m 
 


 
REPORT 
 
 or THE 
 
 ROYAL ACADEMY OF MEDICINE, 
 
 TO THE 
 
 MINISTER OF THE INTERIOR, 
 
 UPON THE 
 
 CHOLERA-MORBUS. 
 
 PUBLISHED BY ORDER OF THE 
 
 FRENCH GOVERNMENT. 
 
 TRANSLATED FR03I THE FRENCH BY 
 
 JOHN W. STERLING, M. D. 
 
 MEMBER. OF THE COLLEGE OF SURGEONS, LONDON, & FELLOW OF 
 THE UNIVERSITY OF THE STATE OF NEW-YORK. 
 
 MEW-YORK: 
 SAMUEL WOOD & SONS, 261 PEARL-STREET. 
 
 1832. 
 
PRINTED AT THE OFFICE 
 
 of the 
 
 MXZDXCO-CHXBURGXCAXi REVIEW. 
 
 No. 261 Pearl-street. 
 
^N^. 
 
 A 
 
 B 
 
 TO 
 THOMAS COCK, 31. D. 
 
 VICE-PRESIDENT OF THE 
 
 UNIVERSITY OF THE COLLEGE OF PHYSICLVNS AND SURGEONS 
 
 OF THE STATE OF NEW- YORK, 
 
 ONE OF THE PHYSICIANS OF THE NEW- YORK 
 
 HOSPITAL, &c. 
 
 THLS TRANSLATION IS INSCRIBED 
 
 BY HIS VERY MUCH OBLIGED AND OBEDIENT SERVANT, 
 
 JOHN W. STERLING. 
 
 
TRANSLATOR'S PREFACE. 
 
 The following translation has been undertaken with 
 
 "O 
 
 the view of introducing into general circulation the 
 opinions entertained by some of the most enlightened 
 physicians of France, and of the numerous authors 
 whose works they have carefully investigated, relatively 
 to the history, nature and most approved treatment of 
 the Spasmodic Cholera. 
 
 The great ravages already Committed by this dis- 
 ease, and the rapidity with which it has extended to 
 different and numerous kingdoms of the old world, 
 have excited alarm and dpprehension in the breast of 
 almost every individual of this country. Indeed, reign- 
 ing as an epidemic, we h<!ve great reason to apprehend 
 its awful visitation, and rh order that it may not come 
 upon us unawares, it is incumbent, on physicians 
 especially, to apply to every source whence they may 
 ascertain the best means of preventing its invasion, 
 restricting its limits, and subduing its deadly effects 
 in those who may become the subjects of it. 
 
 Previous to the reception of the Report of the French 
 Academy in our city, the excellent Discourse by Prof. 
 J. M. Smith, on the Epidemic Cholera, had been for 
 
8 
 
 some time before the public. In collating this dis- 
 course with the report of the Academy, we were struck 
 with the similarity of their conclusions ; yet it could be 
 no longer a matter of surprise when it was fully ascer- 
 tained that the method adopted by both parties, in order 
 to arrive at these conclusions, had been exactly similar, 
 viz., the deep and accurate investigation of every im- 
 portant accessible document relating to the subject of 
 Cholera, allowing their deductions to flow, as it were, 
 naturally, from the various sources whence they had 
 originated. 
 
 Yet, notwithstanding their general resemblance, 
 there are one or more points on which a difference of 
 opinion exists : we are disposed to believe, however, 
 that these discrepancies are more apparent than real, 
 and that there would be no great difficulty in recon- 
 ciling them. We allude to the contagious character of 
 the Cholera ; the authors of the subjoined Report, as 
 will be seen on examining it, being of opinion that this 
 disease has, under certain conditions, been communi- 
 cated by personal contact. 
 
 That persons in constant and untiring attendance 
 on the couch of an individual labouring under the 
 Cholera, are more liable to be attacked in their turn 
 than those who keep aloof from the presence of the 
 disease, we can readily conceive, and the reason 
 seems obvious : the sick person is located in an im- 
 pure atmosphere, probably in the very centre of the 
 epidemic influence, he is surrounded by friends, all 
 
9 
 
 eager to attend to his every want, who render the at- 
 mosphere still more impure by the exhalations which pro- 
 ceed from their lungs and bodies, probably equally pre- 
 judicial to health with the emanations arising from the 
 diseased body : the minds of these friends are greatly 
 distressed, both in consequence of beholding the ago- 
 nies of the sufferer and anticipating the desolation which 
 will attend on his taking off; the fatigue also, the want 
 of sufficient and regular alimentation ; all these circum- 
 stances constitute some of the most powerful predis- 
 posing causes of the disease. Can we wonder then 
 that persons exposed to the influence of these causes 
 should be more susceptible of an attack than those who 
 are not subject to their influence ? And can we be 
 surprized that persons, unacquainted with the laws 
 which govern epidemics, seeing attacks frequently and 
 rapidly treading upon such exposures, should derive 
 them from direct contagion ? Is it not more natural 
 to attribute the causes of violent effects to visible and 
 palpable objects rather than derive them from occult 
 invisible agents which have never been demonstrated to 
 exist otherwise than from analogy 1 It ought not then 
 to be a matter of surprise, to medical men, even if 
 every instance of invasion of this disease were attrib- 
 uted, by those who cannot comprehend epidemial influ- 
 ence, to individual contagion. 
 
 We were almost on the point of uttering the 
 wish that the disease were contagious, rather pre- 
 ferring its invasion in that way than in an epidemic 
 
10 
 
 form ; for, in the one case, our quarantine laws would 
 greatly tend to arrest its progress, or else we would be 
 able to flee from its direful influence ; but, where 
 it pervades the atmosphere, travelling on the wings 
 of the wind, and may approach us in every gale that 
 blows across the Atlantic, or descend upon us with 
 dreadful rapidity from the northern extremity of Asia, 
 we have great reason for the preference ; all human 
 regulations being of no avail in stemming the current 
 of the elements. 
 
 Sanatory measures, however, should be resorted 
 to, especially such as have proved beneficial either 
 in lessening the pre-disposition to the disease, or 
 diminishing its violence among individuals or com- 
 munities exposed to its invasion, and which are fully 
 detailed in the report of the^Academy. 
 
 There is one thought which has been elicited by a 
 remark contained in the following pages, and which 
 we consider of no small degree of importance : it is 
 this: — , 
 
 If the Cholera should invade our land, let there be 
 a mutual understanding among physicians that they 
 will reciprocally assist one another in the services they 
 may render to persons attacked with this malady ; for 
 this is a disease so terrible in its aspect, as to appal even 
 the stoutest heart ; so dreadfully rapid is its progress, 
 and so soon does it cover its victim with the semblance 
 of death, that the physician might possibly consider it 
 needless, in such a case, to attempt to snatch the vie- 
 
11 
 
 tim from the reality, even though the effort might be 
 most availing. Therefore is it necessary that physi- 
 cians should strengthen the hands of one another, and 
 by their united efforts persevere so long as life can pos- 
 sibly be supposed to exist ; for it is thus alone that 
 others have prevailed over this cruel, this merciless 
 destroyer. 
 
 Finally, let the physician, who should be called on 
 to succour an individual attacked with the Cholera, go 
 instantly ; let him not hesitate, through a fastidious ad- 
 herence to the strict rules of medical ethics, and the 
 fear of infringing upon the rights of a fellow-practi- 
 lioner, to go on the instant ; for, in this disease, life 
 hangs on instants, and death waits not for ceremony. 
 
FIRST FART. 
 
 REPORT 
 
 ON THE 
 
 CHOLERA- MORBUS, 
 
 READ BEFORE THE 
 
 ROYAL ACADEMY OF MEDICINE, 
 
 IN 
 
 GENERAL SESSION, 
 
 ON THE 26TH & 30TH JULY, 1831. 
 
REPORT 
 
 ON THE 
 
 CHOLERA-MORBUS, 
 
 The Royal Academy of Medicine has received from 
 the Minister, Secretary of State for the Department 
 of the Interior, the following letter, addressed to its 
 President, dated March 4th, 1831, which we will now 
 read : — 
 
 " Monsieur le Baron, 
 " The Board of Health* of Marseilles has written me, that, 
 in consequence of the great number of vessels which arrive at 
 that port from the Baltic and the Black Sea, it has great reason 
 to apprehend that the Cholera-Morbus will make its appearance 
 in the health establishments there situated ; that, consequently, 
 it cannot acquire too much information respecting this disease. 
 It, therefore, beseeches me to consult, on the nature of the 
 Cholera-Morbus as well as upon its most appropriate preventive 
 and curative means, the Societies of Medicine and other learned 
 
 * Intendance Sanitaire. 
 
2 
 
 bodies of the capital, in order that such means may be had re- 
 course to in case their apprehensions should be realized. 
 
 " The Royal Academy of Medicine being constituted the legal 
 counsel of the Government in every thing that concerns the public 
 health, it is to it alone that I consider it my duty to address my- 
 self. I request you, M. le Baron, to invite this Society to under- 
 take, with the least possible delay, the compilation of such in- 
 structions as may serve to direct the Boards of Health of the 
 Kingdom in the application of those preservative and curative 
 means which they should employ against the Cholera, and to 
 enable them to recognise, in the surest possible manner, the 
 symptoms of this cruel malady. 
 
 " I anticipate from the zeal for the public welfare, of which the 
 Academy has already given so many proofs, that it will eagerly 
 comply with this request, by furnishing me with the work in 
 question. 
 
 (Signed) 
 
 MONTALIVET, 
 Peer of France, Minister of the 
 Interior, Secretary of State." 
 
 In consequence of this letter, the Academy appointed 
 a Committee, composed of MM. Keraudren, Chomel, 
 Coutanceau, Boisseau, Desportes, Marc, Dupuytren, 
 Pelletier, Louis, Desgenettes, Emery and Double, for 
 the purpose of preparing a Report upon this subject. 
 It is the work of this Committee that I am deputed to 
 submit to the Academy. 
 
 This is a grave subject, Gentlemen ; it concerns 
 almost every nation, whom it disturbs, whom it threat- 
 ens, or whom it attacks in their dearest interests. The 
 matter is arduous, immense ; it is sufficient to tell you 
 

 that we will be minute, very minute. But in consider- 
 ing a question in which every thing is new to us, we 
 must present to your view a summary of all the facts, 
 of all the doctrines contained in the numerous docu- 
 ments in existence. , 
 
 The symptomatology of Cholera, its necroscopic 
 characters, the seat and nature of the disease, the 
 chances of safety or of destruction, its treatment, the 
 geographical march of the disease under the influence of 
 causes which favour the extension of it, the prophylac- 
 tic means and sanative measures employed, we have 
 investigated ; notwithstanding each of these divisions 
 has been successively studied, first in Asia, and after- 
 wards in Europe. 
 
 But then, when we shall have completed the reading 
 and the discussion, the Academy will have shared in all 
 the labours of the Committee, or rather these labours 
 will have been executed entirely under its supervision. 
 You will, we are persuaded, have no cause to regret so 
 much pains bestowed, especially if we have had the 
 happiness of rendering them profitable. 
 
 When the Academy shall have adopted the Report 
 and its deductions, it will remain to digest a circum- 
 stantial instruction, addressed to the administrative 
 authorities, to the members of the profession, and to 
 the individuals of the countries threatened or attacked, 
 in order to determine by elaborate and luminous details, 
 what each should perform within the limits of its duties 
 and jurisdiction. 
 
 
Another work will also remain to be performed ; it 
 is a report upon the documents transmitted to the 
 Academy, in order to establish their respective value, 
 and determine the services which each author of these 
 documents, in particular, shall have rendered to the 
 Academy and to the Science. It is upon the accuracy 
 of these documents, it is upon their completeness that 
 the success of the Report depends. 
 
 For we have only been able to work from documents ; 
 and documents, whatever may be their accuracy, never 
 come up to all the ideas, all the expectations, and all 
 the exigencies of the mind which elaborates them. 
 
 Many deficiencies will fortunately be filled up by the 
 young men, enlightened physicians, brave savans, whom 
 the Academy has deputed at Warsaw and St. Peters- 
 burg. 
 
 Furthermore, if the investigation of such a subject, 
 at a distance from epidemic danger and tumults, has its 
 inconveniencies, it is on the other hand attended with 
 its advantages. In this respect, it is with great epidem- 
 ics, in the physical world, as with revolutions in 
 the political : in the midst of the violent jars and 
 sudden revolutions which, at intervals, agitate nations, 
 contemporaries, during the strife of opinions and the 
 shock of parties, may indeed collect materials or even 
 draw up particular memoirs ; but the history of these 
 strange, these dreadful epochs, can only be written at 
 a distance from the events which have accomplished 
 them. 
 
REPORT. 
 
 Committee : — MM. Keraudren, President ; Marc, 
 Chomel, Coutanceau, Boisseau, Desportes, 
 
 DUPUYTREN, PELLETIER, LoUIS, DeSGENETTES, 
 
 & Emery ; Double, Reporter. 
 
 The Cholera-Morbus — as if this malady were 
 the only, the exclusive malady, and that all others 
 scarcely deserved the name — the Cholera-Morbus 
 is a disease the knowledge of which ascends to the 
 remotest times of medical observation. Alreadv 
 very clearly pointed out by Hippocrates, who sub- 
 dued it by the assistance of warm fomentations, it 
 has been admirably described by Araetius of Cap- 
 padocia. The perspicuous, concise, accurate and 
 complete symptomatology, which this author, who 
 wrote at the beginning of the fifth century, has re- 
 corded, compared even with recent descriptions, or 
 those of the present day, scarcely leaves anything 
 
 2* 
 
 
to be desired by the most fastidious individual ; and 
 authors have scarcely done more than copy what 
 Araetius long since wrote on the subject. 
 
 This disease, sui generis, the characters of which 
 are distinct and constant, has frequently presented 
 itself to the notice of observers of every country. 
 It has often been observed appearing accidentally 
 in a single individual or in several isolated persons, 
 developed by the action of particular, idiosyncratic 
 predisposing causes, and then confined to these nar- 
 row limits. In this state it is called sporadic ; there 
 is no physician, of ever so little experience, who 
 cannot cite examples of it. 
 
 Neither is it rare to see the Cholera reign occa- 
 sionally under the influence of a determinate con- 
 stitution of the atmosphere, and in the form of a 
 popular disease, or minor epidemic, as stated by 
 Fouquet. This mode, more justly named catastatic, 
 in order to express that it depends especially upon 
 the regular but exaggerated constitution of the 
 seasons, has often been the mode pursued by the 
 Cholera. Thus was it recorded by Hippocrates in 
 the seventh book on Epidemics: thus was it ob- 
 served by Sydenham, in London, in 1669 and 1676; 
 by Huxham, in 1741 ; thus was it noticed in Paris 
 at different epochs, and more especially during the 
 summer of 1730, and in July, 1780, at which times 
 it was already remarked that the disease was more 
 
fatal to men than to women. Thus was it de- 
 scribed, in upper India, by Lebegue, of Presle, in 
 1762; Paisley, in 1774; by Sonnerat, from 1774 to 
 1781 ; by Curtis and Girdleston, in 1781 and 1782 ; 
 Thomson, in 1787 : thus did it appear to Doctor 
 Noel, (then surgeon-in-chief of the expedition,) 
 among the French troops who, during the last cen- 
 tury, were sent to contest with England the do- 
 minion of the peninsula of India. Disembarked 
 upon the coast of Coromandel, the French army 
 suffered greatly from this epidemic, which was 
 successfully treated bv means of divided doses of 
 Volatile Alkali given internally, repeated every two 
 hours, and administered in an infusion of sweeten- 
 ed balm tea. 
 
 But under all these circumstances, the cholera 
 has never extended beyond the influence of the 
 medical constitution with which it was found con- 
 nected. 
 
 The annals of science also present the Cholera 
 in certain localities, in particular countries, this is 
 the endemic Cholera. Bontius, who wrote in 1669, 
 had already described it under this form in India. 
 Dillon and Lind thus observed it in the same 
 countries ; and since that epoch, the useful labours 
 and the learned memoirs of the Physico Medical 
 Society of Calcutta, have derived similar results 
 from clinical observations. This endemic Cholera 
 
8 
 
 does not extend beyond the limits assigned to it by 
 the local causes, of which it is the effect. 
 
 Lastly, the Cholera exists in the symptomatic 
 form, connected in different cases with severe, acute 
 diseases. In southern climates we find it connect- 
 ed with high grades of bilious fever, and with intense 
 typhoid fevers. Such examples are not rare. M. 
 Bally has seen the Cholera decidedly complicated 
 with a case of yellow fever ; and our colleague 
 Dr. Jackson had previously described a Choleric 
 yellow fever, of which he has given the symptoma- 
 tology, the anatomical characters, and the treat- 
 ment. Torti, and other observers, since his time, 
 have treated the predominant and violent symp- 
 toms of Cholera in irregular (ataxic) remittent 
 fevers. 
 
 It is consequently well established that the Chol- 
 era has been, from time immemorial, observed in 
 the sporadic state, in the catastatic state, in the en- 
 demic state, in the symptomatic state, and that, in 
 these different conditions, it is never propagated 
 beyond the circumstances which attended upon 
 its origin. 
 
 Let us deliberate upon this first order of facts, 
 and again let us recapitulate, and with design, those 
 general results which have been drawn from in- 
 contestable observation and irresistible evidence. 
 Clinical instructions show us the manifestations of 
 
the isolated, sporadic Cholera, in individuals ex- 
 posed to the causes capable of producing it. Every 
 physician has seen examples of it. provided his 
 practice has placed him in the midst of circum- 
 stances more or less capable of giving rise to simi- 
 lar symptoms. 
 
 We can quite as easily conceive the facts of 
 Cholera existing in a certain number of cases at 
 determinate epochs of the year, through the influ- 
 ence of constitutions of the seasons and of con- 
 fined medical constitutions. There are few coun- 
 tries in which clinical observation has not de- 
 tected the catastatic form of Cholera. 
 
 We can also readily conceive that, under the 
 influence of certain climates, from the effect of 
 particular drinks and aliments, and in consequence 
 of determinate localities, the Cholera exists in the 
 endemic state : — the East Indies, since they have 
 been medically investigated, are an incontestable 
 proof of it. 
 
 Finally, facts have also presented themselves, 
 which compel us to admit that the Cholera, with all 
 the characters which are peculiar to it, manifests 
 itself symptomatically in some cases of malignant 
 fever, and that it does not extend beyond these in- 
 dividualities, with which it is closely connected. 
 
 There is then no absolute, natural, necessary, 
 inevitable property in Cholera, of extending from 
 one individual to another. The Cholera is not then, 
 
10 
 
 by its nature, essentially, primitively transmissible, 
 since it has very manifestly been observed in all 
 ages, and by all physicians, in the sporadic slate, 
 the catastatic state, the endemic state, and the symp- 
 tomatic state, without ever having passed beyond 
 the limits assigned to the particular causes which 
 have thus been shown to originate it. 
 
 Should the other scholastic divisions of Cholera 
 detain us even an instant ? Eminently practical 
 geniuses, Hoffman and Frank especially, have al- 
 ready done justice to them. As for us, we write 
 under circumstances too serious, to lay any stress 
 upon these speculative subtleties. 
 
 But the Cholera reigning in great epidemics, in 
 spreading and devastating epidemics, by the effect 
 of circumstances which cannot be rigorously ap- 
 preciated or understood, from the action of occult 
 causes which can neither be controlled nor foreseen, 
 independently of special conditions and physical 
 individualities, unconnected with atmospherical vi- 
 cissitudes and the modification of seasons which 
 give rise to it, exclusively of the local peculiarities 
 and hygienic influences which produce it, remote 
 from acute diseases and those febrile conditions 
 with which it is connected ; the Cholera thus pro- 
 duced has not hitherto been presented to medical 
 investigation ; and it is precisely in this state that 
 we are called upon this day to devote to it our 
 most diligent attention. 
 
PART FIRST. 
 
 SYMPTOMATOLOGY. 
 
 The Cholera in its violent epidemic form has, 
 for nearly fifteen years, exercised its fatal ravages 
 upon the scarcely explored soil of upper India ; and 
 for about three years has sought to place its foot 
 upon our ancient Europe. 
 
 Two different, we might even say opposite, 
 theatres, are thus almost simultaneously opened 
 to this fatal epidemic : the one is the burning soil 
 of the principal districts of the peninsula of India; 
 and the other, several governments of the Russian 
 Empire, and several parts of northern Europe. Let 
 us examine the disease successively upon both of 
 these theatres. 
 
 Upon the continent of Asia, the Cholera has pre- 
 sented the following characters : 
 
 General uneasiness, accompanied by a painful 
 sensation of heat in the epigastrium ; weariness of 
 the extremities ; greater or less debility ; oppres- 
 sion ; the physiognomy of the patient, which at 
 first expressed only uneasiness, changes more or 
 less rapidly, according to circumstances, to the ex- 
 
12 
 
 pression of great anxiety ; at this moment the pulse 
 is quick, but hard and contracted. 
 
 This is the period of invasion of the disease, a 
 period observed by many practitioners, Annesley, 
 Colledge, &c. ; disputed on the other hand by 
 Scott and some other authors. 
 
 Now, let us say in anticipation, that Dr. Annesley 
 attaches to this period so much the more import- 
 ance, inasmuch as, according to him, it is chiefly by 
 acting precisely at this instant that the assistance of 
 art fortunately succeeds in arresting the disease, by 
 stifling it in its work of formation, or at least by 
 preparing it for a successful termination. 
 
 The primary symptoms are sometimes accompa- 
 nied, or at least immediately followed, by a very 
 severe pain at the pit of the stomach, which soon 
 invades the entire digestive tube : this is, of all 
 symptoms, the most durable and the most constant, 
 and is one of the characteristic signs of the disease. 
 
 Next, repeated vomitings supervene, the stools 
 become frequent, attended with a painful sensation 
 of prostration, exhaustion, and as it were of general 
 vacuity. Irregular spasmodic contractions, violent 
 cramps, seize upon the superior and inferior extrem- 
 ities, which, together with the fatigue produced 
 by the repeated vomitings and frequent dejections, 
 cruelly torture the patient. 
 
13 
 
 The evacuations, exclusively composed at first of 
 the substances contained in the stomach and intes- 
 tines at the invasion of the disease, soon assume 
 a particular pathognomonic character ; they con- 
 sist of a whitish, serous, aqueous fluid, somewhat 
 analogous to a decoction of rice mixed with albu- 
 minous flakes, or to the liquid evacuated by the 
 operation of paracentesis : sometimes these sub- 
 stances are still thicker, muddy, and interspersed 
 with diverse grey and greenish colours, but rarely 
 bloody. Occasionally the alvine dejections are for- 
 cibly expelled from the intestines, and as it were by 
 the jet of a syringe, even in an advanced period of 
 the disease. 
 
 There is an absence of febrile re-action ; the pulse 
 is small, vacillating irregular, nervous ; it rather 
 vibrates than beats. This absence of all re-action, 
 even though it may be only a negative symptom, is 
 one of the most decided characteristics of this dis- 
 ease. Except in very rare cases of accidental com- 
 plication, the equally uncommon cases of typhoid 
 terminations or mutations, or those in which the 
 tendency to cure manifests itself and persists a 
 greater or less length of time, never, in this period, 
 has any severe symptom of the choleric epidemic 
 assumed the febrile form unless the disease ter- 
 minated favourably. 
 
14 
 
 The flow of urine is entirely suspended ; the se- 
 cretion of it does not go on at all ; necroscopic ob- 
 servations unite with the symptomatology to prove 
 the complete vacuity of the bladder. 
 
 The spasms rapidly assume a greater degree of 
 intensity ; they successively, and in a very short 
 period, run through the inferior and supeiior 
 extremities, the abdominal muscles, and, in the 
 last place, the thoracic and diaphragmatic mus- 
 cles ; but they rarely extend to the muscles of the 
 back, face, or loins. These spasms are rather of 
 the clonic than of the tonic character. 
 
 Then also supervene deafness, giddiness, tinkling 
 in the ears, and coldness of the whole body. A 
 great anxiety at the precordial region manifests it- 
 self; it is connected with an extreme difficulty of 
 breathing, and excessive debility of the whole sys- 
 tem. The air expired by the patient is destitute of 
 all warmth. The skin is covered with a cold sweat ; 
 and this cold, this humidity, sometimes augments to 
 such a degree, that the dermis is corrugated and 
 folded as if the skin had been macerated for a long 
 time in warm water, or covered by an emollient 
 cataplasm. 
 
 In many cases, the skin, throughout its whole ex- 
 tent, or in certain points, assumes a leaden, bluish, 
 and livid tint. 
 
15 
 
 The sunken countenance ; the deep, hollow eye, 
 surrounded by a livid circle, and the pinched fea- 
 tures ; all give to the patient a ghastly appear- 
 ance. According to the saying of almost all ob- 
 servers, the face of cholerics, differing but little from 
 the hippocratic face, is so highly characteristic, that 
 this sign would of itself suffice for the diagnosis 
 of the disease. The face is triangular, says Dr. 
 Blahodatoff, who observed the disease in the district 
 of Samarski, government of Orenburgh. 
 
 The pulse is contracted, small to excess, it is diffi- 
 cult to seize it, and frequently the pulsations at the 
 wrist are wanting ; they are even scarcely percepti- 
 ble at the heart. At this period, the blood, which 
 a little time previous was oily, thick, black, and 
 escaped but with difficulty from the vein, can no 
 longer escape from it, or at least is expressed from 
 it with difficulty. 
 
 The patient experiences an insatiable thirst, he 
 swallows with avidity cool liquids ; notwithstanding 
 the tongue and mouth are pale, white, moist and 
 cold. The voice is feeble and sepulchral. There 
 are vague jactitations of which the patient is scarcely 
 conscious ; and though he may retain the integrity 
 of his intellectual faculties, all the vital actions are in 
 such a state of exhaustion, that he lies incomplete un- 
 consciousness of his condition, and obstinately wishes 
 to remain at rest, totally indifferent to what is doing 
 
16 
 
 for his relief, and to every thing that is passing 
 around him. Death generally happens in twelve, 
 fifteen, twenty or twenty-six hours after the invasion 
 of cholera. Often, towards the close of the disease, 
 and at the approach of the most imminent danger, 
 the vomitings and dejections diminish, become sus- 
 pended, and cease suddenly. 
 
 The commencement of the disease generally takes 
 place during the night or in the morning ; the other 
 periods arrive with rapidity, and often with confu- 
 sion — for we must not expect any thing fixed, any 
 thing regular, in the midst of this scene of disorder 
 and destruction. In a great number of cases, all 
 the stages of the disease become confounded and 
 exhausted in a very short space of time. One or 
 two hours, at most, sometimes intervene between 
 the violent invasion of the disease and its fatal termi- 
 nation. 
 
 The course and series in which the symptoms 
 are unfolded, connected, and succeed one another, 
 are sufficiently variable : sometimes even the most 
 prominent and most characteristic symptoms are 
 entirely wanting, and that doubtless because they 
 have not been allowed time to develope them- 
 selves : such, for example, are the vomitings. We 
 find some cases in which the disease has pro- 
 gressed so rapidly, that in an instant the individual 
 is found transported from the state of perfect health 
 
17 
 
 to that fatal epoch when the vomitings and stools 
 cease, because all the vital operations, all the invol- 
 untary movements, abandon the life which is soon 
 to cease and be extinct. 
 
 The symptoms in natives and Europeans 
 are the same. The constitution of the individual 
 makes all the difference, according as, whether natu- 
 rally or accidentally, he is found, in the moral as in 
 the physical, either vigorously constituted, or con- 
 siderablv debilitated. 
 
 By analysis, the catalogue of the symptoms of the 
 disease may be thus summed up : — 
 
 Epigastric pains, repeated vomitings, and frequent 
 stools ; the substances, discharged at first, consisting 
 of aliment recently ingested, soon become fluid, 
 whitish, and flocculent ; violent cramps in the supe- 
 rior and inferior extremities ; coldness of the body ; 
 suppression of urine ; the skin of the extremities, 
 of the feet especially, pale, moist, cold and wrinkled; 
 decomposition of the features ; hippocratic counte- 
 nance ; sinkingand notable disappearance of the pulse. 
 
 Investigated in its symptomatology, the medical 
 history of the epidemic cholera has acquired but 
 little in the hands of the physicians of Russia. In 
 Russia and in India the disease has presented itself 
 under the same characters ; upon both theatres na- 
 ture has been faithfully copied. Why then should 
 not their descriptions bear a resemblance? The 
 epidemic influence acting upon almost every indi- 
 
 3* 
 
18 
 
 vidual exposed to it, even in those in whom the 
 cholera was not realised'; the period of imminence 
 marked, although rapidly, in many patients; the 
 choleric physiognomy given as one of the prominent 
 characters of the epidemic ; the absence of all fe- 
 brile re-action ; the frequency of relapses : every 
 circumstance noted by the English physicians in 
 India, has been exactly presented to the view of 
 physicians who observed the disease in Russia. 
 
 Here, however, we observe, in a special manner, 
 that the cramps manifested themselves in a more 
 violent and obstinate form in women than in men ; 
 and still more so among those who possessed a feeble 
 constitution,who were subject to hysterical affections, 
 or placed under the influence of pregnancy, whether 
 in its commencement or its more advanced stages. 
 
 The pulsations of the heart diminished to that 
 degree, that, even by the ear or the stethoscope, 
 its motion could scarcely be distinguished ; and in 
 the most severe cases, it was onlv the left side of the 
 heart that continued to contract slightly ; the pulse 
 then disappeared entirely, and could but with diffi- 
 culty be detected except in the carotids. In certain 
 cases, says M. Jachnichen, it was only by means of 
 the stethoscope that the respiratory movements could 
 be followed. In Russia the stools and vomiting 
 were less frequent and abundant. 
 
 In Poland, the symptomatology the same ; here 
 only percussion has revealed to MM. Briere de 
 
19 
 
 Boismont and Legallois a symptom which had not 
 been so clearly mentioned until then ; it is the dull- 
 ness in the sound (matite) of the abdomen. This 
 phenomenon, say our observers, is particularly re- 
 markable, when we compare it with the sonorous- 
 ness of the belly in individuals attacked with typhus. 
 This dulness is explained, they add, by the enormous 
 accumulation of fluids in the intestines. At Madras, 
 this state of the abdomen had also been pointed out 
 by Annesley. 
 
 By the side of the symptomatology observed first 
 in India, then in Moscow, and finally at Warsaw, 
 let us place the symptomatology described by 
 Aretoeus of Cappadocia ; let us translate it through- 
 out ; and let us not fail, through the puerile appre- 
 hension of being prolix, to be complete and con- 
 vincing. 
 
 In the cholera, an extremely acute disease, says 
 Aretoeus, the whole of the alimentary tube experi- 
 ences a commencement of repulsion, so that the 
 substances collected in the stomach are violently 
 ejected by vomiting, and those of the intestines 
 forcibly expelled from the anus. The matters 
 ejected become liquid and whitish, and those which 
 escape by the fundament are foetid, pituitous, and 
 sometimes bilious. Soon abdominal tension, pains 
 at the pit of the stomach, and violent cholics super- 
 vene. General spasms manifest themselves, painful 
 
20 
 
 contractions in the muscles of the legs and arms 
 ensue ; the fingers are curved, and the nails become 
 livid and extremely cold. There are syncope, ver- 
 tigo, oppression and hiccup. The urine no longer 
 flows ; the voice is extinguished ; the pulse becomes 
 extremely small and slow, and the patient dies over- 
 whelmed with lacerating pains, and in the midst of 
 the most horrible convulsions. 
 
 From these conjoined documents on the subject 
 of the symptomatology of cholera, the following 
 conclusions naturally proceed : 
 
 1. The cholera has been observed at all limes, in 
 the sporadic state, in the catastatic state, in the en- 
 demic state, and in the symptomatic state, with- 
 out ever having extended beyond the limits assign- 
 ed to the particular conditions in which they have 
 been found to arise and terminate. 
 
 2. The epidemic cholera observed in India is 
 little else than the cholera described by the ancients, 
 as to the symptomatology. 
 
 3. The cholera which prevailed in Moscow is the 
 same as the cholera of India. 
 
 4. The cholera which has occasioned such ravages 
 in Poland, and especially in Warsaw, does not differ 
 from the cholera which raged at Moscow. 
 
 Consequently the cholera of the ancients, the 
 cholera of India, the cholera of Moscow, and the 
 cholera of Warsaw, are identical, so far as regards 
 the phenomenal characters. 
 
PART SECOND. 
 
 NECROSCOPIC CHARACTERS. 
 
 It is truly remarkable, as we have just seen, how 
 great is the analogy, agreement, and as it were, 
 identity, which the numerous descriptions of the 
 Cholera, derived from the midst of these different 
 regions, present. In Asia, Persia, Syria, in lower 
 Bengal, Mysore, and upon the Coromandel coast, 
 in Russia and in Poland ; in the authentic reports 
 of the medical societies of Bombay, Calcutta, 
 Madras, of Moscow and of Warsaw ; in the pub- 
 lications of Annesley, Ainslie, Christie, Scott, Con- 
 veil, Johnson, Jameson, Searle, Reymann, Loder, 
 Moran, Jachnichen, of Delaunay, MM. Briere de 
 Boismont and Legallois : whether we meditate upon 
 its particular histories, or read the general de- 
 criptions, always, every where and in all authors, 
 the symptomatology is concurrent and uniform : 
 we mio-ht, it would seem, from this consideration 
 alone deduce one of the arguments in favour of the 
 certainty of medicine. 
 
 It would be well, indeed, if the same result 
 could be obtained from the history of its necros- 
 
22 
 
 copic characters. Whether, in consequence of the 
 nature of the researches, it was necessary to sur- 
 mount greater obstacles, or that habit and ability, 
 zeal, and courage, have been wanting to observers, 
 or that pre-conceived opinions often preside over 
 this part of the subject, or that, lastly, the cadav- 
 eric lesions have been variable and uncertain ; it 
 has always been the case that, upon this point, the 
 detail of facts and the summary of the investi- 
 gations have often been different, and sometimes 
 even contradictory. 
 
 In investigating this order of the subject, there 
 is one consideration which strikes the reflecting 
 reader ; it is, on the one hand, the great diversity 
 and even absolute discrepancy which the results 
 furnished by pathological anatomy present, when 
 we compare those of one observer with those of 
 another ; and, on the other hand, the resemblance, 
 or even uniformity, of these same results in all the 
 particular cases related by one and the same ob- 
 server. This is carried so far, that Annesley, who 
 without contradiction, has given one of the best 
 descriptions of this disease, after having subjoined 
 to some of his cases the pathologico-anatomical 
 researches which appertained to them, discon- 
 tinues the further detail of autopsic examinations, 
 contenting himself with declaring, that the anatomic- 
 al appearances were the same as in the preceding 
 cases. 
 
23 
 
 With these reflections, which may be subservient 
 in estimating the- value of the works we are 
 about to examine, we may say in general that, on 
 the continent of Asia, the researches of pathologic- 
 al anatomy have presented, sometimes the altera- 
 tions, the anatomical characters of gastro-intestinal 
 phlegmasia, and sometimes a simple catarrhal state 
 without any trace of inflammation of the mucous 
 membrane of the intestines. In some cases cere- 
 bral congestions and considerable injections of the 
 vessels of the brain and its membranes have been 
 noted ; in others, lesions of the spinal marrow and 
 its envelopes. In many circumstances pathological 
 anatomy has developed nothing which could afford 
 a sufficient reason for the symptoms of the disease 
 and its termination ; and then it has almost always 
 been attributed to a lesion of the vital properties of 
 the nervous system. 
 
 Let us enter, however, into the details of these 
 researches ; it is the only way in which we can com- 
 prehend and duly appreciate them. 
 
 Doctor Annesley finds, from autopsic investiga- 
 tion that the intestines present a vermillion colour, 
 which, he says, is peculiar to the disease, and which 
 he considers as characteristic of Cholera. 
 
 He attributes the same importance to a gelatin- 
 ous extravasation, to a yellowish, pultaceous, and 
 as it were creamy, matter, which adheres to seve- 
 
24 
 
 ral points of the internal surface of the small intes- 
 tines, and which is there met with in variable 
 quantities, 
 
 According to him, the substance of the heart is 
 softer and more easily lacerated than it generally 
 is in bodies dead from other diseases. The cavi- 
 ties of this organ, as well as the principal arterial 
 and venous truncks, are filled with a thick and 
 viscid black blood. 
 
 The primary and principal strokes of the disease 
 are directed, says Mr. Annesley, upon the nervous 
 system, the lesion of which immediately re-acts 
 upon the sanguineous system. 
 
 Doctor Alexander Gordon, a surgeon attached 
 to the Bombay Presidency, a man of distinguished 
 merit, and who fell a victim to the epidemic, 
 asserts in a memoir addressed to the medical so- 
 ciety of Bombay that, in this epidemic, the lesions 
 of the brain were primitive and essential, whilst 
 those of the intestines were only secondary. In 
 the first subjects which he examined, he had ne- 
 glected to examine the brain, and then he could 
 not discover any thing which could satisfactorily 
 account for the violent nature of the disease. Af- 
 terwards he extended his investigations also to the 
 encephalon, and he there found the vessels injected 
 and the membranes thickened : these lesions, how- 
 ever, did not seem to him to be at all inflammatory. 
 
25 
 
 Doctor Scott, secretary to the Medical Board of 
 the Presidency of Madras, regards these lesions of 
 the brain, on the contrary, as secondary and acces- 
 sory, since the intellectual faculties generally remain 
 perfect during the course of the disease. In the 
 opinion of Dr. Scott, it is in the mucous membrane 
 of the intestines that the important facts of patho- 
 logical anatomy peculiarto the cholera are developed. 
 
 That if the patient is seized with coma, if we 
 observe in him that extreme degree of torpor, into 
 which individuals attacked by this disease fall, if 
 he is entirely unconscious of whatever is passing 
 around him — it is to debility, says Dr. Scott, that 
 we must attribute these symptoms. 
 
 Kennedy, the author of a work ex professo, upon 
 the Indian Cholera, pretends that this disease con- 
 sisting merely in a considerable alteration of the 
 vital functions of the nerves, the system of the 
 circulation is but secondarily affected. There is in 
 the Cholera, according to his views, some occult 
 cause which retains the vital powers in a state of 
 violent oppression ; in a word, says he, the Cholera 
 consists in a more or less forcible concussion of the 
 encephalon, a concussion, the form of which is 
 entirely unknown to us. 
 
 The information derived from the autopsic ex- 
 aminations of those physicians who observed the 
 Cholera at Samarang, sheds no light upon the 
 
 4 
 
 
26 
 
 the nature of this disease. It is scarcely worth 
 while to make mention of the very slight traces 
 of inflammation scattered over the intestines, and 
 still less do we deem it necessary to notice the 
 bloody froth with which the bronchia were filled in 
 many cases, the contraction and vacuity of the blad- 
 der, or the injected vessels of the brain and its 
 membranes. The physicians who have studied the 
 disease in Samarang, have consequently inferred, 
 that, as to its primary cause, it consists in a vi- 
 olent spasmodic affection of the digestive organs, 
 and more especially of the stomach and duodenum. 
 M. Mouet, surgeon-general of the 24th regiment 
 of his Britannic Majesty, and who has given, in the 
 collection of the Philosophico-Medical Society of 
 Calcutta, a very valuable work on the Cholera, de- 
 clares that most frequently the opening of bodies 
 does not furnish any information of importance. 
 Sometimes, says he, we found, either in the intes- 
 tines, or in the encephalon, the vessels considerably 
 injected ; at other times such injections scarcely 
 existed, or even were not at all perceptible. In 
 two cases, in particular, wherein the patients were 
 attacked with coma and violent delirium, he found 
 nothing in the brain, notwithstanding, he adds, the 
 autopsy was always conducted with the most scru- 
 pulous exactness. It was in three subjects only 
 that he discovered the pultaceous matter which 
 
27 
 
 Doctor Annesley was the first to notice in this 
 disease, a matter which he says is constant, and 
 which he regards as the specific cause and conse- 
 quently as the pathognomonic sign of Cholera. 
 
 Dr. Turnbull Christie, attached to the Medical 
 establishment of Madras, and quite recently ap- 
 pointed to take charge of the civil medical depart- 
 ment for the district south of Maratta, in an original 
 and valuable work, entitled Observations on the na- 
 ture and treatment of the Cholera, and the manner 
 in which it affects the mucous membranes, has freely 
 investigated its pathological anatomy. His obser- 
 vations, collected during ten consecutive years and 
 especially in those of 1823 and 1824, as well upon 
 the soldiers of his Britannic Majesty's regiments as 
 upon the natives of cities and country villages, and 
 the frequent opportunities which he has had of 
 seeing the disease in prisons, have favoured him 
 with facilities of opening numerous dead bodies, 
 which are but with great difficulty obtained among 
 the free natives. During the year of 1826 alone 
 the total number of deaths in the whole district 
 of Darwar, amounted to three thousand and fifty- 
 three. We have not, however, any data upon 
 the fixed population of this district. 
 
 The mucous system, according to the opinion of 
 Doctor Christie, is the incontestable seat of the dis- 
 ease. This system, an exception to all others, is 
 
28 
 
 susceptible of two forms of lesion : the inflammatory 
 form, which is common to it with all the other tis- 
 sues, and the catarrhal, which is peculiar to it 
 alone. The catarrhal form is entirely distinct from 
 the inflammatory. In the mucous tissue they 
 generally exist separately, but often they are also 
 united and complicated with one another. The 
 catarrhal form, by being prolonged with a certain 
 degree of activity, ushers in the developement of 
 the inflammatory form. These results of facts are 
 illustrated by the symptomatology compared with 
 that of many other diseases, by the action of med- 
 icines on man and animals, and by direct ex- 
 periments made upon the latter, as well as from 
 certain vivisections. The inflammatory state of the 
 mucous tissue does not differ from what takes place 
 in inflammation in general ; but the catarrhal state 
 is a specific diseased affection of the secretory ap- 
 paratus of the mucous membranes, whence result 
 the augmentation and alteration of the secretion. 
 Then the mucous membrane is white without pain, 
 without tumefaction ; there is a diminution in the 
 propulsion of the blood to the circumference. It 
 is pretty generally advanced, says Dr. Christie, that, 
 in the Cholera, pathological anatomy unfolds nothing 
 which can satisfactorily account for the disorders 
 which exist during life. An opinion like this, he 
 adds, can only proceed from the carelessness of the 
 
29 
 
 researches. The mucous membranes have not been 
 studied with sufficient attention : some physicians 
 have, doubtless, examined with care the secretions 
 furnished by the mucous system : but there are 
 few, or indeed none, who have properly studied 
 the lesions of the membranes which furnish these 
 secretions. 
 
 It is in vain that we search in the encephalon, the 
 nervous system, or in the sanguineous system for 
 the anatomical lesions of Cholera : it is invariably 
 to the mucous system that these lesions belong ; all 
 others are merely accidental or secondary. 
 
 I have constantly found, again says M. Christie, 
 in my very numerous dissections, an opaque, viscid, 
 whitish substance adhering to the surface of the in- 
 testinal mucous membranes ; and in some cases this 
 substance was so abundant as to fill the intestines 
 completely. The membrane was white and smooth 
 throughout its whole extent. Similar alterations 
 have sometimes existed in the pulmonary mucous 
 membrane, and even in the bladder. 
 
 The anatomical lesions which, in regard to fre- 
 quency, may be ranked in the second order, are, 
 
 1st, Venous congestions of several organs, and 
 especially of the abdominal viscera ; 
 
 2d, Accumulations of thick, black blood in all 
 the vessels, and especially in the heart ; 
 
 3d, Traces of injections upon some points of the 
 
 4* 
 
30 
 
 mucous membranes, and especially of the intes- 
 tines. In these cases the inflammation, when it did 
 exist was found confined to the pyloric extremity 
 of the stomach and the small intestines. 
 
 4th. Simple venous congestions in various points, 
 such as have been noticed by Doctor Annesley. 
 
 Resuming the consideration of the secretions ot 
 the mucous membrane, Dr. Christie demonstrates 
 that they are not only increased in quantity, but 
 that they are likewise altered and depraved in qual- 
 ity ; and brings forward a great number of chym- 
 ical analyses and physical experiments to substan- 
 tiate the fact. The author has especially very 
 positively proved that no free acid exists in the sub- 
 stance of these secretions; thus, says he, does the 
 opinion promulgated by Dr. Ainslie upon the path- 
 ogeny of the epidemic cholera fall to the ground. 
 
 Whitelaw Ainslie has resided during thirty years 
 at Madras and in several parts of southern India, 
 in the capacity of physician and member of the 
 committee deputed to investigate the epidemic chol- 
 era. He considers the lesions indicated by path- 
 ological anatomy as of but trivial importance ; he 
 knows them all, he has seen them all. The essence 
 of the disease, in his opinion, resides in a free acid 
 the existence of which he has detected in the sub- 
 stances discharged by stool and by vomiting ; and 
 hence he derives all his opinions relative to the na- 
 
31 
 
 ture of the disease, its indications and its method of 
 treatment. 
 
 James Boyle, from three autopsic examinations 
 only, signalizes slight traces of inflammation in the 
 stomach and intestines ; he lays great stress upon 
 this order of considerations, and roundly asserts 
 that the pathological anatomy of cholera always 
 furnishes similar results. 
 
 At the isle Saint-Maurice, M. Guillemau thus 
 renders an account of his necroscopic observations. 
 It is to the interesting work of our colleague M. 
 Keraudren that we are indebted for this communi- 
 cation. 
 
 Encephalon healthy ; lungs in the normal state ; 
 right cavity of the heart full of a blackish blood, left 
 cavity empty : the stomach presenting diverse alter- 
 ations ; phlogosis and injection of the vessels ; the 
 mucous membrane sometimes destroyed in different 
 points and especially near its orifices, which are 
 sometimes apparently contracted: this organ had 
 preserved its liquids almost unchanged. The small 
 intestines were in general healthy, whilst the tunics 
 of the large intestines were thickened. The latter 
 phenomena presented the greater intensity in pro- 
 portion as the disease had been the more pro- 
 longed. 
 
 Doctor Labrousse thus gives the result of the 
 autopsic examination of twelve blacks, all of whom 
 
32 
 
 died, in the space of twelve hours, from the epi- 
 demic of the isie of Bourbon. 
 
 After death, the body, without any appearance of 
 putrefaction, was generally emaciated, very meagre, 
 notwithstanding the constitution of the patients had 
 been very robust. 
 
 In some the brain had undergone no change ; 
 whilst in others its substance was found softer than 
 in the ordinary state. The longitudinal sinus was 
 gorged with blood, and the lateral ventricles con- 
 tained a small quantity of sanguineous serosity. 
 
 The lungs were sound ; the pericardium contain- 
 ed a little serum ; the heart was slightly enlarged ; 
 the coronary vessels were always filled with a very 
 black and coagulated blood : no adhesion was ob- 
 served in th's cavity. 
 
 The gastro-colic epiploon, and the internal sur- 
 face of the intestines as well as the mesentery, pre- 
 sented a slight degree of inflammation and a great 
 repletion of their vessels. 
 
 The gall bladder, very much distended, contain- 
 ed a thick and blackish bile. The hepatic, cystic 
 and choledic ducts were twice their natural size ; 
 the spleen, pancreas and kidneys presented nothing 
 peculiar. The bladder w r as greatly contracted and 
 in a state of complete vacuity. The stomach, dis- 
 tended with gas, was otherwise empty in several ; 
 in others it contained a greyish white viscid fluid 
 
33 
 
 and some worms. The gastro-intestinal mucous 
 membrane, sound in some individuals, presented in 
 others an intense inflammation which increased from 
 the pylorus to the rectum. The other tunics par- 
 ticipated in this inflammation, with the exception 
 of those of the jejunum and ileum. 
 
 Their cavity enclosed a sero-purulent liquid and 
 sometimes lumbrici. 
 
 The examination of the bodies often other blacks, 
 who died in the first four days of the disease, pre- 
 sented nearly the same phenomena in the three cav- 
 ities, unless it was that the inflammation was more 
 intense. Gangrenous spots were then observed in 
 the small intestines, and the substances contained 
 in their cavity seemed to be the same with those of 
 the dejections. 
 
 Under certain circumstance?, the examinations 
 of the bodies of those who have died in consequence 
 of cholera, have exhibited invaginations of the in- 
 testines, partial ulcerations and even gangrene. But 
 these can only be considered as accidental occur- 
 rences and exceptions ; they should be noticed how- 
 ever in order that our researches may be rendered 
 complete : but it should be mentioned that these 
 lesions have rarely been detected, and that it is not 
 in the most severe and most promptly fatal cases 
 that they have been remarked. 
 
34 
 
 From the observations of writers on the Indian 
 cholera, two original opinions, in relation to its 
 pathological anatomy, are derived which merit a 
 particular examination. 
 
 The first, represented by Annesley, who if he 
 did not discover it has at least supported it with 
 eclat, is characterised by making the cholera consist 
 in a coloration of the intestines, the tint of which 
 varies from a bright vermillion to a deep purple, 
 and in the secretion of a whitish, viscid, and opaque 
 pultaceous matter. This coloration is particularly 
 remarkable upon the peritoneal surface of the duod- 
 enum and jejunum. What need is there of insist- 
 ing much on this coloration ? On the one hand, it 
 is necessary that the existence of these reddish ap- 
 pearances should have been confirmed by every 
 observer ; a great many, however, have denied 
 their existence ; and, on the other hand, in how 
 many cases of different acute diseases have these 
 reddish appearances, these injections not been ob- 
 served ? This lace-work of small injected vessels 
 is almost always discovered after death, especially 
 when but a very short space of time elapses between 
 the decease and the opening of the body. How 
 can any transient red appearances, or partial injec- 
 tions of the intestinal mucous membrane, so little 
 in relation with the general symptomatology, the 
 rapid progress, and fatal termination of the disease, 
 
35 
 
 be seriously invoked as causes of the epidemic 
 cholera ? 
 
 The second original opinion, among physicians 
 who have attended the disease in Asia, appertains 
 almost exclusively to Doctor Christie. In the 
 opinion of this physician, the mucous system is the 
 principal seat of epidemic Cholera, and it is a 
 catarrhal state of this system which constitutes the 
 special modification of it : this modification is, in 
 its turn, nothing else than the increased and vitiated 
 action of the secretory vessels of the mucous mem- 
 brane, andanextraordinaryalteration in thesecretion. 
 Dr. Christie has almost uniformly found the mucous 
 membrane of the intestines pale, white, softened, 
 doughy, very lacerable, and coated with a large 
 quanity of a whitish, viscid, opaque, creamy fluid. 
 
 These facts, which in themselves are of the high- 
 est importance, and which have been likewise con- 
 firmed by many observers, are nevertheless present- 
 ed in a manner too general, too exclusive, by Doctor 
 Christie. Without doubt these conditions of the 
 mucous system exist in many cases of Cholera, but 
 they are not in themselves alone the entire disease. 
 In the normal state, the intestinal mucous mem- 
 brane is also pale, white and soft ; the only differ- 
 ence then is in degree, and this softening of the 
 internal mucous tunic is far from constantly pre- 
 senting itself in the autopsic examinations con- 
 
36 
 
 sequent upon Cholera. The mucous follicles, the 
 glands of Peyer and Brunner, specially destined for 
 the secretion of the intestinal mucous fluids, are 
 without any material lesion in the Cholera, notwith- 
 standing their functions have been manifestly im- 
 paired. In the catarrhal state the occurrences 
 which take place are decidedly opposed to those 
 which ensue in consequence of the inflammatory 
 state of the latter organs. 
 
 From the labours of Christie, it appears that the 
 existence of a catarrhal affection, as an integral 
 part of the Cholera, cannot be doubted ; but on 
 the other hand, this opinion, entirely exclusive, 
 cannot be admitted as such. 
 
 The history of the necroscopic characters has not 
 been less elaborated by the physicians who have 
 engaged the epidemic upon the soil of Russia. In 
 the numerous documents which have reached us 
 from this country we find, in the first place, many 
 of the general results of autopsic examinations ; and 
 these results, variable, uncertain and superficial, do 
 not present any character which has not been de- 
 veloped in the researches of pathological anatomy, 
 consequent upon some other diseases ; none of 
 which can enlighten us as to the nature of the dis- 
 ease, or unveil to us the cause of its rapid march 
 and fatal ' terminations. 
 
37 
 
 Let us see how M. Surgeon Major Sokolow 
 expresses himself upon this point, in his interesting 
 work on the epidemic observed at Orenburg. 
 
 All anatomical researches made upon the bodies 
 of those who have fallen victims to the Cholera, 
 whether at the commencement of the epidemic 
 or towards its close, and repeated as often as any 
 peculiarities in the symptoms or unusual violence 
 and rapidity in the disease served to attract at- 
 tention, may be reduced to the following particulars : 
 tension of the skin ; flexibility of the muscles, at 
 least during the twenty-four hours immediately suc- 
 ceeding death ; a certain flaccidity, a softness of 
 the muscles, and rapid tendency of the bodies to 
 putrefaction. 
 
 In the cavity of the cranium, we uniformly found 
 a great collection of thick black blood, extravasated 
 between the convolutions of the cerebral substance, 
 and a distension, a repletion both of the veins of the 
 brain itself and of the arachnoid. 
 
 The lungs were flaccid and filled with a thick and 
 black blood ; such was also the appearance of the 
 heart, which in some cases presented, internally, pol- 
 ypiform concretions. This last character was par- 
 ticularly remarked in the bodies of those individuals 
 who died, after the termination of Cholera, of lethar- 
 gic fever with stupor. The abdomen never pre- 
 sented adhesions, extravasation or meteorism. The 
 
 5 
 
38 
 
 peritoneum, mesentery, and omenta preserved their 
 normal state ; their blood-vessels however were more 
 distended with blood than ordinarily. The stomach 
 and intestines presented, as w r ell at their internal as 
 upon their external surface, reddish streaks, similar 
 to inflamed scratches, which extended longitudinally. 
 Internally, the intestines were covered with brownish 
 and pretty viscid mucosities. After having washed 
 away these mucosities, we perceived that the thick 
 reddish streaks of the stomach and intestinal canal, 
 and especially of the small intestines, presented 
 neither gangrenous appearance, nor that purplish 
 redness which characterises a decided inflammation. 
 Injections of thick blood were particularly manifest 
 in the venous ramifications of the stomach and liver; 
 the gall-bladder was injected and filled with a con- 
 siderable quantity of bile. The spleen was some- 
 times healthy, but more generally turgid and very 
 lacerable. The kidneys differed but little from 
 the natural state; the bladder was always empty 
 and contracted. We have not in any corpse found 
 the least trace of gangrene. 
 
 Doctor Meusnier, Physician of the Faculty of 
 Paris, Consular Agent of France at Tangaroc, where 
 he has observed the disease, in his letter to the 
 Academy upon the Cholera, thus expresses himself: 
 
 " The disease is decidedly an inflammatory 
 epidemic; the necropsy has exhibited (especially 
 
39 
 
 in those who perished rapidly) very violent inflam- 
 mation of the epiploon, of the small intestine, and 
 of some parts of the stomach ; the gall-bladder but 
 partially distended, and usually containing a deep- 
 coloured and thick bile ; a deep coloration of the 
 muscles in all their fibres, a coloration which I have 
 never seen so strongly marked in other cases of 
 necropsy, consequent to death proceeding from 
 other diseases." 
 
 Doctors Jachnichen and Marcus have published a 
 collection of forty cases of Cholera, followed by 
 autopsic examinations carefully made and exposed 
 with the minutest details. Let us first hear M. 
 Marcus' description of these researches in patho- 
 logical anatomy. 
 
 We have found, says M. Marcus, that a black 
 blood filled not only the cavities of the heart, but 
 also many of the arteries, especially the arteries 
 proper to the heart and those of the base of the en- 
 cephalon ; besides, there were constantly certain 
 fibrous polypous concretions in the cavities of the 
 heart, and also some signs of irritation and appa- 
 rent inflammation over points of this organ. 
 
 We have also directed our attention to the patho- 
 logical state of the envelopes of the spinal marrow 
 and of the coverings of the brain, the whole of the 
 medullary substance of which was found healthy, 
 and we have seen that the first were more frequent- 
 
40 
 
 ]y in a pathological state than the second. Lastly, 
 we have found that the intestinal tube not only did 
 not present uniform characters, but that it even 
 presented those which were contradictory. 
 
 We have been led to conclude that the alterations 
 in the gastro-intestinal system have only been con- 
 secutive and accidental ; that those of the encepha- 
 lon, although much more important, were not how- 
 ever characterised by a disturbance of functions by 
 any means so great as that which obstructed the 
 movement of the heart during life ; that, conse- 
 quently, the phenomena presented by the heart, such 
 as the accumulation of a black blood in its cavities 
 and in the arteries, together with the fibrous concre- 
 tions, were the most constant anatomical characters. 
 
 The stomach and intestines, says MM. Briere de 
 Boismont and Legallois, contained a considerable 
 quantity of a whitish serous fluid. After the escape 
 of this fluid, we found the mucous membrane gen- 
 erally coated with a white, creamy substance : the 
 thickness of the intestinal tunics was sensibly aug- 
 mented, and they gave under the fingers a clammy 
 sensation ; they were of a remarkable whiteness, 
 and presented only a slight linear injection, oc- 
 cupying the most dependent portion of the intestine. 
 Incertain cases, the digestive canaldidnotenclose any 
 serosities ; but it was almost every where lined with 
 a faded white matter, opake, viscid and adherent to 
 
41 
 
 the membranes. The latter were sometimes of an 
 extraordinary whiteness, at other times highly in- 
 jected. Sometimes the white matter was also found 
 in the bladder, but in variable quantity. In gen- 
 eral, the spleen was small, the liver healthy and the 
 gall-bladder moderately distended with a thick 
 deep-coloured bile. The other organs presented 
 nothing peculiar. 
 
 The works on the pathological anatomy of Epi- 
 demic Cholera, published in Russia, considered in 
 relation to the original or new data which they 
 present, reduce themselves, as we perceive, thus 
 far, to the four decadal publications of M. Marcus 
 and his colleagues. 
 
 These forty cases, all of which are followed by 
 autopsic examinations, carefully performed and mi- 
 nutely detailed, are so much the more entitled to 
 particular attention, inasmuch as being collected by 
 three, four or five physicians, these facts are pre- 
 sented with a degree of authenticity which many of 
 the others do not possess. 
 
 To recapitulate. These forty cases present two 
 circumstances which would at first sight seem to 
 deserve examination. These are : — 
 
 1st. Deep spots, resembling ecchymoses, upon 
 the external surface of the heart and at its posterior 
 part ; the different cavities of the heart, and the 
 large trunks which proceed from it containing, in 
 
 5* 
 
42 
 
 all the cases, a great quantity of gelatiniform or even 
 polypiform blood : 
 
 2d. Considerable injections of the dura mater, 
 and sometimes also of the pia mater; the brain 
 dotted with blood, and the spine, in some cases, 
 containing a certain quantity of sanguinolentserosity; 
 the pia mater most usually injected to a remarkable 
 degree ; the spinal marrow softened in several 
 points of its extent. 
 
 The accumulation of blood in the heart and large 
 vascular trunks it would seem should first attract 
 attention, and with so much the more propriety, 
 because this fact, in India as well as in Russia, has 
 been noticed by almost every observer. But can 
 this accumulation of blood truly constitute a cadav- 
 eric lesion to which we should attribute the epidemic 
 cholera ? The blood does not seem to have pre- 
 sented any sensible alteration ; and in fine, there 
 has merely been discovered what is observed in all 
 acute diseases when they run rapidly to a mortal 
 termination. This state is, without any doubt, the 
 normal state of the heart and larger vessels, ac- 
 cording to the general and most approved notions 
 of pathological anatomy. 
 
 And, as it regards those ecchymoses of the exter- 
 nal and posterior surface of the heart, what can we 
 say of a lesion which is not found mentioned by any 
 other observer, and which, even in the examinations 
 
43 
 
 made by M. Marcus and his colleagues, were only 
 detected in nine subjects out of forty ? 
 
 Of all the lesions pointed out by M. Marcus, the 
 most important is, without contradiction, the soft- 
 ening of the spinal marrow, especially as, out of 
 forty facts collected, this softening has been ob- 
 served nineteen times ; and we might say that, if 
 elsewhere, and by other observers, this phenome- 
 non has not been noticed, it is because the re- 
 searches necessary for ascertaining it were not 
 made, since the spine has but very rarely been 
 opened, and even where it has been, it was seldom 
 with attention and desirable precaution. 
 
 On the other hand, however, we may remark 
 that this lesion has only been observed in the moi- 
 ety, at most, of the subjects opened ; that the 
 alteration might be the result of manoeuvres em- 
 ployed in order to examine the spine ; and that 
 the disease has neither been more violent, more 
 rapid, nor more fatal in those subjects in whom 
 this softening has been discovered, than in those in 
 whom it was not detected. From these different 
 considerations we must naturally deduce the fol- 
 lowing conclusions : 
 
 1st. The various anatomical lesions, observed af- 
 ter death caused by the epidemic Cholera, have 
 nothing exclusive, nothing proper to this disease. 
 
44 
 
 2d. These lesions are not more constant as to 
 their seat than as to their nature. 
 
 3d. These lesions have no relation of causation, 
 either with the disease or with the death, in Chol- 
 era ; they can only be considered as more or less 
 accidental, more or less remote consequences. 
 
 4th. Neither the seat nor the nature of epi- 
 demic Cholera have derived satisfactory elucida- 
 tion from pathological anatomy, notwithstanding 
 the researches and endeavours of the great num- 
 ber of enlightened men who have been engaged 
 in them. 
 
 If we now turn back to what has been done 
 with regard to the pathological anatomy of Cholera 
 prior to the epidemic of India, we will learn that 
 Celsus, from the symptomatology alone, had pre- 
 dicted the difficulty of assigning a determinate ana- 
 tomical seat to the Cholera-morbus. 
 
 •' Cholera" says he, " inter intestina stomachum- 
 que versatur : ita lit, cajus potissimum partis sit, non 
 facile did queat." 
 
 We must arrive, however, at the commencement 
 of the seventeenth century in order to meet w T ith 
 concise anatomical annotations upon the peculiar 
 lesion of Cholera. 
 
 Diemerbroeck places the seat of Cholera in 
 the gall bladder, which he has found filled and dis- 
 tended with bile. 
 
45 
 
 Dolaeus and Bartholin attribute the Cholera to 
 gangrene of the small intestines and pyloric orifice 
 of the stomach. These two anatomists have, more- 
 over, found the stomach and intestines tinged ex- 
 teriorly a deep yellow colour. 
 
 Riolan affirms that the liver is dessicated, and 
 indurated, and that the gall-bladder as well as 
 biliary ducts very much dilated. 
 
 Bonetus considers the Cholera as a disease of 
 the liver, when it is not occasioned by poison. 
 
 Mons. Portal coincides with the opinions of 
 Bonetus. 
 
 Hence it results that the Cholera, so far as 
 relates to its necroscopic character, has received, 
 neither previous to the epidemic of India, nor dur- 
 ing this fatal occurrence, nor since, any impor- 
 tant elucidation, notwithstanding the numerous 
 works published on this subject, both in Asia and 
 Europe. 
 
 Hence, thus far, the epidemic Cholera has no 
 positive, definite, or fixed character ; and if it is 
 possible to discover the true seat of this malady, if 
 we may retain the hope of ascertaining its na- 
 ture, we must seek elsewhere than in pathological 
 anatomy for that information which will enable us 
 to obtain this important result. 
 
PART THIRD. 
 
 NATURE OF THE DISEASE. 
 
 Since, in the endeavour to ascertain the seat and 
 nature of epidemic Cholera by the light of patho- 
 logical anatomy, we have failed in our object, let us 
 see whether its symptomatology will not serve us 
 as a better guide. 
 
 In the first place let us examine that remarkable 
 impression which the epidemic stite prcduces upon 
 the general organization. Every where has this in- 
 fluence been observed. In India, as well as in Rus- 
 sia and Poland, physicians of every opinion have 
 carefully noted it : few individuals escape its action, 
 even of those in whom the symptoms of Cholera 
 have not been realized. 
 
 Almost every person residing in countries attack- 
 ed by the epidemic Cholera complain of spontaneous 
 lassitude, general uneasiness, heaviness of the head, 
 frequent vertigo, and prostration carried even to 
 syncope. Hence we manifestly perceive, in all those 
 individuals who are placed within the s here of ac- 
 tivity of the epidemic influence, the unequivocal in- 
 dications of a change, of a diminution in the great 
 
47 
 
 function of innervation, that is to say, of the vivify- 
 ing influence of the nervous system upon the other 
 systems, upon the various apparatuses, and upon all 
 the organs of the economy. Such is the capital, es- 
 sential, and primitive effect of the epidemial agent, 
 since it is exercised upon every individual, whether 
 healthy or diseased, strong or weak, though in va- 
 riable degrees of intensity. This effect, at the same 
 time constant, positive, manifest, predominates over 
 all others. 
 
 To this primary consequence of the diminution 
 of nervous energy, are joined, almost simultaneously, 
 constipation or a slight relax, anorexia, loss of ap- 
 petite, flatulency, a gentle diarrhoea, in short, a more 
 or less considerable disturbance of the functions of 
 the gastro-intestinal mucous membrane. Thus, on 
 the one hand, diminution of the nervous function ; 
 on the other, evident effects of this depression of 
 the nervous energy upon the mucous membranes, 
 which are thereby imperfectly supported, vivified 
 and excited ; these are the two primitive effects 
 produced by the epidemic influence. Now, if we 
 bear in mind these two orders of phenomena, the 
 diminution of the nervous function and the direct 
 bearing of this diminution upon the mucous system, 
 we will manifestly have the rudiments, the germ, 
 and, as it were, the diminutive of the disease. 
 
48 
 
 It is not without motive that we would be desi- 
 rous of dwelling longer on the consideration of this 
 important order : but let us proceed. 
 
 When the Cholera is developed, and when the 
 violence of its assault does not break down at once 
 the bonds of the living organism, the symptoms we 
 have mentioned assume greater intensity. Then 
 commences the period of imminence of the disease ; 
 a period, the premonitory symptoms of which are 
 oppression, weakness of the pulse, discomposure of 
 the countenance, epigastral anxiety, all which symp- 
 toms could neither be so rapidly produced nor more 
 naturally explained than by a diminution of the ner- 
 vous energy, the effects of which are essentially ex- 
 pended upon the digestive apparatus and circulatory 
 system. 
 
 After the example of nature, in the course of this 
 disease, let us rapidly run over the disorders and 
 
 their consequences. 
 
 The contractions of the limbs ; cramps of the ex- 
 tremities ; lypothemias ; faintings ; sinkings ; pale- 
 ness ; the cold and shrivelled condition of the skin ; 
 the blue colour of the fingers and nails ; the hip- 
 pocratic countenance occurring in an instant and 
 without any apparent cause ; the altogether peculiar 
 and frightfully rapid disappearance of the vital 
 powers, which are broken down, extinct, annihi- 
 lated, if they can be said to be at all in action 
 when life is no near its termination ; but which 
 
49 
 
 on the contrary, considered in existence, are feeble, 
 though excitable, and subsequently become vigo- 
 rous, as the patient often passes from apparent death 
 to perfect health as rapidly as he had undergone 
 the contrary change. Do not these symptoms 
 manifestly give a just idea of the disease ? In fact, 
 where also can be found, but in the reduction of 
 the nervous energy, sufficient cause and complete 
 exposition of these difficulties? 
 
 It is because the gastro-intestinal mucous mem- 
 ranes are no longer excited, supported, or stimulated 
 bv the influence of the nervous system, that, struck 
 with atony, in consequence of the alteration in the 
 whole ganglionic system, they no longer have any 
 regulated action, and hence the depraved and aug- 
 mented secretions from these membranes. 
 
 In the catarrhal epidemic affections, hitherto 
 described, the catarrhal lesion seldom passes be- 
 yond the pulmonary and gastro intestinal mem- 
 branes. In Cholera, the catarrhal state is often 
 propagated to all the mucous membranes in the 
 economy. 
 
 Several practitioners, Doctor Orton among others, 
 has seen the epidemic Cholera commence with di- 
 arrhoea only, and even consist in this symptom alone ; 
 the disease otherwise preserving all its rapidity and 
 all its dangers. 
 
50 
 
 It is generally in the form of severe epidemic 
 that catarrhal diseases make their appearance. 
 
 The humidity of the conjunctiva, the softness and 
 flaccidity of the tongue, which, in addition, is com- 
 monly cold, slimy, and white, the pathological state 
 of the mucous membranes, the marked alteration 
 in the mucous secretion of the stomach and bow- 
 els, are incontestable indications of this particular 
 catarrhal state. 
 
 Life, purely virtual, scarcely inherent, as if it could 
 no longer suffice for the whole economy and defend 
 itself upon all points, abandons the circumference 
 and recedes towards the centre ; it shrinks back 
 upon itself, and becomes concentrated at the interi- 
 or. Hence we see that there is no more evidence of 
 vital reaction in the circulatory apparatus than else- 
 where ; the pulse is scarcely perceptible ; respira- 
 tion is inaudible ; leeches can no longer extract even 
 one drop of blood ; and the largest apertures made 
 in the veins, with the view of bleeding, scarcely 
 permit us to express the smallest quantity of this 
 fluid, which besides is thick, black, and viscid. 
 
 The act of formation, the pathogeny of Cholera, 
 as well as the Cholera itself, enlighten our judg- 
 ment then in the determination of the seat and nature 
 of this disease. 
 
 Vomitings ; 
 
 Dejections ; 
 
51 
 
 Matters vomited, resembling a strong decoction 
 of rice ; 
 
 Matters dejected, aqueous, flocculated, whitish, 
 abounding in mucosities ; 
 
 The skin, pale, cold, damp, and wrinkled, especi- 
 ally on the hands and feet, as if these parts had 
 been covered by a cataplasm ; 
 
 The tongue, white, soft, moist and cold, notwith- 
 standing the patient is devoured with an unquench- 
 able thirst ; 
 
 The mucous membrane, often softened and thick- 
 ened, and still more frequently covered with a vis- 
 cid, whitish, opake, creamy substance, which, in 
 certain cases, is so abundant that it obstructs the 
 whole of the intestinal canal ; 
 
 The genito-urinary mucous membrane and the 
 pulmonary mucous membrane in a similar state ; 
 which is never the case in ordinary acute catarrhal 
 diseases, where the alteration is limited to the gas- 
 trointestinal and pulmonary mucous membranes : 
 
 Such are the symptoms which incontestably prove 
 the catarrhal state. 
 
 Let us now present the characters of the nervous 
 state, which are not less decisive : 
 
 1. The epigastral anxiety ; 
 
 2. The spasms ; 
 
 3. The contractions of the limbs ; 
 4L The cramps of the extremities ; 
 
52 
 
 5. Lypothemiae ; 
 
 6. Syncope ; 
 
 7. The cold breath of the patient ; 
 
 8. The weakness and, as it were, disappearance 
 
 of the pulse ; 
 
 9. The insensibility of the respiration ; and 
 10. The Hippocratic countenance. 
 
 Let us now recapitulate this doctrine. 
 
 The Cholera, in its diverse periods of duration, 
 in its variable degrees of intensity, is a special, com- 
 plicated and complex disease, characterized by a 
 great diminution of nervous energy, combined with 
 a particular catarrhal state of the gastro-intestinal 
 mucous membrane. 
 
 Either of these two pathological conditions is 
 susceptible of predominating to such an extent as 
 to demand more particularly clinical attention, ac- 
 cording as they are dependent upon individual pe- 
 culiarities of constitution, the different stages of the 
 disease, &c. 
 
 The predominance of the catarrhal over the ner- 
 vous state, and reciprocally, varies especially with 
 the rapid, fugacious, stages of the disease. In the 
 first stage, the symptoms of the nervous affection 
 are those which generally predominate ; in the se- 
 cond, the gastro-intestinal catarrhal affection is most 
 prominent. Almost always, however, the two stages 
 unite, combine, and become confounded, and with 
 
53 
 
 them are also mingled and blended the phoenome- 
 nal characters of the two pathological states. 
 Such is the disease when exalted to its highest de- 
 gree of intensity. It requires all the attention, all 
 the sagacity of the enlightened observer, in order to 
 lav hold of these various combinations. It is to the 
 predominance of the nervous affection, towards the 
 advanced stages of the disease, that we must attri- 
 bute those frequent typhoid transmutations which 
 we observe at the termination of Cholera. Still is it 
 very probable, from a great number of facts, that 
 even the phoenomena of the catarrhal affection are 
 a primary consequence of the diminution of the 
 nervous energy. 
 
 Having thus investigated the disease in its period 
 of formation, or in its course from health to disease, 
 let us now examine the inverse period, that is the 
 the transition from disease to health, or the cure, 
 and see what it will teach us. 
 
 One of the first indications of cure, in the epi- 
 demic Cholera, is the presence of bile in the evacua- 
 tions by stool and vomiting. 
 
 A still more favourable sign, is the restoration of 
 heat to the external surface of the body, and, 
 especially, the cessation of the stupor and spasms in 
 conjunction with these circumstances. If the stu- 
 por and spasms increase at the moment the cessa- 
 tion of vomiting and purging supervenes, mistrust 
 the fate of your patient. 
 
 6* 
 
54 
 
 The appearance of perspiration is almost always 
 a favourable indication. 
 
 The respiration becoming free and easy, the beat- 
 ing of the pulse returning with regularity in the 
 radial artery, the free secretion of urine ; such 
 are the changes which generally precede the cure ; 
 and it is here especially we would note that the 
 return to health, after an apparent death, is neither 
 less remarkable nor less rapid, than has been, in the 
 inverse direction, the transition from the state of 
 most perfect health to that of the most alarming- 
 disease. 
 
 In fine, wherever the disease has been observed, 
 it has been constantly noticed that we have reason 
 to augur well of those patients in whom there have 
 appeared certain signs of the definitive cessation of 
 the concentration of the forces at the centre, and in 
 whom, on the other hand, were manifested satisfac- 
 tory evidences of the proper radiation of the vital 
 powers to the circumference. 
 
 Thus then, the manner in which the morbid phe- 
 nomena are developed and connected, as well as 
 the course in which they are lessened and dissipated, 
 equally tend to prove that the disease consists in 
 the diminution or suspension of the nervous func- 
 tion, combined with a catarrhal lesion of the gastro- 
 intestinal mucous membranes. 
 
55 
 
 Let us exhaust, if possible, this order of consider- 
 ations, and see whether the treatment which the 
 epidemic Cholera has undergone, can furnish us 
 with useful deductions. The etiological inductions 
 drawn from therapeutic measures are scarcely less 
 useful, or less certain than the curative indications 
 which we deduce from them. It is a just observa- 
 tion, a juvantibus et Icedentibus Jit indication and 
 with equal propriety we might say, a juvantibus et 
 Icedentibus Jit dignotio. 
 
 One means of cure pretty generally adopted 
 in epidemic Cholera, is blood-letting : but it should 
 be remarked that, upon all points and in the eyes 
 of all individuals, the bleeding recommended, here 
 especially, from the commencement of the disease, 
 has been clearly and specially denoted by the title 
 revulsive, and is employed as a means of re- 
 animating, or recalling the excentric circulation. 
 
 Furthermore, bleeding, which is condemned by 
 a considerable number of skilful practitioners, is 
 adopted by none, unless in cases where the patient 
 is young and of a robust constitution. 
 
 M. Noel, in the midst of a pretty extensive epi- 
 demic, performed wonders by means of liquid am- 
 monia, given several times a day in an aromatic infu- 
 sion. M. Deville quickly dissipated the disturbances 
 by the aid of a large dose of ether, administered im- 
 mediately on the accession of the disease. Every 
 
56 
 
 where opium has been associated with diftusibles, 
 with musk, with camphor, ether, or essence of mint ; 
 every where have been prescribed with success 
 tonics, bitters and aromatics. The Russians have 
 particularly extolled vapour baths, warm aromatic 
 applications to the skin, stimulating frictions, &c. 
 
 Vesicatories of every kind and in every degree 
 sinapisms, and external cauterizations, are so many 
 means which have in their turn been resorted to. 
 
 Quite recently Doctor Leo has endeavoured to 
 prove, from a great number of convincing facts, that 
 the method most constantly efficacious against the 
 cholera, consists in the employment of sufficient doses 
 of the sub-nitrate of Bismuth, one of the most active 
 antispasmodics with which we are acquainted. 
 
 Doubtless we have presented enough of these 
 powerful indices to demonstrate that the therapeu- 
 tic means concur with the analytic symptomatol- 
 ogy, in conducting to similar conclusions. 
 
 Having stated what the disease is, let us now pro- 
 proceed, by way of exclusion, to say what it is not. 
 Without contradiction, the epidemic Cholera is not 
 an inflammatory disease ; still less is it a particular 
 inflammation of a determinate organ. If the chol- 
 era was a gastro-interitis, or a hepatitis, the light of 
 pathological anatomy would certainly have revealed 
 it to us ; and even should all the circumstances of 
 the disease not combine to prove that the epidemic 
 
57 
 
 cholera is not essentially inflammatory, would not 
 the total absence of every vital re-action, the fre- 
 quent want of every febrile movement, in the first 
 stages of the disease, be of themselves sufficient to 
 exclude such an opinion ? Let us also add that 
 there never has been observed, in the autopsic ex- 
 aminations of those who have died of epidemic 
 cholera, any of those frequent terminations, common 
 degenerations, or ordinary transformations, which 
 result from inflammatory diseases. 
 
 Neither is the epidemic cholera a typhus. The 
 patients retain to the last moment the integrity of 
 their intellectual faculties : conscience, judgment, 
 reason, presence of mind, all remain entire ; and 
 fever scarcely presents itself in the simple and so 
 frequent cases of epidemic cholera. . There has not 
 been observed in cholera those numerous symptoms 
 of vital re-action which are inseparable from typhus, 
 such as heat of skin, redness and animation of coun- 
 tenance, cough, &c. and never has it been at- 
 tended with exanthematous eruptions, sudamina, or 
 petechias. 
 
 Finally, as has been, very judiciously noted by 
 MAI. Briere de Boismont and Legallois, the typhus 
 is most frequently accompanied with a great sono- 
 riety of the abdomen, whilst, in cholera, this part 
 of the body is particularly remarkable for its ob- 
 tuseness, 
 
58 
 
 Neither does medical analysis permit the reduc- 
 tion or conversion of the epidemic cholera into a 
 simple affection, a mere catarrhal alteration: this 
 would be too great a miscontruction of the remark 
 made upon one of the characters of the mucous 
 system in general and of the gastro-intestinal mu- 
 cous membrane in particular. The ensemble of 
 the symptoms connected with epidemic cholera, 
 their developement, succession and rapidity, as 
 well as the formidable terminations of the disease, 
 decidedly repel this assertion. 
 
 Finally, what judgment can we pass upon the opi- 
 nion promulgated at Moscow in consequence of the 
 chemical experiments of M. Hermann, by which the 
 epidemic cholera is made to depend upon the devia- 
 tion of a particular acid, which this chemist pretends 
 to have discovered in the blood in the normal state, 
 in that of persons in good health ; an acid which M. 
 Hermann no longer meets with in the blood of 
 choleric patients, but which on the contrary is de- 
 tected in great abundance in the matters discharged 
 by vomiting and by stool. 
 
 Now, in the first place, the symptoms of the dis- 
 ease do not in the least degree coincide with this 
 presumed cause, neither does the treatment, not- 
 withstanding, in a small number of cases, the cal- 
 cined magnesia has been given with an appear- 
 ance of success. 
 
59 
 
 But let us attack this opinion on its own ground 
 since we can there oppose it with its own weapons. 
 Numerous and appropriate experiments, repeatedly 
 made by Annesley, have demonstrated most con- 
 clusively that the matters of the stools and vomiting 
 contain no free acid. 
 
 It is thus that Annesley has satisfactorily refuted 
 the opinion of Dr. Ainslie, who, in India, had also 
 attempted to attribute the epidemic cholera to the 
 existence of a particular acid, contained, according 
 to him, in the matter of the secretions. 
 
 And as to ihe presence of a free acid in the blood 
 in the normal state, this assertion is found contra- 
 dicted by every satisfactory experiment hitherto 
 presented. 
 
 The property which the blood possesses of turn- 
 ing the syrup of violets green has been remarked 
 by chemists of the greatest antiquity ; and the ex- 
 periments of Rouelle, the younger, undertaken with 
 the view of determining the nature of the alkaline salt 
 mentioned by Haller and De Haen, have long since 
 settled beyond a doubt the existence of the sub-car- 
 bonate of soda in the blood. 
 
 Bucquet, Baume, Parmentier and Deyeux have 
 since confirmed the results of the experiments of 
 Rouelle. Not only have they proved the presence 
 of an alkaline salt in the blood, but they have also 
 
60 
 
 proved the entire neutrality of the product ob- 
 tained by its distillation in the balneum maris. 
 
 Dr. Marcet, MM. Bestock, Berzelius, Brande, 
 Dumas, Prevost and John of Berlin, in their publi- 
 cations on the blood, all agree in conceding to this 
 liquid the alkaline character. 
 
 Finally, if there was any absolute necessity for it, 
 we might cite, in support of this opinion, the results 
 of the recent experiments which Dr. Dennis of Com- 
 mercy has detailed in his important work on the 
 human blood, and we might also cite those which 
 make the subject of a memoir yet unpublished, to 
 which the Academy has just granted a golden medal. 
 
 M. John, in his tables of the chemical analysis 
 of the animal kingdom, translated by M. Robinet, 
 announces,' it is true, that Prout has found free 
 acetic acid in the blood ; but in consulting the 
 original memoir, volume xxxvi, page 258 of the 
 Annates de Chimie, we soon ascertained that the 
 German chemist had fallen into an error. Prout 
 does not certify the presence of free acetic acid 
 in the blood, but the existence of Benzoic acid 
 only, which M. John himself affirms to be combined 
 with the soda. 
 
 Doctor Albert, sent by the King of Prussia to 
 Moscow for the purpose of studying the cholera, en- 
 deavours to prove that the disease consists in a 
 paralytic affection of the heart. In support of this 
 
61 
 
 opinion he cites the extreme anguish, the oppression, 
 the suffocation with which the patients are seized ; 
 and if the circulation, says he, at the circumference 
 is imperfectly carried on, it is because the heart 
 wants energy to propel the blood from the centre 
 to the periphery. 
 
 This method of investigating the nature of cholera 
 slightly approximates to the opinion promulgated 
 by us. However, the opinion of Dr. Albert is by 
 far too exclusive, much too positive ; by us it par- 
 ticularly appears incomplete, inasmuch as M. Albert 
 has apprehended but one of the fractions of the 
 disease. In the opinion of the Prussian physician 
 the cholera should be classed with the angina para- 
 lytodea of certain observers, and surely the phe- 
 nomenal characteristics of the two diseases are far 
 from bearing a resemblance. 
 
 In such an opinion how can we account for the 
 principal symptoms of cholera, for the vomitings, 
 the alvine evacuations, the epigastral pains, the 
 cramps of the extremities, the mucous contents of 
 the intestines, &c. Neither analogy, nor the simili- 
 tude of cholera and angina paralytodea, could 
 support it. 
 
 Several meritorious authors have sought to estab- 
 lish that the primary cause of epidemic cholera 
 resides in a change of relation between the atmos- 
 pheric electricity and the animal electricity. This 
 
 7 
 
62 
 
 doctrine doubtless is not entirely devoid of facts for 
 its support. Without doubt also it is not unreason- 
 able, neither is it novel to suppose that, in the do- 
 main of diseases, in general, the electricity of the 
 atmosphere performs a certain part. But the phys- 
 ical observations, besides being difficult, dangerous 
 even to attempt, and also the clinical comparative 
 observations, being not less easy to collect, are want- 
 ing even for the mere discussion of this opinion. 
 
 r 
 
 CONCLUSION. 
 
 The critical and exact analysis of the symptoms 
 and necroscopic characters of cholera give this 
 result : that the disease, complex in its nature, con- 
 sists in a general diminution of nervous energy 
 combined with a particular catarrhal affection of 
 the gastro-intestinal mucous membranes. 
 
PART FOURTH. 
 
 PROGNOSIS. 
 
 The Cholera-Morbus, abandoned to the resources 
 of nature alone, is almost always mortal. On the 
 contrary, by means of the assistance of art, if 
 dispensed in time and appropriately, this cruel 
 disease is often happily subdued. This remark had 
 already been made by Hoffman ; and it is thus that 
 Frank expresses himself upon this point : Funestus 
 est plerumque Ckolerce, sibi ipsi relictoz, exitus : sub 
 artis vero prozsidio sat cito concesso, plerique ex 
 ilia, quod tanta in alio morbo symptomata vix sperari 
 permitterent, sanantur. 
 
 Similar results of clinical observation have been 
 noticed in every place where the epidemic has 
 reigned. 
 
 Two principal considerations arise, as a general 
 prognostic, from the study of this cruel malady. 
 
 On the one hand, the physician should not permit 
 himself to be disheartened by the most desperate 
 symptoms — the absolute insensibility of the pulse ; 
 the coldness of the tongue ; the icy coldness of the 
 precordial region. A great number of particular 
 
 
64 
 
 cases prove that patients, even in this state, prop- 
 erly taken care of, have been restored to health. 
 
 On the other hand, the physician in attendance 
 should never place too much confidence in the fa- 
 vourable symptoms ; such security would be fatal. 
 The most encouraging state, in appearance, if the 
 treatment is suspended and the patient left to him- 
 self, does not delay to become desperate ; such a 
 condition leads to a relapse or to death. It is under 
 the influence of similar conditions that typhoid 
 mutations occur. 
 
 The vomiting is incontestably one of the most 
 serious symptoms of this disease ; it generally per- 
 sists for a long time after the dejections and spasms 
 have ceased, and even when the disease assumes a 
 favourable termination, the vomiting, by its obsti- 
 nacy, fatigues and exhausts the patient, retards the 
 cure and protracts the convalesence. 
 
 In general the appearance of bile in the evacua- 
 tions is a good omen : it is seldom that the cure 
 takes place without the existence of this sign. 
 
 As much may be said of the free course of the 
 urine ; of the manifestation of halituous sweats ; 
 of the diminution of the stupor ; of the restoration 
 of the forces ; of the cessation of the cramps. 
 
 It is especially from the intensity of the symp- 
 toms which arise from the derangements of the 
 nervous function, that we must draw our calcula- 
 
65 
 
 tions of the dangers of the disease. The symptoms 
 of the catarrhal state possess but a secondary im- 
 portance. It has often been observed, after the 
 vomiting and stools have ceased, that the danger 
 has gone on constantly increasing : but then the 
 cramps, the restlessness of the patient, the coldness 
 of the chest and of the epigastric centre, the insen- 
 sibility of the pulse, went on increasing also. 
 
 The rising and frequency of the pulse are in 
 general good signs : these are sometimes observed 
 as the cure approaches. 
 
 In a pretty great number of cases, the pulse 
 resumes its natural rythm ; sensation and heat 
 spring up in the extremities ; the vomiting and 
 diarrhoea cease ; yet, however, if by the assistance 
 of art we do not continue every proper effort to 
 support and revive the forces, the disease makes 
 progress, and the patient dies. 
 
 In fine, the data upon which the practitioner may 
 legitimately be allowed to predict a favourable 
 issue of the disease, are : the manifestation of fever; 
 fulness of the pulse ; restoration of heat to the ex- 
 tremities ; the diminution of the avidity for cold 
 drinks ; the gradual disappearance of the epigastral 
 anxiety, and of the burning heat at the umbilical 
 region ; the cessation of the spasms, vomiting and 
 diarrhoea ; the free flow of bile and urine ; the 
 improvement of the physiognomy ; the return to- 
 
 7* 
 
66 
 
 wards the normal state of the aspect and functions 
 of the skin ; the respiration easy and regular ; the 
 normal heat communicated to the air expired by 
 the patient ; the vermiliion colour of the lips, 
 tongue, and mouth ; animation of the eyes. 
 
 The chances of safety increase or diminish ac- 
 cording to the physical complexion or moral situa- 
 tion of the patient, and according to the conditions 
 of the public and private hygiene, under the influ- 
 ence of which Cholera patients are found placed. 
 
 In India, death occurred more promptly among 
 the natives enfeebled by excess and misery, than 
 among Europeans who lived more regular and bet- 
 ter lives. 
 
 There are many more chances of safety for in- 
 dividuals of a strong constitution, and for those who 
 have not been debilitated by excesses, by distress 
 and anxiety of mind, or by fear. 
 
 Patients accumulated in hospitals or in prisons, 
 placed in encumbered, narrow, low, moist, and im- 
 pure wards ; who groan without attention, without 
 assistance, in the desolation and want attendant on 
 poverty ; these are cured with great difficulty. 
 
 When the disease is about to be cured, we see 
 the symptoms, even the most characteristic of dan- 
 ger and the most violent, momentarily suspended, 
 and presenting more or less decided intermissions. 
 
 The chances of success or reverse, of safety or 
 
67 
 
 destruction, vary according to the periods of the 
 epidemic. The disease is particularly more severe 
 and more frequently mortal at the commencement 
 of the general malady. The reverses greatly 
 diminish, when the period of epidemical augment 
 is found exhausted. At the close of the epidemic, 
 nature is almost sufficient to perform the cure. 
 
 The disease often leaves behind it tardy and 
 painful convalescences, from which patients cannot 
 extricate th .mselves. 
 
 Various statistical calculations havo been pub- 
 lished with the view of establishing the chances of 
 invasion of the disease and of mortality in the midst 
 of the diverse populations invaded by cholera ; but 
 wherever these calculations have been attempted, 
 the principal data of the problem present so little 
 of fixity and exactitude, that with an appearance of 
 mathematical accuracy, these calculations, for this 
 reason, can only record in a manner more deplora- 
 ble, the errors which are the inevitable consequence 
 of them. 
 
 The evacuations upwards and downwards seem 
 to have been more frequent, more abundant, and 
 more obstinate in Asia than in Europe ; but the 
 physical characters of these evacuations have been 
 every where the same. 
 
 The return to health after the first period of the 
 disease, without the patient's passing into the febrile 
 
68 
 
 state, has been much more common in India ; and 
 there also the typhoid mutations or terminations 
 have been much less frequent. 
 
 The number of patients among physicians and 
 attendants employed in hospitals, compared with 
 the number of patients among the rest of the popu- 
 lation, has been more considerable on the Euro- 
 pean continent than in Asia ; it is certain, however, 
 that in general, in hospitals conveniently situated, 
 sufficiently aired and kept properly cleansed, there 
 have been but few victims, even among the phy- 
 sicians and nurses. 
 
 The attack when it is not fatal, presents three 
 different issues : 
 
 Immediate convalescence, followed only by great 
 debility ; 
 
 Abundant evacuations of bile voided during sev- 
 eral days, sometimes mingled with blood, and at- 
 tended with particular intestinal pains, and especi- 
 ally with pains in the rectum ; 
 
 A febrile state, the description of which is faith- 
 fully traced in the report from Bengal. The follow- 
 ing are its principal features : 
 
 The fever which constituted the last period of 
 the disease, presented great analogy with the bilious 
 fevers usually spread abroad in these climates. We 
 could observe the following symptoms : heat and 
 dryness of the skin, tongue very much loaded, 
 
69 
 
 mouth dry, epigastral anxiety, agitation, insomnium, 
 pulse very variable, sometimes stupor, delirium and 
 other symptoms of cerebral affection. * 
 
 In general, when the disease was disposed to 
 terminate fatally during this period, the tongue, 
 from the colour of cream, became dry, brown, and 
 even black, it also became more loaded ; the teeth 
 and lips covered with a fuliginous sordes ; the state 
 of the skin varied considerably, shiverings and 
 flashings of heat succeeded alternately ; the pulse 
 was accelerated, feeble, fluttering ; plaintive moans, 
 hiccup, agitation and oppression supervened ; and 
 the patient soon lost all consciousness from the de- 
 bilitating effects of this nervous fever, and also 
 from frequent alvine evacuations, which were al- 
 ways of a dark colour. 
 
PART FIFTH. 
 
 TREATMENT. 
 
 What we have learnt from the physicians who 
 have practised in India in relation to the treatment 
 of Cholera, is characterized by a want of precision, 
 indecision, and uncertainty. Here, it is bleeding 
 which reigns over all the other therapeutic means ; 
 there, it is opium combined with aromatics, with 
 spirits, and with tonics. In the eyes of the greatest 
 number, calomel given in most exhorbitant doses is 
 the real sheet-anchor. Some have boasted beyond 
 measure of alkalis ; others have extolled acids. And 
 unfortunately it is upon preconceived notions, upon 
 the supposed nature of the disease, that these vari- 
 ous therapeutic means, always too generally and too 
 exclusively employed, entirely depend. 
 
 In meditating attentively upon particular cases, 
 in keeping an exact account of general assertions, 
 we see that patients have been treated by bleeding, 
 yet they sink ; that calomel has been administered 
 to them, yet they die ; that opium is given to 
 them, yet they equally perish ; that these differ- 
 ent means are even combined, yet they do not effect 
 their cure. These are serious and melancholy re- 
 
71 
 
 flections, which hereafter, perhaps, may be pro- 
 ductive of benefits. 
 
 Bloodletting is, without contradiction, one of the 
 means which has been most generally advised, one 
 of those upon the efficacy of which the advice and 
 opinions of the physicians of India most frequently 
 agree. To note it at the head of all the others, and 
 to discuss it in the first place, is a duty ; for this 
 reason especially, that it is almost exclusively from 
 the period of imminence, from the beginning of the 
 disease, that it is indicated. Still later, in the eyes 
 of some respectable physicians, bleeding is useless 
 and injurious, difficult or impossible. It is not rare, 
 however, to find physicians who proclaim the good 
 effects of bleeding in almost every stage of the dis- 
 ease. These physicians facilitate the escape of the 
 blood from the vein, when it is expressed from it 
 with difficulty, either by plunging the arm in very 
 warm water, or by applying dry or aromatic fric- 
 tions to this superior extremity, or still further by 
 dipping the arm in a demi-bath, consisting of a very 
 strong infusion of mustard. 
 
 But it is particularly at the onset of the disease 
 that blerding is useful ; it is to this epoch that it 
 has been specially assigned by Annesley : and it is 
 hence that Mil wood has observed, out of eighty- 
 eight patients bled in season, two only died, whilst 
 he had lost eight out of twelve of those who had not 
 
72 
 
 been bled. The author has not stated at what epoch 
 of the epidemic, nor upon what order of patients, he 
 has noted these facts. 
 
 At this period of the disease, the sanguineous emis- 
 sion tends to re-establish the equilibrium of the cir- 
 culation, which, without it, abandons the periphery 
 in order to concentrate itself about the heart and 
 large vessels ; it acts after the manner of diffusible 
 antispasmodics. When the pulse rises after blood- 
 letting, there are great chances of cure, says Dr. 
 Foy, in his letter to our fellow-member M. Bally. 
 
 Still later, bleeding has been found mortal by a 
 great number of physicians. M. Annesley, how- 
 ever, cites examples of bloodletting performed at a 
 very advanced stage of the disease, the result of 
 which has also been to recall the circulation to the 
 circumference : in these examples, the blood was at 
 first thick, and merely escaped from the vein gut- 
 tatim, but towards the last it flowed more easily, 
 became more fluid, and assumed a vermillion colour. 
 This, axlds this physician, was the result to be de- 
 sired ; no matter whether it happened after the 
 subtraction of ten, twenty, or thirty ounces of blood, 
 even if it occurred as soon as a single ounce was 
 obtained, we might hope for the recovery of the 
 patient. 
 
 Let us observe, however, that a great number of 
 patients have sunk after the abstraction of eighteen 
 
73 
 
 or twenty ounces of blood : and, on the other hand 
 many cases of cure have been accomplished under 
 circumstances in which bleeding has not been re- 
 sorted to. 
 
 With respect to bleeding performed when the 
 disease is threatened, (periode de Vimminence]) two 
 important remarks present themselves. 
 
 Bloodletting, thus considered, is almost always 
 advised in young individuals of a robust constitution, 
 and who are placed in the midst of circumstances most 
 favourable for the cure : it is performed early, and, 
 very probably, upon individuals who, even without 
 this means, would have been but slightly indisposed. 
 
 In the second place, it appears certain that, in 
 many cases this means has been, unfortunately, 
 abused, and that w T ith the view of adopting bleeding 
 at the most favourable period, and of making it a 
 preservative against the disease, individuals have 
 been bled who, debilitated by this loss of blood, 
 have thereby been rendered only the more accessi- 
 ble to the epidemical influence, and more cruelly 
 treated by the disease. Perhaps if bloodletting had 
 not been resorted to, they would not have been the 
 subjects ot the disease. 
 
 Leeches have but rarely been employed in 
 Cholera : in the commencement, however, they 
 have been applied for the purpose of diminishing 
 the intensity of the cardialgia. We know, more- 
 
 8 
 
74 
 
 over, that leeches often remain adherent without 
 any secondary effect, and that frequently also they 
 can extract but a few drops of blood. 
 
 Calomel. Scarcely was there a single physician, 
 during the continuance of the epidemic on the con- 
 tinent of Asia, who did not loudly proclaim the valu- 
 able properties of calomel ; yet we know what the 
 mortality has been in this part of the globe ! Scarcely 
 in the numerous cases of Cholera which we have 
 had occasion to read, can we cite any patients who 
 have not taken calomel ; yet, has the issue of the 
 disease been the less fatal ? It is true that the phy- 
 sicians and surgeons in India are of the English school; 
 and we are not ignorant that in that country, all 
 obscure, difficult, and dangerous cases, as well as 
 those in which the indication is simple, regular, and 
 manifest, calomel, sometimes in one dose, sometimes 
 in another, always finds its place, with the title of 
 specific, antispasmodic, antiphlogistic, or purgative. 
 
 Annesley administers calomel in scruple doses sev- 
 eral times a day, with a view of relieving the intestinal 
 mucous membrane of the creamy substance which 
 chokes up and obstructs the intestines. Of all 
 purgatives, calomel, according to this author, is the 
 only one which acts upon this substance, the pre- 
 sence of which is proved in every case of Cholera; 
 and he continues the use of calomel until it is suf- 
 ficiently apparent in the alvine evacuations. From 
 
75 
 
 three to five scruples of calomel are usually neces- 
 sary for the accomplishment of this object. 
 
 This method of treatment was also that of Doctor 
 Corbin; which the Marquis of Hastings caused to be 
 adopted generally, by putting it in the order of the 
 day of the whole English army. 
 
 Doctor Jameson directs calomel as a means of 
 overcoming the spasms of the intestines. 
 
 In some cases aloes are combined with the calo- 
 mel, especially when, from the urgency of the 
 symptoms, it becomes necessary to hasten the ap- 
 pearance of green or yellow bile in the substances 
 voided, an appearance which is always a favourable 
 omen. 
 
 Opium. What we have said of calomel, we may 
 equally affirm of opium : patients cured as well as 
 those who have died, all have taken it, and that in 
 conjunction with calomel at first, but also concur- 
 rently with aromatics and tinctures of various kinds. 
 It is always the opiacious preparation of Syden- 
 ham* to which the preference is given, and we know 
 that in this compound, the opium is found combined 
 with spirituous and aromatic substances. 
 
 Let us here bring to mind, that Bontius, who ob- 
 served the Cholera in India in the catastatic state, or 
 
 * Tinctura Opii Crocata, R. Opium 16. Saffron 8. Cinnamon and 
 Cloves aa L Spanish Wine 150. — Tr. 
 
76 
 
 that of the minor epidemic in 1669, combated it with 
 great success by means of a preparation which is 
 peculiar to him, and in which the opium is found 
 united with aromatic resinous substances. 
 
 Many facts tend to shed suspicions upon the effi- 
 cacy of opium employed alone : it then too fre- 
 quently produces a violent determination towards 
 the brain ; and in the series of the symptoms of 
 Cholera we observe a great degree of stupor, coma, 
 and sometimes, though very rarely, delirium. These 
 inconveniences have not taken place where the 
 opium has been combined with calomel, camphor, 
 ether, or liquid ammonia. 
 
 Mr. Deville surgeon of the French ship la Seine, 
 who has seen and attended the epidemic cholera in 
 Bengal, obtained instantaneous relief and even the 
 prompt cessation of all the symptoms of cholera, by 
 the aid of large doses of Ether, administered from 
 the first moments of the invasion of the disease. We 
 read in his work a great number of facts in support 
 of this assertion. 
 
 Aromatic infusions, sometimes aqueous, at other 
 times spirituous, often present themselves among 
 the auxiliaries of the treatment of the cholera in In- 
 dia; we might say the same of acid drinks and 
 especially of the tartaric lemonade, which Annesley 
 extolled, and which he did not fear giving cold, as 
 well as all other drinks ; which he even prefers ad- 
 
77 
 
 ministering at this temperature, after the example 
 of Galen, of Celsus and Hoffman, notwithstanding 
 the contrary has been advised by almost all physi- 
 cians who have practised in this country and in the 
 midst of this epidemic. 
 
 It is exclusively by warm baths that Hippocrates 
 encountered the cholera-morbus. The warm bath, 
 in the epidemic of India, has been a matter of great 
 controversy ; lauded by some, always at a high 
 temperature, they have been proscribed by many 
 others especially on account of the humidity and 
 coldness which their use inevitably occasions, in 
 spite of the greatest precautions. 
 
 Rubefacients of all kinds and in every degree 
 have been employed, with the intent of recalling 
 vitality to the circumference, of reanimating the 
 circulation and exciting warmth in the cold surface 
 of the skin ; but. generally siiiapisms have been pre- 
 ferred. 
 
 The private correspondent of our very zealous 
 colleague M. Reveille Parise, has informed him that 
 at Batavia they have ascertained the dangers of 
 every emission of blood in the epidemic cholera, 
 and that they there administer with almost constant 
 success, a mixture of two parts of essence of mint 
 (spiritus menthae) and one part of laudanum. In 
 Russia as well as in India, we almost always find 
 the essence of mint associated with opium. 
 
 8* 
 
78 
 
 In passing from Asia into Europe, the therapeu- 
 tics of the epidemic cholera have not made any very 
 important acquisitions ; scarcely have the physi- 
 cians of Russia added any thing to the treatment re- 
 capitulated of the physicians of India. All that we 
 have seen in the Indian therapeutics is to be found 
 in that of the Russians. Among the latter however 
 calomel seems to have been a little less in vogue ; 
 its advantages have been less highly extolled, the 
 insufficiency of it has been more candidly admitted, 
 it has been given in smaller doses and with less per- 
 sistency, and some physicians have even totally 
 proscribed the use of it. 
 
 But now, bleeding especially at the beginning of 
 the disease and sometimes also in its advanced 
 stages ; calomel almost always combined with opi- 
 um ; aromatics ; diffusible stimulants, such as ether, 
 volatile alkali, camphor, musk ; vapour baths, sand 
 baths, baths with a strong decoction of hay ; some- 
 times purgatives, and especially torrified rhubarb for 
 the purpose of overcoming the obstinate constipation 
 which persists during the convalescence : such in 
 short, has been the therapeutics of the Russian phy- 
 sicians against the epidemic cholera. Nitrous ether,* 
 oxygenated muriatic acid diluted with water, have 
 
 * Alcool nitrique. 
 
79 
 
 been equally tried with some appearance of suc- 
 cess. 
 
 It has sometimes been observed that opium in 
 large doses augmented the intensity of the contrac- 
 tions of the extremities ; and it is in these cases that 
 camphor, ether, and musk have been administered 
 with advantage. 
 
 Riverius' draught has been constantly advised and 
 prescribed in order to allay the vomiting ; and we 
 may observe that this symptom is most fatiguing 
 and most obstinate in persons addicted to intoxica- 
 tion and gluttony. 
 
 Against the cramps of the inferior and superior 
 extremities, in addition to the baths of which we 
 have spoken, we also find indicated dry frictions, 
 frictions with spirits of camphor, and aromatic cat- 
 aplasms. 
 
 It is especially in powder and united with pulver- 
 ised gum Arabic, that the Russians recommend the 
 administration of calomel. On this subject, they 
 call the attention very particularly to the astonish- 
 ing capability of the patient to bear strong doses of 
 this substance without its determining any of those 
 bad consequences so frequently formidable in other 
 cases of disease. 
 
 Injections with the decoction of bran or starch, 
 to which laudanum was added, were administered 
 for the diarrhoea, to which were also opposed ene- 
 
80 
 
 mata consisting of decoctions of small bitter oranges, 
 gum arabic and opium. 
 
 The private correspondents of the Academy have 
 informed us that very skilful physicians had given 
 the extracts of hyosciamus and cicuta with remark- 
 able success. Dr. Haaz boasts particularly of the 
 extract of nux vomica. 
 
 Doctor Foy proposes, as capable of modifying 
 the nervous state in cholera, the distilled water of 
 the cherry laurel and the distilled water of bitter 
 almonds. It would be well however to mistrust the 
 effects which these means may produce at that stage 
 of the disease in which the oppression of the forces 
 constitute the only symptom of it. 
 
 At Warsaw, Dr. Leo was convinced that the dis- 
 ease presented no inflammatory character. He con- 
 sequently opposed, in a general manner, every idea 
 of blood-letting. To him blood-letting most fre- 
 quently seemed dangerous. 
 
 Calomel, according to him, vainly irritates the 
 intestinal canal and also augments, with additional 
 dangers, the alvine evacuations. 
 
 Opium given in small doses remains without ef- 
 fect ; and if we increase the quantity of it, it dimin- 
 ishes, it is true, the vomiting and stools, but it kills, 
 says Dr. Leo, by the narcotic excitations which it 
 impresses upon the economy. 
 
 For these means Dr. Leo substitutes what he calls 
 
81 
 
 " his method," of which the following is the sub- 
 stance. He administers every two or three hours 
 three grains of the sub-nitrate of bismuth, in powder, 
 combined with sugar. At the same time he gives 
 an infusion of balm, and directs frictions with a 
 heated mixture of compound alcoholic tincture of 
 angelica and liquid ammonia to be applied to the 
 superior and inferior extremities. At a later period 
 he orders some doses of torrified rhubarb in pow r - 
 der ; but he very particularly insists upon the bismuth 
 in powder, and he affirms that he has not seen one 
 of the numerous patients, who have been treated in 
 this manner, perish : the cure has in general been 
 accomplished at the end of five days. In the opinion 
 of Dr. Leo, blood-letting was but rarely admissible, 
 and only in young individuals of a robust constitu- 
 tion. 
 
 M. Briere de Boismont in one of his letters to 
 our colleague Dr. Esquirol, confirms the advantages 
 of this method in some cases. Every thing goes 
 wrong in the midst of epidemic tumult: M. Briere 
 de Boismont announces, in the same letter, that he 
 has found considerable quantities of sublimate in the 
 calomel iidministered at Warsaw. 
 
 If we have succeeded in rendering the general 
 idea, which it is proper to form of the epidemic 
 cholera, precise ; if we have determined the true 
 nature of it, and if the disease actually consists in a 
 
82 
 
 diminution of the innervation, in a vicious direction 
 of this innervation concentrated upon the internal 
 organs, combined with a particular catarrhal affec- 
 tion of the gastro-intestinal mucous membranes, we 
 will easily succeed in establishing the therapeutic 
 methods best calculated to subdue this disease, and 
 in comprehending the effects of those which have 
 been advantageously employed. 
 
 One prominent fact strikes us, in deeply medita- 
 ting upon the means by the aid of which they have 
 combated the cholera in those parts of the East In- 
 dies, of Russia and Poland w T here it has been observ- 
 ed ; it is the attempt which has been made both in 
 Asia and Europe to discover an uniform, identical 
 method of treatment, for all the individuals attacked 
 with the disease, and hence the total inefficiency of 
 the attempt. Thus we very evidently have seen 
 that the means which have succeeded in some cases 
 have been unsuccessful in others. Blood-letting 
 which appeared beneficial in a great number of in- 
 dividuals, has been evidently injurious in many 
 others. Calomel, which seemed to succeed so fre- 
 quently in the Indies, has often failed at Moscow 
 and at Warsaw. Opium, extolled beyond measure 
 by the Indian practitioners, has produced, under 
 the inspection of the Russian physicians, an aug- 
 mentation of the spasmodic movements pertaining to 
 the disease : whence it follows that there does not 
 
83 
 
 exist, in the epidemic cholera, an uniform, constant 
 treatment applicable to all cases. 
 
 This conclusion, which is also true with regard 
 to all epidemics, we find explicitly admitted, and in 
 a very positive manner, by Dr. James Boyle, who 
 has for a long time studied the epidemic cholera in 
 India. He says positively, page 13 of his Treatise, 
 that we can adopt no uniform method of treatment 
 for all the cho.lericks ; that we must, on the contra- 
 ry, vary the treatment according to each particular 
 case. It is, he adds, in consequence of having indis- 
 criminately put in practice, sometimes blood-letting, 
 at other times calomel, here opium, there warm 
 baths, that the physician has obtained so little suc- 
 cess. Dr. Boyle relates a great number of exam- 
 ples of blood-letting practised unsuccessfully at the 
 period when the blood still escaped freely from the 
 vein. The patients have sunk. 
 
 According to the opinion of Dr. Christie, we must 
 endeavour to appreciate the indications in this dis- 
 ease accurately : and in order to fulfil them we must 
 employ different medicines according to circum- 
 stances : we cannot hope to find a specific applica- 
 ble to all cases of cholera, no more than we can in 
 a great number of other diseases. In this, as in 
 many others, we must expect every thing from the 
 tact and the judgment of the physician. 
 
 M. Meusnier, Doctor of the faculty at Paris, con- 
 
84 
 
 sular agent of France at Tangaroc, in his letter to 
 the Academy upon the epidemic cholera, thus ex- 
 presses himself: " an absolute medicament cannot 
 be pointed out, since blood-letting, drastics, acids, 
 narcotics, the warm bath, and ice, have each in their 
 turn had their successes and reverses. It is espe- 
 cially in the idiosyncracy that the general indica- 
 tions reside ; it is thence we must derive the choice 
 of the means which it is proper to employ." 
 
 In therapeutics, there is no rule of absolute per- 
 fection out of which every thing is wrong and only 
 leads to error. Individualities, which vain efforts 
 of abstraction have so often endeavoured to oblite- 
 rate, are always there, with their peculiar consti- 
 tutions and their special idiosyncracies, in order to 
 change general predictions and command numerous 
 exceptions. These individualities, which often mod- 
 ify in a special manner the morbid conditions, also 
 demand a modification of the therapeutic agents. 
 The great epidemic now under consideration, is a 
 living proof of it. Without doubt it presents capi- 
 tal, general indications, and which may be syntheti- 
 cally expressed ; but it also presents, in individual 
 constitutions, in the variation of symptoms, and in 
 the organic susceptibilities, other indications of vast 
 importance. 
 
 To re-animate the general action of the innerva- 
 tion, and to render the distribution of the nervous 
 
85 
 
 function more regular ; to stimulate and warm the 
 cold surfaces of the skin ; to call life and motion 
 from the centre to the circumference : such is the 
 predominant capital indication in the epidemic 
 Cholera. 
 
 To attack at the same time the catarrhal affec- 
 tion by the aid of means, the happy effects of which 
 have been ascertained from experience, constitutes 
 another analytic indication of nearly equal im- 
 portance. 
 
 Finally, to combat the symptoms in proportion 
 to their relative predominancy, is a secondary or 
 symptomatic indication, which should not be neg- 
 lected any more than the others. 
 
 With a view of fulfilling the indication relative to 
 the innervation, diffusible stimulants and antispas- 
 modics doubtless claim the first place. Thus the 
 physicians of Orenburg have given, with success, 
 a mixture of Hoffman's elixir* and essence of mint. 
 This remedy had become so extensively popular, 
 that every body took it by the title of preservative. 
 
 It is thus that Doctor Noel, when a considerable 
 body of the French army, disembarked on the Cor- 
 omandel coast, were attacked with Cholera, gave 
 
 * R. Peruvian bark, orange peel and sub-carbonate of potassa 
 aa 2. Extracts of holy-thistle, of small centaury, and of myrrh 
 aa 1 ; Madeira wine 48. — Tr. 
 
86 
 
 divided doses of volatile alkali in sweetened infusion 
 of balm with great success. 
 
 It was also with the same object that M . Deville 
 prescribed, at Calcutta, strong doses of ether, from 
 the very commencement of the disease. 
 
 It is, finally, in the same manner that are con- 
 ceived and explained the advantages so frequently 
 derived, at Batavia, from the mixture of two parts 
 of the essence of mint and one part of laudanum, 
 the use of which was persisted in until the cure was 
 accomplished. 
 
 Blood-letting, in young, plethoric individuals, of a 
 robust constitution, administered at the onset of 
 the disease, immediately produces the restoration of 
 the vital powers ; it revives the circulation at the cir- 
 cumference, and calls the blood and the heat to 
 the pale and chilled surface of the body. It is then 
 with this view, and, under the influence of these cir- 
 cumstances, that blood-letting has been advised and 
 performed ; but in subjects of a feeble constitution, 
 or accidentally debilitated, and at an advanced 
 period of the disease, the abstraction of blood has 
 been very often prejudicial. 
 
 In the series of remedies successfully administer- 
 ed against the catarrhal affection, calomel holds the 
 first place, and is given in powder combined with 
 gum arabic. Doctor Christie, in his interesting work 
 on Cholera, has established that it is to this affection 
 
87 
 
 especially that calomel is applicable. It is also 
 against this state of the mucous membranes that 
 Annesley prescribes calomel, in scruple doses, every 
 three hours ; often, he combines it with aloes, in 
 order to obtain more promptly the evacuation of 
 the creamy matter which fills the intestines. The 
 bitter tincture, in the opinion of Annesley, brings 
 about the same effect 
 
 Here also internal stimulants are properly ar- 
 ranged, in the number of which M. Christie places 
 the capsicum in particular : as also external stim- 
 mulants, giving preference to the stimulation pro- 
 duced by the application of vesicatories. Cata- 
 plasms containing a large quantity of mustard, ap- 
 plied early and retained constantly upon the whole 
 extent of the spinal column, will be very efficacious 
 in re-animating the innervation and in producing re- 
 action to the circumference. 
 
 Doctor Poupireff has ascertained, in the govern- 
 ment of Orenburg, the good effects of the serpen- 
 taria virginiana, when associated with cinchona, in 
 reviving the nervous energy and restoring vitality to 
 the circumference. Annesley also advises the bark, 
 in powder, either by itself or combined with aro- 
 matics. But under circumstances, where it is so im- 
 portant to guard against the susceptibility of the 
 stomach, how is it that the sulphate of quinine has 
 not been thought of ? combined with musk, with the 
 
88 
 
 essence of mint, camphor, or ether, this would cer- 
 tainly be a powerful means of assistance. We 
 have not observed that the sulphate of quinine has 
 been placed among the number of remedies ad- 
 ministered against Cholera. 
 
 With the title of diffusible, and for the purpose of 
 producing re-action, Dr. Milwood has extolled 
 James' powder ; and it is with the same views that 
 the Dover's powder has been given. Cupping would 
 also possess numerous advantages in endeavouring 
 to restore vitality to the periphery. 
 
 Most of the articles recommended, for the cure 
 of this epidemic, both in India and in Russia, were 
 manifestl v intended to change the direction of the 
 movements, and occasion re-action from the centre 
 to the circumference : as, for instance, frictions, lin- 
 iments of every kind, baths of warm sand or of 
 roasted bran, vapour baths, ordinary baths at high 
 temperature, &c. 
 
 In attacking then the two general causes of the 
 disease by means applicable to the individualities, 
 we will doubtless oppose the symptoms which are 
 the consequence or the effect of them ; but it is in 
 the epidemic Cholera especially that we must pay 
 attention to the various indications resulting from 
 the different stages of the disease, and the symp- 
 toms which constitute them. 
 
 Thus opium, which acts as a powerful sedative, 
 quiets the vomitings and arrests the diarrhoea ; it 
 
89 
 
 also diminishes the irritability of the system, and 
 advantageously modifies the altered secretions of 
 the intestinal mucous membrane. 
 
 The sub-nitrate of Bismuth seems to have all the 
 advantages of opium, without possessing any of its 
 inconveniences ; however, notwithstanding the at- 
 tempts of Doctors Odier and Marcet, the thera- 
 peutic value of this substance has not yet been 
 definitively determined. 
 
 Frictions, to the superior and inferior extremities, 
 with the oil of turpentine, cannot fail to be advan- 
 tageous in contending with the cramps. 
 
 Against the constipation which supervenes during 
 convalescence, rhubarb, magnesia and calomel have 
 been given. 
 
 The applications of leeches, at the onset of the 
 disease, cataplasms and sedative liniments, often 
 successfully overcome the epigastric anxieties and 
 pains : general bloodletting would be preferable for 
 the removal of internal inflammation, in those cases 
 in which either the symptoms or the consecutive 
 occurrences denote its existence. 
 
 The vomiting is, without contradiction, the most 
 obstinate and most distressing symptom of this dis- 
 ease. Riverius' draught arrests the vomitings, and 
 opium might also be administered with some pros- 
 pect of success. Injections, containing a pretty 
 large quantity of laudanum, thrown into the rectum, 
 
 9* 
 
90 
 
 are efficacious in stopping the alvine evacua- 
 tions. 
 
 It is especially towards the diminution of the 
 evacuations that the symptomatic indications should 
 tend. Nothing leads more rapidly to the destruc- 
 tion of the strength, nothing hastens more speedily 
 the progress of the most formidable symptoms, than 
 the frequency of the vomitings and stools. Not 
 only does every medication, every reparation, then 
 become impossible, but there also results a general 
 exhaustion and absolute loss of every vital resist- 
 ance, by the deperditions and lassitude which the 
 incessantly returning calls for these continual de- 
 jections occasion. 
 
 Again let us repeat that in order to direct suc- 
 cessfully the therapeutic of Cholera, we must not 
 lose sight of the two constituent elements of this 
 disease ; and especially is it necessary to apprehend 
 clearly the indications which flow from them. 
 
 It is very essential to attack each of these ele- 
 ments in the order of their respective predominance, 
 that is, attend to the catarrhal indication when that 
 is most prominent ; and to the nervous indications 
 when they bear the sway. 
 
 We must not omit saying, that, in this dreadful 
 combination of pathological disturbances, as in all 
 complications of disease, it is often sufficient to 
 attack successfully one of the agents, especially the 
 
91 
 
 predominant agent, in order to insure the cure of 
 the patient. The powers of the organism though 
 apparently annihilated, and thus the most promi- 
 nent feature in the disease, have shown themselves 
 quite sufficient to work out the cure of the complaint 
 thus simplified or reduced. 
 
 Unfortunately there are no cases on record, of 
 cholera regularly observed when left to the action 
 of the powers of nature alone, independently of 
 every medical modification. Consequently we can- 
 not compare this order of facts and their results 
 with the results obtained by the combined assist- 
 ance of nature and of art. It would especially be 
 necessary to establish the comparison of these facts 
 in the midst of analogous conditions, favourable or 
 the reverse, that is to say, with equal chances of 
 safetv or destruction. 
 
 We might advance, however, in a general man- 
 ner, that those unfortunates, who, impelled by fatal- 
 ism, blinded by ignorance, or abandoned to the 
 desolation of poverty, have not been assisted, have 
 almost all died ; but, independently of the vagueness 
 of this assertion, we should not forget that, in these 
 cases, the patients of this class were not in equal 
 conditions with others ; these, from the simple fact 
 of their position, were placed in the midst of those 
 conditions in which the epidemic proves most de- 
 structive, such as want, poverty, uncleanness, &c. 
 
PART SIXTH. 
 
 GEOGRAPHICAL MARCH AND MODE OF EXTEN- 
 SION OF THE DISEASE IN ASIA. 
 
 Having exposed the series of changes developed 
 in individuals attacked with Cholera, we are now 
 about to give a rapid sketch of the course of the 
 disease through the different places which have 
 been the theatre of it. In other terms, having re- 
 capitulated the pathological march of the disease, 
 let us also endeavour to give a summary of its geo- 
 graphical route. We shall see whether, from these 
 investigations, any new data will arise for the solu- 
 tion of the problems which have been proposed to 
 us. 
 
 We have not forgotten to mention, and we have 
 the design to prove that, at all times, in India, that 
 is to say, since this country has been medically ex- 
 plored, the Cholera has been observed there in the 
 sporadic state, in the endemic state, and in the ca- 
 tastatic state. 
 
 Observation rested at this point when, in 1817, 
 the scourge under consideration broke out in the 
 eastern regions of the Peninsula of India. 
 
93 
 
 Let us mention here, however, that long previous 
 to 1817, in the year 1783, we find two facts, at 
 least, of this severe epidemic in India. 
 
 The first occurred in Hurdwar, where the Gan- 
 ges takes its source. This country, regarded as 
 sacred, is the rendezvous of a famous pilgrimage, 
 which takes place there every year, and of an ex- 
 tensive pilgrimage, much more famous still, which 
 is renewed every twelfth year only : 1783 was one 
 of these twelfth years. 
 
 A fabulous number of pilgrims were there con- 
 gregated together upon the borders of the river, 
 where they passed the night, poorly nourished, 
 badly clothed, in the midst of all the filth of pov- 
 erty and excess of debauchery. This year the 
 Cholera broke out at the commencement of the sa- 
 cred ceremonies. In less than eight days, the disease 
 counted twenty thousand victims ; yet, neverthe- 
 less was so slightly propagated, that it did not reach 
 even the village of Juwallapore. situated seven miles 
 distant. The epidemic ceased at the same time 
 with the pilgrimage and the ceremonies which were 
 connected with it. 
 
 Second fact. In the northern Circars, a very 
 narrow tongue of land on the sea coast, encamped 
 a division of a thousand artillerists, under the com- 
 mand of Colonel Pearce. In the spring of 1781, 
 this detachment proceeded to rejoin the main body of 
 
94 
 
 the army encamped upon the coast. The epidemic 
 Cholera attacked this detachment. The disease 
 was rapidly fatal ; the catastrophe happened at the 
 expiration of a few minutes, and in the midst of in- 
 tolerable spasms. It was death, says Colonel Pearce, 
 and not disease, that reigned in the camp. Out of 
 one thousand soldiers about seven hundred died. 
 The epidemic ceased at the end of six days in con- 
 sequence of changing the station. 
 
 In this epidemic, says the historian, a frequent, 
 but perhaps exaggerated, use was made of the an- 
 timoniated tartrate of potass.* 
 
 This, we may add, is one of the rare instances 
 in which the emetic has been administered in 
 Epidemic Cholera. 
 
 In the same country, in 1790, Colonel Cockerel, 
 experienced similar misfortunes among the troops 
 which he commanded in that station ; but in a less 
 violent degree. 
 
 However, it is at Jessore, a city situated thirty- 
 three leagues north-east from Calcutta, in the Delta 
 of the Ganges, that this scourgo really manifested 
 itself for the first time. In the afternoon of the 
 19th of August, 1817, Doctor Robert Tytler was 
 called to see a Hindoo who, during the preceding 
 night, had been attacked with evacuations both up- 
 
 * Tartar Emetic. 
 
95 
 
 wards and downwards, accompanied with the most 
 atrocious pains. The patient died the day follow- 
 ing, without any person so much as dreaming of 
 the Cholera-morbus. At a distance from the place 
 some just suspicion was entertained of poisoning 
 by the datura stramonium, inasmuch as the patient 
 was to have appeared on the following day as wit- 
 ness in a criminal cause. But on the morning of 
 the 20th of August, it was ascertained that ten 
 other individuals, in the same corner of the ba- 
 zaar, had died with almost the same symptoms, 
 and that seven others had perished likewise; it was 
 also known that the disease had invaded several 
 divisions of the city. Doctor Tytler attributed the 
 disease to the bad quality of the rice, which, we 
 know, is the food of the Indians. 
 
 Nevertheless, the number of victims increased 
 from day to day. Soon was it ascertained that the 
 disease had already made its appearance, in the 
 month of May, in some parts of Nuddeca, as well 
 as in some other parts of the surrounding districts, 
 and that it reigned in all the country comprised be- 
 tween Siipet and Monghir, even from the mouths 
 of the Gauges to its junction with the Jumna. 
 
 Already at this epoch, one was struck with the 
 singular mode of propagation of this disease. Often 
 by its ravages, it described a complete circle around 
 a place, without at first penetrating into it, and then 
 
96 
 
 removed to a distance ; so that it might be consider- 
 ed free from danger, when suddenly it returned sev- 
 eral weeks or even months afterwards. It has 
 also been seen to ascend and descend, for a con- 
 siderable distance, one of the banks of the Ganges, 
 then stop suddenly, leap across the river, and re- 
 commence its ravages on the opposite bank. 
 
 Let us dwell for a moment, it is necessary we 
 should, on this first appearance of the disease. 
 The Cholera had reigned epidemically, during the 
 first six months of 1817, in the country of Nuddeca 
 and its environs : whilst the neighbouring, sur- 
 rounding villages remained entirely unmolested, 
 the citv of Jessora and those of the districts round 
 about were ravaged ; a great number of dis- 
 tricts remote from one another have been invaded 
 simultaneously or at very short intervals, whilst 
 others much nearer were respected. Here then the 
 disease was not extended by any of the means of 
 successive transmission, and it must be admitted, 
 without a possibility of contradiction, that it was 
 primitively established under the action of occult, 
 general causes, that is to say, by the epidemial 
 influence. 
 
 At Calcutta, the Cholera manifested itself for the 
 first time early in the month of August, scarcely one 
 month after its appearance at a distance of one hun- 
 dred miles from that place : it seemed to gain ground 
 
97 
 
 more and more : but it did not attain its acme until 
 the first days of the month of September. The 
 number of victims was seldom less than two hun- 
 dred a week, in a population of a million of inhabit- 
 ants. The disease was much more destructive, 
 when on the 7th, according to others, the 9th, 
 of November, it attacked, in taking a direction 
 from east to west, the army encamped on the 
 right bank of the Betoah, and concentrated at Jub- 
 belpore, Mendelloa and Sanger. The Cholera- 
 morbus made such terrible ravages in this army, 
 composed often thousand English and eighty thou- 
 sand natives, that a multitude of domestics and 
 other individuals in the train of the troops expired 
 in a few minutes. Those who lived on vegetable 
 substances were first taken off; women and chil- 
 dren seemed to be spared : but, remarkable cir- 
 cumstance, so sudden as was the invasion of the 
 disease, so prompt was its cessation. When the 
 army had crossed the river Betoah, taking up its 
 march along its eastern side, the Cholera was, as 
 it were, cut off. The number of those who died 
 and fled, during the six days in which this epidemic 
 continued, is estimated at from twenty to twenty- 
 five thousand : according to other data, however, 
 the number of the dead could have been only three 
 thousand. 
 
 10 
 
98 
 
 In the same month, and in the same week, the dis- 
 ease reigned in the districts of Behar and Dacca,very 
 remote from and entirely foreign to one another ; 
 it also existed in the cities of Patna and Dacca, 
 which are several hundred miles asunder. 
 
 Irresistible in its march, the Cholera-morbus ex- 
 tended in a short time over the broadest part of 
 the peninsula of India, ravaging successively the 
 cities and neighbourhood of Nagpore, Aurengabad, 
 Ahmednagour and Pounah, in the direction of which 
 great military movements were then going on. 
 
 On the 11th of August 1820, the Cholera broke 
 out at Bombay, and carried off, previous to the 
 month of February following, eleven hundred and 
 thirty three victims : again in the month of Sep- 
 tember 1821 it returned, accompanied with exces- 
 sive heat, when it destroyed, from the 23d to the 
 28th of the month, two hundred and thirty-five 
 persons. 
 
 Pursuing the course of the Nerbudda, in an east- 
 ern direction, the disease arrived at Haschungabad. 
 Beyond the river, in the southern direction, it was 
 observed in the city of Moltay, towards Nagpore. 
 These two places, and a great number of interme- 
 diate villages, had much to suffer ; the city of Mol- 
 tay alone, though inconsiderable, lost five hundred 
 inhabitants : but between Nagpore and Moltay, all 
 the country, which embraces about seventy miles, 
 
99 
 
 remained unmolested ; and Baitool, a large city 
 situated directly between the river and Moltay, was 
 not attacked by it 
 
 The auxiliary troops of Nagpore, commanded by 
 Col. Adam, afforded the first striking example of a 
 numerous body of men penetrating into the epi- 
 dermal region, and suddenly falling from a state 
 of perfect health into a desperate state of disease. 
 On the first of June, the division quitted Nagpore, 
 in order to return to the cantonments of Haschung- 
 abad ; the disease then gradually diminished, and 
 on the 17th and 18th of the same month almost 
 entirely disappeared. 
 
 Let us follow the epidemic towards the junction 
 of the Ganges and Jumna at Allahabad, and in a 
 great part of these provinces of the north. The 
 Cholera was first established there in the spring of 
 1818; it was afterwards observed developing itself 
 in several tQwns situated upon the Doag and the 
 western bank of the Jumna. At the end of March it 
 suddenly broke out in the city and district of Allaha- 
 bad, and there reigned several months with great 
 activity. The troops stationed in the forts and in 
 the town were not attacked until the middle of June 
 following, notwithstanding they had very free com- 
 munication daily with the city. 
 
 In the month of March 1818, still pursuing the di- 
 rection from east to west, it reached Allahabab, a city 
 
100 
 
 situated at the confluence of the Jumna and Ganges, 
 where it maintained itself until the month of August ; 
 from thence it gained Delhi, Jagpour and a camp 
 composed of fifteen thousand natives and an Eu- 
 ropean company of artillery. The disease bore 
 hardest upon that class of poor who had not even 
 rice to eat; however the Europeans, who were 
 most spared by the Cholera-morbus, perished more 
 from intermittent fevers, which reigned simulta- 
 neously. Animals even were under the influence 
 of a morbific constitution ; many camels and goats 
 died from diarrhoea ; and a great mortality w r as also 
 observed among dogs and horned cattle. It was 
 even supposed by the Hindoos that the roots of the 
 bamboo rotted under foot and gave way, when 
 Cholera appeared in their neighbourhood. 
 
 Whilst ascending the course of the rivers which 
 empty into the Ganges, the disease also spread over 
 the western coast of Coromandel, and notwithstand- 
 ing these countries were but thinly inhabited, it 
 marched, without stopping, from the north to the 
 south. In the month of October 1817 it was already 
 observed at Neblore ; in January 1818, at Madras; 
 at Pondicherry, Carnate and Bellary, in the month 
 of June. It was not until January 1819 that the 
 epidemic appeared at Freiwandroum and in the Isle 
 of Manaar, notwithstanding it was discovered in the 
 island of Ceylon so early as the year 1818. Its 
 invasion was always sudden, the individuals attacked 
 
101 
 
 dying, very frequently, in the space of two or three 
 hours. In no place, says Schnurrer, could its ap- 
 pearance be referred to the direct communication 
 of one individual with another. Sometimes it leaped 
 over several points in the line of its route, in order 
 to return and visit with the greater rigour those 
 place which it had at first spared. Its propagation 
 does not seem to have had the least relation with the 
 variations of temperature. 
 
 At the commencement of the same year, (1819,) 
 that the Cholera-morbus appeared in the island of 
 Ceylon, it also manifested itself more towards the 
 east, at Aracan, Malacca, Sinkapour and the island 
 of Sinang : then in the isle of Java, where it re- 
 appeared in 1821, again producing much evil. In 
 the latter island the disease- evidently manifested 
 its relation with volcanic eruptions ; and, on the 
 other hand, it has several times happened that the 
 disease has been suddenly interrupted in its pro- 
 gress, in consequence of explosions of* the same 
 nature. At Manilla, the epidemic was developed 
 three days after a dreadful hurricane, and must 
 have destroyed an enormous number of victims. 
 
 But, the more we advance towards the east, the 
 more uncertain are the data, on account of the few 
 communications which we have had with this almost 
 uncivilized countrv. 
 
 Having visited the Islands Ternate, Coelebes, and 
 Banda, the scourge of Cholera, in 1823, fell heavily 
 
 10* 
 
102 
 
 upon the isle of Amboina. At Macassar, the dis- 
 ease seldom continued longer than three hours ; there 
 involving in its work of destruction apes, dogs, and 
 horned cattle. Two years previously an earthquake 
 had been felt in this island. 
 
 The data on the ravages produced by the disease, 
 in its march from east to west, are a little more 
 exact. In the month of February 1821, its effects 
 were felt at Surat ; then upon both banks of the 
 Indus, and, at the same time, at Mascat, Moultra, 
 Bender-Abbas, and Bassora. From thence, it as- 
 cended the Euphrates by Helle, and towards the 
 end of August, 1821, it invaded Bagdad, where it 
 cut off 30,000 individuals. In this country the name 
 of haouwa was given to it, which signifies tornado. 
 The Persian army, cantoned between Bagdad and 
 Kourdistan, lost more than 2,000 men ; in conse- 
 quence of which catastrophe the Persians were 
 obliged to raise the siege of Ezzeroun, to conclude 
 an armistice and make peace with the Ottomans. 
 
 It was in the month of June, 1822, that the first 
 patients were observed in Mossoul, in August at 
 Marden, in September at Diarbeckur, in October 
 at Orta, and in November almost simultaneously at 
 Bir, Aintab, and Aleppo: in all these places there 
 had also been shocks of an earthquake, especially at 
 Aleppo. On the 10th of June, 1822, the epidemic 
 made its appearance in the vicinity of Laodicea, and 
 
103 
 
 on the 20th at Antioch, which were to the disease the 
 pillars of Hercules, in its southwestern direction. 
 Often, in these countries, death took place within 
 two hours after vomiting had commenced. 
 
 Towards the close of August, 1821, when the 
 disease began to manifest itself at Bagdad, it was 
 productive of great mortality at Schiraz, where a 
 trembling of the earth had likewise been expe- 
 rienced. Departing from Schiraz, the Cholera- 
 Morbus, pursuing its way towards the north, ex- 
 tended to Zergoun and Mayin, where it stopped for 
 this year. Jesd, situated farther to the east, was 
 invaded by the Cholera, first in the month of Sep- 
 tember of the same year, continued to prevail there 
 throughout the month of October, ceased on the 
 arrival of cold weather in November, and reappear- 
 ed at the commencement of the following year, 
 1822. From thence the disease again took a north- 
 ernly direction, spreading desolation throughout the 
 cities of Nain, Kashan, Koom, Kozbroun, Sava, 
 Dain, Killat, Nargan, &c. In summer it reached 
 Tauris, without, at this time, penetrating into 
 Teheran. 
 
 Let us dwell for a moment on this fact. The dis- 
 ease reigned in the west, where it was propagated in 
 various directions. The city of Teheran remained 
 entirely exempt from it. The Schah, from the ad- 
 vice of Dr. Martinengo, interdicted all communica- 
 
104 
 
 tion between this city and the environs; he especial- 
 ly forbade the entrance of caravans into it. The 
 Cholera had, however, mowed down one third of 
 the population of Bassora and of Bagdad ; but let 
 us also add, in order that we may say the whole 
 truth, that the Cholera made pretty extensive 
 ravages at Teheran in the year 1827. 
 
 The cold weather of the month of November soon 
 put a stop to the march of the epidemic ; but it re- 
 appeared the year after in the month of March, and 
 pushed its way even to the frontiers of the Russian 
 empire. In the month of May, it appeared in the 
 province of Schirwan, but recently ceded to Russia. 
 On the 17th of June it made its appearance at Len- 
 koran, on the borders of the Caspian Sea, in the isles 
 situated at the mouth of Kour ; it ascends this 
 river, enters the vallies and gorges of the moun- 
 tains, and arrives at Bakun, a city whose population 
 comprizes 12,000 Persians and 800 Russians. 
 
 In the northern direction, the epidemic was 
 traced no farther than Saharempore : the lofty 
 chains of mountains, which in other places merely 
 retarded the march of the Cholera, here seemed to 
 intercept it completely, and thus preserved the in- 
 habitants of the mountainous districts. 
 
 In September the Cholera reached Astrakan, 
 then Krasnojar ; it continued a month in the former 
 city, and only fifteen days in the latter. From what 
 
105 
 
 has occurred during the last three or four years in 
 Persia and Asia-Minor, we know that, in the coun- 
 tries in which the epidemic appeared for the first 
 time, its appearance usually occurred towards the 
 end of summer, and then it was not very violent, 
 but so soon as the winter had passed, its intensity 
 increased. Now, as the Cholera did not reappear 
 in the course of the year 1824, either in Syria or 
 along the borders of the Caspian Sea, we had some 
 foundation for believing that the disease attained 
 its natural limits at Astrakan and Krasnodar. Un- 
 fortunately it w r as not so. Having, from 1824 to 
 1827, revisited a part of the places which it had 
 ravaged the preceding years, such as Chakolly, 
 Calcutta, the island of Java, &c, it reigned at Pekin 
 during 1821, 1822, 1823, and in 1826, at Koussou- 
 Chaton, a city situated at the distance of 100 
 werstes to the north of the great wall. At Chakolly 
 a little before the invasion of the Cholera, a conta- 
 gious disease prevailed among dogs, which destroyed 
 13— 16ths of their number. 
 
 In the Phillippine Islands of the Indian Ocean the 
 disease made its appearance, where it gave rise to 
 some facts relative to its propagation, which deserve 
 to be noted. 
 
 On the 20th September, 1829, the Tojmz, an 
 English frigate, sailed from Calcutta. Its equipage 
 had communicated freely with the countries in 
 
106 
 
 which the Cholera existed, and with their inhabit- 
 ants. Many individuals were taken sick at the very 
 commencement of the voyage. The frigate stopped 
 at Manilla, and then sailed to Port-Louis in the Isle 
 of France ; the Cholera, which reigned on board 
 rapidly extended to the population of Port-Louis, 
 where in six weeks it. destroyed six thousand men. 
 
 In connexion with this fact, it is essential to 
 remark, that the disease broke out suddenly in 
 different quarters of the town ; that several negresses 
 had gone on board the vessel on the very day of its 
 arrival ; that they continued to remain there as well 
 as frequent it, and the encampment also where the 
 equipage was established ; yet notwithstanding none 
 of them were attacked with the Cholera. 
 
 The disease did not appear more promptly nor 
 more violently in the environs of the encampment 
 than elsewhere, and the physicians have stated posi- 
 tively that it attacked a great number of individuals 
 who had nothing in common with them but the air 
 which they breathed. 
 
 Finally, the disease attacked almost exclusively 
 those poor individuals, who were destitute of the 
 common comforts and even necessaries of life, and 
 especially those whom an extenuation of misery had 
 reduced to an almost habitual state .of disease. 
 
 On the 14th of August, 1817, the royal frigate 
 La Cybele, navigating the China Sea, put in at 
 
107 
 
 Macao, where divers refreshments were purchased 
 for the equipage. Again setting sail on the 18th, 
 she continued her course up the strait, when on the 
 fourth day from her departure, several marines ex- 
 perienced the symptoms, and there the disease 
 ceased. 
 
 It was on the 22d January, 1822, says our col- 
 league Keraudren, in his interesting work on the 
 Cholera of India, that the royal frigate La Cleojyd- 
 tre cast anchor in the Manilla road; on the 30th 
 the Cholera first made its appearance, and on the 
 following days the number of men attacked mul- 
 tiplied to such an extent, that on the 7th proximo 
 M. le Chevalier Courson, of the Ville-Helio, com- 
 mander of the frigate, ordered the departure for 
 Macao. The number of patients had rapidly increas- 
 ed to thirty-two, seven of whom died. Eight days 
 after the departure, there were no more new cases. 
 
 In the frigates Cybele and Cleopatra, M. Kerau- 
 dren justly observes, no circumstance was present- 
 ed which permitted the supposition that the Chol- 
 era was contagious. It must not be forgotten, he 
 adds, that the latter vessel, the Cleopatra, had not the 
 disease on board when she cast anchor at Manilla, 
 and that it ceased soon after her departure. 
 
 M. Levincent, in his inaugural dissertation, pre- 
 sented to the faculty of Paris in July, 1829, relates 
 the following fact. 
 
108 
 
 In 1826, the ship Fils de France, sailed for Nantz, 
 having had no patient with Cholera on board whilst 
 she laid at anchor in the Ganges. Ten days after, 
 in consequence of undergoing repairs, she was 
 obliged to enter one of the basins on the right 
 bank, which it became necessary to empty in order 
 to expose her keel. The fermentation occasioned 
 by the sun, in the muddy bottom of the basin, gave 
 rise to miasmata ; and eighteen hours afterwards 
 the Cholera indiscriminately seized the men, the 
 most vigorous as well as the debilitated. No 
 change however had taken place in the regimen of 
 the equipage. 
 
 This fact is particularly important, in as much as 
 it seems rigorously to indicate that the Cholera- 
 morbus maybe spontaneously developed, in a vessel, 
 under the influence of the insalubrious conditions 
 adapted to their origin. 
 
 At the beginning of July, 1829, the disease had 
 penetrated into the Russian provinces of Shervan 
 and Bakou, whence it spread, following the great 
 line of communication by land, as far as Tiflis, and 
 from the port of Bakou, by sea, to Astrakan. 
 
 In the spring of the year 1830, news was re- 
 ceived that the Cholera-Morbus had re-appeared 
 in Persia, in the province of Chorazan, from whence 
 it passed to Tauris, the usual residence of Abbas 
 Mirza, where it committed great ravages. A 
 
109 
 
 member of the Russian Legation was numbered 
 with the victims, and Prince Dolgorouki, the min- 
 ister, after a very serious attack, escaped death but 
 with difficulty. 
 
 Before proceeding further, let us point out in a 
 summary manner, the principal conditions of the 
 extension of the disease in India. 
 
 In many circumstances, the epidemic Cholera of 
 India has seemed to follow pretty exactly the 
 march of bodies of military troops ; of this we find 
 several instances mentioned in the documents pub- 
 lished by the health officers of Calcutta, Madras, 
 and Bombay. 
 
 This congregating of men, fatigues, privations, 
 dangers, and the excesses inseparable from a mili- 
 tary life, seem peculiary favourable for the exten- 
 sion of this scourge. 
 
 In 1821, as we have already seen, the Persian 
 army, cantoned between Bagdad and Kourdistan, 
 lost more than two thousand men by the Cholera. 
 This fatal circumstance caused the raising of the 
 siege of Erzeroum, brought about an armistice, 
 and shortly after led to the declaration of peace 
 between the Turks and Persians. 
 
 We almost always find in India that the Chol- 
 era is developed simultaneously in several points, 
 and in places very remote from one another, 
 leaving a great number of intermediate cantons 
 
 11 
 
no 
 
 in a state of perfect salubrity. It is thus, for 
 example, that the Cholera appeared simultaneous- 
 ly in the cities of Behar and Dacca, which are 
 at a distance of one hundred and twenty leagues 
 asunder. It is also thus that between Nagpore 
 and Moltay, which the disease so cruelly afflicted, 
 the whole of the intermediate country remained 
 healthy and unmolested. 
 
 Even in the midst of a vast region, suffering 
 under Cholera in all its malignancy, we find cer- 
 tain tracts, considerable spaces, where the disease 
 has not penetrated, whilst the surrounding country 
 is but a theatre of despair and destruction. The 
 Hill-Forts, in Kandiest, says Annesley, remained 
 exempt from the Cholera, whilst the disease in- 
 flicted the greatest ravages on all the surrounding 
 places. 
 
 The individual invasion of this disease is so 
 abrupt, or, in other terms, the space which inter- 
 venes between perfect health and the full mani- 
 festation of the Cholera is so brief, that it becomes 
 impossible to trace the intermediate changes, such 
 as commonly occur in diseases transmissible by 
 absorption ; and as the greater number of patients 
 have been seized without having approached any 
 individual labouring under Cholera, it would seem 
 that the epidemic mode of accounting for its oc- 
 currence is the only admissible one, especially 
 
Ill 
 
 when the logic of the facts does not admit of any- 
 other. 
 
 The sudden and simultaneous appearance of 
 epidemic Cholera in entire districts and particular 
 stations ; the abrupt violence with which it mani- 
 fests itself; the great number of individuals at- 
 tacked at the same instant ; the fierce and rapid 
 march of the disease, and its prompt disappearance 
 after great devastation : these are so many con- 
 siderations which seem to exclude every way of 
 transmission except the epidermal. 
 
 In almost every part of India, persons attending 
 upon the sick have been seized by the epidemic 
 in numbers proportionately less than other indi- 
 viduals : persons attacked with Cholera when 
 placed in large, well-aired and very clean apart- 
 ments, in the midst of patients labouring under 
 different diseases, have not communicated the 
 Cholera to their neighbours : when there was a 
 Choleric person in a house or family, the other 
 inhabitants of the house, or members of the family, 
 were not more exposed to contract the disease 
 than the rest of the population : almost always, 
 when there were several patients with Cholera in 
 the same house, they were attacked in such a 
 mode of succession, in a manner so sudden and so 
 independently of one another, that it was not pos- 
 sible to suppose that the disease had passed from 
 
112 
 
 one to the other : finally, when several indi- 
 viduals have been successively attacked, it has 
 almost always been evident that each of them had 
 been exposed to the same productive causes of 
 the disease, and that moreover they had been pre- 
 pared to contract it by the action of well-deter- 
 mined pre-disposing causes. 
 
 Doctor James Jameson, recording secretary of 
 the Medical Council of Calcutta, has recorded in 
 his report the following fact. — Out of two hundred 
 and fifty-three physicians who have attended to 
 the disease throughout its whole course, three only 
 were attacked by it, one of whom died. The 
 latter case was at Barrachpour, a station but slightly 
 visited by the complaint. The other two, in whom 
 the disease was not very severe, reached the centre 
 of the army at Nagpore. The medical authorities 
 visited the hospitals both night and day, remaining 
 there for a considerable time, yet none of its mem- 
 bers were seized with Cholera. 
 
 Doctor Annesley, for five years physician to the 
 Madras Medical Establishment, had under his care 
 a continued succession of patients, the average 
 number being from one hundred and seven- 
 ty to two hundred per day. The hospital was 
 kept in a state of perfect cleanliness and free ven- 
 tilation. All the wards were open and communi- 
 cated constantly with one another. A great num- 
 
 , 
 
113 
 
 ber of individuals attacked with Cholera were 
 brought to it daily, and, notwithstanding these 
 persons were indiscriminately dispersed among the 
 other patients in the hospital, Mr. Annesley has 
 never seen more than from six to seven cases 
 developed in the house, and that during a period of 
 five years. 
 
 The disease generally attacks those who are 
 debilitated by forced marches, and by excesses of 
 every kind ; poor, uncomfortably lodged, badly 
 clothed, and improperly nourished individuals ; in 
 a word, all those who are suffering from the 
 depressing effects of fear and sorrow, from ex- 
 haustion consequent upon bodily fatigue or dis- 
 sipation, from filth and the privations of extreme 
 poverty. 
 
 Instead of increasing daily and perpetuating 
 itself at the expense of the additional aliment 
 which it constantly finds in its way, the disease 
 has invariably followed, in the places which it 
 has passed through, a pretty regular course of in- 
 vasion, increase, maturity, decline and extinction. 
 
 Annesley, in the epidemic which he has so well 
 described, proves that, in the first period of Chol- 
 era, the disease is rapid and generally fatal ; in 
 the second, more protracted and more successfully 
 treated ; and at a still later period comparatively 
 mild, of short duration and very rarely mortal. 
 
 11* 
 
114 
 
 In 1823, Mr. Dillon calculated, from very ac- 
 curate tables, that, in the beginning of the disease, 
 there were nine deaths out of twenty-four, and 
 towards the decline of the epidemic, one out of 
 fifteen : in the most favourable times of the in- 
 termediate periods, the proportion was one death 
 out of seventeen cases. 
 
 From the official reports of the Presidency of 
 Madras, in 1818, similar results have been obtained, 
 and the same at Bombay and Gaougoug. 
 
 Considered in its general duration, the disease 
 has always been circumscribed within certain limits; 
 as for example, three weeks, one month, two 
 months, and seldom more than three months ; the 
 latter period has been rare in India, and this dura- 
 tion has never been in a ratio with the extent of the 
 population. 
 
 At Husseinbad, the disease declined in fifteen 
 days. In Astia, it reigned from the 23d of April to 
 the 16th of May. At Vizianagram, it became gen- 
 eral in the beginning of July and declined in Decem- 
 ber. At Mazulipatam, it broke out on the 20th of 
 July, was general during the month of August, de- 
 clined in September, and ceased in October at the 
 moment the rainy season commenced. The ir- 
 ruption of 1823, in Bombay and its environs, was 
 of three months' duration. 
 
115 
 
 But observations of this kind derived from mass- 
 es of regular troops, are generally more com- 
 plete and entitled to a much greater degree of con- 
 fidence ; for here the facts can be collected more 
 easily, and may also be determined with greater 
 accuracy. 
 
 In the central divisions of the English army, the 
 Cholera appeared on the 7th of November : from 
 the 16th to the 22d of this month, it was at its high- 
 est degree of intensity; towards its close, it di- 
 minished considerably, and about the 2d or 3d of De- 
 cember it had completely disappeared. 
 
 In the division of the left, the disease began on 
 the 10th of April. It was in all its vigour towards 
 the middle of the month. On the 21st, its intensity 
 was diminished, and after the commencement of the 
 month of May there was not a case to be seen. 
 
 With regard to the Nagpoor division of the army, 
 which had fallen suddenly into a malignant jungle, 
 {foyer epidemique,) it was different. Here the 
 Cholera, without any perceptible distinction of its 
 periods of invasion and increase, immediately 
 attained its acme. Thus the disease, which com- 
 menced on the 31st of May, had already diminished 
 on the 5th of June, and, on the 18th, had almost 
 totally disappeared. 
 
 Among the troops of Rajpoutana, the periods of 
 the disease were still more rapid. The disease 
 
116 
 
 appeared on the 14th of September ; it raged with 
 fury until the 20th, and then, rapidly diminishing, it 
 ceased entirely by the 1st of Octoder. 
 
 In the division of Hansi, the Cholera began its 
 course on the 6th of August ; it increased in force 
 during some days, and then, gradually declining, 
 by the end of that month it was completely 
 extinguished. 
 
 When more or less considerable military detach- 
 ments encamp in the midst of these epidemic 
 jungles, (foyers?) or even when they merely traverse 
 them, the soldiers almost always contract the Chol- 
 era, and that in an intensity proportioned to the 
 action of the general predisposing causes under the 
 influence of which they are found placed : such are 
 anterior fatigues, bivouacs, unwholesome food, 
 humidity, soldier's excesses, &c.; but then the in- 
 vasion of the disease is sudden, simultaneous, and 
 general. 
 
 We read, however, of many instances in which 
 bodies of soldiers, being assailed by the disease, 
 have formed a junction with other troops, yet the 
 latter remaining in health, notwithstanding such 
 junction. 
 
 On the morning of the 11th of May, 1817, a de- 
 tachment of the first battalion 26tji regiment of 
 native infantry, consisting of ninety men, came from 
 a lower post to join the main body of the army 
 
117 
 
 encamped at Sangar. During an ordinary march, 
 the detachment in perfect health, halted half way, 
 selecting as a place of shelter the borders of a lake, 
 situated in the midst of an open plain, and about 
 three miles in circuit, the environs interspersed with 
 trees, and agreeably undulated. All these men 
 continued well even at nightfall ; then the Cholera 
 burst forth. The first patient was seized at mid- 
 night : he died in half an hour ; and before sunrise, 
 twenty-four men out of the ninety were taken down 
 with the disease. Although the camp of Sangar 
 was only five or six miles distant, the men belonging 
 to the detachment were too weak to advance with- 
 out additional assistance. The patients were trans- 
 ported on carts and litters brought from Sangar: 
 but before 11 o'clock in the morning, when, near 
 the close of their journey, five were already dead, and 
 all the others in a moribund state. The next morn- 
 ing a soldier of the same detachment was suddenly 
 seized whilst brushing his clothes ; he died in a few 
 minutes. Several others fell sick on the three fol- 
 lowing days, and before the close of the week the 
 whole of the detachment had entered the hospital. 
 Notwithstanding these men were indiscriminately 
 mixed with the troops of the camp of Sangar, not 
 one individual among the latter was seized with the 
 disease, 
 
118 
 
 In a fort, separated from the city of Hutta merely 
 by a spacious street, there were a number of Sea- 
 poys who remained in a state of perfect health, not- 
 withstanding the violence of the Cholera caused a 
 prompt evacuation of this city; yet the fort was 
 small, its situation less salubrious than that of the 
 city, and its communications with it unrestricted. 
 
 At Kotah, where several hundred persons died 
 daily, the citadel, placed under the influence of 
 similar conditions, was in like manner unmolested. 
 
 The islands at the mouth of the Ganges, which 
 lie near the banks where the Cholera-Morbus 
 reigned, were not invaded by it, notwithstanding 
 their population is dense, and the communication 
 with the country, ravaged by the disease, free and 
 uninterrupted. 
 
 When the main body of an army is attacked with 
 Cholera it will soon be released from it by separating 
 and dividing into several detachments. This happy 
 change will be still more likely to happen, if the 
 main body removes to a better station. 
 
 From the 6th to the 8th of November, 1817, the 
 disease, which had gradually approximated the en- 
 campment occupied by the central division on the 
 banks of the Sind, penetrated into this portion of 
 the army, then under the immediate command of 
 the Governor-General Marquis of Hastings, for- 
 merly Lord Moira. It first attacked the Indians 
 
119 
 
 employed in the suite of the troops, but soon burst 
 forth every where, seizing Europeans as well as 
 natives, and causing death in the space of a few 
 hours. It became necessary to shift the encamp- 
 ment. The march was disastrous: eight thousand, 
 or at least one tenth of the regular soldiers, perished 
 in less than one month. On the 2*2d and 23d of 
 November, soon after the station was changed, the 
 disease became less generally prevalent. On the 
 8th of the following month, there was not a single 
 case of Cholera in this division of the armv. 
 
 Annesley cites many examples in which entire 
 detachments, quitting a station where the disease 
 reigned, lost in their route a certain number of sick : 
 but, when once arrived at the new station they in- 
 tended joining, having no longer any with the 
 Cholera among them, neither giving rise to it in 
 those with whom they became intermingled. Among 
 other facts recorded in his work we find the follow- 
 ing. The Cholera attacked the country troops sta- 
 tioned at Mallinghaum in Candeish ; it reigned with 
 violence over the soldiers posted on the left of the 
 line. The seventeenth battallion of infantrv, on the 
 contrary, which occupied the right of this line, were 
 entirely exempt from it, notwithstanding it main- 
 tained a constant and free communication with the 
 same individuals. This seventeenth battallion, 
 which preserved such a satisfactory state of health 
 so long as it occupied this position, suffered much 
 
120 
 
 in its turn from the Cholera, in its route from Mal- 
 linghaum to Ellichapour, where it was to rejoin the 
 army under the command of Major-General Sir 
 John Doveton. 
 
 The Physico-medical Society of Calcutta, in its 
 interesting collection of memoirs, similar to that of 
 our ancient Royal Society of Medicine, has published 
 a considerable number of partial topographies of 
 India. These topographies, detailed by physicians 
 and surgeons of the English army, are recom- 
 mended by the extent and variety of information 
 which they convey, as well as by the accuracy of 
 their clinical instruction. In these memoirs are 
 exhibited numerous instances of local insalubrity, 
 which it is difficult to avoid, pervading almost every 
 part of India, and also the great extent to which 
 bilious intermittent, and remittent fevers, cholics, 
 dysenteries, &c, &., prevail in this country. 
 
 But on the other hand, we perceive, with satis- 
 faction, that there are certain descriptions of privi- 
 leged places where conditions most conducive to 
 salubrity, public as well as private, abound : there 
 they live in health ; there convalescents may be 
 securely sent; and never does Cholera occur in 
 these situations. Such is the plateau of Neelgeries, 
 which the estimable author of this topography calls 
 the Montpelier of India ; such also is Mount St. 
 Thomas. 
 
121 
 
 It seems certain that the winds neither hasten nor 
 retard the march of Cholera. We have perceived 
 the disease pass from Bengal into the Deccan, and 
 forwards from Jaulna towards Punderpoor, against 
 the southwest wind, which constantly blew at this 
 time during several months in succession. 
 
 Neither do streams, rivers, lakes, nor arms of the 
 sea, oppose the extension of the disease. It seems, 
 on the contrary, that the freshness and humidity of 
 the atmosphere, which reign upon their banks, 
 favour the propagation of it. The Cholera does 
 not absolutely depend, however, on the influence of 
 humidity, on the vicinity of seas, lakes, rivers, and 
 marshes, since places totally opposite have also 
 been subject to it. It has ravaged countries situ- 
 ated, as Catamandou in the Nepaul, more than two 
 hundred leagues from the shores of the ocean, coun- 
 tries which, like Persia and the Arabic Peninsula, 
 have neither rivers, brooks, nor marshes. 
 
 The observations of the physicians of Orenburg 
 and especially those of Doctor Lichtenstadt, prove 
 that the. epidemic was more violent and severe in 
 close weather, on moist and warm or moist and 
 cold days, than when the days were dry and warm ; 
 during dry and cold weather especially, few new 
 cases supervened. 
 
 Certain pretty well attested facts seem to prove 
 that the Cholera is scarcely ever established on 
 
 12 
 
122 
 
 elevated plateaux or mountains. It has not been 
 observed, says Schnurrer, at six thousand feet above 
 the level of the sea. At Tauris, the inhabitants 
 attacked by the disease, retire to the mountains, 
 and thus escape its fury. Dr. Hasper, on the other 
 hand, affirms that he has sometimes seen the Cholera 
 in elevated countries, upon the mountains, at Nepaul 
 for instance, which is more than four thousand feet 
 higher than the ocean ; at Jabolpour, on the south- 
 erly aspect of the mountains of Rewath ; on the 
 highest plateau of the Isle of France, upon the peaks 
 of Tartary, in the midst of the sandy deserts of 
 Arabia, and in the desert Diabekir. 
 
 In the month of June, 1818, the Cholera made its 
 appearance upon the lofty mountains which separate 
 Hindostan from Nepaul, and it was also observed 
 in the vallevs of Catamandou. Padthum, and Bhat- 
 youn, the elevation of which is more than four 
 thousand feet above the level of the sea ; and it 
 even appeared upon the high peaks of the neigh- 
 bouring districts of Himmalah. Doctor Gowan, how- 
 ever, who described the latter irruption, in a memoir 
 communicated to the Medical Society of Calcutta, 
 is fully confident that the disease never appeared at 
 a greater height than six thousand five hundred feet 
 above the level of the ocean. Even until the pres- 
 ent, at least, the mountains of Nilgherry, which 
 limit Mysore in the centre of the Indian peninsula, 
 
123 
 
 have been exempt from the Cholera which ravages 
 at their foot the plain of Counbature. These moun- 
 tains have an elevation of eight thousand seven 
 hundred feet above the ocean, and the habitations 
 extend to at least five thousand feet. 
 
 The Cholera has been observed in India at all 
 seasons. During the winter of 1818, it reigned with 
 violence at Bombay. There, however, it has been 
 noted, that the disease usually becomes milder, or 
 even ceases entirely, at the approach of the winter 
 season, in order to re-appear in the following 
 summer. 
 
 In India, the Cholera attacks men more frequent- 
 Jy than women and children. Schnurrer positively 
 asserts that women and children seem to be alto- 
 gether exempt from it. 
 
 On several occasions, it has been observed that 
 the epidemic ceases suddenly after the occurrence 
 of violent storms accompanied with thunder. Doc- 
 tor Christie noticed a striking example of the kind 
 at Kulladzv, in 1824. 
 
 The invasion of the disease generally takes place 
 during the night and towards morning. 
 
 The commencement of the disease has, in the 
 opinion of almost all practitioners, its prodromes, 
 symptoms characteristic of the period of imminence, 
 which we have previously exhibited. Well, the more 
 intense and extensive the epidemic, the sooner do 
 
124 
 
 these premonitory symptoms diminish, become less 
 evident, and disappear. 
 
 In several places, a little before or at the moment 
 of invasion of the epidemic, it has been noticed that 
 different animals, dogs especially, have been attacked 
 by various, severe, and mortal diseases. 
 
 In India, cases of relapse have not been unfre- 
 quent : few observers are there who have not cited 
 examples of it : Annesley, Jameson, Searle, and 
 Christie, consider it a very common occurrence. 
 
 Long after the cure, says Dr. Jameson, the stom- 
 ach and intestines remain in an almost hopeless 
 state of debility, and the frequent appearance of 
 dysentery, or an obstinate diarrhoea, attest the great 
 ravages produced by the Cholera on the constitu- 
 tion : in these cases the greatest attention must be 
 paid, for some time, in order to prevent a complete 
 relapse. 
 
 One important fact, and which has been pretty 
 generally observed, is the following : — Every person 
 living within the sphere of the epidemic region, 
 who escaped the Cholera, experienced nevertheless, 
 though in different degrees, the disagreeable influ- 
 ence of the epidemic. This influence was betrayed, 
 in the invaded populations, by great uneasiness, fre- 
 quent vertigo, sinkings carried even to syncope, 
 pains in the stomach, constipation, borborygmi, 
 anorexia?, loss of appetite, gentle diarrhoea; in short, 
 
125 
 
 by an universal disturbance of the intestinal func- 
 tions. It was also almost universally indicated by 
 those spontaneous lassitudes, that exhaustion of the 
 muscular powers, which so frequently denote the 
 imminence of grave maladies, those especially which 
 appertain to nervous fevers and typhoid diseases, 
 rather than those of an inflammatory nature. 
 
 12* 
 
\ 
 
 PART SEVENTH. 
 
 GEOGRAPHICAL MARCH AND MODE OF THE EX- 
 TENSION OF THE DISEASE IN EUROPE. 
 
 Let us now follow the geographical march of 
 the disease, at that so highly important epoch, when 
 crossing the Ural mountains, which separate Asia 
 from Europe, the Cholera, without, as it seems, 
 abandoning Asia, penetrated into Europe, first at- 
 tacking those governments in the empire of Russia 
 embraced in the same latitudes, and afterwards 
 advancing upon us in the two-fold direction from 
 the east to the west, and from north to south. 
 
 Let us inquire whether, under the influence of 
 these climates, in which the epidemic Cholera had 
 been hitherto unknown, the disease has lost or 
 gained any thing, and also endeavour to ascertain 
 whether any additional information, relative to its 
 propagation, has been given by those physicians 
 who have studied the subject in these countries. 
 
 The first appearance of the disease was in the 
 city of Orenburg, in the military hospital ; at 
 which place, about seven o'clock in the morning 
 of the 26th of August, 1829, the first case of Choi- 
 
127 
 
 era was signalized. This fact, surprising in its 
 nature, has been as positively established as com- 
 ports with the bounds of possibility. 
 
 In the first place, however, let us cursorily notice 
 the principal data relative to the topography of the 
 country. 
 
 The city of Orenburg, lying in the 51 ° of north 
 latitude, and 72° of east longitude, is situated be- 
 tween the two chains of the Ural range, in a spa- 
 cious, open valley, destitute of wood, and extending 
 in a direction from north-east to south-west. The 
 valley is watered by two rivers, one small, the Sak- 
 mare, and the other more considerable, the Ural. 
 It is a little above the confluence of the two rivers, 
 and on the right bank of the Ural that the city 
 presents its picturesque appearance. The soil on 
 which it stands is equally sandy and argillaceous, 
 but habitually dry. The city, surrounded by walls 
 and bastions, and having four large gates, is inter- 
 sected by a sufficient number of streets of con- 
 siderable width and running in a straight direction. 
 The houses, for the most part of wood, are over- 
 laid with stucco both within and without ; the 
 habitations of the poor, altogether of wood, are 
 C0Lt\Xi with clay. 
 
 The city has two suburbs, one on the north-east, 
 called Cossack, the other on the south-west, named 
 Slobodka. In these the houses are constructed of 
 
128 
 
 a light, porous, moist wood, which is almost always 
 in a half rotten condition. The entire population is 
 about 11,000 inhabitants, of which number six 
 thousand are soldiers.* 
 
 Provisions, consisting of bread, cheese, full-grown 
 meats, mutton especially, of fish, vegetables, and 
 fruits, are wholesome, abundant, easily obtained, 
 and very cheap. Mutton, for instance, is there 
 sold at 50 cops the poud,f that is to say, 90 cents 
 for 40 pounds, or about two cents the pound of 
 this country. 
 
 The inhabitants generally drink the waters of 
 the Ural, which is clear and of good quality. 
 
 It should be mentioned, however, that epizooties, 
 or epidemics among cattle, are annual in this 
 country, by which a prodigious number of them 
 are destroyed. 
 
 We may also state, both with regard to the 
 physical and moral constitution, that the inhabitants 
 generally have but few wants, and that asthenic 
 diseases are very prevalent among them. 
 
 The peasants, for the most part, are principally 
 dispersed in the steppes, where they are almost 
 exclusively occupied in agriculture. 
 
 * According to Malte-Brun, the number of houses is 2S66, 
 and the population 20,000.— Tr. 
 
 f The poud is equal to 40 pounds. — Tr. 
 
129 
 
 Finally, notwithstanding the insalubrious con- 
 struction of the houses in the suburbs, the city 
 and its environs possess in sufficient degrees the 
 known conditions of a great salubrity. 
 
 Behold then the Cholera primarily established 
 in a city which scarcely presented any general 
 cause of insalubrity. It is true, that the season, 
 immediately preceding that in which the epidemic 
 appeared, had been irregular, -inconstant, and 
 marked by great atmospheric vicissitudes ; the 
 humidity especially had been great and sudden, suc- 
 ceeding prolonged heats and extreme drought. 
 
 It is also true, that a considerable quantity of 
 fruits of an indifferent or bad quality had been 
 gathered in this year, and the inhabitants had freely 
 eaten of unripe water melons and cucumbers. 
 
 It is also true that the koumiss, a species of drink 
 made from fermented mare's milk, had failed, and 
 still more the knout, an analogous but better drink 
 made from the milk of the sheep and the cow. 
 
 But already, in antecedent years, had all these 
 anti-hygienic conditions been frequently presented, 
 in the same degree, and in similar combinations, 
 yet without the least appearance of epidemic 
 Cholera. 
 
 Let us further add with respect to fruits, that 
 subsequently to their absolute interdiction, and 
 notwithstanding the rigid measures adopted by 
 
130 
 
 the public authorities to effect their total exclusion 
 from the city, the disease increased with greater 
 activity and counted a greater number of victims. 
 
 The Cholera having appeared then at Orenburg 
 notwithstanding the salubrity of this city, it be- 
 came necessary to seek elsewhere for its origin ; 
 the epidemic reason not being as yet presented to 
 meditative minds, or rather this reason alone was 
 not deemed satisfactory. 
 
 It is in this state of the question that the origin 
 of the disease has been attributed to an importa- 
 tion imputed, by some, to the caravans arrived from 
 Boukaria and Khiva, and by others, to the com- 
 mercial relations established with the neighbouring 
 hordes of Kirguis-Cossacks. 
 
 The Kirguis, a wandering and half-savage peo- 
 ple, encamped in the immense steppes, beyond the 
 Ural mountains, being in constant commercial inter- 
 course with Turkestan, Boukaria, and Khiva, have 
 long been in the habit of furnishing Orenburg with 
 sheep, felt, camlets, &c. JNow, when the Cholera 
 appeared at Orenburg, we know that the epidemic 
 was extending its ravages in Chorazan, in Asia 
 and Persia. 
 
 Let us, however, examine both assertions, that 
 is to say, the importation of the Cholera by cara- 
 vans and by the Kirguis. 
 
 On the 26th of August, 1829, at nine in the morn- 
 
131 
 
 ing, surgeon-major Smirnorff detected the Cholera- 
 Morbus in Andre Yvanoff, a soldier of the 3d 
 batallion of the line then in garrison at Orenburg, 
 who was carried to the military hospital at Oren- 
 burg, where he died at about the expiration of 
 twelve hours from the commencement of the 
 disease. 
 
 From the 26th of August to the 9th of Septem- 
 ber, no other person in Orenburg was attacked 
 with the Cholera. 
 
 On the 9th of September, at 11 o'clock in the 
 night, another soldier, of the same batallion of the 
 line, likewise attacked with this malady, was 
 brought to the military hospital. He died towards 
 five o'clock in the evening of the following day. 
 
 The day after, September 10th, two other pa- 
 tients were sent to the hospital, one of whom died, 
 the other was cured. In both these cases the dis- 
 ease had progressed with less rapidity than in the 
 two preceding. 
 
 On the 11th, a soldier of the same batallion was 
 attacked and carried to the hospital ; then on the 
 14th, a soldier of the batallion of invalids ; again, 
 on the 16th, two other soldiers of the same batal- 
 lion, and, finally, on the 17th, two non-commissioned 
 officers. 
 
 During the whole of this time, and until the 18th 
 of September, only two individuals among the citi- 
 
132 
 
 zens of Orenburg had been seized with the mala- 
 dy ; both of whom died. One was an excise 
 officer, the other a tradesman. 
 
 The commerce of Orenburg, a city altogether 
 commercial, has for a long time been maintained in 
 frequent, extensive, and important relations with 
 Asia, India, and Persia: it is at least since 1813 
 that the city of Orenburg has been in the habit 
 of admitting annually the caravans coming from 
 Kiachta and Boukaria : now, the Cholera reigned 
 epidemically in these countries during the month of 
 August, 1817, and it was not until August, 1829, 
 that it first made its appearance at Orenburg. 
 
 The caravans from Boukaria and Khiva arrived 
 in July (the 20th at the latest) at Orenburg, were 
 admitted into the Court for Strangers, after sani- 
 tary visits and inspection, but the Cholera was not 
 manifested until the 2Gth of August. 
 
 Convoys making a part of these caravans, had 
 entered about the same time into the fortresses of 
 Orstia and Troitzka, yet the Cholera did not appear 
 in these two fortresses. 
 
 The guards and camel-drivers, hired by these 
 caravans in one place and in another throughout 
 their route, have entirely escaped the disease. 
 
 It must also be noted that these Asiatic traders 
 loaded and unloaded their camels during their 
 journey ; that whenever they arrived at an aoula 
 
133 
 
 or encampment of Kirguis, they made numerous 
 exchanges of merchandize for provisions of every 
 sort, which consequently rendered it necessary to 
 unpack the bales in which they were contained : 
 yet, notwithstanding these different operations, there 
 has not been a single instance in which Cholera 
 was communicated. 
 
 From the 26th of August, the day in which the 
 first patient, the soldier Yvanoff, was attacked by 
 the disease, and who died with it on the same day, 
 until the 9th of September, there was not a single 
 individual seized with the Cholera at Orenburg. 
 
 The Cholera suddenly makes its appearance 
 among the poorer class of people, in individuals 
 worn down by hard labour and debilitated by ex- 
 treme want. It w T as not first observed among cus- 
 tom-house officers, in continual communication with 
 the suspected Kirguis and in constant contact with 
 the suspected articles of merchandize. It has not 
 attacked the merchants who purchased camlets, 
 felts, and furs ; it has respected easy or rich 
 people who carried them. The traffic-market 
 of Orenburg, situated at the distance of three 
 versts* from the city, on the right bank of the 
 
 * About two miles ; a verst being nearly two thirds of an Eng- 
 lish mile. — Tr. 
 
 13 
 
134 
 
 Ural, where, during the whole summer and one 
 half of the autumn, the Russian and Asiatic 
 merchants reside and exchange their merchandize 
 with that of the Kirguis, it would seem ought to 
 have been the first theatre on which the disease 
 appeared ; yet, notwithstanding, it was in a lesser 
 proportion and at a later period that these quarters 
 were attacked. 
 
 The Cholera had existed a long time in the city 
 of Orenburg, when it broke out in the badly con- 
 structed fauxbourgs which constitute the boundaries 
 of it. 
 
 Now it was not until the 28th of September that 
 information was received of the first appearance of 
 the Cholera in the environs of Orenburg ; and, 
 surprising circumstance ! whilst the villages nearest 
 to the city, having intimate relations and constant 
 communication with it, were altogether exempt 
 from the Cholera; whilst the fortresses adjacent to 
 Orenburg and situated in the line of the two prin- 
 cipal roads which terminate at this place, preserved 
 their habitual salubrity, — during this time, the Chol- 
 era exhibited its accustomed ravages in villages 
 at some distance from Orenburg, and also in a 
 fortress situated at more than a hundred versts from 
 this city, which had maintained but very little com- 
 munication with it. 
 
 The villages lying east from Orenburg, between 
 
135 
 
 the Ural mountains and the city, but beyond the 
 latter, in the line of communication of Asia with 
 Orenburg; these villages, Nieginka and Kaminoe 
 for instance, although built along the upper Ural 
 and having free intercourse every hour, as well as 
 every day, with the city, have not been invaded by 
 the malady. 
 
 In the military hospital of Orenburg, the Cholera 
 began on the 26th of August, and did not cease its 
 reign until the 20th of November ; the number of 
 persons attacked with the disease was two hun- 
 dred and ninety-nine, of which number two hun- 
 dred and twenty were cured and seventy-nine 
 died : we have stated above that the garrison con- 
 sisted of six thousand men. 
 
 In the city of Orenburg, the disease did not 
 commence until the 15th of September ; and on 
 the 20th of November there was not, either in 
 the city, or its suburbs, a single patient with the 
 Cholera. Of the entire population of the city and 
 its fauxbourgs, which is estimated at seven thousand, 
 there were eight hundred and one patients, out of 
 which number six hundred and eighty were cured 
 and one hundred and one died. 
 
 Immediately after the city of Orenburg, the first 
 two villages attacked by the epidemic were the burgh 
 of Rassipnoe and the village of Bicoulovoy, placed 
 at a great distance from one another, upon two 
 
136 
 
 diverging routes, having intermediate to them 
 a great number of other towns and villages which 
 were not attacked at all or not until a later period, 
 and also having much less communication with one 
 another than each of them had with certain other 
 places until then remaining unmolested by the 
 disease. 
 
 The village of Bicoulovoy w T as attacked on the 
 28th of September ; on the 25th of October it was 
 exempt from the disease : there were in all sixty- 
 one patients, of which number thirty-two recovered 
 and twenty-nine died. 
 
 At Samarsky, the Cholera appeared on the 19th 
 of October, and ceased on the 27th of November. 
 
 At Bardskoy-Stanitzka, it broke out on the 30th 
 of September, and it was not until the 13th of No- 
 vember that no more new cases were observed. 
 
 The town of Rassipnoe experienced the first 
 assaults of the Cholera on the 23d of September ; 
 the disease did not cease until the 24th of October. 
 Out of a total number of 305 patients, they count 
 nineteen deaths and two hundred and eighty-six 
 cures. 
 
 But, let us extend the details of the invasion of 
 the disease still farther. All accounts agree in 
 imputing the developement of the disease to a wine- 
 dealer who had gone on business to Orenburg, and 
 
137 
 
 who, returning sick to the village, died of Cholera 
 on the day following. 
 
 Now let us attend to the clear and exact account 
 of this fact, as related by M. Schoumoff, chief phy- 
 sician to the brigade of Cossack horse-artillery 
 stationed at Orenburg ; let us transcribe the docu- 
 ment. 
 
 1st. All those who were exposed to an immedi- 
 ate contact with the wine-dealer, during his illness 
 and after his death, are entirely healthy, and not 
 one, without exception, has been attacked with 
 cholera. 
 
 2d. The wine-dealer fell sick on the 19th of Sep- 
 tember and died on the 20th ; on the 20th and 22d 
 there were no persons attacked by the disease. On 
 the evening of the 23d there was but one individual, 
 who had been suffering a long time from diarrhoea, 
 and who, in addition, was intoxicated : he died in 
 the space of twenty hours. On the 25th, in the af- 
 ternoon, another individual was taken sick. On the 
 27th there were three new cases, and so on. I pos- 
 itively affirm that between the patients and those 
 w r ho had attended upon the wine-dealer, there had 
 not been the least communication. 
 
 But for what reasons has M. Schoumoff been in- 
 duced to emit this last, so positive, assertion ; and 
 how is it possible that he could prove it ? 
 
 How T ever, it is certain that the cholera, in a pret- 
 
 13* 
 
138 
 
 ty great number of cases, does not exclusively at- 
 tack several individuals at once, as has been ad- 
 vanced by those physicians who have observed the 
 disease in India. In Russia, it has frequently been 
 noticed that individuals were seized successively, 
 one after the other ; and as to the secondary propa- 
 gation of the disease by the air respired by the sick, 
 certain facts, collected in Russia, prove that this 
 mode of transmission has thus taken place under 
 circumstances in which the patient inhabited a con- 
 fined, ill-ventilated locality, or when the attendants, 
 relatives and friends, pressed for too long a time, and 
 in too great numbers, around the patient. 
 
 In every point of view, it is remarked that the dis- 
 ease has been less severe in villages than in the in- 
 terior of hospitals. Does not this fact, which is 
 generally admitted, seem to call for the measure, 
 so propitious in other epidemics, of encamping and 
 placing in barracks in appropriate locations those 
 who are attacked with the cholera. It is especial- 
 ly in the epidemic, now under consideration, that 
 this wise measure would be happily applicable. 
 
 Relatively to this mode of propagation, the air 
 exhaled by patients, which seems to be establish- 
 ed in Russia by a considerable number of facts, 
 whilst in India there is not the least cause for pre- 
 suming it, we will also say that, in these warm 
 climates, they have no need of sealing up the cham- 
 
139 
 
 bers of patients, who, on the other hand, find them- 
 selves as if naturally encamped or barricadoed in 
 their own dwellings. Without taking into the ac- 
 count that, in these countries, the crowding together 
 of patients and great accumulation of individuals, 
 but rarely happens, because the population is not 
 sufficiently dense to admit of it. 
 
 The district of Caen, from the first indications of 
 the disease in the government of Orenburg, adopted 
 the most particular and severe precautions against 
 its propagation. Punishment of death was pro- 
 nounced against every infraction of the sanatory 
 laws ; yet this district, notwithstanding, has been 
 ravaged by the disease. 
 
 By the attention and vigilance of Boards of health 
 measures of strict medical police have been taken 
 since the first appearance of the cholera at Oren- 
 burg ; these measures have been successively ex- 
 tended to the cities and surrounding villages, even 
 to Moscow, without having the least effect in cir- 
 cumscribing the scourge. The disease burst out at 
 Moscow in October 1830. 
 
 The disease, restricted at first to the interior of 
 Russia and of Poland, proceeds onwards to the 
 the coasts of the Baltic, and almost all the ports of 
 this sea become infected by it. In Riga, on the 
 12th of June, there were two thousand five hundred 
 and forty-one patients, of which number twelve 
 
140 
 
 hundred and two perished. On the 26th of May 
 the cholera was observed at Dantzig. 
 
 Towards the south, this dreadful scourge seems to 
 have been equally progressive. Kioff, the Ukraine, 
 Podolia, Volhinia, and Moldavia, in all these prov- 
 inces the victims were numerous and in rapid suc- 
 cession, especially among the Jew population who 
 were there plunged in the most profound ignorance, 
 and consequently reduced to extreme poverty. At 
 Brody, where out of thirty -five thousand inhabitants 
 twenty-four thousand are Jews, there were, on the 
 9th of June, eight hundred deaths out of seventeen 
 hundred patients. Gallacia and especially Limberg, 
 Silesia, and particularly Olmutz, have not been 
 spared. 
 
 Astrakan, a very commercial city, the population 
 of which amounts to thirty thousand inhabitants, 
 was visited by the Cholera in 1823. The disease 
 reigned scarcely six weeks. The number of sick 
 did not exceed two hundred and sixteen, yet the 
 deaths were in the dreadful proportion of one in 
 three. From this moment Russia adopted the most 
 extensive and vigilant sanatory measures, in order 
 to prevent the extension of the disease into the 
 southern districts of the Russian Empire. Every 
 body knows the result of these measures ! 
 
 How great are the precautions which the public 
 administration has taken at Moscow ! Even when 
 
141 
 
 the order was given by the Emperor for raising 
 the cordon which surrounded the city, every pos- 
 sible means was used to hinder the disease from re- 
 appearing, and for preventing its importation in- 
 to those places with which communication had 
 been re-established. Houses suspected of infection 
 continued to be sequestered ; barriers of observa- 
 tion were maintained, and military cordons estab- 
 lished, together with quarantines on the frontiers 
 of the government of Moscow. As for the rest, it 
 is well known. 
 
 Petersburgh, although eighty leagues distant from 
 the nearest point where the disease had made its 
 appearance, was also subjected to the most rigid 
 preventive measures ; a triple cordon guarded the 
 communications ; extraordinary hospitals were 
 there established, and the government prescribed 
 to the inhabitants the laying in of a year's provis- 
 ions. Petersburgh has been twice visited by the 
 epidemic. 
 
 And on the other hand, in Thorn, the Cholera 
 has- not been observed, or at least it did not appear 
 in this place until a much later period : we know, 
 however, that numerous boats coming from War- 
 saw, arrive daily at this large city. But we are 
 now told that these same boats have conveyed the 
 Cholera to Dantzick, situated at the mouth of the 
 Vistula ! 
 
142 
 
 CONCLUSIONS RELATIVE TO THE MARCH AND EX- 
 TENSION OF THE DISEASE. BOTH IN ASIA AND 
 IN EUROPE. 
 
 That the Cholera m India, Russia, and Poland, 
 was primitively, generally, and essentially propa- 
 gated by epidemic conveyance, is beyond the pos- 
 sibility of a doubt ; the facts which prove it are 
 both numerous and conclusive. 
 
 Under all circumstances, we have seen the com- 
 municative power of the Cholera exist in a con- 
 stant relation, and in an exact proportion with the 
 violence of the malady. When the epidemic was 
 attended with most fatal consequences, its propa- 
 gation was equally extensive. The power of prop- 
 agation diminished, on the other hand, so soon as 
 the epidemic lost its intensity. 
 
 In a great many places, the manifestation of the 
 Cholera has been preceded by epizooties, more or 
 less mortal, the ravages of which were exercised 
 upon different species of animals. 
 
 At Moscow, a short time previous to the appear- 
 ance of the disease, the atmosphere w T as obscured 
 by enormous masses of green flies, the species of 
 which was not determined. It seems that this phe- 
 nomenon has repeatedly presented itself in Asia, 
 under similar circumstances. 
 
143 
 
 The disease has been attended with peculiar vi- 
 olence under determinate conditions of the organ- 
 ism. Individuals badly lodged, ill-fed, and ill-cloth- 
 ed ; those who are physically or morally debilitated ; 
 those weakened by excesses, of whatever kind they 
 may be ; gluttons, drunkards, and gamesters ; all 
 persons suffering under the pernicious effects of 
 uncleanness or the abandonment of poverty, were 
 much more frequently and cruelly attacked with 
 Cholera. In Poland, writes M. Briere de Bois- 
 mont, the Jews are the first subjects of this mal- 
 ady. 
 
 In India in general, and at Dantzick, the disease 
 attacks men in particular, and it is among them 
 that it exercises its greatest ravages ; at Casan and 
 Moscow, women were more frequently numbered 
 among the victims of Cholera. Every where, as 
 has appeared hitherto, children are but rarely at- 
 tacked : out of three hundred children employed 
 at Casan, in a manufactory, wherein nineteen adult 
 workmen perished, not a single child took the Chol- 
 era. 
 
 An elevated temperature was always insepa- 
 rable from the existence and propagation of every 
 species of contagion, and more especially of exotic 
 contagions. The Cholera is developed, and has 
 preserved the character of extension which is prop- 
 er to it, at a temperature of thirty degrees above 
 
144 
 
 zero, in India and especially Bengal, and at a tem- 
 perature of thirty degrees below it, in Russia.* 
 
 Every where the general duration of the disease 
 has been circumscribed by certain limits ; we see 
 it cease long before all the aliments of propagation 
 which are placed within its reach have been ex- 
 hausted. 
 
 The disease has not existed at all in several 
 places immediately adjacent to those in which it 
 reigned with fury, without the communications 
 being suspended, and without greater preventive 
 precautions being adopted here than there. 
 
 The disease has appeared simultaneously in 
 places pretty remote from one another ; and on 
 the other hand, has not been at all manifest 
 in some intermediate places. Again, these in- 
 termediate places have been invaded several 
 weeks, months, or perhaps a year afterwards, 
 without any appreciable cause or apparent reasons. 
 
 The epidemic Cholera began in Asia, in the year 
 1817. Holland and England, which keep up ex- 
 tensive and frequent commercial, political, and mil- 
 itary relations with the East Indies, have not yet 
 had the disease. It is only within a few months 
 that these two powers have adopted preventive 
 measures. 
 
 * According to Fahrenheit the range would be from 860 to 2°. 
 -Tr. 
 
145 
 
 In Europe, as well as in Asia, the cases of re- 
 lapse have been so frequent, that it has become a 
 common saying, that it is sufficient to have had the 
 disease once in order to be more disposed to contract 
 it anew, under the action of all the causes capable 
 of giving rise to it. 
 
 The re-appearance of the disease in the cantons 
 which it had deserted, after having there made 
 more or less extensive ravages, is frequent, at least 
 as much so as the examples of individual relapses. 
 
 On the 27th May, 1819, the population of Agra 
 was re-visited by the Cholera, the effects of which 
 it had experienced in the early part of July of the 
 preceding year. The disease lasted eighteen days; 
 and this second time it destroyed a much greater 
 number of victims. Calcutta, Madras, Moscow, 
 &c, have presented similar iterations. 
 
 Observations, in considerable number, attest 
 that change of situation is both a very efficacious 
 mode of escaping the disease when one has not 
 yet been assailed by it, and a sure means of be- 
 coming cured of it when its attack has been 
 realized. 
 
 It has been repeatedly noticed, that bodies of 
 troops seized with Cholera, have been released 
 from it so soon as they separated and divided into 
 several detachments. 
 
 In the island of St. Maurice, where many of the 
 
 14 
 
146 
 
 inhabitants were removed by this malady, twelve 
 only of the Europeans perished, because the latter, 
 placed in easy circumstances, immediately remov- 
 ed from the city. 
 
 At Calcutta, in 1826, the population experienced 
 all the advantages of emigration, on the approach 
 of the scourge the inhabitants quitted their dwell- 
 ings, and they had no cause to regret the circum- 
 stance. 
 
 The invasion of the disease has generally taken 
 place in the night and towards morning. 
 
 In India as in Russia, it has been remarked that 
 persons who escaped the Cholera, though in the 
 midst of the epidemic, experienced, nevertheless, the 
 epidemic influence, which betrayed its presence to 
 the invaded populace, by uneasiness, vertigo, syn- 
 cope, anorexia, flatulency, constipation or diarrhoea. 
 
 That the disease, then, is capable of propagating 
 and transmitting itself to a distance, is so evident 
 a fact, that it is scarcely worth while exposing or 
 mentioning it. 
 
 That, after the example of many other diseases, 
 correctly appreciated in consequence of having 
 been frequently observed, it is propagated by the 
 epidemic method, that is to say, under the influence 
 of occult, unnatural causes, and in a sphere of 
 unbounded and immense activity, is also a fact 
 
147 
 
 which no one denies, and which every one pro- 
 claims. 
 
 But with this mode of propagation is there not 
 another connected ; and do we not see the Cholera, 
 in many circumstances and under certain con- 
 ditions, introduced and established by the migra- 
 tion of individuals or the transportation of mer- 
 chandize ? In a word, can the disease accident- 
 ally extend in any other way than by epidemial 
 influence? Such is the problem, reduced to its 
 most simple form ; and this the question which 
 we now propose to discuss. 
 
 Unfortunately, it is in vain that we call upon 
 facts and reasoning, experience and logic, for the 
 solution of this problem. Reasoning and facts, 
 logic and experience, reciprocally oppose, weaken, 
 or destroy one another, and the mind froe from 
 everv bias remains without the least conviction. 
 
 Here, gentlemen, let our attention be re-doubled. 
 
 Firstly. Districts, cities, and fortresses, have es- 
 tablished rigorous sanatory measures, and the 
 Cholera has not been manifested among them. 
 
 Facts of this nature, and they are not rare in the 
 history of the epidemic under consideration, seem 
 at first sight conclusively in favour of the non- 
 epidemial transmission. 
 
 But to these facts, the opponents reply that 
 places immediately adjoining those which were 
 
 
148 
 
 attacked have escaped, notwithstanding every pre- 
 cautionary measure had been omitted. Might it 
 not equally be retorted, that the preserved coun- 
 tries which have adopted pre-cautionary measures, 
 have not been attacked because such measures 
 were had recourse to ? The disease did not pene- 
 trate these places, because the epidemial region 
 has not extended thus far. 
 
 Secondly. Countries, cities, and fortresses, have 
 employed the most severe preventive measures ; 
 they have adopted them in season, and they have 
 vigilantly insured their execution: yet, notwith- 
 standing, they have been invaded by the epidemic. 
 Cases of this kind are not rare ; they have been 
 observed at Orenburg, Astrakan, and Moscow, for 
 example. These are proofs, it would seem, in 
 favour of the exclusively epidemic propagation. 
 But, the adversaries of this opinion say in their 
 turn, that the sanatory measures, in these circum- 
 stances, were not rigorously enforced ; and they 
 always cite, in support, some cases of infraction ; 
 for, in the present state of civilization, and with 
 the relations which exist between nations, cities, 
 families, and individuals, how is it possible to 
 hinder every communication ? 
 
 Thirdly. Cities, fortresses, and bodies of troops, 
 in the vicinity of the epidemic region, and having 
 free communication with it, have not contracted 
 
149 
 
 the disease. In Europe and in Asia, facts of this 
 nature abound. Irresistible arguments, apparently, 
 against the transmission by individuals or mer- 
 chandize. 
 
 Not at all, reply the antagonists. If the disease 
 has not been communicated in the midst of these 
 circumstances, it is because the requisite general 
 conditions, and the individual predispositions, ne- 
 cessary for its transmission, did not exist. 
 
 Fourthly. Entire cities, villages, fortresses, and 
 bodies of troops, entered into communication with 
 the epidemic region, have been infected and 
 ravaged by the cholera : the disease then is trans- 
 mitted by the communication of men and mer- 
 chandize, say the one ; by no means, the others 
 affirm, the epidemic has been developed, in these last 
 cases, in the same manner and by the same causes 
 as in the preceding, that is to say, by the epidemial 
 action. 
 
 Fifthly. Individuals place themselves in free and 
 entire communication with patients labouring under 
 Cholera: if they contract the disease, some assert 
 that it is by the effect of communication ; others 
 affirm, that it is by the epidemial action : if they 
 do not contract it, it is, according to the saying of 
 certain persons, because the disease is not trans- 
 missible in this way ; and, in the opinion of some 
 
 others, that it is solely owing to the want, at this 
 
 14* 
 
150 
 
 moment, of the requisite pre-dispositions for con- 
 tracting it, in these individuals. 
 
 How then can we escape from this labyrinth ? 
 Let us relate facts. 
 
 A member of a family, or one of the members 
 of a house, being attacked, the disease sometimes 
 declares itself simultaneously, at other times suc- 
 cessively, in several individuals who are found in 
 direct relation with the one first seized. 
 
 Among domestics in houses, and servants in 
 hospitals, the proportion attacked has sometimes 
 exceeded the proportion of persons seized with 
 Cholera among the inhabitants in general. At 
 Moscow, for example, if the proportion, for the 
 population of the city, was three in a hundred, 
 it was from thirty to forty per cent, among the 
 attendants employed in hospitals. In India, on 
 the contrary, Annesley has observed, that the 
 servants of hospitals and of patients in general, were 
 not more frequently seized than other individuals. 
 
 Surgeon Major Smirnoff has seen officers, en- 
 signs and subalterns rendering assistance at the hos- 
 pital during the prevalence of the Cholera. The 
 city also furnished the hospital with many students 
 and a great number of nurses, at this period, yet 
 none of these individuals contracted the disease. 
 
 In many countries and in several instances, indi- 
 viduals either designedly or ignorantly, have slept 
 
151 
 
 in the beds just quitted by patients who were cured 
 of or had died with Cholera ; they have clothed 
 themselves in their shirts and other garments ; have 
 inhaled the breath of patients even in a moribund 
 state ; have touched and agitated the matters ren- 
 dered by vomiting and by stool ; have passed the 
 night with the sick, and in the same bed ; physicians 
 have been inoculated with their blood, have injected 
 it into their veins, have rubbed their skin with the 
 matter of perspiration and the substances ejected, 
 yet have escaped the Cholera. These observations, 
 these diverse experiments, have been often repeated 
 during the epidemics in Asia and Europe. It is 
 however just to remark, that the resolution, sang- 
 froid and courage which generally led to these 
 experiments, must also have been serviceable in 
 preventing the invasion of the disease. 
 
 In all the places where I have been, says Doctor 
 Boschinski, who besides is a professed contagionist, 
 I have noticed that from the very commencement, 
 the Cholera attacked simultaneously a great num- 
 ber of individuals who had not previously any com- 
 munication with the sick ; persons recently arrived 
 at places where the disease reigned, were especially 
 attacked before they could have had the least com- 
 munication with those afflicted with the malady. 
 
 Several individuals who have been subjected to 
 quarantine during the full time, have nevertheless 
 
152 
 
 fallen sick immediately after, and without being 
 notoriously exposed. 
 
 On the other hand, some facts pretty accurately 
 observed in Russia, and especially by the physicians 
 of the government of Orenburg, tend to prove that, 
 under certain determinate circumstances, the ex- 
 haled vapours alone of the circumscribed atmos- 
 phere of the sick may give rise to the transmission 
 of the Cholera. 
 
 We have before noticed the fact relating to 
 the city of Teheran ; wherein this city was pre- 
 served from the Cholera in consequence of the 
 precautions adopted by the Persian emperor, by 
 the advice of the Italian physician Martinengo. 
 
 In Persia, the gates of Ispahan were closed 
 against a caravan which appeared to be infected. 
 This caravan was obliged to pass through Jesda. 
 Shortly afterwards, the Cholera destroyed seven 
 thousand persons in this place, and Ispahan escaped 
 the scourge. 
 
 According to the report of Doctor Onoufrieff, 
 the Cholera manifested itself among the Tartars of 
 the village of Kamale, in the district of Bougdou- 
 rousslausk, on the 10th of December. The first vic- 
 tim was an inhabitant of this village who had just 
 arrived from Firis-Ousman, where the disease 
 reigned. Next some of his relatives died, and then 
 
153 
 
 many of the inhabitants. The population of the 
 village is one hundred and seventeen. From the 
 10th of December to the 17th there were twenty- 
 eight patients ; one only of which was cured, twelve 
 are dead, and thirteen still remained sick on the 1 7th 
 of December. Another village inhabited by Rus- 
 sians, forty sagenes* from the latter, having been 
 informed of the appearance of the Cholera among 
 the Tartars, surrounded the infected village with a 
 sanatory cordon and broke off all communication 
 with the inhabitants : it was preserved from the 
 disease. 
 
 Our honorable associate Doctor Keraudren, in 
 his interesting treatise on the Cholera, relates the 
 following fact. 
 
 In 1822, the approach of the Cholera determined 
 M. De Lesseps the French Consul at Aleppo, to 
 take refuge with all those who wished to accompa- 
 ny him, in a garden at some distance from the city. 
 His asylum was enclosed with walls, and surrounded 
 by a wide fosse ; having two gates, one for coming 
 in and the other for going out. So long as the 
 scourge lasted, he admitted nothing from the ex- 
 terior without subjecting it to the precautions ob- 
 served in Lazarettos. In this colony of at least 
 
 * 230 English feet : a sagene being equal to 7 English feet. 
 — Tr. 
 
154 
 
 two hundred persons, and composed not only of 
 Franks more or less acclimated, but also of several 
 natives, there was not one sick person, whilst in 
 the city four thousand persons were destroyed by 
 the Cholera in the course of eighteen days. 
 
 One consideration, much more powerful still, in 
 the epidemic Cholera of Asia and Europe, seems to 
 give the greatest weight to the opinion of the trans- 
 mission of Cholera: it is the immense extent of 
 country it has passed through, in every direction of 
 the horizon, under diverse latitudes, during opposite 
 seasons, and in different climates. When we see 
 a disease successively invade so long a series of 
 regions, pursuing the course of the communications 
 which the inhabitants have established with one 
 another, the routes which have been traced for their 
 mutual intercourse, are we not compelled to con- 
 sider it as being propagated by individuals or mer- 
 chandise, by the aid of persons or of things ? 
 
 Medical annals, however, are not deficient in 
 examples of diseases having thus successively 
 reigned over a great extent of country, the intro- 
 duction of which could not be attributed to any 
 property individually transmissible. 
 
 The malady called trousse-galant* which succes- 
 
 * A species of Ileus: also, the vulgar name of Cholera-Morbus. 
 — Tr. 
 
155 
 
 sively pervaded entire Europe in 1600, which should 
 not be confounded with the Cholera-Morbus, men- 
 tioned by Zacutus Lusitanus, and described by him 
 under the name of colic, having previously described 
 the Cholera a few pages in advance — this colic, 
 Zacutus himself attributes to an occult cause, a pes- 
 tilential change in the atmosphere. 
 
 Let us also cite the epidemic catarrhal fever of 
 1731. It first appeared in Connecticut : on the 
 following day it attacked the inhabitants of Massa- 
 chusetts ; two days afterwards, one half of the gar- 
 rison of Annapolis Royal was seized with it ; and 
 two or three days later still, the disease extended 
 over the whole of Newfoundland. Towards the 
 middle of November it extended into Saxony and 
 Russia ; then making, as it were, a retrogade march, 
 it passed into Holland, from thence into Scotland, 
 and afterwards to London ; after which, reaching 
 the extremities of the territory of Great Britain, it 
 penetrated even into Ireland. In Paris, it was 
 observed towards the end of January ; in the 
 month of March it reigned at Naples, and in all the 
 southern parts of Italy. 
 
 In order that we may approach nearer our own 
 epoch, let us cite the epidemic which we have 
 recently witnessed, the disease of the hands and 
 feet, called " acrodynia" 
 
156 
 
 The disease, developed at first in Paris, has been 
 successfully carried to Coulommiers, Meaux, Frere- 
 Champenoise, and Montmirail. At the hamlet 
 Bordes, it caused the destruction of one fourth of 
 its inhabitants. 
 
 Persons who took up their habitation in those 
 places where many individuals affected with the 
 disease were congregated, soon contracted the dis- 
 ease ; and if they quitted these places, they were 
 almost as soon relieved from the complaint. At 
 the barrack of Oursine, at that of Courtille, raw 
 soldiers had scarcely arrived before they were 
 attacked by the disease : in the environs of Ferte- 
 Gaucher and Coulommiers, it was the same; indeed, 
 it was merely sufficient for a labourer to commence 
 working on an infected farm, in order to contract 
 the epidemic. 
 
 Who is there would pretend to affirm that this 
 disease was contagious, which besides, resembled 
 no other, which was entirely new to us, and to 
 which, until then, nothing analagous could be found 
 in the annals of the science ? 
 
 Now by the side of these well-established facts, 
 of these assertions which no one can contradict, let 
 us place what was written (November 1825) at the 
 distance of 1500 leagues from us, and nearly at the 
 same epoch, by Dr. Grierson, attached to the divis- 
 ion of the English army at Arracan, and recorded 
 
157 
 
 in the Memoirs of the Medical Society of Calcutta. 
 There exists, says he, a disease which, I think, is 
 peculiar to the natives of India. This disease, 
 having no nosological title, I will designate it by 
 this expression, "burning heat of the feet:" it is by 
 this name that the natives themselves call it. There 
 is often presented, conjointly with the malady, fever 
 and intestinal pains ; frequently also is the disease 
 unconnected with any constitutional or organic 
 affection. 
 
 It is met with in various degrees of severity ; from 
 a painful sensation of heat, dartings in the feet, even 
 to a burning and insupportable pain w r hich destroys 
 sleep and appetite, and at length preys on the con- 
 stitution. A similar pain is sometimes experienced 
 in the hands at the same time. The pain of the feet, 
 w r hen augmented to a very great degree, sometimes 
 mounts along the tibia as high as the knees. There 
 is neither inflammation, tension, discolouration, nor 
 any other notable change in the skin. 
 
 The disease is particularly common among those 
 classes who are exposed to great bodily fatigue. 
 Sometimes the skin is tumid and moist to a certain 
 extent ; sometimes vesicles, filled with a yellow 
 serosity, are observable, and the nails also occasion- 
 ally assume a yellowish tint. 
 
 Several physicians have observed the disease 
 under the same form. All have vainly endeavoured 
 
 15 
 
158 
 
 to discover a method of treatment which would 
 prove uniformly successful : the disease has con- 
 stantly been obstinate, rebellious, and tedious. It is 
 not very unusual to see it terminate by death. (1.) 
 
 Without pretending to resolve the question, but 
 merely with the hope of elucidating it, let us push 
 our analogical comparisons still further. 
 
 Astronomical annals contain the history of a con- 
 siderable number of diverse meteors which, after 
 the manner of the epidemics we have just treated 
 of, have traversed very extensive regions, the uni- 
 form action of which has been successively experi- 
 enced in different countries, within more or less 
 extensive limits, leaving certain cantons here and 
 there unmolested, whilst others have been more or 
 less severely visited by them. 
 
 Our very honorable colleague, M. Tessier, has, 
 in a report, read before the Academy of Sciences 
 in the year 1790, given some very singular details 
 of a hail storm which took place on Sunday, 13th 
 of July, 1788. 
 
 Six hundred and fifty square leagues were rav- 
 aged by this storm ; its direction was from south- 
 west to north-east ; it passed from the south-western 
 
 (1.) Extract from the Memoirs of the Physico-Medical Society 
 of Calcutta, Vol. II. 
 
159 
 
 extremity of France even to the north-eastern ex- 
 tremity of Finland; then traversed Zealand, Hol- 
 land, and extended even beyond the Texel. 
 
 The appearance of the storm, as observed in 
 France, was that of five distinct zones, of which 
 two, encased in the others, were bands of hail. 
 From Touraine even as far as Austrian Flanders 
 and Brabant, that is to say in a medium space of a 
 hundred leagues, the two bands of hail were al- 
 ways separated, although by unequal spaces, the 
 narrowest being three leagues, and the broadest 
 seven leagues and a half. The three bands of rain 
 were much more extensive and irregular. 
 
 On either side of the limits assigned to the con- 
 tinuous bands, the storm had several interruptions ; 
 and at the points where the bands were continuous 
 the borders were not so strictly confined as to pre- 
 vent extensive and serious discharges. It descend- 
 ed upon six pretty extensive cantons of the electo- 
 rates of Laon and Guise, whilst all the surrounding 
 country was passed over uninjured. 
 
 The storm traversed deep vallies, lofty emi- 
 nences, extensive forests, and broad rivers, especi- 
 ally the Loire and the Seine. It discharged hail 
 in countries in which it had scarcely ever fallen 
 before. 
 
 The meteor swept along at the rate of sixteen 
 and a half leagues an hour. The total duration of 
 
160 
 
 the storm was only from seven to eight minutes 
 upon each point which it traversed. 
 
 The trees of the forest and those of large size 
 were in general more extensively injured than slen- 
 der trees and young coppices. 
 
 Certain parishes were almost entirely exempt 
 from its destructive effects, whilst others in their 
 immediate vicinity were completely laid waste. 
 
 In the year 1783, a thick mist was seen to arise, 
 which, similar to the storm we have just described, 
 successively spread itself over a great extent of 
 country, over France, Holland, and England ; tra- 
 versing these places irregularly, and also leaving 
 equally irregular and direful traces of its passage. 
 
 But again, these analogies of epidemic dis- 
 eases, disseminated to a distance, independently of 
 every transmission communicated from man to 
 man, or from merchandise to individuals, and of 
 which we could multiply numerous examples ; 
 the resemblance which, in their mode of extension, 
 they bear to meteors, which travel from one place 
 to another, attacking by preference certain local- 
 ities, are not, we are well aware, adequate to the 
 complete solution of the question under considera- 
 tion, but they may hereafter lead to it. 
 
 These analogies, these resemblances enlarge the 
 field of observation ; they recall the attention to 
 other series of events ; and the understanding, ha- 
 
161 
 
 # 
 bituated to consider the phenomenon under points 
 
 of view less circumscribed, may, at some future 
 day, derive from this consideration more satisfac- 
 tory solutions. 
 
 In the meantime, let us say something of the 
 prophylactic means which the Cholera demands 
 under the present state of our knowledge. 
 
 15 
 
 * 
 
PART EIGHTH. 
 
 PROPHYLAXIS.— SANATORY MEASURES 
 
 In consequence of the immense improvement in 
 social relations, during the last forty years, as well 
 as from the effect of the advancement of the natu- 
 ral and medical sciences, hygiene, both public and 
 private, has made so much progress in France, that 
 we cannot resist this opportunity of announcing our 
 expectations of being preserved from the epidemic 
 invasion of cholera, or at least of seeing its cruel 
 devastations diminished and extinguished at our 
 doors. Look at what happened with regard to ty- 
 phus in the years 1814 and 1815. In consequence 
 of the two-fold invasion, of painful memory, the latter 
 malady had made extensive ravages in Germany 
 and our Rhenish provinces : it reached even Paris, 
 where, both in the city and hospitals we had cases 
 of typhus developed, in consequence of the 
 numerous bodies of troops by which we were in- 
 vaded. The disease, however, could not obtain 
 firm-footing in the midst of the dense population of 
 this capital, being opposed by the daily increasing 
 comforts of civilization, the amelioration in the con- 
 
163 
 
 dition of individuals, the advancement in knowledge, 
 and the progress of hygieine. 
 
 In order that, with regard to cholera, we mav ar- 
 rive at similar and even more happy results, we will 
 notice two kinds of prophylactic measures — those 
 which relate to individuals or society, and those 
 which are derived from private or public hygieine. 
 
 The disease commences, as w T e have seen, with 
 derangements of the functions of the cutaneous tis- 
 sues, of which the mucous membranes are only a 
 kind of continuation or dependency. It is estab- 
 lished upon the concentration of the vital forces at 
 the interior, and upon the general effects of a very 
 peculiar catarrhal affection : Hence, to maintain the 
 normal state of the perspiration, to avoid the causes 
 which tend to produce a catarrhal condition of the 
 gastro-intestinal mucous surfaces, to prevent the 
 perversion of the nervous function and its conse- 
 quences, these are, summarily, the measures which 
 experience has taught to be salutary as it regards 
 the private hygieine. 
 
 It is necessary, in the first place, that the mind 
 should be kept in a calm and sober state, free from 
 every species of anxiety and distress. Regular 
 habits, temperance and agreeable society are also 
 conducive to the bodily welfare. Ambition, sorrow, 
 fear, moral agitations, and in general the violent 
 passions, of whatsoever nature they may be, thrown 
 
164 
 
 into irregular and unrestained action, become so 
 many certain causes of the disease. 
 
 It is requisite also, that the air should be pure, 
 exempt from every species of vitiation resulting 
 even accidentally, from numerous assemblages of 
 men or animals ; for it is especially in the midst of 
 a dense and excessively crowded population that 
 the cholera arises and is propagated. 
 
 Humidity, in whatever form, manner or combina- 
 tion it may present itself, must be carefully avoid- 
 ed. Cold and moisture, heat and moisture, have 
 almost an equal power in producing the cholera. 
 Care should be taken to keep in a dry, elevated 
 situation, under a salubrious exposition, at a dis- 
 tance from evaporations arising from considerable 
 collections of water, especially of stagnant water. 
 The interior of habitations should be exempt from 
 humidity, protected from unwholesome exhalations, 
 spacious, properly aired, easy of ventilation, in a 
 state of cleanliness, and at all times kept free from 
 every encumbrance of men and animals of whatso- 
 ever species they may be. 
 
 It is under circumstances similar to those we are 
 now considering, that the ordinary regimen of hos- 
 pitals is found insufficient or even misunderstood. 
 It would be well to have the power of encamping 
 patients or of locating them by themselves in bar- 
 racks eligibly situated. Particular houses should 
 
165 
 
 also be set apart for the reception of convalescents, 
 in order that they may be removed from the sick as 
 soon as possible, since experience teaches us that 
 relapses very readily and frequently occur, under 
 the influence of conditions susceptible of giving rise 
 to the cholera. 
 
 The clothes must be kept particularly dry and 
 clean ; they should always be sufficient without 
 ever being slight ; rather warm than otherwise, but 
 especially in relation with the real state of the at- 
 mosphere, still more so with the season. Experi- 
 ence has shewn the advantage of flannel girdles 
 worn next the skin. 
 
 Among the number of hygieinic measures which 
 may serve to prevent the invasion of the Cholera, 
 let us mention dry frictions, spirituous aromatic 
 frictions, the common warm bath, compound, cold, 
 or sea- water baths, according to circumstances: 
 the bathing especially, which is now extensively 
 used by all classes of people, must have an admi- 
 rable tendency to preserve us from the attacks and 
 progress of Cholera. We cannot be too cautious, 
 however, in guarding against the humidity which is 
 apt to follow the use of the bath when taken with- 
 out proper precaution. 
 
 Constant caution, with regard to aliment, is a 
 matter of the highest importance. It is almost al- 
 ways after deviations in regimen and excesses at 
 
166 
 
 table, that the disease supervenes ; and it is espe- 
 cially necessary that attention should be paid both 
 to the quantity and quality of food taken as nour- 
 ishment. 
 
 The aliments most appropriate are those which 
 maintain an even balance between decided debility 
 and redundant health ; and those drawn from the 
 animal should predominate over those of the vege- 
 table kingdom. But let us dispense with these fas- 
 tidious details of substances adapted to every condi- 
 tion exacted by the prophylaxis of Cholera; we 
 would much rather state what ought to be avoided 
 than what should be selected. Full-grown, smoked, 
 salted, and fat meats, farinaceous or mucilaginous 
 vegetables, milk, in great abundance, and watery 
 fruits, have generally been prejudicial. 
 
 Drinks, of a bad or even indifferent quality, should 
 be placed first in the list of causes which predispose 
 to the Cholera. All liquids which readily undergo the 
 process of fermentation, and which are so common 
 and numerous in the north; all drinks prepared in 
 Asia with mare's milk and fermented rye ; brandy and 
 strong cordials, the abuse of which is much more pre- 
 valent in those countries in which the vine is not cul- 
 tivated, are so many drinks which predispose to the 
 invasion of the Cholera. Nations, to whom nature 
 has given, with the vine, water of a good quality, to 
 whom she has specially imparted the gift of making 
 
 J 
 
167 
 
 only a moderate use of these articles are much 
 more highly favoured than they are aware of. 
 
 The hygieinic rules, quite the reverse of the ther- 
 apeutic, are nearly the same for every individual. 
 The slight modifications which the hygieine of cer- 
 tain persons demand, will be easily determined by 
 the individuals themselves, from the knowledge 
 which each has of his temperament, tolerances, and 
 repugnancies. 
 
 Under the title of dis-infecting agents, camphor, 
 vinegar, Guytonian fumigations, lime-water, the 
 chlorides, &c. have been frequently resorted to. 
 Experience will develope the efficacy of these 
 agents. 
 
 It is to public hygieine that appertain the clean- 
 liness and salubrity of cities, towns and villages ; 
 the direction, draining, and purification of marshes, 
 ponds, and margins of rivers ; the inspection of 
 every sort of provisions ; the amelioration of the 
 indigent classes, whose subsistence should be liber- 
 ally provided; the dispensation of that assistance 
 which these classes require ; the impartingof advice 
 and consolation of which thev stand in need ; the 
 lodging of troops in barracks and encampments ; the 
 movements of armies ; the organization of proviso- 
 ry hospitals and retreats for convalescents, in case 
 of need; the physical and moral regimen of prisons, 
 and the arrangement of work-shops and manufac- 
 

 
 168 
 
 tories. In concert with physicians, as well as 
 with wealthy and enlightened citizens, the public 
 authorities, guided moreover by the rules of private 
 hygieine which we have just laid down, will, at all 
 times possess the prudence and foresight to antici- 
 pate every need and supply every deficiency. In 
 fine, public hygieine is merely private hygieine on a 
 larger scale, — hvgieine, extended from individuals to 
 assemblages, and from domestic necessities to the 
 exigencies of society at large. 
 
 The administrative authorities should be particu- 
 larly vigilant in seeing that the sick are visited and 
 assisted speedily. M. Briere de Boismont, in one 
 of his letters from Warsaw to M. Esquirol, has 
 clearly pointed out the necessity of this vigilance. 
 
 But to the public hygieine also appertain those 
 sanatory measures which may be demanded by 
 the disease and authorised by our laws. On this 
 point the academy is officially invested this day 
 with a duty of the highest importance ; it must 
 pronounce upon the fitness of these measures. 
 
 We have already said, we have already shewn, 
 that some facts noted, in Europe especially, and of 
 which we have also perceived the indices in Asia, 
 seem to prove that, under certain circumstances, 
 individuals who have lived in the very hot-bed of 
 the epidemic, or have merely traversed it, may carry 
 the disease with them to the places whither they 
 
169 
 
 
 are going, though these travellers themselves re- 
 main exempt from the Cholera. 
 
 Analagous facts induce the suspicion that indi- 
 viduals attacked with the disease, have been able, 
 under certain circumstances, to transmit it to the 
 inhabitants of the country into which they have 
 been transported, or even to the persons by whom 
 they are surrounded. 
 
 Lastly, other facts, and they are not few, tend 
 to imply that the disease is propagated from one 
 place to another by the numerous routes of com- 
 munication. Let us state here, however, with a 
 view to the interest of commercial relations, that 
 we have not seen any positive fact mentioned 
 from any source, which decidedly proves that 
 the Cholera is communicated by the transporta- 
 tion of merchandize ; individuals and their ac- 
 quaintances alone seem to have given cause, in 
 some instances, for accusation or suspicion. 
 
 Notwithstanding the facts of this order are, in 
 our opinion, uncertain, imperfect, and vague, and 
 may all be conceived and explained solely by the 
 laws which govern epidemics ; yet will it suffice 
 us, so far as the science and our own conviction are 
 concerned, to have emitted this opinion : and hav- 
 ing before our eyes what has already been consum- 
 mated in France, on this subject ; guided by the 
 example of neighbouring nations, all of whom have 
 
 16 
 
170 
 
 adopted precautionary measures, and shuddering at 
 the dangers to which humanity might be exposed, 
 the committee do not hesitate to recommend unan- 
 imously, the sanatory measures authorised by the 
 law of the 3d of March, 1822, or the ordonnance 
 of the 7th of August, of the same year. 
 
 The Academy cannot terminate this part of its 
 report without specifying to the government the 
 difference which exists between sanatory regula- 
 tions as applied to inland cities, towns, and vil- 
 lages, and the sanatory regulations in use in mari- 
 time towns. 
 
 In sea-ports, every thing that concerns sanatory 
 police goes on smoothly, regularly, and even in- 
 nocently; but is it the same as regards other 
 places ? The quarantines and military cordons 
 stationed around a city in which a disease re- 
 puted transmissible, prevails, in addition to the 
 demoralization which is the deplorable conse- 
 quence of them, have also the fatal effect of re- 
 pelling, of concentrating populations upon them- 
 selves, of augmenting the want of succour of 
 every kind, of adding to the terror and tumult 
 which there already reign, and thereby excessively 
 promoting the increase of the evil : these are so 
 many serious inconveniences which it would be 
 advisable to avoid. 
 
171 
 
 Finally, the Academy has only been enabled to 
 work from documents, the accuracy of which it 
 cannot guarantee, and from which it has often 
 desired more copious details and deeper investiga- 
 tion. Placed at a distance from the theatre of 
 facts, it has accumulated, assimilated, compared, 
 analysed, and scrutinized them, and the con- 
 clusions which naturally proceed from them, are 
 those which we now present to the government 
 and the public. 
 
GENERAL SUMMARY 
 
 AND 
 
 CONCLUSIONS. 
 
 After laborious research, a prolonged examination 
 of documents intricately connected, after deep 
 investigation of authors who have described the 
 Cholera in the different countries in which it has 
 appeared, and a methodical and critical analysis of 
 the numerous facts collected on this subject, the 
 Academy, happy in responding both to the solici- 
 tudes of the public and the confidence of the Gov- 
 ernment, hastens the publication of the result of its 
 deliberations. 
 
 The Cholera-morbus is a disease which has been 
 known and studied in every age and nation, and 
 has been a matter of controversy in every school. 
 
 Our classics have successively described it — in the 
 form of a sporadic disease, in which it has at all 
 periods presented itself isolately, attacking only 
 one or at least attaining but to few individuals at 
 the same time ; 
 
173 
 
 In the catastatic or milder epidemic form, in 
 which several individuals are attacked at the same 
 time, under the influence of a distinct and protracted 
 medical constitution ; 
 
 In the form of an endemic, in which the disease 
 is produced by the influence of particular localities 
 in warm climates ; as has been observed in the 
 East, in Hindostan, in Italy, &c. ; 
 
 In the form of a symptomatic affection, of an 
 accumulated series of symptoms intimately connect- 
 ed with diverse acute diseases, such as high grades 
 of bilious, typhoid and yellow fevers, intermittent? 
 remittent, pernicious, &c. 
 
 Under these different states and circumstances, 
 the Cholera has never shewn itself transmissible. 
 Never has it extended beyond the causes which 
 excited it ; never has it overleaped the boundaries 
 in the sphere of which it was developed. Whence 
 this rigorous conclusion, that the Cholera is not 
 primitively, naturally and essentially transmissible. 
 
 Except in intensity, gravity, rapidity, and danger, 
 the epidemic Cholera differs but little from the 
 ordinary Cholera, with which we have been so long 
 acquainted. 
 
 Hence, the epidemic Cholera of India is, as to its 
 symptoms, the Cholera of the ancients. The nu- 
 merous descriptions which we possess of it, com- 
 
 16* 
 
174 
 
 pared with that handed down by Arseteus, suffi- 
 ciently attest it. 
 
 The Cholera observed in Russia, with equal uni- 
 formity presents the same symptoms as the Cholera 
 of India. 
 
 Lastly, the Cholera of Poland has in like manner 
 manifested the same character. 
 
 In India as well as in Russia, the Cholera is found 
 pretty well defined by the following symptoms, by 
 which we may always readily recognize it : epigas- 
 tral pains, anxiety, vertigo, repeated vomitings, fre- 
 quent stools ; the matters discharged at first com- 
 posed of recently ingested substances, but soon be- 
 coming fluid, whitish and flocculent ; violent cramps, 
 contractions of the superior and inferior extremi- 
 ties, coldness of the body ; suppression of urine ; 
 the skin of the hands and feet pale, cold, moist and 
 wrinkled ; distortion of the features, hippocratic 
 countenance ; sinking and complete disappearance 
 of the pulse, and total absence of vital re-action. 
 
 On this point, the symptomatology of the epidemic 
 Cholera, there is no difference of opinion. In the 
 East and West Indies, in Russia and Poland, the 
 descriptions are every where identical. 
 
 Nothing, on the contrary, is more variable than 
 the statements given of the necroscopic characters 
 of the disease. Deep meditation upon a very great 
 
175 
 
 number of autopsic examinations which we have 
 closely investigated, lead to the following results : 
 
 1. The pathological lesions discovered after 
 death caused by the Cholera, in India as well as in 
 Russia and Poland, are slight, variable, dissimilar, 
 and even discordant. 
 
 2. In a given system of organs, in the brain and 
 its dependencies, in the digestive tube and its ap- 
 pendages, in the heart and the large vessels which 
 proceed from it, these lesions have no fixed seat, 
 still less have they a definite character. 
 
 3. In a great number of cases, the most scrupu- 
 lous observers affirm that they have not found any 
 appreciable alteration. 
 
 4. Very frequently also, the lesions described 
 present no determinate character ; they do not 
 differ from those which are observed after death 
 produced by certain acute diseases, by those espe- 
 cially which are remarkable for the dreadful rapidity 
 of their progress and the suddenness of their fatal 
 termination. 
 
 5. It has been generally affirmed that the more 
 violent the disease, that is to say, the more speedy 
 its fatal termination, the less sensible have been the 
 pathological lesions. 
 
 6. The intensity of the various lesions found after 
 death from the Cholera, have generally been in a 
 direct ratio to the duration of the disease. 
 
176 
 
 7. One fact, which has been pretty frequently 
 attested in the pathological anatomy of the Indian 
 Cholera, is the whitish cream-like matter adherent 
 to the surface of the mucous membranes. 
 
 The Cholera, as to its nature, is a complex 
 malady. It is a complication resulting from a gen- 
 eral diminution in the energy of the nervous system 
 and a particular catarrhal affection, combined in 
 various degrees. 
 
 Either of these morbid conditions is susceptible 
 of predominating to such a degree as to claim more 
 particularly the attention of the physician, according 
 to the constitution of the individual, the stage of the 
 disease, &c. 
 
 The predominancy of the catarrhal over the ner- 
 vous affection principally depends upon the stages 
 of the disease, and vice versa. 
 
 In the first stage, the nervous affection usually 
 predominates ; in the second, the catarrhal state is 
 most prominent. 
 
 Almost alwavs, however, the two stages are 
 united, blended, and confounded : with them are 
 also combined and blended the phenomenal char- 
 acteristics of the two pathological states. Then is 
 it that the disease is elevated to its highest degree 
 of intensity, and it is then that all the attention and 
 all the sagacity of the enlightened observer are re- 
 quired in order to lay hold of the indications. 
 
177 
 
 The disease is naturally very malignant : individ- 
 uals deprived of the assistance of art almost invaria- 
 bly die. The chances of recovery are greatest 
 when the physician arrives at the period of immi- 
 nence or invasion of the disease, and when the 
 method of treatment employed coincides with the 
 special forms which the disease assumes in particu- 
 lar cases. 
 
 In several places ravaged by the Cholera, statis- 
 tical summaries have been published, giving the 
 relative number of cases, deaths, and cures, with 
 the probable numerical chances of each of these 
 terminations ; but the data on which these numeric- 
 al calculations are based, are so indefinite, that the 
 Academy would not even assume the mere respon- 
 sibility of the citation. 
 
 The lo^ic of facts combine with the logic of the 
 doctrines, to shew that we cannot designate an uni- 
 form treatment, and still less a specific remedy, 
 applicable to all the cases of Cholera. 
 
 Individualities, which modify in a striking man- 
 ner the morbid condition, exact a corresponding 
 modification in the therapeutic agents. 
 
 The only general advice which we can give upon 
 this point, must be summed up in the clinical indica- 
 tions. To rouse the depressed nervous energy, to 
 augment and render its distribution more uniform 
 
178 
 
 and regular ; to stimulate and warm the chilled sur- 
 faces of the skin ; to re-invigorate the vital powers ; 
 these are the predominant and capital indications of 
 the epidemic Cholera. 
 
 Next to attack the catarrhal affection by the aid 
 of such means as have been ascertained by experi- 
 ence to have been productive of the most success- 
 ful results, constitutes another analytical indication 
 of almost equal importance. 
 
 Lastly, to combat the symptoms, in a direct ratio 
 to their urgency and relative predominancy, this is 
 a secondary symptomatic indication, which is equal- 
 ly to be attended to. 
 
 The method of accomplishing this threefold pur- 
 pose, must vary according to the individuality, the 
 epoch of the epidemic, &c. It is only from the 
 accurate perception and experienced tact of the 
 physician, that we must expect those applications 
 which may demand success. 
 
 The disease under consideration is remarkable 
 and dreadful, beyond every other malady, in con- 
 sequence of the fatal extensions which it has made. 
 Taking it up from its commencement, the latter 
 part of August, 1817, and carrying it down to the 
 present day, the Cholera, arising in the Delta of the 
 Ganges, has extended from lower Bengal, its cradle, 
 to the isles Mauritius and Timor, near New Holland, 
 
179 
 
 in the southern direction. Towards the east, it has 
 appeared at Kussuchou, a Russian village, at Pekin 
 and even eastward of this place. On the side of 
 the north, it has gained the frontiers of Siberia and 
 Astrakan as far as Archangel. Finally, on the west, 
 it has attacked Moscow, St. Petersburg, extending 
 its course from Dantzig to Olmutz ; and slightlv 
 declining towards the south, it has accompanied the 
 armies of Russia into the very heart of Poland. 
 
 The disease then has successively invaded an 
 immense extent of country, in every direction of 
 the horizon, during opposite seasons and in very 
 different climates. 
 
 The disease, as is shewn by an immense majority 
 of facts, is extended and propagated in the epi- 
 demial way, and especially under the influence of 
 predisposing causes, the chief of which are : hu- 
 midity, sometimes combined with heat, sometimes 
 with cold ; frequent atmospheric vicissitudes ; large 
 assemblages of men ; the encampments and marches 
 of considerable masses of troops ; excess in eating 
 and drinking ; debauch, uncleanness, poverty ; in- 
 habiting low and damp situations ; dwellings badly 
 ventilated, or encumbered with men or animals ; 
 violent agitations of the mind ; aliments and drinks 
 of a bad quality, difficult of digestion and disposed 
 to fermentation. 
 
180 
 
 We may hope to be preserved from the disease 
 by keeping aloof from the various predisposing 
 causes just mentioned. 
 
 Notwithstanding the cholera, the history of which 
 we have just traced, may be primitively and es- 
 sentially cpidemial, we may however infer from 
 facts that, under certain circumstances, it can be 
 propagated by the migration of individuals ; and 
 even though these facts may only be of value so 
 far as they excite suspicions and give rise to doubts, 
 yet are we in duty bound to take cognizance of 
 them, and adopt corresponding precautionary meas- 
 ures : the prudence of nations demands it. 
 
 We have already noticed that the Cholera- 
 morbus is very apt to follow in the train of large 
 assemblages of troops, in consequence of the priva- 
 tions, fatigues and excesses which usually attend 
 upon the life of a soldier. 
 
 We rejoice, Gentlemen, that the voice of human- 
 
 ■I 
 
 ity has at length been heard. You have now no 
 cause to frame the wish, that Diplomacy, that 
 European representation of the desires and interests 
 of nations, should interfere in these calamitous cir- 
 cumstances. It is now proclaimed to the whole 
 world : France, by the voice of her King, or the 
 King, declaring the wishes of his people, " will en- 
 
 i 
 
181 
 
 deavour to preserve the South of Europe from the 
 scourge of the contagion which war propagates." 
 It is, Gentlemen, from this circle especially, that 
 the first acclamations of gratitude should ascend. 
 
 July 25, 1831. 
 
 (Signed) 
 
 KERAUDREN, President; 
 
 CHOMEL, 
 
 MARC, 
 
 DESGENETTES, 
 
 DUPUYTREN, 
 
 LOUIS, 
 
 EMERY, 
 
 DESPORTES, 
 
 BOISSEAU, and 
 
 PELLETIERj 
 
 DOUBLE, Reporter. 
 
 By the Academy, 
 
 ADELON, Annual President ; 
 Bon. PORTAL, Honorary # 
 
 Perpetual President; 
 PARISET, Perpetual Secretary. 
 
 END OF THE FIRST PART. 
 
 17 
 
 
SECOND FART. 
 
 REPORT 
 
 ON THE 
 
 CHOLERA- MORBUS, 
 
 READ 
 
 13TH SEPT. 1831. 
 
REPORT 
 
 ON THE 
 
 CHOLERA-MORBUS. 
 
 READ AT A GENERAL SESSION OF THE ROYAL 
 ACADEMY OF MEDICINE, SEPT. 13, 1831. 
 
 GENERAL CONSIDERATIONS. 
 
 Among the most remarkable and dreadful phenom- 
 ena of the Cholera-morbus, must incontestably be 
 ranked the character of extension which the disease 
 affects. Already has almost the whole of the conti- 
 nent of Asia been pervaded by it ; a part of Europe 
 is now found, either attacked or immediately threat- 
 ened by this scourge, and we also have great rea- 
 son to apprehend its cruel invasion. Having studied 
 the march, symptoms, necroscopic characters, seat, 
 nature, treatment, and terminations of this fatal 
 malady, the Royal Academy of Medicine has spe- 
 cially directed its practical inquiries to the means 
 of preventing it. 
 
 Here the prophylaxis of the disease, the duties 
 and difficulties are spread over a widely extended 
 field. ^ 
 
 17* 
 
186 
 
 The civil authorities, the members of the medical 
 profession, and citizens, will all have obligations to 
 fulfil and precautionary measures to adopt. These 
 obligations, and precautions must necessarily vary 
 according to the nearness of approximation of the 
 disease to a nation, or its actual invasion. 
 
 The advices then, which the Academy is called 
 upon to give on this subject, will be arranged under 
 two different sections , the one relating to the sup- 
 position that the disease is simply threatened, the 
 other to its actual invasion. 
 
 These advices will also be addressed succes- 
 sively : 
 
 1. To magistrates of everv class ; 
 
 2. To physicians of every order ; 
 
 3. To citizens of all conditions. 
 
 The object of these advices will be to specify 
 in detail what each should perform within the limits 
 of his duties, faculties, means and jurisdiction. 
 
 But let us proceed to declare in the first place : — 
 France, fortunately, is not placed in either of the 
 conditions embraced in the plan which the Academy 
 has just traced. 
 
 Blessed with a most advantageous geographical 
 position, a serene sky, temperate climate, fruitful 
 soil and a happy distribution of territorial property, 
 with industrious habits, instruction pretty generally 
 distributed and, consequently, with a public and 
 private hygieine which leaves but little to be de- 
 
187 
 
 sired, the French have reason to hope that they will 
 be preserved from the visitation of this scourge. 
 
 Besides, in general, the probabilities and espe- 
 cially the risk of propagation of Cholera beyond the 
 limits of the localities actually invaded, always go 
 on diminishing. The torrent seems to excavate 
 a bed less broad and deep, in proportion as it con- 
 tinues to extend, and according as it attacks more 
 enlightened and prosperous nations, especially those 
 who pay strict attention to cleanliness. 
 
 What if, contrary to these anticipations, the dis- 
 ease should attack us, have we not every reason to 
 presume that its force will be diminished by the 
 hygieinic conditions in which we are found placed ? 
 
 Let us again relate in few words what happened 
 with regard to the typhus of 1814-15. 
 
 The disease had made extensive ravages in the 
 two armies, both among the victors and the van- 
 quished. The two banks of the Rhine had griev- 
 ously suffered by it. The disease extended, though 
 gradually diminishing in intensity, even to the bor- 
 ders of the Loire. Soldiers attacked with typhus 
 entered our hospitals in great numbers. Many of- 
 ficers and servants also carried the disease into the 
 different quarters of the city. The French, the 
 inhabitants of the capital especially, endured with 
 great irritation and impatience, the presence of the 
 armies of occupation ; yet notwithstanding all these 
 distressing circumstances, the typhus could not es- 
 
188 
 
 tablish itself amongst us. It became extinguished 
 in the midst of the prosperity and comfort which the 
 inhabitants of the capital and the central provinces 
 enjoyed. ■ 
 
 There is also the more propriety in insisting upon 
 this consideration, in this place, from the fact that 
 typhus, under certain circumstances, and especially 
 since the Cholera has manifested itself in Europe, 
 constitutes in some degree one of the terminations 
 of this malady. Such facts, doubtless, also add to 
 the chances of preservation which we enjoy. 
 
 Nevertheless, the extension to a distance of the 
 Cholera, as it now reigns over several parts of Eu- 
 rope, is an incontestable fact ; this enormous fact 
 surely implies causes which are peculiar to it, and 
 the knowledge of the causes of this phenomenon 
 would be of immense benefit to mankind. 
 
 We may safely affirm, however, that the special 
 manner in which the Cholera is developed, the es- 
 sential cause of its extension, are entirely unknown 
 to us ; this is, at the present day, the most essential 
 point to be illustrated in the general history of the 
 disease ; it is this which should be proposed to the 
 investigations of learned men in every country. 
 Upon other questions, which are connected with 
 the pathology of Cholera, observation has not left 
 us entirely destitute of guides and illustrations ; we 
 have notions, we possess data which are peculiar to 
 this disease. But as to the mode of transmission 
 
189 
 
 setting aside simple general ideas, we have yet 
 every thing to discover, almost every thing to learn. 
 
 But, by way of retaliation, we do positively know 
 that the co-union, the concurrence of a certain se- 
 ries of circumstances, singularly favor the disastrous 
 march of this scourge. Such are great and fre- 
 quent atmospherical vicissitudes ; heat and moist- 
 ure, and sometimes cold and moisture, combined ; 
 excessive and long protracted rains ; uncleanness ; 
 assemblages of men ; the abode of the sick in nar- 
 row, confined apartments which are with difficulty 
 ventilated and encumbered with human and brute 
 beings. Now, is it not evident that in these data, 
 well attested, we must seek for the first rule which 
 is to guide us in the adoption of sanatory measures ? 
 
 On the other hand, it seems that the Cholera, es- 
 pecially since it has been transplanted into Europe, 
 has in certain cases been communicated by the aid 
 of hot-beds of emanation, in which the disease was 
 as it were concentrated ; for example, in conse - 
 quence of extensive accumulations of men, and the 
 crowding of patients together into unwholesome, 
 ill-ventilated and filthy localities. 
 
 The Cholera, also, after the manner of all exten- 
 sive epidemics, is most frequently extended and mul- 
 tiplied, by the influence of general occult causes, 
 which are probably diffused through the atmosphere, 
 the deleterious action of which is also found increas- 
 
190 
 
 ed and favoured by the concurrence of the causes 
 which have been enumerated above. 
 
 These constitute the most positive information 
 afforded by physical and medical observations, re- 
 garding the causes of the extension of the disease : 
 it is within these limits that the foundation of the 
 measures required must be laid. Concerning sana- 
 tory measures, it is evidently from the mode of 
 transmission and propagation of the disease that we 
 must establish t he nature of the precautions to be 
 taken. 
 
 Quarantines become particularly useful against 
 diseases which have a stated period of incubation 
 and an equally fixed period of transmissibility, as is 
 the case with small pox, for example ; but with 
 regard to the Cholera, there is nothing which proves 
 that the disease has a fixed period of incubation, a 
 determinate space of time during which the disease 
 retains the property of transmission, and beyond 
 which this property is extinguished and destroyed. 
 Neither have facts attributed to it a limited sphere 
 of action. Can we then reasonably establish pre- 
 ventive measures in the same degrees and forms as 
 if we possessed the data in which we are deficient ? 
 
 In epidemics similar to the one under considera- 
 tion, the disease itself is perhaps not the most formi- 
 dable scourge. The moral effect exerted upon the 
 inhabitants, and its dreadful consequences, are not 
 less to be apprehended. If we restrict commer- 
 
191 
 
 cial relations too rigorously by quarantines ; if we 
 drive back populations upon themselves by means 
 of military cordons ; if we agglomerate the sick in 
 lazarettos, we will precipitate the dreadful event, 
 augment the misery, multiply the elements of pro- 
 duction and the causes of the disease, and create 
 new hot-beds of choleric emanations ; and those 
 measures employed, in all the good faith of non- 
 savoir, in order to preserve nations from the 
 disease, would on the contrary have a direct ten- 
 dency to produce, propagate, and aggravate it. 
 
 In the numerous epidemics of Cholera which we 
 have had occasion to meditate upon, both in Asia 
 and Europe, patients placed in salubrious situations 
 are visted, touched, moved, changed, dressed, and 
 carefully attended, yet do not communicate the 
 Cholera: physicians proceed to the examination 
 of the bodies after death, dwelling long and minutely 
 in their investigations, yet they have not contracted 
 the disease. Numerous experiments have been 
 made with the view of shedding light upon the man- 
 ner in which the disease is transmitted : one has 
 inoculated himself, has even injected into his veins 
 the blood of individuals actually seized and even 
 dying with the Cholera ; another has inoculated 
 himself with the mucous matters discharged by 
 vomiting and by stool ; another has rubbed his skin 
 with the same substances ; some have laid down in 
 the same beds with cholerics and enveloped them- 
 
192 
 
 selves in the clothes which these patients have just 
 quitted, and others again have gone close to them 
 in order to inhale their dying breath ; yet always 
 without serious consequences. 
 
 Far be from us, however, the rash thought of pro- 
 scribing useful precautions, and condemning pru- 
 dent measures. On the contrary, these useful pre- 
 cautions, we call for them, we plead for them with 
 all our energy : but for the interest of commerce 
 and society, we desire that the endeavour should be 
 to keep these precautions and measures within just 
 limits ; we particularly desire that they should be 
 applied with discretion. Directed by profound 
 knowledge, and especially by the light of experience, 
 they will profit nations without being a burden to 
 them. To individual calamities, to the eventful 
 misfortune of disease, they would not add the uni- 
 versal calamities, the infallible misfortune of poverty, 
 a scourge more formidable still than the Cholera. 
 
 It is with a very correct perception of what is 
 right, and a very proper concern for his triple re- 
 sponsibility as a man, citizen and magistrate, that 
 the minister invokes, in this perilous conjuncture, the 
 illumination of science and the knowledge which 
 flows from observation. Under such circumstances, 
 it is not merely necessary that the impression made 
 should be powerful, but it is particularly necessary 
 that it should be just. 
 
INSTRUCTIONS 
 
 TO 
 
 ADMINISTRATIVE AUTHORITIES, 
 
 IN CASE THE DISEASE IS THREATENED. 
 
 / 
 
 What is the conduct to be observed by the 
 government provided the disease is threatened? 
 What should it direct in case of its invasion ? 
 
 One measure which prudence recommends be- 
 fore every other, is to cause the frontier towns to 
 be medically and carefully inspected, in order 
 to make known, with perfect exactitude, and at 
 every instant the occurrences there taking place, 
 both in relation to the sanative state in general, and 
 the Cholera-Morbus in particular. The journals, 
 without examination or remark, spread news, which 
 are not the less alarming though on the morrow 
 proved untrue ; too often do they exaggerate dis- 
 turbances, in order to add interest to the recital. 
 
 With the view of obviating such serious in- 
 conveniences, enlightened and prudent phy- 
 sicians should instantly be attached to the embas- 
 sies and legations of the neighbouring countries 
 
 18 
 
194 
 
 already suspected or even attacked ; such a 
 measure, adopted immediately, would be of the 
 greatest utility. Through the daily correspon- 
 dence of these physicians, the government would 
 receive documents in which might be placed a 
 degree of confidence proportionate to the dis- 
 crimination observed in the choice of the phy- 
 sicians. 
 
 Such a choice, therefore, should not be deputed 
 to individuals who are strangers to the medical 
 profession. With a constitutional government in 
 which the responsibility of ministers should like- 
 wise be a practical reality, with the elective system 
 by which we are governed, learned bodies com- 
 bining the necessary information for judging cor- 
 rectly, should be exclusively consulted under such 
 circumstances. 
 
 Boards of Health should be instituted in the 
 departments, especially in places bordering on in- 
 fected or suspected countries. France, in this 
 measure, would find an additional source of ob- 
 servation and preservation. 
 
 Let the government prepare in advance, places 
 of observation and the depots to be established 
 in case of actual menace : to it the duty of per- 
 forming belongs, it is ours to advise. When 
 pressing occasion for lazarettos and quarantines 
 
195 
 
 shall be truly felt, it should not be taken by 
 surprise. 
 
 It is quite natural to suppose that, from the 
 force of circumstances, these different precaution- 
 ary measures will be first adopted in some part 
 of our frontiers. It is absolutely necessary that 
 sanatory cordons should be vigilant, complete, 
 and faithfully observed. But, on this subject, 
 the Academy would carry its provisions still far- 
 ther : an intimate conviction and unanimous assent 
 induce us to declare, that it is only upon the 
 frontiers of states attacked or even simply sus- 
 pected, that the preventive measures of sanatory 
 cordons should be established ; applied to the in- 
 terior, these means of sequestration would be 
 useless and dangerous. It is proper for us to 
 sequester foreign nations, who might bring the 
 Cholera to our doors ; but should the disease be 
 declared among us, let us, like true brothers, 
 instead of abandoning one another, afford mutual 
 assistance. 
 
 If, in spite of the measures taken on the 
 frontiers, the disease should reach us, it will then 
 have arrived by the epidemial way ; and then, 
 the hygieinic are the only admissible means : 
 every means of sequestration would be super- 
 fluous. 
 
 Sanatory cordons upon the frontiers would pos- 
 
196 
 
 sess real utility, and be of pretty easy application, 
 without presenting the disastrous inconveniences 
 attendant upon them, if they were compacted or 
 circumscribed towards the interior, and if, for 
 example, they sequestered one department from 
 other departments, one city from another city, or 
 even one quarter from another quarter. 
 
 Warsaw and its environs have exhibited striking 
 examples of the fatal consequences occasioned by 
 useless sequestrations from city to city, from town 
 to town, and from family to family. 
 
 Persons attacked with the Cholera should be 
 disseminated over large spaces, and placed in 
 elevated, dry, and freely ventilated habitations. 
 Let the administration take its precautions before 
 hand. Each threatened city should have one or 
 several hospitals for Cholericks, according to its 
 population : it would be still better to establish 
 these patients in barracks, or even under tents, 
 if the season should permit. These establish- 
 ments, whatever they may be, should be placed 
 on elevated situations, at a distance from large 
 evaporations from rivers or lakes, in the midst of 
 an open country, upon a soil entirely exempt from 
 humidity, and otherwise purified by every possible 
 means. 
 
 And as examples of relapses are frequent, 
 especially when the patients remain in the midst 
 
197 
 
 of influences capable of developing the disease, 
 it would be essential to have houses of convales- 
 cence, places of refuge, for the benefit of in- 
 dividuals too recently cured to return to the bosom 
 of their families, or re-enter the precincts of cities. 
 It is requisite that a certain space of time should 
 elapse between the moment the convalescent 
 leaves the seat of diseased emanation and the period 
 he sets out to mingle with the rest of society. 
 
 As it respects general precautions, the regimen 
 of hospitals, the interior of prisons, extensive 
 work-shops and manufactories, colleges, large 
 boarding-houses, and masses of troops, require 
 much more rigid inspection than is customary. 
 In the wards of hospitals, let the beds be placed 
 at a greater distance asunder, and cleanliness be 
 more strictly attended to ; let scrubbing of tiled 
 floors be interdicted, the humidity resulting there- 
 from would be pernicious ; let the encumbrances of 
 the different houses of detention be diminished, 
 and their purification be strictly enforced ; let 
 the crowded state of work-shops be prohibited ; 
 let the caserns be supervised ; let the soldiers 
 bathe as frequently as possible, their winter panta- 
 loons be given them early, their body-linen fre- 
 quently changed, a little wine be distributed to 
 them, together with a rather more abundant 
 supply of meat and a little less of vegetables, 
 
 18* 
 
198 
 
 and let still greater attention be paid, if it can be 
 done, to the general health of the troops which may- 
 then constitute the different cordons of observation. 
 All these precautions will be productive of the 
 most beneficial results. 
 
 Among the various points of public hygieine 
 which demand special attention, under the suppo- 
 sition that the Cholera is simply threatened, we 
 would specify sinks, common sewers, wells and, in 
 the country, dung-pits. The sanatory police should 
 take such precautions that, during the epidemic, if 
 it should reach us, no operation of draining or 
 cleansing common sewers or sinks, or of purifying 
 wells, should be undertaken : these different, works, 
 incapable, doubtless, in themselves, of producing 
 the disease when it does not exist, might increase 
 and aggravate it, if it did exist. 
 
 Pools, marshes, rivers, the standing water in 
 which hemp is rotted, and water used for domestic 
 purposes, should, in case the epidemic makes its 
 appearance, attract additional solicitude. 
 
 There would be rather an advantage in expend- 
 ing a little less in the construction and support of 
 lazarettos, the establishment of quarantines, in the 
 sanatory cordons, in the appointment of directors, 
 administrators, and sub-officers of the public health, 
 and on the other hand, disbursing more towards 
 
199 
 
 promoting both private and public salubrity. 
 
 Moderate labour is alwavs consistent with the 
 enjoyment of health. For this reason, that species 
 of labour which would tend to make the labouring 
 classes comfortable, would be a good preservative 
 against the Cholera. It would be still more so if the 
 object of this labour is to add to the general salubrity. 
 Hence, the Academy suggests to the local authori- 
 ties the propriety of immediately undertaking the 
 construction of works of general utility, and espe- 
 cially such as may promote public salubrity among 
 unhealthy communities. 
 
 The administration should also ascertain that the 
 tenements of the poor be provided with a sufficient 
 number of apertures, in order that they may be 
 properly purified- 
 
 Of all the modes of transmission, heretofore men- 
 tioned, of which the Cholera is susceptible, the 
 epidemial mode is the most common and evident. 
 Consequently, it is reasonable to direct some cf 
 our precautionary measures towards this point. 
 
 The communication of Cholera through the me- 
 dium of persons, or patients, affords serious and just 
 subject fur apprehension. Against them, therefore, 
 proper sanatory measures should likewise be em- 
 ployed. 
 
 The extension of the disease by means of mer- 
 chandise, being of all modes the most contestable 
 
200 
 
 and the least averred, it is not just to coincide with 
 all the views of the administration upon this point. 
 Besides, excessive measures directed against com- 
 merce, would have the inevitable inconvenience of 
 presenting additional allurements to smuggling, and 
 consequently favour and increase the disease. Now, 
 smuggling, which is naturally composed of persons 
 and things, that is to say, of individuals who 
 carry it on, and of merchandise in favour of 
 which it is carried on, would necessarily become 
 one of the most formidable modes of extending the 
 Cholera. 
 
 It would especially be necessary, with regard to 
 the Cholera in particular, to draw up a new distribu- 
 tive series of suspected or susceptible merchandise, 
 as directed by the ordinance of September. 1821. 
 Every communicable disease has special laws of 
 transmission ; each must therefore have a different 
 series of conductors, bv the aid of which it is more 
 readily extended. Articles declared suspicious, with 
 respect to the plague, might not be so in the same 
 degree, and probably not all, where the Cholera 
 is concerned. Let us add, that the tables annexed 
 to the ordinance of 1821, considered even ab- 
 stractedly of the Cholera, present incongruities 
 and anomalies, which the physical and chemi- 
 cal sciences reprove, and which it is indispensable 
 to abolish. 
 
201 
 
 It would be wise to provide for the general sub- 
 sistence, in case of the proximity of the disease. It 
 would especially be prudent, under such a circum- 
 stance, to give guaranty and security to the numer- 
 ous inhabitants of large cities. 
 
INSTRUCTIONS 
 
 j 
 
 TO THE ADMINISTRATIVE AUTHORITIES, IN CASE 
 OF INVASION OF THE DISEASE. 
 
 Having given such instructions to the authorities as 
 are applicable to the disease when merely threaten- 
 ed, let us now proceed to mention what would be 
 requisite if the Cholera should come to reign 
 amongst us. 
 
 To insure a just distribution of medical assistance 
 among individuals in destitute circumstances ; 
 
 To see that patients are visited and succoured 
 promptly : here success entirely depends upon the 
 means which may have been adopted in the first 
 moments of invasion of the disease; 
 
 To prevent several patients with Cholera from 
 being collected in the same chamber, or even in a 
 narrow, ill-ventilated apartment, and encumbered 
 besides with other individuals even in a state of 
 health ; 
 
 To supervise, with extreme rigorousness, the 
 cleanliness of the streets, the sweeping and washing 
 of markets, the cleansing of slaughter-houses, the 
 
203 
 
 purification of sewers : to afford facilities to the 
 indigent of bathing occasionally, twice a month, for' 
 instance, and also the means of changing conve- 
 niently their body-linen. It is necessary, however, 
 to recommend them to use precautions, both with 
 respect to baths and frequent changes of linen, so 
 that neither the one or the other of these means 
 shall leave on the body prolonged humidity ; 
 
 To forbid, in general, all numerous assemblages 
 of people, whatever may be the motive. Expe- 
 rience has proved that the collection of considerable 
 multitudes has resulted in increasing and aggra- 
 vating the malady ; 
 
 To change provisionally the organization and dis- 
 tribution of markets ; it would be well, especially, 
 to divide and multiply them considerably, to locate 
 them quite near the barriers, and in very open 
 situations ; 
 
 To evacuate all caserns situated in the interior 
 of cities, and to encamp the troops in salubrious 
 positions and at suitable distances ; 
 
 To purify the chambers in which sick persons 
 have resided, either by the aid of lotions of chlorure 
 or by means of Guytonian fumigations ; 
 
 To regulate, especially, the inhumations by the 
 advice of the members of the profession. It will 
 be necessary to maintain an even balance between 
 inhumations too precipitate and inhumations too 
 
204 
 
 long retarded : the former would be dangerous to 
 individuals, in a disease in which death arrives so 
 suddenly and often in the midst of syncopes which 
 may for a greater or less length of time simulate 
 death; the latter might be dangerous to communities 
 during the prevalence of an epidemic, in which ex- 
 perience teaches that, uuder certain circumstances, 
 every patient may become a hot-bed of choleric 
 emanations. The rules to be laid down in like 
 cases must vary according to the intensity of the 
 epidemic and also according to the epoch at which 
 the epidemic has arrived. The conduct may be 
 different, at the invasion of the epidemic, during its 
 greatest intensity, and in its decline ; it may vary 
 also in those moments of enervation, which is some- 
 times observed in the geographical march of the 
 epidemic, independently of the variations connected 
 with the epochs we have just enumerated. In all 
 cases it would be a wise precaution to sprinkle lime 
 upon the bodies of the dead when prepared for 
 sepulture. 
 
INSTRUCTIONS TO PHYSICIANS, 
 
 IN CASE THE DISEASE IS THREATENED. 
 
 Epidemics, in the medical history of nations, 
 sire events of grave importance. It is important 
 that their history should be recorded, that their 
 remembrance should be perpetuated, in order 
 that the direful lessons of these calamities be 
 not lost to succeeding generations. Let us add, 
 that, in the midst of these disasters, the progress 
 of the science is powerfully facilitated, and phy- 
 sicians find brilliant opportunities of confirming 
 the importance of their services. 
 
 The epidemic Cholera has presented, in the 
 regions which it has traversed, notable variations 
 in relation to its duration, severity, and the con- 
 sequences which have resulted from it. If we 
 are doomed to experience its ravages, it is neces- 
 sary that physicians, in the various points in which 
 it may manifest itself, turn to the best account 
 the fatal advantage which they have had of 
 studying it : in order that the experience of those 
 nations who have already observed it may prove 
 
 19 
 
206 
 
 profitable, we have, on our part, exhibited this 
 terrible scourge under all the modifications of 
 which it is susceptible. 
 
 The duties of physicians will vary according 
 as populations are merely threatened, or actually 
 invaded, by the Cholera. 
 
 In times of anxiety, when citizens are con- 
 stantly in dread of the epidemial invasion, the 
 physician, always calm, should apply himself to 
 the deep study of this disease, in order that, if the 
 dangers be realized, he may not enter altogether 
 as a novice upon the career which the Cholera, 
 reigning with more or less fury, will open to 
 him. Epidemial times are days of dread and 
 disorder ; every thing is then done with precipita- 
 tion ; tumult and consternation prevail : it is in 
 moments of perfect tranquillity then that we must 
 prepare for all these scenes of agitation and dis- 
 tress. In every thing, it is advantageous that the 
 observer possess some anticipated notions of the 
 objects which may be presented to his view. We 
 study with greater advantage the phenomena of 
 which we have been forewarned : those which 
 come upon us unawares, confound, and often 
 escape us. 
 
 Among the works upon the Epidemic Cholera, 
 which the Academy would advise as most useful 
 for perusal and study, it would cite the treatise of 
 
207 
 
 Annesley, that of Jameson, of Turnbull, Christie, 
 the treatise of Lichtenstaet, the particular ob- 
 servations and four decades of cases, of M.M. 
 Jachnichen and Marcus ; and as these different 
 treatises, published in the German and English 
 languages, have not been translated into our own 
 tongue, the Academy does not hesitate to recom- 
 mend the reading of the report which it has 
 published on this subject, by invitation of the 
 government. Notwithstanding the works of M. 
 Deville, of M. Keraudren, M. Larrey, and some 
 others upon the Cholera, the French physicians 
 have not yet published any thing complete on 
 this subject. 
 
 We are aware that, up to the present time, 
 there are scarcely any among the French phy- 
 sicians who have had an opportunity of observing 
 the disease. 
 
 The physician who may have some well-founded 
 apprehensions of the proximity of the Cholera 
 among the people whose health is confided to his 
 care, should immediately apply himself to the 
 minutest investigation of the topographical con- 
 ditions which surround him ; he should seek to 
 ascertain, in all their statistical details, the elements 
 of the population in the midst of which he is em- 
 ployed. Still later, by the aid of these prelim- 
 inary data, he will be enabled to fix with precision 
 the number of patients compared with the total 
 
208 
 
 population, and the number of deaths relatively 
 to the number of sick ; to determine the classes,. 
 professions, sex, ages, and constitutions, which 
 have been spared or attacked, cured or fallen 
 victims. 
 
 By means of preliminary statistical observations, 
 he will avoid confounding with individuals ac- 
 tually attacked with the Cholera the number of 
 diseases of a different nature which, during like 
 seasons of the year, usually manifest themselves 
 in the country. He will distinguish also, in the 
 lists of mortality, the deaths happening in con- 
 sequence of Cholera, from those which, at the 
 same epochs of the year, and in ordinary times, 
 occur among the inhabitants of the country in 
 consequence of diseases of a different nature. 
 
 The physician should try to extend very far 
 this species of study of medical topography and 
 statistics. In the number of useful consequences 
 which would result from this order of investi- 
 gation, he will be eager to state to the adminis- 
 trative authorities the ameliorations, which, in 
 this particular circumstance, the public and pri- 
 vate hygieine demand. He will ascertain the 
 sanatory state of all numerous assemblages ; he 
 will direct the local administrations where they 
 should place those choleriques who will not, or 
 cannot, be treated in dwelling-houses; he will 
 
209 
 
 also endeavour to have a house of convalescence 
 prepared before-hand ; he will especially inspect 
 the daily occurrences in hospitals ; he will visit 
 with more than ordinary attention, jails, prisons, 
 the caserns, colleges, and extensive work-houses. 
 It would be a matter of high importance to 
 study the sanatory state of various species of 
 animals, previous to the epidemic, during its con- 
 tinuance, and after its cessation. It would be 
 well to note the differences presented by the 
 animals appertaining to the country and those 
 which are merely temporary ; but he should 
 study more particularly the diseases of domestic 
 animals, of those especially which share with 
 man the labours of agriculture, and which con- 
 stitute a great portion of the riches of rural 
 economy. 
 
 19* 
 
INSTRUCTIONS TO PHYSICIANS, 
 
 IN CASE OF INVASION. 
 
 It is especially under circumstances of invasion 
 of the disease, that the obligations of the physician 
 assume a highly important character. It is incum- 
 bent upon members of the profession, to employ that 
 influence which knowledge gives them, and that 
 consideration which appertains to their station, in 
 controlling the moral of the families whose confi- 
 dence they have acquired. They should be in- 
 structed as to the real dangers of the disease, the 
 nature of the precautions to be observed with the 
 view of avoiding it, and the means which it is neces- 
 sary to employ in order to obtain its cure. Here, 
 every physician may more easily adopt the modifi- 
 cations required by the different constitutions upon 
 which he may be called on to act. 
 
 In general, when called on to study an epidemic, 
 we will not be excusable if we neglect the collection 
 of a certain number of cases. These cases should 
 be numerous, varied, complete : they should present 
 isolated facts of the disease, considered in the total 
 
211 
 
 duration of the epidemic, from its commencement, 
 during its greatest intensity and at its close : they 
 should also embrace the different modes of termina- 
 tion which the epidemic experiences. With the 
 cure, they should make known the methods of treat- 
 ment which have been most successful at each epoch 
 of the disease, considered in general : with the fatal 
 termination they should give the general results of 
 the cadaveric lesions, observed also at different 
 epochs of the epidemic, that is to say, at its invasion, 
 towards its middle, and during its decline. 
 
 When the disease has manifested itself, the phy- 
 sician should endeavour to fix the epoch of its 
 appearance, and determine the precise moment of 
 its developement : he should ascend to the first 
 individual actually attacked, and satisfy himself as 
 to the circumstances under the influence of which 
 this individual was seized. In the same manner he 
 should observe with particular care the first patient 
 attacked by the epidemic, inform himself whether 
 the disease exists throughout the neighbourhood, or 
 if the epidemical fiend has appeared in certain 
 places only: he should also try to discover the 
 manifest state of these differences. 
 
 In the same manner he should trace the progress 
 of the disease throughout all the patients who may 
 have been successively attacked by it, and under 
 the diverse circumstances of localities, approxima- 
 
212 
 
 tions, relations, and communications which have 
 conduced to the extension of the disease. He should 
 draw up a species of geographical chart of the epi- 
 demic ; trace its itinerary ; arrange its genealogy, 
 and thereby follow it step by step from the first to 
 the last, and from its feeblest impressions to its most 
 disastrous desolations. 
 
 He should endeavour to institute a comparison 
 between the medical topography of the places where 
 the disease took its rise, the topography of the 
 countries wherein it has been most easily estab- 
 lished, and the topography of the neighbouring ter- 
 ritories which the Cholera has not pervaded. 
 
 He should try to find out the conditions and 
 causes of these differences, under the three follow- 
 ing points of view : 
 
 1. The countries which have been violently and 
 repeatedly attacked ; 
 
 2. The places which have been but partially and 
 transiently visited ; 
 
 3. The territories which have been completely 
 preserved, either fortuitously or by the intervention 
 of certain sanatory measures. 
 
 The main points which he should endeavour to 
 elucidate, are embraced by the following questions : 
 
 How does it happen when one is placed far from 
 the centre of the disease, without the sphere of its 
 action ? 
 
213 
 
 Can an individual attacked with the Cholera, and 
 transported to a distance, transmit the disease to 
 other persons in the midst of conditions otherwise 
 generally salubrious ? 
 
 In case of the affirmative, what are the circum- 
 stances which favour this transmission ? What, on 
 the contrary, are those which retard or prevent it? 
 
 Can an individual in good health, from the sole 
 circumstance of having lived in the midst of dis- 
 eased populations, carry the disease with him in 
 travelling ? What are the known conditions which 
 augment or diminish this property of transportation? 
 
 Can persons who shall merely have traversed 
 countries where the Cholera reigns, without being 
 attacked by it, become loaded with emanations 
 from the disease, and thereby transport it to other 
 places ? 
 
 An individual labouring under the reigning Chol- 
 era, transferred far from the region where the dis- 
 ease originated, does he acquire greater chances of 
 cure than if he had remained in the place where 
 attacked ? 
 
 A family, a body of soldiers, any assembly of 
 persons whatsoever, among which the Cholera 
 reigns, do they succeed in divesting themselves of 
 the disease more speedily by removing from the 
 place where the scourge had assailed them ? 
 
214 
 
 Different substances in the immediate use of 
 cholericks, such as bed-clothes, matresses, body- 
 linen, tissues, garments, &c, carried to a distance 
 from the hot-bed of the disease, do they preserve 
 for a greater or less length of time the capability of 
 transmitting the Cholera to persons who might 
 make use of them or who should only have occasion 
 to handle them ? 
 
 Other articles worn, touched, preserved, by 
 patients, such as moveables, books, papers, jew- 
 els, can they transport the disease far from the seat 
 of action and beyond the conditions capable of giv- 
 ing rise to a new epidemial region ? 
 
 Can animal, vegetable, or mineral substances, 
 alimentary or other substances which have merely 
 had a place in the country where the disease reigns, 
 and have not been touched by the sick, transmit 
 the Cholera to a distance ? 
 
 Living animals, whether domestic, or cattle, 
 which have remained in the country where the 
 Cholera prevails, can they, by change of place, 
 carry with them the property of communicating the 
 disease ? 
 
 The solution of these questions, we may briefly 
 observe, is arduous, and the attempts to solve them 
 would be perilous. Therefore should we be con- 
 tent with collecting and turning to advantage the 
 fortuitous circumstances which, arising during the 
 
215 
 
 course of the disease, either from generous devoted- 
 ness or adventurous calculations, might furnish, in 
 this respect, some invaluable documents. 
 
 There is another series of questions, which might 
 be more easily answered, and the essays for their 
 solution would be void of danger. 
 
 We should endeavour to ascertain whether, in 
 consequence of large assemblages held in opposition 
 to the laws, the extension of the disease has been 
 favoured ; we should examine how, in such cases, 
 the disease has affected the inhabitants of different 
 communities, after a fair, a market-day, or a public 
 festival. 
 
 At what epoch has the Cholera appeared in the 
 country, and how long has it reigned there ? 
 
 After having entirely quitted a country, has it 
 sometimes re-appeared, and under what peculiar 
 circumstances has it thus appeared the second 
 time ? 
 
 What was the general state of the atmosphere 
 some time previous to the appearance of the dis- 
 ease, then during its reign, and also at the epoch of 
 its cessation ? A summary of the barometrical, 
 thermometrical and hydrometrical observations du- 
 ring these intervals should be given. Electromet- 
 rical observations if they could be conjoined, 
 would also have their importance. 
 
216 
 
 What direction of the horizon does the Cholera 
 seem disposed to pursue, in traversing a country ? 
 
 During the prevalence of the Cholera, has it been 
 noticed that there are any conditions of persons 
 more subject to its attacks than others 1 if so, what 
 were the circumstances of locality, profession, regi- 
 men, habit, age, sex, and fortune which seconded 
 or opposed the invasion of the disease ? 
 
 Is there one period of the disease in particular ? 
 is there one epoch of the epidemic in general in 
 w T hich the extension is most facile and most prompt? 
 This facultv of extension, does it seem to be estab- 
 lished in a direct ratio to the violence of the general 
 disease ? 
 
 Have we any reason for deciding whether the 
 disease has always extended in the epidemic way 
 or whether it has been propagated by emanations 
 around the sick, by migrations of persons, or by 
 transportation of merchandize ? 
 
 Have we remarked that the Cholera exercised 
 any influence upon intercurrent diseases spread 
 over the country, and what was this influence ? 
 
 What are the data relative to the number of 
 deaths in a stated population, and to the proportion 
 of cures and deaths among a certain number of 
 individuals attacked ? 
 
 What method of treatment has most generally 
 proved successful ? 
 
217 
 
 What modifications is it necessary to make in 
 the treatment at the different epochs of the epidemic, 
 at its invasion, its most intense period, and decline ; 
 and also in those periods when we know that the 
 epidemic Cholera, independently of the periods 
 of time we have just indicated, presents movements, 
 either of exacerbation or declension, which discon- 
 cert the most attentive observers ? 
 
 Between patients who have received the assist- 
 ance of art, and those who have been left to the 
 efforts of nature alone, what has been the differ- 
 ence in the proportional number of deaths and 
 cures, and also the difference in the celerity and 
 stability of the cure ? 
 
 Have we been able to form a decisive opinion 
 upon the general effects of opium, calomel, sulphate 
 of quinine, sub-nitrate of Bismuth, musk, oil of 
 cajeput, ammonia, and of certain other medicinal 
 substances? 
 
 Has blood-letting in general been productive of 
 good effects 1 and, in the number of individuals 
 submitted to venesection, are there many in whom 
 the blood would not flow? Under the influence 
 of what circumstances has this phenomenon been 
 noticed ? 
 
 Have we heard that physicians or the public 
 have had successful recourse to any new remedy? 
 
 20 
 
218 
 
 What have been the most ordinary consequences 
 of the disease, as to its consecutive effects upon 
 different constitutions in severe cases, when the 
 disease has not terminated by death ? 
 
 Have there been any examples of relapse or sec- 
 ond attack after a well established cure? 
 
 Can we determine whether the disease, by its 
 general influence, appears to leave in the constitu- 
 tions of individuals any important modification? 
 
 What are the general results of autopsic ex- 
 aminations made at different epochs of the disease, 
 in particular and in general, and also at the different 
 periods of intensity of the epidemic ? 
 
 As soon as an example of epidemic cholera pre- 
 sents itself to medical observation, the physician 
 should inform the competent authority and at the 
 same time request the opinion of some one of his 
 brethren. This measure, both for the interest of the 
 science and humanity, should be taken without bus- 
 tle or eclat ; but should the physician, impelled by 
 an excess of zeal, be in too great haste to declare 
 the existence of epidemic cholera, let him be on 
 strict guard against any mistake. Violent colics 
 and diarrhoeas, gastro-intestinal irritations which 
 frequently prevail during the autumnal season, and 
 which, though they may be somewhat analogous to 
 cholera, are not cholera, might easily lead to error. 
 We know too well that epigastral anxieties, vomit- 
 
219 
 
 ings, diarrhoeas, and even contractions of the limbs 
 are connected, though in slight degrees, with the 
 diseases just enumerated. 
 
 Neither should we confound epidemic cholera 
 with sporadic or indigenous cholera, if we may use 
 the expression. The latter, which is observed al- 
 most every where and at the same time with the 
 diseases of summer and autumn, is less acute, less 
 violent and fatal : it never passes beyond a certain 
 extent of country, and attacks but a very small num- 
 ber of persons at the same time. 
 
 The description of the symptomatology of the 
 cholera may be recapitulated as follows : physicians 
 will ea-ily recognize it by these characters : 
 
 Epigastral pains and anxieties ; repeated vomit- 
 ings ; frequent stools ; the matters voided consist- 
 inw at first of recently invested substances, soon ap- 
 pear fluid, whitish, flocculent ; violent cramps in the 
 superior and inferior extremities ; coldness of the 
 body and abdomen ; suppression of urine; the skin 
 of the extremities, of the feet especially, pale, humid 
 and wrinkled ; tongue white, moist and cold ; pecu- 
 liar expression of the countenance ; distortion of the 
 features, hippocratic face ; respiration scarcely per- 
 ceptible ; sinking and disappearance of the pulse. 
 
 Now, as it concerns the treatment, we may say 
 in general, that, in the first period of the dis- 
 ease, which is characterized by coldness of the sur- 
 
220 
 
 face of the body and concentration of the vital- 
 ity internally, we would advise frictions, either 
 dry, or compound ; the radiation of caloric to the 
 surface, by every appropriate means ; warm cover- 
 ing ; vapour baths, various rubefacients, cuppings, 
 sinapisms and blisters. 
 
 It is also with the view of bringing back the cir- 
 culation to the circumference, in very young persons 
 of a robust constitution, that bleeding has been hap- 
 pily employed at the period of •imminence and as 
 near as possible to the moment of invasion of the 
 disease. 
 
 In this period, may also be administered in- 
 ternally and with advantage, veiy warm aromatic 
 infusions ; such diffusible stimulants as the irritabil- 
 ity of the stomach will permit ; aromatic oils com- 
 bined with alcohol and in conjunction with lauda- 
 num, ether, ammonia, James' powder, Dover's pow- 
 der, &c. 
 
 The special alteration of the gastro-intestinal mu- 
 cous membranes has been combated by calomel, 
 rhubarb, aloes, magnesia, either separately or in 
 combination, giving them according to the indica- 
 tions furnished by the individual constitution. 
 
 At the nervous period, with typhoid tendency, 
 and even with mutations or transformations of the 
 cholera into typhus — cinchona, musk, valerian, bis- 
 
221 
 
 ninth, camphor, and oil of cajeput have been given, 
 together with such other means as are generally 
 adopted in the treatment of typhus. 
 
 With the view of attacking the prominent symp- 
 toms of the disease separately, there have been 
 given, 
 
 For the purpose of arresting the vomitings, Riv- 
 erious' draught, opium, cold drinks, and ice ; 
 
 Against the frequency of the stools, injections 
 containing laudanum into the rectum, aromatic fric- 
 tions upon the abdomen, and sinapisms ; 
 
 Against the pains and contractions of the mus- 
 cles, frictions with the oil of turpentine, or oil of 
 cajeput ; and these means have appeared so much 
 the more efficacious, when they concurrently tend- 
 ed to warm and stimulate the chilled surfaces of the 
 skin, and rouse the diminished energy of the 
 nervous function, so remarkable in this disease. 
 
 As for the rest, concerning the further descrip- 
 tion of the nature and treatment of cholera, the 
 Academy begs leave to decline more ample details, 
 referring the reader to what has already been men- 
 tioned on this subject in the first part of the report. 
 
 The Academy would again insist upon the neces- 
 sity of urging the employment of therapeutic means 
 from the commencement of the disease. In this 
 respect physicians should have an understanding 
 
 20* 
 
222 
 
 with one another, and also with the administration, 
 in order that they may be multiplied on all points, 
 so that patients may readily obtain that immediate 
 assistance of which they stand in need. 
 
 In order that the assistance which persons in em- 
 barrassed or indigent circumstances require may 
 be particularly expedited, it would be adviseable to 
 to augment the number of physicans and surgeons 
 attached to benevolent institutions. 
 
 It would be desirable that every physician should 
 be compelled to certify the precise nature of the 
 disease which has occasioned death, whenever this 
 deplorable event takes place. This would be the 
 only means of ascertaining the actual number of 
 victims in the course of the epidemic. 
 
 Under circumstances so urgent, and where the 
 life of the sick depends upon the promptitude and 
 opportunity of succour, physicians should consider 
 themselves under a religious obligation to carry into 
 the exercise of their art much more eagerness than 
 is usual in ordinary times. In the night as well as 
 the day, at long as well as short distances, they 
 should always be ready. The business on hand is 
 not to snatch here and there a single victim from 
 death; no, entire populations must be plucked at 
 once from the very jaws of destruction. Physicians 
 impressed with the vast importance of the mission 
 
223 
 
 which is confided to them, should rouse up all their 
 energies ; they should possess that courage which 
 the precariousness of their station demands ; and 
 the courage of the physician consists in braving the 
 dangers of disease in the midst of epidemics, even 
 as that of the soldier impels him to brave death on 
 the battle-field. 
 
ADVICE TO CITIZENS, 
 
 IN CASE THE DISEASE IS THREATENED. 
 
 The duties of the administration and the functions 
 of physicians, under the two-fold circumstance of 
 menace and invasion of the disease, are, as we have 
 just seen, difficult and laborious. 
 
 In the midst of these conjunctures, the first ob- 
 ligation on citizens, is to endeavour to second, with 
 all ardour, the administrative authorities and phy- 
 sicians in the important task which is imposed upon 
 them. It does not require a great effort of reason 
 to prove that, in similar circumstances, the safety 
 of society is the supreme law, and that in order to 
 succeed in saving entire communities, every indi- 
 vidual should sacrifice a portion of his time, his for- 
 tune, and even liberty. This concurrence of all 
 parties, always so easily excited among Frenchmen, 
 should not be wanting in these calamitous times, 
 if need should be. 
 
 Experience has proved it more than once : — in ep- 
 idemics, disorder and tumult add to all the dangers. 
 The disease gains upon a greater number of indi- 
 viduals ; the symptoms acquire greater intensity ; 
 
225 
 
 assistance is more difficult and less efficacious, and 
 the mortality acquires a dreadful increase. Let, 
 then, the citizens associate with the public authori- 
 ties in order to prevent disasters upon disasters. 
 At all periods, public order and general tranquillity, 
 are essential to the enjoyment of prosperity and 
 happiness : in times when epidemics reign, order 
 and tranquillity are the only efficacious means of 
 preservation and safety. 
 
 So long as we are merely threatened with the 
 invasion of the disease, it is scarcely necessary in 
 France, where a good bygieine generally exists, to 
 deviate from the ordinary mode of life. Indeed, 
 there would be an advantage in making no change 
 in the general habits, at least with respect to per- 
 sons who are in perfect health, and accustomed to 
 live in a temperate and regular manner. 
 
ADVICE TO CITIZENS, 
 
 IN CASE OF INVASION. 
 
 But should the disease burst forth, a more than 
 ordinary attention to cleanliness, personal as well 
 as domestic, would naturally be a prime object of 
 importance. 
 
 The constant use of dry and aromatic frictions, 
 of baths slightly stimulating ; of sufficient exercise, 
 falling short of great fatigue, and every other means 
 capable of supporting the proper performance of 
 the function of the skin, will be of great utility. 
 
 It will especially be necessary to avoid suppres- 
 sion of the perspiration, chilliness, exposure to hu- 
 midity, to rain, and to the inclemencies of the 
 atmosphere, especially those which the night brings 
 on. 
 
 Let the body, especially the loins, abdomen and 
 flanks, be constantly covered with flannel, worn 
 immediately next the skin ; let the feet, by every 
 appropriate means, be guarded from cold and 
 dampness : coldness and humidity of the feet are 
 among the most frequent causes of derangement of 
 the intestinal functions. 
 
227 
 
 We should equally endeavour to maintain the 
 digestive functions in a favourable disposition ; it 
 would be well to find in the nature of the aliments, 
 and perhaps also in the selection of certain acces- 
 sory medicinal substances, slight tonics and diffus- 
 ible stimulants, in strength proportionate to the ne- 
 cessities of different individual constitutions. An 
 aliment, almost exclusively animal, would, by the 
 title of preservative, have a salutary effect. Beef, 
 mutton, game, eggs, wheat bread, fresh vegetables, 
 in small quantities, and water coloured with a little 
 wine, these are the general bases of every salubri- 
 ous aliment. It would be proper to avoid meats 
 not sufficiently cooked, smoked meats, salt provis- 
 ions, salt fish, pastry, aqueous and crude vegetables, 
 and unripe fruits. 
 
 Of all drinks, very weak wine and water is the 
 most suitable ; or what is still better, wine diluted 
 with four times its quantity of the mineral waters 
 of Bussang, Saint-Pardoux, Saint-Gondon, and 
 Seltz. Weak cold infusions of quassia, hops, balm, 
 odoriferous vervain, &c, might be substituted for 
 the mineral waters. 
 
 Upon ull occasions, spirituous drinks and every 
 excess of the table should be avoided ; an indiges- 
 tion, even slight, during the reign of the Cholera, 
 is almost sure to produce the disease. 
 
 The abuse of wine, brandy, and spirituous 
 liquors, almost inevitably causes the Cholera : we 
 
228 
 
 cannot too often repeat this to persons who are 
 in the occasional habit of committing such excesses. 
 
 It has been observed in the countries where 
 this disease has prevailed, that all individuals 
 placed within the sphere of its action, have had 
 the constitution modified in such a manner that a 
 more or less remarkable diminution of the cuta- 
 neous and digestive functions was always present. 
 It would consequently be essential, in case the dis- 
 ease is threatened, to anticipate this general im- 
 pression and prevent its developement. 
 
 Every person living within the sphere of activity 
 of the epidemic region, who escapes the Cholera, 
 experiences, nevertheless, though in various de- 
 grees, the disagreeable influence of this epidemic. 
 This influence is betrayed, in communities in- 
 vaded, by a general uneasiness, frequent vertigo, 
 exhaustion carried even to syncope, pains in the 
 stomach, constipation, borborygmi, anorexia, loss 
 of appetite, and a gentle diarrhoea ; in a word, 
 by an universal disturbance of the intestinal 
 functions. This influence, extended to a higher 
 degree, is also made manifest by those sponta- 
 neous lassitudes, and that annihilation of the mus- 
 cular powers, which so frequently indicate the 
 imminence of grave diseases, of those especially 
 which appertain to nervous fevers rather than to 
 inflammatory diseases. 
 
229 
 
 Under such a modification of .the public health, 
 individuals seized with indisposition, even slight, 
 should hasten to obtain the advice of a member 
 of .the profession. In medicine, as in morals, it is 
 more easy to prevent the evil than to cure it ; and 
 for this reason, the resources of medicine are par- 
 ticularly efficacious against that state which is no 
 longer health, and which is not yet disease. 
 
 As soon as the first symptoms of the disease 
 are felt, and whilst waiting the arrival of the 
 physician, an effort should be made to re-animate 
 the enfeebled vital action, and excite warmth in the 
 cold surfaces of the body by every means at 
 command. Aromatic, or even spirituous baths, 
 with the precaution of drying and warming the 
 body well after the bath ; the radiation of caloric 
 over different parts of the skin, by passing a 
 heated iron, for example, at a certain distance 
 from its surface ; sinapisms repeated in sufficient 
 numbers, and many other analogous means, will 
 fulfil this first object. 
 
 Internally, a warm aromatic infusion, a few 
 drops of ether on sugar ; a mixture of two drops 
 of the essence of mint, and one drop of the 
 tincture of Rousseau* in a spoonful of sugar 
 
 * A preparation in which one grain of opium ia contained in 
 six drops of the tincture. — Tr. 
 
 21 
 
 «* 
 
230 
 
 and water ; four or five drops of the oil of cajeput, 
 in half a spoonful of mint water, and a spoonful 
 of the syrup of ether. A draught of cool lemon- 
 ade, or even some pieces of ice in the mouth, 
 might allay the vomitings. All these means might 
 be employed with benefit while waiting for the 
 preparation and administration of the special pre- 
 scriptions of the medical adviser. 
 
 Frictions with alcohol and the essence of tur- 
 pentine, with the oil of cajeput and spirits of 
 camphor, would, for the time, afford relief to the 
 pains in the limbs. 
 
 What we have also mentioned, in addition, 
 respecting the treatment of this disease, will serve 
 as a further guide to direct persons who are suf- 
 ficiently intelligent to know how to profit by them. 
 Let persons who do not inhabit dwellings suf- 
 ficiently pure for such a state of disease, or who 
 may not be sure of obtaining at home the requisite 
 assistance, hasten to the establishments which the 
 administration shall have prepared for the purpose. 
 Prom calculations made in Russia, it has been 
 ascertained that, by comparing individuals in em- 
 barrassed circumstances who have been attended 
 at their own dwellings with those, of the same 
 class, who have been admitted into the salubrious 
 establishments set apart for them, the advantage 
 has been immense on the side of the latter. 
 
231 
 
 Among them the disease was of shorter duration, 
 the pains were less acute, the symptoms less 
 violent, and the recoveries more numerous and 
 prompt. For the cure of this disease, simple or 
 compound baths, and aromatic vapour baths, are 
 often required, and such means of assistance are 
 not easily obtained in private domiciles. 
 
 The epidemic Cholera does not attack all indi- 
 viduals without exception who are found placed 
 within the sphere of its influence ; it is necessary, 
 in order that the attack be realized, that there should 
 be a particular disposition of the body, a deter- 
 minate aptitude for contracting it. This predispo- 
 sition, this aptitude, is eminently incurred by fear, 
 uncleanliness, excesses of the table or of any other 
 kind, the abuse of wine, brandy and cordials, ex- 
 posure to cold and moisture ; and, on the other hand, 
 it is by avoiding these general causes of insalubrity, 
 that the Cholera is prevented. This special pre- 
 disposition, this susceptibility, exclusively of the cir- 
 cumstances which we have just enumerated, is 
 wanting in a great number of individuals. It is 
 daily diminished, moreover, in proportion as the 
 epidemic extends to those communities who pay 
 great attention to cleanliness, are more enlightened, 
 and suffer least from the pressure of poverty. 
 
 We read, every day, in the political journals, of 
 newly discovered remedies and specifics for the pre- 
 
232 
 
 vention and cure of the Cholera. The public should 
 always be on their guard against these deceitful 
 promises of preservation and cure : the least incon- 
 venience they can produce is to give false security, 
 and distract the attention from the use of those 
 means which prove decidedly beneficial. If expe- 
 rience should make known remedies more general- 
 ly efficacious than those with which we are already 
 acquainted, if it should discover any decided pre- 
 servative, the Academy will not delay to give offi- 
 cial notice of it to the public. 
 
 By the title of preservative, we would advise, in 
 addition to what we have already mentioned with 
 regard to cleanliness, the frequent washing of the 
 hands with a weak solution of the chlorate of lime, 
 in the proportion of one part of chlorure to one 
 hundred parts of water. We may in like manner 
 employ all the disinfecting chlorures ; frequent or 
 even continued fumigations with the vapour of chlo- 
 rine, by means of the different apparatuses to be 
 found in trade, or even without these apparatuses, by 
 directly disengaging the chlorine from the chlorures 
 by means of vinegar. 
 
 We must however use them with prudence and 
 intelligence ; we might, by being too lavish of them, 
 give rise to injurious super-excitement. 
 
 After the epidemic has ceased, be very cautious 
 how you entirely suspend preventive measures; 
 
233 
 
 facts, in great numbers, attest that the disease 
 has been re-produced in the same place, even 
 with greater violence and intensity than at the 
 primary invasion. It is also necessary to submit to 
 a more or less protracted convalescence, and to a 
 regimen more or less severe, the countries which 
 have just been released from the Cholera. The 
 duration of all the other conditions of this conva- 
 lescence of places, if the expression may be used, 
 should be regulated by the members of the profes- 
 sion, who will themselves take advice from circum- 
 stances actually dependent upon the epidemic. 
 
 Extensive cleansings of the interior and apart- 
 ments of houses, after the epidemic, whitewashing 
 the walls, and washing the curtains and moveables, 
 will constitute so many measures which, if adopted, 
 will incontestable* prove beneficial. 
 
 Often, after the epidemic, in individuals who 
 have been attacked by it, and sometimes also in 
 those who have merely experienced the epidemial 
 influence, of which we have previously spoken, we 
 remark a want of tone, a considerable alteration in 
 the gastro-intestinal functions ; evident derange- 
 ments of digestion, diarrhoea, dysentery and ob- 
 stinate constipation ; attesting the great ravages 
 which the epidemic cholera has made upon the 
 constitution : such affections of the health demand 
 great attention. 
 
234 
 
 It is by means of the fertile instructions of ob- 
 servation, derived from the most correct sources, 
 and the mighty power of the accumulated expe- 
 rience of the most authentic facts, that we have 
 obtained the different periods of the epidemic, its 
 simple menace, its actual invasion, its decline and 
 disappearance. 
 
 The Academy, fully convinced of the vast im- 
 portance of its commission, has neglected nothing 
 that could elevate it to the utmost height of its 
 duties. Each member, from the zeal which he 
 has shewn, whilst the threatened danger is yet at a 
 distance, has fully manifested what efforts and talents 
 he will display 5 should he be called on to attack it. 
 
 Sept. \3th, 1831. 
 
 (Signed) 
 
 KERAUDREN, President ; 
 
 CHOMEL, 
 
 MARC, 
 
 DESGENETTES, 
 
 DUPUYTREN, 
 
 LOUIS, 
 
 EMERY, 
 
 BOISSEAU, 
 
 DESPORTES, 
 
 PELLETIER, 
 
 ITARD, 
 
 DOUBLE, Reporter. 
 
 By the Academy, 
 
 ADELON, Annual President ; 
 B«n- PORTAL, Honorary <$• 
 
 Perpetual President ; 
 PARISET, Perpetual Secretary. 
 
 FINIS. 
 

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