

PESTILENCE. 



have divlar. .1 tiirmselvej. In the majority of cue* the sp 

 symptoms are flnt observed, and afterward* the oollnpn ; the former 

 are characterised by pain, evacuation*, and moan* ; the second, by the 

 suppression of voice, urine, and heat. If, however, the patient get over 

 the cold stage, that of reaction commence*. The coldnea* and blucneas 

 gradually disappear; the pulae return*, increasing in force and fn[u, n,-\ ; 

 to the pale or blue cheek succeeds the flush ; the eye brighten* ; the 

 tongue, which wa of a dirty white, becomes cleaner and dry ; vomit- 

 ing* are lea* frequent, but diarrhoea continues; and there i* some 

 tenderness of the abdomen, with thirst, great diaguat of food, and 

 intense headache. The urine, however, is secreted ; and if all goes on 

 well, at the end of two or three days the features assume their usual 

 expression ; the stools are less frequent and mure natural ; the strength 

 and appetite begin to return ; the pulae resume* its ordinary character; 

 and the patient is convalescent Several varieties occur in the duration 

 and intensity of cholera, and complications are sometimes produced of 

 a character not less fatal than the disease itself. We are informed by 

 II. Dalmaa, that soldier* attacked in full march will retire from the 

 ranks, lay down their arms by the roadside, and expire in two hours. 

 During the prevalence of the last epidemic in India, several instance* 

 were heard of at Houbley and other places in that country, of natives 

 being struck with the disease while walking in the open air ; they fell 

 down, retched a little, complained of vertigo, deafness, and blindness, 

 and expired in a few minute*. This rapidly fatal form of cholera ho* 

 not been observed in this country. The most severe cases that we 

 have met with generally lasted five or six hours; but the average 

 duration of the fatal cases, when they did not terminate in consecutive 

 fever, was from twelve to fourteen hours. When reaction was esta- 

 blished, and fever supervened, the duration of fatal cases was from 

 four to ten days. As a general rule to guide us in forming a prognosis, 

 it may be stated that the more complete ia the collapse, the greater is 

 the danger; and if the patient survive it, the more violent and 

 malignant is the subsequent fever. The coses in which spasms and 

 vomiting are most violent are by no means the most dangerous. 



JfortiJ Anatomy of Cftofera. Dissection presents us with nothing 

 satisfactory by which we can judge of the nature of the disease. There 

 is general venous congestion of all the important organs in the body ; 

 but it is rare that any trace* of inflammation are discovered. The 

 gall-bladder is mostly distended with bile, and its ducts are con- 

 stricted. In the stomach and intestines is found either a transparent 

 or a turbid serous fluid, mixed with a white opaque substance in the 

 form of flakes, and similar in all respects to the matters ejected during 

 life. The mucous membrane lining the intestinal canal is most 

 frequently of a pale white colour, and somewhat more soft and pulpy 

 than in its natural condition ; but occasionally some degree of VOHCU- 

 larity is observed. The urinary bladder is empty and contracted. 

 With respect to the blood, it U found to be more viscid, and darker 

 coloured than natural, which arises from a deficiency of its saline and 

 watery components, and a relative increase of its solid constituents. 

 In 1000 parts of serum, Dr. O'Shaughnessy found 133 of albumen, 

 whereas healthy serum contains only 78 parts. On comparing the 

 blood with the matter found in the intestines, it is manifest that the 

 latter contains all the ingredients of the blood, except the red globules ; 

 and that the aqueous and saline parts pass out of the circulation more 

 rapidly than the albuminous. Tim state of the blood explains the 

 congestion more especially in the lungs, and accounts for the derange- 

 ment of the functions of the respiratory system. 



J/ittory and Statutiet of Cholera. There appears to be little doubt 

 that pestilential cholera lias from time immemorial visited the various 

 populations of the world. It was described by Sydenham in the 17th 

 century, and various outbreaks are recorded during the 18th century. 

 It however excited the greatest attention in Europe during the second 

 quarter of the present century. That this form of cholera is more or 

 less indigenous in Europe is the opinion of most medical writers at the 

 present day. The circumstances which cause the sporadic form to 

 assume a contagious and epidemic character are not well understood. 

 During the present century Europe has sustained three outbreaks of 

 thi disease. The first in 1828-29, 30 and 31 ; the second in 1847-48, 

 and 49 ; the third in 1852-3, and 4. The history of the first outbreak 

 is a* follows : It originated in the district of Nuddeah and in some 

 other parts of the delta of the Ganges, about the end of May or the 

 be {inning of June, 1817. During that year it did not extend beyond 

 the territory of Lower Bengal ; but in 1818 and the early part of 1819 

 it diffused itself throughout the extreme length and breadth of the 

 Indian peninsula, yet leaving untouched many district* placed between 

 its lines of movement. It* progress along the lines selected was 

 wonderfully uniform, l>eing, for some successive months, at the rate of 

 about one degree in a month. As early as 1818, it extended itself 

 beyond the boundaries of Hinduxtan into the Birmese empire and 

 other parts of Eastern Asia, and making gradual progress through 

 these countries, reached China in 1820, and in the following year 

 visited the numerous and populoun inlands of the Indian Archipelago. 

 The Isle of France suffered it) invasion in 1810, and mime cases 

 occurred in the same year at one point in Bourbon. In 1821 it 

 extended along the ehores of the IVman Oulf, and, during this and 

 the following year, spread through part* of Arabia, Persia, and Syria, 

 .ml clotly, threatened Europe. It appeared in the Russian territorial 

 in 1823, at Tefflis, Orenburg, and Astrakan ; but its farther northern 



and western itrogrcjs was stopped for a time. It however reappeared 

 in Orenburg in 1823, and again in 1829, and in 1830 advanced through 

 the southern provinces of the Russian empire, till it reached Moscow 

 on the 28th of September of that year, and Petersburg the yew 

 following. Warsaw was attacked in March, 1831; Danzig in May; 

 Berlin, in August; Hamburg and Sundrrland in October; and London 

 and Paris in 1832. At the end of 1833 it had reached Mexico and 

 several other parts of America. We see that the course of the epidemic 

 was principally from east to west, and it was observed that prior to its 

 appearance in many countries, and during its continuance, easterly 

 winds were uncommonly prevalent ; but most accurate and extensive 

 meteorological observations, made doily during the continuance of the 

 disease, prove that neither variations of temperature, fluctuations of 

 the barometer, change of wind, nor the prevalence nor absence of 

 moisture, affect in the slightest degree it* duration or intensity. 

 i:..v. .-1 complaints appear to have preceded the cholera in most places, 

 and to have continued for some month* after its cessation. In many 

 localities the disease existed only for a few weeks, while in others it 

 lingered for several months. In the first case, the mortality was 

 invariably high ; in the lost, the malignancy of the disease generally 

 diminished as its stay was prolonged. Into whatever country or town 

 the disease advanced, it* first and most deadly fury was expended upon 

 the poorest and most miserable of the population, and upon those who 

 inhabited crowded districts, or low humid localities bordering on a port 

 or river. Among this clogs of individuals whole families were some- 

 time* cut off by it ; indeed it is a peculiar feature of epidemic cholera 

 that it* ravages are confined almost exclusively to the poor. When 

 the disease has appeared in a family occupying a station in life above 

 the labouring class, we have the authority of Dr. Brown for declaring 

 that in every case it has been confined to the individual first attacked, 

 and has not in any instance spread to the other members of the family. 

 The mortality from this disease is very great ; but it varies somewhat 

 in different countries and at different stages of its epidemic career. 

 During its early prevalence in India, in 1817 and 1818, we learn, from 

 the ' Report to the Medical Board at Bombay,' that there is reason to 

 believe that of 1294 coses which received no medical assistance, every 

 individual perished ; and it is added, that it is not ascertained that any 

 person has recovered to whom medicine had not been administered. 

 This appalling statement however is without parallel, and it is grati- 

 fying to know that where the premonitory symptoms have been 

 combated by early and judicious treatment, the mortality has always 

 been diminished. This is strikingly exemplified by the statistical 

 records kept at our different military stations in various parts of the 

 world. In all situations and under all modes of treatment, about one 

 in two died of the cases in civil, and one in three of those in the 

 military hospitals ; a result doubtless to bo attributed to the strict 

 surveillance exercised over the troops, by which nearly one-half of the 

 cases among them were noticed in the premonitory stage, and con- 

 sequently could be treated with a greater prospect of success than 

 those in the civil hospitals, where the great majority of the patients 

 were for advanced in the disease before they applied for medical aid. 

 Of the severe cases however the mortality is probably nearly the same 

 in all, being about 60 per cent. One of the most extraordinary 

 features of this epidemic, observes Major Tulloch, is that the propor- 

 tion of deaths to the number attacked has been very nearly alike in all 

 the military commands of which the medical records have been 

 investigated : for instance In the United Kingdom, the deaths were 

 1 in 31 ; in Gibraltar, 1 in SJ ; in Nova Scotia, 1 in 3i ; in Canada, 1 

 in 3 ; in Honduras, 1 in 3 ; in the Mauritius, 1 in 8J. The Mauritius 

 appears to be the only exception to this; so that either the epidemic 

 was less severe in its character, or the remedies employed were more 

 successful. 



The influence of age on the mortality by this disease among the 

 troops of the line serving in Canada is exemplified in the foil, .\viiif,' 

 table : 



Kntio of Death* at men ARC, per 1000 

 of strength by Epidemic Cholera. 



AflB. 



Under 18 

 18 to 25 

 25 to 83 

 33 to 40 

 40 to 50 



15-5 

 28- 

 36-6 

 70-0 



It appears from the authority to whieh we are indebted for the 

 foregoing table, that female* were attacked in very nearly the same 

 projx)rtion as male*, but that the cases proved more generally fatal. 

 Chililn-n \\ere in a great measure exempt, though, when attacked, they 

 rapidly sunk under it The greater mortality of the disease in females 

 has also been observed in this country. Dr. Ogdon informs us that of 

 145 fatal cases of cholera at Sutherland, 63 were males and 82 females. 

 The information which we possess on the relative mortality of the 

 disease in the different races of mankind is rather meagre. The native 

 Indians of North America suffered from it in an equal degree with the 

 white population; and the same was observed with regard to tho 

 Sepoys in our Indian army. In the Mauritius, whose population in 

 1881 was 90,000, of which 25,000 were whites and the rest coloured, 

 the total number of deaths recorded in the civil and military hospitals' 

 was 1327. Of these 168 were whites, 102 coloured/and 997 blacks, 



