July 27. His dejecta was thrown out on the ground near a public well. The water from this well was used by many families, and fifteen wellmarked cholera cases occurred among those who lived within a radius of four hundred yards of this well.

The absolute truth of the importation of cholera in 1873 into the State of Ohio, stripped of all the fallacious arguments at the time employed to conceal it, is that the disease was imported from New Orleans, La., by the steamer John Kilgore, on May 22; the steamer Charles Bodman, May 24; the steamer H. S. Turner, June 6; the steamer C. B. Church, June 14; and the steamer Nicholas Longworth, June 23; that it was imported from Memphis, Tenn., by the steamers Pat Rodgers, Arlington, Mary Houston and James D. Parker; that a third source of epidemic infection were the steamboats Eddyville and Camelia from Nashville, Tenn. Each of the boats named had cases of cholera and choleraic diarrhoea on board. On the Parker every one on board had symptoms of cholera save the captain and clerk. Later in the season all the steamboats on the Ohio river became cholera-infected and, by all, persons and merchandize which had been exposed to the specific infection were landed in the city of Cincinnati.

Cincinnati being the home station of most of the steamers on the Ohio and lower Mississippi routes, the bed linen used upon them is usually washed by laundresses on shore. On the Nashville and St. Louis boats, such washing is generally done on board by laundresses from the shore, but at times the linen is taken on shore. Dr. Clendenin, through whose exertions, the light of truth shines on this local epidemic, states: "These facts are certainly possessed of the most important bearing upon the history of the introduction of the disease, and from them the diffusion of cholera over the city of Cincinnati may be accounted for."

In

The first cholera death in the city of Cincinnati occurred at the city hospital on the 27th of May, in a man who arrived by steamboat from some Kentucky point May 22. "The day before he was admitted he was taken with diarrhoea, cramps in his legs and vomiting." This case lingered until May 27, when he died. At the Cincinnati hospital the excreta of all patients was placed in drains which emptied into the public sewers; disinfectants were freely used and the drains were constantly flushed with water. the laundry, superheated steam being employed, the most efficient disinfection of fabrics was secured. May 26, a child died of cholera, at the home of its parents, which was at the point of the river bank, east of the city, where steamboats are tied up when not making regular trips. June 6, a third cholera death occurred at a large hotel (the Burnet House), in the person of a young child of a family who had arrived the day before from the South. During the season 207 cholera deaths were reported by the health office, no record was taken of non-fatal cases, and diarrhoeal cases were too trivial to attract notice. The disease was diffused through the districts of the city inhabited by the poorer classes. It was an epidemic during which innumerable foci of infection were established, but which were promptly stamped out. But for that fact the disease would have been as malignant in Cincinnati as it was in some of the small towns on the Ohio river. It is well at this point to record the data in relation to the steamer John Kilgore. This steamer left New Orleans, La., May 13 (during the month of May 125 cholera deaths were reported in New Orleans.) She had a large list of passengers, many of whom were on deck, and most of whom were flatboatmen, from different places on the Mis

sissippi and Ohio rivers. The day after leaving New Orleans, a Mr. Schenck of Cincinnati, a cabin passenger, was taken with cholera; when the Kilgore reached Vicksburg, Mr. Schenck was still alive and the services of Dr. Booth were obtained. Mr. S. died at a point about 50 miles above Vicksburg, and his body was carried to Memphis. The excreta of this case was not disinfected, nor was any care taken with the clothing, bed or bedding. On reaching Memphis, a casket was obtained for the body, which was then forwarded by rail to Cincinnati. Two passengers went ashore at Memphis with choleraic diarrhoea. At Paducah, Ky., an epidemic occurred from contact with this boat. After leaving Paducah, three deck passengers died from cholera; one was buried near Shawneetown, one near Rome, and one above Evansville, all on the Ohio. Her arrival was the first cause of the violent epidemic at Mount Vernon; and had not the health authorities of Louisville been active and vigilant she would have infected that city, for there she landed the greater portion of her deck passengers.

At Carthage, ten miles north of Cincinnati, a most interesting illustration of the portability of cholera occurred. A man named Tenthave, his wife, five children, a sister of the wife, and two young men, arrived in New York on the steamship City of Limerick from Liverpool on July 5, 1873. They left New York City July 6th for Carthage, Ohio, via the Baltimore and Ohio Railroad. On July 10th they arrived at Cincinnati, too late to proceed that day on their journey, and the entire party spent the night in a station-house. Early the next day they left Cincinnati for Carthage. July 13th the boxes and bales of household property arriving, the entire party took possession of a small house. Everything was unpacked for use; the bedding and clothing had not been touched before since they were packed up at Tubbergen, Holland. July 15th a child was taken ill with cholera; a few hours later the father and a second child took the disease. July 16th the mother sickened; July 17th a third child had the disease; July 19th, a fourth child; July 22d, the fifth child; July 23d, the young woman was attacked. These cases all terminated fatally in from eight to twenty-four hours. The two young men suffered severely from diarrhoea, but recovered. Living in the rear of this infected house, some one hundred yards distant, was a young married woman, pregnant with her first child. Forbidden by her husband to go near the Tenthave house, she each day provided some articles of food which she placed on the fence in the rear of the cholera house. Each day she received the utensils in which this food had been served. July 23d she was taken with cholera and died after forty-eight hours' illness, aborting twenty hours before death. By Doctor Bunker, who had charge of these cases, disinfectants were employed, and the disease did not spread in the town of Carthage. On the 21st of July, however, cholera suddenly developed in the negro wards. of Longview insane asylum. This institution is located on the southern ide of Carthage. The negro wards are in a detached building at some distance from the main institution. It was supposed that a perfect system of non-intercourse had been preserved, but the investigations of Dr. Clendenin proved clearly that such was not the case. Joseph Marshall, a negro, the supervisor of the attendants in the negro wards, impelled by curiosity, went frequently to the infected house. After the last death in the Tenthave family, the man Marshall appropriated to his own use a braided shooting-coat which had belonged to Tenthave. He carried the coat to the asylum, and, as he found it wet, hung it up on the back porch

to dry. While in this position it attracted the attention of a patient, who took it down, wore it for the remainder of the day and slept in it that night, when it was again taken possession of by Marshall. The next day the patient who had worn the coat and four other patients were taken with cholera; when Marshall, properly connecting the outbreak with the stolen coat, burned it at the kitchen fire. From this importation thirteen cases of cholera, with nine deaths, occurred.

At Dayton, Ohio, the epidemic was confined to but two houses. At several other points isolated cases occurred, but which, with two exceptions, are traced back to the house epidemic. The only direct importation which could be traced was a man from Memphis, Tenn., who died in a hotel. His case, however, was disconnected with those that followed. Dayton, however, is a great railroad center, and to the efficiency of railroads as common carriers of infection as well as merchandize must be ascribed the occurrence of the disease at Dayton, Springfield and Columbus, Ohio. At the last-named city the initial case occurred in the person of a woman who kept a low grog-shop under the bridge of the Pittsburgh, Cincinnati and St. Louis Railroad as it leaves the city. The position is such that a cholera dejection or a choleraic diarrhoea discharged at that point would inevitably fall at the back door of that house." Not only did the initial case occur at that point, but the majority of the early cases were in its immediate vicinity. After the epidemic had gained full headway in the city, that was the most virulently infected district. Cholera was carried within the State penitentiary walls by guards, teamsters and night watchmen who lived in the infected locality. Of twenty-seven cases which occurred in the penitentiary, twenty-one were fatal.

It was impossible to trace any direct connection between the early cases at Wheeling, West Virginia, and any well-defined focus of cholera infection. They, however, occurred in localities which from their filthy condition were most favorable for the reproduction of the disease. The epidemic having obtained a foothold, many instances of the diffusion of the disease were found. The earliest cases were on June 9th and 20th. tor S. L. Jepson states that the steamers Andes and R. R. Hudson, the weekly packets between Cincinnati and Wheeling during the months of June and July, brought many sick with profuse diarrhoea from the former to the latter city.

Doc

At Pittsburgh, Penn., on July 29th, a man and his wife returned to their home after a visit to Cadiz Junction, Ohio. August 1st the wife was taken with cholera and died August 4th. The day of his wife's death the man was seized and died. Aug. 6th a woman who had nursed these cases was taken with cholera and died. The most active sanitary precautions were adopted. Clothing, bedding and carpets were burned. Aug. 8th, a man who had been employed to destroy this property was taken with cholera and died Aug. 10th. No spread of the disease occurred. The husband of the first case informed his physician that while he was at Cadiz Junction cholera was epidemic among railroad employees.

Three well-defined points of cholera infection occurred in the State of Alabama. In anticipation of cholera infection, the city of Huntsville was placed in as good sanitary condition as was possible. No connection with the epidemic as it existed at either Memphis or Nashville, Tenn., could be found, except that the early cases occurred on low ground, along the While in railroad stations it is customary to keep the closets in cars locked and not to open them until the station is left.

line of the railroad and about 100 yards from the station. The epidemic, however, once started, the disease was carried wherever individuals who had been exposed to the infection resided. It was carried to Monte Sano, a mountain watering-place, and to Johnson's Wells. At Birmingham, June 12th, a man who had been in the city for six weeks, and who was in perfect health, was taken with cholera and died after a day's illness. Three days before this attack he had received his bedding from Huntsville, and had used it up to the time of his death. June 17th a case of cholera occurred in a family who had constantly been with the first case, and before the close of that day there was another case in the same family; both died. No disinfectants were used in either of these three cases. The discharges of all were thrown into a small almost dry" branch" which ran through low marshy ground, from which many people obtained their drinking water. June 19th a man who had just returned from Chattanooga, where he had been for several weeks, died of cholera after eighteen hours' illness. From these cases the epidemic spread in most virulent form.

From Birmingham cholera was carried to the city of Montgomery by a negro man who had been employed as a cholera nurse; no epidemic followed. The city was blessed with a most efficient health officer.

In but two instances could cases of cholera be discovered in the State of Georgia. Both were in the persons of refugees from the disease at Chattanooga. One case was at Atlanta, the other at Dalton; both terminated fatally both were carefully isolated and disinfected. No other cases followed.

At Crow river, Kandiyohi Co., Minn., occurred an interesting group of cases in the family of Swedes named Antonson. This family arrived at New York on the steamer Peter Japson, June 26, 1873. From New York city this family were transported to St. Paul, Minn., via Pittsburgh, Penn., Grand Haven and Milwaukee. They rested twenty-four hours at St. Paul, when they started for Crow River, via Willmar, Minn. They arrived at Crow River July 2d. Before leaving Bergen, Sweden, the effects of this family were packed, except hand baggage. When they arrived at Willmar, Minn., their property was unpacked for additional articles of clothing, and the next day Antonson sickened with cholera, but he did not die until July 10th. July 6th a son was attacked and died in forty-eight hours; July 9th a daughter was taken and died in twenty hours; July 12th another daughter died after ten hours' illness, and the same day the man at whose house in Crow River they had stopped died of cholera eight hours after he was attacked. Two other non-fatal cases occurred. The recital of this group of cases greatly disturbed Pettenkofer, who endeavored by ridicule to bring discredit upon it. But in spite of all subsoil water theories, the case stands, and after a lapse of ten years I have no hesitation in bringing it forward again.

At Davenport, Iowa, an epidemic of eighty-nine cases of cholera, with forty-three deaths, followed the arrival of cholera cases on a steamboat from St. Louis, Mo., on August 14th.

At Kelton, Utah, a house epidemic occurred Aug. 18th in a family recently arrived from Missouri.

At Yankton, Dakota, a virulent epidemic of cholera occurred among Russian emigrants, and at a Russian colony a few miles distant; a few cases of cholera occurred in the city of Yankton, but no diffusion of the disease occurred. Among the Russians the epidemic closely followed the arrival of a large party who had recently arrived from the Odessa district. During 1873 cholera was repeatedly brought into New York harbor, but in no instance did it escape the quarantine grounds.

CHAPTER IX.

CHOLERA IN BOMBAY, ESPECIALLY IN 1883.

ALMOST all the interest in cholera from India now centers upon Bombay. Thus Bombay is connected with Calcutta, Madras and Allahabad by railroad, and can get cholera from them; but it also has pestilences of its own every year. Cholera has prevailed in Bombay city and its Presidency every year since 1848, and almost every month in the year. The most dangerous months are March, April, May and June, perhaps also July; then the cases fall off rapidly in August, September, October and November, to increase twofold in December, January, February and March. June the great southwest monsoons or rain storms come on and flood out the disease.

It is encouraging that cholera is generally far less prevalent in Bombay than in olden times; since the great epidemic of 1865 the deaths have scarcely ever reached an average of 1,000 per year for the whole city, only in 1877, when they counted up 2,510; in 1878, 1,165; in 1883, 1,014.

In 1883 the epidemic commenced in May with 84 deaths; in June there were 84; July, 231; August, 429; September, 152; and then they fell off rapidly with only 24 deaths in October, 4 in November, 37 in December, only 2 in January, 1 each in February and March, and 15 in April.

The cholera of 1883 in Egypt, probably derived from Bombay, commenced in May and died out in midsummer, aided by the great drought, which is just as destructive to cholera germs as excessive rains. The great rise of the Nile also flooded out the pestilence. The cholera of Toulon, Marseilles, France, Italy, Genoa and Naples, Spain and Algiers, died out unusually early in the fall.

The great cholera months in Calcutta are February, March, April and May; out of 25,000 deaths, there may be 12,000 to 16,000 deaths in May, but there will be only half that number in June, and only one-third in July, August and September. But they will double up in October, November, December and January. The February, March, April and May Calcutta germ may be more hardy and last over winter in Europe and America.

The Bombay Presidency covers 124,000 square miles; the population is 16,000,000. The year 1883 was an unhealthy one, as there was not only a wide-spread epidemic of cholera, but much small-pox, while fevers were in excess and locusts abounded. There was unusually heavy rain with the southwest monsoon in June, while the easterly rains in September and October were more abundant and prolonged than usual. There were 500,000 births and 420,000 deaths. Among the 3,000,000 Mohammedans there