MISCELLANEOUS NOTES

OF THE LATE SIR WALTER ELLIOT.

(Continued from Vol. VI., page 201.)

XXVI.

NOTES ON THE DISEASE CALLED CHOLERA MORBUS, OR CHOLERA ASPHYXIA.

Appearance of Cholera in 1787 at Arcot.

THE following notice is from the proceedings of the Medical Board of the Madras Presidency, dated the 29th November 1787 "A disease having prevailed in October last at Arcot similar to an Endemic that raged amongst the natives about Paliconda in the Ambore valley in 1769-1770, in an army of observation in January 1783, and in the Bengal Detachment at Ganjam in 1781, and several other places at different times, as well as Epidemic over the whole coast in 1783, under the appearance of Dysentery, Cholera Morbus, or Mordyscim, but attended with spasms at the præcordia and sudden prostration of strength as characteristic marks; seeing that this Board is ordered to make a record, the Physician General recommends as a guide to future practitioners, that a letter from Mr. Thompson, Surgeon of the 4th Regiment, containing an account of the dissection of one of the patients who died of the disease, and describing the state of the viscera, may be entered on the face of the proceedings, together with two letters from Mr. Duffin, Head Surgeon at Vellore, and one from Mr. Davis, Member of the Hospital Board, containing an account of the causes, symptoms and successful treatment of the sick by the use of the hot bath and fomentations, supporting the vis vitæ with wine, &c., and removing the putrid colluvies from the intestines. The Hospital Board sensible of the advantages that may result to the service from the mode proposed by the Physician

General, direct their Secretary to enter the letters he has mentioned, as follows: . . .

Supposed to be noticed in Hindu Writings.

Cholera has been supposed to be described in the medical writings of the Hindus, some of which are of great antiquity, as may be inferred from their being attributed to Dhanwantary, a mythical personage coinciding in character with the Esculapius of the Greeks. In a work of this author, styled the Chintamani, a disease resembling cholera is classed under the generic term Sannipatha, which includes all paralytic and spasmodic affections. The species of Sannipatha supposed to be the spasmodic or epidemic cholera, is called Sitavga, and is thus described: 'Chilliness like the coldness of the moon over the whole body, cough and difficulty of breathing, hiccup, pains all over the body, vomiting, thirst, fainting, great looseness of the bowels, trembling of the limbs.' Cholera is supposed by others, to be classed under the generic term Ajerna or Dyspepsia. The species, which is considered to correspond with the spasmodic or epidemic cholera is called Vidhumar Vishúchi, and is thus described: 'The Vishúchi is most rapid in its effects. Its symptoms are, dimness of sight in both eyes, perspiration, sudden swooning, loss of understanding, derangement of the external and internal senses, pains in the knees and calves of the legs, griping pains in the belly, extreme thirst, lowness of the bilious and windy pulses, and coldness in the hands, feet, and the whole body.' The first of these descriptions would apply more perfectly to the epidemic cholera, were it not that in a commentary thereon, in a Tamil work styled the Yugumani Chintamani, the Sitavga is stated to be incurable, and fatal in 15 days. The latter description is perhaps less applicable, as not noticing either vomiting or purging amongst the symptoms. An attempt has been made to reconcile these two opinions by supposing that the Vishúch is in fact the Stavga in a more virulent or epidemic form; but

it is not contended that the Vishúchi itself is always epidemic. On the contrary, it is said to be by no means uncommon, and to be described in these familiar but emphatic words, 'being seized with vomiting and purging, he immediately died.' These observations are drawn from a letter in the Madras Courier, dated 2nd January 1819, which was attributed to the pen of a gentleman well known for his partiality to and deep knowledge of Hindu literature. This paper being altogether curious, is given in the appendix, together with a very interesting letter from a respectable and learned native, Ram Raz, attached to the College, to whom it was submitted, in order to be compared with the most authentic copies of the medical works, from which the extracts purport to have been taken.

anus.

Noticed by Bontius in 1629.

"The Dutch physician Bontius, who wrote in the year 1629 at Batavia, thus describes Cholera Morbus: Besides the diseases above treated of as endemic in this country, the Cholera Morbus is extremely frequent. In cholera, hot, bilious matter, irritating the stomach and intestines, is incessantly and copiously discharged by the mouth and It is a disorder of the most acute kind, and therefore requires immediate attention. Its principal cause, next to a hot and moist disposition of the air, is an intemperate indulgence in eating fruits, which, when green or beginning to putrefy, irritate and oppress the stomach by their superfluous humidity, and produce an acrid bile. The cholera might, with some degree of reason, be reckoned a salutary excretion; since such humours are discharged in it as, if retained, would prove prejudicial. However, as by such excessive purgations the animal spirits are exhausted, and the heart, the fountain of heat and life, is overwhelmed with putrid effluvia, those who are seized with this disorder generally die, and that so quickly as in the space of four and twenty hours at most.

"Such, among others, was the fate of Cornelius Van

Royen, steward of the hospital of the sick, who being in perfect health at six in the evening was suddenly seized with the cholera and expired in terrible agony and convulsions before twelve o'clock at night; the violence and rapidity of the disorder neutralizing the force of every remedy. But if the patient should survive the period abovementioned, there is great hope of a cure.

"This disease is attended with a weak pulse, difficult respiration, and coldness of the extremities; to which are joined, great internal heat, insatiable thirst, perpetual wakefulness, and a restless and incessant tossing of the body. If together with these symptoms, a cold and fœtid sweat should break forth, it is certain that death is at hand.'

"In treating of the Spasm,' this author says: 'This disorder of the Spasm, almost unknown with us in Holland, is so common in the Indies, that it may be reckoned among the common endemic diseases of the country. Its attack is sometimes so sudden, that people become in an instant as rigid as statues; while the muscles either of the anterior or posterior part of the body are involuntarily and violently contracted. A terrible disorder! which without any primary defect of the vital or natural functions, quickly hurries the wretched sufferer in excruciating torment to the grave, totally deprived of the capacity of swallowing either food or drink. There are also other partial spasms of the limbs; but these being more gentle and temporary, I shall not treat of them.

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'People affected with this disease look horribly into the face of the by-standers, especially if, as often happens, both the cheeks are drawn convulsively towards the ears when the spasm comes on; a red and green colour is reflected from the eyes and face; the teeth are gnashed; and instead of the human voice, a harsh sound issues from the throat, as if heard from a subterraneous vault: to those unacquainted with the disorder the patient appears to be a dæmoniac.

"Although Bontius has treated of the Spasm' and of

'Cholera Morbus' under separate chapters, it is highly probable that these disorders were one and the same.

Noticed by Dr. Paisley in 1774.

"The next notice in point of time, which we find of cholera is in a letter written by Dr. Paisley at Madras, dated 12th February 1774, as given by Curtis in his publication on the diseases of India. Dr. Paisley says, 'I am favoured with yours, and am very happy to hear you have caused the army to change its ground; for there can be no doubt, from the circumstances you have mentioned, that their situation contributed to the frequency and violence of the attacks of this dangerous disease, which is, as you have observed, a true Cholera Morbus-the same they had at Trincomalee. It is often epidemic among the blacks whom it destroys quickly, as their relaxed habits cannot support the effects of sudden evacuations, nor the more' powerful operation of diseased bile. In the first campaign made in this country the same disease was horridly fatal to the blacks; and fifty Europeans of the line were seized with it. I have met with many single cases since (many of them fatal or dangerous) of different kinds, arising from putrid bile being distributed by accidental causes, or by emetics or purgatives exhibited before it had been blunted or corrected. . . .'

"Sonnerat, whose travels in India embrace the period between 1774 and 1781, speaks of an epidemical disease on the Coromandel Coast, in all respects resembling cholera.

The flux of this kind which reigned some years ago spread itself in all parts, making great ravages: above sixty thousand people from Cheringam to Pondicherry, perished. Many causes produced it. Some were attacked for having passed the night or slept in the open air; others for having eaten cold rice with curds; but the greater part for having eaten after they had bathed and washed in cold water, which caused an indigestion, with a universal spasm of the nervous kind, followed by violent pains and death, if