THE OMAHA DAILY BEE : SUNDAY , AHUL 16 IW-TNVKNTy-FOril PANES.
THE PLAGUE AT ITS HOME
a-ttjon , Spread and Tr t nt of
Cholera in EowUt
REPORT OP AN AMERICAN OFFICIAL
An Jm | > ortnnt Itovlrw of rrrvrnllte Mi' § -
uri-n , liitcntlCBtluiii nnel lr ( nlt
.Sucr < - > of HIP Irrigation Treat
ment Medical
GOES 1 dcnrral Crawford nt St. Potorsbnrfi
rejxirts to tlic State detmrtmemt as follows :
The L.trodui'tion of cholera Into HuMia became -
came nt owe n question of International in
terest and concern. 1 liavc , therefore ,
vvat U J v.rh great rare the progress of the
epiiKn.ic since- its entrance Into the empire
at 's.t. ap-and. wlii-nce it oumc rapidly to
Baka Tillis Astrakhan and thence up the
Volpa n to UKinterior. . I huvo cure-fully
nott J tht measures adopted by the Kussian
Km\.uent in the several places of im-
portnt. tisitcd by the epidemic to combat
tht dre.vse anil reduce Its ravages If possible
tot > tt.t.isum. I hiive itudieU the work
of UK s. nitarj officials , as well as that of
t.jc tiir mil lorivsof the empire , and 1 be
ll vt' ' ! t IK ni.\ duty to malic a report to
the < lFimrttD > 'iii uian the measures taken
nr.it.st -IIP cpidrtnicin Kussin. especially sis
cholera is threatening to Invade the Unitud
e.oK-niMirnt Mrnmirct A-iliist | ; Cholera.
It irj i-w tK-liove-el by the medical author
ities 'hat an rTwtivequnrantine might have
been e-stuo. . . ! > tH'il at Astrakhan , on the Cas
pian sen s'jftlcie-ntly effective , at least , to
have1 | 'revriite-cl the epiUomic from pomp up
the Vc.ir.i mid tlius infectiug the interior of
the empire
Theun < e-rtainty of the peed results of
quiiruotiiir at this point , coupled with the
fad thai the1 local authorities were not well
prepare 3 fur such a quarantine , resulted in
kavii.ir thr ii.nu-s . of this important rity open
to the unui-liiiinp visitor. As soon , howeve'r ,
as cholera broke out in Ualu : the povern-
ine'iit ' i jijt hnrracks at Astrakhan for its
tre ; ii 'i ' in .i i 'i ' minted a sanitary service and
detain ' . ( ] , i rs to keep watch day and night
lor < iii' ' < cr.iir patients , who became person-
nib nnpniiEible fcir the tntnsport of all such
case-s l the barrac-ks. It was the plan of
the pi.vrrnment to e-nforce n riirid system of
isblutiem npuinst the spread of the epidemic ;
this plan soon proved to be impracticable
end , it , fa > t. impossible , due , it is claimed , to
the influence of the masses , who were uu-
wilimp to assist the authorities.
The epiileuiic gradually spread inland
throucli the fiwns of the Volga basin and
had iT.1. hed Kijni-Novporod before the
authorities were able in any marked depreo
to check its ravapes. Here his excellency ,
Baranoff. povenior of the province , took the
matter rindli in hand and acted as a dicta
tor in ull matte-is touching the epidemic.
Governor liaranoff decreed that all persons
arruinp lliut tin1 disease was not , an epidemic
of AMU * c-hc'lera nnd all persons in any
waj oi'posmp the orders of the sanitary
cointn tsi"ii nnd of the doctors should be iin-
meui.uel.v arrested arid imprisoned. He also
eli'irve-i t-fviTc punishment upuu all persons
founo puilt.v of spreading nlurming and cx-
nc'Re-r 'mi * ivjiom of the disease. lie or-
paniye'd u very systematic plan of disinfec
tion. the first and forcnuistof which was the
nhsuiutc rleausinpof the e'ity. Public streets ,
&cwirs public bullellnps. us well as all pri
vate house's in the city , were , under the
strictest surxeillune'o. thoroughly cleaned
and dismfccte'd with either carbolic acid , bi
chloride of mercury , ferric sulphate , dry
heat steam or boiling1 water. Under the sani
tary lavs of Governor Baranoff a ripid in
spection of all classes of feiod stuffs , includ
ing water and mill ; , was strictly enforced.
Art ! 'les of food believed to be especially
lUiule to carry infection , such as mushrooms.
bcnles caviare , especially unclean cabbage ,
llsti not freshly killed , all fruit and vegeta
bles not absolutely Ire'sh and e-lean , were
gathered up by the authorities and sum
marily elestroyexl.
With regard to choleraic patients , a rield
system was enforced to prevent contagion.
All the clothes of such patients were imtno-
diateli burned and new suits given them by
the local authorities. The bodies of the dead
were Immediately buried unwashed and
without funeral rites , nn especial burying
ground having been devoted to such service.
Kveri house in which a patient may have
Lecu taken ill from cholera was thoroughly
disinfected , hot water , steam or dry heat
being used wherever practicable ; this in ad
dition to the general disinfection of ull the
houses in the city.
I may add here ttiat , based upon observa
tion , experience nnd practical tests in the
present epidemic , the medical authorities of
the highest standing in Hussia now uftlrm
that disinfection , as generally understood
auel practiced , is of little or no practical
value , excepting such disinfection as prop
erly conies in the domain of thorough cleanli
ness These medical authorities declare
that the sjstem of trying to kill the bacteria
of cholera by any form of chemical disinfec
tion is of little or r.o avail. It may be inter
esting to note that the experts in cholera in
Kussia looU upon the number of illcs in a
house or locality as Indicating the amount of
danger from uncleanliness in an epidemic of
cholera flies have been found to bo in-
fecleel with choleraic bacteria , and there
fore arc believed to be pron.inent agents in
the spre-d of the disease. It is the opinion
of the me-dical experts who have studied
cholera in Kussia that boiled drinks and
tliOrouphlj couked foods are a safeguard
. ngainst cholera Thorouch cleanliness , thor
oughly boUeit drinks and thoroughly e-ookcd
food stuffs may bo regarded as the present
motto of the sanitary und medical commis
sion of Hussla.
In addition to the preventive methods en-
forceel by Governor Uaranoff against chol
era , as mentioned above , a very systematic
plan was organized on ull the steam and
canal boats , railway trains and trams to pre
vent us much as possible the spread of the
epidemic All trains were ordered to carry
boiling water , as well as boik'd drinking
water , for the use of the passengers. Uv |
liolstood cars were e-oycrcd with oilcloth
and often with linen slips , which were re-
niove-d at the end e > f each trip , washed and
rebelled The closets and washrooms of
raeh car were thoroughly e-ieaned by boiling
water for every trip and disinfecte > d with
carbolic acid A cholera car , thoroughly
equipped for the emergency and attended by
a olosician , was attached to each train.
Similar precauions were taken on steam and
canal bout * and on tram cars.
The it-suits of the rigid practice organized
nnd carried out in Nijnl-Novgorod by Gov
ernor Duration proved to bo eminently suc
cessful Therefore a similar line of sanitation
was adopted in Moscow , and with excellent
results Since 1 have been in Russia I huvo
ottcn heard it remarked that Moscow is nn
uiu-leaucttj . but the small number of deaths
from chole ra in the present epidemic would
see-m to urpue to the contrary. 1 had occa
sion U > Msit Moscow on the outbreak of the
cholera there and 1 particularly noticed a
ven great improvement in this particular
tlnrc mj former visit to that place. The entire -
tire cit jvus cle.au and , as the prefect of
Moscow personally sssure'd me , was in excel
lent condition t. > combat the * epidemic. It is
a matte r of common surprise that cholera
did nut assume u seriously epidemic form in
that i'lt.due. . it is believed , entirely to the
rigid pre-cautious taken with reference to
cleanliness food and drink.
lu St Petersburg n similar line of precau
tions was promptly undertaken and carried
out General von Waul , the prefect of the
city was as uutirinc us he was thorough in
preparing the city in advance of the
outbreak of the epidemic , and 1 may add
that long before the first e-ase appoare-d in the
city evcr.\ thing was in readiness for the
enemy The much love-d mushrooms , stale
cat-hage caviare , be'rnr . and t > or fruit \\cio
mere ilesslj dcait with A tnoivugh watch
was set over the market places , fish stands ,
fruit and vegetable stores , meat and milk
shops , and everything not absolutely beyond
suspicion in the wax < > ; foot ! s tails WHS con
fiscated and summarily destrou-d. Thanks ,
it is bejievcd to the faithful carrying out of
IX'th ' the letter and the spirit of the orders
of Central vouVahl. . the iireseut epidemic
has ai-s jiced puly u nald fo''m in St. Peters-
burp
Tri-alinrnt li.v Ille HUI | HII I'li.v lclHn .
I have jtersonally visitexl the cholera hos
pitals of this city , und 1 havobeuu .groatlp
pleased with the arrangements for the com
fort und treatment of their patients , All of the
uutrumenti ure of approved i
nvHlern tle-M rns the h'upit.i ! . invmu HT *
as we I ! ns the . -are < > f thf slefc iviu r nipnri
Trrfltvrntily With tll"e "f IhC 1'lilU'd
N ursine in the rbolrra linnplMls In St
1'ctcrsburp in under the supervision of the
sisters of th fVx-ifltj nf tbo Heel CroM.
Therr arc tw o dunned of hospital attendant * :
atm rla etompoted of men nure . whose
duty It i * Vi inok after thf mor * I'lborlom
work of the lumpltHls : thenthcre-lnsi Is com
ix * * * * ! entirely of women , who att md to the
more delicate Mtrrlcw mid wlio arc required
to k * * | t the hcwpltnl In perfect order , besides
serving as nssi , Uiits to tbe mule iiurn-s
There arc mnlo nurses in chinte of the bulb
rooms , who rei-nivo the patletits. bathe nnd
dress them , end ttlace them In the bmpltal
l > e ls of the different ward * . Tlie nurninr , I
HID able to sny from ) > eisona ) obst-rvatlon. Is
exe-elleut.
The modlcnl treatment of cholera in
HufcsiM in general Is essentially I ho same : is
that | rat-tli-ed In St. Petersburg. The- baste
idea of this treatment is to assist as far as
pjssi'He that onran or function which Is
most kerlciusly affected by the * thsiusc. Thee
ejK rlal features of this treatment consist
in the subcutamxiU ! ) of injection suit
wr.ter , following-the methodsof the Hullun
physli'inti Cniilaiu. Another measure is the
introduction of a solution of tanuic ueld. I
properly dilute * ! . Into the bowe'ls direct In I
eirde-r lo make this treatment more cushy
understood by the ( reneral ruader , 1 will fol
low un averai'e patient to the cholera hospi
tal mid describe iho treatment as practiced i
the-re. This patient Is taken sick with elu'lI I
ora. not as suelilenly 'is generally supposed ,
and , after much iiersunsl'iti by his friends
nnd rnlittivoB , he is linally r 'iKirted to the
authorities. Inthiscltytlicrctire police chol
era stal Ions , in e-Heh of w hii-h there are special
police ph.\siciutis , wlmse duty it is to assist
iu every case , brought to their notice. The
patient thus reported to the police station is
sent dire-etly to one of the e holera hospitals
generally ag'iius ! his own will and often ,
indeed , too lute for effective1 treatment. The
police physician remains behind nuci super
intends tlio disinfection of the apartments
of th patient uevoi-dirg to jrescribcd )
methods. At the hospital the patient is
llrst taken to the both room of the ward to
which he Is ussigne-d. undressed , and placed
In a hath tub of water somewhat wanner
than the temperature of the body , where ho |
is kept immcised for a period of ten to I
fifteen minutes , after which he is dressed I
with clean linen shirt and drawers and put
to be-d. On his way to his bed ho is tem
poral ily wrapped in woolen blankets. Heis
then examined by t.ho ward physician , who
carefully takes his history and makes notes
of his condition , something as follows :
.Je > lin Jones ; ape 40 ; married , wife and
children : garden laborer ; residence , No. Ill
I'oskl , St. Petersburg ; sick three da.\s before -
fore coming to hospital from dianhifa , pain
in back , headache , loss of appetite , slight
nausea ; sltin warm ; temperature 1 = below
normal ; pulse , weak. The following will
probably bo the treatment : Siflol , one gramme
at a dose every three hours , with subcuta
neous Injection of solution of salt. The diet
will be boiled milk , bread , and tea. It
should bo stateel here that everybody
drinks tea hi Hussin ; it is , in fact the
national drink. The salt water used in
this injection will be about one liter of u one-
half of one per cent solution. This solu
tion is prepared by the druggists as follows :
Distilled water , sterilized by heat , with salt
enough added to make a solution approxi
mating as war as possible the plasma of the
blood. This solution is kept in bottles such
as are used in laboratories and stoppered
with sterilized cotton. When the solution is
to be used its temperature is raised 1o blood
heat by immersing the bottle containing it
in hot water. A large glass-barreled
syringe , with a needle of about Jive inches
lemg. is used in making the subcutaneous in
jection. The site of the puncture of the
hypodermic needle is gene-rally in the ab-
Uomiual wall , to the right and left of the
umbilicus , one-half of the quantity ocing In
jected into either side. In the course of
from six to ten hours ttie salt water is com
pletely absorbed , asshowu by the subsidence
of the swelling. Not infrequently the injec
tion produces considerable inflammation ,
and , rarely , putrescence , due to some un
avoidable imperfection in the operation.
Tlio value ol Uiis method is in doubt even at
the hospitals here ; but it is > believed to afford
temporary relief , at least , to the patient , und
apparently eimproves the circulation and
probably influences favorably the eliar-
rhcua and vomiting. This so-called ir
rigation method is under rigid trial
in this city and I should not he
surprised to lind it finally . dis
carded. The same may be said of the in
ternal use of salol in these cases , a chemical
product of considerable reputation and.
merit in other instance's and harmless. This
preparation is extensively used throughout
Kussia , perhaps in a large measure due to thy
fact that its chc.mie-.ul origin is St , Peters
burg , whence it has traveled around the world.
The diet , as mentioned above namely , milk ,
bread , and tea has proved to be entirely
satisfactory.
At the next visit of the physician some
hours late * the mtient will probably bo
worse , and further evidence of blood poison
ing be manifest through convulsions and
vomitings , with skin eiola. kidneys inactive ,
rt'jid with septiceinia if the case is grave.
The treatment is now changed , and subcu
taneous injections of diuretin are made with
the hope of forcing , il possible , the kidneys
to act ; bismuth and opium to relieve the
vomiting and a hot air buth to
bring up the tempeiuturo of the
surface of the body ure also used.
The diuretin as thus used is also undergoing
n thorough test here , and I should not be
surprised ut seeing its enicae-y in these cuses
seriously questioned. The bismuth und
opium treatment is too well known in the
United States to require further mentioning
hero. I would like to add , however , my
personal testimony to the great eflicucy of
the hot air buth , especially in euises lu the
algid state. 1 have seen this used in the
hospitals here in chole-ra cases , and , with
prompt nnd , 1 believe , permanently good
results. A very simple apparatus can bo
easily constructed in anj household lor the
application of hot air ia such cases. A
frame may be placed on the rails of the bed ,
em which limy bo * prcad ordinary blankets
well twkod In at the sides and around the
patient. Underneath the blankets ou one
side of Iho bed may be inserted one end of
the dhow of a snuill stovepipe , while the
other end is plae-od over the chimney of an
ordinary kerosene lamn to receive the heat
of the flume , thus sending u current of
hot air under the blaiiKels of the patient.
A long thermometer is thrust through the
blankets iu contact with the patient , and the
temperature is thus regulated. This method
of combating the e-old stage of the disease is
neiw in general use hero and grows in favor
with eae-h application. Many patients are
believed to have been saved by this treat
ment alone. I personally recall one case
which I regarde-d hopeless , and which w s
immediately improved by the hot uir bath ,
and who nnullreeovcred. , .
At the next visit of the physician our pa
tient will apparently be somewhat 'inprove > d ,
pulse stronge-r , bodj warmer , but with rico-
wuler dlarrhera and more profuse and fre
quent. The treatircut now will probably bean
an injection into the bowels of about one
liter of a solution of tannic acid of tin- proper
strength. This will probably ho the lust
prescription , us the patient with symptoms
as described abewe will probably soon pass
Into the comatose state , in which further
meuK-al aid will IK ; of no v.tlue. This use of
tannic acid is old , anil , of course , well known
to the average physician , and lias bee-n given
in these case's ou the supposition that the
mcaia of the germs of cholera are of alka
line reaction , the injection belnir thus intended -
tende-d to counteract the choleraic poison
Another reason for thus using tannic acid is
its well known astringent qualities. Both
of these theories are being seriously ques
tioner ! b > menlern investigation in cholera
cas-es.
Of e'ourse , other treatment is given , as the
symptoms of the several patients differ.
Hetu-napthol mixed with bismuth is some
times given iustemd of salol for the diarrhenu
stage , and sometimes otheir antiseptics ; co
caine Is also gh-en with considerable success ,
apparently to relieve vomiting , and in doses
of about threw drops of u 10 per cent solu
tion. In cases coming curly to the hospital
when not violently ill , a dose ol
thirty grammes of e-astor nil is
given. Hypodermic injections of mor.
phiuc are used to assuage the crumps
and colic pains. The patients ure also given
as far as practicable , hot water baths daily
In some OHM'S r. liter of salt solution has
been injected dim tly into the veins of the
patient at the ankle , but the meihol is now
regarded as both dangerous and ineffective
The e-ssenliul features of the treatment of
cholera as practiced in KusMa in the present
e-iiiaemic may be summarized as follows
First , hot water and hot air baths ; second ,
subcutaneous Injections into the ubdomina
wall of 1 liter of a one-half of 1 per cent
Dilution of e-eunsnon salt . third , injection into
the lower bowel of tanuic acid and opium
fourth , hypodermic injection of diurclin for
t\e Uidiif\s lifih ihtirtiiil ailn
i > f S.IL.J lusinutt ) b < tt : tiiil'Hn' ' ' . nj.i im
nii'l ' i asfnr oil at t < M 'i'tuciv in'U '
cat < -il Mmh h | 'Jeri'uc ii.joi-fl-tis 'f umr
phi ne
Gcitrrn input Intent lent Inn * .
I take great pleasure end pride In calling
attention i to the fact that a young ph.\ulemn
of i the UniUni States , because of his emi
nently i iUeTf ful career In tbe Oldenburg
Inntltutfof KKPerlmental Medicine in this
city , was selected by the Itutslnn government
to no to Hateu. erect a lalioratory there
and i conduct a KrSrs of scientific experiments
relative to the cause of cholera , and more e- -
IK > Hlh toils locus in the human body. The
name : of the ptnsle'lan above referred to is
Arthur O. r.lachstein of New York city , a
graduate | of Cornell university , where he re
ceived i the decree of B. A. in IKiS , whence he
went to Lc-ipsic and re-celvexi the degree of
M. D. from the medical university of that
place In IH T. Keturnlng to the United
States , he was made a fe-llow In pathology of
the Johns Hopkins university in 1SIKMM.
One year ago he came to the Oldenburg In
stitute of KxPorimentai Medicine in this
city , where he has devoted his entire time to
the study of disease-producing bacilli and
kindred studies. On the breMiklmr out of the
epidemic in Hussla. Dr. Blnckstein was
thought to be the best equipped for conduct-
imr a series of scietitilic investigations on
cholera. He was. therefore , by special
recommendation , made an active member of
the Institute of Experimental Medicine of
St. Petersburg , and was immediately in
trusted with the important mission above
mentioned.
According to Dr. Blackstcln. there have
been and are still two very different meth
ods of pursuing the sciPtitilic study of
cholera , one of which has been te-rmed the
epldemloloirlcal method. The cclle-cting of
statistics and observations as to the influence
of soil , air , water , and plants upon
the cemrse of the epidemic belont' to this
method. In this wav much valuable information
mation has been collected by Pcttenkofer.
The second method is known as the bacter
iological method , und was successfully In
augurated by Koch. The discovery of a
spocillc perm was a preat step in advance in
the se'lcntilic study of cholera. 'Hie majority
of observers agree that the so-called comma
tacillus is to be found only in the excreta
of i cholera patients and that lu tvplcal cases
it 1 is always to be found there. At the chol-
era i laboratory in Baku Dr. Blackstcin ex
amined ! a large number of cholera patients
with reference to this question , and ho has
assured me personally that his observations
lave convinced him of the correctness of this
lew.
The preat German Pettenkofcr e'laims that
a certain condition of the soil , as yet uu-
cnown , is a necessity for the development of
-holera. At any rate , he claims that t he biolop-
cal propel ties of the comma bacillus are in
sufficient in themselves to lie-count for the
origin of the cholera epidemic. Pettenko-
er's ineenious and masterly work is valuable
ind important a remark which would seem
uperfluous , did I not think that it is being
disregarded by American workers in this
"ine of research.
Koch , on the other hand , claims that an
nfectiou of comma bacillus , even when the
cultures are pure , will produce cholera re
gardless of meteorological conditions. It is
'nteresting to note that in Dr. Blacksteiu's
investigations at Baku he concludes that
loch's work is correct , but that his logic is
'aulty. Dr. Blackstcin argues that Koch's
epical inference should be this : The comma
jacillus. therefore , plays a part in the e-uuse
of Asiatic cholera. Dr. Blackstein would
isk the que-stion , What part do Koch's bae1-
teria play in the causation of cholera ? and
at the same time irould state in so many
words what the aspect of the scientific study
of Asiatic cholera is at the present day. He
says that if workers in this line of study ,
especially those in England and India , would
unite in the solution of this problem they
would do more peed than in persisting in an
effort to belittle the value of Koch's great
discovery.
Dr. Blackstcin admits that the Russian
wcrmnent has mudc great efforts to check
Lhe progress of the epidemic , and in this has
been generally successful , especially iu the
larger cities. But iu those towns in which
the authorities apparently waited for the
decision of the bacteriologist before recog
nizing the existence of Asiatic cholera in
their midst , much harm vas uninteutionallv
done. He claims , what every skillful uhysl-
cian must - admit , that the diagnosis of
Asiatic cholera can be unerringly made with
out the aid of the microscope , and should be
made without it iu the actual treatment of
this disease.
Dr. Blackstein concludes that tbe phrase ,
' killing bacteria.1 i-an only have practical
interest to those people whose business is to
disinfect places and things. The idea , he
claims , which the physician who deals with
cholera patients should be impressed with
should be that the bacteria can be made
harmless. He is fully convinced , as a result
of his own experiments and studies in the gov
ernment laboratory nt Baku , that the direct
scene of action m cholera is the intestinal
canal. A disinfection of this canal is , of
course , impossible , but , fortunately , it is un
necessary , as the meaical profession pos
sesses means to reduce what is known as in
testinal putrefaction to a minimum.
Another very important conclusion of the
Baku investigations is that , in order to con
tract Asiatic cholera , one must , so to speak ,
either eat it or drink it ; that is to say , the
cholera poison , be it the comma bacillus or
otherwise , must be taken into the stomach
in its actire state in food or in drink. A still
more important result of those investigations
is that cooking the food and boiling the drink
render the cholera poison innocuous. If
these conclusions are sound we have a cer
tain safeguard against an epidemic of
cholera. Dr. Blackstcin approves
of the use of salnl , bismuth and
beta-napthol , but concludes from his
observations that the tannic- acid injections
into the bowels , as well us hypodermic and
intravenous injections , do harm without doing
any good. He favors a thorough irrigation
of the pastro-intestmal canal , and aClruis
that if the physician would treat the chol
eraic intestine with the same delicacy with
which a surgeon treats u wounei he would
meet with greater success.
It would oe beyond the aim of this report
to go into the details of tbo work of
the Baku cholera laboratory , especially as
Dr. Blucksteiu assurer me that he will make
an elaborate expose of that work for the
medical world in due course. 1 have there
fore only intended to give a general summiry
of the conclusions reached in the Baku in
vestigations. I simply wish the public at
home to know that , if proper e-are is taken
with their fe > od nnd drink , there need bo hut
little apprehension over cholera in their
midst.
Treatment of Cholera lir Irrlpntlon.
The method of treating cholera patients
by irrigation of the intestinal canal was
introduced at the Obuchoff hospital ,
in this city , September 3 , 1ML , by
Elmer Lee. who came here prop
erly fortified with testimonials for
the express purjiose of obtaining permission
to treat a number of cholera patients by this
method. By way of introduction. I may say
that Dr. L < ec is resident physician of the
Palmer house , Chicapo. He is u fellow of r
the American Academy of Medicine , mem
ber of the American Medical association ,
and was u member of the committee of re
vision of the United States Pharmacopoeia
iu IniiO. On arriving nt St. Petersburg he
was at once put in communication with the
modicul corps of the cholera hospital , to
whom he state-d the ubjo > t of his visit and l
explained in detail his methods of cholera
treatment. He gave the results of his ex
perience in Chicago in the treatment of
entoroceulltis by the irrigation method. As
e-holera is also an enterocevlitis. and as the
method proposc-d by him seemed reasonable' ,
physiological and harmless , it was decided
by the hospital corps to give Dr. Leo u fair
trial. He wus accordingly given ouo case ,
which was admitted to be grave. This case
was promptly treated , but with luiperlect
apparatus , und on the second or thirJ 1
day wus couv ! "sceut. He wus the-n
given two other cases , and they recovered.
He was then jriven four , and sooner or later
he had tre-aied in all
twenty-seven cases IKT-
sonally , twenty-four of whiih recove-red ,
showing n mortality of only 1- per cent. 1
have personally visited these patients at the
Obuchoff hospital and have made clinical
notes iu reference to them ; I have talKed
with several physicians of the hospital staff
und have re-ceivod from them only words of
the highest praise over the results obtained.
Beiore giving an explanation of this method
I will gio a brief clinical rejKirt of the
twenty-seven patients truate-d by Dr. Leo us
1 saw them. puri > > sely abbreviating the same
by the omission of names and other unin
teresting data. Of course , it is understood
that the cholera patients treated in nubile
hospitals belong almost invariably to | K > or
classes. It has been estimated that only
about one-third of ull cholera cases are
taken to the public hospitals in this dty.
1. Obuchoff hospital , St Petersburg. Sep
tember 3 , lta'J2. Patient cholera ; old man
' lui'l ' nirc.idv iKvn ttH.iUHl bv Ihr tnu.il
, remedies butdt'l ti .t MnvalesciIntcllcrt
1 dull , pulse weak lcm c \ < \ nn < l blue.
i eliarrhiiM profuse am } was a prominent
i s.vrni't"1 Thii ( tatient WHR treated In tht
prewnce of the ph > * lttKTiK of the cholera
hospital * nd. bexjausc g i hi * extreme wonh-
new , Irrigation was t < rir.rm d In bed. Fire
liters of strong Castile M > psud lnjoried Into
the colon through a flexible rubber tube
twenty-nix Inches lonuS irrigation wns con
tinued until the outflow was clean. The
tiatient promptly Improved. A similar treat
ment was given the tipxt day. which was
followed by convalescence , and in about a
week thereafter he warfflforbarged cured.
2. Patient new nrrivnrr middle age ; severe
cholera poisoning : skin , eold and cyiuiotlc.
pulse feebl'- . kidneys Inactive. This pa I km t
promptly recover * * ) .
8 Hoy. 10years old ; admitted September
ft ; suln e-yanotlc. pulse feeble , inspiration
short and heavy , much diarrheua and vomit
ing The case was admitted to be grave.
The injecting tube , which Is flexible. WHS era re-
fully passed the entire length of the trans
verse colon and two and one-half gallon * of
strong Castile soap suds were injecte-d. The
boy was then bath-Mi und placed in bed.
On the following day his symptoms hud so
much improved that it was thought unnec
essary to give him further treatment.
Prompt recovery.
4. Patient n = w arrival ; In comatose state
when admitted. Although tronte-d. the pa
tient died same day. Post mortem revealed
only the usual picture of cholera septiciemla.
5. Man of middle age , large uud strong ;
had been sick two days before arrival ; pro
fuse aiarrhuia and vomiting , skin warm ,
pulse moderate ; inljatod once ; prompt re
covery.
0. Man of medium size , greatly emaciates !
and pale ; had been sick three days before
arrival ; rice water diarrheua nnd vomiting ;
pulse extremely weak. The patient was
irrigated twice the first day and twice the
see-ond dnv. He recovered.
7. Boy ; one day siclc : diarrhana , vomiting
and convulsions , with cramps uud severe
e-olic pains : pulse-wcnk , intellect dull , skin
blue. After the firs : irrigatijti the abdomi
nal pains were relieved. There was similar
treatment the second day , followed by re
covery.
S. Young man ; skin very blue , surface
cold , labored breathing , pulse very feeble ,
prof use diarrhoea , and vomiting. He was ir
rigated once the llrst day and once the sec
ond. There waS prompt recovery.
li. Old man ; very sick ; two treatments ;
recover v.
10. Middle aged , black haired peasant ; ex
hausted by several days diarrhei-u and vom
iting ; abdomen collapsed ; cyanotic ; uncon
scious : pulse hardly perceptible ; two irriga
tions ? followed by recovery.
11. Manmiddle aged , gray hair : skin very
cold , anxious expression , benumbed intellect ,
very sevcfc ? diarrheua , but little vomiting ,
skin very blue ; irrigated once the first day :
died the next. Only the usual evidences of
cholera poisoning were revealed in the post
mortem , at which 1 was personally present
12. Man with small icutures , auout 40
years old ; had been sick throe days before
arrival : skin warm , pulse good , diarrha-u
and vomiting , with colic pains. There were
two irrigation treatments , followed by re
covery.
18. Patient a cook : short , heavy set blonde ;
had been sick three days ; very severe
dinrrheuu , but little vomiting ; mind dull ,
seldom spoke , difficult to arouse , skin blue
and cold , abdomen collapsed ; irrigation. The
patient died that night. The post mortem
revealed only the usual evidences of cholera.
14. Young man , acute case : one day sick :
dlurrhei-a and vomiting , with cramps ; one
irrigation : recovery.
lo. Old man ; excessive vomiting , great
prostration , pulse wciiU , skin cold and blue ,
labored breathing. A ter the first irrigation
the abdominal pain , was relieved. He re
covered.
1C. Case complicated with chronic gastro
enteritis of severe character : vomiting and
purging. The patient recovered.
1" . Young man ; had been sick several days :
ficquent diurrheua and vomiting. In this
case Dr. Lee wus unable to introduce the in
jection tube into the colon , but performed
thorough rectal irrigation with good results
The patient rec-overed.
Itt. Young man , yellow haired : sirk one
day before arrival ; s'uin warm , pulse good :
great abdominal pains anddiurrheuu. Ther ?
were two irrigations ttie lirst day and two
the second. The patient recovered.
10. Old man ; hud. been some time sick in
hospital and would not e-onvulesee. Irriga
tion removed a large quantity of green , flaky
coatings from the bowels , followed by relief
and recovery.
'M. Patient siuH one day ! cyanotic. skin
cold and clammy , lips blue , pulse feeble ,
temperature subnormal ; intellect dull ; algid
state ; recovery.
21. Patient a young man ; temperature sub
normal , pulse feeble , face and hands cold ,
skin blue , tongue as usual heavily coated ,
diarrhera , vomiting and abdominal pains.
The patient was irrigated morning and even
ing of the first day and recovered.
22. Young man taken suddenly ill on the
street , brought direct to the hos
pital ; profuse diarrheca and vomit
ing , blue lips , pale , coated tongue.
There was one irrigation the first day and
one tbe second , followed by recovery.
2H. Old man ; severe pain , cx'cessive diar-
rneca , greatly emaciated , very weak pulse ,
skin blue in spots ; had been sick two days
before arrival ; mind dull , respiration fre
quent and labored. There were two irriga
tions the first day , followed by recovery.
24. Boy ; had boon sick one day ; skin blue
and cold , abdomen collapsed , violent diar
rheua and vomiting , with convulsions. After
ouo irrigation there was marked convales
cence and quick recovery.
2.1. Man , middle ugejsick one day before
arrival : pulseulmostimperceptible.lips dark
blue , eyes dull and heavy , checks sunken ,
abdomen collapsed , skin cold and clammy ,
severe diarrheca und much relcning , intellect
dull. This case was grave and thought to be
moribund. The patient was irrigated twice
the first day and twice the second , followed
by recovery.
20. Young man. recent case ; skin blue and
cold , apxlous expression , pulse extremely
weak , respiration labored , profuse diarrheua
and ve > miting , with severe abdominal pains.
There was recovery after three irrigations ,
two the first day and ouo tie see-ond.
' . ' 7. Man. middle ace , t-ill ; face very red ,
hands blue , skin cold ; hud been sick one day ;
profuse diarrhoea , but no vomiting , pulse
weak , temperature normal. Ho recovered
after two irrigations.
Certainly , 1 do not wish to intimate that
the treatment of the twenty-seven cases of
cholera as detailed above is sunlcieiut to es
tablish the permanent value of the irriga
tion method in this disease. I believe , how
ever , that enough has been done in this di
rection to demand the careful atten
tion of the mciiicul fraternity uud to call
for a thorough investigation of this treat
ment. It is in this spirit and with this
motive that I make this report. In this con
nection 1 would say that the physicians of
the Obuchoff hospital , which is the largest
cholera hospital in this city , concluded , after
seeing the results of tbe twenty-seven cases
I above mentioned , that the irrigation method
I should boyiven u fair and impartial trial.
I The chief of the hospital corps therefore as
sured Dr. I ee , as well as myself , lh.it this
method of treating chplcra should be put on
trial for six mouths , after which an odlcial
report with reference to its value would be
published. I would also udd my personal
testimony to the fact that I happened to call
at the hospital a fcw,4ays after the resolu-
tion to put this method on trial and was
pleased to sec that the physicians were
practicing the irrigation method. In fact , 1
saw .1 patient -inder ttus treatment during
my visit. He wus unconscious , collapsed ,
cyanotic and e-oiJani | I-siid to the physician
that , in my opinion , bt could not roe-over.
Two days later I rooelveJ news from the
hospital that this sumo patient wus conva
lescent.
1 trust , therefore , that I may be pardoned
for urging iu this report that the irripation
method ol treating cholera be given a fair
trial should the epidemic unfortunately visit
the United States.
The Irrigation Mrthoil.
The treatment of cholera by irrigation is
hase-d upon the general belief and this bo-
lief has been Imeiisifiod by the experiments
of Dr. Blackstein , and mentioned In this re-
I > ort that cholera is the result of some form
of poison , be it bacteria or otherwise , whicl
acts on the tissues of the colon nnd sooner
or later poisons the * i stem. This treatmen
is aevordiiurly very simple , and e-onsists in
washing out the bowels , and us hizu un a
possible , with some ejleansiug and disinfect
ing liquid that is not harmful. The expeiri
mcnts of Dr lA e , which have been con
flrmtvj by Dr Blucksuun in his special work
at Baku , go to show that strong Castile
soap suds is most offevtive for this purpose
The apparatus usud consists of u plan
rubber tube about four feet long uni
from onev-half M three-fourths of at
inch in diameter , or. speaking more tech
clc-ally , of the diameter of a No. U ) sound o
'
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HIS-IM : N. ictu u Office tnd Mia
t. E. Ulufck iuuuuz < > r 1 N.ldth t
the French scale. This tube can be secured
at auy medical supply store. It should bj
flexible , with emly sufilcieiit resistane-o to
assist in uassinp the anple of the eTjlcm. In
the treatment at the hospital hero the tube
was passed entirely through the transverse
colon in nearly every instuni-e. This tube
shou.d taper bluntly at the end. in the exact
center of which bhould be an aperture equal
in size to about one-third of tbe caliber of
the tube itself. A class jar suftlcient to con
tain about three gallons ana with a common
faucet attachment at the bottom is placed
ou a she-lf about six or seven feet above the
floor. To the faucet is attactied the usual
rubber tube , as in thet ordinary fountain
syringe , tlie other end of which is properly
connected to the injecting tube above men
tioned after it has been carefully pisse > d into
the colon. The patient , of course , is pre
viously prepared for this operation and
placed iu position on tbe Irrigation table
in the immediate vicinity of the apjiarafjs.
The glass jar is then filled with Castile
soap suns EutHciently strong to show indes-
e-ence. The faucet is then turned , and the
irrigation is begun nd continued until the
outilow consists of clean soapsuds. The
patient is then taken from the irrigation
table and placed in a bath of the normal
temperature of the body , after which ho is
properly dressed and put to bod. A second
irrigation , as practiced by Dr. I ee , follows
the lirst in the course of from six to
twelve hours , according to the urgency of
the e-ase. It is claimed that the irrigation
of the colon thus thoroughly performed pro
duces sufficient stimulus and reaction to
cause the e-ontents of the small intestine to
pass freely into the e-olon , which a second
irrigal ion re'inoves.
In addition to this treatment Dr. I eo and
the phy&ie-ians of the cholera liospluilt hero
favor the washing out of the stertnae'li by the
.usual method , although this practice was
not resorted to in the twenty-seven cases
above enumerated. Ouo of the physicians
of the hospital , however , has assured me
that stomach washing will bo adde-d
to irrigation of the ee > lon in the hospitals
in cases sufficiently grave to suggest It. It
may bo noted that of all the patients that I
saw under treatment by tills method not one
offem ! the slightest ohje'ction thereto , but.
ou the contrary , st-eunex ! to think that some
thing was being done for tht-ir relief.
Other pieparations ha\o iweu-.wldod to
the soap suds in this treatment at the hos
pital , intended , if possible , to niuke tbe irri
gation inure offectivc ; but such ineidirlca-
tlor.s of the Injecting fluid nex-d not be dis
cussed here , as they will suggest themselves
to the general ph > sirian. and especially as
soap suds unmedlcateid pruduee e-ejuall.v sat
isfactory re-.ults It will , of course , be
understood that tbe s'iap suds are made
vdth distilled water or water that has beem
recently boiled.
The interim ! medication used by Dr. leis
is equally simple. He pave generally hydro
gen dioxide ( HO2) which Is nothing wore
than distilled water containing an extra
atom of oxygen. This he gave every two or
three hours arid in cupful doses. In addition
IRON worn.
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IltUN01tliS. .
Manufacturing nn t ra
Wroucn * ' and Castlron pulrinc of nil fclmli of
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to this , the patient was give-n aistilled
water frvely , either hot or cold , us
he preferred , in which a little com
mon r.alt was dissolved. Acewding to
symptoms , however , other remedies were
adde-d , such as will occur to the mind of the
general practitioner and whie-li I need not
here enumerate.
It may add intore'st and weight to this re
port to say that since its preparati'm I have
again e-onsultud one of the principal physi
cians of the hospital staff , who. after exam
ining it in detail , assured me that it meets
with his entire approbation. The same phy
sician desirc'd me to say that the same treat
ment has be'on used in dysentery and in
simple cases of cola-e-nteritis since Dr. Lee's
departure with excellent results , and that
the irrigation treatment is still continued at
the Obuchofl hospital with marked buccess
in cholera.
If you do not use a whole bottle of Cook's
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The WcHrliig of IlHlU.
The latest practice in the economy eif
rolling stock on railways is to turn the-
cars at the end of each trip , whereby a
largo percentage of etxtra we-ar ana tear
is s-aveel. Some ye-ars ago a iwrtinn e > f
the \Vubah railroad with old English
iron rails and a small part with bteel
rail : ) fivm the Carnegie * mills , it be
came noceasary after a time to remuve
borne of the main line rails to another
part of the road , and it was obi-crve-d
that after relaying them many gave out
Immediately , while others manifested
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son of this apparently unace-ouritable con
dition an investigation was ordcietd
which showed that the reiad from
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and that in relaying a large number had
bc-en turned e-nd for end. The .o that hael
not been so placed e-xhibiled ne > ad-
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turned rails cue-e-urabed in from thirty to
ninety days. The eone-hisii/n un he-el at
was that the metal had become polar
ized from long UK- , when first laid , and
that the fiber vas broken np by the
trttlllc in the opposite direction. It war.
further proved that cast-lrem wheels
gone fully yielded twice the miu-a e-
when the earn were turned at eiie-h end
of the journey than when they we-rc run
backward und forward without revers
ing. Notwithstanding the value of this
discovery , it was not universally utilized ,
and it is only recently that some of the
American ruilroadu have be iai to rec
ognize its importance.
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