CHOLERA OF 1873. 
BY 
w. R. SEVIER, M. D„ 
JONESBORO, TENNESSEE. 
'REVISEdT 
For sale by Ogden Brothers, Booksellers, Binders and Printers, Knoxville, Tenn. TO CAPT. JOSEPH JAQUES, 
MAYOR OF THE CITY OF KNOXVILLE, TENN. 
In appreciation not of the integrity, capacity and energy which have 
secured him success and eminence among business men; nor of those minor, 
but not less distinctive virtues which, in the esteem of the world, generally 
constitute the graces of personal character; but alone of his uniform, 
LARGE-HEARTED AND OPEN-HANDED BENEFICENCE TO THE POOR is this 
little 'brochure' dedicated, with an expression of the hope, confidently en- 
tertained, that in the practical application of the principles and truths which 
it contains will be found great relief from the scourge of which it treats. 
W. R. S. 
Jonesboro,' Tenn., March 1878. CHOLERAyOF 1873. 
BY W. R. SEVIER', M. D. 
JONESBORO, TENNESSEE. 
[FROM LANCET AND OBSERVER, DECEMBER, 1875.] 
[REVISED.] 
[NOTE,-Jonesboro is an old town, the oldest indeed in the State. It is 
situated directly on the line of the East Tennessee, Virginia & Georgia Rail- 
road; nestling among stately hills, and enjoying an altitude of 1,734 feet 
above the ocean level. The supply of water is abundant-derived from 
springs and wells. A creek of considerable size courses rapidly through the 
southern part of the town, having its origin about a half mile outside the 
Corporation limits. The town and suburban population does not exceed 
1,500. The health of the locality had been excellent, for some two or three 
years, prior to the advent of Cholera.] 
No record of the whole number of cases which occurred 
during the epidemic at Jonesboro, Tennessee, was kept. I can 
only furnish the number of deaths, race, sex, and approximate- 
ly ages, as follows: 15 whites; 15 colored; 16 males; 14 
females; under one year, 2; one year and under ten, 1 ; ten 
years and under twenty, 3 ; twenty and under thirty, 5; thirty 
and under forty, 2 ; forty and under fifty, 3 ; fifty and under 
sixty, 10; sixty and under seventy, 1 ; seventy and under 
eighty, 2 ; eighty and under ninety, 1. Total, 30. 
The first case was that of a refugee from the town of 
Greeileville, on the line of railroad, twenty-five miles west of us, 
on the 29th of June. This case was of violent character, but 
recovered. The patient was assiduously and tenderly nursed by 
one of our kindhearted citizens. The next case, on the 4th 
of July, was also that of a refugee from the same town. He 2 
cholera of 1873. 
was kindly cared for by the same individual, wh » took him to 
his house-an humble but healthily located dwelling-where he 
slept over night in the family room. He was next morning 
transferred to another building, some two hundred yards distant, 
where he stayed until his recovery. The symptoms were rather 
obstinate, but exhibited no malignancy. The next person, and 
the first among our resident population attacked, was the wife of 
the individual w'ho had demeaned himself so magnanimously 
toward "the stranger within our gates " She died on the fourth 
day of her illness. Four colored railroad hands, belonging to 
the gravel train, but having their homes here, next exhibited 
the features of the disease. Two of these died within a few 
hours after the attack : a third, living one mile from town, re- 
covered, but his mother, living in the same house, a feeble 
w'oman, contracted the disease and died. The fourth died of a 
fever, consequent on the cholera, some two or three weeks after- 
ward. The disease now rapidly assumed the character of a 
malignant epidemic. The major part of our population there- 
upon incontinently betook themselves to various places of re- 
treat ; whilst the services of my intelligent associate, E. L. 
Deaderick, M. D., and myself were wholy engrossed by our 
business in town, to the exclusion of country practice. 
The periods marked by the greatest fatality, were respective- 
ly the 29th and 30th of July and the 1st of August. The esti- 
mated mortality, up to this period, was forty to fifty per cent, 
of the whole number attacked. 
The general plan of treatment had been based on the use of 
mercurials, opiates, quinine, brandy, sinapisms, etc. The results 
were anything but satisfactory. True, many gratifying, and in 
some instances surprising recoveries took place; but, on the 
other hand, a number of deaths occurred which, I am now sure, 
would not have occurred under the treatment subsequently em- 
ployed. An anxious desire, stimulated by the appalling mor- 
tality referred to, to comprehend more clearly and satisfactorily 
the true pathology of the disease, led to a more diligent exam- 
ination at the bedside, to a more correct grouping and analysis 
of symptoms, and, finally, to a result, in theory and treatment, 
eminently satisfactory and successful. The disease known as 
Asiatic cholera is essentially toxiccemia or blood-poisoning, and CHOLERA OF 1873. 
3 
the facts and considerations supporting the theory are as fol- 
lows : 
1. Some patients, when first visited, were found to be in a 
dying condition, whilst inquiry revealed the fact, in individual 
cases, that the patient had suffered but little purging, perhaps 
but one or two discharges, and no vomiting at all. The most 
rapidly fatal case we had, was that of a negro man belonging 
to the grave-digging force. He died in a little more than four 
hours after the attack. In his case there was neither vomiting 
nor purging. A near relative of the writer died in Greeneville, 
after eleven or twelve hours' illness, I have been informed, who 
suffered but two discharges from the bowels, and no vomiting. 
2. Cases occurred where death ensued twelve or fourteen 
hours after all discharges had ceased, notwithstanding the best 
directed and most diligent efforts at stimulation and alimenta- 
tion. 
3. The mental lethargy, depressed condition of the heart 
and arteries, feeble respiration, suppressed functions of skin, 
liver, and kidneys, are not singly, but collectively, of value as 
symntoms of this poisoned condition of the blood 
4. The separation of the constituent elements of the blood, 
coupled with the rigid cramping of the voluntary muscles, point 
to the same fact. 
5. The almost uniform effect of remedies of conceded dis- 
infectant and depurative virtues was the prompt amelioration 
of symptoms 
Believing such to be the correct theory in regard to the 
nature of the disease, I expressed the opinion that ' chlorine, 
in some one of its multitudinous combinations," would be found 
the effective remedy. The reasoning and facts were submitted 
to my friend, Dr. Deaderick, who readily and cordially co- 
operated with me in the practical application of the theory and 
the remedy. The first case selected was that of an unfortunate 
"nymph du pave," who had been pulseless for several hours. 
A strong solution of chlorate of potash was injected hypoder- 
mically over each breast, and one and a half to two grains 
prescribed internally every half hour to hour. Twenty-four 
hours afterwards, she was found to be still living, but still des- 
titute of pulse. She was next placed on tr. sesq. chlor, ferri, 
ten to fifteen drops every half hour to hour; and twenty-four 
hours afterward, she was found to be still alive, but still pulse 4 
CHOLERA OF 1873. 
less. She was then placed on sol. perchloride of iron, but no 
appreciable advantage was discovered. She died, having been 
more than sixty hours utterly pulseless. A recovery might, 
perhaps, have been obtained in this case but for a miscarriage, 
which occured a few hours after the attack, 
The litmus test, applied the day before, to the ejections 
and dejections of a lady dying of cholera, revealed the strong 
alkalinity of these discharges- In view of this fact, and that 
the general features of a well-developed case of cholera indicat- 
ed it, I ordered the following formula : 
R Tr. Sesq. Clor. Ferri, Jvi. 
Hydrochloric Acid, . 3i. 
Tr. Opii, .... 5i. M. 
Fifteen to thirty drops, in a wineglassful of water, every 
half hour to hour, so long as diarrhea continues. 
Caution.-Mercurials must not be employed while using 
this mixture. Give from glass tumbler or teacup. Use no 
spoon or metallic vessel in administering the medicine. 
When but little or no vomiting or purging existed, but other 
features marking the malignant type of the disease, parties 
were advised to give, as above, until well-marked and unmistak- 
able evidences of reaction appeared. 
The diet, in connection with this plan of treatment, is re- 
garded as a matter of some importance. ' I prefer rich animal 
broths, beef tea, essence of beef, chicken broth, etc., to rich milk ; 
for the reason that the latter will form curds with the mixture, 
which, if not irritating and indigestible, will, at least, engross a 
large share of the mixture in their formation. The broths I 
advise to be liberally employed, particularly in that class of 
cases where the discharges are very profuse. 
Of forty-five or fifty cases, and many of them of extreme 
character, occurring after the formula was adopted, we lost but 
two, both old brain cases. One laboring under copious serous 
discharges from the ear, associated with locomotor ataxia ; and 
the other under hemiplegia of right side, of many months stand- 
ing.. 
The dose suggested may, I am satisfied, in cases requiring 
it, be safely doubled, tripled, or even quadrupled. A negro 
woman, suffering from an attack of cholera, took a tablespoon- 
ful undiluted. No ill effect nor even inconvenience was sus- CHOLERA OE 1873. 
5 
tained, beyond copious and loud eructations of gas from the 
stomach. A gentlemen gave to his child, nine years old, a tea- 
spoonful. The cholera was, in each case, promptly arrested, a 
second dose not having been required by either. The security 
from ill effects, in such cases, is doubtless due to the alkalinity 
referred to. 
Shortly after the benefits of the remedial means employed 
became manifest, persons living in this, and in other infected 
localities, were advised to employ the Tinct. Sesq. Chlor. Ferri., 
in doses of 10 to 15 drops every 4 or 6 hours, as a prophylactic. 
It is not known that any one, who had conformed to the sug- 
gestion, was attacked. Those adopting this course were advised 
that they might employ a liberal diet consisting of a fair ad- 
mixture of animal and vegetable food, avoiding only such ar- 
ticles as had been observed to disturb the functions of health 
during the non-existence of epidemic influences. A single drop 
of muriatic acid supper-added to each dose might, perhaps, if 
possible, enhance the protective powers of this agent. 
Muriatic acid is doubtless the active element in both th'e 
prophylactic and remedial means suggested; but in view of the 
necessity, which generally exists at such times for the use of 
agents combining other virtues, I prefer the tincture. 
Much has been said and written of cholera-its diagnostic 
and prognostic features-which our observation of this epidemic 
failed to verify. 
The "quick pulse" and "cold skin, covered with a clammy 
sweat," were of such unusual occurrence as to be undeserving the 
importance of symptoms. The skin was, indeed, in nearly all 
instances, of icy coldness, but generally dry ; whilst the pulse, 
except in force and volume, as often as otherwise, exhibited no 
departure from its normal standard. 
The "contracted pupil"* was not observed in any case, ex- 
cept as the result of narcotism. 
The "painless diarrhea" constituted, generally, the initial 
stage of the disease; and vomiting and purging, with "rice-water" 
discharges, were characteristics of the malady in a more active 
and advanced stage of development There were, however, ex- 
ceptions in which the last-mentioned symptoms were not promi- 
GENERAL OBSERVATIONS. 
•Barclay. 6 
CHOLERA OF 1873. 
nent, and a single case in which they were entirelv wanting. 
Death hut rarely results, I believe, from exhaustive discharges. 
There occur many cases of cholera-morbus in which they are 
far more profuse, and yet recovery readily takes place. The 
most rapidly fatal cases will, I conceive, generally be found to 
be of that character where they do not exist; for the reason 
that such discharges are purely eliminative-the efforts and 
channel through which nature seeks to relieve herself of the 
poison. The excretory functions are all suppressed, and in this 
emergency, should the only remaining outlet through the me- 
dium of the bowels be closed, the pent up poisons will only act 
with more deadly certainty and vigor. In the case referred to, 
in which vomiting and purging were entirely absent, there was 
not the slightest swelling of the abdomen or other evidence of 
retained profluvia. 
• 
Suppression of urine was a very constant feature of the 
ease, as it existed among, us; but I think undue prognostic 
value is attached by some authors to this symptom. I drew 
from a male patient, on the fourth day after I had been called 
in consultation, something over an ounce, the first discharged in 
about five days. Dr.* drew from a female patient, 
on the fifth day, about half an ounce, the first voided within 
that period ; yet both patients recovered without any untoward 
symptom. The catheter was introduced, in each case, simply 
for the purpose of ascertaining the condition of this important 
function. 
Important questions here naturally arise touching the prob- 
able existence of uremic poisoning in this class of cases. 
The general symptoms of unemia, as an idiopathic affection, 
so far as the nervous system is concerned, do not correspond; 
but I am not prepared to say that in combination with other 
morbific influences it may not, in some cases, give to us a modi- 
fied form of the disease. I do not think, however, that such is 
the case: and the most plausible explanation we can perhaps 
offer for the non-existence of the disease is the greatly impover- 
ished and altered condition of the blood in some cases, and, in 
others, the vicarious discharge of urea by the bowels. In such 
cases as are characterized by profuse vomiting and purging, this 
explanation will suffice; and in that class of cases where these CHOLERA OF 1873. 
7 
features are absent, death generally ensues too soon to be as- 
cribable, in any measure, to the operation of this cause.* 
The confident assurances given to us by eminent authors 
that cholera makes its attacks only "in the still watches 
of the night," were negatived to such extent that we may liter- 
ally and truthfully say, "day and night were alike" to it. Nor 
was it more regardful of topical features; its visitations not more 
frequent nor more ruthless to dwellings by the water's side than 
to those occupying more elevated and airy situations. 
Opium and brandy were, in some instances found service- 
able during the initial stage of the disease. This is principally 
and particularly true of the latter ; its "modus operandi " being 
doubtless the same as in the bites of venomous serpents. But 
whilst this is true, it must also be said that narcotism and in- 
toxication were alike found to be conditions which co-operated 
powerfully with the original morbific cause in the rapid destruc- 
tion of life. Opium in full and repeated doses is, I conceive, 
under any circumstances, to be avoided as a practice fraught 
with hazard, and not unfrequently followed by irretrievably 
mischievous results. 
Quinine, astringents, pungent tinctures, antispasmodics, etc , 
were found to be of little, if any, benefit in any case. 
Whilst it is perhaps true that no circumstances of local or 
general filth, as ordinarily defined, are capable of giving rise to 
such epidemics of this diease as have from time to time scourged 
the world, they are nevertheless to be regarded in the light of 
co-operative agencies predisposing to the disease by undermining 
the health and thus increasing its mortality; for we hold it as an 
axiom that those laboring under enfeebled or deranged health 
suffer more than the vigorous and robust in this, as in all other 
epidemics. All such sources of local or general filth serve, more- 
over, in a measure, however small, to swell the volume of poison- 
ed atmosphere, which, like a tidal wave, engulfs towns, cities, 
countries and continents in its desolating flood. Therefore, 
"cleanliness next to godliness" is a fit motto for general observ- 
ance by municipalities, families, and individuals- 
What is the natutre of the peculiar morbific principle pro- 
*To assume that because of suppression there is necessarily uraemia, and 
that where death ensues in this class of cases it is necessarily from this cause, 
is a sort of "ergopropter hoc" reasoning, to be credited cautiously in the light 
of facts we have presented. 8 
CHOLERA OF 1873. 
ducing cholera? Whence does it emanate, and in what manner 
does it operate to produce the symptoms witnessed in the dis- 
ease ? These questions have constituted the theme of elaborate 
and profound discussion for more than fifty years past; and yet 
that prince of authors, Watson, characterizes all that has been 
written as the "endless and perplexing" literature of the disease! 
At the risk of being classed with the contributors of this sort of 
material I shall, diffidently and deferentially, submit some facts 
and some reflections which may not be deemed altogether un- 
important. 
In a report to the American Public Health Association on 
the subject of this epidemic, I employ the following language; 
"If it be true, as physiologists assert, that hydrochloric acid 
exists, naturally, in the stomach of every healthy person, we 
need not task ourselves very greatly to comprehend the design 
of the Great Creator in placing it there. It was, by virtue of 
its antiseptic power, to prevent the decomposition of our food 
before its appropriation by the assimilative organs." 
With the view of testing the solvent power of the acid, I 
instituted a series of experiments, the graud result of which was 
a demonstration of the truth that fresh beef, after having been 
digested in water containing thirty-three per cent, of the acid, 
for four and a half hours, at 100° Fahrenheit and subsequently 
allowed to remain in the cold mixture for twenty days longer, 
showed no solvent effect from the acid whatever. The beef, 
however, when removed was remarkably firm-free from any taint 
and in a perfect state of preservation. 
The known virtues of chlorine as a disinfectant, and those of 
its compounds, chloride of sodium, chlorate of potash, bichlo- 
ride of mercury, chloride of z#inc, etc., as antiseptics, give col- 
lateral support to this opinion, touching the true office of this 
agent as it exists in the secretions of the stomach: 
These experiments appear to negative the opinion so uni- 
formly expressed by authors respecting the office of this import- 
ant agent. That its solvent virtues may be enhanced by the 
presence of pepsin, as suggested in a communication from my 
eminent friend, Dr. J. W. Draper, or by the alleged presence of 
acetic, or other acids, constituting the so-called "gastric juice," 
I am not prepared to deny ; but, in the absence of any proof of 
this fact, I am compelled to recognize its prominent and princi- CHOLERA OF 1873. 
9 
pal virtues, as demonstrated by experiments, to be those of an 
antiseptic. 
If I am correct in my opinion touching this property and 
office of hydrochloric acid in the stomach, it will readily be 
seen that its influence and importance are far greater than have 
heretofore been ascribed to it. As a familiar, but very striking, 
illustration of its office and influence, in preventing decompo- 
sition, I refer to the results which succeed a surfeit- 
particularly of animal food. A diarrhea emitting a highly 
putrescent odor generally ensues. Here the amount of food has 
simply been in excess of the amount of acid present, and de- 
composition necessarily follows. One or two doses of muriatic 
acid or of the hyperchlorinated tincture of iron will generally 
suffice to correct the evil. But the field of its operation is not 
restricted to the stomach. It has been found equally efficient 
in correcting the influence of cholera and other poisons after 
they have entered the circulation. 
It will, therefore, be readily understood why the existence 
of atmospheric poisons, as during the epidemic prevalence of 
cholera, creates, so to speak, a double demand for hydrochloric 
acid in the stomach. If the supply of this agent is sufficient to 
repress the septic tendencies of our food, and to correct the 
poisons which are continually entering the circulation through 
the medium of the lungs, no detriment to health will follow. 
But if the supply is insufficient to meet this increased demand, 
the food will undergo decomposition in the stomach, septic 
poisons will be generated, and we shall thus, figuratively, have 
a "fire in both front and rear;" causes without and within 
operating to produce the same result. 
In view of these facts, we can more fully understand why, 
at such periods, certain articles of diet have been known to pro- 
voke attacks of cholera. The exciting cause may be a highly 
poisoned condition of the atmosphere, or it may be a piece of 
putrid pork in the stomach of the patient. 
It will be correctly inferred that I regard the cholera 
poison as the product of amimal decomposition. 
That I may not appear to over estimate the potency of this 
class of poisons, I instance the well known results which 
sometimes succeed dissection wounds. Here a quantity of mat- 
ter, inappreciable it may be to the naked eye, and held perhaps 10 
CHOLERA OF 1873. 
on the point ot a needle, is capable of producing the most 
violent constitutional symptoms, and often death. 
Before adverting to the effects of certain classes of 
morbific agencies, in support of this opinion, I wish to express 
my individual regret that authors have found occasion to devote 
so little space to a consideration of the diseases produced by 
them; for the causes are by no means uncommon, and the re- 
sults are of the most alarming character. For the two fold pur- 
pose, therefore, of exhibiting the importance of this defect, as 
well as the influence of a class of poisons closely related to, if 
not identical with, those producing cholera, I instance : 
1. The effects resulting from eating putrid meats, sausages, 
etc. 
Among other symptoms enumerated by Apjohu,f are 
absence of fever, vomiting and purging, an extremely cold skin, 
a small pulse, and a suspended condition of the secretions. 
2. The disease occasionally resulting from eating cheese, 
boiled custard, etc. 
I have had access to no author besides the one just quoted, 
who devotes even a passing notice to this class of cases. For- 
tunately, however, my experience in the treatment of these 
affections furnishes the desired information. In 1864 or 1865, a 
malady suddenly made its appearance in Cincinnati, character- 
ized by an absence of fever, vomiting and purging, violent 
cramping of the voluntary muscles, a cold skin, feeble pulse, and 
general and extreme prostration of the vital energies, etc I 
do no injustice to my intelligent professional friends, in that 
city, when I say that much difficulty was experienced and much 
care exercised before we were able to determine whether the 
disease was or was not a genuine form of cholera. It was ascer- 
tained, however, the next day, that the cases all owed iheir exis- 
tence to a cneese sold at the "Lower Market," on the day pre- 
vious. All who partook of it were similarly affected. 
I witnessed in this town, (Jonesboro/ Tenn.,) a few years 
since, the poisonous effects of the custard. The husband, wife, 
two children, two guests and servant all prostrated, from the 
same cause at the same time. The disease was characterized by 
a cold skin, feeble pulse, extreme prostration, violent vomiting 
and purging, serous discharges, cramping of the voluntary 
fTweedie's Cyclop. Prac. Med., art.-Toxicology. CHOLERA OF 1873. 
11 
muscles, etc. The attack occurcd, in each case in from one to 
two hours after the food was eaten.* 
In the case of the putrid meats there exist causes, which 
to the senses at least, appear capable of producing the results ob- 
served. These odors, however, are, i think, accidental, not 
necessary concomitants; as no such offensive qualities pertained 
to either the cheese or the custard. Both were free from any 
perceptible impurity or defect, unless it was a degreee of in- 
sipidity which attached to the latter. 
The effects of the cheese were repeated at Warm Springs, 
North Carolina, a few years since ; one or two deaths resulting. 
They have also been experienced at various other points, 
characterized, uniformly, so far as I have been able to learn, by 
the same general train of symptoms. 
The instances of poisoning from custard have, perhaps, 
been of more frequent occurrence, and for the purpose of illus- 
trating the parallelism of results from the papable and the im- 
palpable poisons, I shall briefly refer to a few of them. 
W. N. Vance, M. D., the physician in attendance, reports 
extensive poisoning as having occurred at Flat Lick, Va., many 
years since; the occasion being a bridal festivity. Owing to his 
remoteness from the scene of suffering, full forty eight hours 
elapsed after the attack before any of the symptoms fell under 
his observation. At the end of this period the patients, generally, 
exhibited the symptoms of gastro enteritis, or enteric fever. 
This was true of all excepting, perhaps, a young man named 
Bishop, whom he, in passing, found lying by the roadside, on 
the bank of a creek, whither he had gone to slake his thirst. 
*Before discussing this subject at greater length, I feel that it is important, 
in a medico-legal point of view, to disabuse the public mind of some errors 
which incidents of this character almost invariably give rise to. The sudden 
occurrence of the disease and the violent character of the symptoms, 
naturally, create the suspicion of evil intent on the part of some suspected 
person. 
The poisons, which I am now considering, do not owe their existence to 
malice, nor are they the class of poisons which might be created by boiling 
certain articles in copper or brass vessels,-nor yet do they derive their ex- 
istence or power from any flavoring extract, employed to render the custard 
palatable. They are the products of fermentative action, and are the crea- 
tions of chemical influences which we do not clearly understand. This 
article of diet, after it is prepared, should be kept at a very low temperature, 
and never be used after it has become in the least degree sour, or even inspid. 
I have seen it in thelatter condition, when an occasional bubbleof gas, arising 
to the surface, was the only evidence of the mischief transpiring beneath; but, 
as demonstrated in the cases recited, intensely poisonous. 12 
CHOLERA OF 1873. 
He was in a dying condition, and no time was lost in adminis- 
tering to him, or in making inquiries touching the primary 
symptoms of the case. His body is spoken of as presenting an 
uniform purplish color. This man, probably, died in the initial 
stage of the disease. 
C. P. Gordon, M. D., reports a similar instance of poisoning 
from the same cause at Dalton, Ga., the occasion, like that 
which gave rise to the cases treated by Dr. Vance, being a 
nuptial celebration. These cases were ushered in by a cold skin, 
feeble pulse, vomiting, purging, serous discharges, great pros- 
tration, cramping of the bowels, &c. The secondary stage was 
characterized by gastro enteritic complications-two deaths re- 
sulting. 
Through the courtesy ot J. S. Wellford, M. D. lam furnish- 
ed with the details of many cases oecuring at Richmond, 
Charlottesville, Rapid Ann and Louisa Court House, Va., as 
well as at other points in North Carolina and Georgia * Re- 
specting the cases which fell under his care, Dr. Wellford 
says ;• "In May 1874 I was called on to attend a family, in 
which, after partaking of a Sunday dinner, in the course of a 
few hours, nearly every member had been suddenly taken 
violently ill with vomiting, purging, intense pain in the bowels 
and with marked prostration, accompanied by violent cramps 
in the arms and legs. The evacuations were at first faecal, but 
afterwards became serous." 
W. G. Rogers, M. D., of Charlottesville, Virginia, reports 
a case highly interesting as exhibiting the power of the poison 
in a concentrated state. The custard was prepared on the 8th 
of May 1875, was said to be "sour and turned" on the evening 
of the 9th, having been kept without ice. On the morning of 
the 11th a portion of it was given to a mulatto child, aged two 
years. The child was taken ill, in half an hour, and died with 
all the symptoms of cholera in ten hours after the attack. Dr. 
Rogers' son, a lad of some ten years of age, took some of the 
custard on the 10th, and is reported as having "had symptoms 
of violent cholera morbus, which passed off in about twenty- 
four hours, leaving him debilitated for several days." 
♦Special Report on poisoning by Custards and Ice Creams by J, S. Well- 
ford, M. D. Prof'r. Mat. Med. and Ther. Medical College of Virginia. Read 
before the Medical Society of Virginia. Published in Virginia Medical 
Monthly, January, 1878. C'HOLERA OF 1873. 
13 
J. W. Sehorn, M. D., of Johnson City, Tennessee, reports, 
a typical case of the disease, as it recently occurred in that 
vicinity. The patient, a young man, ate a single glass of the 
custard. He suffered prolonged coldness, reaction not appear- 
ing for twenty-four hours, vomiting, purging, great prostration, 
feeble pulse, violent cramping of the stomach and bowels, 
watery discharges, and entire suppression of the function of 
both the liver and kidneys. 
I might adduce many others of like character, but these 
cases suffice for the purposes in view, and are fairly illus- 
trative of the effects observed from this kind of poison. Except 
in the case of the lad and negro child this article was in each 
instance, prepared the day before, and kept at a temperature 
not sufficiently low to prevent fermentative action. The cases 
were all attributable to such a condition of the custard. 
The antecedent painless diarrhea, which properly consti- 
tutes the primary stage of cholera, is absent from this class of 
cases In the epidemic it denotes the gradual contamination of 
the blood from the prolonged operation of the poison. Those 
cases which succeed a slight, or brief exposure to the miasm 
will generally be found to occur without this precursory 
symptom It is the continued inhalation of the toxical agent, 
1 think, that developes this effect Two ladies, residents of this 
town, sought refuge in the mountains during the prevalence of 
the cholera. They were both attacked in a few hours after 
their return. The irruption was sudden and violent, and without 
any stage of premonition, but yielded kindly to the usual means 
employed. In the class of poisons of which I have been speaking 
the morbific influences do notexist in any such state, and hence no 
oppurtunity is offered for the gradual poisoning of the blood. 
After one or two stools, which will be found in part faecal, the 
dejections will generally gxhibit the characteristic cholera ap- 
pearance. Violent voming and purging are more speedily pro- 
voked by the presence of the palpable poison, and by such means 
the offending matter is eliminated from the system before its 
full toxical effects are experienced. To this fact is owing too 
the less frequently fatal results than are found to attend 
cholera 
The gastro-enteritic complications, observed by Dr. Vance 
and by Dr. Gordon, to occur secondarily in the cases treated by 
them, respectively, were not present in those which fell under 14 
CHOLERA OF 1873. 
the care of Dr. Wellford, Dr. Sehorn or myself; a difference 
attributable doubtless to the greater and less degrees of concen- 
tration of the poison. So too of cholera. This feature did not, 
except in two or three instances, attend the epidemic as it ap- 
peared in this locality. But so often has it been observed to 
mark the history of the disease, as it prevailed at other timesand 
in other localities, that it has been classed, by many authors, as 
a separate, distinct and most dangerous stage of the malady. 
Such was the case in regard to the epidemic as it prevailed 
at Moscow, St. Petersburg, Sunderland and elsewhere. These 
symptoms, therefore, which have been observed in cases of ac- 
cidental poisoning are in strict harmony with those occurring in 
cholera. 
Suppression of urine is a feature generally attending well 
developed cases of cholera, in which the cold stage is protracted. 
But such condition, so far as our observation has served us, is 
found only to pertain to this stage. As reaction is developed 
the lost function is wholly or partially restored. Were the 
operation of causes more prolonged, and were this algid state 
more protracted in these cases we should have this symptom 
more constantly and more conspicuously present. In the case 
related by Dr. Sehorn, such was found to be the fact. Reaction 
was not fully developed until twenty four hours after the attack, 
and not a drop of urine was voided during that period. 
But it may be asked:-Do such agencies assume a mias- 
matic form ? It is not necessary, we conceive to discuss this 
question. Death, decay and exhalation succeed both animal 
and vegetable life; and the mere presence in the atmosphere, of 
effluvia from the putrid carcass, is evidence sufficient that other, 
and perhaps more volatile as well as more poisonous matter, is, 
in like manner, evolved and assumes an aeriform state 
Chemically considered what is the nature of this subtile, 
undefined and powerful poison ? We do not know ; nor are we 
likely to possess such knowledge until the science of Chemistry 
shall have attained to a higher degree of perfection than it has 
yet reached. In the light of the brilliant and substantial 
achievments in this department I have, however, the faith to 
believe that we shall ultimately, and perhaps at no distant day, 
be made as fully and accurately acquainted with the nature of 
this and all other atmospheric poisons, as we now are with tho 
constituent elements of any substance in the organic or inorganic CHOLERA Of 1873. 
15 
world. When such knowledge shall be ours the means, pro- 
phylactic and remedial, employed in the management of dis- 
eases produced by epidemic causes, will be made to rest on 
principles as immutable as those which govern the relations and 
movements of bodies* Untilthen we shall have to be content 
with our observation of phenomena and results. 
Acidity is the common product of both animal and vegetable 
decomposition. The ill results to health which were observed in 
the instances of accidental poisoning mentioned were due to a 
fermented condition of the articles enumerated. The custard 
given to the negro child, and which proved so rapidly fatal in 
its effects, was preceptibly sour twenty-four hours after it was 
prepared. 
Ammonia is, also, a constant and an abundant product of 
animal decomposition. 
It appears probable that the active principle of this poison 
consists of some unknown acid in combination with ammonia. 
That affinities, however, are not fully satisfied, appears evident 
from the fact that the custard is sour when in a highly poison- 
ous state, and that its toxical properties appear to be intensified 
in a ratio with its acidity. We are in the line of legitimate 
inference, if not of necessary conclusion, I think, in assuming 
such to be the relation of these respective agencies in the 
decomposing mass ; for it is difficult to conceive how they could 
co-exist, in a condition of immediate contact, without such 
result. But regarding it as not improbable that some portion 
of the poisonous acid may escape, could it assume and maintain 
a gaseous state? The mere exhalation in this state proves, in 
part, an answer to the question, whilst the facts proven by the 
simple analysis of rain water teaches that nitric acid exists in 
the atmosphere The same, perhaps, is true of some other acids 
We know of no law or principle, governing in the one case, 
which does not apply, with equal force aud pertinency, in the 
other. But that it, for any considerable length of time, does so 
exist we think more than questionable. 
Ozone is said to exist uniformly and everywhere in the 
healthful atmosphere. Its presence, in sufficiency, implies the 
absence of the cholera miasm, whilst the presence of the latter 
as distinctly indicates the absence of the former. Is not the 
same true of its relations to ammonia ? Is it not alike destruc- 
tive to each ? It is also said of this agent that it not only 16 
CHOLERA OF 1873. 
destroys animal effluvia instantly, but that it, in like manner, 
arrests the process of putrefaction. It therefore, not only de- 
stroys the ammonia in the atmosphere, but restrains, entirely, 
the forces which generate it most abundantly. In view of the 
wonderful power of this agent, and of its reputed absence, dur- 
ing the epidemic prevalence of cholera, may we not fairly predi- 
cate of these facts a redundancy of ammonia on such oc- 
casions ? This fact admitted, the combination of these influences 
in the atmosphere, by reason of their close admixture, is again 
suggested as a necssary result. Thus it appears probable that 
the poisonous acid, evolved from decomposing substances, reaches 
the same combination at last; and hence that the toxical principle 
existing in a morsel of putrid meat-a bit of decomposing cheese 
ora glass of fermenting custard is chemically the same invisible 
and destructive poison constituting the cholera miasm. But 
we are again asked could this product of affinities exist as an 
atmospheric influence ? The same general law which governs 
the existence of an acid, or a compound, in a solution in which 
other substances are also present, will, I apprehend, determine 
the answer to this question If no superior, conflicting or divellent 
forces are encountered it may assume and maintain such con- 
dition. It is true of some compounds-and especially those of 
ammonia-that they are highly volatile; and this may be so, in an 
eminent degree, of the hypothetical one in question. 
Such are our views touching the origin and character of the 
cholera poison. The symptoms produced by the epidemic influ- 
ence and by the palpable poison, respectively, exhibit a similitude 
at once striking and complete. The features are identical, with 
such exceptions as have been mentioned and explained. Can we, 
in the light of these co-incident phenomena, ascribe the causative 
influences to any other than a common origin or the effects pro- 
duced to any other than a common cause ? Had these cases oc- 
curred during the epidemic they would undoubtedly have 
all been classed as cholera, nor would the correctness of the 
diagnosis have been questioned. " Like agencies will produce 
like results" is an axiom not less true, " ceteris paribus," 
in medicine than it is in physics. Il decomposed, or decomposing 
animal matter, 'en-masse,' will produce the results observed 
from eating such substances, the same poisons in an aeriform or 
miasmatic condition, will accomplish the same effect. The atmos- 
pheric poison, by reason of a condition of greater tenuity is slower CHOLERA OF 1873. 
17 
in its operation ; but the symptoms when fully developed are, as 
has been observed, identical with those created by the palpable 
influence. 
I have instanced the effects of the articles enumerated, re- 
spectively, not because I suppose that they, alone, are capable of 
producing the results observed, but because they constitute, 
mainly in some shape or other, our supply of animal food, and 
hence the opportunity is more frequently offered for observing 
their effects when in a decomposing state. It is probable that 
nearly all animal substances, in like condition, yield, in greater 
or less amount, the same toxical principle. 
Should the suggestion made respecting the probably combin- 
ed relation of the cholera poison and ammonia, in a miasmatic 
form, ever attain to the dignity of an established truth we shall 
then have an easy explanation of the virtues of the remedial 
means indicated, in the acknowledged disinfectant quality of 
chlorine, and in the well known and powerful affinity existing 
between this element and ammonia. 
I need not, in view of the opinions expressed, stop to in- 
quire whence emanate these toxical agencies. Their sources of sup- 
ply are almost infinite, and are co-extensive with the boundaries 
of animal life, embracing the decomposing filth of cities, 
towns, and crowded communities, of armies, battle-fields, and 
cemeteries; in short, wherever a human being dwells, or an 
animal dies, causes exist, however insignificant, to augment the 
poisonous influences. Under what electric, thermometric, baro- 
metric, or other influence or condition these agencies are aggre- 
gated and condensed,! can not say ; nor am I able to say how 
far such causes may operate to determine the presence or ab- 
sence of ozone from the atmosphere. 
We deduce from what has been said, the following con- 
clusions : 
1. The cholera miasm is the product of animal decompo- 
sition ; and hence the forces producing this poison are, continual- 
ly more or less active. 
2. That its existence, as an epidemic influence, is due, 
altogether, to the absence, or to a deficiency of ozone in the 
atmosphere. When this element is present, in sufficiency, it 
does not, and cannot exist. 
3. That the effect upon the system will depend on the 18 
CHOLERA OF 1873. 
amount of muriatic acid in the stomach. If the supply of this 
agent is sufficient to meet the demand as heretofore suggest- 
ed, no detriment to health, from this poison, will follow any 
amount or degree of exposure. 
It will thus be observed that these two great corrective 
agencies, although operating in different spheres, are beneficently 
ordained and arranged for the preservation and protection of 
life and health: The one operating to repress and correct 
poisons in the atmosphere, whilst the office of the other is, in 
like manner, to repress and correct poisons in the stomach and 
blood. Thus related in their properties, and co-operative in 
their offices, it follows, as an unavoidable corollary from the 
premises, that the absence of one necessitates, for the purposes 
of health, the constant and full presence of the other. 
I have nothing to add to the views expressed concerning the 
pathology of the disease in the body of the report. No single 
feature of such toxemic condition, we believe, is absent; whilst 
we are unable to explain their existence on any other hypothe- 
sis. In a healthful condition, the blood is the "fans et origo" 
of life, furnishing appropriate nourishment and stimulus to all 
the organs of the body; in a poisoned condition it is a stream of 
death, coursing rapidly through the system, impairing, pervert- 
ing, and suppressing their functions. 
The arguments, " a priori" and "a posteriori" furnished by 
the preventive and curative treatment employed, fully sustain 
the value of the agent designated, and give indirect but strong 
proof of the correctness of the opinion expressed touching the 
principal office of muriatic aid in the stomach. 
No circumstances of local or general filth were observed to 
influence or control the presence or character of the epidemic 
in any manner. A rigid surveillance was kept up by the 
authorities for at least a month prior to the advent of 
the disease. Thorough renovation or entire removal was the 
order, and the town, for once at least within the memory of the 
"oldest inhabitant," was perfectly clean. Nor was defective 
drainage or imperfect ventilation observed to exist in connec- 
tion with any residence visited by the disease. 
The exhalations from the lungs, as well as those from 
the discharges seem capable, under certain circumstances, of 
reproducing the disease. But the same difficulty in deciding 
how far it is infectious was experienced here that has general- CHOLERA OF 1873. 
19 
lybeen encountered elsewhere. The whole atmosphere, during 
the epidemic prevalence of cholera, is in a poisoned condition, 
and we cannot, therefore, satisfactorily determine, at all times, 
in individual cases, whether the results are due to general, or 
to special influences. It must be the same morbific principle 
operating to produce the disease in each case. We can conceive 
of the poison passing through the the system and being again 
evolved in the same chemical condition that it was before 
entering; but the gi'eat number of cases occuring simultan- 
eously, in some epidemics of cholera, suggest unavoidably, 
that the poision is endowed with almost infinite diffusi- 
bility, and that each atom is possessed of a power equal to 
that which so often produces fatal results in dissection wounds, 
or that it is capable of reproducing itself, as suggested by 
Liebig. I leave the settlement of this question to those more 
competent to decide. The effect upon the party exposed to 
such exhalations will be determined by conditions heretofore 
stated. 
A very general belief occupies the public mind that persons 
using limestone water are peculiarly addicted to the disease. 
I am not inclined to attach very much importance to this 
opinioh ; but it must be addmitted that during the recent and 
perhaps other visitations of the disease, its virulence was marked 
in the regions of limestone formation Indeed, I am not aware 
that it prevailed outside of such formation during the epidemic 
of 1873. If it were possible for the lime existing in the water 
to displace the hydrogen, and give us cloride of lime instead of 
muriatic acid in the stomach, the opinion would at once appear 
plausible. But the possibility and probability of such displace- 
ment and combination in the alleged presence of acetic and other 
acids, are questions which I leave to the solution of the practic- 
al chemist. 
Some additional facts were observed which perhaps may be 
worthy of note as bearing on the theory offered concerning the 
pathology ot the disease. 
I had, on several occasions, particularly late in the afternoon 
after visiting my patients, found myself laboring under muscular 
debility, or an inability to control muscular movement, I hardly 
know which, to such degreethat I unconsciously sought support 
by placing my hand on any railing or fencing that chanced to 
stand by the way. The feeling was that of intoxication. My 
associate, Dr. Deaderick, experienced the same symptoms. 
Rev. Mr. McCorkle, who had been faithful in his ministrations 
to the sick at Greeneville, and Rev. Mr. Lockwood, who had 
been alike faithful and constant in his holy ministrations at this 
place, both experienced a like effect of the poison. I visited 20 
cholera of 1873. 
the last-mentioned gentleman, who complained that he "could 
not walk straight." There was no other symptom of ill health. 
The same experience was related by others during the prevalence 
of the epidemic. 
I should in conclusion mention, in addition to the two cases 
alluded to in the body of my report, some two or three other 
cases connected with the question of contagion. Dr. Maloney, 
of Greeneville, visited Nashville during the epidemic preval- 
ence of cholera at the latter place. The distance between the 
two points, by direct line, is about 275 miles. There was no 
cholera in the intervening country. On his return he was at- 
tacked and recovered. Mr, Biper, a near neighbor, next suf- 
fered and died. His remains were carried ten miles distant in- 
to the country for interment. Mr. Stevens living in the vici.iity, 
attended the burial, contracted the disease and died. Mr. Miller 
was present when Mr. S. was attacked, went for the physi- 
cian, returned to his home, some four or five miles distant, 
was violently seized on the next day, or day following, and, 
after a critical illness of four or five days duration, recovered. 
No other case occurred in the neighborhood where 
Stevens died, but some two or three were developed in the 
vicinity of Miller's residence. These were, however, on the 
line of railroad, and only thirteen miles from Greeneville. 
In connection with the first appearance of the pestilence 
at Greeneville, should be mentioned the fact that a few days 
prior to that event a public priv\, containing somq, six or 
seven pits, with the accumulated filth of more than thirty 
years was cleaned. This was carted through the streets, in 
open vessels, to the north side of the town, where it was de- 
posited on the land of the contractor. From this point to a 
creek, coursing through the southern part of the town, was a 
gentle declivity, a distance of more than half a mile. The drain- 
age was in the very direction whence the filth was removed, and 
was obstructed almost the entire distance by vegetation and 
other causes. The whole slope presented fairly to the action of 
the sun's rays. The circumstances I regard in the light of con- 
tributive influences only. 
1 beg leave to say that whatever diversity of opinion 
may exist in regard to the views expressed concerning the 
origin and character of the disease, there can exist none re- 
specting the efficacy of the treatment suggested, after it shall 
have been subjected to a faithful trial. The effects of lime- 
water in a case of poisoning by oxalic are not more prompt, 
nor more distinctly marked* 
*NoTE.-*Ihis paper is a more elaborate expression of the views set forth in 
a communication to American Public Health Association, and publishsd in 
their Transactions for 1873. Afterwards to Commissioners appointed by act of 
Congress on the subject of the epidemic. (Vide Cholera Epidemic in the Uni- 
ted States in 1873, page 202.) And subsequently by Cincinnati " Lancet and 
Observer." ADDENDA. 
Taylor (Taylor on Poisons, 3d edition,) is quoted by Prof. Wellford as say- 
ing, in regard to the cases of custard poisoning instanced by the latter, that: 
"The facts are more consistent with the effects produced by malignant 
cholera."3his is certainly, we think, true; but the poison in each case existed 
in a palpable, not in a miasmatic form, as appears to have been supposed by him. 
I am not aware that epidemic cholera visited any one of the localities refer- 
red to by Dr Wellford. Boiled custard, it should be stated, is made of milk, 
eggs, sugar and such flavoring extracts as the taste may suggest. Ice cream 
contains, generally, the same ingredients, and is capable, under the same con- 
ditions, of producing the same results. At the June Session 1878, of the Washington County Medical 
Society, the following resolution was unanimously passed : 
"Your committee appointed, at the May meeting of the Wash- 
ington County Medical Society, to draft resolutions relative to 
Dr. Sevier's report on Cholera, would submit the following : 
Resolved : That it is the sense ot this Society, that the report 
of VV. R. Sevier, M. D., on Cholera of 1873, is a valuable contri- 
bution to Medical Literature, and that this Society heartily en- 
dorses the theory of Cholera, as set forth in said report, togeth- 
er with the treatment recommended therein. 
A. S. N. Dobson, M. D. 
J. W. Sehorn M. D. 
D. J. Gibson, M. D. 
S. E. Lyon, M. D. 
E. L. Deaderick, M. D. 
Committee. 
E. L. Deaderick, Sec'y. W. W. BOVELL, Presd't.