DR. JOHN C. PETERS, of this city, in a recent contribution to the
_Medical Record_, gives the following interesting particulars:
I have read many brilliant essays of late on these topics, but not with
unalloyed pleasure, for I believe that many writers have fallen into
errors which it is important to correct. No really well informed person
has believed for a long time that carbolic alcohol will destroy the
cholera poison; but many fully and correctly believe that real germicides
will. It has been known since 1872 that microbes, bacilli, and bacteria
could live in very strong solutions of carbolic alcohol, and that the
dilute mineral acids, tannin, chloride, corrosive sublimate, and others
would kill them.
In 1883 cholera did not arise alone in Egypt from filth, but from
importation. It did not commence at Alexandria, but at Damietta, which is
the nearest Nile port to Port Said, which is the outlet of the Suez
Canal. There were 37,500 deaths from cholera in the Bombay Presidency in
1883. Bombay merchants came both to Port Said and Damietta to attend a
great fair there, to which at least 15,000 people congregated, in
addition to the 35,000 inhabitants. The barbers who shave and prepare the
dead are the first registrars of vital statistics in many Egyptian towns,
and the principal barber of Damietta was among the first to die of
cholera; hence all the earliest records of deaths were lost, and the more
fatal and infective diarrhoeal cases were never recorded. Next the
principal European physician of Damietta had his attention called to the
rumors of numerous deaths, and investigated the matter, to find that
cases of cholera had occurred in May, whereas none had been reported
publicly until June 21. A _zadig_, or canal, runs through Damietta from
one branch of the Nile to another, and this is the principal source of
the water supply.
Mosques and many houses are on the banks of this canal, and their
drainage goes into it. Every mosque has a public privy, and also a tank
for the ablution, which all good Mohammedans must use before entering a
holy place. There was, of course, great choleraic water contamination,
and a sudden outburst of cholera took place. The 15,000 people who came
to the fair were stampeded out of Damietta, together with about 10,000 of
the inhabitants, who carried the disease with them back into Egypt. Then
only was a rigid quarantine established, and a cordon put round Damietta
to keep everybody in, and let no one go out, neither food, medicines,
doctors, nor supplies of any kind. Such is nearly the history of every
town attacked in Egypt in 1883.
When the pestilence had been let out _en masse_, severe measures were
taken to keep it in Cairo, for up the Nile was attacked long before
Alexandria suffered. This cholera broke out, as it almost always does in
Egypt, when the river Nile is low and the water unusually bad. It
disappeared like magic, as it always does in Egypt, when the Nile rises
and washes all impurities away. There had been little or no cholera in
Egypt since 1865, and there had often been as much filth as in 1883. It
has never become endemic there, as it is a rainless country and generally
too dry for the cholera germ to thrive.
Marseilles had a small outbreak of cholera in the fall of 1883, probably
derived from Egypt, which she carefully concealed. In addition, cholera
was also brought to Toulon from Tonquin by the Sarthe and other vessels.
Toulon concealed her cholera for at least seventeen days, and did not
confess it until it had got such headway that it could no longer be
concealed. At least twenty thousand Italians fled from Toulon and
Marseilles, and others were brought away in transports by the Italian
government. Rome refused to receive any fugitives; Genoa and Naples
welcomed them. There were at least three large importations into Naples.
The outbreak in Genoa was connected with washing soiled cholera clothes
in one of the principal water supplies of the city, and Naples has many
privy pits and surface wells. These privies, or _pozzis_, in the poorer
parts of many Italian towns, are in the yards or cellars, and are so
arranged that when they overflow, the surplusage is carried through
drains or gutters into the streets.
In the lowest parts of Toulon there were no privies at all, and the
people emptied their chamberpots into the streets every morning. This
flowed down toward the harbor, which is almost tideless. Toulon always
has much typhoid fever from this cause; but no cholera unless it is
imported.
The great outbreaks of cholera in Paris in 1832, 1848, 1854, and 1865
have been explained at last by Dr. Marcy. The canal de l'Ourcq is one of
the principal water sources of Paris. The market boats or vessels upon it
and at La Villette are so numerous that Marseilles and Havre alone
outrank it in shipping. The parts of Paris which are always most severely
attacked with cholera, and where the most typhoid fever prevails, are
supplied with this water, into which not only all the filth of the boats
goes, but many sewers empty.
I agree with all that is generally said about civic filth favoring the
spread of cholera, but it does not generate, but only supplies the
pabulum for the germs. I believe as long as the Croton water is kept pure
there can be no general outbreak of cholera in New York, only isolated
cases, or at most a few in each house, and those only into which
diarrhoeal cases come, or soiled clothes are brought; that it will not
spread even to the next house, and that there are no pandemic waves of
cholera.
I think it impossible to pump New York dock water into the sewers, and
that it would be very injurious if it could be done. Almost all our
sewers empty into the docks, and the water there is of the foulest kind.
I do not believe in a long quarantine, and think that of the Dutch is the
best. They only detained the sick, but took the addresses of all who were
let through, or kept back all their soiled clothing, which they had
washed, disinfected, and sent after their owners in three days.
St. Louis still has 20,000 privy pits and as many surface wells. The
importation of cholera into St. Louis is well proved for 1832, 1848,
1849, 1854, 1866, and 1873. Those who used surface well water suffered
much more than those who drank Mississippi water, however foul that may
have been. The history of cholera in St. Louis has been better and more
accurately written up quite lately by Mr. Robert Moore, civil engineer,
than that of any city in this country. He has kindly given me maps of the
city, with every case marked down, with street and number, for all the
epidemic.
Hypodermic injections of atropine and morphine have failed sadly in many
cases. Subcutaneous injections of large quantities of salt and water,
with some soda, and large rectal injections of tannin and laudanum have
been very successful in Italy. If there is plenty of acid gastric juice
in the stomach, the cholera poison and microbes may be swallowed with
impunity. The worst cases of cholera are produced by drinking large
quantities of cholera contaminated water, when the stomach is empty and
alkaline. I think it probable that large quantities, as much as the
thirst requires, of a weak acid water will prove very beneficial in
cholera. Water slightly acidulated with sulphuric, nitric, or muriatic
acid will probably be the best, but it is hoped that phosphoric, acetic,
and lactic acids will prove equally good. Lemon juice and vinegar are
merely acetates and citrates of potash, and are not as good.
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It seems that the offensive smells noticed in the English Houses of
Parliament last session have been traced to their source. It is found
that the main sewer of the House of Commons is very large and out of all
proportion to the requirements, is of two different levels, and
discharges into the street sewer within eighteen inches of the bottom of
the latter drain. There is thus a constant backflow of sewage. Another
revelation is that the drain connected with the open furnace in the Clock
Tower, for the purpose of ventilation, is hermetically closed at its
opposite end.
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