AT F TT T? T) TO THK CONSULTING PHYSICIANS OF BOSTON. A LETTER CONSULTING PHYSICIANS OF BOSTON, WILLIAM READ, M. D., CITY PHYSICIAN. BOSTON: PRINTED BY ALFRED MUDGE & SON, 34 SCHOOL STREET. 1 866. TO JOHN JEFFRIES, M. D., WINSLOW LEWIS, M. D., HENRY G. CLARK, M. D., D. HUMPHREYS STORER, M. D., C. E. BUCKINGHAM, M. D., Consulting Physicians of the City of Boston. Gentlemen : In a communication to the Board of Health, made on the 27th of January last (City Doc. No. 21), I had the honor to state that, owing to evidence other than that of which I was cognizant when I previously reported on the subject of cholera, in the autumn of last year (City Doc. No. 73, 1865), I had been obliged to change my views on the nature of the disease. The subject appeared to me of so grave importance, and so fraught with momentous consequences to the health, happiness and pecuniary interests of the citizens at large, that I felt it to be my duty to exhibit as fully and honestly as my opportunities afforded the means, the reasons for my change of opinion. In a communication recently addressed to the city authorities (City Doc. No. 66, 1866), you have taken exception to this opinion. Had the terms in which you expressed your views been such as are usually adopted in the discussion of scientific subjects, I should have remained silent ; content to leave the decision to the future, with the firm conviction that the irresistible tide of facts, rising higher and higher with each arrival from the regions where cholera has prevailed, would either carry you to better and firmer ground, or sweep you into that ocean of obscurity whence those who sail without chart or compass never emerge. But the extraordinary course you have taken, by introducing matters purely personal to myself, leaves me no alternative as to the nature of my reply. I find myself arraigned at the self-constituted bar of your own peculiar ideas, upon the charges of being suddenly recusant in opinion, and as influencing the Board of Health of this city to a course detrimental to " the health, happiness and pecuniary interests of the citizens at large." Gentlemen, this is no light charge. My sudden change of opinion, which you mention with "regret," was in reality the result of patient investigation and considerable time ; and, gentlemen, some of you at least, may remember that it was announced at a meeting of the profession 6 previous to its being promulgated in my official communication to the Board of Health. From that time till the appearance of your communication, although offering every inducement for a free discussion before my peers, of the strength or weakness of my position, you have not availed yourselves of any opportunity to prove me in error, but have finally appealed to a tribunal, which, although perfectly competent to judge of matters pertaining to the administration of city affairs, is necessarily not expert in a purely professional discussion, and for that reason more liable to accept assertion for proof, and prejudices for well settled opinions. What was my duty? With evidence before me, which, if true, was of the utmost importance in its relation to the safety of this whole community, should I have been doing right in suppressing all discussion lest the amour propre of a few individuals should be offended ? Was I not bound by every consideration to set forth that evidence as fully and completely as my means at command afforded opportunity ? It is certainly a most remarkable confession from gentlemen educated and learned in the science and art of medicine, that a change of opinion is a source of regret. I need not remind you, gentlemen, that the history of our noble profession is one of constant changes in this respect. As investigations conducted under more favorable auspices go on, new truths appear, old errors are discarded, and a general progress of the whole science is the result ; and by none, probably, more than by yourselves, gentlemen, would the assertion that you maintained the same opinions and treated disease on the same principles that your forefathers did, be more indignantly scorned. The time has long since gone by, when the oracular assertion of any man or set of men, unsupported by credible evidence, will be accepted as law in proportion to the dignity or the position of those who thus dogmatize. I am aware, gentlemen, that in my own communication I did perhaps bring forward more of the evidence than was necessary to convince any candid mind that there is in Asiatic Cholera a peculiar element of communicability, of portability, contagion, or call it by what term you will, which gives it a property and power of extending from one individual to another, by some sort of material conveyance. But viewed in the light of its relation to humanity, in that phase of its nature which makes it the scourge of our race in every country where it prevails, can any array of facts relating 7 to it be too " extended " ? Surely the community, the custodian of whose welfare I was, would have had a right to complain, if from any motives I had failed in this respect. But, waiving any further discussion of matters personal to myself, and which has been forced on me by the tenor of your letter, I proceed to an examination of your statements ; and if, upon a careful and attentive perusal, I find no facts adduced to sustain your - position ; a complete ignoring of all that has been put on record, from whatever source or of whatever credibility, to substitute in place of it your own prejudices ; nor anything besides a rehash of arguments which have been often brought before the profession, to be as often exposed because of their sophistic speciousness ; of assertions which are not only unfounded in fact, but which have been repeatedly disproved in a manner so public, that it seems hardly possible that it should not have been brought to the notice of every member of the profession who reads ; I am sure that it is owing rather to the inherent weakness of your case, to the real absence of any evidence in your favor, than to any lack of ability on the part of the eminent gentlemen who compose the board of consulting physicians of the city of Boston. You say : " No change on this point has taken place in the mind of any member of the Board since the report of Nov. 11, 1865, unless it be that the opinion there expressed is more fully confirmed. Nor do they now find in the somewhat extended document designed to show the contagiousness of cholera, presented to the Aldermen by the City Physician on the 27th of January, of this year, any further statements in addition to those with which they were acquainted when they presented their report, such as to lead them now to a different conclusion. " Guaranties and cordons have been as useless to keep out the disease as they have been to prevent an epidemic influenza, or to stop the chilly east winds of the spring. "As this is not the place to discuss the question of the contagiousness or non-contagiousness of cholera, it may be sufficient to say that its origin in a tropical region where it always exists in greater or less severity — its extraordinary course over most of the habitable globe — its pertinacious march against gales of wind and monsoons, or up and down the banks of unnavigable rivers, and even across the ocean, as seen in its catching immigrant ships in different latitudes midway between the healthy port left and the healthy port sailed for.; sometimes following great routes of travel, sometimes passing along byways and circuitous courses, sometimes passing over some large city lying in its direct route from one populous city to another, as in its recent invasion it passed by Lyons on its way from Marseilles to Paris ; always refusing to go on the various radii of public travel from its central emanation, taking that only which leads westward ; its appearance in different parts of the same city or district at the same moment; its disregard of time and seasons, journeying in winter iv spite of the cold of Russia or the steppes of Tartary, and in summer » 8 over southern or northern climes, whichever it may have reached at that season in its relentless and untiring march ; its sparing the inhabitants of a place, or the old inmates of a hospital, into which no small number of cholera patients had been brought, as the Odinka at St. Petersburg ; the great exemption of those most exposed in proportion to their numbers — as physicians, nurses and attendants on the sick — but more especially, that each of them during two, and most of three invasions of the disease, have attended and handled the sick and dissected the bodies of the dead, have known the well to lie safely with the sick and even to sleep with the bodies of the dead, have themselves remained sometimes long in the chamber or ward of the sick or when the dead lay in numbers waiting for interment, without even having seen a case where it was shown to have been communicated by contagion ; all which being so unlike the course of diseases propagated by contagion, such as ship fever, &c, and for which contagion furnishes no explanation, but which can be explained on other grounds, the Consulting Physicians are led to as full an assurance as negative testimony can furnish that cholera is not contagious. " The testimony that it is so is not only negative, but also presumptive, and leaves unexplained many of its prominent features. " They have also stated and now report with emphasis, that in their opinion this disease — not ship fever or other contagious diseases, but cholera — cannot be barred out by quarantine or cordons, which may be considered not only as useless, but even cruel, oppressive and unjust. They have considered cholera as an epidemic, ' something upon the people,' passing through, not carried by or with, but through the atmosphere, governed by laws as much concealed at present from the human mind as is the proximate cause of the disease itself.' "As to what are the exciting causes of cholera, there appears to be no diversity of opinion throughout the medical profession everywhere. Those {sing from personal condition are intemperance, profligacy, immorality, deanliness, fear, sensual indulgence, excessive labor, extreme fasting, mtritious diet, want of sleep —in fine, every violation of diet and reae; ; and every immoral indulgence which impairs the vigor of the body enervates the mind. Any one, and still more, any combination of these ises, will expose the individual more or less to the influence of the fell I Among the causes which act from without upon the human system to uce the disease are, a residence on low ground, a wet soil, noxious lalations from drains where there is imperfect drainage, or from sinks ¦ ly constructed, from stagnant water in pools or shallow ponds in mead-5, swamps or marshes ; especially refuse water from tenements or dis;ts which are not drained, exhalations from interior walls of dirty ises, or from the bodies of human beings in crowded residences, or n unremoved excretions ; deprivation of fresh air for ventilation, or of ndant water for purification ; the decomposition of vegetable and animatter — everything, in fact, which serves to render the air we breathe sonous, impure or insalubrious." i'.t would be difficult in discussing a scientific proposition, one ich depends upon the weight of evidence for its affirmative negative decision, to condense into the same space more se assertion, and direct perversion of facts than you have here le. In attempting to reply to the points made in your communication, I shall not take them up seriatim, but, following a line of demonstration equally appropriate, observe the method proposed 9 by the celebrated Dr. Gooch, in his famous essay, "Is the Plague a contagious disease?" (vol. 2d, New Sydenham Society,) confident that if I establish, beyond a reasonable doubt, the contagious nature of Cholera, I shall have answered them all. The language of Dr. Gooch is as follows : " Some diseases become prevalent because their causes are so diffused as to affect many persons in the same place at the same time; other diseases become prevalent because the bodies of the sick give out a noxious material, which excites similar diseases in the bodies of the healthy. The former are called epidemic, the latter contagious. The causes of epidemic diseases may be either deficient food, as in a general scarcity ; or heat, or cold, or great vicissitudes from one to the other, or noxious states of the atmosphere, which are not perceptible by our senses, thermometers, or barometers. Some of these are understood, as marsh exhalations ; others are involved in great obscurity. The human constitution is a delicate instrument, and can perceive qualities which our philosophical instruments and chemical tests do not enable us to detect. " The noxious matters produced by the bodies of the sick, which propagate contagious diseases from person to person, may be either something visible and substantial, as that formed in the pustules of small-pox, or the vesicles of the cow-pock; or something invisible, the existence of which is known only by its effects, as in the measles, the scarlet-fever, the hooping-cough. "The only way in which we can distinguish those diseases which are prevalent from an extensive cause acting at the same time on a number of people, from those diseases which are prevalent because they are communicated from person to person, is by certain circumstances in the mode of their diffusion. Now, the circumstances by which we know that a disease is propagated by contagion, are these : first, that those persons are most liable to the disease who approach those affected with it, and that in proportion to the nearness of the approach ; secondly, that those who avoid intercourse with persons affected with the disease generally or always escape it, and that in proportion to the care with which they avoid them ; thirdly, that the disease is communicable from one to another by inoculation. If all these circumstances can be ascertained in the difrasion of a disease, and each with clearness and distinctness, we have all the evidence which we can have, for believing that the disease is propagated by contagion. The proof is as complete as the nature of the subject admits. But the evidence for the belief that the disease is propagated by contagion, varies much in degree in different cases ; it may amount only to that which creates a strong suspicion, or it may amount to that which creates an absolute certainty. The most decided single proof that a disease is contagious, is inoculation : yet there are several diseases the contagiousness of which is undoubted, notwithstanding the absence of this proof; as, for instance, the scarlet-fever and hooping-cough. " But there are occasions when it is necessary to act on the supposition that a disease is contagious, though the evidence for this opinion is far shoi't of proof. The question is sometimes so difficult — life and health are so precious — and the precautions necessary to prevent the communication of the disease, if it should be contagious, comparatively such trifling evils, that a prudent physician will take care to be on the safe side, and act as if he was certain it was contagious, although to an indifferent person, weighing the evidence in the scales of mere speculation, it would appear only a bare possibility ; and here is the difference between a science, the subjects of which are inanimate things, like alkalies, and a science the subjects of which are flesh and blood, and health and life : that whereas, in 2 10 the former, the onus probandi lies on him who affirms the proposition, because this disbelief of it leads to no injurious consequence; in the latter, the onus probandi lies on him who denies it, because the disbelief would occasion the neglect of measures which are harmless even if they be unnecessary, but the neglect of which may be fatal if they be essential." In reading the statement above quoted, three points of especial interest present themselves, viz : Ist, that those persons are most liable to the disease who approach those affected with it, and that in proportion to the nearness of the approach ; 2d, that those who avoid intercourse with persons affected with the disease, generally or always escape it, anu that in proportion to the care with which they avoid them ; 3d, that the disease is capable of being communicated from one to another by inoculation. To these may be added a fourth, that the disease shows a tendency to spread in all directions from a centre of infection, following the routes of human intercourse, and independent of, and in defiance to all atmospheric currents. Before adducing the evidences relating to the first of these propositions " that those persons are most liable to the disease who approach those affected by it, and that in proportion to the nearness of the approach," it will be well to consider the nature of this element — contagion — in its relation to disease; and, as expressing in well considered terms, and in a very complete form, the true points at issue, the following extract from v A Report on Spasmodic Cholera, prepared by a Committee under the direction of the Counsellors of the Mass. Med. Society," will be apropos : "In regard to the mode of communication of the disease from place to place, in Asia and in the north of Europe, we have not thought that much reliance was to be placed on the accounts we have received, whether favoring one side of the question or the other. On this account we have omitted many of the statements derived from those countries in relation to this point. Such is the state of society in them, that, unless under peculiar circumstances, the existence of the disease in a city or village would not be noticed, until it had proved fatal in a number of instances, and until its source could not easily be traced among an ignorant and rude people. " So far, then, reliance is to be placed, by those who maintain the propagation of the cholera by contagion, on the general history of its extension, more than on the accounts of its introduction at each place it has invaded. The committee wish not to press this consideration too strongly, but they desire that the force of it should be distinctly seen. For this purpose they beg that the maps should be carefully studied, and that the diversity of climate in the countries traversed by the disease be duly kept in mine. Especially let the disease be traced from Muscat to Persia, to Syria, to Egypt, and to Archangel in the north of Russia. In these various directions we never find it passing from place to place faster than it could be carried by man. It does not always travel so fast as man ; nor perhaps does it always keep the roads, on which most men are travelling. But it 11 never takes the wind for its vehicle to outstrip man in the race ; or at least this does not appear from the history. "The tendency of the epidemic to extend in one particular direction from southeast to northwest has sometimes been asserted. But such a tendency has not been shown. It has not been confined to one line of march. It reached the confines of Egypt, as well as those of Russia, in 1823, when its course was arrested at both points. Again, in 1830, when its violence was augmented in Persia, it approached Egypt, as well as Russia, with a surer step ; and since then it has committed great ravages in Cairo and Alexandria. The last year it reached Smyrna and Constantinople, as well as St. Petersburg. "It has often been asked, if the disease be contagious, why does it leave a town or city, while a majority of its inhabitants have not been affected ? When it enters a new place it generally spreads very rapidly, and if this spreading be owing to contagion, it would seem that this contagion is of the most active and powerful kind. If this be the case, should we not presume that the great majority of men must be liable to its influence? But, in point of fact, it is only a small minority who undergo the disease, in most places where it gains a footing. " Perhaps this question does not admit an answer consistent with the doctrine of contagion. Let us consider it. First, it may be answered that the argument is quite as good against any other cause, which can be assigned, as against contagion. If the cause, be it what it may, can suddenly affect a great number of persons in a city, why does it not affect all ? This leads us to remark, second, that this argument arises from a disposition to assign laws to contagious diseases, rather than to learn what those laws are by observation. " If we will attend to the history of contagious diseases, we shall find that there is not one, which can at all times be produced in every person exposed to its influence. Also, in some seasons a contagious disease is propagated much more readily than in others, so that some atmospheric changes are presumed to favor its propagation. This is true of many contagious diseases certainly, and those the most formidable and most easily communicable through the medium of the atmosphere, such as measles and small-pox. But there are persons who resist these diseases under all circumstances. H^nce we may say that there may be in some persons a positive indisposition to be affected by a particular contagion ; and likewise that in many others there may be produced a more ready disposition to be so affected in particular seasons. So much we learn from observation of various contagious diseases. It is impossible to decide beforehand how large a proportion of men are liable to be affected by any disease, whether contagious or not. It is not therefore an evidence that this cholera is not contagious, although nine men out of ten should not be found susceptible of it. It would not be admitted as evidence that malaria was_ not generated in the site of a new village, because in the first year of its occupation by a thousand settlers only one hundred should have intermittent fever. "On this head then we may conclude that, if the spasmodic cholera be contagious, it may be that different men are susceptible of being affected by the disease more or less readily and with corresponding degrees of violence, the first affected in every place having the disease most severely. This at least comports with the facts noticed in many localities. The disease has been most severe and most fatal during the first two or three weeks and has gradually become less so. Meanwhile, the number who have escaped it entirely may be less than has commonly been stated. A large number may undergo the disease in so mild a form as not to be much regarded. We are told, and by persons who deny contagion, that during its prevalence in a city it has been observed that a great majority of the inhabitants have felt some of the symptoms which belong to the disease, but not so severely as to desist from common occupations ; while others who are obliged to yield, are affected with different degrees of 12 violence. The same is true as to small-pox and measles ; so that if there were not eruptions by which these diseases are identified, their occurrence would not be suspected in many cases. " We conclude then that from the limited number in any given community, who are affected with this cholera, there cannot be inferred a material difference between this and the well known contagious diseases. In regard to all of them we find that they are resisted by some persons, the proportion varying in the different species of those diseases. The most that can be said as to cholera, on this score, is that it finds fewer persons, in most communities, prepared to receive it than most contagious diseases do. Meanwhile it is very possible that the contagion produces a mild disease, which is not recognized for want of specific characters. Diseases are certainly to be described by symptoms ; but when we refer to their causes and even specific causes, we must acknowledge that the diseases produced by the same specific cause may present a variety in the symptoms, as respects their kind and their severity." With this digression we proceed to the evidence : " Dr. Mulig," Physician to the Prussian embassy at Constantinople, and to the Imperial Naval Hospital at Kassim-pacha, reports, that on the 28th of June, the war frigate Mouchbirisourour arrived directly from Alexandria. Until this time, 'no case of cholera or of its prodromes, such as diarrhoea, sporadic cholera, or gastro-intestinal affections were observed at Constantinople.' No sickness being reported on board, the vessel was permitted to come to anchor ; but, on the same evening, twelve patients were sent to the Marine Hospital, eleven of whom were recognized to be suffering from incipient cholera, and one in a state of collapse, which terminated fatally during the night. On further questioning, the surgeon of the steamer stated, that on the voyage two of the crew had died of cholera, and although, when at Alexandria, no cases of cholera had occurred on board, diarrhoea had been noticed. From this steamer, as from a centre of contagion, the disease spread in all directions. To quote Dr. Mulig's report : ' The facts speak for themselves. Up to the 28th of June, nothing in the hygienic condition of the city announced an epidemic of cholera. On this day, the frigate Mouchbirisourour arrives from Alexandria, with cholera-sick on board ; they are landed at the arsenal, and not five days pass before the first case occurs in a patient from the military workmen's barracks, situated hardly ten steps from the landing of the arsenal. From this day, cases multiply in the arsenal, and on board the vessels anchored there ; thus, the corvette Ismir is the first attacked, being, at the same time, nearest the barracks ; and it is only a few days more before the transports, anchored a little further off, are visited by the disease. The guard of Parmak-capon, at the entrance of the arsenal, and only a few paces distant from the barracks, is roughly dealt with in its turn ; finally, the rest of the guard and workshops are infected. In the mean time, the corvette Ismir is towed to the exterior port, where she remains for forty-eight hours ; the cholera continuing, she is removed to Bouyouk-liman ; several days later, the first case of cholera appears in the exterior port. On the other hand, the citizen-workmen, employed at the arsenal, propagate the disease in Kassim-pacha. If we turn to Yeni-Keny, which is a considerable distance from the point of origin, we find here, also, that the disease is propagated from the arsenal, for the first established case is that of a stone-mason from Kassim-pacha, arriving, already sick, at Yeni-Keny, where he dies the next day, with all the symptoms of cholera Is it a contagious disease, or do you wish to quibble upon the word ? Let us state, then, the fact, it is this : cholera patients import cholera. Do you wish an additional proof? — that which has happened to the Marine Hospital itself may furnish it. The first cases of cholera having stayed at the hospital hardly longer than a few days, the patients remaining there for other diseases were affected, and succumbed under 13 > the attacks of cholera. The fourth ward, where the first case of cholera, of local origin, was observed, entering on the 3d day of July with simple diarrhoea, has furnished, subsequently, several other cases. Among the employes, the first victims attacked were a nurse of the cholera ward and two washermen who cleaned the linen of the cholera-sick." (JMed. and Burg. Reporter, Oct. 21, from Gazette Midicale d' Orient, Aug.) "On Sunday, June 11, a vessel, ai-rived at Marseilles from Alexandria, which port she left the Ist of June, bringing sixty-seven Algerian pilgrims, who came from Mecca, by way of Djeddah and Suez, where the cholera was prevailing at the time. At the date of their landing, there had been no cholera at Marseilles ; indeed, the first information of its being at Alexandria was brought by this vessel. Two of these pilgrims, it is known, died on the voyage, and another on landing. On their re-embarking for Algeria, the people of that quarter of the city from which they sailed, mixed with them, and assisted them in loading their baggage. It was in this locality that the first cases of cholera appeared." It was the last week in November, 1848, that it manifested itself at sea, on board of two emigrant vessels, bound,, the one for New York, and the other for New Orleans, when they had been out, the former sixteen days, and the latter twenty-seven days from Havre, which was unaffected at the time of their departure. " Of the vessel that sailed on the 9th of November, 1848, from Havre to New York, the facts were remarkable, and are these : When the vessel referred to (the ship New York) reached the Northern Atlantic coast, near Cape Sable, the weather became cold and boisterous. Among the passengers were a number of German emigrants, who came from a place where cholera prevailed, and had been among it. One of them had a chest of clothing which belonged to a person who had died of cholera. The chest was opened, the clothing taken out and- used, and on Tuesday, the 22d November, a child was taken ill at 2 p. M. and (tied at 8 r. M., and a second child died with similar symptoms. On the following Wednesday and Thursday four men were reported sick, two of whom died suddenly with symptoms of cholera. A third died from what was regarded as a case of dysentery. Twelve were landed at the Quarantine Station at Staten Island, of whom three died, etc. " With some irregularity the disease prevailed on Staten Island, and particularly in the marine hospital, until January 4, when it entirely disappeared. The mortality, in proportion to the population, at this place, was great. One person from the quarantine was taken with cholera in the city, but was sent back, and died. Another case took it, amd died in the same house where he was taken. "No other cases occurred for nine days, when a German, who had hart no traceable communication with the infected places, took it and died. This was all of the disease that occurred in the city, and it disappeared entirely from the quarantine establishment and hospital. "At New Orleans, on the 11th of December, nine days after the appearance of cholera at Staten Island, the ship Swanton arrired from Havre with two cases on board. At the time of the departure of both this vessel and the New York from Havre, there was no cholera at that point. But it is worthy of remark that passengers on board of both of these vessels were from Germany, where the disease was raging, and that the disease made its appearance in France as early as October last, although it had not reached Havre or Paris when these vessels sailed. Seventeen persons died on the Swanton during the passage, the disease having broke out when she was about two weeks at sea. At New Orleans no quarantine regulations prevented the Swanton from landing at once in port, and the 14 cases on board were taken to the great Charity Hospital, where, up to January, as many as fifty cases occurred among the nurses and persons admitted for other complaints. Several cases appeared soon after among the shipping at the landing, but were only regarded as aggravated cholera morbus. " From this time the disease spread rapidly. The deaths for the week ending the 15th, four days after the arrival of the Swanton, before which no case had been reported, were seventeen. During the next five days there were eighty-seven deaths, after which the disease produced a fearful mortality, assuming the form of a general epidemic, the number of deaths up to the 4th of January inclusive, as reported, being 1,115. From this time the disease rapidly disappeared, so that on the sixth of February, the city was said to be entirely free from it ; but it reappeared soon after and produced much greater mortality. From a very early day after the disease spread so rapidly among the shipping in the port of New Orleans, where an immense fleet of steamboats are continually arriving and departing, it began to prevail on board of these vessels while lying there, and on their upward passage on the Mississippi and its tributaries." {Historical Review of the spread of Asiatic Cholera in the U. 8. in 1849, by John Evans, M. D., note Senator elect U. S.) "In 1832, it was developed first in the locality where the first vessel that ever came to this country with cholera on board landed her passengers. It followed the arrival of the brig Amelia, which put in at Fully Island, on the coast of South Carolina, in a stranded condition, and the only cases there —no cholera having been noticed before — occurred among those who had been employed about the wreck. At Detroit, the first cases made their appearance after the arrival of the steamer Henry Clay, in July, 1832, which had cholera on board. It broke out at St. Michaels, a previously healthy village, on the eastern shore of Maryland, just after the landing of Captain Dodsou, who died the morning after his arrival. It appeared amongst the Indians, after the interment of a corpse, dead from cholera, by them. It was brought to Illinois by Captain Blakeman, who had been to St. Louis, where the cholera was, and died of it on his return. It was not seen at Key West until the arrival of the Ajax, in a distressed condition, which had sailed from New Orleans, where the disease was prevailing, and which had the cholera on board at the time." The Constantinople correspondent of the Medical Times and Gazette, an eye-witness, and who fully corroborates the facts of Dr. Mulig's report, writes as follows : " If any one should still have entertained any doubts about the contagious nature of cholera, these must have been finally dispelled by the circumstances attending the last epidemic here, which I shortly described in a previous letter, and which were almost identical with those observed during the visitation of the same disease at the time of the Crimean war. Then, the French troops, who had come from Algeria, where the disease devastated the country, had scarcely been disembarked at Gallipolis, when the cholera broke out amongst the people there. From this place the disease followed the French to Varna, where it decimated the inhabitants, sparing, however, the intermediate centres of population, and more especially Constantinople, with which the French had not had any communication. At a later period, a campw as formed on the heights of Maslac, the echelon of which was Yeni-Keny, in the Bosphorus. This had scarcely been done when the cholera appeared at Yeni- Keny, but in no other quarter of the metropolis. It was only after some time that the disease invaded Pera, the nearest suburb to Maslac, with which the troops lodged in these camps had had frequent communication. Such observations as these are almost as convincing as physical experiments; 15 they show the connection between cause and effect as clearly as it can be shown in pure science." The following extracts are from Kennedy's History of the Contagious Cholera. They were taken from the reports of Medical Officers in India, published by order of government. "About the middle of May, 1825, a convict was sent from a village, where cholera had appeared, to Chanda, eighty miles to the westward. Two hours after his arrival at this place he was attacked with the epidemic, and in two hours Mr. Montgomery saw him ; but in twelve hours from the first attack he was dead. He was carried out for burial by four other convicts : three of them were attacked on that and the next day with similar symptoms, and two died in eighteen hours. A native, who gave them their medicines, was seized with the cholera on his return from the jail, and nearly perished. The disease now spread among the convicts (those only who had been in communication with the persons who labored under it suffered), and six died in as many days. Further: four policemen, escorting treasure from a distant village to Chanda, passed a night at Mhool, where the disease ,was then raging; the next day two of them were taken ill on the road, and died in six hours. The other two, a few hours after their arrival in Chanda, were seized with cholera and died, likewise within six hours. "The cholera first appeared amongst the inhabitants of this place (Ghooty) immediately after the departure of the first battalion of the 16th regiment, amongst whom it had been raging during their march from Hyderabad, and during their three days' continuance at this station. "There is one fact certain, that his Majesty's 34th regiment carried it with them from Bellary to Nundydroog, and that there was no trace of the disease in the villages on the road. Since the regiment passed, every village on this road has been invaded. " A detachment of Europeans from Madras, under the command of Major Wahab, arrived here with the cholera amongst them. The disease first attacked these troops at the Kistnah, after exposure to a heavy storm of wind and rain, and it continued with them from thence to this place, although all the villages in their route were entirely free from the disorder. During the march, sixty individuals perished, of whom eight were Europeans. On its arrival here, the detachment encamped about two hundred yards in front of our artillery lines. In this new situation, three Europeans and a number of natives died. At this time no case of cholera had occured in the encampment. The Europeans, however, of Major Wahab's detachment mingled with our party of artillery; and, in the course of four or five days, the disease began among the latter. Several were severely affected, but they all recovered through the prompt medical assistance afforded. The next seized was the wife of a conductor, in the artillery Hues. She was attended for a couple of hours by her friend Mrs. Gray. Mrs. Gray was seized soon afterwards, and died the ensuing morning. The son of the latter, a boy about six years of age, was infected the day after his mother died, and recovered. My sub-assistant, Mr. Hosklns, who was constantly with the sick, contracted the disease and died in twenty -four hours. Another acting sub -assistant, Mr. Steven, who attended particularly to Mrs. Houghton, a patient who had suffered severely, was attacked; and Mr. McDougall, an assistant-surgeon, who was much among the sick, was also seized. From the artillery lines, the disease travelled to the bazaars, and many of the natives were carried off. The men of his Majesty's 30th regiment, who were in barracks about half a mile to the right of the line, completely escaped, not a man having been affected or any of the followers. "I beg to add that Mr. Jones, surgeon of the 6th Light Cavalry, has just 16 arrived from the Kistnah, by the same route as Major "Wahab's detachment pursued. Mr. Jones states that he found the cholera prevailing in every village, having commenced soon after the passage of Major Wahab's detachment. The inhabitants said they had got it from that detachment. V Of the European patients in Field Hospital for other complaints, three were seized with the cholera after patients had been admitted with the same disease. Of these new cases, two, one on each side of the ward, .were at the part nearest to that which had been appropriated to the reception of cholera patients. 11 Orderly Sepoys, attending on the sick, were so generally attacked, that their attendance came to be enforced with difficulty. "The disease has travelled in the very face of the wind from village to village, from one military station to another, and in the exact route of troops. From Nagpore to Jaulnah, from Jaulnah to. Aurungabad and Mulligaum, from Aurungabad to Seroor, and from that to Bombay. It has progressively visited the different villages between this and Hyderabad. At Hyderabad two officers have lately fallen a sacrifice to the malady. One of these had constantly attended the death-bed of the other, and he himself was a corpse forty-eight hours after." • In Constantinople, no less than twenty-seven physicians and medical assistants were attacked and died, during their attendance on the disease ; and in Paris, and at Toulon, similar results followed. At Halifax, as is well known, two of the physicians who volunteered in aid of the steamer England, which put in there disabled by the ravages of cholera amongst the officers and crew, as well as amongst the steerage passengers, took the disease, and one died. At St. Petersburg, in 1831, the number of attendants on the cholera-sick in the hospitals, who were attacked, and died, was as follows : Merchants' Hospital. Attacked, one purveyor, two feltchers or barber surgeons, four servants ; one dead. Hospital of the Semenoffsky Reg. Attacked by the disease, three feltchers, seven servants ; two dead. Aboucoff Summer Hospital . Servants attacked, eight ; died, three. Cholera Hospital, at the School for the Sons of the Clergy. Of eight servants employed, two attacked. Hemp Merchants' Hospital. Of twelve servants employed, three attacked ; two dead. General Military Hospital, Vibourg Quarter. Physicians, three attacked ; one died. Servants, twelve attacked ; four died. Of twelve medical students employed, pro tempore, all had diarrhoea and other slight symptoms. "This hospital, at first purely military, and in the most perfect state of cleanliness and discipline (as, indeed, all the Russian Military Hospitals are) had few or none of its attendants taken ill. It was only after it had 17 begun to admit civil cholera-sick, and had become somewhat crowded, that the above casualties took place." Cholera Hospital of the Foundling Hospital. Of forty-two attendants, fifteen were attacked, four feltchers included, of whom three were seized. Hospital for the Imperial Stables, at St. Petersburg. Of seven servants employed, three were attacked. Rogistevensky Hospital, established in two inconvenient houses. Physicians, live; and all the attendants of every description attacked. {Report of Drs. Russell and Barry) . "But the introduction of the disease into the country around Chicago furnishes the best evidence of its communication that has yet been afforded. "The city is situated so that on the east lies the broad watery expanse o Lake Michigan. On the west is a wet prairie, almost uninhabited for ten miles ; and on the north and south the sandy lake shore is so closely bordered by the extension of this wet prairie that the country is very thinly settled — an occasional tavern for the accommodation of travellers constituting the principal habitations. Thus it will be seen that the city is almost isolated on all sides. " When the cholera became prevalent, the intercourse with the country was almost suspended. Those who live here, however, will bear me testimony that the winds blow freely and frequently in all possible directions, so that there could scarcely be said to be any obstructions to the free and rapid passage of ' cholera atmosphere.' " A circumstance at my office enables me to say positively, that during the months of May and June the winds were from the east to the west a considerable part of the time. Of this a stove-pipe, a little distance from my east window, frequently and faithfully reminded me. "By reference to a table, in a subsequent part of this article, it will be observed that at the time the cholera began to prevail extensively in the country west of Chicago, about the Ist of August, the winds were never from the east. " Under these circumstances, if the disease was atmospheric in its origin, whether the poison be animalcular, cryptogamous, carbonic, or malarial, we should expect the rich and densely populated country beyond the surrounding prairie to be speedily brought under the baneful influence of this worse than simoon, alter the disease broke out in Chicago. But the history of its spread here, as elsewhere, shows it to correspond with the amount and rapidity of human intercourse. "Instead of its accustomed 300 miles per month, we find it prevailing here for two months before any number of cases occurred in the country, and it was not until the disease had been there three months that the county became generally affected. By physicians from the country who visited the city during this remarkable exemption from cholera, I was informed that the health was unusually good there, for the season of the year. But the manner of its introduction into the different neighborhoods of the surrounding country forms the strongest link, in the history of the spread of the disease, for the support of the doctrine of communication. " James Kerr, resident a few miles distant, and well acquainted with the persons referred to, and Dr. Maxwell, of this city, have furnished me with the following account of the disease at Summit, twelve miles southwest of Chicago, on the Illinois and Michigan canal. 8 18 " This neighborhood had been quite healthy, and no case of cholera had occurred among the inhabitants up to this time. "On Sunday, the 17th of June, a man came from Chicago to remain for a few days on business, at Mr. Heacock's, was taken with the cholera and died the next day. "Mr. Heacock was taken with the disease and died on the 23d; a son on the 24th ; Mrs. Heacock, another son, and an Irish girl, who had gone from Chicago to nurse them, died on the 25th. Another son was also taken very bad at this time, but recovered. A daughter who was taken and brought to the city recovered. "Mr. Webster, who assisted in nursing and burying the last of the above who died, lived at Esquire Brown's, in the neighborhood, was taken on Tuesday, the 26th, and died in a few hours: "On the next day Esquire Brown was taken, and died on the 28th. On the evening of the same day Mrs. Brown, who came to Chicago, was taken as she entered the city, and died early the next morning. Mr. feuthrie, her father, and Mr. McGlashen, her brother-in-law, while taking the corpse to Summit for burial, in a close carriage, were both taken while crossing the prairie. Mr. Guthrie survived a few days and died ; Mr. McGlashen recovered. "Thos. Ferrity was at Mr. Heacock's while the disease was producing its awful ravages in the family, nursing the sick : he went home at night unwell, and told the family with whom he lived to leave the house, for he was going to have the cholera. The family obeyed his warning, and the next day he was found in the house dead and alone. The family that fled escaped the disease. " Mr. Bankson, who lived near Ferrity's, and about a mile from Heacock's, had also been there while they were sick, took the disease, and died the same day. Mrs. Bankson was attacked about the same time. Mr. Grant, another neighbor, was at Heacock's rendering assistance to the sick, but escaped. His son, who attended the funeral of one of the family, however, took the disease soon after and died. These were all the cases that proved fatal, and the neighborhood became quite healthy by the second week in July. "Mr. Kerr observed that but two or three of those who rendered the kind offices of assistance to the sick during this terrible scourge escaped. "Dr. Knapp, who visited them professionally and remained with them some time, had a severe attack immediately after. " The neighborhood ten miles west of this city, at Doty's tavern, at the terminus of the plank road, on the great western thoroughfare from the city, has thus far escaped, but one case having been brought there from town, which was not admitted but sent back to a house in the suburbs where he died. "In the Country west of Chicago. — The following history of the appearance of the disease in the country near Aurora, on Fox River, forty miles west of Chicago, was communicated to me by Mr. Favour, apothecary and student of medicine of that place : " The first case that occurred was about five miles west of Aurora, in the person of a peddler who was direct from Chicago. He stopped at Mr. Sanford's, a farm-house on the road, on Wednesday, the 27th of June, and died of cholera on the following Sunday. On Monday Mr. Sanford was taken with the disease, but recovered. Several members of his family were soon after taken with diarrhoea, but all recovered speedily, and no other case occurred in the neighborhood or in the surrounding country until the 22d of July, when Mr. Van Fleet, a farmer living three miles north of Aurora, returned from Chicago, where he had been to market, and was taken with the disease the same night. He died the next day. On the 24th, the day after he died, Mrs. Van Fleet, who attended upon him, was taken, and died eighteen hours after the attack. On the 27th, a 19 brother of Mr. Van Fleet, who lived within a short distance of his house, was taken. This was all of the disease that had occurred in this neighborhood, which was otherwise healthy up to that time. "About five miles distant from Mr. Van Fleet's, and eight miles from Aurora, a Mr. Leech was taken with cholera on his return home from Chicago, and died on the 24th of July. His son was subsequently taken. These were the first cases in that neighborhood. " The following account of the appearance of the disease in two neighborhoods is furnished by Dr. D. W. Boyd, of Brush Hill, who attended upon the cases referred to : The Buck Horn tavern is fifteen miles northwest of Chicago, on the Milwaukie road, and is kept by the doctor's brother. " On the 3d day of July, Mr. Biddle, who lived two miles beyond, was taken with the cholera on his return from Chicago, and could get no further than Mr. Boyd's tavern. After nursing him two days, Mr. Boyd was taken with the disease on the 6th. " Soon after, five others, being all of his family, were taken with diarrhoea. All these recovered, being early put under the, influence of calomel, camphor and opium. The neighborhood, so far as the doctor was able to learn, and his brother's family in particular, had been healthy up to this time. " At Flagg Creek, twenty miles a little south of west from Chicago, the disease made its first appearance on the 22d of July, under the following circumstances : " Mrs. Martin, a citizen of Lockport, thirty-five miles southwest of Chicago, on the canal, came to the city on the 18th of July, and remained three days. She was taken with a diarrhoea on the 19th, and on the 22d went to Mr. Helmick's, at Flagg Creek settlement. At ten o'clock that night she was taken with rice-water discharges, and died at ten o'clock the next morning. On the 27th, four days after this case died, J. T. Webb, a sailor, came from Chicago to Mr. Glaton's, who lives about eighty rods from Helmick's. He had diarrhoea when he left Chicago, where he saw a patient sick with cholera. He was taken bad on the 27th, and died on the 28th of July. Mr. Helmick, who assisted in nursing Webb, was taken with the diarrhoea on the day he died, and on the 29th had a severe attack of cholera, but recovered. "Mr. Craigmile, who also assisted in nursing Webb, was taken with diarrhoea on the day he .died, and on the 30th it was a well-developed cholera, but he recovered. " On the 31st a Norwegian, who lived at Glaton's, and assisted in nursing and burying Webb, was taken with cholera, and also recovered. He had been to see Craigmile, the case above referred to, the day before. " On the 3d of August, a German, who lived at Craigmile's above referred to, was taken with cholera, but also recovered. " In reference to this history Dr. Boyd remarks : • Previous to the above cases the neighborhood had been very healthy. Diarrhoea now became general in the families of Helmick, Craigmile, Glaton, and others adjacent, excepting two families who lived on the Carrington farm, about threefourths of a mile distant from Helmick's, the members of which kept away from the cholera patients. Diarrhoea continued to the 17th of August ana subsided. It was easily managed by the use of calomel, camphor and opium.' "The doctor relates the case of a Mr. Bush, living at the house of Mr. Farwood, who had not been exposed, (?) that occurred on the 26th of August, a day or two before he wrote, which he considers a victim of fear. (If fear produces cholera, ought we not to meet with cases continually ?) But, says the doctor, the man had been in a rage because a girl came to live in the family from a house where two men had died of cholera. " The circumstances of its appearance at Naperville, thirty miles west 20 of Chicago, were furnished me by my colleague, Prof. Brainard, who, a few days ago, returned from a visit to that place. " Some weeks before any case of cholera occurred there, tests for ozone became quite dark. About the 22d of July, an Irishman, by the name of O'Brien, returned from Chicago, where he had been visiting a relative who died of cholera. Soon after his arrival at home he took the disease and died. In about three days after, a German girl, who had been working at his house, took the disease and died on the 26th. Dr. Sowers attended upon the girl, and took the disease and died the next day. Dr. Hough attended upon Dr. Sowers, took the disease and died two days afterward, about the 20th of July. Miss Rouse, who lived at Dr. Sower's, remained at his house about ten days for fear of carrying the disease with her, packed up her clothes, went home to her father's, three miles in the country, and soon took it. About the 17th of August her father was taken with the cholera, and died on the 20th. Mrs. Rouse, his daughter-in-law, who had been with him while sick, took it and died on the 23d. Her husband took the disease and died the same day. A son-in-law, who lived at Naperville, was there attending upon the sick above referred to, took the disease on the 27th, and died in a few hours. " A man who had lately lost his wife and child by cholera, came to Naperville, and died of the disease at the Pre-emption House on the 24th. Mr. Snyder, who roomed with him, took it and died the next day. Mr. Mackintosh, who boarded at the same house, took it and died on the 2Gth. Up to and during this time the country around it, and the village containing about nine hundred inhabitants, enjoyed good health, with these exceptions. " Dr. Kimberly, of this city, furnishes me with the following account of the disease as it occurred in the neighborhood of Cazenovia, fifteen miles west by northwest of Chicago, where nine persons died in rapid succession, the neighborhood having been healthy up to the time mentioned : 7 cj — c^» •/ — a — — — " About the 20th of July Mr. Barnum came to Chicago to attend the funeral of his brother, who died of cholera. He returned home in the evening, after attending the funeral, was taken with the disease the same night, and died in a few hours. Three of his neighbors, who visited him while sick, were taken immediately afterwards, and died in a short time after their attack. " In the Dutch settlement, near Mr. Barnum's, the disease was introduced by a German, who was taken the night after going to Chicago, a short time after the fatality above referred to, and died in about twelve hours. Four others, who visited him whjle sick, were taken soon after, and all died within four days. These were all the fatal cases that occurred, and the disease soon disappeared." {Prof. Evans, loc. cit.) You cite the Odinka Hospital at St. Petersburg as an instance where it spared " the old inmates of a hospital, into which no small number of cholera patients had been brought." ? A sufficient explanation for this exemption is to be found in a letter from Dr. Marsden of Quebec, already quoted, who writes of this very hospital, which he locates in Moscow, however, " Although there were eight hundred and sixty cases of other diseases in the hospital of Odinka, and five hundred and eighty cases of cholera were admitted, they were kept in separate and distinct wards, and as completely separated from each other as 21 fever and contagious cases in hospitals usually are ; whereas at St. Petersburg (and my authority is Taneschin, the then Physician to the Emperor or Czar of Russia) the cholera lasted nearly all winter in the hospital, when there was none outside amongst the inhabitants, simply because cholera cases were not then separated from other diseases, and fresh admissions found food for the infection." Comment is unnecessary. Were auy proof needed of the fact that cholera patients do infect " the old inmates of a hospital " into which they are admitted, it has been already supplied by the quotations from Dr. Mulig's report, and Kennedy's " History of the Spasmodic Cholera." (See ante, p. 12-16.) Did time and space permit, the evidence bearing on this point, and similar to what I have already quoted, could be multiplied to the extent of volumes. The second proposition is, " that those who avoid intercourse with persons affected with the disease generally or always escape it, and that in proportion to the care with which they avoid them." This involves proving a negative, always a difficult method, and particularly so in a case like this, where from the nature and magnitude of the interests involved, the most rigid scrutiny should be exercised over everything introduced as proof. But no candid and unbiassed mind will hesitate to accord their true value to the evidence which follows, and is gathered from sources equally as credible as those from which the direct evidence previously adduced is derived. And first, is the evidence of Dr. Doeppe, chief physician of the foundling hospital at St. Petersburg ; he says : " Not one of the one hundred and twenty people employed during the whole course of the epidemic, in building the new hospital for the house, was taken ill. I need not mention that they used no precautionary measures, but lived quite in their usual way, generally sleeping at night in the open air, on the bare ground or in their very confined wooden huts. / must, however, not omit to add that they were completely isolated from the rest of the house, and, as usual with these people, lived amongst themselves, having very little intercourse with the city. Further, that the spot where they had to work, was contiguous to the cholera hospital yard, and only separated from the same by a board fence. " I take the liberty of adducing a similar instance, though it does not belong to this place, because I have it from an authentic source, of about six hundred masons who were employed at the Isaacs Church, and whose great dread of the illness caused them to live, though in the midst of the city, almost entirely isolated ; only two sickened, who were immediately sent to the next hospital." " It was observed in India that prisons were in some instances exempt from the disease ; the inhabitants being preserved by the wall which confined 22 them. In the Island of Bourbon the disease did not go beyond St. Denis, this place having been cut off from all communication with other parts of the island. The French Consul at Aleppo shut himself up with many friends and attendants, and they all escaped the cholera, though it was prevalent all around them. " The Academy of Military Cadets at Moscow, which is represented as a large establishment, escaped the disease altogether while it was in the city. All communication with persons out of the establishment was prevented, and to this cause the exemption of its inmates from the cholera was attributed." {Committee's lleport.) " In 1832 the then town of Three Rivers — equi-distant from Quebec and Montreal, where steamei'S were in the habit of touching and landing and embarking passengers daily — established an impromptu system of quarantine founded on non-intercourse, preventing any person from landing there during the prevalence of cholera, and not one case occurred there, whilst Quebec and Montreal numbered the dead by thousands." {Dr. Marsden's letter.) The third proposition of Dr. Gooch is " that the disease in question is capable of being communicated by inoculation." The term inoculation, in the sense in which it is here used, implies the production of a disease by introducing its specific cause- into the system and should not be confounded with the process by which in certain cases the effect is sought to be attained. "At the meeting of the Societe Medicale dcs Hospitaux, at Paris, held November 22, M. Herard reported the case of a young girl affected with cholerine for two weeks, who continued to vomit daily about two quarts of a liquid transparent as water, and but slightly differing from that fluid in composition. Of this liquidi, M. Robin injected a quantity into the trachea of healthy dogs, producing vomiting, liquid evacuations, and chills ; in short, symptoms strictly analogous to those of cholera, and terminating in the more or less speedy death of the animals. The same result followed injection with the liquid portion of the blood drawn from cholera patients during the period of reaction. Injected into the stomach, these symptoms did not follow, a circumstance probably due, according to M. Robin, to the fact that the liquids were digested, and thus lost their toxic properties. In one case, however, a dog which had by chance devoured a large quantity of the alvine dejections of a cholera patient, died with all the symptoms mentioned above. In this case, it was supposed that the stomach was unable to digest the whole of the morbid excretion, and the remainder was absorbed with all its deleterious properties, as in the case of injections into the trachea." {Boston Medical and Surgical Journal, from V Union Medicale.) Dr. Mulig, already quoted, says with reference to the cholera poison, — the virus of the disease : "Cholera does not appear to be contagious by simple contact of the patients ; but the cholera patients rather develop contagion like those affected with small-pox, with this difference, that whereas, in small-pox, contagion is communicated by the skin, in cholera it is through the excretions, especially the stools, that the infection is propagated; thus, the linen stained by cholera patients, houses occupied by them, infected ships, may harbor the contagion for a long time, and become the cause of new infections. It must also be observed that the stools of persons suffering from mild manifestations of the disease, from cholerine and cholera, like 23 diarrhoea, do not contain the contagion any less than the excretions of those suffering from confirmed cholera ; it is, therefore, easy to conceive why a ship, a building, etc,, may be affected without a case of cholera having occurred." (Med. and Surg. Reporter, Oct. 21, from Gazette Midicale d' Orient, Aug.) Dr. Snow, of London, now dead, who, during the visitation of London by cholera in 1854, was most assiduous in his investigations into its nature and cause, and the results of which are accepted by the profession of England as being beyond a doubt, says upon this same point : "1. That cholera is exclusively a disease of the alimentary canal. That at first the disease is confined to this, and the successive stages as they are called, are only the results of the rapid abstraction of the water of the blood from the tissues. " 2. That the primary change in the alimentary canal is always induced by the introduction therein of a specific poison. " 3. That this poison is exclusively contained in the intestinal contents of the infected person, that is to say, in what is purged from the bowels, and vomited from the stomach. There is nothing breathed from the lungs, nothing thrown off from the skin, that will propagate the disease. " 4. That the poison is neither a gas nor a vapor, but a material substance, and exists either as a liquid or a solid. It cannot, therefore, be carried a great way by the atmosphere, and when dry, must be attached to clothing, or disseminated through water, to be carried long distances." It may be disseminated in various ways. The moist excreta of cholera, on the clothes and bedding of infected persons, might be carried mechanically by the vapor of water, and enter the mouth and nostrils in that form, and so be swallowed. In this way laundresses, engaged in washing the clothing of infected persons, were so readily attacked. The poison might dry on infected clothing ; and from such clothing, on its being unfolded or moved, the solid organic matter might escape in small substance ; might be wafted a few feet in the air ; and might, in fact, be absorbed through the mouth, by any one exposed to it. The cholera was introduced into Guadaloupe by the clothing contained in a trunk belonging to a person who died on the voyage thither from Marseilles, where the cholera then was. The washerwoman who washed the clothing died, with all her family. Attracted by the circumstances of the case, many persons came to her house, and of these several died. From this point it spread over the island. "A sailor died in some port in Europe, of Asiatic Cholera, in 1832. A chest containing his personal effects, clothing, &c, was sent home to his family, who lived at a small straggling village on the Atlantic coast, in the 24 State of Maine. It reached them about Christmas, 1832, and was opened on arrival. The inmates of the house were all immediately and suddenly seized with a disease resembling Asiatic Cholera in all its malignity, and died! There had been no cholera in the State. Had this occured in summer, instead of in the depth of winter, and in a more thickly peopled locality, there would doubtless have been a repetition of the recent Guadaloupe tragedy, by which a whole country became infected, from the clothing of persons who had died of Asiatic Cholera, which had been sent ashore to be washed. In this case, had the infamous conduct of the pilot who sent these things secretly on shore, not been discovered, the case would have been handed down as a wonderful non-contagious fact of Asiatic Cholera breaking out without infection or importation." The above, which is quoted by Dr. Marsden, is also attested by the late Prof. R. D. Mussey, of Cincinnati, Ohio. A writer in the London Lancet, Feb. 17, 1866, reports that — " The last case of cholera that occurred in the garrison at Malta, in the late epidemic, was that of a woman who had stolen a chemise, the property of one who died of the disease. She put on this fatal garment, probably soiled with the discharges and certainly unwashed, many days after the death of its former possessor, took the disease and died." In a village not far from Marseilles, and in an isolated place, a peasant and his wife, who had not left the country, sickened and died of the disease. The woman was a laundress, and had received a bundle of linen, belonging to an individual recently arrived from Egypt, and the husband had opened the bundle and unfolded the pieces. It is also asserted that during the Crimean war, the fact that the washermen attending to the washing of the French hospitals, were attacked by cholera, was more than once confirmed. Mr. Blogg, the correspondent of the London Medical Times and Gazette, from Constantinople, during the last epidemic, writes thus : "I can but think that the cholera was contagious. In one instance, the clothes, mattresses, &c, of the sick, were washed at a fountain, and unfortunately, the wastepipe being broken, the foul water communicated with the clean, and in one day sixty people died at Tatavola, a small portion of the city which was supplied by this infected stream." But perhaps the most striking instance of the propagation of the disease is to be found in the history of the Broad-street Epidemic, so called, in 1854. In this case, there was a well in Broad Street, London, into which the contents of a sewer had been percolating for months. Of this water, hundreds of persons had been drinking, and although cholera was present in other parts of London, there were no cases in this locality. At last a 25 case of cholera occurred, and by means of the sewer, the excretions of the patient were mingled with the water of the well. Within three days, more than Jive hundred persons, who used the water from this particular source, were attacked. Acting on his belief regarding the cause of cholera and Its communicability, Dr. Snow removed the handle of the pump in this well, thus cutting off the use of the water, and the disease immediately disappeared. It may also adhere to other material, which has been handled by infected persons, or been brought in contact with their excretions. The postal department of Marseilles numbers one hundred and twenty persons, of whom seventy-five to eighty are clerks : twentytwo are employed at the bureau of departure, and nine at the bureau of arrival. There was not a single death, or even a case of sickness at the former bureau, while of the latter, nine employes were taken sick, and one died. These eight were taken sick one after the other ; this was proved of the first five. The one who opened the despatches from the East fell sick, — was cholerise, was the expression used. Another was put in his place, — the same effect) and so on up to the fifth. Houses also retain the poison. After an epidemic in Vienna in 1855 had been extinguished, the first case, on its reappearance, occurred in a house which had been used as a cholera hospital during the epidemic. The fourth proposition is, " that the disease, cholera, shows a tendency to spread in all directions from a centre of infection, following the routes of human intercourse, and independent of and in defiance to all atmospheric currents." The first of what may be called the modern outbreaks of cholera, — those occurring in the present century, — began, as near as can be ascertained, in 1816-17 ; at all events, in August, 1817, it was at Jessore, a crowded, filthy town in Bengal, situated in the low, wet country, embracing the outlets of the Ganges, and was reported to have been noticed in various distant and more northern parts of the same country, previous to this, during the same season. As remarked in one of the quotations made on a previous page, " The tendency of the epidemic to extend in one particular direction," etc., " always refusing to go on the various radii of public travel from its central emanation, taking that only which leads westward" (letter of the consulting physicians, May Bth, 1866), 4 26 from southeast to northwest has sometimes been asserted. But such a tendency has not been shown," &c. (Ante, p. 11.) A reference to the carefully prepared map of Hindostan, which is appended to the report already cited, will show at a glance that during the year 1817, cholera was known to prevail over a region extending from the river Sinde in longitude 78 east of Greenwich, where it is noted Nov. 6th, to Silhet, a little east of the river Brahmaputra in longitude 92 east, along a belt of about five degrees of latitude. From this " lair "it started. The records show, that in the course of the next year, it had overrun not only Hin* dostan, but extended its ravages on the east as far as Aracan, a city in Burmah, and in another year, 1820, was conveyed to Kesho, a principal city of Cochin China* Three years later it made its appearance at Amboyna, having thus, in six years, made progress in a direction a little south of east, over 40 degrees of longitude. Its course south was comparatively slow, not reaching the extreme point of the Indian peninsula and the Island of Ceylon, till January, 1819. Its course north and west, on the land, was marked by about the same degree'of speed. It was at Bombay in 1818, one year after its first appearance at Jessore, and three years later, 1821, at Muscat, almost due west ; but in the latter instance it crossed the sea. In its course from Delhi to Orenburg, almost due north, a distance not half as great as between Jessore and Amboyna, it was eleven years in its progress, not having appeared there till 1829 ; and to go from Muscat to Astrachan, following the same general direction, it took two years at the first visitation, and nine years at the last, having broken out there in 1823 and 1830. From these two points, Orenburg and Astrachan, as if reinvigorated by the long delay on the road, it swept across the continent in the short space of about a twelvemonth. From Hamburg it crossed to Sunderland on the English coast, about midway between the two extremities of the Island of Great Britain, and from that point extended north to Edinburgh, south to London, and due west to Dublin, each of which places it visited in 1832. It exhibited the same defiance of any fixed line of march in its progress over this country. It made its appearance as has been remarked previously, at the two ports of New York and New Orleans, nearly at the same time. At the former station, under 27 the pressure of a rigid quarantine, it subsided and did not spread. At the latter place, for want of similar precautions it extended through the city, and towards the end of December appeared at Memphis, higher up on the Mississippi River ; at St. Louis in the first week in January, 1849 ; and at several places on the Upper Mississippi in March of the same year. Prof. Evans, already quoted, remarks of this progress up the river : "It extended rapidly up the river, but it is remarkable that along its course the points having the most communication with the steamboats were the first to be inflicted, and in no instance were any of these points affected until steamboats from places below, where the disease was prevailing, had arrived. (Shanks on cholera, in the American Journal for July, 1849.) The disease extended up the Red River, from point to point, in the same manner as up other tributaries of the Mississippi." Chicago and other towns situated on the chain of the great lakes were affected in May. It was not till then that New York was visited by the epidemic, notwithstanding the importation of the disease at Staten Island, and the appearance of several cases in the hospital there six months before. Nearly about the same time, Philadelphia, and the chief cities on the seaboard of the United States became affected. The objection is frequently raised, that, if cholera is a contagious disease, it ought not to be self-terminated or limited in its action on a community. It is a sufficient answer to this, to refer to the arguments already adduced, early in the discussion, and to state that the known facts connected with the rise and progress of diseases recognized as contagious, beyond dispute, fully and completely refute it. The same answer applies to the argument that it has failed of being inoculated in certain cases. Every physician is aware that this process is often ineffectual under even the most favorable circumstances, and yet no one objects, that the disease for which the inoculation is performed, is thereby proved to be a non-contagious one. Equally without foundation, is the assertion that cholera never radiates from a centre of infection, but always moves in a westward course — north, east, west and south did it spread from its original starting point in India, over the whole of the Eastern Continent ; and in our own country, stopped at one point on the eastern coast, it entered by a back door, which was unfortunately left unguarded, 28 and straight up river, first due north, then due east, it swept back to where it was first denied admittance, and thousands paid the penalty, for the remissness of a more foolhardy municipality. Finally, you say, " As to what are the exciting causes of cholera, there appears to be no diversity of opinion throughout the medical profession everywhere." If by this plausible statement, you mean that the opinions you express in your communication, regarding the epidemic and non-contagious nature of the disease, are the opinions held by the profession generally, you state that which is not true. I have yet to learn of a respectable medical journal, one which by a professional reader would be recognized as authority, which does not advocate directly the opposite, and maintain that there is in Asiatic Cholera, an element of portability or communicability, which takes it entirely out of the category of purely epidemic diseases.* I must, in charity, attribute such an assertion to ignorance rather than to an intention to mislead ; to the fact that you do not keep au courant with medical literature, rather than that having read, you would so wantonly pervert the truth. From the evidence thus presented, it is clear that each one of the four propositions, laid down as being requisite to establish the contagious nature of cholera, is more than proved. No candid mind, nor any one not wholly given over to a blind adherence to a previously expressed opinion, can resist the logic which flows from such an accumulation of facts. And being contagious, it is possible to prevent cholera from ever again gaining a foothold on our soil, by cutting off all communication between those who are unfortunately suffering from its attacks, and those who have not yet teen impregnated with its deadly poison. But in a community like our own, made up of so many individual elements, each with its own peculiar interests, it is only by some great central plan of action, which shall include all in its operation, that this result can be attained. The circle of defence must be complete ; else, as in 1854, averted at one point, it will find an entrance through some other channel, where the circle has been broken or left unformed, and by a march in the rear, lay the whole land under its deadly contribution. * I am informed by one of the editors of the Medical and Surgical Journal, published in this city, that their exchanges, both American and foreign, fully sustain me in this statement. 29 Is there not sufficient reason for believing that cholera is contagious, to justify us in acting upon this supposition? —to make it unjustifiable to act on any other? When we reflect on the immensity of the stake at issue, it might be supposed that the remotest possibility of its being contagious, would prompt us to act on that supposition ; and that it would be accepted as a rule of conduct — -" take it for granted that it is contagious, till you are certain it is not." What would be thought of that man who should voluntarily neglect any precaution to protect his family against danger from a disease known to be contagious in its nature and malignant in its character? Shall we, acting for the community at large, govern ourselves by any other principles than such as are safe for- our guidance in our own homes? I have the honor to be, gentlemen, very respectfully, Your obedient servant, WILLIAM READ, M. D., City Physician. Boston, July 30, 1866.