[From The Sanitarian for April, 1893.] CREMATION AND ITS IMPORTANCE IN CHOLERA. ABSTRACT OF DISCUSSION AT STATED MEETING OF NORTH- WESTERN MEDICAL AND SURGICAL SOCIETY OF NEW YORK, JANUARY 18TH, 1893. Dr. Robert Newman. Dr. Newman had prepared an exhaustive paper on this subject, but in order to save time he omitted not only a care- fully prepared bibliography, but also a number of points hav- ing a more or less important bearing on the subject. Creination, he said, is a very old method of disposing of the dead, and was the legal form of burial among the ancients, particularly in Greece and Rome. It was revived about twenty years ago, but made very little progress for about ten years. At the present time it is acknowledged by all unprej- udiced and intelligent persons, and by scientists and sanita- rians particularly, to be the best method of disposing of the dead. The present method of cremation consists in exposing the body in a retort to a temperature of about 2000° F. No fire touches the body, but this heat is sufficient to make the corpse incandescent, and eventually to reduce it to a gray powder or ash weighing about four to six pounds. This is usually placed in terra cotta or marble urns suitably inscribed, and these urns may be kept by the relatives, deposited in a columbarium, or buried. There are now fifteen crematories in this country, and be- tween 1884 and 1892, 2017 incinerations have taken place, 2 Cremation and its Importance in Cholera. 868 of this number being at New York. The Earle Memorial Crematory, at Troy, is the most costly in the country. Scat- tered over this country there are now thirty-two active crema- tion societies. From 1876 to 1887, in the nineteen crema- tories of Italy, 952 bodies were incinerated. There are nine- teen cremation societies in Germany, but progress in this direction is slow, owing to the red tape in the government bureaus. Dr. Petrie, of the Department of the Interior in Berlin, published a paper in which he claimed that cemeteries were perfectly safe if situated in proper soil and managed properly, but in the discussion on his paper it was shown that bacilli had been found in the earth three years after bodies had been buried. It has also been shown that in places where persons dying of yellow-fever have been buried, bacilli identical with those found in the excretions of the yellow-fever patients have been found only a few inches below the surface of the ground. The question of the effect of cemeteries on the health of the surrounding population assumes unusual impor- tance in the neighborhood of large cities like New York, where there are no less than forty cemeteries. Nothing can be found in the Bible which can be construed as opposed to cremation, and many clergymen now favor it. " He who can make men from the dust can bring them from ovens as well as from graves." The vital germ is no more destroyed by a few moments of intense heat than by a slow putrefaction for fifty years. Cremation is a religious rite among the Buddhists in Japan. The doctor then read a long list of names of eminent medical, clerical, and literary people who are in favor of cremation, and said Professor Virchow had written a letter in answer to a request from the Cremation Society of Berlin for a medical expert opinion as follows : To the Board of the Cremation Society, Berlin, December 6th, 1892 : " In answer to your kind letter of the beginning of Octo- ber, in which the directory besought me to give a medical opinion about the usefulness of an introduction of facultative cremation, especially of such persons as have died from cholera or other epidemics, I declare in full maintenance of my opin- Cremation and its Importance in Cholera. 3 ion, given already in 1881 in the German Landtag, that I con- sider cremation very useful indeed with respect to economical as well as sanitary matters. " In times of great epidemic diseases cremation should be considered an entire necessity. Strong heat without the act of burning has already proved, according to my experience, a good means by which the micro-organisms and contagious matters could be destroyed ; of course genuine burning grants a far better security still. " Big cities should try on this account to get their dead cremated, as mass-burials in grounds, which are near popu- lous districts, every now and then revive the fear that some danger might not be excluded for the neighboring dwelling- places. ' " Rudolf Virchow." THE PROPAGATION OF CHOLERA. Cholera comes to the shores of America as an epidemic by the natural ways of travel and commerce, either by travellers and immigrants or by baggage and merchandise, and if once introduced, spreads with great rapidity through excretions, clothing, bedding of the patients, and their dead bodies. Contagion is also carried by insects, water, and earth. Gatti, Grassi,* Koch, Simmonds, and others are authorities that insects and flies have carried cholera. They kept flies who had been seen sitting on cholera corpses at their labora- tories, and after some time found the common bacilli. Water in different ways may be dangerous. It is well known that anybody who drank water from the Elbe during the last epidemic in Hamburg was a suspect, and was kept under observation. Biernackif found in the well in Lublin, a suburb of Hamburg, cholera bacilli. That well was near a single house, in which in a few days twelve persons were seized with cholera. All these had been drinking from that well. His experiments were made very carefully, and he found the specific bacilli in large numbers two days after the beginning of his examinations. Professor C. Fraenkel, of Magdeburg, found comma bacilli * Eulenburg, Real-Encyklopcedie d. ges. Heilk., IV., p. 234. f Deutsche Med. Wochensch., No. 42, 1892. 4 Cremation and its Importance in Cholera. in the Rhine-Ruhr Canal, where a boat had been anchored whose owner had died of cholera, and where his excretions had been emptied. Water in the hold of a vessel is also dangerous. In the hold of a boat on the Elbe Lubarsch found bacilli. On the same boat a child had died of cholera eight days previous. Earth in graves through burials may cause a new epidemy. Sanitary Commissioner Dr. Doering in Berlin has shown that cholera bacilli are living in graves, and may be liberated by water, and thereby create the disease. That graves are dangerous in this way can be proved by an incident in New York. During the cholera epidemic of 1866 some emigrants were buried in Ward's Island, and nearly at the same time a new epidemic appeared in the city oppo- site the island, in Ninety-third Street, near Third Avenue. Similar instances have been observed and have been men- tioned before. As a recapitulation, cholera is propagated by immigrants, mechandise, clothing, excretions, water, earth-corpses, and insects. HOW IS CHOLERA TO BE PREVENTED ? The best prevention is to keep cholera and bacilli out of the country, but if it comes to keep and treat it in quarantine. If it is in quarantine, the best factor to prevent an epidemic and to destroy any contagious carrier is to follow Virchow's advice, heat wel cremation ! The experiment is not new ; has been done and always with success. The following letter shows how heat, even in an imperfect manner, ended an epidemic of yellow-fever : 204 Washington Street, ) Brooklyn, N. February 5, 1889. ) Dear Sir : I am most decidedly in favor of burning the dead, and cannot comprehend why so many object to it. The terrible diseases that from time to time cast communities of human beings into an abyss of grief would lose their hold in a short time if the victims were promptly consigned to the purifying action of the flames. What possible good can there be in burning clothes and furniture, if the infected flesh be allowed to remain in existence ? Cremation and its Importance in Cholera. 5 In 1868 there was a dreadful epidemic of yellow-fever in Lima, Peru, as many as three hundred patients dying each day. From the beginning Dr. Le Piongeon, then practising in that city, urged the cremation of the dead. It was impos- sible to bring the public mind to contemplate such a course. Finally an arrangement was made to keep large fires on the trenches filled with corpses, public attention not being drawn to the fact. At once the plague abated and soon died out. Alice D. Le Plongeon. Sir Spencer Wells recommends cremation in cholera in a communication to the Times and other articles. He says that graves sooner or later will renew cholera epidemics through the earth, water, or air. Koch, F. Kuechenmeister, Blaschko,* Herzberg-in fact, all sanitarians, recommend cremation, and during the last scare, in 1892, the New York quarantine authorities ordered the burning of clothing and bedding, and the cremation of cholera dead in Swinburne Island, when New York and the whole United States were in great danger. The care, hard work, and watchfulness of our health officer of the port of New York, under adverse circumstances, pre- vented the cholera from entering New York and America last summer, and there is no doubt that it will be kept out of America during the next year. With the former experience and better precautionary measures, Dr. Jenkins will be even more prepared to keep the pestilence out of America. If suspects arrive, they must be kept in quarantine under observation a reasonable time, which can be done without going to extremes. If cholera cases appear, they must be treated, and the ships and people disinfected, as also all ex- cretions thoroughly disinfected. Dr. A. S. Ashmead, in Science, gives four rules to prevent cholera, as follows : 1. Let the drinking water be perfectly isolated-that is, keep the cholera germs from the drinking water. 2. Let the faeces and other discharges be disinfected with quicklime or common whitewash. This is, by the way, what Professor Koch recommended to the Central Sanitary Board of Japan. Medizinal Zeitung, No. 60, 1892. 6 Cremation and its Importance in Cholera. 3. Let the clothing be disinfected with dry heat, 2120 Fahrenheit, and afterward with steam. 4. Finally, let the cholera corpse be cremated instead of buried. It may be added that it is necessary to disinfect thoroughly the rooms, furniture, or ships wherein persons were sick with cholera, and sterilize drinking water and milk. A strict ob- servation of all possible carriers of contagion must be main- tained. Vaccination has been practised as a preventive of cholera. The experiments so far do not warrant a decision of its suc- cess. In cases of danger the introduction of crematories, either stationary or portable, is necessary. A German scientist proposes to disinfect the Elbe or other rivers and sewers by electricity. His argument is that an electric current will chemically change the water and thereby destroy cholera bacilli. This may be possible, but at present is only a theory. It has been proven that cholera can be kept from entering America by proper means at the quarantine station. The question now arises, Is it better to continue a plan which has been successful, and will be successful again, or is it wise to suspend immigration, exposing thereby the whole Canada border line-a very convenient way for the introduction of cholera-and at the same time ruining the American commerce and the steamship companies, besides depriving the country of the capital and labor of desirable immigrants ? The question has not been settled by the Academy of Medi- cine's Advisory Committee, nor proclamations, nor our Solons in Washington. The laws of the different States vary very much respecting cremation, but with few exceptions it is not legalized in America ; it is only tolerated. At present our Board of Health does not give a permit for cremation, but issues one instead for burial at Mount Olivet, when it is desired that bodies shall be cremated at Fresh Pond. Every one should decide this matter for himself, but the cremationist has a right to demand that cremation shall at least be made a legal form of burial. Cremation and its Importance in Cholera. 7 DISCUSSION. Dr. S. H. Dessau .thought cremation a very important measure in connection with cholera ; but as Dr. Sternberg claims that the germ of yellow-fever has not yet been dis- covered, he thought it was very doubtful if the organisms found just below the surface of the soil, where yellow-fever corpses had been buried, were really characteristic yellow- fever bacilli. Dr. William Stevens only wished to express the hope that this very interesting paper would be published. Dr. C. A. Leale said that he had recently made a personal investigation of the subject of cremation. It was a mistake to suppose that the ash remaining after incineration is a gray powder. The residue i - a white, absolutely pure, inert sub- stance, which would do no more harm, if eaten, than would a piece of chalk. It is not .all in powder, for portions of bone remain large enough to enable them to be identified. As a proof of this the speaker exhibited a fragment which he had broken off from the upper end of the humerus after the body had been incinerated by exposure to a temperature of 2500° F. The femora, humeri, and sometimes even the ribs and bones of the cranium can be differentiated. He had in a large bottle at home a specimen showing how it was possible from these so-called ashes to identify the body of the person who has been cremated. He had personally superintended the cremation of a body weighing two hundred and forty pounds. The skeleton was a small one, and as the person had suffered from dropsy, a good deal of this weight was represented by water. Accordingly the residue after burning weighed only a little over five pounds, whereas the average weight of the residue is seven pounds. Dr. P. C. Cole said that in February, 1885, he read a paper on cremation, in which he took the ground that the bodies of all persons dying of contagious diseases should be cremated for the preservation of human life, as cremation destroys all disease germs. There is nothing about it to offend the most fastidious ; it is a rapid combustion instead of a slow one per- formed by nature. He did not doubt that the population of Brooklyn is suffering to-day from infection from the numerous 8 Cremation and its Importance in Cholera. large burial grounds about that city, and in country places he had known of sickness occurring in the neighborhood of ceme- teries which could be traced with reasonable certainty to them. He had seen portions of bone left after cremation which were as large as the hand. It could not be denied that a few cases of criminal poisoning, which are now detected by our present system, might pass unnoticed if the bodies were cremated, but even admitting the possibility of this, it would be a small matter compared with the hundreds of thousands of human lives which are sacrificed by the present method of burial. Cremation can never be enforced here bj1, law except in public institutions, but the influence of promine t men, and especially of medical men, will accomplish much in the way of popularizing cremation, and it should certainly be made a legal mode of burial. Dr. J. H. Fruitnight endorsed what had been said about the advantages of cremation in cases of cholera. Most of the opposition to it is the result of ignorance, mar ' persons believing that the body is placed immediately i the fire. Another objection is the liability of cases of criminal poison- ing to escape detection. Dr. y. Blake White also spoke of the effect it would have in shielding crime, although he favored cremation as a sani- tary measure. Dr. Frank Graucr said that in view of the fact that the two great sources of infection in cholera are the water and the soil, cremation should be insisted upon, at least for cholera corpses. Last fall the cases of cholera dying on Swin- burne Island were all cremated, but those dying of cholera in this city v. zre allowed to be buried in zinc-lined caskets, there being no law compelling cremation under such circumstances. Dr. E. S. Peck commented upon the powerful influence which an authoritative opinion like that of Virchow would have in promoting cremation. Dr. F. Peterson said he had been interested in cremation for a number of years. In 1881 he visited the crematory of Gotha, and last year the one at Milan. In 1881 he had pub- lished a paper on the subject, in which he had presented the arguments in its favor. The most important valid objection to cremation is the concealment of criminal poisoning. In Cremation and its Importance in Cholera. 9 this connection it was interesting to recall the statement made by a well-known chemist in discussing the paper just mentioned. He said that alkaloidal poisons are destroyed by burial as well as by cremation, so that the only poison which would not be discovered after cremation and yet which might be detected after ordinary burial was arsenic. He also stated that only about one body in five hundred thousand was ex- humed. Dr. H. L. Taylor said that he had been personally in favor of cremation for many years, and had frequently so expressed himself. It was very important that public sentiment should be arouse to the necessity of making it a compulsory method of disposing of those dying of serious contagious diseases, and he thought the Society should do all in its power to dis- seminate this feeling. He hoped the views expressed in the paper and in the discussion would be given the widest pub- licity. Dr. N wman, in closing the discussion, said that the points brought 2>ut in the discussion had all been covered in his paper, I at some had been omitted in reading. Cremation does not interfere with any dogma or religious creed. The law of Massachusetts in regard to cremation makes it difficult for poisoning cases to escape detection, for it provides that it shall be the duty of certain medical officials to make a special investi- gation previous to cremation whenever there shall be the slight- est suspicion of foul play. Cremation does not interfere with judicial investigation any more than does the present method of embalming, which is now almost universally employed by undertakers. Cremation also does away with the possible horrors of being buried alive. In short, crematkis cleaner than burial, it avoids the constant visits to the cemeteries, the care and expense of tombs, and allows the ground now devoted to cemeteries to be put to a better use. In regard to the yellow-fever germs in the soil, he had said that the earth was found to contain a material which was identical with that found in the excretions of yellow-fever patients. When the process of cremation is completed, on looking through the windows of the retort, one sees the body un- changed in shape, but when the retort is opened, and air admitted, it falls to pieces. 10 Cremation and its Importance in Cholera. Dr. Leale said he would be sorry to have the statement go on record that no religious dogma opposes cremation, for the Roman Catholics are strongly opposed to it. Dr. Newman replied that in 1886 the Pope forbade it, but since then he has not expressed any opinion on the subject. He had in his possession letters from Catholic priests endorsing cremation, and while many priests will not attend cremations, many others do not object to doing so. In Italy, where crematories are most numerous, there is the largest number of Roman Catholics ; it is rather an individual matter with the bishops than a matter of creed. The same diversity of opinion regarding cremation is found among the rabbis, as well as among the clergy of any denomination.