quent progress; and amongst the myriads who were attacked, exhibited perhaps less variety and fewer discrepancies than characterize the operation of almost any other disease to which the human body is subject. The healthy and unhealthy; the strong and feeble; Europeans and Natives; the Mussulman and Hindoo; the old and young of both sexes, and of every temperament and condition, were alike within its influence.

"The attack was generally ushered in by a sense of weakness, trembling, giddiness, nausea, violent retching, vomiting and purging, of a watery, starchy, whey-coloured, or greenish fluid. These symptoms were accompanied, or quickly followed by severe cramps, generally beginning in the fingers and toes, and thence extending to the wrists and fore-arms, calves of the legs, thighs, abdomen, and lower part of the thorax. These were soon succeeded by pain. constriction, and oppression of stomach and pericardium; great sense of internal heat; inordinate thirst, and incessant calls for cold water, which was no sooner swallowed than rejected, together with a quantity of phlegm or whitish fluid, like seethings of oatmeal. The action of the heart and arteries now nearly ceased; the pulse either became altogether imperceptible at the wrists and temples, or so weak as to give to the finger only an indistinct feeling of fluttering. The respiration was laborious and hurried, sometimes with long and frequently broken inspirations. The skin grew cold, clammy, covered with large drops of sweat; dank and disagreeable to the feel, and discoloured of a bluish, purple, or livid hue. There was great and sudden prostration of strength; anguish, and agitation. The countenance became collapsed; the eyes suffused, fixed, and glassy, or heavy, and dull; sunk in their sockets, and surrounded by dark circles; the cheeks and lips livid and bloodless; and the whole surface of the body nearly devoid of feeling. In feeble habits, where the attack was exceedingly violent, and unresisted by medicine, the scene was soon closed. The circulation and animal heat never returned; the vomiting and purging continued, with thirst and restlessness; the patient became delirious or insensible, with his eyes fixed in a vacant etare, and sunk down in the bed; the spasms increased, generally within four or five hours.

“The disease sometimes at once, and as if it were momentarily, seized persons in perfect health; at other times those who had been debilitated by previous bodily ailment; and individuals in the latter predicament, generally sunk under the attack. Sometimes, the stomach and bowels were disordered for some days before the attack, which would then, in a moment, come on in full force, and speedily reduce the patients to extremities.

"Such was the general appearance of the disease where it cut off the patient in its earlier stages. The primary symptoms, however, in many cases, admitted of considerable variety. Sometimes the sickness and looseness were preceded by spasms; sometimes the patient sunk at once, after passing off a small quantity of colourless fluid, by vomiting and stool. The matter vomited in the early stages was, in most cases, colourless or milky; sometimes it was green. In like manner, the dejections were usually watery and muddy;

sometimes red and bloody; and in a few cases, they consisted of a greenish pulp, like half digested vegetables. In no instance was feculent matter passed in the commencement of the disease. The cramps usually began in the extremities, and thence gradually crept to the trunk; sometimes they were simultaneous in both; and sometimes the order of succession was reversed; the abdomen being first affected, and then the hands and feet. These spasms hardly amounted to general convulsion. They seemed rather affections of individual muscles, and of particular sets of fibres of those muscles, causing thrilling and quivering in the affected parts, like the flesh of crimped salmon; and firmly stiffening and contorting the toes and fingers. The patient always complained of pain across the belly, which was generally painful to the touch, and sometimes hard and drawn back towards the spine. The burning sensation in the stomach and bowels was always present; and at times extended along the cardia and oesophagus to the throat. The powers of voluntary motion were, in every instance, impaired; and the mind obscured. The patient staggered like a drunken man, or fell down like a helpless child. Head-ache over one or both eyes, sometimes, but rarely occurred. The pulse, when to be felt, was generally regular, and extremely feeble, sometimes soft; not very quick; usually ranging from 80 to 100. In a few instances it rose to 140 or 150, shortly before death. Then it was indistinct, small, feeble, and irregular. Sometimes very rapid, then slow, for one or two beats. The mouth was hot and dry; the tongue parched, and deeply furred, white, yellow, red, or brown. The urine at first generally limpid and freely passed; sometimes scanty, with such difficulty as almost to amount to strangury; and sometimes hardly secreted in any quantity, as if the kidnies had ceased to perform their office. In a few cases, the hands were tremulous; in others, the patient declared himself free from pain and uneasiness, when want of pulse, cold skin, and anxiety of features, portended speedy death. The cramp was invariably increased upon moving.

"Where the strength of the patient's constitution, or of the curative means administered, were, although inadequate wholly to subdue the disease, sufficient to resist the violence of its onset, nature made various efforts to rally; and held out strong, but fallacious promises of returning health. In such cases, the heat was sometimes wholly, at others partially restored; the chest and abdomen in the latter case becoming warm, whilst the limbs kept deadly cold. The pulse would return; grow moderate and full; the vomiting and cramps disappear; the nausea diminish, and the stools become green, pitchy, and even feculent; and with all these favourable appearances the patient would suddenly relapse; chills, hiccup, want of sleep and anxiety would arise; the vomiting, oppression, and insensibility, return; and in a few hours terminate in death.

"When the disorder ran its full course, the following appearances presented themselves. What inay be termed the cold stage, or the state of collapse, usually lasted from twenty-four to forty-eight hours, and was seldom of more than three complete days' duration. Throughout the first twenty-four hours, nearly all the symptoms of deadly

oppression, the cold skin, feeble pulse, vomiting and purging, cramps, thirst and anguish continued undiminished. When the system showed symptoms of revival, the vital powers began to rally, the circulation and heat to be restored; and the spasms and sickness to be considerably diminished. The warmth gradually returned; the pulse rose in strength and fulness, and then became sharp and sometimes hard. The tongue grew more deeply furred; the thirst, continued, with less nausea. The stools were no longer like water; they became first brown and watery; then dark, black, and pitchy; and the bowels, during many days, continued to discharge immense loads of vitiated bile, until, with returning health, the secretions of the liver and other viscera gradually put on a natural appearance. The fever, which invariably attended this second stage of the disease, may be considered to have been rather the result of Nature's effort to recover herself from the rude shock which she had sustained, than as forming any integrant and necessary part of the disorder itself. It partook much of the nature of the common bilious attacks prevalent in these latitudes. There was the hot dry skin; foul, deeply furred, dry tongue; parched mouth; sick stomach; depraved secretions; and quick variable pulse; sometimes with stupor, delirium, and other marked affections of the brain. When the disorder proved fatal after reaching this stage, the tongue, from being cream coloured, grew brown, and sometimes dark, hard, and more deeple furred; the teeth and lips were covered with sordes; the state of the skin varied ; chills, alternating with flushes of heat; the pulse became weak and tremulous; catching of the breath; great restlessness, and deep moaning succeeded; and the patient soon sunk, insensible, under the debilitating effects of frequent dark, pitchy, alvine discharges.

"Of those who died, it was believed, perhaps rather fancifully, that the bodies sooner underwent putrefaction, than those of persons dying under the ordinary circumstances of mortality. The bodies of those who had sunk in the earlier stages of the malady, exhibited hardly any unhealthy appearance. Even in them, however, it was observed, that the intestines were paler and more distended with air, than usual; and that the abdomen, upon being laid open, emitted a a peculiar offensive odour, wholly different from the usual smell of dead subjects. In the bodies of those who had lived some time after the commencement of the attack, the stomach was generally of natural appearance externally. The colour of the intestines varied from deep rose to a dark hue, according as the increased vascular action had been arterial or venous. The stomach, on being cut into, was found filled, sometimes with a transparent, a green, or dark flaky fluid. On removing this, its internal coats, in some cases, were perfectly healthy; in others, and more generally, they were crossed by streaks of a deep-red, interspersed with spots of inflammation, made up of tissues of enlarged vessels. This appearance was frequently continued to the duodenum. In a very few cases, the whole internal surface of the stomach was covered with coagulable lymph; on removing which, a bloody gelatine was found laid on the interior coat, in ridges or elevated streaks. The large intestine was sometimes

filled with muddy fluid, sometimes lived, with dark bile, like tar; just as the individual had died in the earlier or later periods of the attack. In most cases, the liver was enlarged, and gorged with blood. In a few, it was large, soft, light-coloured, with greyish spots, and not very turgid. In others again, it was collapsed and flaccid. The gallbladder, was without exception, full of dark green or black bile. The spleen and thoracic viscera were, in general, healthy. The great venous vessels were usually gorged; and in one case, the left ventricle of the heart was extremely turgid. The brain was generally of natural appearance. In one or two instances, lymph was effused between its membranes, near the coronal suture, so as to cause extensive adhesions; in other cases, the sinuses, and the veins leading to them, were stuffed with very dark blood." xv.--xxi.

The following extracts will show that the disease was known to Sydenham, and accurately described by that observant physician. He no where mentions bile as forming any part of the discharges from the stomach or bowels; and hence it may be fairly inferred, that such discharges were not present.*

"Qui ab ingluvie ac crapula nullo temporis discrimine passim excitatur affectus, ratione symptomatum non absimilis, nec eamdem curationis methodum respuens, tamen alterius est subsellii. Malum ipsum facile cognoscitur, adsunt enim vomitus enormes, ac pravorum humorum cum maxima difficultate et angustia per alvum dejectio; cardialgia, sitis. Pulsus celer ac frequens, cum æstu et anxietate, non raro etiam parvus et inæqualis, insuper et nausea molestissima, sudor interdum diaphoreticus, crurum et brachiorum contractura, animi deliquium, partium extremarum frigidîtas, cum aliis notæ symptomatibus, quæ adtantes magnopere perterrefaciunt, atque etiam angusto viginti quatuor horarum spatio ægrum interimant."

And again, in his letter to Dr. Brady, describing the epidemics of 1674, 5, and 6, he says,

"Exeunte æstate Cholera Morbus epidemice jam sæviebat, et insueto tempestatis calore evectus, atrociora convulsionum symptomata, eaque diuturniora secum trahebat, quam mihi prius unquam videre contigerat. Neque enim solum abdomen, uti alias in hoc malo, sed universi jam corporis musculi, brachiorum crurumque præ reliquis, spasmis tentabantur dirissimis, ita ut æger e lecto subinde exiliret, si forte extenso quaquaversum corpore eorum vim posset eludere," xxiii.

* I have diligently searched the writings of Sydenham, and I assert, that in no one instance, when treating of Cholera Morbus, whether epidemic or sporadic, has he mentioned a discharge of bile as forming any part, much less as being the cause of cholera. And as Sydenham is allowed to be one of the most accurate observers of nature, we see on what foundation Dr. Saunders and others have built their bilious theory of the disease. The fact is, as I have long ago stated, that the discharge of bile in cholera, is a secondary or ternary link in the chain of cause and effect--and always a sanative effort of the system, as well as a favourable symptom of the disease.

I observe too, that Areteus describes the discharge of bile as only an ulterior effect. "In primis," says he, “quæ evomuntur, aquæ similia sunt; quæ anus effundit, stercorea, liquida, tetrique odoris sentiuntur. Siquidem longa cruditas id malum excitavit, quo si per clysterem eluanter, primo pituitosa, mox bilrosa feruntur."-De Cholera, Chap. 5.

The first of the foregoing extracts describes the disease with great accuracy, as it very generally affected the natives; the second is well exemplified in Dr. Burrel's Report, as it attacked the Europeans of the 65th Regiment, at Seroor. The disease is also accurately described by Girdleston, and by Mr. Curtis of Madras, in 1782, when it raged in the Southern Provinces of the Peninsula. Dr. Taylor also furnished the Medical Board with the account of a disease from a Sanscrit medical work, the MADHOW NIDAN, which clearly proves that the complaint has been long known to the natives.

"It is obviously unnecessary to prosecute this inquiry further; and we shall only add, that Dr. James Johnson is the latest author, so far as we know, who has treated this subject, and who has also the merit of having been the first who has generally pointed out the best method of cure, from a few cases he met with on the eastern coast of Ceylon, where the disease seems to be more prevalent than in any other part of India," xxviii.

The exciting and proximate causes of this interesting epidemic are, like those of most others, concealed in utter darkness-" atra caligine mersæ;" great discrepancy of opinion obtains in India respecting its contagious or non-contagious influence, arising naturally out of the difficulty of the subject.

"Several irresistible facts already noticed or related in the following Reports, and its marked anomaly from all hitherto known simple epidemics, would seem to favour the doctrine of contagion, while the contrary supposition is only supported by a species of negative evidence," xxix.

The Board, however, very properly observe, that this is a question of such importance, that it ought not to be too hastily entertained as proved, nor rejected as unfounded; but prosecuted with that diligent inquiry and cautious induction, which on every subject of science, are so necessary to the attainment of truth.

In respect to the predisposing, [or rather the exciting,] causes, practitioners are unanimous.

"Rapid atmospherical vicissitudes, in regard either to temperature or moisture exposure of the body to currents of cold air, particularly the chill of the evening, after being heated by violent exercise of any kind, inducing debility or exhaustion; low marshy situations, flatulent or indigestible food, especially crude and watery vegetables, which compose a large proportion of the diet of the natives; and particularly that gradual undermining of the constitution which arises in a condensed, dirty, and ill-fed mass of population, are all unquestionably powerful predisposing causes."

Sad experience, however, has shown that the absence of all these afforded no security against the attack. Whether the invisible cause, (whatever that may be,) acts more immediately on the vascular or nervous system, the Board cannot take upon them to determine; but from the various modes of attack which gave rise to the division of the disease into two species and varieties, they are led to the supposition that sometimes the one system, sometimes the other, bears the onus of the first onset of the malady.

The most general attack seems to consist in a spasmodic affection