NARRATIVE OF THE CHOLERA EPIDEMIC OF 1873 IN THE UNITED STATES.
43D CONGRESS, 2d Session, House of Representatives. Ex.Doc.No.95
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Pages 288 through 294
era was spontaneously produced in India; but that in all other 
countries where it breaks out it has always been produced from 
without.  So far as the latter part of this declaration is 
concerned, it is very difficult to conceive how the conference 
arrived at this conclusion, unless we concede that they are 
omniscient.  There were no possible means in their possession by 
which they could have arrived a this conclusion, with facts for 
its basis, and therefore the declaration is pretentious.  With 
reference to the transmissibility of cholera by man, this 
conference declared unanimously that the disease is transmissible 
by man coming from an infected medicu, but man is not considered 
the specific cause, apart from the influence of locality.  The 
influence of locality is there fore necessary to the production 
of cholera, and cannot be excluded form the list of producing 
causes.

Estragulas, in his account of the cholera as it occurred in 
South America, is decided in the expression of opinion that 
it had its origin in Paraguay; for, say he, "it was not until 
1866 that the cholera became known to the countries of La Plata, 
and prior to the appearance of the epidemic in Paraguay, not a 
single vessel from infected ports had arrived either at 
Montevideo or Buenos Ayres, and not a singe case occurred 
at either city before it had been imported from Paraguay.

"Further he says, "If we are to accept the decompositions of 
vegetable matter in India's indigenous flora as one of the 
causes of cholera, we have to admit that analogous decompositions 
could be alike in their results, for the flora of the Himalaya 
and the Cashmere Valley are of analogous type to that of Paraguay, 
and the results of decomposition must be also similar."  But it 
has never been shown what there is specific in the soil of 
India which gives rise to cholera, and it can scarcely be 
admitted that, independently of the causes, the source of 
cholera is a peculiar unique condition of soil there, for 
its analogue is to be found in other parts of the world.  
"Now, in cholera the combination of causes we conceive are 
soil-changes, vegetable and animal decomposition atmospheric 
influences, over-crowding, filthiness, &c.  Why, then, 
should not the same combination of causes give rise to cholera 
in other parts of the world where they exit?"

"In Paraguay before these causes were present there was no 
cholera; when these causes appeared cholera appeared, and 
when these causes ceased there was a total disappearance of 
the disease.  He says, "The troops coming from Brazil did 
not bring cholera to Paraguay, for there was none in any 
Brazilian port of city at the time."  The Paraguayan army, 
when the disease first appeared, was secluded from the rest 
of the world and completely blockaded by land and water."

Sydenham, in his account of the cholera in London in 1669, 
gives a very accurate description of the disease, as witnessed 
at the present day.  He says, "It comes almost as constantly 
at the close of summer and toward the beginning of autumn, as 
swallows in the beginning of spring and cuckoos toward midsummer."  
There is no intimation that the disease was imported into Longon.

Dr. Cooke, in his "Remarks on Cholera," as it occurred in Lexington, 
Ky., in 1833, gives a full and explicit account of the epidemic 
as it occurred in that city, and attributes its origin to malaria, 
and points out the locality where the first case originated, and 
there is nothing whatever said about the disease being brought 
form abroad.

The communication at this time between Lexington and Versailles, 
only twelve miles apart, was uninterrupted, and yet there was no 
cholera in the latter place during 1833, while in 1834 it was 
severely scourged, and Lexington was exempt.  What becomes of the 
transmissibility of cholera in this instance, which "is known not 
to travel faster than man travels," when the people of these two 
places were constantly in communication, and not a case in 
existence in the two places at the same time and in the same year.

In 1833 the cholera broke out on the plantation of the writer's 
father in North Alabama, where there had been no cholera in the 
county up to that time.  There were a large number of whites and 
blacks on the plantation, and yet only about one-third of the 
number were attacked, the first case dying in twelve hours; the 
balance recovered.  No sort of precautionary measures were adopted, 
and the intercourse between the sick and the well was uninterrupted.

With a strong desire to arrive at the truth, and having closely 
observed, through three different epidems of cholera, the 
circumstances and surroundings under which it occurs, he has 
in no instance seen anything whatever which led him to believe 
it was contagious, or that it could be transmitted from one 
point to another by personal intercourse; but, on the contrary, 
believes it to be as free from all infection as remittent or 
intermittent fevers.  The experience of others had led them to 
far different conclusions, but after all, the adoption of that 
plan of treatment best calculated for the relief of our patients 
is the first and most important point to be arrived at.  In the 
language of a distinguished medical man, in a recent letter to 
the writer, "we can afford to shake hands over our differences 
of opinion as to the cause of cholera, if we can agree on its 
treatment.

"With reference to treatment, it is not pretended that anything 
new or original will be offered in this paper.  The writer's 
views as to pathology and treatment have in a great measure 
been derived from the oral and written teachings of Prof.

John E. Cooke, strengthened and confirmed by this own observation 
and experience, running through quite a number of years, during 
which time he has seen cholera in all of its phases.

Cholera is to be cured by producing and keeping up a free secretion 
from the liver and its discharge from the bowels.  The best remedy 
with which to effect this object is calomel.  In cholera it is 
particularly important, because from its small bulk, weight, 
and freedom from taste, it is more easily taken and retained 
than any other medicine, because other cathartics tend more or 
less to produce liquid discharges, and they are already profusely 
so; and because from the rapid course of the disease, the best 
remedy ought to be relied upon as far as is safe.  In all violent 
epidemics peculiar to hot weather, the first cases occurring, as 
a general rule, will be found typical of all subsequent cases in 
so far as the quantity of medicine to produce a given effect is 
concerned.  If in a cholera-epidemic two drachms of calomel are 
required to allay vomiting and produce free biliary secretion in 
the first few cases, the presumption is that this quantity will 
be required in all subsequent cases to produce the same effect, 
and should be given without hesitation.  If a larger quantity is 
required in the first cases, so will it be in all subsequent ones, 
and no hesitation should be had in giving the dose sufficient to 
produce the desired effect, for upon this depends the recovery of 
the patient.  In this connection the writer desires to record 
his opinion as to calomel:  That of all the so-called potent and 
dangerous medicines, he loose upon this as the most useful, 
harmless, and at the same time most abused and misrepresented 
of all others; that the bugbear, salivation, with which the 
ignorant are every day frightened, need not occur in one case 
out of thousands, with proper care in its administration and 
subsequent management.
H.Ex.95----19

Cholera is disease of congestion of all the internal organs, 
attended in the great majority of cases with complete suspension 
of the secretion of bile, and as the restoration of this secretion 
is all-important, the administration of opium in any shape or 
form cannot, in the opinion of the writer, fail to be detrimental 
in its action, from the fact that it increases the difficulty 
which we should be anxious to remove to wit, the locked-up secretion 
of the liver.  Given generally with the view of checking watery 
purging, its failure is signal, from the fact that it does not 
remove the condition of things on which this purging depends, 
and the writer knows no other remedy that will, aside from calomel 
as the chief reliance.

The experience of the resident physicians of Millersburgh in 
the epidemic of 1873, in reference to the use of opium, morphia, 
subcutaneous injection of atropia, &c., was anything but 
satisfactory.

Dr. J. R. Best informed the writer that, so far as he had observed 
the action of these remedies, they were failures.  Dr. John D. E. 
Jarnett, another resident practitioner of Millersburgh, testifies 
to the same facts.  These two gentlemen were unremitting in their 
attentions upon the sick from the first to the closing of the 
epidemic.  Dr. Smith, another of the resident physicians, was 
actively engaged, until prostrated by disease, from which he did 
not recover until the close of the epidemic.  These physicians, 
like the faithful sentinels of an army, remained on duty at the 
peril of their own lives, thus again illustrating the self-
sacrificing character of the medical profession in the hour 
of danger.

In confirmation of the correctness of the above views of treatment, 
the writer herewith records the following cases which occurred in 
Millersburgh, and in which this treatment was adopted:

Case 1.--My first visit was on Monday, September 1, to see a child 
of Dr. D. E. Jarnett, who was supposed by her father to have cholera.  
She had been actively treated, and when I saw her she was measurably 
relieved.  The remedy relied on in this case was calomel in decided 
doses.

Case 2.--The second case visited in company with Dr. D. was a negro 
woman by the name of Wheeler, aged twenty-two years, (the mother of 
one child,) and at this time five months advanced in pregnancy.  
She had been sick for two days, and under charge of Dr. D. E. 
Jarnett.  Her features were shrunken, extremities cool, pulse 
feeble, very hoarse, and not able to speak above a whisper.  The 
vomiting and purging had been arrested, but her condition was a 
very critical one.  No additional medicine was given at this time, 
(12 o'clock.)  She was badly provided for, and without any of the 
necessary appliances or comforts of a sickroom.  Visited her six 
hours afterward; the vomiting and purging had returned, and her 
case was considered much worse.  Two drachms of calomel rubbed up
 with a small quantity of charcoal were given, which promptly 
arrested the vomiting and purging, and after lapse of about twelve 
hours she had several free bilious actions, and her general condition 
improved, but on the next night, in the absence of Dr. D., who was 
then sick, she was induced to take some cholera-nostrum; after which 
labor-pains came on, ending in miscarriage attended with considerable 
hemorrhage, resulting in her death on Friday, six days from the 
beginning of the attack.  But for the occurrence of the miscarriage 
she might possibly have recovered.

Case 3.--A child of this woman, a boy aged two years, was sick at 
the time of our first visit with cholera fully developed, vomiting 
and purging, with involuntary discharges; his features were 
shrunken and extremities cool.  He took half-drachum doses of calomel 
and charcoal, and made a rapid recovery.

Case 4.--A child of Caroline Wood was visited at 2 o'clock Monday 
night; had been sick several hours; was collapsed, and in a dying 
condition.  Death at 3 a.m.  No medicine given.

Cases 5, 6, and 7.--America Parker, mulatto, aged about twenty-two 
years, and mother of several children, living on the bluff south 
side of the creek.  She had active rice-water discharges; she took 
two drachms of calomel and charcoal, and was promptly relieved.  
The mother of this woman was then dying in the same room from cholera, 
after an illness of only a few hours; also, one of America's children, 
aged about five years.  A second child just attacked was subjected 
to same treatment with that of the mother, and made a rapid recovery.  
The first-mentioned child took medicine, but was in a state of collapse 
and no hopes were entertained of its recovery.

Case 8.--A young mulatto woman, Matilda Robinson, aged twenty-two, and 
a mother of several children, was visited early Tuesday morning.  
This was a violent and fully-developed case of cholera, incessant 
vomiting and purging attended with cramps.  Two dracms of calomel and 
charcoal were given, and part of which being thrown up, the dose was 
repeated immediately, and by great effort was retained, the patient 
being held down in bed by two assistants, and the face freely washed 
with cold water.  In a few minutes the vomiting and watery purging 
ceased, and was followed in twelve hours by free bilious evacuations, 
and she rapidly recovered.  A strong and robust negro man died in 
this house same day, after an illness of a few hours.  The treatment 
in his case was calomel and opium, two grains each, at short intervals.

Cases 9, 10, 11, and 12.--Lucy Armstrong, aged about forty, and her 
three children, lving in an adjoining house, all had active cholera 
discharges; at this time were subjected to the calomel treatment, and 
were promptly relieved.  There had been a number of deaths in this and 
the adjoining houses.  One of the physicians present when these cases 
were prescribed for was asked his opinion of their condition.  He 
replied, "They are just such cases as have been dying in six hours."

Cases 13, 14, 15, and 16.--We next visited four patients of Dr. D. E. 
Jarnett, who were convalescent, all of them showing strong marks of 
the recent struggle through which they had passed; these were all 
middle-aged negro men, and had been subjected to the calomel treatment.  
Their names were George Brown, Horace Wood, Tom Lawson, and Henry Lawson.

Case 17.--George Conway, a colored man, aged about forty years, had been 
sick for twelve hours.  This case was visited on Thursday evening at 5 
o'clock, in company of Dr. L. D. Barnes, of Paris; the case was an extreme 
one, extremities cold up to the body, features shrunken and pinched up, 
surface bathed in a cold, thin perspiration, eyes sunken, and pulse very 
feeble at the wrist.  The discharges were involuntary, and almost constant.  
He took two drachms of calomel, and directions left to allow him as much 
powdered ice as he desired, being very thirsty.  This patient was left with 
the impression on the minds of us both that he would be dead in a few hours.  
Returning to Millersburgh Saturday morning to see some other patients, the 
writer called at the house of Conway and found him entirely relieved of 
all symptoms of cholera, and upon inquiry found there had been no action 
of the bowels since taking the calomel.  He was ordered to take a dose of 
castor oil, and no other trouble was experienced.  He was not salivated, 
and made a rapid recovery.

Cases 18 and 19.--Two daughters of George Conway, aged respectively 
fourteen and seventeen years, were treated in the same way, and were 
soon well. These cases were not violent, but were having free rice-water 
discharges.  Several deaths had occurred in this and the adjoining family.

Cases 20 and 21.--Two children of Milly Armstrong were treated; the first, 
aged four years, died; the second, age two years, recovered.

The writer saw several other cases in company with other physicians, to 
whom large doses of calomel were given, and they recovered; whether other 
medicines were subsequently given or not he does not know.

Some slight inaccuracies may have occurred in this report, and if so they 
have been unavoidable, but do not affect the general result.  Accuracy has 
been aimed at; but it is impossible, in the alarm and confusion incident 
to a violent cholera epidemic, to keep a record of every case exactly as 
it occurs.

In a letter from Dr. J. R. Best, he says: "In the late epidemic of 
cholera there were more than twenty recoveries from cholera, and an 
indefinite number from cholerine."  The writer is indebted to Dr. Best, 
who has kindly furnished him with a list of deaths occurring during the 
visitation.

To make Millersburgh as healthy as any other town in the blue-grass 
region, it is only necessary to wipe out these malarial spots and the 
work is done.

PARIS, KY., December, 1874.

It is but just that the converse of this history should be given.  In, 
however, attempting this, and in stating facts which are invariably 
over-looked or set aside by the opponents of the theory of the 
infectioness of cholera, who advocate the malarial origins of each 
demonstration of the disease, we disclaim any spirit of criticism 
of the able paper which we have presented.  Dr. Keller has most ably 
presented and defended his views upon the subject of the epidemic.  
We simply present a few facts that have come to our knowledge, being 
convinced that they form the chain that connects the epidemic of 
cholera at Millersburgh with the disease that was at the time 
traversing railroad lines and the navigable waters of the Mississippi 
Valley.

The first recognized case of cholera in the epidemic of 1873 at 
Millersburgh occurred on the 10th day of July, in the person of a 
negro child two years of age, who died after an illness of six hours.

On the 11th of July five cases of cholera occurred, all of whom died 
after from twelve to thirty-six hours' illness.

On the 12th of July two cases of cholera occurred, and both died; one 
in twelve, the other in twenty-four hours.These eight cases constituted 
the first epidemic at Millersburgh in 1873.  These cases all occurred 
in the persons of negroes; of whom five were males, three were females.  
They all, with but one exception, lived in the immediate vicinity of the 
first case.  The exception, a female, died of the disease at her home, 
some distance outside of the infected district, but she had been visiting 
the cholera sick.

The locality at which these cases occurred was close to the line of the
 Maysville Railroad, in fact almost under the line of the railroad 
embankment, and in a cluster of cabins occupied by negroes, many of 
whom were employed by the railroad company.

It can be conclusively shown that on or about the 6th day of July, 
1873, a railroad employe named Pat. Daily, while at work at the 
railroad cut just above town, was taken suddenly sick with diarrhoea 
and vomiting.  He was carried by his friends to the town; on the 
road he stopped in front of the cabin of Horace Woods to get a drink 
of water, and was then carried to "the old hotel" in town.  He recovered 
in about a week; his disease having been pronounced cholera-morbus.  
Daily was recently from the city of Maysville.

July 9.--The wife of Horace Woods, at whose house Daily had stopped 
for water, was taken with diarrhoea, vomiting, and cramping.  As the 
discharges were of pure rice-water, attended with suppression of 
urine, shriveled skin, and as on the 10th the patient was collapsed,  
the disease was pronounced by Dr. Smith, her medical attendant, to 
be cholera; but as she recovered, the case was recorded as cholera-
morbus. 

July 10.--In the same house with the Woods family, the young 
child of George Baylor was attacked with cholera, and died, as 
before state; and within forty-eight hours two other cholera deaths 
occurred in the same house.

With the cases of July 12 the disease expired, and no more was 
known of it until August 22, when it suddenly re-appeared with 
redoubled virulence.

There had been no meteorological changes between July 12 and 
August 22 to account for the cessation and redevelopment of the 
malarial influences; but the facts go to show that there was no 
more of the disease until after the arrival of two railroad employs 
from Maysville, named Henry Carrington and Harvey McIivain, who both 
died of cholera at "the old hotel."  These men were sick when 
they arrived, and after their cases had become pronounced, the 
disease spread from the building in which they took refuge to the 
lower portions of the town.

It will also be remembered that on August 28 the negro Purcel 
arrived at Millersburgh from Maysville when in collapse from 
cholera, but that he did not die until the third day after his 
arrival.

Had the initial case of the first epidemic occurred at a point 
at which there could have been no possible connection with the 
cholera infection; had the initial cases of the second epidemic 
not followed a positive importation of the disease, the malarial 
theory would have been unassailable.  But the location of all the 
first cases was such as to directly subject them to infected 
persons, and the importation of the second epidemic cannot be 
doubted.

That malarial influences were present at Millersburgh during the 
summer of 1873 is to doubted, but cholera did not occur until 
the disease was brought into the town.  The malarial influences 
of 1874 were positive and defined throughout the Southwest, but 
no epidemic cholera occurred, although its spontaneous development 
had been prophesied by, some theorists.

It is advanced that in the history of a cholera demonstration the 
first death amounts absolutely to nothing; the fact of importance 
is the first case of profuse, painless diarrhoea.  It has been 
shown that the initial case may not terminate until after others 
have succumbed to the disease; and the porter of the specific 
poison does not always himself exhibit symptoms of the disease.

For valuable aid in obtaining the facts herein set forth, we are 
indebted to Surgeon P. H. Bailhache, United States Marine Hospital 
service, stationed at Louisville, Ky.

TAYLOR COUNTY.

The history of the epidemic of cholera in Taylor County is most 
interesting, from the fact that in this county, undoubtedly, is 
to be found the first link in the chain of infection which spread 
to most of the counties of Central Kentucky.

Early in the month of July a negro man applied for work in one 
of the construction-parties of the Ohio and Cumberland Railroad.  
At a later date it was ascertained that he had come from Western 
Tennessee, where he had been working on the Memphis and Paducah 
Railroad.  The man obtained work on the tunnel-section at Muldrough's 
Hills, and was given quarters in a group of cabins occupied by 
other negro workmen and their families.  Not many days after 
his arrival he was taken with an acute diarrhoea, from which he 
was confined to his bed for some eight days.  This attack was 
attended with great prostration and general constitutional 
disturbance.

The dejecta from this case were thrown out on the ground in rear 
of the cabin, which was built upon a hill-side.  Immediately in 
front and below this cabin was a spring, form which the 
neighborhood obtained drinking-water.  On the 14th, 15th, and 
16th days of July there was considerable rain-fall, and by surface 
washings the spring was nearly filled with debris.  On the 17th 
of July two violent and fatal cases of cholera occurred in the 
cabins adjoining the one in which the diarrhoea-patient was 
residing.  Both of these cases died within ten hours.  One was 
in the person of a negro woman, who was eight months pregnant.  
Labor came on during the second stage of the disease, and the 
patient was delivered of a dead child while fully collapsed.

These cases were treated by Mr. W. T. Chandler, of Campbellsville, 
a student of medicine, and who has since graduated with 
distinguished honors.

From these cases the disease was carried along the line of the 
railroad-works to Campbellsville, the county town, and the 
Lebanon, Marion County.

Thirteen cases of cholera are reported as following the cases 
already enumerated, eleven of which terminated fatally.  Dr. 
Hodgen, of Campbellsville, a reliable observer, reports the 
occurrence in the same vicinity of eighteen cases of acute 
diarrhoea which demanded active treatment. The town of 
Campbellsville escaped the epidemic almost entirely; and 
this point is of exceeding interest, as demonstrating the 
efficiency of disinfectants in protecting a community which 
is exposed to the infection of cholera.  Six instances were 
either cases of cholera brought into the town, or the disease 
was developed after the arrival of the individual from an 
infected point.

The Campbellsville cases are as follows:

I.  July 20, a negro man, who had contracted the disease on 
the line of the railroad, died of cholera.

II.   August 10, a white man, who had contracted the disease 
on the line of the railroad, died of cholera.

III.  August 21, a negro man, a refugee from the infected 
town of Lancaster, Garrard County, died of cholera.

IV.   September 2, a white boy from Lebanon, was taken with 
cholera, but recovered.

V.  September 2, a gentleman from the infected town of 
Columbia, Adair County, died at the Campbellsville hotel 
of cholera.

VI.  September 8, a gentleman from the infected town of 
Lebanon, Marion County, was attacked with cholera and 
died.

Each of these cases were isolated as far as it was practicable.  
The excreta of each case were disinfected and buried, and every 
additional precaution was adopted.  Among the residents of the 
town no cases of cholera occurred, although during July and 
August cases of acute diarrhoea were frequent.  The inhabitants 
of this town had declined to attend the Marion County fair.

[Cont'd on Page 295]

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