ART. VII.-Selections from my Medical Note-Book, or Practical Observations on the Indian Village Cholera, &c., &c. By Thomas Moore, B. A., Assistant Surgeon, Bengal Medical Service. Calcutta, 1852.

THIS volume is a reprint, in a revised and collected form, of a series of papers which were, for the most part, published in the London Medical Gazette, some two years since; and, but that cholera was then on the wane in England, the views of the author, both as to the pathology and treatment of this fell disease, founded as they are upon numerous post mortem examinations, would have attracted more attention than they appear hitherto to have done. We commend the work to the attention of the medical profession in India, as recording the results of an earnest and industrious study into the causes and morbid effects of this scourge of our age; for, though we are but little disposed to agree with the conclusions at which Dr. Moore has arrived, we willingly accord him all praise for the patient, and, in this country, laborious investigation in which he has been engaged.

We would ask Dr. Moore, why he has denominated the disease, "Indian village cholera." The impression this suggests to the reader is, that he is about to describe some peculiar form of disease localised in the Indian hamlet, differing in type from that too fatally known to the medical profession, whose dreaded march carried terror and dismay through all the countries it visited, baffling the skill and science of all the most celebrated physicians of Europe. The carelessness or vanity of writers in applying names to diseases, has been a fertile cause of confusion in medical literature; the name should convey some intimation of the nature of the malady, the organ affected, or some generic feature; all of which are wanting in the term, "Indian village cholera," as applied to a disease, which has spread its ravages over most parts of the habitable globe. There is the less excuse for this act on the part of our author, as there are so many synonimous terms for cholera already in common use among medical writers, from the following list of which he might surely have selected one appropriate :

"Asiatic cholera, Indian cholera, spasmodic cholera, epide'mic cholera, malignant cholera, pestilential cholera, cholera 'asphyxia, cholera biliosa, cholera morbus, mort de chien."

Dr. Moore, in accordance with the plan adopted by most systematic writers on the subject, divides cholera into three stages; the symptoms of which, as arranged and grouped by

him, we shall make no apology for presenting at length to our readers :

In its progress, the Indian village cholera is divisible into three stages. The symptoms which denote the premonitory stage from the second or intermediate stage, and this latter from the third or last stage, are, in general, well marked.

Whether cholera has come under my observation in the huts of the natives in their villages, or on board ship, when in medical charge of cooly emigrants, or in regimental and civil hospitals, I have noted a degree of uniformity in the symptoms by which each stage of the disease bas been indicated. The exceptions have been few. I propose, therefore, to select the results of cases treated by me on one occasion as illustrative of the particular features of each stage of the Indian village cholera.

Fatal cases of cholera in the third or last stage.-The Indian labourers, destined as emigrants for Mauritius, had not been on board the "ship Sophia" more than twelve hours, when I was summoned from shore to visit the vessel, in consequence of the outbreak of cholera. The disease had commenced with the men. Until the third day's sail from the Sand Heads, men, women, and children, were attacked by it. To our relief, the cholera then disappeared. It may not be out of place to notice, that by this time, few of the coolies were able to appear on deck in consequence

of sea-sickness.

The symptoms and general features of the disease, as the vessel lay at anchor off Cooley Bazar, were of the worst type. When I went on board, there were three men in the last stage of cholera. They were cold, and covered with a clammy sweat. The perspiration was oozing out in large drops on the forehead, the neck, and on the chest. Their eyes appeared sunken in their sockets. Their breath was cold. In each case the tongue was cold. Their features were shrunk. The skin of the face seemed to have been pinched backwards. The voice was feeble, hollow, inarticulate. Their strength was completely prostrated. In two of these cases the pulse at the wrist was imperceptible; in one, barely perceptible. In the larger arteries the pulse could be felt. It was quick, and communicated to the touch a feeble vibration.

The impulse of the heart could not be felt. The action was rapid, distant, and indistinct. The first, or muscular sound of this organ, was almost inaudible. The second, or arterial sound, was clear, sharp, distinct. The breathing was short, and at intervals laboured. The extremities were icy cold. The nails of the fingers and toes of a deep blue colour, as if steeped in indigo, were curved inwards. Their pulpy points were shrivelled. The calves of the legs suffered from spasmodic contractions. The mus cles of the forearm and arm, in like manner, were seized with convulsive spasms, and became round and hard, as resisting under the grasp as balls of iron.

Vomiting and purging had ceased in two of these cases, and were succeeded by hiccup and dry retching. In the third case, the rice-water or sero-mucous discharge continued to trickle from the bowels, without the knowledge of the patients. Their only desire was for cold water, to quench an insatiable parching thirst.

At the commencement of the attack, frequent and copious rice-water discharges from the stomach and bowels were the most prominent symptoms. Weight, and oppression and spasmodic twinges in the epigastrium, and along the course of the diaphragm, quickly followed. In each case the abdomen was sunken, doughy, inelastic under pressure, without pain

or tenderness, until the spasms extended to the recti muscles. The secretion of urine was suppressed.

These cases of cholera, in the last stage of the disease, had well nigh run their course previous to my visit on board. I need scarcely add, they terminated fatally.

Cases of cholera in the second or intermediate stage.-Besides the three cases in the third or last stage of cholera, there were two men, one boy, and one woman, in the second stage of the disease. Vomiting and purging were the most prominent features in each case. These were the symptoms chiefly complained of by the patients. The liquid discharges from the bowels were slimy, sero-mucous, depositing a flaky sediment, and resembled conjeepanee, or rice-water. The fluid rice-water discharges from the bowels occurred sometimes twice, sometimes three times, or more frequently, in the hour, but occasioned no pain nor uneasiness in the abdomen.

The act of vomiting was frequent, and attended with a feeling of constriction at the pit of the stomach, and with spasmodic twitches shooting back towards the spine. The abdomen was free from pain on pressure, felt soft to the band, and in three cases was inelastic. In a fourth case it was distended with flatus, but in none was the abdomen pinched inwards and backwards towards the spine.

The feet and hands retained some degree of warmth. In the rest of the body the heat was above its natural standard. In the calves of the legs, the muscles were spasmodically contracted. The spasms, however, were not severe; nor protracted in duration. They yielded, in general, to the hand-rubbing and shampooing used by their friends. The tongue in each case was loaded, moist, and warm. With this moisture of the tongue, thirst was urgent. The desire for cold water, to allay the dried parched feeling in the mouth, could not be satisfied. They were allowed to drink as much water as they wished.

The pulse was quick, varying from 110° to 120°, sharp, contracted, wiry under the finger, perceptible at the wrist. The impulse of the heart could be felt. Its action was strong. Its sounds were distinct. In all, there was a marked degree of anxiety in the countenance. Some dulness and suffusion of the conjunctiva of the eyes were noticed, but there was not present that sunken state of the eye-balls into their sockets so characteristic of the advanced stage of cholera. With the exception of the woman, the patients, although weak, possessed sufficient strength to walk from the larboard to the starboard side of the vessel. The secretion of perspiration from the skin was checked. The secretion of urine was suppressed in two; in others, when passed, it was scanty in quantity, and high-coloured.

As to the origin of their illness they were not able to give any satisfactory account. They felt themselves suddenly prostrated in strength after arriving on board. They suffered from languor, from pains and aches over the body and in their limbs, striking upwards and inwards towards the pit of the stomach. All their pains seemed to centre in this particular part of the stomach. Upon these, sickness of the stomach, quickly followed by vomiting and purging, supervened. The discharges of fluid afforded relief. They were not described as having added to their sufferings.

The woman remained under treatment for twelve or fourteen hours. The symptoms progressed unfavourably from hour to hour. They assumed the features of the third stage of cholera. She died. The treatment adopted in the case of the boy checked the vomiting and purging. Hopes of his recovery were entertained. They were not realized. The stage of collapse set in. The pulse disappeared at the wrist. The body became cold, and covered with a clammy sweat. The eyes sank in the sockets. The muscles

of the extremities were cramped into hard, round balls. The tongue be came cold; the breath cold. He died.

The recovery of the other cases took place before we cast anchor in Saugor Roads.

Cases of cholera labouring under the premonitory symptoms.-The cases labouring under the premonitory symptoms of cholera were few. They did not number more than four. The symptoms of which they complained were prostration of strength, wandering pains about the body, more parti cularly in the loins and abdomen; distaste for food; nausea, and inclination to vomit; rumbling of the bowels, occasionally attended with griping and looseness; thirst, with full and loaded tongue. The pulse in each case was full and compressible, ranging between 90° and 959. The skin was hot, rough, and dry.

Three of the cases recovered under the treatment adopted. They were convalescent before the vessel reached Diamond Harbour. The symptoms in the fourth case did not yield so soon to the treatment. The symptoms of the second stage rapidly set in. With difficulty this man's life was saved.

Such, then, were the symptoms by which the premonitory, intermediate, and last stages of the Indian village cholera, amongst these Indian emigrants, were denoted. Such, I may add, is the group of symptoms which has marked the progress of these three stages of cholera in almost all the cases noted by me. With atmospheric changes, the symptoms may vary in degrees of intensity. With atmospheric changes, the virulence of the symptoms may become modified. Under the influence of certain changes in the atmosphere, the disease may disappear as suddenly, and in as unaccountable a manner, from its locality on shore, or from the vessel afloat, as it has made its appearance suddenly and unexpectedly. These modifications in the symptoms, arising from the state of the atmosphere, or from peculiarities in the constitutions of patients, I regard as exceptional; so marked, in general, has been the uniformity in their intensity dur ing the development of each stage of the disease.

Whatever the causes may have been which contributed to the sudden appearance of cholera on board, there can be little doubt that the cases which terminated fatally, exhibited the symptoms of the disease in its severest form.

The symptoms recorded in the fatal cases may be regarded as those met with in three-fourths of the cases which terminate in like manuer. In this, the third or advanced stage of the Indian village cholera, the discrepancy which exists in the catalogue of symptoms is, perhaps, less than in any other disease, with which I am acquainted. The accurate record of the symptoms in a single case will serve to denote those in nine-tenths of the cases similarly affected, and swept away in the same incredibly short space of time. More particularly, in reference to the natives of India, does this observation hold good.

A single report from a village to the effect that cholera has made its appearance, is sufficient warning, that in the course of a few days the inhabitants of that same village will be carried off by tens and twenties, and that in the reports subsequently made, there will not be the slightest dif ference in the development and rapid progress of the symptoms, until the force or virulence of the cholera shall have expended itself.

The general truthfulness of this account will not be disputed by those conversant with the disease, though the symptoms enumerated as pertaining to the premonitory stage, might have been more extended and prominently brought forward; it is

during this period that remedies may be applied with the greatest prospect of success. When the disease has run on to the third stage, the general experience of the profession corroborates what Dr. Moore here states:

General results of treatment in the third stage.-When cholera has advanced to the third stage, medicine and the skill of the physician can effect but little. Cases of recovery, under successful treatment, have been recorded. In what form of disease have not cases of the last or hopeless stage been successfully treated, and duly recorded?

The Pharmacopoeia has been ransacked for some potent specific,-for some infallible anti-cholera pill, or powder, or drop, or mixture. Apparently the search has not been made in vain. For this, the direst scourge of the human race, I believe there are more specifics known, and publicly advertised, than for any other disease to which the human system is subject, the venereal disease excepted. Did these anti-cholera specifics possess only a fractional part of the virtues attributed to them by their puff masters, mankind would have little to dread from cholera.

In the East, or elsewhere, cholera, in its third stage is, numerically speaking, as fatal, perhaps, more fatal, than yellow fever in the West, when black or coffee-ground vomit indicates that the disease has progressed to an advanced stage.

During the prevalence of cholera, therefore, as an epidemic, it behoves every man to observe with more than common attention any derangement of the health, however slight. Among other symptoms occasionally observed for some days prior to the breaking out of the disease, while it may be said to be yet latent in the system, may be mentioned a frequent sighing, accompanied with slight oppression of the breathing, Occasional giddiness, and sense of debility attended with pallor of the countenance, more striking from its being sometimes accompanied by a dark ring round the eyes, while the pulse, so far as we have observed, in place of being " full and compressible," has been weak, small, and oppressed.

Dr. Moore would limit the seat of the disease to the mucous membrane of the bowels. He writes :

Seat of the disease.-The seat of cholera,-the genuine type of which I consider to be that form prevalent in Indian villages during certain months of the year,-is in the mucous membrane of the bowels, and in the structures subjacent to, and contributing to the formation of, the several coats of the intestines. In a practical point of view it is a matter of little consequence in which of the component strata of the mucous membrane of the intestines, the source of the symptoms, and, consequently, the seat of the disease, be fixed.

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Beyond the possibility of cavil, pathological anatomy has revealed, and has proved, that the only type of disease deserving the name cholera, originates in a blaze of inflammatory action, involving every membrane, every tissue, and every glandular body in the gastro-intestinal canal, from the œsophagus to the rectum. This morbid condition of the stomach and

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