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that was on a level with its top, the mill company had sunk a well, and from this well the hands of the mill were supplied with water to drink and cook. An examination of the water by Dr. Dean demonstrated that it was very richly impregnated with organic matter, (I think seven or eight grains per gallon,) and that it responded promptly to the test for sewage contamination. In other respects save those mentioned, viz, its malarial location and the dangerous quality of the water-supply, there was no other cause that I could detect at the mill to engender disease. The prophylactic measures adopted at this place were confined to a closure of the well, and I believe no other cases occurred there. The third instance was that of a German woman, on the corner of Columbus and Lami streets. This locality is in the same part of the city and not more than ten blocks removed from the places where all the other cases occurred. Here we found a low, filthy, German boarding-house, of which the deceased was the landlady. The house in which the case occurred was defective in all respects of sanitary importance, and supplied with water from a well sunk in made ground and strongly contaminated with organic matter, but contained no free ammonia.

The fourth and last instance of an outbreak that occurred during my régime was the case of a negro man near the corner of Ninth and Pine streets. This was clearly an imported case. The man was a boatman,

and had only returned to the city from New Orleans two days before his death. He landed in the city with the premonitory diarrhoea, and on the second day after his arrival was seized with cholera and died in eight or ten hours.

After the occurrence of the last case mentioned-and the cases above enumerated include all that occurred prior to the 2d of June-my connection with the health department ceased, and I have no further knowledge of interest concerning the progress of the epidemic, and have been unable to obtain any other.

Dr. D. V. Dean, the city chemist, who continued to observe the course and causes of the epidemic, has informed me that in a large proportion of the cases afterward reported the use of impure water in the infected families was demonstrated.

The frequent association of the use of impure water-supply with the occurrence of the disease stimulated a pretty thorough examination of the water-supply of the city, and particularly that derived from wells. In many instances wells apparently very dangerous were being used without the production of ill-health.

I saw none of the cases above enumerated in life; but they were all attended by competent physicians, who had abundant opportunities for observation in former epidemics, and I think their impartial diagnoses are entirely trustworthy.

Some of the deaths occurring in May and in June were reported as cholera morbus, when the attending physician was firmly convinced they were true cholera, because the disease was not then recognized as epidemic, and they did not wish to create a sensation or excite public alarm, and others of them were reported as cases of cholera, but recorded by the health authorities as cholera morbus for the same reasons. My own conviction is, that all the deaths reported as due to cholera morbus were really cases of true cholera, or were engendered by the choleraic influence then undoubtedly prevalent. Such a thing as nine deaths from cholera morbus between the 11th of May and the 1st of June and thirty-two deaths from the same cause during the month of June, was never before heard of in Saint Louis, and, I venture to say, will never occur again, except under similar influences, viz, an epidemic

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tendency. It is true that every year we have a few deaths, rarely more than half a dozen, from cholera morbus; but the victims are those whose general health is already enfeebled by age or chronic disease, and they never occur until the latter part of July and 1st of August, when the weather is oppressively warm and the supply of green vegetables and fruits is abundant in the markets. These articles at that season, sold in a stale, green, or decayed condition, are invariably the exciting causes in our sporadic cases. The cases that occurred at the commencement and toward the close of the epidemic were milder, yielded more readily to treatment, and were less strongly marked in their choleraic features than those which occurred at the height of the epidemic, and these peculiarities are true, I think, of the whole epidemic, as compared with the epidemics of 1866 and 1867.

The epidemic in Saint Louis was almost wholly.confined to the northern and southern portions of the city, and in its progress from the south to the north, the direction in which it extended, it seemed to jump over the central part of the city.

The northern and southern parts, as already mentioned, are those parts in which the sanitary improvements are least perfect, where the population is least intelligent and least provident. The central part of the city is that in which the sewer system is most perfect, the streets broadest and cleanest, the tenements most airy and comfortable, the public water-supply almost, if not quite, universally enjoyed, and in which the characteristics of the population is the reverse of those attributed to the northern and southern parts.

The means adopted by the board of health to crush out the epidemic and prevent its spread was the stoppage of the use of impure water, in all instances where its use was detected, and a disinfection of the premises where cholera cases occurred, together with a general renovation and disinfection, so far as it could be effected, of all houses and their surroundings where the disease showed itself. This included cellars, privies, sewers, &c.

The first case, as will be seen from the inclosed list, occurred on the 11th day of May, and the last on the 26th of October. The total number of cholera morbus cases was 137; the total number reported or recorded as cholera was 392. These numbers make a total of cholera and cholera morbus combined of 529.

The facts set forth present a true account of the invasion of this city by the disease, and give a correct history of the first eleven or twelve

cases.

II. THE CHOLERA EPIDEMIC OF 1873 AT THE QUARANTINE HOSPITAL The Quarantine Hospital, a public charity of the city of Saint Louis, is located upon the west bank of the Mississippi river, twelve miles south of the city. The Iron Mountain Railroad passes in close proximity to the hospital, and affords rapid transit to and from the city. At this point is also located the city pest-house, to which patients are conveyed by wagon transportation. Daily communication exists be tween the hospital and that portion of the city of Saint Louis which is known as Carondelet.

At this hospital, on the 26th day of May, a female named McAnnally was suddenly seized with cholera and died after but a few hours' illness. This woman had been an inmate of the institution for some time, was under treatment for syphilitic rheumatism, and had not been away from her ward for weeks.

In the same ward, and occupying the next bed to Aunie McAnnally,

was a woman named Duncan, with two children. This woman was sick with diarrhoea for some days before Annie was taken with cholera. Before Annie died Mrs. Duncan was taken with cholera, and died at an early hour on the 27th, and at a later date her two children died of the same disease. It was subsequently ascertained that Mrs. Duncan had absconded, with her children, from her home in the extreme southeastern portion of the State.

June 3.-A man named James Watt was carried to the hospital from a river-steamer in the collapse stage of cholera, and died within a few hours. No record was made as to the boat from which he was removed, other than the fact that she was from Memphis, Tenn., and bound for Saint Louis.

The epidemic was at first confined to the female ward in which McAn-nally and Duncan had died, and to the male ward in which Watt died; but cases were soon developed in other wards. The disease assumed a severe and fatal type. From the 16th of May to the 15th of September, sixteen fatal cases occurred, with many of recovery; of the last mentioned no record was preserved. Of the fatal cases twelve were males, four were females. The ages ranged from one month to fifty-two years.

All were white.

Dr. R. S. Anderson, the medical superintendent, is kind enough to inform us that "the treatment adopted was experimental. Internally, astringents, opiates, carminatives, stimulants, and cathartics were employed in different cases. Hypodermic injections of both morphia and atropia were resorted to. Externally, frictions with mustard, hot baths, and general applications of warmth were used." Disinfectants were freely used. The patients were isolated as completely as was possible, and scrupulous attention was paid to cleanliness and the removal of the exeretions.

III. The following letter from Dr. Charles Reiss, late Acting Assistant Surgeon United States Army, presents the history of the second group of cholera-cases which occurred at the city of Saint Louis in 1873:

"SAINT LOUIS, Mo., November 1, 1874. "SIR: I have the honor to transmit herewith a list of the cases of cholera which came under my observation during the epidemic in the year 1873.

Early in the morning of May 28 I was called to see a man at the corner of Ninth and Lynch streets, named Dinert, who had come home sick from his work at the Saint Louis Railroad Fastening Company's shops. These shops are situated due north of the United States barracks, upon the banks of the Mississippi river, or rather, on the Iron Mountain Railroad, between the barracks and Dorcas street, in the southern portion of the city. I found the man Dinert to be suffering from cholera.

Upon my return home I was called to return in haste to the same locality, and there found an aged lady named Roberts also attacked with cholera. In a few hours both cases were dead. These being the first cases of the disease, and as they occurred at the same place, my attention was given to discovering the cause of the outbreak. I had heard nothing of cholera in the city up to this date, although bowel-complaints *ere frequent. I had prescribed for several cases at these works, in the persons of new-comers to this city from points upon the lower river; among them a man named Butler, who had for some time a troublesome and exhausting diarrhoea. This man had made constant use of the privy which was also used by Dinert and Mrs. Roberts.

"As will be seen by the accompanying diagram, north of the mill is a row of tenement-houses occupied by the employés. These houses are built upon a lime stone ledge, which upon the north has been extensively quarried. The water used by both the workmen at the mill and the occupants of the tenement houses, was obtained from a well which had been dug in the quarry. Standing at the mouth of this well, it was found to be some 20 feet below the level on which the buildings stood; that it (the well) was surrounded by pools of stagnant water, and that it was flanked east and west by the weather beaten limestone rocks exposed by the former quarry-work.

"Upon the bank, and at the edge of the quarry, were a number of privies for the use of the workmen and their families. These privies consisted of pits which had been dug into the surface-rock, and the sec tion of the rock below these privies was full of crevices. The water of the well was clear, cold, and odorless.

"I had the well closed at once, and caused the locality (houses and privies) to be thoroughly disinfected with carbolic acid and copperas. Instructed the people to use the dirty river-water which the establishment pumped for manufacturing purposes, rather than the clearest wellwater of the neighborhood.

"I heard and saw nothing more of cholera, although bowel-complaints continued to be frequent until June 12, when I was called to see another employé of this company, but who resided on Dorcas street, where a great many of his fellow-laborers lived at the time. This point is within three or four blocks of the mill. The people lived in small houses that were furnished with wells in close proximity to privies, which, owing to the rock-formation, were very superficial.

"The treatment which I adopted was strictly symptomatical-opiates and stimulants, with ice.

"Very respectfully, your obedient servant,

"CHARLES REISS, M. D., "Acting Assistant Surgeon, United States Army.

"Asst. Surg. ELY MCCLELLAN, U. S. A.”

It is well to note that upon the river immediately above the locality described by Dr. Reiss, is a point on the levee at which steamboats land, and at which they are frequently tied up for cleansing purposes.

It was undoubtedly from the three points of infection that have been described that the epidemic at Saint Louis in 1873 originated. The case of May 11, although classed as cholera morbus, was certainly connected with the cholera which, at the time, was epidemic at New Orleans, and at many points upon the Lower Mississippi River.

There can exist no doubt that the case which occurred at the quaran tine hospital on the 26th of May was infected from the female who so soon thereafter was a victim of the disease herself. The evidence as to the cases of May 28 is certainly conclusive. It was from these cases that the disease spread. The violence of the epidemic was confined to the southern sections of the city, in which the infection had been developed.

About the middle of June the board of health became aware that cholera was in the city. The health-officer in his annual report states that "steps were taken to at once place an abundant supply of disin fectants at all the police stations and substations throughout the city. and through the aid of the police-force printed and verbal notice was given to all persons who were not able to purchase disinfectants for

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