State; and at military posts, having but a brief duration although costing many valuable lives. At New Orleans the steamers on the Mississippi river becoming infected, they in turn distributed the disease to troops when in transit. From New York harbor recruits were sent to Richmond, Virginia, where they were taken with the cholera, but it remains in doubt if the epidemic among the troops stationed at that point was due to the arrival of these recruits, or from contact with the cholera germ among the citizens of that city. From Richmond troops carried cholera to Yorktown, Fortress Monroe and Norfolk, Virginia, but no diffusion occurred. From New York cholera was taken by recruits to Louisville, Ky., and was carried by troops from Louisville to Bowling Green, Ky.

The recruits at Newport Barracks, Ky., received the cholera infection from rendezvous in the cities of Cincinnati, Ohio; Chicago, Illinois, and St. Louis, Missouri. What agency the movements of recruits may have had in infecting the city of Cincinnati cannot be determined. If the fact can be fully received that the cholera death in that city of July 11th was in the person of a woman who had accompanied a detachment of recruits from New York harbor, the agency must be admitted.

From Newport Barracks cholera was carried by recruits to Nashville and Memphis, Tennessee; and to Atlanta and Augusta, Georgia. At Nashville the line of cholera infection joined that ascending the Mississippi river; and successively Little Rock, Fort Smith, Fort Gibson, Helena, Jefferson Barracks, and perhaps St. Louis, were infected.

From New York harbor, cholera infection was undoubtedly carried by cholera-infected baggage to the San Juan river, Nicaragua; and as a result a cholera hospital for U. S. troops was established on the shores of Lake Nicaragua.

As a contrast to the story of cholera diffusion in 1866, and as an unanswerable argument to those who assert that this disease has established itself in the valley of the Mississippi and Ohio rivers, and who teach that as the Delta of the Ganges is the habitat of cholera, so is the Delta of the Mississippi, a few paragraphs from my cholera report for 1873 are here introduced:

In the early spring of 1861 the American civil war was inaugurated, and the United States was hurriedly converted into a vast military encampment. In all the cities that had been favorite haunts of cholera in former years, from the Penobscot to the Rio Grande, and from the Missouri to the Atlantic ocean, troops were collected, and vast armies were concentrated in the worst malarial regions of the United States, the valleys of the Potomac, Ohio and Mississippi rivers.

It is estimated that during the years of this war the United States army had in the field an aggregate of 2,335,942 men, or that the mean strength of the armies was about 783,906 men. These troops were in camp, constantly exposed to all the vicissitudes of the campaigns, or were in hospitals where, in spite of the lavish precautions which were adopted, ot infrequently all the disadvantages of overcrowding and deficient food were present. Vast numbers of men were transported to and from the scene of active operations upon steam transports. A very small percentage of the troops were in permanent fortifications. Vast prison pens were formed, in which overcrowding, bad ventilation, indifferent police, and unsuitable food were present to cooperate with local malarial influences upon the unfortunate prisoners.

The record of the medical history of the war demonstrates that there

occurred in the army of the United States, of diseases of malarial origin, 1,468,410 cases, with 46,310 deaths; of intestinal diseases, 1,765,501 cases, with 44,863 deaths. Among the first are included typhoid, typhus, common continued, typho-malarial, yellow, remittent, the intermittents, and congestive intermittent fevers. Among the second are included diarrhoeas, dysenteries and cholera morbus. Of the latter, during the entire war, there were reported but three hundred and five deaths.

It must be borne in mind that these figures represent but one arm of the United States service. When to these already large figures the statistics of the United States navy are added, and to this combination are added the statistics of the Confederate armies, the mass of circumstantial evidence is overwhelming.

In the very region where it is claimed that every epidemic of Asiatic cholera that has visited the United States from 1832 to 1873 originated, de novo these immense bodies of men were congregated, and the exceeding mortalities occurred; yet, during all those years of bloodshed and suffering, not one case of epidemic cholera occurred. Why? Because there was none of the specific poison of cholera, which is alone cholera, from which the disease might be reproduced.

It was my fortune, during the epidemic of 1866, to witness a demonstration of the efficacy of stringent hygienic precautions, in protecting small communities from the inroads of cholera, as well as the portability, of the disease by means of cholera-infected clothing.

During the war, the Pea-Patch Island, at the head of Delaware Bay, upon which is located Fort Delaware, had been used as a prison for Confederate soldiers, of whom many thousands during the war had been confined at that point. All the available space outside the fortification had been covered by the buildings occupied as prisons and hospitals; and from necessity, after the large rate of occupancy, the island at the close of the war was in a most unsatisfactory sanitary condition. During the fall of 1865 and the winter of 1865-66, all unnecessary buildings were removed from the island, the ditches which traversed the island (the surface of which was below high-water mark) were drained and dredged. Débris of all kinds was collected and burned, and the island, at a very considerable pecuniary outlay on the part of the general government, was placed in a most perfect sanitary condition. In the latter part of August, 1866, a case of cholera occurred at Delaware City, the eastern terminus of the Delaware and Chesapeake canal, distant from Fort Delaware one and a quarter miles, from which town the garrison obtained its mail and supplies of all characters. The first case occurred in the person of a canal boatman, and spread to the inhabitants of the town, and a mild epidemic. was instituted. Shortly afterward the town of New Castle, Del., Salem and Bridgeton, N. J., were infected with the disease, thus completely encircling the post within lines of cholera infection. By my advice the commanding officer at the post instituted a rigid system of isolation. But one boat, with a picked crew, was allowed to leave the island each day; and of this crew but one man, the coxswain, a most reliable and intelligent man, was permitted to enter the town. By this man the mail and all necessary supplies were obtained, and by this boat were conveyed to the island. The commissary department having been most liberally supplied, no stores in large bulk were required to be transported to the island. Although the epidemic during the season was so often carried into the towns that have been named, in the vicinity of Fort Delaware, as to in

stitute two distinct epidemics, no case of cholera, or of any disease assimilating it, occurred upon the island, beyond the ordinary diarrhoea of the season, with but a single exception, which can be most satisfactorily accounted for. The isolation of the post which had been instituted had been most rigidly maintained, and, with the exception of the coxswain of the boat's crew already mentioned, no person but the post surgeon had been allowed to leave the island. As post surgeon, my services had frequently been asked during the prevalence of the epidemic; and the precaution always had been adopted of changing my clothing in an isolated shed upon one of the wharves every time I left and returned to the island. Convinced of the non-infectiousness of the disease by some instances which seemed to me to be inexplicable, one evening, on returning to the island weary and exhausted by a fatiguing day's work, I went, in the clothes in which I had been working over a cholera patient in Delaware City, to my quarters, undressed, and retired in the same room with my wife, at that time in extremely delicate health, and the clothing remained in her room throughout the night. The next day my wife had a diarrhoea which she allowed to continue for two days without calling my attention to it; upon the third day cholera was suddenly developed at an early hour in the morning; she became fully collapsed, and reacted only after the most severe struggle. Disinfectants were freely used, every means of isolation was employed, and no other cases occurred.

CHAPTER XV.

THE EPIDEMIC OF 1867 IN THE UNITED STATES ARMY.

FROM all obtainable evidence it seems that there was a "holding over" of the cholera germs from the subsidence of the epidemic of 1866, as had been the case in previous epidemics, to re-develop with increased virulence as the warm rays of the sun reached their "nidus" in 1867.

This was notably the fact as regards the cities of New Orleans, La., and St. Louis, Mo., and at the military station of Jefferson Barracks, Mo. At New Orleans the epidemic of 1866 continued until late in the month of December; perhaps it had not died out in the early days of January, 1867. It, however, reappeared in the month of June, 1867.

At St. Louis, Mo., the epidemic of 1866, lasted through the month of November, perhaps into December, and re-developed almost simultaneously with the New Orleans outbreak, in the month of June, 1867.

At Fort Gibson, Ark., the epidemic lasted into November, 1866, and re-appeared among the Indians and negroes who lived in the vicinity of that post during the last days of June, 1867.

At Jefferson Barracks, Mo., where in the post and the camp of the 56th U. S. Colored Troops a virulent epidemic of cholera, accompanied by a large number of cases of simple diarrhoea in August and September 1866, and where many cases of acute diarrhoea occurred during the remaining months of that year, a few cases of cholera occurred in July, 1867; but while Jefferson Barracks in 1867 did not suffer from an extended epidemic, it is an assured fact that a regiment of U. S. troops from that post -at which they had been organized and from which they were equipped for service occasioned a most disastrous outbreak of cholera on the high, dry plains of western Kansas, and it is to this diffusion of the epidemic of 1867 that especial attention will be directed.

In view of the possible re-development of epidemic cholera, a system of stringent hygienic measures had been adopted at all military posts. That these measures were to a great extent effectual is evident from a study of the Report on Epidemic Cholera and Yellow Fever during the year 1867, by the late Surgeon J. J. Woodward, U. S. Army, from which report the following is taken: "At the majority of the points affected it (cholera) occurred first among the citizens and afterward appeared among the troops, but it was not always possible to obtain the date of the first case among the citizens, and hence it is not possible to assert that this was the invariable rule, though it is believed it was so. This remark cannot,

however, apply to the Kansas diffusion of 1867, for in that year and in that locality all the facts point to the agency of troops, although the actual transportation of recognizable cholera was not at the time known to have

taken place. The 38th U. S. Infantry (colored) was organized at Jefferson Barracks, Mo., early in the year 1867. Recruiting rendezvous for this regiment had been established in all the large cities, notably Chicago, Ill.; Cincinnati, Ohio; Philadelphia, Pa.; Baltimore, Md.; Louisville, Ky.; Nashville and Memphis, Tenn.; Vicksburg and Jackson, Miss.; Atlanta and Augusta, Ga.; New Orleans, La., and St. Louis, Mo. From these rendezvous an aggregate of over twelve hundred (1,200) recruits, mostly discharged soldiers from volunteer regiments, had been massed at regimental headquarters at Jefferson Barracks.

At Jefferson Barracks, during the time of occupancy by these troops, no case of cholera occurred, nor did a case develop until twenty-four (24) days after the last detachment of the 38th Infantry had left that post, but it is stated by Woodward that prior to this final movement of the regiment "a considerable number of cases of diarrhoea occurred" among the men. This regiment being destined for duty in the District of New Mexico, and the Indians on the Kansas prairies having opened hostilities by attacking parties of workmen along the line of the Kansas Pacific Railway, companies were sent forward to the line of that road, after having received their clothing and camp and garrison equipage from the storehouses at Jefferson Barracks. On March 20th Companies A and B, were sent forward and arrived at Fort Riley, Kansas, on the 24th, and remained at that post until May 13th, when they were ordered to Fort Harker, Kansas, arriving at that post on the 15th same month. Companies C, E, I, and G, left Jefferson Barracks on the 12th of May, arrived at. Fort Harker on the 17th, where Company G took station (until June 5th, when it was marched to Fort Hayes, arriving June 15), while the other Companies (C, E, and I,) marched for Fort Hayes, Kansas, where they arrived May 28th. Company K left Jefferson Barracks on the 9th of June, and arrived at Fort Riley on June 12th; left Fort Riley June 19th, and arrived at Fort Harker June 22d. Companies D and F left Jefferson Barracks June 19th and arrived at Fort Harker June 25th. The regimental headquarters left Jefferson Barracks June 22d and arrived at Fort Harker June 27th. Each of these movements was made through St. Louis-by rail to Kansas City, Mo., thence by rail as far as the railway construction was completed, and by march from the termination of the track to the military stations named.

The first reported cholera case in Kansas during the epidemic of 1867 occurred in the person of a quartermaster's employee at Fort Riley, on the 22nd of June. Companies A and B of the 38th Infantry had been on duty at Fort Riley for fifty days (50), and Company K of the same regiment had been for ten days (10) at the post, leaving there on June 19th, three (3) days before the occurrence of the first cholera case. All these troops were suffering much from diarrhoea, and companies D and I, in passing Fort Riley, en route for Harker, had left a number of men sick with diarrhoea. (Woodward). The case of June 22d proved fatal in a few hours. Being casually at Fort Riley, I had an opportunity of inspecting this case. All the characteristic symptoms of malignant cholera were present, but owing to the energetic precautions of Surgeon B. J. D. Irwin, U. S. A., the disease did not become epidemic.

On the 27th of June, the headquarters 38th Infantry with Companies A, B, D, F, H and K were on duty at Fort Harker, Kansas, Companies A, B and K being on duty in garrison. The headquarters and Companies D, HI and F were in camp a short distance southwest of the post. To the command in camp I was attached as medical officer.