?--^': 
 
A TREATISE 
 
 ORIGIN, NATURE, PREVENTION, AND TREATMENT 
 
 OF 
 
 ASIATIC CHOLERA. 
 
 ^ 
 
 By JOHN C. PETERS, M. D. 
 
 NEW YORK: 
 D. VAN NOSTRAND, 192 BROADWAY. 
 
 1866. 
 

 (^q 
 
 Entered according to Act of Congress, in the year of our Lord 1866, by 
 
 D. VAN NOSTRAND, 
 
 in the Clerk's office of the District Court of the United States, for the Southern 
 District of New York. 
 
PREFACE. 
 
 I HAVE been present as a practising physician in New 
 York during the whole of the epidemics of 1849, '54, and '66 ; 
 and have as distinct a recollection of that of 1832 as a boy 
 thirteen years of age, at the time, conld have. 
 
 I have seen no more of true Asiatic cholera, outside 
 of hospitals, than usually falls to the lot one whose resi- 
 dence and practice are in the cleanest portions of this city. 
 But I have visited cholera hospitals in 1849, '54, and '66, 
 and have witnessed every variety of treatment, including 
 the homoeopathic, both of the high and low dilution, of the 
 strict and liberal kind. The lowest average loss in asylums, 
 like the Protestant Half-Orphan, of this city, and in homoeo- 
 pathic hospitals for the reception of the better classes of 
 the poor, like that of the Sisters of Charity in Vienna, is 
 
 from twenty-five to thirty-five per cent. In hospitals where 
 the poorer and most depressed classes, and the almost 
 dead and dying, are received, as well as those in the more 
 or less advanced stages of the disease, as in Tessier's ho- 
 moeopathic wards in the Hospital St. Marguerite, in Paris, 
 and in those of Charges, at Marseilles, the mortality varies 
 from fifty to seventy per cent. These estimates apply ex- 
 
4 PREFACE. 
 
 clusively to cases of true Asiatic cholera, and do not in- 
 clude any of cholera morbus, bilious or septic cho'.era, 
 or that great majority of diarrhoeas which are misnamed 
 cholerine. The examples of actual Asiatic cholera among 
 the middle and better classes are so few, and the slighter 
 similarities are so numerous, that they can hardly be 
 taken into account. Yet all these are counted in , " in 
 cholera times," by almost all irregular practitioners like 
 the eclectics, hydropathists, &c. 
 
 No indulgence is asked for any statements or argu- 
 ments which have been advanced, but I do request a 
 kindly criticism of the literary portion of this treatise ; 
 for the greater portion of it has been written before 8 
 A. M. and after 10 p. m. There has been no leisure time 
 to revise the first rough notes, and three fourths of the 
 materials collected have been necessarily omitted. 
 
 There has been neither opportunity nor inclination to 
 hurry the completion of this little treatise, in order to 
 profit by the excitement of the times ; but its necessary delay 
 has favored a careful watch over the present epidemic, 
 and it is confidently supposed that no facts decidedly in 
 opposition to those on which it is based have been de- 
 veloped this season. 
 
 The opinions which are here advocated and adopted, are 
 those maintained by the most experienced and scientific 
 physicians of the times : 
 
 1st. That Asiatic cholera is both portable and commu- 
 nicable. 
 
PR EF ACE. 5 
 
 2d. It is generally carried about by persons, ships, cloth- 
 ing, and baggage. 
 
 3d. It never affects the entire atmosphere of any one coun- 
 try, district, town, or village, and rarely that of the whole 
 of one hospital, ship, or house ; but only those parts of 
 them into which it is directly imported. 
 
 4th. That the quality of infectiousness belongs peculiar- 
 ly, if not exclusively, to the matters which the cholera 
 patient discharges by vomiting and purging. 
 
 5th. That cholera discharges, if cast away without previ- 
 ous disinfection, impart their own infective quahty to the 
 excremental matters, or any more innocent filth with which 
 they mingle in drains or cesspools, and wherever else they 
 flow or soak, and to the gases and ef&uvia which these 
 substances evolve; thus poisoning the air and subsoil 
 water. 
 
 6th. That no amount of filth, imprudence, or diarrhoea! 
 disease, without the addition of this peculiar cause, will 
 give rise to true Asiatic cholera in temperate climates. 
 
 7th. That if the cholera poison, by leakage or soakage 
 from drains or cesspools, or otherwise, gets access, even in 
 small quantity, to wells or other sources of drinking water, 
 it will infect, in the most dangerous manner, very large 
 volumes of this fluid. 
 
 8th. That the cholera poison affects, with equal virulence, 
 everything in the nature of bedding, clothing, towels, and 
 the like, so that the soiled linen of a single house in 
 
6 PREFACE. 
 
 which there is a cholera patient may spread the disease 
 over a whole district. 
 
 9th. That there is scarcely any limit to the extent to 
 which even a single case of cholera or cholerine may 
 infect a whole neighborhood. 
 
 10th. The counteracting and remedial agencies are simple 
 and efficient. Whenever the disease has manifested itself, 
 even in its slightest form, thorough disinfection must be en- 
 forced. With &is single precaution no epidemic gives less 
 excuse for any unmanly or excessive fear, since none seems 
 to involve less of danger to those around. 
 
 11th. As cholera only affects the air of certain locaUties, 
 there is not the slightest necessity for any of those general 
 departures from the ordinary mode of hfe and diet which 
 were formerly recommended. The golden rule is to Hve 
 temperately, naturally, and well. 
 
 12th. Finally, no case of diarrhoea, cholera morbus, or 
 dysentery, can be converted into cholera unless the patient 
 has also been exposed to the peculiar infection of this dis- 
 ease. 
 
 In conclusion I put in no claim for great originality 
 in any portion of this work, except for the development 
 of the Physiological Theory, and the advocacy of the in- 
 ternal disinfectant and corrective treatment. 
 
ASIATIC CHOLERA, 
 
 1. ORIGIN. 
 
 Ordinary country, or Indian cholera, has been endemic in 
 the delta or marsh region of the Ganges for centuries. But 
 formerly it was a disorder peculiar to the natives, mainly in- 
 duced by their mean habitations, filthy habits, and poor food ; 
 and so rare among the better fed, clothed, and housed foreign 
 residents, that neither of the physicians who had been con- 
 nected, one for five and the other for ten years, with the 
 General Hospital of the Bengal Presidency for Europeans, 
 had seen a single case of the disorder previously to the out- 
 break of the great epidemic of 1817. At Jessore, in 1817, 
 it underwent certain unknown changes, so as to become in 
 many respects a new disease ; it then, for the first time, 
 became epidemic and pestilential, portable and doubtless 
 contagious ; and also first broke loose from its usual con- 
 fines, and commenced that fearful march of seventeen years' 
 duration, which did not cease until it had encircled the 
 globe. The great pecuHarity of that dread march was that, 
 although it reached China to the eastward, it did not, and 
 has never since crossed the Pacific ocean ; its westward 
 course was slow and interrupted, but upon the whole con- 
 tinuous, so that it reached Moscow, Hamburg, England, and 
 America, in about fifteen years. The second epidemic 
 
8 ASIATI C CHOLERA. 
 
 required five or six years to traverse the same space, and 
 that of 1865, only six months. This difference of speed 
 in the progression of the various epidemics is most easily 
 explained by the increased facilities and rate of travel 
 which have followed the extension of steamboat and rail- 
 road enterprises. After 1817, the disease was called epidemic 
 or Asiatic cholera, although twice previously to this date, it 
 had prevailed to such an extent in the town of Jessore and 
 its immediate neighborhood, as to render it necessary to shut 
 the courts of justice, and suspend aU business for a time. 
 
 Dr. Barnes, resident at Jessore for many years, had medical 
 charge of the district, from 1810 till 1823 ; he had been fa- 
 miliar with the ordinary Indian cholera, during all that time, 
 and considered it a disease peculiar to that section of the 
 country, and one which had superseded the periodical remittent 
 fever, formerly so prevalent in that district. He says, the 
 sources of this disease could not be mistaken, although they 
 were too extensive to be brought under human control. 
 Putrid exhalations from the constant and rapid decomposition 
 of animal and vegetable matter, and the use of unwholesome 
 water, were the sole causes. 
 
 But the extent and fatahty of its attack depended alto- 
 gether upon the season, or seasons ; for there were two in 
 which cholera was apt to prevail : 
 
 1st. If those violent storms of thunder, Kghtning, wind, and 
 rain, which annually occur in Bengal, and are known by the 
 name of northwesters, commenced early in March, and re- 
 curred at short intervals, until the rainy season began, then 
 the hot season as it is called, viz., April, May, and June, was 
 comparatively healthy, and vice versa. It is during this first 
 period that the disease is apt to spread to other countries ; 
 
ORIGIN. 9 
 
 for it gathers strength during the hot season, and is carried 
 on by travellers and pilgrims. 
 
 2d. If the annual rains did not terminate till the end of 
 September, and the floods subsided gradually during the 
 month of October, the autumn season would be free from 
 sickness ; but, if the rains ceased at the end of August, and 
 the waters sank rapidly during September, then the pesti- 
 lence commenced at the beginning of October and raged till 
 the middle of December, when it soon became apparently 
 extinct. The weather, in 1816 and 1817, rendered the 
 atmosphere peculiarly favorable for the development of 
 cholera, its extension beyond its usual limits, and even for 
 its generation throughout those parts of Bengal, where the 
 materials necessary for its production existed in a less 
 extensive degree than at Jessore. Instead of the usual 
 rainy and dry seasons, there was scarcely a week during 
 the whole twelve months from January to December, 1816, 
 without rain. The sun was constantly obscured ; the atmo- 
 sphere close, heavy and moist ; while the thermometer never 
 ranged below seventy to seventy-five degrees from March to 
 November. " In such a climate as this," says Barnes, " any 
 person acquainted with the materials that accumulate in In- 
 dian towns and villages, and with the crowded, filthy, and 
 ill-ventilated state of the houses and streets must be satis- 
 fied that these, of all others, are the conditions most favor- 
 able for contagion. The huts of the natives are nearly 
 surrounded with pits, the earth from which is used to 
 raise mounds on which their habitations are erected. These 
 trenches are the receptacles for every kind of nastiness, 
 as well as stagnant water, and the exhalations from them 
 are at times almost insufferable." From July to October 
 
 2 
 
10 ASIATIC CHOLERA. 
 
 the atmosphere of Bengal usually resembles that of a filthy 
 vapor-bath, producing a sensation of indescribable fatigue 
 and oppression, and an exhausting perspiration. 
 
 Jessore is • a thickly-populated town, one hundred miles 
 northeast of Calcutta, on a flat, reedy bank of the Gan- 
 ges, but shghtly elevated above the sea level; dm*ing the 
 rainy season the neighborhood of the place is changed into 
 a fetid swamp, covered with rank vegetation. By the side of 
 this sluggish water, stood the bazaar and long rows of low, 
 mean huts, surrounded by trees, which afforded shade, but pre- 
 vented the rapid escape of moisture. The river was the recep- 
 tacle for excrementitious matter, and the remains of partly 
 burned corpses were also thrown into it, in accordance with 
 religious superstition ; and this filthy water was often used 
 for drinking. In addition to these extremely insalubrious 
 conditions, the first rice harvest turned out badly, for there 
 are two rice crops in India yearly ; the first occurs in 
 August, and is always more or less unwholesome, like 
 very fresh hay ; sometimes it even produces a fatal dis- 
 ease, morbus oryzaeus, marked by vomiting and diarrhoea. 
 It is also asserted that an unusual quantity of spoiled 
 fish was eaten that year, the season being very unfavor- 
 able for its proper curing. Most violent attacks of vom- 
 iting, purging, and cramps, simulating cholera, have some- 
 times been traced in India to eating bad sheU-fish. 
 
 Some of these exciting causes of cholera prevail over 
 other portions of Bengal, besides in the neighborhood of 
 Jessore. 1st. During the rainy season, viz., from June to 
 October, from fifty to eighty inches of water falls, and 
 the surface ' of the Ganges rises until the lower part of 
 Bengal is inundated for a breadth of one hundred miles ; 
 
ORIGIN, 11 
 
 the river itself becomes two miles wide during the wet 
 season, while it is only half that widtli during the dry 
 time. Still, the same happens with the Nile, without sim- 
 ilar pestilential consequences. 2d. On the great plains 
 where lie the principal cities, and where the bulk of the 
 natives dwell, the heat, during the greater part of the 
 year is excessive ; the thermometer often ranging from 
 one hundred lo one hundred and ten degrees. 3d. The 
 population of Hindostan is very great, amounting to one 
 hundred and seventy-two millions, nearly ten years ago ; 
 and it has at least thirty cities with over one hundred 
 thousand inhabitants. 4th. In India, the religious preju- 
 dices of the people not only prevent them from using 
 the cattle-droppings as manure, but they consider them holy 
 and preserve them for religious purposes. There is especially 
 the utmost recklessness as to the disposal of all descrip- 
 tions of offal, and more particularly of the dejections from 
 the human intestine. Montgomery says : " The people are 
 naturally devoid of habits of cleanliness, and almost of 
 decency ; if allowed, they will not only resort to the pubKc 
 thoroughfares for the purposes of nature, but will construct 
 cloaca under the rooms in which they live, cook, and sleep." 
 In short, the filth of the native villages requires to be seen to 
 be believed in ; and the streets of all the cities are narrow, 
 dirty, and ill-paved. 5th. The rivers and streams are made 
 the common sewers and cemeteries of the towns, while the 
 great reservoirs or tanks of water, which are the chief public 
 works in Hindostan of native construction, supply a more or 
 less stagnant fluid, which is largely defiled by the careless 
 habits of the people. 6th. The frequent accumulation of hun- 
 dreds of thousands of persons together during their great 
 
12 ASIATIC CHOLERA. 
 
 religions pilgrimages and public fairs, with all the attendant 
 filth, misery, fatigne, exposure, and bad food. 7th. Every 
 camping-ground, or place of night's-rest of the pilgrims, not 
 only becomes saturated with filth, but remains for days, weeks, 
 or months, a depot of " cholera-dirt" for those who subsequently 
 linger on those contaminated places, or pass very near them. 
 8th. The people eat very httle meat, and subsist mainly on 
 rice. 
 
 Almost all these causes prevail in China, except the care- 
 lessness about human ordure, and the frequent aggregation of 
 inunense multitudes of unclean men, such as occur in the 
 pilgrimages and fairs, which are almost peculiar to the Hin- 
 dostanee and Mohammedan races ; yet cholera does not origi- 
 nate in China, as far as has yet been ascertained. China has 
 a population of over four hundred millions, and hence is 
 more overcrowded than Bengal; it has cities with miUions 
 of inhabitants, instead of a few hundred thousands as in 
 Hindostan ; but aU refuse applicable to the purpose of manur- 
 ing the soil is carefully collected and delivered to the farmers, 
 viz., human ordure, ashes, muck, gypsum, offal, hair, even 
 human hair clipped by the barbers, is saved with all other 
 matters which can invigorate the ground. Personal cleanli- 
 ness is not among the virtues of the Chinese any more than 
 among the Hindoos ; they do not change their under-clothes 
 till they are worn out ; their houses are poorly ventilated 
 and lighted ; many of their streets are crooked and narrow? 
 few of them exceeding ten or twelve feet in width, while 
 most of those in the city of Canton are less then eight ; but 
 although offal and manure are not allowed to decompose in 
 the street, there is a constant stench perceptible arising from 
 the continual passage of the loaded scavenger's carts through 
 
ORIGIN. 13 
 
 the city. Still, we repeat, in spite of all this, cholera does not 
 originate in China, where religious pilgrimages are also not so 
 frequent, nor of such gigantic proportions as in India. 
 
 We will now turn our attention to the effect of pilgrim- 
 ages in the production of cholera in India. 
 
 As early as 1858, Dr. Nardoo, of the Madras medical estab- 
 lishment, drew attention to the causes which give rise to 
 cholera among the pilgrims to Juggernaut. He states that 
 the food of the devotees is prepared exclusively by the 
 priests, in the temples ; this stuff is acrid, oily, and often 
 putrid; and the drink sour. The pilgrims arrive at their 
 tabernacles after undergoing every fatigue on their toilsome 
 marches, half starved, and much exhausted, and are con- 
 ducted to small and badly-ventilated rooms for the accommo- 
 dation of twenty to thirty persons each ; they wash them- 
 selves in foul pools or tanks, and visit the image with their 
 wet clothes still upon them ; eat a variety of bad food with 
 eagerness, taking no notice of its condition, taste, or quality, 
 under a deeply-impressed idea that such observation would be 
 an act of blasphemy ; drink a jumbo full of very sour, rancid 
 tyre and feel themselves refreshed and very much satisfied, 
 for the first twenty-four hours. But on the second or third 
 day the causes of diarrhoea and cholera, viz., sudden transition 
 from heat to cold, ahment of indigestible character, acrid, 
 oily and putrid food, acid drinks, and want of free ventilation 
 and drainage, soon begin their operation. 
 
 The streets and houses quickly become impregnated with 
 noxious exhalations emanating from the decomposition of the 
 excrementitious and urinous deposits with which the streets 
 and aUeys, fields, and plains, are loaded during the assemblage 
 of people in such great numbers, as well as from the dead 
 
14 ASIATIC CHOLERA. 
 
 bodies tlirown out in the fields and towns without sepnlchre. 
 Diarrhoea and cholera having thus originated, great alarm and 
 despair are produced among the pilgrims ; fright and despon- 
 dency on the one hand, and their longings for home, rela- 
 tions, and friends, on the other, act conjointly as depressing 
 agents, rendering their systems more favorable to the action 
 of disease. Dr. Nardoo says the ravages made by this dis- 
 order are annually very lamentable ; and that it is most pitiable 
 to observe the dreadful scenes at Juggernaut, resulting from 
 deaths in such vast numbers. 
 
 Stewart Clarke says a fresh outbreak of cholera takes place 
 at the great fair at Hurdwar, nearly every year. 
 
 Dr. Montgomery, of Madras, has given a most careful and 
 graphic account of the habits of pilgrims, and the origin of 
 cholera among them. He says : *^ The Eastern pilgrims 
 travel, either on foot, walking incredible distances under a 
 burning sun, or closely packed in stifling carts, which are 
 crammed to suffocation by human beings, and from which 
 every breath of air is carefully excluded. Thus, they strug- 
 gle along indifferent roads, or no roads at all, slowly dragged 
 by miserable, half-starved, over-worked bullocks. Their food, 
 indifferent in quality at the best, is cooked under the shade 
 of a tree, or beneath the cart in which they travel; and 
 they drink pernicious arrack, or fermenting toddy, or offen- 
 sive tank or well water, which is scarcely less pernicious. At 
 night they sleep in the foul conveyances in which they 
 have travelled, or lie exposed on the ground, chilled by dews 
 or damp, and subject to the influence of the cold land wind. 
 If they stop at a native town, they crowd into the over- 
 filled bazaars, and sleep, perhaps, in some filthy choutry (or 
 travellers' rest-house), seldom little more than a shed en- 
 
ORIGIN. 15 
 
 closed on two or three sides ; and there they lie packed as 
 close as may be, with the thermometer at seventy or eighty 
 degrees at the lowest. 
 
 " Can it be wonderod at that they are unhealthy ? Is it sur- 
 prising, if, on reaching the goal they seek, when they mingle 
 with others influenced by similar injurious surroundings, and 
 meet in a densely-crowded native town without sanitary pre- 
 cautions, and drink loater defded by cattle, the washings of 
 carts and filthy clothing, and the bathing of crowds of foul 
 human beings, they fall victims to disease ? The wonder is 
 that any should escape. 
 
 " Situated at a distance of forty-five miles from Madras 
 is a native town called Conjeiveram. It is large, pretty, and 
 regularly built ; the streets are very broad, and planted 
 with cocoa-nut trees ; and a beautiful stream runs along its 
 western side. The soil is very fertile ; the river and sur- 
 rounding tanks are favorable for irrigation and cultivation ; 
 the inhabitants are chiefly ryots (cultivators of the soil) 
 and weavers ; and many Brahmins reside there. The large 
 pagoda or temple at Conjeiveram is greatly famed in heathen 
 mythology, and is one of the great strongholds of Hindooism 
 in Southern India. The city therefore appears to be favorably 
 circumstanced for the maintenance of pubhc health. Many 
 of the inhabitants, and especially those attached to the 
 temples, and also the leading cloth merchants of the place, 
 are wealthy. It occupies a somewhat secluded position, and 
 the mode of construction of the town, with its broad streets 
 for the passage of large processions along its leading 
 thoroughfares, is favorable to ventilatiop^. The occupations 
 of the people are. healthful, much of the weaving being- 
 carried on out of doors ; and the general health of the 
 
16 ASIATIC CHOLERA. 
 
 natives is satisfactory. The festival is comparatively of short 
 duration (about ten daj^s), and held in the month of May, 
 which is not unhealthy in that part of India. Yet, with all 
 these advantages, the annual feast at Conjeiveram is almost 
 regularly the means of introducing pestilence into Madras. 
 Scarcely a year np to 1863 passed without an outburst of 
 cholera, during or immediately subsequent to the festival ; 
 and its appearance in Madras, a few days afterwards, has 
 been directly traced in many instances to the visitors re- 
 turned from Conjeiveram. A better-marked example of the 
 deadly effect of these festivals could scarcely be found. For 
 here we have a town naturally tolerably salubrious, with a 
 population independent and healthfully employed, and yet 
 find that cholera appears with the aggregation of strangers, 
 even though the majority of them have come comparatively 
 short distances, and their stay is limited. 
 
 **Up to the festival of 1863 no provision of any kind 
 of an hygienic nature had been made. No latrines or 
 places of public convenience were erected, and an indiscrimi- 
 nate collection of men, women, children, bullocks, horses, 
 and cattle, of all kinds, crowded and defiled the public 
 streets, and polluted the water. Pigs, the natural scav- 
 -^ugers of an Indian town, devoured the foul and decom- 
 posing excreta, festering under a tropical sun, and were 
 subsequently slaughtered to supply pork for Madras. Mad 
 revelry by day and night, when the tumult rendered 
 sleeping a matter of difficulty even to a native, excited 
 to a preternatural degree the religious zeal of the Hin- 
 doo ; while excess and debauchery prostrated his ener- 
 gies and made him an easy prey to disease. The efflu- 
 vium arising from decomposing excreta polluted the air, 
 
ORIGIN. It 
 
 and in this foul atmosphere the inhabitants of the town 
 had to live, with an addition of two hundred thousand 
 strangers. The carts in which the pilgrims came to the 
 feast became saturated with the poisonous atmosphere. 
 The clothing of the poorer saints, tainted by prolonged 
 wear, and the various contaminations likely to arise during 
 an orgie of days, rendered each of the miserable dev- 
 otees, upon his return to Madras, the possible nidus of future 
 disease. Exhausted, weary of excitement, with all the sus- 
 taining hope of religious zeal to support them gone, they 
 hastened back to the presidency town, itself notorious for in- 
 sufficient cleanliness, thus perilling the lives of all. 
 
 " In connection with the foregoing facts regarding the con- 
 dition of a town, when the scene of a religious festival, we 
 will next turn to the consideration of the effects left behind 
 by bands of pilgrims traversing the land. Some of these 
 come from the provinces of Upper and Central India, collect- 
 ing from distant stations in bands more or less numerous, but 
 sometimes amounting to thousands. Many of these, poor, ill- 
 fed, and diseased, start on their tedious journey of some fifteen 
 hundred to two thousand miles. The miserable caravan slowly 
 wends its way, which, for obvious reasons, is that of the grand 
 trunk roads of Southern India. Visiting the sacred shrines of 
 Trichinopoly, weary and exhausted, they still pass on, tiU at 
 length their courage is revived by the longed-for sight of the 
 sacred island of Eamieseweram ; for visits to this island, and 
 bathing in the sacred waters, where the two seas mingle, are 
 supposed to free from sin and give a passport to immortality. 
 This belief explains the strong motive that impels all these 
 pilgrims, who, so long as their religion lasts, will continue to 
 flock to Eamieseweram, and to be a constant source of disease, 
 
 2* 
 
18 ASTATICCHOLERA. 
 
 if stringent measures are not adopted to clieck the evils they 
 give rise to. Ten years ago the population of the island 
 was under five thousand, but no less than one hundred and 
 thirty thousand annually arrived there to worship. To this 
 a large addition must be made for those who failed to reach 
 the goal ; the hearts of many fail them, the money of others 
 fall short ; frequently death has checked them, for thousands 
 of graves, unseen because unmarked, exist on these trunk 
 roads of the pilgrims. 
 
 " But, perilous as is the journey thither, the return is even 
 more fraught with danger. When their ceremonies have 
 been performed, and when the strong feelings of religious 
 enthusiasm have been gratified, they yoke their travel-worn 
 cattle, and set their faces homeward. No longer upborne 
 by excitement, the object of their lives fully attained, wearied, 
 poor, and with no hope to cheer them on their way, they start 
 on their return journey unresisting victims to the first mor^ 
 bific influence which assails them. On the home-stretch all 
 the dangers of the outward route are encountered in an ex- 
 aggerated form; they return to the filthy camping grounds 
 before defiled by themselves ; they listlessly occupy the 
 same infected vehicles which brought them; they are de- 
 pressed by the dread that spoliation of their property has 
 occurred during their absence, and they are in a strange 
 country, speaking an almost unknown tongue. Forced 
 marches knock up both man and beast ; and footsore, down- 
 hearted, and ill-fed, they fall an easy, unresisting prey to epi- 
 demic disease. 
 
 " Another prolific source of cholera is the great fair of 
 Bigginuggar, which annually collects thousands of native 
 traders, and, like that of Hurdwar at the issue of the Ganges 
 
ORIGIN. 19 
 
 from the Himalayas, is equally with Conjeiveram and Ramiese- 
 weram, a source of annual danger. From these centres, cholera 
 almost always accompanies the homeward-bound pilgrims or 
 traders, and the gradual dispersion of the travellers is the im- 
 mediate means of distributing and propagating the disease, if 
 it has seized them. The villages on their route are visited, and 
 as free intercourse with the villagers and frequent access to 
 the crowded and unhealthy bazaars are inevitable and cannot 
 be controlled, great diffusion of cholera results. The public 
 roads and thoroughfares become saturated with elements of 
 disease, and dangerous to troops or private travellers who are 
 exposed to their emanations. We have but to recollect the 
 numberless instances of cholera imported into m^oving cam}: s 
 or attacking private individuals to recognize the facility with 
 which passers-by- are often found to succumb under this con- 
 tagion. Supplies have to be obtained from villages already 
 infected by the pilgrims, and even the slight amount of inter- 
 course thus arising may implicate the safety of a whole com- 
 mand. But, in addition to this explanation of seizures of 
 cholera among soldiers, and independent of the predisposing 
 causes which travelling itself originates, it is no fancied con- 
 clusion to infer that if troops pass near or even rest for a slioit 
 time upon tainted camping grounds, they become the victims 
 of disease. Of this latter point a sad proof was given within 
 the limits of the Madras presidency, at least as affecting- 
 some of its army, for, on the breaking up of the Sangar divis- 
 ion in 1860, many of the regiments, returning to their own 
 stations, crossed the route of the pilgrims who had gone to 
 and returned from Ramieseweram, and in number ous instances 
 they were attacked with cholera. This was no rare coinci- 
 dence, but occurred with such frequency and precision 
 
20 ASIATIC CHOLERA. 
 
 that it must be deemed a natural effect of an undoubted 
 cause. In 1859, Inspector-General Macpherson records, 
 that a detachment of the 74th Highlanders were attacked 
 with cholera from passing within one hundred yards of 
 the camp of the 35th regiment when it was suffering 
 under an epidemic of that disease. The same regiment was 
 subsequently brought down to Madras to embark for 
 England in 1864, and being most improperly encamped 
 on ground deffled by previous occupation, for weeks, of 
 the 76th foot, was attacked with cholera, and a great num- 
 ber of deaths ensued. In this case, the first occupants 
 of the ground had not suffered from the disease ; and in 
 all these instances the troops were in high health ; those 
 from Central India had passed through a glorious cam- 
 paign ; they had won a large amount* of booty, and were 
 under the professional charge of medical officers of great ex- 
 perience, thoroughly competent to adopt any possible means 
 to guard the lives and health of. the men in their charge. 
 Yet, they fell victims to the foul atmosphere and soil of 
 camping-grounds tainted hy previous occupation. The case 
 of the 74th at Madras is another proof of the innate 
 power of infected regiments to generate epidemic disease, 
 for cholera was brought from the camp (six miles off) into 
 Madras, soon took root and spread rapidly in a densely- 
 populated portion of the city, remarkable for its want of 
 ventilation and cleanliness. Analogous to the experience of 
 the detachment of the 74th Highlanders (quoted above) who 
 contracted cholera near BeUary from an affected camp by 
 which it passed but did not halt, was that of a wing of 
 the 43d regiment of Europeans, who passed through a vil- 
 lage near Palmanair — one of a number of small native vil- 
 
ORIGIN. 21 
 
 lages, skirting the frontier border of the Mysore table-land, 
 and some two thousand feet above the level of the sea — it 
 was seized with cholera, and the men brought into Madras 
 dying by scores, some of their dead bodies lying among the 
 living, for miles of their dreadful railway journey. If it 
 were necessary to multiply proofs of the ill effects of native 
 encampments and of native habits of travelling, they could 
 easily be given. 
 
 " The native cities may be regarded as permanent filthy 
 encampments. Madras abounds in cart-stands, where native 
 travellers* vehicles are parked, places uncared for, appa- 
 rently, by any one, and they are for the whole year round 
 nuclei of epidemic choleraic disease. The larger up-country 
 railway stations — as, for example, Coimbatou and Salim — 
 are found to prove perfect nests of cholera ; the virulence 
 of which is maintained by an almost total absence of clean- 
 liness. Cholera is always present in Calcutta, which we have 
 already had characterized as one of the filthiest cities in the 
 world. There is not a month in the year in which deaths 
 do not occur from it, both European and native. It is the 
 cause of one third of the total deaths, which vary from 
 eleven thousand to sixteen thousand per year, out of a native 
 population of about four hundred thousand. The deaths 
 from cholera, from 1840 to 1850 were forty-six thousand, six 
 hundred and ninety-seven ; in 1850 to 1860, forty-five thou- 
 sand, eight hundred and twenty-three. The smallest mor- 
 tality in any one month was, forty-six, in July, 1843 ; the 
 largest is generally in April. 
 
 " No language can be used that would be too strong to 
 deprecate the wanton risk to human life which is needlessly 
 allowed to cause such dire results ; and no exertions should be 
 
22 ASIATIC CHOLERA. 
 
 spared to save the life and protect the health of the general 
 population of India, in villages, cities, and encampments. 
 Very simple measures may suffice to ward off much of the 
 danger now threatening citizens and pilgrims, and those who 
 follow their line of march, and it may even be possible, by 
 timely warning, to enable the commanding and medical offi- 
 cers of troops to guard their men against the dangers of 
 pestilence from occupying old camp-grounds. 
 
 " In accordance with these views, in 1864, steps were 
 taken to mitigate the evils alluded to at the grand feast 
 of Conjeiveram. Cattle were, as far as possible, removed 
 from the strict limits of the town. Public places of con- 
 venience were erected, and their contents removed twice 
 a-day. The main streets were swept and watered, and sup- 
 pKes of good water were made available near places of pub- 
 lic resort. As regards the result of these measures. Captain 
 Cloete, superintendent of police, writes : ^ In 1862 and 1863, 
 at this festival, the effluvium arising from the hedges and 
 ditches on the side of the main street was so offensive as 
 to make it quite sickening to walk in the streets in the 
 morning. In 1864, 1 walked a distance of about two miles 
 at daylight, and experienced no more disagreeable smell 
 than is to be noticed in the bazaar at all times. The con- 
 trast to the previous year was most marked, for not one case 
 of cholera occurred during the festival, although it seldom 
 or never, happens that cholera does not break out either 
 in Conjeiveram itself, or among the people returning from the 
 festival, or in Madras after tlie feast. I have not heard 
 of any case in which the seeds of the disease were traceable, 
 as having been sown in Conjeiveram. It and the adjacent 
 villages have been singularly free from cholera since the fes- 
 tival, and, to my belief, Madras has been unusually so.'" 
 
ORIGIN. 23 
 
 In this conviction, Captain Cloete is doubtless correct. 
 Madras was unquestionably saved from an epidemic by the 
 timely sanitary precautions observed at Conjeiveram. Of 
 the particular caste of persons willing to do the scavengery 
 necessary, none were to be found in the place, and they 
 had to be forwarded from Madras, forty-five miles distant. 
 This absence of the sweeper caste in Conjeiveram causes an 
 accumulation of rubbish, house refuse, and excreta, to remain 
 piled up in the yards, even of the wealthier classes, which 
 alone is sufficient in a hot climate to breed disease. But 
 even the scavengers did not bring back the disease to 
 Madras. Mr. Kinsley says, in a report on these sanitary meas- 
 ures : " During the ten days of the festival the town remained 
 free of cholera, and no cases occurred that year, although tra- 
 dition says that ever since cholera was first known in India, it 
 has never failed to make havoc among the Hindoo population 
 at this festival. So notoriously was, and is, this the case, that 
 it is said people from distant places, before starting for this 
 feast, take solemn leave of their friends in anticipation of their 
 never returning." Similar precautions were observed in 1865 
 with a like favorable result, although the year was notoriously 
 unhealthy. 
 
 We are now prepared to point out the principal factors 
 of an epidemic of cholera: 
 
 1st, An atmosphere impregnated with the products of 
 fermenting human excrement is at once the most obvious and 
 constant concomitant of the disease. 
 
 2d, An elevated temperature with a still, stagnant, and 
 peculiarly oppressive condition of the atmosphere (more 
 oppressive than the elevation of the thermometer can ac- 
 count for). During almost all cholera epidemics the nights 
 
24 ASIATICCHOLERA. 
 
 were warmer tlian the days ; the atmosphere, on both land 
 and sea, was singularly stagnant, and so unusually still, 
 close, and hot, that it was impossible to ventilate even 
 large houses, in which no change of air seemed to take 
 place for almost a week together. 
 
 3d. Unusually high readings of the barometer, viz., over 
 30°, and up to 30.46°, and 30.48^. Such meteorological con- 
 ditions have a marked tendency to favor the chemical de- 
 composition of organic substances, and to render the season 
 defective in those atmospheric changes, which, by decom- 
 posing and dispersing into space the products of putre- 
 faction, renew the purity of the air. 
 
 4:t7i. Lowness of site, swampy grounds, moist soil, decom- 
 position of vegetable matter, and all those causes which 
 tend to produce bilious and remittent fevers. 
 
 6th. Foul camping grounds, filthy streets and yards. There 
 is much proof, that not only the fresh moist soil of contam- 
 inated grounds is injurious, but that these, even when in a 
 dry and dusty condition, are equally dangerous. Numerous 
 instances are given in India, in which travellers, merchants, 
 and soldiers, have encamped upon parched and arid places, 
 and have quickly sickened in great numbers soon after the 
 dust was thoroughly stirred up by the movements of men 
 and animals. 
 
 6th. Impulse water, especially that which is poisoned 
 by the washing of the persons or clothes of cholera sub- 
 jects, or which has been fouled by cholera discharges di- 
 rectly emptied into it, or which has had cholera matter per- 
 colated into it through the soil, or by means of imperfect 
 drains. 
 
ORIGIN. 25 
 
 1th. Bad, spoiled, or defective food; especially spoiled or 
 rancid meats or fish ; unripe or stale fruits and vegetables, 
 &c. The natives of both Hindostan and Egypt prefer un- 
 ripe melons, and think all others destitute of flavor. 
 
 We agree substantially with Dr. McLean, Deputy Inspector- 
 General of England, who concludes, from great experience in 
 India, that cholera is generally propagated by human inter- 
 course, and, in aU probabihty, mainly by the poisonous ac- 
 tions of the excretions of affected persons, after they have 
 undergone certain changes and decompositions ; that camps 
 and dormitories most under the influence of a privy or 
 fsecal atmosphere, invariably present the largest number 
 of cases and the heaviest mortality; that cholera always 
 starts from some city or district in India, and is spread by 
 pilgrims, bodies of travellers, or troops, who are in move- 
 ment from village to village, or from one district to another ; 
 that a tainted regiment or caravan will disseminate the dis- 
 ease along its route ; that a healthy caravan or regiment 
 meeting with a choleraic one almost invariably contracts 
 the disease, and becomes a fresh focus or centre of propa- 
 gation along its line of march ; that healthy bodies of men 
 who camp on ground saturated with the discharges of 
 cholera patients usually suffer severely. 
 
 Dr. Montgomery gives the following summary of the causes 
 of cholera : 
 
 (1.) Undue exposure to the vicissitudes of climate, espe- 
 cially during cold nights following hot days, and the occur- 
 rence of certain atmospheric conditions, including frequently an 
 absence of ozone. 
 
 (2.) Physical fatigue and nervous depression from prolonged 
 
26 ASIATIC CHOLERA. 
 
 traveliing, mental apprehension and sorrow ; or fear, more 
 especially of this disease. 
 
 (3.) Undue abstinence or deprivation of food, or the presence 
 of injurious properties in it. 
 
 (4.) Excess in eating and drinking, and licentiousness. 
 
 (5.) Vitiated atmosphere from all foul causes, such as filthy 
 camps, nasty houses, streets, yards, &c. 
 
 (6.) Direct exposure to the contagion of the disease, 
 
 (a.) As regards the first of these causes, the most unhealthy 
 seasons in India are those before the commencement and at 
 the close of the rains. These periods, technically called the 
 monsoons, rapidly chill the air at their onset, and predispose 
 to fevers and bowel complaints ; while their termination, 
 marked by the subsidence of floods, exposes decaying animal 
 and vegetable matter to the influence of a tropical sun. Hence, 
 out of 92,000 deaths, 65,000 occurred in the seven dry months, 
 and only 17,000 in the five rainy ones. In twenty Aprils, there 
 were 16,193 deaths ; in twenty Augusts, only 2,586 fatal cases. 
 The dry months are : November, December, January, Febru- 
 ary, March, April, and May. The wet months : June, July, Au- 
 gust, September, and October. The hot months are : one half 
 of February, March, April, May, and one half of June ; the hot 
 and wet months : one half of June, July, August, September, and 
 one half of October ; and the cold months ; one half of October, 
 November, December, January, and one half of February. Twice 
 as many die in the cold months as in the wet ; and more than 
 four times as many in the hot as in the wet months. Natives 
 suffer most in the cold months ; Europeans in the hot months. 
 
 A heavy fall of rain for a couple of hours has often stopped 
 an outbreak, at least, for a time. Macpherson always looked 
 
ORIGIN. 2t 
 
 with pleasure upon rain, certain it would relieve him from 
 much of the anxiety which always attends the treatment of 
 cholera. 
 
 As regards atmospheric phenomena, it will be remembered 
 that when the cholera &st appeared in India, in 1817, the year 
 was from its commencement uncommonly moist, and the an- 
 nual rains began in Bengal some three weeks before the usual 
 time. The delta of the Ganges was so flooded as to become 
 one vast sheet of water, and the rains exceeded the average of 
 ordinary years by some thirty-three per cent. Jessore, the 
 station from which the disease originated, was especially ex- 
 posed to these injurious influences, lying as it did in a dense 
 jungle, surrounded by stagnant water, and receiving all the 
 filth of the up-country. The disease, in a mitigated form, was 
 not however absent from other parts of Bengal, and more 
 especially from Calcutta, which was then, and is now, 
 one of the filthiest cities in the world. With appalling ra- 
 pidity the pestilence spread through the different cities of 
 Bengal, up towards the source of the Ganges, and beyond 
 the Jumna. The territories of Oude arid Rohilcund, lying 
 on an elevated plateau, appear not to have suffered in 
 the first instance, though they did subsequently. Within 
 two or three months of the first appearance of the distemper 
 it was brought to the camp of the Marquis of Hastings, 
 then moving slowly through the low and unhealthy district 
 of Bundelcund. A reign of terror followed its appearance — 
 and the army became temporarily demoralized. The epidemic 
 only lasted eight days, but during that time one thousand 
 seven hundred and sixty-four soldiers and eight thousand 
 native followers died. The sudden subsidence of the malady 
 allowed the progress of the army, and its health became 
 rapidly re-established. 
 
28 ASIATIC CHOLERA. 
 
 (5.) Of the second predisposing cause, namely, physical 
 fatigue and nervous depression, it need only be said, that 
 experience has conclusively shown that individuals proceed- 
 ing on long journeys, or after their conclusion, are markedly 
 liable to be attacked. It has been conclusively shown 
 from well-framed and trustworthy statistics, that the prob- 
 ability of cholera in the Indian army may be estimated as 
 being in direct proportion with the number of men and the 
 distance to be travelled. Macpherson alludes to the readi- 
 ness with which, in certain districts, both European and 
 native troops get cholera on their line of march. He says 
 it is weU known how pilgrims on their way through Lower 
 Bengal and Orissa, strew the road to Juggernaut with their 
 bones. Natives traveUing are just as apt to suffer as Euro- 
 peans. Previously fouled camp-grounds are doubtless active 
 agents here. Mental or nervous depression is a recognized 
 source of danger. 
 
 (c.) Undue abstinence, during which the absorbent sys- 
 tem is unusually active and the nervous system suffers 
 under hypersensibility induced by depressed vital power, 
 tends to its development; particularly if any of the little 
 food used is of an improper description, either from directly 
 producing intestinal irritation, or as wanting in nutrition. 
 To the importance of this latter source, too much attention 
 cannot be given. The laborers on the canal of Suez were 
 mainly preserved from cholera, in 1865, by the issue of 
 additional rations of healthy animal food. Certain articles 
 of diet have indubitably been the immediate and exciting 
 cause of a cholera capable of propagation, and of inducing 
 a fatal termination. Many vegetables, more especially of 
 
ORIGIN. 29 
 
 the orders of cruciferae and cucurbitacse, cause many of the 
 symptoms, and are capable of originating the disease, or at 
 least of developing it when the seeds have been latent. 
 Unripe watermelons are conspicuous among these articles of 
 diet, and are consumed by the natives in immense quanti- 
 ties, more particularly when they are travelling and during 
 the hot season — when pilgrimages are usually made. Its 
 first appearance was by some referred to diseased rice. 
 
 (d) Equally, if not more injurious, than insufficient or im- 
 proper food is excess; and this is common among the Hin- 
 doos, in the use of alcoholic and narcotic stimulants and 
 extreme venery, to an amount that would hardly be cred- 
 ited among European nations, but which is common enough 
 among natives, particularly at festivals. 
 
 (e.) Of the evil effects of overcrowding in houses, and of the 
 influence of bad air, it is not necessary to say much, but the 
 imagination of an English mind, could never depict the extent 
 to which causes of disease are allowed to exist in native 
 towns. Mere humanity itself, can, as we know, poison the 
 surrounding air and fill it with fatally morbific elements. In 
 these cases, cholera is not of necessity produced, but a fruit- 
 ful ground is prepared where its seeds will germinate and 
 eventually spring up under favoring circumstances. 
 
 (/.) Last, but not least, among the immediate and direct 
 causes of individual seizures of cholera, stands the exposure 
 to its poison. 
 
30 ASIATIC CHOLERA. 
 
 2. COURSE AND D I S T HI B U T I N . 
 
 Having thus, in some measure, accounted for the origin of 
 cholera in India, it becomes our next duty to chronicle its 
 progress and diffusion over the world. First, we recall the 
 fact, that although it is over forty years since it first prevailed 
 in China it has never crossed the atmosphere of the Pacific, 
 while it has repeatedly been brought across the Atlantic 
 ocean. In 1817, the facilities of travel in India were very 
 much less than they now are in Europe, and we find that 
 cholera then only travelled westward^ about twenty-one miles 
 per week. It is also presumable that there was a greater fre- 
 quency and rapidity of commercial and personal intercourse 
 between Eastern and Western Hindostan than between Cal- 
 cutta and China ; and we find that it only progressed about 
 ten miles a week from the Ganges to Canton. When it 
 reached Europe in 1830, it travelled from eighty to one hun- 
 dred miles a week, and crossed the Atlantic, in old-fashioned 
 sailing-vessels, at a speed of three or four hundred miles 
 in seven days. Again, Moscow was the first large city 
 in Europe reached by the epidemic of 1817, and it did not 
 arrive there till 1830. At that time Moscow was the com- 
 mercial emporium of Central Russia and Western Asia ; pa- 
 godas, temples, churches, Chinese tea-houses, French cafes, 
 Turkish bazaars, and Russian market-places, were there jum- 
 bled together ; and Persians, Armenians, Tartars, Circassians, 
 Russians, Poles, G-ermans, French, and other Europeans met 
 in a common centre. Asia and Europe came together, and, 
 of course, cholera found its way there also, and was thence 
 distributed to Germany, England, and America. 
 
 To return to India. The first great epidemic comxmenced, as 
 
COURSE AND DISTRIBUTION. 31 
 
 usual, in the marsh region of the Ganges at Jessore ; in a 
 month it progressed one hundred miles south to Calcutta, 
 which is one of the filthiest cities in the world, and raged 
 there more than a year. It required between two and three 
 years to traverse India, from Calcutta on the East to Bombay 
 on the West, where it arrived in 1820, and destroyed over 
 one hundred and fifty thousand persons. In 1821, it advanced 
 to the northwest, pursuing the course of rivers and travelled 
 roads to Persia, Arabia, and Asia Minor. There it seemed to 
 stop for a time, and devastated Central Asia ; but in 1829, it 
 reached Southern Persia, and arrived in Moscow in 1830. 
 
 At one time it was quite common to assume that the cholera 
 poison was wafted solely by means of a steady atmospheric 
 wave. But we have no record of a wind which blew for thir- 
 teen years on the line from Calcutta to Moscow ; while we 
 know that in India, the disease advanced from east to west 
 in the face of a monsoon blowing persistently night and day 
 in the opposite direction, and marched down t£e western 
 shore of the Bay of Bengal in the face of a similar wind. It 
 foUowed the course of travellers and not that of the wind. 
 Even of the first epidemic, it is stated by Professor Tommasini, 
 on the authority of Dr. Frias, who had lived several years in 
 Alexandria, that the disease was carried from Mecca to Alex- 
 andria by pilgrims returning from the feast of Kurbar-Bariam. 
 There was no steamboat navigation on the Mediterranean in 
 1817 to distribute the disorder promptly. 
 
 The second great epidemic commenced in India in 1844, and 
 by 1847 had reached Tantah in the delta of the Nile, where 
 165,000 pilgrims had assembled from all parts of Syria and 
 Egypt ; over 3,000 died there of cholera, and soon after the 
 dispersion of this vast crowd, it appeared in Cah'o and Alex 
 
32 ASIATICCHOLERA. 
 
 andria, and also quickly forced its way into Persia. In Lower 
 Egypt alone, 55,000 died in 1847, out of a population of 
 2,500,000. It reached Moscow the same year ; was carried 
 again from Russia and Germany, in ships to London, in Octo- 
 ber, ] 848, and arrived in America soon after. 
 
 About the present epidemic, or that of 1865 and 1866, we 
 have gathered the following account : In the month of March, 
 1865, the cholera showed itself on the banks of the Ganges, 
 its perpetual bed, and raged for twenty-two days as an epi- 
 demic without leaving the country ; then, possibly, somewhat 
 aided by a strong southwest wind, it began to move, dividing 
 itself into two columns, one following the track of the Hindoo 
 pilgrims as far as Mecca and Medina ; the other, not less ter- 
 rible, advanced by Affghanistan towards Cashmere and Bok- 
 hara, and thence forced a passage into the Russian provinces 
 of Asia, and into Russia in Europe, accompanying the caravans 
 of merchants. It broke out on ships with pilgrims, and also 
 on the line of march of the Hindoo pilgrims on their way from 
 India to Mecca, long before anything of the kind had occurred 
 at Mahomet's shrine. Early in May, seven hundred thousand 
 pilgrims and over one million of animals arrived at Mecca. Most 
 of these were, of course, poorly clothed, had long been badly 
 fed, and many of them were exhausted ; they found no en- 
 campment worthy of consideration, no sufficiency of fresh, 
 wholesome food, no fuU supply of pure, fair water ; they made 
 no latrines or drains ; no one was ready or wilKng to bury the 
 dead ; they were exposed to great heat ; and finally, on a par- 
 ticular day each pilgrim was required to sacrifice one animal. 
 The enormous mass of blood and entrails which was cast 
 among the other heaps of filth which had accumulated in a com- 
 paratively small place, was sufficient to engender severe dis- 
 
COURSE AND DISTRIBUTION. 33 
 
 ease : and, in addition, " cholera-matters" were introduced by 
 the Hindoo pilgrims. It is below the mark to say, that forty 
 thousand of the devotees died of cholera in 1865, at and near 
 Mecca. We have seen that the festivals of the Hindoos at Jug- 
 gernaut, Conjeiveram, and Kamieseweram, and their great fairs 
 at Hurdwar and Bigginuggar, have often played an important 
 part in the origin and distribution of cholera — ^hereafter the 
 Kourban-Bairam, or " Feast of Sacrifices," at Mecca, will hold 
 the first rank in public estimation. Mecca is so close to the east 
 bank, and so nearly opposite the centre of the Red Sea, that 
 it becomes a convenient place for the distribution of cholera. 
 Nearly twenty thousand pilgrims from Mecca, all more or less 
 infected, passed the Isthmus of Suez, early in 1865, in order to 
 embark at Alexandria for Europe and Algeria. Suez and 
 Alexandria were healthy until pilgrims returning from Mecca 
 arrived there. 
 
 Dr. Frazer, a resident of Suez, says it is not only the great 
 highway for intercourse and traffic between Europe and Asia 
 including Australasia, but forms besides the chief route for the 
 devout of the Islam world, from Asia and Africa, Bokhara, 
 Turkey, and the Crimea, and from the very centre of North 
 Africa. At Suez, cholera has always been distinctly traced 
 to importation, and has in every instance been brought by 
 the pilgrims on their way either to or from Mecca. It has 
 been brought from North Africa and the Crimea, to Suez and 
 Mecca, and vice versa. 
 
 From Mecca and Suez it quickly reached Cairo, where it 
 raged only twelve days ; the atmosphere of the city is exces- 
 sively dry, as for twenty leagues around there is a complete 
 absence of marshes. But the very place in Cairo, where the 
 common people obtain their drinking water, is impregnated 
 
 3 
 
34 ASIATICCHOLERA. 
 
 with loathsome impurities ; many large barracks are there 
 and a numerous collection of grain and other boats in the 
 vicinity, and the soldiers and boatmen use the river as a great 
 ceBspool or water-closet. 
 
 From Cairo it was carried to Alexandria, where it prevailed 
 three weeks. Alexandria is a damp city, surrounded by 
 immense marshes, and the air is loaded with carhonic add. 
 Cholera once lingered around St. Petersburgh for four years^ 
 apparently because that city is built on marshes, and the air 
 contains at least four parts per thousand of carhonic acid. 
 Cholera first appeared in Alexandria, on May lith, 1865, 
 near the railway station from Cairo, in one of the lowest sub- 
 urbs of the city, and inhabited by 20,000 of the lowest class 
 of Arabs, Greeks, and Maltese. It seemed to arise from one 
 case, but doubtless many others were imported ; only three or 
 four died during the first two or three days ; then eight to ten 
 succumbed daily. By June 1st, there were 30 deaths per day ; 
 on the 17th, 61, and on the 25th, 183. At this time the sani- 
 tary condition of the city was infamous, and the water-supply, 
 derived from the Nile, was charged in its course with decom- 
 posing matter derived from the carcasses of 700 animals lying 
 in the canal. In Lower Egypt alone, over 80,000 died of 
 cholera in 1865. 
 
 The malady was brought to Aleppo by a Persian caravan, 
 August 14, 1865 ; at first there were only five or six deaths 
 per day ; then 40 to 50, and by September 1st, 250 died every 
 tweniy-four hours. It was also taken to Bagdad by pilgrims 
 from Mecca, and thousands died in a short time. 
 
 For some days it was hoped that the disease would be 
 staj'ed at Alexandria ; but it soon appeared at Constantinople, 
 and a few days later at Ancona, in the direct line of steamboat 
 
COURSE AND DISTRIBUTION. 35 
 
 travel. In Constantinople it is estimated that 50,000 persons 
 died ; and in one district of the city, with 2,000 inhabitants, 
 between 300 and 400 succumbed. At Ancona, 1,346 died, out 
 of a population of 46,000. 
 
 Constantinople, like all Turkish and Eastern towns, is dis- 
 tinguished for want of cleanliness ; all offal and filth are 
 thrown into the streets, and what is not consumed by dogs 
 remains under a burning sun, a heap of putrefying vegetable 
 and animal matter ; the only drains are open ditches in the 
 middle of narrow streets ; their sluggish contents empty into 
 the almost stagnant waters of the G-olden Horn, for the cur- 
 rent of the Black Sea passes so gently by the docks as to 
 leave the water in the harbor almost unchanged. 
 
 From Constantinople the disease spread into the surround- 
 ing country, and in almost all cases the infection could be 
 traced to fugitives. The pestilence was particularly violent 
 at the first part of the epidemic ; there were but few premoni- 
 tory symptoms ; cramps and vomiting were rapidly followed 
 by collapse. In the city itself, there were, as a rule, only a 
 very few cases in any recently-afiected quarter, for the first 
 day or two ; afterwards, in a single night, countless victims fell, 
 as if by one stroke from the avenging angel ; then everybody 
 took to flight ; the dead were left unburied, and the sick were 
 deserted by their relatives ; for some days subsequently a few 
 more cases occurred, and gradually such local epidemics 
 seemed to burn themselves out. The same course which the 
 scourge thus pursued in whole quarters of the city was also 
 observed in single streets and houses ; at first the disease was 
 imported, and there was a case or two ; suddenly there was an 
 immense mortality, and then it gradually diminished. A single 
 case in one house was quite exceptional ; there were generally 
 
36 ASIATICCHOLERA. 
 
 several, and in some instances the whole population of a dwel- 
 ling was literally swept away. 
 
 (a.) DISTRIBUTION BY SHIPS. 
 
 Pilgrim and emigrant ships may be broadly described as 
 floating encampments of jGilthy people ; and steamboats, on ac- 
 count of their greater heat below decks, increase all infectious 
 diseases which may be brought to them. It seems that 
 cholera has the same predilection for ships that yellow-fever 
 has ; both have a lengthened incubation at times, and may 
 only break out long after the vessel has left port ; and when 
 the disorder is once established on board, it clings to the un- 
 fortunate boat with great tenacity. In yeUow-fever, it is the 
 exhalations from the patient and the vomits which are most 
 dangerous ; but in cholera the alvine discharges propagate 
 the disorder ; hence, bedding which has been used by cholera 
 patients, and water-closets which have been visited by them, 
 may retain the contagion for a long time. And it seems to be 
 well-proven that the discharges of persons suffering from the 
 milder forms of the disease, called cholera-diarrhoea, or choler- 
 ine, contain the poison just as copiously as the severer varie- 
 ties. As early as 1819, an English frigate carried cholera from 
 Ceylon to Mauritius and the Isle of France, whence it was 
 taken, in 1820, to Zanguebar, on the east coast of Africa. It 
 also arrived in the Philippines by ship from Madras in 1820. 
 But, we first propose to turn our attention to the increase 
 and conveyance of the disease by steamships during the 
 present epidemic, or that of 1865 and 1866. In former times 
 the principal movements of trade and pilgrimage from India 
 were carried on by caravans by land, and in the case of the 
 pilgrims to Mecca, the passage of the Arabian desert contrib- 
 
DISTRIBUTION BY SHIPS. 31 
 
 uted to improve the health of the travellers. At the present 
 day, owing to the conveniences and speed of steam travel, it 
 is by sea, and in a very short time that these journeys are in 
 great part accomplished. On the Red Sea Boats, thousands 
 of Mohammedans of every nationality are now crowded, and 
 numbers of pilgrims from India died on them, during the 
 months of March and April, 1865. On one vessel alone 
 there were no less than eighty deaths from cholera. If 
 an epidemic breaks out among the pilgrims at Mecca, the 
 next places, of all others, most likely to suffer, wiU be Suez, 
 Cairo, and Alexandria ; and if the disease reaches Alexan- 
 dria, the first town in the Papal states will be Ancona, as 
 the communication between the two places by steam is 
 most perfect. The next most exposed places, are : Con- 
 stantinople, Malta, Marseilles, and Gibraltar. And this is 
 the exact route which the epidemic pursued, for, within two 
 or three days after it was decidedly fixed at Ancona, it also 
 appeared in Constantinople. As far as the latter city is con- 
 cerned we are in no doubt about the origin of the disease, for 
 it was brought from Egypt by a frigate, the Mourhir Sourour, 
 laden with stores, and charged with infection ; two cholera 
 patients were landed from her on July 8th, and by the 12th 
 thirty fatal cases had occurred in the hospital, whence it 
 spread into the city. Thus, the epidemic quickly became 
 active at three great centres : 1st, at Alexandria, commanding 
 the whole of the Mediterranean from Tripoli on the east to 
 Barcelona on the west ; 2d, at Ancona, controlling the gulf of 
 Yenice ; and, 3d, at Constantinople, the head of navigation of 
 the Black sea. Steamships plaj^ed a most important part in 
 carrying cholera to various parts of the Black sea, and up the 
 Danube ; finally the regular lines were discontinued when it 
 
38 ASIATIC CHOLERA. 
 
 became only too evident that the disease was carried on, and 
 distributed from them. At one time they were filled with those 
 flying from the various places where the pestilence prevailed, 
 and outbreaks of cholera occurred at the different landings 
 soon after the arrival of the boats. It would also pass by 
 cities nearer the localities where the disease was raging and 
 attack others more distant, but with which steam communica- 
 tion was more frequent and direct. It is stated positively 
 that the epidemic took an overland route in no single instance, 
 at first, but travelled from one coast town to another, as it was 
 carried by steamships. It was also introduced into Beiroot by 
 steamers, some of whose passengers died at the quarantine, 
 others in the houses, or even in the very streets of the town. It 
 reached Malta in the dkect line of steamboat travel by August 
 28th, and Marseilles on September 11th. In the course of five 
 days, foijr steamers arrived at Marseilles direct from Alexan- 
 dria with six hundred and sixty-two passengers, some of whom 
 were Algerine pilgrims from Mecca. One vessel brought 
 sixty-seven pilgrims ; two more had died of cholera on the 
 voyage, and one immediately on landing. At this time there 
 was no cholera in Marseilles, but in eleven days it prevailed 
 as an epidemic. By September 24th, it reached Paris by rail- 
 road from Marseilles ; on September 22d, it arrived in South- 
 ampton, by steamers direct, in four days, from Gribraltar, 
 where the disease was also raging. This is the first time that 
 cholera has reached England by the way of the South; in 
 1832 and 1848, it was introduced into England from Russia 
 and North G-ermany, and directly traced to ships arriving from 
 Riga, Cronstadt, Hamburg, and Dantzig, where the disease pre- 
 vailed in those years, before it did on the Mediterranean. In 
 fact, in January, 1833, an English ship brought down the dis- 
 
DISTRIBUTION BY SHIPS. 39 
 
 <3ase to Lisbon, whence it spread to Portugal and Spain ; did 
 not reach Marseilles till December, 1834, nor Lombardy and 
 Venice till 1836, and Trieste in 1837. 
 
 The point of attack of every epidemic in England has always 
 been at one, or the other, of the principal seaport towns. In 
 1832, it was originally brought from Hamburg to Sunderland, 
 where the Grerman Ocean has its greatest width, and the dis- 
 tance is too great for the disease to be blown across. In 
 1848, it first broke out in London, and could be clearly traced 
 to Hamburg emigrants, as cases of cholera had occurred on the 
 vessel by which they arrived. The third general epidemic 
 reached St. Petersburg in October, 1852 ; prevailed extensively 
 in the north of Europe in 1853 ; reached Hamburg on July 
 28th, and was carried to Liverpool by August 22d ; still arriv- 
 ing in England by the northern route, and not by way of the 
 wind, which would have reached the eastern shore of Eng- 
 land before it did the western, on which Liverpool is situated. 
 In 1866, after the disease had prevailed in various parts of 
 Germany during the winter, it was brought down the Rhine 
 to Rotterdam, and thence taken in a direct line to Hull, on the 
 eastern coast of England, and subsequently, by rail, to Liv- 
 erpool. 
 
 Cholera has always been brought to America by ships. 
 Early in 1832, the brig Carrick, bringing emigrants from 
 England, arrived at Quebec ; forty-two of the passengers had 
 died of cholera on the voyage, and it broke out in a severe 
 epidemic form at Quebec, on the 6th of June ; by the 10th, it 
 had travelled up the St. Lawrence to Montreal, and soon 
 reached Detroit. In the latter part of June the ship Henry 
 I Y. arrived at New York with cholera patients, and the dis - 
 ease appeared in the city by the 24th ; it spread up the Hud- 
 
40 ASIATIC CHOLERA. 
 
 son river, and joined the Canada trail. From New York it also 
 was quickly carried to Philadelphia and the West. Again, dur- 
 ing the second epidemic in Europe, two vessels sailed from 
 Havre, where cholera prevailed ; one, the New York, for New 
 York, the other the Swanton, for New Orleans. Both vessels 
 carried large numbers of German emigrants ; on one the 
 cholera appeared when sixteen days out, with fourteen deaths ; 
 on the other, in twenty-six days, with thirteen deaths. The 
 New York arrived at Staten Island on December 2, 1848, and 
 a severe ej^idemic soon broke out, but was confined to the 
 Quarantine grounds. The Swanton arrived at New Orleans 
 December 11 ; no quarantine was instituted, and in two days 
 cholera patients were taken into the Charity hospital; this 
 was the beginning of a severe epidemic, which lasted the 
 whole of the winter, which was unusually mild. There 
 were three or four hundred deaths from cholera in New 
 Orleans, in December, 1848 ; about six hundred in January, 
 then increasing till June, when there were two thousand five 
 hundred. On the 20th of December, it reached Memphis, by 
 steamboat, from New Orleans, where for twenty-five days it 
 remained confined to the landing-place, and to the persons 
 communicating with the vessel ; then it began to spread to the 
 more distant houses. In the spring of 1849 it was brought to 
 St. Louis and Cincinnati, and the whole vaUey of the Missis- 
 sippi was finally involved. By October of the next year, it 
 reached Sacramento, by means of overland emigrants ; and 
 almost simultaneously arrived at San Francisco by the United 
 States mail steamer Northerner from Panama. The Chinese in 
 Cahfornia suffered the most severely ; the disease was brought 
 ahnost around the world, by way of the west, to reach them 
 there. It is probable that with increased steam communica- 
 
DISTRIBUTION BY SHIPS. 41 
 
 tion to and from San Francisco, it may soon be brought direct 
 from China, across the Pacific ocean. 
 
 In the latter part of 1853, cholera was brought to Liverpool 
 and prevailed during the winter, more or less extensively 
 throughout England. In the fall, cholera-ships came in great 
 numbers to New York ; in October alone, twenty-eight in- 
 fected ships arrived with eleven hundred and forty-one cases, 
 and the disease became epidemic on the Quarantine grounds 
 at Staten Island, but seemed to die out during the winter. In 
 the spring, however, other vessels added fresh infection to 
 the embers of the old, and the first case occurred in New 
 York, on May 11th, and thence spread, as usual, to the larger 
 cities on the regular lines of travel. 
 
 Dr. Swinborne, Port physician of New York, gives the fol- 
 lowing account of the origin of cholera on board the Atalanta, 
 in 1865 : She sailed from Havre, on October 12th, with fifty- 
 two cabin and five hundred and fifty-two steerage passengers, 
 all of whom had been a few hours or days in Paris, where 
 cholera prevailed ; and five days at the hotels, Weissen Lamm, 
 and Hullgarder Hof, in Havre. While at these hotels, emi- 
 grants who had arrived only a few days before, were taken ill 
 with cholera and sent to the hospital. On the first day out 
 (October 13th), a little child from the Weissen Lamm died ; in 
 six days, five deaths occurred in one party from the Hullgar- 
 der Hof. In all, the Atalanta had one hundred and two cases 
 and twenty-three deaths. The Hermann arrived shortly after 
 (November 16) with several cases, and the first death on board 
 occurred in the very family who had lost their mother of 
 cholera at the Hullgarder Hof at Havre. It is also significant 
 that the Atalanta, Mary Ann, Hermann, and Harpswell, all had 
 names on their passenger-lists the owners of which were not 
 
 3* 
 
42 ASIATICCHOLERA. 
 
 to be found among the passengers, but were declared to have 
 been sent to the hospital at Havre. Up to November 17, 
 there had been six thousand deaths by cholera in Paris and the 
 department of the Seine. Another account says : The cholera 
 of 1865 made its first appearance in Havre, on October 10th, 
 and was undoubtedly brought there by German emigrants, of 
 whom about nine hundred arrived between the 7th and 9th, 
 from Paris, where the disease was at its height. These emi- 
 grants were en route for New York, and the cholera broke out 
 among them on the 10th ; eight died in forty-eight hours in 
 the hospital, and two or three more in the emigrant hotels. 
 Many of these emigrants sailed on the Atalanta for New York 
 on October 12th. 
 
 The steamship England, from Liverpool for New York, 
 bringing the same class of passengers, was obhged to put into 
 Halifax, in distress, on the 9th of May, 1866, having had one 
 hundred and sixty cases of cholera and fifty deaths, on that 
 short voyage. On the 18th of April, the steamship Virginia 
 arrived at New York, with over one thousand passengers, 
 most of them Germans, who had come from infected places on 
 the Rhine ; about fifty died of cholera on the passage. 
 
 We all know how cholera prevailed in Paris ; how it ob- 
 tained but a sHght foothold in England last year. How it 
 lingered along the Rhine last winter, and recommenced this 
 spring ; how it was conveyed by German emigrants down the 
 Rhine to Rotterdam, and thence to HuU and Liverpool ; and 
 we all know how many abortive attempts have been made to 
 land it in this country from the steamships Atalanta, Helvetia, 
 Yirginia, and others. The history of the cholera on board 
 these vessels is somewhat peculiar; they and they alone 
 brought cholera to our shores, although other vessels were 
 
DISTRIBUTION BY WIND. 43 
 
 bringing emigrants of the same class and nationality ; but they 
 and they alone, had a lower or orlop deck for passengers, 
 below the water line, where three or four hundred per- 
 sons, out of one thousand, or more, were kept in darkness, 
 heat from the boilers and furnaces, in their own filth, and with 
 very imperfect ventilation. Almost the counterparts of the 
 climate and injurious influences of India were here reproduced 
 artificially, and cholera might almost have originated anew on 
 board this peculiar line of steam-vessels. Not a single case 
 occurred in the comparatively well-ventilated cabins while it 
 raged among the poor steerage passengers. 
 
 It is significant that cholera has always lingered in Europe 
 during the winter preceding its occurrence in America. 
 
 (&.) DISTRIBUTION BY WIND. 
 
 It may safely be affirmed that wind plays but an occasional 
 and insignificant part in the conveyance of cholera ; a favoring 
 gale may promote its transmission somewhat, and an adverse 
 one can only retard it temporarily. Dr. Parke s once thought 
 that it generally progressed with the wind and not by the 
 shortest route of human intercourse, or even by the way of 
 the greatest travel ; but, in 1864, he writes : " On looking back 
 to the epidemics I saw in India, I can perceive many points 
 which are capable of a different explanation,' if putrefying 
 stools are the cause." Stni, when these become dry, they may 
 be blown about by the wind, and some observers have even 
 noticed a peculiar aromatic smell in the air (odor cholerica) 
 when cholera prevailed. The rapidity with which the " rice 
 water discharges" must pass into a dry state, under the burn- 
 ing rays of a tropical sun, renders it highly probable, that in 
 India, dust, the so-called " cholera-dust,'' takes a large share in 
 
44 ASIATICCHOLERA. 
 
 the distribntion of cholera. This remains on the camp-grounds 
 where the disease has prevailed, and may be blown to greater 
 or lesser distances by the wind ; and very frequently it is 
 stirred up by men and animals and carried about in their 
 clothes and skins. In India such cases are thought to be 
 numerous. In 1854, one wing of a cavahy regiment, just 
 arrived from England and in high health, ascended the Ganges 
 in boats ; at a certain period of the voyage it arrived at a part 
 of the country where cholera prevailed in the villages on the 
 banks of the river, but with which they did not communicate. 
 There, cases of the disease occurred in the boats, and the men 
 were advised to push on rapidly, and in a few days after, when 
 they had passed the limits of the existence of the disease on 
 the banks, it ceased to show itself among the troops. The 
 other wing of the regiment foUowed some time afterwards, by 
 the same mode of conveyance ; became affected with cholera 
 at the same place, and lost it again at the same point. 
 These attacks were thought to have arisen from inhaling 
 the air, or cholera dust blown over the river from the 
 infected villages ; but, they may have been caused by 
 drinking the river-water, contaminated, as it must have been, 
 with " cholera matters." Another case seems to point to its 
 diffusion by the air alone : In one of the Western Islands 
 off Scotland, the most remote from the main land, cholera sud- 
 denly appeared, when so little intercourse existed with the 
 place, that the clergyman had continued to pray, regularly 
 every Sunday, for King William the Foitrth, for eighteen 
 months after Queen Victoria had ascended the throne. Still, 
 one or more persons with cholerine may have crossed over 
 from the main land. Again, on the arrival of an infected 
 steamer from Egypt, in 1865, which was permitted to perform 
 
DISTRIBUTION BY WIND. 45 
 
 a three days' quarantine off Beiroot, almost the entire crew of 
 a British corvette, lying at anchor to windward, suffered se- 
 verely from diarrhoea. In this case, the bilge and washing 
 water of the infected ship, and the scrubbings of the privies 
 and the discharges of the cholera patients, may have been car- 
 ried down by the wind to the corvette, and contaminated 
 water may have been used to wash her decks. At Naples, 
 in 1865, the number of cases began to increase coincidentally 
 with the sirocco wind. Hence the sirocco was supposed to 
 carry cholera with it. This theory lasted till the wind 
 changed and blew from a northerly direction, with greater 
 violence than had been known for years before. Still the 
 malady grew worse, and the greatest havoc by it was al- 
 most all on those blustering days. Cholera had already got a 
 footing by means of individuals in Naples, and the public 
 sewers and drains were in a horrible condition. In 1832, Dr. 
 Yache lost thirty small-pox patients in hospital at Staten 
 Island from cholera, where the distance between the hospitals 
 was between two and three hundred feet, and strict non-inter- 
 course was enforced. But it may have been conveyed by 
 clothes, or washerwomen. Dr. Bryson found it on the English 
 fleet, when several miles off shore, after a cruise of some 
 duration, and before any communication had been had with 
 the land. In other cases it is said to have been noticed that 
 vessels would become infected at anchor, in harbor, when the 
 wind blew from the shore, or over other affected vessels. It 
 is possible that it may be carried a short distance by the wind, 
 but not far, as the poison soon becomes so much diffused as to 
 lose its power. Others think it can be blown long distances, 
 and cite the fact that infusoria have been found three hundred 
 and eighty miles from the coast ; that ashes from Vesuvius 
 
46 ASIATIC CHOLERA. 
 
 have been carried by the wind to Yenice and Greece, and 
 have even reached Calabria, fifty leagues off in a thick cloud ; 
 and that the same has happened from Mount Hecla. They bid 
 us to remember, in this connection, that a wind barely sensible 
 moves at the rate of two miles an hour ; a gentle breeze, five 
 miles ; and a very strong wind twenty-five miles ; and a gale, 
 forty miles. Still, as Dr. Sayre has pertinently put it, it did not 
 move two hundred feet, nor twenty feet, from the steerage to 
 the cabin passengers, on board the Atalanta, England, Virginia, 
 and many other steamships, notwithstanding all the breezes 
 which blow on the Atlantic. Again, in the epidemic at Ebrach,' 
 in Bavaria, in 1854, of over two hundred soldiers, guards, 
 nurses, servants, physicians and clergymen, not one was 
 attacked who did not use the affected privies of the prisoners, 
 or wash their clothes. 
 
 (C.) DISTRIBUTION BY DRINKIXG-WATER. 
 
 Impure water is even more injurious than foul air, filthy 
 people, contaminated soil, neglected sewers, cesspools, and 
 privies. In places where the water is not as pm^e as the 
 Croton water of New York, nor as perfectly protected by 
 pipes, the choice of water for drinking and cuKnary purposes 
 demands great care ; and that taken from rivers which pass 
 cities and towns is particularly objectionable, as it is certain 
 to be contaminated with sewerage matters. Thus, Croton 
 water contains but 6.66 of impurity ; London water from 
 19 to 35 ; and Paris water from 24 to 46. If a little of the 
 sediment from the Thames water, after being well dried, be 
 held for a minute or two over the flame of a candle, it wiU 
 emit an odor which is most disagreeable and disgusting, aris- 
 ing from the evolution of gases from the decomposition of 
 
DISTRIBUTION BY DRINKING-WATER. 4t 
 
 organic matter. The consequences of drinking such water in 
 cholera times have been fully developed by Dr. Snow. He 
 tells us that the South districts of London are mostly supplied 
 with water by two companies, the Lambeth, and the South- 
 wark and Yauxhall. In 1849, the water of both companies 
 contained the sewage of London as it was washed to and fro 
 with the tide, and the whole of the districts which they sup- 
 plied suffered severely with cholera. In 1852, the Lambeth 
 company changed their source of supply to Thames Ditton, a 
 part of the river beyond the influence of the tide, and out of 
 reach of the sewage of London. In 1853 and 1854, the 
 districts to which this new water-supply extended suffered 
 less than in 1849, and the houses supplied by the New Lam- 
 beth water not nearly as much as the others. The pipes of 
 both companies go down aU the streets, courts, and alleys. 
 Some houses are supplied by one company, and the rest by the 
 other ; in many cases a single house has a supply different 
 from that on either side. Each company supplies both rich 
 and poor, both large houses and small, and there is no differ- 
 ence in the condition or occupation of the persons receiving 
 the water of the two companies. No experiment could have 
 been devised which would more thoroughly test the effect of 
 pure and impure water on the* progress and distribution of 
 cholera than this, which circumstances placed ready-made 
 before so careful an observer as Dr. Snow. The experiment, 
 too, was on the grandest scale. No fewer than 300,000 people 
 of both sexes, of every age and occupation, and of every rank 
 and station, from gentlefolks down to the very poor, were 
 divided into two groups without their choice, and, in most 
 cases, without their knowledge ; one group being supplied 
 with water containing the sewage of London, and among 
 
48 ASIATIC CHOLERA. 
 
 it, whatever might have come from cholera patients ; the other, 
 getting water comparatively free from such impurity. Dr. 
 Snow obtained at the Registrar-General's office a list of deaths 
 from cholera dnring the first four weeks of the epidemic of 
 1854, and went to the houses himself to ascertain the charac. 
 ter of the water supply. There were 334 fatal cases in all, 
 and 286 of these had lived in houses supplied by the impure 
 water of the South wark and Yauxhall Company ; and only 
 fourteen in those dependent on the Lambeth Company ; in 
 twenty-two instances, the water was obtained by dipping a pail 
 directly into the Thames ; in twelve cases, from pump-wells, 
 &c. Cholera was fourteen times more fatal to those who drank 
 the impure water. In another period of three weeks, 997 
 deaths occurred in houses suppHed with the foul water, and 
 only eighty-four in those which got the purer Kquid. There 
 were six hundred and eleven deaths among the patrons of the 
 Lambeth water, and three thousand four hundred and seventy- 
 six among those of the other company. Dr. Snow has also 
 distinguished himself by the pains-taking manner in which he 
 has proved that cholera may be distributed through the medi- 
 um of drinking-water, by the cholera evacuations getting into 
 pumps and other local supplies of water, owing to accidental 
 communications between privies, drains, or cesspools, and the 
 wells. The most striking feature of these outbreaks is, that 
 they occur very suddenly and nearly simultaneously, and very 
 soon after a single case has happened among the persons 
 whose evacuations contaminated the water. In a very severe 
 outbreak of cholera which took place in Wandsworth road, 
 London, in 1849, the water was not habituaHy poUuted, but 
 became so by the bursting and overflow of the house-drains 
 into the water-tanks, during a thunder-storm. The houses in 
 
DISTRIBUTION BY DRINKING-WATER. 49 
 
 which this catastrophe occurred were seventeen in number ; 
 they were semi-detached villas and genteel suburban dwell- 
 ings ; they were drained and supplied with spring-water on 
 one plan. The water was conducted into a series of tanks 
 placed underground at the back of each house, at the same 
 level, and the water which overflowed ran into a drain which 
 also received the house-drains and the overflow from the cess- 
 pools. The contents of this drain were forced back into the 
 drinking-water tanks at the time of the thunder-storm, and 
 when the tanks were afterward opened by the Commissioners 
 of Sewers, privy-soil was found from six to nine inches deep 
 in them. In order to explain how water can be used under 
 these circumstances, it is necessary to state, that when privy- 
 soil is left at rest in water, it settles principally to the bottom, 
 leaving the water above not much altered in physical appear- 
 ance. At the time of the overflow of the drain, a lady in one 
 of the houses had been suffering for two days with cholera, of 
 which she died two days afterward, and two days subse- 
 quently to her death the great outbreak took place. About 
 half the persons living in the seventeen houses were affected, 
 and about one half of them died. The attack extended to all 
 the houses in which the water was polluted, and did not reach 
 any others, though there were plenty of houses both in a con- 
 tinuous line with these, and before and behind them. Dr. 
 Snow also gives a very full account of the fatal and extensive 
 outbreak of cholera which occurred in 1854, in Broad street, 
 Golden square, London. He quickly suspected some contami- 
 nation of the water, of the much frequented Broad street 
 well, took awaj^ the handle of the pump on his own respon- 
 sibility, and quickly put an end to an epidemic which had al- 
 ready caused six hundred and fourteen deaths. Dr. Snow 
 
50 ASIATIC CHOLERA. 
 
 made inquiry at every house in which the first seventy-three 
 deaths took place during the first two days of the epidemic ; 
 sixty-one persons had certainly drank of this water, and the 
 others had all died or moved away except six. The parish 
 authorities made excavations and found that the contents of a 
 cesspool, situated only three feet from the well passed through 
 its decayed walls, and percolated through the intervening 
 ground and then ran through the open brickwork of the side 
 of the well. A child had died of cholera in the house to 
 which the cesspool belonged, three days before the great out- 
 break and its dejections had been emptied into the cesspool. 
 Seventy workmen of a brewery quite near the pump escaped 
 entirely, because they had a well on their own grounds ; and 
 the inmates of the workhouse situated in the infected district 
 enjoyed a like immunity, from having a pump of their own. 
 A lady who formerly lived in Broad street, but had moved to 
 the West end, had the water from this pump taken out of 
 town to her every day ; she and a niece who was visiting her 
 were fatally attacked with cholera, and her only servant had a 
 severe attack of diarrhoea. A remarkably corroborative fact 
 has been reported by Mr. Lawrence : Bethlehem Hospital and 
 an asylum for children stand near together, on an 0]3en space 
 of ground between fourteen and sixteen acres in extent, in the 
 parish of St. George, Southwark. Being dissatisfied with the 
 filthy water then supplied by the Lambeth Company, the 
 governors of these two institutions, some thirty years ago, 
 sank Artesian wells on the premises and the pure water thus 
 procured is used exclusively by the inmates, about seven hun- 
 dred in number ; it is said there has not been a single case of 
 cholera in the hospital or asylum in any of the three epi- 
 demics, although the disease has prevailed extensively in the 
 
DISTRIBUTION BY DRINKING-WATER. 51 
 
 streets in their immediate vicinity. The epidemic of 1849, at 
 Paris, was evidently spread extensively by means of impure wa- 
 ter ; and at Sevres, diarrhoea frequently became epidemic among 
 those who drank the water of the Seine and ceased when that from 
 an Artesian well was used. In 1865, the clothes and mattresses 
 of cholera subjects were washed in the basin of a public foun- 
 tain at Tavatola ; unfortunately the waste pipe was broken and 
 the foul water was carried into the clean ; and in one day sixty 
 people died in a small section of the city, supplied with this 
 fluid. There were terrible epidemics in 1861 and 1862 at 
 Mean Meer, in India, and the water was not only found brack- 
 ish, but tainted with faecal impurities. The British man-of-war 
 Euryalus had a healthy crew when she went to Tokohama ; 
 but the ship's water was taken from a reservoir situated in a 
 paddy field, which was manured with human ordure, and 
 where the Japanese had been seen to wash their soiled 
 clothes ; three hundred and forty cases of bowel-disease oc- 
 curred among five hundred and twenty men. The small Ep- 
 ping epidemic of 1865 is also quite instructive ; a gentleman 
 had been indisposed for two years with indigestion and great 
 lowness of spirits, and his wife and mother had been out of 
 sorts for a long time. Their sole supply of water came from a 
 deep weU, situated down the hiUside ; this water had had for 
 a long time an unpleasant odor and nauseous taste, and sul- 
 phuretted hydrogen was detected in it, with much organic mat- 
 ter. They were ordered away to the seaside and improved 
 greatly, but unfortunately on their return stayed a day or two 
 in Southampton and Portland, where cholera prevailed ; they 
 returned home, were attacked with the disease, and eight per- 
 sons out of eleven in their family died, including one of the 
 physicians. Their house was half a mile away from any other 
 
52 ASIATIC CHOLERA. 
 
 residence ; it was on a hill ; the temperature was falHng, so that 
 heat had nothing to do with it ; they were attacked suddenly, 
 so that fear had nothing to do with it ; there was no pervading 
 atmospheric influence, for there were no other attacks in the 
 neighborhood ; there was plenty to eat and drink, so that 
 poverty had nothing to do with it. But a leakage was found 
 in the pipes of the water-closet which ran under the founda- 
 tion of the house down towards the well, and sewage-matter 
 was not only distinctly traceable on the outside of the well, 
 but privy filth was found at the bottom of it. It is very evi- 
 dent that pumps and wells which are located near and below 
 the level of drains, cesspools, privies, or stables, may become 
 very dangerous in cholera times. It is also probable that in aU 
 cities which are built on hillsides, the receptacles of drinking- 
 water in the lower parts may become contaminated by foul 
 drainage getting into them from the higher ground. 
 
 (d.) DISTRIBUTION BY INDIVIDUALS. 
 
 Persons, abeady sick with cholera, are the most active 
 agents in disseminating the disease ; they, and they alone, 
 contaminate the air, water, and soil, and bring the disease to 
 our houses, ships, and camps. Among the most striking 
 proofs of this, we select the following : In October, 1865, 
 there was no cholera in Western Grermany, until it was im- 
 ported into Altenburg, near Leipzig, in the very heart of 
 Saxony. A lady and her daughter left Odessa on the 16th of 
 August, when cholera was at its height there, and travelled 
 nine days and nights continuously, to reach their home in 
 Altenburg, on the 24th. The daughter had cholera-diarrhoea 
 when she started, and died in Altenburg in a few days after 
 her arrival. The mother, who had been well previously^ 
 
DISTRIBUTION BY INDIVIDUALS. 53 
 
 sickened on the 27th with real cholera and died in two days ; 
 her sister-in-law was attacked in the same house on the 29th, 
 and died in twenty-eight hours. This dwelling formed the 
 first centre of infection, from which the disease extended. 
 The epidemic lasted from August 28th to November 18th, 
 and one hundred and eighty cases occurred in all, of which 
 one hundred and eight were fatal. It is 'asserted that 
 Altenburg was in an unusually healthy condition, but that 
 the inhabitants live mostly on vegetables, black bread, 
 coffee, and beer ; meat being only used regularly by the 
 better classes. The disease spread from Altenburg to Werden, 
 a neighboring town, by railway communication, and up to 
 October 20th, 1865, there had been one hundred and fort}^- 
 nine cases there, with fifty-two deaths. It is justly thought 
 that this isolated outbreak of cholera in a previously healthy 
 district, and which was clearly traced to persons coming from 
 a centre of infection, must prove an important link in the 
 evidence abeady accumulated to prove the portable and con- 
 tagious nature of the disease, and its comparatively long 
 period of incubation, at times. The sequel of this Altenburg 
 epidemic promises to become still more interesting ; for in a 
 late paper we read : " No cases of cholera have been re- 
 ported from the Prussian army in Saxony, but the close 
 vicinity of this disease at Altenburg makes people look with 
 apprehension on any marked change in the weather, and the 
 heat has much increased of late." The very next steamer 
 brought the following : " The Prussian government is much 
 disquieted at the spread of cholera in the army ; for on the 
 4th and 5th of June, thirty-one cases, six of which were fatal, 
 occurred in the 3d regiment of the guards." A letter from 
 the Grand Duchy of Luxembourg, states that the greatest 
 
54 ASIATIC CHOLERA. 
 
 alarm prevails throughoiit the district, owing to the dreadful 
 ravages made by cholera ; the disease was first brought by a 
 workman from Paris ; it soon spread to eight towns, and in 
 Diekirch, destroyed over one hundred persons, in three days, 
 out of a population of two thousand. Pettenkofer thought 
 he had traced the origin of cholera in Munich, in 1854, to 
 those who brou2:ht goods to the G-reat Exhibition. On July 
 17th, cholera-diarrhoea commenced among them, and by the 25th, 
 thirty cases occurred daily ; one hundred and forty-four cases 
 in aU were reported in July, five hundred and forty-nine in 
 August, two hundred and thirty-six in September, and thirty- 
 nine in October. From these persons and the privies of the 
 Crystal Palace, and those of the houses in which they boarded 
 (for two hundred and fifty-three of them Hved in no less than 
 two hundred and forty-two dwellings, situated in one hundred 
 and ten different streets), the disease is supposed to have 
 spread through the city. Cholera occurred in no less than one 
 hundred and twelve dwelHngs out of one hundred and seventy 
 occupied by this class of persons, and it was also noticed that 
 the disease alniost always commenced three of four days ear- 
 lier in them, justifying the opinion that it originated there. 
 The first case of cholera had been preceded by diarrhoea for 
 eight days. Again, in the prison at Ebrach, in Bavaria, a man 
 named Lorenz Grassl, was brought from Munich, with cholera- 
 diarrhoea, after being detained several days in a poHce-station 
 where cases of cholera had occurred. In a few days he came 
 under treatment for severe diarrhoea, which progressed to 
 cholera, but from which he recovered perfectly. The privies 
 which extended through every story of the prison, were in a 
 most disgusting condition, and it is supposed that the dis- 
 charges from this one cholera patient infected the whole 
 
DISTRIBUTION BY INDIVIDUALS. 55 
 
 offensive mass, so that a severe epidemic soon commenced 
 and killed fifteen per cent, of tlie prisoners. The disease 
 was not confined to the men, for in a very short time it 
 appeared among the female prisoners, who were entirely 
 separated from, and had no direct communication with, the 
 males ; but a woman, named Anna Maria Hefer, washed 
 Grassl's clothes, and she was the first to be attacked among 
 the women. No efficient disinfectants were nsed. About 
 the same time another Bavarian prisoner was taken from 
 Mimich to Kaisheim ; he did not sicken for twenty-two 
 days, and then died of cholera in seven honrs. Disinfec- 
 tants were thoroughly employed, and the disease was con- 
 fined to this one case. Dr. Sayre asserts that in 1849, the 
 epidemic in New York did not originate in Baxter street, but 
 proceeded from an infected person who escaped from quaran- 
 tine, and I have heard of two persons in the first stage of chol- 
 era who escaped quarantine inspection this year. Dr. Atlee 
 of Pennsylvania, asserts that one day in 1854, a car load of 
 emigrants came from Philadelphia, to Columbia, Pennsylvania ; 
 two or three of the passengers iU of cholera were put out on 
 the platform at the railroad station ; four gentlemen seeing 
 them there at the point of death, carried them to a shed and 
 waited upon them ; in forty-eight hours not one of these was 
 living, and in two or three days more, cholera prevailed exten- 
 sively in Columbia. A few days after the outbreak in Colum- 
 bia, an emigrant reached Lancaster, ill with cholerine ; shortly 
 after two or three cases occurred in Lancaster. The same 
 train carried the cholera to Pittsburgh. Dr. C. A. Lee reports 
 the case of a gentleman who had been exposed to cholera in 
 Buffalo in 1832, returned to his home at Mount Washington, 
 Massachusetts, one thousand five hundred feet above the 
 
56 ASIATIC CHOLERA. 
 
 ocean, and died there ; of eight neighbors who nursed him, six 
 were attacked and four died ; there were no other cases with- 
 in fifty miles, and there seems to be no doubt the gentleman 
 brought it with him, and distributed it to his friends. From 
 similar and other cases, Dr. Niemeyer has come to the follow- 
 ing conclusions : 1st. That cholera properly belongs neither 
 to the class of contagious, nor to that of non-contagious dis- 
 eases. 2d. While it is certain that cholera is often not com- 
 municated directly from one person to another, even under 
 circumstances of the greatest intimacy ; on the other hand, it 
 is equally evident that it is spread only by patients afflicted 
 with the disease. 3d. The disorder is propagated by the evacu- 
 ations of individuals infected with cholera, 'probably in all, 
 certainly in most cases. 4th. By means of one infected per- 
 son, in whom the disease has manifested itself only by a 
 seemingly insignificant diarrhoea, cholera can be conveyed to 
 distant and hitherto healthy localities. 5th. This person may 
 travel on and recover without further serious development of 
 the disease in himself, but he may have left behind him in 
 several or many waterclosets, a substance which may give rise 
 to most deadly epidemics. It is thus no longer inexplicable 
 why the cholera in its wanderings takes no defined course 
 at times, but spreads now with the wind, and now against it : 
 how it always foUows routes of travel, and since the building 
 of steamboats and raihoads, has been able to spread more 
 quickly than before ; v/hy it follows only one or a few 
 tracks across the ocean, but takes a hundred roads on land. 
 Although it should have been evident many years ago, the 
 portentous fact now stands out more prominently this year 
 than ever before, that a great length of time may elapse be- 
 tween the departure of passengers by ship, wagon, or rail, 
 
DISTRIBUTION BY INDIVIDUALS. 5t 
 
 and the outbreak of cholera. In May, 1854, the epidemic 
 broke out in Chicago and Detroit before it did in New York, 
 where the cholera subjects landed. Many emigrants passed 
 through New York, from infected ships, and were in passably 
 good health at the time. Detroit and Chicago are in the line of 
 the principal emigrant travel ; cholera had been in neither city 
 since 1849, and none but emigrants from infected ports in 
 Europe, and from infected ships at New York, were attacked 
 at first. It is evident that some of them must have had 
 cholera-diarrhoea, or cholerine, or carried about with them in 
 their clothing and baggage a poison capable of regenerating 
 itself and spreading abroad an influence that produced a 
 general epidemic in the warm months. On board the New 
 York and S wanton, in 1849, we have seen that the disease de- 
 layed its outbreak for sixteen and twenty-six days after the 
 sailing of these vessels. As early as 1853, Pettenkofer 
 proved that the period of incubation might be extended to 
 twenty-one days. Finally, it is well known that cholera has 
 lingered in South G-ermany, Saxony, and along the Rhine, dur- 
 ing the last winter ; thence infected emigrants were brought 
 by rail and steamboat, to be shipped from Rotterdam to 
 HuU, on the east coast of England, then conveyed by rail 
 to Liverpool, and reshipped by the England, Virginia, Helve- 
 tia, and other vessels to New York. Cases of cholera have 
 already occurred at Bristol, Hull, and Liverpool, and the Eng- 
 lish authorities are at last becoming painfully aware of the 
 comparatively great length of time which can elapse between 
 the departure of infected persons and things from the con- 
 tinent, and the outbreak of cholera in England, or at sea. De- 
 pots of cholera are now established at Rotterdam and Ant- 
 werp, for on the Helvetia, which was sent back to Liverpool, all 
 
 4 
 
58 ASIATIC CHOLERA. 
 
 the earliest cases are found to have been Dutch, not Germans, 
 as their names, Evert de Boer, Peter Eelpet, Neisen Gow, 
 Coserline Bosake, nndonbtedly prove. But there can be no 
 doubt that the German emigrants who have been pouring 
 through Rotterdam for nearly a year, originally brought the 
 disease there. Since writing the above we learn that there 
 have been 180 cases and 84 deaths at Antwerp ; 724 cases and 
 431 deaths at Leyden ; 706 cases and 433 deaths in Rotterdam ; 
 305 cases and 169 deaths at Utrecht ; in all, up June 13th, 
 there have been 2,449 cases and 1,438 deaths in HoUand. 
 In Prussia it has declared itself in Berhn, Stettin, and seven 
 or eight other towns. In France, at Amiens and Nantes. 
 The caravans to Mecca have suffered much more severely this 
 year than in 1865. 
 
 (e.) DISTEIBUTION BY CLOTHES. 
 
 After cholera matter has passed into the dried state, healthy 
 men may carry it about in their baggage. Numerous and 
 well-authenticated examples of this have been pubhshed, but 
 the most extraordinary instance of the conveyance of cholera- 
 vapor, or " cholera-dust," was furnished by the postal depart- 
 ment at Marseilles, in 1865. The clerk who opened the 
 despatches from the East, fell sick, with cholerine, another was 
 put in his place, and the same effect followed up to the fifth. 
 Of nine clerks in the bureau of arrival, eight were taken sick, 
 and one died ; of twenty-two clerks in the bureau of depar- 
 ture, there was not one case of sickness. In 1848, two vessels, 
 the S wanton and the New York, left Havre, the one on the 
 31st of October, the other on November 9th ; the one destined 
 for New Orleans, the other for New York. Both vessels car- 
 ried a large number of German emigrants. On the one, cholera 
 
DISTRIBUTION BY CLOTHES. 59 
 
 appeared when sixteen days out ; on the other, in twenty-six 
 days ; or, nearly on the same day in the two vessels, which at 
 that time were one thousand miles apart ; the one in a low, 
 the other in a high latitude. Some days before the outbreak 
 on the New York, a very cold wind sat in, and there was a 
 general ransacking among the baggage for warm clothing. 
 On board the Swanton, just before the occurrence of the epi- 
 demic, the weather was excessively warm, and the passengers 
 searched for lighter clothing, and also rummaged their baggage. 
 In both vessels there were passengers who had left infected 
 places, and Dr. Clark infers that it is far more probable 
 that the poison was carried in their baggage, than to sup- 
 pose that two different atmospheric currents of cholera struck 
 these two vessels a thousand miles apart. As regards 
 the ship New York our information is minute. Among the 
 passengers were a number of German emigrants who came 
 from a place where cholera prevailed. One of them had a 
 chest of clothing that belonged to a person who had died of 
 cholera. Near Cape Sable the weather became cold and 
 boisterous ; the chest was opened and the clothing used ; by 
 the 22d of November five persons died of cholera on ship- 
 board, and twelve were landed sick with it at the Staten Island 
 Quarantine. — ^In 1854, cholera passengers came to the vicinity 
 of Lancaster, Pennsylvania ; their clothes were sent to a high 
 and healthy location at Lancaster ; the relatives, who washed 
 these articles, died of cholera. A sailor died in Europe of 
 cholera in 1832 ; a chest containing his clothing was sent home 
 to a small village in Maine, and was opened on arrival ; the 
 inmates of the house were suddenly seized with cholera and 
 some of them died. The venerable Dr. Mussy, and Dr. 
 Reade are responsible for the above. — At Guadaloupe, in 1865, 
 
60 ASIATIC CHOLERA. 
 
 the whole country became infected from clothing which had 
 been sent ashore from a Marseilles ship to be washed ; and 
 10,806 died out of a population of 149,107. — ^Yomero, one of 
 the most considerable heights at the back of Naples, is the 
 residence of a great number of laundresses, where a large 
 quantity of clothing is washed. Nineteen of these poor women 
 were attacked in 1865, and five died. The height and healthy 
 air of the Yomero seemed to preclude the possibility of 
 cholera ascending to it, but it was discovered that the linen 
 of some who had died, or been attacked by the malady, had 
 been sent up there to be^cleansed. A man who had recovered 
 from cholera in 1865, sent his clothing to be washed in his 
 native town of Rovegno, where no other cases of cholera oc- 
 curred, except those of three women in his family who 
 washed the clothing, all of whom died. A peasant perished 
 in 1865 of cholera, not far from Marseilles, in an isolated 
 place and his wife also. He had not visited Marseilles where 
 the cholera prevailed, but his wife was a laundress and had 
 received a bundle of linen from a person recently arrived from 
 Egypt. The husband opened the bundle and unfolded all the 
 pieces, which were defiled with cholera discharges. We may 
 abnost agree with. Dr. Marsden, of Canada, that all clothing of 
 cholera patients should be destroyed. 
 
 (/.) DISTRIBUTION BY MASSES OF FILTH. 
 
 Accumulations of offal of many kinds may excite disease 
 similar to Asiatic cholera, but cannot originate the real mal- 
 ady unless true cholera filth has been introduced among them. 
 There can be no question that the carelessness with which 
 cholera evacuations are emptied into common privies, gutters, 
 sewers, or upon heaps of manure, greatly promotes the sudden 
 
DISTRIBUTION BY MASSES OF FILTH. 61 
 
 and rapid extension of the disease, and causes most violent 
 and fatal epidemics. There can be as little doubt that many 
 of these disgusting masses are quickly converted by a species 
 of fermentation into huge quantities of "cholera matter." 
 During the Crimean war, in 1854 and 1855, the French troops, 
 who came from Algeria, where cholera was devastating the 
 country, had scarcely disembarked at Gallipohs, when the dis- 
 ease broke out among the people ; thence it followed the 
 French to Varna, where it decimated the inhabitants ; then 
 almost subsided. But immediately after the battle of the 
 Alma, owing, it is beheved, to the army halting for two days 
 on the field, where hundreds of putrid carcasses of horses were 
 scattered about, and the surface of the ground was polluted 
 with ordure, from its occupation by the Russians, cholera, 
 which had previously been in abeyance, increased with great 
 rapidity ; especially as the troops were greatly fatigued, their 
 food indifferent, and the water scanty. From the Alma it was 
 carried to the allied camps before Sebastopol, and caused great 
 losses of men. Both the French and EngKsh fleets were also 
 seriously affected. — ^At the outbreak of the disease in Wheel- 
 ing, in the spring of 1833, the market-place was in a state of 
 unprecedented filth ; the mud, the sweepings of the market, 
 and other impurities had accumulated to the depth of several 
 inches over the whole square. Hard rains, succeeded by a 
 hot sun, had beaten down the dirty mass and baked its surface 
 into a firm, dry crust. A meeting of the common council was 
 called to determine what should be done with this immense 
 accumulation of filth, and the physicians who were consulted, 
 advised that it should remain undisturbed until the disappear- 
 ance of the epidemic. But this advice was disregarded, and 
 the dirt was at once gathered into heaps and carted to the 
 
62 ASIATIC CHOLERA. 
 
 edge of the river bank, a short distance off. The wind at the 
 time blew directly in a line from the pile of dirt to a thickly 
 settled part of the town ; and between midnight and daylight 
 of the next morning, nearly every member of two families, 
 living in the house nearest to the new heap of filth was seized 
 with cholera, and not less than three or four died. Other 
 persons in adjoining houses, and in dwellings in the same 
 row on the opposite side of the street, were attacked at nearly 
 the same time ; while all the houses fronting on the market 
 square became the centre of a most fearful mortality. These 
 few days constituted the greatest period of terror experienced 
 during the epidemic in Wheeling, and Houston says the cause 
 was too palpable not to be recognized by every one./ — At 
 Wakefield in England there are three prisons in one enclosure. 
 One of these is near a sluggish stream on flat and marshy ground ; 
 the sewers of the prison run into it, and the water from the 
 stream is pushed back at times into the drains, and the soil 
 thus often becomes infiltrated with noxious fluids. The venti- 
 lation was also imperfect in this building. In the other two 
 prisons the opposite condition prevailed ; the ventilation was 
 good, and the drains led outside the grounds. Cholera prevail- 
 ed extensively in the first-mentioned estabHshment, and not in 
 the latter ; hence whatever be the cause of cholera, it is inten- 
 sified and multiplied by insalubrious and foul emanations.^ — ^In 
 1849, cholera raged to an almost exterminating extent, in Reed 
 street, Philadelphia, from the east side of Front street down to 
 the Delaware. The dwellings were well built, and well venti- 
 lated, but a few yards only from the door of the last of these 
 houses, the Reed-street culvert emptied its foul matter, and at 
 its mouth was a morass of many acres, which at high tide was 
 covered with water, and at low tide exposed to the rays of the 
 
DISTRIBUTION BY SOIL. 63 
 
 sun. The sewer drained a distance of ten squares or about 
 half a mile ; the county prison was cleared, as it is now, by 
 this drain, of its entire filth, that of water closets included . 
 The feculence which passed through this culvert was poured 
 out on the marsh, underwent a festering putrefaction, and , 
 generated an atmosphere which had much to do in increasing 
 the excessive mortality which marked the epidemic at this 
 spot. These foul gases did not originate the cholera, but 
 greatly intensified it in 1849. But in 1854, the culvert was 
 extended to low-water mark, the morass was filled up and the 
 drainage made complete ; and Reed street, in the epidemic 
 of that year, did not suffer more than other parts of the city. — 
 The western side of Beyroot is usually more healthy than the 
 eastern, but, in 1855, the refuse excrements of the city were 
 transferred there ; the cesspools of Beyroot run from the houses 
 into receptacles in the streets, and their deposits are removed 
 by a class of men called " zibbals," who carry away the filth in 
 large panniers on the backs of donkeys to the dumping 
 ground. Nearly all these men died of cholera, which also 
 prevailed with much greater violence on the west side of the 
 city, than on the east, which is low, marshy, the abode of 
 fevers, and generally more unhealthful. 
 
 (g.) DISTRIBUTION BY SOIL. 
 
 Pettenkofer, of Munich, has paid much attention to the char- 
 acter of the soil and the quantity and quahty of sub-soil water 
 which favor the development of cholera ; but, with little prac- 
 tical result, if one can form a judgment, after carefuUy peru- 
 sing his work, twice, in the original text. He concludes that 
 cholera is propagated by human intercourse, and never with- 
 out this ; not by contact with diseased persons, or their ex- 
 
64 ASIATIC CHOLERA. 
 
 cretions ; but by means of certain changes which the latter 
 undergo after they have penetrated beneath the ground, 
 when the soil is light and porous, i. e., permeable to air and 
 water ; especially of sub-soil water, already impregnated with 
 the products of organic decomposition, of excrementitious 
 or faecal origin, is present within a certain di?tance of the 
 surface, say, within five or fifty feet. This filthy sub-soil 
 water beneath habitations he regards as far more injurious 
 than that of more or less distant marshes, or low banks of 
 rivers. The germs of cholera are supposed to be contained in 
 the discharges of cholera patients, but these do not become 
 poisonous so as to reproduce the disease in others until they 
 have penetrated through the earth down to the sub-soil water. 
 The nearer this sub-soil water lies to the surface, and the more 
 it is contaminated, previously, by drainage from cess-pools, 
 sewers, privies, middens, &c., the more rapid and extensive 
 will be the reproduction of cholera. There may be some little 
 truth in this ; but soil or earth is the best disinfectant, and 
 when rain is poured copiously upon, and sinks down into it, 
 it carries oxygen and dissolved air with it, and begins an 
 action so extensive, that by it, we may say, nearly all the puri- 
 fication of the world is performed. But if rain falls and re- 
 mains on or near the surface, it soon loses its oxygen, purifica- 
 tion ceases, and vapors arising carry up some of the injuri- 
 ous gases with it. This is the case with marsh miasm ; and 
 if water does not flow freely beneath the soil by means of 
 natural or artificial drains, the earth will not destroy the poi- 
 son, which will be liberated in full strength when the ground 
 is turned up. Hence, clay bottoms and rocks a small distance 
 beneath the surface may retain moisture enough to cause dis- 
 ease ; but light porous soils wiU prevent it. The principal 
 
DISTRIBUTION BY SOIL. 65 
 
 proof which Pettenkofer produces in favor of his theory, is 
 the freedom of the city of Wiirzburg from cholera, which 
 never has been able to attain a foothold there. Wurzburg lies 
 high on a hill, all the sewers are hewn out of soHd rock, or 
 built of water-tight masonry, and run from ten to seventeen 
 feet below the surface. The privies and their connections 
 with the sewers are built of stone ; much of the water which 
 falls on the roofs of houses is conducted down into the privies 
 and flushes them into the sewers. The drains all empty into 
 the river Maine, which has rocky banks, at least ten feet high, 
 and its stream is rapid. Hence no impurity remains in houses 
 or streets ; all is carried off by the river. The court-yards of 
 the houses are paved with flagging ; hence nothing soaks into 
 the earth from them. Of course, Wurzburg remains and will 
 remain free from cholera ; it is a veritable place of refuge 
 from it. Of all other cities, where Pettenkofer dwells about 
 soil and sub-soil water, we have a record of disgusting surface 
 filth ; foul, unpaved court-yards ; low grounds, saturated with 
 offensive drainage from above ; offensive privies, unsupplied 
 with water ; noisome drains running directly under the side- 
 walks, and only scantily covered with loose boards ; filthy 
 " street-side conveniences ;" of manure heaps in back yards, 
 where human ordure is cast from numerous houses which have 
 no privies at all ; and of the general use of wooden tubs for 
 water-closets. If these feculent things were rectified, soil and 
 sub-soil water might be safely ignored ; it is scarcely neces- 
 sary to look under the earth for minor evils, when such abom- 
 inable nuisances obtrude on the surface and offend both eyes 
 and nose at every step and breath. 
 
 I feel no inclination to close this chapter without some no- 
 tice of the strongest arguments of those who maintain differ- 
 
 4* 
 
66 ASIATIC CHOLERA. 
 
 ent views ; and will at once give several in addition. 1st. As 
 regards the diffusion of cholera by the air, I call attention to 
 the fact, that a putrid organic liquid can be obtained from the 
 atmosphere of an unclean place, by passing it through a tube 
 artificially cooled. The same may well happen with the filthy 
 air of Bengal an,d other cholera haunts. But gases soon be- 
 come diluted by mixture with air, and harmless. Marsh 
 miasm which cannot enter the closed windows of one side 
 of the house, may become so weak before it can creep aroimd 
 to the other, where the windows are open, that no injury 
 ensues. 2d. A heavy fall of rain often stops cholera, and we 
 know that rain thoroughly washes the air of all its impurities. 
 3d. A violent thunder-storm also prevents cholera, and we 
 know that lightning absolutely seems to burn up all impurities 
 of the air, as flax is burnt in fire. Still, I feel confident that 
 the poison of cholera originates from filthy men and places on 
 the surface of the earth, and that cleanliness and disinfection 
 will prevent all contamination of the atmosphere ; and that 
 even if cholera be introduced into a place, cleanhness and 
 disinfection will check it promptly. 4th. Dr. Yandeveer, in 
 his account of the Franklin street cholera hospital, says that 
 each ward, twenty-five feet by thirty, generally contained 
 twenty-five patients. Physicians, nurses, and attendants, to 
 the number of twenty, occupied adjoining rooms, with free 
 communication and doors frequently open. Post-mortem ex- 
 aminations, to the number of seventy-eight, were made, and 
 the hands of the physicians were freely bathed in the cholera 
 fluids ; the dead, for want of rapid transportation, were some- 
 times piled in coffins, one on top of the other, to the number 
 of ten or twelve. Yet only one of the physicians and nurses 
 was attacked with cholera. Bnt in the recent epidemic at 
 
ARGUMENTS AGAINST CONTAGION. 67 
 
 Ancona, fourteen physicians lost their lives, and the Sisters of 
 Charity were decimated. 5th. Great stress is laid upon the fact, 
 that a man in Munich, while in a state of intoxication, drank 
 a large beerglassful of the rice-water-vomit of a cholera pa- 
 tient without subsequent injury ; and that some of the physi- 
 cians of Munich freely tasted, and even swallowed, cholera 
 discharges with like impunity. But, there is a well-authenti- 
 cated case in which a Parisian dog devoured a large quantity 
 of the alvine dejections of a cholera patient, and died with all 
 the symptoms of the disease ; and Dr. Robin has injected 
 rice-water-vomits and the thinner portions of the blood of 
 cholera patients into the windpipes of healthy dogs, and found 
 them to produce vomiting, liquid evacuations, chills, and 
 speedy death. 6th. Persons have slept in the beds, and 
 worn the clothes previously used by cholera patients, and 
 even suffered agonies of childish fear for many weeks subse- 
 quently, and yet have not contracted the disease ; others have 
 died from similar imprudence or folly. From eighty-four 
 communications about washerwomen, Bally and G-ull con- 
 cluded that they were not much more subject to the disease 
 than others. We should recollect, in this connection, that the 
 number of careful and cleanly persons liable to cholera is 
 always very small ; it has been variously estimated from 
 thirty-seven to sixty-one, at the lowest, and five hundred and 
 thirty-five, in ten thousand, at the highest. The susceptibility 
 varies so much, that one may die from eating a few cherries ; 
 on the other hand, during the last epidemic, in a small town 
 in Kentucky, nine. young men employed themselves in nursing 
 the sick and burying the dead, and as melons were in season 
 and abundant, they all ate freely of them the whole time, and 
 none of them suffered with any symptom of the disease, 
 
68 ASIATICCHOLERA. 
 
 aHhotigh a large number of the inhabitants were attacked. 
 Dr. Salisbury even thinks that cider, sulphur-water, and cer- 
 tain classes of ripe fruit and vegetables, are preventives of 
 epidemic cholera. Again, Dr. Houston, who does not believe 
 in the communicability of cholera, cites his experience at 
 Bridgeport, near Wheeling ; it contained only two or three 
 hundred inhabitants, was situated on an island ; but more or 
 less communication was kept up with WheeKng by means of 
 ferry-boats, and the place was very filthy. The disease com- 
 menced in WheeKng about the 15th of May, and did not ap- 
 pear in Bridgeport until the last week in June, or, in about 
 five weeks ; then it broke out in the night, and in thirty-six 
 hours not less than twenty-two of the inhabitants had fallen 
 its victims. But, cholera is always preceded by diarrhoea 
 and cholerine, and it may be days or weeks before real cases 
 of cholera show themselves. Again, in the Massachusetts 
 state-prison, in 1832, the first case of cholera occurred in a 
 man under solitary confinement ; in the course of an hour 
 four more were attacked in different remote parts of the 
 prison, and in the space of forty-eight hours, two hundred 
 and five inmates of the building had the disease. It is said, 
 triumphantly, " This certainly does not look like contagion." 
 But it does. Cholerine had certainly been at work in that 
 prison, silently but efficiently, until an explosion took place. 
 I have intentionally cited the apparently sudden outbreak in 
 Constantinople in 1865, but in every case it was traced to im- 
 portation ; and excessive filth furnished the other factor of a 
 sudden outbreak. In proof of the above, it is sufficient to 
 cite the conclusions of Jules Guerin, which are now generally 
 adopted by the profession, to prove that the causes of cholera 
 must have been at work in Bridgeport and in the Massachu- 
 
 ^ 
 
ARGUMENTS AGAINST CONTAGION. 69 
 
 setts state-prison long before the outbreak, and that the per- 
 sons who imported it had escaped observation. Previous to 
 1832, it was supposed that cholera attacked its victims in a 
 very sudden manner ; but Jules Guerin first noticed that most 
 of the cholera subjects had been laboring for several days, or 
 even weeks, under a disturbed condition of the digestive 
 organs, which did not appear sufficiently serious to deserve 
 careful attention. Some were so careless upon this point, 
 that they could only give a satisfactory answer after having 
 been questioned three or four times. Of six hundred patients 
 five hundred and forty had shown symptoms of cholerine, or 
 premonitory diarrhcBa ; of five hundred other subjects, almost 
 all had been previously attacked by choleraic diarrhoea of ten 
 or twelve days' duration ; and the rice-water discharges were 
 always preceded by others of a different, though unhealthy 
 character. Of three thousand nine hundred and two addi- 
 tional cases, not one was found without prodromic diarrhoea ; 
 of one hundred and forty-two more, there were only six with- 
 out preceding symptoms ; in ninety-five other cases, the diar- 
 rhoea had lasted two, three, four, and even a greater number of 
 days ; of nine hundred and seventy-four cholera patients, 
 seven hundred and forty had been attacked with premoni- 
 tory diarrhoea, and the rest were exempt, or unable to 
 give exact evidence. Jackson's case, in which the disease 
 is stated to have suddenly occurred in a neighborhood, 
 tweniy-six miles from Philadelphia, and where the only person 
 who had been in the city when cholera prevailed, and who 
 might be supposed to have carried the contagion, escaped, 
 proves nothing ; except, that this or some other person doubt- 
 Jess did bring the disorder, in the shape of cholerine, and that 
 other more susceptible individuals suffered far more severely 
 
to ASIATIC CHOLERA. 
 
 than the one who imported it. We all know what severe at- 
 tacks of scarlet fever and measles may follow exposnre to 
 persons who have either been very slightly sick themselves, 
 or have apparently entirely recovered, so as to be able to go 
 to business, school, or church. — Finally, the apparently sudden 
 and extensive outbreak which cholera sometimes makes, does 
 not accord, it is supposed by some, with the slow and gradual 
 spread which the disease ought only to advance, if it arose by 
 contact from person to person. But we Jiave seen that the 
 seeds of cholera are always sown slowly, although the outbreak 
 may seem sudden. Besides, the communicabihty of the dis- 
 ease does not correspond with the time when the dejections 
 are voided ; but is only developed a few days subsequently, 
 and seems to be exhausted at the end of fifteen to twenty-one 
 days. This peculiarity has been traced to the fact that the 
 rice-water discharges only become poisonous after a while ; 
 for the first few days they are innocuous ; then, as decomposi- 
 tion proceeds they become morbific, and capable of re-produ- 
 cing the peculiar disease of which they were the product. 
 And still more strangely, after a few days more^ when decom- 
 position has reached a farther stage, the contagious property 
 of the evacuations cease. These great facts account for the 
 impunity with which careful and cleanly persons may wait 
 upon those sick with cholera ; for the mysterious and sudden 
 outbreak of the disease, and for its equally sudden subsi- 
 dence. These points have been proved, in the following inge- 
 nious way : pieces of filtering paper, soaked in the rice-water 
 discharges have been given to mice, mixed with their food, 
 and it was found that papers steeped in the very recent, and 
 others dipped in the older discharges, proved alike harmless. 
 But of thirty-four mice that ate papers impregnated with excre- 
 
ARGUMENTS AGAINST CONTAGION. 11 
 
 tse of an intermediate date, thirty became sick, and twelve died ; 
 while the symptoms and appearances noticed after death, are 
 declared to have been similar to those that are proper to 
 cholera as it is seen in the hnman subject. 
 
 The sudden cessation of cholera is often cited as a proof 
 that it depends, not on contagion, but upon some general in- 
 fluence in the air, which is blown upon us like a whirlwind, 
 rages as destructively, and ceases as suddenly. But, if the 
 process by which cholera discharges become poisonous ceases 
 spontaneously in a few days or weeks, the epidemic must 
 die out in the places where it first originated as suddenly 
 as it commenced, although it may spread to other parts of the 
 same city or country. 
 
t2 ASIATIC CHOLERA. 
 
 NATURE. 
 
 It may reasonably be inferred, from all that bas gone before, 
 tbat tbe poison of cholera is somewhat similar to that which 
 arises from offensive sewers and privies, and to which night- 
 scavengers are subject until they become acclimated. In fact, 
 it somewhat resembles the so-caUed septic cholera, which was 
 formerly best seem in the new visitants to the old-fashioned, 
 badly ventilated and equipped dissecting rooms. In former 
 times very few medical students escaped ; the symptoms were 
 a profuse diarrhoea with but little pain, followed by quick ex- 
 haustion ; the discharges were thin, like dirty soap-water, 
 without flocculi, shreds, or bile ; there was some nausea, but 
 not often severe vomiting. Or, cholera is comparable to the 
 sewer-disease, of which cases enough are to be found in this 
 city, but of which Naples sometimes furnishes pregnant ex- 
 amples. In Naples, the public drains empty themselves on 
 the sands in front of the Yilla Reale, which is the most fash- 
 ionable promenade ; heavy rains often flood the streets and 
 flush the sewers and sluices of their accumulated abominations 
 down to the sands and the sea. The waves and surf frequently 
 drive these back, again and again, on the shore ; while the 
 winds rushing up the open culverts force back the fetid gases 
 through the rain openings in the street, and through the open 
 water-closets into the houses, so that the smell through the 
 entire lower part of the city is often awful, and a considerable 
 portion of the population may be suddenly affected with nau- 
 sea, colic, diarrhoea, and even dysentery.— Watson records the 
 sudden outbreak of a violent disorder, a sort of cholera, among 
 the boys in a large school at Clapham ; nearly a score of 
 them were aU at once attacked with the most alarming symp- 
 
NATURE. 1?3 
 
 toms, and two of them died, in consequence of the opening of 
 an old cesspool behind the house, and the distribution of its 
 foul contents over a garden adjoining their play-ground. Sub- 
 sequently two hundred and ten out of four hundred and twenty 
 inmates were affected, and it was found that the drainage 
 of the building was imperfect, the sinks and water-closets 
 not properly trapped, and an old drain under the house was 
 choked. It was then recollected that there had been a strong 
 sewage smell in some of the rooms before the outbreak. The 
 first case reported as Asiatic cholera this year (1866) in New 
 York was doubtless one of septic cholera. We learn that 
 Mrs. Jenkins, aged thirty-five, had been engaged for some days, 
 and at the time of her attack, in removing the contents of an 
 old privy and spreading them as a fertihzer upon a lot of 
 ground, in order to raise a crop of potatoes. She sickened 
 May 1st, at ten a. m., and died in twenty hours ; the post-mor- 
 tem examination revealed lesions similar to those of Asiatic 
 cholera. Although the ceUar of the house was partially filled 
 with stagnant water, and the remainder of the building was 
 filthy, and four other families Kved in it, no one else sickened 
 or died ; showing that it required the concentrated power of 
 the fascal emanations to produce a fatal attack. 
 
 Dr. Kead, of Boston, believes that there are three diseases, 
 or varieties of cholera, very much resembhng each other, each 
 of them capable of producing a fatal result, but radically dif- 
 ferent. All of them are characterized by excessive action 
 of the alimentary canal, and in proportion as the attacks 
 increase in intensity, may bring out the pecuHar features of 
 collapse, viz., the cold, clammy, wet, blue skin ; the pinched 
 features ; husky and often sepulchral voice, and the cramps in 
 the limbs. They are each dependent on different and peculiar 
 
74 ASIATIC CHOLERA. 
 
 exciting causes. The first, is the septic cholera, or that arising 
 from exposure to poisonous gases ; second, common cholera, 
 or cholera morbus, or endemic hepatic cholera ; and third, the 
 epidemic-intestinal, or true Asiatic cholera. The first, he as- 
 sumes, afiects those who are exposed to animal effluvia, whether 
 from dissecting-rooms, or abattoirs, offensive privies and sew- 
 ers, or noxious gases in general. The second arises from a 
 bilious condition ; or use of improper food in the summer 
 time, such as unripe melons, cucumbers, cherries, spoiled 
 crabs, lobsters, fish, &c. ; or from sudden changes of tempera- 
 ture, causing a check of perspiration ; or frequently from all 
 these causes combined. These two are not contagious in 
 the slightest degree, nor capable of being generated ex- 
 cept by the operation of the original exciting causes. 
 In the case of Mrs. Jenkins, in New York, he also sees no 
 reasons for looking beyond septic cholera, for the cause of 
 sickness and death, for she was attacked as many persons 
 engaged in removing night-soil are, when they first begin 
 this occupation and, are not inured to the sickening, filthy 
 odors which then assail them. In the Home for Aged Females 
 in Boston, twenty-seven of the inmates were attacked in 
 1865, in one night, with septic cholera, but only one died. 
 In Edinburgh this form of cholera is not uncommon ; the 
 water supply is good, and brought from a distance in pipes, 
 and not contaminated by sewage ; wells and pumps are not 
 used. The street dirt, and all that is offensive is removed, 
 once or twice daily, by an efficient corps of scavengers, so 
 that large profits are realized by the sale of street manure. 
 But the sewerage is inadequate, and the water-closets, 
 except a few that are well constructed and trapped, are often 
 noxious and most disgusting nuisances, and insidious sources 
 
CHOLERA MORBUS. t5 
 
 of disease, owing to the ascent of noxions gases from the 
 sewers, for wliich they act as ventilators. This is prevented, 
 in some cases, by conducting pipes from below the traps 
 up above the roofs of the houses. Dr. Eead has neglected 
 to include cholera infantum among the diseases which re- 
 semble, and may be suddenly changed into, true cholera. It 
 is well known that in " cholera times" the first cases are often 
 noticed among infants. In fact, the name of cholera is 
 given to any complaint in which the prominent characters are 
 simultaneous and repeated vomiting and purging, with painful 
 spasms of the stomach and bowels, and occasional cramps of 
 the external muscles ; and true Asiatic cholera may aUy itself 
 to aU these. Five varieties have been observed, so different 
 in the circumstances of their occurrence, as weU as in their 
 symptoms, progress, and results, as to merit distinct cons- 
 sideration. These are: first, cholera morbus; second, septic 
 cholera; third, bilious chbUra; fourth, cholera infantum; 
 and fifth, Asiatic cholera. 
 
 1. CHOLERA MORBUS. 
 
 Hot weather, long continued, strongly predisposes the 
 system to cholera morbus, and may itself occasion the dis- 
 ease, without any other cause. Wood says the same may 
 be said of marsh miasmata, for it often precedes the break- 
 ing out of miasmatic fevers, as if from the operation of the 
 same cause. Most commonly, however, the immediate at- 
 tack is brought on by some well-known exciting cause, such 
 as exposure to cold when the body is heated and per- 
 spiring ; the use of certain indigestible and irritating articles 
 of food or , drink, such as cucumbers, melons, various unripe 
 fruits, fat pork, lobsters, crabs, sour and incompletely fer- 
 
!I6 ASIATIC CHOLERA. 
 
 mented liquors, putrid water, excesses at table, and the nse of 
 ice or very cold drinks in excess. Wood has seen the 
 operation of calomel in some instances so exactly like cholera 
 morbus, that the most experienced physician could scarcely 
 distinguish them. In cholera morbus the pulse is usually 
 feeble, countenance pale and shrunken, skin cool and damp, 
 urine scanty or suppressed; and in some cases there are 
 often very painful cramps of the muscles of the abdomen 
 and legs. The vomiting and purging may become almost in- 
 cessant, extremities cold, and extreme exhaustion occur. 
 The vomits may become colorless after a while, but often 
 are sour or acrid. In some instances, when all the indigesti- 
 ble and ordinary fcecal and bihary matters have passed off, 
 the evacuations may become colorless or whitish, as in epi- 
 demic cholera. When true cholera prevails, this disease may 
 be rapidly transformed into it. Lankester thinks that a certain 
 amount of the diarrhoea and cholera morbus of summer may 
 be attributed to the decomposition of animal and vegetable 
 matters, which are directly taken into the stomach in the 
 shape of stale, spoiled, or partly decomposed vegetables and 
 meats. They cause a like corruption of the rest of the 
 intestinal contents, and form a fit nidus for the development of 
 true cholera. 
 
 2. BILIOUS CHOLERA. 
 
 Watson says, there is a complaint of which diarrhoea is one 
 prominent symptom, but which is something more than mere 
 diarrhoea ; it occurs in England and in this country, more or 
 less, every autumn or summer. It is rightly enough called 
 cholera, for it is attended with, and consists mainly, of a re- 
 markable flux of bile. The symptoms are vomiting and purg- 
 ing of liquid matter, deeply tinged with and principally com- 
 
BILIOUS CHOLERA. It 
 
 posed of bile ; violent pains in the stomach and bowels ; 
 cramps of the legs and abdominal muscles ; great depression of 
 the vital power, and a tendency to syncope or collapse. The 
 attack is generally sudden ; at first the contents of the alimen- 
 tary canal are evacuated ; and then a quantity, an enormous 
 quantity sometimes, of a turbid, yellowish, acrid fluid is ex- 
 pelled with violence, both from the bowels and by vomiting. 
 As the vomiting and purging go on, clonic spasms of the legs, 
 especially of the calves, occur ; the surface of the belly is 
 drawn up into knots and after a while the patient exhausted 
 by the pain and spasms, and still more by the copious dis- 
 charges, grows cold and faint. Actual syncope sometimes 
 happens, and occasionally death, but rarely. 
 
 3. CHOLERA INFANTUM. 
 
 This disease occurs in all our largest cities, during the sea- 
 son of greatest heat, attacking children between four and twenty 
 months of age. The first symptom is usually a profuse diar- 
 rhoea, the stools being very fluid, and generally of a very 
 light color, though often curdled, or pale yellow or green. 
 To the diarrhoea is soon added extreme irritability of the 
 stomach. After a while the discharges are often composed 
 entirely of a perfectly colorless and inodorous fluid, contain- 
 ing minute mucous flocculi, and discharged without effort. It 
 is produced by the action of a heated, impure, damp, and 
 stagnant atmosphere, directly upon the lungs and blood, and 
 indirectly upon the skin, and digestive mucous surface ; it 
 becomes more frequent and fatal with the rise of the ther- 
 mometer, and declines with the first appearance of cool 
 weather in the autumn. The worst cases occur among the 
 children of the poorer classes, inhabiting small, damp, and ill- 
 
18 ASIATIC CHOLERA. 
 
 ventilated houses, in narrow confined lanes, courts, and 
 alleys, or in situations abounding with accumulations of filth. 
 In aU cases the cure will depend very much upon our abiUty 
 to remove the patient from the influence of the impure, damp, 
 and heated atmosphere, by which the disease is kept up. 
 
 4. ASIATIC CHOLERA. 
 
 Omitting for the present the consideration of cholerine, or 
 premonitory diarrhoea, we turn our attention to the character- 
 istic phenomena and the nature of Asiatic cholera. The 
 choleraic diarrhoea is attended with very Httle pain, showing 
 great torpor of the nerves ; soon the bowels act by the stimu- 
 lus of distension alone, as there is a paralytic condition of 
 their muscular coat, and the dejections become frequent and 
 copious, and pass off in a fuU stream with very Httle effort. 
 They quickly become watery and serous, and at last present 
 that appearance which has by common consent been called 
 rice-water. They resemble this more than anything else, and 
 are composed exclusively of the serum or wa,tery part of the 
 blood, intermingled with an immense amount of epithelium 
 and some flakes from the mucous membrane. 
 
 After a shorter or longer period of diarrhoea, suddenly, with- 
 out much nausea, vomiting commences, of a similar watery 
 fluid to that discharged from the bowels. The skin also be- 
 comes covered with a cold clammy sweat, which at times is 
 very profuse. Condie justly remarks, that this copious per- 
 spiration is generally not dwelt upon with sufficient emphasis 
 for it is a source of great exhaustion ; it sets in early in 
 the attack, and becomes excessive towards the close of fatal 
 cases. 
 
 In consequence of this drain of fluids from the system, in- 
 
ASIATIC CHOLERA. t9 
 
 tense thirst is experienced, and seems to prevail in direct ratio 
 to the quantity of watery fluid which has been poured out by 
 the discharges, and to depend on them. It is based upon an 
 instinctive desire and urgent demand for a supply of fliiid to 
 make up the waste and drain from the system. Condie has 
 even known patients attempt to allay it by swallowing the 
 fluids they had just before vomited, if they could get no other 
 drink. 
 
 The loss of fluids is so great that the whole body shrinks ; 
 the features become contracted and pinched ; the hands 
 and feet are shrivelled, corrugated, and greatly shrunken, 
 and lose at least one third of their bulk. 
 
 When much serum has been poured out, the blood becomes 
 so thick that it no longer traverses its accustomed rounds with 
 facility, but collects in undue quantity in the right side of the 
 heart, in the vena cava, in the portal and emulgent veins. In 
 fact, the whole venous system is found turgid with black, co- 
 agulated blood. In twenty cases in which cholera-blood 
 was left to stand for some time, not one drop of serum sepa- 
 rated from it. 
 
 The thickness of the blood is such that it does not flow in the 
 usual channels which expose so great a surface to the action 
 of the air, throughout the minute and abundant capillaries of 
 the lungs. Air enters the lungs, but respiration is labori- 
 ous, and attended with a sense of sufibcation from the changed 
 condition of the blood, that resists the full vivifying influ- 
 ence of the air upon it. Ultimately, the proper changes of 
 the blood in the lungs, from merely being imperfectly effected, 
 are entirely suspended ; and that portion which reaches the 
 left or arterial side of the heart, becomes similar to that sent 
 to the Imigs from the right, or venous side. The propulsive 
 
80 ASIATIC CHOLERA. 
 
 power of the heart soon becomes enfeebled ; the general circu- 
 lation almost suspended ; and the dark color of the blood pro- 
 duces a blue or bronzed hue of those parts in which the thin- 
 ness of the skin permits its color to be seen. 
 
 The circulation being almost suspended, animal heat can no 
 longer be generated in sufficient quantities, and the body be- 
 comes not only blue, but cold. 
 
 The most painful and distressing phenomena of this de- 
 structive malady, viz., the cramps and spasms, are ushered in 
 almost simultaneously with these profuse evacuations from 
 the stomach, bowels, and skin, and apparently are intimately 
 connected with them. At times a similar spasmodic irritation 
 extends to the heart and arteries, and the pulse instead of be- 
 coming soft and feeble, may be hard and wiry, while the heart 
 struggles violently. 
 
 Finally, collapse occurs ; the watery evacuations and spasms 
 cease, and the patient lies indifferent, apathetic, fearless, and 
 only craves for drink. 
 
PHYSIOLOGICAL THEORY. 81 
 
 THEORIES. 
 
 {a.) PHYSIOLOGICAL THEOEY. 
 
 CoMPAEATiYELY late discoveries in physiology make it quite 
 plain how easily the immense quantities of fluid discharged in 
 the evacuations of cholera can take place. The normal quan- 
 tity of water poured out daily and hourly by the mucous mem- 
 branes is very great. If we turn down the lower lip before a 
 mirror, and wipe it quite dry, we may see and feel a number 
 of seed-like little glands studding the surface all over. In a 
 few moments each one of the protuberances will be headed by 
 a tiny drop of dew, which grows rapidly larger, till, in a short 
 time, the whole lip is covered with moisture as before. Reck- 
 oning the extent of the gastro-intestinal mucous surface at 
 twenty-four square feet, the square inch we were looking at 
 must be multiplied by 3,456 to get a correct idea of this great 
 secreting surface. The immense amount of water poured out 
 daily, by the mucous membrane of the stomach and bowels, is 
 not naturally destined to be wasted ; but in cholera it is. In 
 health we see how quickly it exudes, and we know by the 
 amount of our faeces, in the normal state, that it does not natur- 
 ally pass off by the bowels into which it is thrown. What 
 becomes of the several gallons a-day which is secreted from 
 this active source ? We know that however weU the mucous 
 membrane may be constructed for purposes of secretion, it is 
 stiU better constructed for absorption ; that water, however 
 quickly it is supplied, will be rapidly taken up, and is ab- 
 sorbed, indeed, with a rapidity very closely proportioned to 
 its quantity. The intestinal canal naturally drinks up not only 
 the fluids which we swallow as food, but also those which it 
 
 5 
 
82 
 
 ASIATIC CHOLERA, 
 
 pours out so copiously for its own digestive processes. What 
 the amount of these is will best be seen by a tabular sketch of 
 the probable (say maximum) quantities of each secretion 
 poured out directly or indirectly from the gastro-intestinal 
 mucous membrane. An adult man is calculated to secrete in 
 twenty-four hours, weights approaching nearly to the under- 
 mentioned : Of saliva, three to four pounds, avoirdupois ; of 
 bile, three to four pounds ; of gastric juice, fourteen to six- 
 teen pounds ; of pancreatic juice, half a pound ; of intestinal 
 juice, half a pound ; thus making a grand total of from tweniy- 
 one to twenty-five pounds of fluid ; of which only so much 
 passes away from the bowels normally, as will prevent the 
 feeces from becoming too solid. 
 
 The clearest notion we can gain of the business performed 
 by all this ten or twelve quarts of water which naturally ex- 
 ude on the mucous membrane of the intestinal canal, and 
 should be taken up by the same membrane again, is by view- 
 ing it as a circulation. In health, it is constantly going its 
 rounds like an endless chain, finding and taking up inside the 
 solid structure of the body substances which ought to come 
 out, and be got rid of ; and meeting in the alimentary canal 
 with nutriment which the body wants, and conveying it in. In 
 cholera this immense exudation takes place, but almost aU ab- 
 sorption is stopped ; consequently, profuse liquid, serous, or 
 almost white discharges must occur. 
 
 The appearances in the stomach and bowels after death are 
 thought to accord with this view of the disease, The 
 stomach often only presents a pale or ^^eUowish appear- 
 ance : or scarcely any change, except, that it is somewhat 
 contracted and thickened. The small intestines are fre- 
 quently found pale and osdematous. But the most common 
 
PHYSIOLOGICAL THEORY. 83 
 
 alteration consist in an enlargement of the solitary glands, 
 from a serous fluid or granular matter deposited in tliem. 
 The epithelium which naturally covers the mucous mem- 
 brane, is always found partially or wholly removed. These are 
 justly regarded as the great pathological features of cholera. 
 As the epithelium is everywhere remarkably endosmotic, 
 the removal of so much of it must interfere greatly with 
 absorption ; and as the viUi are the principal agents of 
 absorption of the nutritive elements resulting from the di- 
 gestion of food, their functions must be much impeded by 
 the removal of their covering epithelium. As the intes- 
 tinal glands are greatly enlarged, they probably pour out 
 a much greater quantity of fluid than natural. 
 
 It is rational to suppose that all the essential elements of 
 a true theory of cholera are contained in the above well- 
 authenticated facts, and that all the phenomena of the dis- 
 ease can be explained by them. Thus Dr. Snow has com- 
 puted that, in a healthy adult of average size, it is only 
 necessary that five pints of serous fluid should be poured 
 out, in order to reduce the blood to the condition that 
 obtains in the collapse of cholera. In the less acute cases, 
 where the evacuations exceed the above quantity, he infers 
 that some of the fluids drank pass off by the bowels ; or 
 assumes correctly that absorption is not altogether sus- 
 pended ; experiments having shown that absorption, although 
 diminished in attack of cholera, does not always cease ; for 
 iodide of potassium, administered during the algid stage, 
 has sometimes been detected in the blood and urine. 
 
 The indications of treatment, according to this view, are 
 to use tonic astringents, especially iron alum, sulphate of 
 
84 ASIATIC CHOLERA. 
 
 iron, simple alum, gaUic acid, muriate tincture of iron, elixir 
 vitriol, sulphuric acid, &c. 
 
 (h,) GLAND THEORY. 
 
 As the solitary glands of the intestinal canal are very 
 much enlarged in cholera, so as to be very distinct and 
 prominent, causing the surface of the bowel to resemble 
 a nutmeg-grater in roughness ; and as the glands of Peyer 
 are also, in most cases, exceedingly distiact and conspicu- 
 ous, so that the inner wall of the intestines seems fretted 
 with separate or aggregated granular protuberances. Dr. 
 Isaac Hayes has selected these facts for the formation of 
 a theory of cholera. He thinks the first step in the dis- 
 ease is an orgasm of these foUicles ; they increase in size, 
 and their secretions are augmented in the same way that 
 that of the mammary glands is. He infers that this exag- 
 gerated exudation from the follicles has been preceded by 
 an active flux towards them, and by that state of turges- 
 cence of the secretory organs which is an attendant upon 
 most augmented exhalations. Thus is caused the serous 
 diarrhoea, which is the first stage of cholera, and which 
 quickly drains from the blood a large portion of its white 
 fluid or serum, and the saline matter which it holds in 
 solution. As soon as this has gone on for a while, the 
 peculiar choleraic symptoms appear, such as debHiiy, cold- 
 ness of the extremities, feebleness of the pulse, and op- 
 pressed respiration, which are the immediate results of all 
 sudden losses of blood. Next, the blood, deprived of its 
 serum by the profuse discharges from the bowels, becomes 
 thickened, and in proportion as it is rendered viscid, the 
 propulsive power of the heart is enfeebled, and the circu- 
 
ELIMINATION THEORY. 85 
 
 lation is diminished. Less blood is carried to the kings, 
 and the respiration becomes embarrassed; the oxygen of 
 the inspired air cannot effect those changes which it ordi- 
 narily produces, and more carbonic acid is retained. Fi- 
 nally, all the blood becomes venous, and the symptoms of 
 cholera asphyxia arise. This view is almost as satisfactory 
 as the physiological one we have already given. 
 
 The indications of treatment, according to this theory — 
 which is based on the well-known law, uhi irritatio, ihi 
 fiuxus — ^are to use sedative astringents, such as opium, acetate 
 of lead, digitalis, &c. 
 
 (C.) ELIMINATION THEOKY. 
 
 Dr. George Johnson, and many other physicians, believe 
 that the cholera stools contain some poisonous materials, by 
 which the disease is not only multiplied in the human sys- 
 tem, but can be communicated to others; and assume that 
 it is also probable that the discharges into the digestive canal, 
 together with the vomiting and purging, are as much parts 
 of the natural process of cure as is the eruption on the skin 
 in small-pox. They oppose the commonly-received opinion 
 that the worst symptoms of cholera are mainly due to the 
 drain of serum from the blood by the vomiting and purging. 
 They say if this theory be erroneous, it is of incalculable im- 
 portance that it shoald be discarded ; for it is unquestionable 
 that it has had an immense influence on the treatment of 
 cholera, as well as on the estimate which men have formed 
 of the effect of various modes of treatment. Let a practi- 
 tioner be thoroughly persuaded that the essential cause of 
 choleraic collapse is a drain of liquid from the blood, and it 
 will be difficult to convince him that opium and astringents 
 
bb A SIATIC CH OLERA. 
 
 can do harm, or that emetics or purgatives can do good. 
 The symptoms of cholera result from a poison which may 
 enter the blood either through the lungs, or by way of the 
 gastro-intestinal canal j and its most constant and characteristic 
 effect is to excite a copious excretion from the mucous mem- 
 brane of the stomach and bowels. Vomiting and purging 
 constitute the means by which the morbid particles are re- 
 moved from the blood and alimentary canal. Hence the pro- 
 cess of elimination takes place by two successive stages. 
 First, there is an excretion of fluid from the blood into the 
 stomach and bowels ; and second, the morbid contents of these 
 viscera are ejected by vomiting and purging. Johnson asks : 
 Can we do anything to assist the natural process? and answers, 
 unquestionably we can, by emetics and purgatives. A purga- 
 tive may be useful by removing two conditions which often 
 obtain in cholera, viz., over distention of the bowels by liquid ; 
 and an accumulation of offensive viscid and semi-soHd secre- 
 tions. 
 
 Johnson gives mild emetics and copious draughts of plain 
 or salt water ; but prefers castor oil as a laxative, because he 
 thinks the object of a purgative is not to remove the poison 
 from the blood and increase excretion into the stomach and 
 bowels ; but simply to expel the morbid secretions which 
 have already been poured out into the ahmentary canal. 
 Wilson prefers charcoal, from its controlling and corrective 
 power over all ferments, acescent and putrefactive. He 
 believes that foul, morbid fermentation in the stomach and 
 bowels is one of the most constant attendants, and not the 
 least of aggravating causes, in the progression of the disease ; 
 for he invariably found, in post-mortem examinations, not- 
 withstanding the gallons of watery fluid which had passed 
 
PARALYSIS THEORY.. 81 
 
 off, that the contents of the bowels were most offensively 
 feculent. After using this remedy a few days, he gave a 
 dose of oil, in order to remove the accumulated charcoal and 
 the putrid matter it had absorbed ; for he found, until he did 
 so, his cases of relapse were frfequent, and sometimes fatal. 
 BiUings prefers epsom salts and tartar emetic ; Jephson, large 
 doses of croton oil. The homoeopathists rely upon ipecac, 
 tobacco, veratrum, hellebore, tartar emetic, mercury, &o. 
 
 (d) PARALYSIS THEORY. 
 
 In many or most cases of cholera, the bowels are said to 
 act one or more times largely, and then all power of absorp- 
 tion from the stomach and bowels is supposed to be gone. 
 The vessels and nerves which preside over absorption are 
 inferred to be paralyzed^ and, by continuity, this paralytic 
 condition is thought to extend to the ganglionic or great sym- 
 pathetic nervous system, which governs and regulates capillary 
 circulation everywhere, but more particularly in the alimen- 
 tary canal. This paralysis of the nerves and capillaries al- 
 lows the blood to become drained of its serum and saline 
 particles, just as an exhausting perspiration occurs from a 
 debilitated skin. 
 
 When the poison of cholera first obtains entrance into the 
 body by being inhaled into the air tubes, it is assumed that the 
 great gastro-pulmonary or pneumo-gastric nerve becomes 
 wholly or partially paralyzed. Then the air which is drawn 
 into the lungs is expelled again in the same state in which it 
 was taken in, except that it has been exposed for a short time 
 to a moist animal surface ; the air remains cold, and there is 
 no elimination of carbon from the lungs, so that this essential 
 part of respiration is in abeyance ; little or no oxygen is in- 
 
88 ASIATIC CHOLERA. 
 
 troduced into the system, and the symptoms of asphyxia 
 arise. The blood becomes black and venous, and the skin 
 assumes a blue color, although the muscles of respiration con- 
 tinue and even increase their action. The breathing is almost 
 always doubled in frequency, rising from sixteen or eighteen 
 to twenty-eight or thirty-four per minute ; still it is almost al- 
 ways costal, and the oppression of the chest may be great. 
 
 The indications of treatment, according to this theory, are 
 to use tonics and stimulants, such as strychnine, nux vomica, 
 veratrine, ammonia, camphor, phosphorus, phosphoric acid, al- 
 coholic stimulants, quinine, &c. 
 
 (e.) FIRST SPASM THEOEY. 
 
 This commences with the assumption that the cholera poison 
 is generally inhaled from the atmosphere into the lungs, thence 
 passes into the blood, and that it is irritant in its nature, as is 
 shown by the painful cramps which it subsequently occasions 
 in the muscular tissues. This poisoned blood excites spasmodic 
 contraction of the muscular walls of the minute pulmonary 
 arteries ; the effect of which is to diminish and, in fatal cases, 
 entirely to arrest the flow of blood through the lungs. In the 
 first and second stages of cholera, it is assumed, without suf- 
 ficient proof, that there is a surprising contrast between the 
 almost constant presence of an extremely ancemic or blood- 
 less condition of the lungs, from which scarcely even a few 
 drops of blood will flow when the tissue is cut, and the hyper- 
 cemic or congested state of all other organs. The passage of 
 blood through the lungs, from the right to the left side of the 
 heart, is said to be in a greater or less degree impeded ; for, in 
 the large majority of cases, in the earlier stages of cholera, 
 the right side of the heart and the pulmonary arteries are 
 fllled, and sometimes distended with blood: while the left 
 
FIRST SPASM THEORY. 89 
 
 cavities of the heart generally contain only a small quantity. 
 The arteries are so empty that vessels of considerable size' have 
 been opened without the escape of blood, as has been done 
 both to the temporal and brachial arteries during life. John- 
 son thinks this condition of things arises not from arrest of 
 blood in the capillaries, but from spasm in the branches of the 
 pulmonary artery, before the capillaries are reached by the 
 blood. He says, we know that the walls of the arteries are 
 muscular, and have the power of contracting on their contents 
 under the influence of a stimulus, such as cold, electricity, and 
 mechanical irritation, and that no physiologist of the present 
 day will deny that spasm of the arteries is as real a fact as 
 spasm of the muscles. He assumes that arrest of the blood 
 in its passage to the lungs is the true key to the pathology of 
 choleraic collapse, and one which will account for all the most 
 striking chemical phenomena of the disease in a simple yet 
 complete manner, viz., for the imperfect aeration of the blood, 
 the faU of temperature, the dark and thickened appearance of 
 the blood, and the suppression of the bile and urine. He 
 says it is obvious that the stream of blood from the pulmonary 
 capillaries to the left side of the heart is the channel by which 
 the supply of oxygen is introduced into the system ; and a 
 great diminution in the volume of this wiU lessen the supply 
 of oxygen in a corresponding degree. Again, the combustion 
 of those constituents of the blood which are normally sub- 
 jected to the action of oxygen will be diminished in propor- 
 tion to the deficiency of that gas. The constituents of bile, 
 urine, and carbonic acid, are all results of oxidation, and none 
 of them can be formed without a large supply of oxygen ; 
 hence suppression of bile and urine during the stage of col- 
 lapse is a necessary consequence. The amount of carbonic 
 
 5* 
 
90 ASIATIC CHOLERA. 
 
 acid expired during collapse is also much diminislied ; and, 
 consequently, ^n excess is retained, not only in the lungs, but 
 in the system in general. Plausible as this and the subsequent 
 theory may appear at first sight, we can scarcely believe that 
 they will be found consistent in ail their parts, or to afford a 
 a satisfactory explanation of the leading phenomena of cholera, 
 or to serve as a safe basis for its rational and successful treat- 
 ment. They seem to account for cholera asphyxia rather than 
 the colliquative form, and are much less satisfactory than the 
 physiological explanation. 
 
 If this theory be true, I would suggest the use of conia, or 
 the active principle of the conium maculatum, for it produces a 
 rapidly-increasing paralysis, first of the voluntary, then of the 
 respiratory muscles of the chest and abdomen, and finally, of 
 the spinal marrow. Acetate of lead will probably prove the 
 next most useful remedy. 
 
 (/.) SECOND SPASM THEORY. 
 
 Bell and Braithwaite adopt a somewhat different spasm 
 theory. They think the subtile poison of cholera acts prima- 
 rily through the blood, and specifically upon the pneumo-gastric 
 nerve, and subsequently on the great sympathetic nerve, which 
 suppKes contractile power to the arteries, intestinal canal, 
 and organs of respiration. A kind of tetanic contraction is pro- 
 duced of all the arteries, thus emptying the contents of all the 
 capillaries into the great central veins. Braithwaite says we 
 all know how small a portion of strychnine will act on the 
 voluntary muscles, and asks why a similar effect should not be 
 caused by the virulent poison of cholera, but on rather differ- 
 ent parts of the nervous and muscular systems from those 
 specifically acted upon by strychnine. He accounts for the 
 
SECOND SPASM THEORY. 91 
 
 intestinal phenomena of cholera by assuming that the portal 
 circulation is at first impeded by meeting the reflux current 
 from the vena cava, and presently becomes reversed, so that the 
 blood is forced back into the mesenteric veins, till it distends 
 their extreme ramifications upon the mucous membrane of the 
 bowels, where its watery portions find a species of vent, just as 
 dropsy takes place from obstruction in the heart, liver, or kid- 
 neys ;'^ from this surface the repellant force squeezes out the 
 serous or watery portion of the blood, carrying with it the mu- 
 cous epithelium, thus constituting those serous or rice-water 
 evacuations which are regarded as characteristic of cholera. 
 These are declared not to be real secretions, but mechanical effu- 
 sions or exudations, which are quite the reverse of vital actions. 
 The kidneys also become mechanically congested, the return- 
 ing current of blood from the kidneys is stopped, and a first 
 effect of this is a cessation of the secretion of urine. The 
 hepatic circulation is affected in like manner, thus suspending 
 or impeding the secretion of bile. 
 
 Bell assumes that the so-called collapse of cholera is differ- 
 ent from the collapse of haemorrhage ; the first is active or 
 dynamic, while the latter is passive or adynamic ; the pulse 
 in hasmorrhage becomes slower, softer, and feebler, till it 
 ceases, but in cholera it is contracted, small, and wiry, as long 
 as it can be felt. The heart in cholera is heard and felt to be 
 struggling in an extraordinary state of excitement, and in the 
 active endeavor to overcome spasmodic obstruction, it is found 
 to be churning as if it would burst, causing a sound which it 
 is difficult to describe, but which once heard can never be for- 
 gotten. 
 
 The first indication, according to this theory, is to bleed. 
 When the sound and action of the heart convey the impres- 
 
92 ASIATIC CHOLERA. 
 
 sion that it is laboring hard with unabated vigor of reaction, 
 Bell thinks the lancet cannot be used too promptly. But when 
 the attack has lasted four or five hours, and the purging is less 
 copious, and the heart, instead of keeping up a continuous 
 struggle, appears to be roused up to reaction at intervals only, 
 then withhold the lancet awhile. If there is a decided re- 
 newal of distress, bleed again, till the thick tarry blood that at 
 first could only be squeezed out and kneaded from the arm 
 with difficulty, flows freely from the orifice and changes to a 
 fair florid hue. Braithwaite relies mainly upon the inhalation 
 of chloroform to overcome the spasm of the capillaries. 
 Opium, assafoetida, and antispasmodics, belladonna, conium, and 
 especially coniaj should prove useful remedies. 
 
 It seems perfectly transparent that Johnson, BeU, and Braith- 
 waite, have mistaken the secondary spasm of the pulmonary 
 arteries, vascular system in general, and of the heart, for a pri- 
 mary disorder. (See page 80, line 12.) 
 
 [g) CONGESTION THEOKY. 
 
 George Hamilton infers that profound passive congestion is 
 obviously present in nearly every violent attack, as is evident 
 from the coldness of the extremities, ears, nose, and some- 
 times of the tongue ; the purple color of these parts, and small 
 feeble pulse. The congestion of cholera is of too much sig- 
 nificance, he thinks, to attempt to sever its connection, how- 
 ever obscure, with the exhausting serous discharges. As long 
 as the heart, lungs, and spinal marrow, remain passively con- 
 gested, so long must almost every portion of the organism 
 partake of this condition. The blood in the arteries becomes 
 almost identical in its dark and carbonized appearance with 
 that contained in the veins. 
 
CONGESTION THEORY. 93 
 
 The first indication is to produce reaction of tlie vascular 
 system, restore a normal fluid to the arterial system, and thus 
 replace lost nerve power, lost temperature, lost secretion, and 
 lost function of every kind. To accomplish all this, Hamilton 
 says we must bleed. For to suppose that the abstraction of a 
 few ounces of blood, so carbonized as to be almost unfitted for 
 the purposes of life, if not positively deleterious, would de- 
 press the strength of the patient, is both illogical and contrary 
 to experience. Before or after venesection, he gives an emetic 
 of ground mustard, to stimulate the arterial circulation and re- 
 store animal heat ; then relies on carb. ammonia and alcoholic 
 stimulants ; and keeps the feet and skin warm. There is gener- 
 ally an excessive cold perspiration, which further depresses 
 the already wasted vital power ; it should be wiped constantly 
 away with heated flannels, and the hmbs rubbed incessantly by 
 strong hands and willing hearts. To arrest the exhausting dis- 
 charges and alleviate the cramps, Hamilton thinks, is no easy 
 task while a profound congestion exists ; but he uses morphia 
 in camphor-water liberally, or pills of opium and camphor, or 
 aromatic tinctures, or creosote. A large dose of calomel, fif- 
 teen to twenty grains, he says, is often necessary, and will 
 promptly arrest both vomiting and purging. 
 
94 ASIATIC CHOLERA. 
 
 PREVENTION. 
 
 The three great means of prevention against a general epi- 
 demic are, Quarantine, Cleanliness, and Disinfection. 
 
 1. QUARANTINE. 
 
 As cholera is always brought to this country and city in 
 ships, a long-continued and most rigid quarantine should be 
 maintained. There is every reason to suppose that that of 1866, 
 severe as it has been, was not sufficiently so. Three weeks' de- 
 tention in quarantine after the last case is none too long, even 
 when coupled with the most perfect disinfection of clothing 
 and baggage. In Europe, the general impression is that 
 cholera cannot be excluded by quarantine ; still, there are not 
 a few instances which prove that it may. At Sarepta, on the 
 Volga, there is a settlement of Moravians, which, during three 
 several epidemics, of the whole surrounding country, remained 
 untouched. In addition to their proverbially good and cleanly 
 habits, these thoughtful people maintained a perfect system 
 of quarantine. Again, there have been fourteen epidemics of 
 cholera at Staten Island, and only four have reached New 
 York. It cannot then be said that quarantine, even in the 
 careless and inefficient manner in which it has, for the most 
 part, been heretofore enforced, has been altogether a failure 
 here. But recent occurrences prove that it must be very 
 rigid to be successful. On the 14th of July, 1866, Mrs. McCoy, 
 a hospital nurse from the quarantine ship Falcon, visited 
 Ward's Island, and was attacked with cholera ; her two chil- 
 dren, who had spent the greater part of the previous day with 
 her, were next attacked. On the 16th, Mrs. Burns, a very 
 healthy woman, and companion of Mrs. McCoy, sickened and 
 
\ 
 
 QUARANTINE. 95 
 
 died in twelve hours. The woman who washed the clothing 
 of Mrs. Burns was the next victim, being attacked on the 18th, 
 and dying after an illness of less than twenty-four hours. 
 The outbreak then became general in the wash-house build- 
 ing, and has since spread to other wards and the lunatic asy- 
 lum. In the course of nine days, thirty-one cases and seven 
 deaths occurred, and in two days after eleven more were re- 
 ported in a dying condition. 
 
 Recruits newly enlisted from among emigrants who arrived 
 in cholera ships, brought the disease to Hart's and Governor's 
 Islands, among the United States troops assembled there, and 
 thence it was carried by them, per the San Salvador, to Tybee 
 Island. In less than a month, of four hundred and seventy sol- 
 diers, only eighty answered at roll-call ; ninety-five have died, 
 over one hundred have deserted, eighty-seven are in hospi- 
 tal, and the rest were more or less sick. It was common to 
 see ten buried before breakfast, and the same number before 
 supper. The statistical reports of the United States army from 
 1839 to '59, contain many similar instances. Thus, in 1848, it 
 was carried by United States troops from New Orleans to Texas, 
 and thence spread far up into the Indian country and to Mexico. 
 From 1848 to 1854, the effects of the Swanton epidemic were 
 regularly carried to Forts Laramie and Leavenworth. Fort Lara- 
 mie is on the route to California and Oregon, and often overrun 
 by emigrants. The cholera was confined to the road, and car- 
 ried along by the emigrants ; many Indians lingered along the 
 line of march, from curiosity and for the purpose of begging, 
 but they paid a terrible penalty. Fort Leavenworth is a general 
 depot of supplies, and a starting point or rendezvous for troops 
 on the march to New Mexico, and to the stations on the Great 
 Plains. The disease was brought to it by troops from St. Louis, 
 
96 ASIATIC CHOLERA. 
 
 and most of the commands also suffered in ascending the Mis- 
 sissippi and Missouri rivers. 
 
 For a week or two, emigrants with supposed cholera mor- 
 bus were admitted into the Bellevue Hospital, in July, 1866 ; 
 but soon the disease took the shape of genuine Asiatic cholera, 
 and by the 25th, nineteen cases had occurred. It has lately 
 been ascertained that the first outbreak this season on Ward's 
 Island originated among passengers from the Atalanta. 
 
 2. CLEANLINESS. 
 
 Watson says some of the causes of cholera are beyond hu- 
 man control. We cannot regulate the temperature of the air, 
 nor determine its barometrical pressure, nor influence, on any 
 large scale, its movements. But we can remove decomposing 
 filth. We can have the streets cleaned, not merely swept care- 
 lessly ; even if the contractors, Hke those of New York, claim 
 that their agreement is to sweep the streets, not to clean them. 
 We can open up close and crowded neighborhoods, and exert a 
 rigid guardianship over the condition of tenement houses ; we 
 can clean the sewers and docks, and remove all nuisances. 
 Most of these essential points have been attended to in New 
 York, but the sewers and docks have not been reached. 
 From the reports of the surgeons of the Board of Health we 
 learn that some of the sewers in the best portions of the city 
 are in a deplorable condition ; many were built by contractors 
 ignorant, or indifferent to the simplest principles of sewerage, 
 so that not a few of them run up hill. Thus, the sewer in 
 Twenty-sixth street, between Second and Third avenues, has an 
 ascending grade of three feet two inches to be overcome by de- 
 posits accumulated from behind, before any flow can occur ; in 
 Thirty-fourth street, between Fifth and Madison avenues, the 
 
CLEANLINESS. 9t 
 
 sewer ascends two feet, in two hundred and fifty ; in Madison 
 avenne, between Thirty-second and Thirty-third streets, it rises 
 eleven inches in two hundred feet ; the sewer in Thirteenth street, 
 between Sixth and Seventh avenues, also runs up-hill, and is 
 always nearly seven eighths full of drain-muck, which is forced 
 back to, and up and down, the Sixth avenue, thence into Four- 
 teenth street, along and past Union square. Nineteenth street, 
 between Sixth and Seventh avenues, is in the same condition. 
 The numerous connections between these overcrowded and 
 noisome sewers and the houses, by means of water-closets, 
 bath-rooms, and wash-stand waste pipes, become so many 
 channels to conduct foul air mto the very centres of our dwel- 
 lings. In most of the lateral rains, except during the progress 
 of a heavy rain storm, the actual flow in the pipes is reduced 
 to a mere driblet, and these appalling masses of filth underly- 
 ing our city, exhale their mephitic vapors into our very sleep- 
 ing chambers ; in fact, our water-closets, bath-tubs, and sta- 
 tionary wash-stands, act as ventilators to the sewers ; and the 
 more completely a house is provided with the modern conve- 
 niences, the more deadly a habitation it may become. Persons 
 living in the immediate vicinity of the obstructed sewers are 
 not the only ones to suffer ; for, if once a sewer becomes 
 wholly or nearly closed, the poisonous gases which are often 
 rapidly and continuously disengaged, are forced back through 
 the connecting pipes into far distant houses. No plumber's 
 trap yet invented can prevent the passage of the foul air, the 
 effect of which is so decided that butchers in London are 
 obliged to avoid the vicinity of ventilating holes and culverts, 
 because their meats soon become tainted. Fortunately the 
 remedy is comparatively easy ; it is only necessary to connect 
 with the waste or soil pipe, just below the lowermost trap, a 
 
98 ASIATIC CHOLERA. 
 
 small tube which must be led up through the roof and out into 
 the upper air. In London, connections have been made with 
 the flues of manufacturing establishments, and it is proposed 
 to erect immense chimney stacks for this sole purpose. In ad- 
 dition, in London, in 1859, £20,000 were expended in flushing 
 the sewers with fresh water ; and one hundred and ten tons of 
 lime, and twelve tons of the chloride, were thrown in every 
 day, at a weekly cost of £1,500. It is to be hoped that during 
 the next winter the grade of our most faulty sewers wiU be 
 changed ; but in the meantime, solutions of copperas, or chlor- 
 ide of lime, or carbolic acid, should be poured into the pipes 
 of wash-stands and bath-tubs, as well as those of water-closets. 
 As a further precaution, a piece of cotton may be placed over 
 each outlet at night, for it has been observed that when meat 
 is exposed to air which has been passed through cotton, it 
 will not putrefy for months ; it is clear that cotton takes up 
 something injurious from the air. 
 
 DOCKS. 
 
 Many of our sewers open into bulkheads instead of the tide- 
 ways, and others even into vacant lots. Our docks, Kke the 
 Thames, are converted into common sewage receptacles. Foul 
 with the daily and hourly influx of abominable filth, they are 
 offensive to the senses, and a cause of added foulness to the 
 incumbent atmosphere. Glaisher says that, during the summer 
 months, the night temperature of the Thames is considerably 
 above the minimum temperature of the air, and that its vast 
 area is simmering aU night long, and throwing off clouds of 
 noisome and noxious vapor, causing the special unhealthiness 
 of those quarters of the town which He nearest its banks. The 
 same is the case with our North and East Rivers. 
 
DISINFECTION. 99 
 
 PERSONS. 
 
 Personal cleanliness is very important, for there is every 
 reason to believe that foul skins and clothing, reeking with 
 iinremoved and decomposing filth, create an atmosphere about 
 each of the " great unwashed," that may be quickly converted 
 into a nucleus of cholera poison, if the least contact with the 
 disease takes place. 
 
 If the owners of emigrant ships would rigidly enforce the 
 cleansing and disinfection of the persons and baggage of their 
 passengers before they are allowed to proceed on board, there 
 is every reason to suppose that not only cholera, but ship- 
 fever and other analogous disorders, would be imported into 
 this country far less frequently than they now are. 
 
 3. DISINFECTION. 
 
 In Europe the general impression is that cholera cannot be 
 excluded by quarantine, but that it may be " stamped out" by 
 disinfection. The Board of Health of Hull, a city that is daily 
 exposed to imported infection, enforce no external regulations 
 against cholera ; but the city and railway authorities take good 
 care to send all German emigrants forward to Liverpool and 
 elsewhere by special trains, and thus avoid any intercourse 
 with them. But cholera has now not only broken out in Hull, 
 Liverpool, Bristol, and London, but in many towns in Lanca- 
 shire and Wales. Southampton is again suffering severely, 
 although the sanitary authorities treat every case and locality 
 of cholera by prompt medical treatment and instant disinfec- 
 tion. Pettenkofer, the chief apothecary to the king of Ba- 
 varia, thinks that the facility of transmission of the disease is 
 60 great, and such the uncertainty and inconvenience of any 
 
100 ASIATIC CHOLERA. 
 
 universal prohibitory restraint upon commercial intercourse, 
 that it is futile to depend upon the isolation and quarantine of 
 entire towns and districts ; but that it is far better to rely 
 upon disinfection of houses, grounds, and the evacuated fluids 
 of the sick. Thorough disinfection and cleansing are declared 
 to be the best means of protection against cholera. AU putres- 
 cent and decaying matter, and very particularly all excrement 
 and whatever has received the choleraic discharges, must be 
 disinfected by powerful antiseptics. Sulphate of iron or cop- 
 peras, in strong solution, is thought to be the most efficient 
 and potent. Carbohc acid, and other coal tar preparations, are 
 next, and nearly equal in power. Wunderhch insists upon the 
 vital importance of complete and frequent disinfection of every 
 privy and filthy place in every diarrhoeal district, both before 
 and during cholera epidemics ; for if cholera discharges get 
 into them, the whole accumulation may be changed into a mass 
 of cholera poison. 
 
 As early as 1854, Dr. Wm. Budd, of Bristol, proved the effi- 
 cacy of immediate disinfection of the cholera discharges. In 
 1849, cholera was brought into the Bristol workhouse by a 
 woman coming from an infected quarter, and not less than one 
 hundred and thirty died out of not quite six hundred inmates. 
 In 1854, immediate disinfection was tried, at the suggestion of 
 Dr. Budd, and although the pestilence was introduced three 
 separate times, the total number of attacks was under thirty, 
 with only eight deaths. We have already stated that the mor- 
 tahty at Ebrach was fifteen per cent, of three hundred and 
 fifty prisoners, where no disinfectants were used ; while at 
 Kaishaim only one case died out of a thousand men, where 
 these were rehed upon. At Traustein, in Bavaria, in every 
 case in which the rice-water discharges were disinfected with 
 
DI SINFECTI N. 101 
 
 sulphate of iron, the disease was confined to the first person 
 seized. The New York Health Board have adopted the dis- 
 infecting plan wisely and efficiently, and would have quickly 
 checked the numerous outbreaks of the distemper if they had 
 been properly seconded by officials and individuals ; although 
 places like the Brooklyn plague district must always be diffi- 
 cult to manage. Thus, in the neighborhood of Yan Brunt and 
 Wallace streets, where the deaths have been most numerous, 
 the ground is low and marshy ; the houses are small and dirty 
 tenements, in which many families swarm. Waste pipes have 
 not been laid through the stieets, and more than three hun- 
 dred famihes, and over fifteen hundred people, are dependent 
 for washing, drinking, and cooking water upon the scanty 
 supply from one dilapidated soil pump. The low, nasty sur- 
 face of every back-yard, is stiU further befouled by numerous 
 surface privies, and by drainage from many shanty stables, in 
 which horses and hogs are crowded. It is no wonder that the 
 disease has become fatal and concentrated, for the air is 
 fieighted with contagion, and the ground from which the in- 
 habitants draw and drink their water is impregnated with the 
 quintessence of the disease. 
 
 It is well to be acquainted with the proceedings and recom- 
 mendations of the New York Health Board : Freshly-prepared 
 lime and charcoal, in the proportion of two parts of the for- 
 mer to one of the latter, ground together in a coarse powder, 
 have been used in vast quantities to disinfect out-door privies, 
 the contents of which could not be safely removed until win- 
 ter. It is supposed that an ordinary house-pailful of this mix- 
 ture, thrown over the surface of the contents of a sink or cess- 
 pool once a week, or even once in two weeks, will render 
 them quite innocuous. This so-called carho-calx mixture has 
 
102 ASIATIC CHOLERA. 
 
 been thickly sprinkled over defiled surfaces and places, such 
 as cellars and ^^ards. 
 
 Chloride of lime, saturated solutions of sulphate of iron, 
 (copperas), carbolic acid, coal tar, and other acids, have been 
 lavishly applied to disinfect waste pipes and house drains. 
 Ten pounds of strong chloride of Hme are directed to be 
 thoroughly mixed in half a barrel of water, and a small portion 
 of it poured daily down kitchen sinks, soil pipes, and all others 
 from which offensive gases arise. But Carbolic acid is the 
 most powerful of deodorizers, preservatives, and disinfectants. 
 Chloride of Hme merely removes the smell of decomposing 
 matter, while carbolic acid actually prevents decomposition. 
 A piece of putrefying meat, soaked in a solution of carbolic ' 
 acid containing one per cent, of the acid, does not lose its 
 offensive smell for two days, when it will be replaced by a 
 faint odor of carbolic acid, and no further decomposition wiU 
 take place for a month or more. Chloride of hme removes the 
 bad smell immediately, but decomposition goes on quite rap- 
 idly. House drains and cesspools, soil pipes of water-closets 
 and privies, and ail foul drains, according to Dr. Harris, should 
 receive a dose of carbohc acid or coal tar, every day or two. 
 After these places have been flushed with a large quantity of 
 water, and a few pints of coal tar have been poured down 
 them, then a teacupful every two or three nights will be suffi- 
 cient, not only to keep down all putrefaction and sink smells, 
 but will maintain constant disinfection. If carbohc acid or 
 coal tar cannot be procured, the same quantities of a thick, 
 creamy solution of chloride of hme, and a pint or two of a so- 
 lution of copperas, in the proportion of ten pounds to a pail of 
 water, may be relied upon. To render the disinfection as com- 
 plete as possible, a pint of this solution of copperas should be 
 
DISINFECTION. 103 
 
 poured into each water-closet and privy-seat every night, and 
 a small quantity down each bath-tub and wash-stand drain. It 
 is highly probable that strong solutions of coarse salt and salt- 
 petre will be found to be almost equally efficacious. 
 
 In private houses, in addition to the free use of lime, 
 chloride of lime, or lime and charcoal, in cellars, the use 
 of coke as fuel, and the presence of a chaldron or more on 
 the premises, wiU be of great service as a preventive of the 
 disease. 
 
 As ozone is deficient in the air in cholera times, steps should 
 have been taken to supply it ; for ozone is a vital element of 
 the air, and oxygen cannot be assimilated by the system with- 
 out its presence. It gives to oxygen its life-supporting prop- 
 erties, but is rapidly destroyed in large towns and in crowded 
 and filthy localities. During periods of great heat of weather, 
 it also loses its active powers. In the absence of ozone, offen- 
 sive products are increased ; wounds become unhealthy and 
 heal slowly ; and diseases which show a putrefactive tendency 
 are influenced injuriously. Fortunately, it can be readily sup- 
 plied to houses and hospitals. Moffatt has used phosphorus 
 for the production of ozone as a purifier and disinfectant, thus ; 
 Take a quart bottle with a wide mouth, into which put rather 
 more than half a pint of water ; on a piece of cork floating on 
 this fluid, place a flat piece of phosphorus with a clean-cut 
 surface ; close the mouth of the bottle either loosely with a 
 cork, or tightly with a perforated cover. This should be done 
 night and morning, or several times a day. Squibb directs half 
 a stick of phosphorus to be laid upon the flat surface of an or- 
 dinary breakfast plate, and water poured upon it sufficient to 
 immerse two thirds of the stick, leaving the remainder exposed 
 to the air ; the plate is then to be placed upon the mantel- 
 
104 ASIATIC CHOLERA. 
 
 piece, out of the reacli of accident or disturbance. At night, 
 more water is to be poured upon the plate, till but a narrow 
 line of the stick is exposed above the surface; for great 
 evaporation will take place before morning. When the de- 
 sired disinfection has been accomplished, the plate should be 
 fiUed with water until the phosphorus is entirely covered. 
 There are several objections to the use of phosphorus : first, 
 from its easy inflammabihty, it is a dangerous substance at best ; 
 second, the vapors from it at night are lurid and disagreeable 
 to the sight of nervous persons ; and third, if too much is 
 allowed to burn, the phosphorous acid irritates the air-tubes. 
 But, in careful and intelligent hands, it is exceedingly useful, 
 and, to cholera patients, somewhat curative. 
 
 Bromine is an excellent disinfectant, and evaporates spon- 
 taneously and so rapidly, that the simple removing the stopper 
 from a narrow-necked bottle will soon deodorize the atmo- 
 sphere of a room. The bottle should not be left open too long, 
 but be closed from time to t'me. 
 
 DISINFECTION OP WATE5. 
 
 In all places where water from springs, wells, or pumps, is 
 used, if there is the shghtest danger of impurity, means of pu- 
 rification should be used. It has been fairly proved that even 
 water, contaminated with choleraic matters, loses its infectious 
 properties by being boiled and filtered. But boiled water 
 should be allowed to become thoroughly cold, and allowed to 
 absorb air in place of that which has been expelled by heat, 
 before it is drank. An excellent filter for the poor is one of 
 the largest-sized common red flower pots, suspended at a con- 
 venient height of a few feet, in a shady place, and having the 
 hole in its base plugged with a sponge, so as to permit only an 
 
DISINFECTION OF WATER. 105 
 
 exceedingly fine stream of water to pass through ; the sponge 
 must, of course, be washed frequently. A good filter should 
 be attached to every faucet from which drinking water is 
 drawn, and a thick flannel bag makes a good substitute until 
 a better can be procured. Every traveller should supply him- 
 self with a small bottle of the saturated solution of permanga- 
 nate of potash, for it has been found, in India, that at stations 
 where the water was turbid, and tasted and smelled of decay- 
 ing organic matter, the addition of a few drops of this solution 
 rendered the water as clear and sweet as spring water in a few 
 minutes. The permanganate is innocent in character, and re- 
 moves the most putrid odors as if by magic. It is an excellent 
 disinfectant, and may be put in the foulest water, or the most 
 repellanr mixtures, and the sense of smell will cease to be 
 offended ; while we may be sure, also, that aU injurious sub- 
 stances will be destroyed. 
 
 The Peroxide of Hydrogen is stiU more ef&cient. It looks 
 like water ; but if we pour it on the filthiest substance, the 
 smell of putrefaction ceases, and in many cases a sweet odor 
 or fragrant perfume, created in an instant, arises in its place. 
 It was formerly dear, and there were but few places where it 
 could be had cheaply, and then only in small quantities ; but 
 Professor Schoenbein has discovered that it may easily be 
 prepared, by shaking violently, for a few seconds, amalgamated 
 granulated zinc with a little distilled water contained in a 
 large bottle. 
 
 Finally, Dr. Thomas Spencer has discovered that the black 
 oxide, or so-called magnetic carbide of iron (prepared by heat- 
 ing together hasmatite, or red oxide of iron ore, with sawdust), 
 frees water from nearl}^ all its organic impurities. If ordinary 
 river water, even the more impure kinds of it, is made to per- 
 
 6 
 
106 ASIATIC CHOLERA. 
 
 colate a layer of magnetic carbide some inches thick, it is not 
 only filtered, but deprived of much of its soluble organic im- 
 purities. The water becomes bright, loses its yellow color, 
 and is free from smell or taste of any kind. If a few drops of 
 a solution of permanganate of potash be well mixed in this fil- 
 tered water, its pink color will remain, while impure water will 
 destroy the beautiful tint of the permanganate. Filters, pre- 
 pared with the magnetic carbide, will last for seven or ten 
 years, without requiring cleansing, or refitting. 
 
 Since writing the above, the principal causes of the malig- 
 nancy of the epidemic at Hart's Island, among the United States 
 soldiers have been ascertained. The place had been previously 
 defiled by thousands of Southern prisoners ; emigrant recruits 
 brought the disease, and the special poison of cholera was 
 multiplied suddenly and extensively. The soil was so saturated 
 with old filth that the drinking water also became contami- 
 nated. The island has wisely been abandoned, as it was im- 
 possible to disinfect the ground and water. 
 
 Cholera has broken out suddenly in the Kings county jail, 
 which is a model of tjleanliness ; thirty-eight inmates were 
 attacked in one night. About one mile off are extensive pig- 
 geries, offal fields, and swiU estabhshments, of the most offen- 
 sive character, which poison the air for acres around ; still 
 none of the pig, swill, or offal men have as yet been affected 
 with cholera. It wiU soon be found that one or more cholera 
 subjects have been introduced into the jail, but that none have 
 gone to the piggeries. 
 
TREATMENT. lOt 
 
 TEEATMENT. 
 
 MANAGEMENT OP PATIENTS AND NURSES. 
 
 In a case of cholera of any severity, the carpets should be 
 taken up ; the room stripped of all unnecessary furniture and 
 ornaments ; the bed — which had better be a single one — should 
 be placed in the middle of the room, for free ventilation and 
 ready access on all sides, and should also be guarded with 
 an India-rubber sheet. All discharges must be received in 
 basins, chamber-vessels, or bed-pans, in which a tablespoonful 
 of the solution of copperas and a tablespoonful of chloride of 
 lime, or a mixture of salt, magnesia, and dilute sulphuric acid, 
 have been put. The air of the apartment, the neighborhood of 
 the bed, the vessels themselves, and the dejections, will thus 
 be thoroughly deodorized, disinfected, and rendered harmless. 
 At the same time, the waste and soil pipes wiU be put in an 
 improved condition, for the greater the number of the dis- 
 charges, the more frequently will the drains and sewers be 
 supplied with disinfectants. Yery careful persons may, in ad- 
 dition, pour a pint or two of the solution of copperas in the 
 water standing in the privy-seat, and sprinkle a teacupful of 
 the carbolate of lime, or chloride of lime, or of the carbo-calx 
 powder, over its sides, whenever cholera discharges have 
 been passed through them. 
 
 Bed and body linen, and toweling used by cholera patients 
 and their nurses, should be immediately put into a tub, in 
 which one ounce of permanganate of potash has been dissolved 
 in every six or eight gallons of water. Or a pint of Labar- 
 raque's solution of chlorinated soda may be used for the same 
 purpose, in a tub of water. Either of these sohitions may be 
 
108 ASIATIC CHOLERA. 
 
 used in cleansing the soiled parts of the bodies of sick or dead 
 persons. 
 
 Nurses should cleanse their hands, and those of cholera 
 patients, frequently, in water in which a few drops of the sat- 
 urated solution of permanganate of potash has been mixed ; 
 and should never partake of food without first carefully wash- 
 ing their hands. 
 
 With these precautions, there is not the slightest danger to 
 those who attend cholera cases. If sickness should occur 
 among them, it may be safely assumed that they had con- 
 tracted it previously, and that the germs were lying dor- 
 mant in their systems. There should be a sufficiency of 
 nurses, so that none of them may become greatly fatigued 
 or distressed, and that each shall have an abundance of sleep 
 and rest, with time for leisurely and regular attendance at 
 meals. Attendants must, of course, be very careful about 
 their food, but should eat sufficiently of plain beef, mutton, or 
 poultry, rice, farina, hominy, bread, toast, and similar staple ar- 
 ticles. Green tea is the best beverage when there is a ten- 
 dency to looseness ; coffee, chocolate, or black tea, may be 
 used when costiveness is present. Salt should be eaten freely, 
 as it is one of the best of tonics and disinfectants. Beaman 
 thinks that a somewhat weakened state of the stomach and 
 bowels predisposes to cholera, and that this is removed by 
 eating freely of salt at meals ; he behoves that at least three 
 fourths of all cases of cholera could be prevented by this sim- 
 ple means. Adults may consume from one half to a whole tea- 
 spoonful at each meal, and in two days it is supposed that the 
 majority of persons will be no longer susceptible to the dis- 
 ease. Its daily use in smaller quantities should, however, be 
 persisted in as long as the epidemic prevails. Tlie moderate 
 
TREATMENT. 109 
 
 use of condiments, snch as black and red pepper, French or 
 Englisli mustard, or Worcestershire sauce, or of cinnamon, nut- 
 meg, allspice, &c., is often useful, for all these articles are anti- 
 septic as well as stimulant. Ginger syrup, with plain or soda 
 water, is a good beverage. Isinglass, one-quarter ounce, sugar, 
 two lumps, in a small tumbler of boiling water, with half a 
 wine-glass of brandy, or a wine-glass of sherry, or two wine- 
 glasses of claret, and a little nutmeg or cinnamon, is a capital 
 nightcap for one who is very much fatigued and afraid of 
 cholera. 
 
 Or a wineglass of the fol ving mixture may be taken occa- 
 sionally : spirit, vini gallici iv. ; aquae cinnamoni, |iv. ; vitel. 
 ovorum. No. 2 ; olei cinnamr t.i,m. v. — Brands. 
 
 If there is any fear from inhaling the breath of a cholera 
 patient, twenty-four grains each of hypermanganate of potassa 
 and hyperoxydate of barium, should be rubbed up with sugar 
 and glycerine, and divided into one hundred and forty-four 
 lozenges ; the patient should use them frequently, and the at- 
 tendants may also. Every ill-smelling mouth will become en- 
 tirely odorless by their use. 
 
 Nurses should wear a broad band of flannel around their 
 persons, and should dress and sleep rather warmly. A check 
 of perspiration, or a chill at night, is especiaUy dangerous. 
 They should not allow themselves to remain costive, but may 
 occasionally take one or two simple non-drastic pills at night. 
 
 Aloes socrotine, two grains ; soap, in fine powder, 2 grains ; 
 ext. nux vom., one quarter grain. 
 
 Or, rhubarb, three grains ; soap, one grain ; ext. nux vom., 
 one quarter grain. Or sulphate of iron may be substituted 
 for the soap. 
 
 If fatigue and distress cause loss of appetite and indigestion, 
 
110 ASIATIC CHOLERA. 
 
 one half or a whole teaspoonful of the compound tincture of 
 gentian, or simple Stoughton's bitters, may be taken in a little 
 sweetened water before each meal; and one or two teaspoonfuls 
 of pepsine wine after each repast. Fatigue and debility may 
 be removed by wine of iron or bark, or sherry and water, or 
 spirits and gum-arabic water, or claret and water. If debility 
 and diarrhoea commence, a small teaspoonful of the following 
 powder may be taken at each meal time : ferri lactici, 3ss«-5j* > 
 calc. phosphatis, Sj* ; calc. carbon, 3ij- ; sacch. lact, gss.-Jj. ; 
 puly. cinnam., 3j ; niix and make a powder. 
 
 Or a pill consisting of one or two grains each of sulphate of 
 iron and extract of gentian, and one quarter grain of extract 
 of nux vomica, may be taken two or three times a day. 
 
 Or a tablespoonful of a solution consisting of; quinine, six- 
 teen grains ; sulphate of iron, twelve grains ; aromatic sul- 
 phuric acid, one drachm, in six ounces of water, may be taken 
 several times a day. 
 
 The sulphate of won is an astringent, tonic and disinfectant, 
 and will not only brace up the system, but destroy any germs 
 of cholera which may have obtained access to the system. It 
 will probably prove the best preventive and curative remedy 
 against Asiatic cholera. 
 
 PRODROMIC DIARRHCEA. 
 
 Gull says that the diarrhoea premonitory of the severer 
 symptoms of cholera is often feculent and bihous, and presents 
 no characteristics whereby it can be certainly distinguished 
 from other forms. The number of discharges that precede an 
 explosion of cholera varies considerably. Frequently there are 
 not more than two or three in twenty-four hours ; at other 
 times as many as twenty, continuing for days, and even weeks. 
 
PRODROMIC DIARRHCEA. Ill 
 
 As cholera prevails in the montlis and seasons in which 
 attacks of diarrhoea, cholera morbus, and other bowel com- 
 plaints, are most frequent, it is not only extremely probable, 
 but absolutely certain, that the majority of those cases have no 
 relation whatever to true cholera. They may and should be 
 regarded with the same equanimity as in more healthy sea- 
 sons, and only require the treatment which has been found 
 efficacious in ordinary times. In fact, the greater number 
 would recover without any medicine, if rest in bed and care 
 in diet were maintained. For the remainder, very simple 
 treatment is often sufficient. 
 
 We append a number of simple but reliable prescrip- 
 tions, from which any intelligent physician can easily make a 
 choice : 
 
 1. Dr. Bowerbank generally found a little gioger-tea, with a 
 few grains of carbonate of soda, and an equal quantity of com- 
 mon sense about diet and absolute rest, quite sufficient. 
 
 2. Other physicians recommend the patient to go to bed , 
 keep warm, and drink several cups of hot green tea, or of 
 herb or mint tea — the object being to produce perspiration. 
 
 3. Peppermint-tea is recommended by Parisian physicians, 
 in quantities of a cupful every quarter or half hour, quite hot 
 and sweetened ; with or without the addition of a tea or table- 
 spoonful of old rum or brandy, and twenty drops of tincture of 
 cinnamon, tiU perspiration is caused and diarrhoea checked ; 
 which generally happens in three hours. If it causes vomit- 
 ing, it should be discontinued. 
 
 4. Physicians of aU schools rely much upon camphor in the 
 treatment of cholera. In 1832, the Edinburgh homoeopathists 
 used over five gallons of the tincture. It is said to have 
 saved fifty-four persons out of sixty-five, and is also supposed 
 
112 ASIATIC CHOLERA. 
 
 to destroy the contagion of the disease, so that the sick person 
 is no longer dangerous to his attendants after he has taken a 
 few doses. Dr. Rnbini, of Naples, claims to have treated five 
 hundred and ninety-two cases without a single death, with the 
 saturated spirits of camphor. We presume that he did not 
 make it six hundred, on the same principle as the boy's father, 
 who killed ninety-nine ducks at one shot, refused to make it 
 one hundred from fear of telhng an untruth. Rubini uses alco- 
 hol, sixty degrees above proof, and says he is able with it to 
 dissolve its own weight of camphor. This XDreparation is nine 
 times as strong as the one in ordinary use, and twice as potent 
 as that used by the homoeopathists. He gives four drops every 
 five minutes ; but in severe cases increases the dose to five or 
 twenty drops, or even a small teaspoonful. Ordinarily, in from 
 two to four hours, an abundant perspiration will break out, and 
 a cure soon follows. As a preventive, he recommends five 
 drops three or four times a day. These doses should always 
 be taken on lumps of sugar, and not in water. In the United 
 States army, from two to four, or even seven and eight grains 
 are often given in a teaspoonful of Hoffman's anodyne. 
 
 5. From a tea to a tablespoonful of paregoric has often 
 proved sufficient. Equal parts of compound spirits of laven- 
 der and paregoric are often rehed upon with confidence. 
 
 6. One or two drachms of alum dissolved in five ounces of 
 water, with the addition of one ounce of syrup of ginger, 
 makes a palatable and useful medicine, in doses of one or 
 several teaspoonfuls, frequently repeated. Iron-alum may be 
 prepared and used in the same way. 
 
 7. Syrup rhei. aromat, gj.; aquae menth. pip., |iv. Dose, 
 one or two teaspoonfuls in diarrhoea, vomiting, cholera mor- 
 bus, and cholera infantum. 
 
PRODROMIC DIARRHCEA. 113 
 
 8. Carbonis ligni, g. ; theraicse, Jj. Dose, one teaspoonful 
 from two to four times a day, in diarrhoea from fascal fermen- 
 tation. 
 
 9. Tinct. cinnamomi, |ss. ; spir. ammon. aromat, §ss. ; de- 
 cocti li83matoxyli, |v. Dose, one quarter part, after every loose 
 motion. 
 
 10. Pulv. carb. ammon., 3ij«; ^<1- mentb. pip., §iv. Dose, 
 one to three teaspoonfuls every half, one, or more hours. 
 
 11. Yelpeau recommends absolute rest in bed, and three or 
 four drops of laudanum every one or two hours, until vomit- 
 ing and diarrhoea pass away. He also advises very small in- 
 jections of starch, with seven or eight drops of laudanum in 
 each. 
 
 12. Ammon recommends potass bicarb., 3j-; aq. menth. 
 pip., §vj. Dose, a spoonful every hour. 
 
 13. Bismuthi nitratis, 3ij« ; pnlv. opii, gr. i.-ij. ; pulv. 
 cinnam., 3ij- Make eight powders, and give one every two or 
 four hours in incipient cholera. — ^Ammon. 
 
 14. Bismuth mixture, prepared exactly like the officinal 
 chalk mixture, is an excellent preparation, and most efficient 
 when there is much distress in the stomach. 
 
 15. Simple chalk mixture, prepared with half an ounce of 
 prepared chalk, a quarter of an ounce of loaf sugar and gum- 
 arabic powder, and eight ounces of cinnamon or other aromatic 
 water, is very useful in diarrhoea. To render it more astrin- 
 gent, one ounce of tincture of catechu, or kino, is often added. 
 The dose is one or two teaspoonfuls, to as many tablespoonfuls 
 for adults. It is supposed that the chalk is not only an asti'in- 
 gent but a disinfectant. If there is much distension of the 
 bowels, one ounce of aromatic powder may be added to the 
 mixture. 
 
 6* 
 
114 ASIATIC CHOLERA. 
 
 16. Others rely on the aromatic powder, composed of cinna- 
 mon and ginger, each two parts ; cardamom seeds and nntmeg, 
 of each one part. Dose : ten to twenty grains, in water. The 
 addition of twenty grains of prepared chalk makes it a very 
 efficient medicine in diarrhoea. 
 
 17. Sodse bicarbonatis, 9j. ; sulphuris prascipitati, 9j. ; tinct. 
 lavand. comp., §ss. ; aquae, §iij.-v. Dose : one or two table- 
 spoonfuls every two or three hours in ordinary diarrhoea pre- 
 ceding cholera. — Gteove. 
 
 18. Infus. acori calami, §iij. ; gum acacias pulv. ^*. ; sac- 
 chari albi, 3ij- Dose : a tea to a tablespoonful every one or 
 more hours. 
 
 19. Tinct. rhatany, ^*. ; aquae calcis §v. One to three spoon- 
 fuls after every passage. 
 
 20. Bismuthi nitratis, 3j -3ij- ; elect, catechu, Sij* Make four- 
 grain pills, and take from one to three every hour in choleriform 
 diarrhoea. 
 
 21. Monesiae, Sj*? aluminis, gr. xxiv. ; confect. aromaticae, 
 3ss. ; syrupi, q. s. Make twenty-four pills, and take two after 
 every passage. 
 
 22. Acidi sulphurici diluti, 3ij. ; tinct. cardamomi co., |ss. ; 
 aquae menth. pip. ad, |vj. ; sacchari albi, §ss. Dose: one- 
 fourth part every two or four hours. 
 
 23. Tinct. gallae, |ss. ; mist, amygdalae, |iss ; mist, acaciae, 
 §ss. ; aquaefontis, §v. Dose : one tablespoonful after every 
 liquid passage in colliquative diarrhoea. — Neligan. 
 
 24. Ext. haematoxyli, 3j. ; decocti cinchonse, giij. ; aqu^ cin- 
 namomi, |ss. ; syrupi aurantii, §ss. Dose : one or two teaspoon- 
 fuls every hour in cholera infantum. — Ure. 
 
 25. Decocti h^matoxyh, gviij. ; aluminis pulv., 3ss. Solve 
 for an astringent enema. — Eeece. 
 
CHOLERAIC DIARRHCEA. 115 
 
 26. Ext. nuc vomicaa, gr. ij.-vj. ; Aquae mellissas, |vj. ; mu- 
 cilag. acacise, |ss. Dose : two spoonfuls every two hours. 
 
 27. Creasoti, 5j j ^^t. glycjnrrhizse, 3ss. ; galbani colati, 3ss. ; 
 althaeas rad. pulv., Sij* Make sixty pills, and take two or three 
 from three to six times a day. — Riecke. 
 
 28. Ferri carbon, saccharati, 3ss. ; pulv. myrrhse, gr. xxiv. ; 
 pulv. aromatici, 3ss. Make twelve powders, and give one 
 every two or four hours in protracted and obstinate diarrhoeas 
 of children. — Neligan. 
 
 29. Ferri sesquioxidi, 5j- > pulv. cinnam. co., 5j« > syrupi 
 Aurantii gj. Make an electuary, and give a spoonful from 
 three to six times a day. — Joy. 
 
 30. Ferri sesquioxidi, gr. x.-xx. ; pulv. aromatici, gr. v. ; 
 syrupi zinziberis, q. s. Make a bolus, to be taken from two to 
 four times a day. — Copland. 
 
 31. Misturae ferri compos. |iss. ; aquae cinnam., |ss. The 
 whole to be taken from two to six times a day in the diarrhoeas 
 of feeble and exsanguine persons. 
 
 32. Ferri et aluminas bisulphat. [iron-alum), gr. v.~x. ; aquae 
 cinnam., §iss. To be taken every two or three hours. — 
 Murray. 
 
 33. Pulv. kino, 3v. ; pulv. aluminis, 3ij« ; ptilv. cinnam., 3ij' ; 
 syrupi, q, s. Make an electuary, and take one or two tea- 
 spoonfuls occasionally. — Savory. 
 
 34. Bismuthi, 5ij- ; cretae prep., Sy* ; pulv. cinnam., 3ij- 1 
 sacch. alb. |iss. Make a powder, and take from one quarter to 
 a whole teaspoonful every two, four, or six hom'S. 
 
 CHOLERAIC DIARRHCEA. 
 
 Le Segue says this is liquid, serous, watery, abundant, and 
 more or less colored. The stools succeed each other every 
 
116 ASIATIC CHOLERA. 
 
 hour or two, or sometimes oftener. After the second or third 
 they become whitish, like very thin paste, are voided without 
 pain, and cause no sensations of burning or tenesmus. In the 
 interval there is an occasional rumbhng. When, after five or 
 six stools, the appearance of the matters passed is unchanged, 
 and the dejections are no more watery nor paler, it is a favor- 
 able symptom. The evacuations are not followed by that sen- 
 sation of sinking so frequently associated with smaller dis- 
 charges. The vomitings are sometimes green long after the 
 discharges have become exclusively serous. It is generally 
 supposed that this form of diarrhoea is not more difficult to 
 treat than the ordinary form. But this is not quite true ; it 
 does not yield very readily, and soon becomes a source of great 
 danger. Burrows says the facility with which the serous 
 diarrhoea may be checked, depends mainly upon the period of 
 the epidemic when the treatment is adopted. Those remedies 
 which are powerless at the height of the epidemic, will prove 
 efficacious towards the decline. Cases of serous diarrhoea, 
 with symptoms of exhaustion, short of collapse, appeared to 
 him, in spite of unremitting attention, to be quite uncontrolla- 
 ble in the month of July ; while cases of equal urgency, in 
 September, were controlled with a facility which often aston- 
 ished him. 
 
 In the treatment of this disorder it is best to commence at 
 once with the most efficient and specific remedies. These I 
 believe to be sulphate of iron (or copperas) ; iron-alum ; nux 
 vomica ; kreosote, which is a pure carbohc acid ; the prepara- 
 tions of Hme and bismuth ; chloroform, &c. I append a num- 
 ber of prescriptions : 
 
 1. Sulph. ferri, gr. ij.-iij. ; ext. nuc vomicae, gr. -J-i; ext. 
 gentian, gr. j., make a pill, to be given every one, two, or four 
 hours. 
 
CHOLERAIC DIARRHCEA. lit 
 
 2. Ferri. sulph., 3j- ; acid sulph. dilut, 3j- ; aq- piir- ©iss. 
 Dose : half or whole wineglass full every quarter, half, or one 
 hour. — Bell. 
 
 3. Ferri. sulphatis, 3j -ij- ; sacchari, Jj. ; aquge cinnamomi, 
 §vij. Dose : a tablespoonful every one, two, or three hours. 
 
 4. Ferri. sulphatis, 9j.-9ij. ; acidi sulphurici, 3ss.-3j. ; sac- 
 chari, Sij- ; aquae, §iv. Dose : one or more teaspoonfuls every 
 quarter, half, one, or more hours. 
 
 5. Ferri sulphatis, gr. v— x. ; acid, sulph. aromat, 3ss-3j ; 
 aqu8B, Jj. Dose : one or two teaspoonfuls in 'water. 
 
 6. Acidi sulphurici diluti., ^iv. ; syrupi aurantii corticis, 
 giss. ; aquae cinnamomi, §j. Dose : one or more teaspoonfuls 
 every half, one, or more hours. 
 
 7. Acidi gallici, 9iss. ; ext. gentian., gr.x. ; ext. nuc vomicae, 
 gr. V. ; make ten pills. Dose : one pill every one, two, or 
 more hours. 
 
 8. Acidi gallici, gr, v. — xx. To be taken in a wineglassful 
 of brandy and water every half, one, or more hours. 
 
 9. Extracti geranii mac. fluidi, S^i* ; tinct. cinnam., |ss. ; 
 syrupi rosae gallicae, §ij. Dose : a dessertspoonful every half, 
 one, or two hours. 
 
 10. Olei. terebinth, 5j.; aetheris sulphurici, Siij* Do^e ; 33S.- 
 5j. in barley-water every one, two, or mxore hours. 
 
 11. Olei. terebinth, §ss. ; mucilag. acaciae, gss. ; tinct. lavand. 
 CO., 5SS. ; aquae cinnam., giiss. Dose: one to three teaspoon- 
 fuls in water every two or more hours. 
 
 12. Olei. terebinth, m. xv.-xxx. ; aq. menth. pip., §j. To be 
 taken every one, two, or four hours. 
 
 13. Olei terebinth, m. xv.-xl. ; mucilag. acaciae, S^j- ; spir. 
 lavand. co., 3ij- To be taken every two, four, or six hours. 
 
 14. Quinse disulph., gr. x-xx. ; ferri. sulph, 9j-9ij. ; aq. pur. 
 
118 ASIATIC CHOLERA. 
 
 ©iss. ; tinct. nuc vomicae, |ss. Dose : one to three tablespoon- 
 fuls every half, one, or two hours. 
 
 15. Creasotii, m. xx. ; tinct. cardam. co., §ss. ; mncilag. aca- 
 cise, §ss. Dose : ten to thirty drops in a wineglass half or 
 quite full of water, every quarter, half, one, or two hours. 
 
 16. Creasoti gutt. x.-xx. ; syrupi tolutani, gss. ; tinct. car- 
 dam. CO., |ss. ; aquae anethi. vel, cinnamomi, |iij. Dose : a 
 tea to a tablespoonful every one, two, or three hours, in chole- 
 raic diarrhoea. — Eichaedson. 
 
 17. Chloroform!, Sy*; tinct. camphorae fort., 5iss.; tinct. opii, 
 5iss. ; olei cinnamomi, m. viij. ; alcohol, 5iij' Dose : five to 
 thirty drops. — Horner. 
 
 18. Chloroformi, x.-xx. ; spts. vini. gallici, 5iij. ; syrup orgeat, 
 5ij. ; aquae, gss.-g. To be taken repeatedly. 
 
 19. Chloroformi, §ss. ; sol. magend., |ss. ; tinct. capsici, |ss, ; 
 syrup zinziberi, §ss. Dose : ten to sixty drops. 
 
 20. Squibb's mixture is much recommended. Tinct. opii, |j. ; 
 tinct. camphorae fort., Jj.; tinct. capsici, g. ; chloroformi, 5iij' ; 
 alcohol, ad. §v. Dose : for infants, one to ten drops in a few tea- 
 spoonfuls of sweetened water, syrup of gum-arabic, or orgeat ; 
 for persons two to six years of age, ten to thirty drops ; from 
 six to ten years old, thirty drops ; ten to fourteen years, half a 
 teaspoonful ; fourteen to eighteen, a small teaspoonful ; all 
 persons over eighteen years, one or two teaspoonfuls. The 
 doses to be repeated after every movetaent. 
 
 21. Tinct. opii, §ss. ; spts. camphorae fort., §ss. ; liq. ammo- 
 niae, |ss. Dose : ten to thirty drops. 
 
 22. Tinct. opii, §ss. ; tinct. camphorae fort, §ss. ; tinct. cate- 
 chu, §ss. ; cinnam., |ss. ; tinct. capsici, co., gss. ; mucilag. aca- 
 cia, |iss. Dose : one or two teaspoonfuls in water as often as 
 necessary in the first stage of cholera. — Houston. 
 
FULLY-DEVELOPED CHOLERA. 119 
 
 23. Acid, sulpli, dilut, m. x. ; aq. pur., vel cinnam., |ss. To 
 be taken every one, two, or more hours. — Braithwaite. 
 
 24. Acid sulpli. dilut., 5ij« ; tinct. cardam. co., 3ij- ; aq. des- 
 tillat. |v., ss, Dose: one or two tablespoonfuls every four 
 hours regularly, and after every liquid stool or vomit. — 
 Miller. 
 
 25. The missionaries at Constantinople relied upon : tinct. 
 opii, tinct. rhei., spir. camphorge, equal parts ; thirty to sixty 
 drops per dose. They claim to have lost but thirty cases out 
 of six hundred, and attributed their great success somewhat 
 to their careful nursing and unremitting devotion, as they 
 remained at the bedsides of the sick for hours, or until all 
 danger had passed. 
 
 26- Quiniae sulphatis, gr. xij. ; ferri sulph. exssic, gr. xxiv. ; 
 pulv. opii, vel ext. nuc vom., gr. iij. ; make 12 pills. Dose : 
 one or two every two, four, or six hours. 
 
 27. Quinias sulph., 9j. ; ferri sulph. exssic, 9ij. ; pulv. cap- 
 sici, 9j. ; make twenty pills. Dose : one or two every one, 
 two, or more hours. 
 
 FULLY-DEVELOPED CHOLERA. 
 
 After a longer or shorter period of diarrhoea, the symptoms 
 of the second stage are added. Suddenly, without much nau- 
 sea, vomiting commences. At first, the ingesta are ejected ; 
 then follows, at diminishing intervals, a serous fluid similar to 
 that discharged from the bowels, but without the admixture of 
 chyle. The powers of life now rapidly fail ; the skin becomes 
 cool, the thirst intense, the, pulse loses its force and increases 
 in frequency, the whole surface of the body is bathed in a 
 profuse perspiration, the features shrink rapidly, and the whole 
 expression of countenance is changed ; the voice sinks to an 
 
120 ASIATIC CHOLERA. 
 
 almost inandible husky whisper ; cramps of the extremities set 
 in, and finally extend to the trmik ; the sensibility is rapidly im- 
 paired, being scarcely aroused by the most violent muscular 
 spasms, and the patient evinces a remarkable indifference, as 
 well to his present condition, as to his future fate. This is 
 incipient collapse. During all this time, many patients suffer 
 less pain than is generally supposed. The intense thirst, the 
 frequent vomitings and calls to stool, are sources of much dis- 
 comfort ; but the only cause of actual pain is to be found in 
 the cramps. Even the pain of these is often much less than in 
 cases of ordinary cholera morbus and cramp colic. 
 
 In this stage the quantity of fluid pouring out from the mu- 
 cous membrane of the stomach and bowels is so great, that all 
 food and medicines, are swept along and away with it. Little 
 or no absorption takes place, and the largest and smallest 
 doses of the most active and the mildest medicines are alike 
 powerless. Brandy and red pepper are as innocuous as water ; 
 half-ounce doses of calomel and laudanum are as innocent as 
 the thirtieth dilution of chamomilla ; five-drop doses of Croton 
 oil are as harmless as so much oil of olives. 
 
 Macpherson's directions are : secure the best hygienic con- 
 ditions possible for your patients ; give them abundance of 
 water to drink and ice to suck ; correct cramps and inordinate 
 vomiting by the internal and external use of chloroform. 
 Apply external warmth and extra bedclothes, if these are 
 grateful to the patient, but if they make him restless, do not 
 press them, for it is unwise to submit him in any way to a dis- 
 agreeable heat, which materially adds to his sufferings and 
 danger. If the perspiration is excessive, wipe him dry from 
 time to time, disturbing him as httle as possible, for excessive 
 rubbing is useless, and exhausting to patient and nurses. But 
 
FULLY-DEVELOPED CHOLERA. 121 
 
 the abdomen and Kmbs, according to Magendie, may be rubbed 
 occasionally with a mixture of tinct. nux vom., |ij. ; linimen. 
 saponis, vel ammonias, vel chloroformi, §ss. Still Macpherson 
 asks whether it is a judicious measure to apply heat externally ; 
 to cover up the patients with blankets ; to stimulate the sur- 
 face with counter-irritants, such as mustard, turpentine, &c. 
 He has done all these things, and questions whether much is 
 gained by them ; he is quite sure that they are very distaste- 
 ful to nine patients out of ten, and their instinctive prompt- 
 ings is worth something ; he knows that it is so in the matter 
 of drink in cholera, and he thinlcs it is so in the question of 
 food, clothing, and frictions ; where they are grateful they 
 may be used, but ought not to be insisted upon when the 
 reverse is the case. There is a greater tolerance of blanket- 
 ing in Europe than in India. 
 
 As soon as the rice-water evacuations commence, Dr. John 
 Gason, of Ireland, places a towel, very tightly rolled up, so as 
 to be nine or ten inches long and one and a half or two inches 
 thick, directly between the buttocks, so that the orifice of the 
 bowel comes directly on the middle of this roller, which 
 should be sprinkled with a solution of chloride of lime, or 
 some other disinfectant. If properly made and placed, it is 
 said, no evacuation can possibly take place, not even as much 
 as wiU stain it. Together with this, a broad flannel bandage 
 should be tightly carried around the whole body, three or four 
 times, and the part next the skin, especially that portion over 
 the bowels, should be weU sprinkled with chloroform. This 
 flannel roller is as important to a cholera patient as a bandage 
 is in uterine hsemorrhage after confinement, for the bowels are 
 completely relaxed and paralyzed, and require support. 
 
 The regulation of the food and drink of the patient is of the 
 
122 ASIATIC CHOLERA. 
 
 greatest importance. When Macpherson first went to India, 
 it was a common practice to withhold water, especially cold 
 water, from cholera patients ; the objection was, that it 
 increased vomiting and so exhausted the sufferer. Following 
 the routine of the day, he acted in this way, but was taught 
 the cruelty and folly of it by personal experience. When a 
 person has been drained for an hour or two by rice-water 
 purging, the desire for water is urgent and instinctive ; the 
 system craves and demands it. Do not then be guilty of the 
 cruelty of withholding water, but give it often and give it 
 cold, for hot drinks are not reHshed by cholera patients. 
 There is no necessity to give large draughts ; but let not the 
 fact that a portion of almost every supply is vomited lead you 
 to withhold it entirely. Let your patients have as much ice 
 as they please. Macpherson never saw a cholera patient to 
 whom ice was not grateful. In his own case, he took no 
 drugs, but drank freely of iced soda-water, to his infinite com- 
 fort and refreshment. When he vomited, which he did often, 
 he drank again ; when too feeble to speak, at a look or a ges- 
 ture, his faithful nurse replenished his glass again and again. 
 He then formed the fixed resolution, never since departed 
 from, never to withhold a cup of cold water from a cholera 
 patient. Seltzer, Vichy, or carbonic acid water, with the addi- 
 tion of a little iron, or some iron-water, like Pyrmont, may be 
 used with advantage. Champagne and water, or iced cham- 
 pagne, may be taken occasionally, or a wine or claret glass of 
 green tea punch, made as follows : 
 
 Infusi thaeas virid. fort, ©ij. ; succi. limonis, Jj. ; spir. vini 
 gallici, |iv. ; sacch. alb., |iv. 
 
 It is worse than useless to attempt to feed cholera patients. 
 The mildest nourishment only adds to the feeling of oppres- 
 
TREATMENT OF COLLAPSE. 123 
 
 sion and general distress, from wliicli only the act of vomiting 
 gives immediate relief. Still, beef-tea, or consomme, well sea- 
 soned with salt, may be tried from time to time ; or a little 
 arrow-root, or solution of isinglass, or gum-arabic, with brandy ; 
 or a few spoonfuls, from time to time, of milk and lime-water, 
 in equal parts ; or milk punch, made with milk, lime-water, 
 and brandy. As a general rule, however, these articles are 
 more useful at a later period. 
 
 As the stomach should be allowed to rest as much as 
 possible, injections of two ounces each of strong green tea 
 and brandy ; or of strong solutions of sulphate of iron, or of 
 creosote or turpentine, may be tried with hope of success. 
 
 Simple soda powders will often relieve the vomiting better 
 than anything eise, although full doses of creosote in mucilage 
 and tincture of cardamoms, are often useful. 
 
 Hypodermic injections of morjohine will often prevent or 
 remove cramps, allay vomiting, check diarrhoea, and produce 
 general comfort. 
 
 COLLAPSE. 
 
 The preceding stage is usually of short duration ; and with 
 the subsidence of the active symptoms, the patient sinks into 
 the third, or cold, or algid stage. The vomiting and diarrhoea 
 cease; the secretions are all suspended, especially that of 
 urine ; the shrivelled skin partially relaxes, and presents the 
 coldness of death ; the pulse is no longer to be felt, and the 
 beating of the heart is scarcely to be felt or heard. 
 
 TREATMENT OF COLLAPSE. 
 
 Macpherson says in the stage of collapse he knows no drug 
 worthy of the smallest confidence. The remedies are either 
 vomited, or, if retained, are inert ; and if given, as they often 
 
124 ASIATIC CHOLERA. 
 
 are, in excessive quantities, they become a serious cause of em- 
 barrassment, interfering especially with nutrition. Some — and 
 in severe epidemics, unfortunately, a great many — ^patients will 
 die ; but such cannot be saved by pouring drugs into them in 
 the collapse of this terrible disease. 
 
 Houston asks, when the patient reaches a state of profound 
 collapse, does anything remain to be done — can the resources 
 of our art furnish any relief? He feels constrained to give a 
 negative reply. Many have recovered from this algid state ; 
 but, under his observation, a larger portion recovered of those 
 who were left to the efforts of nature than of those who were 
 actively treated. The patient may lie for many hours equally 
 balanced between life and death, and, if kept warmly covered 
 in the recumbent posture, in rare cases, the skin wiU gradually 
 lose its deathlike feehng, the dampness of the skin will dry up, 
 the thread of a pulse wiU be occasionally felt at the wrist, and 
 the face will gradually assume the expression of Hfe. These 
 feeble indications of reaction must be severely left alone ; for 
 the brightening spark may easily be extinguished. Nature 
 must be left to finish her own work ; an early recourse to stim- 
 ulants at this critical period has, in many instances, been fol- 
 lowed by a speedy return to coUapse, and death. Small doses 
 of any grateful cordial, such as curacoa, chartreuse, absinth, 
 &c., frequently repeated, may be admissible ; but the principal 
 reliance should be placed on a continuance of diluents and on 
 nourishment. These diluents are of prime importance in the 
 latter stages of the disease. The blood has been rapidly de- 
 prived of its more fluid constituents by exosmosis, and diluents 
 are important, not only to allay thirst, but also to arrest exuda- 
 tion, and convert it, if possible, into endosmosis. Hot green 
 tea sometimes comes in play here. 
 
REACTION. 125 
 
 Bowerbank says, in the prisons and hospitals of Jamaica, 
 when the patients refused to submit to treatment, or to take 
 the medicines ordered, the rule was to put the mattress on the 
 floor and to lay the patient there, placing by his side a bucket 
 filled with ice-water and a tin pannikin. For the most part, 
 these patients received little or no further care ; certainly they 
 were not rubbed and covered up with blankets, as the more 
 tractable were ; but the majority of those left to their own re- 
 sources got well. Dr. Hutchinson practised during the epi- 
 demics of 1849 and 1854. He has seen a number of patients 
 who, left to themselves, went through the collapse and reacted 
 without any treatment, while in a number of other cases the 
 same good result foUowed the use of ice and beef tea only. 
 Under these circumstances, even the highest dilutions of the 
 homoeopathists may honestly be supposed to be useful. 
 
 REACTION. 
 
 Macpherson says : If opium, lead, calomel, and other severe 
 drugs, have been abstained from, nature starts fair in the stage 
 of reaction, which he is sure is not the case when over- 
 weighted with one or the other ; or, as he has often witnessed, 
 with aU of them. He has seen dangerous reaction, i. e., high 
 fever, with cerebral symptoms and coma ; but only when art, 
 coming, not to aid, but to thwart Nature, has interfered with 
 her eliminatory processes, by the too free use of opium, 
 astringents, and such like remedies. In such cases, he resorts 
 to free purgation with calomel, applies ice to the head, and 
 restores the action of the skin by the wet sheet, cold sponging, 
 and the like. When the secretion of urine is long delayed, he 
 has seen good result from the free use of chlorate of potash, 
 and the application of turpentine stupes over the region of the 
 
126 ASIATIC CHOLERA. 
 
 kidneys. Houston prefers strychnine^ gr. j., dissolved in tinc- 
 ture of cantharides, §j. Sweet spirits of nitre, and small doses 
 of nitrate of potash, are important remedies against the reac- 
 tionary fever. 
 
 Macpherson says, as soon as the vomiting ceases, you must 
 support the patient by proper nutriment. At first he usually 
 begins with thin arrowroot, well boiled, and flavored with a 
 little aromatic, only a teaspoonful at a time, giving every now 
 and then a teaspoonful of brandy in it, and never overloading 
 or overdistending the stomach. Instead of water, he now 
 quenches thirst with milk, containing lime-water, and flavored 
 with a few drops of curacoa ; or the milk may be given in 
 soda-water. 
 
 As reaction proceeds, he substitutes strong beef-tea, or, 
 better still, essence of meat, using it in the same cautious way, 
 spoonful by spoonful, at proper intervals. Later still, eggs 
 beaten up with a little brandy, and flavored as before, with 
 curacoa, is often relished. 
 
 The greatest caution is required not to disgust the patient ; 
 not to re-excite vomiting ; not to overstimulate, and bring on 
 cerebral symptoms during the febrile reaction. 
 
 When patients are thus carefully nursed, it is seldom that 
 reaction is excessive. Nothing but mischief may be expected 
 from over-anxiety to hasten convalescence by too freely pres- 
 sing food and stimulants on the weakened stomach. It requires 
 a great deal of coolness and patience to understand this, and 
 many cases go wrong from over-anxiety. In many cases of 
 cholera in Jamaica, after the patient had battled through the 
 disease, he died from the effects of a heavy meal of greasy 
 soup. 
 
 But it is a great mistake to assume that the severe febrile 
 
ALLIANCE WITH FEVERS. 12t 
 
 reaction which often follows the collapse of cholera is always 
 cansed by the abuse of stimulants and opiates. Fever and 
 raging delirium are apt to occur when cold water alone has 
 been used during the whole course of the disease. 
 
 ALLIANCE WITH FEVERS. 
 
 In the fourth stage of cholera, or that of reaction, the 
 patient is apt to suffer with a severe form of fever, which? 
 Aitkin says, is in no respect dissimilar to, and not less fatal 
 than, the typhoid form of typhus fever. These typhoid symp- 
 toms, which are so common in Europe and America, are un- 
 known, or nearly so, in India, where, if a secondary fever 
 ensues, it assumes the form of the remittent fever of that 
 country. But, in a few mild cases, it takes on an intermittent 
 type, sometimes of a quotidian, at others of the tertian kind. 
 Hersch says, it is a weU-known fact, that malarial fever has 
 preceded outbreaks of cholera, not only in single places or 
 particular regions, but in an almost pandemic distribution, and 
 there is every reason to believe that malaria and cholera de- 
 vastate the same ground. Some physicians believe that cholera 
 is in some strange way mixed up with intermittent and 
 remittent fevers in India and the East ; and with typhoid fever 
 in Europe and the West. Others have even gone so far as to 
 describe cholera as an inverted typhoid fever ; it commences 
 with profuse discharges, and the latter is apt to end with 
 them ; the one has collapse before the fever, and the other 
 afterwards, &c. ; the causes of both are said to be similar 
 with the difference of climate only. 
 
 Lankester also says : There is an endemic and epidemic 
 fever which is supposed by high sanitary and medical authori- 
 ties to originate in the spontaneous decomposition of organic 
 
128 ASIATIC CHOLERA. 
 
 matters in drains and sewers ; hence it has been called drain or 
 sewer fever ^ but it is generally better known by the name of 
 gastric or typhoid fever. That this disease is generated by a 
 specific poison, has been demonstrated by Dr. Budd, of Bristol, 
 and should it be capable of demonstration that this disease is 
 really developed de novo by the matters of drains and sewers, 
 it would be an interesting fact, as showing the possibility of a 
 contagious disease being produced afresh. Tanner and Mur- 
 chison wish to change the name of abdominal typhus, or 
 typhoid enteric fever, into night-soil fever, or pyihogenic fever 
 (literally, " born of putridity"). Tanner says, it is generated 
 by putrifying animal matter ; the effluvia from foul drains, 
 or the contamination of drinking-water, from decomposing 
 sewage making its way into wells, are frequent sources of this 
 disorder. There are many facts which show that enteric or 
 typhoid fever often arises from bad drainage ; the danger is 
 greatest when the drain or sewer becomes choked up, and the 
 sewage stagnates and ferments ; there are numerous instances 
 of enteric or typhoid fever appearing in houses having no 
 communication by drains with any other dwelling, e. g., in 
 isolated country houses. Tanner continues : Allowing, there- 
 fore, that enteric fever is generated spontaneously hy the de- 
 composition of sewage and f cecal matter, we should expect to 
 find it most prevalent after the long heat of summer. The 
 attack may occur immediately on exposure to the miasm, 
 especially where the latter is concentrated, with vomiting and 
 purging, so that such cases have sometimes given rise to a 
 suspicion of poisoning, as in the case of the National hotel at 
 Washington, D. C. Even in milder cases, there is a tendency 
 to both sickness and diarrhoea in the early stages ; but almost 
 always there is diarrhoea, which generally increases towards 
 
ALLIANCE WITH FEVERS. 129 
 
 the end of the second week, so that there maj'- be then eight 
 or ten stools a day, which are also remarkable in being alka- 
 line (instead of acid as healthy ones are) , of a putrid character, 
 and for containing a large quantity of ammoniao-magnesian 
 phosphate. 
 
 Some medical men have supposed that occasionally an alli- 
 ance takes place between yellow-fever and cholera. They 
 both arise in hot climates, but the one from the decomposition 
 of vegetable, the other of animal matter. Both affect the 
 blood profoundly ; yellow-fever the red particles, and cholera 
 the white blood. The hsemorrhagic form of yellow-fever has 
 been called the hcemo-gastric pestilence, from its tendency to 
 profuse simultaneous effusions of blood from various parts 
 and organs. Cholera has been termed the JiydrorrJiagic or 
 sero-intestinal pestilence, from the profuse discharges of the 
 serum of the blood, primarily from the bowels, and subse- 
 quently from the stomach and skin, which characterize it. 
 
 1 
 
130 ASIATIC CHOLERA. 
 
 SPECIAL REMEDIES. 
 
 Cold checks cholera? and is a preservative and disinfectant. 
 Bodies greatly cooled cannot decay, and animal matter seems 
 capable of being preserved to endless time by cold ; witness 
 the frozen elephants and mammoths of Northern Russia, which 
 have remained for ages. Ice has proved highly efficacious 
 in cholera. When employed alone, the mortality was only 
 thirty per cent., which is very low, compared with cases in 
 which stimulants and opiates were employed. It relieves, in a 
 remarkable maimer, the burning heat at the pit of the stomach 
 and the insatiable thirst ; it arrests the vomiting, and contrib- 
 utes greatly to excite reaction. Although it is a remedy of the 
 highest promise, it wiU probably not prove as useful in America 
 as in Europe, for we are accustomed to its daily use. In ad- 
 dition to chewing and sucking it frequently, a bit should be 
 swallowed immediately after each dose of medicine. 
 
 Johnson says there is no evidence to prove that the appli- 
 cation of ice to the spine has been useful in any case. It is 
 only certain that some patients wiU recover in spite of it. 
 
 COLD WATER. 
 
 This was first proposed and carried into practice Idj Dr. 
 Shute, of Gloucester, from whose experience and that of others 
 it seems certain that the free internal use of cold water is pro- 
 ductive of the most beneficial effects, and that when it is with- 
 held, the rate of mortality has been much higher than when it 
 is allowed. Wherever cold water formed the base of the 
 treatment, the ratio of deaths was very much lower than when 
 
HOT WATER AND DRINKS. 131 
 
 stimulants, and, in fact, any other remedies, have been employed. 
 Dr. Shute says, mider the cold water system the state of col- 
 lapse is sometimes prolonged to two, three, or four days ; and 
 others have remarked that during the reaction a paroxysm of 
 raging dehrium is apt to occur. It is not, therefore, an inopera- 
 tive system. The cold water is supposed to act by supplying to 
 the blood the serum it loses by the intestinal evacuations ; also 
 by taking up the urea, determining to the kidneys, and rehev- 
 ing the blood of the presence of this poisonous agent. When 
 water is used it should be as cold as procurable, and preferably 
 iced; it should be taken in large and repeated draughts, and 
 although for the first four or five times it may be rejected, its 
 use should be persevered in. It soon remains on the stomach, 
 and when this is effected, a beneficial change in the state of 
 the patient is soon observable. The intense thirst which 
 usually accompanies cholera, would alone justify the adoption 
 of this treatment. Whatever other treatment is adopted, cold 
 water in copious draughts will prove a valuable auxiliary, 
 perfectly safe, agreeable to the patient, and likely to be pro- 
 ductive of the best effects. 
 
 HOT WATER AND DRINKS. 
 
 Ice water relieves the sensation of heat, and it has a pow- 
 erful influence in checking vomiting before and during im- 
 pending collapse, but are these sufficient reasons for giving 
 iced water to a patient in full collapse ? In Johnson's opinion 
 they are not. He is sure that vomiting, when not excessive, is 
 beneficial, and he believes that ice-water lessens the vomiting 
 and the burning sensation in the stomach by diminishing the 
 vascularity of the mucous membrane, and thus interfering with 
 the excretion of the morbid poison, upon the ejection of which 
 
132 ASIATIC CHOLERA. 
 
 the patient's recovery depends. For these reasons, lie beKeves 
 that the administration of ice-water to a patient in collapse is 
 injurious. In most cases he would allow an UDlimited quan- 
 tity of water of the temperature of the room ; but in extreme 
 collapse, he would persuade the patient to drink hot liquids, 
 with a view to add some warmth to the blood. Hot fluids 
 should then also be injected into the bowels ; and if the kidneys 
 act scantily, or not at all, the bladder may be injected full, from 
 time to time, with warm or hot fluids. In deep collapse, Stev- 
 ens' saline solution, heated to one hundred or one hundred and 
 twenty degrees, has often been injected into the veins; always 
 with temporary, and occasionally with permanent benefit ; 
 although the interior of the body in full collapse is so chilled 
 that when these injections return they are quite cold. The 
 stools and vomits in fuU coUapse are quite cold ; and when Cas- 
 sarian section is performed immediately after, or just before 
 death, the foetus and uterus are found equally cold. Hence the 
 use of hot fluids and injections seems rational. I would sug- 
 gest very hot injections of a strong solution of sulphate of iron. 
 This is one of the best disinfectants, tonics, and astringents, 
 and will also tend to remove the deeply venous and asphyx- 
 iated condition more than any other remedy. Hot green tea, 
 with brandy or rum in it, has been successfully used in Paris. 
 
 HEAT. 
 
 The royal committee say, the appHcation of heat to the sur- 
 face in various ways has been largely tried, and it appears to be 
 the uniform experience of the profession, that in coUapse this 
 means is of but little value. The whole tendency of the evi- 
 dence yet acquired for the treatment of this stage is towards 
 a more restricted use of poweful excitants of this kind. 
 
HEAT. 133 
 
 Annesley declares that the warm bath does more harm than 
 good ; the fatigue arising from going in and coming out of it, 
 and from rubbing and dressing the patient, exhausts him. 
 Christie found the bath injurious. Parkes did not see a sin- 
 gle case in which the warm bath appeared beneficial, and he 
 has seen a man walk firmly to the bath with a pulse of tolera- 
 ble volume, and a cool, but not cold skin, and seen the same man 
 carried back in five or ten minutes with a pulse almost imper- 
 ceptible, and a cold clammy surface. Johnson says, while the 
 Jiot-air hath appeared to relieve the cramps and sometimes im- 
 proved the pulse, yet on the whole the patients appeared to 
 be distressed rather than comforted by it. Still there can be 
 no question that to thoroughly warm a patient in collapse is 
 often a real benefit, for the pulse, temperature, and color of the 
 skin, and the expression of the features, all improve simulta- 
 neously. A very convenient and safe way of keeping up the 
 warmth of the body is by the application of hot bottles, hot 
 dry flannels, and hot sand-bags, to various parts of the surface. 
 Slacking several pieces of quick-lime placed on plates in the 
 bed, is a rapid, convenient, and the most efficacious way of 
 producing great warmth without disturbing the patient or 
 injuring his skin. Macpherson says most emphatically that 
 the parboiling system has had its advocates, and hundreds 
 of living East Indian practitioners can testify to the fataHty, to 
 say the least, of this method, even when mustard has been 
 added. To take a man in the collapsed and pulseless stage of 
 cholera, out of the horizontal position, where alone there is 
 hope of safety, and to plunge him in this condition into a 
 bath heated to the highest bearable degree of temperatiu-e, 
 short of scalding, to which mustard in large quantities has been 
 added to make it more stimulating, is about the surest method 
 
134 ASIATIC CHOLERA. 
 
 that can be taken to exhaust the little remains of vitality left. 
 Experience has abundantly proved this ; for so many men have 
 actually perished in the baths that the practice has long since 
 been abandoned in India. But all dirty patients, even if deeply 
 collapsed, should have one thorough salt or chlorine bath to 
 thoroughly cleanse and disinfect their hair and skin. Still the 
 patient should never be allowed to assist himself. He should 
 be lifted in and out, and helped in every possible way. Flan- 
 nels soaked in hot mustard-water may then be wrapped around 
 his body and limbs. 
 
 SALT WATER. 
 
 Bowerbank, of Jamaica, thought he saw more good from the 
 use of Stevens' powders than from any other mode of treat- 
 ment; in fact, in 1854, he confined himself chiefly to these. 
 Having read of the use of sea-water in the treatment of cholera, 
 and from the difficulty of getting the powders. Dr. Campbell 
 and him? elf concluded to give sea-water a trial among the 
 prisoners of the general penitentiary at Kingston, Jamaica. 
 They had buckets of sea-water brought from a distance from 
 the shore, and this weU iced ; it was doled out in smaU quan- 
 tities to the sufferers, who drank it greedily, and, strange to 
 say, of seventeen cases who took it, aU recovered. Unfortu- 
 nately it was not tried till towards the decline of the epidemic. 
 In almost every case, after the fourth or sixth dose, the alvine 
 discharges became tinged with bile, as also the contents of the 
 stomach vomited. From the results of this experiment, he 
 has made up his mind to give sea-water another fair trial if he 
 ever witnesses another epidemic. In fact, if attacked himself, 
 he would rely on the saline treatment and sea-water well iced. 
 
SALT. 135 
 
 This is one of the best antiseptics and disinfectants. Waring 
 thinks there is but little doubt that salt is of the highest value 
 in cholera ; but says the fact must not be overlooked that cold 
 water ad libitum was allowed in addition ; and in all cases in 
 which cold water was used freely the mortality has been less 
 than when it was withheld. The patient may be placed in a 
 hot bath at one hundred and twenty degrees, in which four- 
 teen to twenty pounds of salt is dissolved. Injections of hot 
 salt water into the bowels are said, by Stevens himself, to be 
 more reliable than injections into the veins, in full collapse. 
 Stevens, Yenables, Pidduck, Hastings, Groodrich, and others, 
 gave two tablespoonfuls of table salt, dissolved in four to eight 
 ounces of cold water, repeated every quarter of an hour, until 
 free vomiting was produced, and then cold water in large 
 draughts was advised to allay the insatiable thirst and heat of 
 the stomach caused by the salt. Beaman gave three table- 
 spoonfuls in half a pint of cold or tepid water. It restored 
 the secretion of bile, diminished the cramps, increased the 
 fulness of the pulse, and the voice became stronger and the 
 strength greater ; but in twenty or thirty minutes the pulse 
 may begin to flag, strength decrease, and cramps come back, 
 when the salt must be repeated a second or third time. The 
 latter is rarely necessary. Thus given, salt often produces 
 vomiting in less than one minute. Of six hundred and seven 
 cases treated in this manner only one hundred and twelve 
 died, or about twenty per cent. Hastings lost sixteen cases 
 out of sixty-two under the salt treatment, and double that num- 
 ber when he used opium and stimulants ; but Goodrich lost the 
 whole of twelve cases in deep hopeless collapse. Pidduck 
 gave as much as from four to eight ounces of table salt in a 
 
136 ASIATIC CHOLERA. 
 
 small quantity of water, or nearly a saturated solution, in 
 eighty-six cases of full collapse, with a loss of only sixteen. 
 
 SALINES. 
 
 The saline treatment is based upon the attempt to restore to 
 the blood the fluids and salts which have been poured out in 
 the profuse cholera discharges. It is evident that at best this 
 can be but palliative and auxiliary. All the water and salines 
 which are drank, and injected into the bowels, bladder, and 
 veins, will be simply poured out again until the hydrorrhagia 
 from the stomach and bowels is controlled. It is not until 
 absorption begins again that any good can result from their 
 employment. 
 
 ALKALIES. 
 
 One of the most striking features of cholera is, that all the 
 discharges are acid — ^none have ever been found to be alkaline ; 
 the stools are acid as well as the vomits ; and the blood itself, 
 which is naturally alkaline, becomes neutral, and even acid. 
 Wakefield treated upward of one hundred and fifty cases of 
 choleraic diarrhoea, with thirty grains of sesquicarbonate of 
 soda, in a wineglass of strong mint tea, every half hour. He 
 says no fatal case occurred — the disease was arrested with al- 
 most magical rapidity ; and he rarely had occasion to administer 
 more than three doses before the nausea, vomiting, and diarrhoea, 
 w^ere arrested. The patient was confined to a diet of beef tea, 
 cocoa, or arrowroot. No soHd food — ^not even bread — was 
 allowed. We have already quoted Bowerbank's experience 
 with soda and ginger. 
 
 Beaman gave carb. soda, one half drachm, in two or three 
 ounces of water, with the addition of four or five teaspoonfuls 
 
ALKALIES AND ACIDS. 13t 
 
 of fresh lemon juice, taken wliile effervescing, every hour, 
 for three or four doses ; then every four hours. For forty- 
 eight hours he gave no other medicine. Generally, on the day 
 after the attack, the patient passed a small f^cal evacuation, 
 containing bile ; if he did not, a fev/ grains of rhubarb, aided 
 by the sulphate of manganese, may be administered ; or inspis- 
 sated ox-gall, or aloes. The patient may drink as much water, 
 or toast water, cold or tepid, as may be wished, and no other 
 beverage. For the next twenty-four hours, Beaman gave only 
 weak black tea and thin arrowroot ; on the next day, broth or 
 light meat. 
 
 The saline treatment is almost similar to the alkaline. Ste- 
 vens gave : sodas carb., 5ss. ; sodii chlorid, 9j ; potass chloral, 
 gr. vij. ; every fifteen or sixty minutes. The quantity of chlor- 
 ate of potash is ridiculously small. 
 
 ACIDS. 
 
 Notwithstanding the acid condition of the blood and all the 
 secretions in cholera, the treatment by acids, especially sul- 
 pJiuric acid, is almost the fashionable mode now. Fuller first 
 introduced it in the treatment of English cholera, in which 
 it is doubtless more useful than in the Asiatic form. Still, 
 McCormac put a stop to an epidemic in the Belfast Asylum by 
 administering a daily dose of a drachm of dilute sulphuric 
 acid in an ounce of peppermint water. No subsequent cases 
 occurred. Dr. Worms, chief of the military hospital at Gros 
 Caillou, in Paris, relied altogether upon it in 1865, in half- 
 hourly doses. It may be given in barley water, thin arrow- 
 root, or syrup of raspberries, lemons, or ginger. It is apt to 
 injure the teeth, unless the mouth is rinsed immediately with 
 a solution of soda. Elixir vitriol, and the muriate tincture of 
 
138 ASIATIC CHOLERA. 
 
 iron, given in glycerine, or syrup of ginger, are said to have 
 succeeded when the other failed. Still, I think alum or iron- 
 alum will be found far more safe and useful, although sul- 
 phuric acid is said to be not only a disinfectant, but a styptic, 
 and to cure the white-blood haemorrhage of cholera in the same 
 way that it does red-blood haemorrhage. Phosphoric acid is 
 more pleasant and useful, and does not injure the teeth. 
 
 EMETICS. 
 
 These are rarely given until the stomach is involved, and 
 then they are washed away by the outpouring tide of serum. 
 The large doses of ipecac, and tartar-emetic given by some 
 physicians are generally as harmless and useless as the small 
 ones given by the homoeopathists. At one time Mustard 
 emetics were much employed, but were soon discarded, as 
 experience proved their injurious influences in the stage of 
 coUapse, for then they frequently failed to produce vomiting, 
 and their retention during the stage of reaction, in the form of 
 an internal mustard-plaster on the dehcate lining membrane of 
 the stomach necessarily produced much evil. Table salt is far 
 
 preferable. 
 
 Ipecac. 
 
 Ipecac, has been given in quarter grain, or small nauseating 
 doses. Some homoeopathists give one twentieth grain, or like 
 Yehsemeyer, from four to ten drops of the tincture every 
 quarter, half, or one hour ; others, like Reil, say, it is useless 
 against the premonitions of cholera. Waring says, the mor- 
 tahty has been very large under its use, when given in full 
 emetic doses. Others say, it has been given successfully in 
 five or ten grain doses every five or ten minutes. It causes 
 violent attempts at vomiting, but after three or four doses 
 
EMETICS AND PURGATIVES. 139 
 
 tolerance is established. In the Paris hospitals, in 1865, ten 
 to twenty grains of ipecac, were given whenever there was 
 much vomiting. 
 
 Tartar-Emetic, 
 
 This remedy has been used in cholera, although Wood, and 
 Surgeon Mills, U. S. A., say, the symptoms are more like those 
 produced by an overdose of tartrate of antimony than anything 
 they can compare them to. Kurtz, and other homoeopathists, 
 use teaspoonful doses of a solution of one-grain, in one or two 
 ounces of water. Others says, that one grain doses every 
 twenty minutes have been given successfully ; or tablespoon- 
 ful doses every half hour, of a solution of four or five grains 
 in four ounces of water. Billings, and others, gave three- 
 grain doses every hour, followed by one grain, of opium, and 
 claim that they only lost four cases out of twenty-one, or nine- 
 teen per cent. ; while under calomel the loss was thirty-six per 
 cent. ; and under stimulants, fifty-eight per cent. Littleton 
 gave five-grain doses every twelve minutes till the vomiting 
 ceased ; then forty to fifty grains of calomel. When the full 
 flood of the disease is going on these dangerous doses are 
 washed away and do neither harm nor good. But when this 
 tide is stopped they become deadly ; thus, in Colonel Pearie's 
 French regiment of one thousand men, seven hundred died in 
 six days, under full doses of tartar-emetic. 
 
 PURGATIVES. 
 
 Dr. Davey assumes that purgatives do not act as such in 
 cholera, but restrain the diarrhoea, and effectually check the 
 intestinal discharges ; they act as restoratives of the normal 
 character of the secretions, and establish healthy f^cal dis- 
 charges. He prefers calomel and ext. coloc. co., taken fre- 
 
140 ASIATIC CHOLERA. 
 
 quently and alternately with a mixture of castor-oil and tur- 
 pentine. Aitkin says, the action of cholera most nearly 
 resembles that of Elaterium, or the squirting cucumber. 
 Thus, during the period of transudation, which only lasts 
 about thirty-six hours, the water of the blood passes off be- 
 fore the solids of the serum ; then the salts, before the organic 
 solids, such as albumen and fibrin ; the chlorides, before the 
 phosphates ; the salts of soda before those of potash. It is 
 interesting to note that this order of expulsion is very much 
 the same as that caused by the action of elaterium, Yery 
 soon after the constituents of the serum, or white blood com- 
 mence to run off, an important change takes place in the red 
 blood ; the contents of the red globules transude into the 
 serum, the water passing out first, then the salts, then the 
 chlorides and soda salts, and lastly the phosphates. The 
 blood globules are left shrivelled and dark. 
 
 One would suppose that purgatives would be carefully 
 avoided in this disease. But McGregor has given three doses 
 of five drops each of Croton oil, combined with three-grain 
 doses of opium ; he says the vomiting and purging will cease, 
 the cold and clammy skin become warm and moist, and the 
 tongue and expired air will no longer be cold. Thorne re- 
 gards Croton oil, combined with opium, as an invaluable 
 remedy, which will arrest many cases of vomiting, purging, 
 and cramps, at once. McPherson says Croton oil and opium 
 pills were once regarded as infallible : they are not so now. 
 As turpentine enemas were also used, it is to be supposed that 
 they and the opium prevented the otherwise deadly effects of 
 the Croton oil. But the tolerance of such large doses only 
 proves how low the vitahty of the stomach and bowels sinks 
 in severe cases of cholera and collapse. No one, not even the 
 
PURGATIVES. 141 
 
 homoeopathists, have ventured on the use of elaterium. The 
 latter rely upon veratrum, although Yehsemeyer says it is 
 useless, both when given in dilutions and massive doses. 
 Schweick lost ten cases out of thirty-three, with it. 
 
 Castor Oil 
 
 George Johnson claims to have cured twelve cases out of 
 fifteen, in collapse, with |ss. doses of castor oil, every half 
 hour, till twenty-two or fifty-four ounces had been given ; but 
 other physicians lost eighty cases out of one hundred and 
 eight. As the tongue is cold in collapse, and the sense of 
 taste not very acute, there was no difficulty in giving it in ice- 
 water. But he gave cold water ad libitum; also, an occasional 
 emetic of salt, which seemed to rescue some of the castor oil 
 patients from an almost fatal lethargy ; and two-drachm doses 
 of spirits of turpentine occasionally, as a wholesome stimulant 
 during the stage of icy coldness ; and applied large mustard- 
 poultices over the abdomen. 
 
 Calomel, 
 
 This has been given because it was assumed that there is a 
 suppression of bile in cholera. But the gall bladder is always 
 full in this disease ; and Parkes and Simon have found that 
 bile is always present in the cholera evacuations, but in a 
 modified form ; heat and nitric acid together will always ren- 
 der it manifest. Stillson, of Malta, gave twenty-grain doses 
 every half or one hour during the stage of collapse ; in all, he 
 administered eighty-seven thousand grains to three hundred 
 and seventy-three patients. One man took eleven hundred and 
 sixty grains and recovered ; but the mortality was fifty-two 
 per cent., or about the same as if no medicine at all had been 
 
142 ASIATIC CHOLERA. 
 
 taken. Drs. Ayre and Peacock gave one or two grains, with 
 from one to five drops of landannm, every five, ten, or fifteen 
 minutes, and lost three hundred and sixty-five cases out of 
 seven hundred and twenty-five. Macpherson says calomel has 
 been used to fulfil every indication in turn, according to the 
 peculiar behef of the prescriber. Some gave it as a purgative, 
 others as a sedative, and not a few as an alterative ; or to 
 stimulate all, or many of the secretions ; or to stop the vomit- 
 ing. Then a numerous class gave it for no reason in particu- 
 lar. It was the so-called trump card in their hands, and, like or- 
 dinary whist-players, when in doubt, as men are apt to be when 
 deaUng with cholera, they played trumps, ^. e.,gave calomel. He 
 has seen it given in every conceivable way, and for every possi- 
 ble and impossible end ; in grain doses every half or one hour, 
 and in scruple doses, again and again. It is of no use during 
 the collapse, but by-and-by, when the powers of life begin to 
 revive again, the first thing the system has to do is, to contend 
 with and dispose of more or less calomel. One of the first 
 results is very often vomiting of that green paint looking 
 matter, which is so hard to stop ; or bilious diarrhoea is excited, 
 which may soon bring the case to an unfavorable end. At the 
 best, it disturbs the stomach and interferes with nutrition at 
 the very time when nature needs the wisely cautious helping 
 hand of the physician to assist her when struggling for exist- 
 ence, and when she should not be searched and goaded with 
 powerful drugs, prescribed no matter with what intention. 
 If given during the collapse it accumulates like water behind 
 a barrier, and when the functions begin to be restored, and 
 the barrier gives way, nothing but harm results. Why, says 
 Macpherson, concentrate all our attention upon the bile ? 
 Why not stimulate the kidneys also ? Is the biliary secretion 
 
ASTRINGENTS. 143 
 
 any more in abeyance than this, or any other secretion? 
 Macpherson thinks these pertinent questions ; and recom- 
 mends all, to put them to themselves, when tempted in moments 
 of doubt, or enthusiasm to prescribe wildly. If given at all, 
 it should be combined with large doses of camphor. 
 
 ASTRINGENTS. 
 
 Macpherson says, no class of remedies have been more used in 
 cholera ; the great anxiety has ever been to restrain the evac- 
 uations. Yet he is persuaded that mere purging rarely kills, 
 and in the most fatal form of cholera there is no purging, or 
 very little. He might as well assume that no one ever bleeds 
 to death ; and he knows full well that internal hydrorrhagia is as 
 fatal as internal haemorrhage. Still he thinks that nitrate of silver 
 deserves a more extended trial, for in one epidemic he found 
 it exceedingly useful as an astringent in excessive purging. 
 Some of his native pupils used it extensively during the same 
 epidemic in Hyderabad, and with so much success as to gain 
 for themselves considerable reputation. He used it again in 
 the following year with disappointing results— another proof 
 of the varying constitution of epidemics. G-arlike used, suc- 
 cessfully, injections of sixteen grains of nitrate of silver in 
 four ounces of water, thrown high up into the colon by means 
 of a flexible tube. Others, give one grain of the nitrate in a 
 pill, with or without a quarter of a grain of opium every horn*, 
 for four or six doses. 
 
 Tinct. Ferri Muriat. 
 
 Hancom says the principal effect produced by cholera poi- 
 son appears to be an atony of the secretory and excretory 
 ducts and mucous follicles ; it therefore follows, as a natural 
 
144 ASIATIC CHOLERA. 
 
 indication, to restore power and tone to these vessels as 
 speedily as possible, and this is best effected by the adminis- 
 tration of styptics. His sheet anchor in real Asiatic cholera 
 was the muriate tincture of iron, in as concentrated a form as 
 possible, given immediately after every dejection ; its immedi- 
 ate effect in reducing the quantity of fluid ejected was truly 
 astonishing, and this gradually diminished after every dose, 
 until it ceased altogether, and a cure was effected. The evacua- 
 tions become black after a while. He also used a liniment of 
 strong sulphuric acid 3j'> olive oil §iss ; and the hot air bath, 
 by means of a small spirit lamp, and an apparatus under the bed 
 clothes. He strongly urges the avoidance of brandy, and large 
 doses of opium ; for they both do more harm than good. The 
 agonizing thirst and intense heat in the hypogastric region, he 
 thinks, is best allayed by the free use of iced soda water, and 
 iced champagne, or small pieces of ice retained in the mouth 
 and swallowed occasionally. 
 
 Sir James Murray gave from five to ten grain doses of iron- 
 alum in mint, or some other aromatic water. Sulphate of 
 iron, pernitrate of iron, gallic acid, tannin, and matico, deserve 
 attention. Tinct. matico in 3ss. to 3j« doses, is said to be very 
 useful. Turpentine, and kreosote, and the aromatic elixir of 
 ergot should not be forgotten. 
 
 Acetate of Lead, 
 
 Although the tonic astringents should commend themselves 
 to every one, the sedative astringents have been far more fre- 
 quently used. The latter may be allowable in the earlier 
 stages of the disease, but become dangerous or useless in the 
 more advanced periods. Graves first recommended plumb, acet. 
 9j. ; opii gr. j. ; and confect. rosas q. s., to make twelve pills ; 
 
STIMULANTS. 145 
 
 one every hour. Thorne found gr. ij-iij. of the acetate with one 
 eighth grain of morphine, a most valuable remedy for checking 
 the profuse watery dejections. Houston says, every practi- 
 tioner is prone to settle down upon some favorite prescrip- 
 tion, and the following is the one upon which he finally relied 
 with most confidence, after having given a fair trial to many 
 others : Acet. Plumbi, gr. xxiv. ; pulv. camphorss gr. xxiv. ; 
 morphine gr. ij-iij. ; olie cinnamomi gutt. v. ; mucilage q. s. ; 
 make twelve pills, and give one every two, three, or four 
 hours. It is chiefly applicable to the premonitory stage, and 
 it is asserted that nearly every case will recover under its use* 
 
 Copper, 
 
 Dupuytren relied on acetate of copper. NeKgan recom- 
 mended : 
 
 Cupri sulphat gr. vj. ; myrrhse gr. xij. ; conserv. rosae 9ij. ; 
 make twelve pills and give one every one, two, or six hours. 
 Joy advises : 
 
 Cupri sulph. gr. ss. ; opii pulv. gr. ss. ; confect. rosae q. s., to 
 make one pill ; to be taken from three to six times a day. The 
 homoeopathists rely much upon small doses of copper, or cu- 
 prum, especially in the spasmodic stage, although some of 
 them give it in doses of one tenth of a grain. 
 
 STIMULANTS. 
 
 Waring says, these were formerly considered an indispensa- 
 ble and invariable resource ; but of their real value many 
 doubts are entertained at the present day. It appears certain 
 that the indiscriminate use of stimulants, especially the more 
 diffusible ones, as brandy, if given in ver}^ large quantities, 
 and in a concentrated form, so far from being beneficial, are 
 
146 ASIATIC CHOLERA. 
 
 often actually injurious. Whenever excessive stimulation forms 
 a prominent part of the treatment, the ratio of deaths is increased. 
 Thus, under ipecac, alone, the deaths were fifty-seven per 
 cent. ; when combined with stimulants, they rose to sixty- 
 seven per cent. ; and in the case of ice, stimulants increased 
 the mortaHty from thirty to fifty per cent. Excessive stimula- 
 tion must tend to exhaust the diminished nervous tone ; and 
 there are few points in medicine which require more care and 
 discrimination than the selection of the proper cases and 
 proper periods of administering stimulants in cholera. No 
 rule can be laid down, except that it is certain they should not 
 be given in the excessive quantities formerly prescribed and 
 advised — they should be given more or less largely diluted ; 
 and should not be trusted to alone. 
 
 Macpherson says, stimulants, both of a medicinal and alco- 
 holic kind, have been much resorted to in cholera, and very 
 naturally. The prostration of the powers, both of the circu- 
 latory and nervous systems, is so extreme that we cannot 
 wonder that strenuous efforts been made to rouse and sustain 
 them by the free use of remedies of this class. Yet, he thinks 
 that those who have used them most, if observant and candid 
 men, must admit they have not answered their expectations ; 
 at the least, aU must allow they require to be given with a cau- 
 tious hand. They are useful when given at the proper time 
 and in the right way ; he does not think they are of any use 
 during the collapse, when at first sight or thought they might 
 appear most appropriate or necessary. 
 
 Houston says, when the patient is not seen until the com- 
 mencement of the second stage, the symptoms seem to demand 
 the use of the most powerful stimulants and anodynes, and it 
 is here that the physician is called on to exercise all his for- 
 
STIMULANTS. 14*1 
 
 bearance, and display all Ms decision of character. Having 
 used himself, and having witnessed in others, the nse of every 
 variety of stimulants, and in all doses during the second stage, 
 he was forced to the conclusion, that, as a general rule, they 
 did no good, and in many cases did positive harm. Their 
 effect often was to depress still further the aheady waning 
 organic sensibility, and, even in the few cases where this sen- 
 sibility was aroused by these means and reaction produced, it 
 was too apt to end in fatal congestion of the brain. This 
 happened in many cases treated in the early part of the first 
 epidemic. When feeble signs of reaction from collapse occur, 
 they should not be interfered with ; Nature having commenced, 
 must be left to finish her own work. The renewal of stimu- 
 lation at this period, has, in many instances, caused a speedy 
 return to collapse and death. The principal reliance should be 
 placed on a continuance of diluents, and the introduction of 
 liquid nourishment as soon as the appetite calls for, or the con- 
 dition of the stomach will bear it. Bowerbank is quite certain 
 that, in the epidemic of 1850, in Jamaica, he saw much mis- 
 chief done by the use of spirituous stimulants and opiates, so 
 that, in the epidemic of 1854, he almost entirely banished these 
 remedies from his practice. George Johnson says, again and 
 again, he has seen a coUapse-patient grow colder, and his pulse 
 diminish in volume and power, after a dose of brandy, and ap- 
 parently as a direct result of the brandy. 
 
 Yet aU these physicians give stimulants occasionally. Mac- 
 pherson prefers small quantities of brandy or curacoa ; Hous- 
 ton, small doses of any grateful cordial, such as Absinth, or 
 Kiimmel, perhaps. In Paris, in 1865, green Chartreuse was 
 largely relied upon. It is said that, in the Hotel Dieu and the 
 Hospital Lariboisiere, one in three recovered after having 
 
148 ASIATIC CHOLERA. 
 
 reached a very advanced stage of collapse, before reception^ 
 under the free use of rum and hot tea ; in the proportion of one 
 hundred and twenty-five parts of Jamaica rum to eight hun- 
 dred and seventy-five parts of strong and hot green tea. 
 
 In the earher stages of cholera, small quantities of stimulants 
 may or may not be used. As the disease progresses, the quan- 
 tities may be cautiously increased, and should always be given 
 in some vehicle, like gum-water, orgeat, milk and lime water, 
 green tea, or beef tea. When the full tide of the colliquation 
 is going on, the largest quantities and strongest varieties are 
 swept away like water, and are neither useful nor injurious. 
 In the full collapse, when all discharges have ceased, and ab- 
 sorption has not commenced, brandy, hartshorn, and red pep- 
 per, lie as inert tis flour and water. But, when reaction and 
 absorption begin, if very large quantities of active stimulants 
 have accumulated in the stomach and bowels, the patient will 
 die, as if poisoned with pint (or quart) doses of alcohol ; his 
 face will become turgid and Hvid, or deadly pale and sunken ; 
 vomiting may follow, with involuntary discharges of urine 
 and faeces ; the pulse may become small and frequent, or slow 
 and laboring ; and general insensibihty, an apoplectic sleep, 
 spasm of the muscles, coldness of the extremities, hurried, ir- 
 regular, or sterterory breathing, and aU the signs of venous 
 congestion and asphyxia will appear. 
 
 Turpentine. 
 As a stimulating astringent, Surgeon Major Mudge, of the 
 Madras army, made a trial of turpentine, in an ^gg emulsion, 
 with an aromatic ; and in a number of cases found it more than 
 answer his expectations. It does not seem to have caused 
 vomiting, or even nausea, although it is generally a nauseous 
 medicine. 
 
TONICS. 149 
 
 Ammonia, 
 A Dr. Anderson claims to have cured over one thousand 
 cases of cholerine and cholera, with drachm doses of the aro- 
 matic spirits of anmionia, every half or one hour, in a claret- 
 glass of seltzer, or some other sparkling water. If he had 
 said ten cases, or one hundred, one would feel more inclined 
 to believe him. George Johnson says, in a few cases he gave 
 carbonate of ammonia with apparent benefit, and thinks it 
 deserves further trial as a stimulant during the stage of col- 
 lapse. Surgeon Abadie, U. S. A., says, that aqua-ammoniee in 
 drachm doses, diluted in a few ounces of brandy toddy, with 
 sulphuric ether, proved advantageous. Dr. Burgess used 
 Phosphorus successfully in several cases of the lowest collapse. 
 
 TONICS. 
 
 The best, are : quinine, sulphate of iron, nux vomica, and 
 
 strychnine. 
 
 Quinine, 
 
 Yon Graefe and Schlegel have used it successfully as a pro- 
 phylactic. At Rangoon the treatment of cholera was by large 
 and repeated doses of quinine, but without any encouraging 
 success. The fact is, that while the vomiting is urgent, the 
 quinine is only flushed away and wasted. But when the 
 powers of life were just beginning to fail, small doses of quinine, 
 washed down with iced soda-water, or an ordinary effervescing 
 draught, appeared advantageous. When larger doses were 
 given, the first few might be vomited away, and the patient 
 seem in more or less danger for forty-eight hours, but then 
 strong-smelling evacuations and discharges of urine would 
 occur for the first time, followed by febrile reaction, with con- 
 
150 ASIATIC CHOLERA. 
 
 gestion to the head ; but a more or less speedy convalescence 
 would ensue. Sargent treated seventeen collapse cases, with 
 thirteen recoveries. 
 
 SulpJicde of Iron, 
 
 In the earlier stages, and during convalescence, grain doses 
 of quinine, with two or three grains of sulphate of iron, have 
 been used successfully, when aided by two to four, or six 
 ounces of beef broth occasionally. In collapse cases, grain 
 doses of sulphate of iron four times a day will not suffice, as 
 Sargent lost three cases in succession. 
 
 Strychnine, 
 
 C. E. Jenkins gave strychnine, gr. j., and conserve of roses 
 sufficient to form eighteen pills ; one to be given every quar- 
 ter of an hour, and washed down with copious draughts of 
 cold water, which the patient will greedily and gratefully im- 
 bibe. The first three or four pills will probably be ejected, 
 but the subsequent ones retained, and their good effects 
 speedily perceived. The strychnine being the most powerful 
 tonic known, acts in that capacity on the prostrate nervous 
 system ; and the cold water, in the first place, replaces the 
 loss of the fluids, and in the next, by its coldness, constringes 
 the papiUse of the mucous membrane, thus suppressing their 
 outpourings ; and, lastly, by its volume it distends and gives 
 tone to the otherwise empty and flaccid intestinal tube. 
 
 It was used in forty-seven cases by Dr. Lee ; in moderately 
 severe cases, it controlled the discharges without producing, 
 like opium and other stimulants, a subsequent violent re- 
 action. 
 
TONICS. 151 
 
 Nux vomica and strychnine may act in another way. George 
 Johnson says if we carefully observe the condition of a patient 
 in collapse, we will often find that the intestines are more or 
 less distended with fluid ; and this, too, while perhaps there is 
 a general torpor, and very little effort at expulsion. In this 
 condition, those remedies which act so powerfully and spe- 
 cifically on the muscular system, may stimulate the muscular 
 coat of the bowels to contract, and not only force out of the 
 body the fluids which have already been poured out of the 
 blood-vessels into the alimentary canal, but may bring on a 
 tonic contraction of the intestinal capillaries, and thus check a 
 farther drain from the blood. 
 
 In the collapse stage, Houston, of Richmond, says there is 
 one remedy on which, from past experience, he should be dis- 
 posed to place much reliance in the future ; he alludes to a 
 solution of strychnine, in tincture of cantharides ; one grain to 
 the ounce. In the epidemic of 1847, he saw several patients 
 apparently snatched from the brink of collapse by the use of 
 this combination ; he gave ten drops, every five minutes, in a 
 teaspoonful of brandy and water, till improvement occurred, 
 and then at longer intervals. The effect was too prompt, and 
 was produced too often, to be considered accidental. All 
 remedies, to do good in cholera, must act either by putting a 
 stop to the liquid drain from the blood and chyle bearing ves- 
 sels, or by exciting to increased power and activity the 
 great ganglionic centres. Now, strychnine, says Houston, is 
 known to act more promptly and powerfully on the nerve cen- 
 tres of animal life than any other article of the materia medica, 
 and it is fair to presume that, either directly, or through the 
 animal centres, it may produce a like powerful effect on the 
 organic centres. 
 
152 ASIATIC CHOLERA. 
 
 When the looseness was troublesome and continuons, tend- 
 ing to dysentery, as is so common afUr an attack of cholera, 
 Bowerbank, of Jamaica, found strychnine of much service, 
 either alone or in combination with iron. He generally gave 
 Marshall Hall's formula. 
 
 NARCOTICS. 
 
 Opium, 
 
 Large doses of opium change the arterial blood into venous, 
 and produce that state of coldness, blueness, lividity, and 
 asphyxia, which prevails in the collapse of cholera. Small 
 doses, especially when combined with larger quantities of 
 camphor, ammonia, oil of cajeput, tincture of cardamoms, 
 capsicum, &c., may occasionally be allowed. 
 
 Macpherson declares that no remedy has been more used 
 or rather abused, than opium, and that most East Indian prac- 
 titioners have abandoned it as treacherous and dangerous. 
 He earnestly cautions against its use, for it is useless, even if 
 retained, during the stage of collapse ; but when reaction sets 
 in, the opium, previously inert, begins to be absorbed and act, 
 and at once becomes a serious hindrance to the restoration of 
 the secretions ; and if the quantity has been large, it often has- 
 tens on cerebral symptoms, ending in coma. These are its dan- 
 gers, without, so far as he knows, or ever could discover, a 
 single compensating advantage. 
 
 Mr. Eoss says, either alone, or in combination with calomel, 
 stimulants or antispasmodics were formerly regarded as indis- 
 pensable in the treatment of cholera. This idea is now gen- 
 erally considered as erroneous, as a very high rate of mortahty 
 has followed all those cases in which opium^forms a prominent 
 part of the treatment. It has been given, observes Mr. Ross, 
 
NARCOTICS. 153 
 
 witli a view of relieving the cramps and spasms, but the 
 internal congestion which it produces has undoubtedly proved 
 injuiious. The use of opiates has been carried too far ; they 
 have locked up the biliary secretion, choked the capillaries of 
 the brain with black blood, and overpowered and deadened 
 the nervous sensibility, which ought to be sustained by every 
 effort and appliance, as the only means left us, in the states of 
 collapse, for rallying the declining powers of the patient. 
 Blacklock regards it as poison in this disease. W. J. Cox says 
 it is quite powerless to check the vomiting or purging, or to 
 relieve the cramps, and is totally inadmissible in any stage, or 
 any dose. Waring says the last opinion is perhaps too sweep- 
 ing ; for in minute doses, as employed by Dr. Ayre, it appeared 
 to have a beneficial effect ; but that it is positively injurious 
 in large and frequent doses, either alone, or in combination, is 
 a fact that few will be inclined to doubt, after the experience 
 of the last few years. 
 
 Waring says, in epidemic cholera the efficiency of opium is 
 no better established than that of the greater number of reme- 
 dies employed against this fatal malady. There is no evidence 
 whatever that it is beneficial in very severe cases, and scarcely 
 any of the manner in which it exerts its influence in those of a 
 milder type ; or what symptoms it palliates, or how far it 
 shortens the duration of the disease. Unquestionably opium 
 has prevented the development of many a case of Asiatic 
 cholera, by subduing those premonitory symptoms which 
 have received the name of cholerine. For this purpose, indeed, 
 its value is very great, yet not so much so, as to exceed that of 
 camphor, with aromatic and diffusible stimulants and mild as- 
 tringents, especially of the tonic kind, such as sulphate or per- 
 nitrate of iron, and iron-alum. It is depended upon in a very 
 
154 ASIATIC CHOLERA. 
 
 small number only of eases of the fully-formed disease, and it 
 would almost seem as if it ought to be omitted in the graver 
 forms of Asiatic cholera. 
 
 Morphine — Hypodermic Injection, 
 
 Dr. Willis had recourse to the hypodermic injection of mor- 
 phia as speedily as possible in all cases where the stomach was 
 so irritable and the bowels so loose as to be incapable of re- 
 taining anything ; he selected a point over the stomach and 
 great gangha. The most convenient solution is made by boiling 
 five grains of acetate of morphia, in as much distilled water as 
 will make a drachm when cold ; he injected twelve minims, or 
 the equivalent of one grain of morphia, with a graduated 
 syringe, repeated at such intervals and in such quantities as 
 the cases required. It was of the greatest service in pre- 
 venting intractable choleraic diarrhoea from running into col- 
 lapse, which is not always so easy of accomplishment as 
 most writers assume. Injecting the veins with warm water 
 has a wonderfully reviving power, and although only temporary, 
 enables the morphia to act in advanced stages of the disease. 
 Medicated injections are not useless, and transfusion of blood 
 may be beneficial. 
 
 Cannabis Indica, 
 
 In an epidemic of cholera in Calcutta, Dr. Goodeve employed 
 cannabis very extensively, and his report upon it was in the 
 highest degree favorable. Dr. O'Shaughnessy states that he 
 knows no remedy equal to it as a general and steady stimulant, 
 in 3ss. doses of the tincture. He has known the pulse and 
 heat return, and the purging checked, by a single dose. It 
 allays vomiting much more certainly than opium, and is not so 
 
ANTI-SPAS MODIGS. 155 
 
 likely to lead to cerebral congestion. Dr. Willemein, of Cairo, 
 has related several cases successfully treated by the tincture, 
 in repeated doses of from ten to thirty drops ; in one case of 
 collapse, the patient revived immediately on taking the remedy. 
 It stimulates the nervous centres when their influence is all 
 but suppressed, thus actually preventing the extinction of life. 
 Of course, it was not successful in all cases. It is best given 
 in combination with tincture of cardamoms ; or in supposito- 
 ries, combined with sulphate of iron and cocoa butter. 
 
 ANTI-SPASMODICS. 
 
 Chloroform. 
 
 Braithwaite thinks this will prove the most important remedy 
 in the spasmodic stage of cholera, as it has been found to be 
 wonderfully efficacious in relaxing all kinds of spasmodic ac- 
 tion, such as epilepsy, tetanus, hysteria, puerperal convulsions, 
 &c., and, in his opinion, the pathology of cholera consists in a 
 tonic rigidity, spasm, or tetanic contraction of nearly all the 
 arteries of the body. 
 
 To use chloroform effectually, place the patient in bed in 
 warm blankets, not in cotton sheets, much less in linen ones ; 
 give a glass of brandy in hot water, with sugar and spice ; 
 apply friction to the body by means of warm flannels, and an 
 embrocation of equal parts of Hnimen saponis comp., linimen 
 camphorse comp., tinct. opii., and ext. belladonnse. Apply 
 to the whole surface of the body bags filled with heated sand 
 or bran. Then place the patient under the influence of chloro- 
 form by inhalation, and keep him so, gently, as long as the bad 
 symptoms recur, which they frequently do on its eflects ceas- 
 ing and his regaining consciousness. Give, in the intervals, 
 small quantities of brandy-and-water and thin arrowroot, or 
 
156 ASIATIC CHOLERA. 
 
 milk, for nonrisliment, along with milk-and-water, or soda- 
 water with a little brandy, for drink. Avoid everything else 
 in the shape of medicine, and trust to the efforts of nature in 
 rallying from the poison of the disease. Of course great cau- 
 tion is necessary in administering the chloroform, and in not 
 pushing it too far. In some instances the patient will sleep 
 for twenty minutes or half an hour — in others, for several 
 hours ; and on waking will again be seized with a return of 
 the vomiting and cramps ; then the chloroform must again be 
 resorted to, and the patient kept in a great measure under its 
 influence till these symptoms abate. It may be resumed at 
 intervals for twenty-four hours. The reaction after its use 
 may be so great as to require moderate blood-letting, as 
 occurred to Dr. J. Hill, in two cases, both persons being of fuU 
 habit of body. A small teaspoonful of chloroform poured 
 upon a towel is sufficient for one inhalation. 
 
 Others say, that chloroform should be given a*s an anti-spas- 
 modic, and not as a stimulant ; nor too late, when collapse has 
 too much set in. It is of most service in the spasmodic stage. 
 Although the poison of cholera seems to act primarily on the 
 ganglionic nerves, almost paralyzing them, yet at the com- 
 mencement of the attack the heart and other muscles are in a 
 state of almost tetanic spasm. But this continues a very short 
 time, and if not reheved, is followed by a real collapse. Bleed- 
 ing, chloroform, opium, emetics, and aU other anti-spasmodic 
 and exhausting remedies, ought only to be used when we want 
 to effect relaxation of cramps and other spasmodic action of 
 the arterial system. Hence, chloroform, if used at all, must be 
 used early, and cautiously, and for a short time only. Davies 
 gave it in twenty-two cases as soon as severe symptoms came 
 on, in doses of seven to ten minims every hour, half hour, or 
 
AN Tl-S P A S M D I C S. 15t 
 
 quarter hour, according to the severity of the eymptoms ; four- 
 teen recovered and eight died. In nine more cases, and thirteen 
 very bad diarrhoeas, treated with chloroform, only one died. 
 The diet allowed was nothing but cold milk-and-water, with 
 some carbonate of soda in it, ad libitum. Of fourteen cases 
 treated by Towers, one died. When the doses were given 
 quite frequently, say every quarter or half hour, six cases died 
 in succession ; when given only every one or two hours, seven 
 recovered in succession. Chloroform was also given by inha- 
 lation, with the effect of relieving the cramps in every instance. 
 It was not carried so far as to produce perfect insensibility. 
 Ultimately, Dr. Davies came to the conclusion that no re- 
 liance could be placed on chloroform alone. Macpherson 
 thinks chloroform is the only important addition to our stock 
 of remedies made for some time ; he affirms that the cramps 
 are best relieved by the use of chloroform in doses of five or 
 six minims (about fifteen drops) in a little water ; if the vom- 
 iting be excessive, a little may be sprinkled on a pad of lint 
 covered with oiled silk, or guttapercha tissue applied to the 
 epigastrium ; or spongio piline may be used. He has given 
 chloroform in this way, both externally and internally, and 
 always with good effects. 
 
 It has been successfully employed by Mr. Brady, of Harrow, 
 Plummer, Boynton, and others, in doses of six to ten drops 
 every half or one hour. Mustard poultices, and other counter- 
 irritants, were applied externally. Sargent gave chloroform, . 
 camphor, and turpentine, in four cases, and none recovered. 
 It often allayed the vomiting and cramps, but did not arrest 
 the course of the disease. 
 
 It was tried at the London hospital, given both b}^ the 
 stomach and by inhalation, but all the patients died. 
 
158 ASIATIC CHOLERA. 
 
 Some physicians think that the nsnal doses of chloroform 
 in cholera are too small, and that fifteen, twenty, or thirty drops, 
 or more, can be given at each dose, without danger. They as- 
 sume that the impression of the remedy on the ganglionic cen- 
 tres in cholera must be rapid and energetic to be beneficial, 
 and, to this end, large doses should be given. 
 
 Dr. Grason, of Ireland, gives only three-drop doses every five 
 or ten minutes. 
 
 Dr. Brady relied upon : chloroform, 3j. ; spir. terebinth, gj. ; 
 mucilag. acacise, ^*. ; aq. pur., |ij. Dose : a large teaspoonful, 
 containing about six minims of chloroform, and forty of spirits 
 of turpentine. 
 
 Dr. Henry Hartshorne's prescription is, perhaps, the best : 
 chloroform, 5iss. ; tinct. opii., 3iss. ; spir. camph., 3iss. ; spir. 
 ammon. aromat., 3iss.; creasot., gutt. iij.; ol. cinnam., gutt. 
 viij. ; spir. vin. gaU., 3ij- Dose : one teaspoonful to be put in 
 a wineglass of ice-water, and two teaspoonfuls of that given 
 every five minutes, followed each time by a lump of ice. 
 
 Chlorodyne. 
 
 The wife of an English chaplain, in Paris, has recently ob- 
 tained notoriety by administering chlorodyne in fifty or sixty 
 cases of incipient cholera, successfully. Johnson thinks it wiU 
 relieve the cramps, and, by its narcotic action, somewhat re- 
 tard the recovery of the patient, but concludes that it is much 
 less dangerous than opium and strong astringents. 
 
 BLEEDING. 
 
 Braifhwaite and Bell think cholera consists in a tonic 
 rigidity, spasm, or tetanic contraction of aU the arteries of the 
 body, caused by some violent poison acting on the sympathetic 
 
BLEEDING. 159 
 
 nerve, and all its branches and connections. The small termi- 
 nal arteries and capillaries being thus spasmodically contracted, 
 the blood is driven inward upon the great veins. When the 
 congestion towards internal parts has reached to such a point 
 as to oppress the action of the heart, yawning first, and then 
 shivering, or a sense of suffocation and pain in the prsecordia 
 are the indications of oppressed circulation, and of the com- 
 mencing effort of the heart to overcome the mass of blood 
 which is stifling it. If by the appHcation of tourniquets to the 
 limbs, or by bleeding ^ part of the blood which is rushing from 
 the extremities to increase this congestion, is prevented from 
 reaching the great veins — then the heart, excited to increased 
 action, is enabled by this relief more quickly to overcome the 
 obstruction and restore the balance of the circulation, and the 
 parox^^sm passes off. If not thus mechanically aided, the 
 heart, after a severe struggle to maintain the circulation dur- 
 ing the period of spasm or constriction, is at length relieved 
 by this cramp of the capiUary circulation passing off itself ; 
 and then the heart and arteries, so long excited by the strug- 
 gle, maintain for a time their increased action after the obstruc- 
 tion in the capillaries is removed, and produce apparent febrile 
 action ; presently this excitement subsides, the vessels become 
 relaxed, and sweat succeeds. 
 
 All depends upon the period at which bleeding is resorted 
 to. If early in the congestive stage, or just previous to its 
 second accession, it is invariably successful ; if just as the 
 congestive stage is passing off, when the pulse begins to ac- 
 quire a little power, it is invariably fatal. Dr. Bell explains 
 these facts in the following manner. In the first stage the heart 
 is excited to the utmost by distension of its cavities from be- 
 hind, and opposition to its action by spasm of the capillaries 
 
160 ASIATIC CHOLERA. 
 
 in front ; bleeding gives relief from the pressure, a tergo, and 
 probably aids in relaxing the spasm, while at the same time, 
 by reheving the congested state of the great secreting organs, 
 it enhsts their sympathies in support of the vital actions ; and 
 the power of the heart being unimpaired, can now carry on 
 the circulation with vigor. But in the second stage, the heart's 
 energy is much exhausted, and its vital irritability impaired by 
 long-continued distention ; hence sjTicope and relapse will be 
 the probable effects of bleeding. 
 
 George Johnson says, bloodletting has often afforded great 
 relief in the stage of collapse ; he assumes that by lessening 
 the over-distension of the right cavities of the heart, it in- 
 creases the contractile power of their muscular walls. It is 
 most useful when there is rapid breathing with an oppressive 
 sense of suffocation, an almost entire arrest of blood in the 
 lungs, and a cessation of vomiting and purging. Macpherson 
 says, he saw bloodletting employed at one time ; he has now 
 entirely abandoned it. 
 
 HOMCEOPATHY AND CHOLEEA. 
 
 In Ruckert's Clinique, or collection of aU homoeopathic 
 cures which have been reported in, or translated into the Ger- 
 man language, from 1822 to 1850, we find that the homoeopa- 
 thists depended upon thirty-five remedies in the treatment of 
 cholera. Twenty-two of these are not homoeopathic in any 
 sense, but act as alterative or antagonistic medicines, viz., 
 liquor ammonia, nitrate of silver, arsenic, asarum europseum, 
 belladonna, camphor, chalk, conium, cantharides, charcoal, 
 copper or cuprum, hyosciamus, ipecac, mercury, nux vomica, 
 opium, phosphorus, phosphoric acid, prussic acid, acetate of 
 lead, rh us toxicodendron, secale, stramonium, and sulphur. 
 
HOMCEOPATHY AND CHOLERA. 161 
 
 Most of these have been faithfully tried in the regular school, 
 with what success the preceding pages will testify. With the 
 peculiarly homoeopathic remedies, viz,, Tartar-emetic, Croton 
 oil, and Elaterium, the regular school have made more experi- 
 ments than the homoeopathists themselves. 
 
 Knorre abandoned the homoeopathic remedies, and gave 
 grain doses of carbonate of ammonia every half or one hour. 
 Reil gave two drops of aqua ammonia every ten minutes. 
 Kurtz gave it on the slightest appearance of approaching col- 
 lapse, and attributes his principal success to it. Ebers gave 
 six to eight drop doses every quarter of an hour in threaten- 
 ing cases. Steart gave thirty-drop doses, and claims to have 
 saved one hundred and forty-two cases. 
 
 Arsenic is one of the most decided tonics, and greatly relied 
 upon in the regular school in chronic and exhausting diar- 
 rhoeas. 
 
 Cux3rum or copper, and acetate of lead, are astringents much 
 in use in the regular school in diarrhoea, cholera, and dysen- 
 tery. Fieischman says cuprum is not useful against the 
 cramps, and Rummel preferred hyosciamus. 
 
 Phosphorus is a tonic and stimulant like camphor and harts- 
 horn ; and phosphoric acid is a tonic and astringent like sul- 
 phuric acid. 
 
 Secale is a styptic remedy which produces powerful con- 
 traction of the capillaries, and has been much used by the 
 homoeopathists in cholera. 
 
 Rhus toxicodendron is an irritant and stimulant remedy like 
 cantharides. 
 
 It is fair to assume that all the so-called cures of cholera, 
 with homoeopathic doses of allopathic remedies, were merely 
 recoveries. 
 
162 ASTATIC CHOLERA. 
 
 If the spasm theory be true, belladonna, conium, opium, and 
 stramonium, act as antagonistic remedies, and homoeopathists 
 must always fail with them, as their doses will always be too 
 small. 
 
 If the elimination theory be correct, there can be no greater 
 objection to the use of hellebore, jatropha curcas, tobacco, 
 and veratrum, than to tartar-emetic, ipecac, and mercury. 
 
 We are not in want of remedies against diarrhoea and sim- 
 ple cholera. It is in the algid, ataxic, and fuU collapse cases 
 that help is required. In these forms, Fleischman and Tessier, 
 who have had the largest homoeopathic hospital experience, 
 say that homoeopathy is comparatively powerless. Fleischman 
 says, he has tried every remedy again and again, but has little 
 to say in praise of them. Tessier says, the number of deaths 
 generally corresponds to the number of cases of black, algid, 
 ataxic, or collapse cases. During the epidemic of 1849, he 
 only saw one case of either of these forms get weU. Hahne- 
 mann's method seems to him to be limited to cases of diar- 
 rhoea, cholerine, and simple cholera. Tessier says, it seems 
 fair to treat the black and ataxic forms of cholera in the usual 
 manner, inasmuch as homoeopathy fails completely in both of 
 these varieties. 
 

 
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