OUTBREAK OF CHOLERA AMONG CONVICTS. TRANSLATED FROM THE REPORT OF THE CHOLERA COMMISSION FOR THE GERMAN EMPIRE OUTBREAK OF CHOLERA AMONG CONVICTS. AN ETIOLOGICAI STUDY OP THE INFLUENCE OF DWELLING, FOOD, DRINKING-WATER, OCCUPATION, AGE, STATE OF HEALTH, AND INTERCOURSE UPON THE COURSE OF CHOLERA IN A COMMUNITY LIVING IN PRECISELY THE SAME CIRCUMSTANCES HY MAX yon PETTENKOFER, M.D., PROFESSOR OF HYGIENE AT THE UNIVERSITY OF MUNICH, MEMBER AND PRESIDENT OF THE CHOLERA COMMISSION OF THE GERMAN EMPIRE. WITH EIGHT LITHOGRAPHIC TABLES. LONDON: ASHEE & CO.,' 13, BEDFOED STEEET, COVENT GAEDEN, W.C. PHILADELPHIA : J. B. LIPPINCOTT & CO., 715 & 717, MAEKET STEEET. 1876. Introduction. Cholera in Munich .... 1 Description of the Prison at Laufen 9 Outbreak of Cholera in the Prison at Laufen and Extent of the Epidemic 13 Introduction of Cholera into the Prison at Laufon "... 18 The first cases of Cholera * 27 Course of the Epidemic of Cholera in the Institution 28 Separation of the Prisoners into Groups corresponding to Workrooms and Dormitories 29 Arrangement of the Attacks in their Chronological Order of Succession in the Workrooms and Dormitories 32 Comparison between different Departments of Work and different Localities 38 Influence of Age ; 46 Influence of Imprisonment on the Attacks of Cholera 53 Influence of Bodily State 55 Influence of Previous Diseases 56 Influence of Nursing aud Treatment on Cholera Patients " 58 Account of the Measures adopted 59 Dissemination of Cholera outside the Circle of Prisoners in the establishment and in the Town of Laufen 60 Overseers » 61 Officials and other Servants of the Establishment and their Families 63 Military Detachment to guard the Prisoners 63 Population of the Town of Laufen 64 Influence of different kinds of Privies 66 Disinfection of Excrements 71 Dietary • 73 Stores and Raw Products introduced into the Establishment 74 Drinking Water 74 Introduction of Cholera from the Prison into other Places by means of discharged Prisoners 82 Attacks after Discharge, and further Dissemination of Cholera consequent thereon 85 Further Dissemination of Cholera through the Medium of discharged Prisoners who remained well .... 89 The Epidemic of Cholera at Kostlarn • 92 Supplementary History of Cholera in the Town of Laufen and its Environs 99 Meteorological Remarks 10 * SUPPLEMENTS. Plan of the Town of Laufen. Ground Plan of the Prison at Laufen — Plan 1. Main Building, Underground Floor — Plan 11. Plan of ground floor — Plan 111. Plan of first-floor — Plan IV. Plan of second-floor — Plan V. Plan of third-floor — Plan VI. The Cholera in Munich 1873 and 1874. Ihe cholera commission for the German Empire, appreciating the advantages which would accrue from an extremely exact and detailed account of the course of an epidemic among a group of several hundred persons living in almost exactly the same circumstances and in every respect under the most rigid inspection and control, in furthering our knowledge of the mode of distribution of the disease, commissioned me to draw up a report of the outbreak of cholera observed in the Royal Bavarian prison at Laufen on the Salzach in December 1873, which, as regards the number and virulence of the cases, has hardly its equal in the history of cholera in Europe. After I had fulfilled this charge at the third conference of the commission since its appointment, which was held at Berlin from October 12th to October 20th 1874, the commission recommended the publication of the report at the Chancery Office, which the latter ordered to be carried out. Holding fast to the principle, that the distribution of cholera from place to place is effected by human intercourse, the question, which first forces itself upon our notice, is from where and how the cholera was brought to Laufen. It could of course come there from all places, where cholera prevailed at the time and with which the penal establishment had any direct or indirect communication. It is true that there were no positive indications of its having had any definite place of origin, although it is a fact that the institution had not such an uninterrupted personal and actual communication with any other place affected with cholera as it had with Munich. It must therefore be accepted as the most probable explanation, that the epidemic of cholera in the prison at Laufen had its origin in the epidemic of cholera at Munich. This view is rendered still more probable by the further fact, that all the Bavarian prisons in which cholera appeared during the year 1873 were those only, to which convicts were regularly removed from Munich. All the other Bavarian prisons, which did not receive their prisoners from or through Munich, remained una ffected by cholera on that occasion. Under these circumstances it may not be inappropriate to preface my description of the cholera at Laufen with an account of some general facts relative to the epidemic at Munich and some remarks thereon; in doing which I will not anticipate a more minute description of the same from another point of view. The accompanying card shows the number of cases of cholera and choleroid disease (choleraic diarrhoea and diarrhoea), as they were daily reported in Munich at the Royal Police Stations. KThe first case in Munich is inscribed on June 25th. The person affected was an American clergyman, ad arrived in Munich the day before from Vienna, being already ill and the illness terminated fatally. The patient was taken from the station to a neighbouring hotel, the Rheinischer Hof and from there to the General Hospital. — The second case affected a merchant from Darmstadt, who arrived likewise l IN IIvODUC'I lON. m Munich from Vienna already ill, was also taken from the station first to an adjoining hotel (bcnweizer Hof) and soon after from there to the General Hospital, where he recovered. / Mr ' The next cases now (2 on the 21st, 2 on the 22nd, 1 on July 27th) affected persons, who had] never left Munich, who had not visited at least at the time any centre of infection or place affected with n cholera, whose infection therefore may be assumed to have had its origin in Munich itself. According to the views commonly entertained we should expect that the first cases occurring in Munich ought to be traced back to the first cases coming from Vienna. An investigation having this object in view gives however a completely negative result. All persons, who had come in contact with the two first cases at the station, in the Rheinischer and in the Schweizer Hof, as well as iv the General Hospital, remained unaffected, moreover the above-mentioned institutions and houses, in which these two patients coming from Vienna with the disease already upon them had found admission and gone through with their illness, did not exhibit for weeks after any cases of cholera or diarrhoea, even when the cholera seemed already widely disseminated in the rest of Munich. Nay, the first five cases occurring in Munich happened one and all to persons who had come in no contact whatever with the two patients coming from Vienna or those in their immediate vicinity and moreover in parts of the town exactly opposite to that, in which the station, the two above-mentioned hotels and the General Hospital are situated; one case affecting the wife of a professor at 6 Upper Garten-Strasse, whose infant had died suddenly the day before of acute intestinal catarrh (?), one case, that of a labourer's wife (street hawker) in the suburb Au, 4 Kramergasse, one, that of a labourer in the Au, 5 Durchlass, one in the suburb Giesing, 14 Birkenau. Only in the case in Upper Garten-Strasse could a very far-fetched connection be discovered with au external centre of infection. Namely a visitor from Vienna had been in the house of the professor about a fortnight before the attack, but had remained only 2 hours with the family, was apparently quite well and had not used any water-closet in the house; besides which the physician who was first called to the American clergyman, was also physican to the family of the professor. If we endeavour to trace an infection to this visit of a Viennese, who was apparently quite well and with whom the patient came in only temporaiy contact, or to the physician, it must appear all the more remarkable, that no infections took place among those in the vicinity of the two cholera patients, who came from Vienna, nor among the numerous patients of the ; physician. Staff Surgeon Dr. Friedrich has made ihe first twelve cases of cholera in the last epidemic at "Munich the subject of a very comprehensive and minute investigation, but, as appears from his report presented to the Medical Society of Munich, has not found the slightest data for the assumption that the i first cases of the epidemic had any connexion with cases of cholera or diarrhoea coming from abroad. This want of proof occurs very frequently, it may be said regularly, on making a more exact examination into the origin of local epidemics, but it would certainly be wrong to conclude from it, that local epidemics seldom derive their origin from imported cases of cholera, that cholera can spread from I place to place even without the influence of human intercourse, that it arises spontaneously; the fact can only warraut the assumption, that the infected persons and the intercourse only with them are not the sole causes at work. A very instructive example on this head has also been furnished by the epidemic which occurred in the town of Heilbron on the Neckar in Wirtemberg in August 1873, of which another i member of the commission (Dr. Volz) will shortly furnish a minute report based on a very exhaustive ) description by the district surgeon Dr. Horing. I may state here by way of preliminary, that a gymnastic fete took place at Heilbronn in the/ beginning of August which attracted visitors from a distance, even from Bavaria, where the cholera had' already appeared in Munich. The introduction of the cholera was of course apprehended, but the fete passed off without the occurrence of any symptoms. Attention was now principally directed to any passengers who might arrive from Vienna or Munich infected with cholera and who were to be most carefully isolated in a part of the hospital set apart for this purpose. But it was destined to come in another way 2 la the night between August 25th and 26th 5 persons were suddenly and almost simultaneously seized with violent symptoms of cholera between 12 and 1 o'clock in a low lying part of the town in different houses at a distance of 80 or 90 paces from each other. These 5 cases had all terminated fatally by noon on August 26th, so that there could not any longer be the slightest doubt that Asiatic cholera had broken out in Heilbron. Neither any connexion of the first cases with patients living elsewhere, nor any personal connexion between the cases themselves could be proved in spite of the most minute investigation, but the presence of cholera in Heilbron notwithstanding manifested itself unmistakably in 5 houses at the same time. Nor does the -further progress of the disease there furnish any proof, that the morbific principle in cholera really proceeds from the infected persons, for if the first case can occur in a house without the presence of a patient affected with cholera, the cases which follow the first case can occur in the same way and it is quite arbitrary to explain the following cases as having been infected by the first patient. The facts connected with the distribution of cholera leave us a certain choice in explaining them between the influence of the locality infected and the influence of the person infected, who is in an infected locality or comes from one. As soon as an infected locality and infected patients coincide, it is indifferent, which of the two agencies are adduced; as soon as they no longer coincide, the question arises: does. the active principle originate in the person affected and cling only to the locality? or does it originate in the locality and cling only to the person affected, who can then likewise disseminate it from place to place, in the same way as those who have come in contact with an infected locality when in a state of health? Five other cases occurred up to September 2nd in oue of the 5 houses, which had furnished the first cases in the night between August 25th and 26th. The first case must be explained without infection by patients and there is no obstacle to the 5 cases which followed this one being explained like the first. A person who had assisted a female patient until her death in one of the houses first affected, was already attacked on August 27th in another quarter of Heilbron at some distance from this house. It cannot be determined, whether this person was infected by the patient whom she nursed, or whether the nurse suffered from the same cause, as the patient. When once infected localities have been formed and infected localities and infected persons coincide, it is perfectly optional to substitute the one for the other. I shall endeavour to show at the conclusion of my work, that we get involved in far less contradictions, when in explaining the distribution of cholera from place to place through human intercourse we regard the infected locality and not the patient as the centre and view the latter only as the conveyer of something from the The subsequent course of the cholera in Munich from the end of July 1873 to the end of April 1874 contradicts most decidedly the commonly received view, which regards the patient or his evacuations as the principal source or focus of the malady. A glance at the topographical map of Munich shows how rapidly the epidemic began to develop from the end of July. Already 39 cases were recorded on August 1 lth and 12th. But now a sudden check occurred, during which the epidemic no longer increased in dimensions, and such a marked diminution set in in September, that the last day of this month and the two first days of October passed without any fresh attacks of cholera or allied diseases. During the whole of October only few and sporadic cases occurred with quite free intervals. Only 2 isolated cases occurred in the first 14 days of November, so that no epidemic worth speaking of prevailed after this date. The cold time of year too having now set in, which is commonly regarded as most unfavourable for cholera, a*) comparison between the different epidemics throughout Germany commencing with the year 1831 showing that the number of cases rapidly declines after October, I entertained the hope, Munich *) Statistical communications on the course of epidemics of cholera in Prussia. By H. Brauser. With a preface by Dr. Housselle, Berlin. 1862. Hirschwald. 3 INTRODUCTION. had got over its epidemic at least for this year and the coming winter, although a circumstance occurred during its progress in August and September, which deserves attention as evidencing the fact, that Munich could not in reality have fully received its absolution this time. The most low-lying parts of the town in which the epidemics of 1836 and 1854 had wrought most havoc, were but very little or not at all affected and this always appeared to me a suspicious circumstance, leading me to expect a further outbreak in September and October; as this however had not yet presented itself even up to the beginning of November, I looked upon it as certain, that there would be no more cases of an epidemic character during the winter, although individual cases like those in October might perhaps be continued throughout I was lulled into this at last certainly treacherous feeling of security principally by two facts. In the first place no case was known to me in the whole history of cholera in North and South Germany, where a place of some importance had exhibited two perfectly distinct epidemics in one and the same year, of which the one had occurred in summer, the other in winter and the winter epidemic had been worse than the summer epidemic. Epidemics extending over a long period have certainly been known, as for instance that at Erfurt in the year 1849, which lasted from May till the beginning of November (Pfeiffer), or epidemics which have visited a town two years running, as for example Halle 1849 and 1850 (Delbriick), but the cold season was always free from them and no summer epidemic had preceded in those places, where the cholera was not developed until the colder season of the year (Munich 1836). Relying moreover upon the prevalent notions, I attached also great importance to the fact, that there had been no revival of the epidemic in October, although one circumstance led me to anticipate it. House leases are generally taken for half a year in Munich and dwellings are principally changed only at the two so-called terms, Easter (April 24) and Michaelmas (September 29th). This was also the case at Michaelmas 1873. About 5000 families changed their dwellings. Reckoning a family at only 3 persons, this change of dwelling represents a removal of 15000 persons of the population of Munich. Two kinds of forces must now frequently obtain here, both supposed to favour the distribution of cholera: first people moved out of infected districts into districts which had hitherto remained free, where therefore they could introduce the disease and then people moved out of districts, which had hitherto remained free, into infected districts and could therefore be attacked there. The question might have been seriously discussed, whether a sanitary state such as that in which Munich found itself towards the end of September, did not justify the change of habitation being suspended on this occasion and postponed to a later period, when there could no longer be any doubt that it could be carried out without any danger of disseminating the cholera. At all events such a regulation would have been as justifiable as other quarantine regulations, which are directed against cholera. But every interference of this kind in human domestic matters is attended with so much difficulty and has such wide-spreading consequences, that on mature consideration we are soon obliged to refrain from it and leave the affair to take its own course, even at the risk of the mischief being actually brought about by our non-interference. The result of the change of dwellings in Munich which took place quite in the ordinary way at the Michaelmas quarter 1873 showed however that the apprehension was unfounded and that all the sacrifices which would have been made, would have been undergone without profit. The epidemic did not immediately break out again after the removal, but declined more and more on the contrary until the middle of November. The following change of quarters (Easter), which again exactly coincided with the conclusion of the winter epidemic that had broken out in the meantime, may also be drawn within the circle of this consideration, for the cholera which broke out again in the second half of November 1873 continued until April 28th 1874 and the very considerable change of habitation which took place at Easter 1874 prevented just as little the complete extinction of the disease which now at length resulted, immediately after it as that at Michaelmas 1873 had effected its revival. 4 v INTRODUCTION. If we consider more closely the long-continued winter epidemic of Munich, which contrary to all expectation had broken out in November after a previous summer epidemic, the winter epidemic also can again be distinctly divided into two groups; the first mounts up rapidly from November 15th, already reaches its maximum of 56 cases on December 4th and Bth and again declines considerably towards the end of December. This first division of the winter epidemic prevailed in a very marked degree in the low-lying parts of Munich, which had been spared in such a striking manner during the summer epidemic. We see the disease amply made up for what it had neglected in summer. The second group of the winter epidemic is formed partly by the continuation of cases in the quarters of the preceding group, partly of cases from other quarters, which had not yet been materially affected in the summer, partly also of cases in quarters, which were already affected in the summer and in which the epidemic broke out anew. A number of houses, which had formed the head-quarters of the epidemic during the summer, strange to say did not present a -single case in the winter epidemic, although the change of quarters which resulted in the meantime had been very considerable; thus for instance 137 persons had entered into or removed from 5 such houses. I cau only indicate these interesting and important relations, further particulars it is to be hoped, will soon appear in a minute report by the district surgeon Dr. Frank. I shall occupy myself here only with the occurrence of cases of cholera in the prisons und lock-ups of Munich, from which prisoners were transferred to the prison at Laufen and other Bavarian penal establishments. The following establishments will be considered here: (I) the Royal Police Prison of Munich (Wein-Strasse) , (II) the Public Jail (lower Anger), (III) the Prison for Unconvicted Prisoners (Bad-Strasse), (IV) the District Prison of Munich on the right of the Isar (Lilienberg in the Au), and (V) the Military Prison (Karlsthor). With the consent of the minister for justice I applied to the various medical officers, who supplied me with the following information respecting the cases of cholera and allied diseases which occurred in the prisons placed under their professional care from August Ist to December 1873. I. POLICE PRISON. Dr. Frank, surgeon to the police has sent me the following list LIST of those cases of cholera, which occurred in the arrest-houses of the Royal Police. 1. Knecht Ignaz, had been for some time attendant to turnkey Brerl and predecessor, was taken ill with choleraic diarrhoea at the police-station (Wein-Strasse 13/0) on December Bth and taken to the General Hospital. He is a confirmed dram-drinker and is said to have often had symptoms of delirium tremens. At the time of his seizure no case had yet occurred in the lock-up. Recovered. 2. Niederlechner Alois, stocking- weaver, was taken ill in the lock-up (Wein-Strasse 13/1) Room No. 14/1 on January 2nd, was removed to the General Hospital and died there on January 3rd. Had been in confinement from December 29th to January 2nd. 3. Buchner Josef, servant, attacked in the lock-up (Wein-Strasse 13/0) Room No. 1 (underground-floor) on January 21st, was taken to the hospital and died there on January 25th. Had been in confinement from January 18th till the morning of the 21st. LIST of those cases of cholera, which occurred in the adjoining city goal in Gruft-Strasse. 1. Mangs Andreas, tobacconist, attacked in the city goal, Gruft-Gasse, No. 1 /111, Room No. 50/111 on October 6th, was immediately removed to the City Hospital and died there on October 7th. He had i been 12 days in confinement. 5 2. Schmidbauer Max, waiter, attacked in room No. 13/00 (No. 24/0 is above this room) on January Bth, was removed to the General Hospital and recovered. He had been 2 days in confinement. 3. Ha fner Josef, belt-maker, attacked in room No. 65/11 on January 7th, was removed to the General Hospital and died there on January Bth. He had come from Freising on January 4th, was still quite well on the 6th and attacked with diarrhoea from 6th to 7th. Had been in confinement from January 4th to 7th. 4. Prcestel Margaretha, maid-servant, attacked in room No. 9/00 (No. 23 is above No. 9) on March 9th; was removed to the General Hospital, where she died on March 13th. Had been in confinement since March 4th. 5. Waibl Johanna, maid-servant, attacked in room No. 25/0 (No. 13/00 is exactly under No. 25/0) on March 10th, was removed to the General Hospital and recovered. Had been in confinement since January 31st. 6. Stegmaier Ignaz, bookbinder, attacked with diarrhoea in room No. 65/11 on January 2nd, was removed to the hospital, had an attack of cholera in the night between January sth and 6th and was reported as affected with cholera on January 6th. He died on January 14th and had been l 1l 1 / 2 days in confinement prior to the attack. 7. Brey Joseph, shepherd, attacked with choleraic diarrhoea in room No. 23, ground-floor (No. 9 is under No. 23), on January 10th and was removed to the hospital; recovered. Had been 1 day and 2 nights in confinement. 8. Koenig Georg, servant, attacked with choleraic diarrhoea in room No. 13, underground-floor (No. 25 is above No. 13), and was removed to the hospital; recovered. Had been in confinement from February 9th to 14th. 9. Marx Emil, compositor, attacked with diarrhoea and spasms in room No. 11, underground-floor, on March 21st and was removed to the hospital. Had been in confinement since February 24th, first 3 or 4 days in No. 35, then in No. 11, where he was taken ill; no case of cholera had hitherto been in either room, No. 35 and No. 1 1 ; recovered. 10. Maier Theres, labouring woman, attacked with cholera in room No. 25/0 (No. 13 is under No. 25, and No. 36 above it) on March 24th and was removed to the hospital. She had been in confinement here from March 14th to 24th. Recovered. 11. GOAL FOR UNCONVICTED PRISONERS IN THE ANGERSTRASSE. Professor Alois Martin, MD., has furnished the following list: LIST of the prisoners attacked with cholera in this prison from August Ist 1873 to January Ist 1874. Day When Nature Where removed or I TJT?MAT?Tf« of admission, attacked. of illness. discharged free. «JiMAiU\.&. NAME. o 1. Zauser Maria, maidservant August Ist. August 19th. Cholera. General Hospital. Brought back again on from Bregenz, set. 25. August 27th. 2. Lang Johann, labourer of August list. August 14th. Cholera. ditto. Brought back again on Munich, set. 39. August 23rd. 3. LangJul. Michl, editor of Dec. 4th. Dec. Bth. Choleraic Discharged free. Did not return again. Munich, set. 34. gave himself np. diarrhoea. 4. Raming Josef, journeyman Oct. 25th. Nov. 3rd. Choleraic Professionally treated tailor of Munich, act. 30. diarrhoea. in the gaol, and discharged cured. 5. Oswald Bernhd., butcher Nov. 17th. Dec. 16th. Cholera. General Hospital. Died on Dec. 18th. from Stefansberg, set. 28. 6. SolchAndreas, man-servant Nov. 22nd. Dec. 16th. Cholera. General Hospital. Died Dec. 17th. from Hitzelsberg, set 54. 6 p. m. 7. Marx Gabriel, shoemaker Nov. Bth. Dec. 22nd. Cholera. General Hospital. Escaped from hospital from Maxlried, act. 39. shortly after removal. 6 Dr. Martin remarks also that besides the cases of cholera and choleraic diarrhoea an unusually, large number of cases of simple. diarrhoea were simultaneously observed and treated in the prison, especially in the first half of August and in the second half of November. 111. GOAL FOR UNCONVICTED PRISONERS IN BAD-STRASSE. Dr. Martins, surgeon to the goal sends the following particulars: LIST of the cases of cholera and allied diseases which occurred in the prison in Bad-Strasse in Munich from August Ist to December Ist 1873. ?. ,T, T , ? „ t% j r ii. i Duration of imprisonment prior No. NAME. Day and nature of attack. to a t tac k # F 1. Zintel, Babette. Aug. 20th, Diarrhoea with voming. 3 days (imprisoned Aug. 17th). 2. Hoefner, Franziska Aug. 25th, „ „ „ 8 days ( „ Aug. 17th). 3. Pleiner, Theresa. Oct. 7th, Cholera. Died. 4 »/, months ( „ May 17th). 4. Wagner, Anna. Oct. 15th, Acute diarrhoea. 2 months ( „ Aug. 18th). 5. Hauser, Adelheid. Nov. 14th, „ 1 day ( Nov. 13th). 6. Fest, Benno. Nov. 18th, Cholera. Died. 5% weeks ( „ Oct. 6th). 7. Boeckel, Marie. Nov. 1 lth reap. 19th, Cholera. 4 resp. 12 days ( „ Nov. 7th). 8. Sedelmaicr, Martin. Nov. 20th, Cholera. Recovered. 3 weeks ( „ Oct. 29th). 9. Maier, Max. Nov. 26th, Cholera. Died. 2 months ( „ Sept. 3oth). 10. Kohlhofer, Franz. Nov. 26th, Acute diarrhoea. 6% weeks ( „ Oct. 7th). 11. Metzger, Leonhard. Nov. 2Cth, „ „ 3% months ( „ Aug. 9th). NB. Rosalie Baumann, who was committed to prison on August 23rd and removed to Wasserburg on November 7th 1873, never suffered from diarrhoea, but from cardialgia with occasional vomiting, especially towards the end of October. IV. PRISON FOR CONVICTED AND UNCONVICTED PRISONERS ON THE RIGHT OF THE ISAR. District-surgeon Dr. Laval has forwarded the following particulars: The daily average number of prisoners in the prison on the right of the Isar on the Lilienberg between August Ist and November 30th 1873 was 35.5, among which 3 were females. A. Total. B. Women. Maximum A. Minimum A. August 34 5.8 September 37. i 2.4 October 35 1 .» November 35.& 2.2 48 21 On November 10th 1873 was received into the prison: Maria Hagenburger, act. 53, wife of a cottager at Haimhausen, in the district of Dachau; she was well when she entered, caught cold whilst in solitary confinement (through opening the windows too late in the evening) and after indulging too freely in cold fat meat, had a severe attack of diarrhoea during one day, was affected with cholera in the night between 17th and 18th, was transported in the afternoon of the 18th to the hospital at Haidhausen and died there on the 20th. The autopsy confirmed the diagnosis. — Nothing was known of there having been a case of cholera in her home before her entrance into the prison. No other case of cholera occurred among the prisoners or the attendants in the above-mentioned interval. V. MILITARY PRISON. Staff-surgeon Dr. Hirschinger sent me the following report: Military jwrsons under arrest: 1. Gunner Georg Saver, ill with diarrhoea from August Bth to 19th 1873, under arrest since 7 2. Private Kasper Gaab, ill with cholera from August 9th to September 20th, arrived here from Ulm on August 4th; 3. Private Xaver Stegmaier, ill with diarrhoea from August 9th to 17th, under arrest since 4. Rifleman Martin Sachsenhauser, ill with diarrhoea from August 9th to 17th, under arrest since July 18th; 5. Private Korbin Stocker, ill with diarrhoea from August 12th to 21st, under arrest since August 6th. 1 The following table gives a comparative view of the cases in each prison: POLICE PRISON GOAL PRISON PRISON MILIT. PRISON on the Lilienberg Wein-Strasse. Lower Anger. in Bad-Strasse. - n c j^ u a * Karlsthor. ATTACKS. H ATTACKS. fl ATTACKS. I" I ATTACKS. I" I ATTACKS. I" I «f *f -si. "si "s"§. Day. Mines. &A Day. | Illness. |S Day. | Illness. g.S Day. | Illness. |S Day. | Illness. |-2 Dec.B 1873 Choi. diarrh. — Aug. 14 Cholera 19 Aug. 20 Diarrhoea. 3 Nov. 18 Choleraf 8 Aug. 8 Diarrhoea. 18 Jan. 2 1874 Cholera f*) 5 „ 19 „ 4 „ 25 „ 8 „ 9 Cholera. 6 „ 21 „ f 4 Nov. 3 Choi, diarrh. 10 Oct. 7 Cholera f 123 „ 9 Diarrhoea. 31 Dec. 8 „ 5 „ 14 Diarrhoea. 61 „ 9 „ 23 JO WN PRISON. „ 16 Cholera f 30 Nov. 14 1 „ 12 „ 7 Oct. 8 1873 Cholera f 112 „ 16 , f 25 , 18 Cholera f39 Jan. 2 1874 „ f 1V 2 ,22 „ 45 „ 19 „ fl2 „ 7 „ f 4 Aug. Diarrhoea. „ 20 „ 21 „ 8 „ 2 Nov. „ „ 26 , f 61 „ 10 Choi, diarrh. 1V 2 » 26 Diarrhoea. 46 Feb. 14 „ 6 „ 26 „ 107 March 9 Cholera f 6 » 10 40 „ 21 Diarrhoea. 26 „ 24 Cholera. 11 *) Fatal cases are indicated by a cross. If we consider the prevalence of cholera in the Munich prisons in which unconvicted prisoners were confined, ifc appears, that with the exception of the military prison they were very little affected by the summer epidemic, suffering for the most part only from the winter epidemic. This circumstance corresponds entirely to their local situation and to the nature of their immediate surroundings. In those cases, which had been in confinement only a few days, it must be left undecided, whether the infection was contracted in the prison or perhaps outside it. In the police prison and the adjacent town prison indications an epidemic influence could strictly speaking be perceived only from January to March 1874, when also the surrounding quarter was affected; the symptoms too in the public goal (Lower Anger) were but faint in August and did not assume a decided character till later. The local epidemic influence was most evident in the prison for unconvicted prisoners in Bad-Strasse, a prison constructed and managed in strict accordance with the cell system and that at the very time when the winter epidemic re-commenced and visited especially that very part of Munich, the so-called Isar suburb, in which Bad-Strasse also is situated. The prison on the right of the Isar, which showed no traces of a house epidemic either in the epidemic of 1836 or in that of 1854 in spite of an imported case, exhibited this time also only one quite isolated case. The prevalence 8 of cholera in the prison in Bad-Strasse is also of interest in many respects, and we may expect to hear a further account of it from Dr. Martius at some future period. On another occasion I shall have to speak of the striking fact, that no cases of illness occured in the ante-room at the police-station, which hundreds of prisoners passed through, who were conveyed from and via, Munich. The military prison presents a remarkable contrast to the other prisons for nnconvicted prisoners at Munich. This prison was involved not only in the summer epidemic, but exhibited 7 cases during the winter epidemic also, which did not happen till after the Ist of December, and are uot contaiued in the above communication. It is situated in the higher part of the town near a brook, and the remaining prisons (especially that on the Anger and in Bad-Strasse) in the lower part. In August there were violent local outbreaks quite in the neighbourhood of the military prison, for example in some houses in Schommergasse, which also did not share in the subsequent winter epidemic. The military prison did not however despatch any prisoners in August to the civil prisons in question, but only 1 in October to the goal at Munich and 1 to the prison at Laufen. The fact that the civil prisons for unconvicted prisoners at Munich, which despatch convicts to Bavarian prisons in other parts of the country, materially participated only in the winter epidemic, coincides strikingly with the further fact, that the cholera also did not begin to appear in these remote prisons prior to this period, and not at all in the other Bavarian prisons, which did not receive their supplies from Munich. In the workhouse at Rebdorf near Eichstatt, which is not under the control of the Minister of Justice, but is a police institution under the Minister of the Interior, the first case of cholera affected a man who had shortly before on November 2 1 st been removed from Munich, where he had occupied the police prison. A house epidemic was developed, which lasted until January 7th and gave rise to somewhat more than 30 cases. A fatal case of cholera took place in the house of correction at Lichtenau on November 25th, the patient being a convict who had come from Munich (Frohnfeste) on November 23rd. There was also a case terminating in recovery on December Bth, the subject a man who had been lodged in the ante-room at the police-station from November 27th to December sth, and who had arrived in Lichtenau on December 7th. The epidemic was limited to these two imported cases. It is evident that the individual tendency to cholera was not at all wanting at this time as regards the prisoners at Lichtenau, as a convict (Oswald), who -was removed to Munich on November 15th to take his trial, was lodged in the goal there, took the cholera there on December Kith and died of it on the 18th. The first case of cholera in Laufen on November 29th affected a prisoner, who had already been iv confinement for 8 months. Six cases of cholera and 7 of choleraic diarrhoea occurred in the female prison at Wasserburg between December 30th and January 3rd, although strange to say the epidemic did not spread any further. I will first submit the occurrence of cholera in Laufen to a thorough investigation, and reserve the likewise very interesting but much smaller epidemics at Rebdorf and Wasserburg for a special consideration. I may mention also beforehand as a striking fact, the circumstance, that the cholera could not this time find its way from the prisons for uncouvicted persons at Munich into the nearest situated prison, the great goal at Munich, in spite of numerous prisoners having been removed there. DESCRIPTION OF THE PRISON AT LAUFEN. The town of Laufen with its 2100 inhabitants is situated at the south-eastern end of the Bavarian table land on a narrow neck of land, in a serpentine bend of the river Salzach, which the latter makes here flowing round the town on its two long sides on a steep decline. The surface declines gradually in 9 INTRODUCTION. the longitudinal direction of the neck, and still more abrubtly so in the transverse direction towards the The prison is situated almost at the commencement of the highest part of the town, 14.826 metres above the mean level of the Salzach according to the measurement of the official architect, Mr. Heihnaier. The town well-sinker gave me his experience of the strata, which are passed through in boring wells. The same strata are found in the highest situated as in the intermediate and lowest parts of the town, only of different thicknesses. A layer of sand more or less thick constitutes the surface for the most part; then follows Alpine gravel (dolomitic limestone) which forms the actual fundament of the town. A thin stony layer succeeds (conglomerate) called Hurt, then again sand and gravel, then once more a hurt, but of much softer consistence than the upper layer. Ground-water collects in and below this, from which the wells derive their supply. a. The strata are found to be of about the following thickness in the highest part of the place, outside the town (Zimmermeister): Sand 1 to 1.31 .3 metres Pebbles 12 „14 „ Hard conglomerate ... 0.4 „ 0.7 „ Sand and gravel | . 1 r Soft conglomerate J Below this gravel with water, b. In the higher part of the town (Braver Barth): Sand and gravel . . . . 10 to 12 metres Hard conglomerate ... 0.6 „ 0.7 ? Sand and gravel | 9 r q Soft conglomerate I c In the lowest part of the town (Fleischbank) : Gravel 3 metres Conglomerate 1 metre, including water. It is generally believed in Laufen, that the water in the excavated wells is simply water filtred from the Salzach, because the height of the water in the wells is evidently influenced by the level of the Salzach. For several reasons I do not consider this view correct, at least not generally so. When wells rise and fall with the adjacent river, this is still no proof that the water of the river penetrates into the soil, any more than the simultaneous rise and fall of tributary rivers with the main river, into which they discharge themselves, is a proof, that the tributaries receive their water from the main river. It can arise, and in fact generally does arise from the fact, that the main river elevates the height of water in the tributary simply by acting as a dam to it, by which only the passage of water into the main river is impeded, and therefore when the main river rises, the water in the tributary rises also. Tf the wells in Laufen are really fed by water from the Salzach, the water in the wells must also have the same composition as the water of the Salzach, which is not the case, as I shall prove later in speaking of the drinking-water of the prison. Lastly the level of the water in the wells compared with that of the Salzach, so far as this has been ascertained, is against the assumption. Mr. Heilmaier compared the level of the two wells in the prison with the level of the Salzach on the same plane on December 14th 1873, and found the level of the water in the wells 0.4 to 0.6 metre above the level of the Salzach. It seems to me therefore, that the excavated wells in Laufen like those elsewhere are really fed by the surface drainage, by land -springs, and their height is in reality influenced only by the greater or less stagnation or sluggishness of the Salzach. At all events still further measurements of a greater number 10 INTRODUCTION. of wells extending over a larger area would be requisite, before the contrary could be maintained. The view, that the wells contain filtred Salzach water, cannot at all events be extended to the two wells in the prison, as the water would have to flow uphill, in order to reach them. The main building of the present prison was formerly a hunting-lodge and partially the residence of the archbishops of Salzburg, and was built in its present dimensions in the years 1694 to 1702.*) It consisted originally of the prince-bishop's castle and a stable for 58 horses and other premises. The stable was afterwards used for a long time as a salt -magazine. Iv accordance with a ministerial decree of December 15th 1861 the chateau after having been employed for various purposes, at last as cavalry barracks, was converted into a prison. The accompanying plans, represent its present condition, as it appears after having undergone a tolerably appropriate adaptation to its present uses. Plan No. I, ground-plan, illustrates the situation of the individual parts, its privies, wells, and drains. The out-flow of the superficial drainage and canals is of course in the direction of the Salzach. The ground of the institution is level from the main road to the Salzach, and falls then perpendicularly .about 15 metres deep into the river, from which a solid-built protecting wall arises to the level of the base of the building, standing on a framework of stakes and provided with ties and buttresses. The situation commands a magnificent view of Salzburg, the district watered by the Salzach on the south, the opposite Haunsberg, Waidworfch, the town of Laufen itself and its fields and immediate environs. Opposite Laufen, on the Austrian bank of the Salzach, connected with Laufen by a bridge, are situated the places Oberndorf and Altach, which formerly, when Laufen was still the property of the prince-bishop of Salzburg, and afterwards in the possession of Austria, formed a suburb and numbered just as many inhabitants as Laufen. In adapting the old building to its new functions, the main building — the former chateau — remained unchanged as regards its outer walls and foundations, only a stair-case and all the privies, cess-pools and drains were newly constructed, and besides these only partition- walls changed and removed. The former stable lying to the north, afterwards salt-magazine and wood-house, was converted into an hospital and church after removal of the vaulted roof, tearing up the floor, washing out and removal of the subjacent earth which was highly impregnated with salpetre, the old walls being considerably elevated, so that there arose a ground-floor and first-floor; only the first-floor was wanting where the church existed; the whole height of the building being devoted to this purpose. Underground apartments were not constructed. The hospital and overseers' rooms, as well as the doctor's surgery are on the ground-floor. The upper story is in reality the store-house, and the rope-makers work there under cover in bad weather. The interval between the church and the main building was filled up some years later with a little cell-prison, which was built up new from the ground. It has an apparatus for hot-water heating (Perkins' system) in the underground-floor, the ground-floor and first story have 16 cells each in two rows, traversed by the usual corridor with sky-light, besides a larger room. All the essential architectural features of the main building are represented in Plans II to VI, and speak for themselves, so that I have but very little to remark upon them. Only the west and north sides of the house are provided with underground-floors, the south side not at all, the east side only partially. The drying apparatus is found in the north-east corner of the latter. The superficial dimensions of the individual rooms, in case it should be found of interest, can easily be ascertained on the plans which are provided with a scale, and the height of the rooms is almost everywhere the same, after deducting the space between the ceiling and floor 3.5 metres. The cubic dimensions of each room can therefore be easily ascertained. *) See topographical history of the town of Laufen. By Rev. Heinrich Gentner. Published after his decease by Josef Gentner, town-clerk at Laufen. Munich 1863. Expressly copied out of the XXII volume of the Upper Bavarian Archives, which information I owe to the kindness of Mr. Fockerer the mayor. 11 mi ijV ¦;¦..¦'. :''.. < ,v i /• ii _„„ i- •__ rpUr. ;,, n t;ti,t; f ii Vina Ihe arrangement of the privies is best seen in the plans of the upper stories. ±ne institution nad partly the tub system, partly the cess-pool system with descending pipes, and the arrangements are the same throughout all the stories. The position of the cess-pools can be seen in the ground-plan I. A cast-iron pipe 0.2 metres in diameter proceeds from each ccs:-pool (including that for the cell-prison and that for the hospital, which do not belong to the main building) through all the stories, and has a free opening above the roof. This pipe receives lateral pipes in each story in a convenient corner, which come from the individual closets. Thus for instance the pipe cQming from the cess-pool on the south side of the main building receives 4 on the ground-floor and just as many in the first, second, and third stories, therefore altogether 16. The closet-pipe on the north side of the house receives none on the ground-floor, in the first, second and third stories 6 each, or 18 altogether, that likewise on the east side receives pipes from 18 closets. These privies grouped together round one main pipe are as a rule divided into halves and are accessible to somewhat large adjoining rooms. According to plan IV the privy No. 36 on the first-floor is in connexion for example with the work-room of the tailors No. 38, as well as with the dormitory of the straw- workers No. 32, the privy No. 42 both with the dormitory of the tailors No. 41, and the workroom of the shoemakers No. 45 and No. 46. The work-rooms and dormitories, which do not enjoy such free access to these privies, make use of wooden tubs, which are then emptied into these privies and cleaned in the court-yard with water, which flows through canals down to the Salzach. The three large cess-pools of the main building are about 4 metres in diameter and 6 metres in depth, are constructed out of bricks and cement, so contrived that the bulk of the solid matters is separated from the fluids, and are carefully closed at the surface. The fluid matters are removed every week by means of syphons into portable barrels, and the solid matters are taken away in carts every 6 or 8 weeks, and employed as manure on the land belonging to the institution. — What hygienic importance may attach to these architectural arrangements, will be discussed in the course of our investigation. PREVIOUS SANITARY CONDITION IN THE PRISON AT LAUFEN. The prison at Laufen, calculated at the time of its erection to hold about 500 prisoners, was opened in the course of the year 1863 and has had the following average number of inmates in the different years which have intervened: 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 145 315 395 422 418 498 565 532 466 424 403 The average daily number of patients in the hospital among this average number of inmates was according to Dr. Berr: 9 10 40 10 10 12 |13 9 10 12 3 Out of all the prisoners brought to the institution there died in the different years: 3 18 7 10 9 3 5 13 [11 11 23 The attacks and deaths from cholera are not iucluded in the year 1 873, in which case the number of deaths iv this year would amount to 106. The year 1873 even independent of the cholera presents the highest mortality. 12 OUTBREAK OF CHOLERA IN THE PRISON AT LAUFEN AND EXTENT OF THE EPIDEMIC. Although the Royal Bavarian Prison at Laufen with an average of 500 prisoners had received from July to October 1873 during the period of the cholera epidemic in Munich numerous reinforcements from that city, especially from the goal on the lower Anger, in which two cases of cholera and an unusual number of cases of diarrhoea had already occurred in August, the institution remained nothwithstauding free from an epidemic of cholera. A few cases of dysentery and diarrhoea occurred it is true as they did at all times, one man too who had been some time in confinement even dying of cholera after 10 hours illness in August, whilst another who had come a short time before from Aichach via, Munich was attacked with choleraic diarrhoea on October 6th; as however these attacks did not occur more frequently than usual at this time of year, when no epidemic of cholera was in the neighbourhood, the institution could in reality be. declared free from cholera up to the end of November. Immediately on the outbreak of cholera in Munich, every effort had been made in all the Bavarian prisons to prevent these institutions becoming infected, without interrupting the committal of prisoners to the prisons for unconvicted persons or penal prisons, or their removal from them. The measures adopted, which consisted essentially in thorough disinfection of the excrements with sulphate of iron, enforced cleanliness, warm clothing, increased hygienic care in general, and then in careful medical inspection of all attacks, especially all cases of diarrhoea, seemed also to be effectual, for with the exception of three prisons for untried prisoners in Munich itself, where a few mild and sporadic cases occurred, the cholera did not find its way during the summer epidemic into the great prisons of the country, which received many reinforcements at that time out of and via Munich. The following Bavarian prisons for male convicts were those chiefly concerned: 1) The Prison at Munich in the Au, 2) „ „ at Lichtenau in Mittelfranken, 3) „ „ at Kaisheim in Schwaben and Neuburg, 4) „ „ at Laufen on the Salzach, 5) The Reformatory for juvenile offenders* in Niederschonenfeld near Rain on the Danube, 6) The Cell-Prison in Niirnberg, as well as 7) The Police Prison (Workhouse) in Rebdorf near Eichstatt; for female convicts: 8) The Prison at Wasserburg on the Inn, OUTBREAK OF CHOLERA AT LAUFEN The Bavarian Minister of Justice kindly acceded to my request and gave me the following particulars about all the prisoners who were brought to the above-mentioned institutions either out of or via Munich during the period from August Ist to December 16th 1873: a. Christian and surnames, b. Age, c. Trade or occupation in freedom, d. Duration of the preceding imprisonment, c. Place, where it took place, f. Duration of residence in Munich, as well as the prison or lock-up, in which the individual in question was lodged, and if possible the number also of the lock-up, g. Lastly the route taken from Munich to the institution and the mode of transport (whether by railway, carriage, or on foot). During this time there were sent out of and via Munich: To the Prison at Munich 40 „ „ „ at Lichtenau . . - . 61 „ „ „ at Kaisheim 19 „ „ „ at Laufen 128 „ „ Peformatory at Niederschonenfeld 19 „ „ Cell-Prison at Nuremberg ... 7 „ „ Prison at Wasserburg .... 11 „ „ „ at Sulzbach . . . ... 48 total 373 It will be seen, the institution at Laufen received the largest share. Of the 128 sent there, 43 had been stationed for some time in Munich. The arrivals were distributed according to time as follows: in August out of and via Munich I out of Munich 36 12 in September 15 | 4 in October 30 | 11 in November 42 | 13 in December 5 I 3 Whilst now the 9 Bavarian prisons, to which prisoners were sent from and via Munich, were not at all involved in the summer epidemic, cases of cholera appear pretty simultaneously with the commencement of the winter epidemic in Munich in four of these institutions, but by far the most in the prison at Laufen. Such a sudden and violent outbreak took place there, that it has not its equal in the history of cholera in Europe. Only one case is known to me, the outbreak of cholera in King's County prison New York in the year 1866*) which cau be compared to it. The prisoners who came from the prisons for unconvicted prisoners at Munich were affected by the epidemic as follows: t ') Annual Report of the Metropolitan Board of Health. New York Albany. 1867. p. 379. 14 Prisoners despatched to the prison at Laufen from August Ist until December 4th 1874. 1) from the prison on the Unteranger at Munich: ARRIVAL FROHNFESTE ILLNESS DURING IN LAUFEN LOCK-UP THE EPIDEMIC IN LAUFEN No. Day Month Floor o f room Day Month Nature of illness 2 August II 17 — — — 2 „ 111 17 — — — .6 „ 111 17 — — — 7 „ II 17 — — — 9 „ 111 12 — — — 9 „ 111 5 — — — 10 „ ra 3 - - - 11 „ 111 5 — - - 23 „ 111 17 5 Dec. Choi, diarrhoea. 11 Sept. II 17 6 „ Diarrhoea. 4 October I 5 — — — 19 II 15 — - — 19 „ 111 5 _ — _ 25 „ 111 10 _ - - 25 „ II 6 — — — 26 „ 111 5 8 Dec. Diarrhoea. 29 „ 111 4 _ — _ 29 „ II 5 7 Dec. Diarrhoea. 29 II 34 _ _ _ 31 _ II 9 r}-T\ Diarrhoea 5| Dec. 2 Nov. 11l 17 5 Cholera, f 3 „ I 7 4 n Diarrhoea. 6 I 14 _ _ _ 7 I 16 5 Dec. Cholera, f 9 14 9 " 111 17 _ — — 9 „ 14 4 Dec. Diarrhoea. 12 „ 111 16 _ — — 15 „ I 7 24 Nov. Diarrhoea. 23 „ II 7 io Dec. Diarrhoea. 28 „ II 10 28 Nov. Diarrhoea. 29 „ 111 7 1 Dec. Cholera. »29 „ ITI 17 6 Choi, diarrhoea, 1 Dec. II 17 - - 1 II 13 1 Dec. Diarrhoea. 4 „ 111 17 — - - 2) Prisoners despatched from the prison in Bad-Strasse, Munich : 2 August • 41 — — — 4 „ 52 11 Dec. Diarrhoea. 17 Sept. . 66 — — — 28 „ 55 4 Dec. Choi, diarrhoea. 28 „ . 73. 17 3 „ Diarrhoea. 3) Prisoners sent from the prison on the Lilienberg in the Au: 4 | August | . | 17. 11. 2 |— | — | — 4) Prisoners sent from the military prison at Munich: 11 | October | | | — | — — It may appear remarkable that so few of those who arrived in August and up to October 25th were affected by the epidemic compared with those who arrived afterwards, but this is dependent on the fact that the majority of those who first arrived were already discharged again, before the epidemic broke out — for the term of punishment only amounted to a few weeks in many cases. 15 The following table contains all the cases of diarrhoea, choleraic diarrhoea and cholera which occurred among rather more than 500 prisoners at Laufen from November 20th to December 21st 1873. " "T^TA^iD^wTT^" DIED OF*) DATE To^T Cholera geraic 0^ December 1 ... 6 1 4 33 5 18 56 25 25 5 35 8 32 75 24 . 24 0."!! 22 8 7 32 12 . 12 7 12 5 3 20 3 3 8 . . ' 5 8 11 24 8 1 4 tRII • • • Total" ...... 128 43 136 307 81 2 83 From the 136 cases of diarrhoea 11 must be deducted, which happened before the outbreak ot cholera, ana anecteu persons who were afterwards attacked again by cholera, choleraic and simple diarrhoea. In calculating therefore the percentage of attacks, only 125 cases of diarrhoea and .296 cases of all diseases are accepted. Of the remaining 125 cases of diarrhoea 104 were treated as out-patients, 21 as in-patients. This list prepared from individual numerical reports differs somewhat apparently trom the chief list by the resident physician of all cases of cholera and choleroid disease clinically treated from November 29th, but only in the fact that Dr. Berr excluding those treated for diarrhoea out of the hospital included only those treated as in-patients in, the chief list. In order to make my report quite conformable to that of Dr. Berr, it would have been necessary to make a distinction between cases of diarrhoea treated in and out of the hospital, and also to exclude some cases of relapse. With the consent of the commission I have forborne to make these exclusions, as they would only hinder us in our survey, without making any material change in the general sketch of the epidemic. For the sake of comparison however I subjoin here Dr. Berr's general report. •) Remark.— The number of fatal cases does not refer to the day, on which death resulted, but to the day of attack. Hi AND EXTENT OF THE EPIDEMIC. GENERAL REPORT on the course of the epidemic of cholera from November 29th 1873 to the last recoveries on January sth 1874. tDATE. Attacked Cured Died Remainder DATE. Attacked Cured Died Remainder ember 29 .. 1 . . 1 December 19 ... 5 1 65 30 . . 4 . . 5 „ 20 ... 10 .55 jmber 1 . . 7 . 1 11 „ 21 ... 3 . 52 2 . . 5 . 2 14 „ 22 ... . . 52 „ 3 . . 5 . 1 18 „ 23 ... . . 52 „ 4 . . 38 2 5 49 „ 24 ... . . 52 5 . . 47 3 16 77 „ 25 ... 5 . 47 6 . . 27 1 11 92 26 . . . v 2 . 45 7 . . 17 . 6 103 „ 27 ... 4 . 41 „ 8 . . 16 . 11 108 „ 28 ... . . 41 9 . . 10 . 7 111 29 . . . 5 . 36 10 . . 2 . 8 105 „ .30 ... 3 . 33 11 . . 6 2 7 102 „ 31 ... 9 . 24 12 . . 2 . 2 102 13 . . 1 4 . 99 1874: 14 . . . 10 1 88 January 1 . . 24 15 . . 1 7 1 81 ?2 . . 24 „ 16 . . 1 9 "2 71 ?3 13 . 11 17 . . . . . 71 ?4 5 . 6 18 . . 1 . 1 71 ?5 6 Total 191 38 82 70 1 191 38 82 191 108 83 The resident medical officer Dr. Alois Berr has given me the following information respecting the symptoms held to be diagnostic of the different maladies: Diarrhoea (white evacuations, 3 or 4 times or oftener in 24 hours) was only considered and denoted — apart from its coincidence with the time of the epidemic — as specific, when accompanied by a state of general nervous depression (Praecordial anxiety, turgeseence of the carotid pulse, tinnitus aurium, moderate vertigo) — to distinguish it from gastric affections (dyspepsia), which constitute a permanent object of out-door treatment in about 2 or 3 per cent of the inmates. I hold that the former cases of diarrhoea designated ?specific" are not to be placed outside the circle of epidemic influence ; on the other hand they are not in the same category as the clinical i. c. severe attacks, and are generally left altogether out of account, where the subject of observation is not so directly under our eyes as in a penal community. ?The attack was regarded by me as choleraic diarrhoea (epidemic) as soon as vomiting and decline of strength, retention of urine and spasms accompanied the symptom of diarrhoea, and ?as cholera vera or asiatica, as soon as rice-water evacuations, collapse and hoarseness set in. ?I may remark here also, that 36 cases admitted into the hospital as cases of choleraic diarrhoea, during the course of the disease became gradually affected with cholera and 22 of them died." 17 INTRODUTION OF CHOLERA. The number of inmates in the institution at the time of the epidemic was as follows: On December Ist 1873 the number of prisoners amounted to 509. During the period between December Ist and sth, on which day no more prisoners were sent, there had been 11 fresh arrivals and 2 prisoners had returned from transport, So that the whole contingent of prisoners to be taken into consideration during the epidemic amounted to 522. Of these 522 there were attacked according to the above-mentioned table with cholera, simple and choleraic diarrhoea . 56.7 per cent „ cholera , . . . 24.5 „ „ choleraic diarrhoea , . . 8.2 „ „ diarrhoea 23.9 „ died 15.9 „ The few facts, which I have communicated here, already suffice to make this epidemic appear a problem well worthy of the most thorough investigation. With the consent of the Bavarian Minister of Justice and the Imperial Chancellor I not only went myself to the spot, where I made a number of inquiries from December 9th to 17th, but I induced the other members of the cholera commission for the German Empire to betake themselves also to Laufen, and convince themselves of the actual facts. I was unwilling in such an important matter to bear the whole responsibility, so that nothing, which might be of service to the investigation, should be neglected or overlooked. After the commission had held a full meeting at Munich on January 12th 1874 by order of the Imperial Chancellor, and had been made acquainted with the facts by me, as far as I knew them, they went, myself excepted, with the sanction of the Bavarian Minister of Justice to the prison at Laufen on January 15th, made a thorough examination of the institution, discussed many particulars with governor Schicker and Dr. Berr, made some further important inquiries, and commissioned me after their return from Laufen at a meeting at Munich on January 19th to draw up a minute report. If now almost a year elapsgd before this report was completed, it is partly due to the comprehensive nature of the task and the necessity of making many supplementary inquiries, partly to my endeavour to furnish a report as exact and comprehensive as possible. This endeavour determined me, not to comprise the cases at Laufen as isolated per se, but as far as possible in connection with others, which involved me in more work, than I had calculated at first, and obliged me to repeatedly trouble many others also with questions and answers. I shall now try to relate the facts arranged according to certain points of view. INTRODUCTION OF CHOLERA INTO THE PRISON AT LAUFEN. However convinced we may be, that the cholera did not arise spontaneously in Laufen, we have had little success in ascertaining the time or the mode of its introduction. It will be perhaps most practical to take the intercourse with Munich as the starting-point of our investigations. Quite apart from the fact, that the introduction of the disease from Munich was just as possible during the summer epidemic, but did not take place, those prisoners first claim our attention, who were sent to it from Munich several weeks before the outbreak of the malady in the institution, and especially those, who had resided some time in Munich. These are enumerated in the following table, which presents a list of all the prisoners 18 in number despatched from the goals for untried prisoners in Munich beginning with November Ist. 18 DAY CHRISTIAN OCCUPATION work-dormi- DAY NATURE OF and AGE IN room tory op of REMARKS admission SURNAME FREEDOM PRISON No No ATTACK ATTACK Nov. 2 Bernhard, Georg 55 Wheelwright Brushmaker 11 64 Dec. 5 Cholera Died „ 3 Eder, Xaver 24 Servant Spinner 57 99 „ 4 Diarrhoea 6 Schuller, Georg 27 Bricklayer Shoemaker 45 80 — — Bronchitis, Dec. 14 „ 7 Christlbauer, Xaver 32 Baker Baker 21 48 Dec 5 Cholera Died „ 9 Eibach, Sebast. 28 Tailor Tailor 38 39 - — „ . Rottenfusser, Ludw. 29 Butcher Spinner 57 98 - — „10 Huber, Anton 39 Bricklayer Glove-maker 57 70 Dec. 4 Diarrhoea „12 Bichler, Joseph 41 Tailor Tailor solitary condiment — — ?15 Holzmiller, Sebast. 37 Servant Spinner solitary confinement Nov. 24 Diarrhoea „23 Huber, Albert 19 Shepherd Spectacle-maker 84 80 Dec. 10 „ „24 Pankratz, Joseph 31 Tailor Shoemaker 45 83 „ 6 „ „28 Gallecker, Xaver 21 * Servant Straw-worker eoSES"* Nov * " 28 „ 29 Markl, Michael 39 Miller unemployed — dnderarrert Dec. 1 Cholera „29 Stob, Joseph 42 Innkeeper Spectacle-maker 84 98 „ 6 S^™ 1 " Dec. 1 Kaufer, Xaver 27 Butcher Spinner. 57 98 — - — „ 1 Pfliiger, Joseph 17 Butcher Straw-worker continlment Dec. 1 Diarrhoea „ 3 Gleisner, Max 21 Locksmith Locksmith 12 64 — — „ 4 Keller, Konrad 22 Butcher Washer _ nm ierarrest — — Next in order to these come those, 28 in number, who were despatched from other goals for untried prisoners after November Ist,1 st , but who travelled via Munich. They remained on an average, only 1 day in Munich and were lodged in the guard-room No. 13 at the Munich Police Station, through which room those prisoners coming directly from Munich had also to pass- *§ W OCCUPATION PLACE if If §* NATURE °| NAME O IN op * H °~ »* of REMARKS. *S * FREEDOM PRISON TRIAL °% Nov. 1 Hurael, Michael 20 Dairyman Spinner Kempten confinement Dec. 4 Diarrhoea Isselhardt, Jacob 35 Shoemaker Shoemaker Augsburg 45 83 „ 5 Diarrhoea Rankel, Joseph 40 Shoemaker Shoemaker Augsburg 45 82 — — Rohrl, Max 23 Labourer Tinman Straubing 12 64 Dec. 4 Choi, diarrh. „ 2 Bock, Xaver 36 Cottager Basket-maker Aichach 47 48 „ 5 Diarrhoea Diarrh.,Nov.i> Klingseisen, Joseph 38 Labourer Spinner Weilheim 57 70 ? 5 Cholera Died „ 3 Fredl, Paul 19 Servant Spectacle-maker Straubing con SnL t — — Gutowsky, Stanisl. 36 Dealer Tailor Augsburg 38 97 — „ 4 Stegbauer, Johann 21 Shoemaker Shoemaker Straubing 45 80 Dec. 3 Diarrhoea „ 5 Griiner, Alois 20 Servant Tailor „ JZ*Znt » 5 Diarrhoea „ 6 Prugelmeyer, Jos. 34 „ Tailor „ 38 41 — — Zullncr, Alois 32 n Spectacle-maker „ 84 94 Dec. 4 Cholera „ 7 Mader, Joseph 31 H Spinner Augsburg 57 70 — — „ 8 Sigl, Michael 54 „ « Straw- worker Straubing 47 32 Dec. 9 Diarrhoea Hackl, Michael 22 Worker in wood Joiner Straubing 71 70 ?3 Cholera Died Huber, Dismes 20 Servant Cleaner Augsburg 72 98 — — Suss, Martin 29 „ Shoemaker Straubing 45 80 Dec. 6 Cholera Died Scheick, Georg 35 Brewer Shoemaker Straubing 45 83 — — „ 10 Pledl, Joseph 44 Labourer Spinner Deggendorf 57 67 Dec. 4 Cholera Died Sturm, Loreuz 23 Servant Straw-worker Weilheim 47 32 — — '„ 11 Leinfelder, Peter 21 Miller Spectacle-maker Aichach 84 94 — — „ 14 Bauer, Joseph 21 Servant Tailor Passau 38 70 Dec. 7 Cholera „ 15 Maier, Philipp 51 Labourer Washer Augsburg 15 97 „ 6 Cholera Died „ 18 Brandstetter, Jos. 48 „ Tailor Passau 38 83 „ 5 Cholera Died t23 Muller, Narziss 45 „ Weaver Memmingen 58 98 „ 5 Cholera Died 26 Heinzle, Jakob 23 „ Straw-worker Memmingen 72 97 — — 30 Zettler, Joseph 26 Bricklayer Tailor Kempten 38 32 — — 3 Kornbrust, Jos. 52 Tailor Tailor Kempten 38 99 — — 19 INTRODUCTION OF CHOLERA. A larger number (43) comprises that section of the prisoners despatched to Laufen between November Ist and December 4th, some of whom had come from other provincial prisons without stopping at Munich, whilst others had voluntarily given themselves up in order to undergo their term of punishment. The following table comprises this third portion of fresh arrivals. *§ v TO OCCUPATION WOKK " DORMI - 1 NATURE II NAME PREVIOUS room tory 5 op REMARKS °§ INSTITUTION No. in the ° ILLNESS Institution p Nov. 2 Zeilbeck, Johann Kelheim Straw-worker 72 70 — Morhart, Michael Krumbach Shoemaker 45 83 Dec. 1 Cholera Diarrhoea, N0v.28, Died „ 3 Loibl, Johann Viechtach Glove-maker 57 99 — — „ 4 Ziller, Simon Freising Straw-worker 72 97 Dec. 4 Cholera Died Dietl, Joseph Deggendorf Spinner 57 99 „ 8 Cholera Died „ 5 Janker, Joseph Bogen Straw-worker 47 83 — — „ 6 Ziegler, Barthol. Landshut Rope-maker 47 98 — — Bschorr, Joseph Donauworth Weaver 58 99 — — Stadler, Michael Wolfstein Spinner 57 98 Dec. 10 Diarrhoea „ 7 Habrunner, Josef Vilshofen Straw-worker 72 70 ?8 Choi, diarrh. „ 8 Rupprecht, Josef Kotzting Spinner 57 67 — — Kaufmann, Sebastian Landsberg Brushmaker 11 64 — „ 9 Geiger, Josef Mindelheim in Hospital — — — — Christl, Alois Wasserburg Spinner 57 64 Dec. 10 Diarrhoea Eberle, Pankranz Schongau Cleaner — 98 — — „11 Voslauer, Mathias Traunstein Spectacle-maker confinement — — „ 13 Kratzer, Michael Friedberg Straw-worker 72 70 — — Yolk, Josef „ „ 72 67 Dec. 9 Diarrhoea „ 14 Liebhart, Franz Rottenburg Joiner 71 70 „ 2 Cholera Diarrhoea, Nov. 23, Died „15 Retzer, Michael Pfarrkirchen Potato-peeler 47 32 „ 5 Cholera Died Simon, Georg Pfaffenhofen Straw-worker 47 32 — — Koch, Anton Mie^bach Farm Labourer — 67 Dec. 4 Cholera Died Prager, Leopold Wolfstein* Straw-worker 72 | 67 ?6 Cholera „16 Feldmaier, Andreas Pfarrkirchen Tailor confinement ~ — „18 Fritz, Josef Pfaffenhofen Spectacle-maker 84 80 Dec. 10 Diarrhoea Kraml, Josef Pfarrkirchen Knitter 57 80 — — „ 19 Venus, Simon Wasserburg Locksmith 12 64 Dec. 3 Cholera Died „ 20 Feistle, Josef Weilheim Straw-worker 72 97 „ 4 Diarrhoea „ 22 Dallinger, Johann Munich ? Shoemaker 45 82 — — „24 Freidhofer, Conrad „ ? „ 45 82 Dec. 8 Choi, diarrh. „26 Lumberger, Carl „ ? Cooper 11 64 ?8 Diarrhoea Lachenmaier, Georg Augsburg Joiner 71 70 ?5 Cholera Died „27 Huber, Georg Pfarrkirchen Straw-worker 72 97 — — „28 Schmidbauer, Seb. Landshut „ 47 32 Dec. 4 Cholera Died „ 30 Weichsel, Albert Munich? Joiner 71 70 ?6 Cholera Died Dec. 2 Wagner, Gottlieb Zusmarshausen Rope-maker 47 98 „ 7 Cholera Wagner, Josef „ Spinner 57 70 — — Wagner, Mathias „ Spectacle-maker 84 94 — — „ 3 Ober, Josef Erding Straw-worker 72 70 — — Heckengruber, Josef Eggenfelden Washer 15 56 — — Rieblinger, Josef Augsburg „ 15 56 — — Asen, Sebastian Freising „ 15 56 — — „ 4 Kinateder, Johann Pfarrkirchen „ 15 06 — — The first subject of investigation with respect to these three divisions is, when and in what number cases of cholera, choleraic and simple diarrhoea appeared among them, and then to compare them with the cases which occurred throughout the whole population of the prison. With regard to the period of attack no difference is observed between these three divisions, they were very uniformly implicated in the course of the epidemic from November 29th to December 10th, and 20 in no wise took the lead, so that it would seem as if it was not they who had infected the establishment, but that like the older inmates they had become first infected within it. The cases of diarrhoea (21) observed in the establishment in November 1873 were rather more numerous than usual, but did not show any special preference for the recent comers over those who had been already some time in confinement. No case of cholera appeared among them before December Ist, even the cases of diarrhoea did not occur more frequently among them till after this time. The majority of those, who came via Munich (27) and other places (43), presented only 3 cases of diarrhoea (Mohrhardt, Liebhart and Bock) before December Ist, and even the 18 sent from the goals for untried prisoners in Munich exhibit only 2 cases of diarrhoea before December Ist, namely Holzmuller, who arrived on the 15th but was not taken ill till November 24th, and Galleker, who was already suffering from diarrhoea when he came from Munich, and was placed at once in solitary confinement, and consequently did not come into any contact at all with the other prisoners. Moreover the amount of sickness and mortality in these three divisions presented no essential difference in the course of the epidemic from the average amount among the other prisoners. Of the 18 persons constituting the first division there were attacked with: Cholera 2, of whom 2 died Choleraic diarrhoea 2 Diarrhoea 7 total 11. Of the 28 persons constituting the second division there were attacked with: Cholera 9, of whom 7 died ¦ Choleraic diarrhoea 1 Diarrhoea 5 total 15. Of the 43 persons constituting the third division there were attacked with: Cholera 11, of whom 7 died Choleraic diarrhoea 2 Diarrhoea 6 total 19. If we calculate the percentages of these numbers, and compare them with those which obtain for the whole prison population, we have the following result: NATURE OF FIRST SECOND THIRD MEAN OF TOTAL DISEASE DIV, S ,ON DIVISION D.VISION D ™ s Cholera ll.i 32.i 25.5 24.r 24.5 Choleraic diarrhoea ... ll.i 3.5 4.9 5.6 8.2 Diarrhoea 38.8 17.9 13.9 20.2 23.9 Total 61.i 53.5 44.3 50.5 56.4 Deaths from cholera ll.i 25.0 16.4 17.9 15.9 The section of the 522 prisoners, numbering 89, comprising those who arrived in the establishment between November and December 4th, presented no material points of difference during the course of the epidemic from the whole number, of which it formed about 1 j 6 . The greatest deviations occurred in 21 the first division, but as the smallest absolute numbers obtained here, less weight can be placed upon them. The larger the numbers of the three divisions become, the more nearly their percentage approximates that of the whole number of inmates. A striking circumstance presents itself pretty uniformly in the three divisions, when we dissect them into three parts, the first comprising the arrivals from November Ist to 14th, the 2nd those from the 15th to 29th, the day of the first case of cholera, and the 3rd those from the latter date to December 4th, and see how many attacks took place in the course of the epidemic. A. From November i st to 14 th - THREE DIVISIONS TOGETHER SECOND DIVISION THIRD FIRST DIVISION DIVISION Number of persons 8 22 19 48 Cases of cholera 2 6 4 12 Cases of choleraic diarrhoea . — 1 1 2 Cases of simple diarrhoea. ... 2 5 3 10 B. From November 15 th to 29 th - Number of persons 6 4 .15 25 Cases of cholera — 3 5 8 Cases of choleraic diarrhoea . . 1 — 1 Cases of simple diarrhoea ... 5 — 3 8 C. From November 30 th to December 4 th - Number of persons 4 2 9 15 Cases of cholera — — 2 2 Cases of choleraic diarrhoea . . — — — — Cases of simple diarrhoea ... 1 — — 1 There were attacked in the first division 4 of the 8 persons who arrived in section A b „ i, b |f M ? » p -t* 1 11 ii 4 11 ii ii ii ii There were attacked in the second division 12 of the 22 persons who arrived in section A « ii ii ii ii ii ii 'i 9 f! — ii ii " ii ii ii ii n In the third division there were attacked 8 of the 19 persons whe arrived in section A " ii ii •*" ii ii ii ii ii 9 Q Cj 11 11 V 11 11 11 11 11 yJ According to these tables the new arrivals in the establishment during the fortnight which preceded the outbreak of cholera seem to have borne the brunt of the malady. The numbers are here also far too small to enable us to draw any definite conclusions from them, although it is still a remarkable fact, that those who arrived after the outbreak of the epidemic and whilst it was still raging, should have been so slightly affected by it. Of the 15 new arrivals in the interval C only 3 were attacked during the different stages of the epidemic, whilst not less than 18 of the 25 who arrived in the interval B were attacked, and the majority of them with the more acute form. The circumstance is all the more striking in the preceding case, since of the 15 new-comers in section C, 5 were at once drafted off to the 22 washing department, and not a single one of these 5 newly arrived washers took the disease, although the department of washers, as I shall show afterwards, did not suffer less than the others. Another fact was observed, which proves still more distinctly even than the foregoing, that admissions at least into the main building of the establishment after the epidemic had already broken out, did not bring that danger, that might have been supposed. The little cell-prison, destined mostly for juvenile offenders, whom it is desirable to withdraw from the bad influences of the common prison, adjoins the main building. There where 35 prisoners undergoing solitary confinement in it at the time of the (continued, p. 24.) LIST of prisoners placed in solitary confinement who were removed to the common prison on December 4th 1873. OCCUPATION g 1 DAY NATURE NAME AGE in o - -| of op REMARKS PRISON *M ATTACK ATTACK _5 - 1 Albert, Johann 20 Spectacle-maker 94 — — 2 Bauer, Max 18 „ 94 — — 3 Fredl, Paul 18 „ 94 — — 4 Lang, Josef 19 « 94 Dec. 11 Diarrhoea treated as out-patient 5 Meller Josef 18 „ 91 Dec. 11 Diarrhoea treated as out-patient 6 Schollhammer, Anton 19 „ 94 — 7 Voslauer, Matth. 18 „ 94 — — 8 Ruissinger, Jos. 20 ,94 — 9 Birkmeier, Anton 23 „ 94 — — died of Typhus ou January 1»* 1874 10 Bedachi, Franz 17 Locksmith 64 — — relaxed bowels on Dec. 29th 11 Lorenz, Ferd. 22 „ 64 Dec. 15 Diarrhoea treated as out-patient, as on Nov. 20th 12 Gruner, Alois 18 Tailor 97 — — 13 Hebenspreger, Michael 19 „ 64 Dec. 16 Diarrhoea treated out of hospital 14 Danzer, Georg 39 „ 39 — — 15 Deierl, Josef 19 „ 41 — — 16 Feldmeier, Andr. 25 „ 98 — — 17 Obermeier, Franz 20 „ 39 — — 18 Wiespauer, Korb 16 ? 39 Dec. 4 Choleraic diarrh. 19 Bichler, Josef 41 „ 39 — — 20 Bohm, Josef 22 Shoemaker 83 Dec. 6 Diarrhoea treated out of hospital 21 Staufer, Max 17 „ 80 - — 22 Bachmeier, Max 17 Straw- worker 70 Dec. 6 Diarrhoea treated out of hospital 23 D.rakolitsch, Jesef 19 „ 70 Dec. 5 Diarrhoea treated out of hospital 24 Pfliigler, Josepf 17 „ 70 Dec. 1 Diarrhoea treated out of hospital from Dec. 1«t to 10 tii, came from Munich on Doc. Ist 25 Gallecker, Xaver 20 „ 70 Dec. 10 Diarrhoea suffering from diarrhoea on arrival from Munich on Nov. 28th 5 taken ill again on 10* and treated in hospital 26 Schratzenstaller, Franz 35 „ 70 — — 27 Hummel, Michael 19 Spinner 32 Dec. 4 Diarrhoea treated as out-patient 28 Ostermeyer, Jos. 19 Straw-worker 70 — — 29 Holzhauser, Franz 18 „ 70 — — 30 Scheuerer, Ferd. 56 Gardener 67 Dec. 11 Diarrhoea treated in hospital 31 Sandner, Andr. 17 Straw- worker 70 Dec. 4 Cholera died on Dec. Bth 32' Seeholzer, Ludw. 18 Shoemaker 80 — — 33 Klotz, Ignatz 23 Weaver 98 Dec. 6 Cholera 34 Altmann, Josef — — — — — placed in a cell for another complaint. 35 Gross, Michael 20 Gardener 67 — — slept only in the building for solitary confinement, occupiedduringtheday in the open air, later in room 67. Discharged on Dec. 4th and continued well afterwards. 23 outbreak of the epidemic began so unexpectedly to assume such large dimensions on the 3rd of December and especially in the night between December 3rd and 4th, space had to be procured for the patients. It seemed most appropriate to occupy the whole building for solitary confinement as a hospital. The prisoners located there had to be distributed among the other inmates in the common prison, where there happened to be room, which was done early on December 4th. As now empty places had arisen principally through attacks oi cholera and cases of death, it is of great importance to notice the distribution of the cell -prisoners, who may be regarded as hitherto free from cholera, among the general body of prisoners already affected with cholera in the main building, as well as what happened to these new comers as it were. Governor Schicker and Dr. Berr have given me the necessary details on this head. (See table page 23.) The distribution of the cell -prisoners and the number of attacks among them was as follows iv the individual dormitories : No. of Dormitory 32 39 41 64 67 70 80 83 91 94 97 98 No. of new-comers 1 4 1 3 2 8 2 1 1 8 1 2 Cases of cholera — — — — — 1 — — — — — 1 „ „ choleraic diarrhoea — 1 — — — — — — — — — — „ „ diarrhoea I — — 2 1 4— 1 1 I__ Consequently among all the prisoners here in question, who were removed into the main building from an out -building hitherto free from cholera just at the worst time, there occurred only 2 cases of cholera, 1 with fatal issue, 1 of choleraic diarrhoea, 1 of diarrhoea treated in the hospital, and 10 of diarrhoea treated as out-patients. — The removal took place early on the morning of the 4th. The first cases, which presented themselves in the course of the day among those removed, were one of diarrhoea (the spinner Hummel), one of choleraic diarrhoea (the tailor Wiespauer), and one of cholera, the patient being the straw- worker Sandner, a strong young man aged 18, who had already beea 9 months in prison. He was removed to the hospital from the dormitory No. 70 shortly before midnight in the night between December 4th and sth, when he already presented well-marked symptoms of cholera. If it is here assumed, that he was not already infected when he left his cell, which is not probable for other reasons, but that he became infected only on entering the dormitory No. 70 early in the morning, the period of incubation in this fatal case can only have lasted somewhat more than 15 hours. Why the only fatal case should affect one of that section of the 34 prisoners in solitary confinement, which was placed in dormitory 70, a plausible reason will be given hereafter, when I shall discuss the course of the disease in the establishment relative to dormitories. It was this very dormitory No. 70, which furnished the most numerous and the severest cases. Sandner seems then to have found in one part of the room just a sufficient residue of infecting matter, whilst the remaining 7 prisoners in solitary confinement, who were simultaneously removed with Sandner to the same room, all escaped with slight diarrhoea, or had no illness at all. The assumption, that at the time, when the removal of the cell-prisoners took place, although at this very time most attacks occurred, yet the main building no longer acted so perniciously on new-comers as it had done a few days before, as well as the assumption, that the mild cases also among those removed did not proceed from their former residence in the cells, but were caused rather by their afterwards entering the sphere of infection in the main building, finds some farther support in the period when diarrhoea broke out among this group of 34 persons. Whilst the cases of diarrhoea had reached their maximum in general on December 4th and sth and then quickly declined, we remark only 3 out of 24 the 11 cases of diarrhoea observed among the cell-prisoners occurred between JNovember 29th and December sth, the majority not till after this day, and 6 of them after December lOfch. Of 118 cases of diarrhoea which were observed among all the inmates of the prison between November 29th and December 21st, 67 occurred before December sth and 51 after this date, only 24 more after December 10th, which is about a fifth or 20 per cent of all, whilst in the case of those removed from solitary confinement about half or 50 per cent occurred during the last-mentioned period. The fact that the great majority of the cases which occurred among those removed were of such a mild character, that the cases of cholera amounted to only 3 per cent, whilst they constituted iv genera 1 25 per cent, we night be tempted to attribute to individual disposition or idiosyncrasy and especially to the circumstance that the majority were young men between 18 and 22, — but a comparison we shall subsequently make of the occurrence of cases of cholera in prisoners of the same age undergoing common Srisonment will show, how little protection against cholera was afforded by youth, as soon as certain lities came in question. Before entering upon the discussion of the first cases of cholera, I will give another glance at the cases of diarrhoea which preceded them from November 20th to the 28th, which might possibly be precursors of the epidemic, and see, whether they predominated among individuals, who had arrived in the establishment only a short time before, and had possibly already brought the germ of the disease with them and then distributed it, or whether among such, as had already been some time in eonfiuement. The cases of diarrhcea, which preceded the outbreak of cholera on November 29th from November 19th to 28th, affected the following prisoners. ¦D a y Duration Dormiof NAM E. of Occupation . REMARKS Attack Imprisonment No. Nov. 19 Adlhoch 7 weeks Tailor 32 Ziegler 2 months Spinner 32 „ 20 Lorenz 2 „ Locksmith Solitary Attacked again with diarrhoea on December 12th after removal to common prison „ 21 Maier 5 „ Spectacle-maker 94 Fuhreisen 4)4 „ Rope-maker 98 Attacked with cholera on December sth Muller 1% years Weaver 99 „ 23 Andre 5 months Joiner 70 „ „ cholera on December 4th and died Liebhart 10 days Joiner Hospital „ „ cholera on December 2nd and died „ 24 Gassner 5 months Rope-maker 98 „ „ choleraic diarrhoea on December Bth Holzmiller 10 days Spinner 97 „ 25 Baumgartner 10 months Weaver 99 „ „ cholera on December 4th and died Berger 2 „ Shoemaker 83 Brunbauer 2 „ Joiner 70 „ „ cholera on December 4th and died Goberle 3 „ Straw-worker Hospital „ „ choleraic diarrhoea „ 26 Mumhofer 4 „ Washer - 56 „ „ cholera on December Ist Greiner 6 „ Joiner 70 „ „ cholera on December 4th and died Hoss 3 „ Straw-worker 22 „ „ diarrhoea on December Bth „ 27 Reischl 5 „ Weaver 97 „ „ choleraic diarrhcea on December Ist „ 28 Mohrhard 26 days Shoemaker Hospital „ „ cholera on December Ist and died Enzensberger 1 month Shoemaker 86 » » diarrhoea on December 4th Ten of these 20 cases of diarrhoea (Adlhoch, Lorenz, Maier, Fuhreisen, Muller, Gassner, Goberle, Mumhofer, Reischl and Mohrhardt) were treated in the hospital, — 10 (Ziegler, Ander, Liebhart, Holzmiiller, Baumgarten, Berger, Brunbauer, Greiner, Hoss and Enzensberger) were treated as out-patients. Gallecker, who came from Munich on November 28th with diarrhoea, is not included, because he 25 INTRODUCTION OF CHOLERA. was placed at once in solitary confinement, where be remained until the morning of December 4th, when be was removed to room No. 70 as dormitory and room 72 as workroom, where be again fell ill on December 10th and was treated in the hospital for diarrhoea until December 16th. It would seem that almost all the cases of diarrhoea, which could be regarded as the immediate forerunners and importers of cholera, were observed in persons, who had already been at least two mouths in confinement, with only two exceptions, viz Holzmiiller and Mohrhardt, the former of whom had come from Munich 10 days before the attack, but without any symptom of illness. Holzmiiller had been 8 months in the prison for unconvicted prisoners on the Anger in Munich and related, that he had already suffered from an attack of diarrhoea before his removal to Laufen. He slept in the establishment in No. 97 and worked in No. 57. As however the diarrhoea did not manifest itself until 10 days after his arrival in Laufen, this can hardly be regarded as an imported case, but it seems more natural and reasonable to seek the cause of its origin in the establishment itself, even if it was already a case of / Mohrhardt arrived in the establishment on November 2nd, and did not come either from or via Munich. He was placed with the shoemakers, and removed to the hospital on account of gastricism on Nov. 28th. He was discharged cured on the 30th, but returned again with cholera on December Ist, and died on December 2nd. He is therefore properly enumerated among those who were infected in the hospital, two fatal cases having occurred in the hospital on the same day, in whose vicinity Mohrhardt had been lying. Neither can the majority of the 20 cases of diarrhoea from November 19th to 28th be regarded as active precursors of cholera, because they participated in the subsequent course of the malady just as much as those prisoners, who had not yet suffered from diarrhoea. Only 6 remained free afterwards, 9 had cholera, 2 choleraic diarrhoea and 3 a second attack of diarrhoea. Six of the 9 cases of cholera terminated fatally. Of those treated for diarrhoea between November 20 th and 28 th there were on December Ist, 2 with cholera, 1 with choleraic diarrhoea, n 11 "2nd, 1 „ „ „ „ 4 th, 4 „ n 1 with diarrhoea, m »i 5 th, I ? ii „ „ 8 th, 1 „ choleraic diarrhoea, 1 with diarrhoea, „ „ 12 th, 1 „ diarrhoea, the temporary rythm of the epidemic in this group is therefore not essentially different from that in all the groups, it is neither much in advance of nor behind it. Twenty cases of diarrhoea in more than one week among more than 500 prisoners, of which only half required hospital treatment, is an event, which often occurs even without the cholera being near, and perhaps only accidentally coincides also in the present ease with the epidemic of cholera which followed it. Dr. Berr informed me of all the gastric attacks from August to December 1873. In the whole month of November 45 attacks of this kind happened, among them 13 cases of diarrhoea treated in and 16 out of the hospital, consequently altogether 29. Of these 3 occurred before the 19th and 6 after November 28th. During the whole of October there were only 14 gastric cases, 5 of them cases of diarrhoea, which required treatment, on the contrary in the previous September there were 21 gastric attacks, including 8 cases of diarrhoea. The latter were however accompanied by a great number of cases of scurvy in September, of which about 13 cases were treated in and 53 out of the hospital. There were only 9 gastric disorders in August 1873, including 5 cases of diarrhoea. Dr. Berr has taken the trouble to investigate the occurrence of gastric affections and diarrhoea during the months from August to November in the year 1872, the following figures being the result of 26 THE FIRST CASES OF CHOLERA. his investigation, leaving out of account the 6 cases of diarrhoea which happened in November 1873 after the outbreak of cholera: AVERAGE NUMBER OF CASES OF NUMBER OF ¦ PRISONERS Gastric affection Diarrhoea 1872 1873 1872 1873 1872 1873 Augnst . . 358 ( 490 17 9 6 5 September 14 21 5 8 October. . 26 14 8 5 November ( 18 39 4 23 Total 75 83 23 41 In the preceding years 1870 and 1871 the numbers from August to November were. August to 18?0 lg7l lg7o 18?1 lg7o lg7l November 519 438 71 56 18 15 From this it is evident, that the number of gastric attacks and more particularly cases of diarrhoea had undoubtedly already increased considerably in November 1873 as compared with the preceding years, and this may be supposed to be a forerunner of cholera, but this increase bears no comparison whatever to that which obtained even in cases of diarrhoea after the outbreak of cholera, as is evident from the table given at page 16, where 50 cases of diarrhoea occurred in only 2 days (December 4th and 5 th), or more than as many again as had happened in the whole month of November. THE FIRST CASES OF CHOLERA. The first cases of cholera also furnish no clue or evidence to support the assumption of a distinct introduction at a certain time or through a certain person. The first case on November 29 th was that of Joseph Rosskopf, aged 22, an unmarried servant, who had been 8 months in prison. He was one of the weavers and winders, 36 in number, who all worked together in room 58 on the second floor, but with the exception of two, who were lying ill in the hospital, slept in 8 different rooms, most being in the rooms Nos. 97, 98 and 99 on the third floor. Roskopf slept in No. 99. He went into the hospital with choleraic diarrhoea on the day in question, but soon passed into the cold stage of cholera, recovered from it and was discharged cured on December 15th. His state of health was robust on being admitted into the institution. In April 1873 he had been treated in the hospital for rheumatic fever, and in September he was also under medical treatment as an out-patient for scorbutic symptoms. The second case on November 30 th was that of Nicolaus Maier, aged 31, an unmarried brazier, who had been a year in confinement. He was placed in the establishment with the blacksmiths and locksmiths, who 20 in number worked altogether in No. 12 on the ground-floor and slept in No. 64 on 27 THE FIRST CASES OF CHOLERA. the second floor. He was at once seized with symptoms of cholera, but recovered likewise, after having passed through the typhoid stage, and was discharged cured on January 4ih 1874. His state of health was also robust on his admission into the establishment, and he had always remained well. The third case (also on November 30th) was that of Jakob Ettl, aged 31, an unmarried bricklayer, employed as straw-worker during his one year and 5 months imprisonment. The straw-workers formed an important part of the establishment, being 88 in number, and worked principally in 2 rooms, 51 in No. 47 on the first floor, and 32 in No. 72 on the second floor, and slept in the rooms Nos. 32 and 48 on the first floor, No. 70 on the second floor and No. 97 on the third floor. Ettl worked in No. 47 and slept in No. 48. Besides straw- work he and 11 others, mostly feeble and decrepid subjects, were employed in peeling potatoes. He died on December 2nd in the cold stage of cholera. The state of health of Ettl on his admission into the institution was tolerably good (scrofulous), he was treated in the hospital for gastric disorder in April, for intermittent fever (with clonic spasms) in May, for a scrofulous affection of the neck in July. The 6 additional cases of cholera and 1 of choleraic diarrhoea which occurred on December Ist were distributed as follows: The 6 patients affected with cholera, 4 of whom died, were: Markl, in lock-up, came from Munich on this day with diarrhoea. Mayerhofer, joiner, workroom 71, dormitory 70, died. Mohrhardt, shoemaker, in hospital for gastric disorder since November 26th, died. Mumhofer, washer, workroom 15, dormitory 56. Weinhofer, joiner, in hospital for tuberculosis and erysipelas of face, died. Zotter, weaver, in hospital for Bright's disease, died. Reitichl, shoemaker, workroom 45, dormitory 80. The following cases of diarrhoea occurred on this day: 2 from workroom 84, dormitories 91 and 94, 1 „ „ 45, „ 83, 1 „ „ 15, ? 56, 1 in the cell-prison, the subject a new comer from Munich (Pflugler). COURSE OF THE EPIDEMIC OF CHOLERA IN THE INSTITUTION. The first acute maladies (cholera and choleraic diarrhoea) exclusively affected persons, who either slept, or were occupied during the day in the east wing of the main building, or were lying in the hospital, the cases of diarrhoea also were most prevalent in the above-mentioned part of the main building. The shoemakers' workshop No. 45 in situated on the first floor in the middle of the east wing above the smiths' workshop No. 12 on the ground-floor, the dormitory of the joiners No. 70 on the second floor, and directly adjoining it their workshop No. 71. ' The straw-workers' workroom No. 47 is situated at the southern corner of the wing, next to it the dormitory No. 48, above on the second floor another straw-workers' room No. 72, and above this on the third floor dormitory No. 99, from which the first case of cholera proceeded. The hospital must be taken as a second primary focus of infection. Only the two parts of the building mentioned above (east wing of the main building and hospital) and no other parts were concerned in the first 10 acute cases, and the further course of the epidemic has also shown, that the disease committed the greatest havoc also in the spot where it began. In order to be able to institute investigations as to the local distribution of cholera in the 28 COURSE OF THE EPIDEMIC IN THE ESTABLISHMENT. establishment and solve further questions connected therewith, it is above all things necessary to separate all the 522 prisoners into groups corresponding to their respective workrooms and dormitories. The working departments to which the prisoners belonged form a natural and lucid basis for both. SEPARATION OF THE PRISONERS INTO GROUPS CORRESPONDING TO WORKROOMS AND DORMITORIES. I As a basis for statistical comparisons and investigations we can employ the tabular statement pared by Dr. Berr with the assistance of the superintendent Herr Schicker and the different overseers meet the wishes of the members of the cholera commission of the German Empire after their visit Laufen, and which gives information as to the name, age and occupation of each of the 522 prisoners, duration of imprisonment, workroom and dormitory, their state of health on being admitted into the establishment, date and nature of illness in the institution. December Ist was taken as the fixed startingpoint. Four of these tables may be given here by way of illustration: A Trade No. of ta « . Date , Nature Jz; | State of of attack I NA M E out of B &l| health on in of REMARKS • 3 ° f OCCUPATION N °" ° f Workroom Dormitory Workroom Dormitory 1 in lock-up Lock-up 2 Writers 50 48 4 Bakers 21 48 21 Joiners 19 71 70 95 Spectacle-makers 2 Hospital 2 in 84 80 42 Shoemakers 32 „ „ 91 19 45 80 56 „ „ 94 1 4C 80 0 M n 98 3 46 82 2 „ Hospital 6 45 82 1 Bookbinder 57 70 11 45 83 12 Brushmakers 11 64 2 Hospital 20 Farm Labourers 22 Ropemakers *? loutofdoors/ H ,j I— ly-tf 97 1 / \ 64 21 Jof doors \ 98 4 Gardeners „ 67 36 Spinners and Knitters 3 Domestic Servants 2 57 32 2—48 1 „ 56 1—67 1 64 6 Glove-makers 3 n 67 2 57 56 3 n 70 2 „ 99 13 97 7 Cooks . . . . , 20 48 9 „ 98 1 Basket-maker 47 48 3 99 2 Hospital attendants .... Hospital 88 Straw-workers 1 sick new-comer „ 45 47 32 3 Lithographers 50 48 1 46 32 4 Cleaners 6 47 48 1—97 1 50 48 3—98 24 72 70 1 Barber — 70 8 72 97 1 Joiner , . . . . 11 64 3 Hospital 20 Blacksmiths and Locksmiths 12 64 26 Washers 63 Tailors .16 15 5G 3 38 32 10 15 97 30 t „ 39 36 Weavers and Winders 20 » 41 l 5 8 56 2 » 64 2 „ 67 1 » 67 2 „ 82 2 „ 70 1 „ 91 1 » 83 10 „ 97 2 97 7 98 1 , 98 11 „ 99 1 „ 99 2 Hospital 30 ACCORDING TO OCCUPATION. The foregoing table prepared with the assistance of the tabular reports gives us an insight into the distribution of the prisoners according to occupation, workrooms and dormitories. The prison for solitary confinement has found no place in it, and for this reason, because the prisoners in solitary confinement were removed on December 4 th, before the epidemic had attacked its victims, and as already mentioned, in order to obtain space for the hospital, the prisoners in solitary confinement were distributed about among the other prisoners, and are entered under those occupations, workrooms and dormitories, to which they were assigned on this occasion. I refer the reader for other particulars to the table on this subject communicated at page 23. These remarks naturally lead to the consideration, how many individuals in the individual departments of work were attacked by cholera, choleraic and simple diarrhcea. This comparison can be taken as a measure both of the influence, if any, of occupation as well as that of the workroom or locality, both which influences are inseparable. The 27 departments quoted in the preceding table, and which have certainly very different numerical values (from 1 to 95) were affected in the following manner. ATTACKS AND DEATHS ARRANGED ACCORDING TO OCCUPATION. OCCUPATION Cholera Diarrhcea Death diarrhoea 1 in Lock-up 1 — — — 4 Bakers I—ll 95 Spectacle-makers 20 9 27 9 1 Bookbinder — — — — 12 Brush-makers 4 15 4 20 Farm-labourers 3 1 2 2 4 Gardeners 1 — 1 1 3 Domestic Servants 1 — 1 — 6 Glove-makers 3 — — 2 7 Cooks I—2l 1 Basket-maker — 1 2 Hospital Attendants — 1 Sick new-comer — — — — 3 Lithographers — — — 4 Cleaners — — — — 1 Barber 1 — — 1 1 Cooper — — 1 — 20 Blacksmiths & Locksmiths 5 2 3 2 63 Tailors 10 6 17 5 2 Writers — . — — _ 21 Joiners 11 — 3 11 42 Shoemakers 10 3 18 7 22 Rope-makers 3 6 7 2 3(5 Spinners 9 16 9 88 Straw-workers 24 9 14 14 26 Washers 5 2 7 4 36 Weavers 15 3 6 8 522 128 43 125 83 hAs however the workrooms, in which the prisoners spend the greater part of the day, are not element to be considered, supposing the morbid infection is more or less prevalent in certain 31 COURSE OF THE EPIDEMIC IN RELATION TO DORMITORIES. localities, bat the dormitories, in which the prisoners, far more crowded together than in the workrooms, have to pass the whole night, are at least of equal importance, it is necessary to examine the relation of attacks to dormitories. The two following tables serve for this purpose, the first of them giving a summary comparison from this point of view, whilst the second table (Page 33) dissects the attacks in each dormitory into the several departments of labour found in it. I. SUMMARY COMPARISON OF THE ATTACKS AND DEATHS IN THE SEVERAL DORMITORIES. _ . Number of _, . Choleraic '.. Dormitory Cholera Diarrhoea Deaths Prisoners Diarrhoea 32 51 14 6 9 7 39 30 3 2 9 2 41 20 4 3 5 1 48 26 5 — 6 4 56 20 4 2 2 3 64 37 9 4 11 6 67 30 10 2 3 7 70 52 17 2 10 15 80 23 5 1 7 4 82 11 2 1 6 1 83 12 3 1 8 2 91 33 5 6 10 1 94 56 14 2 16 7 97 45 11 2 11 9 98 44 9 8 7 6 99 17 7 — 5 3 Hospital 14 5 1 5 Lock-up 1 1 — — — 522 128 43 125 83 (See Table, Page 33) ARRANGEMENT OF THE ATTACKS IN THEIR CHRONOLOGICAL ORDER OF SUCCESSION IN THE WORKROOMS AND DORMITORIES. I have prepared the tables given at pages 34 — 37 in order to present a general view of the attacks occurring in the individual workrooms and dormitories as regards their order in point of time. I have divided the individual cases according to the grades of attacks; cholera, choleraic diarrhoea, and simple diarrhoea. Each case is entered under the category of the above-mentioned forms of disease with the number of the day of the attack. The cases which ended in recovery have a point beside the number of the day, those which terminated fatally a cross. When for instance the list of spectaclemakers is sought for in the first table (Pages 34. 35), it is found in the first columu , that there were 95 of them altogether. In columns 2 and 3is seen their distribution in the several dormitories, and in the 3 following columns, how many of them were attacked on each individual day in each dormitory with cholera, choleraic and simple diarrhoea. As almost all the cases occurred in December, and comparatively few in November, the plain figures always denote days in December, the attacks on days in November 32 COURSE OF THE EPIDEMIC IN RELATION TO DORMITORIES. ¦ are indicated by an oblique stroke, and the figure 11 being placed after them. The first case of cholera with fatal result among the 56 spectacle-makers occurred in dormitory 94 on December 3rd (3f), 4 cases follow on December 4 th, 2of them with fatal result. A case of diarrhoea already appeared on November 21st (21/11) Precisely the same system of signs is employed in the second table which is arranged in relation to dormitories. (Pages 35. 36. 37.) 11. RELATION OF THE ATTACKS AND DEATHS TO DORMITORIES AND DEPARTMENTS OF WORK. ° eS «S j o si < g "g 8 8 £ 3 -g 8 8 2 jjjjj iililil First Floor. Third Floor. Room 32: 3 Tailors — — 2 — Room 80: 2 Spectacle-makers — — 2j — 2 Spinners 1 — 1 1 20 Shoemakers 5 1 5 4 46 Straw-workers ....... 13 616 6 l_Spinner — — - — — -_ . 23 5 1|74 14 6 9 7 Room 82: 9 Shoemakers 2 1 5 1 Room 39: 30 Tailors 3 2 9 2 2 Weavers — — 1 — Room 41: 20 Tailors 4 3 5 1 n ~ 1 B*l l" Room 48: 4 Bakers 1 — 2 1 Roem 83: * J* ilor \ 1 ~ ~ 1 _ ? o 11 Shoemakers 2 1 8 1 2 Domestic servants — — — — — rr— — ! 7/11 o|lB|2 ,„°,V " ', * Room 91: 32 Spectacle-makers 5 6 9 1 1 Basket-maker -— l— x caver _j _ j i| _ 3 Lithographers - - - - -33- 5 I 6 10 j 1 2 Writers _o , '*_*." o Room 94: 56 Spectacle-makers 14 2 16 7 7 straw-workers 3 — 2 2 _, Room 97: 1 Cleaner — — — — 25 5-64 2 Tailors - - 1 - Second Floor. J R°.pe-maker j- - - - t> id n m ll > spinners — 1 1 — Room 56: 2 Glovers ____ g q^.^^^ 4 _ 3 2 1 Spinner _ _ _ _ 10 Washers .1 — 6 1 16 Washers 4 2 1 3 10 Weavers 6 1 6 1 Weaver — 1 _ 45 11 2 11 j 9 20 4 2 2 3 Room 98: 3 Spectacle-makers 1 1 — 1 Room 64: 12 Brushmakers 4 1 5 4 ? Tailor?. '.'.'.!!!"' 1 Farm Labourer — — — — 21 Rope-makers . ........ 3 6 6 2 1 Cooper — 1 9 Spinners „. . 2 — 1 2 20 Blacksmiths and Locksmiths 5 2 3 2 7 Weavers 3 I—l 2 Tailors . _ l l - 44 9 8 7 6 1 Spinner — — 2 — Room 99: 2 Glovemakers .. .- 2 — — 1 07 ~"T T~~l 7" 1 Tailor — — — — 61 9 4 11 6 3 S pi nners j _ 2 ! Room 67: 19 Farm Labourers 3 1 2 2 11 Weavers 4 — 3 1 4 Gardeners 1 — l 1 17 7 ~ 5 3~ 1 Domestic Servant 1 — — — Hospital: 1 Tailor l — — 1 2 Permanent Attendants — — — , — 3 Spinners 3 — — 3 1 JJJceration of Foot — - — — 9 Woo™ o it 1 Wossitis (Spectacle-maker) ..... — — — — —^weavers l l - — j Abscess of Hand „ — — — — 30 ' 10 2 3 7 1 Erysipelas of Face (Joiner) 1 — — 1 f7O: 1 Bookbinder ___ _ J gastric'disorder (Shoemaker) .' ." '.'. II I } 2 Glove-maker l_ 1 1 1 Oligcemia „ ...._____ 1 Barber 1 — _ 1 1 Emphysema of LuDg (Straw- worker) 1 — — 1 2 Tailors*) i___ 1 Marasmus „ l _ _ 1Q t • . „ „ 1 Inflammation 01 Eye-lid „ — — — — ly Joiners . ft 3 Q .n.,,, t-v. .j %t . " o . w a y 1 Bnght's Disease (Weaver) 1 — — j l 3 Spinners 2 - — 2 l_Tonsillitis — —|- 24 Straw-workers 3 2 6 2 14 — 5 JJ — ~ ~ 52 17 2I 10 15 Lock-up: 1 Weaver ...., 1 — — — *) One of these tailors (Carl Gallier) was in Kempten from November 23rd to December 3rd during the transport. 33 CHRONOLOGICAL DISTRIBUTION OP THE ATTACKS. a) in relation to occupation. I no of No of CHOLERAIC OCCUPATION CHOLERA DIARRHCEA Dormitory Occupants DIARRHCEA 1 in Lock-up Lock-up 1. — — 4 Bakers 48 4 5f — 20. 95 Spectacle-makers 80 2 — — 10. 10. 91 32 4+ 4. 5. 5. 8. 5. 7. 8. 8. 9. 10. 1. 3. 4. 5. 5. 5. 5. 5. 11. 11. 94 56 3f 4f 4f 4 - 4 - 5 t &t 5f 5- 6. 9. 21/11. 27/11. 1. 3. 3. 4. 5. 5. 5. 5. 6. 7. 8f 5. 5. 5. 6, 8. 9. 11. 14. 98 3 5f 6. — Hospital 2 — — — 1 Bookbinder 70 1 — — — 12 Brushmakers 64 12 4f bf bf bf 4. 3. 4. 4. 4. 6. 20 Farm-labourers 64 1 — — — ¦ 67 19 4f 4. 7f 5. 5. 5. 4 Gardeners 67 4 4+ — 11. 3 Domestic Servants 48 2 — — — 67 1 15. - - 6 Glove-makers 56 2 — — — 70 2 6. . — 4. 99 2 5f 6. — — 7 Cooks 48 7 6f — 3. 10. 1 Basket-maker 48 1 — — 5. 2 Hospital Attendants Hospital 2 — — — 3 Lithographers 48 3 — — . — 4 Cleaners 97 1 — — — 98 3 — — 1 Barber 70 l 5-j- _ _ 1 Cooper 64 1 — _ g. 20 Locksmiths 64 20 30/11. 3f 4f 5. 5. 4. 9. 20/11. 7. 8. 63 Tailors 32 3 — _ 5 8 39 30 2f 4f 7. 4. 11. 4. 4. ft. 5. 5. 5. 6. 7. 8. 41 20 3. 4. 5. 6 + 4. 7. 7. 4. 4. 5. 6. 9. 64 2 — 7. 16. 67 1 4f — - 70 2 7. _ 83 1 5f _ _ 97 2 — _ 5. 98 1 _ _ 99 1 2 Writers 48 2 _ _ _ 21 Joiners 70 19 If 3f 4f 4f 4f 4f 5f — 30/11. 1. 5. 5f 5f Hospital 2 if 2f — — 42 Shoemakers 80 20 2 .3f 6f 6f 6f 9 2 3. 5. 9. 13. 82 9 6. 7f 8 . 30/11.4.5.5.5. 83 11 4. 5f 5. 1. 4. 4. 5. 6. 7. 10. 10. Hospital 2 If _ _ 22 Rope-makers 97 1 _ 98 21 4f 5. 7. 6. 7. 8f 8. 8. 16. 4. 4. 5. 5. 8. 10. 34 (cont.) CHRONOLOGICAL DISTRIBUTION OF THE ATTACKS. a) in relation to occupation. CHOLERAIC OCCUPATION N °- ° f CHOLE RA ' D I AR R II CEA Dormitory Occupants DlAKrlxiUliA E Knitters 32 2 3f 4. 56 1 — 99 3 3f — 23 / u - 4 4-88 Straw-workers 32 46 4f 4f 5f 5f 5. 5. 6. 6. 6. 4. 4. 5.5. 10. 12f 30/11. 4. 8. 8. 9. 11. 70 24 4f 5. 6f 5. 8. 1. 5. 6. 9. 10. 11. 97 8 2f 4f 5. 6. — 4. 4. 10. 26 Washers 56 16 4f 6f 6f 6. 9. 11. 29/11. 97 10 7f — 4. 8. 8. 8. 10. 14. 3C Weavers and Winders 56 1 — — 5. 67 2 7. 10. 82 2 — 6. 91 1 — — — 97 10 5f of 5f 5f 6f 6f 1. - 98 7 5. 6. 6. 12. — 99 11 29/11. 4f 7. 7. — 5. 5. 6. Hospital 2 If — — CHRONOLOGICAL DISTRIBUTION OF THE ATTACKS. b) toith reference to dormitories. Dormitory CHOLERAIC OCCUPANTS CHOLERA DIARRH(EA No. DIARRHCEA 32 !> Tailors — - 5. 8. j 2 Spinners 3+ (formerly in room 90) — 4. 46 Straw-workers 4f 4f 5f 5f 5. 5. 6. 6. 6. 7. 4. 4. 5. 5. 10. 12f 30/11. 4. 8. 8. 9. 11. 39 30 Tailors 2f 4f 7. 4. 11. 4. 4. 5. 5. 5. 5. 6. 7. 8. 41 20 Tailors 6f 4. 5. 3. 4. 7. 7. 4. 4. 5. 6. 9. 48 4 Bakers 5f — 20. 2 Domestic Servants — — 7 Cooks 6f — 3. 10. 1 Basket-maker — — 5. 3 Lithographers — — — 2 Writers — — 7 Straw-workers 30/1 If 4. Gf - 9. 21. 35 TIME OF ATTACKS IN RELATION TO DORMITORIES. (cent) CHRONOLOGICAL DISTRIBUTION OF THE ATTACKS b) loith reference to dormitories. Dormitory CHOLERAIC OCCUPANTS CHOLERA DIARRHCEA no. DIARRH(EA 56 2 Glove-makers — — — 1 Spinner — — — 16 Washers 4f 6f 6f 6. 9. 11. 29/11. 1 Weaver — — 5. • 20 94 12 Brushmakers 4f fif &t 5 t 4 - 3. 4. 4. 4. 6. 1 Farm-labourer — — — 1 Cooper - _ 8 . 1 Spinner — — 10. 20 Locksmiths 30/11. 3f 4f 5. 5. 4. 9. 20/11. 7. 8. 67 19 Farm-labourers 4f 4. 7f 5. 5. 5. 1 Domestic Servant 15. — — 2 Glove-makers 6. — 4. 19 Joiners If 3f 4f 4f 4f 4f 5f 5f 5f — 30/11. 1. 5. 3 Spinners 4f 5f — — 24 Straw-workers 4f 5. 6f 5. 8. 1. 5. 6. 9. 10. 11. 52 80 2 Spectacle-makers — — 10. 10. 20 Shoemakers 2. 3f 6f Gf 6f 9. 2. 3. 5. 9. 13. 1 Spinner — — 23 82 9 Shoemakers 6. 7f 8. 30/11. 4. 5. 5. 5. 2 Weavers — — 6. 11 83 1 Tailor 5f _ _ 11 Shoemakers 4. 5f 5. i. 4. 4. 5. 6. 7, 10. 10. 12 01 32 Spectacle-makers 4f 4. 55. 8. 5. 7. 8. 8. 9. 10. 1. 3. 4. 5. b. 5. 5. 5. 11. 11. 1 Weaver — — 33 94 56 Spectacle-makers 3f 4f 4f 4. 4. 5f 5f 5f 5. 5. 6. 9. 21/11. 27/11. 1. 3. 3. 4. 5. 5. 5. 5-»6. 7. 8f 5. 5. 6. 8. 9. 11. 14. 97 1 Cleaner — — _ 8 Straw=workerB 2f 4f 5. 6. — 4. 4. 10. 10 Washers 7f _ 4. 8. 8. 8. 10. 14. 36 TIME OF ATTACKS IN RELATION TO DORMITORIES. (cant.) CHRONOLOGICAL DISTRIBUTION OF THE ATTACKS b) toith reference to dormitories. Dormitory CHOLERAIC OCCUPANTS CHOLERA DIARRHCEA No- DIARRHCEA 98 3 Spectacle-makers 5f 6. 3 Cleaners — — 1 Tailor — — __ 21 Ropemakers 4f 5. 7. 6. 7. 8f 8. 8. 16. 4. 4. 5. 5. 8. 10. 9 Spinners 4f 6f — 10. 7_Weavers 5f 6. 6. 12. — 44 99 2 Glovers 5f 6. — _ 1 Tailor — — _ 3 Spinners 8+ — 23/11. 4. _ll_Weavers 29/11. 4f 7. 7. — 5. 5. 0. 17 Hospital 2 Attendants — — — 1 Varicose Ulcer — — — 2 Spectacle-makers (Glossit&Absc.man.) — ; — — 2 Joiners (Erysip. of face) If — — (carbuncle of back) 2f — 2 Shoemakers (Gastric disorder) If . — — (Oligoemia) — — — 3 Straw-workers (Pulm. Emphys.) 4f — — (Marasmus) — 5. — (Blepharitis) — — — 2 "Weavers (Bright's Disease, If — — Tonsillitis) — — — 14 Lock-up 1 Weaver 1. — — Lastly I considered it also useful to make an alphabetical list of all persons attacked, in order to facilitate finding any individual case in the tables, which have been arranged according to occupation, dormitory, stage of disease, and the latter always in the alphabetical order of the names, and are kept by me in this state. It seems to me not improbable, that this great epidemic and its course in so isolated a group of persons may give rise at some later period to still farther researches and considerations than I have hitherto instituted,, and am about to discuss in the next few pages. If similar investigations should be hereafter carried out by others, it will be a boon to have some older lucidly arranged material to compare notes with. I have not added the Christian name to the surname, as is usual, but the prisoner's number in t register, because the same Christian names are not unfrequently met with in company with the same ames, aud the identity of individual cases might thus be rendered doubtful, which is impossible when the number in the register is employed. I do not consider it necessary to publish this comprehensive table, but it is deposited with the documents and papers which I keep for future requirements. 37 COMPARISON BETWEEN DIFFERENT DEPARTMENTS OF WORK AND DIFFERENT LOCALITIES. I will now compare first of all the different departments of work with each other. Departments comprising less than 10 individuals cannot be chosen for purposes of comparison, because all kinds of accidental circumstances might seriously affect the figures or proportions: if however only those are compared which comprise more than 10 individuals, the 12 departments thus obtained give the following result*. —-¦- j — . • Choleraic _. OCCUPATION Cholera , Diarrhoea Deaths Diarrhoea 95 Spectacle-makers ....... 20 9 27 9 12 Brushmakers 4 1 5 4 20 Farm-labourers 3 1 2 2 20 Blacksmiths and Locksmiths 5 2 3 2 63 Tailors. . 10 6 18 5 21 Joiners 11 — 3 11 42 Shoemakers 10 3 18 7 22 Rope-makers 3 6 6 , 2 36 Spinners and Knitters .... '9 1 6 9 88 Straw- workers 24 9 17 13 26 Washers 5 2 7 4 36 Weavers and Winders .... 15 3 6 8 481 Prisoners 119 43 118 76 24.7 o/° 8.9 °/o 24.5% 15.8 0/ 0 i I The mean number of attacks among these 481 prisoners is not essentially different from that found above at page 18 to obtain among all the inmates of the prison, but important differences are observed among the individual numerically equal divisions. The 20 farm -labourers, the 20 blacksmiths and locksmiths, the 21 joiners, 22 rope-makers and 26 washers were very unequally attacked by the disease. The joiners came off the worst, 11 out of 21 being infected and all 11 dying of cholera, they were therefore more than 5 times decimated. The farm-labourers were least visited, then the rope-makers and tailors. As regards the two former, probably most observers will consider the immunity as the result of their daily prolonged sojourn in the open air, i. c. the prolonged absence from infected spots, and I also agree with this view in the case before us, with this proviso however, that the sojourn in the open air very frequently but not always and of necessity implies a sojourn in a non-infected or non-infecting place. There cannot be two occupations more different than husbandry and rope-making and yet as regards acute attacks, a similarly favourable condition prevailed among farm-labourers and ropemakers. The farm-labourers were principally occupied in October with cleaning and ploughing up the soil, throughout November with road-making, cleaning^ the roads and carting sand and gravel. The greater number of cases of choleraic and simple diarrhoea, which prevailed among the rope-makers, might be very well explained by the circumstance, that the rope-makers were obliged to remain within the prison walls, whilst the farm-labourers could remove to a distance from them, and further that the ropa-makers worked in the hospital store-house in bad weather, the ground-floor of which was certainly a centre of infection. Besides which the rope-makers slept almost exclusively in No 98, that part of the building, in which the epidemic began aud was in general more violent 38 INFLUENCE OF OCCUPATION AND LOCALITY. In like manner nothing can be conceived more different than the trade of the smiths and locksmiths and that of the brushmakers. But both suffered above the average from cholera, and the brushmakers still more than the smiths and locksmiths. The two divisions slept together on the 2nd floor in room No. 64, and their workshops were directly adjacent to each other in the eastern part of the establishment on the ground-floor in Nos. 11 and 12. The smiths 1 workshop was of course somewhat more and better ventilated, than the workshop of the brushmakers, and it may very well be supposed, that on this very account the locksmiths suffered somewhat less than the brushmakers. I At the time of an epidemic of cholera, and especially at the time of such an immense outbreak, that in Laufen, the greatest fear would be entertained for the department of washers according to the ws commonly received. When we consider, in what a high degree the joiners suffered, who had nothing do with those attacked, at most made coffins for the dead, it must appear remarkable, how comparatively tie the washers suffered, in spite of their having to wash all the linen of those affected. The 26 linenshers did not suffer proportionally so much, as the 20 rusty smiths and locksmiths. Whether the infection of the patients' linen, which was only put in force after the actual outbreak of the epidemic, l explain this, I must leave undecided. The different degrees of immunity which were observed in the department of the spinners and knitters and that of the weavers and winders, each comprising 36 prisoners is remarkable. The weavers had 6 more cases of cholera and 2 more of choleraic diarrhoea than the spinners, but the same number of cases of diarrhoea and 1 death less than the latter. There is consequently a difference, whether we examine the number of attacks, or the number of deaths from cholera. — A satisfactory reason for this difference cannot be deduced either from the nature of the occupation, or from the individual circumstances of the individual prisoners There were even somewhat younger persons on an average among the weavers, than among the spinners, the mean age of the 36 weavers being 33, that of the 36 spinners above 34. tey had this one feature in common, viz, that their workrooms, were in the western part of the house, tiough their dormitories were mostly in the opposite eastern part. The workroom of the spinners is indeed very favourably situated. The steward's rooms and thje guard-room of the soldiers are on the ground-floor in this part of the house, above them on the first floor the offices of the officials, then on the second floor the spinning-room, and above this on the third floor the dormitories of the shoemakers, which stand empty and are ventilated the whole day. This part of the house lias also no cess-pool, which influence I shall discuss fnrther on in a special section. But even these circumstances are inadeqnate to explain the peculiar fact of the case, the real cause seems to lie in quite a different direction, as a glance at the above table illustrating the chronological distribution of the attacks with reference to occupation and dormitory clearly shows. If we compare there I groups of spinners and weavers, who both occupied adjacent dormitories in the western part of the c, which apart from the above-mentioned advantage of the spinning-room over the weaving-room — could be favourable to both, we find that they had another circumstance in common with each other, viz, they slept in many different dormitories; the 36 spinners occupied 9, the 36 weavers 7 different rooms, rooms 56, 67, 97, 98 and 99 were tenanted by spinners as well as weavers. The epidemic ran a ;y uniform course amoug these departments as it did in the whole establishment, although the spinners i altogether about a day in advance of the weavers. The greatest difference however was remarked strange to say in that vety section of the spinners and weavers, which was quartered in one and the same dormitory No. 97. Thirteen spinners slept in this room, which was situated over the highly infected room No. 70, among whom there occurred only 1 case of choleraic diarrhoea and 1 of simple diarrhoea, and no case of cholera, and at the same time 10 weavers, among whom there occurred 6 cases of cholera all with fatal result and 1 of choleraic diarrhoea. The remainder of the spinners (23) dispersed throughout the other dormitories presented 9 cases 39 INFLUENCE OF OCCUPATION AND LOCALITY. of cholera all terminating fatally, and 5 of diarrhoea, and the remainder of the weavers in the other dormitories, amounting to 26 in number, presented only 8 cases of cholera with 1 fatal result, 2 of choleraic diarrhoea, and sof simple diarrhoea. Setting aside therefore the spinners and weavers in dormitory No. 97, the weavers came off decidedly better than the spinners, the exact reverse of what obtained in dormitory No. 97. The temptation now was great to look for an explanation of these differences in room 97. I have not succeeded in finding out anything. I have compared the two groups as regards age, state of health, previous illnesses, duration of imprisonment, in short from every point of view contained in the tables, but without any positive result. As it would be however of such great importance and of such incalculable advantage, to get leading points of view for such occurrences, commonly called enigmas, but which may be only the expression of regular influences not yet discovered, I communicate in full the numerical tables relative to the 13 spinners and the 10 weavers in dormitory No. 97 (see pages 41. 42.) Perhaps another may be more fortunate than I, or may have his attention directed to things, which are wanting in the tables, and must in future, be drawn into the sphere of examination. Can there perhaps be islands of immunity even in infected dormitories, as there are in infected places? Have the spinners in No. 97 accidentally had something in their beds, a different straw, or were they stuffed at another time? Or what else has protected them from cholera? — I regret, that this remarkable circumstance in room No. 97 did not present itself to my notice, whilst I was in Laufen, and that I neglected to examine the bedsteads of the individual pi'isoners. I know now only, that in future we must go still further into particulars than hitherto, if we would arrive at more certain conclusions by a process of exclusion. But this very case in a prison shows, how easy it must be, to prevent cholera, if we only knew the reason why 10 weavers and 13 spinners could lie together in the same room, and the weavers almost all died of cholera, whilst the spinners had not a single case. I think, what protected the spinners, must be so cheap and easily procured, that every body could be supplied with it at the time of cholera. We shall next compare together two of the larger divisions, the 42 shoemakers and the 88 strawworkers, which are similar in so far, that the shoemakers worked exclusively in the eastern part of the establishment in Nos. 45 and 46 just under the joiners' dormitory No. 70, and slept exclusively in the western part in Nos 80, 82 and 83, whilst the straw-workers likewise worked in the eastern part of the building (southern half) in room No. 47 on the first and No. 72 on the second floor, and the greater part of them (45) slept also in No. 32 on the first floor in the western part; only 24 being lodged in dormitory No. 70, in. which the joiners also slept. It might be expected therefore, that the straw-workers would have suffered more than the shoemakers. Taking the total number of cases of cholera, choleraic diarrhoea and simple diarrhoea into consideration, the shoemakers have suffered more (73 per cent) than the straw-workers (59 per cent). . Taking only the cases of cholera and choleraic diarrhoea into consideration, the shoemakers have had fewer cabes (30 per cent), the straw-workers more (37 per cent), but taking the deaths from cholera into consideration, both divisions have had the same (16 per cent). It cannot therefore at all events be said, that the straw- workers, a part of whom slept in 70, suffered more than the shoemakers. It is to be remarked further, that among the 24 straw- workers, who were assigned to room No. 70 , there were 5, who were not removed there from solitary confinement until December 4th, and 3 who did not come to the establishment until 1 after December Ist, so that in reality only 16 can be reckoned. Lastly there were 2 other divisions, 95 spectacle-makers and 63 tailors, who had this circumstance in common, that their workrooms were in the western half of the building, as also the greater part of their dormitories, which latter were only partially in the eastern half. The tailors' shop is No. 38 on the first floor, that of the spectacle-makers No. 84 on the third floor, the tailors' dormitories No.'s 39 and 41 on the first floor, the spectacle -makers occupying the corresponding rooms above these on the third floor. The locksmiths and brushmakers slept between these in No. 64 on the second floor, and the farm-labourers (continned, p. 43) 40 INFLUENCE OF OCCUPATION AND LOCALITY. SPINNERS AND KNITTERS IN DORMITORY No. 97. ©•§ TRADE g x Duration State of Attack in -vrArpTruT? fa .2 O w the JNAIUxtJc/ |« NAME r~T~" §g. ° f health eBtablish - op REMARK S fl , All AUK 1 a i p M ° nth l 12378Duschl, Joh., 33 Man-servant Spinner 5797 3 mos I Fair 5 Dec. Choi. Diarrhoea Discharged cured Dec. single (chron. 14th bronch. catarrh ) 22581 Holzmiiller, Seb., 34 Man-servant ! Spinner 57 97 since Fair 24 Nov. Diarrhoea, j Came from the goal at single Nov. 15 treated out of i Munich (Anger No. 1) 1873 hospital where he had been Bmos r in prison and fell ill before his removal here 32373 Blau, Carl, single 42 Labourer Spinner 57 97 3 mos Fair Sept. Scurvy Oct. Gastric disorder j ( | ! 42347 Brumbauer,Lor., 31 Butcher I Spinner 5797 3% mos j Robust Discharged free from single the establishment Dec. 10th 5 2461 Fischer, Mich., 40 Cottager Spinner 57 97 2 mos Robust 1 Dec. Bronch. Catarrh, married 14 „ do. ! ! 62383 Freidl, Josef, 28 Fisherman Spinner 57 97 3 mos Robust Discharged Dec. 27th single 1873 [ 7 2350 Hoff, Johann, 25 Labourer ! Spinner ,57 97 3% mos Robust Sept Scurvy Treated as out patient married „ Angina tons. do. Oct. Ecthyma dors. do. Discharged Dec. 11th 82556 Mader, Josef, 30 Man-servant Spinner 57 97 3 weeks Robust single ! | 9243l|Muller, Lorenz, 31 Shepherd Spinner Js7 97 2% mos Robust married 102411 Pellkofer, Josef, 58 Peasant Spinner 57 97 3 mos Robust Was employed in potatomarried peeling with 11 other prisoners 112376 Rath, Georg, 21 Bricklayer Spinner 57 97 3 mos Robust J Entered hospital as Bjngle8 j n gl e attendant on Dec. 15th 122360 Resch, Josef, 39 Bricklayer Spinner 57 97 3'/, mos Fair Discharged Dec. 14 married I 41 INFLUENCE OF OCCUPATION AND LOCALITY. SPINNERS AND KNITTERS IN DORMITORY No. 97. I* • 6 ¦§ TRADE as- Duration State of Attack in vtatttri? Jz; "Sb O g the XNAIUHH 1(3 NAME 5 ~T~§3 establiBh - op REMARK £ a ¦< outside the ln OS g imprison- on ment a "* establish- P O . ATT A PIT O o establishment ment ? o ment admission c aiia^iv J25 /? Montli 12 2371 Straubinger, Jos., 32 Dealer in Spinner 57 97 3% mos Robust Aug. Prim. Syphilis Discharged from the single wood establishment Dec. 19th WEAVERS AND WINDERS IN DORMITORY No. 97. 1 2441 Eckl, Mathias, 41 Labourer Winder 58 97 2 mos Robust Oct. Scurvy Treated as out-patient married 5 Dec. Asiatic Cholera Died in typhoid stage Dec. 9th 2 1517 Hotschl, Martin, 33 Man-servant Weaver 58 97 1% years Fair June Diarrhoea and single (Dyspepsia) Gastric disorder Treated in hospital 5 JF c Sept. Scurvy and Oligoemia Treated as out-patient 5 Dec. Asiat. Cholera Died of cholera Dec. 6th 3 2138 Hofdeck, Alexis, 29 Weaver Weaver 58 97 6% mos Robust Sept. Scurvy Treated as out-patient single 5 Dec. Asiat. Cholera Died in typhoid stage Dec. Bth 4 2092 Hofmarksrichter, 26 Servant Weaver 58 97 5 mos Robust Oct. Erysipel. of face Josef, single 5 Dec. Diarrhoea Did not consult doctor 6 „ Asiat. Cholera Died suddenly of cholera Dec. 6th 5 2517 Pfefferl, Georg, 54 Labourer Weaver 58 97 5 weeks Fair 5 Dec. Asiat. Cholera Died after 10 hours' single (Paresis illness cruris) 6 2262 Waldinger, Mich., 24 Bricklayer Weaver 58 97 4% mos Robust 6 Dec. Asiat. Cholera Died of cholera on Dec. single 10th 7 2269 Reischl, Josef, 25 Weaver Weaver 58 97 4% mos Fair Nov. Gastricism. Treated in hospital single (Pulmonary 1 Dec. Diarrhoea Cured on Dec. 4th tubercle) 5 „ Choi. Diarrhoea (relapse) 8 2231 Binder, Joh., 45 Bricklayer Weaver 58 97 5% mos Fair Oct. Scurvy Treated as out-patient widower 9 2476 Hartmann, Josef, 35 Weaver Weaver 58 97 2 mos Robust Was formerly treated married as out-patient for irrelevant symptoms appointed hospital attendant Dec. 4th 10 2226 Huber, Ignatz, 22 Servant Weaver 58 97 5 % mos Fair Sept. Scurvy Treated as out-patient sm S le (Pulmonary tubercle) 42 INFLUENCE OF OCCUPATION AND LOCALITY. n an adjoining room No. 67, only separated by an overseer's room. Next to the ' farm-labourers and rope-makers the spectacle-makers and tailors undoubtedly came off the best. If we take all three forms of disease together, the spectacle-makers showed 58, the tailors 54 per cent, which was not below the mean of the whole establishment, but looking only at the acute forms of disease, and especially at the deaths, there- is an evident balance in favour of the two divisions, as the following comparision clearly shows: Spectacle- Tailors All prisoners makers Cholera 21.0 15.9 24.5 Choleraic Diarrhoea . . 8.4 9."> 8.2 Diarrhoea 28.4 28.9 23.9 Deaths from Cholera . 9.4 7.9 15.9 The attacks which befell those spectacle-makers and tailors, who were quartered here and there in other dormitories than those assigned to the majority, have not been deducted here. Among the 5 spectacle-makers in dormitories Nos 80 and 98 there occurred 1 case of cholera, 1 of choleraic and 2 of simple diarrhoea, and 1 death, and among the 13 tailors dispersed about in other dormitories 3 cases of cholera, 1 of choleraic diarrhoea, 4 of diarrhoea and 2 deaths. It appears very evident from the number of dases of cholera aud choleraic diarrhoea and deaths which occurred in the dormitories Nos 39 and 41 ou the first, aud in those of the spectacle-makers Nos 91 and 94 on the third floor, that the intensity of the disease increased as we approached the east front of the building. The rooms 41 and 94 belonging to the northern wing of the building, have each one window opening to the east. Room 41 on the first floor has indeed only this oue window, whilst the corresponding rooms 67 and 91 above it have each besides v this window to the east two other windows to the north which are wanting in room No. 41, the cell-prison being built up against the northern wall of the room on this side. Room 41 is therefore considered close, and not so well ventilated as those situated above it, is on this account also never occupied by so many prisoners as the smaller room No. 39, which has two windows to the north. The second floor of the main building looks directly over the roof of the adjacent cell-prison and has therefore retained the two windows to the north. Thirty tailors now slept in room 39, of whom only 3 were attacked with cholera, 2 with choleraic and 9 with simple diarrhoea, and 2 died. Twenty tailors slept in room 41, 4 of whom were attacked with cholera, 3 with choleraic and 5 with simple diarrhoea, whilst 1 died. Room 41 therefore presented 20 per cent of acute attacks (cholera), room 39 only 10 per cent. The same thing was observed on the third floor in the dormitories of the spectacle-makers. Thirty two spectacle-makers slept in No. 91, and they presented 5 cases of cholera = 16 per cent, 56 slept in the room No. 94 lying to the east, and had 14 cases of cholera = 25 per cent. The cases of cholera began on December 3rd in room 94, on the 4th in 91. The division of the joiners was the only one that remained day and night without interruption in the eastern wing, they alone were constantly in the centre of the eastern wing, and never left it. They worked in No. 71 and partly also in an adjoining room No. 72 opening into the passage, and slept close by in No. 70. Only 19 of the 21 joiners slept at the time in No. 70, 2 of them being in the hospital when the cholera broke out, the one with erysipelas of the face, the other with a carbuncle, both of them also took the cholera and died, but their infection must be placed to the account of the hospital. Among the 19 joiners in dormitory No. 70 there were 9 cases of cholera (47 per cent), which all terminated fatally, and only 3 of diarrhoea. No other department suffered so enormously. 43 The room 70 proved also injurious to its other occupants, who spent the day at a greater distance from it than the joiners. The number of its inmates rose gradually during the course of the epidemic to 52 persons. Deducting the 19 joiners from these, there still remain 33 persons, who were exposed to its nocturnal influence. From these 8 prisoners (straw-workers) are to be deducted, who were not transferred to it from solitary confinement until December 4th (see table at page 23), likewise one who arrived on Dec. 3rd. After deducting these there were besides the joiners: 1 Bookbinder, 2 Glove-makers, 1 Barber, 2 Tailors, 3 Spinners and 16 Straw-workers. Total 25 -prisoners. These furnished 7 cases of cholera . . . . . . . =28 per cent, 2 cases of choleraic diarrhoea . . = 8 „ 1 case of diarrhoea = 4 „ 5 cases of death =20 „ One of the glove-makers took the cholera and died. The barber took the cholera and died. One tailor took the cholera. Two of the 3 spinners took the cholera and both died. It is evident that slight cases did not occur at all in this dormitory properly speaking. The cases of diarrhoea prevailed for the most part only as sequelae among those, who were transferred to this dormitory from solitary confinement on December 4th. Of these 8 prisoners who came from the cell-prison, 4 had diarrhoea and 1 even cholera, the only case which ended fatally among those removed from the cell-prison to the common prison. The number of these prisoners removed from solitary confinement to the common prison amounted to 34. They had afterwards altogether 11 more cases of diarrhoea, 1 of choleraic diarrhoea, 2 of cholera and 1 case of death. Eight were quartered in No. 70. All the cases of death and 4 cases of diarrhoea (36 per cent of all cases of diarrhoea) affected these 8 individuals (23 per cent of 34). Whilst I was in Laufen, my attention was drawn to the fact that another section of prisoners consisting for the most part of straw- workers had suffered very much, indeed most after the joiners, namely those, who were employed in peeling potatoes for the kitchen in November and even later. This work was performed in workroom No. 47, and 12 mostly elderly and decrepid individuals were selected for it. FORMER Dormitory ATTACK NAME AGE REMARKS OCCUPATION No. Day Nature Sagerer 68 Straw-workers 97 Dec. 2 Cholera Died Ettl 31 „ 48 Nov. 30 Cholera Died Strassburger 45 „ 48 — — Sehnitzer 59 ' „ 32 — — Huber . 45 „ 32 Dec. 8 Choi. Diarrhoea Maier 66 „ 32 Dec. 7 Cholera Hofstetter 49 „ 32 — — Retzer 62 „ 32 Dec. 5 Cholera Died Mosch 67 „ 32 Dec. 12 Choi. Diarrhoea Died (Marasmus) Knopfle 55 „ 32 Dec. 5 Cholera Died Pellkofer 58 Spinner 97 — — Sporrer 53 Knitter 97 Dec. 3 Cholera Died 44 INFLUENCE OF OCCUPATION AND LOCALITY. Only 4 among these 12 persons were a little under, the remaining 8 all above 50 years old, and this might lead us to suppose that the high degree of disease and mortality proceeded from age. I thought however that I ought to prosecute my researches still further, as just as high a rate of disease and mortality had appeared in other departments of labour consisting mainly of young robust individuals, whose mean age did not exceed 25, as among these old deerepid potato-peelers. It seemed to me all the more necessary, to scrutinize the potato-peelers somewhat more closely, when I discovered in my inspection of the establishment from top to bottom, that liquid matters from the cess-pool, which is situated in the hospital yard to the north of the main building penetrated in no inconsiderable quantity into that part of the cellar, in which the potatoes were stored. — The potatoes were it is true carefully kept clear of that spot, and tubs were placed under for the reception of the liquids which dropped through, — but it was always possible, that some of the infecting matter generally supposed to exist in excrements, might have reached the potatoes, and that the potato-peelers, who first came in contact with it, received proportionally more of it than the others. — But the investigation has proved most positively, that no infecting matter can be assnmed to have adhered to the potatoes. I first compared the rate of disease and of mortality among the potato-peelers with that among the other inmates of the prison who were above 50. There were 41 prisoners 50 years old and upwards. Among these occurred: 19 cases of cholera =46 per cent. 4 „ „ choleraic diarrhoea . . . =10 „ 20 deaths =48 „ Among the 12 potato-peelers occurred: ¦ 6 cases of cholera =50 per cent. 2 „ „ choleraic diarrhoea . . . =15 „ These differences are so slight that taking into consideration the smallness of the number of potato-peelers no positive conclusion can he drawn from them. Nor does it make any difference, if we exclude the 8 potato-peelers above 50 years old from the 41 older prisoners. — There appear then among 33 of the oldest prisoners: 14 cases of cholera = 42 per cent. 3 „ „ choleraic diarrhoea . = 9 „ 6 „ „ diarrhoea =18 „ 14 deaths =42 „ What however most militates against the view of the infection arising from the common work of potato-peeling, is the chronological distribution of the attacks in this group. One occurred as early as November 30th, one on the 2nd, one on the 3rd, two on the sth, one on the 7th, one on the Bth, and one on the 12th of December, consequently more scattered in point of time than was the case with any other division of labour. (Compare tbe two tables on the chronological distribution of attacks in relation to occupation and dormitories.) The attacks were more crowded in point of time everywhere else. Among the joiners, c. g. in dormitory 70 one took the cholera on December Ist, one on the 3rd, four on the 4th and fhree on the sth, and this was the last of them. Considering the high individual predisposition which must be assumed to have been present among the potato-peelers in virtue of their age, the attacks should have occurred very simultaneously, if a common and simultaneous infection had taken place. 45 INFLUENCE OF AGE. INFLUENCE OF AGE. Prisoners from 16 to 73 years old were in the establishment. The influence of age on the frequency of cholera in general has been already often investigated, and the investigation has always shown, that the individual tendency to be attacked by genuine cholera is very different at different ages, that as a rule the age of childhood from about the Bth year and the period of youth up to about the 22nd year is least attacked, that then the tendency increases somewhat until 40, that it however rapidly increases from this time , which likewise holds good as regards the mortality, only in a still higher degree. It would have been superfluous therefore to repeat this investigation in the prison at Laufen. But other circumstances rendered it expedient to do so: first not only were the cases of cholera and deaths from cholera exactly known in this case, but also the number of cases of choleraic and simple diarrhoea, which we are justified in regarding as induced by the same specific cause, but which can seldom be studied with such exactness as in the case before us, and then it was a point of great interest to consider and compare the already well-known influence of age with other influences arising from occupation and locality. The table at page 47 gives the age in the first column, in the second the number of prisoners of this age, and the remaining columns give the numbers of those attacked with cholera and choleroid diseases in their several forms, and how many remained entirely free from disease. Among those aged 18 some are also included, who had not yet quite reached this age. This table shows a slight difference to the former ones, it mentions 129 cases of cholera and 42 of choleraic diarrhoea, whilst 128 cases of cholera and 43 of choleraic diarrhoea are enumerated elsewhere. I have probably inscribed a case of choleraic diarrhoea among those of cholera in copying from the individual tables, but it did not seem to me worth while going any further into this mistake, as it cannot exercise any material influence upon the result. (See table at page 47). I have first of all divided the 522 prisoners into 4 groups, from 16 to 22, from 23 to 29, from 30 to 39 and from 40 upwards. These 4 groups furnish the following numbers: AGE 16 to 22 23 to 29 30 to 39 40 to 73 Number of persona . 113 155 140 114 Cholera 13 34 39 43 Choleraic diarrhoea . 10 12 9 11 Diarrhoea 36 33 34 22 Deaths 6 21 20 36 If we calculate the percentage of attacks and deaths for each group from tl the following result: Cholera 11.5 j 21.8 \ 27.8 j 37.7 | Choleraic diarrhoea. 8.8 U2.1 7.7 Uo.e 6.5 J58.5 9.6 166.61 66.6 Diarrhoea .... ,v, v . 31.8 J 21.i ) 24.2 J 19.3 j Deaths 5.3 13.5 14.2 31.3 from these figures, we have Dr. Berr has ascertained, that the mean age of all the prisoners amounted to 29 years those attacked 32 „ those who died 35 46 INFLUENCE OF AGE. LIST OF THE ATTACKED AND EXEMPT IN RELATION TO AGE. NUMBER OF THOSE IN THE NUMBER OF THOSE IN THE ESTABLISHMENT . ESTABLISHMENT ATTACKED WITH ATTACKED WITH __ TOTAL . I EXEMPT TOTAL I _ EXEMPT Cholera .™ Diarrho,. Cholera ° h ° le ™ C Diarrhea Diarrhoea Diarrhoea 18 15 1 fl 1 5 8 43 5 2 f2 1 - 2 19 22 1 fl 2 8 11 44 5 2 fl — 2 1 20 25 3 2 8 12 45 9 2 fl -' 3 4 21 24 5 f3 2 8 9 46 3 1 fl — — 2 22 27 3 fl 3 7 14 47 5 3 f2 — 1 1 23 19 6 f3 2 2 9 48 3 1 fl 1 1 — 24 24 6 f5 — 7 11 49 7 1 fl 1 3 2 25 25 3 fl 6 3 13 50 4 3 |3 — — 1 26 23 5 |3 2 6 10 51 5 2 t 1 — — 3 27 20 4 |2 2 2 12 52 3 1 f 1 — 1 1 28 26 5 f3 — 7 14 53 7 2 f2 1 2 2 29 19 5 f4 — 6 8 54 3 2 \2 — — 1 30 18 4 f3 3 5 6 55 1 If 1 — - — 31 21 7 f5 1 6 7 .56 3 2 f2 — 1 — 32 10 — — 2 8 58 1 — — — 1 33 12 5 f 2 2 1 4 59 5 2 2f — 1 2 34 18 3 fl 1 7 7 60 - 1 — — 1 — 35 13 3 T l 2 2 6 61 1 1 fl — — — 36 18 9 t* — 2 7 64 11 — — — 37 16 5 |4 - 6 5 65 1 1 If — — — 38 71 — 24 66 21 __i 39 6 2 — 1 3 67 1 — fl 1 — — 40 16 4 |2tl 3 2 7 68 1 1 If — — 41 93f3 1 2 3 73 1— l__ 42 11 4 f3 1 2 4 Total 444 97 f55 fl 36 109 202 78 32 f26 fl 6 16 24 444 97 f55 jl 36 109 202 Total 522 129 fBlj |2 42 I 125 226 In the first place we perceive, that those aged 40 and upwards have suffered most also in the prison at Laufen as everywhere else, both as regards cases of cholera and especially deaths, and the percentage of both is seen to increase from youth to age, although not in exact proportion to the increase of years. The cases of choleraic diarrhaea differ much less comparatively than the cases of cholera, the cases of diarrhoea on the contrary are almost the exact reverse of those of cholera ; they are most frequent in the youngest and most seldom in the oldest group. The first group has been somewhat protected Est severe form of desease not only by its youth but also by another circumstance, viz the greater of the 34 cell-prisoners belonged to them, who were not removed to the common prison till December and consequently were not exposed to the full infecting power of the main building. But even when are excluded, the first group has still the advantage as regards cases of cholera and deaths. Among the prisoners removed from solitary confinement to the common prison there were 27 under 23 years old. They presented 47 INFLUENCE OF AGE. 1 case of cholera, 1 „ „ choleraic diarrhoea, 10 „ „ diarrhoea, 1 death. Three were between 23 and 29. They presented 1 case of cholera. Two were between 30 and 39. They remained exempt. Two were above 40. They presented 1 case of diarrhoea. Deducting these 27 younger cell-prisoners from the remaining 113 prisoners belonging to the same group, there remain 86, who had been always in the common prison. They presented 12 cases of cholera == 13.9 per cent, j 9 „ „ choleraic diarrhoea = 10.4 ? „ / 54.5 per cent. 29 „ „ diarrhoea = 30.2 „ „ I 5 deaths = 5.8 „ „ If we compare the 27 persons who were previously in solitary confinement with the above, we 1 case of cholera = 3.7 per cent, 1 1 „ „ choleraic diarrhoea. == 3.7 „ „ / 44.4 percent. 10 „ „ diarrhoea = 37.0 ? „ J 1 death = 3.7 „ „ The difference therefore between solitary confinement and common imprisonment is not so evident in the general rate of sickness (44.4 and 54.5 per cent) as in the number of acute attacks and deaths which correspond thereto (cholera and choleraic diarrhoea in the one casse being 7.4 per cent, in the other 24.3 per cent). The whole population of the prison it has been shown above at page 1 8 was affected as follows : Total rate of sickness 56.7 per cent, Cholera 24.5 „ „ 1 ) ..... o \ 32.7 per cent. I Ka Choleraic diarrhoea . . 8.2 „ ? | r > 56.6 per cent. Diarrhoea 23.9 „ „ J Deaths 15.9 „ „ We might be tempted to attribute the more favourable condition of the cell-prisoners less to their locality than to a slighter individual predisposition in consequence of more regular circumstances, a larger space etc., the amount of sickness and mortality from all diseases being usually less in cell-prisons than in ordinary prisons. The favourable influence arising from the previous prolonged sojourn in the cellprison may be supposed to have continued even on removal to the common prison. There is not much to object to in such a supposition, there is indeed much probability in it, but on the other hand even making this allowance the influence of the new locality manifested itself very distinctly notwithstanding in the removal of these 27 young people from their cells to the main building. Eight of them were placed for instance in dormitory No. »70, and 8, consequently the same number, in the room No. 94, and it might be supposed, that these 2 groups of 8 each would be equally affected. There is however a great difference. The 8 in room No. 70 had 1 case of cholera, 4 of diarrhoea and 1 death after their entrance, the 8 on the contrary in No. 94 only 1 case of diarrhoea. I shall prove further on, that not even youth found pity in the eyes of the destroyiug angel in room No. 70. It is interesting, to pursue the influence of age still more in detail. It may be considered as proved that the individual groups do not differ from each other in the total number of attacks of 48 INFLUENCE OF AGE cholera, choleraic and simple diarrhoea, but — on an average at least — in the, number of attacks of more acute diseases, of cholera and choleraic diarrhoea, which as well as the deaths increase with age. I have now divided each of the larger departments of labour into 2 halves, a younger and an older, and reckoned the number of cases of cholera, choleraic diarrhoea and deaths affecting them. The department of the straw-workers comprises 88 prisoners, each half 44. The younger half includes people from 17 to 31, and their mean age is 23. The older half includes people from 31 to 73, and their mean age is reckoned at 45 years. A very great difference exists therefore between the two mean ages, proving that many of those in the second half were at an advanced age. The younger half of the straw- workers had 7 cases of cholera ....,....= 15.9 per cent, 5 „ „ choleraic diarrhoea =11.4 „ 3 deaths — 6.8 „ The older half had 18 cases of cholera = 40.9 per cent, 4 „ „ choleraic diarrhoea = 9.0 „ 11 deaths = 25.0 This result therefore harmonizes fully with the general rale. Moreover there is the numerous department of the spectacle-makers 95 in number, 47 belonging to the first division comprising persons from 18 to 27 with a mean age of 22, and 48 to the second half comprising persons from 28 to 59 with a mean age of 37. The mean age of the two halves is therefore not nearly so different as among the straw-workers, and it is consequently to be expected, that the two halves of the spectacle-makers will exhibit a correspondingly smaller difference as regards cases of cholera and deaths. The younger half of the spectacle-makers had 8 cases of cholera = 17.oper cent, 6 „ „ choleraic diarrhoea =12.6 „ 1 death ....... = 2.i „ The older half had 12 cases of cholera = 25.0 per cent, 2 „ „ choleraic diarrhoea = 4.i „ 8 deaths = 16.6 „ We see that the assumption holds good, at least as regards the cases of cholera and deaths. That besides age the locality also exercises a powerful influence upon the more acute forms and deaths, is unmistakably manifest especially in the case of the spectacle-makers. The 95 spectacle-makers all worked, as appears in the table communicated at page 30, in one room (No. 84), and slept principally, with the exception of those dispersed in some other rooms, in the rooms Nos 91 and 94. Thirty-two slept in No. 91, and they presented 5 cases of cholera = 15.6 per cent, 6 „ „ choleraic diarrhoea =18.7 „ 1 death = 3.i „ r Fifty-six slept in room No. 94, and they presented 14 cases of cholera = 25.0 per cent, 2 „ „ choleraic diarrhoea = 2.6 „ 7 deaths = 12.8 „ Bit is evident, that room 94 was much more heavily visited than room No. 91, that the difference cularly in the number of deaths is just as great, as between the younger and older halves of the 7 49 straw-workers, among whom the mean age of the two halves was 23 and 45. The question therefore arises here, whether the difference of age between the spectacle-makers in rooms 91 and 94 was perhap also similar. The investigation shows now that the average difference of age among the prisoners in the two rooms was but insignificant. The mean age of the 32 spectacle-makers in No. 91 was 27, that of the 56 in No. 94 only a little higher, 34. The 14 prisoners who were affected with genuine cholera in room No. 94, were of the age of 23, 24, 25, 27, 28, 29, 31, 33, 36, 37, 42, 56 and 59, and among those who remained free from cholera in No. 91 there were 10 over 30, and one even 53. — Some other causes therefore must have occasioned this great difference. As all the spectacle-makers worked in one and the same room, as they had all exactly the same food etc., and the two parties had only different dormitories, I cannot help attributing some influence here also to the dormitory. Room 91 is a part of the western, room 94 of the eastern portion of the main-building. Great exceptions to the influence of age occur here and there also in the other departments of labour. The 63 tailors c. g. who suffered remarkably little, exhibited in the younger half, comprising people from 16 to 27, a mean age of 23, and in the older, comprising people from 28 to 53 a mean age of 36 are therefore on an average of the same age as the spectacle-makers. The younger half of the tailors had 6 cases of cholera =18.7 per cent, 5 „ „ choleraic diarrhoea =15.6 „ 2 deaths =6.2 „ The older half 4 cases of cholera =12.9 per cent, 1 „ „ choleraic diarrhoea ...... n 3.1 „ 3 deaths =9.7 „ The relation is reversed as regards the tailors, the younger half had materially more cases of cholera and choleraic diarrhoea than the older, only in the deaths does the influence of age re-assert itself although very feebly in favour of the rule. The tailors all worked like the spectacle-makers in one room No. 38, and slept for the most paxt in two rooms, 30 in No. 39 and 20 in No. 41. The remaining 13 were quartered with the prisoners in other dormitories, being occupied with patchwork for the time being. The 56 who slept in the two dormitories appropriated to the tailors, had together (see table of the chronological distribution of attacks in relation to occupation and dormitories at page 34) 7 cases of cholera = 1 2.5 per cent, 3 deaths = 5.3 „ The 13 tailors dispersed among the other prisoners in the other dormitories had 3 cases of cholera = 23.0 per cent, 2 deaths = 15.3 „ The mean of the whole prison population is (see above afc page 18) for cases of cholera 24.5 per cent, ? deaths 15.9 Whilst therefore the tailors in the rooms specially appropriated to them remain far below the mean both as regards cases of cholera and deaths, that section of the tailors which slept dispersed among the whole prison population, presented the very same mean as all the prisoners. In the above comparison between the younger and older halves of the tailors the influence of dormitories has not been considered. If we now eliminate the cases of cholera and deaths, which did not affect the dormitories Nos 39 and 51, we find, 50 1 case in dormitory No. 67 Kafer 2477 | oct. 35, died, 1 „ „ „ „ 70 Bauer 2578 j cet. 20, and 1 „ „ „ „ 83 Brandstetter 2587 | cet. 47, died. bOf these Bauer belonged to the younger half, the two others, Kafer and Brandstetter to the older, uctiug these 13 tailors in the above comparison of the two halves, the younger presents a still more rvourable contrast to the older. This circumstance invites us to further investigation. The first thing which occurs to us is the uestion, whether the younger and the older portion of the tailors were distributed in such a manner in lie two dormitortories Nos 39 and 41, that the younger half occupied the unfavourable locality, the lder the favourable locality in this case. The room 39, which contained 30 inmates during the epidemic, >elongs to the western part of the house, and is immediately adjacent to the tailors' workshop, and the oom 41 with 20 inmates to the eastern part and has, as is evident on the plan, only a single window The 30 tailors in dormitory 39 number together 909 years, have consequently a mean age of 30. and the 20 tailors in dormitory 41 number together 528 years, and have therefore a mean age of 2C> years. t is a fact that the eastern part of the house appeared throughout to be the worst, and it is likewise a fact, ;hat the younger part of the tailors was more numerously represented in the eastern dormitory No. 41, than the older in the western room No. 39, although the latter contained a greater number of inmates in proportion to its size. The facts therefore really coincide in this case with the assumption, that the influence of locality has counterbalanced in some measure the influence of age, nay, that the influence of locality has been more emphatic than the influence of age, that the common rule has been actually reversed by it in this case. Whether now the coincidence of the facts with the assumption is accidental, or the result of a physical connexion, cannot be determined at present, but the case is important enough, to invite the earnest attention of investigators in any cases occurring in the future. The division of the 42 shoemakers likewise resisted the influence of age up to a certain point. The younger half, comprising people from 17 to 30, had a mean age of 25, the older from 32 to 59 a mean of 39. The shoemakers were olde* than the tailors by a few years. The younger half exhibited 5 cases of cholera = 23.8 per cent, 1 „ „ choleraic diarrhoea = 4.8 „ 5 cases of cholera = 23.8 per cent, 2 „ „ choleraic diarrhoea = 9.5 „ 4 deaths = 19.0 „ Here the difference is slight, but is not so antagonistic to the rule as in the case of the tailors, the older half has although not more cases of cholera, at least somewhat more cases of choleraic diarrhoea and deaths than the younger. Both halves were attacked with the more acute diseases in the same ratio as the general body of risoner's. All the shoemakers had the same workroom No. 46 and the small adjacent room No. 45 on le first floor, which is situated exactly under the so heavily visited dormitory of the joiners No. 70 on he second floor in the eastern part of the buildung, and all slept in the western part in the dormitories, os 80, 82 and 83. Two were in the hospital. The number of attacks and deaths was pretty uniform among them in the different dormitories. There was a difference only in the cases of diarrhoea. If the ses of diarrhoea are also included, the shoemakers had altogether an extremely high rate of sickness, those in 51 INFLUENCE OF AGE. dormitory 80 = 55.9 per cent, 82 - 88.2 „ 83 = 100.0 „ altogether 71.4 „ The mean age of the shoemakers distributed in the three dormitories is pretty equal, the 20 in room No. 80 number together 668 years, the 9 in room No. 82: 277, and the 11 in room 83: 363 yeare, corresponding to a mean age of 33, 31 and 33 years. The influence of age between the attacked and non-attacked is very evident in room 80, where the majority were quartered. The 6 attacked with cholera and choleraic diarrhoea had a mean age of 37 years, as well as the 5 attacked with diarrhoea, on the contrary those who remained exempt had a mean of not quite 29 years. Apart from the circumstance, that comparatively more younger people (some were but 17 and 18) were in room No. 80 than in the two other rooms, the comparatively slight number of cases of diarrhoea in contrast to rooms Nos 82 and 83 still remains in reality unexplained, like the remarkable immunity of the 13 spinners in room No. 97. Altogether the influence of age appears very unimportant in the case of the shoemakers, and their rate of sickness is on the whole very high. I am certainly right in attributing this fact to the circumstance, that a common focus of infection in all probability to be sought for in their workroom, exercised a general and intensified influence upon them. Their workshop is situated in the centre of the east part of the main building, and if the shoemakers had slept there also, perhaps they would have fared still worse than the joiners, who remained day and night in this part of the house. Of the joiners in the establishment 10 (from 19 to 25) had a mean age of 22, 11 (from 28 to 65) „ „ „ „ „ 39. The younger half had 5 cases of cholera =50 per cent, — case of choleraic diarrhoea = — ? 5 deaths =50 „ The older half 6 cases of cholera = 54.5 per cent, — case of choleraic diarrhoea = — ? 6 deaths = 54.5 ? Two might be deducted from the older half, who were in the hospital on account of other maladies at the time of the outbreak of cholera, we're attacked there and died of cholera. But the younger half would then present a still more unfavourable contrast, for then only 44.4 per cent of the older half would have been attacked with and died of cholera, whilst 50 per cent of the younger suffered. The difference between old and young, a rather considerable one (22 and 39) is wholly uninfluential in the case of the joiners. There must have been some good reason, why milder forms of disease hardly occurred in this division (the 21 joiners had 11 cases of cholera ending fatally and only 3 of diarrhoea) but only fatal attacks of cholera. Nothing is to be found in the individual circumstances of the joiners calculated to explain even in the remotest degree the unexampled virulence of the disease among them. The joiners in prison are as a rule among the elite of their company. Not ouly a certain skill and ability, but also bodily vigour is requisite, where a prisoner has to be employed in joinery. The younger half of the joiners presents the lowest mean age (22) of all departments of labour in the prison at Laufen. Two of the 11 deaths which occurred among the joiners are, as already mentioned, to be put to the hospital account; they were 52 INFLUENCF OF CONFIMENT. certainly elderly people, one 51, the other 65 years old, but the remaining 9 were mostly robust men and were 19, 21, 21, 23, 24, 31, 37, 48 and 50 years old. Here therefore the common rule does not at all hold good, that age makes a difference. Neither can the cause be sought in the joiner's work, for it has never yet been observed in cholera epidemics either in large cities or in large prisons, that the joiners have had principally to suffer. Nor can the cause exist in the other domestic circumstances of the joiners, for they were exactly the same as among the other prisoners, they had no other food, no other clothes, no other bed etc.. than all the rest. The only thing, that could be mentioned as a difference, was, that the joiners could take a drop of brandy here and there, as they required spirits of wine for polishing purposes. But it is not to be supposed, that it was supplied to them in such quantities at Laufen, that they could all have become dram-drinkers, not even if they had been willing to drink the prepared solution of lac. Only their locality was peculiar to them, and they were distinguished from all the rest in this single fact, viz, that no other division worked and slept so exclusively in the same point of the house, in Nos. 70 and 71, the centre of the eastern part, which was characterised throughout as the most baneful. I will only add further, that the rooms could not be injurious by reason of their arrangements, j>r dimensions. A joiner's workshop naturally required a much larger space than a tailor's workroom or a spinning-room. And the dormitory of the joiners with its 3 windows is indeed one of the finest, largest, and brightest rooms in the whole establishment. There remains therefore but one mode of explanation, to regard a certain situation in the house as the predisposing cause. ¦ INFLUENCE OF IMPRISONMENT ON THE ATTACKS OF CHOLERA. It is a very generally received opinion, that long-continued imprisonment materially predisposes to cholera. The circumstance that the cholera chose Laufen out of all the Bavarian prisons for such an unheard of explosion as had never yet occurred in this land, already militates against this view. The duration of punishment is comparatively short in Laufen. The establishment is no house of correction, but only a prison, and most of those within it, are condemned only to a few months imprisonment. In the house of correction at Au in Munich there were a great number of convicts condemned to 10 and 20 years, Sic even for life, and yet this house of correction remained quite free from cholera on this occasion; r two cases imported from Munich occurred in the house of correction at Lichtenau, where similar ditions prevail, and the house of correction for female convicts at Wasserburg had only very few cases. Although for these general reasons no essential difference dependent on longer or shorter duration of imprisonment was to be expected at Laufen, I yet considered it my duty to employ the opportunity presented to me of minutely investigating this influence. I counted those who had been 2 months and less in confinement. Their number amounted to 163. These 163 had 40 cases of cholera = 24.5 per cent j 13 „ ? choleraic diarrhoea . . = 8.0 „ / 53. s 34 „ „ diai-rhoea = 20.8 „ J 31 deaths . . = 19.0 „ 76 not attacked = 46.6 „ 53 Deducting these 163 prisoners, and the attacks and deaths which occurred among them from the whole prison population of 522, there remain 359 prisoners, who had been longer than 2 months in confinement. These 359 prisoners presented 88 cases of cholera =sb 24.5 per cent j 30 „ „ choleraic diarrhoea . . = 8.3 „ ;58.t 91 „ „ diarrhoea -= 25.3 „ ) 52 deaths = H.s „ 150 not attacked = 41.9 „ It is perfectly evident, that the duration of imprisonment has not exercised the slightest influence. Dr. Berr has come in a somewhat different way to the same result as I have. He divided the prisoners into several groups according to the length of imprisonment, and regarded only the general rate of sickness and deaths. His results are as follows. 1) Less than 6 months in confinement, 350 prisoners. Of these 1 90 =55 per cent were attacked 51 = 15 „ died. 2) From 5 months to 1 year in confinement, 110 prisoners. Of these 65 = 59 per cent were attacked. 18 = 16 „ died. 3) From 1 to 2 years in confinement, 41 prisoners. Of these 25 = 61 per cent were attacked. 11 = 27 „ died. 4) From 2 to 3 years in confinement, 18 prisoners. Of these 14 = 77 per cent were attacked. 3 = 17 „ died. 5) More than 3 years in confinement, 3 prisoners. Of these 2= 66 per cent were attacked. — = - „ died. This comparison would seem to indicate that the duration of imprisonment had after all some influence, when it had lasted more than 1 year, for although it is true the rate of sickness in the 3rd division from 1 to 2 years is not materially higher than that of the two previous groups, yet the mortality is very decidedly so. However this increased mortality may not be solely dependent on the duration of imprisonment, as other circumstances may have also had some influence, which is especially evident when we examine the mean age. If we investigate the age of the 41 prisoners of this third group, it appears that the greater number of them were advanced in years. The mean age of this group amounted to 37 years. There were 14 individuals among them 40 years old and upwards. The mean age of 37 is close upon 40. The comparison above at page 46 on the influence of age shows, that the mortality begins to increase considerably after 40, so that at all events not only the period of confinement, but also the high age has contributed to increase the mortality in this group of 41 prisoners, who had been 1 and 2 years in confinement. The influence of locality on this group must also be taken into account. 54 INELUENCE OF BODILY CONDITION. That the duration of imprisonment cannot per se increase the mortality, is evident from the fact, that the 18 prisoners, who had been even more than a year, who had been 2 and 3 years in confinement, exhibited a mortality of only 17 per cent, which is not materially higher than that among those who had been confined less than 6 months and up to 1 year. INFLUENCE OF BODILY STATE. There is a regulation in the Bavarian prisons, that every new-comer is to be medically examined, and his bodily condition inscribed in one or other of 3 classes, feeble, tolerable and robust. The diagnostic features of these 3 conditions employed by Dr. Berr were as follows: 1) feeble muscular tone, ancemia etc., — feeble. 2) hernias, tumours, tuberculosis or other organic defect, the individuals being in other respects above class I — tolerable. 3) The absence of these signs — robust. Defects in the limbs or organs of sense which occurred in about 20 cases, when the degree of resistance to disease or its course and issue would not seem to be influenced thereby, were not taken into account. Dr. Berr counted among the 522 prisoners placed under his medical care 306 robust = 58.6 per cent, 184 tolerable — 35.2 „ 32 feeble = 6.2 „ Of the robust 171 =56 per cent were attacked. 41 = 13 „ died. Of the tolerable 111 = 60 „ were attacked. Of the feeble 17 = 53 „ were attacked. 7 = 22 „ died. I have pursued these three classes somewhat more in detail in the group of 163 prisoners who had been only 2 months and under in imprisonment. Among these there were 107 robust = 65.8 percent, 48 tolerable = 29.4 „ 8 feeble = 4.8 „ Among the 107 robust were 23 cases of cholera = 21.5 per cent, j 8 „ „ choleraic diarrhoea . . = 7.5 „ , 48.6 21 „ „ diarrhoea = 19.6 „ I 20 deaths = 18.7 „ , 55 not attacked =51.4 , Among the 48 in tolerable health there were 15 cases of cholera = 31.2 per cent, | 5 „ „ choleraic diarrhoea . . = 10.4 „ , 66.6 12 „ „ diarrhoea = 25.0 „ I 16 not attacked — 33.4 „ 55 INFLUENCE OF PREVIOUS DISEASE. Among the feeble there were 2 cases of cholera = 25. 0 per cent, | — „ „ choleraic diarrhoea .. = — ? \ 37.5 1 „ „ diarrhoea .....= 12.5 „ J 5 not attacked == 62.5 „ An essential difference does not therefore exist between these three classes, only the deaths show a preponderance among the feeble, and this result obtains whether we consider all the prisoners together as Dr. Berr does, or only those who had been but 2 months in imprisonment. INFLUENCE OF PREVIOUS DISEASES. It has been already mentioned, that the state of health in the prison could not be called good in the half year preceding the epidemic. At the time of the outbreak of the cholera epidemic 60 other prisoners entered, who had been treated for scurvy partly as in-patients, partly as out-patients in the course of the summer and autumn. These scorbutic patients now exhibited a strikingly higher rate of sickness and mortality compared with the other prisoners, as appears in the two following lists, the one (a) relating to occupation, the other (b) relating to dormitories. Cases of Scurvy treated in and out of Hospital, from May to November 1873, arranged a) according to occupation: 1 under arrest. 1 Baker. 2 Brushmakers. 19 Spectacle-makers. — Farm-labourer. 1 Gardener. 3 Glove-makers. 1 Domestic Servant. 2 Lithographers. 4 Smiths and Locksmiths. 16 Tailors. 2 Rope-makers. 5 Spinners and Knitters. 10 Straw-workers. 1 Washer. 12 Weavers and Winders. 90 56 INFLUENCE OF PREVIOUS DISEASES. b) Relation of cases of scurvy to dormitories. No. of Dormitory THE SCORBUTIC SUBJECTS PRESENTED Cases of Scurvy No. m. i Choleraic -p.. , *H\x. > T . . ¦> i J Cholera _? , Diarrhoea Deaths Not attacked Diarrhoea 7 32 1 1 1 1 4 12 39 1 — 6 1 5 3 41 1 — 1 — 1 5 48 — — 1 — 4 3 56 1 — 1 — 1 6 64 3 1 1 2 1 4 67 3 — 1 2 - 6 70 4 — — 4 2 2' 80 1 — — 1 1 2 82 1 — — 1 1 2 83 1 1 — 1 - 7 91 1 3 - — 3 12 94 4 — 2 — 6 7 97 3 — — 3 4 4 98 2 1 — 1 1 4 99 4 — — 4 — 3 Hospital 2 2 1 1 Arrest — 1 — — — 90 33 8 14 23 35 expressed in percentage | ¦ | 36.6 [' 8.8 | 15.5 | 25.5 | 38.8 Percentage among all prisoners | | 24.5 | 8.2 | 23.9 | 15.9 j 43.3 This table of scorbutic patients leads us to the further enquiry, whether the remarkably severe visitation of certain departments of labour or localities during the course of the epidemic may have been dependent on the fact that the attacked and deceased prisoners in question included a more than average number of such, as had formerly suffered from Scurvy. The investigation however gave a negative result .in every respect. I will notice a few classes for the sake of example. Twelve of the 30 tailors, who slept in dormitory No. 39, formerly had scurvy, and only 1 was attacked with cholera and died, whilst 4 out of 6 scorbutic subjects in room No. 70 were attacked with cholera and all died. It is also interesting, to remark the influence of the epidemic upon the scorbutic subjects among the spectacle-makers in the dormitories Nos 91 and 94. There were 7 scorbutic subjects in the but slightly visited room No. 91, of whom only 1 took the cholera, whilst 4 of the 12 scorbutic spectacle-makers in the more seriously affected room 94 were attacked with cholera. ' Only 3 of the joiners in dormitory No. 70, who came off the worst of any, had previously had scurvy. Two of these were attacked with cholera and died, whilst the remaining 9 deaths among the joiners affected individuals, who had not previously suffered from scurvy. However much previous attacks of scurvy predisposed to Cholera, the influence of locality was still always at work to make the scorbutic more prone to the disease than the non-scorbutic. Had the 12 scorbutic tailors been in dormitory 70 instead of dormitory 39, they would in all probability have presented more than 1 attack and 1 death. 57 INFUENCE OF TREATMENT. With regard to the increased individual tendency to cholera after previous attacks of scurvy oue observation is well worthy of attention, which Dr. Berr makes iv his excellent account of the' local epidemic in this prison presented to the Ministers of Justice and of the Interior. In the year 1854, when the house of correction at Munich was also attacked quite at the conclnsion of the epidemic, 1 52 cases of scurvy had been under treatment during the previous summer, and many of these persons were afterwards affected with and died of cholera. INFLUENCE OF NURSING AND TREATMENT ON CHOLERA PATIENTS. The establishment has one medical officer, Dr. Berr, who has held the appointment for 7 years. One overseer and in addition 2 prisoners are generally employed as attendants on the sick in the hospital. It is self-evident that this staff of attendants proved insufficient, when the epidemic assumed such large dimensions. — Dr. Berr remained day and night at his post, till he broke down under the burden of his work on December Bth. Dr. Klinger, medical referee to the Minister of the Interior, and councillor Pefcersen, prison referee in the ministry of justice, had hastened to the seat of calamity from Munich on December 4th armed with fall power to at once make every possible arrangement to alleviate the distress and calm the prison population. It can be imagined what sensation must have been aroused among the prisoners, when this crowd of severe attacks and rapid deaths suddenly set iv. The majority of the prisoners at Laufen were only condemned to a few months' imprisonment, and they had to forfeit their lives in such numbers. The behaviour of the prisoners might at last be called exemplary, but it was only the consequence of the exemplary conduct of the doctor, director, clergyman, officials and overseers, as well as of the cooperation of the ministerial commissioners. The impossibility of their discharge was made clear to the prisoners, some divisions having thought they were justified in demanding it, all possible assistance and relief were assured them, they were visited and talked with more attentively, and allusion was made to the armed guai'd, who would be summoned only with reluctance to employ violence, but who would finally do their duty without reserve. Aud thus the prisoners remained perfectly quiet, half paralyzed by fear, half yielding to necessity. Only those who had just served their time, could not be detained an hour longer. Dr. Berr received 2 medical students from Munich, Messrs Schinke aud Schiilein, to act as assistants, of whose services he speaks in terms of great commendation. Six trained hospital attendants came from the order of brothers of mercy at Neuburg on the Danube, and 6 overseers and 20 prisoners likewise volunteered their services as nurses. The district surgeon of Laufen, Dr. Loder, took Dr. Berr's work during his week's illness. The persons occupied with the care and treatment of the cholera patients almost all enjoyed immunity. Dr. Berr manifested no symptoms whatever of cholera, but those of cerebral congestion in consequence of over-exertion and night-watching. The two assistants remained well. The clergyman also Herr Seybold and Dr. Loder were not taken ill. The G attendants from the order of brothers of mercy were also exempt. The overseer in the sick department Georg Raab remained well in spite of very great exertion, excepting an attack of diarrhoea, which did not affect him till December 10th and lasted until the 14th, but did not compel him to be absent from duty. The 2 permanent hospital attendants chosen from among the prisoners remained well likewise. 58 Only 3 fell ill out of 20 prisoners who voluntarily undertook the duty of nursing at various periods of- the epidemic, 2 being affected with transient diarrhoea treated out of hospital, and 1 with choleraic diarrhoea which terminated fatally. The latter (Deisinger, 40 years old, unmarried rope-maker) died according to the account of [Dr. Berr less of choleraic diarrhoea than of exhaustiou: he was selfsacrificingly active and conscientious in nursing his sick fellow-prisoners, and Dr. Berr felt it his duty to make special mention of this self-sacrifice in his report. — : : ACCOUNT OF THE MEASURES ADOPTED. I shall borrow something on this head from the report of Dr. Berr, to furnish a proof, that the epidemic did not manifest such an intensity, because anything was neglected in this case, that had been done in other analogous cases, and which it might be assumed would have hindered the spread of the disease here also, if it had been done. The patients were constantly kept apart from those who remained well. "When the hospital no longer sufficed for the reception of the patients, the cell-prison was emptied and transformed into a sick station, for which the broad high corridor provided with a sky-light and running between both rows of cells wa6 particularly applicable. When this place also no more sufficed, the prison chapel situated between the hospital and cellprison was occupied with patients, by which means 50 more beds were obtained for them. The chapel was it is true somewhat difficult to warm, but the room was bright and airy. As soon as possible Dr. Berr established two subordinate departments, a quarantine department for convalescents, for which he chose rooms 56 and 57, then a probationary department for those cases the specific nature of which was still doubtful, or their intensity but slight (Diarrhoea station). For this purpose he employed rooms 98 and 99. Sixteen persons under hospital treatment for diverse maladies were placed at the very outbreak of the epidemic in room No. 102, which had previously served as a dining-room for the overseers, and none of these took the cholera • With the assent of the minister the following additional measures were put in force: 1) Regular allowance of coffee, afterwards of beer also x j 2 liter per head per day. 2) Double the ordinary weekly allowance of meat for dinner. 3) Improvement of the morning meal (soup). 4) Half an hour's exercise in the open air in the morning and afternoon, taking with them their blankets out of the bed-rooms. 5) Diminution of working hours by l l^ hours a day in favour of sleep. 6) Allowance of drawers and flannel jackets. 7) Allowance of claret and cigars for the overseers. Whatever was necessary for the sick department, Dr. Berr immediately requested, and was most liberally and powerfully supported by the government. The disinfection of the closets had been in full operation since August, and I shall speak more particularly on this subject hereafter. Moreover another special precaution had been adopted since midsummer in consequence of tidings from Munich, viz all convicts on their arrival had to use a weak solution of carbolic acid to wash their hair etc. in taking the [cleansing bath which every new comer has to undergo, The same measure was also adopted when any prisoner was discharged from the establishment during and after the epidemic. 59 » DISTRIBUTION OF CHOLERA AMONG THE SERVANTS OF THE INSTITUTION. Intense fumigation with chlorine was carried out in the dead-room. The bodies were burie< within 24 hours after a careful autopsy, and the coffin was covered with chloride of lime after being deposited in its place. All large funeral processions were forbidden by the police and the time of buria either early in the morning or late in the evening. All the rooms in the establishment were fumigated with sulphur (12 grammes of sulphur to 1 cubic metre of air) from December sth to 19th. The linen of those affected with less acute types of disease was also completely separated from that of the healthy, treated first with strong lye, and afterwards put in solution of carbolic acid. The department of washers was not more affected than the other prisoners. Bed clothes, bed-stead and linen of those who had died of cholera were rendered innocuous in the most effectual manner. Everything was consumed in an ever burning fire in the hospital yard. The prisoner who had to keep up this fire, remained well. DISSEMINATION OF CHOLERA OUTSIDE THE CIRCLE OF PRISONERS IN THE ESTABLISHMENT AND IN THE TOWN OF LAUFEN. Besides the persons, who had to deal with the cholera patients, there were others also who came in manifold and uninterrupted, partly direct, partly indirect contact with the prisoners and the establishment, so that it is of importance to ascertain, how far the malady spread to them also. First of all there follows a LIST OF OFFICERS AND ATTENDANTS IN THE PRISON AT LAUFEN. FAMILY O | NAME AND STATION -s • g DWELLING REMARKS S « .2 £ i a bo h t;j j_j 1 Schicker, Georg, Director .1.2 Official residence between dead-1 pi t»j t houseofestablishment&barrackj an ' 2 Braun, Otto, Manager ,1.4 Edlmann, ironmonger, Rupertus- Platz 3 Berr, Dr. Alois, Surgeon .1 1 80 Rupertus-Platz, lower town 4 Seybold, Alois, Chaplain 1 ... Burgfeld, parish of Heining 5 Demeter, Ludwig, School-master 1 ... Lohn, soap-boiler, Schrannen- Platz 6 Scherer, Josef, Bookkeeper 1 ... Rupertus-Platz 7 Barthel, Heinrich, Clerk ..11 No. 34 an der Salzach 8 Brucker, Andreas, Clerk 1 ... No. Ban der Stadtmauer Choleraic diarrhoea, Dec. 9th— 13th 9 Eimerich, David, Porter .1 4 In the establishment 10 Schulz, Anton, Workmaster .1.3 106 Schrannen-Platz 11 Mildhammer, Ludw., Head) ? / 105 Schrannen-Platz. R00mN0.49l nu , -p. „ Q ? , overseer } • A \ ¦' ' { in the establishment J Cholera, Dec. 6-9, died 12 LUdWIg ' HH ° USe J •1 • * 106 V, Tauben-Gasschen 13 Mehlem, Josef, Overseer of I , 2 1 98 Schrannen-Platz. Room No. 691 Diarrhoea and interruption of joiners J • \ in the establishment } duty, Dec. 5—20 14 Reitberger, Josef, Overseer of I * jDax, hat-maker, No. 44. Room locksmiths J ' ' ' \ No. 65 in the establishment 1.5 Flechtncr Ernst, Overseer oft # j .3 20 Obslaufen. Cell-prison I Not on duty during the epidemic weavers J r I on account of gastric fever 60 DISSEMINATION OF CHOLERA AMONG THE SERVANTS OF THE INSTITUTION. FAMILY o NAME AND STATION -g | g DWELLING REMARKS £ f> "6 I I J> I I E 6 - 16 Eckert, Jacob, Overseer ofl . „ JNo. 77 Lower Town. Room spectacle-makers J * ' ) No. 92 in the institution " E *d^3 ° VerSeer> '° "I •» ¦ > j Ma^pM^ N °- '¦ M5 ° n } Di.rrhoeaDcclOtoU.c.-p.tient " U : b ;.Uf rMB> B< ""*} ... 1 Da*, batter, No. 44. CeU-pn S o»{ nTelhi^lo^wwi 19 Treiber, Nikolaus, Overseer ofl , , /Obslaufen No. 9. Room No. 651 r v n ?, farm-labourers ) ¦ 1 • X { in the institution } Cohc - Dec ' sth 20 Zimmermann, Georg, Overseer ofl j fPollner, farmer, No. 12. Rooml Choleraic diarrhoea at his lodging tailors J ' ' \ No. 40 in the institution J Dec. B— l2, absent from duty 21 Kraus, Ernst, Overseer of shoe- 1 - „ fSulzmeier, inn-keeper, No. 89. makers J ' " \ Room No. 92 in the institution 22 Renz, Adolf, Overseer of gar-1 , 0 /Briindl, butcher, No. 28. Rooml n,. ?, deners j [ • X •2 { No. 92 in the institution } Colic Dec. sth 23 Muller, Karl, Overseer of washers .1.1 Sommerreder, inn- keeper, No. 34. Room No. 96 in the institution 24 Giindel, Philipp, Overseer of) , „ XT „, . ? ... ? -, „ -. ?, straw-workers j 1 • . . Room No. 65 in the institution Colic Dec. sth 25 Rachel, Georg, Overseer of brush-) , „ ?,.,,.,. ? makers I Room 101 in the institution 26 duller, Konrad, supernumerary , § , Room 101 in the institution { E^gJJf Jta J-M- -* 27 Attenberger, Josef, formerly) , n.. . J Convalescent from pleuro-pneumoverseer of bricklayers J 1 ' • • Cell-prison j nia^ absent from duty at critical 28 M^cle G ma rr k g ers° VerSeer 1 * • ¦ • Room 101 in the institution 29 Ha cc S ell U p e rison 6ter ' ° VerSeer in } 1 • • • Room 40 in the institution { in eell -P rison 30 R gttmaken spinTef/ °V ' ' ' 65 in the institution 31 61 "' ° VerSeer ° f } 1• • • Room 101 in the institution Cholera Dec. sth. died 32 tsse 0 ;^ 6 " *} * • ¦ ¦ P™ Hospital Cholera Dec. Bth. died 33 F Ttht 1 office DVerSeerempl ° yed } 1 • • • Room 96 in the institution Cholera Dec. 4th. died 34 Mi^j^ aul ' overseerofstraw -} 1 ... Room 69 in the institution - 34 men therefore came in direct contact with the prisoners, whilst 18 women, and 25 children were in intimate relationship to these 34 men altogether 77 persons. OVERSEERS. tThe overseers are partly married, partly single, must however with the exception of the house•d be all regarded as living in the establishment, as even the married ones spend only a few hours with their families which live in the town, and the remaining time in their respective departments and the nights in the overseers' rooms. According to the report of the director the married overseers are from 1 / 4 to 1 / 2 hour at breakfast, dinner and supper, then every second holiday from Ipmto 10 p m with their families. 61 DISSEMINATION OF CHOLERA AMONG THE ATTENDANTS IN THE INSTITUTION Nme overseers' rooms are to be seen in the plans of the main building: Nos. 40 and 49 on the first floor; Nos. 65, 69, and 74 on the second floor, and Nos. 81, 92, 96 and 101 on the third floor. Besides these there is an overseer's room in the cell-prison near the chapel, and one in the hospital. Two overseers (20 and 29 on the list) slept in No. 40, of whom one was attacked with choleraic diarrhoea on December Bth and treated at his town lodging. The head-overseer (11) slepb in No. 49, he was attacked with cholera on the 6th, removed to his dwelling in the town and died there in the typhoid stage of cholera on the 9th. Four overseers (14, 19, 24 and 30 on the list) slept in No. 65; 2 of these, 19 and 24 felt unwell with colic on December sth. Two (13 and 34 on the list) slept in No. 69, one married, the other single. The married overseer was attacked with diarrhoea on the sth, was obliged to give up work and remained in his dwelling in the town until his complete recovery on December 20th. The overseers' rooms Nos. 74 and 81 were not occupied at the time of the epidemic. Three (16, 21 and 22 on the list) slept in No. 92. Only one of these overseers complained of colic on Deecember sth. Two overseers (23 and 33 on the list) slept in No. 96. One of them (Penzl. 33) was the first case of cholera among the overseers, he was attacked on December 4th and died in the comatose stage after 10 hours' illness. Four overseers (25, 26, 28 and 31 on the list) slept in No. 101. Of these Wagner (31), overseer of the rope-makers was attacked with cholera on December sth, was removed like Fenzl to the cholera hospital (formerly plague-house, now dead-house with separate sick-room in connection with it) erected by the town-council in the suburb of Obslaufen, and died there on December 6th. Wagner came in contact with the body of Fenzl, and believed he caught the cholera in this way. Nos. 15, 18 and 27 on the list occupied the overseers' room in the cell-prison near the chapal. 15 and 27 are not to be reckoned, as they were both outside the institution in the town hospital on account of illness at the critical time. The overseers' room in the hospital was occupied jointly by Nos. 17 and 32. Mall (32), messenger was attacked with cholera on December Bth and died on the 9th; Raab (17) overseer in the sick department, was attacked with diarrhoea on December 10th, from which he suffered until the 1 4th, but without giving up his work. Only 22 of the 24 overseers are to be taken into account, because 2 (15 and 27) were absent, indeed to establish perfect uniformity of circumstances, Neubauer (12) the house-steward must also be deducted, as he did not pass day and night in the establishment like the other overseers, but only the day like the officials and other attendants. Strictly speaking therefore only 21 overseers are to be reckoned. Among these there occurred: 4 cases of cholera = 19.0 per cent 1 case of choleraic diarrhoea . . . = 4.7 „ 2 cases of diarrhoea =9.5 „ 3 cases of colic = 14.3 „ 4 deaths = 19,0 „ Whether now we include the 3 cases of colic, which all happened on December sth the day on which the epidemic reached its maximum, among the specific attacks or not, the overseers when contrasted with the prisoners present on an average a much lower rate of sickness, on the contrary the mortality from cholera is considerably higher than among the prisoners. 62 DISSEMINATION OF CHOLERA AMONG THE SERVANTS OF THE ESTABLISHMENT. On making farther investigations we see but this additional fact, that essentially the same causes, the same opportunities for infection must have operated in the case of the overseers as in that of the prisoners. The first case among the prisoners came out of room 96 on the third floor, which formed part of the east wing of the building, in which wing and in which story (room 99) the cholera began also among the prisoners and reached its highest intensity just one story below 96 among the joiners in No. 70. The second case of cholera (Wagner 31) came out of room No. 101 on December sth, directly adjoining dormitory No. 99, in which the first case of cholera in the institution (Rosskopf) had occurred on November 29th. The third case of cholera (Head overseer Mildhammer) came out of room 49 on December 6th, which occupies the same place on the first floor, as 101 on the third. The corresponding room No. 74 on the second floor was not occupied. The fourth case of cholera among the overseers happened lastly on December Bth and came out of the overseers 1 room in the hospital. Eeach of the two primary centres of infection, the east wing of the main building as well as the hospital, play therefore as conspicuous a part in the occurrence of acute attacks among the overseers, as among the prisoners. The first and so rapid case among the overseers (Fenzl, 33, room 96) shows clearly, that it is not necessary to have come in close contact with cholera patients and prisoners beforehand. His occupation differed from that of the ordinary overseers, he did duty not with the prisoners, but in the director's office, where he was occupied the whole day with writing. Karl Miiller (23), now head-overseer, at that time overseer of the washers, was joint occupant of the room 96 and remained entirely free from disease. The fact therefore, that the second overseer who took the cholera (Wagner, 31, from room No. ]01) came k contact with the body of Fenzl, loses all weight as a proof of the nature of the infection. Looking to occupation Fenzl might have laid claim to immunity. The whole body of officials and their families remained free from cholera, and Fenzl was occupied the whole day in the offices of the establishment, but his dormitory seems to have exercised a decisive influence. The case of choleraic diarrhoea affecting the overseer Zimmermann (20), room No. 40, which was treated outside the institution, and that of diarrhoea affecting the overseer Mehlem (13), room No. 69, will be considered in speaking of the influence of the epidemic on the town of Laufen. OFFICIALS AND OTHER SERVANTS OF THE ESTABLISHMENT AND THEIR FAMILIES. Unmistakable as it is, that the overseers participated in the attacks of cholera, or generally in the epidemic affecting the prisoners among whom they lived, it is just as clearly evident in the case of the officials and other servants of the institution, who excluding the porter lived outside the institution, that the epidemic found its limits here. The porter's dwelling is in the south-western part of the main building. Of the persons employed in the secretary's office Briicker the clerk (No. 8 on the list) suffered from choleraic diarrhoea and was treated at his lodgings. No further attacks followed this one. MILITARY DETACHMENT TO GUARD THE PRISONERS The soldiers requisite for guarding the prisoners are quartered quite near the establishment, adjoining it indeed, as is evident in ground-plan I. At the critical time the guard consisted according to the communication kindly furnished by Lieutenant Max Biiller, of 3 officers, and 67 non-commissioned officers, 63 musicians and privates of the Ist infantry regiment (Konig in Munich). Every day 1 non-commissioned officer, 1 lance-corporal and 12 men occupied the guard-house in the west wing of the main building (see Plan III). There were 2 day watches, for which 6 men were also requisite. The guards were relieved from the guard-house of the institution. No watch was stationed in the interior of the building in corridors or in rooms, but all in the open air, in court-yards etc. The guard-house in the establishment was regularly occupied until December 6th. When howeve the epidemic assumed such unexpected dimensions in the house on December 4th and sth, the commandan in order to secure the troop from infection considered it his duty to make a change and have the watcl relieved direct from the neighbouring barracks. The guard-house in the institution was not left an< evacuated until the evening of December 6th. Strange to say the cholera was not transmitted to the soldiers. During the whole course of the epidemic only 2 soldiers suffered from some slight gastric disturbance, for which they were subjected by Dr. Berr to merely prophylactic treatment (2 days absence from duty and cholera drops Tinctura Valerianoe with Tinctura Thebaica). The commandant provided also warm clothing (flannel waistcoats, drawers, worsted socks) and good shoes, as well as warm soup in the morning and evening, strictly enforcing cleanliness, disinfection of privies and having the rooms at the barracks several times fumigated with sulphur. POPULATION OF THE TOWN OF LAUFEN. It is of the greatest interest to observe the effect produced on the town of Laufen by the infecting focus) in its midst. The consternation and horror in the whole town can be easily imagined. The outbreak of cholera in the town also was daily expected, for which apprehension there was all-sufficient reason. The number of officials and servants living in different parts of the town outside the institution, who were obliged to keep up a regular daily intercourse with it, amounted to 22, the number of members in their families to 53. The danger increased, when the overseers began to fall ill, of whom the married ones had intercourse with their families in the town. When I arrived in Laufen, I inquired immediately, whether any cases of choleraic or simple diarrhoea had yet occurred in the houses, in which overseers and officials of the institution lived. The absence of all symptoms of this kind led me to entertain the hope, that the town would be spared, and I expressed this view also in a sitting of the board of health at Laufen, to which the chairman district-surgeon Dr. Loder had invited me. All precautionary measures were moreover energetically and carefully put in force to avert such a sad event. And in reality this heavy cholera cloud rising from the institution passed over the alarmed town without letting anything drop, without committing further havoc. One sole exception can be proved, but even this proves with remarkable distinctness the very sharply defined local limits of the explosive outbreak in the establishment. (See dwellings of the officials and overseers in the town in the map of Laufen.) I was highly and disagreeably surprised, when Dr. Loder, the district-surgeon, informed me on December 15th at 8 a. m. that he had now 2 undoubted cases of cholera under his care in the town, the subjects being 2 children, both of which would end fatally and which were moreover in a house occupying a very bad situation. In the night between December 14th and 15th Therese Ensmann, 2*/ 2 years old, and Marie Ensmann, 1 year 8 months old, children of a saddler, were attacked with cholera. Dr. Loder gives the following account of the case: ?The parents and their two children inhabited the first floor of the house No. 27 in Jagerwirths-Gasschen with a south-west aspect. The number of dwellers in this house amounted to 9 persons at that time. The situation of the house is highly unfavourable; the street itself is narrow, generally very dirty, the air rendered impure by the effluvia from a slaughter-house opposite and its dung-heap, on which animal excrements are frequently suffered to accumulate in a highly improper 64 DISSEiMINATION IN THE TOWN OF LAUFEN. and often culpable manner. All the inhabitants of the house and especially the Ensmanns had always been notorious for great uncleanliness in -their households; in addition to which there was great poverty in the Ensmann family, bad sometimes unwholesome food, c. g. the frequent consumption of sheep's blood fried in rancid fat and so on." When I betook myself to this house with Dr. Loder, Therese was already dead, and Marie lay in articulo. Both children died 14 and 13 hours after the commencement of the attack with all the symptoms of cholera. Frau Ensmann seemed to be still well. We spoke to her and learned, that she had nursed Mildhammer the head-overseer of the prison, whilst he was lying ill with cholera in his house 105 Schrannen- Platz and where he also died. She cleaned Mildhammer's bed-clothes and linen and after his death his room also, as well as all objects, night-chair etc. used by him during his illness. Although the nursing of cholera patients in the prison itself, as I have shown above, did not produce any baneful influence whatever, the intercourse between Mildhammer and the woman Ensmann would always have been sufficient to explain the infection of Frau Ensmann, but not that of her children. The woman assured me that her children had never been in Mildhammer's dwelling, and that she had not brought them any victuals etc. from there with her. I learned at last on making minute inquiry, that she had been presented with a jacket worn by Mildhammer and taken it home with her. I wished to see the jacket, but the woman told me, it was hanging at the time in the store-room. As one of her children was lying dead and the other moribund, I left the house again, to make further inquiries at a more convenient season. Frau Ensmann was however attacked with cholera in the night between December 15th and 16th and died in 10 hours. After the death of Frau Ensmann the house was emptied, disinfected and fumigated with sulphur. No further cases occurred in Laufen. This isolated case of importation from the institution into the dwelling of Mildhammer, and from there into the dwelling of Ensmann is rather puzzling for those who do not credit the ordinary doctrine of contagion, which would apply very well to this case, but would not apply to all other cases: but to assume its correctness merely because it would serve just here to explain the facts, is more than I can ever resolve to do in the face of so many other fatts. I have therefore taken much pains to ascertain, in what way the woman Eusmann could have conveyed the cholera in the institution to herself and her children. The house, in which Mildhammer lived, is in Schrannen-Platz, being one of a row of houses fronting this square but opening behind into the so-called Tauben-Gasschen opposite the sick department of the prison. This house No. 105 was at that time inhabited by 14 persons, who all except Mildhammer remained perfectly free from cholera as well as choleroid disease. Mehlem the married overseer of the joiners, who was attacked with violent diarrhoea on December sth and was treated at his home, lived also at 98 Sch:annen-Platz. The cholera, of which Frau Ensmann and her two children died, was certainly no other than that of which Mildhammer also died. If now Mildhammer produced infection solely in virtue of his malady, why did not Frau Ensmaun and her children produce farther infection? Sporadic infection proceeding from a focus of disease seems to me most simply explained by the assumption, that the cholera-patient brings so much with him here and there from an infected spot in some garment or otherwise, as suffices to set up infection in other spots, which however has no further consequences, if the new spot does not possess all conditions favourable to the increase and propagation of the transported infecting material, in which case the latter serves only as the germ for a new seed. II assume now by way of preliminary, that Frau Ensmann and her children were infected by an , to which infecting matter from the institution adhered, and I have taken much pains to come such an object. But all ray endeavours have been in vain. As unfortunately I could no longer speak to Frau Ensmann, I applied to Frau Mildhammer. She however answered all my questions with great reserve, it appeared to me as if she feared I wished to bring 65 INFLUENCE OF DIFFERENT WATER-CLOSETS. out, that she might have caused quite unintentionally it is true the death of Frau Ensmann and her children. I afterwards persuaded HerrSchicker the director to investigate the matter, and his confidential inquiry elicited the following story: Frau Mildhammer had taken a woollen house-jacket which however her husband had never worn at the institution, and one of his recently washed shirts out of the wardrobe and given them to the woman Ensmann. I was afterwards informed too, that Frau Ensmann had received a pillow on which Mildhammer had lain. Herr Schicker had the kindness to make iaquiry about it and to communicate the following particulars to me: ?No pillow or anything else, except what he had on him on leaving the institution, had been taken out of the establishment into his private dwelling during the whole period of his illness nor afterwards. Nor had his widow given away any pillow from the bed of her husband, but when Mildhammer was already in the dead-house, the man who laid him out sent to Frau Mildhammer for a pillow, that the body might lie higher. The widow hereupon sent Frau Ensmann with a pillow from Mildhammer's bed to the dead-house and after the funeral Frau Ensmann fetched it again from the deadhouse. This pillow has been hanging ever since in Frau Mildhammer's attic." No more facts requiring investigation presented themselves to me, and Frau Ensmann has faken the secret with her to her grave. I need hardly mention, how important it is in investigating the etiology of cholera, that just these isolated cases of infection, proceeding from on infecting focus situated elsewhere, should in future be examined with the greatest care. I revert here to a doctrine already often expressed by me, viz, that the occurrence of cholera on board sea-vessels gives the best prospect of success in this inquiry. With regard to the foregoing case I will only draw attention to the intervals of time between the attacks. Mildhammer was attacked in reality in the institution on December sth, but the more acute symptoms did not appear till the 6th and he died on the 9th. Frau Ensmann and Frau Mildhammer nursed the patient by turns from December 6th. The children of Frau Ensmann were attacked on December 15th, Frau Ensmann herself on December 16th. From December 6th to 16th are 11 days, from December 9th to 15th 7 days. Before discussing the question as to the further dissemination of cholera from the powerful focus of infection which the prison presented, beyond the limits of the town ot Laufen, I have to consider some other circumstances in the prison itself, which have some relation to the intensity and disseminating power of the disease. The treatment of the excrements occupies the first place here. INFLUENCE OF DIFFERENT KINDS OF PRIVIES. I have already communicated the more essential particulars relative to the nature of the privies in my description of the prison at Laufen in the introductory chapter. The only remaining matter ot interest is to learn what relation therte was between the different departments of prisoners so variously affected and the different kinds of privies. First of all an attempt can be made to make a division corresponding to the two chief systems, which were and are still in use, the cess-pool and the tub system. A great difficulty however at once springs up rendering a perfect comparison an impossibility, viz, the circumstance, that the different departments very often employed the one system by day and the other by night. For instance all the shoemakers slept on the third-floor in the rooms Nos 80, 82, and 83, and used only tubs., which were emptied every 66 INFLUENCE OF DIFFERENT KINDS OF PRIVIES. morning, as long as they remained in the dormitories; they all worked however on the first-floor in the workroom No. 45 and the small adjacent room No. 46, and used hj day the privy No. 42, which is entered from the workroom, and is connected with the cess-pool of the main building on the east side. Is now the enormously high rate of sickness among the shoemakers (over 70 per cent) to be attributed to the tubs of the dormitories, or the privies of the workroom? Most people would be still inclined in the present day to consider the cess-pools with "their decomposing contents worse than the fosses mobiles which were changed every day. The three large privies in the main building connected with workrooms and dormitories and passing through all the stories is an arrangement, which quite apart from cholera is certainly not to be commended from a general hygienic point of view. The greater part of the emanations from the cess-pools ascended into the house through numerous (52) privy-holes during the greater portion of the year, and first of all indeed into the dormitories and workrooms. Hitherto only a faint idea had been formed of the quantity of matter passing out into the air from full cess-pools, it was merely known, that there was a bad smell; since however Dr. Erismann at my suggestion determined this effluvium quantitatively also with tolerable exactness in the hygienic institution at the university of Munich, we have been astonished, nay actually horrified at the matters which are poured into a house from a fall cess-pool 18 cubic metres in dimensions daring 24 hours, even when only Vooo of the contents of the cess-pool passes into the air; for this one-thousandth part comprises on an average not less than 18 kilogrammes of carbonic acid gas, ammonia, sulphuretted hydrogen and volatile compounds of carbon together, or almost just as many cubic metres in gaseous volume. Dr. Erismann's work on this subject is being printed and will shortly appear in the journal of biology. As the iron privy pipes in the establishment, which it is true have a free opening above the roof, are not specially and constantly ventilated by fans or fires, the draught of air goes for physical reasons out of the closet-pipe into the interior of the house during the greater part of the year, namely as long as it or parts of it are warmer than the surrounding free air. The strength of the draught increases with the difference of temperature between the interior and exterior, and closing the aperture and door of the privy, and even opening a window in the privy furnishes only a very imperfect and slight protection against this constant current of gaseous impurity into the house. It might therefore be expected, that all the rooms, which were immediately connected with these privies ought to have exhibited many more cases of cholera and deaths than the rooms with tubs. Although now a perfect comparison is not to be carried out for the reason above-mentioned, the occurrence of cholera and deaths in the different rooms of the establishment is still a very good field for the study of this important question. There are some departments among the prisoners, which only make use of tubs both in their workrooms and dormitories, and others which resort only to privies with cess-pools. The prisoners undergoing solitary confinement had only the tub system, and they as is well known suffered hardly at all, only one case of death occurring among 35. This immunity cannot however be attributed to the influence of the particular system, as it continued for the most part even when 34 of them were distributed among the prisoners in ordinary confinement at the very worst period of the epidemic (the morning of December 4th) and were exposed like them to the influence of privies in dormitories and workrooms. The rope-makers with one exception slept in room 98 on the third-floor, and worked either in the open air or in bad weather in the rope-makers' attic under the roof of the hospital. They had only tubs to make use of both in the dormitory 98 and in the rope-makers' attic. It might be pointed out, that only 3 cases of cholera and a single death had occurred among 22 rope-makers, although a greater number of cases of choleraic and simple diarrhoea took place, and it might seem natural to attribute this undeniable advantage to the fact, that they did not come in contact with the privies of the institution. 67 INFLUENCE OF DIFFERENT KINDS OF PRIVIES. Apart from the fact, that the slight number of acute cases among the rope-makers might proceed from other causes, c. g. their prolonged stay in the open air, another department, which likewise used only tubs both in their workrooms and dormitories, exhibited quite the contrary result. The department of washers is occupied during the day on the ground-floor in No. 15, the washhouse proper (20 men), and in No. 16, the mangling- and ironing-room (5 men) and 1 in the drying room on the under-ground floor, and slept until December Bth partly (16) in No. 56 on the 2nd floor, partly (10) in No. 97 on the third-floor. — The mean age of those in No. 56 is 30, that of those in No. 97 26. One of the two who died in No. 56 was 40 years old, the other 50. Although a great difference is observed between these two groups as regards the number of cases of cholera, 25 and 10 per cent, this difference is more than counterbalanced in the general rate of sickness by the greater number of cases of diarrhcea in the younger group, 44 and 70 per cent. The department of washers had only tubs when at work in the day-time in Nos 15 and 16, the 16 men, who slept in dormitory No. 56 during the night also, whilst the 10 in dormitory No. 97 went to the adjacent privy No. 95 during the night. The group in dormitory No. 56 ought therefore to have had a decided advantage over those in No. 97, which was indeed shown in a smaller number of cases of diarrhoea, but also in a much greater number of severe cases. The 16 washers in No. 56 had 4 cases of cholera, of which 3 ended fatally, 2 cases of choleraic and 1 of simple diarrhoea. If the advantage of the tub system over the cess-pool system is to be measured by these facts, we shall be obliged to give the preference to the worse system. The attacks which befell the washers cannot, as indeed happens elsewhere, be attributed to their occupation, for it has already been proved above, that all the linen of cholera patients had been carefully and effectually disinfected, so that the washers had not suffered more than other departments. Moreover the temporary occurrence of attacks among them by no means favours the idea of a special or different mode of infection to that among all the rest. The comparison between the department of shoemakers and that of brushmakers is of interest, these two groups being in so far opposite, that the shoemakers were exposed by day to the emanations from the eastern cess-pool (privy No. 42), and had only tubs in their dormitories, whilst the reverse obtained among the brushmakers, who used tubs by day, and were exposed by night to the emanations from the northern cess-pool (privy No. 62). The locksmiths occupied a similar position to the brush-makers. In making this comparison some evidence might also be expected, whether the 'cess-pool emanation acted more injuriously during the work by day, or during sleep at night, in which latter case the brush-makers ought to have fared worse than the shoemakers. The relation is as follows: Shoemakers*). Cholera .... 25 per cent, \ Choleraic diarrhoea 7.5 „ \ 77.5 Diarrhoea . . . 45.0 „ J Deaths .... 17.5 „ Brushmakers. 33.3 \ 3.3 J 77.2 41.6 ] 33.3 We might easily be misled to draw the conclusion from these figures, that cess-pool emanations have no influence either by day or by night on the rate of sickness, but a very important influence on the severity of the attacks and consequently on the deaths: such a conclusion would correspond to many preconceived and current opinions. A further investigation very soon teaches us however, how deceptive such solitary accidental coincidences may be, although they may very well serve to support here and there some one popular idea. *) The two shoemakers in the hospital are not reckoned. 68 INFLUENCE OF DIFFERENT KINDS OF PRIVIES. Besides the brashmakers other divisions also were equally exposed to the emanations trom the northern cess-pool, c. g. the weavers in work-room No. 58 on the same floor, the tailors in work-room No. 38 a story lower through the medium of the privy in No. 36 and the straw-workers in dormitory No. 32, as well as the spectacle-makers a story higher through the medium of the privy in No. 85 both in their work-room No. 84 and in their dormitory No. 91. The tailors suffered remarkably little, and that very section of the spectacle-makers, which was exposed to the emanations from the northern ces3-pool by day and by night escaped with remarkably mild attacks. Every one therefore, who imagines the mischief proceeded from the cess-pools and privies, must assume that the northern cess-pool contained least poison, and that the poison was concentrated principally in the eastern cess-pool, with which the shoemakers' workroom No. 45, and the joiners' dormitory No. 70 communicate. He who imagines that a material influence proceeds from the cess-pools, is compelled to assume as the active cause of the higher mortality and rate of sickness not the northern cess-pool, because this cess-pool proved so favourable to the other departments, but only the eastern cess-pool, to the direct emanations from which however the brush-makers for instance were not at all exposed. The above-mentioned comparison therefore between the shoemakers and brush-makers furnishes no conclusion with regard to the question, how far the influence of cess-pool emanations acts more banefully during the night and during sleep, than during the day and during work. The circumstance, that the iron privy-pipe is carried down from the first-floor to the cess-pool outside the building in the wall of No. 11 the brushmakers 1 workroom, makes no difference, as this pipe is quite compact and all around it dry. If thick iron and massive walls however allow perhaps just as many noxious matters to pass out of cess-pools into dwelling-rooms, as the open holes of privies, there will not indeed be in future any more occasion to resort too all kinds of closure, but everything had better be left open at once, as some trace will at last penetrate everywhere. Every limit to the localisation of an infecting material in a building, that is so manifestly expressed elsewhere, would be overthrown, if it were asserted, that the joiners, shoemakers and brushmakers had suffered more than the other departments in proportion as they were more exposed to the influence of the eastern privy. If it really depended upon this cause, the brushmakers who only communicated with the solid, fluid and gaseous contents of the eastern cess-pool through a partition of iron and stone, should at all events have been much less affected than the shoemakers, near whose workroom three open pipes opened into the privy, the door of which leading into the workroom not only closed very defectively and was very frequently opened and shut, but to which every individual betook himself several times daily to perform his natural functions and sat down over the open pipes. In reality however the brushmakers suffered even more than the shoemakers. If now the germ of cholera is held to reside principally in the alvine evacuations, it must be admitted, at least in the preceding case, that these cholera germs reached all the cess-pools, for no cesspool remained free from cholera evacuations. They must be assumed to be also equal in all other respects. As they are of equal size, their contents are also qualitatively quite equal. The nature of the excrements is dependent on the nature of the food. As the food of all the prisoners i& the same, fceces and urine must also be the same. Since the investigations of C. Voit meat-foeces bread-foeces and foeces from other food can be distinguished very exactly from each other, but not joiners' foeces and tailors' foeces, when joiners and tailors have had the same food. It cannot therefore in any way be assumed, that the emanations from the eastern cess-pool could have acted differently to those from the northern and southern cess-pools. Nor is it demonstrable, that the draught through the pipe from the eastern cess-pool was stronger than that from the northern and southern, indeed an observation made by Dr. Berr renders the contrary state of things the more probable of the two. At the critical time the north-west wind prevailed, which must have acted more on the northern than on the eastern cess-pool. If there had been an east wind, it might have been said that the eastern privies had more draught. The whole probability, that 69 INFLUENCE OF DIFFERENT KINDS OF PRIVIES. the eastern cess-pool was more baneful tban the northern, is consequently reduced to the matter of fact, that the eastern cess-pool is a part of the east wing, and the northern cess-pool situated near the northwest corner of the institution is a part of the west wing, and the east side and west side of the house have shown a difference in many other respects in the way in which they were attacked. I have mentioned above, that the enormous mortality among the joiners might be due to the fact, that they alone remained day and night in the centre of the eastern wing, at night in No. 70, by day in No. 71, and I am doubtful if they would have shared the same fate, if they had been as constantly cooped up together in one and the same place in the western wing. They were actually exposed without interruption to the influence of one and the same part of the building, but not of one and the same cesspool. At night they used the privies connected with the eastern cess-pool, by day on the contrary the privies No. 76, which belong to the southern cess-pool. It was the same thing also with a large portion of the straw-workers. The straw-workers, who worked during the day in No. 72, slept for the most part (24) in the same dormitory No. 70 as the joiners, the smaller number (8) in the dormitory No. 97, which is a story higher, but directly above No. 70. These 32 straw-workers had the same privies by day and night as the joiners, and if this had been decisive, they ought to have been visited just as much as the unfortunate joiners. They had certainly a sick-rate of 50 per cent, but a death-rate of only 12.5 per cent, whilst the joiners had one of 47 per cent. The 8 straw-workers, who slept iv room No. 97, fared comparatively much worse, than those (24) in No. 70, without our being able to attribute it to the influence of the privies. If it is asked, what advantage these straw-workers had over the joiners, I can allege nothing, except that they did not live day and night in the centre of the east wing with the joiners, but removed towards the southern end of it when at work during the day. The tailors on the first-floor were exposed the whole day to the emanations from the northern cess-pool in privy No. 36, and a part of them to those from the eastern cess-pool in privy No. 42, as well as the shoemakers in their workroom and the joiners in their dormitory, without being attacked by acute disease in anything like the same degree. The case of the spectacle-makers, who had their workroom and dormitories on the third-floor is highly interesting. That part of them, which was in dormitory No. 91 and numbered 32 persons, was just as much tied to the spot, as the 19 joiners. By day all the spectacle-makers in workroom No. 87 were exposed to the emanations from the northern cess-pool in privy 85, and at night the 32 men went to the same privy only from their dormitory. Their sole change of place consisted therefore in wandering from the one to the other side of the privy in question. And how mildly this department was visited in comparison with the joiners! 32 had 1 case of death, whilst the 19 joiners had 9 deaths affecting mostly young robust subjects. That division of spectacle-makers (56) which slept in room 94 which is separated only by an overseer's room from No. 91, but partially reaches to the eastern wing of the building, fared again much worse, they had 7 deaths, 4 times as many in proportion, as those in No. 91. I will mention another remarkable circumstance. The spinners, knitters and glove-makers work together on the second floor in room ' No. 57, and do not use any privy there during the day, but a tub, which is placed in dormitory No. 56 for the washers. As the spinners, as I have already mentioned, were on the whole more mildly visited than the weavers, I hoped to find perhaps an explanation in the privy arrangements, for the weavers were exposed the whole day in their workroom No. 58 to the northern cess-pool through the medium of the privy No. 62; I should have liked to find also a reason for the immunity of the 13 spinners, who slept in the dormitory No. 97 which was so heavily visited in other respects. But even the most minute analysis led to no result. 14 of the 36 spinners slept in rooms, 70 DISINFECTION OF EXCREMENTS. which had only tubs (1 in No. 56, 1 in No. 80, 9 in No. 98 and 3 in No. 99), but they had altogether 3 cases of cholera, which all ended fatally and 3 cases of diarrhoea. The sick-rate is therefore a little below, the mortality considerably above the mean. I could get hold of only one fact, which might perhaps be quoted as favoring the theory of infection by privies. The soldiers remained free from cholera. The privy for the guard is near the south wall in the court-yard at the entrance into the prison. But no great weight can be attached to this fact either. In the first place the mere coincidence of two facts, unless it recurs very regularly, does not furnish the slightest proof of their physical connexion and the dependence of the one upon the other, and then this privy was used also by overseers, who must be considered quite as infected with cholera, as the prisoners. I have also to mention the following particulars for the benefit of those who may wish to institute further comparisons. The relation of the privies connected with the northern and eastern cess-pool to the workrooms and dormitories is evident on looking at the plans of the house. The privies connected with the southern cess-pool, which do not directly communicate with any workroom or dormitory, but only through the intervention of a corridor, are used so far as I have not already mentioned, by the porter and his family on the ground-floor, then by the cooks and bakers, those on the first-floor by the secretaries and headoverseer, and by the lithographers, who work close by. The straw-workers, who work in No. 47, and sleep for the most part in No. 32, do not use this privy during the night, but the privy No. 42, which the shoemakers have also. The southern privy in the second-floor No. 76 is used by the joiners and straw-workers by day and occasionally also by the house-chaplain and school-master The southern privies on the third-floor are not used by prisoners either by day or by night, but only by the overseers, who have their rooms near them. When the prisoners are once in the dormitory, it is not opened any more during the night, and only those prisoners therefore can visit a privy (luring the night, who are in dormitories communicating with a privy, as is seen in the plans. Tubs are erected in all the other dormitories. DISINFECTION OF EXCREMENTS. The question of disinfection of excrements is intimately connected with the privies and their arrangement, so that I believe it will be the most appropriate place to discuss it here also. I give partly communications of Dr. Berr and some officers and overseers, partly my own observations. Dr. Berr has furnished the Ministers of Justice and of the Interior with the following report on this subject: The disinfection of the privies has been effected for years by means of sulphate of iron (80 grammes per man per day, since August 1873 after the experience gained in the epidemic at Munich 120 grammes of sulphate of iron per head per day mixed with crude carbolic acid (10 grammes per head per day). In this way 5300 kilogrammes of sulphate of iron and 260 kilogrammes of carbolic acid were employed in the period between July Ist and December Ist 1873. Of course there was no reduction in these quantities either at the time of the house epidemic or after it, but on the contrary too much if anything was done in this direction. ?The contents of the cess-pools as well as the sides of the descending pipes were often tested with respect to their acid reaction, and always found strongly saturated." 71 DISINFECTION OF EXCREMENTS. Moreover in consequence of news from Munich after midsummer the special precaution was taken, of making all newly arrived convicts use a weak solution of carbolic acid for washing the hair in their first bath, The same measure was also afterwards enforced during and after the epidemic on the discharge of any convict. Supposing all that had been prescribed was punctually carried out, the cholera even when introduced into the prison ought not to have spread according to the view commonly entertained. Instead of this however there followed such an explosion here, as had never been heard of in times, when disinfection was not yet thought of. The supporters of the view, that disinfection of the excrements is a measure of the utmost importance to prevent the dissemination of cholera, are still very numerous. They can it is true allege all kinds of excuses why disinfection availed nothing in Laufen, but they can never get over one thing, viz, that making all due allowance for deficient execution the disinfection was after all far better and more thoroughly carried out than on any previous occasion, and that the result not only did not correspond to the expectations and exertions that were made, but the very contrary happened. It is self-evident, that no scrupulous cleanliness could prevail in the besieged privies during the the height of the epidemic, when half the prisoners were already suffering from cholera, choleraic and simple diarrhoea, but who could conclude from the circumstance, that almost all had the cholera at a certain time, that they had first got the disease from this source? It may be also said, that there will have been times and privies, in which the acid reaction of the excrements was temporarily suppressed by an alkaline one. I believe so myself, for during my stay in the institution I have not always been unsuccessful in demonstrating carbonate of ammonia in the air of different privy-pipes by means of moistened turmeric paper. As regards the carbolic acid, my own observations tend to confirm those made also by Dr. Klinger, that there was not much smell of it in the large privies. Nor was it ascertained by analysis, how much pure hydrate of phenyl the crude carbolic acid contained. So much can hardly have been employed, that the disinfected matters contained 1 per cent of actual carbolic acid. Moreover I have seen in the boobs of the institution, that 3195 kilo, i. c. 64 cwt of sulphate of iron were actually consumed in 168 days from July Ist to December 15th, making nearly 20 kilogrammes per day and reckoning the average number of prisoners at 500, 40 grammes daily for 1 prisoner, and as this metallic salt is not an article of food, and cannot be applied to any other purpose in this quantity, even a very scrupulous believer in disinfection can come to no other conclusion, than that the sulphate of iron was really thrown down the privies. I convinced myself too personally, when the great northern cess-pool was emptied, that even its sediment had a thoroughly acid reaction. I am wiling moreover to concede in favour of the believers in disinfection, that perhaps the mode of disinfection adopted in Laufen, however well intended and conscientiously carried out in the establishment, may have failed notwithstanding to kill the cholera germ supposed to be in excrements, that corrosive sublimate would perhaps have had a better effect: but I cannot concede in their favour, that any other danger proceeded from these excrements of the prisoners, than that proceeding from them at other times when cholera does not prevail and caused by pollution of the air with matters not peculiar to cholera An experiment was made with the, I will assume, improperly and therefore unsuccessfully disinfected contents of these cess-pools at Laufen, which weighs heavily in the balance. The liquid contents of the cess-pools are, as already mentioned iv the introduction, often pumped out during the month and spread upon the fields. When the epidemic had broken out, this was at first omitted through a very justifiable fear of endangering the public health. As however not only far more evacuations took place at this time, but also more disinfecting fluid was put down the privies, all the cess-pools soon became full to overflowing. The liquid contents of the northern cess-pool even found their way at this time into the cellar, into which they trickled down the walls and from the ceiling, so 72 DIETARY IN THE ESTABLISHMENT. that wooden tubs were placed trader to catch the liquid. When it was proposed to empty the cess-pools, public opinion and general sanitary considerations hindered the carrying out of this intention. Nobody would undertake this dangerous operation, and no parish would let this dangerous dung be carted through its roads and put on its fields. The sanitary board deliberated, whether at least the liquid portion of the contents of the cess-pool might not be thrown into the rapidly flowing Salzach, as it was already disinfected; as however the mischief might have originated in the disinfected cess-pools, this would not do, especially as the Salzach on leaving the institution flows round the whole town of Laufen, and according to the views of most people the wells of Laufen are fed essentially by Salzach water filtering through the soil: it was to be feared, all the wells in the town would be poisoned. And yet it was impossible to let the institution be any longer flooded with its own filthy mire. As necessity knows no law, means and ways were also found to empty the terrible cess-pools. The prohibition to carry it away was withdrawn, places fixed upon, where the liquid matters and dirt might be taken, and at last three intrepid farmers were found in the neighbourhood, who agreed to risk their lives for good money and good manure, and empty the cess-pools in the institution (the northern, southern and eastern in the main building, that of the cell-prison, that of the hospital and that of the director's house) in the nights of Dec. 17th and 18th, o"n each occasion between 12 p. m. and 6 a. m., and remove the contents out of the institution and out of the town. Seventy-five carts each drawn by 2 oxen were necessary for the purpose. Reckoning a cart at 20 cwts, the whole amount was 1500 cwts. The operation of emptying the cess-pools and filling the pails was performed by 8 prisoners, who volunteered for the work, and 4 men from the town (the sexton Fuchs and 3 assistants). Treiber the overseer superintended the whole business. Six drivers were also occupied in the transport, being sent by the three farmers who undertook the job. I was not an eye-witness it is true, but it seemed afterwards, as if the tubs and boxes had not all been hermetically sealed. It remains to be stated, that not one of these 19 individuals who had come in the closest contact with the contents of the cess-pools was attacked with cholera, choleraic or simple diarrhoea, nor did any dissemination of cholera result in the neighbourhood of Laufen, or near the place of unloading. Nor did any harm happ"en to those who had undertaken the work. I have already mentioned the disinfection of the infected linen and bodies, the burning of beds, bedsteads and blankets of those who had died of cholera in speaking of the measures adopted in the care and treatment of the patients, and have nothing further to add. DIETARY. The sudden appearance of cholera in the prison at Laufen, the very unusual dimensions and violence, which it assumed, and in addition its short duration, as if it had broken out in an ordinary small house inhabited by a few people, where it usually runs its course within a fortnight, will make an impression on every body that the prisoners had all received some poison pretty simultaneously, which affected them more or less according to their individual disposition and other allied influences, or that some pernicious circumstance had simultaneously but transiently affected them all uniformly. In such cases we generally think first of food and drink, and suppose the people must have eaten or drunk something poisonous. The attacks could scarcely indeed have occurred more suddenly and vehemently, if all the prisoners had eaten poisonous fungi at some meal. 73 STORES AND RAW MATERIALS INTRODUCED. - DRINKING-WATER OF THE INSTITUTION. The impression is still further strengthened by the circumstance, that only the prisoners and overseers, whose food is cooked in the establishment were attacked, but not tbTe officials and soldiers, who had meals outside the institution. It is also to be remarked, that the unmarried overseers were more frequently and severely attacked than the married ones. The great difference however in susceptibility observed among the different departments, although their dietary was perfectly uniform, militates against the view of their food having had any influence. The tailors have exactly the same food as the joiners. What however renders this theory absolutely impossible, is the remarkable immunity of the prisoners iv solitary confinement, who partook of the very same food prepared in the same kitchen, in the same vessels and by the same cooks, as the prisoners in ordinary confinement, ate therefore out of the same dish as it were with them, but only began to be attacked with cholera and diarrhoea, when they were removed out of the cell-prison into the common prison, and even then only in a milder form and later than those confined in the common prison. I shall give here (p. 75, 76) the dietary in the institution for prisoners and overseers, which is the same as that prescribed in all Bavarian prisons. I will not say, that it might not be improved, or should be improved, but I believe it may be acquitted of having caused the cholera in this institution. I have inquired also about the sources from which the provisions were derived, and have learned nothing calculated to awaken the slightest suspicion of anything having reached the institution, that was not likewise employed in every other house at Laufen. STORES AND RAW PRODUCTS INTRODUCED INTO THE ESTABLISHMENT. I have also made inquiry about everything else in the shape of stores, raw products and other neccessaries, that were sent to the institution after Oct. 1873, whether perhaps there might be something among them, with which the cholera or the cholera germ could have been introduced; but this investigation also threw no light on the matter. I communicate the list of these also (p. 77, 78) in case some other person should be able to find out something among them. DRINKING-WATHER. Drinking-water still plays as is well known a very prominent part in the present etiology of cholera, and nothing would be more in harmony with the popular taste, than to assume this colossal outbreak of cholera in the prison at Laufen in the winter of 1873 had the same cause, as the explosion of cholera in Golden Square, London, in the summer of 1 854, viz the pump in Broad Street, — this view would easily find favour with most people. The case of Golden Square has'iriade so great an impression in England, that it is already considered justifiable to regard the whole cholera question, at least so far as epidemics are concerned, as a mere question of drinking-water. I endeavoured to show only a short time ago, on what a feeble basis this very proof of the influence of drinking-water rests, supposed to be derived from the outbreak in Golden Square*), and it is *) See Zeitschrift der Biologic Vol. X p. 439: Is drinking-water the source of epidemic typhus? 74 DIETARY. therefore very gratifying to me to be able to test the influence of the drinking-water in the epidemic in the prison at Laufen more exactly, than would have been possible in an epidemic affecting a whole urban district and a population living in freedom. The institution has two wells, which I have already mentioned in describing the institution m the introduction. The one is situated in the garden outside the southern boundary wall of the establishment, and is employed only to water the garden, The other is situated in the hospital court-yard (see groundplan). It is the well, which properly speaking supplies the institution with water. All the drinking- water DIETARY IN THE ROYAL PENAL PRISON AT LAUFEN. WEEK- TIME WEEK- TIME op FOOD INGREDIENTS of FOOD INGREDIENTS DAY DAY DAY DAy Monday Morning Burnt-meal per head: burnt -meal Thursday Noon Groat Soup per head: groats 3 oz, Soup 1 oz, suet 1 oz, salt with meat beef4oz;— forlOOmen: vinegar and seasoning sa lt 3 lbs, spices 3 oz, as required, greens 8 oz. Noon Pease with per head: pease 5 oz, , Evening Wheat meal per head: flour. 3 oz, suet Kraut sauerkraut % lb, suet Soup % oz; — for 100 men: % oz, burnt-meal 3 oz; , salt 3 lbs, spice 3 oz. — for 100 men: salt (Burnt-meall , r , 3 lbs, spice. Friday Morning { goup jas on Monday. Evening Groat Soup per head: groats 3 oz, suet „ Noon Dumpling per head: flour 4 oz, white % oz; — for 100 men: bread 5 oz, suet % oz; salt 3 lbs, spice 3 oz, —for 100 men: salt 3 lbs, greens 3 oz. spice 3 oz, greens 8 oz. (Burnt-meall „ Evening Potato Soup per head: potatoes 1 lb, Tuesday Morning | g jas on Monday. suet oz? burnt-meal % oz: — for 100 men: „ Noon Rumford for 100 men : pearl-barley salt 3 lbs, spice 3 oz. Soup 11 lbs, pease 11 lbs, potatoes oO lbs, pork Saturday Morning IU ™ " mea }as on Monday. 3y, lbs, salt 2 lbs, vine- * bou P J gar 2quarts, white bread n Noon Rumford for 100 men : pearl-barley 12 j/g lbs, pepper 1 oz, Soup 11 lbs, pease 11 lbs, majoram 2 oz. potatoes 50 lbs, pork 3'/ 2 lbs, salt 2 lbs, vine- Evening Potato Soup for 100 men: potatoes gar 2 quarts, white bread 100 lbs, burnt-meal lib pepper j 9 oz, suet lib 9 oz, salt marjoram 2 os. 3 lbs, spice 1 oz. Evening Bread Soup per head: rye-bread 4 oz, Wednesday Morning jίurnt-meall ag on Mond suet '/ 4 oz;- for 100 men: J B I Soup J sa lt 3 lbs, spice 3 oz. Noon Potato Soup per head : potatoes 2 lbs, . (Burnt-meall ? A suet % oz, burnt-meal Sunday Morning [ goup }as on Monday. V^r f°r.lo°f ° r . 10 ° ™ eD: „ Noon Rice Soup per head: rice 3 oz, beef salt 3 lbs, spice 3 oz. - \ oz . _ for 100 men: Evening Rice. Soup per head: rice 2 oz, suet salt 3 lbs, spice 3 oz, % oz; — for 100 men: greens 8 oz. salt 3 lbs, spice 3 oz, Evening Burnt-meal per head: burnt-meal 3 oz, greens 8 oz. " goup SU et / 4 oz; - for 100 men: iίurnt-meall „ , salt 3 lbs ' yine S ar 2«2 ''« Thursday Morning I g |as an Monday. quarts, spice 3 oz. 10* 75 DRINKING-WATER. — DIETARY. for the prisoners is pumped out of this well, the wash-house and bath-house are likewise supplied from it, and most of the water used for cleaning is taken from here. The establishment has also running water, conducted from the opposite bank of the Salczach, from Oberndorf, but this to my knowledge flows only into the kitchen, and is employed for cooking and washing up. The water from the pump in the hospital court is preferred by all for drinking purposes to the water laid on, because it always tastes fresh and good and has the same temperature in summer and winter. After violent and continuous rain it exhibits here and there a little turbidity, but no material change in taste. The soldiers on duty at the guard-house were probably not forbidden to fetch their drinkingwater from the running water in the kitchen, but they never did so, procuring it invariably from the pump in the hospital court-yard. With respect now to the chemical composition of these two waters, they are similar as regards solid residue and amount of chlorine, at all events not nearly so different, as might have been supposed from their different origin, the one from a bubbling spring on the heights on the opposite bank of the Salzach, the other from a well excavated so to say in the midst of the institution and surrounded by different cess-pools. Both are calcareous hard waters, such as are found everywhere throughout the whole Bavarian table-land and also in the mountains, as far as the chalk formation reaches; it seemed sufficient for the purpose of comparison, to examine their appearance and taste, solid residue and amount of chlorine, especially as the latter substance generally indicates, how far the vicinity of refuse matters from the human household exercises an influence. Both waters were clear and colourless and of a good taste. That from Oberndorf tastes a little of the wooden tubes, through which it is conducted. [continuation of the text at p. 79.] [continuatiou of the text at p. 79.] DIETARY OF SICK PRISONERS. The dietary is divided into 1 / 4 diet, x / 2 diet and 4 / 4 diet. 1) The diet consits of three pain or meal soups to a quart, or a glass of milk and 2—32 — 3 plain or meal soups. The soups must be well prepared with herbs and well salted. 2) 1 / / 4 diet consists: in the morning of burnt-meal soup, made of meal 1 oz, suet x / 6 oz, salt 11 l i os, at noon of meal-soup made of groats, rice, white bread, I—21 — 2 boiled eggs or cooked fruit (plums 2—32 — 3 oz); in the evening of meat soup made of groats, millet etc., bread IV2 — 3 oz according to order. —If the patient receives 3 oz of bread, 3 oz are given at noon and 3 in the evening. 3) V 2 diet consist: in the morning of burnt-meal soup, at noon of thick soup, 12 oz of beef or roast veal or mutton and vegetables. The quantity of meat is dependent on the order; in the evening of soup, jam when it is ordered, 6 oz of rye-bread or 3 oz of white bread, if it is specially ordered. 4) 4/44 /4 diet consists: in the morning of burnt-meal soup; in the evening thick soup, 3—43 — 4 oz of beef, vegetables, in the evening thick soup, 2—3 oz of beef, veal, mutton, 6 oz of rye-bread, which in urgent cases may be increased to 8 oz when ordered. DIETARY FOR THE OVERSEERS. Morning. Burnt- meal soup daily, in addition loz of meal, 1 / i oz suet, 1 / i lb of white bread per man Noon. Barley, groats, rice etc. alternately 2oz per head, pease 4 oz, bread 3oz for soups etc. ; then 1 lb of vegetables, l /i oz of suet, 7 oz of beef (on Sundays instead of beef 7 oz of veal) and Va quart of beer per head. Evening. Barley-, groat-, rice-, burnt-meal soup 2 oz; then 7 oz of beef, 1 lb of vegetables, in addition V* oz of suet, then as at noon Va quart of beer per head. Ilb of bread (rye-bread) allowed daily to each person. 76 GOODS AND RAW PRODUCTS ORDERED BY THE INSTITUTION. LIST of raw products ordered by the managers of the prison at Laufea from Oct. Ist to Nov. 30th 1873. ARTICLES NAME OF VENDOR WHENCE OBTAINED Day I Month | Year 1 Oct. 1873 17 trousers, waistcoats, coats Anton Stangl, clothier Laufen 1 „ „ 1 sofa frame, 6 stools, 3 crosses, Karl Reisclu, joiner Laufen 1 box, 6 bedsteads 1 „ „ 10 kilo, of tow-yarn E. Stoekhamer, wife of carpenter Obslaufen near Laufen 3 „ „ 1 1 '/» kilo, of yarn Rochus Diezinger, messenger | Reichenhall 4 „ „_ 11 trousers, waistcoats, coats Anton Stangl, clothier ; Laufen 4 „ „ 19% kilo, of yarn Th. Lepperdinger, farmer j Buchach, district of Oberndorf 4 „ „ 5% kilo, of flax Theres Kapeller, farmer's wife Mayei'hofen near Laufen, road from Laufen to Freylassing 5 „ „ 19 kilo. 200 g.n. of calf-skin, 41 Antou Messner, currier Laufen kilo. 500 gm. of shoe-leather, 41 kilo, of welt-leather, 4 kilo, of sheep's-leather 6 „ „ 500 kilo, of raw hemp Martin Schellmoser, rope-maker Laufen 6 _ „ „ 36 common deals, 19 cherry-tree Johann Wimmer, carpenter Friedorfing, road to Tittmoning planks, 7 beech planks 6 „ „ I^os kilo, of straw Joseph Bavth, brewer Laufen 6 „ „ 380 kilo. 500 gm. of iron, 133 kilo. August Edelmann, ironmonger Laufen 500 gm. of sheet-iron 6 „ „ 11 trousers, waistcoats, coats Anton Stangl, clothier Laufen 6 „ „ 3 pairs of women's boots Ign. Eisgruber, shoemaker Oberndorf (Austrian Laufen) 6 „ „ 5% kilo, of hemp-yarn Elisabeth Kroiss, farmer's wife Gauschburg (district of Oberndorf) 8 „ „ 101 kilo, of iron " August Edelmann, ironmonger Laufen 8 „ „ 7 kilo, of hemp-yarn Jos. Niedefhauser, baker Oberndorf (Austrian Laufen) 9 „ „ 50 kilo, of rye-meal Joseph Schneider, baker Laufen 9 „ „ 1.5 kilo, of brass August Edelmann, ironmonger Laufen 10 „ „ 10 kilo, of lard Leonhard Lechner, butcher Laufen 11 „ „ 68 kilo, of iron August Edelmann, ironmonger Laufen 11 „ „ 5 lbs of nails „ „ Laufen 11 „ „ 16 trousers, waistcoats, coats Anton Stangl, clothier Laufen 11 „ „ 22 '/i kilo, of yarn Mar. Niederstrasser, farmer's wife Oed, parish of Steinbruning near the Freflassing road 11 „ „ 17% kilo, of hemp-yarn Simon Lang, farmer Petting near lake Waging 11 „ „ 31% kilo of tow-yarn Franz Stadler, innkeeper Laufen 13 „ „ 10 quires of coloured paper Max Laumer, bookbinder Laufen 13 „ „ 5 pairs of shoes " Ign. Eisgruber, shoemaker Ouerndorf (Austrian Laufen) 15 „ „ 4 kilo, of hemp Martin Schellmoser, rope-maker Laufen 15 „ „ 22 trousers, waistcoats, coats Anton Stangl, clothier Laufen 17 „ „ 10 kilo, linseed oil Franz XaverGasteger, tradesman Laufen 17 „ „ 2 kilo, of copal varnish Franz Straussenberger, painter Lanfen 18 „ „ 54 metres of fustian Franz XaverGasteger, tradesman Laufen 18 „ „ 5 doz. pegs Max Laumer, bookbinder Laufen 18 „ „ 18% kilo, of tow-yarn K. Schmidlechner, farmers wife Reit, near Skt Pantaleon (Austria) 20 „ „ 12 metres of fustian Franz XaverGasteger, ti'adesman Laufen 20 „ „ 5 quires of white paper Max Laumer, bookbinder Laufen 20 „ „ 20 trousers, waistcoats, coats Anton Stangl, clothier Laufen 20 „ „ 3 pairs of shoes Ign. Eisgruber, shoemaker Oberndorf (Austrian Laufen) 21 „ „ 16 kilo of ox-leather Anton Messner, currier Laufen 21 „ „ 5 packets of nails August Edelmann, ironmonger Laufen. 22 „ „ 10 metres of beaver Franz Xaver Gasteger, tradesman Laufen 22 „ n 15 kilo, of tin August Edelmann, ironmonger Laufen 22 „ „ 4% kilo, of flax-yarn Maria Gjerlinger, fanner's wife Oberhaining near lake Absdorf 12% kilo of yarn Theres Jell, farmer's wife Harpfetsham, Lowenau (Tittmoning road 23 „ „ 15 kilo. 700 gm. of calf-skin, Anton Messner, currier Laufen 40 kilo, of shoe-leather, 35 kilo. of welt-leather 25 „ „ 51 pairs of shoes Pet. Eisgruber, shoemaker Uebersee (Chiemsee) 27 .„ „ 210 kilo. 500 gm. of iron August Edelmann, ironmonger Laufen 27 „ „ 10 kilo, of olive oil, 10 kilo, of Fraz X. Gasteger, tradesman | Laufen linseed oil 27 » „ 500 gm. of cinnabar Franz Straussenberger, painter Laufen 27 „ „ 7 kilo, copal varnish, 10 litres of Franz X. Gasteger, tradesman Laufen vinegar, 2 kilo, of gum-arabic, 1 kilo, of nitric acid 27 „ „ 22 trousers, waistcoats and coats Anton Stangl, clothier Laufen 27 „ „ 4 pair of shoes Ign. Eisgruber, shoemaker Oberndorf (Austrian Laufen) 27 „ „ 9 kilo, of yarn Anna Strasser, farmers wife Mayerhofen near Laufen, road to Frey - 77 GOODS AND RAW PRODUCTS ORDERED BY THE INSTITUTION. of raw products ordered by the managers of the prison at Laufen from Oct. Ist to Nov. 30th 1873. DATE ARTICLES NAME OF VENDOR WHENCE DERIVED Day | Month Year 27 Oct. 1873 12 l / t kilo, of yarn . Elisab. Schmelzi, farmer's wife Haarmoosnr.Leobendorf(lakeAbtsdorf) 27 „ „ 19 kilo, of hemp-yarn Franz Wasinger, farmer Salzburghofen 27 „ „ 8% kilo, of hemp-yarn A. M. Buchstetter,' farmer's wife Obereching (Austria) 29 „ „ 12 kilo, of oakum, 1 girth Martin Schellmoser, rope-maker Laufen 29 „ „ 12 kilo, of tow-yarn Georg Arnstorfer, farmer Aglassing'near Oberndorf 29 „ „ 20 % kilo, of yarn Theres Maier, farmer's wife Au (Lowenau) 29 „ „ 24 kilo, of yarn Josephs Esterer, farmer Ringham (Salzburg-Wasserburg road) 30 „ „ 30 kilo, of iron August Edelmann, ironmonger Laufen 31 „ „ 5 kilo, of yarn Elisabeth Barbinger, farmer's wife Gomming, district of Oberndorf 3 Nov. „ 27 kilo. 500 gm. of ox-leather Anton Messner, currier Laufen 3 „ „ 75 kilo, of iron August Edelmann, ironmonger Laufen 3 „ „ 41 trousers, waistcoats, coats Anton Stangl, clothier Laufen 3 „ „ 5 pairs of shoes Ign. Eisgruber, shoemaker Oberndorf (Austrian Laufen) 4 „ ?3 pieces of different woods, 64 Johann Wimmer, carpenter Friedorfing (Tittmoning road) boards for bookbinding, 88 common boards, 10 cherry-tree planks, 3 beech planks, 5 bolts 4 „ „ 17'/, kilo, of yarn Sailors' Hospital Oberndorf (Austrian Laufen) 5 „ „ 41 B/ 2 12. „ „ 1 - - 1 "eatment. 7 Muhlschuster, Peter 17 12. „ „ 1 — — — 1 8 Abtmeier, Georg 67 14. „ „ — f Jan. 16 — — l 9 Putz, Antod. 2 14. „ „ 1 — — — 1 10 Zehentleitner, Josef 11 wks 15. „ „ 1 — — — 1 11 Sebeck, Carl 46 15. „ „ — f Jan. 20 — — l 12 Moser. Crescenz 25 16. „ { gjjjgj; } 1 - - - 1 13 Vockinger, Maria 32 19. „ Cholera 1 — — — 1 14 Schartl, Franziska 54 19. „ „ 1 — 1 15 Ranzinger, Josef 10 wks 22 „ „ | — — I—l 1G Preisinger, Anna 64 23. „ „ |— f Jan. 24 — — 1 17 Koch, Franziska 43 24. „ „ - — I—l belongs to the adjoining pa| rish of Hubreit. Total .. | 8 | 7 | 2 2 15 concluded KOSTLARN, the 2Sth of January 1874. Dr. BrUMer. 95 THE EPIDEMIC OF CHOLERA AT KOSTLARN. This case is iv so far of importance, as it seems to prove the conveyance of cholera from Laufen to another place by a discharged, though healthy prisoner, and to form the only exception to the common rule. At first sight, and considered in the light of the views which still prevail at present on the mode of distribution of infectious diseases, there arises at once a certain probability, that the coincidence between the arrival of Lorenz Brumbauer and the outbreak of cholera at Kostlarn was perhaps no accident after all. Neither individual cases of cholera, nor epidemics appeared anywhere either before or afterwards in the so thickly populated neighbourhood of the market-town of Kostlarn. The epidemic at Kostlarn appeared quite isolated both as regards place and time, and it would be desirable to have some explanatory reason for it. Brumbauer was discharged from the prison at a time, in which attacks of cholera were still occurring, although the principal burst of the storm was already over, and he brought various articles with him. This very much favours the view of the possibility of an influence, which he might have exercised in some way or other. On the other hand this view is opposed by the fact, that a pretty long interval elapsed between the discharge of Brumbauer from Laufen and his arrival in Kostlarn. From Dec. 10th to the 18th makes 8 days. Then Brumbauer had always been well both in the prison and afterwards. His prison history is as follows: No. in Register 2347. Brumbauer, Lorenz, single, cet. 31, butcher. Occupation in the prison: spinner. Workroom No. 57; dormitory No. 97. Duration of imprisonment: 3l3 l / 3 months. State of health on admission: robust. Illness in the prison: nOne. Discharged from prison on Dec. 10th. It is therefore necessary, not only to trace out exactly his course from Laufen to Kostlarn, but also minutely to investigate his communications in Kostlarn, Brumbauer himself could no more be examined on the subject, for at the time, when this had become of interest, he had already taken himself off, and his place of abode could no more be ascertained. Sufficient facts have however been gleaned in the course of the investigation to give a correct idea on this question. It is quite certain that he re-appeared in Altotting on the 12th of December, where he came to his former master Georg Leibenger, and wished to be again in his service. Leibinger declared on affidavit on Jan. 12th: ?The journeyman butcher, Lorenz Brumbauer of Thanham in the district of Griesbach, was in my service before he went to Laufen to undergo his sentence. On the 12th of last month he arrived at mine from there, and remained till the following day. Where he passed the night on the 10th and 11th, before he came to me, I do no>t know, nor whether he came to me on foot or by coach. He had only those articles of dress with him, which he wore on his body. He passed the night at mine in a journeyman's bed. He went off again on Dec. 13th, because I did not take him into my employ again, and the district-officer also objected to his stopping. Where he took himself to, and what became of him afterwards, I do not know, as I have heard nothing more of him. Disinfection was carried out in my dwelling according to official directions, and nobody has been attacked with cholera or choleroid symptoms." The district-officer at Alfcotting remarks in addition, that Brumbauer had been directed to the district officer at Griesbach, where he probably also presented himself. The documents reveal nothing on this head. I considered it most important to make inquiries in Kostlarn itself about Brumbauer, who at all events after the outbreak of the epidemic must have become an interesting personage there. I applied therefore by letter in May 1874 to Herr Stofl, the mayor of Kostlarn, whose circumspection and trustworthiness were known to me from the reports of the district-surgeon and Dr. Brunner. Herr Stofl sent me the following communication dated May 15th 1874: 96 THE EPIDEMIC OF CHOLERA AT KOSTLARN. ?As far as can be ascertained, Brumbauer took the road to Altotting and Rotthalmunster; he is said to have stopped in Munich and Altotting*), but this statement cannot be verified, as Brumbauer has long been absent again from here. Brumbauer arrived here on Dec. 19th, and passed the night a^ Gruber's inn. He wore some of the clothes he brought with him from the prison at Laufen, whilst the rest were sent on here to Gruber's the next day in a carpet-bag from Rotthalmunster, where he passed the night at Ostermayer's inn. Brumbauer stayed from Dec. 20th to Jan. 4th 1874 at his mother's and his cousin's in Leiten (1( 1 / 2 hour's walk from Kostlarn), who both live in the same house, dined at his mother's, 65 years old, and slept during the night at his cousin's, 66 years old, in on* and the same bed. There were besides in this house his cousin's wife, Maria, 59 years old, and his mother's sister, Maria Brumbauer, 64 years old. Brumbauer was constantly in their society, without one of them being taken ill. ?Brumbauer came daily from Leiten to Kostlarn, and associated with various acquaintances in the public-houses. On Jan. 4th Brumbauer removed his quarters to Kostlarn, and took lodgings at Georg Still's, labourer, 40 years old. There were also living there Maria the wife of Stiedl, oct. 43, and their boy cet. 9. Brumbauer was also in the society of these persons until Jan. 15th, without one of them being attacked. At the same time he renewed his visits to the public-houses, especially that kept by Kopfhammer, where he stopped half a day at a time, often drinking out of the same glass with his friends, without one of them being the worse for it. n On the 15th of January Brumbauer left here for Simbach on the Inn, it is said. He wore the clothes and linen he had brought with him during his residence in Leiten and Kostlarn, had them washed by the hospital laundress, a woman a little more than 60 years old, without her being attacked. No symptoms of choleja appeared in Leiten and Thanham. „ According to the statement of Benedikt Schiedlmeier, publican, and his wife Margarethe, Angerer (the first case of cholera at Kostlarn) played cards with Brumbauer for about an hour 2 or 3 days before his death. It is not asserted that he drank with Brumbauer on the evening of the 7th (Angerer was attacked with cholera on this evening), and the fact is positively denied by Angerer's widow. No case of cholera is known to have occurred after Jan. 24th." — Such is the report of a thoroughly impartial man! After this series of indubitable facts, I have at length abandoned the idea of there still being any connexion between the arrival of Brumbauer and the epidemic of cholera at Kostlarn, although at first one circumstance repeatedly tempted me to think so. Sixteen, namely, of the 1 7 cases of cholera which occurred, affected inhabitants of the narrowly circumscribed cholera district, or such as had been visitors in the houses there. A single case forms an exception, Peter Miihlschuster, No. 7 on the list, who was attacked with choleraic diarrhoea on Jan. 12th, which quickly terminated in recovery. This young man worked as journeyman at a shoemaker's in the more elevated part of the hamlet, in a house, where no one else fell ill, and slept at his parents' house, which like that oi Franziska Koch, the sister of Michael Koch, who nursed the sick and laid out the bodies in the infected houses, was situated outside the cholera district, and in which also no one else was attacked ; but Muhlschuster had resoled a pair of boots for Brumbauer, about which however I could not find out, whether they had been brought over from Laufen or were another pair. Muhlschuster was the only one of all the persons affected with choleroid disease, who had never come in contact with the cholera localities or persons out of them. The coincidence however of the choleraic diarrhoea of this journeyman shoemaker and the soling of Brumbauer's boots seems to me now just as accidental, as the coincidence of the pump in the low-lying cholera districts of Kastlarn with the immunity of the more elevated part of the hamlet with its iron reservoir, into which an abundant supply of good water is poured, conducted thither from a spot half an hour's walk distant, and at a cost of 12000 Florins. *) Brumbauer seems to have gone from Laufen to Freilassing, and by railway to Altotting via Munich, which ¦would exactly fill up the time, till he came to Leibingers' inn. Ed. 97 THE EPIDEMIC OF CHOLERA AT KOSTLARN. All adherents of the drinking-water theory will indeed claim this case to be one in their favour and ask in astonishment, if not in positive indignation, how I can venture to make such a bold and arbitrary assertion, but I have a reason for it. This drinking-water conduit has only existed about three years. In the year 1865, when these water-works were not yet in existence, the market-town of Kostlam had a violent epidemic of Typhoid, according to the statement of Dr. Stommer the district-surgeon, 56 cases which, like the cases of cholera on this occasion, were limited essentially to the low-lying part of the town. Munich had also a very violent epidemic of typhoid in the winter of 1865 — 66, and the coincidence of the winter epidemics of cholera «n Kostlarn and Munich in 1873 — 74 has much more weight with me, than the one hour's game at cards of the strolling prisoner Lorenz Brumbauer with the consumptive Josef Angerer, and the intercourse of the former with the boot-soling Peter Miihlschuster. I prefer therefore to pass over these trifles, although they would have been very convenient for me at the time to enable me to give a contagionistic explanation, than to give up great general points of view, which are calculated to lead us further, and have already conducted us to some fixed principles. And therefore the mighty and terrible outbreak of cholera in the prison at Laufen turns out to be a local event sharply circumscribed in all directions. The great focus of infection, which had been formed there, has not become a centre of infection to other places which kept up a manifold intercourse with it; it cannot therefore be compared to a vegetable unit, which supplies all the environs with seeds, but rather to a volcano, the liquid lava of which hardly pursues its devastating career to its foot, whilst the cinders, often hurled far and wide from its glowing mouth, fall down in other places, without kindling or forming new craters. Such outbreaks of cholera have often been called explosions, and are also comparable to loaded mines, seeing that they can indeed be made to flare up by means of human intercourse, by persons coming from cholera districts, bringing with them a still glowing ember from there; but what, strictly speaking, makes a locality a cholera locality, is no more brought there by human intercourse, than the power of gunpowder is located in a piece of touch-wood. The burning touch-wood in a gun without powder is a perfectly harmless thing. If we only learn the lesson from the catastrophe at Laufen, that the ravages which cholera causes, are much more dependent on the locality, than on the introduction of the cholera-germ, then the 83 prisoners who died out of 500, have not been sacrificed in vain. Science and practise will then soon take another direction, in which they will more quickly arrive at better and more definite results, than has hitherto been the case. In India, the home of cholera, the view has recently been gaining ground, that the power of cholera is not dependent on intercourse, but on local and personal circumstances, upon which man has it in his power to exercise some influence. One of the most recent reports on cholera there, unlike previous ones, in which great stress was laid upon measures for isolation and disinfection, proves a very essential decrease of cholera cases in those very Indian prisons which were formerly the hot-bed of the disease. According to Cuningham's communications, 300 deaths from cholera occurred annually between 1860 — 7 among the prison-population of Upper India, comprising an average of 15000 souls, i. c. 20 per thousand; in the epidemics which have occurred there since 1867 uot more than 162 have died annually out of an average prison-population of 17000, making 3 per thousand. This decline, indeed a comparatively still greater one, has manifested itself also in the prisons of the Madras Presidency, where the cholera occurs still more frequently than in Northern India. According to the computations of Dr. Cornish the average number of deaths per annum from cholera among the *) Report on the Cholera Epidemic of 1872 in Northern India, by J. M. Cuningham M. D. Surgeon Major, Sanitary Commissioner with the Government of India. Calcutta. 1873. 98 HISTORY OF CHOLERA IN LAUFEN AND ITS ENVIRONS prison population of the Madras Presidency before 1867 was 23 per thousand, since 1867 it has been l'/a per thousand. Since 1867 not only have sanitary improvements of various kinds been carried out in the Indian prisons, but movement i. c. the abandonment of the infected spot has also taken the place of the quarantine, isolatiou and disinfection system on the outbreak of cholera. The same principle is now also practically introduced into the Indian army, so far as military exigencies allow it, and even here a material improvement is making itself perceptible. In building barracks, not only is the place chosen with a view to the greatest possible immunity from cholera, but a place, a station, is also fixed upon beforehand for every garrison, to which they can remove on the breaking out of cholera, in which migrations even the patients are taken with them as a rule. It is seldom, that a great number of cases of cholera continue to occur among troops who have moved off at It is not my present task, to discuss preventive measures, but I have one or two matters to communicate, relative to the history of the cholera in the town of Laufen, in order to entirely fulfil my immediate task, the investigation of the outbreak of cholera in the prison. SUPPLEMENTARY HISTORY OF CHOLERA IN THE TOWN OF LAUFEN AND ITS ENVIRONS. The representation of the outbreak of cholera in the prison at Laufen would not be complete, if I left unmentioned its liability to cholera in former years, and especially those events having a relation to cholera which preceded the outbreak ; they seem to me indeed to be of capital importance from an etiological point of view. The first epidemic which visited Bavaria in the year 1836, left Laufen and its immediate neighbourhood quite unaffected; the nearest cholera district to Laufen at that time was Oltotting and Neuotting on the Inn, where 14 attacks and 8 deaths occurred among about 3200 inhabitants. In the year 1854, in which Munich and numerous places in Upper Bavaria had epidemics of cholera, one sporadic case of cholera occurred in Laufen on Aug. 24th, which terminated fatally, but gave rise to no further cases. — No other cases appeared at that time in the district. Neuotting on the Inn was again the nearest cholera district, where 43 attacks and 24 deaths from cholera occurred in a very sharply defined part of the town between Nov. sth 1854 and Jan. 10th 1855. The cholera seasons in Oetting seem to differ regularly from those in Munich. The cases of cholera in Oetting in 1836 happened betwen Aug. 22nd and Sept. 291h, were therefore materially in advance of the epidemic in Munich, which did not begin there till November, and reached its height in December: on the contrary it was the reverse in 1854, then Munich had an epidemic, which reached its culminating point at the end of August and then declined, so that it was already pronounced to be extinct in November, when the cholera first began in Oetting. The prison at Laufen has existed as such since the year 1863. The year of war, 1866, which counted numerous and violent epidemics of Cholera in Austria, in North Germany, on the Rhine, and in Belgium, left the whole Swabian and Bavarian table-land on the right of the Danube entirely free from cholera, in spite of active intercourse with the theatre of the war through the medium of the hospitals for [continuation of the Mxt at p. 102.], 99 HISTORY OF CHOLERA IN LAUFEN AND ITS ENVIRONS. LIST OF THE CASES OP CHOLERA which occurred at Salzburg between August 15th 1870 and October 25th 1873. (20,336 inhabitants — 1,012 inhabited houses at the last census.) ! 2 3 4 5678 9 10 Jl ~S~^~ „ POSITION DWELLING |g Whether the SU RNAME g | or d d 6 y<3 + + -1-^ patient came TRADE * PLACE from any other — — — of of .REMARKS rua.\jn hnnsp - a "8 j,« of the patient No.ofhou B e, pl aC e, and if * Attack Death Story) 6ri so, when "3 1 6 zr^ I g & I - 1 Salzburg fester. Hof — arrived Bohm m. -40 Baker, mar- Aug. 13 Aug. 17 Hotel . from Vienna, ™d Aug. 14 2 „ Hotel — arrived Bell —f. 55 Widow Aug. 14 Aug. 16 de TEurope from Munich, Aug. 14 3 363 Getreide- 143 — Henneberger m. —56 Aug. 27 Aug. 27 363 Getreide-Gasse, so- Gasse called Kronhaus, a 3rd floor building crowded with elderly reduced individuals. Large pig-sty belonging to butcher Steil. 2 large cess-pools wooden privy receptacles. 4 n — Weibhauser m. —63 „ Aug. 28 Aug. 29 The house stands in almost the lowest-lying part of the town, a few yards from the Salzach, the threshold of the buildin g to wardsGries- Gasse 1° 3' 0" above the level of the Salzach. The house has 3 stories, dwellings on both sides of the passages. Great want of cleanliness. . Drinking-water from the town water-works. 5 „ „ „ Schmid —f. 77 Aug. 29 Aug. 29 6 „ „ „ — Mauer- —f. 38 Maid-servant, Aug. 30 Aug. 30 kirchner single 7 „ 44 Gold-Gasse 36 - Henneberger —f. 48 single Aug. 27 Aug. 30 Cess-pool. Gold-Gasse lies low. Visited her brother who had cholera. 8 „ Maxplan — came from Max- Gluck m. —24 Servant, Sept. 3 — Discharged cured Sept. n ίabenbauer" plan, Sept. 3 single 12th. Employed by scavenger, who also empties the cess-pools in the hospital. 9 „ Linzer-Gasse 23 — Gmachl m. —32 Butcher, Sept. 3 — Discharged cured Sept. n Mondschein" single 7th. 10 „ 363 Getreide- 143 — Frauenlob m. —63 Sept. 3 Sept. 6 Gasse 11 „ Linzer-Gasse — arrived Lauer m. —53 Manufacturer Sept. 3 Sept. 4 ?Gablerbrau a from Vienna, married Sept. 3 12 „ 31 Miillner- 5 — . Schnell —f. 42 Cook, single Sept. 7 — Discharged cured Sept. Haupt-Strasse 11th. 13 „ 140 Kai-Gasse 42 Gatterer m. —55 Servant, Sept. 18 — Discharged cured Oct. 3rd floor single 19th. 14 „ Hagenau near — came from Merks m. —28 Hodman at Sept. 19 Sept. 24 Bergheim Hagenau, water-works, Sept. 19 single 15 „ Linz — came from Somonini m. —66 Green-grocer, Sept. 22 — Discharged cured Sept. n Traube" Linzer-Gasse married 30th. Sept. 22 16 „ Geigl near — came from Korn m. -36 Miller's man, Sept. 25 — Discharged cured Oct. Salzburg Geigl single 7th. 100 HISTORY OF CHOLERA IN LAUFEN AND ITS ENVIRONS. [continuation,] LIST OF THE CASES OF CHOLERA which occurred at Salzburg between August 15th 1870 and October 25th 1873. (20,336 inhabitants — 1,012 inhabited houses at the last census.) 1 2 3 4 5 678 9 10 11 DWELLING If Whether the SURNAME g § P ° S ™° N o (Street, '4* P^nt came - « TRADE Day Uay X PLACE .. \ . H 2 from any other — — — o f of REMARKS No. of house, -J place, and if of the patient Story) ° 6 * so , when « ||. " Attack Death 17 Salzburg Glasenbach — came from Hofer —f. 62 Widow of Oct. 9 Oct. 10 Glasenbach water-man 18 „ 129Kai-Gasse 98? — Walter -f. 28 Maid-servant, Oct. 14 — Discharged cured Oct. Frohnveste ' single 25th. 19 „ 35 Gold-Gasse 75 — Muller m. — j24 Brick-maker, Oct. 14 — Discharged cured Oct. single 20th. Cess-pool, butcherDaghofer's slaughter-house. LIST OF THE CASES OF CHOLERA which occurred in Salzburg from February Ist 1874 to March Bth 1874. 1 Salzburg St. Rott — arrived from the Reuer —f. 31 Working- Feb. 1 Feb. 4 lln the 9th month of Rott (Bay. woman, pregnancy frontier) Feb. 2 single 2 „ St. John's about — Griinwald —f. 69 Single „ 6 „ 7 Had been in the mcdi- Hospital, 2nd 200 cal department for floor muscular rheumatism since Jan. 31st, and lay next the woman Reuer who had cholera. 3 „ „ „ — Holzer —f. 65 Maid-servant, „ 12 „ 13 Had been in the medisingle cal department since Nov. 10th with heartdisease and hemiplegia, was in the same room as the two preceding patients, but on the opposite side. 4' „ „ „ — Koberger —f . 8 Foundling „12 — Discharged cured March 6th, had been in the medical department sinoe Feb.6th for gastric catarrh and was placed in another room. 5 „ 43 Stein-Gasse „ — Kraus m. —32 Painter, „ 9 — Discharged cured Feb. single . 14th. 6 „ 30 Stein-Gasse „ — Oberhuber —f. 48 Wife of „ 9 — Discharged cured March painter 7th The house has a drain which opens into the main - drain in Stein- Gasse, the latter discharges its contents into the Gersbach. A porter out of the same house died of cholera at Reichenhall on Feb. 23rd. 7 „ Rainberg 6 — Schwab m. —32 Waggoner, „ 21 Feb. 23 Wooden shed, stable • single for 6 horses, in which patient also slept. Cess-pool. 8 „ St. John's „ — Weber m. —60 Bricklayer, „23 „24 :Had been in the mcdi- Hospital, 2nd single I cal department since floor Jan. 26th for cardiac disease, slept in a bed adjoining that of the attendant. 9 „ Ditto, ground- „ — Fischwenger —f. 45 Laundress, „26 — Discharged cured March floor single 15th. 101 IHISTORY OF CHOLERA IN LAUFEN AND ITS EVIRONS. the sick and wounded established in Munich and other places. The adjacent part oi Austria, to which Salzburg and the places on the right bank of the Salzach lower down the stream belong, enjoyed the same immunity at that time. — Salzburg must besides be enumerated among those towns, which have hitherto shown themselves exempt from cholera, which is remarkable considering the active intercourse kept up with it by strangers and the circumstance, that the town is frequently sought out just at cholera seasons by persons flying from cholera, some of whom are always attacked in their place of refuge, but invariably without causing an epidemic. Salzburg has also no inconsiderable garrison, and the circumstances connected therewith are likewise considered well calculated to introduce and disseminate cholera in a place. Salzburg was however in great danger of losing its reputation for constant immunity during the recent epidemic, and that on two occasions, the first time in August 1873, the other time in February 1874. From Aug. 13th to Oct. 14th 1873 there occurred 19 cases of cholera in Salzburg, only 8 of which were introduced from without, 1 1 of which therefore had arisen in the town itself, most of them (5) in a poor quarter. Between Feb. Ist to Oct. 14th 1874 the disease again elevated its head and caused 9 attacks, a single one of which may be classed with imported cases. On this occasion several patients of St. John's Hospital (1 male and 5 females) were attacked. It is believed that the first patient had brought the cholera with her from without. The tables kindly sent me by Dr. Minnigerode are given in the two preceding pages. On both occasions when traces of cholera appeared in Salzburg, they were also remarked in the neighbouring watering-place Reichenhall, where some cases in August produced great alarm among the visitors. But no epidemic propagation resulted either in Salzburg or in Reichenhall in this year, so that the immunity of both towns remains not only unshaken, but has been verified anew. Strange to say the district in the valley of the Inn in the immediate vicinity of Laufen, Altotting and Neuotting, which had shown signs of epidemic dissemination in each of the two preceding cholera periods, did not manifest any susceptibility for cholera in this recent cholera period, although a railway from Munich to Oetting had arisen in the meantime since 1854, and several of the prisoners discharged from the prison at Laufen during the epidemic had passed through these two places. The germ was undoubtedly brought to Oetting through the active intercourse with Munich and Vienna both during the summer and winter epidemics, but seems to have found no place this time for its further development. In the same manner however the town of Laufen and the district presented the very opposite state of things in 1873 to that which obtained in the years 1836 and 1854. Two house epidemics occurred in two villages of the district, in Gerspoint and Surrheim, on the road along the left bank of the Salzach between Salzburg and Laufen, between Sept. 26th and Oct. 11th, occasioning 5 deaths from cholera in Gerspoint, and 3 in Surrheim, without local epidemics being developed. The same thing happened in Oberndorf (Austrian Laufen) on the other bank of the Salzach, where 3 cases of cholera occurred in one house (Billerhardt the tanner) in the beginning of October, 2 of which ended fatally, without the malady being disseminated any further there either. Several suspicious cases of diarrhoea occurred at the same time in the parish of Salzburghofen. (I derive these facts from the reports of Dr. Loder and Dr. Berr of Laufen, and Dr. Rosner of Oedhof.) — What however deserves the greatest attention in deciding on the etiology of the prison epidemic, is the fact, that pretty much at the same tune, (only about a week earlier), as the house-epidemics appeared at Gerspoint, Surrheim and Oberndorf, the same thing happened in a number of houses in the two snburbs of Laufen, viz, Obslaufen and Villern. Ten cases of cholera occurred there between Sept. 16th and Oct. Bth, and 1 case of choleraic diarrhoea at Meyerhofen, Bof which cases ended fatally. Dr. Berr has also minutely investigated and described this little local epidemic, having himself treated almost all the cases. An introduction of the malady from without through the medium of patients could not be detected in spite of all the researches. The investigations as to there being any personal connexion between this little epidemic 102 HISTORY OF CHOLERA IN LAUFEN AND ITS ENVIRONS. in the suburb and the subsequent great epidemic in the prison in December turned out equally unsuccessful. What, however, the houses attacked at Obslaufen and Villern had in common with the prison, is their local situation. (See plan of the place.) The Salzburg road runs parallel with the river near a slight eminence, passes through the places Villern and Obslaufen, dividing them into a more elevated portion towards the west, and a more low-lying portion declining towards the Salzach on the east. The cholera in Villern and Obslaufen appeared only in houses on the eastern slope between the road and the river. The difference in height between the road and the river, according to measurements made in several places, amounts to between 9 and 14 metres Three houses and an adjoining house in Villern were affected with cholera, and 3 houses also in Obslaufen. The affected houses were everywhere close to each other. The prison at Laufen is also placed on this eastern declivity, with this single difference in situation, that a protecting wall, — 14 metres high from the level of the river to that of the road, — rises up on the spot where the prison stands, and the slope between the base of this wall and the road is artificially filled up, so that the prison seems to be placed on a level plain bounded by a perpendicular wall rising up from the margin of the river, whilst the houses in the suburb stand on a steep decline. If the parts of Obslaufen and Villern, where these cholera-houses are situated, had protecting walls reaching up to the level of the road, and if the intervening ground were filled up there also, their situation would appear quite identical with that of the prison. These 10 cases of cholera and deaths in the suburb of Laufen among cottagers, boatmen and poor people, and their remarkable local limitation have certainly the same etiological significance as the 125 cases of cholera and 83 deaths in the prison. The affected houses comprised 40 inhabitants altogether. Consequently 25 per cent of these were attacked and 20 per cent died of cholera, while 24 per cent of the 522 prisoners were attacked and 16 per cent died of cholera. The cholera which affected these houses in Obslaufen and Villern towards the end of September and in the beginning of October, invaded their immediate neighbourhood and the town itself just as little as the epidemic in the prison in December had done, and the only essential difference between these 3 different parts of Laufen attacked by cholera is in the time of the outbreak of the malady. The course of the malady was equally rapid everywhere, these house-epidemics were everywhere extinct in a remarkably short time, which was also the case with the house-epidemics at Gerspoint and Surrheim, as well as with those at Salzburg. The outbreak of cholera in the prison presents therefore no specific difference from the other outbreaks in Laufen and its environs, it has only caused much more sensation than the other local explosions, and is far better adapted for etiological study than the former. The Cholera Commission of the German Empire could not therefore neglect anything that might contribute to put it in possession of all the facts in the most comprehensive form. Such an unusually violent outbreak of cholera in a large building, inhabited by such a number of men, living in almost exactly the same circumstances, is, as the history of cholera teaches, a very rare event in Europe, that will not soon recur. The commission were therefore certainly justified in every respect in betaking themselves to the place itself, and claiming the co-operation of public bodies and persons in the attainment of their object, which also was always willingly afforded them. At the request of the Imperial Chancellor and the Cholera Commission, I now publish these facts, without first drawing any definite conclusions from them, which I had better postpone, till I have also discussed the occurrence of cholera in three other Bavarian prisons, in the penal work-house at Rebdorf, and in the prisons at Wasserburg and Lichtenau. The* case at Laufen seems to me to take rank as a typical case, it is a true classical example, a cabinet-piece for the study of the etiology of cholera, and during my long labour a feeling often consoled 103 METEOROLOGICAL REMARKS. me akin to that which palaeontologists may here and there experience, when after having found individual parts of some interesting antediluvian animal in different places, here in one stratum a vertebra or pelvic bone, then again elsewhere a scapula or a foot, again somewhere else a tolerably well-preserved skull-bone, they suddenly find a large and complete skeleton, may be, lying also in a corner of the earth unknown and remote as the little town of Laufen, or in a stratum, as despicable, as the stratum of human society, which is deposited in a prison. My next task will be to extricate the skeleton with the greatest possible care, without breaking much, erect it in its anatomical nakedness, and replace none of the still absent pieces by my fancy. How far I have succeeded, let professionalists decide, whom I here urgently invite to the study of the object. METEOROLOGICAL REMARKS. I have introduced this subject with some notes on the course of the cholera in Munich, and appended a chart, drawn up partly by Dr. Port, partly by Dr. Wolff hiigel, and on which, besides the numerical frequency of cholera, there is also to be seen the movement of the ground-water in Munich, the temperature and pressure of the air, as well as the amount of atmospheric deposit on every day fr6m June 1873 to May 1874. The influence of the seasons on the occurrence of cholera is a fact at least as certainly demonstrated in India, the home of cholera, as well as in extra-Indian districts and with us in Europe, as the influence of communication. As however the idea of season is of a somewhat complex character, it is necessary to examine in what the observed influence actually consists. It is customary to regard the temperature of the air as the influential principle, because epidemics are most frequent and violent in summer and autumn. The course of the last cholera epidemic in Munich and Laufen has sufficiently shown, however, that there are very important exceptions to this rule. We cannot then look for any special progress in our knowledge of causes, if we rely solely on this agency, the temperature, and are obliged therefore to take other agencies into the circle of our considerations. I will certainly not anticipate considerations and conclusions from another quarter, but only incite thereto, when I confess here, that the undisputed influence of the seasons on the frequency of cholera in and out of India seems to me to depend principally upon the effect of atmospheric deposits upon the soil, especially upon the amount of water and humidity in different strata, which is most distinctly evidenced in some specially favourable places by the height and movement of the ground-water. In some places this influence, especially as regards typhoid fever, the mode of dissemination of which has much resemblance to that of cholera, has been already demonstrated in such a manner and during such a period, that it is much more probable than most of the formerly accepted causes of such-like disease, and that there is certainly no longer any danger in turning back, if we would make further researches in this direction. For this reason the movement of the ground-water, as observed in three different parts of Munich, is found represented directly under the numerical frequency of cholera in the above-mentioned chart of Munich, one part (Physiological Institute) situated in the south, the other (Oberwiesenfeld) in the west, and the third (Polytechnicum) in the north of the town on the left bank of the river. In the first place the observations were made daily by me or my assistants, in the second place by Staff-surgeon Dr. Port at intervals of a few days, and in the third place a self-registering water-mark has been contrived by Dr. yon Bauernfeind, the director, the watch-work of which marks the height of the ground- water every two 104 METEOROLOGICAL REMARKS. hours, the daily mean being deduced from these observations. This apparatus was under repair for some time on account of a broken chain, hence the interruption to be seen in the curve. It would certainly be of great interest now, to represent the same meteorological dates and the height of the ground-water in Laufen also, — but the needful machinery is wanting for this purpose, there exifts no meteorological station in Laufen, the observations at which could betoken the rhythm of atmospheric appearances for a somewhat long period, nor are observations of the ground- water made there. The ground-water in Laufen is riot at all adapted for the latter, as its level assimilates too much that of the river, and its height is too much influenced by the damming up action of the river. In Laufen therefore, as in many other places, the sole criterion for determining the changes in the humidity of the ground, which are so distinctly expressed in Munich by the level of the wells lying above the damming up influence of the Isar, are the varying amounts of atmospheric deposit. It is a fact well known to all meteorologists, that the amount of rain-fall increases in the same latitude as we approach a high mountain, and for this reason it may be assumed that the amount of rain in Laufen will be somewhat larger than in Munich, in proportion as the former is nearer to the Alps than the latter. Dr. Rudolf Spangler, who keeps a chemist's shop in Salzburg, and who has gained some merit as a hygienist in his native town, was so kind as to inform me of the amount of rain, and the height of the river and ground-water in Salzburg, inclosing also a treatise by Fritsch on the periodicity of the water-level of the Salzach. An approximate calculation for Laufen can be made by comparing the amount of rain-fall in Munich and Salzburg: Munich exhibits 357.15 Paris lines = 803 millimetres of rain, as the mean of 17 years' observation, Salzburg 492.89 Paris lines = 1109 millimetres in the year as the mean of 14 years' observation, consequently about 38 per cent more than Munich. Laufen may perhaps have 15 to 20 per cent more rain-fall on an average than Munich. I had however au opportunity only a short time ago of convincing myself most positively that it is impracticable to assume the amounts of rain-fall to be essentially equal even in places lying near each other and equally distant from the mountains, or for example to deduce the rain-fall at Laufen from that «t Salzburg or Munich. Munich is situated in the valley of the Isar at the same distance from the mountains, as Augsburg in the valley of the Lech, and both cities are not 42 English miles distant from each other in a straight line. The average rain-fall at Munich and Augsburg does not essentially differ, when extended over long periods of time, but such great differences obtain in individual years and seasons, as I had not expected. The proof thereof can be taken from the following table, in which the amounts of rain observed at the two meteorological stations are compared. Monthly Rainfall in Millimetres *) in Munich Augsburg January 1873 ... 6.7 ~~2hT February 51.0 123.6 March 32.6 107.1 April 53.8 97 0 May 122.5 120.2 June 132.1 169.4 July 74.9 94.0 August 171.9 50.6 September 66.0 64.2 October 50.8 78.3 November 32.5 100.6 December 11.9 23.9 January 1874 ... 14.6 60.2 February 22.4 56.5 March 28.4 85.G April 71.8 76.3 May 145.5 117.5 - *) Remark. In order to convert millimetres into Paris lines, divide the number of millimetres by 2.2; 105 METEOROLOGICAL REMARKS. Augsburg had therefore 31 per cent more rainfall than Munich in the year 1873, consequently bore exactly the same relation to Munich this year as Salzburg does on an average. I am very much inclined to assume, that the remarkable and constant immunity from cholera of towns, like Salzburg and Insbruck, which are situated in the valleys of rivers on common alluvial soil, but among mountains, as Munich is situated on the table-land lying in front of the mountains, is solely due to the state of the ground- water and the amount of rain-fall, from which all the ground- water proceeds. The soil of Munich does not differ materially from that of Salzburg, with the exception of individual parts of the latter town, which stand on solid rock, Salzach pebbles and Isar pebbles being very similar; on the contrary the amount of rain-fall at Munich is very different from that at; Salzburg. The immunity of Augsburg in the year 1873 in contrast to the epidemic at Munich, and the violent epidemic at Augsburg in the year 1854, simultaneous with that at Munich, seem also to me much more naturally explained by the different amounts of rain-fall in the two places and in the two years, than by any difference in the measures resorted to in both towns. The people of Augsburg congratulated themselves, it is true, upon having saved the town; it often happens that men ascribe to themselves as a merit, what heaven has done for them. I shall speak more fully in another place of the immunity of Augsburg in the year 1873. This temporary agent seems to me to have been not less the cause, why the cholera which began to germinate at Munich in August, was suddenly arrested in its development, and declined till it became extinct, to break out again in the cold season only after long-continued drought, and to last until the spring of- 1874. I only mention here these relations of Munich and Augsburg, to which I shall revert more at length on another occasion, and have also added this appendix on the defective meteorology of Laufen, only to draw the attention of all professional men to the fact that in future the medico-etiological investigation of certain epidemics can no longer make progress, without taking meteorological influences into consideration; but that the amount of rain-fall, and at the same time the nature of the soil and climate, must be examined more attentively and exactly, than has hitherto been the case. I find myself, as regards this view, in harmony with the conclusions of the recent international sanitary conference at Vienna, which unanimously accepted a motion to this effect. * Printed by R. BOLL. BERLIN. 106 JTMI ~*y Jo7i JGises.XmiA.. frmrav^aL 3v */os- *f&?z~ r Flan If Lith. hy- Jdk. Moists Min.rf'trr. Flan 11. GROUND PLAN OF THE 3 rd. FLOOR. . - ¦ . PRISON AT MAIN BUILDING. Xiik. ly. Joh. Moists Munckai MUNICH