheless, for a long 
 time after the outbreak of cholera Indica in 1817, 
 practitioners were as confident that they could cure 
 the disease, if they were only called in in time, as 
 they had been in the case of cholera nostras. When 
 cholera nostras was fatal, it was so nearly as rapidly 
 as cholera Indica. 
 
 6. As to their aetiology, both diseases have been 
 attributed to the air, to a certain epidemic influence 
 acting on the system ; they have been attributed to 
 irregularity of the seasons, to heat, especially moist 
 
APPENDIX. 213 
 
 heat,* to exhalations from the soil, and to marsh 
 poison. The influence of falls of rain in producing 
 both diseases has been observed. Both have been 
 attributed to emanations from sewers and privies — 
 the case of the school at Clapham, in 1829,t is a 
 good example of this in cholera nostras. They have 
 both .been ascribed to bad drinking water. 
 
 On the part of the patients, they have in both 
 diseases been considered to have been predisposed 
 by some irregularity of diet, by indigestible vege- 
 tables, fruit, or fish, by alcoholic excess, by the 
 exhaustion of great fatigue, or of sexual indul- 
 gence, by depression and poverty, by sudden frights, 
 by^ exposure to rapid changes of temperature, and 
 especially to night chills, with the abdomen imper- 
 fectly protected. 
 
 7. Both diseases have, on the whole, been sup- 
 posed to attack adults most ; but neither age, nor 
 sex, nor race, has afforded any real immunity. 
 Travellers, and those who are moving from place to 
 place, have suffered most from both affections. 
 Sailors come under this category. Whether there 
 has been warning in the way of malaise, or of 
 diarrhoea or not, the absolute invasion of the disease 
 is always sudden, and has constantly suggested the 
 idea of poisoning. In both diseases the attack is 
 often ascribed to the violent action of purgative 
 
 * Moist heat has, from the days of Hippocrates downwards, 
 been considered by the vast majority of writers as the great 
 propagator of epidemic diseases. 
 
 t Medical Gazette, 1S29. 
 
214 APPENDIX. 
 
 medicines. The commonest hour for an attack of 
 either disease is in the early morning. 
 
 8. Both diseases occur sporadically, endemically, 
 and epidemically. Both diseases are migratory. There 
 have been some very considerable epidemics of cholera 
 nostras. A disease must have been tolerably widely 
 spread to have many familiar names for it in 
 Europe, and popular rhymes would not have been 
 made about a disease that was not common. 
 
 9. Both diseases appear to attach themselves to 
 certain places and parts of places, and both, on the 
 whole, prefer low flat ones. We read of repeated 
 outbreaks in one place or district, as in Ghent and 
 Nimeguen, London, Breslaw, the South of France, 
 South of Grermany^, and Italy. In like manner 
 cholera attached itself to Groa and Surat, to the 
 Malabar and Coromandel coasts, to Bengal, to 
 Calcutta and Bombay, and at various times to 
 Java. 
 
 10. Both diseases are influenced much by season. 
 This, I think, cannot be doubted, whatever the effect 
 of particular meteorological changes may be. Both 
 are, undoubtedly, diseases of heat and of hot coun- 
 tries, and essentially of the hot seasons of hot coun- 
 tries. That cold is inimical to the spread of both 
 is certain ; it is remarkable how constant the seasons 
 have remained in some cases. July, August, Sep- 
 tember, and October were the great months for the 
 epidemics of cholera nostras in former times. Cholera 
 Indica has visited London epidemically four times, 
 and the chief — nay, almost the whole — mortality 
 
APPENDIX. 215 
 
 lias been in those months. Neither disease is abso- 
 lutely tied down by season, although they both have 
 a distinct preference for particular seasons at parti- 
 cular places. 
 
 11. Both forms of cholera have always been 
 thouaht, when epidemic, to exercise an influence on 
 other diseases, as on diarrhoea, dysentery, or fever. 
 Indeed, this influence on intermittent fever has been 
 more observed in cholera nostras than in Indica. 
 There is no question that in both forms diarrhoea is 
 often succeeded by cholera, and that in both dysen- 
 tery has been described as running into cholera, and 
 cholera as ending in dysentery. 
 
 12. The close analogy of the cold fit in some in- 
 termittents, and the much closer of the algide form 
 of pernicious fever, and also the resemblance of 
 some forms of congestive typhus, have been pointed 
 out mth reference to both forms of cholera, so much 
 so that many have regarded cholera as a form of 
 fever. 
 
 13. The close analogy between the efi'ects of some 
 poisons,* for instance, elaterium or arsenic, and of 
 
 * I am not sure whether some respects, in which the action 
 of cholera resembles that of an irritant poison, have often been 
 pointed out. 
 
 When the d)se of the poison is large, it destroys by general 
 irritation, and not a trace of morbid change of structure is to 
 be found after death. It follows from this law, that the larger 
 the dose, or the greater the intensity of the poison, the more 
 rapid its action, and the less the probability of finding any 
 specific alteration after death. 
 
 This is exactly the case with cholera. AYhere death is 
 
216 APPENDIX. 
 
 an attack of cholera, has often been indicated in 
 the case of either disease, and an accordance has 
 been shown between the post-mortem appearances 
 caused by either form of cholera and hy arsenic, 
 down even to the shedding of epithelium, and the 
 presence of the sporules, supposed to be character- 
 istic of cholera. This has been shown in several 
 cases of arsenical poisoning by Yirchow and by 
 Hoffman, quite recently. 
 
 14. With reference to the period of incubation of 
 the diseases, extremely little is known about cholera 
 nostras ; indeed, it is only during the epidemics of 
 the disease, that it could well have been observed ; 
 but the seizures in it, as in cholera Indica, were 
 always marked by .suddenness, and the period of 
 incubation could not have been usually more than 
 from eight to twenty-four or forty-eight hours, as 
 is usually the case in cholera Indica. "We know 
 nothing of protracted incubation in cholera nostras ; 
 
 rapid, no structural changes are observed ; it is when the case 
 has been protracted, that they are to be found. 
 
 Again, Majendie brought to light the curious fact, that if, 
 after having poisoned the animal, and even after the poison 
 has begun to act, we inject an aqueous fluid into its veins in 
 such quantity as to cause an artificial plethora, as long as 
 this artificial plethora can be maintained, the action of the 
 poison is superseded. No sooner, however, does the plethora 
 cease, than the poison acts again in its usual time, and even, 
 perhaps, with more than its accustomed severity. 
 
 How often has this been illustrated in the case of injections 
 into the veins in cholera — the wonderful reaction, so commonly 
 followed by speedy collapse ! 
 
APPENDIX. 217 
 
 and the long periods for cholera Indica, sometimes 
 as much as three weeks, in cases occiirring on board 
 ship, have been assiuned, in order to account for out- 
 breaks, which are capable of other explanations. On 
 this head one cannot speak very positively, as our 
 information is indefinite. 
 
 15. To these points of agreement in detail, one 
 more general consideration may be added — this great 
 practical difficulty, that even in India at the present 
 day it is by no means always easy to say what is 
 malignant cholera and what is not, except during 
 the prevalence of epidemics. How often has one, 
 on hearing that a friend had suffered from an attack 
 of cholera, and recovered by the use of some new 
 cure, exclaimed, that it could not have been a case 
 of true cholera — how often in Indian Returns have 
 cholera biliosa and maligna been confounded ! In 
 some returns of European soldiers in Madras, cholera 
 biliosa has been set down as almost as fatal as cholera 
 mahgna. Owing to this difficulty, Mr. Jameson's* 
 remark is C[uite a just one, that in the early part of 
 the pestilence of 1817, many persons who died from 
 cholera, were classed under the head of bowel com- 
 plaints, or anomalous cases. Finally, in studying 
 the history of cholera in all ages, and reading 
 accounts of its different forms in India, it is difficult 
 for even the most dispassionate to pronounce posi- 
 tively, which cases were cholera nostras and which 
 cholera maligna. 
 
 * B engal Keport. 
 
218 APPENDIX. 
 
 16. With reference to the intimate nature of the 
 disease, and of the theoretical division " zymotics," 
 one or two other points of resemblance are worth re- 
 cording. Most practitioners have thought it possible 
 to prevent the full development of either disease, 
 whether by diluents, evacuants, or opiates. An im- 
 prudence of diet, or of treatment, during recovery, 
 has been found in both to produce a relapse, that is 
 an actual reproduction of the attack. In both, one 
 attack gives no permanent immunity from a second 
 one. 
 
 But, notwithstanding the close parallel it has 
 been possible to draw, notwithstanding their many 
 points of agreement, most practical physicians are of 
 opinion that the two diseases are distinct. 
 
 We may, therefore, next consider some of the 
 points of difference between the two affections. 
 
 With so many points of accordance between 
 cholera nostras and cholera Indica, what are the 
 points in which they differ most ? 
 
 1. Cholera Indica is, on the whole, more inde- 
 
 pendent of season ; it is not so much of a 
 summer disease as cholera nostras. 
 
 2. It travels much farther ; the greatest epi- 
 
 demics of cholera nostras that we know 
 of, ran over a single country, perhaps, but 
 did not travel all over the globe. 
 
 3. Then cholera Indica is by the immense 
 
 majority of physicians believed to be con- 
 tagious, whereas the reverse is the case 
 with nostras. 
 
APPENDIX. 
 
 219 
 
 4. Cholera nostras, it is said, arises spontane- 
 
 ously ; cholera Indica does not. But 
 until the difficult subject of spontaneous 
 generation is better understood, the dis- 
 tinction does not help one much. 
 
 5. The poisonous nature of the cholera ex- 
 
 creta is almost universally believed in ; 
 whereas it has scarcely been ever sus- 
 pected of those of the other disease — 
 though the possibility of their being so 
 still remains, and it was fully admitted 
 in the case of the cognate diseases, dysen- 
 tery and diarrhoea. 
 
 6. Then there is the undoubted greater inten- 
 
 sity of symptoms, and far greater mor- 
 tality, of cholera Indica. 
 
 Most of these points are differences of degree, but, 
 granting their existence to the fullest possible extent, 
 are they sufficient grounds for separating the two 
 diseases ? I shall not enter into a general examina- 
 tion of those differences, and shall confine my 
 remarks only to the questions of comparative malig- 
 nity, of contagiousness, and of specific poison. 
 
 (a) Is mere degree of malignity a sufficient 
 ground for considering two diseases different ? 
 
 Take influenza. When it is prevalent, you have 
 every degree of lung affection, from a mere catarrh 
 to a pnuemonia that proves fatal. 
 
 Take scarlatina. You may have the slightest 
 rash possible, no sore throat at all, an attack for 
 
220 APPENDIX. 
 
 whieli it is difficult to confine the patient to the 
 house ; or you may have a malignant disease, with 
 sore throat, that proves fatal in a day or two. 
 
 Take small-pox. You may have slight fever, 
 followed by a few pustules, or you may have the 
 ordinary course of average small -pox, or you may 
 have the horrors of the confluent, or of the hsemorr- 
 hagio form of the disease. 
 
 If we take the instance of j^lague, how various 
 are its forms ! In the first place, there is a general 
 division, understood in the East, into mild and 
 malignant ; in the second place, the disease usually 
 kills in three or five days, while there are instances 
 of sufferers succumbing in a few hours. 
 
 In each of these diseases, in spite of their varying 
 degrees of intensity, the unity of their different 
 forms is not disputed. 
 
 Or take dysentery, the history of which has many 
 points of analogy with that of cholera. You have 
 it in Europe epidemic or sporadic — in one case con- 
 tagious, in the other not ; but scarcely ever does the 
 worst epidemic form of it come up in malignity to 
 some bad Indian forms of the disease. Yet no one 
 has supposed the Indian form to be a different 
 disease from the European, or the epidemic from the 
 sporadic. 
 
 Or take all the varieties of European cholera itself. 
 A slight attack of cholera nostras differs as much from 
 an acute one of it, as an acute one of it does from 
 an average one of cholera Indica. The disease has 
 been subdivided endlessly, according to its degrees ; 
 
APPENDIX. ^21 
 
 but tlie various forms of it in Europe have not been 
 counted diiferent affections. Wliy, tben, should the 
 Indian and European forms, which are often distin- 
 guishable with difficulty, be separated ? 
 
 Mere difference in intensity appears to offer insuf- 
 ficient grounds for their separation ; especially as the 
 difference between slight and severe attacks of cholera 
 is supposed by some to depend, not on the different 
 quality of their poisons, but on the quantity of the 
 morbid matter offered to the system, and on the fit- 
 ness of the system to be influenced by it. 
 
 (b) Then cholera Indica is in these days almost 
 universally believed to be in some degree contagious, 
 whereas the opposite belief is entertained with respect 
 to cholera nostras. Yet if it be true that epidemic 
 diarrhoea is at times contagious, it is very unlikely 
 that this should not be sometimes true of epidemic 
 cholera nostras also. 
 
 But the whole subject of contagious and epidemic 
 disease is a very complicated one. It seems highly 
 probable, that all epidemic diseases are under certain 
 circumstances more or less contagious, and it is well 
 known, that contagious ones have periods when they 
 spread widely — in other words, become epidemic — 
 and periods dm-ing which they remain dormant. 
 
 We have this well illustrated in Calcutta in a very 
 contagious disease, and in one but slightly so — in 
 small-pox, with its specific poison, and in cholera ; both 
 are rarely entirely absent ; both evidence their pre- 
 sence at particular seasons of the year, and also become 
 epidemic at intervals, often, by the waj^, raging 
 
222 APPENDIX. 
 
 together at tlie same time. Something of this kind 
 must have occurred during the epidemics of small-pox 
 and of cholera nostras in London, in Sydenham's 
 day. The germs of cholera nostras must have re- 
 mained there in some shape during the rest of the 
 year, to be revivified and become epidemic every 
 autumn, just as the germs of small-pox were for 
 a time latent. 
 
 Or take the analogy of dysentery. Few at the 
 present day admit it to be contagious. It certainly 
 is not usually so. Yet there is little doubt that now, 
 as in past ages, when the disease becomes epidemic, 
 it is contagious. 
 
 On the whole, I think, we are scarcely warranted 
 in saying absolutely, that an epidemic of cholera 
 nostras may not be contagious, or in thinking that the 
 difference in contagiousness affords sufficient ground 
 for making nostras a different disease from Indica. 
 
 (c) But in addition to these differences as to ma- 
 lignity, contagiousness, and power of spreading, the 
 prevailing belief at the present day is, that there is 
 a specific poison present in cholera Indica. In that 
 case, almost identical symptoms are produced in the 
 absence and in the presence of a specific poison ; and 
 if the specific poison — at least wliat contains it — has 
 been discovered in the case of cholera Indica, it is only 
 after a very long search, and who will say that there 
 may not be a specific poison in cholera nostras, 
 when it is epidemic ? 
 
 Supposing it to be established that there is a speci- 
 fic poison present in cholera Indica, in that case it 
 
APPENDIX. 223 
 
 should produce some specific effects, as small-pox or 
 typhoid poison do. Yet there are no structural 
 lesions that are characteristic of the operation of 
 the cholera Indica poison, as contradistinguished 
 from the lesions of cholera nostras.* 
 
 "We cannot, of course, expect to discover the 
 cholera germ in a tangible form, any more than any 
 other morbid poison ; but it is extremely desirable, 
 that we should have full and unquestionable evidence, 
 respecting what are commonly believed to be the 
 bearers, and by many the only bearers, of contagion, 
 the dejections with their specific poison. 
 
 Some more satisfactory proof of the existence of a 
 specific poison, is desired, than the apparent commu- 
 nicability of the disease by polluted drinking water, 
 (the evidence of which is always open to exception, 
 as at most only affording a presumption,) or than 
 experiments on the lower animals, giving very 
 doubtful results. 
 
 In short, I shall conclude this comparison, by 
 remarking that broader lines of demarcation between 
 the two diseases continue to be very much wanted. 
 
 * We know nothing of the fresh generation of any animal 
 poison that we are well acquainted with, such as small-pox ; 
 we only know of its reproduction and multiplication. If, 
 therefore, cholera is being constantly engendered afresh in 
 India, its poison must surely be very different in nature. 
 
APPENDIX. 225 
 
 NOTE. 
 
 ON ENDEMIC AND EPIDEMIC COLIC. 
 
 As it has been said by so high an authority as 
 Hirsch* that no endemic colic has been described in 
 the East, it may be worth while to say something 
 on the subject. 
 
 One of the colics mentioned by Then Ehynef can 
 easily be identified with the endemic ^je?^ sool (stomach 
 pain) of Bengal, so named owing to the lancinating 
 pain in the stomach being supposed to resemble the 
 effect of the trisula (three-spiked trident) of Shiva. 
 This affection is to this day treated by violent 
 pressure, and by binding a weight over the stomach. 
 Yarious forms of stomach disease are very possibly, 
 as Dr. T. W. Wilson has shown,J confounded under 
 the name of pet sool. But probably it is a form of 
 endemic colic. It leads to much wasting and atrophy, 
 but never to paralysis, and is never epidemic. 
 
 Carreri's account of a flatulent colic in Bombay 
 (very likely, as Dr. Morehead tells me, the null still 
 common there), which has been already quoted, § 
 
 * Medizinische Geographie. t Supra p. 104. 
 
 X Indian Annals, vol ii., p. 97. § Supra p. 113. 
 
 Q 
 
226 APPENDIX. 
 
 may represent one of the forms of disease that 
 Then Ehyne alludes to ; but though it con- 
 tinues to exist, it is not epidemic either. Martin,* 
 in 1702, says that a certain Yenetian was very suc- 
 cessful in curing colics in India by the use of a 
 heated circular plate of metal ; and Paxman, in 
 1737, says that colic and colicky pains are common 
 in India. We know less than we should do about 
 the less prominent diseases of natives ; but at the 
 present day colic is known in Bengal, Bombay, in 
 Marwar, and elsewhere. 
 
 I have not found any recent notice of endemic 
 colic in Ceylon. There was a virulent colic at 
 Newer Elia, in 1856, but it was traced to lead 
 poisoning. As to-' colic in other parts of the East 
 besides India, Then Rhyne himself tells us else- 
 where,t that the colic passion was treated in Japan 
 by acupuncture. It was therefore known in that 
 country. 
 
 About much the same time as Then Ehyne, we 
 have an account of two sorts of colics in Japan by 
 Kaempfer.ij: The one he merely mentions as an 
 endemic pain or colic, and gives no description of. 
 The other he describes at length. It is not like 
 ordinary colic, but a special spasm of the muscles 
 of the abdomen, with much pain in the groin. The 
 tympanitis is so excessive as sometimes to threaten 
 suffocation ; but apparently few or none died of the 
 
 Supra p. 117. f ^P> cit., p. 186. 
 
 X Supra p. 108. 
 
APPENDIX. 227 
 
 complaint, which was always relieved by acupunc- 
 ture. Those who recovered, whether men or women, 
 often had affections of the genital organs of a chronic 
 nature afterwards. But here I think it is plain (and 
 he half suspects it himself) Kaempfer has made some 
 confusion of colic with endemic forms of sarcocele, 
 or with syj)hilis. 
 
 Kaempfer especially says of this disease, that it 
 was got from drinking a fermented liquor made 
 from rice, when it was drank cold. If you sipped 
 it warm, it did no harm. Possibly there may have 
 been lead or other poisoning from the process of 
 distillation. But there is no mention of paralysis. 
 While we thus hear a good deal about endemic colics 
 in the East, none of them correspond with Then 
 lihyne's account of theu- leaving behind them 
 paralysis, or of their being epidemic, which I 
 suppose he meant, when he said the disease raged 
 fatally all over the East. 
 
 Then Ehyne probably spoke rather vaguely, for 
 at the very time when he was writing of the pre- 
 valence of colic in the East, Tachard* declared that 
 all sorts of colics were little known in Siam. In 
 fact, there is very little to show, that any true colic 
 has ever been extensively diffused epidemically in 
 any part of the world. 
 
 The wider question, after all, remains behind : Is 
 there such an independent disease as colic Pf Like 
 
 * Histoire Geaerale des Yoyages, &e., vol. xii., p. 200. 
 t Sauvages described no fewer than twenty-two species of 
 colic, so that the disease was more varied even than cholera. 
 
 Q 2 
 
228 APPENDIX. 
 
 ileus, which is no longer described as a distinct dis- 
 ease, is it not rather a symptom of diseased action ? 
 Did it not, much better than cholera, deserve the name 
 of an indigestion, the term by which the older Indian 
 writers were so fond of describing mordeshin ? Is it 
 ])ossible for a colic, not to mention ileus, which has 
 sometimes been thought contagious and epidemic, to 
 spread further than the causes that have produced it 
 — in other words, to become contagious or epidemic ? 
 It is not probable that it can, and the epidemic de- 
 scribed by Paulus ^gineta was probably not a true 
 colic. But granting the existence of an endemic 
 vegetable colic* in tropical countries (which most 
 modern authors are inclined to deny, except as 
 the result of lead "poisoning), it is a disease, the 
 march of which is comparatively slow ; it is never 
 rapidly mortal, as we infer that the disease was, 
 to which Then Rhyne alluded. 
 
 Then Rhyne's account of this colic may be com- 
 pared with that given by Paulus ^gineta of the 
 contagious epidemic of his day, which began in 
 Italy, but overspread many Roman provinces. It 
 was a colic, which produced epilepsy and paralysis. 
 The epilepsy (convulsions ?) was usually a fatal 
 symptom — paralysis, on the contrary, a favourable 
 one. There was loss of power, but not of sensation, 
 in the extremities, and patients usually after a time 
 regained their power. Unfortunately, the treatment 
 
 * On this subject see Boudin's Geographie Medicale, vol. ii., 
 p. 377 ; and Morehead's Diseases of India, 2ad edit., p. 455. 
 
appe^;dix. 229 
 
 recorded does not throw any light on the maladj. 
 Avicenna, while saying that colics were often epi- 
 demic, was evidently puzzled by these nervous 
 symptoms described by Paulus. 
 
 Jordanus* compares with this epidemic a disease 
 which he had seen spring up in his time — that is, 
 within the last thirty years — and become endemic in 
 Pannonia, in Austria, and also in some tracts of Grer- 
 many. It was a colic with paralysis, and as young 
 children, and even infants, were attacked with it, as 
 well as adults, there can scarcely have been lead 
 poisoning. Jordanus suggests no cause for it, but 
 he remarks that, when studying in France and in 
 Italy, he had never heard it mentioned, even in the 
 lectures of professors. 
 
 As early as 1684 EttmuUerf observed, that Austria, 
 Moravia, and Franconia, where colic prevailed, were 
 " loca vinosa," but he does not hint at lead, though 
 doubtless in this case it was in fault. 
 
 On the whole, I think, that in the present state of 
 our information, it is probable that there are endemic 
 colics without any connection with lead poisoning, 
 that it is certain, that endemic colics do exist at the 
 present day in some tropical countries, and that it is 
 not probable that fatal contagious epidemics of colic 
 can have been true colic. 
 
 * Luis Novae Descriptio, 1580. 
 t Opera, 1684, p. 138. 
 
APPENDIX. 
 
 231 
 
 SUPPLEMENTAEY ;N0TE. 
 
 Until these slieets were printed, I had not seen 
 Dr. Balfour's Statistics of Cholera (Madras, 1870). 
 From it I gather a few additional names for 
 cholera : — 
 
 Arabic. 
 
 Arabic. 
 
 Canarese, Tamul, Teloogoo. 
 
 Hindost. 
 
 Mahratt. 
 
 Tamul. 
 
 Nepalese. 
 
 P. Hindost. 
 
 P. Hindost. 
 
 Maradi ul aswad 
 Halqi, Bhaka 
 Wati Bedi . . 
 "Wakul Jalab 
 Ukari Jalab 
 Uri Kath 
 Jharoti . . 
 Kai Dust 
 Bad Howai 
 
 Many of these names are descriptive of purging, 
 while Bad Howai, i.e., bad air, seems to exist as a 
 name, though I doubted this at x^age 7. 
 
 It may be worth mentioning as to the pestilence 
 which prevailed in India in the latter part of the 
 seventeenth century, that Dr. Meade, early next 
 century, talks of the plague as being well known at 
 Surat. 
 
232 APPEXDTX. 
 
 With reference to tlie non-diffusion of cholera in 
 the beginning of the eighteenth century, Captain 
 Hamilton, in his account of India, although he 
 alludes freely to the mortality of Europeans, does 
 not mention cholera at all. 
 
 A reference by Dr. Bryden to Grant Duff's his- 
 tory enables me to say, that the G-eneral of the 
 Mahrattas, Hurry Punt, mentions, about 1786, 
 cholera having been fatal to their army engaged 
 with Tippoo. This is an important notice of the 
 disease in armies far removed from the coasts. 
 
 I have just received from Dr. Bryden a publica- 
 tion entitled, " Note on the Epidemic Connection of 
 the Cholera of Madras and Bombay." It makes me 
 partially regret, that J have not endeavoured to point 
 out the connection between famines and mete- 
 orological changes with the spread of cholera. But 
 I could have done so only in a vague and imperfect 
 way, for the periods of which I treat. 
 
 When Dr. Bryden endeavours to generalise on 
 those times, he is, owing to the scantiness of the 
 information before him, and the liveliness of his 
 imagination constantly outstripping not only facts, 
 but legitimate inductions from such facts as do exist. 
 I shall point this out in a few instances, at the same 
 time remarking, that Dr. Bryden's paper affords the 
 best evidence of the want of a collection of facts, such 
 as I have endeavoured to present, and which I have 
 already expressed a hope may serve as a corrective 
 to over-bold speculation. 
 
 1. As to the occurrence of cholera at Ai-ano-al 
 
APPEND rx. 233 
 
 (which was in central India, and not, as stated by 
 me, near Delhi) some few years before 1343, I liave 
 Professor Dowson's authority for saying, that it is 
 extremely doubtful whether the disease can be 
 identified as cholera ! 
 
 2. Dr. Bryden " takes this epidemic to have been 
 the origin of Hecker's great black plague of 1348," 
 seemingly not knowincr the history of that pesti- 
 lence, the nature of which has never been doubted, 
 and which he is the first to identify with cholera ! 
 
 3. Dr. Bryden, strangely entertaining the old 
 belief that Bontius is the first Euroj)ean who gave 
 an account of cholera in the East, sees some con- 
 nection between his description of cholera in 1629, 
 and the year in which an abnormal meteorology 
 initiated in India the terrible famine of 1630-31. 
 But Bontius talks of no new disease, of no epi- 
 demic — he merely describes cholera along with 
 fever, dysentery, and other diseases of Java. 
 
 4. Exactly the same remark applies to the 
 writings of De Thevenot, Fryer, and Dellon, wlio 
 about the years 1666, 1674, 1676, described cholera 
 (but no epidemic of it) as one of the diseases of the 
 country from the interior near Surat doT\Ti the coast 
 to Groa. This Dr. Bryden describes as cholera on 
 the southern highway, on which he considers 
 Sydenham's cholera to have been consequent — /. c, 
 the London outbreaks were consequent on epi- 
 demics, which have never been recorded. 
 
 o. He thinks he finds the trace of the fact of 
 an invasion in 1684 following the cholera of 1676. 
 
234 APPENDIX. 
 
 We have already seen that tliere is no epidemic of 
 1676 on record, and that though there may have 
 been some epidemics of cholera in 1684, the great 
 mortality of that and of subsequent years was 
 caused hy a pestilential fever which, at all events 
 without further information, we are not warranted 
 in pronouncing to have been cholera. 
 
 6. Dr. Bryden says that in the years 1769-70, 
 we have the first notice in Madras of the appear- 
 ance of an epidemic after 1756 ; but it is almost 
 certain that the violent epidemic of 1757, described 
 by Orme, was cholera. Paisley, writing in 1774, 
 recollected the disease to have been horribly fatal 
 among the blacks in our first campaign in the 
 country, and in 1766 Q-rose wrote of mordeshin as a 
 disease of great severity, well known on the Malabar 
 coast. 
 
 7. Dr. Bryden thinks that the bad remittent 
 fevers of Calcutta about 1768-71 were cholera. 
 What I have said in the text and in the note on the 
 fever of 1762, is a pretty sufiicient answer to this. 
 What is said of that year applies equally well to 
 the later period. A disease cured mainly by bark, 
 marked by repeated fits of fever, sometimes with 
 remissions of only four or five hours, with delirium, 
 in which men sometimes committed suicide, and a 
 disease of which Clark did not lose a single case, 
 was surely, notwithstanding the presence of some 
 choleraic symptoms, no cholera. Clark, and other 
 navy surgeons, knew mordeshi and cholera morbus 
 well, and could not have mistaken it for a fever. 
 
EEHATA. 
 
 Page 44, line 15, for " and " read "tells that it." 
 
 Page 126, note, for "relative" read "friend." 
 
 Page 194, line 10, for "March " read " April." 
 
 Page 231, line 5, for "halqni" read " halgi." 
 
 Page 233, line 4, cancel " ! " 
 
 Page 234, lines 26 and 27, cancel two lines, from " in which " to 
 " single case," and insert " of great violence, coma, congestions of 
 internal viscera, non- suppression of urine." 
 
 ADDEKDTJM. 
 
 Mr. Dick, writing in the Medical Commentaries for 1785, vol. x., 
 of sunstrokes in the Carnatic, says that in the last war they were 
 more fatal than the cholera morbus or dysentery, just as one might 
 write of modern campaigns —for instance, the last Burmese one. 
 
 Clark, Jas., 72 
 
 Hastings, 137, 138 
 
 Niebuhr, 126 
 
 Cleghorn, 6ij 
 
 Hay, 144, 148, 180 
 
 
 Cleyer. 28, 103 
 
 Heberden, 63 
 
 Orme, 125 
 
 Cocchi, b7 
 
 Helwig, 62 
 
 Orton, 180 
 
 Corbyn, 151 
 
 Henneu, 74 
 
 Ovingkin, 111, 113 
 
 Comisb, 185 
 
 Heraelitus, T., 22 
 
 
 Correa, 83 
 
 Hippocrates, 8, 15-18 
 
 Paisley, li6, 134 
 
 Craw, 157, 181 
 
 Hirsoh, 3, 225 
 
 Papin, 119, 120 
 
 Cruiksha.Tik, 150 
 
 Hoffman 62, 216 
 
 Paulus JE. , 32, 33 
 
 Currie, J. , 73 
 
 Holinshed, 44 
 
 Paxman, 120 
 
 Currie, "W., 70 
 
 Holmes, 70 
 
 Pechlin, 60 
 
 Curtis, 139, 141 
 
 Homberg, 105 
 
 Pettenkofer, 16S, 1S6 
 Piso, K., 48 
 
 Davis, 145, 146-- 
 
 Impey, 135 
 
 Pisu, G., 54 
 
 Degner, G5, 77 
 
 Ives, 126 
 
 Pilciiitii, 63, 64 
 
234 APPENDIX. 
 
 We liave already seen that there is no epidemic of 
 1676 on record, and that though there may have 
 
 remissions of only four or five hours, with delirium, 
 in which men sometimes committed suicide, and a 
 disease of which Clark did not lose a single case, 
 was surely, notwithstanding the presence of some 
 choleraic symptoms, no cholera. Clark, and other 
 navy surgeons, knew mordeshi and cholera morbus 
 well, and could not have mistaken it for a fever. 
 
I.— INDEX OF AUTHOEITIES. 
 
 A'Costa, 88 
 Aetius, 31,32 
 Ainslie, 180 
 Alexander, 32 
 Anglada, 45 
 Arbuthaott, 120 
 Aretasus, 22, 24, 27 
 Armstrong, 74 
 Asclepiades, 19 
 Averrhijes, 38 
 Avicenna, 35, 38 
 
 Baldceus, 99 
 Balfour, 13S 
 Barnes, 150, 19 
 Bartolomeo, 142, 143, 144 
 Beaulieu, 92, 93, 94, 95. 
 Bissett, 69 [96 
 
 Black, 60, 71 
 Bogus, 126 
 Bontius, 92 
 Boudin, 228 
 Bryden, 168, 185 
 Burke, 134 
 
 C8eliusA.,21, 22 
 Carreri, 113 
 Celsus, 19-21 
 Chambers, 3, 71 
 Cbapman, 59 
 Charaka, 26 
 Cbin-obe-cbin, 28 
 Chishobn, 72 
 Claremout, 50 
 Clark, Jn., 134, 142, 148, 
 
 161, 182 
 Clark, Jas., 72 
 Cleghorn, 60 
 Cleyer. 28, 103 
 Cocchi, 67 
 Corbyn, 151 
 Cornish, 185 
 Correa, 83 
 Craw, 157, 181 
 Cruikshank, 130 
 Currie, J. , 73 
 Cm-rie, W., 70 
 Curtis, 139, 141 
 
 Davis, 145, 146 
 Degner, 65, 77 
 
 Dellon, 106, 107, 1O8 
 DeThevenot, 101, 102 
 D'Orta, 84, 87 
 Douglas, 64 
 Dowson, 79 
 Duff, G., 112 
 Duffin, 146 
 Duncan, 146 
 
 Erasistratus, 19 
 Ettmiiller, 60, 229 
 
 FemeUus, 43 
 Fodere, 72 
 FoUy, 135 
 Fontana, 134 
 Forbiu, 109 
 Forestus, 44 
 Fryer, 103 
 
 Gadesden, 39 
 Gardiner, 50 
 Galen, 8, 31 
 Gaskoin, 3 
 Gentil, 127, 128 
 GUbert, A, 39 
 Girdlestone, 140 
 Goodeve, E., 172 
 Goodeve, H. H., 193 
 Gordon, 39 
 Gramann. 50 
 Greenhow, 60 
 Greenhill, 36 
 GriesLuger, 210 
 Grose, 124 
 
 Hastings, 137, 138 
 Hay, 144, 148, 180 
 Heberden, 63 
 Helwig, 62 
 Henneu, 74 
 HeracUtus, T., 22 
 Hippocrates, 8, 15-18 
 Hirsch, 3, 225 
 Hoffman 62, 216 
 HoHnshed, 44 
 Holmes, 70 
 Homberg, 105 
 
 Impey, 135 
 Ives, 126 
 
 Jameson, J., passim 
 Jameson, T., 149 
 Johnson, J., 149, 150 
 Johnson, 125 
 Jordanus, 229 
 Josephus, 41 
 Jukes, 148 
 
 Kaempfer, 109, 226 
 Kafee, K., 110 
 KoHig, 141, 142 
 
 Le Blanc, 88, 89 
 Lentilius, 62 
 Lind, J., 135 
 Lind, J., 126 
 liinsohott, 89 
 Iiommius, 46-7 
 liUiUier, 118, 119 
 
 Macnamara, 1 In, 150 
 Macpherson, H. M., 185 
 Macrae, 160 
 Malcolm, 101 
 Malouin, 67 
 Mandelsloe, 98 
 Martin, R., 185 
 Martiu, P., 117, 118 
 Mercurialis, 33, 47, 48 
 Mezeray, 44 
 Moorcroft, 197, 198 
 Morehead,225, 228 
 Morgagni, 209 
 Morton, 58, 59 
 Moyses, A, 45 
 
 Niebuhr, 126 
 
 Orme, 125 
 Orton, 180 
 Ovington, 111, 113 
 
 Paisley, l>6, 134 
 Papin, 119, 120 
 Paulus JE. , 32, 33 
 Paxman. 120 
 Pechlin, 60 
 Pettenkofer, 168, 186 
 Piso, N., 48 
 Piso, G., 54 
 Pitcuiwi, 53, 64 
 
INDEX, 
 
 Pringle, 66 
 Prosper, A., 48 
 
 Quintilian, 168 
 
 Raphael, V., 40 
 Eeliman, i)7 
 Ehazes, 33, 35 
 Ki-vierus, 46, 52, 53 
 Piouppe, 70 
 
 Saunders, 73 
 Sauvages, 12, 13 
 Schonlieid, 50 
 Scott, passim 
 Scoutetten, 4 
 Short, 3, passim 
 Sims. 69 
 
 Smith, A., 209 
 Smith, B., 163 
 Sonnerat, 129-133 
 Sprenger, 36 
 Stavorinus, 127 
 Stewart, T>., 185 
 Sutton, 209 
 Su^ruta, 25, 26 
 Sydenham, 54, 56 
 
 Tallmann, 71, 72 
 Tavernier, 85, 89 
 Then Uhyne, 103, 
 
 105, 225 
 Tholozan, 134 
 Thompson, 146 
 Tod, 100, 101 
 Torti, 63 
 
 Tralles, 67, 68, 69 
 Tytler, 153, 159 
 
 Valentyn, 120 
 Van der Heiden, 44, 51 
 Yan S'ivieten, 65 
 Varro, 109 
 
 Wanmann, 128 
 Willan, 73 
 WilUs, 56, 57, 58, 77 
 Wilson, T. W., 
 Wiae, J., 4 
 , T., 25, 26 
 
 Young, 159 
 
 Zaoutus, 49, 96, 97, 98 
 
 II.— INDEX OF SOME SUBJECTS. 
 
 N.B. — Where not stated otheitoise, the headings refer to Cholera. 
 
 Acupuncture 30, 81 
 aetiology, 131, 132, 157, 
 
 167, 194, 212 
 Ague, 52, 59, 63, 66, 215 
 
 Cautery, 81, et passim 
 Cholera Epidemics, 46, 
 
 54, 57, 70, 83, 100, 1 04, 
 
 130 
 Cholera Infantum, 70, 
 
 200 
 Chronology, 186 
 Colic, Epidemics of, 33, 
 
 37, 45, 49, 104, 225 
 Congestive Eever, 74, 215 
 Contagion, 51,76,77, 148, 
 
 195, 205, 221 
 
 Descriptions, 19, 22 25, 29, 
 34, 46, 51, 55, 57, 65, 71, 
 72, 73, 80, 93, 102, 107, 
 128, 141 
 
 Dysentery, 43, 49, 50, 60, 
 61, 65, 96, 220 
 
 Endemicity, 159, 179 
 Epidemicity, 183 
 
 Fever in Bengal, 112, 198 
 Ganges Water, 88 
 
 Geography, 186 
 
 , Physical, 187 
 
 Griping of Guts, 59, 66 
 
 Hahits, 122, 192, 213 
 Hooghly, Sickness in, 126, 
 
 193 
 Hospitals, Portuguese, 84 
 Hygiene, 197 
 
 Incuhation, 194, 216 
 Influence on other Dis- 
 eases, 215 
 Intercourse in East, 91, 
 175 
 
 Ligature, 22, 35, 87, 197 
 Localisation, 214 
 
 Malignity, 219 
 
 Morhid Appearances, 146, 
 
 196, 210 
 Moxa, 81, 197 
 
 Names, 6, 14, 176 
 
 Origin, 163 
 Organic Germs, 109 
 
 Pathology, 31, 53, 58, 63, 
 
 67, 121, 195 
 Pestilential Fevers, 109 
 Pilgrims, 192 
 
 Poison, 32, 48, 62, 215 
 
 , Specific, 222 
 
 Portuguese Practice, 84, 
 
 114 
 Predisposition, 192 
 Prognosis, 77, 155, 212 
 Propagation, 168 
 Protean Nature, 47 
 
 Sailors, 70, 92, 97, 99, 
 
 125, 128, 139, 193 
 Seasons, 161, 172, 185,214 
 Soil, 66, 168 
 Soldiers, 82, 99, 136, 140, 
 
 192 
 Symptoms of cholera, 208 
 
 (see Descriptions) 
 
 Tahle of, 180 
 
 Travelling, 193 
 
 Treatment, 41, 56, 58, 64, 
 68, 96, 102, !07, 113, 
 139, 140, 146, 153, 196, 
 211 
 
 Trousse Galant, 44 
 
 Yarieties of Cholera, 13, 
 178, 217 
 
 "Worship of Goddess, 115, 
 152 
 
 Zymotics, 218 
 
 LONDOiS : PKINTED BiT KANKEN & CO., DEUllY HOUSE, ST. MAEY-I.E-STKAND, W, C. 
 
February i 1S84. 
 
 CATALOGUE OF WORKS 
 
 PUBLISHED BY 
 
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Catalogue of. Works PuhlisJied by H. K. Lewis. 5 
 
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Catalogue of Works Published by H. K. Lewis. 
 
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10 Catalogue of Works Published hy H, K. Lewis. 
 
 J. F. MEIGS, M.D. 
 
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 \V. PEPPER, M.D. 
 
 Lectuyey on Clinical Medicine in the Univeysity of Pennsylvania. 
 
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 ELECTRICITY IK" ITS RELATION TO PRACTICAL 
 
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 NITRO- GLYCERINE AS A REMEDY FOR ANGINA 
 
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Catalogue of Works Published by H. K. Lewis. 11 
 
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 SURGICAL CASES: Mainly from the Wards of the 
 
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12 Catalogue of Works Published by H. K. Lewis. 
 
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 I, 
 
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 II. 
 
 ON THE TEMPERATURE OF THE BODY AS 
 
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Catclogiie of Works Published by H. K. Lewis. 13 
 
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