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Rise and Progress of Pestilential Cholera.

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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. In 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.

1

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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Origin of Pestilential Cholera in several Places.

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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.

was altogether unusually wet. During the first six months of this year, the endemic Cholera Morbus had shown itself sooner, and prevailed more extensively, than in former seasons.

The work of Mr. Orton, and also the Calcutta Report, give the fullest information as to the exceeding insalubrity of the year 1816 and beginning of 1817, throughout Bengal. The details will be found exceedingly interesting by every one who wishes to make himself thoroughly acquainted with the entire history of the great epidemic of this year.

It will be afterwards seen that the outbreak of the disease in other countries was very generally preceded by a greater amount than usual of sickness, more especially of diarrhoea and other bowel complaints, among the inhabitants.

We are now ready to examine the evidence adduced by our author in proof of his position that Infection has been the principal agent in the diffusion of the Pestilential Cholera. In commencing his investigation of the subject, he assures us that, from the very first," his mind was entirely unbiassed, and desirous of adopting that view of it which well-ascertained facts should most fully support.' We doubt it not; and all that we ask of him is to concede the same degree of candour and honest intention to those who may differ from him.

He first of all appeals to the evidence contained in the three official Reports from Bombay, Calcutta, and Madras-so justly characterized by him as the "original sources for information as to this and various other topics; because the opinions of the Indian reporters were generally derived from an extensive and varied experience of the disease during a number of years, and they were certainly not biassed in favour of contagion (infection)— that being a property which the diseases of India seldom present"-to which we have already so often referred. All these, he remarks, "favour the infectious nature of the disease more or less." He goes on very frankly to admit that "it is quite true that a majority of the surgeons and assistant-surgeons in India, who sent reports to their respective medical boards, state that they do not believe the disease infectious;" but then, says he, 66 a large number of them give a very different opinion, whilst the reasons, assigned by many for believing the disease to result from other causes than infection, are actually favourable to the existence of an infectious property;"-a remark, by the bye, not very complimentary to the sagacity of those gentlemen who witnessed the facts which they undertook to commemorate. But let that pass; and let us now look with 'unbiassed' minds at the more important statements in the three official reports to which so much importance is justly attributed by Dr. C.

That from Bombay was published in 1819, that from Calcutta in 1820, and the one from Madras in 1823. The members of the Medical Board in the first of these Presidencies, after candidly admitting that “ they are aware of the doubtful nature of the ground on which they tread," adopted the following conclusion, which, we need scarcely say, is prominently brought forward by our author.

"It appears to them incontrovertible that this disease is capable of being transported from one place to another, as in cases of ordinary contagion or infection, and also to possess the power of propagating itself by the same means that acknowledged contagions do-subject, however, to particular laws, with which we

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may never become acquainted-that is, by the acquisition of fresh material with which to assimilate."

The reporters, in another passage however, remark with great fairness and propriety, that the doctrine of the Infectiousness of the Cholera is a question of the greatest importance and ought not to be hastily entertained as proved, nor rejected as unfounded; but prosecuted with that diligent enquiry and cautious induction which on every subject of science are so necessary to the attainment of truth: and we entertain a confident hope that the wide range through India which the disease has taken, will have afforded to some gentlemen more ample means of determining it than we possess." We shall see, as we proceed, the result of subsequent researches on this very point among the medical men of India.

After quoting the above general conclusion of the Bombay Board, Dr. C. next adduces the testimony of an unprofessional gentleman, which, as a matter of course, cannot carry much weight, and then that of several medical officers, whose evidence he considers to be highly favourable to the doctrine of the infectious nature of the epidemic. The following is a part of this evidence :

"Dr. Taylor reports, that whenever the disorder appeared in any particular spot or family, a considerable proportion of the family or neighbours were attacked within a very short period of each other; on many occasions I have seen three or four of a family, lying sick at once.' Dr. Burrell informs us that, in the short space of six days, every attendant, in his hospital, on the patients affected with cholera, had the disease. And Mr. Craw states, that every one of the attendants, thirty in number, in the hospital of the 65th regiment, were attacked.”*

Now, may it not be very reasonably conjectured that, in many of these instances at least, the disease was caught quite independently of direct infection from the sick, seeing that there prevailed at the time in the affected localities an epidemic disease, which is described by another of the reporters as "creeping from village to village, raging for a few days, and then beginning to decline." The very same sort of evidence might be adduced to prove the infectiousness of Influenza, if the mere circumstance of many members of a family lying ill at the same time be considered as any thing like satisfactory proof; and if we are to attribute the sickening of every one, without exception, of the attendants in the hospital of the 65th regiment to direct transmission of the disease, then indeed must Cholera be vastly more virulently infectious than the very worst forms of Smallpox or Scarlatina. But that little importance is to be attached to the point so prominently urged by Dr. Copland is tolerably clear from the circumstance that Dr. Taylor-whose evidence has been adduced by him in favour of infection-expressly tells us that scarcely any of his hospital attendants were attacked. Some of the other gentlemen bear testimony to the same effect. Mr. White, for example,

* Neither of those gentlemen, however, it is worthy of notice, expressed themselves convinced of the infectiousness of the cholera. The former merely stated that "he would be cautious in reporting the disease not infectious;" while the latter was unwilling, he said, to express any decided opinion upon the point in question.