CXXl 



they found in the low lands of India, and which they doubtless acquired, 

 carried with them, and spread. Of the practical value of those accounts 

 but little is known. It is certain, however, that European and American 

 physicians, generally, did not become deeply interested in the study of 

 cholera until the latter part of the first third of the present century. The 

 wide dissemination of cholera is dated from the Indian epidemic of 1817. 

 It will be remembered that in that epidemic the disease was of unusual 

 severity, particularly among the British troops, and was quite rapidly car- 

 ried over ninety degrees of longitude and sixty-six degrees of latitude. 

 Toward the latter part of 1823 it had appeared in Astrachan on the north 

 side of the Caspian sea. This fact was of special interest to European phy- 

 sicians. After six years cholera appeared again in Russia, and there were 

 such reasons for believing it would soon reach England that the British 

 government sent two physicians to meet the disease in Russia and study 

 its characteristics. Steadily marching westward, the cholera reached the 

 eastern shore of England in November, 1831. 



How wide-spread and destructive cholera was in Europe during 1831- 

 ^32, and how it was brought to this country and disseminated, is familiar ' 

 to all. The epidemics of cholera, that have subsequently swept over both 

 Europe and America have not differed from the first either as to the cha- 

 racteristics of the disease or the means by which it is spread. That cholera 

 has its origin in India is commonly believed, but just how it originates 

 has not been discovered. If such density of population, such high mean 

 temperature and rainfall, such extreme poverty and domestic hardship, 

 and such domestic filthiness as can be found in India above every coun- 

 try, are, when properly conjoined, sufficient to produce cholera, then its 

 constant prevalence in the low lands of India need not occasion surprise. 



It is commonly believed that cholera is produced by a specific poison ; 

 but what that specific poison is has not been determined. Dr. Robert 

 James Graves, of Dublin, was, I believe, the first to point out that cholera 

 in its progress, whether by land or water, seems regulated by no common 

 physical circumstances, except human traffic and human intercourse. This 

 he did in a lecture which was, I believe, first published in 1843, but possi- 

 bly not earlier than 1S4S. He clearly showed that cholera was carried by 

 land no faster than men traveled, and by water no faster than ships sailed. 

 The literature of cholera shows that the most eminent medical writers 

 in Europe and America were slow in appreciating the correctness and the 

 value of Dr. Graves's observations. During the American epidemic of cho- 

 lera (1832-35) Dr. W. E. Harner, Professor of Anatomy in the University of 

 Pennsylvania, described an exfoliation of the epithelial lining of the ali- 

 mentary canal, whereby the extremities of the venous system of the part are 

 denuded, as being characteristic of cholera alone. In 1849 I^'"- ^am'l Jack- 

 son, Professor of the Institutes of Medicine, and Dr. John Neill, Demon- 

 strator of Anatomy in the University of Pennsylvania, in conjunction with 

 Dr. William Pepper and Dr. Paul B. Goddard, presented a report to the 

 College of Physicians of Philadelphia, in which they, too, showed that the 



