New York, September 1, 1884. To The Editor Of The New York Medical Journal:

SIR: I have been exceedingly interested in Dr. Bartlett's suggestive article in your issue of August 30. But a sufficient number of well-established facts are known to account for all the peculiarities and vagaries of cholera.

1. Cholera has existed in Hindostan for centuries. It was found there by Vasco da Gama in 1496, and there is a perfectly authentic history of it from that time down to the present.

2. It is never absent from India, from whence it has been conveyed innumerable times to other countries. It has never become domiciled in any other land, not even in China, parts of which lie in the same latitude; nor in Arabia, to which country pilgrims go every year from India; nor in Egypt, nor Persia, with which communication is so frequent; much less in any other part of the world. Canton in China, Muscat and Mecca in Arabia, lie nearly in the same degree of latitude as Calcutta, in which cholera is always existent; yet these places only have cholera occasionally, and then only after arrivals of it from Hindostan.

3. The arrival of cholera in other countries is often involved in some easily removable obscurity, which is deepened only by the ignorance and want of veracity of quarantine and other officials.

4. Cholera is almost always preceded by a premonitory diarrhoea, which lasts from one or two to three or four or more days before urgent and characteristic symptoms show themselves. Of 6,213 cases, no less than 5,786 had preceding diarrhoea. The sufferers from this sow the germs of the disease in numerous, often distant and obscure, places, to which no choleraic person is supposed to have come.

5. The discharges swarm with infective bacteria of various kinds, some of which, especially Koch's comma bacilli, seem to be specific.

6. The disease has been reproduced in men and some few animals by their swallowing the discharges.

7. The discharges, according to the experiments of Thiersch, Burdon-Sanderson, and Macnamara, are not virulent and poisonous for the first twenty-four hours; on the second day eleven per cent. of those who swallow them will suffer; on the third day, thirty-six per cent.; on the fourth day, ninety per cent.; on the fifth day, seventy-one per cent.; on the sixth day, forty per cent.; and after that the discharges have no effect - the bacteria die, and the poison becomes inert.

Professor Robin reproduced cholera in dogs, and the celebrated dog Juno died of cholera in Egypt last year. Professor Botkin, of the University of Dorpat, reproduced cholera in dogs by the subcutaneous injection of the urine of cholera patients. Even if the comma bacilli are not found in the urine, other bacteria are; and even Koch supposes that they secrete a virulent poison similar to that of some insects, which may be absorbed into the blood and escape from the kidneys.

8. Some of the manners and customs of the Hindoos are very peculiar. They always defecate upon the open ground, and will not use privies or latrines This is a matter of religious obligation with them. It is also obligatory upon them to go to stool every morning; to use the left hand only in wiping themselves; to wash their fundaments after stool; to wash their whole persons and clothing every day; and, finally, also to rinse their mouths with water, and this they often do after washing in foul tanks, or still fouler pools of water. On steamships, where tubs of water were provided for washing their fundaments after defecation, Surgeon-General De Renzy saw many Hindoos rinse their mouth with the same water.

9. The population of Hindostan is nearly three hundred millions, and at least one hundred million pounds of faecal matter is deposited on the open ground everyday, and has been for centuries.

10. Much of this foul matter is washed by rains into their tanks and pools of water, which they use indiscriminately for washing, cooking, and drinking purposes.

11. The poison of cholera has repeatedly been carried in soiled clothing packed in trunks and boxes, and conveyed to great distances.

12. Articles of food, even bread and cake, as well as apples, plums, and other fruit, handled by persons in the incipient stages of cholera, have been known to convey the disease.

13. The number of epidemics produced by cholera discharges getting into drinking water are almost innumerable, and those from contaminated milk are not few.

14. The first case of cholera is generally counted from the first fatal one, whereas this is almost always preceded by non-fatal ones, which have escaped notice. And each subsequent fatal case is interwoven by one, or several, or even many, non-fatal causes. If the string of a row of beads is broken, and the beads scattered everywhere, it would be just as improper to say that they had never been upon a string as to say that, because all the fatal cases of cholera cannot be traced to equally fatal ones, no connection ever existed between them.

These points are necessarily stated categorically, but every one can be proved, if proof is called for. The numerous and very large pilgrimages of the Hindoos must not be forgotten.

John C. Peters, M.D.

83 Madison Avenue.