ORIGIN, HISTORY, CAUSE, PREVENTION AND CURE OF CHOLERA i Origin, History, Cause, PREVLJuIION AJNI) uUtlrj Or , ¦fflwi^"* *"""" I " d ™ a^™ w ™ H . I Its Progress 11( i JRnvages Tlir*oiigJi the World, aiicl ENDOR3EI)"*AND APPROVED BY THE MEDICAL FACULTY. A NEW YORIx PHYSICfAH, To be Issued May 33. MUNRO'S TEN CENT NOVEL, No. 65. BUFFALO JACK ; OR, OUT ON THE PLAINS. BY CAPT. LATHAM C. CAHLETOI9. AUTHOB 09 BLACK BILL THB TRAPPKR, THB BOOTTT OF TIPPEOANO^, BIG BSJIKX THB ETOKON, ETC. The ingenuity with which the incidents recorded in this Novel are woven together shows the flexible genius of the author. He deals with a subject which is in itself fascinating, and bis fertile pen has rendered it intensely thrilling and interesting. The characters are, as usual with him, forcible in their expressions and originals in their ideas. Buffalo Jack combines the common-sense philosopher with the bold and daring backwoodsman, and as a specimen of that blunt and honest class of pioneers, which is fast disappearing before civilization, as it penetrates the Far West, is especially worthy of study. His faithful comrade through life, the. Comanche Chief, with the lovely Myrtle, who figure ; ; uinentlyin the story, perform their parts admirably, and as they pass from the scene the reader will almost drop a tear at the thought tha* the race to which they belong is gradually fading, as dvilizaiioi drives them toward the Pacific. Petito Monte is a genuine specimen of the Mexican character. The other characters take up the niches allotted them, and having run their race, pass away, leaving a favorable and pleasing impression upon the reader. The Novel, as a whole, is an admirable one, as are all those of its author. The books are for sale by all News Dealers, or sent, post-paid, on receipt of price — 10 cents. Address, GEORGE MUNRO & Co., Publishers, 137 WILLIAM STREET, N. V THE Origin, History, Cause Prevention AND CURE OF CHOLERA, WITH AN ACCOUNT OF ITS PROGRESS AND RAVAGES THROUGH THE WORLD, AND THE LATEST AND MOST SUCCESSFUL TREATMENT, KXDOnSKD AND APPROVED BY THE MEDICAL FACULTY. " Cleanliness is next to Godliness." — St. Paul. NEW YORK:' -^p* GEORGE MUNRO & Co., PUBLISHERS, 187 William Stkket. Entered according to Act of Congress, in the year 1865, by GEORGE MUNRO & Co., In the Clerk's. Office of the District Court of the United States for che Southern District of New York. Muneo & oo.'s-Publishing. 's -Publishing House, 187 William St., N.Y» s HISTORY OF THE CHOLERA. The term Cholera literally means an overflow of bile, from two Greeks words, x ar i\- bile and P fw , to flow. Technically 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, affecting 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 gentlemen who have made the most thorough investigation appear to disagree. The report of an Egyption Commission of Inquiry 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, which 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 me end of their sacred journey ; and as if this 10 ¦ ' HISTORY OF THE CHOLERA.. I 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. " Here we have at least all the predisposing causes, according 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 m this nest of putridity, carried off one hundred thousand pilgrims in the course of a fortnight, and spread to Egypt, with a result 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 generated, 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 entered 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 consequence of great public disasters, more particularly of inundations. 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. On occasions, in the year 1816, as stated by Jameson, in Calcutta alone, there were no less than 21,876 deaths ; in Bombay 14,000; and that 8 percent, of all deaths recorded, were ascribed to that pernicious disease, five percent, of which came upon the European troops. From 1820 to 1828 inclusive, the disease, somewhat different 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 1829, it took a westward course, and established itself on the European borders (Ovenbv n strochan.) and then marched over Europe; 'in arily arrested by unfavorable 'seasons. . . ;au through! ¦' »"' HISTORY OP THE CHOLERA. 11 the valley of the river Volgo — a distance of 356 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, reaching London and Paris, early the following year. Almost simultaneously with London, the disease appeared in Ruebeck, wiience the tide of emigration took its direction, and from this port spread over the Western hemisphere in 1882. The successive visitations in 1834, 1837, 18,49 and 1.85-1, observed substantially the same course and peculiarities. AN AMERICAN PHYSICIAN'S OPINION. Carroll Durham, M.D., holds the following language : . "Like all invasions, and all epidemics, cholera comes from flic East, marching westward. It is known to have existed in the delta of the Ganges since 1629. But in 1817 it appeared in Hindustan,' as a widespread and terribly -fatal epidemic. From Calcutta and.Jessore its progress was westward, 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 Russia. 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 Hamburg. In October, 1831, it appeared in Sunderland, England, 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 out 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 New York, and prevailed with great fatality until late in the autumn. It re-appeared in 1834, but in a less degree. In. 1847 and 1848, cholera again invaded Europe from the 12 HISTORY OF TnE CHOLERA. 1 East. December 8, 1848, the packet ship New York arrived at quarantine, at States Island, N. T., having on board a number of passengers sick with the cholera. Several had died on the voyage. From this infection cholera prevailed at quarantine for several weeks, and two or three cases, which were traced to this vessel, occurred in New York. "Again, February 13, 1849, 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 York until June, 1849. It prevailed until October. In the summer of 1854, it was again epidemic in New York, and now threatens us again. In June, 1865, it was announced that cholera was prevailing 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 Mediterranean and Adriatic, reaching Marseilles and Paris, from the latter of which, by way of Havre, the cases brought to New Yorft: in the month of* October, 1865, by the Atalanta, were exported to us." OBSERVATIONS ON DISEASE. It was in 1665 that the great plague devestated London. It appeared in Europe forty-five times during the seventeenth century, but it only 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 malignant fever, similar to the plague, hi Odessa, and the cholera 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 Tartary and Siberia to 13 HISTORY OP THE CHOLERA. European Russia, the same route which the plague followed in 1333, when it destroyed a fourth of the population of Europe, and three-fourths of that of England. It is singular that while the plague was passing through Russia, recently, the cholera broke out in Arabia, passing through Egypt, on to Constantinople, Jerusalam, Malta and Tuscany, and even reached Marseilles and Paris. In 1832, 1834, 1849, and 1854 the cholera visited the United States. From 1849 to 1852 a particular epidemic prevailed in Europe and America. Since 1854 the prevailing diseases in America have been in the lungs, throat, and nasal passages, and influenza, pneumonia, and consumption have been destructive. During 1856 and 1857 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, smallpox and fever; from 1669 to 1672, cholera and dysentery ; 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. from 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 tirst time that the disease, as an epidemic, 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 became its victims in one Indian Presidency alone — that of Bombay. The following year it demanded the sacrifice of fifty thousand lives in the single city of Bassorah. On its Way through Europe in its first visit, Austria was the greatest sufferer, three hundred and thirty-eight thousand persons having died in the Empire of this plague in 1831,; of that number two hundred and forty thousand were Hungarians. Next year it reached Great Britain on its 14 HISTORY OF THE CHOI/ERA. way here, and thirty thousand victims perished ia that country. from 1832 to 1854. Since the advent of the Asiatic cholera to this country, in 1832, we have never been a year without a few cases of il, in a modified form. In New York city, the years 1834, '39 '40. '44. '45, and '48 bad distinctive cases of the more malignant type ; but except in the first named year (18.34), its presence was not seriously felt, or its poison endanger- ingly diffused. The year 1849 began a new cholera inva- sion, and from that time there have been regularly every year decided cases of malignant cholera. In order to draw sn-eh conclusions as figures can suggest on this head, the following table is annexed, setting forth the lininber of deaths by the three classes of cholera in N-ew York city from the ravaging visitation of 1849 to and including the year 1864 : Year. Cholera. . Cholera Cholera •Moj-bus. Infantvun. ' 1849. 5,071 ¦ 241 926' 1850 57 744 " 713 - 1851 3 102 721 1852.. 374 238 915 1853. , 33 72 922 1854 ......2,509" 301 1.525 1855.... 19 39 1,135 1856... 8 50 1,381 1857.......... 11 42 .1,308 1858 5 51 1,579 1859...... 9 62 1,3C4 1860...... 17 -79 ¦ 1,6.69 1861 12 93 l ; 207 1862 9 84 . 1.280 1863.. 9 112 . 1,525 1864 ... 12 73' 1,311 RESUME OF WHAT CHOLERA HAS POKE, The first epidemic crossed the continent of Europe during the year of 1831, and was announced ia England by a few 15 HISTORY OF THE CITOLERA. scattering cases in October of that year, and in' the latter part of the 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 clays later, viz. : the Bth of June, it was announced in the city of Quebec. June 24th the epidemic 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 communication 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 malady 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 dcs 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 195.000 pilgrims from Mecca had jnst -arrived, 3,ooo perished. It is worthy of special remark in this place that cholera had been fearfully fetal in eastern Asia, and after devastating the towns on the Caspian and Black Seas, it reached the city of Moscow during the- year 1 847. 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 single night on the road to Arafat, the very place which, was 16 . HISTORY OF THE CHOLERA. i again the scene of similar ravages from the same malady in the spring of 1865. In September the epidemic reached 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 maladyoccurred in most of the ports between Hull and Glasgow, before the beginning of winter. The wave of epidemic pestilence had manifestly, reached the British Islands, but it remained in abeyance, with only occasional outbursts here and there, in filthy, crowded quarters, until the warm days of the spring of 1849. On the 2d of December, 1848, 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, arrived at New Orleans, and the first case of cholera in that city occurred on the the sth 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 sth it appeared 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 I lth, 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 Yoxki 17 EISTOKY OF THE CHOLERA. In Great Britain the same epidemic destroyed nearly 70,000 lives. In Russia in Europe, nearly 600,000 perislied. 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 afflux of the great wave of death which swept over the Continents in 1849, it taught precisely the same practical lessona as all the previous visitations of cholera. In 1834 the epidemic killed 971 persons in New York, and 2,509 in the summer 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 characteristics 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 epidemic 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 Bth of July, it soon insinuated its deadly poison throughout the crowded and filthy quarters of that city, and in the course of a few we.eks was destroying a thousand lives daily. The island of Malta and the city of Ancona, on the Gulf of Venice, were readied by the epidemic early in August, and it commenced its 18 HISTORY OF TIIE onOEKRA. 1 ravages' there/ al though the absolute quarantine and sanitary cordons of those places had attempted to defy its approach. At the same time, and probably at a date considerably earlier than this; the same malady was rife in the dty of Bagdad and on the bonders of the Persian Gulf; and at later dates it spread to Jerusalem, Damascus, Trebizoiid, 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 samo 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 immigrants, and in the city of Sacramento, (18th 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 of this city estimated the rate of mortality at one per cent, per day. Awful proportion ! In San Francisco, owing to its fortunate locality, cholera never could find itself a home. The largest amount of deaths in the beginning of December, 185.0, when the cholera reached its achme of violence, did not exceed four 'per day. By Christinas that disease had entirely disappeared from our city, though it yet prevailed to a limited extent on the steamers arriving from Panama. and from Nicaragua to 1853 and 1854.. CAUSE OF THE CHOLERA.. One of the primary opinions is that cholera is undoubtedly caused by imperfect drainage. In large cities this is particularly the cause. The scientific drainage of great HISTORY OF THE CHOLKKA. 19 cities applies itself to the dispersal of the waters that fall upon or collect within 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 removal-; but the former are quite as important and as deleterious 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 undraiued 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 Cloncaa of Rome still show, after the lapse of two thousand years, a solidity of construction and a skill in engineering that amazes latter-day pigmies. And no modern nation, except the amphibious and moiling Dutch, bfive ever done a work of drainage equaling that performed by the Pharoaiis fur the Marc.otic lake. The French, with their executive and generalizing faculty, have applied the resources of hygiene and of engineering 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 Paris, and paints in shuddering clair-ohscur its vast network of sewers, which boats? may thread and armies traverse. London, too, has scented the importance of this ill-odored subject, and is constructing k vast works, at imperial cost, to exorcise the foul demons that, have so long undermined her health and morality. But New York, brilliant and beautiful above ground, still refuses to know on what pestilential foundations she rests — still shows how '¦ detsinit in piscum mtdier •jonnosa saperne — still trusts that her dead offal may bury its dead, and not corrupt the living witli il — still dances over a mud and filih volcano, till the eruption of plague shall confound and terrify her into decency. Will the reader follow us into these underground caverns, and learn kow they have been built up by negligence, 20 HISTORY OF THB CHOLEKA. arched over by greed, and left as a perpetual nicer of pestilence under as fair a spot as earth's surface shows? A map of the hydrography of New York island, prepared with great labor and cost by that accomplished engineer, Egbert L. Viele, shows the original sand-spit enlarged on each side by a breadth of made ground, pierced in the neighborhood of the Tombs by a profound waterchasm, and channeled, in- different parts of its surface, both in the upper and lower town, by import-ant streams winding over much of its face, and 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 month and piling a mass .of earth directly upon the rotting boards. In clue time the trap went down, and one victim never ascended alive. In the Tombs prison of the same city it has happened more, than once that fate has oul stripped justice, and the key that locked in at sunset a hale man, though a rascal, has turned at morning to"disclose a gasping wretch, done to death by the pestilent exhalations of a single night. LOW SITUATIOKS. 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, increased 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 extent, the atmosphere through which they are diffused. Generally speaking, the mortality from cholera has heen greatest in the lowest levels, owing, as may readily be supposed, 21 HISTORY OP THE CHOLERA. i 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, Dr. Rotton noted the fact of the great mortality from the disease among the occupants of cellars, and hence, it became his invariable practice to have such persons, when attacked, immediately 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, las been the favorite haunt of the cholera in successve periods of its appearance from 1831-2 to 1854. Its sjwerage was deplorably defective, being by open sewers (onnected with the river. Malignant cholera spread to a rtuch greater extent on the line of open sewers than in the >ther poor and densely inhabited places. In other districts, ye 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, appointed "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 ventilation. Examples of this nature have been furnished in all parts of the civilized world— in the East Indies, at Karrachee, 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 hoppickers at East Farleigh, the pauper children at Tooting, the lunatics in the Wakefleld Asylum, the convicts at the Wakeiield Old Prison, the inmates of the Millbank Penitentiary, 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 HISTORY OF TJIB CHOMRA. ll* ' were smitten with the secret pestilence, and of these no less than one hundred and eighty died. The girls, whose dormitories were the most overcrowded and the worst ventilated, suffered more severely than the boys. ' The essential cause of all this mortality was declared to be. "the inordinate crowding, of the establishment." The numbers crowded together into the dormitories wei'e so great, that each boy had only one hundred and fifty cubic feet, and each girl one hundred ami thirty-three cubic feet of air allowed for respiration, and some of the apartments were, at the same time. s«. faultily constructed — there being windows on one si c onl r — that no effective ventilation could possibly be kept up. HEAT. Dr. Chapman has published numerous papers in the London Mrdir-al Times mi- 1- Gazette upon the employment oi 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 summer 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 consequently its action is proportionately more powerful and intense." CHOLERA LANDMARKS IN NEW YOKK. As New York City, from its position, is pretty certain to be visited by the dreadful scourge, anything respecting its condition 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 Roosevelt streets, appearing also at the same time in Reade, Washington 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 Grand and 23 HISTORY OF THE CHOLERA. Broome, expressively called "Rotten ßow," became another center. The same may be said of Corlears Hook, and anybody who has been np town in cars of the First and Second avenues, might recall spots which promise to become cholera .favorites.- . . * In the epidemic of 1849, 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 hospital gives this picture of the spot where the disease first broke out : "No. 20 Orange (now Baxter) street, lies 3.0 or 40 yards in a southeasterly direction from the Five Points. The entrance 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 Sot, on which are two old and ruinous tenements, one a prolongation backward of the front liotise, 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 diirerent stages of cholera. There was nothing under them but mud and filth, and nothing over them but a few rags of the 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 tlie region west of the New York Hospital on Broadway — the same quarter now occupied, largely by wholesale dry-goods houses, and traversed continually by street-cars of two or throe lines, where smallpox and typhus have raged, with scarce an intermission, for nearly two years. The cholera in 1849 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 OB 1 THE 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 spacious cross-streets have no idea of the nooks and holes where cholera may delight to make its fearful dwellingplace. 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 oa Cliff street, while stables and tan-vats conveniently occupy the angles, and a soap factory faces them all from the further side of Cliff street. Cholera might naturally enough make its headquarters here. CHOLERA IN OLD HATTNTS OF DISEASE. Dr. Laycock, in his highly interesting Report on Health, slates that the cholera of 1831 in England selected nearly all the old haunts of the plague, and appeared to possess a pred-eliction for the old haunts of disease. • "It is a singular coincidence," he remarks, "that while the cholera commenced in the Hay market, near the traditional spot of- the plague under consideration (in 1604), and probauly near to that of 1551, the first death from cholera took place also in the parish of St. Michael, Spurriengall, and on June sih." 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 HISTORY OF TnE CHOLERA. 25 the town of Pollockshaws, it snatched its first victim from the very same room and the very bed in wliich it had broken out in 1832. Its first appearance in' Bermondsey was close to the same ditch in which the 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 iv several other places, and the 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 precisely the same 'district*, several of them having changed places 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 1849. 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 furnish victims to* the pestilence throughout the early duration of the oui break. Kent and Mew-streets, Southwark, 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. Acland relates that, with, one exception, 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 HISTORY OF THE OHOLKEA.. S 0 Putting aside drainage, the Prussian capital is, in the width and general arrangement of the streets, and the. better ventillation of the houses, superior to the French : but yet the proportionate mortality from cholera was much greater, or at the rate of nearly 2 1-2 to 1 in 1831, in the former than in the latter city — which, as commonly described, was so great a sufferer. In the second attack (in 1837), the mortality was still heavier in Berlin, or, as the difference between 1,426 and 2,174 deaths. Berlin was then so far behindhand in the comforts of life, as not to have 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 Taglioni, and have not taste enough to appreciate or feel the want of a supply of water in their kitchens, sculleries, drains, sewers, and water-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 experience 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 primary 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 coliapso stage of the true cholera. IMPURE WATEE. The effect of impure water is shown in the ravages of cholera in two of the southern districts of London. It is related as follows : "These districts (comprising nearly a fifth of the population 27 HISTORY OF THE CHOLERA.. of the Metropolis) have been notorious for the great severity 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 districts) were living under precisely similar social and sanitary circumstances. And when, at the. end of the epidemic period, 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 populations 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 an improvement made by this water-company in the interval between the t^yo 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 61 1 ; while among the tenants of the rival company (whose supply 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 concerned 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 epidemic, drank a water somewhat less impure, 118 ; for those who, in 1853-4, drank the worst water which had been supplied, 130; for those who, in this epidemic, drank a comparatively clear water, 87." 28 HISTORY OF- THE CHOLERA.. Dr. Sutherland, in his report to the Genera] Board of Health on the cholera epidemic of 1849, says, that the injurious 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 tune, much additional evidence of a confirmatory character has been collected. Two examples are recorded by Dr. Acland, in his valuable and interesting "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 from a purer source. The other case is that of the county jail, in which cases have occurred in every epidemic, whilst the city jail, which is not far from the other, has uniformly escaped. The only apparent 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 w T ell-pool, within ten feet of ono of the prison drains. No sooner were the supply pipes disconnected with this impure source, than cholera and diarrhoea ceased. It appears from an elaborate inquiry by the General Board of Health, at the close of the cholera epidemic of 1854, that the contrasted effects of the disease on the people of two large sections of the population, are only explicable by the fact that one division, comprising 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 mortality 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, derived 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 29 HISTORY OP 'TUB OnOLKEA. on the influence of water upon the spread of the disease. The deduction from the microscopical and chemical examination 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 South wark and Vauxhall water is one of the worst, and the waters of the other companies might be arrayed 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, 318 deaths from cholera occurred in ten weeks. In the 4:0.040 houses that received the impure water from Battersea, 2,448 persons, it was ascertained, died from cholera in the same time. The deaths in the latter districts exceeded by nearly 2,000 the deaths that would have occurred if cholera had. only been as fatal as it wasjn the houses that derived their water from Ditton." Dr. Sutherland makes the following remarks upon these results: "When it is considered that the sanitary condition of the population docs not materially differ, except in the quality of the water supplied by the two companies, it is difficult to resist this statistical evidence 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 of a farm-yard or filthy court ; receiving the surface-drainage of v heaps of stable manure, pig-sties, lfe'6. How often do we notice, Sayft Dr. W. J. Cox, green, slimy, stagnant pools, in the dtts'e vicinity, and affording the sole water-supply, of cottages. Such a state of things does not oftcnoccur 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 frequent occurrence of bowel-complaint, and the sudden inroads of epidemic cholera, which makes its attacks without 30 HISTORY OF TUB CHOLERA. v i any other apparent provocation. In the new settlements of the West, the enterprising pioneer and his family often pay a tax in the shape of disease, and not seldom of lite itself, from the use of bad water or its imperfect supply : and in new towns other schemes of improvement are tried, before sanitary measures, both for present and fururn projection, such as paving, drainage, and a supply of good potable- vvatcr, are thought of. Dr. Cox tells us, that water tainted with various organic matters, whether gaseous, as carbide or sulphide, of hydrogen, *or solid, as putrescent vegetable fibre, or vitalized, as algic, confervse, hydrse, fungi, infusoria, &c — is a very frequent cause of severe visitations of bowel complaints during the summer months. Several instances came under his own observation, in 1853 and 18f>4, of the aggravation of epidemic diarrhoea from this cause. " That water falling <>n a growing soil, and running off to lie in stagnant pools, is .sine to become tainted with animal and- vegetable life, is well known; and when to this is superadded the eir<"r t ii!.s l :an.<:es of the said soil being highly charged with oft'ete organic products, the water thus collected must necessarily be highly impure, and most unfit for human consumption." I'OVEKTT A C'AIJSK. The poor suffer great privations andsubmit to many inconveniences ; and the cleanly among them deserve tnoro consideration tlian 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 lime of discomfort and unpleasantness ; but in must lonoiiiented dwellings there is a washing on almost awry day of the week. Quarrels arise among the numerous inhabitants of a house respecting the day on which they can have the use of the lines and drying apparatus in the space which is often far too small and very inconvenient. It is by ho 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 use niSTOUV OF TIIR OMOT.KKA. 31 of another family; the mischief of this in cnsos wlicre 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 washing day in the rooms in which families live, or in the washhouse, which is accessible from the various apartments. There is also a frequent scarcity of water. Nuisance doctors should make it their business to look into such details of human life as these ; and where the requisite supervision is neglected should insist upon its observance. " Until the dirty habits of some of the poor are corrected, and the cleanly encouraged, there will always be apprehensions of cholera in such summers us we have this year, originating in the foulness of crowded and filthy rooms. When we take into consideration the modern style of bulding, the 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 checked and obstructed, the frequent removal of refnse will appear essential to the healthy condition of the inhabitants. .IS CHOI.KKA. CONTAGIOUS. In this connection we cannot do better than quote from the very thoughful treatise of Dr. Brigham : " That some cities and fortresses, which established rigorous quarantine regulations, have escaped the disease, is very true, but it is also true that other places, immediately adjoining those which were attacked, have- escaped, notwithstanding that every preeationary 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 tii.' t quarantine enactments can do toward preventing the spread of a disease from one country to another has been done in Russia, Austria, and Prussia. " In ltussia immense lines of troops were drawn to arrest its progress ; St. Petersburg was entirely surrounded oy cordons 32 HISTORY OF THE OHOLKRA 5 4 | i|.| II ! smntnires ; but all these regulations, enforced by a powerful and despotic Government, were unable to prevent the approach and the spread of cholera throughout the Russian Empire. The efforts of Austria were equally unavailing, for in a short time the disease passed her triple cordons and invaded the country from Poland. - Prussia employed 60,000 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 of Medical Sciences for May, 1832). — ' An fitt&iense expenditure of money, the suspension of commerce, a stop put to industry, multitudes deprived of the means of acquiring subsistence, and whole families rendered favorable subjects for the disease ; but no stop to the extension of the disease— on the contrary, its pro?. — 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. (i. 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 coaltar, and is more convenient lor use in the sick room. Dilute' it. 52 HISTORY OF THE CHOLERA. 7. Bromtne.—ls a powerful disinfectant ; to be employed by physicians. 8. Permanganate of Potasm. — To be used as an immediate and most effective disinfectant. Dilute the saturated solution of this salt in from 10 to 500 parts of water, according 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. Heat. — Boiling water or steam to be employed in cleansing as the most certain means of disinfecting contaminated clothing, etc. 10. Charcoal. — As a disinfectant or deodorant for extensive use in masses of putrescent material, and for local purification, fresh charcoal is of acknowledged value. The British Sanitary Commission in the Crimea, ordered whole shiploads 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 which 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 British Goverment : — "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 disinfectant 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 CITOLERA. 53 inexpedient to remove them, should be covered to the depths of two or three inches with a layer of freshly burnt vegetable charcoal in powder. Freshly burnt lime may be used in the same way, but is less effectual than charcoal. If neither charcoal nor lime be at hand, the filth 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 besr 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, ia 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 210 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" (permanganates) "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 manual 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 HISTOEY OS 1 TJ3E OHOBSRA. I! PKEVENTIVE AGAINST CHOLEKA. Much depends on each individual as to the mode 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 likely to derange the bowels. Abstain from an excess. of alcoholic drinks. It is a great popular error to suppose that drinking plenty of whisky or brandy is in any way a preventive against epidemics, but more particularly cholera. Avoid excessive study or labor ; sleep in well-ventilated rboma and keep the house well ventilated and dry, and at a moderate tempera! u re. Dress Warmly, particularly about Iho abdomen. A very good plan is to wear flannel over the bovvels. Abstain from excessive pleasure ; keep regular hours, retiring at a seasonable time. Take moderate outdoor exercise, but regularly every day. Pay particular attention to water-closets, and sea 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 twioo 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 epidemic in the atmosphere. Water should be boiled and filtered, not through charcoal but through regular filteringpaper, which can be obtained from any druggist. By all means don't be induced to take tlfte various patent medicines 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 physician of good judgment and intelligence fears to visit any city or place where cholera prevails, or to remain at his post of professional duty in the midst of an epidemic of the disease,, for he knows that the exciting causes of cholera are avoidable, and that its premonitory stages can be very certainly arrested if the general health and personal habits are good. KotMug could better illustrate the value of proper attention 1 55 HISTOnY OF THB CHOLKKA. to personal health and daily habit?. In short, C olera as a pestilence must be regarded as a preventable disease. THE CIIOJVKRA. CONFERENCE At Constantinople, Turkey, received recently from tie 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 IPjaz, should report on the health of the pilgrims. 2. The presence of several vessels of war to interrupt maritime communication. 3. An organized surveillance over the Egyptian coast to prevent any disembarkation in infringement of the prohibition. The manner of carrying this plan, into execution was set forth as follows : 1. In the event of cholera breaking out among the pilgrims, the members of the Ottoman Commission, assisted, if need be, by other medical men appointed ad /tor, shall report 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 embarkation, and shall invite all pilgrims destined, for Egypt to proceed thither by land. 8. At the same time the vessel of war shall send away from the ports of embarkation all steamers and sailing vessels 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- coast, commencing from a point to the south of Jiddah to be determined. Further, they shall assign to the suspected vessel, after re-victualling them, in case of necessity, a locality on the coast of Arabia — Tor, for instance — where they shall perform quarantine. 56 HISTORY OF THE CHOLERA. 5. With regard to the caravan, it must be stopped, as ia usual, several days' march, from Suez, where it shall be visited 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 rule, namely, to make them wait till the end of the interdiction. However, it may be possible to assign 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 Bel instant, several modifications were made in the French proposals, owing to the strong objections urged by the English delegates on behalf of the Indian pilgrims. By paragraph three, as it now stands, the ships of war are to send away all steamers and sailing vessels from the ports of embarkation only ; and paragraph six has been altered as follows : " 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' inarch 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 fumigating 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 sheetlead, by bending the edges upward, and numbers of them are placed on the floor and elsewhere in the hold, and statelooms, 57 HISTORY OF- THE CHOLERA. (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 hydrochloric acid is poured on the manganese, twenty or thirty carboys being necessary. This is done as rapidly as possible, 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 permeates everything, perfectly neutralizing all infection, killing all insects and animal life, and deodorizing everything impure or diseased. If by any accident a fire should be burning, 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 in 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 necessarj r 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 evacuate 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 quaranle, signifying forty. EARLY TREATMENT. In 1854 certain towns in England were almost shielded from this dreaded enemy by preparing their sanitary defences 58 HISTORY OF THE CHOLERA. I 5n lime. Worcester, on the Severn, entirely escaped it. In Ibis country it is recorded that in Philadelphia the most active .measures were taken to guard the public health in the epidemic of 1819; 2,970 privies were cleaned ; 340 houses were cleaned by the authorities; 188 poiids drained , 66 rag and bone-shops closed, and in all, over 6.000 flisfincJi 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 dirtfest streets, and reduced the deaths to some 633. la Baltimore very few deaths occurred. The great desideratum for the treatment of the disease is to meet it early. The danger with the premonitory symptom — ihc .painless diarrhoea — is that nobody' thinks anything of it. The poor are especially negligent of this warning. One symptom of the disease is the indifference it inspires. It is related that in the medical house-to-house yi si rations 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 reports of the General Board of Health of London, it appears that out of 30,000 cases treated early, of which 6,000 were developed cholera, only 280 went to the state of collapse. This is the fact which justifies the excellent plan already suggested — the house visitation and treatment. The great malter with the poor is to provide remedies quickly, and to lead them to guard immediately against the diarrhoea. For oilier persons, the 'medical advice is, as soon as this 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 ihe disease there is but little danger. The number of deaths to cases treated at this period are wonderfully small. HISTORY OF THE CHOLKEA. 59 PERSONAL AVOIDANCE OF THE CHOLERA. Dr. Sayers holds that if the people understood the single fact that cholera always is preceded by certain premonilory symptoms, such as lassitude, languor, debility, and a diarrhea:!-, 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 attention to the first symptom, which is diarrhoea.' At the very first approach, the patient should assumq. a horizontal posture and retain it, with the hips Higher than the shoulders, 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 tiling 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 slay at his friend's house Keeping this position for forty-eight hours, in the majority of instances, the disease will pass over, and the patient, on recovery, need make no Vcj-y great changes in his mode of life. Of course, if he lias bad habits, he should reform them ; eat and drink ra row ally, and attend to business as usual, but not overdo ii. In the present state of the atmosphere, when pestilence is abroad, t lie system is rendered more liable to exhaustion, and he should husband his strength by avoiding violent exercise. VAKIATIONS 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 individua — from the simplest diarrhoea with little pain aud' no 60 HISTORY OF THE CTTOLTCU A.. 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. Sometimes the premonitory symptoms are protracted, and the patient 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~ iiveness, 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 Ms 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 suddenly stricken to the earth, vomited, turned cold, and died. Between 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 twentyfour 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 th 3 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 longer able to perform those violent motions — so that theyj HISTORY OF THE OITOLERA. 61 together with the cramps, usually disappear somet ime before death. 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 purging 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 reaction, it is a favorable sign, and generally announces the return, of circulation. The spasm at the pit of the stomach is often very acute, and the belly is almost always drawn toward 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 accelerated at an early stage, and on the accession, of spasm or vomiting, suddenly disappears from the extremities. On the cessation of the vomiting or spasm, and -"sometimes, apparently, 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 email, 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 countenance, or the hoarse, plaintiye whisper (vox cholerica), or the discolored skin, or the chilled breath ; 62 HISTORY OF THE CHOLERA.. r I r 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 cholera, 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. " A rise of temperature has been repeatedly observed to take .place just before death : but the development of heat under such circumstances 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 tho arterial system, or of any improvement in the function of respiration. The heat, in such instances, has continued well marked for some hours after death. The skin, in complete collapse, is- generally insensible even to the action of chemical 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 operation ; nor can leeches draw blood from an early peried of theattack. The bluenes*, so characteristic of cholera in tho East, has by no means been found an invariable, or even a very common phenomenon in England or 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 collapsed and flaccid. The gall-bladder is, almost without exception, 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 commonly, 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 remarkably 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 in 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 bloodvessels of the vertebral column and spinal cord may be noticeably congested, and in some cases there are marks of inflammatory 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 occurrence. The following, by Dr. Hamlin, condenses all that can be >¦¦ 80 lIISTOKY OF THB CHOLERA. i ¦v.-. .. said on the subject. His statements are clear, and his experience enables him to speak with confidence on the subject: 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 become prevalent in the United States : Dear Sir — The cholera, which has just left us after committing 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 bo 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 thoughtless indiscretions of some member of a household, may invite 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 perspiration would comprise a large number. A strong, healthy, HISTORY OF THE OHOI.EHA. 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 locality ; 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 refreshing breeze wan 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 disturbance 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 attack 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 perfectly 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 mental 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 diarrhoea continues for a day or two, and the foolish person keeps about, then suddenly sinks, sends 82 HISTOKY OW TUB CHOLERA, I for the physician, and before lie 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 diminishing doses ; twenty- tiye, twenty, fifteen, ten, nine, when careful diet is all that will be needed. In case the first doso does not stay the diarrhoea, continue to give it in increasing doses— thirty-five, forty, forty-five, sixty — at every movement 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 onethird 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 tho pit of the stomach, and kept on till the surface is well reddened. 3. The patient, however well he may feel, should rigidly 83 HtSTOBT Of TnS, CHOLKBiu ! observe perfect rest. To lie quietly on the back is one-half of the battle. In that position the enemy fires over you, but the moment you rise you are hit. When attacks come in the form of a diarrhcea, these directions will enable every one to meet it successfully. 4. But when the attack is more violent, and there is vomiting, 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 Washb urn— have used it in very many cases with wonderful success. It consists of equal parts of laudanum, tincture of capsicum, tincture of ginger, and tincture of cardamom seeds. Dose, thirty to forty drops, or half a teaspoonful in a little water, 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. TKEATMENT OP 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, fop when that has become decided and unmistakeable I have never known the patient to recover. 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 vanishing 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 CHOLEBA, especially the extremities, sinapisms and friction, will often in an hour or two work wonders. Thirst.— ln 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 tke 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 nourishmefit, 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 Decoction, 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 ali 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 revived 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 vomiting), etc., a few pounds of pounded mustard, a bottle of brandy, a paper of camomile flowers, and a paper 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 remedies recommended by physicians, but I have found none to be at all compared with the above. During the recent 85 HIBTORX OF THB OHOLEBA. |p cholera I cannot find that any treatment haa been so successful 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-contagiousness 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 OHOLKEA. 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 unhealthy 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 prefer making insurances here. These are certain tests, statistical 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^era, that very few if any died who slept in the second story, 4* '. Tlw Uon>H*art«d Ha»%«iX, 41. Old Jim of tk* 41 Th« Whit«-Hetni*4 Haat» k! t2« S*o« of Lealt lilaaA. 81. Sily«rhe«l», t? 1 ¦¦; SOJr&BOOXS. SH? , Origin, history, cases, prevention and cure of cholera, WCB 069 1865 Condition when received: The inside page of the front paper cover bore an old mend that obscured the gutter text. In addition, there was an old mend that obscured a word on the last line of text. Conservation treatment: The old mends and associated adhesive were softened using methyl cellulose (A4M, Talas) as a poultice and removed with a Teflon spatula. The mends were reapplied using tosa tenguio (Japanese Paper Place) and wheat starch paste (zin shofu. Bookmakers). Conservation carried out by Rachel-Ray Cleveland NLM Paper Conservator, 08 / 2007 NATIONAL LIBRARY OF MEDICINE NLH 02Tf13i471 1 MEDICAL LIBRARY