the army, were appointed to ascertain the facts, and to "make a detailed report of the information collected, on or before the first day of January, eighteen hundred and seventy-five, to the President, to be submitted to Congress."

To carry out this intention Dr. McClellan was associated with Dr. Woodworth, the Supervising Surgeon of the Merchant Marine Hospital Service of the United States. Dr. McClellan received instructions on 7th May to proceed to Louisville, Kentucky, and from that point to visit all the towns at which cholera had prevailed in 1873, but, inasmuch as there had been 264 localities infected, which were scattered over 18 States, while there were only 238 days available for the purpose, a personal visit to each was impossible, and it became necessary to issue circulars soliciting information from the various medical practitioners in these localities, who had had an opportunity of observing or collecting facts regarding the epidemic. When the replies were deficient in details further information was asked for. Dr. Woodworth addressed two hundred and sixty copies of his circular to medical practitioners in the infected districts, and received answers from eighty-four only; and, though Dr. McClellan does not mention the number he sent out, it appears from his account he did not succeed in eliciting contributions from many of whose assistance he would have been glad to avail himself, and those he did receive were often too meagre to be of much service. Drs. Woodworth and McClellan drew up separate reports, which were submitted through their respective Departments, by the date named in the original resolution.

The volume under consideration commences with the report of Dr. Woodworth, which, with its appendices and index, submitted through the Treasury Department, extends to 28 pages. The remainder is occupied by Dr. McClellan's Report, submitted through the War Department, which extends to 1025 pages, and embraces-1st, The History of the Cholera of 1873 in the United States, compiled by Dr. McClellan; 2nd, An Account of the travels of Asiatic Cholera in Asia and Europe, by Dr. John C. Peters, of New York, and in North America, by Dr. McClellan; 3rd, A Bibliography of Cholera, drawn up by Dr. John S. Billings, Assistant Surgeon United States Army, filling 315 pages. There is an outline map showing the distribution of the epidemic in 1873, and twelve plans of towns where it prevailed, attached to Dr. McClellan's history; and fourteen outline maps to illustrate the supposed routes of cholera from India to other parts of the world, in its various epidemic diffusions.

The first case of choleraic disease in New Orleans, which attracted attention, died in the Charity Hospital on 4th March,

1873, having been attacked on the 2nd. Though returned as cholera morbus in the first instance, the symptoms were so characteristic of malignant cholera that it led to inquiries as to previous cases, when it was ascertained that deaths had occurred from a similar disease on the 9th, 10th, and 28th of February, and on 1st, 2nd, and 3rd March. Dr. McClellan states the deaths from the disease were, in March 16, April 90, May 125, June 18, July 4, after which there were but single deaths in August, September, and November.1 In April the disease appeared at several points along the Mississippi, and became more frequent in May and June. The epidemic was at its height in July and August at various points along the Upper Mississippi, the Missouri, and Ohio, and soon after sensibly declined in force. The disease seems to have been common in the states of Louisiana, Mississippi, and Arkansas, along the banks of the river, and for some distance back into the country; it was extensively diffused through Tennessee and Kentucky, to the south of the Ohio river, and in the portions of the States of Ohio and Indiana, on the north bank of that river, and for some way back. In the south-western portion of Illinois there was a good deal of the disease in the neighbourhood of the Mississippi, but as it went north it retired from the river more and more. Missouri, west of the Mississippi, there were a considerable number of manifestations near that river, as well as on the course of the Missouri itself. Farther north there were outbreaks at Burlington, and Davenport, Iowa, both on the Upper Mississippi. Chicago was the only place on the great lakes which suffered from cholera in 1873. Wheeling, in West Virginia, may be considered the eastern point to which the epidemic reached, for although there was a slight manifestation at Pittsburg, there were only five cases, which occurred between the 1st and 8th August. To the south of Tennessee, Huntsville, and Birmingham, Alabama, were affected; one imported case was reported at Montgomery, Alabama, and one each at Atalanta, and Dalton, Georgia, but no others followed. There was an outbreak of considerable intensity at Denison, in the north-east of Texas, from August to October. In the north-west there was a limited, though severe eruption of malignant cholera, among a party of Swedish emigrants, in July, at Crow River, thirty miles from Willmar, Minnesota; and the

In

1 In No. V. of the new series of 'Reports of the Medical Officer of the Privy Council and Local Government Board,' Mr. Radcliffe gives (p. 195) a table of the deaths each month, under the three denominations of Cholera Spasmodica, Cholera Morbus, and Cholera Infantum. The total is 359, or 100 more than given by Dr. McClellan, but both agree in showing the greatest mortality in May, and a rapid decrease in June and July.

115-LVIII.

2

following month another, chiefly among Russian emigrants from Odessa and the Crimea, at Yankton, in Dakota. These will be noticed again in connection with a supposed introduction of virus from Europe, in their bedding and clothing. Lastly, four deaths from cholera occurred in August, at Kelton, a small town of 450 inhabitants, on the Pacific Railway where it crosses the Sierra Nevada in the north-west of Utah; no emigrants had arrived at this place previous to these cases occurring.

It thus appears the force of the epidemic was experienced along the Lower Mississippi, through the States of Tennessee and Kentucky, the portions of Ohio, Indiana, and Illinois, to the north of the rivers Ohio and Mississippi, with extensions into the States of Missouri, and Iowa, to the west of the Mississippi. Around this continuous manifestation of the disease there were outlying attacks of varying extent, at Pittsburg, Pennsylvania, Huntsville and Birmingham, Alabama, Denison, Texas, Yankton, Dakota, Crow River, Minnesota, and even Kelton, Utah, as are to be met with more or less around every considerable epidemic. During its prevalence, too, diarrhoea is reported from many points in the epidemic area to have been unusually frequent, and this was experienced beyond the cholera field altogether, as San Antonio, Texas, where diarrhoea was noticed as unusually prevalent as early as December, 1872, and continued up to June, 1873, while "several cases are said to have assimilated cholera," (p. 448). As to the latter, indeed, there are numerous notices from medical practitioners in the infected districts that cholera morbus, exactly resembling what they met with in other years, was more frequent during 1873, and many, even to the last, maintained that they encountered no new disease in 1873, as these cases were indistinguishable from those that they were familiar with in previous years, and that they arose at points, and under circumstances, which they believed precluded exposure to previous cases, or to fomites proceeding from them, while the resulting mortality was moderate.

In his report Dr. Woodworth expresses his desire to set forth, briefly, the facts which establish the connection of the mercantile marine with the importation of Cholera into the United States, and to suggest what may be done to prevent, or limit future outbreaks. Success in this latter, he admits, in common with the answer to any question, will depend upon the extent and accuracy of our knowledge of the factors of the problem. As a basis for his practical recommendations he states, compendiously, "What is known and accepted concerning the cause of malignant cholera-its origin, character, mode of propagation, transportation, &c.," in the form of nine propositions as follow:

"I. Malignant cholera is caused by the access of a specific organic

poison to the alimentary canal; which poison is developed spontaneously only in certain parts of India (Hindostan).

"II. This poison is contained primarily, so far as the world outside of Hindostan is concerned, in the ejections-vomit, stools, and urine-of a person already affected with the disease.

"III. To set up anew the action of the poison, a certain period of incubation with the presence of alkaline moisture is required, which period is completed within one to three days; a temperature favouring decomposition and moisture or fluid of decided alkaline reaction hastening the process, the reverse retarding.

"IV. Favourable conditions for the growth of the poison are found (1) in ordinary potable water, containing nitrogenous organic impurities, alkaline carbonates, etc.; (2) in decomposing animal and vegetable matter possessing an alkaline reaction; (3) in the alkaline contents of the intestinal portion of the alimentary canal.

"V. The period of morbific activity of the poison-which lasts, under favourable conditions, about three days for a given crop-is characterized by the presence of bacteria, which appear at the end of the period of incubation and disappear at the end of the period of morbific activity. That is to say, a cholera ejection, or material containing such, is harmless both before the appearance and after the disappearance of bacteria, but is actively poisonous during their presence.

"Note. It is not meant by this that the bacteria so found are the cholera poison, since they differ in no appreciable manner from bacteria found in a variety of other fluids. Indeed, Lebert hints that the bacteria may even be the destroyers of the poison.

"VI. The morbific properties of the poison may be preserved in posse for an indefinite period in cholera-ejections dried during the period of incubation, or of infection-matter dried during the period of activity.

"VII. The dried particles of cholera poison may be carried (in clothing, bedding, etc.) to any distance; and when liberated may find their way direct to the alimentary canal through the medium of the air-by entering the mouth and nose and being swallowed with the saliva-or, less directly, through the medium of water or food in which they have lodged.

"VIII. The poison is destroyed naturally either by the process of growth or by contact with acids: (1) those contained in water or soil; (2) acid gases in the atmosphere; (3) the acid secretion of the stomach.

"IX. It may also be destroyed artificially (1) by treating the cholera-ejections, or material containing them, with acids; (2) by such acid (gaseous) treatment of contaminated atmosphere; (3) by establishing an acid diathesis of the system in one who has received the poison.

"Note.-Why, when perennially endemic in India, with which country intercourse is constant, the disease becomes epidemic elsewhere only at long intervals, is beside the present purpose to inquire. What conditions, meterologic, telluric, and diathetic, are necessary to its epidemic spread, even in India, are not yet de

termined; and no practical result for the object of this paper could accrue from speculation thereon.”—(P. 8, 9.)

We quite agree with Dr. Woodworth that the conditions necessary for the epidemic spread of cholera, either in India or elsewhere, are not yet determined, and that their consideration, at present, might not have assisted him to draw up rules for the exclusion of the disease from, or its limitation within, the United States; but he forgets that this is a direct admission that his knowledge of the factors which cause the migrations of the disease from one part of the world to another-to America among the rest is most imperfect, and that, consequently, on his own showing, his conclusions can have little weight. We readily admit that an officer, placed as he is, at the head of a department to watch over the public health, must frequently act on imperfect information in devising the measures to protect it from injury, and may thereby be led to make recommendations which are subsequently found to be useless, if not sometimes actually hurtful. We have no desire to criticise such endeavours harshly, but, in submitting these remarks to our readers, we consider it incumbent on us, in the true interests of medical science, to point out this anomaly, and to caution them against placing implicit confidence in theories which, on the face of them, are far from representing the whole facts, and which most likely may have to undergo great modification as our knowledge extends.

Dr. McClellan opens his report with a chapter on the clinical history of the epidemic of 1873. The second chapter is on the etiology of cholera, in which he sets forth, in seven propositions, what he considers the nature of the cause and the mode of its diffusion, and illustrates his views by experiments and opinions brought together from a variety of sources after extended research. As these propositions cover much the same ground as those of Dr. Woodworth, it is unnecessary to introduce them here. The third chapter is on the prevention of cholera; the fourth, by Dr. Peters, on the origin and spread of the cholera which reached the United States in 1873, in which he goes back to the occurrence of the disease in Persia in 1865, and gives an outline of its manifestation in India, Persia, and Europe, up to 1873, from which he believes it to have been carried to America in the beginning of that year. The fifth, and seventeen following chapters, are devoted to the details of the individual outbreaks in the different states, in which the epidemic appeared in 1873, and the twenty-third to the narration of its occurrence among the troops of the U.S. Army, to which is appended an abstract of the state of the weather from December, 1872, to November, 1873, from the monthly weather