THE following observations are, we understand, from the pen of the gentleman who is mentioned in our last as humanely exerting himself to put a stop to its ravages at the place of his residence.

Cursory Observations on the Epidemic of the Rainy Season of 1817, as it prevailed in a part of the British Provinces under the Presidency of Fort William.

Histories of widely spread epidemic disorders are seldom composed with accuracy during the immediate season of their influence; and happily for mankind, this season is seldom of long duration. But in the present instance, it has been prolonged sufficiently, to furnish many medical men with opportunities for collecting abundant materials for framing reports of facts and observations.

And it is upon the evidence resulting from a careful and judicious collation of the reports of many, that precautionary and remedial practices of general applicability can alone with safety be founded.

Where the disease has greatly prevailed, the demands for assistance on the medical practitioner have been too frequent, and too urgent, to leave him the power to arrange facts, observations, and deductions, suitably to the objects thereby to be answered.

An epidemic, in its commencement, in its progress, and in its decline, assumes differences of character, modified by various causes in its varying periods, and contracts differing symptoms from differing localities and differing habits of individuals connected with their avocations, &c.

Hence a medical man at Calcutta describing the present disease as it there occurred, may give its picture differently from that drawn by a practitioner of equal education, talent for observation and habits of practice, taken two months afterwards from patients at Benares; and though perhaps agreeing on main points, indicating the propriety of some difference in the treatment.

Every practitioner who shall commit his sentiments to the public, upon the nature, and the suitable treatment of the

disorder, who shall endeavour to analyse its causes and to guard against its future occurrence, must count upon his opinions being freely discussed.

And though conscious that discussion is the crucible in which observation is purified, he will not unfrequently, through an apprehension of being engaged in controversy, be deterred from communicating reports of great practical value. Thus the care of medical character powerfully interposes to repress the free transmission of medical opinions, until the period arrive when the medical man may feel himself prepared to embrace the subject with "all appliances and

means to boot."

But as diffidence frequently attends science, so presumption often accompanies ignorance,—and hence too frequently the dogmas of empiricism are obtruded as the inductions of experience.

Grievous mischiefs may obviously arise from the public diffusion of recipes or forms of practice, for the removal of the disorder, founded on incident, and not upon principle.

And the editors of public papers would act wisely in refusing to all such a place in their columns, till they shall have consulted the members of the medical board, or other practitioners of merit, upon their general suitableness.

And all accounts of the disorder given by those who pursue not strictly the profession of medicine, should be received with extreme caution and only after a rigorous examination.

As under this predicament, and as subject to this ordeal, must be regarded the observations of the present writer. Uninfluenced by some of the causes which restrain, as is conceived, the pens of some medical practitioners, he trusts that his motives may extenuate the temerity of the present attempt.

Thinking it more suitable to present a statement of facts, whilst they are fresh in his memory, than to wait for the period, when under an arrangement less defective and in a happier dress, they might be less unworthy of record, he is willing to hope that abler hands may not disdain to correct his errors.

On the 20th September, information was received that a violent disorder had suddenly and recently appeared at Chuprah, which for some days had destroyed from fifty to sixty natives a day, and had produced the greatest consternation amongst the inhabitants of that populous town. The symptoms and circumstances detailed, seemed to identify the cholera morbus in its most active form, and a mode of treatment corresponding with this supposition was laid down by two able practitioners, consulted on this occasion by the writer.

But reflection upon some cases of intermittent and of bilious remittent fevers, which had come under his observation in several parts of the country, during the preceding week, awakened a doubt of the propriety of prescribing any general practice, until the nature of the disorder should have been more particularly ascertained.

A journey of eighteen hours brought him to Chuprah. The great number of fresh corpses which, nearly submerged, rolled down the Ganges, the burning pyres along its banks, the vast clouds of vultures, which hovering over the river, and descending upon human carcasses, scarcely disputed for their prey, shewed too plainly the past excesses of the disorder. And the crowds of human beings which thronged the eastern road, evinced as strongly the public apprehension of its future ravages. The city was in fact nearly deserted by its inhabitants, who sought an asylum in the groves and fields, and more especially in those contiguous to Hajeepoor, and consecrated by the alleged visit of Hurreehur.

"The mother fled; and she whose hour

was come

"Fell by the road.”

Southey's Don Roderick.

The magistrate caused it to be publicly announced through the town and its neighbourhood that medicines would be given to the sick. Before night forty patients were brought to the residence of a civil servant, who offered the lower rooms of his own house, with the outhouses, for their accommodation. In general, these were persons affected with cholera morbus in its advanced stages. Some lay in a state bordering on insensibility, interrupted only by occasional vomiting, immediately after which they relapsed into stupor. Others writhed on the ground in silent agony; whilst others again absolutely shrieked and roared from violent pain. This pain in some had its seat round the navel, in others at the pit of the stomach; by some it was referred to the chest, by others to the loins, and by others again to the limbs. The pulse in many was not perceptible at the wrist, and the beating of the heart was only barely distinguishable. In such the surface of the body was cold, sometimes dry, but more commonly bedewed with a clammy sweat. In other patients more recently affected, the skin was drenched with hot sweat, from intenseness of pain, but of these the instances were few. In the former the hands were half opened, without consciousness of external touch, and the fingers and toes were not easily straightened. The countenance exhibited an appearance shrunk, shrivelled, and preternaturally aged,

It was irregularly marked with deep

babes,

"New widows with their infants in

their arms,

"Hurried along-Nor royal festival, "Nor sacred pageant, with like multitudes

દર

E'er fill'd tire public way-all whom (disease)

firmity

plied

playing a strong picture of severe and

yesterday

persons were affected with both vomiting and purging, others with vomiting or purging alone. The belly was generally rather lank, and in prolonged instances of disease, flattened and sunk. The body itself had a character of collapse similar to that expressed by the face. The breathing was ordinarily easy; thirst was excessive, but the secretion of urine was for the most part suspended during the violence of the symptoms. A few cases of persons labouring under bilious remittents mixed with the cholera for a short time, threw some little obscureness on the nature of the disorder. Preparations were made for an hospital establishment, the Public Court House being appropriated to this use, and the following persons were placed at the disposal of the writer; one native doctor with medicines; two Chupprassees; four Mehturs; two Behistees; two Bildars; and two native writers. A mat was given to each patient, with two large earthen bowls, and several small ones; a Brahman prepared large quantities of rice gruel. The medicine in readiness were:

No. 3.-Pills of calomel, seven grains; opium, one grain and a half.

No. 4.-Pills of calomel, three grains; opium, half grain; powders of calomel in like doses, without opium.

Pills of Jumulgota.*-No. 1. Containing one seed, pounded, and formed into a pill, with the pulp of roasted date. No. 2.-Pill of half a seed; castor oil; simple infusion of senna; compound in fusion of senna, accidulated with lime juice; laudanum ; madeira and mulled port

wine.

General treatment on the 21st and its results.-1st. To those who were insensible or much exhausted, a table spoonful of wine, mixed with water or rice gruel, and repeated if rejected, until the pulse should be perceptible at the wrist.2d. The limbs of those affected with spasms, to be first worked in their natural directions, and afterwards well chafed; cold extremities to be strongly rubbed.-3d. Cloths wrung out of hot

*We have not been able yet to discover the botanical name of this seed in Ainslie, or any native vocabulary to which we have access.-Ed.

management of the comparatively few cases under treatment, and of those which might occur, to his charge. It was intended to present a separate history of each case, detailing all the symptoms, the treatment adopted, the state of the patients three times a day, and the results, with reflections on the suitableness or unsuitableness of the practice. And the materials for the report were collected in notes, made by an European gentleman, who remained in the hospital, and accompanied the writer in his frequent round of visits. But it was subsequently thought that the details of nearly three hundred cases of one disorder, with symptoms not widely different, would prove less satisfactory than observations drawn from the practice in general. Observations on the use of wine and opium in certain stages of the disease. In cases of great exhaustion, as indicated by coldness of the hands and feet, loss of pulse in the wrists and ancles, diminished susceptibility of im

The thermometer for some time had ranged from 100 to 106° in the sun, and from 80° to 86° in the shade,

come on as early as might have been expected. The pain commonly began to diminish as soon as free purging took place, and vomiting went off, and it gradually ceased in general; but in a few cases which ended fatally, the evacuation only mitigated, and did not entirely remove the pain. Laudanum was observed, even when rejected almost instantly after being taken, to quiet the irritation in the stomach more rapidly than opium in the solid form even when retained, and the calomel without solid opium produced purging more quickly, more copiously, and apparently with less distress. From thirty to sixty drops of laudanum were given with every pill of calomel when there was vomiting.

pression in most of the organs of sense as well as that of feeling, frequent but feeble vomitings, half suppressed, hiccoughing, involuntary evacuation of the contents of the intestines. A small glass of Madeira, with water, generally produced a reaction of the heart, sufficient to force the blood into the vessels of the extremities; and this recovery of the circulation, suspended by the depressing power of the disease, was considered as desirable to be effected, before purgative medicines were given in the commencement of the treatment, and seemed to be supported by subsequent facts. For although several persons did recover, to whom purgatives were administered whilst the state of exhaustion remained undisturbed by stimulants, yet it was remarked, that such patients were thrown into greater weakness, and stood in need of more watching and more support against their sinking from profuse evacuations of the intestines, than those who had their circulation somewhat excited by wine previously to purgatives being given. But wine was never given in the beginning, except in cases of sudden and great prostration of strength, or of positive debility, and then never in larger quantities than two table spoonsful as a dose. But in the progress of the treatment, when vomiting continued to alternate with purging and the latter might be at least in part attributed to the action of medicine, wine was given in conjunction with laudanum, and though frequently rejected, always appeared to quiet and relieve. The dose of laudanum was generally rather small, and repeated according to the frequency of the vomiting.

Many of those patients who had taken the calomel and opium in the largest doses, some time after the purging had ceased, complained of a burning sensation within the belly, which was accompanied by a small quickened pulse, with distressed countenance. Castor oil

or

senna re-establishing the purging, brought away bloody stools, after which the patients were for the most part relieved from their complaints. But those stools were passed when the disease long protracted had been left to itself, and also after other purgative medicines, and likewise in cases of relapse. As, however,strong suspicion arose that the combination of solid opium with calomel injured the operation of the latter, it became important to the speedy termination of the disorder, to employ a purgative of still greater activity than calomel, and with this view the Jumalgota was brought forward.

conjoined.

Although vomiting often took place after the pill was swallowed, yet though carefully looked for, it was seldom found to have been rejected. The opium frequently failed to relieve the pain wherever situated, but it seemed not unfrequently to calm the irritability of the stomach. When the largest dose of calomel and of opium was given, and followed by an ounce of castor oil, full purging did not

It is uuderstood that a moderate dose of calomel will frequently prove more purgative than a very large dose.

Asiatic Journ.-No. 30.

out opium.

As this medicine frequently causes vomiting as well as purging, even in a healthy condition of stomach, it was thought essentially necessary to guard against the former effect, by giving laudanum along with it, in every instance in which there was either vomiting, or disposition towards it. But in cases where there was only purging or pain in the belly, either alone or accompanied only with lightness or swimming in the head,, the jumalgota was given without laudanum; the smallest dose was half a seed, the largest a seed VOL. V. 4 D

and a half. It was given to children lately taken from the breast, and to persons in the early, middle, and ad vanced periods of life. With the laudanum it was not often rejected; alone it sometimes caused vomiting; but in such instances it did not fail to purge, and the vomiting ceased when the purging became frequent. It purged many, and failed to purge, or purged only imperfectly, a few far advanced in the disease, and who afterwards died. These persons vomited almost incessantly from the first attack, and two of them passed blood in their stools. Its operation in opening the bowels ordinarily took place from three quarters of an hour to within an hour and a half after its exhibition.

Persons who presented themselves in the early stages of the disorder were early relieved.

Case. A Hindoo of about thirty years of age was attacked in the forenoon with a violent pain in the pit of the stomach, which lasted till about two o'clock, and then became intolerable, but was accompanied neither with vomiting nor purging. Soon after the attack he fell down as in a fit, but speedily recovered his senses.

At two he was brought to the hospital. He complained of intense pain in the pit of the stomach, could not stand upright, and bellowed with agony; his pulse was hurried, but stronger than any before felt in this disorder; he was covered with hot sweat, and his countenance expressed the utmost suffering; the belly was neither full nor hard, nor retracted, but occasional strainings and eructations indicated that vomiting was about to come on.

Though he could not walk without assistance, he retained more strength than was usual after such a period of suffering, even without evacuation.

A Jumalgota pill of one seed was given with thirty drops of laudanum; within an hour he began to purge, had eight evacuations, drank largely of congee; the pain left him; at the end of the fourth hour he declared himself free from uneasiness and well, though weak.

The next morning he went to his usual occupation, and had no relapse.

Case 2.-A Moosulman, between sixty and seventy, said that he had been just seized with a violent pain in his belly that

Blistering with Spanish flies was thought too slow in its operation, seldom practicable in those cases apparently requiring its use, from the extreme restlessness of the patients, and therefore was sparingly tried, but blistering in a more rapid way was substituted and some advantage resulting, it is thought well to relate the cases in which it was employed.

Case 1.-Samdehul, aged 25, Gwala, having had a violent attack of cholera, attended with great pain in the pit of the stomach which gradually declined as purging became copious and vomiting subsided, complained of the pain remaining after the other symptoms of disease had wholly ceased.

A wad of cotton dipped in oil and turpentine, and squeezed nearly dry, was placed upon the spot indicated as the seat of pain and set on fire. A second was placed an inch lower on the belly and fired in the same manner. The wads were permitted to burn till the skin immediately surrounding them was raised into a circular line of blister, and were then struck off by a flirt of the finger. The patient cried out during the process, which lasted only a few seconds. He said he was relieved from his pain instantly, and it did not recur for the following two days he stayed in the hospital to recover from weakness, as he had come in for a relapse with symptoms of the most formidable kind.

Case 2.-Hindoo, about 45, had also recovered from cholera, and said he should

Gwálá, Cowherd.-Ed.