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 TREATMENT 
 
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 THE 
 
 QMGtN* HtSTOHYt CAUSE, PREVENTION 
 
 AND 
 
 CURE OF CHOLERA 
 
 * With an account of its Progress and Ravages through the 
 World, and the Latest and Most Successful Treatment, Remedies 
 and Disinfectants Endorsed and Approved by the Medical Faculty. 
 
 ''Cleanliness is next to godliness.'' — St. Paul. 
 PRICE, TEN CENTS EACH. 
 
 GEORGE MUNKO & Co., Publishers, 
 
 137 WILLIAM STREET, N. Y 
 
THE 
 
 ©rujiit, jgisiorj, Cause, |kclmiftott 
 
 AND 
 
 CURE OF CHOLERA, 
 
 WITH AN ACCOUNT OF ITS PROGRESS AND 
 RAVAGES THROUGH THE W^RLD, AND 
 
 THE LATEST AND MOS* SUC- 
 CESSFUL TREATMENT, 
 
 ENDORSED AND APPROVED BY THE 
 
 MEDICAL FACULTY. 
 
 " Cleanliness is next to Godliness." — St. Paul. 
 
 f^^^;?!^f 
 
 ^0T 
 
 ^ NEW YORK: 1 
 
 ORGE MUNRO & Co., PUBLISHERS, 
 187 William Street. 
 

 Entered according to Act of Congress, in the year 18G5, by 
 
 GEORGE MUXRO & Co., . 
 In the Clerk's Office of the district Court of the United States, 
 for the Southern District of New York. 
 
 — — * 
 
 Munro & Co.'s Publishing House, 137 William St., N.Y. 
 
HISTORY OF THE CHOLERA. 
 
 The term Cholera literally means an overflow of bile, from? 
 two Greeks words, WW?-, bile and P^, to flow. Techm-;- 
 cally its Classification belongs to diseases of the digestive 
 tube. In this category it has three distinctive appellations 
 — cholera morbus, cholera infantum, and choler asphyxia. 
 This last is the fearful epidemic known as Asiatic Cholera. 
 It is epidemic as opposed to endemic : that is to say, affect- 
 ing the many rather than the few — people of all nations and 
 classes generally, rather than persons of certain habits and 
 grades particularly. 
 
 ITS ORIGIN. 
 
 Upon this point the Commission and the medical gentle- 
 men w r ho have made the most thorough investigation appear 
 to disagree. The report of an Egyption Commission of In- 
 quiry professes to have discovered what geologists would 
 term the matrix of the cholera, and they certainly make out 
 a very good case in support of their hypothesis. They aver 
 that its origin is in that sterile part of Arabia, flanking the 
 Red Sea, called the Hedjuz, wherein stands the holy cities of 
 Mecca and Medina. The London Court Journal 'gives the 
 following results, elicited by their investigations : . 
 
 " The annual pilgrimage to Mahomet's tomb congregates 
 on this burning desert eight hundred thousand pilgrims, who. 
 live in the midst of the most indescribable filth. They die ; 
 like rotten sheep, and are not even buried, but shuffled under 
 a toot or so of sand, w T mch is easily blown off the corpses. 
 Some two millions of sheep are offered as sacrifices, all the. 
 offal of which is thrown under the burning sun to help the 
 miasma. The pilgrims wear, the same garments from the 
 beginning until the end of their sacred journey ; and as if this 
 
10 HISTORY OF THE CHOLERA.. 
 
 were not sufficient help to originating and spreading disease, 
 the clothes of one who chances to die, no matter of what 
 disease, are carefully preserved and distributed as memorials 
 among the relatives'and friends. 
 
 <k Here we have at least all the predisposing causes, accord- 
 ing to the most logical reasoning, for the. institution and 
 propagation of cholera ; but, in addition, we have also the 
 * vouched for fact that this year the cholera did break out in 
 this nest of putridity, carried off one hundred thousand pil- 
 grims in the course of a fortnight, and spread to Egypt, with 
 a remit which everybody knows. The Egyptian sanitarians 
 argue that here we have the nursery, the hot-bed where the 
 successive visitations of cholera westward have been gene- 
 rated, and whence they have been propagated ; and if they 
 will not succeed in earning universal belief, we can hardly 
 find grounds for denying their minor postulate, that here, at 
 least, the present incursion of cholera found its source." 
 
 ANOTHER THEORY OF ORIGIN. 
 
 The cradle of that pernicious disease, which has again en- 
 tered the gates of our land, is East India. For at least a 
 century it has been recognized in that portion of the globe, 
 as an entirely local disease, and looked upon as a conse- 
 quence of great public disasters, more particularly ot inunda- 
 tions. From time to time it extended, and diffused itself 
 over a larger tract of ground, following in its course chiefly 
 rivers or the principal avenues of commercial intercourse. 
 Orf occasions, in the year 1816, as stated by Jameson, in Cal- 
 cutta alone, there were no less than 21,876 deaths; in Bom- 
 bay 14,000; and that 8 percent, of all deaths recorded, 
 were ascribed to that pernicious disease, five per cent, of 
 wdrich came upon the European troops. From 1820 to 1828 
 inclusive, the disease, somewhat ditferent from its subsequent 
 course, made strides to the east and west, paying a visit to 
 China and Persia, receding, however, from its expansion. 
 But in the year 1820, it took a westward course, and estab- 
 lished itself on the European borders (Ovenburg : and Astro- 
 chan.) and then marched over Europe, but was temporarily 
 arrested by unfavorable seasons. From Astrochan through 
 
TTTSTOnY OF THE CTTOT/Rn.V. 11 
 
 the valley of the river Vol go— a distance of 350 verst — it 
 reached Moscow in two months, and from thence overran 
 
 Russia within one year. The revolutionary war then raging 
 between Prussia and Russia, (1831) was conducive of a more 
 rapid approach of the disease to the northeastern borders of 
 Prussia, where Russian and Prussian troops were brought in 
 contact. Henceforth, the disease ravaged Germany and the 
 adjourning countries, northwest, southwest and west, reach- 
 ing London and Paris, early the. following fear. Almost 
 simultaneously with London, the disease appeared in Rue- 
 beek, whence the tide of emigration took its direction, and 
 from this port spread over the Western hemisphere in 1832. 
 The successive visitations in 1834. 1837, 1S1 ( J and 185-1, ob- 
 served substantially the same course and peculiarities. 
 
 AX AMERICAN PHYSICiAN'S OPIXIOX. 
 
 Carroll Durham, M.D., holds the following language : 
 "Like all invasions, and all epidemics, cholera comes from 
 the East, marching westward; It is known to have existed 
 in the delta of the Ganges since 1629. But in 1817 it ap- 
 peared in- Hindustan, as a widespread and terribly fatal epi- 
 demic. From Calcutta and Jessore its' progress was west- 
 ward, although it spread also into China and the Indian 
 Archipelago. In July, 1821, it had reached Muscat, in 
 Arabia, and in 1823, it touched the Georgian frontier of Rus- 
 sia. Thence it spread northward through Russia, Poland 
 and Austria, extending in July, 1831, to St. Petersburg and 
 Cronstadt, and in October, to- Berlin, Vienna, and Ham- 
 burg. Li October, 1831, it appeared in Sunderland, En- 
 gland, having been brought from Hamburg. It extended to 
 London in February, 1832. appearing first in the immediate 
 neighborhood of the shipping. From England it crossed to 
 France, breaking cut March 23d, in Paris, where in one 
 month it carried off 20,000 persons. It was conveyed in an 
 emigrant vessel from London to Quebec, where it appeared 
 June 8, 1832. A few weeks later it -became epidemic in the 
 city of Xew York, and prevailed with great fatality until late 
 in the autumn. It re-appeared in 1834, hut in a less degree. 
 In 18±7 and 1848, cholera again invaded Europe from the 
 
12 HISTORY OF TTTE CHOLERA. 
 
 IJast December 8, 1848, the packet ship New York ar- 
 rived at quarantine, at Staten Island. N. Y., having on 
 board a number of passengers sick with the cholera. Several 
 had died on the voyage. From this infection cholera pre- 
 vailed at quarantine for several weeks, and two or three 
 cases, which were traced to this vessel, occurred in New 
 York. 
 
 " Again, February 13, 1819, cholera broke out on board 
 the packet-ship Liverpool, on her way to the port of New 
 York. There were fifty cases, of which forty died. During 
 the succeeding months of spring and early summer, several 
 vessels successively brought the disease to the quarantine ; 
 but it did not become epidemic in the city of New Yofk until 
 June, 1S49. It prevailed until October. In the summer of 
 1351, it was again epidemic in New York, and now threatens 
 us again. 
 
 In June, 1865, it was announced that cholera was prevail- 
 ing at Mecca, and on the route from Mecca to Alexandria. 
 It was very fatal at Alexandria, Cairo, and Constantinople, 
 It extended to Jerusalem, and along the shores of the Me- 
 diterranean and Adriatic, reaching Marseilles and Paris, 
 from the latter of which, by way of Havre, the cases brought 
 to New York in the month of October, 1865, by the Ata- 
 lanta, were exported to us." 
 
 OBSEPwVATIONS ON DISEASE. 
 
 It was in 1665 that the great plague devestated London. 
 It. appeared in Europe forty-live limes during the seven- 
 teenth century, but it onlv raged violently in England 
 three or four times during that period. About the time, of 
 the plague a disease prevailed called the " plague of the 
 intestines," similar to the Indian cholera. In 1829 the 
 plague broke out in the Russian army in Bulgaria, and 
 cholera soon afterward appeared in -the Russian southern 
 provinces. During the Crimean war there was a malig- 
 nant fever, similar to tli-e plague, in Odessa, and the chol- 
 era broke out at the same time in the Russian army. The 
 recent plague of St. Petersburg came from the north of the 
 Himalayas, and passed through Tarlaiy and Siberia lo 
 
HISTORY OF THE CHOLERA.. 13 
 
 European Russia, the same route which the plague folio w- 
 Cvi in 1333, when it destroyed a fourth of the population of 
 Europe, and three-fourths of that of England. It is singu- 
 lar that while the plague was passing through Russia, 
 recently, the cholera broke out in Arabia, passing through 
 Egypt, on to Constantinople, Jerusalam, Malta and Tus- 
 cany, and even reached Marseilles and Paris. In 1832, 
 1834, 18-1-9, and 1851 the cholera visited the United States. 
 From 1819 to 1852 a particular epidemic prevailed in Eu- 
 rope and America. Smce 1854 the prevailing diseases in 
 America have been in the lungs, throat, and nasal passages, 
 and influenza, pneumonia, and consumption have been de- 
 structive. During 1856 and 185-7 diphtheria was fatal. 
 From-1661 to 1664 the diseases prevalent in England were 
 ague ; from 1664 to 1666, lung affections and the plague ; 
 from 1667 to 1669, small-pox and fever; from 1669 to 1672, 
 cholera and dysentery j from 1673 to 1675, measles, cough, 
 and catarrh. During the second quarter of the present 
 century there was a tendency in London to diarrhoea and 
 diseases of a choloraic character, which were more fatal 
 from 1827 "to 1831. • Diarrhoea continued fatal up to 1837. 
 
 FEOM 1629 to 1832. 
 
 The earliest mention of a cholera and a specific disease 
 was in 1629. • Its ravages were extensive, but are very 
 little known. The first time that the disease, as an epi- 
 demic, created any widespread alarm was in 1764, when it 
 swept through India, hurrying to a sudden death thirty 
 thousand natives and one thousand Europeans. This was 
 quiet work, however, compared with its fatal devastations 
 in 1820, when one hundred and fifty thousand persons be- 
 came its victims in one Indian Presidency alone — that of 
 Bombay. The following year it demanded the sacrifice of 
 fifty tnousand lives in the single city of Bas?orah. On its 
 way through Europe in its first visit, Austria was the 
 greatest sufferer, three hundred and Ihirty-eigHt thousand 
 persona having died in the Empire of this plague in lbol ; 
 of that number two hundred and forty thousand were 
 Hungarians. IS ext year it reached Great Britain on its 
 
14 HISTORY OF THE CTIOLETCA. 
 
 way here, and thirty thousand victims perished in that 
 
 country. 
 
 from 1832 to 1851. 
 
 Since the advent of the Asiatic cholera to this country, 
 in 1S32, we have never been a year without a few cases of 
 it, in a modified form. In New York city, the years 1834, 
 '89 '40. '44. '45, and '48 Lad distinctive cases of the more 
 malignant type ; but except in the first named year (1834), 
 its presence was not seriously felt, or its poison endanger- 
 in gly diffused. The year 1819 began a new cholera inva- 
 sion, and from that time there have been regularly every 
 year decided easts of malignant cholera. In order to draw 
 such conclusions as figures can suggest on this, head, the 
 following table is annexed, setting forth the number of 
 deaths by the three classes of cholera in New York city 
 from the ravaging visitation of 1849 to and including the 
 year 18(34: 
 
 Year. Cholera. Cholera Cholera 
 
 Moil) as. Infantum. 
 
 1849 '.5,071 241 ^ y26 
 
 1850.... 57 744 713 
 
 1851 3 102 721 
 
 1852.. 374 238 915 
 
 1853 33 72 922 
 
 1854... 2,509 301 1525 
 
 1855 19 " 39 1.135 
 
 18.56 8 50 1.381 
 
 . 1857 11 42 1,303 
 
 1858 5 51 1,57.9 
 
 1859 ; 9 62 1.304 
 
 1860 17 79 -L609 
 
 1861..' 12 93 1,207 
 
 1862 9 84 1.280 
 
 1863 9 112 1,525 
 
 1864 12 • 73 1,311 
 
 RESUME OF WITAT CTTOLEUA HAS DO^E. 
 
 The first epidemic crossed the continent of Europe during 
 the year of 1831, and was announced iu England by a few 
 
JITSTOttY OF TITTC CTTOLEnA. 15 
 
 Scattering cases in October of that year, and in the latter part 
 oft lie following winter (1832), and as soon as the warm days 
 of summer arrived, the malady assumed all the characteristics 
 of an epidemic, and during that season it killed 21,000 
 inhabitants of the British Islands. On the 26th of March, 
 1832, the epidemic was first announced in Paris, and during 
 the subsequent thirteen months it destroyed 20.000 people in 
 that city. During the first week in June, 1822, the cholera 
 was found prevailing in a crowded emigrant ship in the 
 St. Lawrence river ; a few days later, viz. : the 8th of June, 
 it was announced in the city of Quebec. June 21th the epi- 
 demic had reached the city of New York, and at the same 
 time emigrants having cholera were arriving from sea. Very 
 speedily thereafter^ it was announced at Albany, Troy, and 
 various towns and cities along the. lines of water communica- 
 tion and the principal commercial routes of the Northern, 
 Middle, and Western States. It killed 3,513 persons in New 
 York. The epidemic of 1834 seemed to obey similar laws of 
 progression, and there appeared to be a tendency of the mala- 
 dy to become naturalized or protractedly prevalent in various 
 places and under conditions of marked insalubrity. Since 
 the days of the great plague, of a former century, there had 
 been no such terror from pestilence throughout the civilized 
 world. On the continent of America such ravages of an 
 epidemic had been deemed hardly possible. But another 
 great epidemic was des tined to • destroy more lives than the 
 first. 
 
 In the month of July, 1848, the cities of -Alexandria and 
 Cairo, and the villages in the delta of the Nile were ravaged 
 by epidemic cholera, which had slowly made its way from 
 the eastward. In the village of Tantah, in the delta, where 
 1 95.000 pilgrims from Mecca had just arrived, 3,000 perished. 
 It is worthy of special remark in this place that cholera had 
 been fearfully fatal in eastern Asia, and after devastating the 
 towns on the Caspian and Black Bcas, it reached the city of 
 Moscow during the year 1847. So fatal was that epidemic 
 in the crowds of pilgrims who had assembled in the vicinity 
 of Mecca, that from two to three thousand perished in a sin- 
 gle night on the road to Arafat, the very place which was 
 
16 niSTOEY OF TIIE CHOLERA. 
 
 again the scene of similar ravages from the same malady in 
 the spring of 1805* In September the epidemic readied the 
 city of Hamburg, and- various ports on the German Ocean. 
 September 22d, 1848, cholera made its advent on shipboard 
 in the Thames, at London, and a few cases of the mala y 
 occurred in most of the ports between Hull and Glasgow, 
 before the beginning of winter. The wave of epidemic pes- 
 tilence had manifestly reached the British Islands, but it re- 
 mained in abeyance, with only occasional outbursts here and 
 there, in filthy, crowded quart ere, until the warm days of the 
 spring of 1849. On the 2d of December, 184r8, persons sick 
 with cholera were landed from an emigrant ship at the 
 Quarantine Hospital on Staten Island. Sailing from the port 
 of Havre the 9th of November, the epidemic exhibited itself 
 the 16th day -of the voyage, and before reaching the port of 
 New York it killed fourteen of the passengers. About the 
 same time, other emigrant vessels with cholera on board, ar- 
 rived at New Orleans, and the first case of cholera in that 
 city occurred on the the 5th of December. Before the end 
 of the succeeding month of January, an epidemic was so 
 fully established that nearly 1,400 had perished by it. Two 
 weeks after the appearance of the first case of cholera at New 
 Orleans, the malady reached Memphis ; January 5th it ap- 
 peared at St. Louis ; January 20th it reached Nashville, and 
 during that month a few cases occured at Cincinnati. The 
 valley of the Mississippi was thus selected as the earliest seat 
 of the second great epidemic cholera, and this circumstance 
 was manifestly connected with the commerce of the western 
 rivers by steamboats. The first cases were on the steamboats 
 at each of these places. But at an early period in the spring, 
 viz. : May 11th, the epidemic had gained foothold in the city 
 of New York, in the purlieus of the Five Points. Rapidly 
 gaining headway, the visitation became wide-spread and very 
 fatal previous to the beginning of July. Its rapid extension 
 throughout all the chief routes of water communication and 
 the centres of commercial intercourse have become facts of 
 history — facts which teach important lessons. Previous to 
 the succeeding New Year, cholera killed 5,071 inhabitants of 
 the city of New York. 
 
/ HISTORY OF TLIE CIIOLEEA. 17 
 
 In Great Britain the same epidemic destroyed nearly 
 70,000 lives. In Russia in Europe, nearly 600,000 perished. 
 The slighter epidemic wave which touched our shores in 
 the summer of 1854, had a history very similar to that of 
 the still slighter visitation in 1834. Whether we regard this 
 as a fourth and independent epidemic, or as a secondary 
 a mux of the great wave of death which swept over the Con- 
 tinents in 1849, it taught precisely the same practical' lessons - 
 as all the previous visitations of cholera. In 1834 the epi- 
 demic killed 9T1 persons in New York, and 2,509 in the sum- 
 mer of 1854. 
 
 On the 11th of May, 1865, the first case of cholera at 
 Alexandria in Egypt was announced in the north-western 
 district of that city, near the railway station, a filthy suburb 
 inhabited by 20,000 Arabs, Greeks and Maltese, who were 
 living in gross neglect of every hygienic law. From this 
 point the malady gathered strength and assumed the char- 
 acteristics of an epidemic. On the 25th of June the deaths 
 from cholera in that city were occurring at the rate of 200 
 per day. But previously to the latter date the same epi- 
 demic had been announced at Cairo and other places on the 
 Nile and . in its delta. At the same time, and previously, 
 Mecca and Medina in Arabia, and the vast caravans of the 
 Moslem pilgrims that were crowding the thoroughfares and 
 encampments of that region, had become hotbeds of the 
 cholera. By midsummer it was estimated by the Pasha of 
 Damascus, that of the 700,000 pilgrims who visited Mecca 
 in the. month of May, more than 40,000 perished from 
 cholera. Before the middle of August, 80,000 persons had 
 perished from cholera in Lower Egypt alone. Sweeping 
 around the eastern coast of the Mediterranean, the epidemic 
 quickly reached the ports of Beyrout, Jaffa, Alexandretta, 
 and Smyrna, and appearing at the Naval Hospital, near the 
 gates of Constantinople, the 8th of July, it soon insinuated 
 its deadly poison throughout the crowded and filthy quar- 
 ters of that city, and in the course of a few weeks was 
 destroying a thousand lives daily. The island of Malta and 
 the city of Ancona, on the Gulf of Venice, were reached 
 by the' epidemic early in August, and it commenced its 
 
18 niSTOKY OF THE OTTOI/ETCA... 
 
 ravages there, although the absolute quarantine and ran- 
 itary cordons of those places had attempted to defy its ap- 
 proach. At the same time, and probably at a date ccm-* 
 siderably earlier than this, the same malady was rife in t i i o 
 city of Bagdad and on the borders of the Persian Gulf; and 
 at later dates it spread to Jerusalem, Damascus, Trebizond, 
 and Varna, eastward ; and later, to San Severo, Alba ete, 
 Palermo and Valentia. At the last-named city the epidemic 
 was fully announced about the middle of August. During 
 the months of August and September the epidemic visited 
 Marseilles and Toulon, in France ; and Catalona, Gibraltar, 
 Barcelona," and Madrid, in Spain ; and at about the same 
 dates reached Odessa and various ports on the Black Sea. 
 During the last weeks of September, the epidemic began to 
 manifest itself in Paris and in Southampton, England, and 
 their surrounding districts. 
 
 IN CALIFORNIA. 
 
 The visitation of the epidemic to California is first dated 
 from the fall of 1850, when that disease broke out nearly at 
 the same time at Carson Valley, among the Overland immi- 
 grants, and in the city of Sacramento, (ISth October.) At 
 the last-named place it raged with great violence for more 
 than a month, and subsided in the early part of December. 
 Dr. H. Gibbons ot this city estimated the rate of mortality 
 at one per cent, per day. Awful proportion ! In San Fran- 
 cisco, owing to its fortunate locality, cholera never could 
 find itself a home. The largest amount of deaths in the 
 beginning of December, 1850, when the cholera reached its 
 a chine of violence, did not exceed four per day. By 
 Christinas that disease had entirely disappeared from our 
 cily, though it yet prevailed to a limited extent on the 
 steamers arriving from Panama and from Nicaragua to 1S53 
 and ltio±. 
 
 CAT7SE OF THE CHOLERA. 
 
 One of the primary opinions is that cholera is undoubt- 
 edly caused by imperfect drainage. In large cities this is 
 particularly the cause. The scientific drainage of great 
 
HISTORY OF TUF, CHOLKTCA.. 19 
 
 ciMes applies itself to the dispersal of the waters that fall 
 upon or collect wiihia their soil, as well as of the waste and 
 deposit of their inhabitants. The latter, as more visible 
 and offensive, usually get some attention paid to their re- 
 moval ; but the former are quite as important and as dele- 
 terious unless properly led away. In both respects modern 
 foresight is shamefully behind that of antiquity. The 
 Pontine marshes are not a blot on old Rome. And, to 
 come nearer, would the Egyptians ever have left undrained 
 such a series of shallow ponds as stretches behind Fort 
 Hamilton, loading the summer air with ague, and costing 
 Uncle Sam in three years' hospital outlay enough to buy 
 and cleanse those stagnant pools? The Cloacae of Rome 
 still show, after the lapse of two thousand years, a solidity 
 of construction and a skill in engineering that amazes lat- 
 ter-day pigmies. ' And no modern nation, except the 
 amphibious and moiling Dutch, have ever done a work of 
 drainage equaling that performed by the Piiaroahs for the 
 Harcotic lake. 
 
 The French, with their executive and generalizing 
 faculty, have applied the resources of hygiene and of engi- 
 neering to this problem with more boldness than any other 
 modern people. . Who can forget the magnificence with 
 which Victor Hugo, lights up the subterranean gloom of 
 P.'.ris, and paints in shuddering clair-obscur its vast net- 
 work of sewers, which boats may thread and armies tra- 
 verse. .London, too, has scented the importance of this 
 ill-odored subject, and is constructing vast works, at 
 imperial cost, to exorcise the foul demons that have so long 
 undermined her health and morality. But New York, bril- 
 liant and beautiful above ground, still refuses to know on 
 what pestilential foundations she rests — still shows how 
 '• tit? si nit in piscum mulier jonnosa sdperne" — still trusts 
 that her dead offal may bury its dead, and not corrupt the 
 living with it — still dances over a mud and fihh volcano, 
 till the eruption of plague shall confound and terrify her 
 into decency. . 
 
 Will the reader follow us into these underground caverns, 
 and learn how they have been built up by negligence, 
 
20 HISTORY OF TIIE CHOLERA.. 
 
 arched over by greed, and left asji perpetual nicer of pesti- 
 lence under as fair a spot as earth's surface shows? 
 
 A map of the hydrography of New York island, pre- 
 pared with great labor aud cost by that accomplished 
 engineer, Egbert L. Yiele, shows the original sand-spit en- 
 larged on each side by a breadth of made ground, pierced 
 in the neighborhood of the Tombs by a profound water- 
 chasm, and chauneled, in different parts of its surface, both 
 in the upper and lower town, by important streams wind- 
 ing over much of its face, aud discharging, usually through 
 extensive marshes, into the North and East Rivers. Death 
 has occasionally resulted immediately from this shameless 
 recklessness in this regard. Four or five years ago two 
 young men, standing at the corner -of a street crossing the 
 Bowery, New York city, suddenly vanished, dropping 
 thirty feet into an old well which had been " improved " 
 by planking over the mouth and piling a mass of earth 
 directly upon the. rotting boards. In due time the trap 
 went down, and one victim never ascended alive. In the 
 Tombs prison of the same city it has happened more than 
 onoe that fate has outstripped justice, and the key that 
 locked in at sunset a hale man,' though a rascal, has turned 
 a4 morning to disclose a gasping wretch, done to death by 
 the pestilent exhalations of a single night. 
 
 LOW SITUATIONS. 
 
 It is well known that liability to visitations of fevers and 
 cholera, depends in no small degree on low situations, and 
 proximity to river-banks or stagnant water. It was said, in 
 reference ..to the intimate relations between the activity of 
 the disease, and the proximity of the river Thames, London, 
 that two causes were at work in such a locality. First, in- 
 creased humidity ; and, secondly, and more especially, the 
 large evaporating surface of foul water, by which noxious 
 effluvia are continually given off, and poison, to a certain. ex- 
 tent, the atmosphere through which they are diffused. Gen- 
 erally speaking, the mortality from cholera has been great- 
 est in the lowest levels, owing, as may readily be supposed, 
 
HISTORY OF THE CIIOLERA. 21 
 
 to their imperfect drainage, and, consequently, to the greater 
 humidity and impurity of the air of such places. 
 
 During the cholera season of 1849, in New York, Br. Rot- 
 ton noted the fact of the great mortality from the disease 
 among the occupants of cellars, and hence, it became his in- 
 variable practice to have such persons, when attacked, im- 
 mediately removed. He does not know of a single ease of 
 recovery of those who were not removed. Rotherhithe, a 
 district of London, on the south bank of the Thames, 
 has been the favorite haunt of the cholera in succes- 
 sive periods of its appearance from 1831-2- to 1854. Its 
 sewerage was deplorably defective, being by open sewers 
 connected with the river. Malignant cholera spread to a 
 much greater extent on the line of open sewers than in the 
 other poor and densely inhabited places. In other districts, 
 we are told that the line of habitations, badly cleansed, and 
 suffering from defective drainage, formed the line of cholera 
 Cases in 1831-2. -The reports of the medical inspectors, ap- 
 pointed by the Board of Health in London, in 1854, concur 
 in- showing that wherever cholera has become localized, it 
 was found to be connected with the aggregation of filth from 
 one cause or another. 
 
 IMPURE AIR. 
 
 Some of the most frightful ravages of cholera on record 
 were owing to the direct pulmonary poisoning by impure air 
 and animal effluvium, accumulated for want of suitable ven- 
 tilation. Examples of this nature have been furnished in all 
 parts of the civilized world— in the East Indies, at Karra- 
 chee, among the troops, at Juggernaut, among the native 
 population, also in the crowded and ill-ventilated barracks ; 
 in England, among the brickmakers at Southal, the hop- 
 pickers at East Farleigh, the pauper children at Tooting, 
 the lunatics in the Wakefield Asylum, the convicts at the 
 Wakefield Old Prison, the inmates of the Millbank Peniten- 
 tiary, and of the Taunton Workhouse. At a time when no 
 case of cholera had occurred in the neighborhood of Tooting, 
 and when, indeed, even diarrhoea was not at all prevalent in 
 the village, three hundred of the inmates of the establishment 
 
22 HISTORY OP TFTE CHOLERA. 
 
 were smitten with the secret pestilence, and of these no less 
 than one hundred and eighty died. The girls, whose dormi- 
 tories were the most overcrowded and the worst ventilated, 
 suffered more severely than the boys. The essential cause 
 of all this mortality was declared to he ''the inordinate 
 crowding of the establishment." The-nnmbers crowded to- 
 gether into the. dormitories were so great, that each boy had 
 only one hundred and fifty cubic feet, and each girl one hun- 
 dred and thirty-three cubic feet of air allowed for respira- 
 tion, and some of the apartments were, at the same time, so 
 faultily constructed — there being windows on one si "e only 
 — that no effective ventilation could possibly be kept up. 
 
 Dr. Chapman has published numerous papers in the Lon- 
 don JI -fi a I TtiKfs an > G*rtkefte upon the employment of 
 his favorite remedy, for different complaints. He has lately 
 written an article upon the cholera, in which he lays down 
 the following propositions ': 
 
 " The primary cause of cholera is, as a general rule, the 
 excessive heat of hot climates, and temperate climate in sum- 
 mer when cholera prevails. The proximate cause of 
 cholera is of precisely the same nature as that of summer or 
 cholera diarrhoea, but it is far more developed, and conse- - 
 quently its action is proportionately more powerful and 
 intense." 
 
 CHOLERA LANDMARKS IN NEW YORE!. 
 
 As !New York City, from its position, is pretty certain to be 
 visited by the dreadful scourge, anything respecting its con- 
 dition will prove of interest. Surely it must be instructive to 
 note the quarters in which cholera has in former years made 
 its first appearance. The first epidemic of this disease in 
 New York, broke out in the vicinity of Cherry and Roose- 
 velt streets, appearing also at the same time in Reade, Wash- 
 ington and Duane streets. Of course the Five Points, which . 
 had then all the peculiar characteristics it has since lost, was 
 violently attacked, as well as the whole region of the Sixth 
 Ward. A section of Laurens street, between Graud and 
 
HISTOHY OF THE CHOLERA, 23 
 
 Broome* expressively called "Rotten Row," became another 
 center. The same may be said of Corlears Hook, and any- 
 body who has been up town in cars of the First and Second 
 avenues, -might recall spots which promise to become cholera 
 favorites. 
 
 In the epidemic of 18-19, the first appearance was at Nos. 
 21 and 23 Baxter street, and next at Nos. 8 and 10 Mulberry 
 street. The physician of the first established cholera hospi- 
 tal gives this picture of the spot where the disease first broke 
 
 OUt : 
 
 u No. 20 Orange (now Baxter) street, lies 30 or 40 yards 
 in a southeasterly direction from the Five Points. The en- 
 trance to the rear lot is gained by an opening scarcely two 
 feet wide, or more than six feet in length, pierced through 
 the front house. Passing through this a distance of forty 
 feet, you reach the rear lot, on which are two old and ruin- 
 ous tenements, one a prolongation backward of the front 
 house, and the other standing across it at right angles ; the 
 adjoining house an extension backward in the same manner, 
 thus cutting off almost completely the admission of fresh air. 
 The small area that is unbuilt upon is covered,.with black 
 pools of filthy water. The apartment where the first case 
 occurred is a basement or cellar in one of these buildings. 
 * * * At my first visit on the 16th of May, five human 
 beings, one man and four women, lay upon the floor in differ- 
 ent stages of cholera. There was nothing under them but 
 mud and filth, and nothing over them but a few rags of tire 
 filthiest description. Civilization and a great city could 
 scarcely afford a parallel to the scene." 
 
 For two weeks the disease stayed in this locality; then 
 appeared in a filthy quarter in Stanton street, afterward in the 
 region west of the New York Hospital on Broadway— the 
 same qu art er now occupied largely by wholesale dry-goods 
 bouses,! and traversed continually by street-cars of two or 
 three lines, where smallpox and typhus have raged, with 
 scarce an intermission, for nearly two years. 
 
 The c»iolera in 18±9 showed a like beginning in other 
 cities. In Philadelphia it appeared.in two districts where 
 cleansing had been inadequately performed ; but the work 
 
24 HISTORY OF TIIE CHOLERA. 
 
 was taken hold of in such earnest that 2,700 privies were 
 cleaned, 340 houses cleaned by authority, 188 ponds drained, 
 66 rag and bone shops closed, and 6,000 sources, of disease in 
 all removed, so that in that city but 747 persons died, while 
 in New York the number was 5.071. In Boston the disease 
 commenced and remained in three or four narrow lanes in 
 the northern and most crooked portion of that crooked city. 
 Citizens whose homes are on the avenues and the spa- 
 cious cross-streets have no idea of the nooks and holes 
 where cholera may delight to make its fearful dwelling- 
 place. Pass up Cliff street, above Frankfort, and the place 
 will be reached, lying in a rude triangle inclosed by Cliff, 
 Frankfort, and Vandewater streets. Through a tenement 
 house on' Vandewater street is a narrow alley (four feet 
 wide) which forms the only communication with five other 
 houses, standing first three, then two behind them, a small 
 court, in which is ^ their common privy, being between. 
 Those furthest back from Vandewater, street abut against 
 four others, which in turn touch three others fronting on 
 Cliff street, while stables and tan-vats conveniently occupy 
 the angles^, and a soap factory faces them all from the fur- 
 ther side of Cliff street. Cholera might naturally enough 
 make its headquarters here. 
 
 CHOLERA IN OLD HAXNTS OF DISEASE. ' 
 
 Dr. Laycock, in his highly interesting Report on Health, 
 s'ates that the cholera of 1831 in England selected nearly 
 all the old haunts of the plague, ami appeared to possess a 
 predeliction for the old haunts of disease. " It is a singu- 
 lar, coincidence, " he remarks, "that while the cholera com- 
 menced in the Haymarket, near the traditional spot of the 
 plague under consideration (in 1604), and probably near to 
 that of 1551, the first death from cholera took place also in 
 the parish of St. Michael, Spurriengall, and on June 5;h." 
 It was in this parish, and on June 4th, 1604. that the first 
 death from the plague occurred. The first case that occurred 
 in Edinburgh in 1848, took place in the same house, 
 and within a few feet of the same spot where the epidemic 
 of 1£32 commenced its course. On its reappearance in 
 
niSTOEY OF TITE CHOLERA. 25 
 
 the town of Pollocksliaws, it Snatched if s. first victim from 
 the very same room and the very bed in which it had bro- 
 ken out in 1832. Its first appearance in Bermondscy was . 
 close to the same ditch in which 1he earlier fatal cases 
 occurred in 1839. At Oxford, in 1839 as in 1832, the first 
 case occurred in the county jail. This return to its former 
 haunts has been observed in several other places, and iho 
 experience in foreign countries has been similar. At 
 Grouingen, in Holland, the disease in 1832 attacked, in the 
 better part of the city, only two houses, and the epidemic 
 broke out in these two individual houses on the visitation 
 of 1848. But it was observed, that while in both epidemics, 
 those of 1832 and 1848-9, the disease was localized in pre- 
 cisely the same disiricls, several of them having changed 
 plnces in the relative degree in which they have suffered. 
 The earliest case of cholera in Chelsea (near London), in 
 1848, is said to have been in Whitehall Court, and there 
 it continued to exist until the end of the epidemic in 18-19.. 
 The first case m 1854 was in the same place, perhaps also 
 in the same house, in both visitations. A very similar fact 
 is presented by Augusta Court, in which the three earliest 
 fatal cases of cholera, in Chelsea, occurred in February, 
 1832; and which being revisited. in 1854^ continued to fur- 
 nish victims to the pestilence throughout the. early dura- 
 tion of the outbreak. 
 
 Kent and Mew-streets, Sonthwark, on the south side of 
 the Thames, London, which were severely visited at an early 
 period of the last epidemic, were also among the first seats 
 •of cholera in 1832. Dr. Aclancl relates that, with one ex- 
 ception, every yard and every street in St. Thomas's parish, 
 Oxford, England, which had been attacked by cholera in 
 1832 and 1849, was revisited in 1854. It is evident from 
 these and many more analogous facts, that, although we are 
 unable to explain all the conditions for the development of 
 cholera, it is impossible for us to deny the great influence of 
 locality on its production. 
 
 IN BERLIN. . 
 
 No surprise need be felt that Berlin was scourged with the 
 cholera in 1831, and again with still greater severity in 1837. . 
 
26 niSTORY OF THE CHOLERA. 
 
 Putting aside drainage, the Prussian capital is, in the width 
 and general arrangement of the streets, and the better ventil- 
 lation of the houses, superior to the French : but yet 'the pro- 
 portionate-mortality from cholera was much greater, or at 
 the rate of nearly 2 1-2 to L in 1831, in the former than in 
 the latter city — which, as commonly described, was so greiifc 
 a sufferer. In the second attack (in 1S3T), the mortality 
 was still heavier in Berlin, or, as the difference between 1,420 
 and 2,174 deaths. Berlin was then so far behindhand in the 
 comforts of life, as not to hare water conveyed in pipes into 
 the city and the houses. Three hundred thousand people 
 have taste enough to be in dreamy ecstacies at the singing 
 of Madame Pasta,, or the dancing of T aglioni, and have not 
 taste enough to appreciate or feel the want of a supply of 
 water in their kitchens, sculleries, drains, sewers, and wa- 
 ter-closets. 
 
 NARCOTIC POISON". ' 
 
 The narcotic poison that is the remote cause of cholera, 
 possesses a deadly enmity to the electric life that exists in 
 both the blood and the body of human beings. The poison 
 of opium produces, says Dr. Stevens, a similar deadly effect 
 on the life of the blood and the body, consequently, the ex- 
 perience derived from thousands of fatal cases, proves that 
 the inhuman invention of adding the poison of opium to the 
 poison of cholera is, when used by itself, or with brandy, or 
 chalk mixture, the certain means of causing death in every 
 severe case of the new disease. For even in the less severe 
 cases, where the patients do not become collapsed, the pri- 
 mary calm produced by the deadening effect of the opium is 
 followed by a reaction in the vascular organs, in the form of 
 a symptomatic fever, that is nearly as fatal as the collapse 
 stage of the true cholera. 
 
 IMPFRE WATER,- 
 
 The effect of impure water is shown in the ravages of 
 cholera in two of the southern districts of London. ■-. It is re- 
 lated as follows : 
 
 " These districts (comprising nearly a fifth of the popula- 
 
niStOHY OF TTTE CTIOLF.KA. 27 
 
 tion ofthd Metropolis) have been notorious for the great se- 
 verity, with which cholera has visited them. Throughout 
 these districts, during the epidemics of 1853-4, there were 
 distributed two different qualities of water ; so that one large 
 population was drinking a tolerably good water, another 
 large population an exceedingly foul water: while in all 
 other respects these two populations (being intermixed in 
 the same districts, and even in the same streets of these dis- 
 tricts) were living under precisely similar social and. sanitary 
 circumstances. And when, at the end of the epidemic pe- 
 riod, the death-rates of these populations were compared, it 
 was found that the cholera mortality in the houses supplied 
 by the bad water had been three and a half times as great as 
 in the houses supplied by the better water. This proof of 
 the fatal influence of foul water was rendered still stronger 
 by reference to what had occurred in the epidemic of 1848-9. 
 For on that occasion the circumstances of the two popu- 
 lations were, to some extent, reversed. That company 
 which, during the later epidemic, gave the better water, had 
 given, during the earlier epidemic, even a worse water than 
 its rival's; and the population supplied by it had at that 
 time suffered a proportionate cholera mortality. So that the 
 consequence of aniiiiiprovement made by this water-com- 
 pany in the interval between the two epidemics was, that 
 whereas, in the epidemic of 1848-9 there had died 1,923 of 
 their tenants, there died In the epidemic of 1853-4 only 611 ; 
 while among the tenants of the rival compan} T (whose sap- 
 ply between the two epidemics had . been worse instead of 
 better), the deaths which in 1848-9 were 2,880, had in 1853, " 
 1854, increased to 3,476. And when these numbers are 
 made proportionate to the populations or tenantries con- 
 cerned in the two periods respectively, it is found that the 
 cholera death-rates per 10,000 tenants of the companies were 
 about as follows: for those who, in 1848-9,. drank the 
 worse water, 125 ; for their neighbors who, in the same epi- 
 demic, drank a water somewhat less impure, 118 ; for those 
 who, in 1853-4, drank the worst water which had been sup- 
 plied, 130; for those who, in this epidemic, drank a compa- 
 ratively clear water, 37." 
 
28 HISTORY OF TITE CHOLERA. 
 
 Dr. Sutherland, in his report to the General Board of 
 Health on the cholera epidemic of 1849, says, that the ; 
 rious effects of unwholesome water had been manifest in 
 nearly every affected place — and adds, that a number of 
 most Severe and fatal outbursts of cholera were referable 
 to no other cause. Since that time, much additional evi- 
 dence of a confirmatory character has been collected. Two 
 examples are recorded by Dr. Acland, in his valuable and in- 
 teresting "Memoir on the Cholera in Oxford" — the parish of 
 St. Clements, which suffered a large mortality in 1832, when 
 the inhabitants had filthy water from a sewer-receiving 
 stream, and an insignificant mortality in 1849 and 1854, 
 when the water was derived v.from a purer source. The 
 other case is that of the county jail, in which cases have oc- 
 curred in every epidemic, whilst the city jail, which is not 
 far from the other, has uniformly escaped. The only appa- 
 rent difference between the two establishments in 1854, 
 seems to have been that the supply of water for the use of 
 the county jail, and of which the soup and gruel were made, 
 was pumped from a filthy well-pool, within ten feet of one 
 • of the prison drains. No sooner were the supply pipes dis- 
 connected with this impure source, than cholera and diarr- 
 hoea ceased. It appears from an elaborate inquiry by the 
 General Board of Health, at the close of the cholera epi- 
 demic of 1854, that the contrasted effects of the dis- 
 ease on the people of two large sections of the popu- 
 lation, are only explicable by the fact that one division, com- 
 prising a population of about 268,171 persons, drank impure 
 water; whilst the other, numbering about 166,906 persons, 
 used a clearer, and comparatively pure water. The mortal- 
 ity from cholera among the drinkers of impure water — of 
 water impregnated with the sewerage of the metropolis, and 
 containing in solution a large quantity of saline matter, de- 
 rived from the intermixture of sea-water— being at the rate 
 of 130 to every 10,000; that of the drinkers of the pure 
 water being only at the rate of 37 to every 10,000 persons 
 living. • 
 
 In the report on Epidemic Cholera in London, in 1854,- 
 by Dr. Sutherland, much interesting information is afforded 
 
ITISTOTCY OF TTTE cnoi.EEA. 29 
 
 on the influence of water upon the spread of the disease. 
 The (.led net ion from the microscopical and chemical examin- 
 ation of the water used in the houses and neighborhoods 
 where the disease was most; prevalent, by Dr. Hassall, was: 
 "That there is no water supplied to the metropolis that 
 does not contain dead and living organic matter, animal and 
 vegetable. But the Thames Ditton water, supplied by the 
 Lambeth Company, is by much the purest of' the waters, 
 while the Southwark and Vauxhall water is one of the 
 worst, and the waters of the other companies might.be ar- 
 rayed in a series between these two." From an inquiry 
 instituted by the Registrar-General, the following results 
 appear: "In 26,107 houses that derived the water from 
 Ditton, SI 8 deafehs from cholera occurred in ten weeks. In 
 the 40.0-10 houses, that received the impure water from Bat- 
 tersca, 2,445 persons, it was ascertained, died from cholera in 
 the same time. The deaths in the latter districts exceeded 
 by nearly 2,000'thc deaths that would have- occurred if chol- 
 era In ad only been as fatal as it was in the houses that derived 
 their water from Ditton." Dr. Sutherland makes the follow- 
 ing remarks upon these results: "When it is considered 
 thai', the sanitary condition of the population does not. mate- 
 rially differ,, except in the quality of the water supplied by 
 the two companies, it is difficult to resist this statistical evi- 
 dence of the predisposing effect of the Battersea Water, and 
 of the loss of life which has arisen from its use." 
 
 The deleterious effects of impure water are not seen in 
 cities or large towns alone: they occur in small villages, 
 sometimes in the solitary farm-house — any place, in fine, in 
 which the pump or draw-well is in the midst ol a farm-yard 
 or filthy oonrt : receiving the surface-drainage of heaps of 
 stable manure, pig-sties, &c. How often do we notice, says 
 Dr. YV...J. Cox. green, slimy, stagnant pools, in the close . 
 vicinity, and affording the sole water-supply, of cottages. 
 Such a state of things does not often occur in this country; 
 but in too many instances there is a neglect to obtain an 
 adequate supply of pure water, the penalty is paid in the fre- 
 quent occurrence of bowel-complaint, and the sudden in- 
 roads of epidemic cholera, which makes its attacks without 
 
30 history of TiiR dior.ROA. 
 
 any other apparent provocation. In Hie new settlements of 
 the West, the enterprising pioneer and life family often pay 
 a tax in: the shape of disease, and not seldom of luei.t.self, 
 from the use of had water or its imperfect supply : and in 
 new towns other schemes of improvement are tiled, before 
 sanitary measures, both for present and future protection^ 
 such as paving, drainage, and a supply of good potable w ftter, 
 are thought of. 
 
 "Dr.- Cox tells us, that water tainted with various orrank 
 matters, whether gaseous, as carbide or sulphide of faroro- 
 gen, or solid, as putrescent vegetable fibre, or vitalized as 
 algae, conferva, hydroe, fungi, infusoria, && — is a very fre- 
 quent cause of severe visitations of bowel complaints during 
 the summer months. Several instances cyme under his own 
 observation, in 1853 and 1854, of the aggravation ofepid«*m3* 
 ie diarrhoea from this cause. " That water falling • n a grow- 
 ing soil, and running off to lie in stagnant pools, is sure to 
 become tainted with animal and vegetable life, is well 
 known: and when to this is superadded the circumstances 
 of the said soil being highly -charged with effete organic 
 products, the water thus collected must necessarily be highly 
 impure, and most unfit for human consumption." 
 
 POVERTY A CAUSE. 
 
 .The poor suffer great privations and submil to many in- 
 conveniences ; and the cleanly aim »ng them deserve tn'»ra 
 consideration than they receive. Even in the homes of 
 poor men whose wives are really cleanly, the former see 
 with aching hearts the approach of washing day. When 
 this needful sanitary operation is performed once a week it 
 is a time of discomfort and unpleasantness ; but in inosl 
 ler.cmented dwellings there is a washing on almost every 
 < ! av of ihc week Quarrels arise among the numerous in- 
 habitants of a house respecting the day on which they ean 
 have the use of the lines and drying apparatus in the space 
 which is often for too small and, very meonyenieuU Ii is 
 by no means an uncommon practice, in order to save. fuel. 
 time, and so on, for one woman to leave the hot, dirty 
 water in which her clothes have been washed, for the us<? 
 
HISTOKY OF THE CHOLERA. 81 
 
 of another family: the mischief of i his in cases where skin 
 
 and other disorders are prevalent, is evident. It is not 
 unusual for the clothes in which the sick have lain, or in 
 which persons have died, to be kept waiting for the wash- 
 ing day in the rooms in which families live, or in the wash- 
 house, which is accessible from the various apartment. 
 There is also a frequent scarcity of water. Nuisance doc- 
 tors should make it their business to look into such details 
 of human, life as these; and w r here the requisite supervision 
 is neglected should insist, upon its observance. Until the 
 dirly habits of some of the poor are corrected, and the 
 cleanly encouraged, there will always- be apprehensions of 
 cholera in such summers as we have this year, originating 
 in the foulness of crowded and filthy rooms. When we 
 ^fc*Jnto consideration the modern style of bu'ld- 
 5rn^1ie confined space in .the rear of houses allowed for 
 air, the compensation for narrow sites, afforded by increased 
 height in the houses, whereby the circulation of air is 
 cheeked and obsti inXed, the-, frequent removal of refuse 
 will appear essential to the healthy condition of the inhab- 
 itants.. 
 
 IS CHOI.KKA CONTAGIOUS. 
 
 In this connection we cannot do better than, quote from 
 . the very thoughfnl treatise of Dr. Brig ham : 
 
 " That some cities and fortresses, which established rigo- 
 rous quarantine regulations, have escaped the disease, is very 
 true, but it is also true that other places, immediately adjoin- 
 ing those which were attacked, have escaped, notwithstand- 
 ing that every precauonary measure had been omitted. It is 
 further true that numerous countries, cities and fortresses 
 have adopted and enforced the most severe and preventive 
 regulations — that they adopted them early and enforced them 
 with rigor — and yet the disease appeared among them. All 
 that quarantine enactments can do toward preventihg the 
 spread of a disease from one country to another has been done 
 in Russia. Austria, and Prussia. 
 
 ■ "In r.ussia immense lines of troops were drawn to arrest 
 its progress'; St. Petersburg was entirely surrounded by cor- 
 
32 ITISTORY OF TIIE CHOLKKA 
 
 don .9 arrnff fires; but all these regulations, enforced by a 
 powerful and despotic Government, were unable to prevent 
 the approach and the spread of cholera throughout the Rus- 
 sian Empire. The efforts of Austria were equally unavailing, 
 for in a short time the disease passed her triple cordon* and 
 invaded the country from Poland. Prussia employed HO, 000 
 of her best troops to enforce her rigorous restrictions, and 
 travelers bear testimony to the severity with which they 
 were enforced. And what have been the results ? (Turning 
 to The American Journal (f Medical Sciences for May, 
 1832). — * An immense expenditure of money, the suspension 
 of commerce, a stop put to industry, multitudes deprived of 
 the means of acquiring subsistence, and whole families ren- 
 der^ favorable subjects for the disease : but no stop to the 
 extension of the disease— on the contrary, its prof/rrs^^s 
 rendered more fatal. As an instance of this, Bivslau my 
 serve as an illustration, and a warning to other cities. . That 
 city contains 90,000 inhabitants~-aciive, commercial and in- 
 dustrious, many of them manufacturers and artisans. A 
 quarantine of twenty days, with the difficulties, almost insur- 
 mountable which it entailed, was established at the borders 
 of the province, and maintained with a rigor which might 
 serve as a model to other nations. But in the midst of this 
 apparent security, a woman living in a damp part of the 
 town was attacked by the cholera, and in a few days the dis- 
 ease spread. The most minute researches on the part of the 
 public authorities could not discover any communication 
 between this woman and any stranger or goods suspected of 
 being infected. But when the disease spread, the authorities 
 saw too late the deep injury their sanitary measures had 
 inflicted.' 
 
 il Taught by lamentable experience, "Russia, Austria and 
 Prussia have withdrawn their cordons, and acknowledge 
 not only their inutility, but that the}' are productive of im- 
 mense evils. Indeed, all the nations of Europe are abandon- 
 ing severe quarantine regulations, and it is to be hoped that 
 the cities of the United States will not adopt them, but place 
 all their reliance, for the prevention of the disease, on the 
 
lUSTORV OF TTTE CHOLERA. S3 
 
 removal of those causes which in all countries have appeared 
 to produce it." 
 
 NON-CONTAGION DISCI" .-SEP. 
 
 I. The great numbers attacked simultaneously, and who 
 had previously had no intercourse with the sick — a fact 
 which all writers on cholera admit — cannot be accounted for 
 without supposing the disease to be simply epidemic. 
 
 II. The general exemption trotri the disease of medical and 
 other attendants on cholera cases : 
 
 1. Dr. Jameson says that of between 250 and 300 physi- 
 cians engaged in cholera practice in Bengal, only i/iree took 
 the disease. 
 
 2. At Bombay, none of the hospital attendants were at- 
 tached, though they were assisting the patients day and 
 nJglrf. 
 
 3 The Madras report snows that, in the hospital of the- 
 Royals, only 1 out of 101 attendants were attacked, and at 
 the receiving hospitals for cholera patients at Trmchinopoly, 
 St. Thomas du Mount, and Madras," the attendants were nu- 
 merous, and sometimes shared the same bed with patients ; 
 yet not one took the disease. 
 
 4. At Berhampore now of the native attendants on the 
 cholera hospitals were affected. 
 
 5. A letter addressed to the Medical Council of Moscow 
 by eight chief physicians to the hospitals of Astrakhan, says: 
 u We have all, without any precaution, touched and rubbed 
 the sick; and we have daily visited the hospitals crowded 
 With cholera patients, where we have respired their breath, 
 yet we have neither contracted the disease, nor conveyed it 
 to our families. The attendants who nursed and applied 
 frictions to the patients — who put them into baths, changed 
 their linen, and performed other offices for the sick — re- 
 mained free from cholera. In the military, as well as in the 
 civil hospitals, the linen and clothes of cholera patients were 
 transferred to other patients without being previously fumi- 
 gated or ventilated, and, nevertheless, those who wore those 
 garments did not become affected with cholera. Several 
 nurses and mothers, having cholera, suckled their children 
 
34 niSTOPwT of tite crroT/ETiA.. 
 
 both during and after the disease ; yet the latter were not 
 attacked*" 
 
 6.. Dr. Lefevre, physician to the British Embassy at St. 
 Petersburg, reports as follows : 
 
 "In private practice, among those in easy circumstance . 1 
 have known the wife attend the husband, the husband attend 
 the wife, parents their children, children their parents — and 
 in fatal ^cases, where, from long attendance and anxiety of 
 mind, we might expect the influence of predisposition to ope- 
 rate; in no instance have I found the disease communicated 
 to the attendants." 
 
 7. During the prevalence of the epidemic at Moscow, 587 
 persons" affected with cholera were admitted into a hospital, 
 where there w^ere already 860 patients laboring under other 
 diseases. Kot a single one of the latter took the cholera. 
 
 Dr. Zudkoff, of Moscow T , who had formerly been a conta- 
 gionist, declares that he saw, to his astonishment, that all the 
 attendants, and ail the soldiers, handled the sick, and sup- 
 ported their heads while they vomited, without using the 
 least precaution, and without contracting the disease. 
 
 8. Mr. Searie, who attended a very large number of pa- 
 tients in Warsaw, where he had charge of a hospital for the 
 poor, writes that not one of the attendants, not one, of the 
 nurses, not one of those who handled the dead, fell a victim 
 to the scourge. 
 
 9. I i Berlin, 409 houses were visited by the epidemic, 
 and in 273 of these only one individual in each house was 
 affected, while in the remaining 136 four or five suffered in 
 each. Such is the density of the population in the quarlers 
 of Berlin so attacked, that the census assigns 4,200 families, 
 with an average of four persons to each family, to those 409 
 houses, being an aggregate of 16,800 residents who lived 
 in immediate contact with cholera. Of this mass only 803 
 were stricken with the disease, or about 1 in 18 persons. 
 
 : 10. In the Marine Hospital of St. Petersburg, of forty*- 
 three attendants on cholera patients, not a sinr/le one was 
 affected, and in the temporary hospital in that city, of flfty- 
 eight attendants only one was attacked, and he after drink- 
 ing kicass while very warm. 
 
HIST0KY OF TT7E CHOLERA.. 35 
 
 11. Those engaged in post-mortem examinations of chol- 
 era cases have not been attacked by the disease. Such ex- 
 aminations have everywhere been made without any precau- 
 tions, and with perfect impunity. 
 
 12. Dr. Foy of .Warsaw, and ten others, inoculated 
 fhemselves with t lie blood of cholera patients, tasted iheii 
 cl( j cot ions, and inhaled their breath, without receiving the 
 disease. 
 
 13. As to the capability of merchandise to convey, and 
 afterward to communicate, the infections germ of cholera, 
 the Central Board of Health in a communication to the 
 Privy Council, remark : 
 
 " There is, perhaps, no question in the whole range of 
 sanitary police on which so many and such irrefragible facts 
 can be brought to bear as on this — derived, too, from the 
 most authentic sources. 
 
 "Seven hundred and thirty ships, laden with hemp and 
 flax, from infected'ports of the Baltic, arrived at the differ- 
 ent quarantine stations in this country between the 1st of 
 June and the 31st of December, 1831. Many vessels also 
 arrived laden with wool and hides ; yet not a single case 
 of cholera occurred among any of these ships outside of the 
 Cattegat Sea, nor among the people employed in opening 
 and airing their cargoes in the lazearets. At the hemp and 
 flax wharf of St. Petersburg, where several thousand tons 
 of these articles arrived during the spring and summer from 
 places in the interior, where cholera existed at the time of 
 their shipment for the capital, the persons employed in 
 'bracking' or sorting, and who. generally passed the night 
 among the bales, did not suffer so early in the season, nor 
 so severely, as other classes of the general population. The 
 same observation holds good with respect to all the rope- 
 walks of St'. Petersburg and the Imperial manumctuiy.of 
 linen cloth at Alexandrofsky, where all the yarn is spun 
 from flax bracked and hackled on the spot." 
 
 14. Down to the 29th of February, 1832, Mr. Aspinwall, 
 American Consul at London, reported to this Government, 
 that only one medical practitioner had died of cholera in 
 England, although at a moderate computation, 1,000 or 
 
30 IIISTORY OF THE CIIOLKEA.. 
 
 more, ha 1 been in constant attendance on cholera patients. 
 And, according to The MedicprChirurgical Review, for 
 April, 1832, not a single medical man was affected by the 
 cholera in Sunderland, Newcastle, or Gateshead, England. 
 
 THE NON-CONTAGION HYPOTHESIS. 
 
 When the cholera prevailed in its most virulent form 
 among the armed vessels and transports of the East India 
 Company's fleet in the waters of Tennasscrine and Pegu, in 
 1853, no case occurred among the medical officers or hospi- 
 tal attendants. At that time, the writer, having medical 
 charge of a war-stearner, freely handled the persons and 
 clothes of cholera patients, inhaled their effluvia, and mingled 
 his breath with theirs — with the' impunity he expected. So 
 likewise did his assistants. No precautions were taken 
 against contagion, because contagion was never thought of 
 among men w r ho annually renewed their acquaintance with 
 cholera. We believe that physicians and nurses are less 
 liable to the disease than other classes of persons, because; 
 by constitution as well as habit, perhaps, they are less liable 
 to that sort of anxiety and alarm — because in the midst of 
 the disease their minds are actively and wholesomely em- 
 ployed — and because they are continually impressed with tho 
 importance of hygienic care, and necessarily inured to the 
 practice of it. 
 
 Cholera is strictly an epidemic, existing by force of a mys- 
 terious poison diffused through the atmosphere. Whether 
 the influences which produce this poison are " telluric," 
 "electro-magnetic," or " aniinaicular, " we kno w no better 
 now than- we did 50 years ago. Cholera moves in the form 
 of a volume, or field (of greater or less extent) of such poi- 
 soned air. Its rate of progress is comparatively uniform, 
 and its track not more eccentric than may be accounted for 
 by the influence of prevailing winds. As soon as it reaches 
 any given place, all the persons residing in, arriving at,, or 
 passing through that place, who may be predisposed by cer- 
 tain conditions, hereinbefore stated, become the selected ob- 
 jects of its attack,, however widely they n*ay be scattered; 
 and without regard to their possibilities of. communicating 
 
HISTORY OF THE CHOLERA. 37 
 
 with each other ; it is sufficient that they are included in tire 
 Choleraic atmosphere. ChDlera is never brought — it corner. 
 If passengers sailing from a port of France, where the epi- 
 demic prevails, arrive in an American port, whither it has 
 not yet come, bringing with them the germs of the disease 
 alive in their own systems, those germs will not grow and 
 spread in the new and healthy air, but will wither and die 
 out for want of then* natural pabulum — the Choleraic atmos- 
 phere. 
 
 But if that atmosphere accompanies them, then the germs 
 will flourish and be propagated. This is wliy the cholera 
 did not extend to London in 1831, or New York in 1?48, 
 '•"although it had been introduced, and persons had been ex- 
 posed to its infection. The ease* had been brought, but the 
 evid"nric h&d not arrived. On the other hand, "it spread 
 like wildfire in Paris, in 1832," because the epidemic brought 
 its own cases along with it. But the presence of the- chole- 
 raic atmosphere is an essential condition of the spread of 
 cholera. Without it, a few isolated cases of aggravated 
 cholera morbus, in individuals rendered peculiarly suscep- 
 tible ajid sympathetic by their local and personal accidents, 
 are the worst that need be feared, and we believe that such 
 examples of cholera morbus, occurring during the preva- 
 lence of an actual epidemic, constitute a large proportion of 
 the whole number of cases counted as true cholera. Upon a 
 prepared nervous system, it is most natural that the fiercer 
 disease should beget its kind, even though the progeny may 
 "be of weaker powers. 
 
 All attempts to prove that the disease was imported into 
 Sunderland and England, in 1831, failed; and the opinion 
 that it was not imported at all became very' general, not only 
 at Sunderland, but throughout England, and especially 
 among members of the medical profession. On the 28th of 
 April, 1832, at the last meeting for that session of the famous 
 Yv r estminster Medical Society (the? members of which, by 
 their profound learning and their intimate acquaintance with 
 the disease, were as well qualified to decide this important 
 question as any other body of men in the world), the pro- 
 longed discussion "on the nature, character, and treatment 
 
38 HISTORY OF THE CHOLERA. 
 
 ot; Cholera Morbus" was concluded by the adoption of the 
 following resolution : 
 
 11 That the Westminster Medical Society, having devoted 
 the uninterrupted space of six months to the serious and dis- 
 passionate consideration of the malady which has been pre- 
 vailing in England -since the latter end of September last, and 
 especially in the Metropolis, and having heard the several 
 arguments, depositions, doctrines, and facts, of the many 
 members practically, as well as theoretically, engaged in that 
 important inquiry, declare that, in the opinion of the major- 
 ity of the Society, the evidence brought forward to prove the 
 said: malady to be a contagions disease /l"S complete!'; failed ; 
 and that ep&rg circumstance which has come to the knowl- 
 edge of the Society shows the disease in question to have 
 begun, progressed, and ended in the ordinary way of every 
 other epiuemic disorder:" — that is, a disorder which falls at 
 once upon great numbers of people. 
 
 It is impossible to realize how an intelligent being can 
 pass by the subject of cholera without a thorough investi- 
 gation ; GYory man ought to know all that Is known by 
 physicians of its origin, and how to prevent its attacking 
 him; to pass* it by as a matter which he cannot colnpre- 
 hend, is to acknowledge one's self a fool or a suicide. 
 
 When cholera first appeared, and typhus fever was only 
 an occasional visitant to some filthy district of the city, 
 there was some apology; but now, that 500.000 of our 
 population are, by their abodes and habits of living, offer- 
 ing as food for the pestilence, and are now awaiting the 
 warmth of another season, we hope most earnestly that onr 
 people will shake off their apathy, and try and realize their 
 ignorance and their danger. If God ever . designed that 
 selfishness , should bring its own punishment, surely there 
 is fear of a terrible reckoning for ISfew York. The owners 
 of tenant houses may secure twenty per cent, this season, 
 but the organic law is destined to prove a hard master ; 
 perhaps the landlord and the tenant will go the same way. 
 
 D seases are produced by laws unerring in their action 
 as ihose by which the body is formed or health restored. 
 Just as certainly as the merest mite that dances in the sun- 
 
HISTORY OF THE CHOLERA. 89 
 
 b?am,. the moss that covers the root or tree, the tiny hum- 
 ming-bird, lordly man, the ponderous elephant, the mighty 
 whale, and the infusoria of the ocean, all originate from 
 eggs and seeds, just as certainly are the infectious diseases 
 produced in the same way. • 
 
 Yellow fever is the product of closely confined warmth 
 and moisture ; it originates directly from these two condi- 
 tions! united, they produce a vegetable fungus, of micro- 
 scopic size, which is inhaled by human beings, and thus 
 produces the disease. ' It is always brought to this city 
 in the holds of vessels from warm climates only. It is never 
 propagated from a single person to another ; but it may 
 be brought to any place, where the necessary conditions of 
 atmosphere exist, by clothing or cargoes in bulk ; and 
 thus other centers of propagation for these Vegetable fungi 
 may be formed, precisely as we form mushroom-beds from 
 mushroom-spawn in a damp and dark cellar ; or toadstools 
 spring up in the same place, or at the root of a tree in the 
 forest. Frost at once destroys yellow fever, therefore it is 
 of vegetable origin. 
 
 Cholera is not produced by a vegetable fungus or moss ; 
 Lt originates in human filth. Wherever human beings con- 
 gregate in close quarters and in vast numbers, in a confined 
 atmosphere in this country, there either typhus fever, 
 malignant dysentery, or cholera infantum of our summers 
 are produced. * Asiatic cholera is produced by an animal 
 germ. It came first to this country in a ship, in June, 1832. 
 It first, appeared in Quebec, passed to Montreal by the 
 14th, and was in New York on the 25th. 
 
 Cholera is defective vitalization of the blood, or want of 
 pure air, producing defective nutrition. This causes relax- 
 ation of the contractile powers of the blood-vessels of the 
 body. The entire tract of intestines opens its myriad blood- 
 vessels, and all the albuminous or flesh-making*"material 
 passes off from the bowels. It is rapid cholera infantum, 
 only it preys upon the adults chiefly. Not a single case of 
 chol'-ra occurred on board the Atalanta in its spacious 
 cabins, during all tire terrible death-scourging among the 
 poor steerage passengers. What can be more convincing ? 
 
40 • HISTORY OF THE CHOLERA. 
 
 There was filth and confined air, animal poison in its high* 
 est degree, depressing the areation of life renevation of the 
 blood ; not producing typhus fever, but cholera. The 
 solids of the human body are relaxed, when the blood 
 loses its life-giving power, and animalcules can act readily, 
 perhaps enter the blood-vessels themselves. 
 
 HOW TO ALLAY FEAR. 
 
 Cholera is, to a great extent, a nervous disorder. Where 
 dread or panic prevail, there the pestilence will rage. Fear 
 will cause at once the premonitory symptoms. It will be- 
 come very important, then, to calm the nervous and unrea- 
 sonable alarm of the ignorant classes. They should be 
 shown that cholera is a disease, easily managed if it be met 
 early enough, and that there are simple and effective reme- 
 dies for the premonitory symptoms. For this purpose an 
 excellent plan which has been followed successfully in 
 Europe — that is, the employing a certain number of volunteer 
 visitors to go about from house to house in the poor wards 
 to inquire where these warning symptoms are prevailing, 
 (which are generally neglected or unnoticed by the poor,) 
 and to administer simple remedies ; or if that is not practi- 
 cable, to show the people where these can be obtained; to 
 give advice and instruction and encouragement, and perhaps 
 leave sanitary tracts bearing on this matter. Such persons 
 might do much to quiet apprehension and meet the cholera, 
 when almost alone it can be resisted, in the painless diarrhoea 
 which precedes it. 
 
 Along with these visitors should be established Cholera 
 Dispensaries, especially for cholera patients, where advice, 
 medicine and treatment could be given at all hours of the day 
 and night, gratuitously, to the poor. It must be remembered 
 that it is the ignorant and needy classes who will suffer most 
 from the pestilence. 
 
 TTTE INFLUENCE OF FEAR 
 
 If anything could render cholera contagious it would be 
 the enervating influence of panic — as when, wanting a con- 
 tagion of its own, it rides on the contagion of fear. For fear 
 
HISTORY OF TIIE CHOLERA. 41 
 
 diminishes the nervous power, depresses and enfeebles the 
 action of the heart, detracts the blood from the -extreme ves- 
 sels, and deranges the secretions: 
 
 "Fear," says Dr. Falconer " diminishes the power of the 
 heart, and enfeebles the pulse — sometimes to such a degree 
 that the blood does not flow on opening a blood-vessel. Fear 
 also arrests the natural secretions, and renders those who 
 are frightened more liable to be attacked by contagious dis- 
 eases." 
 
 " The tendency of fear," says Dr. Brigham, "is to pro- 
 duce and spread spasmodic complaints, and to become epi- 
 demic during great public calamities. It not only disposes 
 a person to be affected by a contagious disease,- 1 but actually 
 produces a disease, and symptoms similar to the premonitory 
 symptoms of cholera." He calls attention to the fact that a 
 person whose mind is constantly on the alert to detect some 
 symptoms of disease of the stomach or bowels, who anxiously 
 watches the effect of everything he eats or drinks upon the 
 organs of digestion, will be very certain to create in them a 
 morbid sensibility, which will be followed by indigestion, 
 diarrhoea, or other derangements ; and suggests that there is 
 great reason to apprehend that many, very many cases of 
 cholera, if not produced by fear alone, are aggravated by it 
 to a dangerous degree ; and cases of "common cholera" are 
 transformed through the influence of fear, into the malignant 
 and fatal. " At the present alarming time, no duty of medi- 
 cal men, and of all those who have influence over the faith of 
 others as regards the epidemic, seems more imperative than 
 that they should steadily endeavor to quiet public alarm, and 
 constantly abstain from creating any fear about the preva- 
 lence of the disease and its contagious nature. Hundreds 
 will die of common cholera, if they are not assured, and 
 made to believe, that the disease which affects them is not 
 the cholera wdiich their fears suggest. In such cases every 
 look, question and action of a physician is very important. 
 He has it in his power, not only to endanger the lives of the 
 sufferers, but to spread around a far more dangerous * conta- 
 gion than that of cholera — the contagion of fear ; to drive 
 froni the bed of sickness the anxious relatives and useful 
 
42 HISTORY OF THE CHOLEEA. 
 
 attendants, palsy the hand of chanty, and create in those 
 who are obliged to attend upon the sick a disposition to a 
 disease closely allied to, if not identical with, malignant chol- 
 era ; for the passion of fear falls in and unites with the dis- 
 ease, and attacks and paralyzes the same organs." 
 
 A man was once journeying in the interior of Turkey, 
 when he met the Pestilence. "Where are you from?" he 
 asked. " From killing 2,000 people in Smyrna," replied the 
 Pestilence. " That's a lie," said the man, " I know that you 
 have killed 6,000 there." "No," said the Pestilence, "I 
 killed 2,000, and Fear killed 4,000." ■ 
 
 Adults exhibit a much more lively susceptibility to cholera 
 than children,, the . apprehensions of the latter not being so 
 easily excited. It has been observed that the little ones 
 enjoy a remarkable exemption from the disease; and its 
 attacks are to be looked for, for the most part, among the 
 most intelligent children of five or six years and upward, 
 who have derived from what they have heard or read, a 
 depressing anxiety respecting it — as of some invisible, myste- 
 rious, and fearful calamity, which is stealing upon them and 
 those who are dear to them. In children, fear, like other pas- 
 sions, is soon effaced ; but it is also more sudden and. power- 
 ful 'in them, and far more likely to operate dangerously upon 
 their delicate and susceptible nervous organizations when, 
 by their intelligence and imagination, they are in a condition 
 to entertain it. 
 
 EFFECT OF THE WAE. 
 
 The terrible ordeal through which this country has re- , 
 cently passed, has produced a harvest of weakened constitu- 
 tions, through physical and mental suffering, that invites an 
 epidemic to gather them to an eternal rest ; and possibly 
 never in our country's history were we in a condition or po- 
 sition less prepared to meet a scourge, If the missiles of de- 
 struction have not battered down our houses, nor applied the 
 torch to them, nor encircled us season after season, with 
 fortifications, the war has wrought effects far more terrible 
 than these, and can be found in every house and family— 
 pale, cadaveric faces, shrouded in mourning, meet us every- 
 
HTSTOEY OF TTIE CHOLEPwA. 4-3 
 
 where ; thousands of sickly, insufficiently nourished women' 
 and children, formerly strangers to want, are at this time 
 crowding our dispensaries and other associations for relief. 
 Owing to the exorbitant high price of. almost all the neces- 
 saries of life, it is next to imposssible for the masses to ob- 
 tain sufficient nourishment, or to be comfortably clothed or 
 sheltered ; high rents result in crowding to a still greater ex- 
 tent the already overcrowded tenement houses; these influ- 
 ences, above all others, are calculated to render citizens less 
 capable of resisting the cholera or any other epidemic. 
 
 IX THE HOUSES OF THE EICH. 
 
 From a study of the history and the predisposing causes 
 of cholera, we turn to the practical questions: How may 
 we ward off the disease ; or how, if it come among us, may 
 we circumscribe its extent, and moderate its malignity? 
 
 Preventive measures may be collective, undertaken by the 
 State, for the common good ; or individuals, set on foot by 
 individuals or single families, for their own benefit. 
 
 In cities the sewers receive the refuse from houses. If the 
 sewers were properly constructed, this refuse would never 
 stagnate in them. . But even so, decomposition of organic 
 matter must continually go on in them, evolving noxious 
 gases. To prevent these gases from flowing back into the 
 house through the waste and soil-pipes, stench-traps should 
 be placed in these pipes. They consist of an elbow formed 
 in the pipe, and in which water remains, constituting a bar- 
 rier to the backward flow of the gases. p But this is an effec- 
 tive barrier only so long as the gases are subjected to no up- 
 ward pressure. If the gases be subjected to such "pressure, 
 they Rubble up through the water in the trap, and pass into 
 the house through the outlets of bath-tubs, wash-basins and 
 closets. Now, it is notorious that in but few sewers is the 
 flow of matter unimpeded. Kb provision is made for the 
 outlet of gases from the sewers. The gases accumulate, and, 
 by this accumulation, and by the heat evolved in their gehe^ 
 ration they become subjected to pressure. They bubble up 
 through the stench-trap, and pervade the house. Thus the 
 city houses of the rich ventilate the sewers ! The refuse is 
 
44 IIISTORY OF TTTE CHOLERA.. 
 
 discharged into the sewers, only that it may there he eon- 
 verted into poisonous gases, and be received again, in that 
 form, into houses. The more completely, under these cir- 
 cumstances, a house is provided with the "modern conve- 
 niences," the more deadly a habitation is! In many houses 
 there are, besides the main stench-trap already described, 
 secondary traps under each basin, closet, or sink. In these 
 cases, the portion of pipe intervening between the main-trap 
 and the secondary traps becomes a " closed chamber," in 
 which the poisonous gases forced up from the sewer are con- 
 fined. Any increase of temperature, or from the heat of the 
 house, will expand these gases, and cause them to bubble up 
 through the secondary traps, and into the house, as before. 
 These '.most serious clangers may all be obviated by ventil- 
 ating the sewers or the waste-pipes. The latter can be done 
 for himself by every householder. It is only necessary to 
 connect with his waste or soil-pipe, just below the upper- 
 most trap, a small pipe, which shall be led up through the 
 roof, and shall open into the atmosphere, allowing the gases 
 to escape. This will prevent any pressure of gases below 
 the traps. Personal observation and experience have con- 
 vinced us of the great value of this ventilation of waste- 
 pipes. On a large scale, ventilation of sewers in English 
 towns has reduced the mortality from typhus to one-half its 
 former amounts. It should be noted that, as many of the 
 predisposing causes of cholera are the same as those of 
 typhus and of diphtheria, so preventives of the former are 
 also preventives of the latter hardly less deadly maladies. 
 
 FIRES AS A PREVENTIVE. 
 
 Liglit fires as a preventive -of the dreaded Asiatic cholera. 
 The apparent recent tendency of fevers, whether epidemic 
 or contagious, prevailing among the inhabitants of large 
 cities, and in some localities in the country, is now sought 
 in the habits of social life. Thus: 
 
 Dr. Parkin, late Medical Inspector of the cholera in the 
 West Indies, believes that he has discovered a cause for 
 the greater prevalence of certain diseases now than for- 
 merly, in the fact of the general substitution in dwellings 
 
HISTOEY OF THE CIIOLERA. 45 
 
 of furnaces for the more genial and healthful old-fashioned 
 prates aud fire-places. Many of the facts mentioned by 
 Dr. Parkin, in Irs work on " The Causation and Preven- 
 tion of Disease, London, 1859," seem to corroborate this 
 theory. Birmingham and other large manufacturing cities, 
 it seems, enjoy an almost complete exemption .from fevers 
 and other diseases produced by bad air. The reason 
 assigned is the number of factory fires. 
 
 Dr. Parkin further states that the postmaster of Torre de 
 tre Ponti (a town in Italy situated on the margin 
 of the Pontine Marshes,) and who appeared to enjoy perfect 
 health, thus accounts for the circumstance : "t have re- 
 sided," said he, " more than forty years in this place, and 
 I have never had the fever. The only precaution I take 
 is, not to leave the house until the sun is somewhat above 
 the horizon; to return home before nightfall, and then to 
 lr/ht a fire. I live well, and take wine — that is all my 
 secret." The natives of some parts of Africa, also, says 
 Dr. Parkin, speaking from personal observation, adopt the 
 same practice, "as I had an opportunity of observing, with 
 a party of untutored Africans, captured in a slave ship and 
 located on one of the estates in Jamaica." 
 
 Another example given as haviug been observed by Dr. 
 Macculloch, says that a superintendent engaged in direct- 
 ing the cutting of wood in Africa, erected, twenty earthen 
 furnaces on the spot where his men were employed, light- 
 ing them every day. Before this he had always from forty 
 to forty-eight of his workmen sick, but in a very short time 
 the invalids were reduced to twelve, then to four, and 
 finally to one. Dr. Acton, also, relates another similar in- 
 stance of a man, whom he found in one of the most un- 
 healthy corners of the Pontine Marshes, where he had been 
 employed for several years in making charcoal from turf. 
 During this period he had never been afflicted with any 
 disease — though surrounded by victims of the pestilential 
 fever of the Pontine Marshes — and, when questioned re- 
 specting a circumstance so extraordinary, ascribed it to the 
 fact of his making it a particular point to return home 
 
46 HISTORY OF THE CHOLERA. 
 
 before sunset, and to keep up a continual fire until morn- 
 ing. 
 
 Xapoleon had fires lighted for sanitary reasons, the mo- 
 ment his troops encamped. Unquestionably the modern prac- 
 tice of heating dwellings by furnaces tends to vitiate the ail 
 sooner than the use of the open fires and grates. In fevei 
 and ague districts of this country, old inhabitants learn the 
 
 EFFECT OF WATER. , 
 
 TTe have heretofore referred to the importance of pure watei 
 in the treatment of cholera. The matter has attracted 
 attention, and we particularly notice an able article by Dr. 
 Louis T. Pirn, in the St. Louis Republican. The basis of the 
 article in question was an experiment ina'e during the prev- 
 alence of cholera at St. Louis, in 1849, with a view of ascer- 
 taining what kind of insect life water, under different cir- 
 cumstances., was likely to produce. Six bottle being thor- 
 oughly cleansed, were filled as follows : 
 No. 1. With hydrant water only. 
 
 " 2. Hydrant water, admixed with charcoal. 
 
 " 3. Hydrant water, admixed with lime. 
 
 " 4. Hydrant water, admixed with wood ashes. 
 
 " 5. Rainwater, as taken from the cistern. 
 
 " 6. Hydrant water, thorougly filtered through sand 
 and gravel. 
 
 All the bottles were uncorked, with a gauze covering to 
 protect the necks from the admission of insects. 
 
 No. 1. Became thick and of a dark green hue in 24 hours. 
 
 " 2. The same. 
 
 " 3. Not so much deteriorated, lasting 36 hours before 
 becoming offensive. 
 
 u 4. About the same as No. 3. 
 
 " 5. Became black and putrid in 40 hours. 
 
 " 6. The hydrant water filtered through sand and gravel 
 was as sweet at the expiration of 17 days as when first 
 exposed. 
 
 This experiment simply proved that rain water did not 
 become outrid so soon as hydrant water from the Mississippi, 
 
HISTORY OF THE CTTOLTmA. 47 
 
 and that hydrant water, filtered through sand and gravel, 
 remained sweet and good about ten times as long as unfil- 
 tered rain water, placed under similar circumstances. 
 
 The theory adopted by Dr. Prim is that the changes in the 
 color, consistence and odor of the water tested, arose from 
 the decomposition of animal or vegetable matter, or both, 
 and that this foreign matter was one of the causes of cholera. 
 In the case of the filtered water these substances were 
 removed, and the gentleman who made the experiments 
 declared that the filtered hydrant water was used exclusively 
 in his family during the cholera seasons of 1849 and 1851, 
 and although he lived in a neighborhood where the scourge 
 raged with great virulence, there was not a case or symptom 
 of cholera in his family during that time. It is admitted by 
 the writer that infusoria as well as vegetable matter may be 
 seen in water after it has been kept at rest in the sun's rays 
 . for a period of twenty-four hours and exposed to the atmos- 
 phere, but the quantity of decomposable matter found under 
 ordinary circumstances is regarded as wholly insufficient to 
 account for the sudden, changes noted in the above table. 
 
 Glancing at the recorded history of cholera since it first 
 made its appearance in an epidemic form, and following its 
 course around the globe, the fact is deduced that water is . 
 the medium by which it is transported from place to place. 
 Its line of march is chiefly confined to large bodies of water, 
 and its movements are ''explained by the myriads of ova or 
 eggs that are borne by currents of air, which, falling into 
 water, the proper matrix for their development into animal- 
 cular life, become the poison to that element, and cholera is 
 the result of its use. In the vast serial ocean that surrounds 
 the globe there are counter-currents of air which carry the 
 eggs to different parts of the globe simultaneously ; and 
 while the substratum deposits its contents in a continuous 
 line along the earth's surface, the superimposed currents bear 
 them to remoter regions, and in opposite directions. Water 
 is essential to the existence of animal life, and whether used 
 in the desert or on the mountain-top, on ship-board or on the 
 banks of the Mississippi,- when filled with these dead and 
 putrid animalcules, cholera will surely be the result." 
 
48 niBTOTlT OF TIIE CTTOLERA. 
 
 Our conclusion in the premises are, that cistern water of 
 ordinary purity is an almost certain safeguard against chol- 
 era, and if that cannot be had, it is proper to boil filter, or 
 otherwise purify water before drinking it, especially when 
 cholera is about. All sanitary measures are proper, in view 
 of the approach of the dread Asiatic Scourge, but we must 
 be particularly cautious as to what we drink. 
 
 PRECAUTIONARY RULES AND DUTIES 
 
 1. Avoid all causes of excessive nervous exhaustion ; 
 avoid intemperance in eating and drinking;, live upon a 
 nourishing diet, and keep the digestive functions in a health- 
 ful condition. 
 
 2. Avoid and discourage panic and needless anxiety when 
 the epidemic is announced, remembering that in its premon- 
 itory stage, cholera is generally curable, and that all the ex- 
 citing causes of the malady can be avoided. 
 
 3. Promptly second the efforts of the public authorities in 
 all enlightened plans for protecting the public health, espe- 
 cially in all that relates to civic cleanliness, the abatement of 
 nuisances, and the proper care and feeding the poor. 
 
 4. If in business, or charged with any public or philan- 
 thropic duty, do not forsake your post of personal or official 
 labor, except when suffering from premonitary symptoms of 
 cholera or other sickness. 
 
 5. Aid and encourage the removal and prevention of the 
 localizing and exciting causes of cholera throughout the dis- 
 trict in wdiich you reside. 
 
 6. Give particular attention to the drainage, dryness, and 
 cleanliness of your premises and the neighborhood, and see 
 to it that, the water supply is both pure and sufficient. 
 
 > 7. Inculcate habits of personal neatness. 
 
 8. Avoid the employment of purgative drugs, except when 
 prescribed by your physician. 
 
 9. Avoid and prevent effluvia from excrementitious mat- 
 ters, sewers, privies, or chamber vessels. Frequently and 
 thoroughly disinfect these sources of fever poison. 
 
 10. Insist upon the utmost cleanliness and purity of every 
 portion of your apartments, furniture and domicile. 
 
HISTORY OF TIIE CTTOLERA. 49 
 
 11. Thoroughly and frequently ventilate every apartment 
 in the dwelling, even to the cellars, closets and vaults, 
 This should be aided by fires in open fire-places, wherever 
 available. 
 
 12. Carefully protect the body against sudden alternations 
 of temperature. ATear flannel, and when exposed to change- 
 able temperatures, or suffering any disorder of the bowels, 
 wear a broad flannel band extending from the top of the hips 
 to the middle of the body. - 
 
 13. Be prudent in the use of food and beverages, being 
 particularly attentive to quality and digestibility. 
 
 14. Bear in mind the fact that a painless diarrhoea is the 
 most invariable precursor of cholera, and that if not imme- 
 diately and properly treated, it will more probably termi- 
 nate fatally than favorable. \ * 
 
 RULES TO BE OBSERVED IN CASE OF ATTACK. 
 
 1. Soon as attacked by the premonitary diarrhoea or any 
 symptoms of cholera, seek immediate repose in a recumbent 
 position, where warmth and a pure atmosphere will be en- 
 joyed. Immediately procure competent medical attendance. 
 
 2. Let the excrementitious matters from the sick be disin- 
 fected in the vessel soon as voided, by means of carbolate of 
 lime, sulphate or proto -chloride of iron, coal-tar, carbolic 
 acid, or permanganate of potash ; and let no person directly 
 use the privy into which such materials are emptied while 
 cholera is prevailing. "Wherever practicable let the evacu- 
 ated matter be deeply buried in the earth, and immediately 
 covered with quicklime, or coal-tar and gravel. 
 
 2. Let all the vessels and clothing that are used by the pa- 
 tients, be immediately cleansed with boiling water and soap 
 or alkaline chlorides, or permanganates. 
 
 4. Preserve the utmost degree of personal cleanliness of 
 the sick, and of their attendants. 
 
 ON CLEANSING AND DISINFECTIONG. 
 
 Putrefaction and the effluvia from effete organic matter, 
 are among the most active and preventable of the localizing 
 causes of cholera and fevers. To prevent such evils, and 
 
50 HTSTOKY OF TIIE CHOLERA.. 
 
 destroy noxious exhalations, is the chief object of all the 
 processes of cleansing- and disinfecting. Water is the uni- 
 versal agent of cleansing. The I rife value of baths, clothes- 
 washing, scrubbing, and flushing, will never be properly 
 appreciated until the relation of these homely duties to the 
 prevention of infection and disease is more generally under- 
 stood. Sewers, house-drains, water-pipes, arid water- 
 closets, should be frequently flushed with water — let on in 
 the largest practicable volume — for thorough cleansing ; 
 water-closets, privies, and waste-pipes in houses should be 
 flushed in this manner every day. 
 
 Infected clothing and the utensils used in the sick room 
 should be washed or scalded in hot water the moment they 
 are removed from use. It is recommended that the cloth- 
 ing of the sick with fefcat disease should be immediately 
 plunged into boiling water,, or soaked in a w.eak solution of 
 chloride of lime, or permanganate of potassa. Of the for- 
 mer, 1 oz. to the gallon of water is sufficient ; or of the 
 latter, a few grains, or just sufficient to give the water a 
 slightly reddish tint ; this is a powerful disinfectant, and if 
 boiling heat cannot at once be applied to the contaminated 
 garments, the permanganate fluid should ^be employed. 
 Soap and other alkalies are valuable aids to water-cleans- 
 ing. 
 
 Currents of fresh air, and all methods of ventilation, 
 cleanse'by oxidizing and drying. Ventilation, therefore, is 
 no less a purifyer than water. Drying tends to arrest 
 putrefaction, therefore it purifies, and should be effectively 
 applied wherever practicable, particularly upon the walls 
 and floors of domestic apartments, in closets, cellars, court- 
 yards, and stables. The application of quicklime , rapidly 
 promotes the drying of places upon and near which it is 
 spread. It also arrests putrefaction. 
 
 HOW TO USE DISINFECTANTS. 
 
 1. Quicklime. — to arrest putrefaction, to act as a rapid 
 dryer, and to decompose certain moist and hurtful affluvia, 
 sire w the dry lime upon the earth ; or, distribute upon 
 plates, etc. 
 
HISTORY OF THE CHOLERA. 51 
 
 2. Chloride of Lime. — Employ this for same purpose as 
 quicklime, also as one of the cheapest sources of chlorine. 
 One pound of this substance will usually disinfect about 
 1.000 gallons of fluid sewerage. To mix immediately with 
 offeusive materials, it may, for convenience, be combined 
 with water in proportion of 1 lb. to the gallon. 
 
 3. Chloride of Zinc. Pr do- Chloride of Iron, Sulphate 
 of Iron, or Nitrate of lead.— Make a saturated solution of 
 the salt, and use such solutions diluted in eight or ten 
 times the quantity af water. 
 
 4. Chlorine Gas. — When required more copiously than 
 it would ordinarily be given off by the Chloride of lime or 
 Labarraque's solution, the following ready methods maybe 
 resorted to for generating it : 
 
 Quick Method.— Pom diluted hydrochloric, sulphuric, 
 nitric, or acetic acid upon cholride of lime, zinc, or soda. 
 This may be done gradually by means of a glass or lead 
 syphon, or by the capillary syphon of lanip-wiek, dropping 
 the acid upon the chloride, if desirable to evolve the chlorine 
 steadily for many hours. 
 
 C lorine water may be readily prepared by mixing two 
 tablespoonsiul of common salt in two teaspoonsful of red 
 lead in a quart of w 7 ater, and add half a wine-glassful of sul- 
 phuric acid. It will give off gas as needed. It must bo 
 borne in mind that chlorine is irritating to the lungs. It is 
 believed not to disinfect and destroy the cholera poison 
 itself, but it arrests putrefaction and destroys man} 7- noxious 
 gases. 
 
 5. Nitrous Acid G is. — This is prepared by putting a 
 mixture of nitrate of potassa, (saltpetre,) and sulphuric acid 
 in an iron or porcelain dish. It must not be breathed. 
 
 6. Coal Tar.— To be used in sinks, sewers, privies, and 
 bed-pans, by directly applying it, and allowing it to be 
 washed away. It serves an excellent purpose when painted 
 frequently upon the interior walls or sides of stables, prison 
 cells, privy vaults, etc. Carbolic acid is derived from coal- 
 tar, and is more convenient for use in the sick room. Dilute 
 it. 
 
52 IIISTOTCY OF TTTE CHOLERA. 
 
 7. Bromine. — Is a powerful disinfectant ; to be employed 
 by physicians. 
 
 8. PrrmangnnaU of Potassa.— -To be used as an imme- 
 diate and most effective disinfectant. Dilute the saturated 
 solution of this salt in from 10 to 500 parts of water, accord- 
 ing to the requirements for the occasion. It is the neatest 
 and most effectual of all the disinfecting fluids, and can be 
 used in less quantities than most others. A few drops of the 
 solution will instantly disinfect a quart of drinking water. 
 
 9. HeaL — Boiling water or steam to be employed in cleans- 
 ing as the most certain means of disinfecting contaminated 
 clothing, etc. 
 
 10. Charcoal. — As a disinfectant or deodorant for exten- 
 sive use in masses of putrescent material, and for local puri- 
 fication, fresh charcoal is of acknowledged value. The Brit- 
 ish Sanitary Commission in the Crimea, ordered whole ship- 
 loads of peat charcoal, which they used in the progress of 
 their work of purification in the hospitals, barracks and 
 camps in the East. A Report of that Commission states that 
 " perhaps the best deodorizing compound was one used by 
 the inspectors in all their works. It consisted of one part of 
 peat charcoal, one part of quicklime, and four parts of 
 sand or gravel " But it may properly be stated in this 
 Report that charcoal does not seem to disinfect or destroy 
 the cholera poison. The ships w r hich were employed in 
 transporting charcoal from Constantinople to the Crimea 
 were ravaged by cholera. 
 
 The following advice concerning disinfection has recently 
 been promulgated by order of the Privy Council of the Brit- 
 ish Goverment : — 
 
 u In the ordinary emptying of privies or cesspools, use 
 may be made of perchloride of iron, or chloride of zinc, or of 
 sulphate of iron. But where disease is present, it is best to 
 use chloride of lime or Condy's fluid. Where it is desirable 
 . to disinfect, before throwing away the evacuations from the 
 bowels of persons suffering from certain diseases, the disin- 
 fectant should be put into the night-stool or bed-pan when 
 about to be used by the patient. 
 
 " Heaps of manure or other filth, if it be impossible or 
 
HISTORY OF TIIE CHOLERA. 53 
 
 inexpedient to remove them, should be covered to the depths 
 of two or three inches with a layer of freshly burnt vegeta- 
 ble charcoal in powder. Freshly burnt lime may be used in 
 the same way, but islesa effectual than charcoal. If neither 
 .charcoal nor lime be at hand, the tilth should be covered 
 with a layer some inches thick of clean dry earth. 
 
 " Earth, near dwellings, if it has become offensive or foul 
 by the soakage of decaying animal or vegetable matter, 
 should be treated on the same plan. 
 
 " Drains and ditches are bear treated with chloride of lime, 
 or with. Condy's fluid," (permanganates,) "or with chloride 
 of iron." 
 
 " Linen and wearing apparel, requiring to be disinfected, 
 should without delay be set to soak in water, containing 
 per gallon, about an ounce either of chloride of lime or of 
 Condy's red fluid. The latter, as not being corrosive, is 
 preferable. Or the articles in question may be plunged at 
 once into boiling water, and afterwards when at wash be 
 actually boiled in the washing water. 
 
 '• Woolens, bedding, or clothing which cannot be washed, 
 may be disinfected by exposure for two or more hours in 
 chambers constructed for the purpose to -a temperature of 
 git) to 250. degrees Fahrenheit. 
 
 '■For the disinfection of interiors of houses, the ceilings 
 and walls should be washed with quicklime water. The 
 wood-work should be well cleansed with soap and water, 
 and subsequently washed with a solution of chloride" (per- 
 manganates) "of lime, about two ounces to the gallon." 
 
 In presenting these practical suggestions, it is not intended 
 to unwarrantably exalt the value of disinfecting agents. With 
 reference to the whole subject the remark adopted in a man- 
 ual published by the U. S. Sanitary Commission: "That 
 there is no substitute for fresh air to meet the physiological 
 requirements of respiration and health, should be indelibly 
 impressed upon every mind. Better that all substances at 
 present employed as disinfectants and deodorants were at 
 once prohibited, than that such agents should practically tend 
 to be regarded as substitutes for a pure atmosphere. 
 
54 HISTORY OF THE OHOLERA. 
 
 PEEYENTIYE AGAINST CHOLERA. 
 
 Much depends on each individual as lo the mole of life 
 .adopted, during the Winter, as a preventive to cholera. 
 In the first place, eat nothing but the most wholesome, 
 digestible and nutritious food, avoiding everything liUely ^ 
 to derange the bowels. Abstain from an excess of alcoholic 
 drinks. It is a great popular error to suppose that drink- 
 ing plenty of whisky or brandy is in auy way a preventive 
 against epidemics, but more particularly cholera. Avoid 
 excessive study or labor ; sleep in well-ventilated rooms 
 and keep the house well ventilated and dry, and at a mod- 
 erate temperature. Dress warmly, particularly about the 
 abdomen. A very good plan is to wear flannel over the 
 bowels. Abstain from excessive pleasure ; keep regular 
 hours, retiring at a seasonable time. Take moderate out- 
 door exercise, but regularly every day. Pay particular 
 attention to water- close! s, and see that they are kept clean. 
 
 Chloride of lime should be thrown into them once a 
 week, and if in a boarding-house or very large family, 
 where there are many using them, it should be used twice 
 a week. Cathartics should be avoided as much as possible, 
 as when the bowels are once deranged it is difficult to get 
 them right again, more particulary when there is any epi- 
 demic in the atmosphere. Water should be boiled and 
 filtered, not through charcoal but through regular filtering- 
 paper, which can be obtained from any druggist. By all 
 means don't be induced to take the various patent medi- 
 cines advertised as preventives and cures for cholera. 
 
 Such is the well-founded assurance of personal security 
 from cholera, when the principles of hygiene and the means 
 of proper care are practically understood, that no physic 'ma 
 of good judgment and intelligence fears to visit any city 
 or place where cholera prevails, or to remain at his post of 
 professional duly iu the midst of an epidemic of the disease, 
 for he knows that the exciting causes of cholera are avoid- 
 able, and that its premonitory stages can be very certainly 
 arrested if the general health and personal habits are good. 
 Nothing could better illustrate the value of proper atten- 
 
HISTORY OF THE CHOLERA.. 55 
 
 lion to personal health and daily habit-. In short, C oleva 
 os a pestilence must be regarded as a preventable dise /se. 
 
 THE CHOLERA CONFERENCE 
 
 At Constantinople, Turkey, received recently from the 
 French representatives the following proposals in regard to 
 the stoppage of all sea communication between Arabia and 
 Egypt in the event of another epidemic. 
 
 1. That the Ottoman Sanitary Commission, now in the 
 H jaz, should report on the health of the pilgrims. 
 
 2. The presence of several vessels of war to interrupt mar- 
 itime communication. > 
 
 3. An organized surveillance over the Egvptian coast 
 to prevent any disembarkation in infringement of the pro- 
 hibition. 
 
 •The manner of carrying this plan into execution was set 
 forth as follows : 
 
 1. In the event of cholera breaking out among the pil- 
 grims, the members of the Ottoman Commission, assisted, if 
 need be, by other medical men appointed ad Loc, shall re-' 
 port the fact to the local authorities, and to the vessels of 
 war stationed at Jiddah and Yembo, and shall also transmit 
 the intelligence to Europe. 
 
 2. On the declaration of the said medical men, .the local 
 authorities shall interdict, until further orders, all embark- 
 ation, and shall mvite all pilgrims destined for Egypt to pro- 
 ceed thither by land. 
 
 8. At the same time the vessel of war shall send away 
 from the ports of embarkation all steamers and sailing ves- 
 sels which may be found there, and shall exercise a strict 
 surveillance in order to prevent any clandestine departure. 
 
 4. On advice being received of the presence of cholera* 
 among the pilgrims, the Egyptian authorities shall forbid the 
 entry of all arrivals from the Arabian xoast, commencing 
 from a point to the south of Jiddah to be determined. Fur- 
 ther, they shall assign to the suspected vessel, after re-vic- 
 tualling them, in case of necessity, a locality on the coast of 
 Arabia — Tor, for instance— where they shall perform quar- 
 antine. 
 
50 IIISTOTCY OF TITE CTTOLEEA. 
 
 5. With regard to the caravan, it must be stopped, as is 
 usual, several days'- march from Suez, where it shall be vis- 
 ited by a medical commission, and shall not be allowed to 
 
 enter Egypt until its sanitary state is declared free from 
 danger. 
 
 6. As respects the pilgrims destined for India or other 
 countries beyond the Red Sea, it will be best, in' order to 
 avoid the risk of a partial embarkation, to subject them to 
 the same general rale, namely, to make them wait till tlie 
 end of the interdiction. However, it may be possible to as- 
 sign them a particular spot some day's journey to the south 
 of Jiddah, where they may embark. 
 
 7. The prohibition to embark shall cease fifteen days after 
 the last case of cholera declared in Hijaz. 
 
 Objection was made to these requirements by the English, 
 Russian, Turkish and Persian delegates, but there was a 
 majority in favor of them, in spite of a declaration on the 
 part of the Turkish government that it could not engage to 
 carry out the scheme. At the last meeting, however, on the 
 3d instant, several modifications were made in the French 
 proposals, owing to the strong objections urged by the En- 
 glish delegates on behalf of the Indian pilgrims. By para- 
 graph three, as it now stands, the t ships of war are to send 
 away all steamers and sailing vessels from the ports of em- 
 barkation only ; and paragraph six has been altered as fol- 
 lows : 
 
 " With regard to the pilgrims destined for India, or other 
 countries beyond the Red Sea. it would be best to assign 
 them a special point for embarkation several days' jnarch to 
 the south of Jiddah. unless the authorities judge that they 
 may be embarked without risk at Jiddah." 
 
 DISINFECTANTS ON SHIPBOARD. 
 
 The following is a new and improved method of fumisra- 
 ting. and disinfecting vessels, which is thorough and reliable. 
 The old plan of burning tar is not sufficient to destroy the 
 infection of cholera: Large shallow pans are made of sheet- 
 lead, by bending the edges upward, and numbers of them 
 are placed on the floor and elsewhere in the hold, and state- 
 
HISTORY OF TTTE CHOLERA. 57 
 
 rooms, (if there be any,) and cabin. A layer of manganese 
 is then spread in each, some two hundred or three hundred 
 pounds being used for a single vessel.. The hatches, and 
 all other openings to the outer air, are fixed ready to be 
 closely battened down in a moment's- time. Then hydro- 
 chloric acid is poured on the manganese, twenty or thirty 
 carboys being necessary. This is done as rapidly as possi- 
 ble, as the deadly gas begins to generate immediately, and 
 • the operator hurries to the deck, the hatches are battened 
 down, and he leaves the ship. All trunks, boxes, and chests 
 are previously opened of course, so -that the gas can have 
 free access. Chlorine forms in immense quantities and per- 
 meates everything, perfectly neutralizing all infection, killing 
 all insects and animal life, 'and deodorizing everything im- 
 pure or diseased. If by any accident a fire should be burn- 
 ing, the gas extinguishes it at once. The man who puts the 
 acid on the manganese must not tarry, of course, or he 
 would be killed by the gas m less than ten minutes. The 
 vessel is thus left alone for some hours, after which the 
 hatches are opened, ventilators put up, the gas blown out, 
 and the ship is as pure as when first built. Of course, it is 
 necessary, to transfer the passengers to some other vessel, or 
 to land them while the process is going on. Moreover, 
 before the whole vessel is fumigated, each passenger selects 
 a suit of clothes from his wardrobe, tickets it, and these suits 
 are hung up in a special room, which is closed and fumigated 
 by the same process. Then the passengers bathe, and those 
 with beards shave their faces, if they shave at all, and evacu- 
 ate the bowels, dress rapidly in their purified clothes, and are 
 immediately transferred to another ship. 
 
 QUARANTINE. 
 
 This word originates from the custom of keeping a vessel 
 "with a contagious disease on board, at anchor for forty days 
 off French ports, from the numeral quarante, signifying forty. 
 
 EARLY TREATMENT. 
 
 In 1854 certain towns in England were almost shielded 
 from this dreaded enemy by preparing their sanitary de- 
 
58 HTSTORY OF THE CHOLERA.. 
 
 fences in lime. \Voreester, on the Severn, entirely escaped 
 it. In this country it is recorded that in Philadelphia the 
 most active measures were taken to guard the public health 
 in the epidemic of IS ±9 ; 2,970 privies were cleaned ; 340 
 houses were cleaned by the authorities; 188 ponds drained , 
 66 rag and bone-shops closed, and in all, over 6. 000 'tis inc$ 
 sources of disease removed. The consequence was that 
 'the number of deaths in that city was only 747, while in 
 New York they amounted to 5,071! In Boston, good 
 health arrangements kept the pestilence in the lowest and 
 dirtiest streets, and reduced the deaths to some 633. In 
 Baltimore very few deaths occurred. 
 
 The great desideratum for the treatment of the disease is 
 to meet it early. The danger with the premonitory symp- 
 toms — the painless diarrhoea — is that nobody thinks any- 
 thing of it. The poor are especially negligent of this warn- 
 ing. One symptom of the disease is the indifference it in- 
 spires. It is related that in the medical house-to-house 
 visitations in Glasgow, before the cholera of 1854, out of 
 45,000 cases visited and treated, only fifty-two died ; so 
 important is the. early treatment. The ratio of deaths'to 
 cases increases almost geometrically, as time is suffered to 
 elapse between the first symptom and medical treatment. 
 And from repons of the General Board of Health of Lon- 
 don, it appears that out of 30,000 cases treated early, of 
 which 6,000 were developed cholera, only 280 went to the 
 stale of collapse. This is the fact which justifies the ex- 
 cellent plan already suggested — the house visitation and 
 treatment. The great matter with the poor is to provide 
 remedies quickly, and to lead them to guard immediately 
 against the diarrhoea. For other persons, the medical act- 
 vice is, as soon as \his forewarning symptom is perceived, 
 that they should go directly home, with as little effort as 
 may be, and at once place themselves in a reclining posture, 
 and check the diarrhoea with any ordinary opiate or other 
 medicine, till their medical adviser can be summoned. At 
 this stage of the disease there is but little danger. The 
 number of deaths to cases treated at this period are won- 
 der fulLy small. 
 
HISTORY OF TIIE CHOLERA. 59 
 
 PERSONAL AVOIDANCE OF THE CHOLERA^ 
 
 Dr. Stayers holds that if the people understood the single 
 faet that cholera always is preceded by certain premonitory 
 symptoms, such as lassitude, languor, debility, and a 
 diarrhoea, and that in this stage of the disease it is nearly 
 always curable, if the proper precautionary measures are 
 taken, it would tend to allay the popular terror. At this 
 stage of the disease, it is of the first importance to pay at- 
 tention to the first symptom, which is diarrhoea. At the 
 very first approach, the patient should assume a horizontal 
 posture and retain it, with the hips higher than the shoul- 
 ders, and under no circumstance assume the perpendicular, 
 even for a moment. Absolute, positive rest is needed, the 
 body being kept in a warm condition. Any artificial means 
 can be used for that which may be necessary. The main 
 thing is the horizontal position, and perfect rest at the very 
 commencement of the disease. If the patient, is down 
 stairs when taken, let him stay there or be carried up. If 
 lie is out visiting, let him stay at his friend's house. Keep- 
 ing this position for forty-eight hours, in the majority of 
 instances, the disease wil! pass over, and the patient, on 
 recovery, need make no very great changes in his mode of 
 life. Of course, if he his bad habits, he should reform 
 -them ; eat and drink rationally, and attend to business as 
 usual, but not. overdo it. In the present state of the atmos- 
 phere, when pestilence is abroad, the system is rendered 
 morn liable to exhaustion, and he should husband his 
 strength by avoiding violent exercise. 
 
 VARIATIONS IN THE SYMPTOMS. 
 
 The general features — what one may term the contour— 
 of Cholera Asphyxia, that compendium of the prominent 
 phenomena from which, in all latitudes, seasons, localities 
 and classes, the disease may be easily and certainly made 
 out, being sharply defined and uniform, the same symptoms, 
 nevertheless, vary infinitely on the degree of their intensity, 
 "according to circumstances" internal or external to the in- 
 dividual — froin the simplest diarrhoea with little pain and no 
 
60 HISTORY OF TITE CTIOLEIIA.. 
 
 cramps, and no graver derangement of the circulation and 
 temperature of the surface than occurs from the operation of 
 an ordinary purgative, up to the overwhelming attack of a 
 prostration so paralyzing that the person stricken has 
 scarcely become sensible of pain when the secretions are 
 suppressed and the heart's action sinks suddenly. Some- 
 times the premonitory symptoms are protracted,' and the pa- 
 tient has a week or more of warning, in the form of diarhoea, 
 uneasiness, and a sense of heat and " thrill" in the stomach 
 and bowels; in some cases, not diarrhoea, but obstinate cos- 
 tireness, prevails. Sometimes he "falls dead in his tracks," 
 like the men in the army of the Marquis of Hastings. At 
 Bellamy, in India, a tailor was attacked while at work, and 
 died in his working attitude, cross-legged on his mat ; and a 
 merchant, concluding a bargain, vomited twice and instantly 
 expired. At Mecca, individuals in perfect health were sud- 
 denly stricken to the earth, vomited, . turned cold, and died. 
 Betw r een these two extremes the merciful admonitions are of 
 various duration, from. a few hours to a few days; in the 
 large majority of cases the disease takes from six to twenty- 
 four hours to fully develop itself, and terminates by death or 
 convalescence in from one to two days from the inception Of 
 collapse. 
 
 Sometimes the patient sinks at once, after discharging a 
 small quantity of colorless fluid by vomiting and stool; 
 sometimes the vomiting and purging are preceded by the 
 spasms. , Sometimes the matter vomited, instead of being 
 colorless or whey-like, or like seething of oatmeal, is green, 
 and the dejections instead of being thin, and whitish and 
 muddy, are red and bloody, or they may even consist of a 
 greenish pulp, like half-digested vegetables. 
 
 We have described the cramps as usually beginning in the 
 extremities, and thence creeping gradually to the trunk; but 
 in some cases they are simultaneous in all ; and sometimes 
 the order of succession is reversed, the abdomen being first 
 affected, and then the hands and feet. Generally, neither the 
 vomiting nor the purging are symptoms of long continuance ; 
 either they are checked by art, or the enfeebled body is no I 
 longer able to perform those violent motions — so that they, 
 
mSTORY OF ttik ottoleua. 61 
 
 together with the cramps, usually disappear some time be- 
 fore deatli. After the first emptyings of the bowels, the stools 
 have been observed to be yellowish, turbid, or frothy, like 
 yeast, and though generally inodorous, they sometimes emit 
 a rank, fleshy smell. The dejections are seldom attended 
 with much griping, and sometimes they are effected without 
 effort or uneasiness, though generally the calls are sudden 
 and irresistible, and the discharges expelled with alarming 
 force. Tenderness of the belly, on pressure, is not among 
 the most common symptoms, nor are the vomiting and purg- 
 ing by any means the most important or dangerous ; in a 
 great number of fatal cases, they have not been profuse, and 
 have ceased, even without remedies, early in the attack. The 
 cramps sometimes precede the vomiting and purging ; but in 
 the low and most dangerous form of cholera, spasm is often 
 absent, or is present in a very slight degree. Tetanic spasms 
 of the legs, thighs and loins, have been observed, but there is 
 no general tetanus (lock-jaw), or even trismus. Hiccough 
 in cholera is not indicative of danger ; on the contrary, when 
 it occurs in the interval of struggle between death and reac- 
 tion, it is a favorable sign, and generally announces the re-, 
 turn of circulation. The spasm at the pit of the stomach is 
 often very acute, and the belly is almost always drawn to- 
 ward the spine by a remarkable, permanent contraction of the 
 abdominal muscles. The pulse occasionally, though rarely, 
 keeps up tolerably. for several hours after the disease has 
 plainly declared itself. Generally, it becomes small and ac- 
 celerated at an earbf stage, and on the accession of spasm or 
 vomiting, suddenly disappears from the extremities. On the 
 cessation of the vomiting or spasm, and sometimes, appa- 
 rently, from the exhibition of remedies, the pulse will return 
 to the extremities- for a short time, and then again be lost. 
 In the less severe cases it is not wholly extinguished, though 
 much reduced In volume, and a thread of pulse, however 
 small, is almost always felt at the wrist, where recovery from 
 the blue or cold stage is to be expected. The sinking of the 
 pulse in cholera is a symptom not less characteristic than the 
 cadaverous countenanqe, or the hoarse, plaintive whisper 
 (vox choltrica), or the discolored skin, or the chilled faeath ; 
 
62 IIISTORY OF THE CnOLKP.A.. 
 
 when it can be felt, it is generally regular and extremely 
 feeble, " sometimes soft, not very quick, usually ranging from 
 80 to 100." 
 
 In the state of the skin, as in the other symptoms of chol- 
 era, striking variations are found. The surface is sometimes 
 observed to be dry, though cold ; and in a few rare cases, 
 natural — " nay, of preternatural warmth.' 1 A rise of temper- 
 ature has been repeatedly observed to take place just before 
 death ; but the development of heat under such circum- 
 stances appear to be confined to the trunk and head, and in 
 almost all cases may be regarded as a fatal symptom. It is • 
 not indicative of any restoration of the diffused energy of the 
 arterial system, or of any improvement in the function of 
 respiration. The heat, in such instances, has continued veil 
 marked for some hours after death. The . skin, in complete 
 collapse, is generally insensible even to the action of chemi- 
 cal agents, and hence the usual vesicatories fail to blister. 
 The application of mineral acids, or of boiling water, in this 
 condition *of the skin, produces little or no effect, and now 
 and then a patient is found who is insensible to the opera- 
 tion ; nor can leeches draw blood from an early peried of the 
 attack. The blueness, so characteristic of cholera in the 
 East, has by no means been found an invariable, or even a 
 very common phenomenon in England or the United States. 
 Dr. White, one of the physicians to the Gateshead Dispen- 
 sary and Cholera Hospital, states that in scarcely one case in 
 ten, in his practice, did the discoloration assume that form ; 
 but there is often a deep, brownish hue of the face and 
 hands. This blueness, or brownness, can often be temporarily 
 dissipated by energetic friction. Absence of the peculiar 
 " cold sweat" is a rare, and, we believe, a decidedly nn favor- 
 able sign. . 
 
 The urine, from having been limpid and free, will become 
 more and more scanty, and its passage will sometimes be at- 
 tended with such difficulty as almost to amount to stranguary ; 
 but as the collapse advances, this condition gives place to 
 that in which the kidneys have ceased to perform their of- 
 fice, and there is no more secretion. Some patients complain 
 of an urgent and painful desire to empty the bladder; but 
 
HISTORY OF THE CHOLERA. 63 
 
 the bladder is already empty, and, after death, is found to be 
 dwindled to the smallest size; the desire may arise from the 
 contraction of the posterior disk of the bladder hard against 
 the internal meatus, as disclosed in post-mortem exami- 
 nations. 
 
 The pains of cholera are agonizing to the sufferer, and at 
 times so pitiful as to move the attendants to tears. The pa- 
 tient tosses incessantly from side to side, and complains of 
 intolerable weight and anguish at his heart. Ashe struggles 
 for breath, his imploring looks and gestures make you almost 
 feel the horror that is burning and gnawing, and wrenching 
 and strangling at his stomach and chest. At times, especially 
 when the cramps are most severe, he rolls about and screams 
 — and then there is that weary, weary cry for " water, w 7 ater, 
 water," and that heart-rending, haunting wail, when the 
 cold, bony grip of death is on him. 
 
 Violent headache is far from being a common symptom in 
 cholera — a neuralgic pain over one eye is less rare. The 
 cramp is invariably increased on moving. In some cases the 
 patient declares himself free from pain and uneasiness, just 
 when the dead-cold skin and the sharpened, anxious features, 
 and the absence of pulse at the wrist, most surely portend 
 speedy dissolution. 
 
 During all this mortal struggle and commotion in the hody 
 the mind remains clear and the perceptions unimpaired, 
 almost to the final moment of existence. "The patient, 
 though sunk and overwhelmed, listless, averse to speak, and 
 impatient of disturbance, still retains the power of thinking 
 and of expressing his thoughts, so long as his organs are 
 obedient to his will." Dr. Lawrie, Professor of Surgery in 
 the Andersonian University, who closely observed the epi- 
 demic as it appeared' at Sunderland, Newcastle and Gates- 
 head, in 1832, commenting upon the declaration of the ma- 
 jority of medical men, that the mind is always unimpaired, 
 says it appeared to him-,, in many cases, affected Jo a degree 
 little short ot what we find in concussion of the brain. He 
 remarked this particularly in several children • when undis- 
 turbed they lay in a dull, sleepy, semi-comatose state, breath- 
 ing with perfect calmness ; when roused, they thought only 
 
64 IIISTORY OF TIFE CHOLERA. 
 
 of relieving their distressing sensations, and called vocifer- 
 ously for cold water. But he does not say that he found 
 them irrational or incoherent, or their condition was other 
 than that which should attend upon congestion of the vessels 
 of the brain. 
 
 TIIE EUROPEAN AND EAST INDIAN FORMS. 
 
 The points of difference between the phenomena of the 
 European and the Indian forms of the Epidemic were intelli- 
 gently stated by Drs. Russell and Barry, in a joint report to 
 the British Government, dated " St. Petersburg, July *27, 
 1831," and by Dr. Lawrie of Sunderland and Newcastle, in 
 a communication to The Medico- Chirurgical Review, in 
 1802 : 
 
 1. — "The premonitory stage occurs in a much larger pro- 
 portion of cases in the English than in the Indian disease. 
 In the latter it is the exception, in the former the general 
 rule. 1 ' 
 
 2. — "The evacuations, both upward and downward, seem 
 to have been much more profuse and ungovernable in the 
 Indian than in the European cholera, though the character- 
 istic of the evacuations are precisely the same." 
 
 3. — " Restoration to health from the cold stage, without 
 passing through consecutive fever of any kind, is far more 
 frequent in India than in Russia or England, nor does the fe- 
 ver in India assume a typhoid type." [Recovery directly 
 from the cold stage, without the fever, is the rule in India ; 
 whereas, in England or in the United States, we believe that 
 •few who once have been fairly collapsed, will escape the 
 consecutive fever.] 
 
 4. — " The proportion of deaths in the cold stage, compared 
 with those in the hot, is far greater in India than in Western 
 Europe." 
 
 o. — " The head is more frequently affected in the British 
 than in the Indian form of cholera — as shown by great men- 
 tal oppression and insensibility dnring collapse." . 
 
 6. — According to Dr. Lawrie, "the discoloration of the 
 surface is neither so frequent nor so extensive in India as in 
 England." [The blue is the common discoloration in India 
 
TTTSTORY OF THE CTTOT/ERA. 65 
 
 the brown in Europe ■ though in many cases in both England 
 and this country, there has been a well-marked -purplish 
 
 change.] 
 
 THE EUROPEAN FORM NOT "SUDDEN." 
 
 M. Guerin, a celebrated French physician, in an exhaustive 
 report submitted to the French Academy, says that "before 
 the epidemic of cholera which ravaged Europe in 1832, it 
 was generally admitted that this terrible scourge attacked its 
 victitmMn the most sudden manner, and struck them down 
 with a degree of violence that was only comparable to the 
 effects of a lightning-stroke. All the writings of this period 
 take up this view of the disease. * Meanwhile, at the com- 
 meneemsHi; of the epidemic of 1832, I perceived that it was 
 quite otherwise. About a week after the appearance of the 
 disease I wrote in the following terms to the Gazette. 
 Medic ah : 
 
 " '-Most of the patients attacked with cholera have been for 
 several days, or even weeks, laboring under a disturbed con- 
 dition of the digestive organs, wmich did not appear suffi- 
 ciently serious to them to deserve careful attention ; such 
 even have been their carelessness on this point that we have 
 often been obliged to question them very closely in order to 
 elicit information from them. It is only after having been 
 asked three or four times whether they have had diarrhoea 
 that they give a satisfactory reply. From this we conclude, 
 (1.) That in many cases where. this diarrhoea has not been 
 noticed there is reason to suspect carelessness in observation 
 on the part of the patient. (2.) That this diarrhoea, the pTe- 
 cursor of cholera, should receive the careful attention of 
 medical men, parents, and even of the authorities, who 
 should recommend to the poorer classes — and publish the 
 recommendations by all the means at their disposal — to pay 
 proper attention to this state of the digestive system, and 
 should make known to them the fatal consequences of 
 neglecting to treat, the diarrhoeal attack.' This opinion, 
 winch had its origin In facts, was developed and confirmed 
 by them. In proportion as the patients crowded into the 
 wards of the Hotel Dieu, where I especially carried on my 
 
60 niSTORY OF TITE CETOLEP.A. 
 
 observations, my convictions became more and more 
 strengthened. Out of 600 patients* questioned in the most 
 careful manner, 5i0 had shown symptoms of tholerine 
 
 (premonitory diarrhoea) before their entry into the hospital. 
 From this I concluded, on the 12th of April : 
 
 1. "That cholera is always preceded and announced by a 
 series of symptoms, to which, with a desire to caution the 
 public, I have given the name of cholerine. 
 
 2. u That cholerine is the first stage of cholera. 
 
 3. " That cholera, properly so called, is only an atbranced 
 stage of the disease which has hitherto been unknown in its 
 first or premonitory period. 
 
 4. " That it is always possible to arrest the development 
 of the mortal stage of cholera by attacking the disease in its 
 curable one> 
 
 "The existence of a prodromic or premonitory period 
 in cholera is certain. The truth was accepted and admitted 
 at the period of its announcement by the majority of physi- 
 cians. The exceptions have hardly an existence, and are 
 more apparent than real, being clue to the absence of powen 
 of careful observation on the part of the patients. 
 
 " Since 1832 there have been at short intervals three new 
 epidemics of cholera. Moreover, this dreadful malady haj 
 spread during the same period, or successively, cxrer the 
 various countries of Europe and Asia. Has it in every in- 
 stance conformed to the laws of its first evolution ? Haa 
 the prodromic or premonitory period always prceded the 
 mortal stage of this disease •? It is of the highest importance 
 that the reply to these questions should be in the affirma- 
 tive. For if this view — regarding it in its origin as one of 
 the conquests of science and a benefit to humaity — receives 
 from all recorded observation thS character of an unim- 
 peachable truth, it is essential that it be published in all 
 populations and countries, as affording a sheet-anchor (una 
 ancre de salet) in the perils which menace human beings. 
 Now, having been requested by the Academy of Medicine 
 to superintend the general report upon the epidemics ol chol- 
 era, I have been placed in possession of all the scientific 
 documents, home and foreign, relating to the subject. 
 
IIISTOTCY OF TUB CITOLTCEA.. 67 
 
 "The result of an examination of these I have the honor 
 to communicate to the Academy. Commencing with En- 
 gland, we find the following remarks in the report of the 
 * General Board of Health,' published in 1850 : ' Whatever 
 doubts there may have been during the epidemic of 1832' as 
 •to the existence of prodromic symptoms (diarrhoea), the ex- 
 perience of the last epidemic solves the question completely. 
 In one hospital where the first symptoms were minutely in- 
 quired into, it was found that of five hundred patients al-. 
 most all, without exception, had been previously attacked 
 # bv choleraic diarrhoea, often or twelve days' duration. Dr. 
 Burrows states that the replies- of the patients showed that 
 the ' rice-water' discharge of cholera was always preceded 
 by others of a different, though unhealthy character. Dr. 
 M'Loughlin states: ' 1 believe I am correct in concluding, 
 that of 3,902 cases of cholera, I have not found, one without 
 prodromic diarrhoea.' , 
 
 " In France there are the same confirmations as in En- 
 gland. M. M. Levy found that of 142 patients, (at the hos- 
 pital of Val-de-Grac,) there were only six without prodro- 
 mic symptoms. In 95 cases the diarrhoea had lasted for two 
 two, three, four, and even a greater number of days. A 
 general inquiry, instituted by the ' Comite Consulatif d' Hy- 
 giene,' during the epidemic of 1853, gives the following as' 
 part of its report : ' From the 1st of November, 1853, to the 
 22d of January, 1854, of 974 choleraic patients admitted to 
 the hospitals of the capital, 740 had been attacked with pre- 
 monitary diarrhoea; the others appeared exempt, or were 
 unable to give exact evidence.' To these authentic state- 
 ments I may add those which have been made by the differ- 
 ent departments of France in reply to the questions of the 
 authorities. Almost ail the local physicians answer that 
 cholera commences in the great majority of cases by diarr- 
 hoea and other premonitory symptoms. The cases of sudden 
 cholera, if they really exist, do not exceed five or six per 
 cent." 
 
 HELPS AND HINTS TOWAEDS A PATHOLOGICAL DEFINITION. 
 
 The consecutive fever of cholera is not an integrant and 
 necessary part of the disease. It cannot be distinguished 
 
68 niSTOTCY OF TFTE CHOLETU. 
 
 from an ordinary continued fever, except by the rapidity and 
 fatality of its course. It is the result of nature's effort to re- 
 cover herself from the stunning shock that has prostrated 
 her, and the oppression that keeps her down. Cholera is 
 only cognizable nith certainty during the cold or "blue" 
 period ; of the three stages, the collapse alone is true chol- ■ 
 era. Where medical measures have been promptly, energe- 
 tically and successfully employed, the essential and diagnos- 
 tic symptom, sudden sinking of the circulation, has often not 
 developed itself ; and there are cases where an excited vas- 
 cular action has accompanied the first tumult of the system 
 in cholera. These are precisely the cases which yield most 
 certainly and promptly to the remedial measures. In India 
 it has been observed that these favorably indications chiefly 
 appear among the European soldiers, who usually imbibe 
 spirits freely at the commencement of the attack. During 
 an invasion of cholera in Malacca and Burmah, in June and 
 July, 1852, the writer of this had medical charge of an East 
 India Companj^s war steamer in the Bay of Bengal and the 
 Straits of Malacca. The ship's company was composed of 
 Europeans and natives— Malays and Mohammedans— in 
 about equal proportion. Under the peculiar treatment, to be 
 described further on, not a single case of collapse occurred 
 among the Europeans, all of whom "indulged" liberally, the 
 officers in wine and toddy, the men in their regular grog, 
 twice or three times a day, and in irregular "drinks" as 
 often as they could get them ; whereas, among the natives, 
 most of whom were abstemious, by reason of "piety" or 
 vows, every case w r as collapsed; but the recoveries, even 
 from the cold stage, amounted to eighty per cent. If the 
 superficial veins and arteries be opened in the cold stage, the 
 contained blood may flow out ; but their walls then collapse, 
 and no more blood can be drawn. There is no authentic 
 fatal case of cholera on record where the circulation has 
 not been arrested, in the extremities at least, long before 
 death. 
 
 An increase of temperature is often observed, just before 
 dissolution; but the development of Heat in such instances 
 is [mrlia% being confined to the trunk and head, and is a 
 
niSTORY OF THE CnOLERA. 69 
 
 fatal symptom. This mocking warmth is generally appre- 
 ciable for some hours after death. The application of boil- 
 ing water to the skin, in the worst cases of collapse, pro- 
 duces little or no effect, and some patients are insensible to the 
 operation ; but it is certain that in a body but just dead of 
 some other disease, boiling water will visieate readily. So 
 extreme is the diminution, or so complete the destruction of 
 the nervous energy of the skin, in the cold collapse of chol- 
 era, that there is less vitality there in such eases, the patient 
 being still alive, than in the skin of a body recently dead of 
 a dif> rent disease. An Eastern physician states that he has 
 applied boiling water to the feet and lips of patients in India, 
 without eliciting a tone or gesture of complaint. 
 
 The change in the condition of the. blood — ' : dark, black 
 or tarry; thick, ropy or sirupy — is fully proved to be in the 
 ratio of the duration pf the disease, the blood more or less 
 rapidly changing from a natural to a morbid state, as the 
 disease advances : such, is the general rule. Observe, that 
 the blood is usually found to be less changed in those cases 
 of cholera which are ushered in with pxcitemeiif, than where 
 collapse has occurred at an early period of the attack. The 
 blood is sometimes found, on dissection, to be of as dark a 
 color in the left as in the right side of the heart — affording 
 reason to believe that in the whole arterial system it is. 
 equally changed. In many cases the temporal artery has 
 been opened, after attempts to procure blood from the 
 brachial or jugular veins had failed, and the blood in the 
 artery was found dark and thick, like the venous blood ; it 
 flowed in a languid, ropy stream, and then the artery col- 
 lapsed. 
 
 Hiccough is a favorable sign, and seems to announce the 
 return of circulation, especially when it occurs in the inter- 
 mediate moments between the threatening of death and the 
 beginning of reaction. 
 
 While burning thirst, pain at the stomach, cramps, 
 asphyxia, clammy sweat, cadaverous edldness, and aphonia, 
 may all be present, vomiting and purging may be absent, 
 aad "yet ' the case will rapidly run to a fatal termination. 
 The fact is, the vomiting and purging axe not only t; tar Irom 
 
70 HISTORY OF TIIB CHOLERA." 
 
 being the most important or dangerous symptoms " — it is not 
 only true that " the clanger of the ease is by no means de- 
 pendent on the quantity of matter discharged from the 
 stomach and bowels," and that " in some of the worst cases 
 this is not very considerable, and in some of the most success- 
 ful it is very great " — but it is our conviction that the vomit- 
 ing and purging are, in their original intention, genuine 
 efforts of nature to relieve the engorged vessels and restore 
 the -equilibrium of the circulation; that they constitute 
 nature's safety-valve to the congestion ; that their presence, 
 in coHrpse, is generally a favorable, and their sudden disap- 
 pearance, a very unfavorable sign. 'They almost invariably 
 cease a short time before death in the cold stage ; they fre- 
 quently return in a notable degree at the beginning of reac- 
 tion. Mr. John Fyfe of Newcastle, England, attended 579 
 cases of cholera ; and in all these, he says, collapse never 
 came on " until after profuse serious discharges from the 
 bowels." Was not nature, by those discharges, struggling 
 to prevent the collapse ? — in the language of Dr. James 
 Johnson, Physician Extraordinary to the King of England, 
 was she not making "violent, but too often unsuccessful, 
 efforts to restore the broken balance of the circulation, and 
 to re-establish the secretions, by sickness and purging — the 
 ejected fluids being rxudatv>n<, not secretions ?" Here nature 
 cries to us for help, and shows us ho>c to help her — disclos- 
 ing to us the inner mystery of cholera. * If we do not make 
 haste to aid her in the direction she points out, she will ex- 
 haust herself by her own tremendous efforts. 
 
 In cholera there is every reason to believe that every 
 species of secretion, in all parts of the body, is abolished. 
 No known functions of the mucous membrane of the alimen- 
 tary canal could form matter like that which is discharged ; 
 and as there is no circulation going on in the skin, but rather 
 a complete. state of asphyxia there, there can be no secretion 
 of perspiration. The "cold sweat" of collapse is licit true 
 perspiration (like the critical perspiration of the consecutive 
 feve:'), but exudation ; and. viewing the skin and the mucous 
 membrane as one continuous surface, it is just to conclude 
 that this exudation is homogeneous throughout. " Whence, 
 
HI6T0BT OF THE CHOLERA. 71 
 
 then, and how, come these discharges ? Qn the skin, certainly 
 not from circulation, for there is none there ; and it is more 
 than probable that the capillary circulation of the mucuous 
 membrane of the intestines is equally absent. It would seem 
 as if the elements of the body, composing the parts nearest 
 to the surfaces, became subject to new affinities, forming a 
 new substance, incapable of being retained by the mem- 
 branes, but rapidly oozing through them. Two facts go to 
 support such an hypothesis : First, the abundant new forma- 
 tion transuded, where no circulation exists ; and second, the 
 rapid amaigrissement of the body. This wasting of the body 
 is not merely apparent, it is real; the usual roundness of the 
 parts is taken off, and tendons and other salient points 
 become strikingly prominent. 
 
 Of the two great classes of functions performed by the or- 
 gans of which man is composed, one only is primarily para- 
 lyzed by the poison of cholera. The operations of the senses, 
 and of the intelligence, are either left untouched or are affected 
 but in a secondary manner. It is the animal that dies ; the 
 Intelligence, awe-stricken, surveys the scene of death, and 
 trembles and wonders. These functions by which mere exis- 
 tence is preserved — those complicated powers by means of 
 which we are forever appropriating, and converting into a 
 part of ourselves, portions of the matter around us — are, all 
 at once and all together, deranged and disabled by the blow 
 of this terrible angel. Nutrition is annihilated ; respiration 
 becomes difficult, irregular, and inefficient, the involuntary 
 muscles no longer perform their offices ; the voluntary are 
 contracted in painful knots by other powers than the will ; 
 the blood ceases to circulate; its physical properties are 
 altered, its serous element suddenly thrown out upon the in- 
 testinal mucous surface of the body ; the secretions are all 
 arrested, and animal heat is no longer produced. 
 
 The victim of cholera does not die " solely of starvation, 
 caused by vomiting and diarrhoea," as certain doctors hold; 
 but by paralysis of the nervous system and consequent chem- 
 ical and organical decomposition of the blood. During the 
 prevalence of cholera, there are observed among persons 
 otherwise healthy, various anomalous affections of the nerv- 
 
7a 
 
 HISTOBT OF THE OHOLEB4L 
 
 ous system — such as cramps, cold sensations of the hands, 
 feet and legs, a peculiar thrilling in the extremities of the 
 fingers and toes, and an oppressive feeling of anxiety in the 
 region of the heart. After the first, or premonitory stage of 
 cholera, bile ceased to be formed. We always find the gall- 
 bladder full ; but this filling has taken place before collapse 
 set in. There are no signs of bilious absorption. Adult age 
 exhibits a much more lively susceptibility to the cholera 
 poison than early life ; great numbers of children escape it, 
 simply because they are less subject to the predisposing 
 influence of fear. 
 
 The idea of Bleeding in the stage of collapse, has its origin 
 in an hydraulic theory totally inadmissable in cholera. There 
 is not too much blood in the whole body, but too much at 
 the centers and too little at the surfaces. A return to healthy 
 distribution and eireulation will not result from abstracting, 
 any more than from adding, a portion of the dammed-up 
 mass. The cessation of arterial action is not owing to the 
 state of the fluids, but to determinate derangement in the 
 nervous power by which the machinery of circulation has 
 been stopped. Besides, in most eases you cannot bleed ; 
 thickened and stagnant in the vessels, the blood cannot be 
 made to flow; and if a few ounces be squeezed from the 
 orifices it hangs from them in long, tarry strings — to no pur- 
 pose. 
 
 The experiment of Galvanizing is a kindred absurdity. The 
 desideratum in cholera is not the sujyph./ or restoration of 
 vital or nervous power, but the propulsion of that power to 
 the surfaces from which it has receded. 
 
 THE FEVER STATE. 
 
 A patient, having once fairly entered the stage of collapse, 
 is rarely restored to health without passing through a fever 
 closely resmbling the typhus miliar of Great Britain. The 
 system, under the influence of the peculiar and mysterious 
 poison by means of which the Asiatic cholera does its work, 
 has been sunk into the lowest state of human existence. 
 Those vessels that had ceased to pulsate, and those muscular 
 fibrils that had been for clays convulsed, contracted, and, aa 
 
HISTORY OF THB OHOLEIU. ft 
 
 it were, knotted and twisted in spasm, cannot at onco resume 
 their healthy action. The vix medicatrix naturce, in resum- 
 ing its efforts, seems over-eager for the restoration of the 
 functions, and consequently sets up an exaggerated and dan- 
 gerous action in every artery. After the "blue" cold period 
 has lasted from twelve to twenty-four, seldom to forty-eight 
 hours, the vital powers begin to rally, the circulation and 
 animal heat to be restored, the cramps to relax, and the 
 vomiting and purging to diminish, if they have not already 
 ceased. The warmth returns gradually, the pulse rises in 
 strength and fullness, and then becomes sharp, and some- 
 times hard. The patient now complains of headache, with 
 ringing in the ears. The tongue becomes more loaded, red- 
 der at the tip and edges, and dryer; thirst continues, but 
 there is less nausea. High-colored urine is passed with pain, 
 and in small quantities. The pupil is generally dilated, and 
 soreness is felt on pressure over the liver, stomach and bow- 
 els. The stools are no longer like water ; they first become 
 brown and thin — then dark, or black, and pitchy; and for 
 some days the bowels continue to discharge immense loads 
 of vitiated bile. A profuse critical perspiration may appear 
 on the second or third day, and leave the sufferer conva- 
 lescent: but more frequently the quickness of pulse and 
 heat and dryness of skin are aggravated, the tongue becomes 
 deeply furred, brown and dry, and sometimes hard, the eyes 
 suffused and drowsy ; there is a dull flush on the face, with 
 stupor and heaviness. Commonly, at this time, there is low, 
 muttering delirium, or other marked affections of the brain ; 
 dark sordes collect on the lips and teeth, the patient is pale, 
 squalid, and low, catches his breath, is extremely restless, 
 and moans " solemnly." The pulse becomes weak and trem- 
 ulous, on the skin rigors alternate with flushes of heat. Then 
 comes a blessed insensibility, and the patient soon sinks un- 
 der the prostrating effects of frequent pitchy alvine dis- 
 charges—death arriving on the sixth, eighth, or tenth day, 
 or even later, to the very individual whom the most assidu- 
 ous attentions had barely saved in the cold stage. Constipa- 
 tion is not an uncommon symptom in the febrile stage, and 
 the urine is often secreted abundantly— -in fact, dangerous 
 
1A 1T13T0RY OF TAB CHOLBISA. 
 
 retentions are to be guarded against. It is probable that the 
 duration of the consecutive fever is, in the majority of Eu- 
 ropean cases, commensurate with the duration and severity 
 of the collapse, and not materially dependent on the kind of 
 remedies employed. But, sometimes a very mild case pre- 
 cedes a dangerous fever, especially in Europe ; and some- 
 times after the severest collapse there is no fever at all, es- 
 pecially in India. In Western Europe the consecutive fevei 
 has been regarded as more frequently fatal, unless strictly 
 vratched, than collapse itself; and in cases of recovery from 
 even mild forms of fever, relapses, more or less alarming, 
 have not been very uncommon there. 
 
 PASSING FEOM THE STATE OF COLLAPSE. 
 
 When the more formidable symptoms of collapse have set 
 in with severity, the chances of recovery are in all cases pre- 
 carious; and it the constitution has been impaired by pre- 
 vious disease, or has failed by reason of age, the case has 
 always been regarded as nearly hopeless. But in childhood, 
 youth, and vigor of life, a well-instructed, sagacious and per- 
 severing use of remedies will often be rewarded with com- 
 plete success. A thread of pulse, however small, is almost 
 always felt at the wrist where recovery from the " blue " or 
 cold stages is to he expected. In such less formidable cases, 
 it is never wholly extinguished,- though much reduced in 
 volume; the respiration, too, is less embarrassed, and the 
 oppression and anguish at the chest are not so overwhelm- 
 ing, although vomiting, purging and cramps may have been 
 more intense. Just where the favorable turn is taken, in the 
 first feeble efforts at reaction, the return of circulation is 
 often curiously announced by hiccough. Then the surface 
 begins to grow warm, the pulse reappears at the wrist, and 
 increases in strength and volume, and the natural hue of the 
 skin is restored. Next, the vomiting and purging cease, or 
 rapidly diminish — (in certain cases of recovery from extreme 
 collapse they even return for a time, after having quite dis- 
 appeared) — the cramps are relaxed, fcecal matters reappears 
 in the stools ; bile, urine, and saliva are once more secreted 
 
 and discharged ; the voice becomes stronger and more natu- 
 
 ■ 
 
OTSTOItY OF THE CHOLKV.A. 75 
 
 ral— the racked and broken wretch sighs, weeps, and lives. 
 When the vital forces have begun to rally, the physician 
 cannot be too vigilant : he must watch nature warily, suspi- 
 ciously, and prevent recurrence of collapse on the one hand, 
 to repel congestions on the head and viscera on the other. 
 Where the strength of the patient's constitution, or the cura- 
 tive means employed, are, although inadequate wholly to 
 subdue the disease, sufficient to resist the violence of its 
 onset, nature makes various efforts to rally, and holds out 
 strong but fallacious promises of returning health. Or when 
 the restorative efforts are opposed by previous organic dis- 
 ease, general feebleness of constitution, or the worn out ener- 
 gies of age, we must not calculate too confidently on any 
 imperfect reaction that may be induced. In all such cases, 
 the lost heat may be wholly or partially restored ; if only 
 partially, the chest and abdomen will become warm whil8 
 the limbs remain deadly cold — a most evil omen ; the pulse 
 may return, growing moderate and full ; the vomiting and 
 cramps may cease ; the stools may become green, pitchy, and 
 even feculent ; there may be a partial restoration of the na- 
 tural excretions — and yet the patient will suddenly relapse 
 and sink, not from violent reaction or the development of 
 any local inflammation, but from want of energy in the vital 
 powers to carry forward the attempts at restoration which 
 seemed so happily begun. The sufferer may have fallen into 
 a flattering slumber; but now anxiety and sleeplessness 
 will return, and all the alarming symptoms be re-established. 
 These ignus-fatui of rallying sometimes flicker for two or 
 three days, and all that time life and death will be poised in 
 a sensitive balance. In some of the most rapidly fatal cases 
 warmth has partially returned to the surface, and the pulse 
 has fluttered and flattered immediately before death. Be it 
 remembered that the real danger is by no means in propor- 
 tion to the quantity of matter discharged from the stomach 
 and bowels. In some of the most trying cases this is not 
 very considerable, and in some of the most successful it has 
 been very great. Neither is cramp nor spasm a sure cri- 
 terion. The great danger arises from suspended or imperfect 
 
76 HISTORY OF THE CHOLEBA. 
 
 circulation. Restore and equalize this, and you have " cured 
 the cholera." 
 
 THE D^AD. 
 
 It used to be believed, rather fancifully, that the bodies of 
 those who died of cholera underwent putrefaction sooner 
 than those of persons dying under the ordinary circumstan- 
 ces of mortality. There is no evidence of any such tendency 
 to rapid decomposition, and people should beware of the no- 
 tion. In some instances, the body — at least the trunk and 
 head — has remained sensibly warm for some hours after 
 death ; and spasmodic twitchings of the muscles have taken 
 place and continued for some time, in the corpse. Dr. Law- 
 rie observed that convulsive movements were common after 
 mental life was quite extinct ; and that it was almost impossible 
 to say " at what moment the vital motions ceased to vibrate." 
 A body lies apparently lifeless, suddenly a convulsive shud- 
 der shakes it ; its hands are clenched ; if you insert your 
 own within them, and force them open, they shut again with 
 a spasmodic catch. Thus, those who clung to the notion 
 that rapid decomposition is peculiar to death by cholera, are 
 apt to bury with indecent haste; while those, on the other 
 hand, who are ignorant and superstitious in regard to the 
 fallacious warmth and the convulsive movements, are loth to 
 inter until the remains have actually begun to putrify. On 
 the 24th of July, 1832, the Special Medical Council of the 
 New York Board of Health, presented a report in relation 
 to the unnecessary haste with which the bodies of persons who 
 had died of cholera had, in some instances, been interred : 
 
 "The Council," they said, "are of opinion that the dead 
 may, with perfect safety to the living, remain unburied at 
 least six hours [why not twelve ?] even during the present 
 warm season, and under proper precautions, for a much 
 longer period. They also deem it expedient that the public 
 should know that the neighborhood of the hospitals and 
 burying-grounds has not been found, upon inquiry, to be pe- 
 culiarly liable to the disease. At the public burying-ground, 
 called the Potter's Field, where nearly 100 bodies have been 
 buried daily, during the past week, none of those engaged 
 
HISTORY OF TIIB CHOLERA. 77 
 
 in the work have been taken ill ; and of the 100 persons liv- 
 ing in the Asylum for the Deaf and Dumb, within 200 yards 
 of the same, not one is known to have been attacked." 
 
 APPEARANCES ON DISSECTION. 
 
 The appearances disclosed on post-mortem inspections of 
 the bodies of those who have died of cholera, vary according 
 to the duration and intensity of the attack, the age, constitu- 
 tion and previous health of the " subject," and the remedies 
 administered; but enough of uniformity is found in the reports 
 of the most instructed and careful observers — especially as to 
 the points most significant, and of the first pathological 
 importance — to serve the purpose of a description addressed 
 to the unprofessional multitude. Enough, too, we think, to 
 afford an accurate definition of the disease, in place of the 
 bewildering guess-work of the text-books. In the language 
 of the Medico- Chiru7\gical Review. " The man who would 
 treat disease successfully, must not consider his only aim and 
 object to be the knowledge of the various morbid changes 
 which take place in the structure of the different organs, 
 and of the symptoms by which they are distinguished ; his 
 researches must be directed beyond this — to the laws of vital 
 actions, to the manner in which they are disordered, and to 
 these agents capable of restoring them to their healthy 
 state." 
 
 The bodies of those who have sunk in the earlier stages 
 of cholera exhibit hardly any unhealthy appearance; the 
 stomach and intestines are apt to be paler, and more dis- 
 tended with air than usual, and some explorers have discov- 
 ered, fancifully perhaps, a " characteristic foeter" from the 
 abdominal cavity. But in the more protracted cases, a 
 greater or less degree of injection of the mucous membrane, 
 with occasional ccchymosis, is the most frequent appearance. 
 It has also been observed, in erases where the violence of the 
 spasms proved the most prominent symptom, that the mu- 
 cous membrane presented that appearance which approaches 
 nearest to inflammation. The large intestines are sometimes 
 filled with whitish and flaky-turpid fluid, sometimes with 
 greenish, yellow, or tarry matter— in other words with the 
 
78 niSTORY OF THE CHOLKKA. 
 
 characteristic discharges, or with vitiated bile, just as the 
 patient may happen to have died in the earlier or later 
 periods of the attack, in collapse or in the struggle for reac- 
 tion. In like manner the stomach Contains either the injesta 
 in an altered state, or the same " veal-soup-like" stuff that 
 the patient has been vomiting ; or its contents may be green 
 or dark. So, likewise, as to the vascular appearances pre- 
 sented by the alimentary canal, the varieties seem to corres- 
 pond, with instructive regularity, to the duration, the stage, 
 and the intensity of the attack. The mucous membrane is 
 generally somewhat softened; sometimes of an unnatural 
 paleness throughout, " but oftener having various portions 
 tinted of various hues," from the pale rose to the dark brick- 
 dust and slate-colors, as venous or arterial injection predom- 
 inates ; patches of ecchymosis and arborizations of the larger 
 branches are frequent ; but the most common appearances 
 have been a red or purplish speckling of the mucous mem- 
 brane, generally over the whole surface, but more apparent 
 in some parts than in others. Sometimes these different 
 appearances are scattered throughout the entire extent of the 
 alimentary canal ; at other times the stomach alone is colored 
 and the intestines pale, or the stomach pale and different 
 portions of the intestines darkly injected. The venous trunks 
 of both stomach and intestines are generally found remarka- 
 bly engorged. The rule, divested of its numerous excep- 
 tions, or rather modifications, dependent upon circumstan- 
 ces and conditions which the intelligent physician will not 
 fail to take into the account of each individual case, is : 
 Where the patient has not lingered, but succumbed early to 
 a rapid attack— no striking vascular change, beyond general 
 venus congestion, and turgidity of the prominent vessels. 
 
 Where collapse, in its completest form has been develop- 
 ed, repelling and damming the current of the blood — univer- 
 sal dark engorgement, with deep discoloration of the internal 
 surface of the stomach and intestines. Where the disease 
 has been protracted, and has reached the stage of consecu- 
 tive fever — every degree of arterial injection, in addition to 
 the congestion, from the lightest blush to the angry flush of 
 exaggerated action and incipient inflammation* These are 
 
HISTORY OF THE CHOLERA. 79 
 
 the keys of the stages, the mad malady rings many a change 
 on them. 
 
 The liver is commonly found enlarged and gorged with 
 blood ; but not always. In some cases it is large, soft, and 
 light-colored, and not very turgid ; in others, it is even col- 
 lapsed and flaccid. The gall-bladder is, almost without ex- 
 ception, full of green or black bile. The spleen and kidneys 
 are not always surcharged with blood : quite frequently they 
 present a perfectly natural and healthy appearance. The 
 bladder is always empty and contracted. The lungs have 
 often been found in a natural state, even in cases where there 
 has been much oppression of respiration. Much more com- 
 monly, however, they are either gorged with dark blood, so 
 that they have lost their characteristic appearance and have 
 rather assumed that of the liver or spleen, or they are re- 
 markably collapsed, their bulk so much reduced that they lie 
 in the hollow on each side of the spine, leaving the cavity of 
 the thorax nearly empty. 
 
 In the majority of cases, the heart and its larger vessels 
 are distended with very dark blood. All the cavities of the 
 heart are filled with a thick, blackish treacle, and blood so 
 dark that, when extended on a white surface, it resembles in 
 color the piece of the darkest cherry, is often found in the 
 arch of the aorta, and m the other great arterial trunks. The 
 principal venous vessels are usually found engorged — the 
 most forcible injection could not have completely filled them 
 — and the contained blood is black and sirupy. The vessels 
 and membranes of the brain are frequently turgid with 
 blood, particularly toward the base. A fluid is sometimes 
 found effused into the convolutions in considerable quantity, 
 with more or less serum in the lateral ventricles. The blood- 
 vessels of the vertebral column and spinal cord may be no- 
 ticeably congested, and in some cases there are marks of in- 
 flammatory congestion in the larger nerves. But the cases 
 in which the brain presents a natural appearance, and those 
 in which the sinuses, and the veins leading to them, are 
 stuffed with almost black blood, are of equally common oc- 
 currence. 
 
 The following, by Dr. Hamlin, condenses all that can be 
 
80 niSTOHY OF THE CHOLERA. 
 
 said on the subject. His statements are clear, and his ex- 
 perience enables him to speak with confidence on the sub- 
 ject : 
 
 Dr. Hamlin, for many years a missionary of the American 
 Board at Constantinople; has furnished to the Christian 
 Mirror on account of his very successful treatment of the 
 cholera in that city. His practice has extended through 
 three visitations of this dreaded disease, in 1848, 1855, and 
 1865. The suggestions are so simple that we publish them, 
 in the hope that they will do good, if the cholera should be- 
 come prevalent in the United States : 
 
 Dear Sir — The cholera, which has just left us after com- 
 mitting fearful ravages, is making its way into Europe, and 
 will probably cross the Atlantic before another summer has 
 passed. Having been providentially compelled to have a 
 good degree of practical acquaintance with it, and to see it 
 in all its forms and stages during each of its invasions of 
 • Constantinople, I wish to make to my friends in Maine some 
 suggestions which may relieve anxiety, or be of practical 
 use. 
 
 1. On the approach of cholera, every family should be 
 prepared to treat it without waiting for a physician. It does 
 its work so expeditiously that while you are waiting for the 
 doctor it is done. 
 
 2. If you prepare for it, it will not come. I think there is 
 no disease which may be avoided with so much certainty as 
 the cholera. But providential circumstances, or the thought- 
 less indiscretions of some member of a household, may in- 
 vite the attack, and the challenge will never be refused. It 
 will probably be made in the night ; your physician has 
 been called in another direction, and you must treat the case 
 yourself or it will be fatal. 
 
 CAUSE AND SYMPTOMS. 
 
 3. Causes of Attack. — I have personally investigated at 
 least a hundred cases, and not less than three-fourths could 
 be traced directly to improper diet, or to intoxicating drinks, 
 or to both united. Of the remainder, suppressed perspira- 
 tion would comprise a large number. A strong, healthy, 
 
HISTORY OF THE CHOLERA. 81 
 
 temperate laboring man, had a severe attack of cholera, and 
 after the danger had passed, I was curious to ascertain the 
 cause. He had been cautious and prudent in his diet ; he 
 used nothing intoxicating ; his residence was in a good lo- 
 cality ; but after some hours of hard labor and very profuse 
 perspiration, he had lain down to take his customary nap 
 right against an open window, through which a very refresh' 
 ing breeze ivas blowing. Another cause is drinking largely 
 of cold water when hot and thirsty. Great fatigue, great 
 anxiety, fright, fear, all figure among inciting causes. If one 
 can avoid all these, he is as safe from the cholera as from 
 being swept away by a comet. 
 
 4. Symptoms of an Attach. — While cholera is prevalent 
 in a place, almost every one experiences more or less dis- 
 turbance of digestion. It is doubtless in part imaginary. 
 Every one notices the slightest variation of feeling, and this 
 gives an importance to mere trifles. There are often a slight 
 nausea or transient pains, or rumbling sounds, when no at- 
 tack follows. No one is entirely free from these. But when 
 diarrhoea commences, though painless and slight, it is in 
 reality the skirmishing party of the advancing column. It 
 will have at first no single character of Asiatic cholera. But 
 do not be deceived. It is the cholera nevertheless. Wait a 
 little, give it time to get hold, say to yourself, " I feel per- 
 fectly well, it will soon pass off;'' and in a short time you 
 will repent of your folly in vain. I have seen many a one 
 commit suicide in this way. Sometimes, though rarely, the 
 attack commences with vomiting. But in whatever way it 
 commences, it is sure to hold on. In a very few hours the 
 patient may sink into the collapse. The hands and feet 
 become cold and purplish ; the countenance, at first nervous 
 and anxious, becomes gloomy and pathetic, although a men- 
 tal restlessness and raging thirst torment the sufferer while 
 the powers of life are ebbing. The intellect remains clear, 
 but all the social and moral feelings seem wonderfully to 
 collapse with the physical powers. The patient knows he 
 is to die, but cares not a snap about it. In some cases, 
 though rarely, the diarrhcea continues for a day or two, and 
 the foolish person keeps about, then suddenly sinks, sends 
 
82 niSTORT OF THE CHOLERA. 
 
 for the physician, and before he arrives " dies as the fool 
 dieth." 
 
 COURSE OF TREATMENT. 
 
 1. For Stopping the Incipient Diarrhoea. — The mixture 
 which I used in 1848 with great success, and again in 1855, 
 has during the epidemic been used by thousands, and although 
 the attacks have been more sudden and violent, it has fully 
 established its reputation for efficiency and perfect safety. 
 It consists of equal parts, by measure, one of laudanum, one 
 of spirits of camphor, two of tincture of rhubarb. Thirty 
 drops for an adult, on a lump of sugar, will often check the 
 diarrhoea. But to prevent its return care should always be 
 taken to continue the medicine every four hours in diminish- 
 ing doses ; twenty- five, twenty, fifteen, ten, nine, when care- 
 ful diet is all that will be needed. In case the first dose 
 does not stay the diarrhoea, continue to give it in increasing 
 doses — thirty-five, forty, forty-five, sixty — at every move- 
 ment of the bowels. Large doses will produce no injury 
 while the diarrhoea lasts. When that is checked, then is the 
 time tor caution. I have never seen a case of diarrhoea 
 taken in season which was not thus controlled, but some 
 cases of advanced diarrhoea, and especially of relapse, paid 
 no heed to it whatever. As soon as this becomes apparent 
 I have always resorted to this course : Prepare a teacup of 
 starch boiled as for use in starching linen, and stir into it a 
 full teaspoonful of laudanum for an injection. Give one- 
 third at each movement of the bowels. In one desperate 
 case, abandoned as hopeless by a physician, I could not stop 
 the diarrhoea until the seventh injection, which contained 
 nearly a teaspoonful of laudanum. The patient recovered, 
 and is in perfect health. At the same time I use prepared 
 chalk in ten grain doses, with a few drops of laudanum and 
 camphor to each. But, whatever course is pursued, it must 
 be followed up or the patient is lost. 
 
 2. Mustard Poultices. — These should be applied to the 
 pit of the stomach, and kept on till the surface is well red- 
 dened. 
 
 3. The patient, however well he may feel, should rigidly 
 
mSTOKT OF THJB CHOLEBA* $$ 
 
 observe perfect rest. To lie quietly on the back is one-half 
 of the battle. In that position the enemy fires oyer you, 
 but the moment you rise you are hit. When attacks come 
 in the form of a diarrhoea, these directions will enable every 
 one to meet it successfully. 
 
 4. But when the attack is more violent, and there is vomit- 
 ing, or vomiting and purging, perhaps also cramps and colic 
 pains, the following mixture is far more effective, and should 
 always be resorted to. The missionaries— Messrs. Long, 
 Trowbridge, and Washburn— have used it in very many 
 cases with wonderful success. It consists of equal parts of 
 laudanum, tincture of capsicum, tincture of ginger, and tinc- 
 ture of cardamom seeds. Dose, thirty to forty drops, or 
 half a teaspoonful in a little wate/, and to be increased 
 according to the urgency of the case. In case the first dose 
 should be ejected, the second, which should stand ready, 
 should be given immediately after the spasm of vomiting 
 has ceased. During this late cholera siege no one of us 
 failed of controlling the vomiting and also the purging by at 
 most the third dose. We have, however, invariably made 
 use of large mustard poultices of strong, pure mustard, 
 applied to the stomach, bowels, calves of the legs, feet, etc. 
 as the case seemed to require. 
 
 TREATMENT OF COLLAPSE. 
 
 Collapse, — This is simply a more advanced stage of the 
 disease. It indicates the gradual falling of all the powers of 
 life. It is difficult to say when a case has become hopeless. 
 At a certain point the body of the patient begins to emit a 
 peculiar odor, which I call the death odor, for when that has 
 become decided and unmistakeable I have never known the 
 patient to in §eover. I have repeatedly worked upon such 
 cases for hours, with no permanent results. But the blue 
 color, the cold extremities, the deeply-sunken eye, the van- 
 ishing pulse, are no signs that the case is hopeless. Scores 
 of such cases in the recent epidemic have recovered. In 
 addition to the second mixture, brandy, (a tablespoonful, 
 every half hour) bottles of hot water surrounding the patient, 
 
84 HISTORY OF THB CHOLBBA. 
 
 especially the extremities, sinapisms and friction, will often 
 in an hour or two work wonders. 
 
 Thirst.— In these, and in all advanced cases, thirst creates 
 intense suffering. The sufferer craves water, and as sure as 
 he gratifies the craving, the worst symptoms return, and he 
 falls a victim to the transient gratification. The only saft 
 way is to have a faithful friend and attendant who will not 
 heed his entreaties. The suffering may be, however, safely 
 alleviated and rendered endurable. Frequent gargling tfce 
 throat, and washing out the mouth, will bring some relief. 
 A spoonful of gum Arabic water, or of camomile tea, may 
 frequently be given to wet the throat. Lyndenham's White 
 Decoction may also be given, both as a beverage and nour- 
 ishment, in small quantities, frequently. In a day or two the 
 suffering from thirst will cease. In a large majority of cases 
 it has not been intense for more than twenty-four hours. 
 
 Diet. — Rice water, arrowroot, Lydenham's White Decoc- 
 tion, crust water, camomile tea, are the best articles for a 
 day or two after the attack is controlled. Camomile is very 
 valuable in restoring the tone of the stomach. 
 
 The Typhoid Fever.— A. typhoid state for a few days 
 will follow all severe cases. There is nothing alarming in 
 this. It has very rarely proved fatal. Patience and careful 
 nursing will bring it all right. The greatest danger is from 
 drinking too freely. When the patient seemed to be sinking, 
 a little brandy and water, or arrowroot and brandy, have re- 
 vived him. In this terrible visitation of the cholera we have 
 considered ourselves perfectly armed and equipped, with a 
 hand-bag containing mixture No, 1, mixture No. 2 (for vom- 
 iting), etc., a few pounds of pounded mustard, a bottle of 
 brandy, a paper of camomile flowers, and a r ^er of gum 
 Arabic. ■** 
 
 I lay no claim to originality in commending this course of 
 treatment. I have adopted it from suggestions of able and 
 experienced physicians. Having been the only doctor of 
 many poor families living near me, I have tried various re- 
 medies recommended by physicians, but I have found none 
 to be at all compared with the above. During the recent 
 
HlflTORT OF THB CHOLKBA. &> 
 
 cholera I cannot find that any treatment has been bo success* 
 ful as this. 
 
 Contagion. — The idea of contagion should be abandoned. 
 All the missionaries who have been most with the malignant 
 cases, day after day, are fully convinced of the non-conta- 
 giousness of the cholera. The incipient attacks which all 
 have suffered from are to be attributed to great fatigue, 
 making the constitution liable to an attack. 
 
 C. Hamlin. 
 
 CHANCES OF AVOIDING THE CHOLEEA. 
 
 A correspondent of the New York Express offers the 
 following sensible and practical suggestions, tending to allay 
 unreasonable apprehensions of danger from cholera in New 
 York, and Brooklyn as well, which, as they are justified by 
 the past and the present, will, we believe, be found to hold 
 good in the future : 
 
 In the first place,, it is said that New York is a very un- 
 healthy city, especially at present. But the life-insurance 
 men of the city tell us that they lose fewer lives here than 
 elsewhere in proportion, while the agents of New Jersey, 
 Connecticut, and Massachusetts say the same thing, and pre- 
 fer making insurances here. These are certain tests, statisti- 
 cal pecuniary facts that may give relief. The politicians may 
 have made mistakes. 
 
 In the next place, when the cholera previously visited the 
 city a very small per cent, of the population, especially of the 
 acclimated, cleanly-living population, were sick, and, of 
 course, not anything like so large a per cent, died — less than 
 one per cent. died. Again, it is the testimony of some of the 
 best physicians in the city, and having the most extensive 
 practice during and upon the chc J <era. that very few if any 
 died who slept in the second story, <md that all who slept in 
 the third story were exempt. There may be exceptions to 
 this, but they are certainly few, and the idea is worthy of 
 note and application. It came out some years ago in connec- 
 tion with another matter without reference to cholera. 
 
 Finally, is an attack of cholera s( Mkely t® prove fatal as 
 is usually supposed ? By no mean* A physician, worthy 
 
£8 HISTORY OF THE CHOLBEA- 
 
 of the utmost confidence, says that having charge of a hospi- 
 tal in which one hundred and forty-nine were attacked, he 
 did not lose one. The course pursued was, as it always 
 should be, to place the patient on the back in bed, as soon as 
 first attacked; but on plenty of clothes, and put clothes, 
 wrung out of hot water, with plenty of mustard on them, on 
 the feet, legs and over the bowels. Keep the patient quiet 
 and warm from the very first moment of attack, and in 
 ninety-nine cases in a hundred the disease will make no 
 further headway. If medicine is taken it had better be under 
 the advice of a physician. To review : 
 
 First. It is not probable cholera will visit us at all. 
 Second. If it does occur, the healthiness of the locality of 
 New York will deprive it of its terrors. Third. The per 
 centage of the cleanly part of New York people who will 
 be attacked will be small. Fourth. - Those who sleep, and, 
 still better, live on the second story, can hardly expect to 
 be attacked. And, fifth. The disease is very easily controlled 
 in the outset. 
 
 In conclusion, we beg to remind the reader that the fore- 
 going hints are only the skirmishers, to keep the enemy at 
 bay until the u regular army," the active, intelligent physi- 
 cian, can get on the field. Send for him at once, then. Re- 
 member that an ounce of prevention is worth a great many 
 pouuds of cure in this disease, and that it, of ail others, de- 
 mands immediate, prompt, and active treatment, which we 
 insist can only be afforded by a medical man. 
 
 THE EOT* 
 
-— 
 
 full of abaorbteg inter**! Wt defy *• world to produce a bettor 
 book. 
 
 To be Issued Sept. 8th. 
 
 MUNRO'S TEN CENT NOVEL, 
 
 No. -47. 
 
 MAD MIKE; 
 
 OR, 
 
 i THE DEATH SHOT. 
 
 BY L. AUGUSTUS JQITES, 
 
 AtJTHOB OF "THE ROLLIOKIWe RjLXGBBS,'' "LlOHTEOOT THE 
 
 8cout," "Bold Soixp-Hu^tee*, " fco., &o. 
 
 This admirable story, like all others emanating from the brain of 
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 Bale by all Booksellers and News Agents, and sent free on receipt 
 of price — 10 cents. 
 
 GEORGE MUNRO & Co., Publishers, 
 
 137 WILLIAM STREET, N. Y. 
 
INRO'S TEN CENT PUBLICATIO 
 
 
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