Juke 1,
ON CHOLERA.?BY C. MACNAMAKA.
1868.]
ORIGINAL COMMUNICATIONS. ri
ON CHOLERA. yC.
Surgeon
to
Macnamara,
the Calcutta Ophthalmic Hospital.
disease which is capable of being generated at all seasons of the year in certain parts of India, and occasionally over vast tracts of Asia, Europe, and America ; it shows a marked predilection for those living under insalutary conditions, or whose health has been impaired from disease, or depression of the nervine force ; it is very apt to be developed among new-
Definition.?A
Cholera is comers to a locality in which the disease prevails. generated indiscriminately among persons of both sexes and all ages. It is characterized by nausea, faintness, and a feeling of oppression in the prsecordial region, griping pains in the abdomen, frequent purging, (the stools being alkaline when passed, and in appearance resembling rice-water,) constant vomiting, partial or complete suppression of urine, and profuse perspiration. The skin is inelastic, and that of the hands and feet shrivelled and dusky ; the eyes are sunk, and the features pinched ; cramps are felt in the limbs; there is difficulty of breathing, intense thirst, excessive restlessness, rapid and small pulse, and suppressed voice. The external temperature of the body is slightly below 90?, and a peculiar sweetish sickly odour (fishy) is exhaled from the body, breath, and dejections. If left to nature, about one-half of those attacked with cholera recover of themselves, reaction supervening, and often being accompanied with fever, and not unfrequently with suppression of urine and various other complications : or the disease may terminate, within a few hours from its commencement, in fatal collapse. History.?The early Sanskrit writers are our most ancient authorities in the science of medicine. Of these Chararka is by the Hindus to have derived his knowledge from a
believed
personage known
as Dhawantari, coinciding in Esculapius. Chararka's works are incomplete ; but in the Nidan of his disciple Susruta, we meet with the following description of a form of Vishuka." The patient is attacked with vomiting, purging, faintness, thirst, pain in the abdomen, yawning, forgetfulness, burning heat in the stomach, duskiness of the surface of the body, pain in the head and heart." The ?worst symptoms are blueness of the gums, lips, and nails, diminution of the senses, coldness of the body, sunken eyes, suppressed voice, a feeling of complete lassitude;" but "if burning of the palms of the hands and body, accompanied with sharp vomiting," occur, the patient is likely to recover; and should he digest his food, all danger is passed," the patient obtaining immediate relief, the purging stops, and he is in comfort." If this description refers to cholera, the disease must have been in existence for many centuries, Susruta being mentioned in the Mahabarata, which was compiled before the
mythological
character with
"
"
"
Christian
era.
These Hindu authorities lived and wrote in the NorthWestern Provinces of India, and it is remarkable that they describe Yishuka as being a sporadic disease,?a character it has retained up to the present time in the North-West, with the exception of waves of the disease which seem to pass over the
country from time to time. Hippocrates,* Galen, and Whang-shoohof are witnesses to the existence of cholera in their day, both in Europe and
China, and they have been succeeded by a Roman, and Arabian authors, bearing record
series of Grecian, to the fact of the
* Hippocrates Coi, de morb, vul. lib. v, Sec. VII, fol. 1144, Ed. fol_ Francofurti, A. D., 1624. t Transactions of the Medical and Physical Society, Calcutta,Vol. I.
p.,
204.
121
presence of cholera in the various countries in which they lived up to the present time.* The literature of the middle ages is singularly barren in original observations regarding the science of medicine. Men occupied themselves rather with the ancient terms of art than with actual
observation, and, in their critical researches, overimportant events that were passing before their eyes ;f and this is precisely what is now going on among looked the
Hindus and Muhammadans in India. The Baids and Hakims pore over their ancient works with the greatest avidity, but are utterly blind to the necessity of noticing what is passing around them. Consequently, we have but few records in Persian any other Oriental language to enlighten us as to the history of the diseases of India.]: Otherwise there can be little doubt that we should have evidence of waves of epidemic cholera or
passing over the length our occupying it.
and breadth of the country
long prior
to
The earliest record of the existence of cholera in Hindustan, the pen of a European, occurs in the " Lendaa du India" by Gaspar Correa. He says that, during the spring of the
from
men had died in the army of Zamoryn, the year 1503, 20,000 enemy of the King of Cochin, and that the cause of this " by the current spring diseases, mortality was enhanced
also small-pox, besides sudden-like, which struck pain last out eight hours' time." and
which there was another disease, belli/, so that a man did not
in the
The same author informs us that in the spring of 1543 he met with cholera in an epidemic form at Goa that the natives called it moradexy, and that the mortality was so great that it " so grievous was the was with difficulty the dead could be buried; seemed throe, and of so bad a sort, that the very worst
portion (in the stomach) to take effect, as proved by vomiting, with draughts of water accompanying it, as if the stomach were parched up, and cramps that fixed the sinews of the joints and of the flat of the foot with pain so extreme, that the sufferer seemed at point of death; the eyes dimned to sense, and the nails there
of the hands and feet black and arched." In 1563, Dr. G. D'Orta,? another Portuguese, gives us a vivid He says the of cholera as he met with it at Goa.
description
called it hackaiza (haiza), the name it is known by India to this day. He adds that the disease is always " most severe in June and July." Linschot, a Dutchman, who resided at Goa for some few years " the diseases which these changes prior to 1589, remarks that inhabitants of Goa are several, to the of the season bring Arabs
throughout
mordexin occurs, which among which that commonly known as on very suddenly to those subject to it, with swelling of the stomach and continual vomiting, till they fall into a faint. This disease is common, and proves deadly to many."|| comes
There
seems,
therefore,
no
reason
to
doubt that
epidemic
cholera existed in Goa, the only province in India known to Europeans during the sixteenth century, and that its phenomena, and the time of its principal visitations, were precisely similar to the disease as seen there at the present day. In the seventeenth century we have evidence of the presence of epidemic cholera in Bataviall (1629), in the province of Medicina, lib. IV, Chap. XI. Cholera, Chap. 16, Alexandri Tralliani. Aretseus, lib. II, Chap. V. Coelins Aurchinus, lib. Ill, Chap. XX. Avicenna, p. 492, Edit. Rome, 1593. the Middle Ages. Translated by Dr. f Hacker on the Epidemics of Babington: London. 1846. of Cholera. By G. Gaskein, MedicoJ Contribution to Literature Chirurg. Review, 18e7, p. 217. 217. Gaskein on the Literature ? Medico-Chirurg. Review, 1867, p. of Cholera, 32. || Quarterly Review, 1867, p. An account of the diseases of the East Indies, by T. Bontius Translated and published in London, p. 26. *
Celsus A. C. Celsi
De
THE INDIAN MEDICAL GAZETTE.
122 Goa in
1638,*
and in London
during
the autumn of
1669,f
at Goa, and lastly near Surat, where Thevenot, a Frenchman, was himself attacked with cholera some time prior to in 1676
1678. In 1762 it is said to have prevailed very extensively in Upper Hindustan, destroying, according to Le Begue de Presle, thirty thousand natives and eight hundred Europeans.^ The earliest account we have of the occurrence of cholera
India, from the pen of an English physician (Dr. Paisley), is Madras, February, 1774, and is to be found in Curtis's Works on Diseases of India, published in Edinburgh in 1807. It is somewhat remarkable that this important communication should not have been brought to light until thirty-three years after it was written, particularly as, in the meantime, Dr. Girdlestone had published a work in London, in 1787, on the Spasmodic Affections" in India, under which heading he gives an accurate description of cholera. It is evident, therefore, that, in spite of Dr. Paisley's letter, neither Girdlestone nor " a general meeting of the Faculty at Madras" which he consulted in 1782, recognised the disease we now designate cholera as cholera. I am anxious to bring this point somewhat prominently forward, not as a proof of ignorance or neglect on the part of the authorities whom I shall quote, for they had a perfect right to follow Cullen's nosology, and class cholera under the heading of spasmodic diseases if they pleased; but, supposing this were the case, we can hardly be surprised at failing to meet with a description of the disease as cholera among the writings of English physicians in India, during the latter part of the eighteenth and the beginning of the nineteenth centuries. In 1774, Dr. Paisley, of Madras, writes :??"I am happy to hear you have occasioned the army to change its ground, for there can be no doubt, from the circumstances you have mentioned, that their situation contributed to the frequency and violence of the attack of this dangerous disease, which, as you have observed, is true cholera morbus, the same they had at Trincomale." (In a foot note Dr. Curtis remarks that this must refer to some occasion long anterior to the war of 1782.) Dr. Paisley goes on to observe that it is often epidemic among the " In the first campaign made in this country, the same blacks. disease was terribly fatal among them, and fifty Europeans of the line were seized with it. I have met with many single cases
in
dated
"
since."
In 1770 cholera was endemic among the natives in the in Arcot, and throughout the Travancore
Valley country-||
Amboo
In 1781 we find cholera in the district of Ganjam.
Bengal troops marching that,
prevalent during
the month of March
It attacked a division of some 5,000 through that province under Colonel
Pearse. He reports
besides those who died, no less than five admitted into hospital on the 22nd of March. He adds :?" Death raged in the camp with horror not to be desIn the cribed, and all expected to be devoured
hundred
men were
vain I studied to discover
by
pestilence.
the cause of our misfortune. I attributed it to a poison, but at length found that there had been a pestilential disorder raging in the parts through which our first
marches lay, and that part of
our camp was already drinking the air of death and destruction." In the course of a few days 1,143 men were in hospital affected with this disease. On the
29th of
March, however, the sick were reduced to 908, and on following month the force was able to march,
the 1st cf the
leaving 300 men convalescent behind. It will be observed that Colonel Pearse does not mention the disease as being cholera; he calls it a pestilence, and in the following quotation from a des*
of the Supreme Government to the Court of Directors, mention is made of cholera. Thi3 document is dated 27th April, 1781, the occurrence of the disease is notified, and the destruction which it caused in this detachment mentioned in
patch
of becoming regret.* After adverting to its progress in the Circars, the letter proceeds:?" The disease to which we allude has not been confined to the country of Ganjam ; it afterwards found its way to this place (Calcutta); and after chiefly affecting the native inhabitants, so as to occasion a great mortality during the period of a fortnight, it is now generally
terms
and pursuing its course to the northward." The progress of this epidemic has never been recorded ; but we have, at any rate, evidence of epidemic cholera raging throughout the
abated,
Ganjam in March and April, 1781, of its travelling to Calcutta, attacking the inhabitants of that city and the intervening country, and passing on in the same northerly direction. Here, unfortunately, a blank occurs in the history of its progress ; but we find that in April, 1783, cholera burst out at Hurdwar, and in less than eight days is supposed to
district of
northward
have cut off twenty thousand victims. This is precisely the course, and about the same time which subsequent waves of cholera have taken when passing over India;
and it seems to me that this fragmentary hiutory is presumptive evidence that the epidemic was of a similar nature to that which occurred in 1817, and on subsequent occasions. This position is strengthened by the fact that Dr. Girdlestone says :f? "
Spasms
tb'the Medea
Frigate. Edinburgh, 1807,
I) Idem, p. xvi.
p. 85.
the
was
first
disease which
among the More than fifty
appeared
troops who arrived at Madras in October, 1782. of these fresh
men were killed by them within the first three they landed in that country, and in less than a month's time upwards of a thousand had suffered from attacks of these complaints." He goes on to describe the disease:?" Coldness of the surface of the body, especially of the hands, feebleness of the pulse, spasmodic contraction of the lower extremities, the hands and feet become sodden with cold sweats, nails livid, pulse more feeble, breath cold, thirst insatiable, vomiting incessant,
days
after
which last, if not checked, soon terminates the existence of the patient." This is evidently an account of the disease we recognise as epidemic cholera. Fra Paolino da S. Bartolomeo, in
work published at Home in 1796, gives a curious account "The disease is called mirtirissa, or cholera.^ He says nircomben, in the language of Malabar, viszucega in Sanscrit, vulgarly mordexein, and not morte de chien as described by Sonnerat. It is an intestinal colic caused by the cold wind from the Ghattes, or from bathing in the cold mornings. This disease is frequent in Malabar in October, November, and December, when the wind comes from the Ghattes loaded with particles of nitre; it is as common on the Coromandel Coast in April and May, and often carries off thirty or forty persons in a village during one night; for, unless instantly relieved, it destroys a
of
life in the out
course
with terrible
of
a
ferocity,
lew hours. In 1782 the disease broke and destroyed an enormous number of
people! In the month of May, 1782, cholera was raging in an epidemic form at Trincomale, and our fleet at anchor there was severely affected."? M. Sonnerat, || in his Travels in India, also mentions the existence of epidemic cholera along the Coromandel Coast from 1772 to 1781; so that we have independent evidence of the existence of this disease in an epidemic form in Bengal during March, 1781, in Madras, and, in fact, along the whole of the Eastern Coast of India in 1782, and at Hurdwar in the Punjab during the year 1783. *
Quarterly Keview, No. 243, p. 23. t the works of Sydenham, by T. Levari. London : 3rd Edition, p. 146. t American Cholera Gazette, p. 3. An account of the diseases of India, ? by C. Curtis, formerly Surgeon
1868.
no
Report
tories
*
[Juke 1,
1820.
the
to the
Epidemic Presidency
Cholera of
Morbus
as
Bengal, by James
it visited the TerriJameson.
on the Hepatitis and Spasmodic Affections Girdlestone, M.D. Loudon. 1787. Alle Indie Orieutali, p. 350., J Viaggio ? Scott's Madras Reports on Epidemic Cholera, p. vii. Scott's Madras y Reports, p. iv.
t Essays J.
on
subject
in
Calcutta, India, by
June 1,
THE ACTION OF COBRA POISON.?BY J. FAYRER.
1868.]
123
I conceive this, therefore, to be a history, though far from a cidental remark of Dr. Duncan, made five years after the occurdetailed one, of the first wave of epidemic cholera which passed rence, and had most fortunately been able to refer to Dr. the medical returns of the corps never could over India since the English occupied the country ; and it seems Cruickslianks, that the reason for our not clearer indications of the have led to the knowledge of it. Hence, as already observed,
possessing
though cholera very rarely appears in the sick returns of former hardly recognised as cholera. Moreover, it was not till 1786 times, it is by no means to be thence inferred that it did not that the Hospital Board was established in Bengal and Madras, then exist."* We are, I think, therefore justified in arriving at the conclubefore which period no returns of the sick were made. Mr. Scott adds, that the reports from that date up to 1802 were kept in sion that it was nothing new for cholera to spread over India in Our possessions in India also, prior to 1781, an epidemic form prior to 1817 and 1819. The nature of the no regular order. were surrounded by vast arrears of unsubjected country, beyond disease was then fully recognised, and the country subjected which the course of the epidemic could not possibly be traced; to our rule, so that British Officers were for the first time in a but the details above given are, nevertheless, important, as in- position to report upon the cholera as it affected the natives of dicating the fact that, within twenty-four years of the battle of the country.f {To be continued.) Plassey, we have evidence of a wave of epidemic cholera passing over a considerable portion of India. During the month of October, 1787, epidemic cholera committed terrible ravages at .Arcot and Yellore. With regard to this outbreak, Mr. Davis, a member of the Madras Hospital Board, remarks:?"I found in what was called the Epidemic Hospital, three different diseases, viz., patients labouring under cholera morbus, an inflammatory fever, with universal cramps, and a spasmodic affection of the nervous system, distinct from cholera morbus. I understood, from the Eegimental Surgeon, that the last disease had proved fatal to all who had been attacked with it, and that he had already lost twenty-seven men of the regiment in a few days. Five patients were then shown to me with scarce any circulation whatever to be discovered; with their eyes sunk within the orbit; jaws set, bodies cold, and extremities livid." They were being treated with castor-oil.* During the year 1790 cholera was very prevalent again in Ganjam; in 1794 at Yellore, where it was described as the circumstances of the disease arises from the fact that it was
"
Causis." From the returns
kept in the Office of the Bengal Medical
Board
during early part of the present century, and which relate exclusively to the European troops, I find that in 1808 five cases of cholera are reported,?one at Meerut, one at Delhi, another at Muttra, and two in Calcutta. In 1809 three cases occurred, and in 1811, 1812, 1813 no less than seventy-nine cases of cholera are reported as having taken place at Chunar, but not a single one from any other station in the Presidency. During the year 1814 instances of cholera occurred at Cawnpoor, Nagpoor, Benares, Meerut, Dinapoor, and the Presidency; in all forty-six cases, and eleven deaths. These are the first deaths reported from this disease among our European troops in Bengal. In 1815 and 1816 there were no cases of cholera; and in this Presidency only two cases occurred among the troops at Benares in 1817, although the disease was raging throughout the whole of Bengal, showing that statistics, drawn simply from the reports of our European troops, are hardly to be relied the
?upon It
as a
criterion of the existence of cholera in India.
appeared
in
a
crowded barrack in Fort
William,
in
1814,
among recruits just arrived from England,-f and in an epidemic form at Jaulnah during the same year. With regard to this
outbreak, Dr. Cruickshanks subsequently explained (in 1831) that I entered these cases in the Hospital Keturns as bowel complaint in. 1814, because the matter ejected by vomiting and stool was of an aqueous or mucilaginous consistency, containing no bile." Mr. Scott observes with regard to this report:? "This paper of Mr. Cruickshanks is of great importance, "
inasmuch hitherto
as
it evinces that cholera did exist to to have occurred at so recent
suspected
an a
extent not
date,
and also
that, even under these circumstances, no trace of it is found in the public records; for, unless we had been guided by the in*
Report, p. xii. Concise Narrative of Parts connected with the Disease which t ccurred in the District of Jessore, by B. Tytler: Calcutta, September, 1817. Printed by C. M. Pratt aad Co. Scott's A
Scott's Report, p. xi. t Prior to 1760 tho Company's territories in India were confined to an area containing some 15,000 square miles. In 1765 the Company acquired command over Bengal, but not till 1775 over the zamindari of ?
to 1799 the Hizam's came under their rule;
territory, the Carnatic, in 1801 Bundeikhund; in 1802 Kuttack and Balasore ; the Duab, Delhi, and Ahmadnuggar in 1803 j Gujrat in 1805 j and Kumdon, Sagur, Ruttiab, and Darwar in 1817. Benares.
From
1792
GoraVpoor, and Bareilly
ON CHOLERA.?BY C. MACNAMAKA.
1868.]
ORIGINAL COMMUNICATIONS. ri
ON CHOLERA. yC.
Surgeon
to
Macnamara,
the Calcutta Ophthalmic Hospital.
disease which is capable of being generated at all seasons of the year in certain parts of India, and occasionally over vast tracts of Asia, Europe, and America ; it shows a marked predilection for those living under insalutary conditions, or whose health has been impaired from disease, or depression of the nervine force ; it is very apt to be developed among new-
Definition.?A
Cholera is comers to a locality in which the disease prevails. generated indiscriminately among persons of both sexes and all ages. It is characterized by nausea, faintness, and a feeling of oppression in the prsecordial region, griping pains in the abdomen, frequent purging, (the stools being alkaline when passed, and in appearance resembling rice-water,) constant vomiting, partial or complete suppression of urine, and profuse perspiration. The skin is inelastic, and that of the hands and feet shrivelled and dusky ; the eyes are sunk, and the features pinched ; cramps are felt in the limbs; there is difficulty of breathing, intense thirst, excessive restlessness, rapid and small pulse, and suppressed voice. The external temperature of the body is slightly below 90?, and a peculiar sweetish sickly odour (fishy) is exhaled from the body, breath, and dejections. If left to nature, about one-half of those attacked with cholera recover of themselves, reaction supervening, and often being accompanied with fever, and not unfrequently with suppression of urine and various other complications : or the disease may terminate, within a few hours from its commencement, in fatal collapse. History.?The early Sanskrit writers are our most ancient authorities in the science of medicine. Of these Chararka is by the Hindus to have derived his knowledge from a
believed
personage known
as Dhawantari, coinciding in Esculapius. Chararka's works are incomplete ; but in the Nidan of his disciple Susruta, we meet with the following description of a form of Vishuka." The patient is attacked with vomiting, purging, faintness, thirst, pain in the abdomen, yawning, forgetfulness, burning heat in the stomach, duskiness of the surface of the body, pain in the head and heart." The ?worst symptoms are blueness of the gums, lips, and nails, diminution of the senses, coldness of the body, sunken eyes, suppressed voice, a feeling of complete lassitude;" but "if burning of the palms of the hands and body, accompanied with sharp vomiting," occur, the patient is likely to recover; and should he digest his food, all danger is passed," the patient obtaining immediate relief, the purging stops, and he is in comfort." If this description refers to cholera, the disease must have been in existence for many centuries, Susruta being mentioned in the Mahabarata, which was compiled before the
mythological
character with
"
"
"
Christian
era.
These Hindu authorities lived and wrote in the NorthWestern Provinces of India, and it is remarkable that they describe Yishuka as being a sporadic disease,?a character it has retained up to the present time in the North-West, with the exception of waves of the disease which seem to pass over the
country from time to time. Hippocrates,* Galen, and Whang-shoohof are witnesses to the existence of cholera in their day, both in Europe and
China, and they have been succeeded by a Roman, and Arabian authors, bearing record
series of Grecian, to the fact of the
* Hippocrates Coi, de morb, vul. lib. v, Sec. VII, fol. 1144, Ed. fol_ Francofurti, A. D., 1624. t Transactions of the Medical and Physical Society, Calcutta,Vol. I.
p.,
204.
121
presence of cholera in the various countries in which they lived up to the present time.* The literature of the middle ages is singularly barren in original observations regarding the science of medicine. Men occupied themselves rather with the ancient terms of art than with actual
observation, and, in their critical researches, overimportant events that were passing before their eyes ;f and this is precisely what is now going on among looked the
Hindus and Muhammadans in India. The Baids and Hakims pore over their ancient works with the greatest avidity, but are utterly blind to the necessity of noticing what is passing around them. Consequently, we have but few records in Persian any other Oriental language to enlighten us as to the history of the diseases of India.]: Otherwise there can be little doubt that we should have evidence of waves of epidemic cholera or
passing over the length our occupying it.
and breadth of the country
long prior
to
The earliest record of the existence of cholera in Hindustan, the pen of a European, occurs in the " Lendaa du India" by Gaspar Correa. He says that, during the spring of the
from
men had died in the army of Zamoryn, the year 1503, 20,000 enemy of the King of Cochin, and that the cause of this " by the current spring diseases, mortality was enhanced
also small-pox, besides sudden-like, which struck pain last out eight hours' time." and
which there was another disease, belli/, so that a man did not
in the
The same author informs us that in the spring of 1543 he met with cholera in an epidemic form at Goa that the natives called it moradexy, and that the mortality was so great that it " so grievous was the was with difficulty the dead could be buried; seemed throe, and of so bad a sort, that the very worst
portion (in the stomach) to take effect, as proved by vomiting, with draughts of water accompanying it, as if the stomach were parched up, and cramps that fixed the sinews of the joints and of the flat of the foot with pain so extreme, that the sufferer seemed at point of death; the eyes dimned to sense, and the nails there
of the hands and feet black and arched." In 1563, Dr. G. D'Orta,? another Portuguese, gives us a vivid He says the of cholera as he met with it at Goa.
description
called it hackaiza (haiza), the name it is known by India to this day. He adds that the disease is always " most severe in June and July." Linschot, a Dutchman, who resided at Goa for some few years " the diseases which these changes prior to 1589, remarks that inhabitants of Goa are several, to the of the season bring Arabs
throughout
mordexin occurs, which among which that commonly known as on very suddenly to those subject to it, with swelling of the stomach and continual vomiting, till they fall into a faint. This disease is common, and proves deadly to many."|| comes
There
seems,
therefore,
no
reason
to
doubt that
epidemic
cholera existed in Goa, the only province in India known to Europeans during the sixteenth century, and that its phenomena, and the time of its principal visitations, were precisely similar to the disease as seen there at the present day. In the seventeenth century we have evidence of the presence of epidemic cholera in Bataviall (1629), in the province of Medicina, lib. IV, Chap. XI. Cholera, Chap. 16, Alexandri Tralliani. Aretseus, lib. II, Chap. V. Coelins Aurchinus, lib. Ill, Chap. XX. Avicenna, p. 492, Edit. Rome, 1593. the Middle Ages. Translated by Dr. f Hacker on the Epidemics of Babington: London. 1846. of Cholera. By G. Gaskein, MedicoJ Contribution to Literature Chirurg. Review, 18e7, p. 217. 217. Gaskein on the Literature ? Medico-Chirurg. Review, 1867, p. of Cholera, 32. || Quarterly Review, 1867, p. An account of the diseases of the East Indies, by T. Bontius Translated and published in London, p. 26. *
Celsus A. C. Celsi
De
THE INDIAN MEDICAL GAZETTE.
122 Goa in
1638,*
and in London
during
the autumn of
1669,f
at Goa, and lastly near Surat, where Thevenot, a Frenchman, was himself attacked with cholera some time prior to in 1676
1678. In 1762 it is said to have prevailed very extensively in Upper Hindustan, destroying, according to Le Begue de Presle, thirty thousand natives and eight hundred Europeans.^ The earliest account we have of the occurrence of cholera
India, from the pen of an English physician (Dr. Paisley), is Madras, February, 1774, and is to be found in Curtis's Works on Diseases of India, published in Edinburgh in 1807. It is somewhat remarkable that this important communication should not have been brought to light until thirty-three years after it was written, particularly as, in the meantime, Dr. Girdlestone had published a work in London, in 1787, on the Spasmodic Affections" in India, under which heading he gives an accurate description of cholera. It is evident, therefore, that, in spite of Dr. Paisley's letter, neither Girdlestone nor " a general meeting of the Faculty at Madras" which he consulted in 1782, recognised the disease we now designate cholera as cholera. I am anxious to bring this point somewhat prominently forward, not as a proof of ignorance or neglect on the part of the authorities whom I shall quote, for they had a perfect right to follow Cullen's nosology, and class cholera under the heading of spasmodic diseases if they pleased; but, supposing this were the case, we can hardly be surprised at failing to meet with a description of the disease as cholera among the writings of English physicians in India, during the latter part of the eighteenth and the beginning of the nineteenth centuries. In 1774, Dr. Paisley, of Madras, writes :??"I am happy to hear you have occasioned the army to change its ground, for there can be no doubt, from the circumstances you have mentioned, that their situation contributed to the frequency and violence of the attack of this dangerous disease, which, as you have observed, is true cholera morbus, the same they had at Trincomale." (In a foot note Dr. Curtis remarks that this must refer to some occasion long anterior to the war of 1782.) Dr. Paisley goes on to observe that it is often epidemic among the " In the first campaign made in this country, the same blacks. disease was terribly fatal among them, and fifty Europeans of the line were seized with it. I have met with many single cases
in
dated
"
since."
In 1770 cholera was endemic among the natives in the in Arcot, and throughout the Travancore
Valley country-||
Amboo
In 1781 we find cholera in the district of Ganjam.
Bengal troops marching that,
prevalent during
the month of March
It attacked a division of some 5,000 through that province under Colonel
Pearse. He reports
besides those who died, no less than five admitted into hospital on the 22nd of March. He adds :?" Death raged in the camp with horror not to be desIn the cribed, and all expected to be devoured
hundred
men were
vain I studied to discover
by
pestilence.
the cause of our misfortune. I attributed it to a poison, but at length found that there had been a pestilential disorder raging in the parts through which our first
marches lay, and that part of
our camp was already drinking the air of death and destruction." In the course of a few days 1,143 men were in hospital affected with this disease. On the
29th of
March, however, the sick were reduced to 908, and on following month the force was able to march,
the 1st cf the
leaving 300 men convalescent behind. It will be observed that Colonel Pearse does not mention the disease as being cholera; he calls it a pestilence, and in the following quotation from a des*
of the Supreme Government to the Court of Directors, mention is made of cholera. Thi3 document is dated 27th April, 1781, the occurrence of the disease is notified, and the destruction which it caused in this detachment mentioned in
patch
of becoming regret.* After adverting to its progress in the Circars, the letter proceeds:?" The disease to which we allude has not been confined to the country of Ganjam ; it afterwards found its way to this place (Calcutta); and after chiefly affecting the native inhabitants, so as to occasion a great mortality during the period of a fortnight, it is now generally
terms
and pursuing its course to the northward." The progress of this epidemic has never been recorded ; but we have, at any rate, evidence of epidemic cholera raging throughout the
abated,
Ganjam in March and April, 1781, of its travelling to Calcutta, attacking the inhabitants of that city and the intervening country, and passing on in the same northerly direction. Here, unfortunately, a blank occurs in the history of its progress ; but we find that in April, 1783, cholera burst out at Hurdwar, and in less than eight days is supposed to
district of
northward
have cut off twenty thousand victims. This is precisely the course, and about the same time which subsequent waves of cholera have taken when passing over India;
and it seems to me that this fragmentary hiutory is presumptive evidence that the epidemic was of a similar nature to that which occurred in 1817, and on subsequent occasions. This position is strengthened by the fact that Dr. Girdlestone says :f? "
Spasms
tb'the Medea
Frigate. Edinburgh, 1807,
I) Idem, p. xvi.
p. 85.
the
was
first
disease which
among the More than fifty
appeared
troops who arrived at Madras in October, 1782. of these fresh
men were killed by them within the first three they landed in that country, and in less than a month's time upwards of a thousand had suffered from attacks of these complaints." He goes on to describe the disease:?" Coldness of the surface of the body, especially of the hands, feebleness of the pulse, spasmodic contraction of the lower extremities, the hands and feet become sodden with cold sweats, nails livid, pulse more feeble, breath cold, thirst insatiable, vomiting incessant,
days
after
which last, if not checked, soon terminates the existence of the patient." This is evidently an account of the disease we recognise as epidemic cholera. Fra Paolino da S. Bartolomeo, in
work published at Home in 1796, gives a curious account "The disease is called mirtirissa, or cholera.^ He says nircomben, in the language of Malabar, viszucega in Sanscrit, vulgarly mordexein, and not morte de chien as described by Sonnerat. It is an intestinal colic caused by the cold wind from the Ghattes, or from bathing in the cold mornings. This disease is frequent in Malabar in October, November, and December, when the wind comes from the Ghattes loaded with particles of nitre; it is as common on the Coromandel Coast in April and May, and often carries off thirty or forty persons in a village during one night; for, unless instantly relieved, it destroys a
of
life in the out
course
with terrible
of
a
ferocity,
lew hours. In 1782 the disease broke and destroyed an enormous number of
people! In the month of May, 1782, cholera was raging in an epidemic form at Trincomale, and our fleet at anchor there was severely affected."? M. Sonnerat, || in his Travels in India, also mentions the existence of epidemic cholera along the Coromandel Coast from 1772 to 1781; so that we have independent evidence of the existence of this disease in an epidemic form in Bengal during March, 1781, in Madras, and, in fact, along the whole of the Eastern Coast of India in 1782, and at Hurdwar in the Punjab during the year 1783. *
Quarterly Keview, No. 243, p. 23. t the works of Sydenham, by T. Levari. London : 3rd Edition, p. 146. t American Cholera Gazette, p. 3. An account of the diseases of India, ? by C. Curtis, formerly Surgeon
1868.
no
Report
tories
*
[Juke 1,
1820.
the
to the
Epidemic Presidency
Cholera of
Morbus
as
Bengal, by James
it visited the TerriJameson.
on the Hepatitis and Spasmodic Affections Girdlestone, M.D. Loudon. 1787. Alle Indie Orieutali, p. 350., J Viaggio ? Scott's Madras Reports on Epidemic Cholera, p. vii. Scott's Madras y Reports, p. iv.
t Essays J.
on
subject
in
Calcutta, India, by
June 1,
THE ACTION OF COBRA POISON.?BY J. FAYRER.
1868.]
123
I conceive this, therefore, to be a history, though far from a cidental remark of Dr. Duncan, made five years after the occurdetailed one, of the first wave of epidemic cholera which passed rence, and had most fortunately been able to refer to Dr. the medical returns of the corps never could over India since the English occupied the country ; and it seems Cruickslianks, that the reason for our not clearer indications of the have led to the knowledge of it. Hence, as already observed,
possessing
though cholera very rarely appears in the sick returns of former hardly recognised as cholera. Moreover, it was not till 1786 times, it is by no means to be thence inferred that it did not that the Hospital Board was established in Bengal and Madras, then exist."* We are, I think, therefore justified in arriving at the conclubefore which period no returns of the sick were made. Mr. Scott adds, that the reports from that date up to 1802 were kept in sion that it was nothing new for cholera to spread over India in Our possessions in India also, prior to 1781, an epidemic form prior to 1817 and 1819. The nature of the no regular order. were surrounded by vast arrears of unsubjected country, beyond disease was then fully recognised, and the country subjected which the course of the epidemic could not possibly be traced; to our rule, so that British Officers were for the first time in a but the details above given are, nevertheless, important, as in- position to report upon the cholera as it affected the natives of dicating the fact that, within twenty-four years of the battle of the country.f {To be continued.) Plassey, we have evidence of a wave of epidemic cholera passing over a considerable portion of India. During the month of October, 1787, epidemic cholera committed terrible ravages at .Arcot and Yellore. With regard to this outbreak, Mr. Davis, a member of the Madras Hospital Board, remarks:?"I found in what was called the Epidemic Hospital, three different diseases, viz., patients labouring under cholera morbus, an inflammatory fever, with universal cramps, and a spasmodic affection of the nervous system, distinct from cholera morbus. I understood, from the Eegimental Surgeon, that the last disease had proved fatal to all who had been attacked with it, and that he had already lost twenty-seven men of the regiment in a few days. Five patients were then shown to me with scarce any circulation whatever to be discovered; with their eyes sunk within the orbit; jaws set, bodies cold, and extremities livid." They were being treated with castor-oil.* During the year 1790 cholera was very prevalent again in Ganjam; in 1794 at Yellore, where it was described as the circumstances of the disease arises from the fact that it was
"
Causis." From the returns
kept in the Office of the Bengal Medical
Board
during early part of the present century, and which relate exclusively to the European troops, I find that in 1808 five cases of cholera are reported,?one at Meerut, one at Delhi, another at Muttra, and two in Calcutta. In 1809 three cases occurred, and in 1811, 1812, 1813 no less than seventy-nine cases of cholera are reported as having taken place at Chunar, but not a single one from any other station in the Presidency. During the year 1814 instances of cholera occurred at Cawnpoor, Nagpoor, Benares, Meerut, Dinapoor, and the Presidency; in all forty-six cases, and eleven deaths. These are the first deaths reported from this disease among our European troops in Bengal. In 1815 and 1816 there were no cases of cholera; and in this Presidency only two cases occurred among the troops at Benares in 1817, although the disease was raging throughout the whole of Bengal, showing that statistics, drawn simply from the reports of our European troops, are hardly to be relied the
?upon It
as a
criterion of the existence of cholera in India.
appeared
in
a
crowded barrack in Fort
William,
in
1814,
among recruits just arrived from England,-f and in an epidemic form at Jaulnah during the same year. With regard to this
outbreak, Dr. Cruickshanks subsequently explained (in 1831) that I entered these cases in the Hospital Keturns as bowel complaint in. 1814, because the matter ejected by vomiting and stool was of an aqueous or mucilaginous consistency, containing no bile." Mr. Scott observes with regard to this report:? "This paper of Mr. Cruickshanks is of great importance, "
inasmuch hitherto
as
it evinces that cholera did exist to to have occurred at so recent
suspected
an a
extent not
date,
and also
that, even under these circumstances, no trace of it is found in the public records; for, unless we had been guided by the in*
Report, p. xii. Concise Narrative of Parts connected with the Disease which t ccurred in the District of Jessore, by B. Tytler: Calcutta, September, 1817. Printed by C. M. Pratt aad Co. Scott's A
Scott's Report, p. xi. t Prior to 1760 tho Company's territories in India were confined to an area containing some 15,000 square miles. In 1765 the Company acquired command over Bengal, but not till 1775 over the zamindari of ?
to 1799 the Hizam's came under their rule;
territory, the Carnatic, in 1801 Bundeikhund; in 1802 Kuttack and Balasore ; the Duab, Delhi, and Ahmadnuggar in 1803 j Gujrat in 1805 j and Kumdon, Sagur, Ruttiab, and Darwar in 1817. Benares.
From
1792
GoraVpoor, and Bareilly
