A NOTE OF WARNING. 
LESSONS TO BE LEARNED 
FROM THE 
CHOLERA FACTS 
OF THE 
IP_A_ S T YIEjAIR,, 
AND FROM 
RECENT CHOLERA LITERATURE. 
15 Y 
EL Y Me CL ELL. IX,' rftrLK' 
SriMJEOX UNITE!) STATICS AUMV. 
FROM THE DECEMP.ER NO. RICHMOND AND LOUISVILLE MEDICAL JOURNAL. 
LOUISVILLE, KY.: 
RICHMOND AND LOUISVILLE MEDICAL JOURNAL BOOK AND JOB STEAM PRINT, 
101 Green Street, 2<i door west of Post-office. 
1870. As the Author was unable to read proof he asks attention to the 
following— 
Page 3 line 3 for cholera, Asiatic, read Cholera Asiatiea. 
p. 4 line 14 for foci read focus. 
p. 5 line 12 for infliction read infection. 
p. 11 line 10 for we read they. 
p. 11 line 17 for prediction read suggestion. 
p. 21 line 5 for as a Christian read or a Christian. 
p. 21 line 15 and 10 omit words those of. 
p. 22 line 12 for few roads read three roads. 
p. 22 line 19 read, no other clothing either by day or night, 
p. 20 line 7 for ablutions read ablution. 
p. 30 line 5 for refutes read refute. 
p. 37 line 1 for of read with. 
p. 37 line 24 omit the word who. 
p. 39 line 24 for were read teas. 
j). 39 line 3 for Lent read Tent. 
p. 41 line 3 for word such read greater. 
p. 42 line 22 for of Thudichum read by Thwdiekwm. 
p. 42 line 23 for his read this. 
p. 43 line 1 for indicates read indicate. 
ERRATA. With the Pompliments 
aF THE AUTHOR. A NOTE OF WARNING. 
LESSONS TO BE LEARNED 
FROM THE 
CHOLERA FACTS 
OF THE 
PAST YEAR, 
AND FROM 
RECENT CHOLERA LITERATURE. 
B Y 
ely McClellan, m. b., 
Surgeon United States Army/ 
FROM THE DECEMBER NO. RICHMOND AND LOUISVILLE MEDICAL JOURNAL- 
LOUISVILLE, KY.: 
RICHMOND AND LOUISVILLE MEDICAL JOURNAL BOOK AND JOB STEAM PRINT, 
101 Green Street, 2d door west of Post-office. 
1876. ASIATIC CHOLERA. 
During the past eighteen months, the English, Indian and 
Continental sanitary observers have recorded outbreaks of 
cholera, Asiatic, in various portions of India and Turkey in 
Asia. Such records have their significance as indicating the 
gradual approach of cholera (A.)* to Europe. As such they are 
accepted by European sanitarians, and it is time that American 
authorities should shake off the lethargy which in former years 
has permitted this disease to enter and to devastate this conti- 
nent, and by the judicious employment of those methods which 
science has placed within their grasp to prohibit the importation 
of the disease. 
The time has surely come when American physicians should 
carefully study the innumerable facts which have been gathered 
of the movements of this fatal disease throughout the world, to 
base their theories f upon these facts and not upon hypotheses % 
which they may have been taught. It is therefore proposed in 
this article to gather together all the cholera notes which have 
appeared during the years 1875 and 1876, and to present them 
with some notice of recent cholera literature and remarks upon 
the great truths therein contained, for the consideration of such 
professional men as may be interested in this study. 
Early in 1875 cholera (A.) was reported to have become epi- 
CHOLERA ASIATICA IN SYRIA. 
* Cholera Asiatica. 
f A true theory is a legitimate deduction from many facts, not contra- 
dicted by equally numerous and equally well attested facts. An hypothesis is 
an idea or supposition or conjecture, which remains to be proven.—Peters. 
A theory is founded on inferences drawn from principles which have been 
established by evidence.—Fleming. 
t An hypothesis is a guess or supposition made concerning the cause of some 
particular fact, with the view of trying experiments or making observations 
to discover the truth. A theory is a complete system of suppositions put to- 
gether for the purpose of explaining all the facts that belong to one science.— 
Taylor. 4 
ASIATIC CHOLERA. 
demic in Syria, and Dr. George E. Post,* surgeon to Saint 
John’s Hospital at Beirtit, reports such facts as could at the 
time be gathered as to the epidemic. 
“ The disease first developed at Hamath, a Turkish town of 
some 50,000 or 60,000 inhabitants, in the person of an Albanian 
recruit, some 500 of whom had recently been received at the 
garrison. These recruits are reported as being in bad sanitary 
condition at the time of their arrival, but there was nothing to 
excite suspicion that any of them had been exposed to cholera 
(A.) infection. 
“On the 22d of March a case of cholera (A.) occurred in the 
person of one of these recruits, and it was soon followed by 15 
others in the garrison; of these 16 cases, 15 proved fatal. 
From the foci thus established at the barracks the disease 
spread to the town. 
“ From Hamath a detachment of troops were sent to Da- 
mascus. They carried the disease with them, and soon all the 
villages along the line of march were infected. Early in June 
the disease developed in Damascus, a panic occurred. The in- 
habitants scattered in all directions, and carried the disease to 
Lebanon and anti-Lebanon, points which had in other epidemics 
proved safe asylums from its ravages. July 5th a woman of 
Damascus arrived by Diligence at Beirfit. Two days after her 
arrival she died of cholera. This case and probably others 
which followed, established ‘foci’ of infection at that town, but 
the disease did not become epidemic until seven days after the 
■first case had died.” 
1 As yet but fragmentary notes of this epidemic are at our 
command. We quote from the “Lancet” and the “Medical 
Times and Gazette.’’! From these journals we learn that the 
Syrian authorities were at first disinclined to acknowledge that 
the disease at Hamath was cholera (A.), and it was not until 
the disease had become virulently epidemic that any steps were 
taken to investigate the outbreak and the condition of the suf- 
fering communities. Such, unfortunately, is the early history 
of almost all epidemic diseases of a virulent character. Local 
authorities almost invariably attempt to cover up the existence 
of infectious diseases, in the vain hope that by so doing the 
* Lancet, London Edition, August 28, 1875. Dr. Post is the distinguished 
son of Dr. Alfred C. Post, of New York City. 
f The London editions of both journals alone used. ASIATIC CHOLERA. 
5 
financial prosperity of the infected locality may not be disturbed. 
Such events have but lately transpired upon our own shores. 
It was known for some time that yellow fever was virulently 
epidemic at the Havana. Vessels with passengers, crew and 
cargo, were constantly arriving at ports of the United States, 
and one morning a case suspiciously like that disease occurred 
in the city of Savannah. Prior to the occurrence of this case, 
one or more infected vessels had arrived at that port. The first 
case was rapidly followed by others, the mortality each day in- 
creased, and still the very existence of the disease was held as a 
state secret. Finally the explosion occurred, the fact could no 
longer be concealed, the infliction spread over the city. Those 
of the inhabitants who possessed the requisite means left the 
place, and the daily telegraphic reports announced the death of 
many refugees, some as far north as New York city. Had the 
importation been cholera in place of yellow fever, many 
points of infection would have been established, and by this 
time an epidemic would have been established. 
To return to the Syrian outbreak. On the 24th of July it 
was reported that Dr. Dillon, the resident sanitary officer of the 
Turkish government at Mossul, had been sent to Hamath; but, 
unfortunately, on the fourth day after his arrival he was taken 
with cholera (A.) and died. August 14th it was reported that 
Antioch, Salahich, Deir Ali, were infected, and that the disease 
had become epidemic among the Druses. September 18th the 
disease was reported at Aleppo, Tripoli, Beyrout, Lattakia and 
Sienket Haibe in the Lebanon. October 30th it was stated 
that cholera (A.) had greatly abated in Syria, but on the 18th 
of December it was prevalent at Kirsada and Insi Mossul. 
With these notes the record of the Syrian outbreak closes. 
A commission of experts are, however, upon the ground; all 
events will be thoroughly sifted and subjected to a rigid exami- 
nation, when it will undoubtedly be found that this demonstra- 
tion of the disease has in no way departed from those already 
on record. 
A leading article in the “New York Times” upon this sub- 
ject is of interest, as throwing some light upon the circumstan- 
tial evidence which already surrounds this demonstration : 6 
ASIATIC CHOLERA. 
“ No great Asiatic pestilence has ever scourged the East or 
Levant and allowed Damascus to escape. At least two great 
caravans, the pilgrimage of Hadjis from Bagdad and the great 
commercial caravan from the same region, have for centuries 
made the plain of Demeshk-i-shem their terminus, and these 
caravans carry pestilence in their train under any and every 
quarantine which European skill can devise and Turkish ad- 
ministration execute or attempt to execute. It was by this 
ready path that the plague entered Palestine when the troops 
of the French Directory occupied it, and entered it again under 
Napoleon’s sedulous imitator Ibrahim Pasha, thirty years later. 
The great commercial caravan this year (1875) would have 
reached Damascus, in the usual course of events, shortly before 
the breaking out of the cholera whose devastation is just an- 
nounced, and it will not be surprising if later advices prove the 
caravan to have been its source, as present news places its 
beginning on the caravan route.” 
Hamath is north of Damascus a little over one hundred miles, 
but is upon the great route of travel to and from that city. 
It is as yet impossible to account in detail for this outbreak of 
cholera, although the route by which the infection would prob- 
ably again reach the eastern shores of the Mediterranean and 
Russia was last year indicated by Dr. Peters.* 
Although from Hamath the spread of the disease (from the 
foci therein established) over Syria is clearly demonstrated, Dr. 
Post rather inclines to the belief that it was an endemic out- 
break. The untimely death of Dr. Dillon will probably prove 
an obstacle to the development of the initial facts of this dem- 
onstration, but developed they will surely be, possibly before 
these pages issue from the press. 
It is, however, perfectly allowable for us to judge this out- 
break by the history of former epidemics, and a recent commu- 
nication of Dr. James McCraith,f Surgeon to the British Sea- 
men’s Hospital of Smyrna, entitled “How the cholera got into 
Salonica and was carried out again without accident” is cer- 
tainly suggestive as regards this outbreak. 
“ Salonica is a walled Turkish town, open only at the sea 
entrance. At this town during each epidemic of cholera, the 
surveillance exercised is said to be extreme. In 1865 the 
* Cholera epidemic of 1873 in the United States, p. 689. 
f Medical Times and Gazette, December 11, 1875. ASIATIC CHOLERA. 
7 
quarantine establishment of the city was removed to a long 
distance on the coast, and at this establishment some fifty or 
sixty fatal cases of the disease occurred. 
“ During the height of the disease at the quarantine, the 
inhabitants of Salonica were startled to learn that cholera (A.) 
had occurred at a small village but one hour’s distant, with 
which the city was in free pratique, and that several cases had 
proved fatal. Immediate investigation followed, and it was 
proven that the head of the family in which the disease had 
first occurred had a few days previously visited Salonica to 
purchase supplies; that while in the city he had purchased a 
'grego' or great coat, made of goats’ hair, from a man who had 
been employed at the quarantine, but who by some means had 
gotten into the city; and it was positively determined that this 
coat had belonged to a man who had died of cholera (A.) at the 
quarantine.” 
Dr. McCraith remarks, that Salonica was saved from the 
disease by the merest accident, for had the grego been sold in 
the Jew quarter of the city, an epidemic undoubtedly would 
have been developed. 
Immediately preceding this outbreak in Syria, there had been 
no unusual activity of cholera (A.) in India. It must, how- 
ever, be remembered that in certain portions of the Indian Em- 
pire (the Presidencies of Bengal, Bombay, and Madras, and 
notably only those portions of these Presidencies that lie upon 
the coast) the disease is endemic; that each year there are two 
or more outbreaks of the disease. The hill country is com- 
paratively exempt from the disease; yet to this, in these later 
years, there have been marked exceptions, as will be hereafter 
shown. That the disease was by no means quiet, however, is 
shown by the report of Dr. Henry King,* the Acting Sanitary 
Commissioner with the Government at Madras. This report 
shows that in a population of rather more than 31,250,000 in- 
habitants there were, in 1875, 87,943 cholera deaths. 
The Indian reports for the period of which we are treating 
also indicate a startling advance of the disease. The hill sta- 
tions, the Sanitaria, can no longer be considered as health re- 
CHOLERA IN INDIA. 
* Medical Times and Gazette, March 25, 1876. 8 
ASIATIC CHOLERA. 
sorts, and this not from any fault of their location, but simply 
from the indifference of the local authorities, who have permit- 
ted, year after year, the simplest sanitary laws to be disre- 
garded. It would seem as if these same authorities had been 
determined to demonstrate, beyond a peradventure, the truth 
that cholera (A.) can be carried wherever man may wander; 
and that the disease may be propagated in any locality, no mat- 
ter how far removed it might be from malarial or telluric in- 
fluences. 
Simla, the summer seat of the Government of India, is 
located in the Himalayas, to the north of Hurdwar, upon the 
northern borders of the Punjab, at an elevation of 7,000 feet 
above the sea, and distant from Calcutta over a thousand miles 
of travel. It is acknowledged to be the most beautiful hill san- 
itarium in the world. It formerly consisted of but Peterhooff, 
the summer residence of the Viceroy, the establishments of 
other officials and their dependants; but it would now appear 
as if the sanitary authorities were satisfied “ with the pureness 
of the mountain air as a safeguard against the diseases of the 
plains; for on the face of every hill houses are piled one above 
the other from the bottom to the top, and thus the drainage 
from the uppermost houses saturates and poisons the soil around 
those below them. In the very centre of the station, in the 
worst possible site that could have been selected for it, is placed 
a foul and crowded native bazaar. The principal thoroughfare 
leads through this bazaar, and every one passing along it is ex- 
posed to the malarious vapors which such a locality must needs 
generate.”* 
Since 1865 cholera (A.) has almost yearly appeared at Simla 
in a deadly form, and it must be accepted as a very strong 
argument that the disease will occur and develop its virulent 
power wherever it may be carried by human agencies, and 
wherever it finds, when so conveyed, a suitable nidus. Further 
evidence that this sanitarium has been destroyed by human 
agencies alone is found in the report of the Sanitary Commis- 
sioner with the Government for India in 1865.f 
* Medical Times and Gazette, Nov. 6,1875. 
f Proceedings of Sanitary Conference of Bengal, 1875. ASIATIC CHOLERA. 
9 
“ The sides of the hill8 were everywhere studded with human 
excrement, and the smell which arose in every direction was 
a disgrace to a place which professes to be an asylum for the 
sick; the water was contaminated. In summer the dry beds 
of the mountain torrents are places of convenience and filth. 
The edge of the hill, at a few yards distant from the public road, 
was lined with filth, and was evidently the resort of the numerous 
native servants of the locality. At some distance lower down 
the slope is the spring from which the water supply of the sum- 
mer residence of the Viceroy and many of the largest and best 
English houses in the vicinity is drawn. What must occur 
after every rainfall is but too obvious.”* 
The “ Medical Times and Gazette ” of October 23, 1875, notes 
the fact that the Sanitary Commissioner has advised the aban- 
donment of Simla for the next three years, and the removal of 
the summer seat of Government to Raneekhet. 
At the same date that the outbreak of cholera (A.) of 1875 
was reported at Simla, the disease had become epidemic at Kus- 
cuolie, the latter also a sanitarium. This is a point of inter- 
est to cholera students, as it is the locality at which Pringlef 
was able to determine the way in which the Cordon-de-Sant6 
had been broken in 1872 and the station infected by cholera. 
Pringle traced the epidemic of that year to a cow-feeder who 
returned to the sanitarium after a visit to some infected villages 
upon the plains. 
October 2, 1875, cholera (A.) was reported to have broken 
out amongst the European garrison at Delhi. 
May 15, 1876, the disease was reported to be spreading 
through Cashmere. 
August 5, 1876, cholera (A.) is again reported at Simla and 
at Darjuling and Murree. 
It will be observed that the reports we have noted relate to 
the “ up country ” stations of India. No note is made of the 
violent outbreaks of the disease near the coast, especially those 
in the Presidency of Bombay, although they are the undoubted 
starting points of these epidemics. Persia and the remaining 
Asiatic States remain to be heard from, when the advance of a 
* Macnamara, Treatise on Cholera, p. 262. Macnamara, History of Chol- 
era, p. 397. 
f Edinburgh Medical Journal, Sept., 1874, p. 231. 10 
ASIATIC CHOLERA. 
new epidemic for the nations of the western world may be an- 
nounced, and it3 progress, step by step, may be mapped out. 
Without further comment upon these facts, we pass to the 
consideration of certain valuable additions to cholera literature 
which have been issued during the present year. The works to 
which we refer are from the hands of gentlemen whose names 
are familiar to all students of the disease, and who are received 
as authorities upon this subject by the vast majority of readers. 
I. Reports of the Medical Officer of the Privy Council and 
Local Government Board. New Series, No. V. Payers Con- 
cerning the European Relations of Asiatic Cholera, Submitted 
to the Local Government Board in Supplement to the Annual 
Report of the Present Year. London. 1875. 
II. A History of Asiatic Cholera, by C. Macnamara, F. C. 
U., Surgeon to the Westminster Hospital. London. Macmil- 
lan $ Co. 1876. 8vo., pp. 466. 
III. Cholera Epidemics in East Africa; an Account of the 
Several Diffusions of the Disease in that Country from 1821 till 
1873, with an Outline of the Geography, Ethnology, and Trade 
Connections of the Regions through which the Epidemics passed. 
By James Christie, A. M., M. D., late Physician to the Sultan 
of Zanzibar. London. Macmillan # Co. 1876. 8vo., pp. 508. 
The first volume which we notice is the last of that most 
valuable series of reports on Public Health, published under 
the supervision of Mr. John Simon, who has been for many 
years, as is known to all, the Medical Officer of the Privy 
Council. 
The attention of the sanitary authorities of Great Britain 
having been turned to the examination of the two last cholera 
(A.) epidemics in Europe, the task of collecting and of present- 
ing the evidence obtained was assigned to Mr. Netten Badcliffe, 
who is known as a careful and accurate sanitary observer, who 
has especially interested himself in the study of cholera (A). 
As to the manner in which this task has been performed, we 
can but quote the introductory remarks of Mr. Simon : 
“All the facts point to a single conclusion as to the spread of 
the disease—namely, that human intercourse is the single active 
factor in diffusing the infection. Detailed observation of par- ASIATIC CHOLERA. 
11 
ticular outbreaks of cholera and suggestions of analogy and 
experiment have long led European pathologists to believe that 
the disease possesses great, though peculiar, power of spreading 
from the sick to the healthy; and Mr. Radcliffe in his very 
wide epidemiological study finds no reason to impute to cholera 
(outside of India) any other mode of origination and extension 
than such as that doctrine expresses.” 
Sanitary students have long been under obligations to Mr. 
Radcliffe for original experiments, plainly expressed opinions, 
and invaluable suggestions. To him we are indebted for the 
first steps which led to the observations from which the work, 
third upon our list, was formed. 
Radcliffe, in 1865, directed attention to the occurrence of 
cholera (A.) upon the slave dhows running north and captured 
off the coast of East Africa previous to the cholera (A.) appear- 
ing in the Hedjaz, and he suggested that the disease must 
have existed in East Africa at that period. This prediction 
has now become a fact. In this report Mr. Radcliffe has 
adopted the form of a narrative of facts, and these facts all point 
but to a single conclusion as to the spread of the disease, and 
that is that human intercourse is the single active factor in dif- 
fusing the infection. 
As regards the question of quarantine, which has for years 
been a vexation to sanitarians, Mr. Simon, in consideration of 
all earlier data, and the later facts presented by Mr. Radcliffe, 
remarks: 
“That a quarantine of a sort to be trusted in as a national 
defence is not conceivable, except in proportion as a people live 
apart from the great highways of commerce, or are ready and 
able to treat their commerce as a subordinate political interest; 
that though undoubtedly quarantine planned with the precision 
of a scientific experiment and conducted with extreme rigor, 
may keep cholera out of places (such as remote islands) where 
the extremely difficult conditions can be completely fulfilled, 
yet, under other circumstances, quarantine can not reasonably 
be expected so to succeed, and must be regarded as a mere irra- 
tional derangement of commerce. Seeing that cholera is dif- 
fused in all directions by means of constantly moving streams 
of religious pilgrimage and commercial enterprise, the first 
condition of treating a contagion so distributed would be to 
‘ immobilize ’ at discretion the great tides of human intercourse; 
a manifestly impossible project.” 12 
ASIATIC CHOLERA. 
Later, he writes : “ It can not, I think, reasonably be doubted 
but that, as conditions of filth, and especially as filthy condi- 
tions of water supply are the main facilitating conditions for the 
dissemination of cholera in Europe, so they must be immensely 
potent influences in favoring the advance of cholera from sta- 
tion to station in successive epidemic outbreaks in the countries 
which lie between India and Europe; and it would seem certain 
that, along the whole succession of lands which transmit the 
streams of westward traffic from India, common hygienic vigi- 
lance in respect to those conditions may be of very great effect 
in impeding the diffusion of cholera.” 
Macnamara, for many years was Surgeon to the Calcutta 
Ophthalmic Hospital, and during the entire period of his resi- 
dence in India was a most enthusiastic cholera student. In 
1870 he published a treatise on Asiatic Cholera; a work noted 
for the clearness of the testimony offered and for the boldness 
with which his deductions were advanced and defended. He is 
known as an exponent of that thoroughly practical theory which 
claims that cholera (A.) is a disease of human beings, which is 
carried from place to place “through a continuous chain of in- 
dividuals affected with the disease or through articles stained 
with their dejecta." This theory, which has enlisted the entire 
sympathy of the most distinguished cholera observers of the 
world, offers (should its premises prove to be true) the only 
means of escape which communities exposed to the infection of 
the disease may avail themselves of. 
For should the disease be conveyed by an epidemic wave of 
some mysterious oscillating material which is influenced by tellu- 
ric or meteorological disturbances, what steps may be taken 
against it? Or, should the disease originate in that wonderful 
atom termed malaria, supported by local influences, such as filth, 
etc., the only remedy to be found is in the herculean task of 
removing from the face of the earth all decomposing matter 
which may engender malaria. 
Upon either proposition it is fruitless for communities to hope 
that they may guard themselves. Better than indulge in so 
vain an effort whenever cholera occurs, they should adopt the 
legend of the dark ages and write upon their walls “ the visita- ASIATIC CHOLERA. 
13 
tion of God.” Fortunately, we are not called to bow to such 
blind theory and to submit to be led to the slaughter. The 
same mighty power that let loose this dread disease has also- 
appointed the way of escape. By exercising the intellectual 
powers which they received from their creator, Snow, Farr, 
Simon, Budd, Peters, Macnamara and others have elaborated 
this practical theory, supported by an indisputable array of 
facts, and this theory places in the hands of all communities 
the means of guarding against the disease. 
Cholera (A.) is not a contagious disease, per se, but when the 
excreta of a person suffering from the disease have reached a 
certain stage of decomposition (or, as a late writer put it, of 
development) it becomes infectious and is capable of reproducing 
the disease, is the argument which is advanced, and to prevent 
the excreta of such cases reaching this stage is the remedy 
offered. 
Within the compass of Macnamara’s work will be found a 
comprehensive, but of necessity condensed, narrative of the 
travels of cholera (A.) from the times of Vasco di Gama to the 
present. Such an array of truths are presented as must con- 
vince the most skeptical, provided they will allow the immen- 
sity of the facts, gathered from the entire range of cholera his- 
tory of all nations, to drive from their minds some isolated in- 
stances of individual experience in their native villages, which 
have hitherto obscured all else from their eyes. 
It is very true that in detail Macnamara has been telling 
again the same old story, and that perchance it may not have 
been told in any more appealing style than that adopted by 
others, yetthe facts not theories advanced will be forever dupli- 
cated by cholera (A.) epidemics, and each outbreak will more 
clearly demonstrate the assertion that no epidemic of cholera 
(A.) has ever occurred in Asia, Europe, Africa or America, 
without leaving a broad trail, by means of which it may be 
traced back to its point of eruption in British India. 
We are accustomed to hear it stated in this country that the 
government of India has produced the best practical workings 
the world has ever known. Nothing can be more fallacious 
than this statement; and that which has been hinted at by 14 
ASIATIC CHOLERA. 
former authors is by Macnamara most strenuously insisted upon. 
It is a surety patent to all fair-minded students that cholera (A.) 
originates alone in India, and that the entire civilized world 
has a right to demand that all necessary measures be taken by 
the government of that country to prevent the escape of the 
disease from their borders; and it is still more true that while 
under the auspices of this Indian Government much has been 
written upon sanitary improvements, little or nothing of a prac- 
tical nature has been accomplished. Why so little has been 
accomplished, and why the Indian Government should be held 
to a strict accountability, will be obvious to all who make them- 
selves familiar with the story as now told by Macnamara, and 
as it has been told again and again by Peters and others. 
So long as the great religious festivals of the Hindoo are 
tolerated; so long as the death-rate of these unfortunates i3 
annually as great as it is at present (for we read that at Puri, 
the site of the far-famed temple of Juggernaut, there are annually 
12,000 cholera deaths, and as yet the government has attempted 
at this point no sanitary surveillance, as they have at Hurdwar, 
Allahabad and other points); so long as these unfortunate people 
are permitted to collect by the hundreds of thousands in lodg- 
ing houses, the very description of which is sickening; so long 
as the priests are allowed to batten upon the sale of “holy 
food; ” so long as these worshipers, worn out by the fatigues of 
travel, by debaucheries, and by bodily infirmities, are permitted 
to pursue their weary way along all thoroughfares, so long 
will cholera (A ) be conveyed from the holy cities to all portions 
of India and to all nations of the world. 
At the present day it is surely madness to dispute the array 
of truths as presented in this the latest history of the disease, 
and to assert upon the strength of instances of insignificant 
value that the facts narrated can tend but to this broad truth. 
Strange as it is, there certainly are numbers of such misguided 
individuals, and conspicuously among them we find the name 
of the statistical officer of the Sanitary Commissioner with 
the government for India. The reports of this gentleman are 
based upon communications made to him by medical officers 
located throughout Bengal. It is a notorious fact, that of late ASIATIC CHOLERA. 
15 
years in Bengal little or no effort lias been made to keep any 
record of the migrations of cholera, for it has long been assumed 
that the disease is only blown about by the winds, and therefore 
any inquiry into the track of an epidemic is useless. 
This state of medical opinion undoubtedly results in great 
measure from the dogmatic assertions of this statistical officer, 
who found himself obliged to differ with his predecessors to in- 
sure his own notoriety, must perforce manufacture a theory, and 
having observed locusts borne by the wind 500 miles out at 
sea, concludes that cholera (A.) is an aerial something which 
can also be blown by the wind like the locust, a few dropping 
here and there, while huge swarms settle down in other places. 
It is most pitiable to notice in his reports such childish illustra- 
tions as the following: “I have often said that no palpable 
manifestation realized to my mind the idea of the diffusion of 
the impalpable agent, cholera, except a locust flight. At one 
time leaving not a trace behind, at another dropping individuals 
only from the locust cloud, at a third sending down powerful 
offshoots; the locust flight darkening the sky overhead, tra- 
verse the widest tracks until it alights, because it has struck 
against an aerial wall of obstruction.”* 
“ The flight of locusts appear to have deposited their eggs, 
and the larvae are described as covering the country. 
“ The locusts are out over almost all the entire country. 
They are now doing little harm, but great apprehensions are 
entertained for the result when the young crops are produced.”f 
It is evident from such remarks that Bryden infers that there 
are cholera eggs or germs as well as those of locusts. As 
cholera often travels against the strongest winds and has often 
been manifestly carried about by cholera patients, soiled cloths, 
etc., the germs of cholera must attach themselves to persons 
and clothes. Bryden’s theory, when stripped of its false 
assumptions about aerial conveyance, unwittingly gives proof 
and force to the more correct theory of human conveyance. 
It is very true that the task of tracing cases of cholera (A.) 
* Thia aerial wall must be an opposing wind, but against opposing winds 
cholera often travels. 
f Report on the general aspects of epidemic cholera in 1869, part 2, page 38. 16 
ASIATIC CHOLERA. 
through Bengal in these later days is a task of gigantic propor- 
tions. The native population is immense, estimated at 100,000,- 
000. The movements of pilgrims are so vast that no one knows 
how cholera (A.) enters the various cities, towns and villages, 
for the natives exercise all their cunning to avoid falling into 
the hands of the English medical men. Add to these obstacles 
the apathy induced by a temperature of 90° to 105° in the 
European, and then, to all else, the reprehensible conduct of 
the statistical officer in obstinately contending for his theory, 
and it is easy to understand how all spirit of independent inves- 
tigation is well nigh crushed out among the Bengal medical 
men, and they can find nothing human in the diffusion of the 
disease. It is unfair to say that this gentleman has been mis- 
led by the reports of his subordinates, for it may justly be 
charged that he has misled the local medical men, not they him. 
The expose made by Macnamara will undoubtedly bear good 
fruit, and if naught else is accomplished by his work, for this 
alone the world will remain his debtor. 
Dr. James Christie, late physician to the Sultan of Zanzibar, 
has been known to the Profession as a cholera observer for 
some years. In 1870 and 1871 he published in the “Lancet ”* 
papers upon cholera in East Africa, and having achieved a most 
signal success in collecting data, has given to the world a valu- 
able work. It is certainly to his credit that in the wilds of 
Africa, surrounded by all the privations of life in Zanzibar, he 
has been able to track out the course of this disease better than 
it has been done in many more favored lands. 
One of the most fortuitous results of this work is the public 
refutation which is made of the much-quoted statement of the 
Bengal statistical officer, that the cholera which occurred upon 
the East coast of Africa, in Zanzibar in 1869, was bloivn over 
in a few days from India.f It will be remembered that this 
statement was made in spite of the of Dr. Kirk, of 
Zanzibar,! “that the epidemic had come from the West to the 
coast of Zanzibar,” and it has long been known to students that 
* Lancet for 1870 and 1871. 
f General aspects of epidemic cholera in 1869. J Ibid, page 38. 17 
ASIATIC CHOLERA. 
this same Bengal officer suppressed the positive fact given by 
Kirk, that the disease arrived by caravan from the Northwest. 
Christie demonstrates beyond a peradventure, that the Mecca 
cholera in 1865 had crossed the Bed Sea at Suakem and Mas- 
suah in Nubia, traveled along the northern caravan route down 
through Abyssinia and Ethiopia, and that the disease was epi- 
demic upon this route from 1866 till 1869, when it reached Zanzi • 
bar from the West and not from India on the East. In making 
this statement, Christie modestly states “ that this fact seems 
to have escaped Dr. Bryden’s attention,” but at the same time 
he asserts that the fact was distinctly stated in an official report 
sent to Bengal.* Kirk also repudiates utterly the statements 
of Dr. Bryden,f and proves that the cholera reached Zanzibar 
only by propagation along the line' of human travel, and that 
it was several years in reaching Zanzibar from Mecca.J 
It would be quite unfair to make these statements without 
presenting in detail the proof. 
The first report of Dr. Kirk, dated November 25, 1869, 
states, “ it is now more than a month since the first rumors 
reached us of the approach of cholera from the West.”$ 
Dr. Bryden suppressed part of Kirk’s second official report, 
which was dated February 6, 1870, in which he states a fact 
which Christie|| writes was well known to every one in Zanzi- 
bar : “ Cholera came to us by the Masai, or northern caravan 
route.” Christie says this seems to have escaped Dr. Bryden’s 
notice, for the statement is distinctly made that the epidemic 
came to the coast from the West along what is known in Zanzi- 
bar as the northern caravan route, and he “ feels assured that 
Dr. Kirk would repudiate the conclusions arrived at by Dr. 
Bryden, and maintain, on the contrary, that the epidemic in 
East Africa was not air-borne by the northeast monsoon of 1869, 
but was propagated along the line of human intercourse, as he 
distinctly states, from the Masai country.”^ 
Dr. Bryden makes no notice of Dr. Christie’s reports in 1871 
and 1872 to the Epidemiological Society of London. 
* Kirk’s Official Reports, Nov. 25, 1869, and Feb. 6, 1870, 
f General Aspect of Epidemic Cholera in 1869, p. 38. 
J Christie, op. cit., pp. 97-118. $ Christie, op. cit., pp. 465-474. 
|| Ibid, p. 460. Ibid, p. 466. 18 
ASIATIC CHOLERA. 
From such an expose, it is evident that if Dr Bryden is capa- 
ble of so many suppressions and deviations of the truth about 
one epidemic, how many may he not be guilty of in the scores 
of epidemics he has described ? 
The simple truth of all this is, that the Bengal officer sup- 
pressed so much of the reports of these gentlemen as interfered 
with his theory, trusting, no doubt, that Zanzibar was so far 
away that no one would detect him; but fortunately the eyes 
of careful observers were on his work. Peters, of New York, 
first called attention to his error. Netten Radcliffe followed it 
up, and now Macnamara, Christie, and Kirk have sent him 
completely to the wall. 
The reports of this Bengal statistical officer are filled with 
such inaccuracies and childish conclusions, that they are un- 
worthy to be longer received as authority. It would be well 
could we stop here; but the results of this theory have had so 
much effect upon others; have caused so many “ one-sided ” 
opinions to be recorded, and have in reality produced such dis- 
astrous consequences in Bengal, that we are compelled to call 
attention to a recent and striking illustration. Two medical 
officers of the British service, on special duty with the Sanitary 
Commissioner with the Government for India, have, for the past 
few years, been frequently before the medical world through the 
medium of their microscopic examinations. The work which 
they have produced is certainly wonderfully good, and would 
stand forever to their credit, had they evidently not strained 
their conclusions to suit the theories now fashionable in Bengal. 
The most recent demonstration upon which we base this asser- 
tion is to be found in the “ Lancet ” of this year.* 
Surgeon-Major J. Fairweather, Civil Surgeon at Delhi, re- 
ported that during the epidemic of 1875 a fatal disease strongly 
resembling cholera broke out among the cats of the city. He 
details at length a series of experiments made by him to deter- 
mine the possibility of inducing this disease in cats by the ex- 
creta of human cholera patients, as well as the communicability 
of this disease from one cat to another. These experiments are 
conscientiously reported. The cases of failure are even more 
* Lancet, July 22 and 29, 1876. 19 
ASIATIC CHOLERA. 
prominently noted than those of success, while the notes of 
post-mortem appearances are conspicuous. At the request of 
the Sanitary Commissioner, the entire viscera of two cats (one 
of which died of the natural disease and the other of the in- 
duced disease) were preserved in spirits and sent to Calcutta to 
be examined by Drs. D. Cunningham and Lewis, and the notes 
of these gentlemen appended to the original paper are a won- 
der of one-sided investigation. Their report concludes as fol- 
lows : “ The specimen sent from Delhi showed no anatomical 
or microscopic appearance indicating that the animals from 
which they were obtained had been affected by cholera or any sim- 
ilar disease.''' 
The grounds upon which this opinion was based appear to 
have been: 1. That the intestinal contents gave an acid reac- 
tion with litmus paper;* 2. That a round worm was found in 
the intestines, which worm frequently gives rise to intestinal 
disturbance and severe vomiting in their hosts; 3. That in an 
experiment made by them with two cats kept without food for 
twelve hours and then killed, the intestinal contents, according 
to their idea, were 11 scarcely to be distinguished from the spe- 
cimen sent down from Delhi.” 
The civil surgeon at Delhi was certainly most remiss not to 
have been cognizant of the fact that an epidemic of “round 
worms' had attacked the cats of that city; and further, that 
the human epidemic had diminished the supply of feline food; 
for certainly these two causes are sufficiently powerful to 
account for the large number of dead cats found daily by the 
police inspectors, or else the opinion which we have quoted 
bears the impress of local influence. 
The work of Christie contains much that is new and inter- 
esting. For the first time the great caravan routes leading 
from the city of Zanzibar are described. Upon them the way is 
now clear to study the travels of cholera (A.). These routes go 
out into the interior in various directions—south, west, north- 
west, and north. Upon them the caravans from the north meet 
* As regards the acidity of the intestinal contents, it must be borne in 
mind that the specimens had been immersed in alcohol for some time be- 
fore examination. 20 
ASIATIC CHOLERA. 
the caravans of the south; commodities are exchanged, among 
the list of which is cholera (A.). Here we find history repro- 
ducing itself; this time upon virgin soil. It has been conclu- 
sively shown that this disease is diffused over India by the an- 
nual “ pilgrims’ progress,” having as an initial point of depart- 
ure the great gatherings of the inhabitants. So we read in 
Christie “ that at Berbera, on the African coast of the Gulf of 
Aden, just below the Red Sea, there is annually held a fair, 
which lasts from October until April, the town being entirely 
deserted during the interval. It may be described as the meet- 
ing-place in Africa of the numerous tribes and the traders of 
the Red Sea, the Persian Gulf, the Gulfs of Oman, Aden, and 
various parts of India. Formerly as many as 20,000 strangers 
were usually collected there at one time, and although the fair 
has decreased much of late years, still there is annually a very 
large gathering. The inland tribes of Africa leave Berbera in 
the month of March on their return journey.”* 
New light is also thrown upon the great cholera outbreak at 
Mecca in 1865, when over 20,000 pilgrims died of the disease 
in six days. It is shown that cholera (A.) was epidemic at the 
homes of many of the pilgrims who had arrived from India, 
and that the Mecca outbreak did not occur until after the ar- 
rival at that city of these people. 
As we must henceforth look upon Mecca as a focus from 
which cholera (A.) has been distributed to the continent of 
Africa, it is well at this time to pass briefly in review some of 
the most important facts attending this great annual gathering. 
For many centuries there has been a perennial stream of pil- 
grims to and from the holy city of Mecca. To be present at 
the Kourban Bairam, which, by reason of the Mohammedan 
year being shorter than the Christian by rather more than 
eleven days, is gradually shifted from season to season through- 
out the year, is the great aim of Mohammedan life. To accom- 
plish this, homes are abandoned and the most exhausting jour- 
neys are undertaken. From the North Atlantic and Mediter- 
ranean shores of Africa; from Timbuctoo and Western Africa; 
from the borders of Siberia, the Danube, the Euxine, and the 
* Christie, pp. 126 to 147. ASIATIC CHOLERA. 
21 
Sea of Azof; from the western frontiers of China; from India, 
South Africa, and the most remote Mohammedan extensions in 
the East, a constant stream of human beings moves to and from 
Mecca. For the pilgrimage, at least once in a lifetime, is bind- 
ing on all true Mohammedans, and he who dies without having 
made it, may as well die a Jew as a Christian.* 
The return of one body of pilgrims is never accomplished 
before another body is upon the move. They arrive at Mecca 
in great caravans from Egypt, Damascus, and Persia, or at 
Jedda (the port of Mecca) upon native vessels. The misery of 
these pilgrims and the hardships which they endure have been 
fully set forth by the few Europeans'! who have succeeded in 
penetrating among the faithful at the celebration of their re- 
ligious ceremonies. 
The native vessels which carry pilgrims to Jedda rival those 
of any slave dhow ever captured. Each passenger receives but 
sufficient space upon which to squat. To stretch himself, he 
must encroach upon the territory of his neighbor. The intense 
beat of the day, the chill of the night, the privation from food 
and exercise, the loss of sleep induces a physical condition be- 
fore their arrival but little short of death; many die of ex- 
haustion before reaching port, and the great mass of those who 
land can with but difficulty drag themselves to the holy city. 
In the caravans persons of importance travel with considera- 
ble comfort, but the poorer classes are absolutely foot passen- 
gers, making their way by assisting at the loading and unload- 
ing of the camels, and subsisting upon the charity of the rich. 
Begrimed with filth (for the Moslem law allows sand ablu- 
tions where water is scarce), unprovided with changes of rai- 
ment, overpowered with penury and fatigue, the aged and the 
* A1 Koran. Translation by Sale, p. 152. 
f A Faithful Account of the Religion and Manners of the Mohammedans, 
etc., etc. By Joseph Pitts. London, 1708. 
f Translations of the Koran. Preliminary Discourse. G. Gale. London, 
1801. 
f Travels in Arabia. By J. S Burkhardt. Two vols. London, 1829. 
f Narrative of a Journey into Khorasan. J. B. Fraser. London, 1825. 
f Personal Narrative of a Pilgrimage to El Medina and Mecca. By Cap- 
tain R. F. Burton. London, 1856. 22 
ASIATIC CHOLERA. 
young engage in a scramble for existence, each actuated by tbe 
hope of reaching their highest earthly ambition of kissing the 
Black Stone in the Kaaba, or else fainting upon the road, “ they 
may depart to instant beatitude, for all who die during a pil- 
grimage are martyrs.” 
As caravans approach El Medina they are greatly increased in 
number by the addition of smaller bodies of pilgrims, taking 
advantage of the convergence of routes to this city made holy 
by having been the home and by containing the tomb of the 
Prophet. By the 25th of July of each year the city is thronged 
by vast crowds who stop to visit the sacred tomb. From 
Medina there are few roads to Mecca ; along them the pilgrims 
hurry; forced marches are made, and increased privations are 
endured. At certain fixed points upon all approaches to Mecca 
the ihram or sacred habit is -put on, without regard to age or 
infirmities ; the ordinary clothing is cast aside, and is replaced 
by two cloths; one of which is used to conceal the genitalia, 
while the other is thrown over the shoulders, and no other cloth- 
ing. Either by day or by night it may be worn until the pil- 
grimage is accomplished. 
With head and feet uncovered; forbidden to kill louse or flea 
upon their persons, or to hold intercourse with women, they 
enter upon the last stage of the journey. Of the ihram, Burk- 
hardt writes : “Whether assumed in summer or in winter the 
ihram is equally inconvenient and prejudicial to health, par- 
ticularly among the Northern Mohammedans who, accustomed to 
thick woolen clothes, are at this period obliged to leave them 
off for many days.” 
Having arrived at Mecca, the pilgrims, without rest or re- 
freshment, enter upon their religious duties. These duties have 
been so frequently described that any repetition is unnecessary, 
save upon two points having a direct bearing upon the diffusion 
of cholera (A.). The first duty is the visit to the Kaaba, the 
holy temple, the tomb of Ishmael, in which rests the stone let 
down from Heaven. Upon arriving at the Kaaba, it is urged 
as an especial duty that all pilgrims shall drink and perform 
their ablutions at the holy well Zem Zem. This is the spring 
which gushed out for the relief of Ishmael when, with his mother ASIATIC CHOLERA. 
23 
he was driven from the tents of his father Abraham. The well 
is in a room upon the southeastern portion of the Kaaba. Its 
mouth is surrounded by a wall five feet in height and about ten 
feet in diameter. Upon the wall attendants stand; the water 
is drawn in leathern buckets; each individual drinks all that 
he can, and upon each several skinsfull of the water are dashed. 
With this holy water each devotee is permitted to wash all per- 
sons of his body above the waist, but it must flow unobstructed 
over the lower extremities. 
The room is constantly flooded with the water thus used en 
douche, and it flows back into the well in a steady stream, car- 
rying with it the impurities obtained from the persons of the 
pilgrims. This water, when first drawn, is milkish in color. 
It is tepid, saltish, and bitter, though to a less degree than the 
other wells of the town. Its inordinate use, and the pilgrims 
always drink it to excess, invariably induces diarrhoea in, and 
a crop of boils upon, the persons of those who drink it. It is 
so holy that none may be lost; with it the floors of the Kaaba 
and its surrounding porches are daily washed, and the water 
thus used is eagerly drunk by the lower classes of the pilgrims. 
Nearly every family in the town obtains daily a jar of this 
water, which they use only for drinking and ablutions. Few 
pilgrims quit Mecca without carrying some away in bottles of 
copper or tin. Clothes are dipped in it, folded, and laid care- 
fully away, to be used at far distant homes as winding-sheets. 
It is impossible to overestimate the influence of Zem Zevn water 
in the diffusion of cholera, both at and from Mecca. 
The succeeding duties of the pilgrims are arduous in the ex- 
treme. Even the strong and hardy Burton, who visited Mecca 
as a Moslem, was unable to complete them through sheer 
fatigue. 
The sanitary condition of Mecca, at the time of the festivals, 
is thus described by Burkhardt: * “ Kubbish and filth covered 
all the streets, and nobody appeared disposed to remove it. The 
skirts of the town were covered with the carcasses of dead 
camels, the smell from which rendered the air, even in the midst 
of the town, most offensive, and certainly contributed to the 
* Travels in Arabia. Vol. II., p. 85. 24 
ASIATIC CHOLERA. 
many diseases now prevalent. Several hundred of these car- 
casses lay near the reservoirs of Hadj, and the Arabs inhabit- 
ing that part of Mecca never walked out without staffing into 
their nostrils small pieces of cotton, which they carried sus- 
pended by a thread around the neck. But this is not all; at 
this time the Meccans are in the habit of emptying the privies 
of their houses, and being too lazy to carry the contents beyond 
the precincts of the town, they merely dig a hole in the street 
before the door of the dwelling and therein deposit them, cover- 
ing the spot only with a layer of earth. The consequences of 
this habit may be easily imagined.” 
Again he writes: “The termination of the Hadj gives a very 
different appearance to the temple. Disease and mortality 
which succeed the fatigues endured on the journey are caused 
by the light covering of the ihram, the unhealthy lodgings at 
Mecca, the bad fare, and sometimes absolute want, fill the 
mosque with dead bodies carried thither to receive the Imam’s 
prayer ; or with sick persons, many of whom, when their disso- 
lution approaches, are brought to the colonnades, that they 
may either be cured by the sight of the Kaaba, or at least have 
the satisfaction of expiring within the sacred enclosure. Poor 
Hadjys, worn out with disease and hunger, are seen dragging 
their emaciated bodies along the columns. When they feel 
their last moments approaching, they cover themselves with 
their tattered garment, and often a whole day passes before it 
is discovered that they are dead. There are several persons in 
the service of the mosque employed to wash carefully the spot 
on which those who expire in the mosque have lain, and to 
bury all the poor and friendless strangers who die at Mecca.” 
As the Moslem endeavors to secure the rapid decomposition 
of the dead, the most primitive methods of interment are 
adopted. Their burial grounds are described as dangerous 
places, and Captain Burton was frequently obliged to resist with 
armed force parties who would bury their dead within the very 
shadow of his tent. Absolutely no sanitary precautions are 
adopted at Mecca to prevent the origin or spread of disease. 
The formulae of Inshallah and Kismat are used in the place of 
methods of prevention, and epidemics are looked upon as pun- ASIATIC CHOLERA. 
25 
ishment of God upon the sins of the world. In face of all the 
causes of disease which riot in this ancient city, it is an abso- 
lute fact that cholera (-4.) has never occurred there until after the 
arrival of the Indian pilgrims ; until after they have joined the 
vast crowd, and until after the disease has occurred amongst 
them* 
An explosion of cholera (A.) having once occurred at Mecca, 
the terror and confusion becomes almost indescribable, but the 
sense of religious duties is so strong that the ceremonies are 
never abridged. They progress at their usual rate, and the dead 
and the dying are packed in with those as yet uninfected. The 
duties once completed, the vast crowds struggle to escape from 
the holy city even more eagerly than they did to enter it. With 
death staring them in the face, they set out upon the return 
journey. Their track is marked by the dying and the dead. 
None can stop to care for the sick or to bury the dead. It is a 
race for life. 
Among the caravans, the virulence of the disease generally 
subsides in traversing the arid waste of Arabia, but the poison 
fixed upon articles of clothing, camp furniture, and merchan- 
dise, is the means by which outbreaks of the disease are occa- 
sioned in cities upon the routes to far distant homes. 
Among the pilgrims returning in the native dhows, exposed 
to alternations of heat and moisture, filth and overcrowding, the 
disease remains in violent presence until land is made. Not 
infrequently dhows have been found at sea, drifting, with car- 
goes of dead and dying. 
At Mecca it is thus shown the essential factors of a cholera 
outbreak are frequently gathered together. An immense mass 
of human beings, soiled and prostrated by long journeys, suf- 
fering from the want of food, the want of rest, the most intense 
mental excitement, the head and feet exposed, without covering, 
and the body with but a single cloth, to the fierce rays of the 
Arabian sun; scorched by day and chilled to the bones by 
night; the specific poison of cholera lurking in the garments 
of some of the pilgrims; Zem Zem water to furnish the 
* See Radcliffe on Origin of the Diffusion of 1875. Op. cit., p. 14. 26 
ASIATIC CHOLERA. 
medium in which this poison may multiply itself; the intense 
solar heat to hasten the development of virulence in this specific 
poison which until this combination of moisture and heat was 
inert and harmless; it may be asked, if these garments were 
infected with cholera matter, why was it that the disease did 
not develop during the long journey from which these people 
had just arrived, especially as frequent ablutions is an article 
of faith with them ? The answer is found in the fact, that upon 
long desert journeys water is a commodity more precious 
than gold, and that simply the form of ablution by rubbing the 
hands and face with sand is the rule under such circumstances. 
It is more than probable that of the 100,000 individuals who 
upon that day, in 1865, were gathered around the holy well Zem 
Zem, the bodies of nine-tenths had not known water since 
leaving their homes. 
In connection with this Arabian story the influence of pil- 
grims and tramps of all nations and to other shrines in convey- 
ing infectious diseases from country to country presents itself 
in strong light, and to it the attention of sanitarians has of late 
years been directed. The pilgrimages to and from India and 
Arabia have been studied, their influence in the dissemination 
of disease has been positively determined, and it behooves us to 
apply the same measure of investigation to other countries. 
Eussia, especially her southeastern provinces, is at present the 
most interesting of all the new fields of study. It will be 
remembered that in 1872 Pelikan announced that cholera (A.) 
had become endemic in this portion of the empire; but Netten 
Badcliffe was able to show that the disease which had existed 
for so long a time was not the result of acclimatization but 
rather that of constant importation. 
Dr. John C. Peters, whose investigations have done so much 
towards establishing the truth as to this disease, and whose 
memory will be cherished long after the names of those who 
have attempted to defame him have been forgotten, has lately 
called attention to the pilgrims of Eussia. He quotes Dr. W. 
H. Dixon,* who writes: 
“ Next to his religious energy, the mastering passion of the 
* Free Russia, page 34. ASIATIC CHOLERA. 
27 
Russian is the irresistible craving of his heart for a wandering 
life. All Slavonic tribes are more or less fond of roving to and 
fro, of peddling, tramping and seeing the world. 
“ A pilgrim perfect in bis calling will go from shrine to shrine 
for several years. They go in bands of 50 or 60 and some 
reach the valley of Nazareth, the heights of Bethlehem and 
Zion and return to the shrines at Kieff. You meet them on 
every track, you find them in the yard of every house. They 
creep in at back doors and carry about with them relics and 
rags which they vend at high rates. A bit of rock from Naz- 
areth, a drop of water from the Jordan, a thread from the 
Saviour’s seamless coat, a chip of the genuine cross. 
“ Thousands of such vagrants roam about the country, and 
the peasant who thinks the crossing of his doorstep by a pilgrim 
brings him blessing, not only lodges him for the night, but 
helps him on the road by day. Every year they go to Kieff 
and other Russian shrines, and to Jerusalem. Annually some 
hundreds achieve the highest effort of kissing the stones in 
front of the Redeemer’s tomb.” 
In any country infested by disease and by tramps, who can 
truthfully declare that an individual in whom the disease has 
developed has not come in contact with infected persons ? The 
negroes upon a Mississippi plantation may have been kept at 
their work by day, and, so far as their master was able, to their 
cabins at night; but who can positively assert that these cabins 
were not, during the darkness of the night, the refuge of 
some tramp, who departing before day left the disease behind 
him. The mere assertion of individual opinion is of no value 
if it can be shown beyond the possibility of a doubt that no 
communication with the infected objects, animate or inanimate, 
existed. The case is different. The evidence, however, must 
be submitted to critical investigation before it can be accepted 
as final. 
Macnamara,* having access to the reports of the Government 
Emigration Agent at Calcutta, is able to throw some light upon 
the subject of the introduction of cholera (A.) into the West 
Indies in 1872, and the data furnished of cholera upon the Sea 
Queen, the Humbar, the Poonah, the Kate Killock, and the For- 
farshire, in 1872; the Emnor, the Golden Fleece, the Sir H. Law- 
rence, the Hereford, and the Lochlomond, in 1873, has probably 
* A history of cholera, p. 361. 28 
ASIATIC CHOLERA. 
furnished the clew by means of which the introduction of the 
disease into the United States in 1873 may be robbed of its 
mystery.51' 
It may be well to briefly recall the evidence found and offered 
so far as relates to the introduction of the disease in the United 
States in that year. In attempting to investigate the initial 
steps of this outbreak, we were at once confronted by the asser- 
tion, that the disease had originated in or near the city of New 
Orleans, that it was of domestic origin, and that it could not 
be traced to any foreign importation. The task of eliciting any 
further testimony than that presented by the State Board of 
Health was well nigh hopeless, but by dint of patient investi- 
gation the following truths were established. 
1. That the majority of the first 25 fatal cholera cases narrated 
in the report of the Board of Health originated upon the steam- 
boat and ship levees of the city of New Orleans. 
2. That a total of 6,079 foreign emigrants arrived at the 
port of New Orleans in 1873, 5,869 of whom were from Europe. 
3. That the emigrant boarding-houses face the river upon 
the steamboat levee, and that during the months of January, 
February and March, 1873, the majority of these houses were 
filled with emigrants. 
4. That the quarantine maintained at the Mississippi river 
station during the months of December, 1872, and January and 
February, 1873, was utterly worthless, and that the reports of 
the quarantine officer could not be relied upon. 
During that investigation it was several times intimated to 
us that cholera (A.) had existed in the West Indies during 
the late months of 1872, but the only tangible fact we could 
find was the report of the United States Consul at Kingston, 
Jamaica, that a coolie ship had arrived at Bluff’s Bay in that 
island, having lost some 60 coolies from the disease, and that 
one case had occurred upon the island since the arrival of that 
vessel. The official report of the Commissioner of Emigration 
of the State of Louisiana shows that in 1873, 210 emigrants 
were received by him from West Indian and South American 
ports, but no record of the number of passengers or the num- 
* Cholera epidemic of 1873 in the United States, page 104. ASIATIC CHOLERA. 
29 
ber of the crews o£ the vessels could be obtained. The evi- 
dence furnished by Macnamara will undoubtedly bear fruit in 
due season. 
It is at present a notorious fact, that during the past year 
cholera (A.) having escaped from India spread to the eastern 
shores of the Mediterranean. It is also true that during the 
past year there have been violent explosions of the disease in 
India, and that the disease more frequently breaks out in the 
hill country than it has ever before done. It is a fact that a 
considerable body of Mohammedan troops in Syria became in- 
fected with the disease, which they communicated to the sur- 
rounding country. Again, cholera history is in the process of 
repeating itself. Nations are arming for the final contest be- 
tween the cross and the crescent. The followers of Mohammed 
are ranging themselves upon the line of the Danube. The 
Porte will from necessity call in all her outlying bodies of 
troops, and it may be looked upon as a matter of almost abso- 
lute certainty that before the eastern question is settled cholera 
will have invaded Europe; and in one or two years North 
America will in all probability be called upon to record a new 
epidemic of the disease. 
The time therefore has come when it is necessary that medi- 
cal men should consider with care all facts which have been 
elicited from previous epidemics. The subject is so vast, the 
interests at stake are so vital, that all minor considerations 
should be set aside, and while the differences of opinion of all 
fair reasoning minds should be respected, no one should hesitate 
to form and record his opinion. 
By a considerable number of American medical men cholera 
(A.) is looked upon as an endemic disease of malarial origin. For 
the consideration of such gentlemen we would recall attention to 
a statement made in the history of the cholera epidemic of 1873, 
page 659. During the late civil war, the United States had in the 
field an army of 2,335,942, or during the years of the war a 
mean strength of about 783,905 men. These troops were in 
camps constantly exposed to all the vicissitudes of campaigns, 
or were in hospitals where, in spite of the lavish precautions 
which were adopted frequently, all the disadvantages of over- 30 
ASIATIC CHOLERA. 
crowding and deficient food were present. Vast numbers of 
men were transported to and from the scene of active opera- 
tions upon steam transports. Prison pens were formed, in 
which overcrowding, bad ventilation, indifferent police and 
unsuitable food were present to cooperate with local malarial 
influences upon the unfortunate prisoners, and these events 
occurred within the limits of the worst malarial districts of the 
United States. 
The record of the medical history of the war demonstrates 
that there occurred, in the army, of malarial diseases, one million 
four hundred and sixty eight thousand four hundred and ten 
cases, with forty-six thousand three hundred and ten deaths, 
and of intestinal diseases, one million seven hundred and sixty- 
five thousand five hundred and one cases, with forty-four thou- 
sand eight hundred and sixty-three deaths* Add to these 
figures the statistics of the United States Navy and those of 
the Confederate Army and Navy, and the mass of circumstan- 
tial evidence is overwhelming. The figures at our command 
give a total of ninety-one thousand one hundred and seventy- 
three deaths from malarial and intestinal diseases occurring in 
a highly malarial district, and yet not one case of cholera (A.) 
occurred upon the continent. As if to emphasize this fact, of’ 
the two million three hundred and thirty-five thousand nine 
hundred and forty-two men composing the army of the United 
States, but three hundred and five deaths occurred from cholera- 
morbus. Reverse this picture. The war was at an end, the 
armies of the North and of the South had been disbanded but 
a few short weeks, when cholera (A.) having been imported into 
the United States, the movements of recruits for the small stand- 
ing army of the nation diffused the disease and induced the 
American epidemic of 1866 and 1867. 
By the movement of troops in India this disease has, time 
and again (since the memorable epidemic in the army of the 
Marquis of Hastings) been carried from one station to another. 
In 1832 the troops en route for the Black Hawk war scattered 
the disease over the Northwest and down the Valley of the 
Mississippi to the city of New Orleans. The Crimean war ex- 
* Cholera Epidemic of 1873 in the United States, p. 659. ASIATIC CHOLERA. 
31 
hibits another notable instance of the diffusion of cholera (A.) 
by the movements of armies. The movements of a few recruits 
in 1866 scattered the disease over the States, and in 1867, by 
the movements of but two infantry regiments, the disease was 
diffused over the high dry plains of Kansas. We, ourselves, 
in the latter year, were upon duty with a moving column of 
troops infected with the disease, among whom it did not “die 
out ” until the head-waters of the Arkansas river were reached, 
in the heart of the Sierra Nevada. 
This evidence is so plain and so convincing that it is almost a 
work of supererogation to add additional testimony. Upon it 
we would present for consideration the following propositions: 
Proposition I.—Cholera (A.) has never yet originated upon 
the North American Continent, hut that it has invariably 
reached its shores after it has been transported across the Atlantic 
ocean. 
The stability of this proposition having been established, the 
work of arresting the disease after it has been imported and of 
protecting the interests of the communities committed to our 
care, is a matter of small difficulty. (We write of communities 
in the interior of the continent.) But there are many who will 
not recognize the value of this illustration, and to such we 
would throw out for consideration the following queries: Has 
an epidemic of cholera (A.) ever occurred on the American 
Continent at a time when the disease was confined to India ? 
Has an epidemic of cholera (A.) ever occurred in the inte- 
rior of the American Continent prior to the announcement of 
its arrival in Western Europe, or at the seaports of North 
America? 
During the past few years we have heard much of two in- 
stances of mysterious development of cholera (A.) during the 
year 1835 in the States of Kentucky and Mississippi, but the 
gentlemen who use these illustrations either forget or are igno- 
rant of the fact that throughout the years 1832,1833,1834, and 
1835, cholera (A.) was not only epidemic in the United States, 
notably in the Valley of the Mississippi, but that each year a 
fresh importation of the disease occurred. In 1832 cholera (A.) 
was imported into the harbors of Quebec and New York from 32 
ASIATIC CHOLERA. 
Great Britain. In 1833 it was imported into New Orleans from 
the West Indies. In 1834 Quebec again received the disease 
from Europe, and in 1835 New Orleans, La., and Charleston, 
S. C., received it directly from the Island of Cuba. 
We assert confidently and without fear of satisfactory contra- 
diction that all the facts which can be gathered prove the truth 
of this proposition, and we maintain that upon its truth the 
safety and well-being of all communities lying within the bord- 
ers of North America depend, and these communities should be 
possessed of sufficient information to enable them to discrimi- 
nate between counsellors whose opinions are valuable and those 
whose opinions are worthless. The time has come when the 
health office of great cities should not be entrusted to inexperi- 
enced men from party considerations alone; such individuals 
are in the majority of instances unable to properly discharge 
their duties, and they may often be classed among those (to 
borrow an illustration) who are ignorant even of their own un- 
fitness, or of the very existence of knowledge which they do 
not themselves possess. 
The diffusion of a proper knowledge of cholera (A.) among 
the laity of American communities is influenced to a marked 
degree by those medical men who are unable to distinguish 
between cholera Asiatica, cholera sporadica, cholera morbus, 
and some forms of pernicious intermittent and remittent fevers. 
These gentlemen will tell one “that they know cholera, for they 
have treated it all their lives,” and they are seemingly oblivious 
to the fact that America has known but five epidemics of the 
disease; that there was a lapse of thirteen, four, ten, and six 
years respectively between each epidemic, when the United 
States was absolutely free from the disease. 
We are reminded of a notable instance of this ignorance 
which occurred in a large city during the heated term of 1874. 
The leading newspaper of that city one morning contained the 
startling intelligence that a fatal case of Asiatic cholera had 
occurred the day before, giving detailed particulars. Being 
anxious of adding to our stock of cholera knowledge, we tele- 
graphed the gentleman reported as having had charge of the 
case, asking its identity, and received the answer now before us. Pages 33-40 missing ASIATIC CHOLERA. 
41 
body has been subjected are due each of the post-mortem 
changes which have been reported. Space, however, forbids 
the extension of the subject to such length. 
The analogy between the symptoms presented in cases of death 
from haemorrhage and those of death from cholera (A.) are most 
striking; but it must be borne in mind that the collapse of 
cholera differs from that of haemorrhage in this, that in cholera 
it is but the fluid contents of the blood vessels that are drawn 
off, the solid constituents remain, the corpuscles are rendered 
unfit to carry oxygen, and the diseased mucous surfaces are un- 
able to absorb fluids which may come in contact with them. In 
haemorrhage the entire constituents of the blood flow away, 
but the power of absorption is present and is rapidly accom- 
plished. 
The rationale of a case of cholera (A.), when viewed from the 
standpoint of this practical theory, is as follows: The specific 
poison of cholera gaining access to the stomach of an individ- 
ual whose digestive powers are impaired (either by disease, 
fatigue, mental emotions, privation from food, excessive debauch 
of every description, or from anything which may tend to ren- 
der the intestinal juices alkaline), a rapid proliferation of the 
morbid matter takes place. This morbid matter fastens upon 
the intestinal epithelium, destroys and strips it off. The irrita- 
tion caused by this induces the primary symptoms of the dis- 
ease. The villi of the small intestines having lost their epithe- 
lial covering, an exudation of the watery constituents of the 
blood occurs. As the dehydration is accomplished, the tissues 
are called upon, and to the rapid abstraction of the major por- 
tion of the water in the economy the subsequent symptoms of 
the attack depend. 
Instances are recorded of the recovery of dropsical patients 
from attacks of cholera (A.) where so complete had been the 
abstraction of the fluid that the skin hung in loose folds upon 
the body.* 
If cholera (A.) is a disease of the intestinal mucous surface; 
if the symptoms of the disease are induced alone by the rapid 
dehydration of the economy ; if it depends alone upon the rapid 
* Medical Times and Gazette, August, 1866, p. 138. 42 
ASIATIC CHOLERA. 
pouring out of the fluid portion of the blood, why is it that the 
disease is not invariably fatal ? Why is it that, if left to Na- 
ture, about one-half of those attacked with the disease recover 
of themselves, although suppression of the urine may have 
existed, and fever and other complications may have occurred? 
To our mind, the most plausible answer which can be ad- 
vanced, is that of Dr. Pacini, of Florence, “ that in some cases 
the vessels of the mucous membrane beneath the detached epi- 
thelium become clogged with the viscid blood, which acts, in 
fact, as an impediment to the circulation through them, serving 
a curative purpose, just as a coagulum would do in the case of 
a wounded artery; for, by arresting the circulation, new epi- 
thelium is allowed to form over the abraded portions of the 
intestine, preventing the outpouring of the serum from the 
denuded vessels.”* 
This is an eminently practical theory of Pacini, and one which 
has all the well-known symptoms strongly in its favor; for we 
well know that the vessels of the mucous membrane become not 
only plugged, but at times they are intensely congested, and 
occasionally as reaction comes on they give way with a result- 
ant hsemorrhage.f 
The chemical analyses of the rice-water discharges of Thudi- 
chum are strong evidence in support of his theory. He writes : 
“Rice-water contains the following ingredients: Yibriones, 
cells from the surface of the intestines, granular debris of cells, 
mucine, modified hsemochrome, albumen, albuminous body giving 
rose-pink reaction, butyric acid, acetic acid, ammonia, leucine, 
inorganic salts. It is in an active state of decomposition and 
evolves gas, which at first is composed almost entirely of nitro- 
gen. Soon, however, carbonic acid prevails, and ultimately 
nothing but carbonic acid is evolved. At one period some 
hydrogen is developed. We can not discover any specificity in 
the above ingredients, but many of them are analogous to the 
products of ordinary processes of putrefaction. If it is ad- 
mitted that cholera evacuations acquire infective powers only 
after the period of fermentation, it is also easy to understand that 
the specific infecting power may belong to albumen or mucine 
at a particular stage of disintegration or chemical cleaverage.” 
The examinations of Thudichum, conducted with all the 
* Macnamara, op. cit., p. 345. f Idem., p. 449. ASIATIC CHOLERA. 
43 
appliances of a liberal government, indicates the existence of a 
considerable amount of molecular matter in these dejections ; 
and it is this molecular matter which is claimed to be the spe- 
cific infecting cause, when it has advanced to a certain stage 
of decomposition. This matter has been most carefully studied 
by Macnamara,* and from this study he is led to insist that it 
is this molecular matter having advanced to that stage, charac- 
terized by the presence of vibriones (not the vibriones them- 
selves), which is capable of inducing the disease. It is asserted 
by him “ that the fresh dejecta in the active stages of the dis- 
ease contain no vibriones, but toward the end of collapse, when 
the evacuations are passed less frequently, probably remaining 
in the intestines for some hours, vibriones may be seen in the 
fluid immediately after it has been passed.” 
By the majority of observers, it is insisted that the destruc- 
tion of the intestinal epithelium occurs during the life of the 
patient. Indeed, this is an essential to the perfection of this 
practical theory in the etiology of the disease. All the events 
in the clinical history of a‘case of cholera seem to bear out this 
theory; but Parkes, Aitken, Bruberger, Lewis, Cunningham, 
and others, object to this theory of ante-mortem epithelial de- 
struction, on the ground that they have been unable to discover 
any evidence of epithelial cells in fresh cholera stools. The 
solution of this difficulty, it seems to us, to be most easy. Each 
of the gentlemen enumerated have based their opinions upon 
the investigation of rice-water dejecta; that is, they have 
looked for the fragments of a dam in the mighty rush of the 
waters that followed its destruction. The rice-water dejecta are 
the result not of an effort on the part of Nature to eliminate from 
the blood any morbific material which it may contain, nor do 
they result from any disturbance of the nervous system, but 
they occur simply because the specific poison of cholera has 
stripped off the epithelial layer which formed the protective 
covering of the blood vessels, and there is naught to prevent a 
rapid exudation of the fluid portions of the blood. As the dis- 
ease advances, the entire mucous surface of the alimentary 
canal, from the mouth to the anus, is stripped of its epithelium, 
* Op. cit., p. 334. 44 
ASIATIC CHOLERA. 
and the process of dehydration is more rapidly performed. The 
dejecta in which to look for these fragments of the epithelium 
are therefore those of the premonitory stages, or in the first 
that are rice-water in character, not in those which are voided 
after the intestinal canal has been washed by the torrent which 
has poured through it. 
Oh, men ! who hold in your hands the most sacred domestic 
ties, abandon the hypotheses which have caused sorrow and 
mourning so often throughout the land. Abandon the teachers 
who have led you astray, and whose counsels have caused such 
destruction of human life. Study this practical theory. It is 
but a legitimate deduction from many facts not contradicted by 
equally numerous and equally well-attested facts. This theory 
has been the means of saving thousands of valuable lives; it 
has lessened the cries of widows and orphans; it is the means 
appointed by which dire calamity may be averted. 
The injury inflicted upon the world by the apathy and ego- 
tism of the Indian sanitary authorities can never be counter- 
acted. These authorities stand arraigned before the world for 
having permitted the continual escape of this dread disease 
from its home. Already Persia has so often been invaded that 
the domestication of cholera (A.) in that country may be taken 
as an assumed fact. Asia and Europe are, and perhaps always 
will be, exposed to its inroads; but America, surrounded by 
water, a hemisphere to itself, with natural advantages which no 
other nation enjoys, may, by the exercise of scientific prudence, 
keep the disease from its shores; nay, may defy it. 
The remedy is simple. 1. Prevent the importation of the 
disease. In a series of papers which we published during. 1874 
in the “American Practitioner,” and later in the “ History of 
the Cholera Epidemic of 1873 in the United States,” we ad- 
vanced and advocated the establishment of a national health 
office; not an office exercising any sanitary jurisdiction over 
the country, but an office at which sanitary information might 
be collected from all quarters of the globe, and from which 
prompt and reliable data could be furnished to all local health 
offices of the movements of infectious diseases. The small an- 
nual outlay which such an establishment would cost offers an ASIATIC CHOLERA. 
45 
efficient protection to the lives and property of 40,000,000 of 
people. Official information of the state of the yellow fever epi- 
demic at Havana would have placed in the hands of the authori- 
ties of Savannah knowledge which would have been a power in 
protecting that beautiful city from the ravages of the disease. 
2. Stamp out the disease in each and every instance in which 
it appears, after access to the continent has been gained. This 
is to be accomplished by the thorough disinfection of all of the 
excreta of such cases; the destruction of all fabrics that may 
become soiled with such discharges, and the employment of 
other hygienic measures. PERIODICAL mm LITERATIM 
Interesting to Physicians. 
Every physician who is just to his patients and to himself must read faith- 
fully and regularly the periodical medical literature of the day. It is only 
thus that he can learn quickly and correctly all of the improvements con- 
stantly taking place in every department of his Profession. To all who thus 
seek to make themselves most efficient in practice and most successful in com- 
petition, the undersigned offers the 
Biohme&d and Louisville Medical Journal 
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