Report on Cholera to the Medi- 
cal Society of the County 
of Kings, 
BY 
WM. HENRY THAYER, M. D., 
J. E. bakerttCd., 
.. Committee on Hygiene. 
April, 1885. 
REPRINTED FROM 
2T1)C Xcto ¥orfc .fttrttral Journal 
for June 6, 18S5. Reprinted from the New York Medical Journal 
for June 6, 1885. 
REPORT ON CHOLERA. 
Part I.* 
By J. E. BAKER, M. D., 
BROOKLYN. 
Cholera Epidemics. — Cholera is endemic in India, 
where it has existed for centuries, prevailing more or less all 
the time. In other parts of the world cholera exists mainly 
in great epidemics, having their starting-point in India dur- 
ing some virulent outbreak there. 
The first great epidemic, it is said, began to spread from 
India in 1817, but did not reach Europe until 1820, arriving 
in England in 1831. The following year, 1832, in early 
spring, it landed at Quebec, then extending up the St. Law- 
rence by the great lakes to Chicago, and thence to other 
parts of the United States. This, the first epidemic, con- 
tinued in different parts of the world, and finally disappeared 
about 1834, seventeen years after it first spread beyond the 
confines cf India. 
The second great epidemic, and the most fatal, began to 
extend from India about the year 1841, and reached Eng- 
land in 1848, and America, at New Orleans, in 1849, prevail- 
ing in different parts of the country for four or five years. 
The third great epidemic began its march from India in 
* Read before the Medical Society of the County of Kings, April 
21, 1885. 2 
REPORT OX CHOLERA. 
April, 1865, reaching England July 10th, the same year, and 
America, May 1st, the following year, 1866, at New York. 
A fourth epidemic of cholera commenced its westward 
course from India in 1883 and extended to Europe in June, 
1884, and, unless its rate of travel is different from that of 
former epidemics, or unless it is kept back by sanitary sci- 
ence, it will surely complete its journey as in former epi- 
demics. 
Aside from the great interest in the probable visitation 
of cholera to this country, is that shown by the vigorous 
researches made bearing upon its {etiological relations by the 
leading scientific men of the day. 
For these investigations men have been sent from differ- 
ent countries to the various cholera districts. The German 
Government has sent a commission, with Dr. Koch at its 
head. The English Government has sent a commission simi- 
lar, with Dr. Klein as its leading spirit. The French Gov- 
ernment, besides sending out a commission of its own men, 
has sent out two Swiss physicians under its direction. 
Two of the ablest papers that have appeared recently in 
this country on the present status of the study of cholera 
were penned by Dr. Frank Hamilton and Dr. Flint, Sr. The 
latter maybe fairly considered an exponent of the principles 
enunciated by Koch, while Dr. Hamilton represents a class 
who discredit the deductions of Koch, as might be inferred 
from the following statement which he makes in reference 
to cholera, that “ microscopical studies have taught us abso- 
lutely nothing.” 
The Comma Bacillus.—The question at issue is this: 
Is the doctrine true which assumes that the so-called comma 
bacillus is the essential cause of epidemic cholera ? 
Koch reports that it is present in all wrell-marked cases, 
that in one hundred examinations it was absent in none. 
The French commission refuse to accept Koch’s conclusions; REPORT ON CHOLERA. 
3 
although in twenty-four autopsies made by them a micro- 
organism was found in all but three cases, yet their report 
declares that they “ do not feel authorized to attribute a 
specific action to the microbe which they found in great 
abundance in the majority of cases.” 
Koch not only found it present in well-marked cases of 
cholera, but found it absent in diseases other than cholera. 
Dr. Lewis, of the British army, who has studied cholera 
both in India and Marseilles, severely criticises Dr. Koch’s 
report, and makes the statement that he has frequently found 
the comma bacillus in the salivary secretions of the mouths 
of healthy persons, but Koch shows that these are of a dif- 
ferent form, and that they have been known for some years. 
Dr. Flint (“ New York Medical Journal,” October 25, 1884) 
adds this fact in support of Koch’s view, that he is “ not 
aware that in any instance as yet the presence of this parasite 
has been demonstrated by the culture-test except in cases of 
cholera. Obviously this test is essential in order to remove 
all doubt as to the accuracy of microscopical observations.” 
Not only is the cultivation-test considered important as 
bearing on the identity of the comma bacillus, but a still more 
deciding factor in the fate of this micro-organism is the test 
by inoculation. Whether the cholera-germ is inoculable or 
not is a feature of the researches so far involved in great un- 
certainty. Dr. Flint aptly says that “ if, as in the case of 
the Bacillus tuberculosis, the parasite of cholera, after a 
series of cultivations, is capable of producing the disease by 
inoculation, the proof of its being the essential cause is ab- 
solute.” 
Besides the experiments of Koch, the two Swiss phy- 
sicians sent out by the French Government report that they 
produced the disease in animals by inoculation. There are 
other experimenters who have reported the same success; but, 
from the fact that other equally eminent investigators have 4 
REPORT ON CHOLERA. 
obtained negative results, it must necessarily follow that the 
demonstration of the comma bacillus as the essential causa- 
tive agent of cholera can not at present be received with 
universal satisfaction. 
The severest blow, however, the comma bacillus has re- 
ceived is at the hands of the English commission. A pre- 
liminary report, given by Dr. Klein last November, briefly 
says this : That the comma bacilli are not characteristic of 
cholera, since they are present in diarrhoea and dysentery ; 
that they behave precisely like other putrefactive organisms 
when cultivated artificially ; and, finally, that all attempts 
made by the investigators to induce cholera in animals, by 
either feeding or inoculation with these germs, have signally 
failed. 
It is reported that Dr. Klein has even shown his con- 
tempt for the microbe theory by swallowing a quantity of 
the bacilli without harmful result, but this freak is laughed 
at in Berlin by the friends of Koch, who assert that it proves 
nothing except that a suitable nidus is needed for the bacilli 
to develop in, as in other acute specific diseases, which Dr. 
Klein did not have. 
Some French physician has also swallowed cholera mat- 
ter in the form of a pill without bad results, but, when the 
same was given to dogs and guinea-pigs, death soon fol- 
lowed. 
However, all these investigators seem to agree on one 
fact—that there is a specific cholera-germ, but that the 
comma bacillus is this germ all will not admit. This much 
is reasonably certain, that, whatever may be the fate of the 
comma bacillus, the tests by cultivation and inoculation will 
be the chief means of its final establishment or overthrow. 
Bearing upon the general nature of the disease, the fol- 
lowing points are interesting, as well as showing the chief 
characteristics of the infecting material: REPORT ON CHOLERA. 
5 
1. The manner of transportation and diffusion of the 
cholera-germ. 
2. The sudden onset of the disease and rapid prostration 
following. 
3. Filth an essential factor. 
4. Possibility of the disease being “ stamped out.” 
5. Necessity of prompt treatment. 
1. Transportation and Diffusion.—With reference to its 
transportation, Dr. Hamilton (“ New York Medical Journal,” 
Nov. 15, 1885) says that “the cholera-germ may be con- 
veyed from place to place by clothing or by any other tex- 
tural fabrics, by articles of food, by water, and by animate 
and inanimate substances. It may be conveyed for a consid- 
erable distance by the air. How far it can be thus conveyed 
it would be impossible to say, but probably much would 
depend upon the force of the wind and other atmospheric 
conditions. There is, no doubt, a limit to its conveyance 
by this method, and I have reason to believe that it can not 
be thus conveyed beyond a mile or two.” 
Dr. Leale, in a recent article on the study of Asiatic chol- 
era (“ New York Medical Journal,” Jan. 3, 1885), makes the 
statement that “ histories of past epidemics in this country 
clearly inform us that it enters, by commerce with infected 
ports, by either the contaminated clothing of passengers or 
polluted rags.” The doctor adds that “ newly manufactured 
woolen or other goods have never been the carriers of dis- 
ease,” but that “ old rags and the wearing apparel of those 
from infected places are to be specially guarded.” 
That these germs are carried cliietly by means of wear- 
ing apparel and polluted rags there are many curious and 
perfect illustrations. The following are a few : Dr. Atlee, 
of Pennsylvania, in a report of cholera in 1873, states that 
“ a car-load of emigrants came from Philadelphia to Colum- 
bia, Pa. Two or three of these emigrants, who were ill of 6 
REPORT ON CHOLERA. 
cholera, were put out on the platform at the railroad station. 
Some gentlemen, seeing them at the point of death, carried 
them to a shed and waited upon them. In forty-eight hours 
these emigrants and these gentlemen were dead, and the 
disease spread in the town.” 
• An illustration of its extension by means of old cloth- 
ing is given in a report by Dr. Leale of the entrance of 
cholera in the vicinity of 440 West Fifty-second Street, 
New York city, during 1866. “The person attacked was 
a driver, Peter Crow, on the Tenth Avenue cars, and while 
in perfect health at 4.30 p. m. Sunday, August 12th, he sat 
upon some baggage that had been carried on the front of the 
car by a party of five German emigrants who had just landed 
at Castle Garden. While sitting on their bundles of cloth- 
ing, he states that he felt a peculiar chilly sensation, and 
that when he arrived at his home, seven hours afterward, at 
11.30 p. m., he commenced to have nausea, vomiting, and 
purging, which were soon followed by severe and painful 
cramps.” “ Within twenty-four hours from the time he 
came in contact with the infected clothing he was in the 
profound collapse of the algid stage of cholera.” 
Another interesting example occurred at the close of the 
second great epidemic at Suspension Bridge, a small village 
twenty-two miles from Buffalo. Dr. R. J. Rogers, the only 
physician practicing there at that time, in a letter to Dr. 
Frank Hamilton, says that about the 15tli of July, 1854, 
a company of German emigrants were dumped upon the 
banks of the river from the cars, awaiting transportation 
across the then unfinished bridge. Two or three cases of 
what were called cholera morbus were reported, and, on 
visiting them, he found unmistakable symptoms of Asiatic 
cholera. One of the men died in a few hours. The report 
goes on to say that the residents began to be attacked the 
following day. REPORT ON CHOLERA. 
7 
Dr. J. II. Raucli, secretary of the Illinois State Board of 
Health, gives a striking instance of the portability of the 
infective agent of cholera. In an address before the Na- 
tional Conference of State Boards of Health in 1873, Dr. 
Rauch says that “ there were outbreaks of epidemic chol- 
era at Carthage, Ohio, Kandiyohi County, Minnesota, and 
Yankton, Dakota, caused by cholera poison packed up in the 
household effects of emigrants in Holland, Sweden, and 
Russia, respectively ; these emigrants sailed from healthy 
ports, in healthy vessels, and were subjected to the usual 
sanitary requirements of the period. They passed through 
New York and all the intermediate territory without injury 
to the public health. But, when their infected goods were 
unpacked in the interior of the continent, they liberated the 
poison which gave rise to the local outbreaks.” 
These examples just related clearly confirm the manner 
in which the cholera-germ is usually carried; besides, they 
decidedly illustrate that this germ is long lived. It has been 
stated that this germ becomes inert in a very brief period, 
and that it is destroyed by desiccation; but surely these 
statements must be taken with a grain of allowance in the 
face of the foregoing facts. 
2. Sudden Onset and Rapid Prostration.—That the on- 
set of cholera is sudden and the prostration following rapid, 
goes without saying. The visitation of every epidemic ex- 
emplifies that fact. In the Peter Crow case, reported by 
Dr. Leale, it will be remembered that there was vomiting 
with purging seven hours after he was exposed to the 
bundle of rags on the street car, and within forty-eight 
hours his father and mother were stricken down with the 
disease. 
Dr. Rogers, above quoted with reference to the Suspen- 
sion Bridge scourge, says that “ the visitation was remark- 
able for the suddenness of its appearance, its short duration, 8 
REPORT ON CHOLERA. 
the number of cases, and its terrible fatality.” On the sec- 
ond day after the landing of the emigrants, a tramp, a ship- 
carpenter, and three laborers were attacked, and all died 
after a very brief illness. A few days later a number of 
laborers attended a wake of a patient who died of cholera, 
and, of those present at the wake, five died within twenty- 
four hours. Dr. Leale says that “ the period of incubation 
is only of a few hours’ duration, acting as rapidly as yeast 
acts upon dough.” Dr. Rogers further makes the observa- 
tion bearing upon the rapid and profound prostration fol- 
lowing the attacks, that “ one remarkable feature of the 
epidemic was that in a majority of the later cases there was 
an absence of the usual premonitory symptoms, many of the 
patients being in collapse within an hour. In the earlier 
cases, however, there was the usual vomiting, and then the 
rice-water discharges, accompanied with no pain usually, 
but with great lassitude and dejection, followed bv cramps, 
confined mostly to the muscles and tendons of the toes, a 
gradual lowering of the temperature, profuse sweating and 
great thirst, the skin assuming a leaden color and losing its 
contractility, the pulse deserting the wrist, the tongue be- 
coming cold, and the voice husky. As the period of uncon- 
sciousness approached, there would be restlessness, and, 
long after the cessation of the pulse, there would be con- 
siderable muscular activity. During the two or three most 
fatal days I would find the patients, within a few hours of 
the attack, with a cold tongue and pulseless, and with such 
a degree of hoarseness that they could only speak in a 
whisper, and still they could get up and walk about the 
room. Some had no vomiting or purging, and lived but a 
few hours.” 
3. Filth an Essential Factor.—Mr. John Simon, the 
chief medical officer of the English Privy Council, in a re- 
port to Parliament, says that “ cholera derives all epidemic REPORT ON CHOLERA. 
9 
destructiveness from filth, and especially from excremental 
uncleanliness.” 
Dr. F. A. Burrall * states that “ the chosen haunts of 
cholera are in low, dark, damp, overcrowded dwellings, and 
among the ill-fed, badly clothed, filthy, and dissipated, 
where this disease makes its greatest ravages.” 
In addition to these conditions requisite to render the 
communication of cholera by the ordinary methods effec- 
tive, Dr. Frank Hamilton mentions low lands and freshly 
exposed soil. With reference to the former he says: “ If 
these lands are alluvial, and especially if underlaid with clay 
so as to retain moisture, they favor the propagation of chol- 
era as well as of other diseases.” 
The report of the Registrar-General of England for 
1848-’49 concludes with the statement that “ the cholera 
rapidly diminishes a few feet above the low ground on a 
level with the Thames.” It was during this same epidemic 
that the disease proved so terribly fatal at Toledo and San- 
dusky, Ohio, where in the latter city it is stated seventeen 
physicians died from the disease. Both these cities are 
located on low and exceedingly rich alluvial plains. Dur- 
ing the Suspension Bridge epidemic referred to, Dr. Rogers 
states, “ more than nine tenths of the victims resided on 
the narrow flats bordering the river on both sides,” and, 
“ of all the fatal cases, but five occurred in that portion of 
the village which was situated above these low plains.” 
As to the effect of the freshly exposed soil, the follow- 
ing, reported by Dr. Frank Hamilton, is interesting: “On 
Saturday, July 24, 1852, a ditch was commenced for the 
purpose of laying pipes through Ellicott Street, Buffalo. 
On Monday the work was renewed, and it was open com- 
pletely on Tuesday. The excavation brought to the sur- 
* Burrall on “ Cholera.” 10 
REPORT ON CHOLERA. 
face a large amount of alluvium underlying made ground 
of clay and sand. The cholera was prevailing in a mild 
form in some other parts of the city, but Ellicott Street 
had always been regarded as healthy, and had almost en- 
tirely escaped in previous epidemics. It was occupied by 
the best class of citizens. There were twenty residences 
upon the portion of the street corresponding with the 
ditch. On Monday the first case of cholera occurred among 
the residents, and on this and the following days there were 
nineteen cases and nine deaths. The ditch was closed, by 
order of the Mayor, on Wednesday, and from this date 
there were no new cases of cholera.” 
Dr. Flint says, with reference to the influence of filth, 
that “ some striking facts observed in India bearing on this 
point have been noted by Koch. It seems that in certain 
parts of India the water used in bathing, washing, cooking, 
and drinking is contained in tanks which are liable to be- 
come polluted by human excrement as well as by various 
kinds of filth. The occurrence of localized epidemics of 
cholera in the vicinity of these tanks had been a matter of 
frequent observation. Such a localized epidemic occurred 
during Koch’s visit in India. About one hundred persons, 
living in huts situated in the vicinity of a tank, had been 
attacked with cholera. Examinations of the water in this 
tank showed the presence of the comma bacilli. The dis- 
appearance of these from the tank was coincident with the 
ending of the cholera epidemic. Examinations of water in 
other tanks were negative as regards the presence of these 
bacilli. That the water in the tanks gave rise to cholera 
had been previously the opinion of medical practitioners in 
India, and it had been observed that the substitution of 
pure water in certain situations had led to the disappear- 
ance of the disease.” 
At Suspension Bridge, Dr. Rogers says, “after the dis- REPORT ON CHOLERA. 
11 
ease began to subside, on examination, under the Bellevue 
House, a large amount of tilth was found to have accumu- 
lated, and also stagnant water. There was no cellar. Two 
men brought from Lockport were employed to clean the 
premises and remove the filth, and both of them died in a 
day or two of cholera.” 
One would think it almost useless to multiply instances 
showing the part that filth occupies in the prevalence of 
cholera; hut the examples given illustrate the fact so 
graphically that they easily hear repetition in emphasizing 
the prominence of this element in the study of the aetiology 
of this dread disease. 
4. Possibility of the Disease being “stamped out."— 
Whether this disease can he kept away or checked, or 
made to disappear entirely, is a question for the most 
urgent consideration. That the disease is easily controlled 
and quickly yields to efficient sanitation, or, as it is tritely 
termed, the “ stamping - out ” process, there is abundant 
evidence to prove. 
During the epidemic of I860, at the Crow houses on 
West Fifty-second Street, cases continued to recur, even 
with the ordinary methods of disinfection and fumigation ; 
but just as soon as Dr. E. B. Dalton, Sanitary Superintend- 
ent of the Board of Health, took it in hand, employing on 
a larger scale the most vigorous and effective methods, 
burning all suspicious articles, not a single case of cholera 
followed. In Dr. Dalton’s report of the disease during the 
year 1866, during which time over one thousand deaths 
occurred in New York city, he makes the statement that 
“fumigation, either with chlorine or sulphurous-acid gas, 
has, with two exceptions, been followed by complete immu- 
nity from the disease.” 
The most striking illustration of the efficacy of the so- 
called “ stamping-out ” process is seen in a report given by 12 
REPORT ON CHOLERA. 
Dr. Frank Hamilton, who had complete control of the sani- 
tary conditions of Blackwell’s Island during the sudden and 
violent outbreak there in 1866. The following is, briefly, 
Dr. Hamilton’s report: “ On August 1st there were 29 new 
cases and 10 deaths; on August 2d there were 33 new 
cases and 14 deaths. On the next day (August 3d),” says 
Dr. Hamilton, “the most important sanitary changes had 
been made, some of which were very radical, and were in 
operation. On this day, August 3d, there were 30 new 
cases and 13 deaths; August 4th, 21 new cases and 4 
deaths; August 5th, 12 new cases and 7 deaths; August 
6th, 4 new cases and 3 deaths; August 7th, 1 new case and 
1 death.” 
It will be seen, from this statement, that the epidemic 
began to decline from the day that the sanitary changes 
were enforced, and in four days—that is, on the 7th day of 
August—there was but one new case. Dr. Leroy M. Yale, 
one of the house staff there at that time, says, in a report, 
that on August 7th, the fourth day after the introduction 
of the rigid sanitary measures, “the epidemic was virtually 
at an end.” 
It is said that, in New York city, during the summer 
and autumn of 1866, cholera occurred in three hundred and 
sixty-two houses more or less widely separated from each 
other, and so completely was its diffusion checked that in 
no instance did the disease spread proximately beyond the 
house in which a case or cases occurred. Dr. Flint makes 
the assertion that “ never before or since, in any other part 
of this or in any other country, have measures for the pre- 
vention of epidemics of cholera been devised so scientific- 
ally, so thoroughly carried out, nor so successful in the re- 
sults as those employed by the New York Metropolitan 
Board of Health in 1866 and 1867. The fact should be 
cited everywhere as evidence that cholera is a disease REPORT ON CHOLERA. 
13 
which may be stamped out by efficient sanitary measures 
efficiently employed.” 
5. Necessity of Prompt Treatment.—Aside from the im- 
mense practical importance of cholera prevention is the ne- 
cessity of immediate treatment. 
Cholera is classed, along with small-pox, measles, etc., as 
an infectious disease, the latter running a certain definite 
course, neither of them susceptible of being aborted. Not 
so, however, with cholera. It is the general belief that, if 
predisposing causes be removed and appropriate and im- 
mediate medication employed, perhaps a majority of cases 
will speedily recover. 
But there must be no delay. Dr. Hamilton says that “ it 
is not often that a patient is saved to whom remedies are not 
applied until the period of collapse has arrived; but a large 
proportion are saved by appropriate remedies employed in 
the earlier stages of the disease.” Dr. Yale, in a report on 
cholera at Blackwell’s Island, says that, of those brought 
first to the “ diarrhoea hospital,” not one died. The terri- 
ble fatality of the Suspension Bridge epidemic was no doubt 
due in a great measure to the fact that so many of the cases 
went into collapse so quickly, long before the arrival of the 
physician. 
Dr. Flint, who has had extensive clinical observations in 
the treatment of cholera, says that “ there is no disease with 
greater certainty controlled at the outset than this.” In 
order to carry out these prompt measures, he maintains that 
“ the only effectual plan is to organize a sanitary police, and 
provide for one or two domiciliary visits daily at every 
house within the limits of the epidemic, the purpose of the 
visits being to inquire if any one be aftected with diarrhoea, 
to impress the importance of immediate attention to it, and, 
when circumstances render it necessary, to supply at once 
appropriate remedies. . . . Abundant proof of the success- 14 
REPORT ON CHOLERA. 
ful operation of the system of house-to-house visitation was 
furnished by its practical results in London and other towns 
in Great Britain during the epidemic of 1849.” 
As to medication, the list of remedies in fashion at the 
present day is not very long. Calomel has its advocates. 
Venesection has always had its friends and enemies. Even 
in the stage of collapse, where one would think blood-letting 
dangerous and where no one would seem to doubt the effi- 
cacy of externa] warmth and stimulants, it is asserted, on no 
less an authority than that of Dr. Parkes, who had a large 
clinical experience in India in 1843, that blood-letting and 
cold affusion were used with success in this stage, the 
embarrassed circulation being relieved and the respiration 
stimulated in the same manner that a new-born babe’s res- 
pirations are quickened by the application of cold water. 
There is one drug, however, concerning which there has 
been a great deal said, and that is opium. During the first 
stage, Dr. Flint says, in his recent article, “ the controlling 
remedy par excellence is opium. Let opium, conjoined 
with rest of the body and of the digestive organs, be judi- 
ciously employed before the characteristic choleraic dejec- 
tions occur, and the further development of the disease is 
prevented with almost absolute certainty. Let this treatment 
be promptly resorted to as soon as choleraic dejections have 
taken place, and, in a large proportion of cases, the disease 
is arrested.” 
This is putting the early treatment and its results in a 
nutshell. The positive manner in which it is expressed, 
coming from so eminent an authority, must necessarily carry 
great weight with it. If the statement be true, or even par- 
tially true, considering the fact that during the past century 
one million lives annually on an average have fallen victims 
to this terrible Oriental plague, the necessity for immediate 
medication becomes vastly more manifest and markedly em- REPOET ON CHOLERA. 
15 
pliasizes the immense responsibilities of those whose duty it 
is to care for the health of large municipalities. 
The usefulness of opium in an epidemic of cholera mor- 
bus was seen a few years ago at Turk’s Island, West Indies. 
The epidemic was attributable to impure water. The drink- 
ing-water there is rain-water collected from the roofs of 
houses into large tanks. When there was a scarcity of 
rain the wafer became quite low in the tanks, and con- 
sequently mixed with the sediment at the bottom. This 
epidemic lasted several weeks, and ended when plenty of 
rain filled the tanks with pure water. At this time there 
were nearly a hundred people stricken down, and the at- 
tacks of some were so sudden and severe that they had to 
be carried home. One grain of opium in pill was given 
hourly until relief was obtained, then given every two or 
three hours, as the case indicated. There was not one death 
during the entire epidemic, and all the cases yielded so 
readily to the drug that no other remedies were resorted to, 
except, however, in a few who were peculiarly susceptible 
to the effects of opium on the skin. In these cases large 
doses of astringents were used, but with apparently little 
effect, and, as in those cases that did not receive immediately 
the routine treatment, recovery seemed to follow much 
more slowly. In the few cases that were quite severe, 
where the stomach was not in a condition for the reception 
of medicine, morphine by the hypodermic needle was used 
with admirable results. 
Now, assuming that, in the early stage, opium has a posi- 
tive effect in controlling this disease, which we may grant for 
the present is due to some specific germ, it would be curi- 
ous to know what the peculiar action of the drug is. Of 
course, whether the germ is narcotized or whether it is de- 
stroyed directly or indirectly by checking the alkalinity of 
the intestinal contents, is at present all speculation. Dr. 16 
REPORT ON CHOLERA. 
Hamilton says: “ It is only necessary to suppose, what 
seems probable, that the period of life or activity of the 
germ in the human system is brief, and that opium holds 
the secretions in a normal condition until the germ perishes 
or the force of the virus is expended” (“ New York Medical 
Journal,” November 15, 1884). 
In conclusion it may be stated: 
1. That cholera occurs mainly in great epidemics, 
starting in India and moving in a westerly direction, 
reaching America usually about a year after its appearance 
in Europe. 
2. That the fourth great epidemic has reached Europe. 
3. That the identity of the comma bacillus as the causa- 
tive agent of cholera is not as yet accepted by all scientific 
investigators. 
4. That the manner of transportation and diffusion is 
generally by means of rags and polluted clothing, the latter 
being worn usually by emigrants. 
5. That the incubation period is very short, the onset of 
the disease very sudden, and the prostration following quite 
rapid. 
6. That filth in all its forms is a necessary concomitant 
to the disease. Filth may exist without cholera, but cholera 
seldom prevails without filth. 
7. That the disease can be arrested and completely 
stamped out by efficient and vigorous sanitation, as has been 
demonstrated beyond all question. 
8. That in addition to the extreme importance of effi- 
cient sanitation is the absolute necessity of the prompt 
attention to immediate treatment by the method of house- 
to-house visitation within the cholera limits, and, if need be, 
the instant removal of patients to hospital accommodations. REPORT ON CHOLERA. 
17 
Part II.* 
By WILLIAM I1ENRY THAYER, M. D., 
BROOKLYN. 
To the report just presented by Dr. Baker I wish to add 
a few words on the pathology of cholera, with a brief re- 
view of the most approved methods of treatment; an out- 
line of the epidemic of 1866 in Brooklyn and New York, 
with a description of the means employed to arrest it. I 
have taken the liberty to speak in the first person, as suited 
to the nature of my paper. 
In a report of this kind, designed chiefly to initiate a 
discussion in the society bearing mainly on the subject of 
prevention and treatment of cholera, it is not desirable for 
me to devote much time to detailed description of the dis- 
ease. It is enough to say, in the language of Dr. Parkes, 
who wrote in 1847, from five years’ experience of cholera in 
India, that “ it is primarily a disease of the blood ; and the 
changes induced in the function of respiration, directly con- 
sequent on the alteration of the blood, are the proper and 
distinctive symptoms of the disease.” The purging, vomit- 
ing, and cramps are speedily followed by the symptoms be- 
longing to the circulation, that group of symptoms which 
marks the algid stage, “ which afford the only measure of 
the severity of the case, and from them only can a correct 
prognosis be formed.” 
Dr. Parkes says: “ The vast majority of untreated cases 
die.” 
The first indication, when the patient is seen at the out- 
set, is to arrest purging. For this purpose absolute rest is 
* Read before the Medical Society of the County of Kings, April 21, 
1885. 18 
REPORT ON CHOLERA. 
required, with astringents and sedatives—sucli as acetate of 
lead with opium, or tannin, or the mixture prepared by Dr* 
Squibb, in 1866, of camphor, capsicum, chloroform, and 
opium. 
But astringents and all other measures may fail to arrest 
the purging, and the algid symptoms begin to appear. 
“ The list of remedies which have been used in cholera to 
counteract the deeper and more important changes in the 
blood comprises all the stronger medicines known to physi 
cians at the present day,” says Parkes, “ and it appears to 
me,” he continues, “ no one medicine has been found more 
efficacious than another.” The warm bath is injurious. 
Cold affusion is grateful, and sometimes temporarily bene- 
ficial. Stimulants are quite useless, and indeed hurtful. 
Venesection was much in favor with East India surgeons at 
one time, but in subsequent epidemics the results were un- 
favorable. Calomel, strychnine, sulphuric acid, chloroform, 
camphor, saline enemata, enemata of brandy and water, re- 
peated doses of castor-oil, ice-bags to the spine—these are 
the remedies which have been used with more or less ap- 
parent success by different men in different epidemics. 
My personal experience in 1849 and 1866 leads me to 
say that very little time should be spent in any attempt to 
arrest the diarrhoea by astringents or kindred medicines. 
When the algid symptoms begin to appear, it is too late to 
cure the disease by stopping the diarrhoea. Indeed, some 
observers believe it to be salutary. Every one who has had 
experience in cholera knows that the diarrhoea is no index 
of the severity of the disease. The cases most rapidly fatal 
are those in which the evacuations are least. This fact gives 
color to the opinion held by some that the discharge from 
the bowels is the means of eliminating the choleraic poison. 
In 1849 the experience of East India surgeons led me to 
bleed the patients. In a dispensary practice in which I saw REPORT ON CHOLERA. 
19 
a number of cases there were some recoveries under venesec- 
tion : in the case of one man, whose radial pulse was already 
entirely absent, and blood could for some minutes only be 
forced out drop by drop from the median basilic vein by 
continual “stripping” of the arm from the wrist to the 
elbow, I think it was a full half-hour before it flowed spon- 
taneously. When this occurred, the skin began to grow 
warm and less livid, respiration became easier, and the patient 
went on to recovery. But there were others, whose condition 
seemed more hopeful when first seen than this man’s, who 
were bled while there was a radial pulse, who did not for a 
moment improve under the venesection. 
In 1866, when I had charge of the Hamilton Avenue 
Cholera Hospital, venesection was not employed there. Af- 
ter a trial for a few days of various remedies which had been 
most approved, all the cases not hopelessly advanced were 
treated with calomel, in doses of from three to ten grains, 
according to the age of the patients, repeated at hourly 
intervals till three or four were taken, or bilious dejections 
began. The results were gratifying. We had eighty-four 
patients with cholera, of whom twenty-six recovered and 
fifty-eight died. Thirteen only of these entered the hospital 
before the algid stage ; of these, twelve recovered; they 
wrere treated with calomel from their entrance. The one 
who died had no calomel. Seven of the fifty-seven who 
entered in the stage of collapse recovered under the calomel 
treatment. The mortality is far greater than it would be 
if the patients came under treatment at the outset of the 
disease; two thirds of these wrere already in the stage of 
collapse when they entered the hospital. 
The general plan of treatment was absolute rest, no food 
while vomiting continued, ice or wTater in frequent small 
quantities, astringents and opiates if seen very early; but if 
diarrhoea continued, or if there was the slightest hint of 20 
REPORT ON CHOLERA. 
algid symptoms, calomel in repeated doses until bilious 
evacuations were produced. After tliis, nourishment in 
small quantities. But this general plan was so far varied 
that, after the calomel treatment was adopted in the hos- 
pital, we never gave astringents or opiates, or took any di- 
rect method to arrest diarrhoea; all patients not hopelessly 
collapsed and past the power of absorbing medicines were 
put on calomel at once. 
Emetics have been recommended to be given until vig- 
orous emesis is produced, resulting sometimes in the dis- 
charge of undigested food long retained, which the involun- 
tary vomiting of cholera had not dislodged. According to 
Dr. J. C. Hutchison, who had charge of the Brooklyn Chol- 
era Hospital in 1854, after emesis produced in this way the 
choleraic vomiting usually stopped. 
The calomel treatment was pursued in the four cholera 
hospitals of New York and Brooklyn in 1866, with about 
the same results in all. It met with favor in Europe and in 
the U. S. Army. The “Report on Cholera in 1867 ” in 
“Circular No. 1, Surgeon-General’s Office, 1868,” contains 
favorable testimony to its efficacy from many army sur- 
geons. In 1854, Dr. Hutchison, who treated one hundred 
and forty-four cases in his hospital, made no attempt to 
check the diarrhoea, but gave one grain of calomel every 
hour j and all those who entered the hospital in the first 
stage recovered. 
Nevertheless, an examination of cholera reports in sev- 
eral epidemics in Europe and India discovers nearly as fa- 
vorable testimony of the use of some of the other remedies 
already enumerated; and shows that longer experience with 
any plan of treatment is needed to establish its value, and 
that remedies sometimes owe their apparent success to the 
mild character of the epidemic. The remedies thus far 
addressed to the algid stage of the disease have been em- REPORT ON CHOLERA. 
21 
pirical. In the first stage there seems to be a clear indica- 
tion to arrest diarrhoea. But the essential nature of the 
fully formed disease consists of material alterations in the 
blood ; not merely in loss of serum—which is not so con- 
siderable as frequently takes place in “ cholera morbus ”— 
but in disorganization of the red corpuscles, by which its 
oxygenating power is lost or impaired. The blood is in- 
variably deeply carbonized after the formation of the algid 
stage, and, on exposure to the air, is very slow to absorb 
oxygen. The expired air contains no trace of carbonic acid, 
and has an excess of oxygen—a condition fairly attributable 
to the abnormal condition of the red corpuscles. The pa- 
tient dies asphyxiated. -Whatever mode of treatment is to 
be beneficial after the disease is fairly established must in- 
clude remedies which have an influence beyond checking 
the discharges; they must have the power of arresting the 
destruction of the red corpuscles, a result to be attained by 
staying the germination of the specific cause of cholera 
within the body. Now, has calomel the power to do this, 
and are there other medicines equally effectual ? 
Parkes says “the vast majority of untreated cases die.” 
But such a statement must be taken as referring to the 
Hindoo population, who sicken and die in their hovels in 
the concentrated choleraic poison arising from the saturated 
ground, not only refusing medical treatment, but neglecting 
all improvement of their unhealthy surroundings. Such an 
opinion may not be correctly given of persons at rest in a 
well-ventilated building, in a wholesome locality, carefully 
nursed, and, after these provisions, trusted to their natural 
restorative powers. There is probably a self-limitation in 
cholera, and, if the patient is not rapidly killed by the altera- 
tions of the blood, the system slowly recovers itself. This is 
still an open question. I am unable to produce any favorable 
reports of cases in which no medicine was administered; 22 
REPORT ON CHOLERA. 
unless we except the following statement of Dr. Hutchison 
in his report: “Whenever in any case we are at a loss to 
know what treatment to adopt, or if we find the patient 
growing worse under the influence of remedies that we 
think best adapted to the case, the better plan is to rely on 
the vis medicatrix naturae. This I have repeatedly done 
with much satisfaction, patients in the deepest collapse 
having reacted without any treatment—in one case without 
even ice, beef-tea, or external applications.” But, accord- 
ing to Dr. Hutchison’s report, patients received in the first 
stage were treated with repeated small doses of calomel, 
and all recovered. 
The returns of the mortality from cholera in Brooklyn 
and New York in the various hospitals and public institu- 
tions, and in the community outside, are instructive as to 
the influence of their various circumstances upon the mor- 
tality, as will be seen by the following table: 
Cases. 
Deaths. 
Percentage 
of deaths. 
Brooklyn Cholera Hospital, 1854 
144 
88 
61 
Brooklyn, Hamilton Ave. Hospital, 1866 ... 
84 
58 
69 
“ City Park Hospital, 1866 ...... 
18 
11 
61 
Kings County Penitentiary, 1866 
87 
67 
77 
Brooklyn cases, outside hospitals, 1866.... 
572 
408 
71 
New York Red House Hospital, 1866 
50 
33 
66 
“ Battery Hospital, 1866 
149 
107 
72 
Blackwell’s Island Lunatic Asylum, 1866... 
98 
62 
63 
“ “ Workhouse, 1866 
204 
147 
72 + 
“ “ Almshouse, 1866 
111 
90 
81 
“ “ Charity Hospital, 1866 .. 
50 
42 
84 
“ “ Penitentiary, 1866 
19 
7 
36 
By tliis table it will be seen that in cholera hospitals the 
percentage of deaths ranged from 61 to 72, averaging 65f, 
nearly 66, while the percentage of deaths in Brooklyn out- 
side of hospitals was 71. A large majority of the hospital 
patients were in the algid stage on admission, and some of REPORT ON CHOLERA. 
23 
them moribund; but most of those who were still amenable 
to treatment recovered, who, under their average circum- 
stances in tenement-houses, would have died. 
The returns from the penitentiary on Blackwell’s Island 
probably give a fair showing of the results of cases placed 
in the most favorable circumstances: nineteen cases and 
seven deaths = 36 per cent. The subjects averaged twenty- 
seven years of age, were probably generally vigorous and 
were where they came under treatment at once and were 
not removed. Hospital patients, on the other hand, are 
aggravated by transportation when they need absolute rest, 
and have been ill for hours when put under treatment. 
The workhouse had 72 per cent, of deaths, the patients 
being older and less vigorous; the almshouse 81 per cent., 
the patients being still older and generally broken down; 
and the Charity Hospital 84 per cent., the inmates being 
already diseased. 
I suppose it may be maintained as an undisputed fact 
that cholera is extended from the subject to other persons by 
the evacuations only. Further time is required to settle the 
question whether the comma bacillus is the essential germ 
of the disease. But this is immaterial while we know that 
the evacuations contain the poison, and all of it. This 
places the extension of cholera within our control. The 
history of the epidemic of 1866 affords many instances of 
the possibility of arresting the epidemic promptly by suita- 
ble disinfection. It is not possible always to trace the cases 
to their source of infection. Thus, in Brooklyn the first 
case was in Walcott Street, Twelfth Ward, July 7th. Other 
cases occurred within the next four days in the Third, 
Fourth, Sixth, Ninth, Twelfth, Seventeenth, and Nineteenth 
Wards, points widely distant from each other. In New 
York three cases occurred in the first week of May, the 
third case being five miles from the others. There was no 24 
REPORT ON CHOLERA. 
evidence of the source of infection in any of them. Thor- 
ough disinfection of the premises was made, and no other 
case was seen in New York for a month. 
In these two cities, cholera was confined almost exclu- 
sively to tenement-houses, or such places as the miscellaneous 
filthy hovels on the wet and foul soil of the Twelfth Ward 
of Brooklyn, or institutions where many persons were 
crowded together. And the experience has been the same 
everywhere. The cholera poison does not easily germinate 
or develop in clean places. It requires moisture and filth. 
In the four cholera hospitals of Brooklyn and New York 
no case occurred among the attendants, who were numerous 
and passed their whole time in the buildings. 
The chief means of arresting the epidemic are ventila- 
tion of houses and chemical destruction of the excreta. In 
1849 it was not yet known or suspected that the epidemic 
was to be arrested by disinfection of the excreta, and no 
attention was paid to them ; nevertheless, there were many 
single cases of cholera in private houses, where there was 
nothing to prevent its extension but cleanliness and good 
ventilation. And even in a public institution in Boston—a 
temporary home for destitute children —which had perhaps 
thirty inmates, the matron died under my care after nine 
hours’ illness, and was buried from there two or three days 
later, yet no other case occurred in the house. At that 
time, therefore, cleanliness and ventilation wrere all that 
aided its own limitations in checking the spread of cholera. 
It was regarded as an epidemic whose extension was due to 
atmospheric conditions unknown and uncontrollable. 
At present, it having been demonstrated that the excreta 
carry the poison, which may be transmitted from the sick 
to the well through drinking-water which it has contami- 
nated, or through the air of confined apartments which it 
has infected, the indications are clearly for the chemical de- REPORT ON CHOLERA. 
25 
struction of all discharges and the thorough purification of 
the clothing and bedding of the sick, and a provision for 
water for household uses from sources entirely beyond pos- 
sibility of contamination by cholera poison. In the matter 
of drinking-water, Brooklyn is safe, for the Health Commis- 
sioner has at last succeeded in having every well within the 
city limits filled up, so that the whole water supply now 
comes from Hempstead, some miles in the country. All 
that remains, therefore, is to destroy the excreta. If this 
is thoroughly done, no disinfection of houses after the 
death or removal of cholera patients—by steam, sulphurous- 
acid gas, chlorine, or any other method—can be necessary, 
because no germs or cholera poison will have escaped into 
the air, or, if escaped, will have been retained within doors 
if the building has been constantly and thoroughly venti- 
lated. 
To disinfect the excreta we may employ bichloride of 
mercury or chloride of lime, either one of which is deemed 
effectual by the Committee on Disinfectants of the Ameri- 
can Public Health Association. They advise chloride of 
lime dissolved in water, in the proportion of four ounces to 
the gallon of water—one pint of this solution to be added 
to each discharge in cholera, to be left in the vessel ten min- 
utes before it is emptied into the water-closet; or corrosive 
sublimate and permanganate of potash, dissolved in soft 
water, two drachms of each salt to the gallon. This is 
equally effective, and has the advantage of being inodorous, 
but the discharge requires to stand in the vessel an hour 
after the solution is added before being emptied into the 
water-closet. 
The Committee of the Public Health Association assert 
that sulphate of iron is not a germicide, but valuable as an 
antiseptic, “ its low price making it one of the most valua- 
ble agents for the arrest of putrefactive decomposition in 26 
REPORT ON CHOLERA. 
privy vaults.” That it exercises a restraining influence upon 
the development of disease-germs can hardly be questioned 
when we consider what good results followed its use in 
1866. In the Hamilton Avenue Hospital it was system- 
atically added to every dejection; and if it is inert, then 
we must believe that the most complete ventilation is an all- 
sufficient disinfectant. The hospital occupied one floor of 
a building measuring seventy by one hundred and ten feet, 
high-studded, with all its many windows and three large 
doors constantly open, through which there was a fresh 
breeze blowing most of the time. The other three hospitals 
in the Metropolitan Sanitary District used sulphate of iron 
as a disinfectant in the same way, and no case of cholera 
originated in any one of them. 
“In the New York hospitals of the Health Department 
all bedding and clothing soiled or used by the patient was 
boiled in a solution of permanganate of potassium for two 
hours, and then removed and boiled in pure water. Chlo- 
ride of lime, or Labarraque’s solution of chlorinated soda, 
was scattered freely about the floors.” In the Hamilton 
Avenue Hospital the floors were scrubbed with soap and 
water; the blankets and other clothing, after removal from 
a patient, were immersed in a barrel of water to which a 
pint of Labarraque’s solution had been added, and, after 
remaining there twenty-four hours, were boiled and washed. 
One woman washed these clothes for flve weeks. Mattresses 
and pillows were thoroughly aired ; if wet, they were 
burned. 
There were several striking instances during the epi- 
demic of 1866 of its prompt arrest in public institutions by 
dispersion of the inmates and thorough disinfection. A 
notable one is that of the workhouse on Blackwell’s Isl- 
and, where, under the direction of Professor Frank H. 
Hamilton, the inmates were distributed as far as the vacant REPORT ON CHOLERA. 
27 
places in the building would permit, disinfectants were thor- 
oughly used, the diet was improved, and every possible step 
was taken for cleanliness and the chemical destruction of 
the excreta. The epidemic began to decline from the day 
these measures were fully carried out, and in five days it 
ceased entirely. It lasted nine days, during which time 
123 of the 800 inmates died. 
At the Kings County Penitentiary, which had eighty- 
seven cases, all the inmates who were well were removed 
to tents outside the prison on the 5tli of August. Only 
six cases occurred after removal to the tents, and three 
of these were in attendants, who continued to sleep in the 
prison. 
The cholera poison does not spread far from its source 
Lebert says : “ According to the most recent investigations, 
it is well established that cholera is as old as the human race 
in India, and that the mouths of the Ganges and Brahma- 
putra are to-day, as they have been from time immemorial, 
the centers of departure of the great Indian epidemics of 
this disease” (Ziemssen, i, 353). Parkes, speaking of the 
disease at Moulmein, in Burmah, says: “ For many months 
it was confined almost entirely to the houses situated on or 
over the river, and chiefly to the south end of the town. 
One side of the main street runs close to the river, and the 
great majority of cases occurred on this side.” “ The only 
Europeans attacked at the commencement of the epidemic 
were the sailors belonging to the ships in the river ; the 
ships nearest the shore suffered most. Thus nine cases oc- 
curred on board II. M. brig Britomarte, lying close in shore; 
she was moved about a mile away, into the center of the 
stream, and no more cases occurred.” “ No case occurred 
in the European and native regiments, whose barracks are 
situated half a mile from the river, although these men were 
allowed unrestricted intercourse with the bazaar.” 28 
REPORT ON CHOLERA. 
In several European steamers that arrived with cholera on 
board during the spring of 1866 the disease was confined 
to the steerage, where it originated, no case occurring in 
the cabin. On board the steamer England there were two 
hundred and fifty deaths by cholera during the voyage, but 
no cabin passenger was ill. The same is true of the Vir- 
ginia, which arrived on the 18th of April; no cabin passen- 
ger was affected. In Brooklyn, in the Twelfth Ward, where 
nearly half the cases occurred, the disease clung especially 
to certain houses, situated nowise worse than many others, 
and peculiar only in having cholera eases already there. It 
is difficult to understand its spreading around the world at 
long intervals only, rather than prevailing every year wher- 
ever a suitable nidus can be found, without admitting some 
other means of transmission besides personal contamina- 
tion. But this is the only means of extension thus far dem- 
onstrated ; and we find it possible to check its extension as 
soon as discovered. 
By far the most important consideration is the removal, 
before the invasion of the epidemic, of all media for the 
development of cholera-germs in the soil, or the air of 
houses and localities, by measures of general and local puri- 
fication, and especially by complete sewerage of every in- 
habited district, and by every possible provision against 
crowding and the faulty construction of houses. The lew York Medical Journal, 
* ' 
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