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Annals of cholera; from the earliest periods to the year 1817 online

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the name occurs in works of European travellers : —
Mordshi, morshi, morexi, morexin,mo)'dcxin, mordeshin,
mort de cJiien. Scholars consider the derivation from
the Mahratta word modna, to tear or twist, the most

(e.) The names locally employed in the East to
designate cholera, are most of them more or less
descriptive of vomiting and purging, or, put in its
simplest form, of motion up and down : —











C Upurwai turwai.

I Sweta Rasa, white fluid.

f Morshi, Modsi, Modavasi.

I Tural.

f Hagok.

I Koganla.

Dank lugna.


Ooola, oota.

MoTi-pet, mouth and belly.

Enerum Vandee, vomiting and purging.

[ Kiritiripa.

\ Xicumber, gush of water.
I Shani.
' Yisuchika.



Similarly in Europe : —

German Brech-ruhr, vomiting and purging.

Dutch Brak-loup.

i Unbloody dysentery.
Plague in the guts.

Turkish and Russian names, calling cholera the
black disease, are, I suspect, more recent than the
period now treated of.

3. Another set of names expressed more or less
theoretical views respecting the nature of the disease,
or described some of its leading features. I give
only such as have been used before 1817; most of
them had indeed been employed before 1770.

(a.) Such symptoms as referred to the nervous
system attracted attention. Cholera has been at
times classed in Indian as well as in European
medicine among spasmodic or nervous affections,
and has, in consequence, been sometimes termed in
India sitanga som'puf. It has been called a tetanus ;
it has been even named mirgee, the common Hindo-
stanee word for giddiness or epilepsy. It has been
called cramps, spiasms, syncope.

(b.) It has often been confounded with diseases of
the digestive organs, such as diarrhoea, colic, ileus,
dysentery, and with fever. Hence we have such
names as dysenteria incruenta, colica ?niseraica, cholera
intermittens, and fehris cacatoria.

Cholera has also been confounded at times with
ileus Tndicus, and with diarrhren chokroide^.

{c.) As long ago as 1763, Sauvages established no


fewer than eleven varieties, and lie explains that
the disease is called cholera morbus, to distinguish
it from cholera ira, that bile, and choler or anger,
may not be confounded : —

1. Spontanea. 6. Intermittens.

2. Sicca, or Iv-/^". 7. Indica.

3. ^ruginosa, e fungis. 8 Verminosa.
. ^a. venenis fossil. 9. Arthritica.

" lb. ,, animal. 10. Crapulosa.

5. Dysenterica ^ruginosa. 11. Serosa, ay^oXos.

Other names given to it, most of them also long
before 1817, were —

Passio cholerica.
Cholera legitima.

illegitima, or notha,

humida, t-^^Ti.





To enter into any minute criticism on all those
names would occupy no small space, and I trust
that, without doing so, the reason for bringing so
many of them together, mil be apparent in the
sequel. Dry though this enumeration of teims
must be to most readers, a knowledge of them is of
much importance, both as affording a clue to many
notices of cholera in the writings of professional
and of unprofessional men, which have hitherto
escaped noticej and also as affording many curious
indications of the diffusion of the disease, and of
the theoretical views tliat have been entertained


from time to time respecting the nature of the

As comparative grammar throws much light on
the history of races, so does comparative nomen-
clature on the history of a disease.

I shall at present only remark, that one or two
conclusions flow irresistibly from the preceding list,
such as, that the diagnosis of cholera from colic and
ileus and dysentery, must have been in former times
most inaccurate ; and, indeed, this is not surprising,
while to this day colic and ileus continue to be very
vague and uncertain terms : that, having such a
variety of names, cholera must have been a disease
presenting much variety of symptoms : and, further,
that cholera must have^been a disease very familiarly
known, for in Europe almost every country had a
popular name for it, and in India there was not a
district or a language, that had not its local name
for the complaint.

In one shape or another cholera may, therefore,
be said to have been in all ages a world-wide




Cholera is made mention of in the earliest medical
writings tliat are in existence. It is in the works
of Hippocrates that we first find the word xox'tp-n. It
is repeated frequently by him, as well as the phrase,
choleric affections. No systematic description is
given of the ordinary form of the disease, though
several cases of it are recounted.* For instance : —

" At Athens a man was seized with cholera. He
vomited, and was purged and was in pain, and
neither the vomiting nor the purging could be
stopped ; and his voice failed him, and he could not
be moved from his bed, and his eyes were dark and
hollow, and spasms from the stomach held him, and
hiccup from the bowels. But the purging was
much more than the vomiting. This man drank
hellebore with juice of lentils ; and he again drank
juice of lentils, as much as he could, and after that
he vomited. He was forced again to drink, and the
two (vomiting and purging) were stopped ; but he
became cold. He was washed with plenty of (hot)
water down to the genital organs, until the upper

* Epidem., book v., 4, 29, 27.


parts also grew warm, and he lived ; and next day
lie took some gruel (meal with water)."

Here is another case : —

"Eutychides had a choleric affection, which ended
in a tetanic seizure of his legs, along with purging.
He vomited for three days and nights a quantity of
coloured and very red bile, and he became powerless
and oppressed with nausea, and he could retain
nothing — -neither drink nor food ; and there was
complete retention of urine {tov oipov ttoxx-o o-x£a-<s), and
there was no passage downwards. By vomiting
soft dregs were evacuated, and they also passed
downwards." Again : —

" It happened to Bias, the pugilist, who was a
great feeder, to have a choleric attack from eating
flesh. ... In summer reign choleric affections
and intermittents."

The two first of these cases are descriptions of
sporadic cholera of some intensity ; the last is only a
case of indigestion.

We have seen something of the treatment of the
first of these cases, but Hippocrates says more on the
subject of treatment.*

*' In cholera, for the pain, it is proper to give
what is ordered among the remedies for relieving
pain, and to take care of the belly, moistening it
with drinks (internally), and relaxing the whole
body except the head, with warm baths. In this
way, some fluid being introduced, the vomiting is

* On Affections.


easier, and any adhering matters are expelled up-
wards, while the alvine evacuation is facilitated ;
but if the patient is empty, he vomits and purges
with greater difficulty. In the evening he should
get what is prescribed for persons over purged by an

Hippocrates mainly assigned disordered bile (pro-
bably using that word in an extended sense) as the
cause of cholera and kindred affections, and the
disorder was induced by indigestible articles of diet
and by excesses at table. He thought men of middle
age most subject to these attacks, and the summer
season most favourable to their occurrence. In his
Aphorisms* he places chronic diarrhoea, cholera, and
dysentery next each other.

It would thus seem that sporadic cholera was
common enough in the days of Hippocrates ; but
there is no hint of the disease being epidemic,
although it was more frequent at a particular season.
Hippocrates gives most of the symptoms of cholera,
including suppression of urine, but expresses no
opinion as to the gravity of the disease. His treat-
ment was mainly diluent, with the external use of
warm water. Though in one case he mentions giving
hellebore, he gave very little active medicine ; and it
was only in later stage.3 that he ordered medicines
to suppress purging.

But Hippocrates described another kind of cholera, f
" In x"'-^;'* ?^p«, the stomach is distended with air,
borborygmi are heard, there is pain in the sides and

* 3 Sect., 30. t De Vietu.


in the loins. The patient, unable to pass anything
downwards, is constipated. In order to quiet
vomiting, we must produce action of the bowels.
The patient must have immediately a clyster, hot
and as oily as possible. He must be anointed freely
with oil ; he must be extended in a bath, and cold
affusions must be used slowly. If, when he is re-
vived, alvine evacuations follow, he is cured. . .
If the pain does not abate, give him asses' milk to
di'ink until he is purged. If the stomach is relaxed
and he has bilious motions — if he has griping, vomi-
ting, oppression, or gnawing feeling, it is best to keep
him quiet and give him oxymel to drink, &c." He
attributed this affection to indigestible substances,
especially to eating assafoetida with a quantity of

I think that all must frankly admit that the above
account does not describe any known form of cholera.
There are, indeed, rare cases of cholera with a very
small amount of evacuation, but never characterised
at the onset by flatulence and constipation. This
division of Hippocrates has been followed by many of
the early authors, but by no means by most of them.
The disease was evidently a flatulent colic, such as
is not very unfrequent in any country, and some
forms of which, occurring in the East, have been
described by such terms as Ileus Indicus or Colica

We have evidence that the successors of Hippo-
crates were acquainted with cholera, as we know
something of their mode of treatment. For in-


stance, Erasistratus ordered wine, but in very small
quantity; and Asclepiades (•wlio tkought tlie de-
finition of flow of Lile too naiTOw, and called it a
flow of tumour; gave his patients tke first day wine
and polenta. Tkey add, liowever, but little to our
knowledge of cliolera.

At tbe commencement of the present sera Celsus*
wrote tbe following account of tbe disease : —

" Cliolera simul et dejectio et Tomitus est : pree-
terque bsec inflatio est ; intestina torquentur, bills
supra infraque erumpit, primum aquse similis, deinde
ut in ea recens caro lota esse videatur, interdum
alba, nonnunquam nigra vel yaria. Ergo eo nomine
morbum bunc ^o/.i^ay Grrgeci nominarunt. Prseter ea
vero, quEe supra comprebensa sunt, stepe etiam cr-ura
manusque contrabuntur : urget sitis, anima deficit :
quibus concurrentibus non minim est si subito quis
moritur. Neque tamen ulli morbo minori momento

" Protinus ergo ubi ista cceperunt, aquae tepid83
quam plurimum bibere oportet et vomere. Vis
imquam ea sine vomitu sumitur ; sed etiamsi non
incidit, tamen corrupta3 miseuisse novam materiam
prodest, parsque sanitatis est vomitum esse suppres-
sum. Si id incidit, protinus ab omni potione absti-
nendum est. Si vero tormina sunt, oportet frigidis
et bumidis fomentLs stomacbum fovere, vel, si venter
dolet, iisdem egelidis, simul venter ipse mediocriter
calentibus juvetur. Quod si vebementer et vomitus
et dejectio et sitis vexant, et adhue subcruda sunt

* De Medicina, lib, iv., cap. 11.

c 2


qvLse vomuntur, nondum vino maturum tempus est :
aqua, neque ea ipsa frigida sed potius egelida, danda
est. Admovendumque naribus est pulegium ex
aceto, vel polenta vino aspersa, vel mentlia, vel quod
secundum naturam est.

" At cum discussa cruditas est, tum magis veren-
dum est ne anima deficiat. Ergo tum confugiendum
est ad vinum. Id esse oportet tenue odoratimi, et
cum aqua frigida mixtum, vel polenta adjecta, vel
infracto pane : quem ipsum quoque assumere expedit :
quotiesque aliquid aut stomaclius aut venter eflPudit,
toties per lisec vires restituere. . . . At si inanis
est homo, et crura ejus contraliuntuT; interponenda
potio absintliii est. Si extremse partes corporis £ri-
gent, ungendse sunt calido oleo, cui cerse paulum sit
adjectum : calidisque fomentis nutriendse. Si ne sub
bis quidem quies facta est, extrinsecus contra ventri-
culum ipsum cucui^bitula admovenda est, aut sinapi
superimponendum. TJbi id constitit dormire oportet :
postero die utique a potione abstinere : die tertio in
balneum ire : paulatim se cibo reficere somnoque
quisquis facile acquiescit : vitetque lassitudinem et
frigora. Si post suppressam cboleram febrieula
manet, alvum duci necessarium est : tum cibis vinoque
Titendum est. Sed bic quidem morbus et acutus est,
et inter intestina stomacbumque versatur sic ut cujus
potissimum partis sit, non facile dici possit."

In tbe foregoing sentences, Celsus gives a clear
account of a very decided cbolera, a disease in wbicb
be is not sure wbetber tbe stomacb or tbe intestines
are most involved. He s&ys little or notbing


of the causation of the malady, but he gives a good
idea of the practice of the period. He began
"svith ordering water as an emetic, with the object of
stopping the vomiting by clearing the stomach, and
considering, that the water would be useful by dilu-
tion, even if it did not produce vomiting. He recom-
mends externally frictions with oil, sinapisms, and
dry cupping. He also recommended wine pretty
early. Every practical man will recognise the sound-
ness of his advice in being cautious not to induce
relapses by giving too much drink or food.

The descri23tion of the disease given by Coelius
Aurelianus,* about eighty years after Celsus, was
admirable. He considers cholera to be closely
allied to diarrhoea. He mentions many symptoms
of much importance. For instance, he enumerates
as precursors of cholera, heaviness and tension of the
stomach, feeling of discomfort, restlessness, flatulence,
nausea. He notices blackness of the coimtenance and
sharpening of the features, egestion of thin, watery
fluid, the eyes growing red towards the close, re-
covery by gradual relaxation of the symptoms,
especially the discharges taking place at longer
intervals. He uses the very phrase of consecutive
fever, now so much employed. His allusion to it is
more distinct than that of Celsus, and he discusses how
it can be best kept off, recommending abstinence.

He says little of the pathology of the disease. It
is usually "caused by some variety of indigestible
food, and^he alludes to the analogy of sea- sickness.
* Acut. Morb., lib. III., cap. 19, 20, 21.


In his chapter on treatment he criticises severely the
practice of others, especially that of giving emetics — a
measure, he says, like bleeding a man suffering from
haemorrhage or from profuse perspiration. He also
mentions that Heraclitus Tarentinus used opium
and henbane, and other remedies to restrain the
discharges ; but his own practice is essentially the
same as that of Celsus. He recommends ligatures
to the limbs, but that they should be frequently
changed, lest the pressure should be too continued.
This practice is of interest, as being so common in
Eastern countries. He gave wine, and in the decline
of the disease he gave drinks made of the juice
of quinces, pomegranates, and autumn fruits, a
practice in which he was followed by all the later
authors. He was cautious to prevent relapses,
and was quite aware of the gravity and of the
antiquity of the disease, for he says that the ancients
described it as acute and very swift, being rarely
protracted to the second day.

I have not quoted Aurelianus at length, as I sub-
join a very similar account of the disease by one who
was nearly his contemporary, and one of the most
valuable early writers on medicine, Aretseus of Oap-
dadocia* : —

" Cholera is an inverted movement of everything
in the whole body to the stomach, to the belly, and
to the intestines — a very sharp malady. For the
matters collected in the stomach escape by vomiting,
and the fluid matters in the belly and intestines run
* Morb. acut., lib. II., c. 5 ; Morb. acut. curat., lib. II., c. 4.


through by the lower passage. What is first vomited
is like water, but what passes by stool is stercoraceous
fluid and of ill odour. For continued bad digestion
has been the cause of this. But what is washed
away is first like phlegm, afterwards like bile. At
the beginning the disease is free from pain, but
after that, there are tension of the stomach and
tormina of the belly ; but if the disease increases,
the tormina are augmented, there is syncope, the
limbs are unknit, there is helplessness, loathing of
food ; and if they swallow anything, yellow bile
rushes out unceasingly by vomiting with sickness,
and the dejections are like. There are spasms, and
drawing together of the muscles of the calves of the
legs and of the arms. The fingers are twisted ; there
is vertigo and hiccup ; the nails are livid ; there is
cold refrigeration of the extremities, and the whole
body becomes rigid ; but if the malady runs on to
its end, then the man is covered with perspiration ;
black bile bursts out upwards and downwards. There
is retention of urine from spasm of the bladder ; but,
indeed, much water is not collected in it, owing to
the pouring out of the fluids into the intestines.
There is loss of voice ; the pulse becomes very small
and frequent, as in syncope ; there are constant
fruitless attempts at vomiting, desire to evacuate
with tenesmus, but dry and without fluid ; death,
full of pains and miserable, with spasms and suf-
focation, and fruitless vomiting. . . . But if he
rejects everything by vomiting, and a perpetual
perspiration flows, and the patient becomes cold and


ash- coloured, and the pulse approaches extinction,
and the patient becomes speechless, it is well, under
such circumstances, (for the physician) to make a
graceful (becoming) retreat." We shall have occa-
sion to notice this singular remark afterwards.

Aretseus devotes a very full chapter to the internal
treatment of the disease, and to the application of
local remedies. These, however, need not be detailed
here. The principle of his treatment was that
it was bad to suppress excretions which ought to be
removed. He used, therefore, diluents chiefly, and
water in small quantities. He remarks, what is very
characteristic of the disease, that patients always
preferred cold drinks, but sometimes he gave them
hot ones. If there were signs of the patient's strength
failing, he gave wine and the juice of fruits^

Aretseus, while he describes the symptoms of the
disease so well, does not enter into its pathology ;
but as to its setiology, he observes that the disease
prevails most in summer, next most in autumn, less
in spring, and least in winter : and as to age, that
young men and men at their prime are attacked
most, old men least, boys more than old men, but
not very fatally.

We must now turn to accounts of cholera by
another class of authors.

There is much variety of opinion as to the com-
parative antiquity of Hindoo and Chinese and of
Greek medicine. As some claim a far greater anti-
quity for the two first than for the last, I might have
commenced this sketch of the history of cholera with


extracts from the Shastras and from tlie earliest
Chinese books; but I have thought it most con-
venient to introduce the Sanscrit accounts of cholera
here, as they are probably not earlier than the latter
half of the second century ; not that I presume to
settle a question on which scholars are much divided.

" Visuchika chiefly attacks those who are timid or
immoderate in their living. . . . Along with
convulsions, the patient has intellectual torpor,
diarrhoea, vomiting, thirst, giddiness, restlessness,
tenesmus, yawning, feeling of heat, lividity, shiver-
ing, pain in the head and at the prsecordia. The
belly is retracted : the patient, whose voice is lost,
is in a state of extreme agitation. The gases con-
tained in the belly rise. When the faeces and the
air remain shut up in the belly, the patient grows
weak, loses power of moving, then come hiccup and
eructations. . . . When the patient's gums are
livid, his nails and lips pale, when he vomits abun-
dantly, and loses consciousness of his acts, when
his eyes become hollow, when his voice is lost,
when his joints are all relaxed, one ought to have
recourse to the instructions of the sacred books,"*
or, as Dr. Wise translates it, " such a person may
be taken out to be burnt, he will not recover."

With respect to treatment, Dr. Wise tells usf that
besides commencing with an emetic, and the appli-

* Ayurveda of Su^ruta. Calcutta, 1835, Vol. II. p. 518.
The chapter is in verse. I follow a translation by Dr. Lietard,
given by Scoutetten,

t On Hindoo Medicine, 1845, p. 330,


cation of the actual cautery to the ancles, Su9ruta
recommended a compound of myrobalan, orris root,
assafoetida, the seeds of the "Wrightia anti-dysenterica,
red garlic, rock-salt, and atee^, of each equal parts.
These were reduced to powder, and mixed with
warm water for use,

Charaka, a later writer, added opium and black
pepper to the mixture. This receipt is said to cure
cholera when the eyes are sunk, the pulse is imper-
ceptible, and the extremities are cold.

In addition to these prescriptions,* Dr. Wise also
mentions a potion, the chief ingredients of which
were Sinda salt and hutcli infused in water. The
hutch is a warm stomachic like ginger.

In the preceding description of cholera, which is,
I believe, treated under the head of indigestions, we
have a very fair account of cholera, but by no means
so complete as some of those already quoted. It
gives us no idea of what was the degree of fre-
quency of cholera in India, but it shows that there
was a very acute form of it to be met with, of so
severe a nature, that in the end it was usual to
abandon all attempts to save the patient.

I think the reader cannot fail to be struck with
the very close resemblance between the concluding
sentences in Aretseus and Su9ruta. Their structure
is similar ; they occur in both at some interval

* It is curious to find in these prescriptions the prototype of
all the opium and assafoetida and black pepper cholera pills,
which always have been employed in Bengal, and are at the pre-
sent day popular with the natives of India, and much used in
European practice.


from the description of the disease. They both
consider what should be done when the case
becomes hopeless, and both agree that the patient
may be abandoned by the physician. I cannot but
think that the Sanscrit author, having Ai-etseus before
him, was shocked at the suggestion of the phy-
sician's simply beating a retreat, and therefore
recommends recourse to the last rites of religion.
Others may think Areteeus borrowed from the
Sanscrit. But, for the history of cholera, this chrono-
logical question is of no very great imj)ortance.

"We are able to see these Sanscrit accounts, as they
appeared in a somewhat altered form, in Southern
India, in the books of the Tamul physicians. Theii-
present form is of uncertain date.*

" The Vidhuman Visuchi (the third species of
ajerna, or indigestion) is most rapid in its effects :
its symptoms are dimness of the sight, persj^iration,
sudden swooning, loss of consciousness, derangement
of external and internal senses, pains in knees and
calves of legs, griping pains in belly, extreme thirst,
lowness of the windy and bilious pulses, coldness in
the hands, feet, and whole body."

The more spasmodic form, sitanga soniput, was
thus described : — " Chilliness, like coldness of the
moon, over the whole body, cough, and difficulty
of breathing, hiccup, pains all over the body,
vomiting, thirst, fainting, great looseness of the
bowels, trembling of all the limbs."

Sitanga soniput was said to be simply spasmodic,
* Madras Courier, January, 1819. Quoted by Scott.


and tliough usually yet not suddenly fatal. The
visuchi is most rapid in its progress, and at times

In the preceding extracts from the Tamul there

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