higher up the river were comparatively fewer. In Agra the deaths did not exceed 10 daily, although the town contained 30,000 people. Not 500 in all died in Muttra ; and about a like number died in the immense city of Delhi. About 1819 there was prepared for the Indian Gov. Report on the Epidemic Cholera Morbus in the Presidency of Bengal in the Years 1817-18-19, by James Jameson, Esq. This is the document from which we have already quoted. In 1819 there was pub. in Bombay: Reports on the Epidemic Cholera of Hindostan and the Peninsula of India since 1817. In 1824 there was pub. in Madras: Report on the Epidemic Cholera as it appeared in the Presidency of Fort St. George, drawn up by Wm. Scot. This contains an appendix of sick returns and meteorological tables. In 1827 Mr. K. H. Kennedy pub. in Calcutta: Notes on Epidemic Cholera. We next hear of the Cholera in Persia in 1821; and at Astrakhan in Sept. 1823. There was every reason to believe that it was being brought westward by the caravans. Several local epidemics occurred in Persia between the years 1823 and 1830. The city of Ispahan issued orders to the caravans to pass in another direction, by Yezd; they did : Yezd had a C. visitation-Ispahan escaped. Teheran, the seat of Gov. of all Persia, was vigilant at first, and escaped; it relapsed, and had a severe visitation in 1829. C. was now on the highway to Russia, where we hear of it in the following year, 1830. It was said to have derived new force this year on the western shores of the Caspian Sea. It ravaged Germany in 1831. The city of Vienna, and the Austro-Polish province of Galicia, suffered severely from this visitation. In the former, in 18 weeks, 411 deaths occurred out of 690 cases within the city, and 1547 out of 3000 attacked in the suburbs. In Galicia 97,770 are reported to have died out of 260,944 attacked. The Austrian Gov. has pub. a seemingly circumstantial account of this visitation. The divisions of Prussia eastward of the Vistula suffered severely. In its march from Asia through the Continent of Europe it has been computed that the C. carried off more than 900,000 lives. It was still on the march; and ultimately encircled the world, in the language of Dr. Farr, "destroying men wherever it found them in circumstances that lent it power." In 1831 the following documents regarding C. were pub.: (1) Rapport sur le Cholera Morbus Pestilentiel, par Alexandre Moreau de Jonnès, with map (Paris); (2) Rapport de 1 Académie Royale de Médecine sur le Cholera Morbus (Paris); (3) Rapport sur le Choléra Morbus fait à la Société de Médicine de Lyon, par L. P. A. Gauthier (Lyons); (4) Observations sur le Cholera Morbus recueillies et publiées par l'Ambassade de France en Russie (Paris). About this date Dr. Kennedy pub. his Hist. of Contagious Cholera, which reached a 3rd ed. in 1832, and from which last ed. we have quoted. The first appearance of this modern C. epidemic in Gt. Brit. was at the village of Team, near Gateshead, in Aug. 1831. It appeared in Sunderland on 24th Oct. same year, and visited Edin. on 22nd Jan. 1832. One week later, and it had commenced its ravages at Rotherhithe and Limehouse, in the East Lond. district. It was afterwards reported that 48 deaths occurred from C. in Lond. in 1831. It did not appear in Dublin until 3rd March, 1832. The Lond. Gazette of 21st Oct., 1831, announced the precautions to be taken against the spread of C. These were mainly the estab. of a Board of Health in every town, to correspond with the Board in Lond., and to consist of magistrates, clergy, and two or three of the faculty of medicine. Large towns were to be divided into districts, with committees of inspection. Cleanliness and free ventilation were strongly recommended; the immediate burning of old rags, paper, cordage, clothes, hangings, etc.; the copious use of soap and water to furniture, clothes, and person; chloride of lime and water to drains and sinks, etc.; hot lime wash to the walls and roofs; and every particle of filth to be carefully removed. On the 13th Feb., 1832, a notice was issued from the Council Office, at Whitehall, announcing that fatal cases of C. had occurred at Rotherhithe, and spread indescribable alarm through the metropolis. All the horrors which Defoe had depicted of the Great Plague rose before the imagination. The physicians were divided in opinion; some contending that no new disease existed, and that it was not contagious. The ravages of the disease were considerable during Feb., March, and April, and then abated; but it again burst forth towards the end of the summer with more violence than ever. The pub. of the weekly B. of Mort. was suspended. On the 2nd Sept. the number of cases reported to the central board, exclusive of Lond., was 68,855, and the total deaths 24, 180. By the end of Nov. the disease had died out in Gt. Brit., but it had then reached the Canadas and U.S.-Wade. The suspension of the weekly B. of Mort. appears at first sight to have been a very remarkable proceeding; seeing that the Bills, as we have already fully shown [BILLs of MORT.], were originated for the very purpose of giving information regarding the ravages of the Plague. Assuming the statement to be true, and we take it from Wade [Wade's Brit. Hist. Chronologically Arranged, 5th ed., 1847], an authority usually very accurate, it can only have originated in a knowledge of the fact that the returns furnished by the Bills were very defective, and calculated to mislead. We suspect, for many reasons, this to be the true solution. The Board of Health collected much information respecting this epidemic. A table was prepared showing the names of places attacked; the date of the first case: the date of the last case; the number of days' duration; the total deaths; the total recoveries; the proportion of deaths to cases; the pop., and the proportion of pop. attacked, and proportion of deaths. All the places were numbered on one of Arrowsmith's large maps. The T. and map are now in the library of Her Majesty; but copies are very properly deposited in the office of the Reg.-Gen. From these documents it appears that the number of deaths in "Lond. and its vicinity," between Feb. 14 and Dec. 18, 1852, were 5275-made up as follows: from 14 Feb. to 15 May, 994; from 15 June to 31 Oct., 4266; and for the remainder of the year, 15. The deaths in "the country" were returned as 26,101; the total deaths in Gt. Brit. standing therefore at 31,376. The deaths in Ireland up to 1 March, 1833, were returned as 21, 171-making total for U. K., 52,547. The deaths from all causes recorded in that year appear to have been very far short of what the real facts must have been; and therefore throw doubts upon all the figures. Dr. Farr points out, "The returns which the Board of Health in 1832 procured were voluntary, partial, and evidently defective. The pop. of the places in Gt. Brit. which made returns was 5,223,657: so it would appear the majority of the places in the country altogether escaped attack or notice." We shall have occasion to compare some of the figures of this period with those of 1849; and some points of very marked resemblance will be found. [See 1849.] Early in 1832 the aid of Parl. had been invoked, and a measure was passed, receiving the Royal Assent 20 Feb., 1832-2 Wm. IV. c. 10-An Act for the Prevention, as far as may be possible, of the Disease called the Cholera, or Spasmodic or Indian Cholera, in England. The preamble set forth : Whereas it has pleased Almighty God to visit the U.K. with the disease called the Cholera, or Spasmodic or Indian Cholera: and whereas, with a view to prevent as far as may be possible, by the Divine blessing, the spreading of the said disease, it may be necessary that rules and regulations should from time to time be estab. within cities, towns, and districts affected with, or which may be threatened by, the said disease; but it may be impossible to estab. such rules and regulations by the authority of Parl. with sufficient promptitude to meet the exigencies of any such case as it may occur. Be it therefore enacted, etc. And it was enacted that H.M. Privy Council might at any time issue Orders in Council to prevent the spreading of Cholera in England. The Act was a temporary one. It was renewed by 3 & 4 Wm. IV. c. 75, and then expired; other provisions having been made. The best records regarding this outbreak in Gt. Brit. were kept in Glasgow. On the 13th Feb., 1832-same day as in Lond.-the existence of C. in that city was officially announced to the Board of Health. A few cases had been believed to exist previously. The outbreak continued for a period of nine calendar months, and attacked, according to the returns made to the Board, 6208 individuals. The deaths according to the Mort. bills amounted to 3166. During the whole period of the continuance of C., diarrhoea was very prevalent among all classes; but among those in comfortable circumstances it was easily checked. Of the entire pop. I out of every 32 was attacked, and I out of every 67 died of it. In order to bring out the facts in the clearest possible light there was prepared the following: Table Exhibiting the Mort. in Glasgow in the Years 1831, 1832, and 1833, with the Increase of Deaths in 1832 at each period of life; and the number of Deaths from Epidemic Cholera at each age, distinguishing the Sexes: It is seen from this T. that the mort. of females by C. exceeded that of males by 328. The mort. of Glasgow at each period of early life, indeed at every age under 50, had uniformly averaged more among males than females; but from C. the female deaths at every period of life, with two exceptions, exceeded the males-the exceptions being at 2 years of age, when they were as 22 to 25; and at 85, when they were as 2 to 9. The following T., extracted from the B. of Mort. for 1832, gives the number of deaths from C. in each month: January... November... 25 February December March April May 87 264 229 June..... 196 44I 1222 243 334 Total 3166 Certainly one important result followed the obs. made in 1831-2. It was found that C. in its worst form was preceded by diarrhoea; and that this diarrhoea was sometimes in a mild form, in others a first stage of the disease. Now to arrest this diarrhoea is to prevent C., as to extinguish a spark is to prevent a conflagration. It is true (says Dr. Farr) that perhaps 90 cases out of a 100 of epidemic diarrhoea left to themselves go no further; but it is equally true that the 10 residual cases turn into Cholera if they are not treated in the first stage; and the fact that one of the 10, even with treatment, turns into C., does not invalidate the practice. In 1832 also a severe outbreak of C. occurred in Paris. 18,654 deaths were reported to have occurred between March and Oct. of that year. Under date 1849 in this art. we shall give a T. showing the monthly intensity of the epidemic on this occasion. In 1832 various important publications appeared regarding the C., viz. :-(1) A Warning and Admonition to the Brit. Public on the Introduction of the Cholera of India, by Sir Gilbert Blane, M.D.; (2) Report on the Chemical Pathology of the Malignant Cholera, by W. B. O'Shaughnessy; (3) Pop. Returns of 1831, with an Appendix as to Cholera Morbus in England in the 14th Century; (4) Rapport au Comte de Rigny sur le Cholera Morbus observé dans l'Inde, en 1829-30, par J. J. A. Souty (Paris); (5) Rapport à l'intendance Sanitaire de Rouen sur le Cholera Morbus à Sunderland, Newcastle, et les Environs, par Emile Dubuc (Rouen); (6) Relation Médicale de la Commission de Marseille envoyée à Paris, pour observer le Cholera Morbus (Marseilles); (7) Oficial Reports by Drs. Russell and Barry on the Cholera Spasmodica in Russia in 1831; (8) Report on Spasmodic Cholera by the Massachusetts Medical So. (Boston, U.S.). In 1833 was pub. by Sir Gilbert Blane, Bart., Select Dissertations on several Subjects of Medical Science, and therein some interesting obs. were contained regarding the nature and progress of the C. epidemic. In 1834 there was pub. in Paris, Rapport sur la marche et les effets du Cholera Morbus dans Paris et les communes rurales du Département de la Seine. In 1837 another outbreak of C. occurred in Rome, the Two Scilies, Genoa, Berlin, etc. We are informed, upon what appears good authority, that in the four months July, Aug., Sept., Oct., no less than 5419 deaths occurred in the Imperial city, out of a pop. not exceeding 156,000. In 1837 or 1838 Captain A. M. Tulloch and Mr. Henry Marshall, Deputy Inspector of Hospitals, prepared for the Sec. -at-War a Report on the Sickness and Mort. among the Troops in the West Indies. An abstract of that report, prepared by Captain Tulloch, was given in vol. i. of Statis. Journ., at p. 429 of which is the following: The negro race suffer to a much greater extent than white troops by epidemic C. When this disease made its appearance at the Bahamas, though none of the white troops died from it, there were 20 of the black troops cut off out of 62 attacked, and it ran very rapidly to a fatal termination. The same has been observed wherever the native troops in the East Indies have been attacked by this disease. In 1838, 331 deaths were regis. from C. in England, and no less than 2482 from Diarrhoea. A table at the end of this art. will show the deaths ann. from this date. In 1838 Dr. Boehm, of Berlin, pub. an able work on the C., which attracted much attention in Europe. About 1838 or 1839 Major Tulloch prepared a Statistical Report on the Sickness and Mort. among the Troops in the U.K. An abstract of this, prepared by Mr. J. W. C. Lever, is pub. in Statis. Journ. [vol. ii. p. 250], from which we draw the following: Epidemic Cholera.-During the 3 years that this disease prevailed, about 2.8 p. 1000 of the strength were ann. cut off by it. This epidemic appears to have exerted its fatal influence in all localities with undeviating regularity; for we have here instances of different bodies of troops quartered in various situations throughout the kingdom, and yet the proportion of deaths is within a fraction the same in all; but it did not prove equally fatal to all classes, the mort. having increased progressively with the advance of age, as is shown by the following T.: Aggregate strength of 14,103 7223 2229 37,439 Of 171 treated for this disease among the Dragoon Guards and Dragoons, 54 died, or about onethird of the whole number attacked. Among the other troops the proportion was much the same. In 1840 there appeared in the Journ. of the Statistical So. [vol. iii. p. 113], Report of a Committee of the Statistical So. of Lond. appointed to collect and inquire into Vital Statistics, upon the Sickness and Mort. among the European and Native Troops serving in the Madras Presidency, from the Year 1793 to 1838. From this we take the following: Cholera.-The Madras returns do not distinguish between epidemic and the milder disease of C. morbus; and it is stated, upon the best authority, that almost every sudden invasion of disease which proves fatal is classed under the head of C.-a fact which would tend to indicate a careless system of obs. similar to that which in this country so much swells the apparent mort. caused by apoplexy and consumption. It is therefore prob. that some portion of cases not belonging to this class are included under this head, and tend, in some degree, to invalidate the comparison between There can however be no doubt that this disease, in its this Presidency and other countries. most malignant form, is more general, and recurs more often, in the East Indies than in any other country occupied by Brit. troops. It attacks both Europeans and natives in greater numbers and with greater severity than in any other country, but not with equal force; for among the natives the admissions amount only to one-third and the deaths to one-half of those which prevailed among Europeans. In several of the countries occupied by Brit. troops the C. is happily a stranger. Among those in which it has hitherto appeared it has prevailed to the extent exhibited in the following T.; but as it has been only a transient visitor, and its ravages during the short period of its prevalence have been calculated as extending over the whole period examined, during the greater part of which the disease was almost, or entirely, dormant, the statement does not give a correct view of the intensity of the disease during the time of its prevalence. In Nova Scotia and New Brunswick, for instance, the In Canada it prevailed in epidemic only prevailed in 1834, when it cut off nearly 39 p. 1000 of the force; but this mort. extended over a period of 20 years makes the ann. average ratio only 1'4 p. 1000. 1832 and 1834, and the ratio of mort. during the 2 years was 22 p. 1000 of the mean force, although on an average of the whole period it was only 2'1. Ann. Ratio p. 1000 of mean Strength: Admis- Deaths. Madras Presidency. (Europeans) 27 7'6 Gibraltar ... (Natives) 9 4' 2.2 6 2'1 Ann. Ratio p. 1000 of mean Strength: Admis- Deaths. Nova Scotia and It appears to have occurred [in Madras] in an epidemic form among the European troops at 3 several periods during the 12 years, and to have prevailed at the same time among both classes of troops. The greatest mort. which it occasioned among the European troops was 2'24 p. 1000 of the mean strength in 1832-3; and the greatest mort. among native troops occurred in the same years and amounted to 75 p. 1000. In some years it will be seen that the disease was almost entirely dormant.. Although the disease is much less prevalent, and causes a less amount of mort., among the native troops, it is greater in intensity, as among that class 1 in 2'2 of those attacked died, and among the Europeans only 1 in 36. The latter, it may be remarked, is almost exactly the same ratio of intensity which has been found to prevail in all the European and American stations in which the disease has of late years made its appearance among the troops, as will be seen in the following extract from the official reports: So that neither climate nor treatment appear to have had any effect in modifying the fatality of this disease. In 1840 also Dr. Robert Cavan, M.D., read before the Brit. Asso. at Glasgow a paper: Vital Statis. of Glasgow, Illustrating the Sanitary Condition of the Pop., wherein he furnishes the statistics we have given under date 1832, and many others. In the Second Report of a Committee of the Statis. So. of Lond. appointed to collect and inquire into Vital Statistics upon the Sickness among the European and Native Troops serving in the Madras Presidency, pub. in vol. iv. of the Journ. p. 137, occurs the following: Cholera appears to have been far less prevalent among both classes of troops at Moulmein than in Madras. As however this is a disease possessing somewhat of a periodical character, and the returns from the Tenasserim provinces do not extend over an equal number of years as those furnished from the Madras peninsula, the following results may be liable to modification. Among the Europeans the admissions into hospital] were 27, and the deaths 7'6 p. 1000, in Madras, and only 6 and 28 respectively in the Tenasserím provinces. Among the native troops the admissions and deaths were 9 and 4'04 p. 1000 respectively in Madras, and o'4 and 0'06 p. 1000 respectively at Moulmein. In 1841 a paper was read by Major A. M. Tulloch, before the Statis. So. of Lond. : Comparison of the Sickness, Mort., and prevailing Diseases among Seamen and Soldiers [in the Mediterranean] as shown by the Naval and Military Statistical Reports [Statis. Fourn. vol. iv. p. 1], in which, under "Epidemic Cholera," we find the following: The extent of sickness and mort. by this disease in the two forces is shown by the following T.: Naval Force.-Out of an aggregate strength of 55,709, attacked, 92; died, 22. of 62,300, Military Force.Although this epidemic prevailed to so great an extent among the troops at Gibraltar in 1834, and was common also throughout the peninsula in that and the preceding year, it will be observed that the navy suffered comparatively little. The facility of removing vessels from the quarter when the disease originated, so soon as cases began to appear, no doubt contributed greatly to this exemption, as all the attacks occurred in harbour, or in the immediate vicinity of the shore; and the prevalence of the disease was checked on putting to sea. From the above statement of the number of attacks and deaths by C. in the naval and military force respectively, the proportion of recoveries appears to have been greatest among the former, in the proportion of 1 in 4 to 1 in 3; but it seems rather doubtful whether 33 of the cases which occurred on board the Castor, when lying off Santaner, were of genuine Asiatic Cholera, as only 3 terminated fatally, and the symptoms were comparatively mild. Deducting these, the proportion of deaths to recoveries would be precisely the same in both services, viz. 1 in 34. In a paper read before the Statis. So. in 1841 by Charles Barham, M.B. Cantab., Physician to the Cornwall Infirmary, etc., Remarks on the Abstract of the Parish Regis. of Tavistock, Devon, there occurs the following [vol. iv. p. 37]: The Cholera, however, though twice or three times introduced, did not take root, nor spread beyond the person first attacked; an exemption the more remarkable, as the neighbouring town of Plymouth was most severely visited by this scourge; and as the situation of Tavistock, on a river which empties itself into Plymouth harbour, is such as has in other instances apparently favoured the spreading of the disease. The dreadful havoc caused by the Plague in 1626 serves to show that a similar immunity to that recently enjoyed cannot be counted on if another pestilence should occur. A paper was read before the Statis. So. in 1844 [vol. viii. p. 83], by Dr. J. Graham Balfour, M.D., Comparison of the Sickness, Mort., and Prevailing Diseases among Seamen and Soldiers, as shown by the Naval and Military Statistical Reports. This was based upon a later Report of the Health of the Navy than that reviewed by Major Tulloch in 1841. This present report comprised: 1. The Cape of Good Hope, Western Africa, and the Mauritius. 2. The East India command. 3. The Home and various forces. His remarks and comparisons were confined to the second head, for reasons stated in the paper. Under "Epidemic Cholera," the following T. is given : This disease has proved more prevalent and fatal among the military than among the sailors, and the proportion of deaths to cases has also been higher. Dr. Wilson, however, states his opinion that some cases of common C. have been included, which seems prob., as in 1835 we find 21 admissions recorded and no deaths. C. being an endemic disease in India, although prevailing occasionally as an epidemic, it was naturally to be expected that the troops would suffer more from it as being more exposed to endemic influences. In 1832 it raged with great violence at Colombo and Trincomalee, cutting off nearly one-fifth of the white troops at the latter station, while only 9 cases occurred among the sailors in the harbour there, of which three terminated fatally; and throughout the rest of the command there were but 15 attacks and 1 death recorded. In 1845, the C. was epidemic at Cabul, which from 1839 to 1842 had been the seat of war, and the scene of great triumphs and disasters. In the summer of 1846 a form of disease prevailed in Lond. which has been designated in the U.S. Bills of Mort. Cholera infantum. The disease here proved fatal to many old people. The Reg.-Gen. says adults died of attacks which could not in their symptoms be distinguished from Asiatic C. "It was, however, quite evident from the first, that the epidemic had not the character of that malady which broke out here in the winter of 1832, but was closely allied to the C. described by Sydenham." [See 1669.] The mort. of the year was very heavy; and the epidemic was apparently as fatal in inland towns as in ports. In Lond. 228 deaths were referred to C., and 2152 to diarrhoea. In Bombay epidemic C. prevailed in the spring of the year, and a part of the army of Scinde, at Kurrachee, was assailed by the disease in its most fatal forms. It acquired great force about the Indus. From Affghanistan, the Punjaub, and Scinde, the epidemic extended later in the year over Persia and Syria. In a paper read before the Brit. Asso. in 1846 by the late Col. Sykes: Statistics of the Gov. Charitable Dispensaries of India, chiefly in the Bengal and North-Western Provinces, a letter by Dr. S. Davis respecting the inhabitants of Patna is quoted, and the passage contains the following: During the 8 yearsof my residence I have seen several severe visitations of C. and remittent fever, the former usually making its appearance at the commencement of the hot winds. There is often in April and May an indescribable but well-understood state of the atmosphere, accompanied with variations in the wind, and a hazy and sultry appearance that is favourable to the production of the former very frightful disease. During such weather you find vegetation blighted by impalpably small animalculæ, which elude the perception of the naked eye, but are easily discerned by the aid of microscopic instruments. I have long thought that C. and some other diseases have their origin in animalculine blight, and late writers have brought together so many facts bearing on the subject, that this opinion gains ground with me daily, nor is the circumstance of diseases spreading more in crowded cities than in smaller localities at all contrary to this theory, since there are so many more points of attraction or deposit. In 1846 Dr. Allan Webb pub. in Calcutta, Pathologia Indica; or, the Anatomy of Indian Diseases, based upon Morbid Specimens in the Museum of the Calcutta Medical College, in which work much information is given concerning the early hist. of C. in India. In June, 1847, the C. prevailed at Astrakhan, at the mouth of the Volga, on the Caspian Sea. By Sept. in that year it had reached Moscow. The Reg.-Gen. in his report on the public health for the third quarter of 1847 said: The great historical epidemics have diminished in intensity; and there appears to be no reason why they should not be ultimately suppressed with the advance of the pop. amongst which they take their rise. Their origin is obscure, but influenza appears generally to have become first epidemic in Russia, C. in India. It is in India that the source of the latter disease must be attacked. If the health of 1 |