CHOLERA HYGIENE 
By ely McClellan, m. d. 
ASSISTANT SURGEON U. S. A. 
[REPRINTED FROM THE AMERICAN PRACTITIONER, 1874.] 
LOUISVILLE: 
PRINTED BY JOHN P. MORTON AND COMPANY. 
1874. CHOLERA HYGIENE. 
By ely McClellan, m. d. 
ASSISTANT SURGEON U. S. A. 
[ Reprinted from The American Practitioner for February, 1874.] 
LOUISVILLE : 
PRINTED BY JOHN P. MORTON AND COMPANY. 
1874 CHOLERA HYGIENE. 
During the months of August and September, 1873, it 
was the fortune of the writer of these pages to witness the 
epidemic of cholera in the counties of Garrard and Marion 
of the state of Kentucky, and at a later date to investigate 
the manifestations of the disease as they appeared in some 
twenty-six counties of the state. 
A careful study of this epidemic, and a rigid comparison 
of the features presented by it with authentic histories of the 
disease, as well as those manifestations which the writer had 
witnessed in widely-separated regions of the United States, 
developed no new facts in the etiology of cholera. 
In the vast majority of the locations infected with cholera 
in the state of Kentucky during the past year the direct 
ii>iportation of the disease has been most satisfactorily proven. 
The facts relating to the individuals who acted as the porters 
of the disease have been obtained, and step by step, from its 
inception to its close, the epidemic has been traced. At a 
few points the data which relates to the importation of the 
disease is obscure; but as each of these localities is upon the 
line of public travel, it is safe to affirm that these instances 
present no exception to the fixed laws by which the progress 
of cholera is governed. 
In witnessing and noting the effect produced upon the 
public when the disease of the past summer was developed, 
the writer was profoundly impressed with several facts. 4 
Cholera Hygiene. 
I. The eagerness with which the public mind fastened upon 
any thing which could give information of cholera. This was 
not alone exhibited by those individuals who were influenced 
by personal fears, but by noble men and women, who lavishly 
poured out their substance as well as sympathy upon the sick 
and dying. 
II. The terror which was exhibited in some localities on 
the development of the disease, and the inefficient means 
adopted, from a want of knowledge, to prevent its spread. 
III. The utter impossibility of instituting proper sanitary 
regulations in a cholera district after the disease had become 
epidemic. 
Deeply impressed with these facts, and with the train of 
thought to which they lead, the following outlines of the 
etiology of cholera, and a statement of the sanitary pre- 
cautions which should be adopted to prevent the develop- 
ment and spread of the disease, have been prepared. Scarcely 
a doubt exists, judging from past experience, that cholera 
development can be controlled by sanitary measures, and 
that in isolated cases the disease can be stamped out by the 
proper use of disinfectants. But how powerless are sanitary 
officials in communities where the alarming ignorance and 
carelessness of individuals favor the development and spread 
of this most fatal disease! 
When the authorities of inland towns as well as of large 
cities are convinced of the efficiency of hygienic regulations 
in protecting the health of communities intrusted to their 
care; when the members of such communities are possessed 
of sufficient knowledge of the disease to enable them to 
perform their individual duties before, during, and after an 
epidemic; then may scientists who devote their attention 
to the preservation of the public health hope to effectually 
enforce such measures as may check cholera as effectually 
as vaccination has checked small-pox. 
That the death-march of cholera has not been arrested, Cholera Hygiene. 
5 
that again the disease has advanced to the Atlantic coast 
of Europe, that again the British islands have been invaded, 
that again the disease has been brought to New York harbor, 
renders it necessary that the possible development of cholera 
in America during the ensuing year should be met by every 
sanitary engine of destruction which it is within the power 
of the public to employ. 
On the 30th of September, 1873, four cases of cholera 
were reported to have reached Liverpool by direct importa- 
tion from Havre.* On the 7th of October of the same year 
a case of cholera was discovered on a ship from Caen, which 
had passed Gravesend, on the river Thames; and during the 
fall of the same year one Havre and two Hamburg steamers 
brought the disease into New York harbor. In each of 
these instances the disease was vigorously stamped out at 
the quarantine. 
The events of the next few months will determine whether 
the United States will again become inflicted with the disease 
from European importation, or whether the poison from which 
the disease is developed has remained dormant in localities 
which were affected during the past year, to be redeveloped 
in its full malignant power at a fitting season. 
What is cholera? This question—so often asked, so often 
answered—has been ably met by Macnamara, from whom we 
quote in detail: 
“ Cholera is a disease which is generated at all seasons of the year among 
human beings inhabiting certain parts of India. It is capable of being dissemi- 
nated over the world through the instrumentality of the fomites of those who 
suffer from the disease, though it may be only in the mild form usually described 
as cholerine. Cholera has a predilection for persons whose general health has 
been impaired from defective hygienic circumstances, from disease, want of proper 
food, or any similar cause. In the same way depression of the nervous force, by 
inducing an abnormal condition of the intestinal secretions, whether permanent 
or temporary, renders an individual peculiarly liable to an attack of cholera. 
“ The seizure is characterized by nausea, faintness, and a feeling of oppression 
in the praecordial region, griping pains in the abdomen, frequent watery purging 
* Medical Times and Gazette, October 4 and 11 and November 1, 1873. 6 
Cholera Hygiene. 
(the stools being alkaline when passed, and in appearance resembling rice-water), 
constant vomiting, suppression of urine, and profuse perspiration; the skin is 
inelastic, and that of the hands and feet shriveled and dusky; the eyes are 
sunk and the features pinched; cramps are felt in the limbs; there is difficulty 
of breathing, intense thirst, excessive restlessness, rapid, small pulse, and sup- 
pressed voice; the external temperature of the body sinks below 38° F., and 
a peculiar sweetish, sickly odor (fishy) is exhaled from the body, breath, and 
dejections. 
“ If left to nature about one half of those attacked with cholera recover 
of themselves, reaction supervening, and often being accompanied with fever, 
and not unfrequently with suppression of urine and various complications; or 
the disease may terminate within a few hours from its commencement in fatal 
collapse.” * 
A careful study of the various epidemics of cholera amply 
demonstrates the following facts: f that cholera, or that which 
produces cholera, is portable; that the poison may be carried 
from an infected locality to one that is healthy, and that in 
the latter the disease may be developed and assume a malig- 
nant epidemic form; that the disease advances in a general 
westward course through the world, and invariably follows 
the lines of travel; that the most active agents in its distribu- 
tion are individuals who, having become infected, it may be 
insensibly, at a point where the disease is epidemic, pass 
over the ordinary lines of travel, and place a greater or less 
distance, according to the length of the period of incubation 
and the rapidity with which the journey is performed, between 
the point of original infection and the localities at which they 
establish foci of disease; finally, that the cholera poison may 
be carried from an infected point to a healthy community, in 
which the disease may become epidemic, while the individual 
who has acted as the porter of the disease enjoys an entire 
immunity. 
* Treatise on Asiatic Cholera, C. Macnamara. Churchill & Sons, London, 
f Science and Practice of Medicine, Aitkin, Amer. ed., p. 620; Principles and 
Practice of Physic, Watson, Amer. ed., p. 916; Text-book of Practical Medicine. 
Niemeyer, translation; Notes on Asiatic Cholera, J. C. Peters, Van Nostrand, 
N. Y.; Cholera in Insular Positions, Smart, Lancet, May, 1873; Report on Epi- 
demic Cholera, Circular No. 5, S. G. O., Washington, 1867; Report of English 
Army Medical Department, London, 1871; “Channels through which Cholera is 
Communicable,” Murray, British Medical Journal, August, 1873. Cholera Hygiene. 
7 
Through the kindness of Dr. John C. Peters, who possesses 
a most accurate knowledge of the habits of cholera and of the 
topography of its favorite routes, whose maps are monuments 
of his indefatigable devotion to the study of this disease, we 
are able to trace in Asia and Europe the steps of the epi- 
demic which burst upon the United States during the summer 
of 1873. 
The great epidemic of cholera in the years 1865, ’66 and 
’67 left Russia with only eighty-three cases of the disease in 
1868. These cases occurred in Kiev, the holy city of Russia, 
situated on the river Dnieper, and to which city over fifty 
thousand pilgrims come annually. In 1869 there were nine 
hundred and eleven cholera cases in Russia, which spread 
from Kiev north-east toward Orel and Moscow, and down 
the river Dnieper to Odessa. In the mean time the great 
Hurdwar epidemic of 1867, in Northern India, had been 
carried along the north Persian route, by way of Jelalabad, 
Cabul, Herat, Meschid, to Asterabad, upon the Caspian Sea, 
across which it was conveyed by steamers to Baku, and from 
thence overland, by way of Tiflis, to Poti, upon the Black 
Sea. In 1870 cholera was developed at Taganrog, on the 
sea of Azof, and at Kertch, in the Crimea, and spread through 
Russia. In consequence of this importation, in 1870, in Rus- 
sia twenty thousand one hundred and forty cases occurred.* 
In 1869 a fresh outbreak of cholera occurred at Peshawer, 
in the Punjab. Again the disease was conveyed over the 
North Persian route toward Europe. At the same time it 
was carried down the river Indus, infecting all towns upon 
its banks, to the city of Kurrachee, at the mouth. From this 
point the disease was carried up the Persian Gulf to Bushire; 
from thence overland, by way of Shiraz and Ispahan, to 
Teheran, at which city the North and South Persian routes 
come together. 
* Practitioner, Oct., 1873, p. 308; Brit. Med. Jour., Aug., 1873, p. 220; Sixth 
Annual Report of the Sanitary Commissioner with the Government of India. 8 
Cholera Hygient. 
The ports of the Black Sea were again infected in 1870. 
The epidemic in Russia was re-enforced, and in 1871 there 
were three hundred and five thousand two hundred and twenty 
cases reported, and the disease was carried into Poland. By 
means of the travel upon the rivers Niemen and Vistula, 
which rivers are connected with the Dnieper by canals, 
cholera was carried to Konigsberg, Stiffin, and Dantzic, on 
the Baltic. In these cities the epidemic lasted during 1871, 
’72 and’73. In 1872 Prussia and Austria were invaded. Again, 
in 1873, did the disease appear in the Baltic cities, and spread 
through Europe to England. 
In February, 1873, cholera was reported in the city of New 
Orleans, but whether it was imported from Hamburg or from 
Rio de Janeiro remains to be solved. 
The epidemic of cholera, as it affected Garrard County, 
Ky., presents a notable instance of the portability of the 
disease. 
On the 10th day of August, 1873, a gentleman arrived in 
Lancaster, having traveled on horseback from Russellville, 
Tenn., which town prior to his departure was infected with 
cholera. A few hours after his arrival in Lancaster he was 
attacked with the disease. No care was taken to disinfect 
the dejections or in any way to isolate the case. He was 
visited by his father-in-law, who remained one night in the 
sick room; the next day was taken with cholera, from which 
he died in a few hours. The second victim to the disease 
was a negro man, who had been employed to nurse the case. 
From these cases the disease spread and became epidemic. 
The report of Drs. Berry and Wilson,* gentlemen who 
responded to the call of the suffering citizens of Lancaster, 
having been questioned by some ill-disposed individuals, we 
fully indorse, from personal observation, the correctness of 
the statement of these gentlemen. 
By the majority of authorities the period of incubation 
*A History of Cholera at Lancaster in 1873, Amer, Prac., Oct., 1873. Cholera Hygiene. 
9 
of cholera ranges from thirty-six hours to six days. Petten- 
kofer, in 1853, demonstrated that in some instances this period 
might be prolonged to twenty-one days. Taking into con- 
sideration these facts and the rapid rate of modern travel, it 
is in no way surprising that cholera strides across oceans or 
continents, and is developed almost simultaneously in widely 
separated localities. 
The late epidemic fully illustrates this fact. During the 
months of February, March, and April, 1873, cholera was in 
the city of New Orleans, but no point outside of that city 
was known to have been infected. During May nine distinct 
points, widely separated, but all within direct communication 
with New Orleans, were infected, and from these points the 
course of the disease can most easily be traced.* 
Central Kentucky furnishes several notable instances of 
the immunity from the disease which occasionally individuals 
enjoy, although they may be the carriers of the infection to 
others. 
Dr. L. S. McMurtry, of New Orleans, relates a case which came under his 
observation during a visit to Garrard County. A negro woman was attacked 
with cholera September 2, 1873, and died after fifteen hours’ illness. She had 
lived in a retired locality, had not been from home all summer, had been 
exceeding careful as to her diet, and her house was a comfortable cabin. No 
cases of cholera had occurred in the vicinity. Her death was followed by the 
development of choleraic symptoms in all the members of her family, from 
which two children died. No cause could be assigned to this outbreak until 
it was discovered that a boy from the infected district in Lancaster, which town 
was nine miles distant, was living in the house; that he had arrived a few days 
prior to the attack of the woman, and that since his arrival he had been in all 
respects one of the family. There can be no doubt that he was the infecting 
agent, although he personally escaped the disease. 
Dr. S. P. Craig, of Lincoln County, Ky., in describing the 
outbreak of cholera in the town of Stanford in that county, 
states “that cholera was developed, August 29, 1873, in a 
portion of the town occupied almost exclusively by negroes, 
and the disease was traced to a filthy privy and cesspool in 
rear of the houses in which the first cases occurred. Prior 
* Publication of the American Public Health Association. 10 
Cholera Hygiene. 
to this outbreak several refugee negroes from the infected 
district in Lancaster arrived at these houses, and remained 
until the disease was developed in Stanford. They are known 
to have used this privy. None of this party were attacked 
with cholera.” 
These are by no means isolated instances, but are fully 
corroborated by history of other epidemics. 
The distribution of cholera by individuals, the length of 
time to which the period of incubation-may be extended, 
and the fact that individuals may convey the poison without 
themselves becoming the subjects of the disease, fully refutes 
the theory “ that cholera is conveyed by some mysterious 
agency, which enables it to overleap all barriers and suddenly 
to develop itself in distant and isolated communities.” 
Endemic in that country which is watered by the Ganges 
and its tributaries, following the lines of travel, frequenting 
the large social and religious gatherings of the inhabitants, 
cholera ever strives in their dispersion to find an outlet from 
the country. Grand highways of pestilence have been formed, 
and the trails of the disease are found over Asia, Europe, 
America, and the eastern coast of Africa. Nor have its 
ravages been confined to continents; for the islands of the 
Indian and Atlantic oceans, of the East Indian, Australian, 
and Polynesian archipelagoes and those of the Mediterranean 
Sea, have all undergone severe epidemics.* 
Ever unsuccessfully striving to acquire a local habitation 
in the Western World, thousands of miles of land and water 
are crossed. The severity of Russian and Canadian winters 
are withstood in the close, hot, ill-ventilated cottages of the 
peasants; but at last the poison-producing power dies, the 
disease outside of its natural habitation becomes extinct, is 
no more capable of reproducing itself. But the great high- 
ways are still open, and presently the warning is given that 
once again cholera has commenced its death-march. 
* Dr. Smart, Cholera in Insular Positions. Cholera Hygiene. 
11 
The only recorded instance which will bear a searching 
investigation into all its details of cholera originating outside 
of Hindoostan is that related by Estrazulas of the endemic 
of 1866, ’67 and 68 in South America.* In this instance there 
was a combination of all the well-known “factors” of cholera 
within the lines of the opposing armies during the Paraguayan 
war. The disease, once developed, obeyed the known laws 
by which its course has always been governed, and gradually 
was carried through the Argentine Confederation and Uruguay, 
reaching the last-named only after the third outbreak. 
The theory of Estrazulas, that cholera originated in Para- 
guay, finds an opponent in Dr. Rego, president of the Imperial 
Academy of Medicine at Rio de Janerio,f who shows that 
before the disease occurred in Paraguay the cities of Pernam- 
buco, Guanzy, and Rio de Janeiro had been infected with 
cholera; that prior to the outbreak in Paraguay a troop-ship 
left Rio for the seat of war; when two days out from port 
the troops on this vessel were attacked with cholera; that 
after entering the Parana River, but before coming within 
the lines of the army, she was turned back and placed in 
quarantine at St. Catharine, Brazil. 
In the review of Dr. Rego’s work by Estrazulas much 
stress is laid upon seeming inconsistencies in the narrative 
of events; but the reviewer seems to have overlooked the 
fact, in his anxiety to establish his “endemic theory,” that 
the infected troop-ship, although she did not come within 
two hundred miles of the locality in which cholera was de- 
veloped, still was on the Plata and Parana rivers, and was 
in communication with other vessels for some time before 
she was turned back to quarantine. 
According to Dr. Smart,J cholera is endemic on the Malay 
* Epidemic Cholera in South America, Estrazulas; American Journal Medical 
Sciences, July, 1873. 
f Review American Journal Medical Sciences, October, 1873. 
J London Lancet, March 22, 1873. 12 
Cholera Hygiene. 
Peninsula and the islands of the Asiatic Archipelago, but 
he is able in each outbreak to trace the exciting cause to 
importation. 
During the past year Pelikan and other Russian sanitarians 
startled the medical world by announcing their conclusion 
that cholera had become endemic in Russia; that the last 
outbreaks of the disease in Eastern Europe were not from 
new importations from Asia, but were from the seeds of the 
disease having remained latent from former epidemics. 
The evidence upon which this opinion was based seemed 
at the time it was published to be unanswerable; but at the 
recent meeting of the British Medical Association Dr. Rad- 
cliffe,* representing the Medical Department of the Privy 
Council, demonstrated the erroneousness of the conclusions 
to which Pelikan had arrived. It can be conclusively shown 
that although the disease lingered at Kiev, the holy city of 
Russia, during the years 1865, ’66, ’67 and ’68, it had been 
constantly re-enforced by successive cholera arrivals by way 
of the Red Sea and North Persian routes. 
The mass of evidence which has been collected by careful 
observers f in the history of cholera may be summed up 
under a few propositions. 
1. That cholera is a contagious disease, resulting from an 
organic matter, which entering into the alimentary canal acts 
upon and destroys the epithelium. 
Without entering into a description of the pathological 
conditions induced by cholera, the report of the post-mortem 
examinations made by Hayem, of Paris, in 1873 are cited as 
indicative of the results obtained by previous observers: 
* Medical Times and Gazette, July 12 and August 9, 1873. 
f Lecture on Epidemic Cholera, Professor Alfred Stille, University of Penn- 
sylvania, Philadelphia Medical Times, July, 1873; Fauvet on Cholera, Medical 
Times and Gazette, October 18, 1873; Memorandum on the Propagation and 
Prevention of Asiatic Cholera, William Rudd, M. D., Clifton, 1861; Watson’s 
Practice of Medicine, op. cit.; Niemeyer’s Text-book of Medicine, op. cit.; 
Aitken’s Science and Practice of Medicine, op. cit. Cholera Hygiene. 
13 
“ The only organs constantly involved are the intestines. The capillaries, 
the different layers of the epithelium, the sets of glands, and the villi had all 
undergone certain changes, but differed in no way from the changes observed 
in ordinary intestinal catarrh. In the blood there was found an increase of the 
white corpuscles and small, fragmented globules. These are explained by the 
stasis of the blood in the algide period and the decrease in the proportion 
of water. No microscopic characters peculiar to cholera are found.” * 
Jaccoud, in his admirable paper on Asiatic cholera in 
Pathologie Interne, translated by Prof. Octerlony, of Louis- 
ville, states: “The other lesions observed in cholera and the 
symptoms arising from them are not immediate effects of the 
poison, but necessary consequences of the primary lesions, 
and in a great measure of mechanical origin.” f 
2. That the respiratory and digestive organs are the avenues 
by which individual infection is accomplished. 
The majority of observers unite in the opinion that by the 
medium of infected air, water, and food the cholera poison 
gains access to the system. Dr. Ball, of the Hotel Dieu, 
thinks that although the digestive tube is the habitat, as it 
were, of the choleraic poison, yet the lungs are the principal 
vise of infection. Dr. Murray, in his admirable paper on the 
“ Channels through which Cholera is Communicable,” records 
his opinion that in some instances the cholera poison enters 
the system through the skin; and further states that the pro- 
fuse cold perspiration of a cholera patient, from its peculiar 
and characteristic odor, is an evidence of the elimination of 
the disease by the same means. 
3. That the active agents in the distribution of the cholera 
poison are the dejections of persons who have become infected, 
* London Lancet, October n, 1873. 
f Richmond and Louisville Medical Journal, August, 1873. 
Aitken’s Practice of Medicine, op. cit., p. 623; Niemeyer, Text-book, op. cit., 
p. 646; Manual of Practical Hygiene, Parkes, Am. ed., 1868, p. 62; Jaccoud, 
Asiatic Cholera, op. cit., p. 8; Snow’s Report on the Cholera Outbreak in Saint 
James’s Parish, London, Churchill, 1855, p. 119; Medical Times and Gazette, 
October 18, 1873; British Medical Journal, August 23, 1873. 14 
Cholera Hygiene. 
or of those in whom the disease is fidly developed; that in these 
dejections there exists an organic matter which in a certain stage 
of decomposition is capable of reproducing the disease. 
That the rice-water discharges are not simply the watery 
portions of the blood, as is popularly believed, is demonstrated 
by chemical examination. 
Dr. Thudicum, who has made a careful quantitive exami- 
nation of the dejecta of cholera patients, finds that these fluids 
contain “vibriones, cells from the surface of the intestines, 
granular debris of cells, mucin, modified hemochrome, albu- 
men, an albuminous body giving a rose-pink reaction, butyric 
acid, acetic acid, ammonia, leucine, and some inorganic salts. 
The discharges in a state of active decomposition evolve 
nitrogen, then hydrogen, and ultimately nothing but carbonic 
acid.” * 
The most careful and patient investigations have failed 
to determine the presence of any fungoid growths in cholera 
dejections that differ from those grown in the dejections of 
patients who may die from other intestinal diseases. 
Macnamara states that the rice-water discharges are always 
alkaline; that soon after they are passed they separate in the 
vessel into two portions, the floculent matter sinking; that 
the rapidity with which this takes place is an evidence of the 
severity of the attack ; for if this separation takes place very 
speedily, it indicates the complete death and disintegration 
of the organic matter, and an unfavorable termination of the 
case may be predicted. He says: “The floculent matter of 
the stools is composed of epithelial cells and the mucous 
lining of the intestinal canal in various stages of decompo- 
sition. The epithelial cells, disintegrated and changed so as 
scarcely to be recognized under the microscope, are full of 
molecular matter, precisely as in other instances of decom- 
posing organic matter, but no new chemical elements can be 
discovered.” 
* Macnamara, op. eit., p. 351. Cholera Hygiene. 
15 
It is from this organic matter, in what is termed the vibri- 
onic stage of decomposition, that Macnamara insists that the 
dejections of cholera receive their contagious properties; and 
he bases his opinion upon the results obtained from the ex- 
periment hereafter noted. 
If a sufficient amount of the fresh dejecta of a cholera 
patient to produce a slightly opaline tinge be added to water, 
and the fluid be exposed to the full rays of a hot sun, at the 
.end of twenty-four hours “the vibrio stage of decomposition 
or change in the organic matter is in full force, the surface 
of the fluid being covered with large vibriones. During the 
next twenty-four hours no additional changes will be ob- 
served, but on the next ciliated infusoria will have appeared 
in the fluid and replaced the vibriones, that are no longer 
to be found in motion, but collected together at the bottom 
of the vessel. In a few days longer bubbles of gas will rise 
to the surface, and the sides of the vessel will be lined with 
confervoid growths.” * 
Prof. Thiersch fed white mice upon the dejecta of cholera 
patients. Strips of paper were saturated in the dejecta at 
various stages of decomposition, with the result that all the 
animals who ate of the discharges which had been exposed 
to the air for from two to six days were seized with diarrhea, 
suppression of urine, and after death the presence of large 
quantities of an odorless, colorless liquid was detected in 
their intestines. 
In 1866 Dr. Burdon-Sanderson t confirmed these experi- 
ments of Thiersch and added much interesting data. He 
demonstrated that the liability to attack was greatest when 
the papers from the third and fourth days of decomposition 
were eaten, much less and nearly equal as regards the second 
and fifth days, and least of all as regards the first day. The 
*Macnamara, op. cit., p. 396; Lionville on the Propagation of Cholera, 
Medical Times and Gazette, October, 1873. 
f Communicability of Cholera, London Lancet, Dec., 1867, p. 770. 16 
Cholera Hygiene. 
fluid contents of the intestines of mice that had died from 
eating human cholera dejections was collected and subjected 
to the same tests, when it was found that it communicated 
“a malady indistinguishable in character from that developed 
by the human dejections in other animals of the same kind.” 
These experiments have been fully corroborated by those 
of Thudicum, Marshall, Meyer, and others; but in the hands 
of Macnamara * they seemed to have failed, while good for- 
tune gave him the results of an accident, unfortunate to the 
individuals involved, but of incalculable value to science. 
“ In 1861 a small quantity of the dejecta of a cholera patient was known 
to have been accidentally washed into a vessel containing water. The mixture, 
after being exposed to the heat of the sun for one day, was swallowed by nineteen 
men. They all remained perfectly well during the day; ate, drank, went to bed 
as usual, and slept as usual. One of them on waking the next morning was 
seized with cholera. The remainder of the party passed through the second 
day perfectly well, but two more of them were attacked with cholera the next 
morning. All the others continued in good health till sunrise of the third day, 
when two more cases of cholera occurred. The other fourteen men escaped 
the disease. That the water of which they drank had been contaminated with 
organic matter was first discovered from the appearance of vibriones on its 
surface, and this ultimately led to the detection of all the circumstances. Cholera 
was not prevalent at the time, nor had it visited the locality at which this 
occurred for several years.” 
This occurrence led to a number of experiments, which at 
this time can be but briefly noticed, and from which it was 
determined that if the alkaline cholera dejecta, even in a stage 
of decomposition, be rendered acid, the molecular action is in- 
stantly destroyed; that if the dejecta of a cholera patient are 
mixed with the healthy gastric juice of carnivorous animals, 
the molecular changes are arrested and the organic matter 
appears to be digested. Reasoning from these experiments, 
it is safe to assert: 
I. That the dejections of a cholera patient swallowed, before the stage of 
vibrionic decomposition has taken place, by a healthy person will be so acted 
upon by the acids of the stomach that molecular decomposition will be impossible. 
* Macnamara, op. cit., pp. 196, 381, 395. Cholera Hygiene. 
17 
II. That in a healthy subject, the functions of whose stomach are regularly 
and properly performed, the action of the gastric juice will destroy the molecular 
process of decomposition, and no infection will result. 
III. That if a large quantity of water infected with cholera stuff is swallowed, 
a portion will inevitably pass at once from the stomach to the intestines, and as 
their contents are alkaline the process of infection will quickly take place; or 
if this contaminated water be drunk while the individual is fasting and the secre- 
tions of the stomach are alkaline, the gastric juice will not be sufficiently powerful 
to arrest the decomposition, and infection will result. 
The experiments upon which these assertions are based 
we advance as sufficient reply to and explanation of the 
cumstances which, in 1833, led to the assertion that cholera 
was not a contagious disease. So universally was this theory 
accepted, and so conclusive seemed the facts that individuals 
had tasted and drunk of cholera dejections, had fed the same 
to animals, and had even inoculated themselves with the rice- 
water discharges, and yet all escaped with impunity, that at 
the present day the dogma of non-contagion is adhered to 
by many. 
It is further urged against the theory of the contagious- 
ness of cholera, the supposed immunity to the disease enjoyed 
by the attendants upon the cholera sick. 
Is not this a question worthy of careful consideration ? 
We are profoundly impressed with the belief that, proper 
precautions having been taken, cholera attendants may enjoy 
the most perfect security from the infection. But the ques- 
tion is, are those attending upon a case of cholera safe when 
the disease and its products are left to nature alone? 
During an epidemic of cholera all the members of a commu- 
nity are not attacked. No epidemic upon this continent has 
been entitled to be denominated pandemic. An epidemic of 
cholera does not occur in every locality contaminated by the 
arrival of cholera patients.f It is particularly those whose 
systems are vitiated by other disease; those who are suffer- 
* Macnamara, op. cit., pp. 383, 384, 402. 
f Jaccoud, op. cit., p. 8; Macnamara, op. cit., p. 194; Physical Course of 
Epidemic Diseases, A. H. Howe, Churchill, London, 1865. 18 
Cholera Hygiene. 
ing from depression of the nervous force from any cause, 
but especially from that depression which follows excessive 
fatigue, debauches, or fear; those who live in open violation 
of all hygienic laws; those impoverished by want, who are 
particularly liable to the disease. We have shown how the 
system of a healthy person may resist the invasion of the 
disease, but these individuals have nothing to resist with, and 
therefore succumb. 
It is unnecessary to refer to Indian or European epidemics 
to illustrate the truth of these assertions. The epidemic 
of 1873 in the state of Kentucky furnishes many marked 
examples, and from our notes collected for a history of the 
epidemic the following cases are taken: 
1. A young man eighteen years of age, a native of Nelson County, was 
infected in Marion County, where he had been in attendance upon a friend 
who died of cholera. On the 20th of August he returned to his home and was 
attacked with the disease. Many hours passed before a physician could reach 
him, and his friends ignorantly emptied the dejections upon the ground near the 
house. The case terminated fatally after nine hours’ illness. Upon the arrival 
of his physician a most careful disinfection was instituted; but all the decom- 
posing dejecta were not reached, for six members of his family were attacked 
by cholera, and three died. 
2. September 2d a young man twenty-six years of age died in Nelson County 
of cholera. On the 31st day of the previous August he had visited the house of 
a relative in Marion County where there were several persons sick from cholera, 
and where no process of disinfection had been instituted. During his visit he 
sat upon a porch which was quite near to a mass of dibris upon which all the 
cholera dejecta had been emptied; and upon this porch he ate his dinner. That 
evening he left for his home; and it is positively ascertained that in no other 
way did he come in contact with contagion, yet in two days’ time we find him 
sickened and dead. 
Another instance is strikingly illustrative: 
3. On the 25th of August, 1873, a lady died *n ie city °f Bowling Green 
of cholera. Her body was removed to Louisville for burial, and the coffin 
having been opened the body was viewed by her family. Within a few days 
four cases of cholera occurred in the family, from which three died, and all the 
remaining members suffered more or less violently from diarrheas. 
4. That cholera dejecta coming in contact with and drying 
upon any object, such as articles of furniture, bedding, or clothing, Cholera Hygiene. 
19 
will retain indefinitely its power; and that under favorable cir- 
cumstances the process of decomposition will at once commence. 
To demonstrate the value of the facts on which this propo- 
sition is based, Macnamara mixed a fresh cholera dejection 
with sand and allowed the mixture to dry rapidly under the 
heat of the sun. After a lapse of seven years “ a small quan- 
tity of this earthy-looking stuff was placed in water and 
exposed to the sun, when it could not be distinguished from 
a fresh cholera stool.” * 
With the knowledge obtained from this experiment we 
are able to understand the numerous instances upon record 
of persons being attacked with cholera after wearing the 
clothing or sleeping in beds previously used by cholera 
patients. 
To refute the theory of contagion as illustrated under this 
proposition, the fact is brought forward of cholera clothing 
having been washed with impunity on the part of those per- 
forming the work. Such, however, are isolated instances, and 
are accounted for by the fact that the susceptibility of individ- 
uals to cholera poison varies so greatly, and that the number 
of car'efid, healthy persons who are physically liable to the 
disease is always small in every community. 
5. That through the atmosphere of infected localities the 
disease is frequently communicated to individuals. 
Upon this point the investigations of Niemeyer induced 
the following record of his views: 
“The cholera poison is rarely taken into the system by drinking water 
containing it. As a rule, it undoubtedly enters the nose and mouth with the 
air, and is swallowed with the saliva. Using infected privies is so dangerous, 
because they are the favorite lurking-places for cholera-germs, and the gases 
arising always contain dust-like particles.” 
The results of Pettenkofer’s theory are that the emanations 
from infected soil impregnate the atmosphere with the cholera 
poison. It is indisputable that when cholera dejections are 
* Macnamara, op. cit., p. 398. 20 
Cholera Hygiene. 
deposited in impure privies, cesspools, or drains the poison 
is propagated and diffused. Adair County, Ky., furnishes a 
marked instance. 
In the rear of a livery-stable situated in the town of Columbia was a privy, 
the vault of which was filled to overflowing with putrid excrementitious matter, 
and the ground in its vicinity was saturated with the drainage from it. During 
the months of July and August some attempts were made to cause this privy to 
be disinfected and cleaned. These attempts at sanitary reform were resisted 
by the proprietor of the stable. Late in the month of August a negro boy, who 
had become infected with cholera in another county, came to this stable, suffering 
from diarrhea, and made use of this privy. The diarrhea became cholera, and 
he died; and from that infected privy an epidemic of cholera spread, which cost 
that community twenty-six valuable lives. 
6. That water contaminated by surface-washings, by drainage 
from neglected sewers, cesspools, or privies, may and does become 
contaminated zuith the cholera poison. 
Water undoubtedly performs a most important part in the 
diffusion of cholera. Macnamara insists that an epidemic 
outburst of cholera can only occur through the drinking- 
water of the place becoming contaminated with cholera 
matter.* 
The investigations of Dr. Snow, in London, during the 
epidemics of 1849, 1853, and 1854 prove that cholera may be 
actively distributed through the medium of drinking-water. 
The persistence of a cholera epidemic in Russia during 
the winter season was only partially accounted for by the 
habits of the Russian peasants, the construction of their 
houses so as to exclude all air, the faulty heating apparatus, 
etc., until Dr. Routh pointed out that in the Russian settle- 
ments every thing is thrown out around the dwellings; and 
that, owing to the intense cold and the great expense of 
transporting drinking-water, the inhabitants are in the habit 
of drinking the water from melted snow; that the snow used 
for this purpose has been frequently that upon which the 
* Macnamara, op. cit.; “Mode of the Communication of Cholera,” Snow, 
Churchill, London, 1855; “Influence of Impure Water in the Diffusion of 
Cholera,” British Medical Journal, August, 1873. Cholera Hygiene. 
21 
cholera stools have been thrown, and that by this impure 
drinking-water the epidemic is prolonged there can scarcely 
be any doubt. 
The epidemic in Central Kentucky during the past season 
furnishes a striking illustration of the power of drinking-water 
in disseminating the disease: 
Several isolated cases of cholera had occurred, in the town of Lebanon, near 
to a small creek which forms one of the drains of the town. A few days after 
their occurrence the Marion County Fair was held upon the grounds near Lebanon. 
As the water-supply was less than the demand, the deficiency was supplied from 
the town. Unfortunately a well was selected on low ground and quite near to 
the banks of this creek. On the second day of the fair a violent rain-storm 
deluged the country. The creek was filled to overflowing, and it was impossible 
that the surface-washings should not have infected this well. On the third and 
fourth days of the fair the water of this well was served as usual; and on the 
night of the last day (August 31st) cholera, malignant in its type, was developed 
in all localities inhabited by those who had visited the grounds and drunk the 
water. 
Great stress is laid upon the fact that subsequently the water from the 
same well was used by individuals with impunity, for which certainly the theory 
of vibrionic decomposition, which has been so fully noted, offers a sufficient 
solution. 
7. That without a combination of all the well-known factors 
of cholera the disease can not origmate de novo. 
Masses of decomposing debris, animal or vegetable, can 
not of themselves produce the cholera poison. They are the 
hot-beds in and on which the cholera excretions having been 
placed the poison is reproduced with fatal rapidity. 
Peters points out as the principal factors of an epidemic 
of cholera: 
1. An atmosphere impregnated with the products of fermenting human 
excrement. 
2. An elevated temperature, with'a still, stagnant, and peculiarly oppressive 
condition of the atmosphere. 
3. Such meteorological conditions as have a marked tendency to favor the 
chemical decomposition of organic substances. 
4. Lowness of site, swampy ground, moist soil, decomposition of vegetable 
matter, and all those causes which tend to produce bilious and remittent fevers. 
5. Foul camping-grounds, filthy streets and yards. 
6. Impure water. 
7. Bad, spoiled, or defective food. 22 
Cholera Hygiene. 
The summary of cholera causes by Dr. Montgomery may 
be added to the list of Peters. It is as follows: 
1. Undue exposure to the vicissitudes of climate, especially during cold 
nights following hot days. 
2. Physical fatigue and nervous depression. 
3. Undue abstinence or deprivation of food. 
4. Excesses in eating, drinking, and licentiousness. 
5. Vitiated atmosphere from all causes. 
6. Direct exposure to the contagion of disease. 
The summaries given agree with those of all observers 
who have devoted sufficient study to the disease to entitle 
them to be recognized as specialists. 
During the past year Dr. G. E. Nicholas, the medical 
officer of health for Wandsworth, England, advances the 
theory that flies form one of the most, if not the most, com- 
mon and direct means of the propagation of cholera. This 
opinion is based upon the argument of Prof. Leidy, of Phila- 
delphia, and Dr. Nicholas’s personal observations. The com- 
munication concludes with the remark that “the diarrhea 
season is generally believed to be associated with the fruit 
season, and perhaps justly so; but then it is the fly season 
also, and the fruit may not be per se the cause but only the 
vehicle of the poison communicated by the fly.” * 
Since the preceding pages were prepared the following 
translation of the paper of Hogyes has appeared in the cur- 
rent medical journals. It is so strongly corroborative of the 
statements of Thiersch, Sanderson, Macnamara, and others, 
which have been noted in detail, that the translation, as it ap- 
peared in the Medical Record of January 15, 1874, is hereby 
transcribed as additional evidence of the truth of the facts 
elicited by earlier observers. The italics are our own. 
“Action of fresh Cholera Discharges upon Animals.—An interesting 
series of experiments with the discharges from cholera patients was made during 
the latter part of July of this year (1873) by Andreas Hogyes, of the Univer- 
sity of Pesth, a report of which is published in the Centralblatt filr die Med. 
* London Lancet, November 15, 1873. Cholera Hygiene. 
23 
Wissensc., No. 50. The points which it was sought to determine were, in brief, 
the following: 
“ I. Do fresh cholera discharges operate injuriously upon the organism of 
lower animals, and under what manifestations ? 
“ II. Does an artificially excited catarrh of the stomach and dowels increase 
the susceptibility to the action of the cholera discharges ? 
“ III. Can a current of air bear away particles from the discharges which 
are capable of affecting the organism injuriously, and what difference is there 
in this respect between non-disinfected and disinfected cholera discharges, simple 
diarrheal discharges, and putrefying fluids? 
“IV. Are cholera discharges freed from their form - jiving) elements still 
able to act upon animals? 
“ V. What portions of the disinfected or non-disinfected discharges does the 
air-current bear away, and what is the further destiny of these form-elements 
when they fall upon a neutral medium or one adapted to their development ? In 
what manner do these elements modify the action of this medium ? 
“ To decide the first and second questions, fresh cholera discharges were 
given to healthy dogs, and to others in which an artificial catarrh of the stomach 
and intestines had been excited by the administration of croton-oil, sulphate of 
copper, etc. Both dogs were made sick, with frequent vomiting and diarrhea; 
but while the previously healthy animals recovered in three or four days, those 
in which a catarrh had been excited died the day following. 
“ To determine the third question, rabbits were placed under a bell-glass and 
exposed to air which had become impregnated as desired from either cholera 
discharges, disinfected or not disinfected, diarrheal discharges, or putrefying 
fluids. Two rabbits, in one of which a bronchial catarrh had been produced 
by inhalations of ammonia, were exposed for twenty-four hours to air from 
cholera discharges not disinfected. On the third day following violent purging 
set in, and both animals became soon cold and collapsed. The one in which a 
bronchial catarrh had been excited died first, and the other five hours later. A 
rabbit exposed for twenty-four hours to air from disinfected cholera discharges 
remained well; another exposed for an equal length of time to atmosphere im- 
pregnated fro7n simple diarrhea stools escaped. uninjured; while another which 
remained for twenty-four hours in atmosphere contaminated from putrid fluids, 
though at first made insensible, afterward recovered without harm. 
“As to the fourth point, cholera discharges were injected into the jugular 
veins of dogs and guinea-pigs; the discharges in one case having first been freed 
from their form-elements by thorough filtration and in the other not. The effect 
in both instances was the same. 
“ To determine the final points, a current of air was made to pass through 
fresh cholera discharges, both disinfected with carbolic acid and not disinfected, 
and then conducted through two separate vessels, which contained, respectively, 
an indifferent fluid-medium, and one adapted to the support and development 
of any living forms which the current should bring to it. The two fluids used 
were distilled water and the fluid of Cohn. In a short time, in the fluids com- 
municating with the undisinfected discharges, a considerable number of form- 
elements had accumulated, which proved to be almost exclusively the bacteria 24 
Cholera Hygiene. 
which are usually found in putrid animal fluids. In twelve hours Cohn’s fluid 
had become clouded and milky; in twenty-four hours it was covered with a 
thick bluish-green fungous slime, and emitted a foul odor. The distilled water 
remained clear. Both these fluids, when injected into the veins of dogs and 
rabbits, caused the same symptoms as after injection of the cholera discharges 
themselves. This was also true of the fluid of Cohn after its fungous elements 
had been quite removed by filtration, showing that these elements are at least 
not the only source of infection. Similar experiments with discharges which 
had been disinfected with carbolic acid showed that the organisms which the 
air-current brought to Cohn’s fluid were incapable of propagation. Upon injec- 
tion of the distilled water and fluid of Cohn, after previous disinfection of the 
discharges by carbolic acid, only symptoms of carbolic - acid poisoning were 
manifested.” 
Lebanon, Kv. CHOLERA HYGIENE. 
Cholera having been demonstrated to be a contagious 
disease, which is spread by the dejections of individuals suf- 
fering from choleraic diarrhea as well as from the developed 
disease, it becomes a matter of vital importance to inquire 
what means may be employed to prevent or arrest the devel- 
opment of the disease in any threatened community. 
That the occurrence of cholera may be prevented by proper 
precautions, and that it may be stamped out when once devel- 
oped, is most certain. * To insure this grand result is necessary 
the co7icerted action of each and every individual. One careless 
or indifferent member of a community may not only render nega- 
tive the wisest precautions, but may endanger the lives of all. 
The results obtained by experienced observers demonstrate 
that the means of prevention against a general epidemic of 
cholera are: 
I. Quarantine; 
II. Cleanliness; 
III. Disinfection; 
IV. Individual Habits. 
I. Quarantine.—With the subject of quarantine, from 
the geographic location of the territory to the inhabitants 
* Report on Epidemic Cholera, Circular No. 5, Surgeon General’s Office, 
Washington, 1867; The Mecca Pilgrimage and the Cholera, Medical Times and 
Gazette, April 26, 1873; Prophylaxis of Asiatic Cholera (McCormac), British 
Medical Journal, August 23, 1873; Progress of Sanitary Science, British Medical 
Journal, October 25, 1873. 4 
Cholera Hygiene. 
of which these pages are addressed, but little of interest pre- 
sents itself. Cholera, following the great lines of travel, only- 
reaches the interior of a continent after the note of warning 
has been sounded from one or other of the ports of entrance. 
At such points the subject is of vital importance; but the 
disease having escaped the cordon, and having become do- 
mesticated in any community, it behooves all within the lines 
of travel from that infected point to consider carefully and 
earnestly such means of prevention as the knowledge which 
sanitarians possess of the disease has placed at the disposal 
of the public. 
II. Cleanliness. — Cleanliness in what? Cleanliness in 
every thing. To maintain the perfect sanitary condition of a 
large city trained minds are devoted and thousands of money 
are lavishly expended; but in the small interior towns, with 
some few bright exceptions, little or no attention is paid to 
the subject, each property-holder following the bent of his 
own mind. In these towns the streets and natural drainage 
sources are the receptacles of filth. The ground within and 
around out-houses is the depository of human excrement. 
The negro in his cabin is permitted to rival the pollutions 
of Jessore or Madras, while the only scavengers to be found 
are the hogs that roam the streets. The latter, after devouring 
indescribable filth, are presently served as articles of food. 
To secure the best sanitary condition of a town, it should 
be the duty of the trustees to appoint an inspector, who should 
have at his command an efficient corps of laborers. By this 
inspector all that is detrimental to the public health should 
be removed. 
To what should his attention be directed ? 
i. To the condition of each house and its surrounding prem- 
ises.—Debris of all kinds should be collected in heaps and 
destroyed by fire. No rank vegetation, which too often con- 
ceals pernicious substances, should be allowed to stand, and Cholera Hygiene. 
5 
when cut down should be destroyed by fire. Out-houses 
of all kinds should be inspected. Privies, stables, chicken- 
houses, etc., should be cleaned and disinfected. The debris 
should be buried in such position as not to affect the water- 
supply. Dirty and damp cellars should be cleansed, venti- 
lated, and disinfected. 
The water-supply should be rigidly examined, and prop- 
erty-holders required to place their wells and cisterns in good 
condition. Debris should not be permitted to accumulate 
upon the ground. The well should be securely covered and 
closed. The sides should be banked up, so that the surface- 
washings may be from, not to, it. 
Despite the theory of Pettenkofer, the action of the soil 
as a filter surpasses all others, and from a carefully-kept well 
pure drinking-water may always be obtained. If a privy- 
vault should be close to a well, or if a house or other drain 
should pass in its immediate vicinity, the walls of that well 
should be rigidly and frequently examined, and water taken 
from the bottom of the well carefully tested, lest contaminating 
drainage may occur; and all wells so situated that they must 
inevitably receive impure drainage or surface-washings must 
be closed in such manner as will absolutely prevent access to 
their contents. Localities which' in a past season had been 
infected, and where systematic disinfection had not been in- 
stituted during the prevalence of the disease, should be most 
carefully cleansed. Every portion of the premises upon which 
cases of cholera had occurred should be reached by the dis- 
infecting agents. It should be borne in mind that it is far 
more prudent to err from overzealous cautiousness than from 
negligence. 
Individuals arriving in any community from a locality 
known to be infected should be at least subjected to a close 
surveillance. If their effects have been so situated that by 
any possibility they could have become infected, they should 
be subjected to sufficient disinfection. The individuals should 6 
Cholera Hygiene. 
be required to use a carefully-disinfected privy until the utter- 
most limit which can be placed on the period of the incuba- 
tion of cholera has been passed. For the efficient disinfection 
of clothing, etc., no plan proposed exhibits more favorable 
results than that of Dr. Ransom.* In the use of this hot-air 
closet it was found that a temperature of 250° F. was effectual 
in destroying the contagion of small-pox. 
A rigid house-to-house system of inspection, once having 
been established, should never be abandoned. An occasional 
inspection amounts to nothing. Eternal vigilance is the price 
of safety. 
2. To the condition of the natural drainage of the town, 
water-courses and other natural drains should be kept free 
and unobstructed, and disinfectants should be constantly 
used throughout their length. The vegetation which almost 
invariably lines the streets of small towns and chokes the 
roadside drains should be removed; and then not left to 
decay in the center of the road, but should be removed 
beyond the town limits and there destroyed with fire. Ponds 
and pools of stagnant water within or near the limits of the 
town should be filled up; filled up not with the debris of the 
town, but with fresh earth, which is one of the most valuable 
disinfecting agents. 
Cholera having appeared in a town, it is desirable that 
the authorities select an isolated building, which may be 
used as a hospital. The house selected should be sufficiently 
commodious to prevent overcrowding, and to admit of the 
separation of the convalescents from the sick. This building 
should be placed in the charge of a competent physician, 
who should be assisted by a corps of nurses, and the hos- 
pital should be furnished with all necessary appliances. To 
this building all cases of .cholera which occur should be 
removed. 
A distinguished physician of Nashville has pointed out 
* British Medical Journal, September, 1873. Cholera Hygiene. 
7 
that in an epidemic of cholera want of proper food and the 
privations to which the lower classes are always subjected 
during an extensive epidemic adds fuel to the fire, and his 
suggestions of immediate relief of their wants is worthy the 
consideration of all town authorities. 
The general cleanliness of a town having been secured, 
there remains to be noted that of individuals. Scrupulous 
care of the person secures the removal of what may and 
often does prove the nucleus of disease. Personal cleanli- 
ness is best secured by a daily bath. In the sultry and 
oppressive weather in which cholera most frequently makes 
its dread appearance, the bath, as hot as can be borne with 
comfort, affords the most efficient relief that one can secure. 
A thorough soaping and rubbing of the body with a flannel 
cloth removes all effete matter from the skin, and the free 
use of hot water imparts a cooling freshness, a solace from 
which none may be debarred; and which, taken in the early 
morning, invigorates to meet the fatigues of the day, and at 
night encourages refreshing and strengthening sleep. 
The under-garments should be frequently changed, and 
those which have been worn during the day should inva- 
riably be removed on retiring to bed. Clothing that has 
been worn through the day should never be exposed in the 
sleeping-apartments during the night-hours, and should be 
well cleansed and aired before being again used. 
Trivial and unnecessary as such rules may seem, the 
observance of them will be found of incalculable value. 
III. Disinfection.—What vaccination is to small-pox 
hygienic regulations are to cholera. The rigid observance 
of sanitary laws presents to this virulent disease a wall which 
is almost insurmountable. The foundation of this wall—this 
line of demarkation between health and disease, between life 
and death—is undoubtedly laid in disinfectants. If the port 
of entry is passed by cholera, if the embargo there laid upon 8 
Cholera Hygiene. 
the disease has been insufficient to arrest its progress, it 
behooves each community to raise the wall for their own 
protection, and it is all the more necessary that the founda- 
tions are made sure. 
The day has passed in which nauseous-smelling substances 
are looked upon as disinfectants. “To change the odor is 
not to disinfect. The odor produced by a putrescent animal 
mass may be covered, but the effete matter, the product of 
decomposition, is still present in the air that is breathed, al- 
though the nostrils, overpowered, fail to detect its presence.” 
To borrow the words of Dr. Craig, “a true disinfectant must 
be antiseptic; that is, it must possess the power to destroy 
or to render inert the products of decomposition of organic 
matter or of morbid action in the living body through the 
agency of a reaction in which the disinfectant itself under- 
goes chemical destruction.” * Therefore that agent is the 
most acceptable and useful which destroys utterly and for all 
time the effete matter with which it may come in contact. 
A study of these agents renders it necessary that some 
one or other of the classes into which they have been divided 
should be adopted; but as it is unnecessary in a paper of 
this character to enter fully into the study, and as we will 
endeavor to point out those which will be most valuable in 
the emergency of which we are treating, we will pass over 
the complicated classifications of Jeannel and others and adopt 
that of Dr. Craig. 
1. Destructive disinfectants, “which act by oxidizing and 
consuming whatever organic matter they may come in con- 
tact with, attacking the more advanced product of putrefac- 
tion first.” 
2. Conservative disinfectants, “ which destroy effluvia and 
organic matter when in small quantities, but are inert upon 
large masses.” 
* Report on Disinfectants and their use in connection with Cholera, Circular 
No. 5, S. G. O., Washington, 1867. Cholera Hygiene. 
9 
The action of the agents which are classed under these 
grand divisions, and their application, will be considered 
when treating of the emergencies which demand their use, 
and those only will be noted that are attainable by all classes 
of individuals. 
Experience has taught us that water, that indispensable 
element, is a most efficient agent in the diffusion of cholera 
poison. 
The question naturally arises, can water which is contami- 
nated with organic matter be detected, and when detected can 
it be rendered by any process of purification safe for human 
use? Facts based upon extended observation demand an 
affirmative answer. To detect impure water, or water which 
has been contaminated by organic matter, Rawlinson says: 
“ If the water from a certain well or tank be placed in a tall glass, covered 
and exposed to the sun, and after twenty-four hours a drop be examined under 
the microscope, we find its surface covered with molecular matter and vibriones. 
We may be almost certain that the organic matter from which these vibriones 
are formed is capable of inducing cholera, supposing it, of course, to have been 
derived from cholera ejecta.” * 
This method of examination is certainly beyond the pop- 
ular reach. Few individuals are skilled in the use of the 
microscope. Chemistry, however, affords a simpler means, 
and one which is within the reach of all. 
Place a quantity of the suspected water in a glass vessel, 
and add, drop by drop, a solution of the permanganate of 
potash (which may be obtained from any chemist) until a 
pink color is imparted to the liquid. If after standing a short 
time the color disappears, it indicates the presence of organic 
matter. Add again the solution of the permanganate until 
the color is again produced. If the organic matter has all 
been decomposed, the water will after the lapse of hours 
retain the pink color; but if organic matter is still in solu- 
* Rawlinson “ On the Best Method of keeping Water Sweet.” Macnamara, 
op. cit., p. 498. 10 
Cholera Hygiene. 
tion, the color will again disappear. The greater the amount 
of the salt decolorized before the water retains the pink 
color, the larger the quantity of organic matter present in 
the water. 
Before proceeding to the subject of the purification of 
water it is well to examine into the sources from which water 
for domestic purposes is ordinarily obtained. 
In communities not provided with a carefully-delivered 
water-supply the purest water that can be employed for do- 
mestic purposes is that obtained from securely-guarded wells 
and from cisterns which are supplied with rain-water. They 
alone can be protected from surface-washings. Cistern-water, 
however, must be as carefully examined and tested as the 
well-water. Rain-water, it is well known, may contain organic 
matter of animal or vegetable origin. Even when it has been 
collected in a clean glass vessel, before it has come in contact 
with roof or soil, it has been found to be impure from organic 
matters, etc., which it has derived from the atmosphere in its 
passage through it, when taken near inhabited places. 
Snow and snow-water is much less pure than rain-water, 
for the crystals of which it is composed imprison the impuri- 
ties of the atmosphere; and it is said “that snow frequently 
contains so much organic matter as to show confervoid vege- 
tation under exposure to light.” * 
The water of rivers, marshes, ditches, canals, and ponds 
is contaminated with organic matter derived from decaying 
animal and vegetable remains, and from debris of all kinds 
which necessity or surface-washings empties into them. Ne- 
cessity demands that the water of large rivers shall be em- 
ployed by the cities and towns upon their banks. In such 
instances all the aids which science affords are employed in 
the purification of the fluid before it is distributed for gen- 
eral use. But stagnant wrater, or the water of nearly dry 
streams or that of marshes, should never be employed for 
* Brande and Taylor’s Chemistry, American ed., 1867, p. 138. Cholera Hygiene. 
11 
domestic purposes until it has been deprived of its deleterious 
constituents. 
Spring-water may be contaminated from surface-washings 
or from organic matter with which the strata of soil through 
which it passes may be impregnated.* 
Impure water may be rendered serviceable and fit for use 
by boiling, which act precipitates most of the mineral con- 
stituents and destroys utterly all molecular matter. 
Dr. Taylor, a returned missionary from China, reports that 
during a residence of many years among the Chinese no cases 
of cholera came under his observation; and this absence of 
the disease he attributes to the fact that tea is the beverage 
of the country; consequently nearly all the water which the 
inhabitants drink has been boiled. 
By the process of filtration water may be thoroughly 
purified. Indeed so perfectly does the combination of boil- 
ing and filtration purify water that it is asserted that water 
in which cholera discharges have been mixed loses entirely 
its infecting properties on being subjected to these simple 
expedients. 
Dr. Peters suggests an excellent filter for the poor “in 
one of the largest-sized common red flower-pots, suspended 
at a convenient height in a shady place, and having the hole 
in its base plugged with a sponge, so as to permit only an 
exceedingly fine stream of water to pass through; the sponge 
to be frequently washed.” Filters containing the black oxide 
of iron are said to be efficient in removing organic matter 
from water. 
Of such vast importance does this subject become that 
during an epidemic of cholera in any community each family 
should be provided with drinking-water only after it has been 
subjected to some such process. Water so prepared, to which 
ice is added, is not only harmless but palatable. Ice may be 
* Brande and Taylor’s Chemistry, p. 133; A Manual of Practical Hygiene 
(Parkes), p. 16; A Treatise on Hygiene (Hammond), p. 216. 12 
Cholera Hygiene. 
used with impunity, for it is one of the purest forms of water 
when taken from a deep lake or pond. Faraday demon- 
strated the fact that water in freezing deposits nearly all 
of its constituents, and that the unfrozen portions contain the 
impurities. 
Not unfrequently individuals are placed in such positions 
that they are unable to procure water which has been purified 
by either boiling or filtration. The permanganate of potash, 
which has already been noted, now becomes invaluable. The 
action of this salt is explained by Dr. Craig as follows: 
“ When the permanganate is added in suitable quantities to impure water 
it converts the organic matter into carbonic acid, water, etc., undergoing itself 
a gradual decomposition, with the deposition of insoluble dentoxide of man- 
ganese.” “A method which will destroy organic matter in water 
without adding to it any thing unpleasant or injurious is an evident desideratum 
at all times, and especially during the prevalence of cholera, and there is per- 
haps no method more effectual and convenient than that by treatment by the 
permanganate.” 
The practical application of this agent requires the use 
of from half a grain to one grain of the salt to the gallon 
of water, and about two hours are required for its action. 
In smaller quantities the solution should be added, drop by 
drop, until the pink color is evident. In a tumblerful of 
water but a few moments are required for its purification. 
At some of the Indian stations, where the water was offensive 
from decaying organic matter, a few drops of the permanga- 
nate purified the water almost instantly. 
The peroxide of hydrogen, an antozone, is said to be still 
more efficient in the purification of water. It is a powerful 
oxidizer, and completely destroys organic matter with which 
it comes in contact. 
The late Ashantee war called forth, among other notes 
of moment, the invaluable memorandum of Crooks on the 
purification of drinking-water. This observer demonstrates: 
I. That the organic matter in impure water may be divided 
into three classes: (a) Matter in a state of putrefaction; Cholera Hygiene. 
13 
(b) Matter ready to become putrid; (c) Matter which is slow 
to decompose. 2. That the permanganate of potash acts 
powerfully upon organic matter of the first class, but that 
its power over substances of the remaining classes is not 
only slow but uncertain. 3. That a mixture — consisting of 
permanganate of lime, one part; sulphate of alumina, ten 
parts; fine clay, thirty parts—is the most effectual purification 
of drinking-water now known. 
The use of impure water almost invariably results in the 
development of diseases of the alimentary mucous membrane, 
and of specific diseases, such as malarial and typhoid fevers 
and other affections; but simply impure water will not in- 
duce the disease known as cholera. To produce cholera from 
water it is essential that the water must have received a portion 
of the organic matter from the dejecta of an individual who is 
infected with the disease. 
An unknown traveler infected with cholera may deposit 
his dejections in such position that the water-supply of a 
community will become infected. None knew of his arrival; 
his departure was not noted; therefore when days have passed, 
and cholera has been developed in persons who have used 
this contaminated water, the members of the community are 
at a loss to account for its development; but invariably a 
prompt and persistent inquiry along the line of infection will 
result in the detection of the individual who has scattered the 
disease. 
It has been shown that privies, cesspools, and sewers, the 
receptacles of human excrement and of other forms of filth, 
become hot-beds for the dissemination of the cholera infec- 
tion, when the dejections of an individual suffering from the 
disease are mixed with their contents. It has been further 
shown that the effluvia from such localities is impregnated 
with decomposing organic matter, and that when inhaled this 
organic matter becomes mixed with the saliva, is swallowed, 
and the disease is reproduced. 14 
Cholera Hygiene. 
Experience, that mighty expression of power, has demon- 
strated that certain agents, classed under the general head 
of destructive disinfectants, will most effectually destroy this 
poison. Of these agents we will select but those whose 
efficiency has been well tested, and whose small cost places 
them within the reach of all classes—namely, sulphate of iron, 
or copperas, lime, and charcoal. 
Each of these agents belongs to the class of destructive 
disinfectants; each acts promptly and powerfully upon organic 
matter, and a combination of the three procures a more pow- 
erful disinfecting agent for the purposes now under considera- 
tion. Dr. H. C. Wood thus describes the disinfecting action 
of copperas: * 
“ It is antiseptic, but it also decomposes sulphureted hydrogen, precipitating 
sulphide of iron. It is decomposed by ammonia; the oxide of iron, a persistent, 
powerful ozonizing agent, being precipitated. It slowly but persistently attacks 
organic matter about it, oxidizing it, and being reduced to a sulphide of iron.” 
The experiments of Eckstein, made in a privy which was 
in daily use by a large number of persons, confirmed the 
value which has been assigned to this agent. 
Macnamaraf found in cholera dejections which were treated 
with sulphate of iron the infusoria and molecular action was 
instantly destroyed and did not recommence. His experi- 
ments fully substantiate the statements made by Dr. Budd in 
1866, and by Dr. Angus Smith in 1869. 
Lime as a disinfectant is of value from its power of de- 
stroying organic matter by the process of oxidation, as well 
as by its powerful affinity for water. The chloride of lime 
as a disinfectant is claimed by Eckstein to be equal if not 
superior to sulphate of iron. Macnamara found, however, 
that although its presence in a cholera dejection arrested the 
action going on in the molecular matter for a time, it was very 
soon resumed. Charcoal acts as a mechanical disinfectant, 
entangling the organic matter in its meshes. 
* Pliila. Med. Times, July 12, 1873, P- 655. 
| Macnamara, op. cit., p. 401. Cholera Hygiene. 
15 
The most advantageous use which can be made of these 
agents is as follows: a mass composed of two parts of un- 
slaked lime and one part of charcoal is cast upon the ex- 
posed surface of an impure privy or cesspool; upon this is 
poured after a few hours a solution of sulphate of iron, which 
has been prepared by adding the salt to boiling water in the 
proportion of five pounds to the gallon. A sufficient amount 
of this solution to saturate the mass should be used, and its 
application should be made daily. 
In the consideration of agents which act as disinfectants 
to human excrement the value of fresh earth must not be 
overlooked. Its value during the late war in privy sinks, 
which were daily used by large numbers of men, was fully 
demonstrated. The practice, which is so universal through 
the Southwest, of defecating upon the ground and of leaving 
the excrement uncovered, should be rigidly discountenanced, 
and the use of sinks which may be disinfected should be 
insisted upon. The modern earth closet, which is simple 
in its construction and so cheap as to be within the reach 
of all, should be universally provided for the use of females. 
Goodell * has shown how many and how serious are the 
disorders to which the female is liable arising from the 
miserably faulty closet conveniences which, especially in the 
country, are provided for their use. 
During the prevalence of cholera it is most prudent for 
those persons living in the immediate vicinity of infected 
localities to adopt some measures by which the disinfection 
of the atmosphere may be accomplished. It has been shown 
by various experiments that during the prevalence of cholera 
there is an absence of ozone in the air. Ozone is a peculiar 
element, which is supposed to be oxygen acted upon by 
electricity. It is characterized when in a concentrated form 
by a peculiar, pungent odor, “and by its intensely oxidizing 
and bleaching power, so that substances on which* common 
* Philadelphia Medical Times, August, 1873. 16 
Cholera Hygiene. 
oxygen produces no effect are rapidly oxidized on contact 
with air which contains only a small portion of this odorous 
principle.” * 
To detect the presence or absence of ozone in the atmos- 
phere, Schonbein, the discoverer of this elenr nt, prepared 
slips of paper, which, having been soaked in distilled water, 
were placed in a solution of iodide of potassium and starch, 
in which they were left for five or six hours. They were 
then dried in a cool, dark place, in the horizontal position, 
so that the iodide solution might be equally diffused. 
The experiment is performed by hanging these papers 
in a box from which the bottom has been removed. They 
should not touch or rub against each other, and on being 
exposed for observation should be moistened with distilled 
water. If ozone is present in the atmosphere, the slips are 
rendered blue; if the ozone is deficient, no change of color 
is produced. 
Various other processes have been described by which 
these papers may be prepared and the presence of ozone 
determined. Conspicuous among them are the methods of 
Moffat, Lowe, and Beard. 
Although by some authorities the peculiar properties 
ascribed to ozone are doubted, still the majority of observ- 
ers describe it as the vital element of the air; “that from 
its presence oxygen is life-supporting, and that in the absence 
of ozone offensive products in the air are increased, and all 
diseases which show a putrefactive tendency are influenced 
injuriously.” f 
Several methods for the artificial production of ozone are 
described: the slow oxidation of phosphorus, the slow com- 
bustion of sulphuric ether. The method of Boeltzer, of add- 
ing one part of sulphuric acid to two parts of permanganate 
of potash, is attainable by all. This mixture will continue 
to give off ozone for several months. 
*Brande and Taylor’s Chemistry, p. Iio. 
t Peters, op. cit., p. 103; Parkes, op. cit., ] . 83-85. Cholera Hygiene. 
17 
For the purification or disinfection of the air many other 
expedients are suggested as of practical value. Charcoal, 
from its rapid absorption and subsequent oxidation of organic 
emanations. Chloride of lime, exposed in a shallow vessel and 
moistened with water, gives off chlorine, which is supposed 
to destroy organic matter. Bromine—This substance, diluted 
and exposed in saucers, is a popular aerial disinfectant. Nitrons 
acid—the gas may be evolved by placing a small portion of 
copper in dilute nitric acid—is a most powerful disinfectant. 
Sulphurous acid, most easily evolved by burning sulphur, is 
also supposed to act powerfully on organic matter. 
It is prudent that during a cholera epidemic one or other 
of these disinfectants should be exposed in all rooms of houses, 
especially those used as sleeping-apartments; but if bromine, 
nitrous, or sulphurous acid be employed, great care should 
be used that the gas is disengaged slowly. 
The theory that flies may become the carriers of cholera 
poison has been advanced; and as the idea carries with it 
an air of plausibility, effort should be made to counteract 
any injurious influence which they may exert. The most 
scrupulous cleanliness, not only of cooking-utensils and table 
furniture, but of the rooms in which food is stored or pre- 
pared, should be observed. Gauze covers for dishes should 
be used, and every appliance which may prevent their entrance 
into houses should be adopted. 
The occurrence of a case of cholera in any community 
should lead to a general and complete disinfection of all 
points at which the individual may have been during the 
few days previous to his attack. With the first symptoms 
of the disease the house in which the patient lies should 
be put in order. The various vessels and appliances for 
the sick should be without excitement placed ready at hand. 
The vessels from which drink and medicine are to be admin- 
istered should be placed in the room, and not mixed indis- 
criminately with those in use by the healthy members of the 18 
Cholera Hygiene. 
family. A deep but narrow pit should be dug in the yard 
adjoining the house, in such position that no possible drain- 
age can be established to the water-supply, and the bottom 
of this pit should be covered with the crystals of the sulphate 
of iron. A large supply of a saturated solution of copperas 
should be prepared, and after each vomit or dejection of the 
patient a quantity of this solution should be added, and 
the whole intimately mixed. The vessel containing the mix- 
ture should be at once carried from the house, its contents 
emptied into the pit; the vessel should be carefully washed, 
and the water which has been used for that purpose should 
be treated as the dejection has been. The mass at the bottom 
of the pit should now be covered to the depth of two or three 
inches with fresh earth. This maneuver must be repeated 
after each use of the vessel. 
A tub of water, which has been strongly impregnated 
with carbolic acid, the addition of which must be made with 
boiling water, should be in a convenient position, into which 
all cloths or articles of clothing should be cast as soon as 
removed from the patient. Should necessity require bathing 
of any portion of the patient’s person, water containing a large 
per cent of carbolic acid or a solution of the permanganate 
of potash should be employed, and in a similar fluid the at- 
tendants should frequently rinse their hands. When the 
dejections are passed involuntarily, and the clothing beneath 
the patient becomes saturated, carbolic acid or the perman- 
ganate should be added. 
Should death occur, all clothing which has been on or 
around the body should be at once removed and instantly 
thrown into the tub of carbolized water. The body should 
be washed in one or other of the disinfecting fluids, and all 
water which has been used on the person or on the clothing 
must be treated as the dejections have been. Should the 
mattress be found soiled with the discharges, it should be 
burned at once. Indeed it would always be more prudent Cholera Hygiene. 
19 
to destroy by fire all fabrics which have been soiled by these 
fatal dejections than to risk the development of a single new 
case. The body having been placed in the casket, crystals 
of sulphate of iron or of permanganate of potash should be 
placed around it, so as to act upon any product of decom- 
position which may occur prior to burial, which in no case 
should be delayed. 
It is prudent and well for the healthy occupants of a 
house in which cholera has become developed to at once 
subject themselves to some prophylactic treatment. Expe- 
rience seems to indicate that an acid mixture containing qui- 
nine and iron is most efficient. Should a second case occur, 
at its termination the house should be abandoned, at least 
until a most careful system of disinfection shall have been 
instituted. 
IV. Individual Habits. — Niemeyer,* writing in 1870, 
says: 
“ Certain influences appear to increase the predisposition to the severer forms 
of the disease, or to diminish the resisting power of the organism to the action 
of the poison. Chief among these are errors of diet, emetics, and laxatives, 
catching cold, and other debilitating influences. It is true, foolish people seek 
to excuse their excesses at the time of cholera epidemics by saying that the mode 
of living can have no effect in inducing cholera, because persons who lead the 
most proper lives are attacked by and die of the severest forms of the disease. 
Whoever is exposed to a poison whose action kills many persons, while others 
recover from it, is foolish to subject himself to injurious influences which lessen 
his chances of recovery, even if the avoidance of these injurious influences gives 
no guaranty of a favorable termination.” 
We have quoted the remarks of Niemeyer in full, so 
applicable are they to a class in every community who find 
in times of public danger only fresh and additional excuses 
for self-indulgence. 
It is related by a prominent physician of Paducah, Ky., 
that during the epidemic of 1873, “after the sale of vege- 
tables had been prohibited within the city limits, that the 
*0p. cit., p. 647. 20 
Cholera Hygiene. 
mortality among the poor whites and negroes diminished; 
but that many of the German population, regardless of the 
prohibition, would go out of the city and obtain vegetables. 
It came to be a recognized fact that Monday was the largest 
burying-day, from the fact that individuals of this class would 
drink excessively and eat freely during Sunday, and a large 
number were invariably attacked with cholera on Sunday 
night and Monday morning.” 
On the development of an epidemic of cholera it is well 
for all persons in whose power it may be to at once leave 
the infected locality. Niemeyer’s rules were: 
(1) To start soon enough. 
(2) To go as far as possible. 
(3) Not to return until the last trace of the disease had 
disappeared. * 
Admirable rules, if adopted and carried out to the letter. 
But one who starts too late may carry the disease in his 
person; one who travels too short a distance may be over- 
taken by the disease; while those who return to their homes 
with the same haste that attended their departure not infre- 
quently fall victims to the disease. 
Flint recommends that the removal of persons in districts 
where, owing to the activity of auxiliary causes, the disease is 
especially rife, should be enforced, as a sanitary measure, by 
municipal authority, f 
Those individuals who remain in an infected locality during 
an epidemic of cholera, from necessity or from philanthropic 
motives, will do well to observe rigidly fixed rules as to their 
individual habits, which may properly be considered under 
several heads. Of personal cleanliness sufficient has already 
been noted; we therefore pass to other considerations. 
1. Dress.—The surface of the body should at all times, 
both of the day and of the night, be fully and warmly pro- 
*Niemeyer, op. cit., p. 662. 
t Principles and Practice of Medicine, p. 468. Cholera Hygiene. 
21 
tected. Under-garments which have become saturated with 
perspiration should be removed, the surface of the body 
briskly rubbed, and dry articles substituted. Whatever may 
suddenly check perspiration or induce a chilliness is consid- 
ered dangerous and should be avoided. A broad flannel 
bandage worn over the abdomen and around the person, even 
in the oppressive weather of summer, will impart a sense of 
comfort and a decided relief to the abdominal malaise so 
universally experienced during a cholera season. 
2. Diet.—While it is advisable for all persons to be careful 
in their diet, and rigidly to avoid all articles of food that are 
known to be indigestible, it is still as necessary not to produce 
too sudden and radical a change in the diet. In other words, 
excesses of all kinds should be avoided; the digestive appa- 
ratus should be encouraged to the performance of its duty 
by the presence of good, well-prepared, wholesome food. 
Beef, mutton, poultry; rice, hominy, farina; wheat, corn, rye; 
coffee, tea, chocolate; and the various condiments, as salt, 
pepper, mustard, and other spices, may be freely used. Nor 
can we see any reason why such articles as butter, milk, 
eggs, etc., which a distinguished physician prohibits under 
the generalization of animal products, should be prohibited. 
Wine, brandy, and malt liquors may not only be allowed, 
but when used in moderation are extremely useful in evert- 
ing those debilitating influences which so often prevent the 
system from repelling the disease; but their use should be 
interdicted positively whenever undue stimulation results. 
Experience has shown that a debauch predisposes to cholera 
when the disease is epidemic. 
The free use of salt with food during a cholera epidemic 
is strongly recommended by several writers, who urge that 
the debilitated condition of the stomach and bowels, which 
is known to predispose to cholera, is removed by its tonic 
influence. In this way it has undoubtedly some prophylactic 
power. Its value as a disinfectant is recognized. 22 
Cholera Hygiene. 
The condition of the drinking-water should always be an 
object of solicitude, and it is well to cultivate self-control, 
and to refrain from drinking water except from the supply 
which is habitually used; that is, a person whose home is 
in an infected locality should be careful to supply his family 
with pure drinking-water, and should impress upon one and 
all the absolute necessity of drinking none other. 
In relation to the vexed question of the use of fresh 
vegetables and fruits, upon which so much has been written, 
it is safe to assert that such ripe and well-cooked vegetables 
as an individual habitually uses with impunity may be eaten 
during a cholera epidemic; but when it is known that certain 
articles have invariably produced indigestion when eaten 
prudence demands that they should be rigidly avoided. 
The necessity of restrictions among the lower classes of 
society arises from the fact that persons of this sort im- 
prudently indulge in the use of unripe and badly-cooked 
vegetables, or those in which the process of vegetable de- 
composition already has commenced. But it is not to be 
imagined that such fruit will per se produce cholera. It may 
induce an attack of sporadic cholera or cholera morbus, and 
it does predispose to the rapid development of the disease 
after the specific poison has entered the alimentary canal. 
It is well to close this paper with a remark borrowed in 
part from Dr. Murray. Concealing the truth does no good; 
but it creates confidence when a true knowledge of the mode 
by which cholera is communicated, and the absolute power 
which disinfectants exercise in arresting the spread of the 
disease, is made public. 
Lebanon, Ky.