R EPO IirsL> T ON THE EPIDEMICS OE WHEELING, BY DB. S. L. JEPSON., OF WHEELING. At the last meeting of this Society I was appointed a member of the “Committee on Climatology and Epidemics,” but beg the privilege of con- fining my report to Epidemics alone, and will only attempt to give a brief and necessarily imperfect account of those which have occurred in Wheel- ing, my own field of observation. Since no report has been made for sev- eral years, I will go back as far as 1872, at the close of which there appeared in the city PUERPERAL FEVER. This disease made its appearance in December of that year, and prevailed until the following Summer. Indeed the tendency to puerperal diseases has continued almost to the present time. It is impossible now to tell how many cases occurred or how many deaths have resulted from this cause. But they were much more numerous than at any other time since the year 1847, when, I am informed a great epidemic existed both in the city and neighboring country. Tn this later visitation the cases and deaths were so numerous as to strike terror to the heart of every pregnant woman, and also to cause all physicians to look forward with dread to every expected obstetrical case The first case attended by myself was first seen on Dec. 23rd. So far as I can learn this was the second case in the city. My next case occurred on Jan. 3rd. As this was a typical case serving well to illustrate the type of of the disease as it prevailed here, and as it was the only case in which an autopsy was held ,1 here present brief notes taken at the time. S. II. colored, act. 1!) unmarried in previous good health, was delivered of her first child Jan. 3rd, 1873, by a midwife. Labor natural. I was called to see her at 1) A. m., Jan. 4th, 32 hours after delivery. She had passed no urine. IdrewofF nearly half agallon. At this time the abdomen was distended with gas, and there was considerable pain, even when the patient was quiet, while there was marked tenderness on pressure in the iliac and hypogastric regions. A vaginal examination discovered great tenderness in both iliacs. Pulse 112, and rather full but soft. Temperature 101 if degrees. Tongue dry, and sordes on teeth. Ordered hot poultice to the abdomen, preceded by turpentine stupe. Morphia gr. and quinine grs. 2 every two hours. I _ - 34 Epidemics op Wheeling. Jan. 5, 9 A. m.. Pulse 120, temperature degrees. A marked dimin- ution of the tenderness in the iliac regions, while that in hypogastric was increased, and also extended up to umbilicus. Marked tympanites. In the evening the temperature was 1041 degrees, and the pulse was weaker. Morphia gr. every three hrs.; also brandy in addition to the other treat- ment. Jan. 6, 9 a.m. Temperature 104 degrees. Pulse 130 and losing strength. Delirium at times. Abdomen becoming even more tympanitic, but the tenderness not marked. A quantity of muco-pus offensive in character, flowed into the bed pan from the vagina to-day. From this day the pulse rapidly gave way, there being hut little sign of improvement at any time; and death occured at 5 o’clock p. m. of Jan. 7th, the fifth day. after confine- ment. No urine was passed after delivery except through the catheter. A hasty and partial examination of the body was permitted, which revealed the following appearances. Intestines enormously distended with gas, and also contained a large quantity of liquid feces. A considerable quantity of fluid in peritoneal cavity. A few lymph floculi were scattered over the lower bowels. No agglutination of the intestines nor other evidence of general peritonitis. The serous covering of the uterus was inflamed, the inflammation apparently of a low type. Ovaries much congested. No evidence of sthenic inflammation any where present. Uterus was well contracted. No further examination made. During the past two years many cases have been reported to our local Society, none of which differed materially from this case. The disease generally set in within forty-eight hours or at longest seventy-two hours after delivery, the initial symptom being either a distinct chill or chilly sensations. These were immediately followed by fever, the temperature varying from 102 to 105 degrees during the course of the disease. The pulse was quick and never strong; abdomen always distended, and tenderness in pelvic region; always more or less tendency to delirium. My own expe- rience is that the abdominal tenderness did not commonly extend as high and was not so great as in the case detailed above. The lochia and also the milk became suppressed, or perhaps the secretion of the milk never became established. The tongue early became dry, sordes appearing on the teeth, and the pulse soon gave way. There was generally little or no abatement of the symptoms at any time in the fatal cases, the disease passing rapidly into a typhoid stage, which speedily terminated in death by asthenia. I have seen or heard of no evidence pointing to the contagiousness of the disease. No one physician had more than his share of these cases. The disease was not at all localized in the city; and indeed I believe several cases occurred in the country. During the prevalence of the disease, there occurred in my own practice several cases in which delivery was followed on the second or third day by a slight increase of temperature, (99 to 101 degrees,) with some tympanites and pelvic pain and tenderness, all the symptoms yielding readily to a few doses of opium. Treatment.—In the bad cases this consisted generally of opium freely, with early and persistent stimulation with quinine and alcoholics; locally, turpentine followed by hot poultices. Some of our physicians used veratrum in conjunction with opiates early in the disease. Others employed tincture of iron. In a few cases mercurials were employed. In many cases vaginal injections of a solution of carbolic acid or other disinfectant, were employed. One or two physicians used blisters Dr. S. L. Jepso:*. 35 to the suprapubic region, apd had confidence in their efficacy. I think how- ever, the profession Avill bear me out in the statement, that no treatment Avas settled doAvn on Avith confidence in its beneficial results. The mortality under all plans of treatment Avas very large. TYPHOID FEVER. In the autumn of 1873 and later, typhoid fever prevailed in Wheeling to an extent never before observed in the city. It became epidemic in Sep- tember, and was not confined to any one part of town, but was present in every ward and street. The number of cases can only be estimated, but they were certainly not less than four hundred, and may have been as many as five hundred during the last four months of the year. The number of deaths likewise is uncertain. The number of deaths returned to the Health Officer during those months was thirty, but this is below the actual mortal- ity, the returns in no case being full. One marked feature of this epidemic was the mildness of the large majority of the cases. Many of the patients, while having all the ordi- nary symptoms of genuine typhoid fever as seen every year, could with difi- culty be persuaded of the importance of lying in bed, and indeed of some it may be said that they did not pass a whole day in bed during a sickness of two to three weeks duration. One case of this kind occurred in my practice, the patient being a boy 9 yrs. of age. He spent the mornings in an easy chair, but towards evening was compelled to resort to his bed or a lounge. The case was a well marked one, but all my endeavors and warn- ings failed to keep him in a recumbent position ; and after an illness of more than two weeks duration, he made a slow but perfect recovery. Another peculiarity of this epidemic was the unusually large number of cases occurring among children, some of them being very young. I think it would be safe to say that a majority of the persons attacked were under eighteen years old. In the quite young patients the disease was generally remittent in type. As to the cause of this epidemic, no theory has been offered that is at all plausible, and I therefore prefer to present none here. The following facts however may be given: About the time of its commencement, cholera had just left the city. On account of the presence of this disease as early as the latter part of June, more than ordinary attention had been given to the sanitary condition of the city during the whole summer. In the prosecution of this sanitary work, over two hundred privy vaults were cleansed during June and July, (“better late than never,” being the idea,) the contents being removed by the abominable bucket and cart sys- tem, and transported through the streets to be dumped into the river, not unfrequently a part of the load escaping on the streets. Is it possible that this stirring up of old vaults in the hot months and the letting loose of foul gases throughout the city, had any influence in the causation of a typhoid epidemic which set in two months later ? CHOLERA, In June 1873, as above remarked, Wheeling in common Avitli many other towns and cities of the South and West was visited by malignant cholera. Being Health Officer of the city, I was in a position to watch its progress, and hence am able to report more fully upon it, than upon the other epi- demics here referred to, the direct prevention or control of which our health laws do not contemplate. 36 Epidemics of Wheeling. As I propose to enter somewhat fully upon a history of this epidemic, if so few cases as we had can be dignified with such a title. It may be well in order to a more correct understanding of the facts here given, by those who have never visited Wheeling, to say a word touching the topography, sanitary aspects &c, of the city. Topography.—Wheeling is situated on the east bank of the Ohio River (ex- cept the Seventh Ward, which is on Wheeling Island, and may be omitted in the consideration of the subject, as no case of cholera occurred in it), on “an average elevation of six hundred and forty feet above the sea level,” and the “river bottom” on which two-thirds of the city is built is forty feet above low water mark in the Ohio. That part of the city under considera- tion is divided into seven wards, numbered front north to south 1st, 2nd, 3rd, 4th, 5th, 6th and 8th, the 1st being the highest and the 8th the lowest ground. Wheeling Creek, a stream of considerable size, divides the city between the Fourth and Fifth wards. The Eight Ward is separated from the remainder of the city by a wide common, through which a small stream flows. The common is laid out in streets, and contains a number of residences recently erected. The whole city is surrounded by high hills, which so closely overlook the river that the city is cramped for room, and so extends in width only from one to eight squares, the average not exceeding four. The length is about four miles, and it contained a population of 26,000. In order that an approximate idea may be had of the location of the chol- era cases (the number of each house being given in an accompanying table), I will state that our streets running uorth and south are named, from the river eastward, Water, Main, Market, Chaplain, Eoff, Jacob, Woods, etc.; those running east and west, First, Second, Third, etc., and each house is numbered from north to south on a basis of one hundred to each square. Sanitary Condition.—As a result of the proximity of the hills, upon the sides of which many houses are built, in many places it is impossible to dig privy vaults that will not rapidly fill with water. In some parts of the city, too, the same state of affairs exists by reason of former swamps and small water-courses having been filled up, previous to any attempt at drain- age. This is true, particularly in the Spring and in very wet weather, of portions of every ward in the city. As a consequence, the city contains an unusual number of offensive vaults, many requiring cleaning every year, and some rapidly filling up, even in dry weather, after being cleansed. The city in 1873 was badly paved and poorly sewered. Many of the streets south of the creek, and almost all the alleys, were entirely unpaved, while that portion of the city was and is still 'most deficient in sewerage. The waste water from hydrants, kitchens and stables, therefore, finds its way into the alleys and street gutters, while the more solid offal was thrown out, in the confident expectation that it will be speedily removed by some of the innumerable hogs which roamed through the city. As soon as the city became “threatened with epidemic disease”—an emergency in the absence of which the Health Officer has riot the power to em- ploy a single assistant,—a Sanitary Inspector was appointed for each ward with full potver to compel the abatement of all nuisances. Men under the control of the Street Commissioner Avere kept constantly at Avork in some part of the city, and lime Avas scattered at intervals in the gutters aud alleys. So that Wheeling, while not in a condition to especially repel cholera, Avas neither in a condition to especially invite it. We will noAV proceed to detail the first reported cases, and refer to such others as seem to be of sufficient interest to merit some attention. Case No. 1.—The first case that presented symptoms of cholera did not come to my knowledge until the end of the month in which it occurred, Dr. S. L. Jepson. 37 when I saw the death certificate, written “Cholera Nostras.” The date of the attack was June 9, the patient, a German woman, aged fifty years, resi- dence 2,114 Main Street, Fifth Ward, wife of the proprietor of a lager-beer saloon, which was in the same house as that occupied by the family, who lived in the rooms back of the saloon. The second and third stories were occupied by two families, six individuals being on the second floor, and four on the third. A man and son on the third floor were newspaper carriers, and a man and son on the second floor were laborers, with no regular place of employment. A privy vault was in common use at this house, and was also used by the visitors to the saloon. The rear wall of the cellar formed one wall of the privy vault, which was in very bad condition, the fluid con- tents of the vault leaking through into the cellar of the dwelling. On June 9, about 3 p. m., after her morning work, this woman was suddenly taken with diarrhoea, full cholera symptoms rapidly developed, and after about three hours of collapse she reacted, but died on the sixth day with “cholera typhoid.” This patient was subject to attacks of what her physi- ician calls “gastric and intestinal catarrh” every Summer. She had not been absent from the city during the Summer, nor had any of the inmates of the house. No stranger had been visiting them, and no direct means of introduction of the disease has been discovered. Case No. 2.,—Male, aged twenty-two years; residence 3,600 Chaplain Street, Eighth Ward. In good health, temperate, and worked at the La Belle Iron Mill. The house in which this case and the succeeding one occurred, is a large two-story brick tenement, occupied by five families, con- taining nineteen individuals, eleven up stairs and eight down. Those per- sons engaged away from the house were occupied as follows; The father of Case No. 2, with two other men, worked at the Glass Works of Hobbs, Brockunier & Co., who employ about three hundred hands; three at La Belle Mill; one a laborer without steady employment. The premises were in bad condition. The cellar was very damp, and contained a small quan- tity of offensive water; an open board drain intended to carry waste water from the hydrant was defective and filthy; at the foot of the yard was an unused privy vault almost full, and but imperfectly covered. This patient had for several days been suffering with a diarrhoea, and was hence unusually prudent in diet. On the day of his attack with cholera, he walked to his physician’s office, a distance of two squares, and fainted twice on his way home, from exhaustion caused by previous copious discharges. On this day, June 20, vomiting, cramps, and rice-water purging set in, suc- ceeded by collapse, from which the patient reacted, and recovered after six days. # Case No. 3.—The next case was the mother of the above, aged sixty-one years. In only tolerable health. Had nursed her son, and was thus con- stantly exposed to the disease germs. Was suddenly attacked on June 28, having had no premonitory diarrlicea. Collapse occurred, followed by reac- tion in a few hours, and recovery on the 30th, the case being milder than No. 2. In about a week after her recovery, the husband had an attack of cholera morbus, from which he recovered without serious illness. None of these patients, so far as can be learned, were in any way exposed to the disease previous to the occurrence of the first case in the house. Case No. 4.—Male, aged thirty years; residence 3,631 Eoff Street. In previous good health, moderate drinker, worked at the La Belle Mill, at which Case No. 2 was employed. Residence one and a half squares from cases Nos. 2 and 3, but there was no acquaintance even between the fama- lies, and no intercourse. After nearly a week’s diarrhoea, by which he was not kept from his regular employment, this man was stricken down with cholera on the night of July 3. Collapse set in, followed by reaction in a few hours, and recovery after four days. The patient in all probability 38 Epidemics of Wheeling. used the vault at the mill during his premonitory diarrhoea, and may thus have been exposed to the poison of the disease deposited by Case No. 2. Case No. 5.—Male, aged sixty-six years ; residence 2,523 Chaplain Street. Healthy, temperate. Occupation, Justice of the Peace. Had diarrhoea for nearly a week, which was checked before July 4, on which tlay he attended a picnic in the country. He committed no imprudence in eating, hut drank freely of lemonade made with limestone water, and to this attrib- utes his relapse. At 1 o’olock A. m., July 5, he was seized with violent symptoms, the disease rapidly developed, collapse coming on in a short time. Reaction, however, was brought about in a fewr hours, and the patient recovad after seven days, sickness. There was a total suppression of urine for fifty-four hours. The residence of this patient was nearly a mile from that of any previous case, and no possible connection with any other case can be traced. The premises were in good sanitary condition, but an alley in the rear, and a gutter at the side of the house, were sometimes offensive, but these were never a cause of complaint. It is not necessary to give at length the history of every case, all essen- tial facts being given in an accompaning table. The cases reported below, however, seem to have some special interest by reason of their connection with each other or with other cases, and are therefore given somewhat in detail. Case No. 7. Male, aged sixty-two years; residence 3,824 Eoff Street. Healthy, temperate. Occupation, night-watchman at the Riverside Nail Mill, which is on Main Street, extending from Twenty-fourth to Twenty- fifth Streets. Employed with him was another night-watchman, Mr. A., who tells me that previous to Mr. H.’s sickness (Case No. 7), he (Mr. A.) had a diarrhoea for three days; but kept at his post in the mill, using the privy vault on the premises. He described his diarrhoea as being painless, and so loose and watery as to necessitate great haste in reaching the vault. It was also so prostrating as to compel him to lie at home for a week after it was controlled, which was quickly done by early treatment. Mr. H. had diarrhoea at the same time, and not only remained in the mill with Mr. A., using the same vault, but visited him at his house after he was com- pelled to cease work. His diarrhoea ran on for nearly two weeks before he was attacked with choleraic symptoms. On the evening of July 9, vomit- ing and purging set in, followed by cramps of the extremities and speedy collapse. The dejecta were decidedly rice-water in character. Recovery ensued after seven days illness, during which time typhoid symptoms existed, as indeed was true of almost every case that recovered. Cases 10 and 11, were a man and wife, age respectively, seventy-three and seventy years, residence No. 30 Fifth Street, healthy, temperate, the hus- band a manufacturer. Local sanitary condition very good, being high and dry, and the premises in perfect condition. The husba'nd, a man of uncom- mon vigor for his years, was attacked with diarrhoea on July 20. Received medical treatment on July 21, but the diarrhoea was not checked. On the evening of the 22d, the stools were decidedly rice-water in character. On the morning of the 23d collapse set in ; some little reaction manifested, but death resulted on the 24tli at three P. M. Neither cramps nor pains at any time. The wife was a constant watcher at her husband’s bedside, and although in excellent health previously, was worn out with anxiety and nursing. She was attacked suddenly with violent symptoms at five A. M. of the 25th, and died in collapse at 9 p. M. of the same day. In this case vomiting, purging, cramps, and rice-water dejecta were all present. The only possi- ble connection traced between these and other cases, is the fact that Case 10 was in the habit of frequently visiting the mills in his business capacity, Dr. S. L. Jepson. 39 and several cases had occurred among the mill hands. The location of the cases was nearly two miles from any previous case. Case 12.—Female, aged fifty-two, residence 1,102 Chaplain Street, where she kept a boarding house; was somewhat worn down by hard work and the cares of her occupation, otherwise healthy. Sanitary conditon of the premies bad. In the yard but ten or twelve feet from the kitchen, and on liigher ground, was a large privy vault which had been cleaned out in May by my order, but which had again rapidly filled up, owing to the nature of the ground, and was again exceedingly offensive, the contents of the vault escaping at one point on the side next to the house. On this side of the house in the second story, were two rooms which contained an offensive odor, the cause of which could not be discovered, although diligent search was at different times made. One of these rooms was occupied by the patient as a sleeping apartment. This lady was in her usual health until the morning of her fatal sickness. The evening previous she had eaten a dish of ice cream. On the morning of July 25. she went as usual to the butcher shop one square distant, and on her return proceeded to prepare for the breakfast. She soon complained of not feeling very well, and about seven o’clock an exhausting diarrhoea set in. Two hours later violent cholera symptoms commenced, and the case resulted fatally at 9. p. m. Case 14.—Male, aged forty-seven, temperate, healthy, an artist, two weeks from Philadelphia on a visit to a brother at No. 59 Twenty-sixth Street. Was attacked suddenly with great violence at eight p. m. on July 29, two hours after having eaten his supper. Was in a collapse when a physician reached him at ten o’clock. Eecovered in a week. The brother had a sim- ilar, though less severe attack three days before. The case was not reported, being called cholera morbus. Cases 14, 19, 32, 33, 34 and 35, constitute a group of considerable interest, and I shall speak of them together. They all occurred in a small frame house of two rooms on one floor, located in the Fifth Ward, on a high point overlooking Wheeling Creek, and nearly half a mile distant from any other dwelling on the same side of the creek. The house was occupied by two families, about ten individuals, nearly all unclean in their habits* and inebriates. Case 14.—Male, aged fifty-eight, occurred on August 29, was compara- tively mild, and was not reported as cholera. The patient recovered on September 10. Case 19.—Female, aged twenty-eight, intemperate; occurred on Septem- ber 2, was also mild, recovering on September 6, and was not reported. The other cases occurred respectively on September 14, 19, 24 and 25, and were all fatal. It was not until the 25th that any case was reported to me. I immediately visited the house, where I found one person dead, one dying, and the third in a semi-collapse. A somewhat intelligent woman, who had been nursing these patients, gave me a full account of all the cases that had occurred, as did also the two patients who recoverd, and I cannot doubt that they were all the v ictims of the same disease. I found that there was no privy accommodations whatever on the premises, and the cholera dejecta had been thrown out on the ground in the neighborhood of the house. The floor of the dwelling was also in a horribly filthy condi- tion. No attempt whatever had been made at either cleanliness or disinfec- tion. Several of the inmates Avere in a besotted condition at the time of my visit. All Avas done that was necesary to put the premises in good con- dition, disinfectants having been freely used. Cholera had disapeared from the city proper on September 7. In this isolated position it lingered untli these measures enforced, after which no other case occurred. 40 Epidemics of Wheeling. Case 24.—Male, colored, aged sixtv-seven, residence in private alley near Tenth and Market streets, laborer, very intemperate, sanitary surroundings bad ; house low, dark, and poorly lighted and ventilated. This man had been suffering with a diarrhoea for some days, and was much prostrated thereby, no medical treatment having been received. On September 3, at ten A. m., he was attacked with cholera, and died at twelve P. M. on the 4th. Case 31.—A daughter of the above, age twenty-six, prostitute, was attacked with diarrhoea on the 5th, but like her father, neglected it, and on Sep- tember 7, at eight p. M., violent cholera symptoms set in, which terminated her life in six hours. Case 27.—Female, aged fifty-two, intemperate; had been in the city about a month, selling pictures from house to house. She was boarding at No. 1,214 Water Street, a German hotel. Had diarrhoea for some days. On September 5, at six A. M., was seen by the proprietor vomiting in the yard ; ate no breakfast. Cholera in its usual form soon after developed ; the patient was removed to the hospital, and died there at nine P. M. In the room with this woman was her husband, who, although making no com- plaint, had also diarrhoea, and when seen at nine A. M. had a cold, shriv- eled surface, feeble pulse, and slight cramps in the legs. He also was sent to the hospital, confined to bed, put under treatment, and in a few days recovered. Before making any comments on the facts here given, we desire to refer to a most interesting group of cases that occurred in the country four miles away, and which are not connected with the epidemic in the city. Mr. J. T. C., a medical student, for some months resident in the Good Samaritan Hospital of Cincinnati, Ohio, took passage for this city on the steamer Andes on June 13. On June 15, he was attacked with a painless, liquid diarrhoea, which continued without treatment until he reached home, The Andes landed at Wheeling on the morning of the 17th, and Mr. C. started immediately for his home, walking one and a half miles and riding in a wagon the remainder of the distance. The diarrhoea continued, and vomiting set in the next day. Mr. C. described the dejecta to us as “resem- bling water into which a small quantity of milk had been poured.” Medi- cal treatment, with perfect rest, wrought a cure. On June 21, four days after Mr. C’s arrival at home, his mother aged fifty-two, in previous good health, was attacked with choleraic symptoms, and after being sick a week, recovered. On June 25, Mr. C’s grandmother, aged seventy-three, was sim- ilarly attacked, and died in twelve hours. On June 30, Miss C., aged nine years, was similarly prostrated, but recovered in about a week. Cramps accompanied all these cases except Mr. C’s. Treatment was promptly administered by Mr. C., a very intelligent student, else the deaths might have been more numerous. The house in which these cases occurred is situated on a high point in the country, the family is possessed of ample means, and no sanitary defect existed. The cases could not be traced to any error in diet. It is worthy of remark that the first death from cholera in Cincinnati was not publicly reported until June 14, one day after this gentleman had left the city. Nothing resembing cholera had occurred in the Samaritan Hospital previous to his departure. That the cases were cholera, however, and that Mr. C. was the carrier thereof to his home, we cannot doubt. If any additional evidence on this point is desired, the following facts seem to supply them. The only place at which Mr. C. stopped between the boat landing and his home, was the house of a black-smith about three miles out of the city. Here it became necessary for him to resort to the privy vault. Within ten days thereafter, the black-smith, his mother, wife and six children, every occupant of the house, were seized with vomiting, | Number. 1 Ward. Residence. * rXl Color. 6 u Married or Single. Occupation. Hate of Attack | Date of j Recovery. Date of Death. I Dnration of Fatal Cases. Sanitary Condition. Habit9 and Physical Condition of Patient. Remarks. 1 5 2114 Main St. F. W. 50 M Housekeeper. June 9 - June 15 6 days Bad. 1 >elicate health Preinon. diarrhcB t. 2 8 IfloO Chaplain St. M. W. 22 S. In iron mill. 20 June 26 - - Bad Temperate—healthy. Premon. diarrhoea. 3 8 3600 Chaplain St. F. W. 60 M. Housekeeper. 28 J uly 1 - - Bad- Not very strong. Sudden invasion. 4 8 3631 EolT St. M. W. 30 M. In iron mill. luly 3 6 - - - Good Healthv—Mod. drinker. Premon. diarrhaea. 5 6 2523 Chaplain St. M. W. 66 M. Justice of the Peace. 5 12 - - - Med. Healthy—temperate. Premon. diarrhoB'. 6 6 2629 Chaplain St. M. w. 60 M. In B. AO. K. R. Shop. 6 10 - - Good Healthy—temperate. Halfday’s diarrhoea. 7 8 2824 Eoff St. VI. w. 60 M. In iron mill. 9 17 - - - Good Heal til v—temperate. Premon. dia'rhoea. 8 4 1714 Eoff St. M. w. 48 M. Street paver. 16, 4 p. m. ~ July 17, 5 a m. 13hours Bad. Intemperate. P emon. diarrhoea. 9 8 3426 Market St. M. w. 48 M. Laborer. 21, 9 p, m. - 23, 6 p. m. 45hours Good Good health. Premon. diarrhaea. 10 1 30— 5th St. M. w. 73 M. Manufacturer. 22. 8 p. m. - 24, 3 p. m 43hours Good Healthy—temperate Premon. diarrhoea. 11 1 30— 5th St. F. w. 70 M. Housekeeper. 25, 5 a. m. - 25, 9 p. m IHliours Good Healthv—temperate. sudden invasion. 12 2 1102 Chaplain St. F. w. 48 M. Housekeeper. 25, 9 a. m. - 25, 9 p.m. 12hours Bad. Worn down by care. sudden invasion. 13 6 59— 26th St. M. w. 49 S. Artist. 29 Auir. 5 - Good Healthy—tenipei ate. Sudden Invasion. 14 5 Poverty Point. M. w. 5S M. Laborer. Vug. 29 Sept. 10 - Bad. Healthy. Premon. diarrhoea. 15 2 1057 Morrow St. M. w. 59 M. Cigar maker. 30.3 p. m. - Aug. 31,11a. m. 2< hours Good Very intemperate. Premon. diarrhoea. 16 5 2219 Eoff St. M. w. 30 S. In iron mill. 30,4 p.m - 81, lij^p.m 7V6 hr’s Med. Intemperate. Premon. diarrhoea. 17 8 3722 Eoff St. M w. 35 M Teamster. 31,8a. m. - 31,11 a. m. Sliours Good Intemperate. Premon. diarrhoea. 18 5 2224 Main St. M. w. 28 S. In iron mill. 31.6 p. m. - 31,12 p. m. Ohours Good intemperate. Unknown. 19 5 Poverty Point. F. w. 28 M. Housekeeper. Sept. 2 Sept. 6 - Rad. Intemperate. Premon. diarrhoea. 20 6 2408 Short St. F. w. 38 M. Housekeeper. 2, 8 a. m. - Sept 2,12 p. m. 16hours Med. An invalid Premon. diarrluea 21 8 Country Road. M. w. 32 M. In iron mill. 2 Sept. 14 - - Bad. Intemperate. Premon. diarrhoea. 22 6 3013 Market St. F. w. 48 M. Housekeeper. 2,12p m. - Sept. 9,10 a. m »V£days Good Healthy—temperate. Sudden invasion. 23 1 North of 1st, on Main St. M. vv. 40 M. In iron mill. 3,10a.m. - 4, 7a. m. 21 hours Med. Healthy—temperate. Premon. diarrhoea 24 2 Near 10th & Ma ketSts. M. col. 67 M. Laborer. 3 10 a.m. - 4,12 p . m. 38hours Bad Very intemperate. Premon. diarrhoea. 25 6 2407 Alley C. M. w. 37 M. In iron mill. 3. 9 p. m. - 4, 12 p. m. 27hours Good Very intemperate. Premon. diarrhoea 26 8 3725 Jacob St. M. w. 48 M. Shoemaker. 3.12 p.m - 5. 6 a. ni SOhours Good Verv intempeiate. Premon. diarrhoea. 27 3 1214 Water St. F. w. 52 M. Peddler. 5,7 a. m. - 5, 9, p. m 14hours Good Intemperate. Premon. diarrhoea. 28 6 2318 Woods St. M. w. 44 M. In iron mill. 5 Sept, 10 - Good Healthy. Premon. diarrhCBe. 29 8 3638 Eoff St. M. w. 57 M. In glass works. 6 14 - - - Good Not robust—Mod. drink’i Premon. diarrhoea. 30 6 2623 Jacob St. M. w. 23 M. In iroh mill. 6 11 - - - Good Healthv—Mod. drinker. Preinon. diarrhoea. 31 2 Near 10th & Market Sts. F. Col. 26 S. W asherwoman. 7 8p.m. - Sept. 8.2 a. in. 6hours Bad. Healthy—Prosti'ute. Preinon. diarihcB.t. 32 5 Poverty Point. F. w 11 S. Child. 14, 8 a. m. - . 14, 8p. m 12hours Bad. Healthy. Premon. diarrhoea. 33 5 Poverty Point. F. w. 55 VV id Housekeeper. 19 - 30 11 days Bad. Unknown—intemperate. Premon. diarrhoea. 34 5 Povertv Point. F. w. 41 M. Housekeeper. 24.10a.m. - 25, 5 p. m. 31 hours Bad. Unknown. Unknown. 35 t Poverty Point. M. w 10 S. Child. 25,9 a. m 26,4, a. m 19hours Bad. Healthy. Unknown, Cholera Cases occurring in Wheeling, West Va., in the Epidemic of 1873. 42 Dr. S. L. Jepson: purging and cramps,—either one, two, or all of these symptoms. The smith himself was the first to be attacked, had all these symptoms, and by reason of consequent debility was unable to resume work for about ten days. All the other cases were milder. I have visited this house, and did not learn of any error of diet to cause such a result. Having now completed our account of the cases occurring in Wheeling and vicinity, we may state that the facts here given were received in no ill- stance at second hand, but directly from either the attending physician, or the patient and present friends, or in most instances from both. We have visited every house—with a single exception—in which any case occurred, and our aim has been to give facts exactly as they existed. Mortality.—By a reference to the table, it will be seen that we had two distinct visitatio ns of cholera. One commenced on June 9, or, if we throw out Case 1, on June 20, and ended on July 29, during which time only thirteen cases occurred, with six deaths, a mortality of forty-six per cent. The disease then suddenly disappeared, not a single case occurring until exactly a month later, August 29, from which time until September 7 no less than eighteen cases occurred, when it again departed from the city proper; four additional cases occuring, however, between September 14, and September 25, in an isolated dwelling, making in the second epidemic a total of twenty-two cases, with sixteen deaths, a mortality of seventy-three per cent. During the Summer, then, there occurred thirty-five cases and twenty-two deaths, giving a mortality of sixty-three per cent, which cer- tainly entitles the disease to be called malignant, whether it be of Asiatic or American origin. Distribution of the Disease.—By a reference to the table it w ill be seen that the cases were located by wards as follows : First, three; Second, four; Third, one; Fourth, one; Fifth, nine; Sixth, eight; Eighth, nine; thus the three last named wards, which are south of the creek and joining one another, contained twenty-six out of the thirty-five cases. The case in the Third Ward was not a resident of it, but a peddler temporarily stopping there, and who may have been exposed to the germs of the disease in some of the houses visited by her daily. She was a German, able to speak little if any English; the wafds south of the creek contain the greatest propor- tion of our German population, facts which render it probable that she plied her vocation principally in that part of the city. The case occurring in the Fourth Ward was a street paver, and on the day of his attack and previously, was at work in the Fifth Ward. One of the three in the First Ward—the patient whose wrife also died—was in the almost daily habit, in conducting his business, of visiting the nail mills in the Sixth Ward. It is evident that the disease was in a great degree localized in the three lower wards. Local Sanitary Condition, Effects of,—After a careful study of these cases, we are not convinced that the comparative uncleanliness of different parts •of the city affected the location of the cases, since there is no great differ- ence in this respect between the different wurds. The Third and Seventh are always the cleanest, and contained but one case, but the Second, which contained four cases, and the Fourth, which contained but one, are both less cleanly than the Eighth, which contained nine cases. The latter, however, as already stated, is the lowest, and next to it the Sixth and Fifth, which likewise are perhaps generally in the poorest sanitary condition, being to a very great extent unpaved and unsewered. Thus elevation, rather than cleanliness, seemed to exert a protecting influence, if indeed we are justified in drawing any conclusion where so few cases occurred. The sanitary surroundings of the houses in which cases occurred, cer- tainly did not in many instances exert any great influence. We have en- Dr. S. L. Jepsoi*. 43 deavored in the table to give some idea of the condition of each house vis- ited, and its surroundings. Of course this can he but imperfectly done without a full description of the premises. The local sanitary condition is regarded as having been bad in fourteen cases, medium in four, and good in seventeen. In but four or five instances were the sanitary defects so bad as in our opinion to serve in any great measure as the predisposing cause of cholera. Certain it is that, with these few exceptions, many much worse places entirely escaped; while a number of the houses visited Avere very favorably located, and in excellent condition. Habits, etc., of Persons attacked.—We are convinced that in this, as in other epidemics of cholera, the personal habits and mode of life, together with the previous state of health of those attacked Avith the disease, had much influence not only in inducing the attack, but also in bringing about a fatal termination. It will be seen that thirteen of the patients had been intemperate, three of them moderate drinkers, four in impaired health, and fifteen in good health, of Avhich last number, three were over sixty-five years of age. Others might possibly be added to one or other of the unfavorable classes here named, Avere full data at hand. But even with these partial positively ascertained facts, we have a total of tAventy-three persons Avho, by reason of either habits of drinking, previous ill health, or advanced years, were certainly not in a condition to resist this disease (I might also add to this list two fatal cases in children aged ten and eleven respectively). Of these, no less than sixteen died, a mortality of seventy per cent. Of the remaining twelve, previously temperate and healthy, six died, being fifty per cent., and tAvo of these received no medical treatment, nor any proper care or nursing until in extremis. It will be observed also, that ten out of the thirty-five persons attacked were employed in some of our iron mills. They are generally men of robust constitution, but careless concerning their health and habits of living. The business calls them to labor in an atmosphere Avhose temperature is exces- sively high; and very commonly after finishing a short piece of work, they stejj to the coolest place they can find, and sit down until their services are again required, often also drinking freely of ice Avater, and sometimes hav- ing cold Avater by the bucketful poured over their naked backs, from which the perspiration is steaming. To this we find a number of these men attrib- ute their sickness; and that it had an influence as in some measure an excit- ing cause we are inclined to believe. Premonitory Diarrhoea.—It is worth while to note the large number of cases in which premonitory diarrhoea occurred, viz., tAventy-seven. The duration of this diarrhoea varied from half a day to over a Aveek. We had during the epidemic an unusual number of cases of diarrhoea in the city, in Avhich the stools Avere very liquid, and often of a light color, being generally described as “milky.” Judging from the readiness with Avhich these yielded to treatment—though a few of them were quite rebellious,—avc cannot doubt that a numbet of deaths could have been prevented, had the patients given early Avarning of the existence of a diarrhoea, and at once placed themselves under intelligent medical treatment. This is a point already well established by past experience, and it should be impressed upon the public on all proper occasions. • . .4 Sanitary Treatment.—The Health Officer is the sole health authority in Wheeling, save a “Committee on Health” of the City Council, to whom the Health Officer is responsible. The statutes require physicians to report all cuses of “Asiatic Cholera” to the Health Officer immediately on their recognition. Great doubt, however, existed in the minds of physicians here as elsewhere, as to the exact nature of the disease when it first appeared. Hence there Avas a hesitancy in announcing a case to be cholera, and hence delay, and often entire failure, to report the cases. Again, the law Avas fre- 44 Epidemics of Wheeling. quently disregarded without even this excuse. Even late in the epidemic, in some instances the first intimation the Health Officer received of the existence of a new case was from the local columns of the morning papers, or from rflmors heard on the streets. As soon as discovered, however— which was sometimes done by tracing these street rumors—in all cases meas- ures for thorough cleansing and disinfection were instituted. Whether any positive good was accomplished by the use of disinfectants, is a problem we are unable to solve. All the facts to be derived from our observations on this subject, may perhaps be best briefly expressed as follows:— Case 1 disinfected promptly. No second case. Case 2 not disinfected. A second case (No 3), after which disinfection. A case called cholera morbus occurred after this. Case 4 probably not disinfected. No second case. Cases 5, 6, 7, 8, and 9, disinfected. No second case. Case 10 disinfected. A second case (No. 11), the wife, who died the next day. Case 12 disenfected. No second cholera case. Two cases of diarrhoea, neither severe, and a case of cholera morbus, after disinfection. Case 13 disinfected. No second case. This case followed three days after a case of what was called cholera morbus, which was not disinfected. Case 14 not disinfected. Five additional cases (19, 32, 33, 34, and 35), followed before disinfection, after which there occurred no other case. Cases 15, 16, 17, 18, 20, 21, and 22, disinfected. No second case. Case 23 disinfected. Two children of this patient attacked with diar- rh