spasms, cold sweats and thirst increased with the vomitings.

*

*

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

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 faet. 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

1847.]

Epidemic Spasmodic Cholera.

465

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. In the Bengal Report, we are informed that

"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.