Section I.--Origin and Development.

Epidemics have occasionally prevailed in all ages. Sometimes they have been circumscribed in their influence, and limited to particular localities; while at other periods they have taken a wider range and extended over larger sections, inflicting the most lamentable results, and augmenting the bills of mortality to an incredible degree.

The earlier writers have given some account of these diseases, which have occasionally prevailed as very fatal and devastating epidemics; surpassing all other diseases in their mysterious origin, in their rapid extension, and in the duration of their prevalence. In the East,--in Egypt, and on the eastern border of the Mediterranean, fearful epidemics have prevailed from time immemorial. They have often proved very destructive, especially in the Middle Ages, and as late as the sixteenth and seventeenth centuries. During the prevalence of the "Pestis," which raged throughout Europe between the years 1347 and 1350, according to computation, a fourth part of the inhabitants of this part of the globe was carried off. The estimates of the vast numbers swept away by its repeated occurrence and prevalence appear quite incredible.

During the time it raged at Marseilles in 1720, it is reported that in the Charity Hospital there were admitted from October 3d to February 28th, 1,013 patients, of whom 585 died; and during the same period, in another hospital, there were admitted from October to July 3d, 1,512 patients, of whom 820 died. The population of Marseilles previous to the occurrence of the disease was estimated at about 90,000, of whom 40,000 died; leaving only about 10,000 of the whole population who had not been attacked or in any way affected; so that the record shows the appalling mortality of fifty per cent. of those who were attacked.

The bills of mortality in 1770 and 1771 were as appalling as any arising from epidemics of a later day. A very extended notice of the "Pestis" as it raged in Moscow in the year 1771 is given by M. Gerardin, who, quoting from the published statistics, observes: "In April, the deaths were 744; May, 851; June, 1,099; July, 1,708; August, 7,268; September, 21,401; October, 17,561; November, 5,235; December, 805"; making a total in nine months of 56,672, which is considerably less than the estimate given by De Mertens, who thinks the whole number carried off by this pestilence, from the city alone, cannot be less than 80,000. These statistics bear a striking resemblance to those of the Epidemic Cholera, whose fatality is materially varied by the seasons of the year; the greatest being usually at the close of Summer or the beginning of Autumn. There are, in short, many points of resemblance in this and former epidemics to that of the Cholera, which naturally lead to the supposition that all have had a common origin, if, indeed, they be in many respects dissimilar.

Their pestilential character, their extended influence, and their great fatality, rendered their appearance and progress a special terror to physicians, and melancholy apprehension to the people. They seem to have been regarded as the manifestation of an invisible power, which directed and guided "the pestilence that walketh in darkness" and "the destruction that wasteth at noon-day;" a visitation or chastisement over which human ingenuity and medical skill had little control. Under these impressions, the earlier physicians labored and endeavored to satisfy the great mass of mind that these occasional and special developments of disease arose from natural causes, and were subject to certain natural laws. They ascribed their origin to the commingling of some specific poison in the food, and drink, and air, which, through these "media," was received into the system.

Subsequently, they seem to have made some advance on this theory, and considered the extreme Summer heat--especially the intense heat of the sun in a dry season--the emanations from stagnant waters, and the miasm exhaled from the soil, and from putrid bodies of animals, as the chief causes of all epidemics. These views prevailed for a very long period, and have undergone no very remarkable change from the observations and discoveries of centuries.

Modern and quite recent writers have advanced nearly the same doctrines, embracing, however, the principal sources of insalubrity--the malarious and miasmatic influences; and have assigned as the cause of epidemics, especially that of Cholera, a peculiar constitution of the atmosphere, and certain predisposing causes combining with each other, so that an association or union of these two independent and individual causes are necessary and essential to the production of the disease.

Eminent scholars and pathologists have, during the century last past, patiently searched for its final cause, without arriving at any better, wiser, or more satisfactory conclusion than the earlier writers, who regarded it a poison, commingled with the food they ate, the water they drank, and the air they breathed. The modern writers, according to the more popular views, almost universally adopt the hypothesis that the remote or final cause of the Cholera is a specific poison; for at no period has a person in good health in this or any other country been known in a few minutes to be shriveled up, his face and extremities to turn purple, his whole body to become of an icy coldness, and with or without vomiting a peculiar fluid, like rice-water, to die in a few hours, except under the influence of poison. That this disease, so appalling and destructive in its effects, and so mysterious in its wanderings, should spread over countries in respect to climate, soil, geological formations, and as to the moral and physical habits of the population, so utterly opposite to those where it first originated, is only explicable on the hypothesis of its propagation on the principle of a specific disease-poison.

How and in what manner it travels has not been satisfactorily determined. Whether independent of any and all human agency, or absolutely dependent on ordinary communication and intercourse of tribes, and peoples, and nations, is as yet unsettled. It is, however, a matter not of so much consequence as the fact that, in all its nomadic life, it retains unchanged its youthful disposition, vigor and energy. It seldom shows any inclination to associate, or coalesce, or even adopt the milder habits and manners of others.

Perhaps some idea of its character may be obtained from a microscopic view of its birthplace and its surroundings. Whether the locality of its irruption in 1629, or that of 1817, whence it spread over the greater part of the globe, be entitled to the unenviable distinction of fostering its gestation, concealing and protecting its birth, and nursing its infancy, is immaterial;--since the similarity of these localities strikingly illustrates its cause and ultimate development.

On the north side of the island of Java, about 6° S. lat. and 107° E. long., near the mouth of the river Jacatra, is situated Batavia, in the midst of swamps and marshes, surrounded by trees and jungle, which prevent the exhalations from being carried off by a free circulation of the air, and render the town peculiarly obnoxious to marsh miasmata. Besides this, all the principal streets are traversed by canals, planted on each side with rows of trees, over which there are bridges at the end of almost every street. These canals are the common receptacles for all the filth of the town. In the dry season their stagnant and diminished waters emit a most intolerable stench, while in the wet season they overflow their banks and leave a quantity of offensive slime. From these united causes, it is not surprising that Batavia has been considered the most unhealthy spot in the world, and has been designated the store-house of disease. According to Raynal, the number of sailors and soldiers alone who died in the hospitals averaged 1,400 annually for sixty years, and the total amount of deaths in twenty-two years exceeded a million of souls. The city was inclosed by a wall of coral rock, with a stream of water on each side within and without. Few Europeans, however, sleep within the town, as the night air is considered very baneful. The inhabitants, possibly, as an antidote against the noxious effluvia arising from the swamps and canals, continually burn aromatic woods and resins, and scatter about a profusion of odoriferous flowers, of which there are great abundance and variety. During the prosperity of the Dutch East India Company, Batavia obtained the title of Queen of the East, as the resources of all other districts were sacrificed to its exclusive commerce. Here, in this noted locality, was the Cholera bred and reared in 1629, under circumstances of great significance, admirably adapted to convey some idea of its cause and character.

A learned professor, speaking of the diseases of India, observes: "CHOLERA is the most acute of acute diseases. It seems to have existed in Batavia as far back as 1629; and it has been known to prevail as an occasional epidemic in India at different years and places from 1774 to 1817. Since then it has been endemic, and is a disease whose germs are essentially maintained in, or upon the soil. It annually recurs at many of our large stations, commencing generally at the beginning of the hot season, but sometimes occurring in the rainy and cold season. Its greatest proclivity to propagation is amongst populations living in low, damp, crowded, and ill-ventilated situations, especially if the water supply is impure. Nearly all the diseases fatal in India are accompanied by profuse discharges, with which the air, water, linen, bedding, closets, walls of hospitals, and barracks become more or less infected; so that the 'Materies Morbi' come into contact with all the inmates of buildings where the disease prevails."

Its origin, or reappearance in 1817, is not in any respect essentially different from its earlier development on the Jacatra. The River Ganges, in India, like the Nile in Egypt, flows for a long distance through a low, level country, which it annually inundates. Dividing its waters about 200 miles from the sea, the Delta of the Ganges commences and continues its variegated and checkered surface, till, approaching the borders of the sea, it presents a peculiar aspect, being composed of a labyrinth of creeks and rivers, called "The Sunderbunds," with numerous islands, covered with the profuse and rank vegetation called "jungle," affording haunts to numerous tigers and other beasts of prey. This large river, "a Deity of the Hindoo," is subject to an annual freshet, often rising to the height of 32 feet in the month of July; when all the lower parts of the country adjoining the Ganges, as well as the Burrumpooter, are overflowed for a width of one hundred miles; nothing appearing but villages, trees, and sites of some places that have been deserted. Here in this vast pest-house, where every conceivable vegetable and animal substance is left upon the soil by the retiring inundation, exposed to the heat and dews of a tropical climate--where, too, noisome and infectious diseases have prevailed for centuries, the Epidemic Cholera is said to have arisen and acquired its strength and full development. A fit origin for a fatal and devastating pestilence.

To this low, insalubrious, and festering locality, this vast pest-house, where so many noxious and noisome diseases are generated, and where so many epidemics have arisen and so often swept over the surrounding regions with most fatal and desolating effects, is ascribed the birthplace of the Epidemic Cholera of 1817. Here it is said to have first made its appearance at Jessore--a populous town in the centre of the Delta of the Ganges; whence attaining its growth and power, it has extended its influence as from a common centre, and marked its progress with hecatombs of victims in the direction of almost every point of the compass.

Here we may remark, that it is not our intention to travel over the whole ground embraced by the subject under consideration; but, on the contrary, to present in this treatise only a cursory view of a few prominent features which may interest and aid in the important object of deducing from the pathology and the varied phenomena of the Cholera some general principle of practice. For this, and to this, our labor and our investigations are directed. Availing ourselves of every source of information within our reach, and relying in part on the observations and experience of others, we shall aim to present such facts and arguments as will shed light upon the subject, and aid in the accomplishment of this desirable object. However difficult this may appear, it is nevertheless believed to be within the province of science and unbiased reason.