broad and more general bearings. They seem to have been examining the eddies by the shore, and to have forgot all the while to watch the great current of the ocean stream.

With the view of keeping our readers' attention steadily directed to the topic most worthy of consideration, we shall occasionally in the sequel employ the terms "importationist" and "non-importationist," in place of those of "infectionist" and "non-infectionist," in more common use.

Having cleared our way of any difficulties arising from the ambiguity of certain technical expressions, we should now at once proceed to examine the arguments adduced by Dr. Copland to show that pestilential cholera is not only essentially and primarily communicable from one person to another, but also that its wide diffusion and extension have been chiefly attributable to this property of infection. But, before we can do this with any advantage, we must first investigate a point in the history of the disease on which our author dwells with great emphasis, and the right determination of which is very intimately connected with our ulterior enquiries. Dr. Copland divides Cholera into three species; 1, the bilious; 2, the flatulent; and 3, the spasmodic, or mort de chien of East Indian writers; while what has been generally termed the Epidemic or Pestilential disease is declared by him to be not Cholera at all, but a distemper that is sui generis, essentially and fundamentally distinct not only from the various species of Cholera now enumerated, but also from all other diseases, and which he proposes to designate by the appellation of " Asphyxia pestilenta." He employs indeed the term of Choleric Pestilence; but only for the sake of convenience. Now the main question comes to be, how are we to distinguish between the malignant or aggravated form of endemic Asiatic Cholera, so well known to, and so well described by, many E. Indian writers during the latter part of last century and the beginning of the present one, and this pestilential disease, which Dr. Copland considers to be of very recent origin and of an essentially different nature.

Let us

see what he says upon the subject; and, first of all, we shall look at the definitions which he has given of these two fundamentally-distinct disorders.

Spasmodic Cholera" is defined thus: vomiting and purging of watery matters, without any appearance of bile; spasms violent and extending generally through the frame; (it is subsequently said, "spasms of a violent, painful, and tonic character, attacking the muscles of the abdomen, thighs, legs, thorax, and lastly the arms and hands;") speedily followed by sinking of the powers of life. This disease is endemic in some inter-tropical countries. Sometimes, Dr. C. says, it has prevailed epidemically; and then he admits that it "nearly approaches" the pestilential disease; viz., the Asphyxia pestilenta. He does not consider it to be infectious. Let the reader particularly mark this point.

On the other hand, the definition of the "Pestilential Disease" stands thus:"Anxiety and oppression in the chest, epigastrium and præcordia; disturbance of the bowels, with nausea, faintness, giddiness, and depression of vital power; frequent ejections of an offensive fluid, resembling rice-water, from the bowels and stomach, followed by spasms, tremours, distress; a cold, clammy, purplish, and shrivelled state of the surface; coldness and rawness of the expired air; a sense of painful or burning heat at the epigastrium, with

1847.] Difference (?) between Spasmodic & Pestilent. Cholera. 461

urgent thirst, and rapid disappearance of the pulse; the distemper being often preceded by indigestion and diarrhea, and frequently followed by febrile reaction, affecting chiefly the brain and abdominal organs."

The one definition is certainly considerably fuller than the other; but where, it will be asked by many, is the material difference between them? In the latter, the general appearance of the patient, the state of the surface of the body, and the rapid sinking of the pulse are made prominent characteristics; but then, if we turn to Dr. Copland's own description of the bad cases of the Spasmodic Cholera, what do we read?

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"In the course of a few hours," says he, "the features shrink, the hands and feet become cold and clammy, the exacerbation of the spasms force out a cold clammy sweat on the face and breast, the pulse is extremely small and weak, or nearly disappears;-in a case which came before me in Africa in 1816, the pulse could scarcely be felt four hours from the attack. The powers of life fail very rapidly; the eyes sink and are surrounded with a livid circle; the countenance assumes a remarkably anxious cast, or is pale, wan and shrunk; and the spasms extend to the very fingers. The breathing now becomes extremely laborious; the patient is restless, and at last is carried off, sometimes in the space of ten or twelve hours."

The accuracy of Dr. Copland's description is well shown by comparing it with the accounts left us by Curtis, Girdleston, Duffin, and other medical men who wrote upwards of seventy years ago. Take that of Curtis, a naval surgeon, writing of the mort de chien, or the malignant endemic cholera, at Trincomalee in 1782:

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"In all of the cases, the disease began with a watery purging, attended with some tenesmus, but with little or no griping. This always came on some time in the night, or early towards morning, and continued some hours before any spasms were felt. The purging soon brought on great weakness, coldness of the extremities, and a remarkable paleness, sinking and lividity of the whole countenance. Some at this period had some nausea and retching to vomit, but brought up nothing bilious. In a short time, the spasms began to affect the muscles of the thighs, abdomen and thorax, and lastly they passed to those of the arms, hands and fingers. The hands now began to put on a striking and peculiar appearance. The nails of the fingers became livid and bent inwards; the skin of the palms became white, blanched, and wrinkled up into folds, as if long soaked in cold water. All this while the purging continued frequent, and exhibited nothing but a thin watery matter or mucus. In many, the stomach became at last so irritable that nothing could be got to rest upon it; but every thing that was drank was spouted out immediately, without straining or retching. The countenance and extremities became livid; the pulsations of the heart more quick, frequent and feeble; the breathing began to become more laborious and panting; and, in fine, the whole powers of life fell under such a great and speedy collapse, as to be soon beyond the power of recovery."

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Girdleston has described with equal accuracy the disease as observed by him in the naval hospital at Madras, in the course of the same year, 1782. One passage in his description is remarkable.

"The hands and feet generally become sodden with cold sweat; the nails livid, the pulse more feeble and frequent, and the breath so condensed as to be both seen and felt, issuing in a cold streim, at a considerable distance. The thirst was insatiable, the tongue whitish but never dry; vomitings became almost incessant; the No. 108 30

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spasms, cold sweats and thirst increased with the vomitings.

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remissions."

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Some died in the first hour of the attack; others lived a day or two with

It would be easy to adduce from other writers descriptions of the mort de chien, corresponding in almost every particular with the definition of the pestilential disease given by Dr. Copland. But this must surely be unnecessary after the preceding details. We shall therefore only allude to the published evidence of one or two gentlemen who were in India for several years before, as well as after, the outbreak of the great epidemic of 1817 at which period our author supposes that his "Asphyxia pestilenta" first manifested itself,-and who must therefore have been fully competent to judge of the question under consideration.

"The disease in the 9th Reg. N. I. in 1814," says Mr. Duncan, in a report, dated September 1819," resembled in every particular (with the exception of the heat at the præcordia) the Cholera at present so common, although it could not be called epidemic."

Mr. Cruickshank has given a more minute description of the disease of 1814. The following is an extract from a report that was sent in by this gentleman to the Madras Government.

"When taken into hospital," Mr. C. observes of the first cases he saw, "they exhibited all those symptoms, now so well known, of persons labouring under the advanced and fatal stage of Epidemic Cholera; the skin cold, and covered with cold perspirations; the extremities shrivelled, cold, and damp; the eyes sunk, fixed, and glassy, and the pulse not to be felt. These persons all died, and I find, on referring to such notes as I have preserved, that, influenced by consideration of the vascular collapse and total absence of arterial pulsation, I had denominated the disease Asphyxia. Many sepoys were brought into hospital in circumstances approaching to those above detailed. Of them, in a considerable proportion, the disease terminated fatally. Thus the cases which I first saw of this malady, in the aged among the camp-followers, differed in no respect from the worst cases of that affection since so well known under the name of Spasmodic Cholera. That name, however, I did not adopt, neither in my public reports nor in the private notes which I took at the time. In this I was chiefly influenced from considering the nature of the matter ejected by vomiting and by stool, which in cholera is said to consist of bile, but which in these cases was aqueous or mucilaginous. Besides, it was evident that the diluent treatment, recommended in cholera, would never be applicable to such a disease as that with which I had to contend. I continued, therefore, to employ in my reports the term bowel-complaint,' both because I found it in the hospital-books on joining the corps, and because, if it conveyed no very precise idea of the malady which it was meant to designate, it was at least an appellation whence no erroneous impressions could be derived."

After the perusal of these extracts-and they might easily be multiplied if need were few readers, we should suppose, will be able to discover for themselves the diagnostic differences of two diseases, which are, however, declared by our learned author to be essentially distinct from each other. That he should, notwithstanding such evidence (with which he must be perfectly well acquainted), heroically maintain that there is "a marked distinction" between the malignant form of endemic Cholera, known by the name of the mort de chien, and the epidemic disease which has attracted so much notice for the last 30 years, seems indeed very sur

1847.[ Difference (?) between Spasmodic & Pestilent. Cholera. 463 prising. Yet, he confidently assures us that he is fully convinced of the fact. Nay, he does not hesitate boldly to declare that in the correctness of his opinion-viz. that the former disease does not exhibit the pathognomonic symptoms of the latter-"he is borne out by the experience of every well-informed and candid observer, who has seen the disease in this country." Strange assertion!-from one, too, who has never witnessed a single instance of Spasmodic Cholera in the East Indies, and in the very teeth of such men as Dr. Johnson and Mr. Ranald Martin-not to enumerate a host of other Oriental authorities-who have expressly declared the very contrary in their writings. Indeed, we in vain search for any testimonies among our East Indian practitioners in support of this singular dogma of Dr. Copland. On this ground alone, therefore, we might very fairly declare it to be utterly erroneous. But, as the correct solution of the point at issue has a very direct bearing upon the still more important question of the alleged infection (the importable infection, be it always remembered) of the disease, we are disposed to devote a page or two more to the subject, with the view of giving an ample opportunity to our author to produce his reasons for the singular opinion which he has adopted. In the section on the Diagnosis of the Pestilential Cholera, we come to the following passage:

"In the Spasmodic or severe form of sporadic* Cholera, the discharges from the stomach and bowels are certainly either not coloured by bile, or but little, excepting at the commencement, and when the disease begins to yield; but they are accompanied with a different train of symptoms. The spasms are more tonic, and confined more to the muscles of the abdomen and of the thighs and legs, than in the Pestilential disease: and, in the former, the vertigo, deafness, headache, marked affection of the respiratory function, and of the circulation, characterizing the latter, are entirely wanting.

"In sporadic or Bilious Cholera, the very dark, thick, and ropy appearance of the blood; the cold, wet, and shrivelled state of the surface, and its leaden, dark, or purplish colour; the almost total absence of pulse at the wrist; the very marked and rapidly increasing collapse of the powers of life; the disagreeable and earthy colour of the body, even during the life of the patient; the burning sensation between the scrobiculus cordis and umbilicus; the complete arrest of the glandular secretions; the cold tongue and mouth; and the coldness of the respired air, which characterize the Pestilential disease, are entirely absent.”

It is scarcely necessary, we should think, to offer any comments upon these remarks. No one requires to be told how to distinguish the pestilential from the common bilious form of Cholera: the difficulty lies in distinguishing the former from the spasmodic or malignant form of the endemic disease of the East Indies. We doubt much whether "the vertigo,

*The epithet "sporadic" cannot be correctly applied, at least by Dr. Copland, as a distinctive appellation of the malignant endemic Cholera; for he has already admitted, on the one hand, that this disease occasionally prevails epidemically, and, on the other, that the Pestilential disease sometimes appears sporadically. It would almost seem from this misapplication of the term by our learned author that, in spite of his strong prepossessions to the contrary, he had unconsciously been led to recognise the truth of the general opinion, that Malignant Cholera and his new Pestilence are one and the same disease; the former being its sporadic, the latter its epidemic form.

deafness, headache, marked affection of the respiratory function and of the circulation," that are alleged to be characteristic of the former, will much assist the practitioner at the bed-side of his patient. As to the gratuitous assumption that " the absence of the bile" in the one disease "is to be imputed to spasm of the common biliary duct rather than to a suppression of the secreting and excreting functions, whilst in Pestilential Cholera, these functions are altogether arrested," it is quite obvious that it will never do to rest a diagnostic discrimination upon any hypothetical distinctions. We must look at facts, not fictions, in forming an opinion upon such a point. Now, what says our author himself-not to quote any foreign or intrinsic authority-upon the necroscopic state of the biliary organs in these two diseases, that are said to be "different in all their relations"? In the description of Spasmodic Cholera, given at page 322 of the 1st vol. of the Dictionary, we are told that, "in fatal cases, the liver has been found congested, the gall-bladder and hepatic ducts filled with dark-coloured inspissated bile ;" and at page 106 of the 3rd volume, in the account of the post-mortem appearances of the Pestilential Disease, we read that "the liver is generally pretty full of dark-coloured blood; the gall-bladder often much distended with tenacious ropy bile, of a dark yellow or green colour." Where, pray, is the difference between these two statements? Dr. C. adds, "the urinary bladder is always contracted and empty." The same necroscopic appearance was observed in fatal cases of malignant Cholera 70 years ago; for we are expressly informed by Mr. Davis, who was a member of the Madras Hospital Board in 1787, that "the bladder was most singularly contracted, and did not exceed in size a large nutmeg."

There is another alleged diagnostic mark upon which Dr. C. lays much stress. He says: "The secondary fever and consecutive phenomena, which follow upon the cold and blue stage of the malady, also furnish remarkable proofs of dissimilarity between the Pestilence and the severe forms of Cholera observed in hot countries............ After these latter, the patient recovers without any consecutive disease, and frequently the tumult of the frame leaves it benefited by the changes it induces; but, in the present pestilence, the consecutive states of the disease are as dangerous as the blue stage." Now, Dr. Copland does not require to be informed that the secondary fever, to which he alludes, was of infinitely greater frequency in Europe than in India; and, indeed, this very circumstance has been particularly dwelt upon by almost all writers on the subject, as one of the most prominent features of difference between the disease as seen (more especially on its first outbreak) in its primary and indigenous seat in the East; and when it became transplanted into more temperate climates, it appeared to assume something of the type of the endemic fevers of the countries which it visited. Without pursuing this subject, we shall merely give one short passage from the Madras Report in confirmation of the first clause of this sentence.

"When medical aid is early administered, and when the constitution is otherwise healthy, the recovery from an attack of (epidemic) Cholera is so wonderfully rapid, as perhaps to be decisive of the disease being essentially unconnected with any organic lesion. In natives of this country especially, in whom there is ordinarily very little tendency to inflammatory action, the recovery from Cholera is