James Annesley from Ireland spent nearly four decades in Madras, first as an assistant and later as a senior surgeon attached to the Madras Medical Establishment. During this span of service he published the book in 1825 on the most prevalent diseases of India comprising a treatise on the epidemic cholera of the East. This paper recounts the epidemiology of cholera and the efforts made to manage it in the Madras Presidency in the 1820s, keeping in view the life of Annesley and the contents of his book.