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generally so speedy and perfect that it can only be compared to recovery from syncope, colic, and diseases of a similar nature; but in Europeans, in whom there is a much greater tendency to inflammation and to determinations to some of the viscera, the recovery from Cholera is by no means so sudden or so perfect."

We have already seen that Dr. C. admits that the Spasmodic Cholera or mort de chien sometimes prevails epidemically, and that then it approaches very nearly to the pestilential disease of 1817. As the admission of this circumstance is of very material consequence in investigating the true nature of the latter, it may be worth while to adduce one or two authentic instances of the fact mentioned, in the way of illustration. the Bengal Report, we are informed that

In

"A division of Bengal troops, consisting of about 5000 men, was proceeding, under the command of Colonel Pearse of the Artillery, in the Spring of 1781, to join Sir Eyre Coote's army on the coast. It would appear, that a disease resembling cholera had been prevalent in that part of the country (the Northern Circars), some time before their arrival; and that they got it at Ganjam on the 22nd March. It assailed them with almost inconceivable fury. Men, previously in perfect health dropt down by dozens; and those even less severely affected were generally dead or past recovery in less than an hour. The spasms of the extremities and trunk were dreadful; the distressing vomiting and purging were present in all. Besides those who died, above five hundred were admitted into hospital on that day. On the two following days, the disease continued unabated, and more than one half of the army was now ill. In a note it is added, 'the occurrence of the disease on this occasion is noticed in a letter dated 27th April, 1781, from the Supreme Government to the Court of Directors; and the destruction which it caused in this detachment mentioned in terms of becoming regret.'

"After adverting to its progress in the Circars, the letter thus proceeds: The disease, to which we allude, has not been confined to the country near 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 abated, and pursuing its course to the northward.' It would have been interesting to have traced this disease, as it seemed to have put on the Epidemical form, but every attempt to discover its further progress has proved fruitless."

In the same Report it is stated, that, " in the month of April 1783, Cholera destroyed above 20,000 people assembled on occasion of a festival at Hurdwar." Sonnerat, in his travels, alludes to an epidemic which very closely resembled the recent pestilence, and which, in one visitation, carried off above 60,000 persons from Cherigam to Pondicherry! "The Indian physicians," he says, "could not save a single person." Mention is made by this author of a still more destructive outbreak of the pestilence, two years later. Whoever reads his narrative cannot hesitate for a moment in recognising all the characters of Epidemic Cholera.

After quoting several other instances of a similar nature, Mr. Ranald Martin very emphatically remarks:

"It thus appears clearly that Epidemic Cholera prevailed at various remote periods, and at many of the principal stations throughout British India, sometimes coming as a wide-spread pestilence, and, at others, deso

lating only particular localities." Yet in spite of all this, Dr. Copland does not hesitate to declare "that the accounts, which we possess of the epidemics and pestilences which have ravaged various countries (Hindostan, among the number; Rev.) in former times, do not furnish us with the history of any disease which may be considered as identical in its nature with this pestilence; and that it must, owing to this circumstance, and to the uniformity of its characteristic phenomena, be viewed as being of modern origin (1817), and sui generis." Now, we are not surprised that Dr. C. so resolutely maintains the position which he has taken up; as it is quite obvious that, having admitted (as he has done) that the spasmodic Cholera of the East is not infectious, he would be obliged, by the very force of common consistency, to view the Pestilential disease in the same light, if there be in truth no essential difference between the two maladies. We are quite willing to leave the facts already quoted, and the inferences plainly deducible from them, to speak for themselves.

Before, however, quitting this part of our subject, it may not be amiss to remind our readers that a malignant form of Cholera, resembling in most respects the endemic disease of the East, was not uncommon in this country in the time of Sydenham, who has described it with his usual accuracy. After relating its symptoms, and mentioning that it was almost invariably limited to the month of August, he very pointedly alludes to the marked difference between it and the more common bilious form of cholera, such as is met with at other times of the year; "as if," says he," there lay concealed some peculiar condition of the air of this particular month (August), which is capable of communicating either to the blood or the ferment of the stomach a sort of specific alteration, adapted only to this disease." It is worthy of notice that the Bombay Report alludes, in very emphatic terms, to the resemblance in the features of the disease depicted by our English Hippocrates, and those of the epidemic from which India was at that time (1819) suffering; and Mr. Martin likewise has taken an opportunity of remarking that "many of the cases described by Sydenham would seem to have been of the true spasmodic nature."

The pernicious Intermittent Fevers also, so faithfully pourtrayed by several of the older physicians, occasionally exhibited a train of symptoms that bore a very close resemblance to those of malignant Cholera. It is impossible to read their descriptions without being struck with this resemblance, and admitting that the idea of Dr. Negri-"that the malignant cholera of our days belongs to the same class of diseases which was seen by Mercatus in Spain, Torti in Italy, and Morton in England"—is not entirely fanciful. But we have not to go so far back to find records of cases, exhibiting most, if not all the features of Spasmodic Cholera. Without making any extracts, we may allude to the description given by Frank at the beginning of the present century, of what he calls "intermitting Choleric Fever;" also to the account of an Epidemic Cholera at Leeds in 1825, by Messrs. Thakrah and Dobson, in the Number of the

* The Influence of Tropical Climates, &c., by James Johnson, M.D. and James Ranald Martin, Esq. 6th Edition, p. 306, 1841.

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Medico-Chirurgical Review for April 1832. We may likewise refer to the work of Dr. Ayre, published in 1833, for some illustrations of a similar fact.

As a useful preliminary to the examination of details touching the question of Infection being the principal agent in the propagation of the Choleric Pestilence, we shall here take a rapid survey of the most prominent circumstances connected with the rise of the great Epidemic of 1817, and of its subsequent diffusion over the greater portion of the habitable world. Dr. Copland's account of its origin is as follows:

"Pestilential cholera first made its appearance in Jessore, a populous town in the centre of the Delta of the Ganges, and cut off the majority of those whom it attacked. It spread from the town in all directions, and reached Jaulnah, on the Madras side of the Indian peninsula, in June, 1818, and Bombay in August of the same year. It continued to spread and to prevail throughout all parts of India and the adjoining countries, and still prevails in many districts, although in various degrees of severity, &c., with intervals of complete immunity from its presence. Indeed, it may be said to have become naturalized in India, forming one of the diseases of the country.”

He then tracks the subsequent course of the Pestilence in successive years; eastward to the Burmese empire, the kingdom of Siam, China, the Phillippine and other islands in the Indian Archipelago; and westward to Persia, Arabia, Syria, Judea and the Georgian frontiers of Russia. 1823, it had reached Astracan on the banks of the Caspian; beyond which it did not extend for the present. For five or six years subsequently, we know little or nothing respecting its progress; the pestilence seems to have been lying dormant in the regions to the southward of this great inland sea. All that we can say, with any degree of certainty, is that, in 1829, it suddenly broke out with great violence at Orenburg, a Russian town on the Tartar frontier, about 400 miles north of the Caspian and about 1000 miles distant from the places where it had prevailed extensively in 1823. It is universally admitted that no satisfactory explanation ever has been given of the source or causes of the unexpected outbreak at Orenburg: this is a point which seems to be conceded by all who have enquired into the subject. The pestilence continued in that town until February 1830, after which time it seems to have entirely ceased for several months in the Russian territory. In July, however, of this year, it appeared a second time at Astracan with intense malignity, destroying in twenty-seven days upwards of 4000 persons in the town, and of 21,000 persons in the province. It then ascended rapidly the Volga, and reached Moscow in September. It continued to spread westward and northward through Russia and Poland; also to Moldavia and Austria. In May 1831,* it reached Riga and Dantzig; in June and July, Petersburg and Cronstadt; in August, Berlin; subsequently Hamburgh, and at length, in October, it appeared upon our own shores at Sunderland. London was not visited until the second week of February in 1832. The disease appeared at Calais a month subsequently, and, a fortnight later, Paris was visited by the pestilence. In June of this year, it made its appearance at

* In this year also, it prevailed in Egypt epidemically at Cairo, where it proved very destructive; also at Smyrna and Constantinople.

Quebec and Montreal, and also in New York. In July, it spread to Philadelphia, and several other cities; thence to nearly the whole of North and South America. It was not until the latter part of 1833, that it reached Spain. It visited several parts bordering on the Mediterranean in 1834; and reappeared, in a very partial manner however, in London and some other places in this country, as well as on the Continent and in North America, in the same year. In 1837, it proved very destructive in Rome. "It spread," continues our author, "to various other countries not mentioned in this brief sketch between the years 1831 and 1837; and few places were entirely exempted from it, excepting those which were placed under strict quarantine." It is much to be regretted that Dr. C. has not particularized the places that enjoyed the immunity to which he here. alludes.

So much for the geographical history of the world-wide diffusion of the great pestilence of the 19th century-a history which will not fail to suggest, to the mind of the attentive reader, various reflections on the much vexed question as to what agency this diffusion was chiefly attributable. But we shall not say more upon this point at present; for we must recall the reader's attention, for a few moments, to the locality or regions whence the pestilence issued. We have seen that Dr. Copland, without hesitation, asserts that "it first made its appearance in Jessore, a populous town in the centre of the Delta of the Ganges." The reader might naturally suppose, from this simple and unqualified announcement, that the truth of the statement had never been questioned, and that no doubt has ever existed as to the exact spot in which the pestilence was generated, and from which it emanated to devastate the earth. Now, what do we read on this subject in the Calcutta Medical Report, that was drawn up with such elaborate care, and after the most sifting examination of a vast amount of evidence?

"It is certain that nothing could be more erroneous than this notion of the local origin of the Epidemic. For, not to speak of its frequent occurrence so early as May in some parts of Nuddea and other districts already adverted to, it is quite clear from the statements of the medical staff, written separately and without interchange of knowledge or communication, that, more than a month previously to Jessore's becoming affected, the disease had begun to prevail epidemically in the distant provinces of Behar and Dacca; and that, before the expiration of the first week in August, it had firmly established itself in many other parts of Bengal."

After giving a variety of details, which it is not necessary here to record, the editor of the Report continues :

"These facts are more than sufficient to show the fallacy of every theory, which attempts to derive the disease from any local source; or to trace it to any one particular spot, as the centre from which it was emitted to the surrounding countries. They prove, without the possibility of dispute, that it broke out in very remote places at one and the same time, or at the distance of such short intervals, as to establish the impossibility of the pestilential virus being, in this state of its progress, propagated by contagion (infection), or any of the other known modes of successive production; and that its general diffusion was therefore referable to some causes of more universal operation."

How can we resist such testimony as this, based too, as it is, on the most ample and satisfactory evidence obtained in the very region where

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the epidemic took its rise? Is it not rather singular that our author should not have even alluded to it? One might almost fancy that he supposed that the admission of the disease having sprung up in various places about the same time was somehow opposed to his favourite tenet of its being a new distemper, essentially different from any endemic disorder of the country in which it arose. But, however this may be, there cannot be a reasonable doubt, we should suppose, that the epidemic of 1817 did not commence in any one single and definite spot. Mr. Orton, whom we shall afterwards find that Dr. C. is happy to quote as an infectionist, has distinctly asserted that it was in the district of Nuddea, and not of Jessore, that the disease commenced. "It is, however, shown," says this most competent witness, "that this was far from being its sole local cause....... Such and so striking being the circumstances attending the rise of the malady, and its first and principal ravages all over lower Bengal, we may fairly infer that it was owing to this exaltation of the common causes of endemic or sporadic disease that it took on the epidemic and contagious form, and thus became capable of diffusing itself far and wide over the earth." A very important admission from an author whom Dr. Copland quotes with deservedly high commendation.

Dr. Johnson also, writing in 1832, expressed his opinion respecting the origin of the Epidemic Cholera in the following terms:

"It is clear to demonstration that the disease did not originate in Jessore; on the contrary, there is as good, indeed better, reason to suppose that it was carried to Jessore, than that it first broke out there. In truth, there is no proof that it sprung up in any one town, or even district; but, from some causes of which we are, and ever shall be, entirely ignorant, it was generated in the province of Bengal, in several places at the same time, and very probably under similar circumstances. Let what will have been its origin, it did not commence at Jessore, nor do we know at what place it did commence, and consequently any argument or train of reasoning founded on such assumption is utterly baseless."*

It would also be leaving a very inaccurate impression on the reader's mind-one, too, at variance with the history of almost all other devastating pestilences-if we were to suppose that the great Indian Epidemic of 1817 broke out all at once, and without premonition, "like a thief in the night." It was not so. The preceding year (1816) had been unusually sickly. An aggravated form of Remittent Fever prevailed epidemically in the upper provinces of India, and occasioned such mortality as "surpassed any thing on record in the medical annals of Bengal." In many native villages the whole population was ill, and shops were shut for want of people to attend them; the banks of the rivers were at all times covered with the dying and the dead; in Cutch and in Scinde, several cities were said to be so depopulated that the living were unable to bury the dead. It would seem, also, that great mortality prevailed among the horned cattle.†

The Spring and Summer of 1817 presented singular deviations from their ordinary course. The rains set in earlier than usual, and the season

*Medico-Chirurgical Review, No. 33, p. 78.

Vide Medico-Chirurgical Review for July, 1832, p. 74.