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.
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.