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REPORT

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ON THE

MORTALITY OE CHOLERA

IN

ENGLAND,

1848-49.

LONDON :

PRINTED BY W. CLOWES AND SONS, STAMFORD STREET, FOR HER MAJESTY’S STATIONERY OFFICE.

1852.

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CONTENTS.

LETTER OF THE REGISTRAR-GENERAL TO THE RIGHT HONOURABLE SIR GEORGE GREY, Bart., M.P., Her Majesty's Principal Secretary of State for the Home Department.

Letter to the Registrar General, by William Farr, Esq.

PART I.

Page

REPORT TO THE REGISTRAR-GENERAL on the MORTALITY OF CHOLERA. Importance of having a complete Abstract of the Facts connected with the Cholera Epidemic from the Register Books of Deaths ii

Method of making the Abstracts, and Explanation of the Tabular Results . . . ii-iii

England devastated by Plagues from the earliest times : — Plagues of the 6th and 7th Cen- turies ; Black Death of 14th ; Sweating Sickness of 16th; Plagues of 17th Century . iii

Practical Effect of the Diffusion of the true Doctrines of Public Health .... iv

Examples showing that the Health of various parts of the Kingdom is not equally Bad . iv

Mortality at Different Ages .......... iv

The Health- of the People is Worst in Large Town Districts . ..... iv

Deaths at Different Ages, contrasted in Districts where the Mortality is Low and where it

is High .............. v

Names of some Healthy and Unhealthy Districts ........ vi-vii

England the Healthiest Country in the World ........ vii

Cholera more Fatal in Asia than in Europe ........ vii

Course and Progress of Cholera — Dates of its reaching different Places . . . . vii-viii

Survey of the prevalence of Cholera and Diarrhoea in England since the Registration Act

came into Operation ............ viii-xi

Progress of Cholera in London in 1848 ......... xi

Extracts from the Registrars’ Weekly Returns; Distinction between Summer Cholera and

Asiatic Cholera ; time when the former merged into the latter ..... xii-xvi

Table showing the Comparative Duration of Fatal Attacks of Diarrhoea, Summer Cholera, and Asiatic Cholera ............ xvii

Cholera in the South-Eastern and South-Midland Divisions in 1848 . . . xvii-xviii

Great Mortality from Cholera in the Chesham Sub-District of Amcrsham in 1848, and Abstract of the Fatal Cases .......... xvii-xviii

Cholera in the Eastern, South-Western, West-Midland, North-Midland, North-Western,

A ork, Northern and Welsh Division — Names of the Districts in which it was most Fatal

in 1848 .............. xviii-xx

If

IV

CONTENTS.

Page

Cholera in England, 1849— Remarks on its'Progress — >ts prevalence in Public Institu- tions, and Dates of its Appearance in particular Districts ...... xx-xxiii

London Cholera Field, 1849 — London the Centre of a Great System of Attack: the Extent of the London Cholera Field shown ...... . xxiii

Cholera broke out as the Temperature advanced in London : its Progress traced— Ex- tracts from the Weekly Reports — Proportion of Deaths from Cholera and Diarrhoea to 10000 Persons Living ........... xxiii-xxviii

While Cholera prevailed in London, all the region around suffered — Names of Districts

which were Attacked, and Proportion of Deaths to 10000 Inhabitants . . . xxviii-xxx

Portsmouth Cholera Field.— Names of Districts which Suffered, and Rate of Mortality xxx Plymouth Cholera Field. — Names of Districts which Suffered, and Rate of Mortality-

Places on the Coast severely Visited ........ xxx-xxxi

Bristol Cholera Field. — Names of Districts which Suffered, and Rate of Mortality . xxxi Merthyr Tydfil Cholera Field. — Names of Districts which Suffered — Progress of the

Epidemic and Rate of Mortality . ........ xxxii -xxxiii

Wolverhampton Cholera Field. — Names of Districts which Suffered, and Rate of Mor- tality xxxiii

Liverpool Cholera Field. — Names of Districts which Suffered ; Progress of the Epi- demic in Large Town Districts of Lancashire, and Rate of Mortality . . . xxxiii-xxxvi

Hull Cholera Field. — Names of Districts which Suffered; Progress of the Epidemic,

and Rate of Mortality xxxvi-xxxviii

Tynemouth Cholera Field. — Names of Districts which Suffered ; Progress of the Epi- demic, and Rate of Mortality xxxviii-xxxix

Influence of Sex on the Mortality from Cholera. — Proportion Dying among Males and Females in England from Cholera and from all Causes : when the Mortality from Cholera attained a High Rate, the Deaths of Females exceeded those of Males. Table showing the Number of Fatal Cases of Cholera in London among Males and Females at different Ages, in each of 15 Weeks in 1849 ...... ... xxxix-lxi

Mortality from Cholera and Diarrhoea at Different Ages. — Comparison of the Deaths among Males and Females at Different Periods of Life: after the Age of 25 the chances of dying increase with age. Table showing the Mortality per Cent, amoug Males and Females from Cholera and Diarrhoea in 1849, ai‘d from all Causes, 1838-44, at Dif- ferent Ages, in England ........... xli-xlii

Duration of Fatal Cases of Cholera.— Explanation of the Chances of Dying within a given Period from the Time of Attack. Table supplying a ready Means of Calculating the future Duration of Fatal Attacks at any Stage of the Disease . . . • xliii-xliv

Cholera Epidemics of 1832 and 1849 Compared. — Tables showing the Population and

the Deaths from Cholera in different Districts, during the Uo Epidemics . . xliv-xlvi

Influence of the Seasons in 1831-2 and in 1848-9. — Remarks on the Prevalence of the Epidemic in Different Months, and Tables showing the Mortality, during each Month, in England, London, Paris, and Liverpool .... ... xlvi-xlvii

Meteorological Influences. — Explanation of Diagrams illustrating the Progress of Cholera, and the Meteorological Phenomena, on each Day of 1849 — Remarks on the Circular Diagrams, showing the Mortality and Temperature in each Week of 1 1 Years,

1840-50 ............. xlvi-xlviii

Plague and Cholera Years in London. — Remarks on the Diagrams showing the Mor- tality in London during the Great Plague Years ...... xlviii-xlix

Fatal Days of the Week. — Table showing the Number of Deaths on each Day of the

Week in all England, in London, and in the other parts of England .... xlix

Locality. — Remarkable Variation in the Mortality of different Localities, illustrated by several Tables, showing Population, Deaths, and Area, in Districts and Groups of Dis- tricts on the Coast and Inland; in the Seaports, in large Inland Towns, and in the Coal Districts ............. xlix-lvii

Cholera three times more Fatal on the Coast than in the Interior of the Country . li-lii

Names of Large Inland Towns in which Cholera was only Slightly Fatal in 1849 . liv

CONTENTS.

V

Page

Great Mortality in Merthyr Tydfil : Filthy State of the Town described . . . . Iv-lvi

Dates of the Epidemic Attacking certain Districts ....... lvi

Causes of the Mortality in London .... Ivii

(i.) The Thames and the Water Supply.— Mortality in Districts supplied by each

Water Company — Number of Gallons raised by evaporation from the Thames . lviii-lxi (2.) Elevation. — Elevation of the Soil has a more constant relation with the Mortality from Cholera than any known element : Mortality from Cholera is in the Inverse Ratio of Elevation — Remarks — Tables and Diagram illustrating the Comparative Mortality of Districts at different Elevations .... lxi-lxv

(3.) Density. — Density a less Important Element than Elevation — Remarks and Tables illustrating the Influence of Density of Population on the Mortality from Cholera. ............ lxvi

(4.) Wealth and Poverty. — Remarks and Tables illustrating the Influence of Wealth

and Poverty on the Mortality from Cholera ...... lxvi-lxviii

Mortality in London from Ordinary Causes ........ Ixviii

Conditions in which Cholera is Most Fatal. — Comparative Influence of Density,

Wealth, and Elevation of the Soil ......... lxix-lxxi

Number of Persons Attacked by Cholera in England ...... lxxi

Cause of Cholera is some Chemical Modification of Organic Matter .... lxxii

Origin of Epidemic Cholera in the Delta of the Ganges. — Extracts from Reports of

Army Medical Officers in India ......... Ixxii-lxxiii

Theories and Analogies —

(1.) The Theory of Volcanic Agency ........ Ixxiv-lxxv

(2.) The Electrical Theory ......... lxxv-lxxvi

(3.) Bad Water — Practice among Native Indians of using Boiled Water . . . lxxvi

(4.) The Fungus Theory ........... lxxvi

(5.) Theory that Cholera is Propagated by Human Intercourse, and that it is a Local

Affection of the Alimentary Canal ....... Ixxvi-lxxviii

(6.) Theory of Contagion .......... lxxviii-lxxix

(7.) Hypothesis of Spontaneous Developement lxxix-lxxx

(8.) The Zymotic Theory . _ . . . . . . . . . lxxx-lxxxiii

The Pestilences of the Present Day are most Fatal in Low Places : —

(1.) Ague and Remittent Fever. — The Fever of the Mediterranean and the Tuscan

Maremma ........... lxxxiv-lxxxv

u (2.) Yellow Fever; its Prevalence in Lands of Low Elevation — The Delta of the Mississippi in the Gulf of Mexico its Great Centre ; — Fever in the West Indies and the West Coast of Africa ....... lxxxv-lxxxvii

(3.) Plague; its Prevalence in Lower Egypt on Alluvial Ground; on the European Shores of the Bosphorus ; in Syria, Persia, and the Coasts of the Mediter- ranean— Table showing the Excess of Mortality, in different Parishes of Loudon, in the Plague Year, 1665 ......... ]xxxvii-xc

The Human Race Destroyed Periodically by Five Pestilences. — Conditions under which they are most Prevalent — Moral and Physical Characteristics of the Inhabitants of Healthy and of Unhealthy Localities ; in High Lands and on Low Marshy Coasts . xc-xciv

Sanatory influence of Healthy Localities on the Human Frame — Effects of Elevation on

Health, Mortality, and Race ......... xciv-xcv

The Finest Races of Animals are bred in the most Healthy Localities . . . xcv-xcvi

Pestilence a great Warning as well as a great Calamity ...... xcvii

Salubrity one of the Causes of the Greatness of England— The Importance and the Means

of Preventing a Deterioration of Race ........ xevii-xcviii

VI

CONTEXTS.

Conclusion — Practical Suggestions : —

(i.) Safety is enjoyed by removal from Infected Places to the high Salubrious Districts (2.) Strangers should avoid visiting Towns in an Epidemic .....

(3.) When the Population is removed, it should be to High and Dry Ground, where Good Water can be procured .........

(4.) High Places away from Marshes are also generally Sait; Asylums from Plague, Yellow Fever, Remittent Fever, and Ague .......

(5.) Armies Suffer more on the March than iu Station — Danger of Encamping on Low Grounds by Rivers . . . . . . .

(6.) Travellers in Unexplored Countries should not Rest on Low Swampy Spots (7.) Intercommunication. — Quarantine of little avail ......

(8.) Food .............

(9.) Water .............

(10.) Removal of Refuse . . ... . . . -

(11.) Air ..............

(12.) Earth. — Importance of Good Sites for Dwellings. .

(13.) Colonies. — Importance of the Selection of Good Sites for New Towns (14.) Climate. — The necessity of Sanatory Measures in India . . . . .

(15.) The Medical Profession. — The Office of Medicine is to raise Men to a IIich Standard of Health ; and to Prevent as well as to Cure Sickness .

Pace

xeix

xeix c c ci ci cii cii cii -cii i ciii ciii

ciii— civ

TABLES : —

Annual Mortality per Cent, from All Causes in the Seven Years, 1838-44, in each of the Statistical Districts of England, arranged in the order of the Mortality of

Females cvi-cxi

Annual Mortality per Cent, from All Causes at different Ages 1838-44), in each Statistical District of England, arranged in the order of the Mortality of Females, in each of the 11 Divisions of England ....... cxii-cxxv

Annual Mortality per Cent, from All Causes at different Ages (1 38 44', in 21 Healthy Statistical Districts of England ....... cxxvi

Annual Mortality per Cent, from All Causes at different Ages (1838-44), in

33 Unliealthy Statistical Districts of England ....... cxxvii

Mortality per Cent, from Cholera among Males and Females, at different Ages, in

each of the 11 Divisions of England in 1849 ....... cxxviii

Mortality per Cent, from Diarrhcea among Males aud Females, at Different

Ages, in each of the 1 1 Divisions of England in 1849 ..... exxix

Mortality from Cholera and Diaurikea in some of the Most Fatal Districts in 1849 exxx

Deaths from Cholera in England aud in London ou each Day of each Week of the

Year 1849 cxxxi

Mortality from Cholera and Diarrhcea in each Division, County, and District of

England, 1849 .......... cxxxii-cxxxix

Districts in which there were No Deaths from Cholera in 1849 . . . cxl-cxli

Area, Population, and Deaths from Cholera and Diarrhcea, in 1849, and from All

Causes in the 10 Years 1841-50, in 47 Seaport-Town Districts .... cxlii

Area, Population, and Deaths from Cholera aud Diarrhcea in 1849, and from All

Causes in the 10 Years 1841-50, in 41 Inland Town Districts .... cxliii

Deaths from Cholera and Diarrhcea on each Day of the Most Fatal Months of 1849 in the following Groups of Districts: —

(1.) Portsea Island and Alverstoke. (2.) Salisbury ..... cxliv

(3.) Plymouth, East Stonehouse, and Stoke Damerel. (4-) Bristol, Clifton, aud

Bcdminster ........... cxlv

(5.) Wolverhampton and Dudley. (6.) Liverpool and West Derby . . . exlvi

(7.) Manchester, Chorlton, and Salford. (8.) Leeds and Ilunslet . . . cxlvii

(9.) Hull and Sculcoates. (10.) Tynemouth, South Shields, Newcastle-upon- Tyne, and Sunderland . .

(11.) Merthyr Tydfil, Cardiff, and Neath.

cxlviii

cxlix

CONTENTS.

Vll

Deaths from Diarrh<ea, Dysentery, and Cholera, registered in London in each Week of the ii Years 1840-50

Elevation, Area, Number, and Annual Value of Houses, Population, and Deaths from Cholera, in the London Districts ........

(1.) Districts of London, arranged in the order of Mortality from Cholera in 1849, and exhibiting the coincident Results derived from the Facts given in the previous Table ...••••••

(2.) Districts of London arranged in the order of their Elevation above the Trinity High-Water Mark, of the Thames, and coincident Results cor- responding with those in the previous Table (1) .... clvi-clvii

(3.) Districts of London arranged in the order of their Density of Population, and coincident Results corresponding with those in the previous Tables (1 and 2) .......... clviii-clix

(4.) Districts of London arranged in the order of the Annual Value of House and Shop-room, and coincident Results corresponding with those in the previous Tables (1, 2, and 3) ...... clx-clxi

(5.) Districts of London arranged in the order of their Annual Mortality from All Causes (1838-44), and coincident Results corresponding with those in Tables (r, 2, 3, and 4) ...... clxii-clxiii

Diagram of the London Districts, showing their Elevation, their Mortality from Cholera, and from all Causes; their Density of Population, Value of Houses, and Amount paid for Relief of the Poor ; also their Water Supply .... clxiv

Diagram of the London Sub-Districts, showing their Elevation and Mortality from Cholera .......... ... clxv

Sub-Districts of London arranged in the order of their Elevation, showing the

Mortality from Cholera to 10000 Inhabitants ..... clxvi-clxviii

Average Mortality from Cholera in Groups of Sub-Districts of London, arranged in the order of their Elevation ....... . clxix

Deaths from Different Causes in London during the Week when the Mortality

from Cholera was Highest ......... clxx-clxxii

Meteorology of the 11 Years 1841-5 1 ........ clxxii

Weekly Number of Burials from All Causes in London during Plague Years, compared with the Average of 7 Years (1640-46) and with the Cholera Year

1849 * clxxiii

Deaths of Males and Females from Cholera, in London, in each of 65 Weeks

(October, 1848, to December, 1849) ..... .... clxxiv

Page

cl

clii-cliii

cliv-clv

MAP AND DIAGRAMS.

[To be placed at the end of Part J.]

Plate

Map of England, shaded, showing the prevalence of Cholera in different localities, and the dates of its appearance in 1849 ........... 1

Diagram, in Colours, representing the Deaths from Cholera and Diarrhcea in England on each Day of the Year 1849 ; also the Meteorological Phenomena recorded at Greenwich on the corresponding Days ............ 2

Diagrams, Coloured, representing the Deaths from Cholera in each of the 11 Divisions of England on each Day of the 7 Months, May to November, 1849 • • . • . .3

Diagrams, in Colours, representing the Temperature and Mortality from all Causes in

London for each Week of ii Years, 1840-50 4

Diagrams representing the Deaths in London in each Week during the Plagues, and con- trasting the same with the Average Mortality in 7 ordinary Years (1640-46), and with the Cholera Year, 1849 .............

Mil

CONTENTS.

PART II. — TABLES.

Page

184b. — Deaths from Cholera in the Divisions and Counties of England during the year

1848, and in the Months of October, November, and December . . . 1-2

, , Deaths from Cholera in the Divisions of England, in each Week of the last Three

Months of 1848 ........... 3

, , Deaths from Cholera at different Ages, in the Divisions of England, during the last

Three Months of 1848 .......... 4

1849. — Deaths from Cholera and Diarrhoea (distinguishing Sex) in each of the Divisions,

Counties, and Districts of England, during the Year 1849 .... 5-19

, , Deaths from Cholera and Diarrhoea in England, on each Day of each of the

Twelve Months of 1849 .......... 20-21

, , Deaths from Cholera and Diarrhoea in the Eleven Divisions of England, on each Day

of each Month of 1849 .......... 22-33

, , Deaths from Cholera and Diarrhoea in the several Counties of England, on each

Day of each Month of 1849 ......... 34-105

, , Deaths from Cholera and Diarrhoea in London, on each Day of each Month of

1849 106-107

, , Deaths from Cholera and Diarrhoea, at different Ages (distinguishing Sex), in

each of the Divisions and Counties of England, during the Year 1849 • • 108-119

, , Deaths from Cholera in England, and in each of the Eleven Divisions in 1849 ; show- ing the Duration of the Attacks among Males and Females at different Ages . 120-165

, , Notes on Cholera, giving a brief Sketch of remarkable Facts connected with the Epidemic ; also showing the Population, 1841, and the Number of Deaths from Cholera and Diarrhoea in 1849, in each of the 2189 Sub-Districts of England . 166-300

TO THE RIGHT HON. SIR GEORGE GREY, BART., M.P.

*4

Her Majesty's Principal Secretary of State for the Home Department.

General Register Office, 10 th February , 1852.

Sir,

I have the honour to submit to you the following Report on the Mor- tality of Cholera in England.

I was requested in 1850 by tbe General Board of Health to make out a “ Return of all Cases of Cholera that had occurred in England and Wales, distinguishing Sex and Age.”

After well considering the subject, I thought it desirable, not only for the use of the General Board of Health, but for circulation throughout the country, that a complete history of the late epidemic should be drawn up from the facts recorded in the register-books of deaths, distinguishing not only sex and age, but also the profession, the date of death, the place of death, and the duration of illness of all persons who died of Cholera or Diarrhoea in the years 1848 and 1849; giving not only the bare facts but exhibiting in Tables the various combinations of age, profession, locality, &c.

This duty has been confided by me to Mr. W. Farr, the Examiner and Com- piler of Abstracts in this department. The Tables have been framed under his direction with the greatest care and accuracy, and are illustrated by various ingenious Diagrams ; and the following Report has been written by him after much research and great attention given to the subject.

I have the honour to be, Sir,

Your faithful Servant,

GEORGE GRAHAM,

Registrar- General.

TO THE REGISTRAR-GENERAL.

Sir,

In the Report which I have the honour to submit to you, I have endea- voured to carry out the investigation which you deemed desirable ; and to show the effects of all the circumstances recorded in the Registers on the fatality oi the greatest epidemic that has for many years infested England.

In conformity with the plan sketched in your letter the abstracts were care- fully made under the superintendence of Mr. J. T. Hammack ; the tabling was superintended by Mr. J. Thornton ; the calculations by Mr. W. Clode. The diagrams on Plates 2, 3, were drawn by Mr. C. A. Cocke ; the other dia- grams by Mr. J. R. Sowray. The notes and observations in the London Weekly Tables were greatly extended during the progress of the epidemic ; and were, except in the interval from August 11th to September 22nd, under the charge of Mr. J. Angus. All these duties were discharged with great care and ability.

The Census of March 31, 1851, was published after the first calculations of the mortality of the epidemic were made ; and advantage was taken of the new Population Returns to determine, accurately, the mortality of the districts of London and of the country, in which the disease had been most fatal. When the numbers and ages of persons living in tbc different professions and occupa- tions are ascertained from the Census Returns, the influence of occupation on health, on this and on other diseases, can be determined.

I have the honour to be, Sir,

Your obedient Servant,

WILLIAM FARR.

Statistical Branch,

General Register Office,

February 7, 1852.

PART I.— MORTALITY OF CHOLERA.

I

REPORT

ON THE

MORTALITY OF CHOLERA IN ENGLAND, 1848-49.

If a Foreign Army had landed on the coast of England, seized all the seaports, sent detachments over the surrounding districts, ravaged the population through summer, after harvest destroyed more than a thousand lives a day for several days in succession, and, in the year it held possession of the country, slain rifty-three thousand two hundred and ninety-three men, women, and children — the task of registering the Dead would be inexpressibly painful; and the pain is not greatly diminished by the circumstance that in the calamity to be described the minister of destruction was a Pestilence that spread over the face of the island, and found in so many cities quick poisonous matters ready at hand to destroy the inhabitants.

In following cholera through its fatal way, however, the inquirer meets with some grounds of consolation. He sees places on every side which the epidemic passed over, leaving the inhabitants in the serene enjoyment of health and complete immunity. And the hope is perhaps not fallacious, that an examination of the results of the second may be the means of mitigating, if not preventing_a third invasion ; for whatever may be the immediate cause of cholera, it will appear evident that in England it is only seriously fatal under certain known physical conditions, which admit to a great extent of remedy.

It is not necessary to describe here the nature of the disease. The task devolves on others of analysing- the changes which the frame suffers under cholera ; of investigating the effects of medicine; of relating the steps which were taken to relieve the population attacked in various places; of discussing in detail the various theories which have been produced to explain the phenomena ; and finally of portraying in this epidemic the moral effects, which, as historians have not failed to perceive, possess the highest interest in the great catastrophes of moriality.*

Under the Act for the Registration of Births, Deaths, and Marriages, the name, sex, age, and occupation of every person who dies in England — as well as the time, place, and cause of death — are registered. The whole of this system of observation and record was in operation when cholera broke out. The quarterly abstract of deaths for the whole kingdom, and the London tables which are published weekly — presented notices of its rise, progress, and decline in particular di-tricis. When the epidemic was over, it appeared desirable to give a complete abstract of the facts. Accordingly a list of every case of death from cholera and diarrhoea, in 1849, was transcribed from the

* See the Report of the Board of Health ; and the appended Reports of Dr. Sutherland and Mr. Grainger, whose active and arduous labours in the epidemic deserve the highest praise. The College of Physicians has, it is understood, appointed a learned committee to report on the subject. The chemistry of the disease is ably discussed by Dr. It. D. Thomson, Trans, of Royal Medical and Chirurgical Society, vol. xxxiii. The disease is well described by Dr. Budd, in the Cyclopaedia of Practical Medicine, and sketched in the Lectures of Dr. Watson, with his accustomed felicity and accuracy.

b

IX

Cholera Tables.

Registration volumes which for that year contained 440853 deaths. The roll of deaths was in the following form : —

Population.

No. District. Sub-district. 1 83 1 1 841

45852 Nantwich. Nantwich. 8560 9431

Date of Death.	Place.		Sex.	Age.	Profession.	Cause of Death.
1849. July 10	Wych House Bank,	Nantwich	M.	6	Salt-boiler's Son	Cholera, 13 hours.
>> 9	Welch Row		F.	5	Confectioner’s Daughter	Cholera, 6 hours.
,, 10	Vauxhall		M.	72	Labourer ....	Cholera, 28 hours.
,, 8	Wood Street		F.	48	Basketmaker’s Wife	Cholera, brought on for
,, 10	Wood Street	9 9	M.	67	Shoemaker ....	want of the common necessaries of life. — Inquest. Cholera. — Inquest.

The whole forms a large mass of manuscript, which contains the particulars of 72180 deaths. Upon inquiry it was found that the list of persons who died of the two diseases would fill a tliick octavo volume of about 2500 pages. Three courses were open ; (1) to publish those facts simply; (2) to publish the tabular abstracts in detail ; or (3) to publish the abstracts and the salient facts relating to each locality in a condensed forim The publication of the cases in detail would have been attended with several advantages ; it would have enabled the medical men of the country to study the particular facts in their respective districts, surrounded by the circumstances which affect and modify the mortality ; and the publication of an extended tabular summary ol the daily deaths in each of the 2189 sub-districts of the country would also have possessed interest. As the work on e-ther plan would, however, have been exceedingly voluminous, the third course was adopted : in the meantime the manuscript list of the 72180 cases, and the extended tabular abstracts, are preserved among the records of the General Register Office, and will always be accessible to the local inquirer, as well as to the general student of this great and extraordinary epidemic.

The first of the following series of tables shows that 1057 males and 877 females died from cholera during the year 1848, and that of those numbers 612 males and 493 females, died in the three months of October, November, and December. '1 he numbers in each county and division are shown separately (pp. 1 — 2). The weekly deaths from cholera in each division, and the ages at death in the last three months, are added (PP- 3—4)-

The second series of tables shows of the 53293 deaths from cholera, and 18887 fr°ni diarrhoea during the year 1849, how many occurred in each of the 11 divisions, 44 counties (or groups of counties), and 623 districts of England (pp. 5 — 19). The districts are here arranged in the same topographical order as is adhered to in all the Reports of this Office. Each district stands in its place, although no death from cholera was registered within its limits ; the population of 1841 is set forth in a distinct column, and shows the lowest numbers that could have been exposed to the attacks of the disease. In the towns, and in the manufacturing and mining districts, the population was, of course, much greater in 1849 than in 1841.

The third is a remarkable series of tables. It shows the number of deaths from cholera and from diarrhoea on each day of the year 1849, in all England, in 11 divisions, and in 44 registration counties (pp. 20 — 107 ). Thus the march of the

epidemic through every county can be followed day by day.

In the returns that have previously been made of the mortality of cholera in this and in other countries, only the deaths from that disease in parts known to be severely in'ected have been inserted, and it is evident that under such a system — based- on imperfect registration — many deaths must have escaped observation. But the causes of nearly all the deaths in England are registered, and all the deaths of 1848 and 1849 are

Health of England. iii

recorded in the volumes from which the present return is derived ; so that the reader can now trace the progress in place and time of the great epidemic through 17 millions of people, settled over a wide extent of country, in all the various circumstances of life. And the difference in the time of invasion, as well as the absence or the inconsiderable mortality of the epidemic in places lying by the side of' districts overwhelmed by its effects — is undoubtedly one of the circumstances which most deserve attention in the study of cholera.

The fourth series of tables shows how many males and females died at various ages of cholera and diarrhoea in the divisions and counties cf England. Taking 100 years as the limit, the lifetime is divided into twenty equal quinquennial periods; and the tables show that the deaths were distributed unequally over the whole of these periods. The deaths in each of the first five years of life are separately given ; as in that short interval of age a remarkable change takes place in the form and fatality of the disease. (Tables pp. 108 — 119.)

A swift and precipitate course ending in dissolution, is a characteristic of all plagues, and fixes attention in cholera. The duration of 39468 fatal cases of cholera, and of 7896 fatal cases of diarrhoea, is shown in the fifth series of Tables. The duration in hours and days is exhibited at the quinquennial ages that have been already named. Tables are given for all England, for England exclusive of London, and for each division of the country (pp. 120 — 165). The 623 districts of England are divided into 2189 sub-districts. The population (1841), the deaths from cholera, and the deaths from diarrhoea in each sub-district, are given in the notes (pp. 166 — 300) which close the volume. The London Registrars returned every case of death from cholera or diarrhoea weekly, and, in the height of the epidemic, daily, accompanied by any information which either the informants, or their own observation, supplied, respecting the state of the streets or houses in which the deaths occurred. This information was necessarily col- lected in haste; but was found to be substantially correct, and had an excellent effect at the time, in directing the immediate attention of the authorities to some of the most crying evils that induced and aggravated the disease. A digest of these Registrars’ local reports is embodied in the notes, which contain many curious ar.d suggestive facts ; and the gentlemen who abstracted the cases were requested to compile from the transcripts short notices of the first and last deaths, distinguishing the dates of such deaths ; as well as the professions of the persons who died, and the localities which suffered most in every sub-district. The local inquirer is requested not to accept any opinions expressed in the notes, or the summaries of the facts themselves, as ultimate results ; but to consider them only as indications of the direction in which investigation may be advantageously employed. Upon the number of deaths returned, and the tabular results, lull reliance may be placed ; as they have been derived directly from returns, and have been duly checked.

It may increase the usefulness of this Report to give, from the registration returns, a brief, connected summary of the progress of the epidemic, and to describe its effects on the health and population of England. But it will be convenient to notice, first, what the health of the country has been, and what it was immediately before this great disturbing cause appeared.

HEALTH OF ENGLAND.

Although no regular Registers of Deaths were kept before the Reformation, the chro- nicles show clearly enough that England has been periodically devastated by famines and plagues from the earliest times. A large proportion of the population of the island has been more than once swept away by these visitations. The great plagues of the sixth and seventh centuries — which destroyed, according to some estimates, half the inhabitants of tbe Eastern empire — extended to Britain. Besides the Black Death in the fourteenth century, the sweating sickness of the sixteenth century, and the plagues of the seventeenth century, terminating in the plague of 1663 described in detail by the historians — a long catalogue of famines and epidemics may be given, which, though briefly and imperfectly noticed in the chronicles, were perhaps not much less fatal.

After the Revolution the great plagues ceased; but the mortality was kept up by

b 2

IV

Health of England.

typhus, small-pox, influenza, and other zymotic diseases. The writings of Mead, Pringle, Lind, Blane, Jackson, Price, and Priestley, — the sanatory improvements in the navy, the army, and the prisons, — as well as the discovery of vaccination by Jenner, — all conduced to the diffusion of the sound doctrines of public health, and had a practical etfect, which, with the improved condition of the poorer classes, led to a greatly reduced mortality in the present century. Since 1816 the returns indicate a retrograde move- ment. The mortality has apparently increased. Influenza has been several times epidemic, and the Asiatic cholera reached England, and cut off several thousands of the inhabitants in 1832. It reappeared and prevailed again, as we have seen, with no miti- gated violence, in 1849.

The health of all parts of the kingdom is not equally bad. Some districts are in- fested by epidemics constantly recurring ; the people are immersed in an atmosphere that weakens their powers, troubles their functions, and shortens their lives. Other localities are so favourably circumstanced that great numbers attain old age in the enjoyment of all their foculties, and suffer rarely from epidemics. The variations in the mortality are seen in’the Tables (pp. cvi-cxxvii), which have been extracted and arranged from the Ninth Annual Report. The rate of mortality is calculated on 2,436,648 deaths in the 7 years, 1838-44 ’ and on the population taken at the Census of 1841, in the middle of the period. On tracing over 324 sub-divisions of the country, the force of death in males and females of different ages, the most remarkable differences are discovered. Here of 1000 young children under 5 years of age forty die, there a hundred and twenty die annually; here, of 1000 men of mature age (35-45) nine die, there nineteen die yearly; of 1000 men of 45-55 years of age twelve die in one district, thirty in another; at the more advanced ages of the next decennium (55-65) twenty-four die annually in one, fifty in another district: of 1000 females of all ages without distinction, 14 die annually in three districts, 15 die in eighteen districts, 17 (or less) in forty-eight districts. And in strong contrast, 23 in 1000 females die in twenty districts, 26 in 1000 in three districts, 27 in seven districts, 31 in two districts.

The mortality at all ages, without distinction, differs much less than the mortality of children, and less even than the mortality of men and women of the age of 35 and upwards in the several parts of the country. The population from the age of 15 to 35 is unsettled ; at that age the emigration of servants and artizans from the country to the towns takes place; and as consumption, the disease then most fatal, is slow in its course, its victims in many cases retreat from the towns to their parents’ homes in the villages to die. And the death is registered where it happens, not where the fatal disease begun, so that, on comparison, it is told twice in favour of the towns; once in being withdrawn from the town register, and a second time in being added to the country register, to which it does not properly belong.

Independently of external causes, and by the force of a natural law, the mortality varies at different periods of life: so that the rate of dying in two mixed popula- tions may differ according to the varying proportions of children, young persons, or old people. The series of tables (pp. cxii-cxxvii) shows the rate of mortality at six periods of life, under five years, at 10-15, 35-45, 45—5 5 , 55—65, and 65-75. ^ *s shown in

the extreme cases, that when the general mortality is either high or low, the mortality at nearly all these ages is high or low ; and a collation of the whole leaves little doubt on the question of the relative insalubrity of the various parts of the country.

Upon looking generally at the health of the population, it will be found that people suffer most in the great town districts. Liverpool and Manchester are the places of highest mortality, then follow some of the districts of London, Merthyr Tydfil, Bristol, South Shields, Macclesfield, Hull, several districts of Lancashire, Sheffield, Nottingham, Leicester, Stoke-upon-Trent, Wolstanton and Burslem, Leeds, Newcastle-on-Tyne, Birmingham, Coventry, Wolverhampton, Newcastle-under-Lyme, Derby, Salisbury, Northampton, Bradford, Gateshead, Shrewsbury, Walsall, Norwich, Colchester, Sun- derland, Exeter, Worcester, Bedford, Dudley, Bath, Ipswich, Carlisle, Lancaster, Cambridge, Aylesbury, Maidstone, Canterbury, Wycombe, Gloucester, Wakefield, and Reading.

The mortality is not increased equally at every age in these districts. And it varies

V

Healthy and Unhealthy Districts contrasted.

considerably in the two sexes ; the returns for childhood, manhood, and old age, males and females, conspire in proving the prevalence of general causes of insalubrity operating with different degrees of intensity, but with much greater force than in other parts of the country.

It is probable that under any circumstances a certain number of children born will never reach maturity ; that in a numerous population there will every year be deaths at all ages, from internal or external causes. In the present state of mankind it is im- possible to say how small the inevitable loss by death is, as in every place, and among all classes of people, certain known sources of insalubrity exist, which unquestionably account for a part of the prevalent mortality. The annual mortality of males and females of all ages in England is at the rate of 22 in 1000; in Glendale, Bellingham, and Haltwhistle, three districts of Northumberland, the mortality in the same seven years was 14 in 1000. Not to take an extreme case, a group of 21 statistical districts has been formed, and a table of the mean mortality has been deduced from the whole; which, as it represents the lowest rates of mortality hitherto observed, over a period of seven years in a considerable population, may for the present be called the mortality of man from natural causes. The excess of mortality over this standard may be un- hesitatingly referred to artificial, unnecessary causes, in such tables as the following, showing the waste of life and health in 40 town and city districts. An equal popu- lition (100000) is saken at six ages; and it will be observed that the insalubrity tells with most effect against childhood: the mortality under 5 years of age is raised 124 per cent. ; in manhood it is raised 77, 83, 70 per cent, at three ages, and in puberty and old age 45 per cent. Out of a given number of men, at different ages, the deaths by unnatural causes increase every year; for the table shows that to 100000 living in each period, the deaths are 700 by unnatural causes at the age of 35-45 ; and 1060 at 45-55 ; 1682 at 55-65. The rate of mortality is raised in a less ratio, but to a much greater extent in old than in middle age, for the natural mortality in old age is high. The absolute number of deaths is greatest in infancy, as the number of old persons living is small compared with the number of children living in every popula- tion ; so that whether the ratio of increase on the natural rate of mortality, the actual increase in the rate of mortality, or the number of deaths be regarded, children are the most cruelly treated by the destroyer. Yet of- every 17 men w’ho die in towns, 7 die by unnatural causes ; and of 1000 living at the age of 40, seven die ; at the age of 50, eleven die ; at the age of 60, seventeen die; at the age of 70, twenty-six die every year from causes evidently external and unnatural. Women escape with the least loss ; yet five in every fifteen annual deaths would not happen in healthy places.

Annual Rate of Mortality per Cent, [or per 100000J in Healthy and Unhealthy Districts, also the Excess of Mortality due to Unhealthiness.

MALES.	FEMALES.
Age.	Districts in which the Mortality is
Low.	High.	Excess,	Low.	High.	Excess.
0—5 IO-15 35-45 45-55 55-65 65-75	4- 323 •393 •913 1276 2396 5- 657	9678 •572 1613 2336 4078 8*224	5-355 •179 • 700 1 060 1 • 682 2567	3 66o •460 •992 1172 2*131 4-799	8-405 •603 I'4II 1895 3-323 6964	4745 •143 •419 •723 1 192 2 • 165

The table may he read thus without reference to decimal points. To 100000 boys living, 4323 die in comparatively healthy places, and 9678 in unhealthy places, the excess of deaths chargeable on the latter is 5355-

It often happens that unhealthy and healthy villages, streets, parishes, and towns are in immediate juxtaposition ; and constitute parts of the same district. The effect of

vi Sanatory Survey of England.

this admixture on the results is, that the unhealthy districts are less unhealthy , and experience a lower rate of mortality than they would if all the healthy parts were eliminated. Upon the other hand, the healthy districts are made to appear less healthy than they would if they consisted only of healthy places, inhabited by people in good circumstances, under a proper course of diet, discipline, and exercise. The difference in the mortality of the two classes of districts is therefore understated.

The healthiest districts of the country can readily be pic ked out of the tables. But some may be named, as it is of importance that they should be generally known ; not only for the sake of those who wish to resort to healthy localities, but that the precise condition of the parishes and populations that live in the best health may be studied.

Among the healthiest Registration Districts in the country are Glendale, Bellingham, Hal twhistle, Morpeth, Rothbury, Alnwick, Belford in Northumberland; Brampton and Longtown in Cumberland ; Bideford, Holsworthv, South Molton, Torrington, Crediton, and Barnstaple, in North Devon; Anglesea, Tregaron, Lampeter, Newcastle-in- Emlvn, D<dgelly, Conven, Bala, Festiniog, Aberystwith, in Wales; Hendon and Barnet in Middlesex ; Ciodstone, Reigate, and Dorking, in Surrey ; the Isle of Tnanet (including Margate and Ramsgate*) and Eastry (including Deal) in Kent ; the Isle of Wight; Blything, Mutford, Wangford, in Suffolk ; Havant, Catherington, Fareham, Droxford, South Stoneham, New Forest, Lymington, Christchurch, Ringwood, Fording- bridge, and Uomsey, in Hampshire; Steyning, Thakeham, and Worthing, in Sussex.

If the degrees of mortality are represented by shades on a map, or shadows on the face of the country, Berwick-on-Tweed is slightly shaded, nearly all Northumberland is white from the Cheviot Hills and Flodden to Otterbum and Hexhain away over the forests, wastes, and fells, to Longtown, Brampton and the hilly regions, round the lakes of Cumberland and Westmorland, to Ulverstone, north of Morecambe Bay. A dark shade rests on Carlisle, and extends, growing lighter, over Cockermouth and Whitehaven. From Newcastle down the Ty ne on both sides, the shades are thick and dark, and over D irham along the west the lessening shadow reaches Barnard Castle. The shadow over Yorkshire is light, the hilly north region is scarcely stained, and generally the great basin of the Humber, with the Ouse and Trent, is clear, but darken- ing shadows extend along the Ouse, the Aire, and the Don, becoming black over Sheffiidd, Leeds, and Hull the great port of the Humber. Derby, Leicester, and Nottingham, form a black triangle, sending a prolongation of shadow towards Sheffield and Stoke-on-Trent, but surrounded on the other side by light spreading over Buxton, the Peak of Derbyshire, much of Leicestershire, Nottinghamshire, and Lincolnshire. Lancashire is covered with a mass of darkness, that the light points along the coast can scarcely pierce. The blackness extends to Macclesfield, Stockport, Newcastle- under-Lyme, Wolstanton and Burslem. Shadows extend in a line through Shrews- bury, Wolverhampton, Dudley, Birmingham, and Coventry, with light on both sides, and the shade descends to Tewkesbury, darkening over the Severn and Gloucester. A shadow of some density stretches out in a south-westerly direction from Ely, Wisbeaeh, and Kings Lynn, over Cambridge, Bedford, and Northampton, to Buck- ingham. Norfolk, with the exception of Norwich, is made light by the contrast with this region and another on the borders of Norfolk and Suffolk, extending from Colchester, Ipswich, and Yarmouth, to Saffron Walden. Essex and Hertford are light ; Middlesex white, out of London, which is darkly shaded. Kent has over it a light shade, which turns dark over Chatham, Canterbury, Maidstone, and Dover. There is a general whiteness over Surrey, Sussex, Hampshire with the Isle of Wight, and parts of Berkshire, from the Thames to the sea; Reading, Brighton, Portsmouth, and South- ampton, are the dark spots in this field. The misty shadow is quite visible over Dorset, and grows cloudy over Wiltshire, of which Salisbury is the black centre; but the mist clears away in North Wilts, and disappears m whiteness over the Cotswold Hills, Westbury, and \\ heatenhurst in Gloucestershire, divided by the Severn. Tew kes- bury, Newent, Cheltenham, and Gloucester, make the northern borders of Glouces- tershire dark, and the shadow from Wiltshire descends on the southern border from

Some of these districts suffered from Cholera, as will be subsequently 6hswn.

Cholera.

vii

Devizes down the Avon, thickening over Bath, Clifton, Bedminster, and turning into a black mass over Bristol. Somersetshire is shaded on the side next Wilts and along the Avon, but is lighter towards the sea channel, and the whiteness is diffused over Exmoor, Dartmoor, and the whole of North Devon. Dark shadows rest on Exeter, and extend, growing much lighter, up the Yale of the Exe, to Tiverton. Plymouth, Devonport, and Stoke Damerel are enshrouded in black mist ; but the expanse of this great county is white, and so is Cornwall as far as Falmouth, but the parts to the south- west, studded with mines, are shaded to the Land’s End. A tract of whiteness, sixty miles in breadth, stretches from Devon, Somerset, and Cornwall, over the Bristol Channel, and covers the western half of Wales, from the sea-shore to the mountains, as far as Anglesea, Conway, and St. Asaph* Newport is dusk, Merthyr Tydfil is a black mass, and the shades spread over Glamorganshire and Brecknockshire, the field of the Welsh coal and iron works.

The light parts of the country in the map represent a population in health and vigour, rarely attacked by zymotic diseases, living in considerable numbers to an advanced age ; the dark parts are real “ valleys of the shadow of death,” where the population is sickly, feeble, short-lived,- — where thousands of the infants are convulsed, the children’s brains inflamed, tuberculous, distended with water, — where small-pox, measles, and scarlatina, instead of being light eruptions, destroy the structure of the skin, putrefy the throat, inflame the lungs, — where the natural process of teething is often fatal to the child, childbearing to the mother, — where typhus, pneumonia, bronchitis, asthma, and consumption, destroy thousands of lives, beieaving families, and leaving multitudes of widows and orphans, following in the train of untimely death. England, according to the latest observations, is the healthiest country in the world,* yet it is not easy to calculate in ordinary times her losses by diseases, from which parts of the country are free, and which the progress of social improve- ment and medical science may remove. How can the sufferings of a large part of a nation be estimated ? How can the effects of disorderly morbid states on the passions and conduct of the people be weighed ? How can the value of time wasted, of great plans perishing unmatured, of works cut short by death, of men taken from the service of their country and mankind before their time, be measured ? If the loss is indefinite, its magnitude is unquestionable. We have now to describe its increase by the invasion of a foreign plague, which displayed a similar, but not the same partiality, in the selection of its victims, as the ordinary endemics of the country.

CHOLERA.

Cholera is more fatal in Asia than in Europe ; and several partial epidemics are described in the annals of India before the rise of that great epidemic of 1817, which encircled the world, and destroyed men wherever it found them in the circumstances that lend it power. The slow diffusion of that epidemic and its ravages through 1832 and 1833 in England have been frequently described. Since 1817 India has experienced several partial epidemics. I11 1845 cholera was epidemic in Cabul, which from 1839 to 1842 had been the seat of war, and the scene of great triumphs and great disasters. Bombay was attacked in the spring of 1846, and a part of the army of Scinde at Kurrachee was assailed by the disease in its most fatal forms. From Affghanistan, the Punjaub, and Sinde, the epidemic extended over Persia and Syria in 1846, reached Astrakhan at the mouth of the Volga on the Caspian Sea in June 1847, Moscow in September 1847, Petersburg and Berlin in June 1848, Hamburgh in September 1848, Edinburgh at the beginning of October 1 848. f The epidemic

* The following Table is from the 6th Animal Report, p. xxxix. where the data will be found for these and other estimates.

England 22 deaths annually to 1000 living.

France 24 , , , , xooo , ,

Prussia 27 ,, ,, 1000 ,,

Austria 30 ,, ,, 1000 ,,

Russia 36 ,, ,, 1000 ,,

f See Report of the Board of Health. Map.

viii

Cholera in England.

travelled at the same rate as the epidemic in 1830—1 ; the dates of the attacks of which are given by Dr. Kennedy.*

The first epidemic starting from Bengal in August 1817, reached Bombay on August 10th, 1818, and Astrakhan on September f 8th, 1823, and there it died away. In Persia, several local epidemics appeared at intervals in the 7 years, 1823-30. The great epidemic that traversed Europe is said to have sprung up in June 1830 on the low western shores of the Caspian Sea. The velocity of the two epidemics only differed in Asia: it was the same in Europe.

It is worthy of remark, that in the hot season of 1846, when the cholera epidemic acquired great force about the Indus, summer cholera and diarrhoea prevailed with great violence in England.

CHOLERA IN ENGLAND.

The deaths from cholera in England were 331 in 1838 ; 394 in 1839 ; 702 in 1840 ; 443 in 1841: and 1620 in 1842. The deaths from diarrhoea in the 5 years (1 838-42) were 2482, 2562, 3469, 3240, and 5241. I shall trace the progress of the'-e diseases from 1842 by the help of the Quarterly Returns. The slight increase of mortality in the quarter ending September 30, 1842, was referred to diarrhoea and cholera, which “was more preva'ent than usual in the season, though in a mild form.” According to the Registrars (Reg. Gen. Quar. Rep. 1842, 3rd Qu ), “bowel complaint” prevailed at Brighton, Plymouth, Dudley, Wolverhampton including Bib-ton, Birmingham, Liver- pool, Manchester, several Lancashire districts, Leeds and Sunderland. English cholera was fatal to 3 aged men at Northampton ; 1 person at Ipswich. It prevailed at Deritend and Bordesley near Birmingham, Basford, Macclesfield, Liverpool (where 1 death was registered “Asiatic cholera” of 4 or 5 hours’ duration), West Derby, Black- burn (where “ 29 persons died of cholera”), Bury and Bolton (where an “epidemic of diarrhoea or English cholera prevailed among all classes”), Chorlton, Manchester, Salford, Dukenfield sub-district of Ashton and Oldham, Bradford. In London (1842) 704 deaths were referred to diarrhoea, 1 1 8 to cholera. Wages were reduced, and there was consider- able manufacturing distress in this year. The men “ turned out ” in many districts.

1 843. In the summer quarter (July, August, September), “ bowel complaints ” were noticed in Exeter, Wolverhampton, Lincoln, Nottingham; “an extensive mild fever prevailed ” in Macclesfield, “ together with English cholera, but not of a fatal character.” Diarrhoea was prevalent in Liverpool and West Derby ; 40 of the 95 deaths in Chorlton-upon-Medlock were “ from diarrhoea, cholera, or other diseases of the bowels.” The symptoms, the Registrar states, were, in many cases — “ diarrhoea, vomiting, and colic ; often with coldness of the skin, and sometimes of the breath ; blueness of the skin and sunken eyes; the dejections sometimes colourless, with white flakes, but generally bilious and feculent.” Cholera was fatal to 43 persons in the Hulme sub-district. English cholera prevailed so far as to constitute an epidemic in Manchester ; 1 case terminated fatally in 24 hours. Ashton, Oldham, and Halifax were attacked by diarrhoea and “English cholera.” In the year 1843, 834 deaths were referred to diarrhoea, 85 to cholera, in London.

1844. In the summer quarter, 47 cases of cholera were registered in London, 414 of diarrhoea. A case of English cholera was registered at Kingston in Portsea Island. Diarrhoea was prevalent and fatal in Bedford, Clifton, Stroud, Dudley, Wolverhampton, Coventry, Macclesfield, Chorlton, Manchester, and Huddersfield. In the quarter ending December, 5 cases of cholera were registered in London ; 3 at Sedgley in the Dudley district, where “ bowel complaint” continued prevalent. In the year 705 deaths were referred to diarrhoea, 65 to cholera, in London.

* See the valuable and lucid History of Contagious Cholera, p. 198. Report of Hoard of Health. Map.

Astrakhan .... July 20, 1830

Moscow Sept. 1830

Petersburgh .... June 26, 1831

Berlin Aug. 31, 1831

Hamburgh .... Oct. 1831

Sunderland .... Oct. 24, 1831

Edinburgh .... Jan. 22, 1832

by J. Kennedy, 3rd edit. 1832.

June 1847 Sept. 18, 1847.

June 1848.

Sept. 1848.

Oct. 4, 1848.

Oct. 1, 1848.

Map,

IX

Cholera, 1845-6.

1845. Only 26 deaths from cholera were registered iri London during the summer quarter: 2 deaths from cholera occurred in St. George’s, Clifton; 1 in Sedgley, Dudley. In the autumn quarter of the year 2 deaths from cholera happened in Sheffield North. Cholera and diarrhoea were rare, and attracted little attention. In this year 841 deaths were referred to diarrhoea, and 43 to cholera, in London.

1846. The winter quarter (January, February, March) was exceedingly mild, the mortality low. In the remarks attached to the June quarter, it is stated that there was an evident tendency in the mortality to decline through the 7 spring quarters 1839-45; kut that in the spring of 1846, this tendency was counteracted, and the deaths exceeded the average. The deaths in London, at the close of June, from diarrhoea, dysentery, and common cholera, rose to 40 weekly. The progress of the epidemic abroad, and the bad sanitary condition of London and many towns, justified the warning in the remarks of this quarter, — not to wait until cholera reached the country, but to look before, and to remove the nuisances which give the disease breath, life, and being, Tne air was 2° above the average temperature, and the horizontal movement was less than it was in spring, 1844, in the proportion of 655 to 948 miles weekly. In the summer quarter (July, August, September) of 1846, an extensive epidemic prevailed. The 5 weeks from July 11 to August 15 were the most fatal in London. Young children were the principal sufferers : it had the usual symptoms of cholera infantum. “The disease also proved fatal to many old people; and some adults died of attacks which could not in their symptoms be distinguished from Asiatic cholera. It was, however, quite evident from the first that the epidemic had not the characters of (hat malady which broke out here in the winter of 1832, but was closely allied to the cholera described by Sydenham, which he says lasted a month and — “ earn anni 'partem , quae cestatem fugientem atque autumnum imminentem complectitur (unice ac eadem prorsus fide , qua veris primordia hirundines, aut insequentis lempestatis fervorem cucidus), amare consuevit.”*

While the deaths in London were little more than 14 per cent, above the return of 1845, the deaths rose from 25,166 to 38,826 — or about 52 per cent, after a correction fir increase of population— in the towns and other districts of the kingdom, included in the return. In some of the densely-peopled towns the mortality was doubled. The deaths in the corresponding summer quarters of the past and present year were, in Maidstone, 124 and 239; Brighton, 219 and 364; Portsea Island, 239 and 433; Winchester, 89 and 141 ; Oxford, 89 and 194; Northampton, 182 and 220; Bedford, 182 and 255 ; Ipswich, 119 and 240; Norwich, 308 and 454; Plymouth, 191 and 279 ; Clifton, 323 and 436 ; Worcester, 106 and 173 ; Dudley, 457 and 745 ; Walsall, 1 57 and 288 ; Wolverhampton, 438 and 687 ; Wolstanton and Burslem, 164 and 315* Coventry, 188 and 300; Nottingham, 285 and 467 ; Lincoln, 154 and 246. No such mortality has been witnessed in Birmingham for many years; the deaths in 1845 were 694, in 1846 they amounted to 1623. In Liverpool and the adjacent district of West Derby, the deaths in the summer quarters of 1845 and 1846 were 2596 and 4090; in Manchester, and the contiguous districts of Salford and Chorlton, 2408 persons died in 1845, and 4297 in 1846. Stockport, Macclesfield, Chester, Blackburn, Preston, Bury, Bolton, Wigan, Prescot, Ashton, and other districts of Cheshire and Lancashire, suffered to an equal or a greater extent. The districts of Yorkshire did not escape ; 1039 persons died in Sheffield, where only 446 died in the summer quarter of 1845, and the mortality in any preceding summer since 1838 had never exceeded 647. Hudders- field, Leeds, Hull, and York suffered severely. In Sunderland, Gateshead, Tyne- mouth, and Newcastle-on-Tyne, 1170 deaths were recorded in the summer quarter of 1845, and 2313 in the corresponding quarter of 1846. The epidemic was apparently as fatal in the inland towns as in the ports.

Upon the other hand, the mortality of the quarter was below the average in Pontypool and Newtown; but slightly above the average in the other districts of Wales; and generally the country and southern districts suffered comparatively little. f

* Sydenham Opera. Obs. Med. Anni 1669. He also describes the severer epidemic of 1676, “ Insueto tempestatis calore evectus.”

t Reg. General's Report on the State of the Public Health in the quarter ending September 30, 1846.

X

Cholera and Influenza, 1847-8.

The diarrhoea was in some districts of a dysenteric character, but generally chole- raic, and often terminated in English cholera. At Nottingham a case was returned as Asiatic cholera, terminating in 12 hours. In London 1549 deaths in the quarter were referred to diarrhoea, 75 to dysentery, and 197 to cholera. In the last quarter of the year diarrhoea, dysentery, cholera, influenza, and typhus were unusually common in London, and in many other town districts. The iron, coal, pottery, cotton, and woollen districts, and generally the counties north of Staffordshire, were severely visited. Scarlatina was fatal in the northern districts. In the year 2152 deaths were referred to diarrhoea, 228 to cholera, in London-.

1847. The temperature of the winter quarter was below the average; inflammation of the lungs aud typhus prevailed. Diarrhoea and fever raged among the poor starv- ing Irish, who flew from the famine caused by the potato failure to England. From the same cause provisions were dear; there was much distress in many parts of the country. In the spring quarter (April, May, June), the mortality, in the words of the Quarterly Report, “ increased ; common cholera was fatal ; scurvy prevailed more or less over the country from the want of vegetable food, the potato having failed; all food became scarce and dear; typhus broke out, is still epidemic, and shows no sign of decline.” In the summer quarter (July, August, September), the mortality slightly decreased in the country ; in London there was no sign of improvement. Small-pox, measles, scarlatina, diarrhoea, dysentery (slightly), typhus, and ervsipelas prevailed: ill persons died of typhus in one week ; epidemics of typhus and influenza set in, and made the mortality in the last quarter of the year higher than in any quarter of any year since the registration commenced. The mortality in London was raised by influenza from 1086 in the week ending November 20, to 1677 in the week ending November 27; 2454 in the first, 2416 in the second week of December: the epidemic and the mortality then gradually declined. The deaths, directly or indi- rectly caused by influenza, were not less than 5000 in six weeks. In the year diarrhoea was fatal to 1976, cholera to 1 1 7 persons, in London: 307 deaths were referred to dysentery.

1848. The influenza epidemic extended into the winter quarter of 1848 (January, February, March), and the mortality was greatly above the average. Typhus, scarla- tina, hooping-cough, and small-pox were epidemic in many parts. The mortality of Birmingham, Sheffield, Manchester, and Liverpool remained exceedingly high. Inthe next three months “ a very remarkable improvement in the state of the public health ” was observed ; the mortality was but slightly above the average of the season. In- fluenza was no longer epidemic in London. Typhus, which was fatal to 1279 persons in the last quarter of 1847, declined from that time, and in the June quarter of 1848 was only fatal to 882 persons. “ There is as yet no trace of the epidemic of cholera, which is ravaging Russia from Moscow to St. Petersburgh, and is ascending the Danube.”* The mortality in the summer quarter (three months, July, August, Sep- tember) was below the average. “ The improvement in the public health is consider- able, in all the divisions of the kingdom, except London.” * The principal seats of the carpet, iron, pottery, silk, and cotton trades are particularly cited ; and the improve- ment is ascribed to the comparative cheapness of provisions, and the infrequency of fever consequent upon the diminution of Irish immigration. Diarrhoea was, however, prevalent in Brighton, Ipswich, and Yarmouth, in Dudley, Walsall, Co- ventry, Birmingham, and Leeds. Dysentery was rather more fatal than usual ; it caused 65 deaths in Penzance, and was also fatal to many persons in Marazion, the neighbouring sub-district. The mortality of the autumn quarter (October, November, December) was “ below the average;” yet cases of “Asiatic” or “ epidemic” cho- lera occurred in October, and in the remaining months of the year.

1934 deaths were referred to cholera; 829 in the first nine months, and 1 105 in the last three months of the year 1848. The former were generally considered cases of common “English” cholera; many of the latter were universally held to be “Asiatic” cholera. The two forms are often not distinguished in the rcturus. The cases, sepa-

Registrar-General's Quarterly Report*, 1848.

What is Diarrhoea ?

xi

rately considered, run so insensibly into each other, that the attempt at distinction would have been fruitless. They differ perhaps, in fact, no more than distinct and confluent small-pox, simple and malignant scarlatina, simple and phlegmonous erysipelas, which are properly held to be varieties of the same maladies.

Without entering into any disquisition in pathology, it is also necessary to notice here the connexion of diarrhoea and sporadic cholera with Asiatic cholera. Diarrhoea, in the sense of u dejectio frequens ,” frequently accompanies teething in children; it is the result of a whole class of medicines, and of irritating, indigestible food. Many poi- sons induce it. It is one of the most constant symptoms of typhus, and runs insensibly into dysentery. The last stage of consumption is marked by colliquative diarrhoea. Like pain and “ fever,” it is a symptom of many diseases. “ It is often brought on by that power which is exerted in every part of the body of freeing itself from any- thing painful and oppressive” (Heberden’s Commentaries). The ulceration of the intestines in typhoid fever, in consumption, and in dysentery, are its common causes ; in many cases no structural change can be detected in the mucous membrane ; and many of the purgative medicines are first absorbed and taken into the blood before their specific action is induced.

In abstracting the cases of 1849, for the series of tables in this volume, all cases returned as “ cholera,” whether English or Asiatic, cholerine, “ bowel complaint,” and diarrhoea simply, or as a complication of other diseases, were transcribed. All the cases in which the term “ cholera” or “ choleraic diarrhoea” occurred, were re- ferred to cholera; about 300 cases, in which diarrhoea was evidently a symptom of consumption, or some other disease, were struck out; the residue of the cases was classed under diarrhoea.

Excluding the symptomatic affection, such as is observed in fever, consumption, and enteritis, there is evidently an idiopathic disease, which may properly be called diarrhoea, and is as constantly observed in English towns when the temperature rises above 6o° as bronchitis and catarrh when the temperature falls below 32 ’.

Again, wherever dysentery is epidemic, a great number of cases occur which exhibit all the intermediate symptoms between simple purging without fever and the cha- racteristic fever, pain, and bloody mucous discharges of dysentery. The dysentery often begins as simple diarrhoea. In such circumstances the diarrhoea is really a con- stituent part of epidemic dysentery, modified by the condition, place, and age of the patients. In like manner, the diarrhoea which is generally prevalent at the same time as cholera, often painless, with rice-water evacuations,* vomitings, and slight spasms, is to be held, in its various shades, a constituent part of the cholera epidemic. Many of the cases of diarrhoea in 1 849, it maybe held, however, were of a simple character, and of the same nature as the diarrhoeas of other years.

We shall now give a more particular account of the progress of cholera in 1848, and of the first appearance of the new epidemic form.

CHOLERA IN LONDON, 1848.

London. — In London deaths \vere referred to cholera in every month of 1848: 3 were registered in the weeks of January, 3 in February, 2 in March, 4 in April, 3 in May, 8 in June; the increase taking place in the third week of June, when the mean daily temperature rose and remained above 6o°. The disease was epidemic, and the deaths registered in July were 66, in August 64, in September 31. The deaths from cholera registered in each week of these three months w’ere, 3, 7, 9, 21, 26, 21, 19, 17, 7, 7, 7,6, 7, 4. This epidemic subsided in September; it presented little that w;as extraordinary in its course, or in the number of cases. The deaths registered from cholera in the first week of October were 13, and in the twelve subsequent weeks of the quarter, 30, 45, 34, 65, 62, 54, 34, 20, 21, 29, 31, and 30. The temperature was

* Dr. R. D. Thomson has shown that this fluid is not the serum of the blood, but has the same chemical qualities as the effusions into serous membranes. The light flakes are the epithelial scales of the intestine. — On Cholera, Trans. Royal Med. Chir. Soc., London, vol. xxxiii.

Xll

1848. Summer Cholera in London.

declining; yet the mortality increased rapidly in October, and 65 persons died from cholera in the first week of November. The cases were severe and rapidly fatal. It was evidently the epidemic cholera — the Asiatic cholera. To every one accustomed to observe popular disease the difference in the two forms was striking. Some extracts from the weekly table will show their different characters. The following is from the notes to the week when the common summer epidemic of cholera was at its height : —

Cases of Cholera Registered in the Week ending July 29 th.

In Bel "rave (sub-district) F. 54, “Asiatic cholera (58 hours' duration).''

Mr. Jorden, the Registrar, states that “ this was a distinct case of Asiatic cholera (?), occurring in his own practice, of whicli he had seen much both at home and in the East. The patient was said to have suffered from a severe attack, when it prevailed before, some 16 years ago. She was of delicate health, and suffered from psoriasis inveterata. She was attacked suddenly in bed at 4 o’clock in the morning, having the day before dined on half-boiled cabbage and some sort of dumpling.’’

In St. John the Evangelist, Westminster, a boy, aged 4 months, “ cholera infantum (4 dags’ duration)." In the same sub-district, a boy, 3 months, “cholera infantum (4 dags).’ ’ No breast-milk after the first six weeks.

In Gray’s Inn-lane (sub-district), a boy aged 11 months, “diarrhoea — cholera (4 dags)."

In Somers Town, a boy aged 4 months, “ cholera (2 dags' duration), typhus (1 dag)."

In Camden Town, M. 62 years, “dysentery (11 dags), cholera (3 dags)."

In West sub-district of Islington, a boy, 7 weeks, “ cholera (5 dags)."

In East sub-district of Islington, a woman aged 29 years, “cholera (4 dags), collapse on the 4th day.” She was the wife of a shoemaker, and lived in one of the dirty confined courts out of the High-street.”

In St. Anne, Westminster, a boy aged 16 months, “cholera infantum (7 or 8 dags).”

In Saffron Hill, a boy aged 22 days, “cholera infantum (6 dags), convulsions (4 dags)."

In sub-district of Goswell-street, M. 77, “diarrhoea (6 dags), which assumed symptoms of cholera, exhaustion (3 dags).”

In North sub-district of West London, a boy aged 6 months, “ cholera (24 hours)."

In Haggerstone West, a carpenter, 76 years, “natural death, sudden, from English Cholera." (inquest). In Bethnal Green (Town), at No. 12 Carlisle-street, son of a brewer’s servant, aged 7 weeks “cholera 2 dags').''

In St. Mary, St. George-in-the-East, M. 59 years, “English cholera (6 dags).’’

In Limehouse, F. 40 years, “ cholera (3 dags), collapse (25 hours).”

In Ratclifl'e, M. 51 years, “ cholera maligna (30 hours).’’

In Lambeth Church sub-district (2nd part), at 137 Regent-street, F. 16 years, “English cholera (2 dags), exhaustion.”

In Camberwell, at 4, South-street, daughter of a letter-carrier, aged 2 years, “English cholera (6 dags).” In Holywell and Moorfields, Shoreditch, a boy aged 19 months, “ English cholera (4 dags)."

In same sub-district, M. 24 years, “spasmodic cholera (4 dags).”

In East sub-district of Greenwich, M. 61 years, “cholera.”

In same sub-district, M. 71 years, “cholera ^4 dags)."

In same sub-district, M. 60 years, “ asthma (20 gears), cholera (4 dags)."

In same sub-district, a girl, 1 year, “ cholera.”

In Battersea, a boy, 1 year, “cholera (4 dags)."

In all the cases of cholera, except one returned by the coroner, the cause of death was certified by the medical attendant.

Cases approaching the Asiatic form occurred early in the year. I11 the week ending May 6th, a woman of 75 died of cholera in Rotherhithe, after 5 days’ illness ; another, aged 43, died of cholera in Oxford Terrace, after 2 days’ illness. In the following week ending May 13th, a woman aged 40 died in Aldgate, Whitechapel. A note stated that “the case presented the appearance of Asiatic cholera, viz., purging constant, no bile in stool, cholera voice, suppression of urine; died in four days, in a state of collapse.” In the week ending June 3, a boy aged 12 years, died of cholera in Rotherhithe, after 48 hours’ illness. A man aged 51, died of Asiatic cholera, according to the return of the week ending June 17th, in the Hanover Square sub-district, after 36 hours’ illness. In the week ending July 8th, a man aged 68, was returned as having died of Asiatic cholera in Greenwich East. Again, on September 12th, a pilot, aged 55, died of Asiatic cholera (36 hours’ duration), at 8, Frederick Street, Greenwich West; and was registered in the week ending September 1 6th . On September 22nd, a mariner, aged <2, died aft* r 11^ hours’ illness of “Asiatic cholera,’’ at 8, New Lane, St.John, Horsleydown, in the district of St. Olave. These were probably two real cases of the new epidemic form ; still the contrast of the October returns with that of the last week of September is striking. t

1848. Asiatic Cholera in London. xiii

Cases of Cholera returned in the Week ending Sept. loth. — (All are certified by Medical Attendant.)

In Belgrave (sub-district), St. George, Hanover-square, F. 74 years, “English cholera (18 days' dura- tion) .”

In South sub-district, St. Giles-in-the-Fields, F. 4 years, “English cholera (to hours’ duration).”

In Amwell-street, Clerkenwell, F. 40 years, “ bronchitis (23 years’ duration), English cholera (1 week).” In Mile End Old Town (Upper), a girl, 8 months, “ cholera infantum.”

The great change now takes place.

Fatal Cases of Cholera Registered in the Week ending Saturday, October the 7th. — (All are certified

by the Medical Attendants.)

In Old-street (sub-district), St. Luke, at 39, Rahere-street, died on September 29, wife of a gentleman, 59 years, “ disease of the bowels, simulcting Asiatic cholera (38 hours’ duration).”

In south sub-district, West London, F. 27 years, at 3, Harp-court, St. Bride’s, on October 2, a porter’s wife, “cholera (13 hours’ duration).”

In St. Bartholomew’s Hospital, West London, M. about 40 years, a porter, on October 4, “ Asiatic cholera.”

In Town (sub-district), Bethnal-green, at 4, Cheshire-street, on September 28, a weaver, F. 21 years, “ enlargement of the heart (12 months’ duration), cholera spasmodic (12 hours).”

In Spitalfields, Whitechapel, M. 23 years, mariner, at 21, Princes-street, on October 5, “ cholera (12 hours’ duration).”

In Whitechapel North, a girl, 4 years, a labourer’s daughter, at 14, Thames-street, on October 2, “ English sporadic cholera (7 days' duration).’’

In St. Paul (sub-district), St. George-in-the-East, M. 38 years, a coal-whipper, at 3, Lower Chapman- street, on October 3, “ cholera (2 days' duration) .”

In Mile-end Old-town Lower, Stepney, M. 47 years, a coal-meter, at 6, Globe-terrace, on October 6, “ cholera (36 hours' duration).”

Mr. Castleden, the Registrar, states — “ Mr. Todd, the surgeon in this case, certifies, that the above was a case of Asiatic cholera ; and the informant states, that her father (the deceased) got up on Thursday morning, about 4 o’clock, with a bowel complaint, for which he took some gin and ginger, and then went to his work, on board ship, which he was compelled to leave about mid-day. He returned home in a cab, and died yesterday morning at 4 o’clock. The medical gentleman was in close attendance to the very last.”

In Lambeth Church, 2nd part (sub-district), at 2, Orsett-street, on September 30, daughter of a chair- maker, 11 months, “ cholera (3 days’ duration): convulsions (1 hour).”

Mr. W. H. Wheatley, the Registrar, states, “ that at otie end of the street mentioned above, in the centre of the road, is an open drain, which is very offensive at times — drainage to houses very bad. Scar- latina has been very prevalent there.”

In Rotherhite, at 2, Lower Queen-street, on October 2, a boy, 11 years, son of a carpenter, “ cholera (9 hours' duration).”

In same sub-district, at 11, Silver-street, on October 1, F. 38 years, wife of a mariner, “ cholera (19 hours’ duration).”

In same sub-district, at 17, Hanover-street, on October 4, a girl, 2 years, “ cholera (2 days’ duration).” In Greenwich West, sub-district, at 9, Skinner-street-row, on October 1, F. 37 years, widow of a black- smith, “ cholera (4 days’ duration).”

Fatal Cases of Cholera Registered in the Week ending Saturday, October the 14 th. — (Five are cases in which Inquests were held : of the remainder, all are certified by Medical Attendant except two.)

In London Hospital, Whitechapel Church (sub-district), on October 8, Henrick Vandershaaff, a cattle drover, aged 65 years, “ diarrhoea (7 days’ duration) ; Asiatic cholera (36 hours’ duration).”

In Aldgale, a boy, 1 year, a labourer’s son, at 6, Cow-yard, Rosemary-lane, on October 10, “ Asiatic cholera (24 hours’ duration).”

In St. John (sub-district), St. George-in-the-East, M. 28 years, a labourer, at 5, Green-bank, on October 10, “ Asiatic cholera (11 h >urs’ duration)”

In the Leather- Market (sub-district), St. Mary Magdalen, Bermondsey, at 1, Friendly-place, on October 8, M. 40 years, a labourer, “ Asiatic cholera).

In Kennington, 1st part (sub -district), Lambeth, M. 39 years, a labourer, at 18, Kennington-place, on October 9, “ Asiatic cholera (4 days’ duration) ; collapse (16 hours).”

In Woolwich Arsenal (sub-district Greenwich), on October 3, M. about 60 years, a convict, “ cholera (8 hours’ duration).” Inquest.

In same sub-district, on October 7, M. 48 years, a convict, “ Asiatic cholera (11 hours’ duration).” Inquest.

In same sub-district, on October 7, M. 31 years, a convict, “ Asiatic cholera (4 hours’ duration).’’ Inquest.

In same sub-district, on October 8, M. 42 years, a convict, “ Asiatic cholera (13 hours’ duration).” Inquest.

In same sub-district, on October 10, M, 55 years, a convict, “ Asiatic cholera (8 hows’ duration).” Inquest.

XIV

1848. First Cases of Asiatic Cholera in London.

Mr. Richard Rixon, the Registrar, states, that “ The above five deaths occurred on board the “ Unite” Hospital Ship, in the River Thames, oft’ the Royal Arsenal. There have been no cases in the Arsenal, or in any part of the town, to his knowledge, and he has made every inquiry.”

In St. Olave and St. Thomas (sub-district), at n, Magdalen-court, Tooley-street, on October 12, F. 49 years (kept a fruit stall in Bermondsey-street), “ Asiatic cholera, (18 hours' duration)."

In Chelsea South (sub-district), at White Hart-court, on October 7th, M. 14 years, a mason’s son, “cholera morbus (16 hours’ duration)."

In same sub-district, at White Hart-court, on October 7, M. 40 years, a stonemason, “cholera morbus (30 hours’ duration).”

In same sub-district, at. the Royal Hospital, on October 10, M. 68 years, a soldier, p. m.., “ cholera morbus (12 hours’ duration).”

In same sub-district, at 5, White Lion-street, on October 13, M. 46 years, a pensioner, “ cholera Anglica (1 week's duration)-, delirium tremens, cirrhosis.”

In same sub-district, at. White Hart-court, on October 8, F. 13 years, daughter of a baker (deceased) p. m., “ cholera morbus (3 7 hours' duration).’’

In the Green (sub-district), Bethnal -green, at 3, Chester-street, on October 8, a boy, 11 weeks, a weaver’s son, “ English cholera (1 month’s duration).”

In Spitalfields (sub-district), at 17, Wilson’s-place, on October 9, F. 32 years, wife of a joiner, “ malig- nant cholera (29 hours’ duration).”

In St. John (sub-district), St. Olave, at 3, Cross-street, oti October 4, M. 77 years, a cooper, “ cholera (65^ hours’ duration).”

In same sub-district, at 13, Sard’s-rents, on October 14, M. 30 years, a carpenter, “ cholera maligna (32 hours’ duration).”

In the same house, on October 6, F. 2 years, daughter of a carpenter, “ diarrhoea, convulsions.”

Mr. Beusted, the Registrar of St. John, Horsleydown, states, “ These two cases were those of a father and daughter, who lived at No. 13, Sard’s-rents, Church-street, St. John’s, Southwark; the latter died of 1 diarrhoea, followed by convulsions ;’ the former of ‘ malignant cholera,’ was attacked at 12 o’clock on Friday, October 14th, and died at 4 p. m, on Saturday. From inquiries I have made, it appears that he was a very sober and industrious man; that he and his wife were cleanly in their habits, but that one or other of the family has been constantly ill since they lived in their present residence. There are, 1 believe, upwards of 20 houses within 4 or 5 feet of a filthy open sewer, and this fact has been constantly repre- sented to me (as Registrar) by the inhabitants of those houses. The illness which is caused by so great a nuisance can hardly be wondered at, for in some places I do not think it is above 3 feet from their doors. The deceased lias left two children, one not out of danger, and the other very ill. These circum- stances have been the more impressed on my attention by a visit from the medical gentlemen (Messrs. Phil- lips and Button) who atteuded the cases, and state, as their opinion, that this open sewer was the prin- cipal cause of the illness.”

In St. James, Bermondsey, at 1, Matilda-place, on October 12, F. 7 years, a labourer’s daughter, “ cholera (13 hours' duration).” No medical attendant.

In Lambeth Church, 1st part (sub-district), at 26, Lower Fore-street, on October 1, M. 22 years, a labourer, “ cholera (9 hours’ duration V’ Not certified.

In same sub-district, and in the same house, on October 12, M. 23 years, a labourer, “ cholera (2 days' duration); consecutive fever (6 days).’’

In Rotherhithe, M. 29 years, caipenter of the brig “Malta,” died on board, in the River Thames, on October 7, “ English cholera (24 hours' duration).”

In same sub-district, at 15, Spread Eagle-court, on October 1 2, a boy, 6 years, a labourer’s son, “ cholera (24 hours' duration).’’

In St. Paul, Deptford, Greenwich, at 23 Griffin-street, on October 10, F. 31 years, a labourer’s wife, “ cholera (4 days’ duration)."

In “ Dreadnought,” Hospital Ship, Greenwich West sub-district, on October 9, M. 21 years, an apprentice, “ cholera.”

In same ship, on October 9, M. 23 years, an apprentice, “ cholera.”

In same ship, on October 6, M. 16 years, an apprentice, p. m., “ recovery from small-pox, diarrhoea 27 daps’ duration; sudden vomiting, purging, and collapse about 24 hours."

In Clapbam (sub-district), at Prescolt-place, on October 10, M. 44 years, a bricklayer, “ malignant cholera 9 hours’ duration."

Fatal Cases of Cholera Registered in the Week ending Saturday the 21 st of October.

Ten are cases in which Inquests were held: the remainder are all reported to be certified by Medical

Attendants, except one.

li Woolwich Arsenal (sub-district Greenwich), on Oct. 13, M. 30 years, a convict, “Asiatic cholera

,2 > hours’ duration).” Inquest.

In same sub-district, on Oct. 14, M. 58 years, a convict, “Asiatic cholera (52 hours' duration).” Inquest.

In same sub-district, on Oct. 16, M. 67 years, a convict, “ Asiatic cholera (19 hours’ duration).” Inquest.

In same sub-district, on Oct. 16, M. 62 years, a convict, “Asiatic cholera (100 hours’ duration).” Inquest.

1848. First Cases of Asiatic Cholera in London. xv

In same sub-district, on Oct. 17, M. 26 years, a convict, “Asiatic cholera (6 hours’ duration).” Inquest.

In same sub-district, on Oct. 18, M. 25 years, a convict, “ Asiatic cholera (4 days’ duration).” Inquest.

In same sub-district, on Oct. 19, M. 23 years, a convict, “Asiatic cholera (4 days’ duration).” Inquest.

Mr. Rixon, the Registrar of the sub-district, Woolwich Arsenal, makes the following statement: — “ The seven deaths from Asiatic cholera, registered by me last week, occurred in the “ Unite ’’ hospital ship, among convicts from the “ Justitia’ hulk, lying oft the Royal Arsenal wharf. The surgeon attributes the disease to the unhealthy state of the atmosphere and to the locality, a common sewer being in the immediate vicinity. The captain of the ship ascribes it to the rotten condition of the hulk, and to heat generated during the night by so many men being closely packed together, a ward having from ten to twenty-four men sleeping in it, according to its size. The last two cases were of athletic young men, and lasted four days. The former patient was pulseless from the first, and comatose during lour hours previous to death — the latter was sensible to the last. They were carefully attended to, visited every hour night and day; and were treated witn mercury, mustard poultices, stimulants, and all the usual remedies. The whole of the convicts were removed yesterday (the 20th instant) from the “Justitia,” and put on board the “Hebe” and “Sulphur” receiving vessels, opposite the Royal Dockyard, which arrangement, I find, has created some alarm in the yard. This morning (Saturday) a rigger was taken home from the Dock- yard very ill, and afterwards a shipwright, and both cases are pronounced by the surgeons as decided cholera. Otherwise, the town remains free. Scarlatina is still very prevalent.”

In Chelsea, North East (sub-district), M. 15 years, “epidemic cholera (3 days’ duration).”

In same sub-district, a boy, 6 years, “epidemic cholera (9 hours’ duration) .”

Mr. Smith, the Registrar of the north-east sub-district of Chelsea, states that “ the two boys belonged to the same family. The elder was employed on board a lighter at Isleworth, and had eaten heartily of mussels on the day before the attack. Finding himself ill, he returned home under heavy rain, which wetted him to the skin. His parents, who are in poor circumstances, procured medical aid, but were not able to provide the comforts necessary for his case; and to the want of these, the surgeon thinks, is principally owing the fatal termination. The younger was constantly in the room during bis brother’s illness, but was not seized till after his death. His illness is attributed by the medical attendant not merely to contagion, but to miasma generated in a badly ventilated and comfortless apartment, and increased by the presence of a sick person.”

In Islington East (sub-district), son of a paper-stainer, 3 years, “ cholera epidemica (18 hours’ duration).”

Mr. Butterfield, the Registrar of the East sub-district of Islington, states that “ the boy who resided at 15, Lower Queen-street, New North Road, was taken ill at hall-past 6, A.M., with rigors, bilious vomiting, and purging with rice-coloured evacuations, and all the symptoms of true cholera. Medical advice was not obtained till half-past twelve, when it did not avail. The patient died at halt-past one, a.m., on Saturday, after an illness of 18 hours. Miasma issuing from an open, offensive drain in the backyard, seemed to be the primary cause.” Dr. Bossy, who attended the above, has another decided case in an adult, which has not been fatal.”

In Christchurch (sub-district), Marylebone, seaman, 22 years, “ malignant cholera (2 days’ duration), secondary fever (3 days).”

Mr. Obre, the Registrar, states that the deceased was a seaman who had arrived from Sunder- land, in the brig “ Marsden,” on the loth: had febrile symptoms, with diarrhoea, till the 13th, when he removed to Lisson Grove. These symptoms continued till the 15th, when the choleraic poison showed itself, and he died on the 17th. Dr. Miller adds, that “ the patient was brought home on Friday evening in a state of collapse, and died of ‘ Asiatic cholera,’ in the stage of secondary fever.”

In Whitechapel North (sub-district), seaman, 43 years, “Asiatic cholera (3 days’ duration).”

Mr. Chapman, the Registrar, states that “this sailor was brought from a lodging-house, 118, Rose- mary-lane, to the Whitechapel Workhouse, on the 16th October, and died on the 18th. It appears he had not been many days from on board ship.”

In Ratcliff (sub-district), Stepney, on board a collier in the River Thames, M. 19 years, “ diarrhoea (4 days’ duration), Asiatic cholera (9 hours).”

Mr. Wells, the Registrar of Ratcliff, mentions that “ besides the above case, he had three others (one English, two Asiatic), on which inquests had been held; but they were not yet registered, as he had not obtained the coroner’s signature. The four cases occurred on board colliers in the Thames.

In St. Paul’s, Deptford (sub-district), Greenwich, M. 66 years, “ cholera Asiatica (17 hours’ duration).’’

Mr. Marchant, the Registrar of St. Paul’s, Deptford, states that “ this person resided in a very healthy, airy situation, and was of steady habits; by trade a carpenter, but only working at. his trade occa- sionally, having other resources. He ate a hearty dinner of boiled mutton, spinach, and potatoes, on the day previous to that on which he died.”

In Islington East (sub-district), a labourer, 15 years, “ diarrhoea (5 days' duration), spasmodic cholera.”

In same sub-district, a boy, 6 years, son of a pauper stonebreaker, “ natural, with symptoms of spasmo- dic cholera (11 hours’ duration), ill fed and poorly clothed.” Inquest.

Mr. Butterfield, the Registrar, states that “ these two were brothers, and died in Ward’s Place, a close confined, badly ventilated place, off' the Lower Road.”

xvi 1848. Quick Course of Asiatic Cholera in London.

In Goswell-street, Clerkemvell, F. 24 years, “ Asiatic cholera (36 hours' duration).’’

In Cvipplegate sub-district, M. 45 years, “Asiatic cholera (4 days’ duration)"

In South-east sub-district, City of London, M. 27, “ cholera Asiatica (12 hours’ duration).’’

In Aldgate sub-district, M. 50 years, “died by the visitation of God from Asiatic cholera (20 hours' duration).” Inquest.

In St. Saviour (sub-district), a boy, 7 years, “Asiatic cholera (15^ hours’ duration).”

In St. James, Bermondsey, at 17, Mary gold-street, 011 Oct. 14, Thos. Daws, aged 20 months, “ Asiatic cholera (20 hours' duration).” He was attended by the wife of John Elliott.

In same sub-district, at 17, Marygold-street, on Oct. 17, John Elliott, aged 26 years, a nail-caster, “Asiatic cholera (60 hours’ duration .”

In Camberwell, a spinster, 21 years, “spasmodic cholera (7 hours' duration).”

In same sub-district, a spinster, 25 years, “spasmodic cholera (11 hours' duration).”

In same sub-district, widow of an Italian warehouseman, 42 years, “spasmodic cholera (13 hours’ duration)."

In same sub-district, a widow, 45 years, “spasmodic cholera (40 hours’ duration).”

The above 4 cases occurred in Peckham House Lunatic Asylum.

In Chelsea South (sub-district), at White Hart-court, on Oct. 13, F. 46 years, soldier’s widow, “ cholera morbus (24 hours’ duration).”

In same sub-district, and at the same house, on Oct. 16, a girl, 10 years, “cholera morbus (9 days’ duration), lever consecutive (7 days). Daughter of the above.

In Islington West (sub-district), a labourer, 40 years, a pauper in Islington Workhouse, “ cholera Anglicu (1 month's duration), dysentery (7 days).”

In St. Paul (sub-district), St. George-in-the-East, a girl, 10 years, “natural death by the visitation of God, viz., cholera (18 hours’ duration).” Inquest.

In Limehouse (sub-district), Stepney, M. 25 years, “cholera biliosa, cerebral congestion.”

In St. Saviour (sub-district), F. 15 years, “ansemia (4 months' duration), diarrhoea (2^ days), spasms and cramp (24 hours).”

In Christchurch (sub-district), St. Saviour, son of a weaver, 5 years, “destitution, cholera (12 hours' duration).”

In same sub-district, wife of a weaver, 36 years, “destitution, cholera (6 days' duration).''

In same sub-district, daughter of a weaver, 3^ years, “destitution, cholera (96 hours' duration).”

In same sub-district, daughter of a weaver, 1^ years, “ destitution, cholera (34 hours' duration).”

The above 4 cases occurred in Christchurch Workhouse; all members of one family.

In same sub-district, 59, John-street, daughter of a tinman, 8 years, “ cholera (12 hours’ duration).’’

In the Leather Market sub-district, Bermondsey, at 27, I’age's-walk, on Oct. 17, M. 51 years, a cooper, “cholera spasmodica (135 hours' duration).”

In same sub-district, and at the same house, on Oct. 15, F. 53 years, a cooper’s wife, “spasmodic cholera (46 hours’ duration).”

In Kent-road (sub-district), St. George, Southwark, son of a haruess-maker, 21 months, at 5, Williams- place, “cholera morbus (6 hours’ duration).”

In Lambeth Church, 2nd part (sub-district), a waiter, at 6r, Devonshire-street, aged 41 years, “cholera, accompanied with spasms, cramp, and hiccup ( attended 12 hours)-, disease existed 5 days.”

In Battersea (sub-district), daughter of a carman at Nine Elms, aged 1 year and 8 months, “cholera (9 hours' duration) ”

In Greenwich YVest (sub-district), in “ Dreadnought” hospital ship, M. 39 years, “bronchitis (4 weeks' duration), cholera.”

In St. Paul. Deptford (sub-district), Greenwich, at Florence-road, on Oct. 16, M. 66. a carpenter, “Asiatic cholera (17 hours’ duration).”

In St. George (sub-district), Camberwell, at 4, Thomas-street, Wyndhani-road, wife of a fish-vender, 58 years, “spasmodic cholera (15 hours' duration).”

The term “ English” cholera is objectionable, as it implies that the disease is peculiar to England ; whereas it prevails, in nearly ttie same form, all over the world, and is described by Celsus and the ancient writers, as well as by Sydenham. For the sake of distinction, as it is so much under the control of temperature and season, it may be called “ Summer Cholera.” About half the fatal cases of Asiatic cholera terminate within 24 hours of the appearance of its characteristic symptoms: it will be shown here- after that the average duration of 19232 fatal cases in males was 2 *06 days, and of 20236 cases in females 2 ’ 10 days.

The average duration of 4045 fatal cases of diarrhoea in males was i6’04 days, of 3851 females 16*69 days. The summer cholera has an intermediate duration of about five days. The difference is seen in the subjoined table of cases taken indiscriminately from the Returns of 1848 : more than half the cases of Asiatic cholera terminated in less than a day ; half the cases of summer cholera did not terminate in three days; and half the cases of diarrhoea lasted more than six days. This is a new and important element in the diagnosis.

1848. South Eastern and the Midland Divisions. xvii

Duration of Fatal Cases of Diarrhoea, Summer Cholera, and Asiatic Cholera, in London, 1848.

—	Total Deaths.	Under one Day.	Number of Cases terminating in the several Days.
I	2	3	4	5	6	7	8
Diarrhoea ....	Il6	I	I	8	l6	9	5	9	13	8
Summer Cholera .	Il6	9	12	14	17	23	II	6	7	4
Asiatic Cholera	129	66	21	12	4	12	6	I	5

Number of Cases terminating in the several Days.

		9	IO	II	12	13	14 — 21	21 — 28	28—35	35 & up.
Diarrhoea ....	Il6	I	5				12	13	7	8
Summer Cholera . .	116	4	I	. .	2	I	2	I	2	. .
Asiatic Cholera . . .	129				I	• •	• *	* *	I	* *

CHOLERA IN THE COUNTRY, 1848.

2. South Eastern Division. — Deaths from cholera occurred in every month of 1848, except February; namely, 3 in January, 4 in March, and 2, 2, 5, 11, 15, 14, 18, 12, 2 2, in the subsequent nine months, making a total of 108 fatal attacks. Guild- ford and Kingston in Surrey, each furnished 2 deaths. In Kent 4 deaths took place at Bromley; 2 at Dartford ; in Gravesend 7; North Aylesford 3 ; Hoo 2; Medway (including Chatham) 13; Sevenoaks 3 ; Sheppev 4 ; and Eastry 2. In Sussex, there were in Uckfield 2 deaths; Cuckfield 5; and Brighton 3. In Hampshire, in the great naval station of Portsea Island and the adjoining district of Alverstoke there were 6 and IO deaths respectively; in the Isle of Wight 4; Stockbridge 2 ; Basingstoke 3 ; and Andover 2. In Berkshire, there were in Newbury 2. deaths; Wantage 2, Wal- lingford 2 ; Reading 3 ; and Windsor 2.

3. South Midland Division. — Cholera which was fatal in each month of the year 1848 was most prevalent after July, and destroyed 150 lives by the end of December. In January 1 death occurred; in February 2 ; and 1, 2, 5, 5, 8, 17, 12, 22, 31, and 44 respectively, in the subsequent months. I11 Middlesex 4 fatal cases took place at Staines ; at Uxbridge 10 ; Brentford 13 ; Hendon 8 ; and Edmonton 8. In Hertford- shire, Bishops Stortford furnished 3 deaths; Iloyston 3; Hertford 2; Watford 4; Hemel Hempstead 5 ; and Berkhampstead 3. In Buckinghamshire a remarkable mor- tality took place in the Amersham district, where cholera was fatal to 46 persons (population 18212 in 1841), 43 of whom died in the Chesham sub-district (which con- tained a population of 5811 in 1841); excepting 2 children who were attacked early in September, all the deaths occurred subsequent to November 10th : in many instances the attacks were of short duration.

The following is an abstract of the deaths from cholera in the Chesham sub-district : —

F. 2 years and 9 months, hawker’s daughter, named Hearn, “ cholera, (8 days’ duration),” Chesham September 14. >

F. 10 months, labourer’s daughter, “ cholera (8 days’ duration),” Chesham, September 16.

F. 62 years, miller’s widow, “cholera, (2 days’ duration)," Waterside, Chesham, November 11.

M. 10 months, labourer’s son, “ cholera (1 day’s duration),” Waterside, Chesham, November 13.

M. 1 year and 10 months, labourer's son, “cholera (2 days’ duration),” Waterside, Chesham, November 14.

M. 1 year and 7 months, Hawker’s son, named Aris, “cholera (2 days’ duration),” Waterside, Chesham, November 14.

F. 49 years, labourer’s wife, “cholera (28 hours’ duration)," Chesham, November 15.

F. 3 years and 11 months, hawker’s daughter, named Aris, “cholera,” Waterside, Chesham, November 16.

F. 29 years, brush-handle makers wife, “cholera (60 hours’ duration),’’ Waterside, Chesham, November 16.

F. 55 years, labourer’s wife, “ cholera (12 hours' duration)," Waterside, Chesham, November 16.

M. 8 years, “ cholera (38 hours’ duration)," Waterside, Chesham, November 18.

M. 13, baker’s (deceased) son, “cholera (36 hours' duration),” Waterside, Chesham, November 18.

F. 46 years, labourer’s wife, “ cholera (19 hours' duration),” Waterside, Chesham, November 18.

c

xviii 1848. The Eastern, South Western, and West Midland Divisions.

M. 51 years, labourer, “ cholera (28 hours’ duration),’’ Waterside, Chesham, November 19.

F. 49 years, gamekeeper’s widow, “cholera (26 hours’ duration),’’ Waterside, Chesham, November 20.

F. 20 years, single woman, “ cholera (32 hours’ duration),” Waterside, Chesham, November 21.

F. 28 years, single woman, “ cholera (15 hours' duration),’’ Waterside, Chesham, November 21.

M. 69 years, labourer, “ cholera (4 days’ duration) ; relapse (8 days),’’ .Waterside, Chesham, December 2.

F. 55 years, bricklayer’s widow, “cholera (20 hours’ duration),” Waterside, Chesham, December 3.

M. 43 years, labourer, “ cholera (3 days' duration),” Waterside, Chesham, December 3.

F. 60 years, labourer’s wife, “cholera (2 days’ duration); feverit(4 days),” Waterside, Chesham, December 4.

F. 36 years, miller’s wife, “cholera (22 hours’ duration),” Waterside, Chesham, December 4.

M. 8 years, labourer’s son, “ cholera ; fever (9 days’ duration),” Waterside, Chesham, December 5.

F. 42 years, labourer’s widow, “ cholera (2 days’ duration),” Waterside, Chesham, December 6.

M. 19 years, labourer’s (deceased) son, “ cholera (10 days’ duration),” Waterside, Chesham, Dec. 8.

F. 1 year aud 7 mouths, labourer’s daughter, “ cholera (4 days' duration),” Waterside, Chesham, December ir.

M. 1 year and 10 months, butcher’s son, “cholera (6 hours’ duration),” Chesham, December 11.

M. 4 years, butcher’s sou, “cholera (n hours' duration),” Chesham, December 13.

M. 4 years, shovel-makers son, “cholera (4 days’ duration)” Waterside, Chesham, December 14.

F. 2 years, labourer’s daughter, “cholera (108 hours' duration),” Chesham, December 15.

F. 76 years, widow, “cholera (46 hours’ duration),’’ Waterside, Chesham, December 16.

M. 10 years, tailor’s son, “cholera (17 hours' duration),” Chesham, December 17.

F. 8 years, sawyer’s daughter, “cholera (7^ hours’ duration),” Chesham, December 17.

M. 11 years, paper-maker’s son, “cholera, relapse (8 days' duration),” Waterside, Chesham, December 19.

M. 6 years, labourer’s son, “cholera, fever (5 days’ duration),” Chesham, December 19.

F. 74 years, gardener's widow, “cholera (3 days' duration),” Chesham, December 20.

M. 12 years, shovel-maker’s son, “ cholera (18 hours’ duration),” Chesham, December 21.

M. 65 years, paper-maker, “cholera (22 hours’ duration).” Waterside, Chesham, December 21.

F. 52 years, hawker's wife, named Moore, “cholera (8 hours’ duration),” Chesham, Dec. 25.

F. 70 years, labourer’s wife, “cholera (42 hours’ duration),” Chesham, December 25.

F. 56 years, labourer’s wife, “cholera (11 hours’ duration),” Chesham, December 28.

F. 39 years, single woman, “cholera (24 hours’ duration),” Latimer, Chesham, December 29.

M. 38 years, sawyer, “cholera (11 hours' duration),’’ Chesham, December 30.

Iii Eton there were 2 deaths; in Aylesbury 8 ; and Newport Pagnell 2. In Oxford 2 fatal cases are recorded. In Northamptonshire there were 2 deaths in Towcester; Northampton 2; Wellingborough 6; Oundle 2; Peterborough 3: In Huntingdon 3 deaths took place. In Bedfordshire 2 deaths occurred in Bedford; 5 in Biggleswade ; 2 in Ampthill ; and 2 in Leighton Buzzard. In Cambridgeshire, Chesterton fur- nished 2 deaths; Cambridge 6; Newmarket 8; Ely 6; North Witchford 3 ; and Wisbeach 18; of which 15 took place in the Upwell sub-district, where the epidemic commenced on November 25th, and prevailed throughout December amongst labourers: 13 of the 1 5 deaths were of males, most of them in the prime of life, aud in no instance is the duration of the attack stated to have exceeded 30 hours.

4. Eastern Division. — Cholera was fatal to 65 persons in 1848, and deaths occurred during every month of the year, viz., 3 in January, and 1, 1, 3, 4, 2, 3, 5, 9, 14, 6, 14, respectively in the subsequent months. In Essex 6 of the deaths occurred in West Ilam ; 2 in Romford; 2 in Orset ; 4 in Chelmsford ; 2 in Tendring; and 2 iu Saffron Walden. In Suffolk 2 deaths took place in Thingoe; 2 in Samford ; 3 in Wood- bridge ; 2 in Blything ; and 5 in Mutford. In Norfolk 2 deaths happened in Tuns- stead ; 2 in Aylsham; 4 in Norwich; 3 in Mitford; 4 in Kings Lynn; 4 in Down- ham; 2 in Depwade ; and 2 in Docking.

5. South VVestern Division. — There were 68 deaths from cholera in 1848; and February was the only month during which no fatal case was recorded : 1 death took place in January; 1 in March, and 1, 2, 2, 7, 6, 20, 1 1, 9, 8, in the subsequent months. 2 deaths occurred at Pewsey, in Wiltshire. In Devonshire it was most fatal at Plymouth, where 15 persons died of the disease, 3 of them being female convicts on board the “Cadet,” on Nov. 23rd, 26th, and Dec. 7th respectively: 3 fatal cases happened at East Slonehouse, adjoining Plymouth, and 1 in Stoke Damerel; St. Thomas furnished 2 cases; Exeter 3; Kingsbridge 2; Plympton St. Mary 2; Tavis- tock 2; and Bideford 2. In Cornwall cholera was fatal to 12 persons in Penzance, chiefly in miners’ and mariners’ families, and during the autumn ; at Redruth 5 deaths occurred. In Somersetshire 3 deaths took place in Wells and 2 in Bath.

6. West Midland Division. — The number of deaths from cholera was 101 in

1848. North Midland, North Western, York, and Northern Divisions, xix

1848, distributed over every month; there were 5 fatal cases in January, and 1, 1, 6, 4, 4, 6, 26, 1 6, 11, 11, 10, in the succeeding months. In Gloucestershire 4 deaths happened at Bristol; 2 in Clifton; 2 in Stow-nn-the-Wold, and 2 in Cheltenham. 3 cases occurred at Clun, in Shropshire. In Staffordshire it was fatal to 2 persons at Stone; at Stoke-upon-Trent to 4; Cheadle 3; Uttoxeter 4; Penkridge 2; West Bromwich 3, and Dudley 6. In Worcestershire 4 deaths happened in Stourbridge and 3 in Kings Norton. In Warwickshire, Birmingham furnished 10, and Aston 8 fatal cases (the number of deaths which occurred at these places in 1849 was — in Birming- ham 29, and Aston 6). In Foleshill there were 2 deaths; Rugby 3; Warwick 6, Alcester 2 ; and Shipston-on-Stour 4.

7. North Midland Division. — Cholera was fatal in 85 cases during 1848, there being in January 4 deaths, and 3, 1, 3, 2, 3, 15, 10, 4, 11, 16, 13, in the subsequent 11 months. In Leicestershire 4 deaths happened in Lutterworth ; 3 in Blaby ; 3 in Loughborough ; and 5 in Leicester. In Lincolnshire there were in Bourn 3 deaths ; in Boston 2 ; Horncastle 3 ; Spilsby 5 ; Caistor 10: of which 5 took place at Great Grimsby on the coast, and 5 at Market Rasen in the interior ; in Glandford Brig 3 ; and in Gainsborough, on the River Trent 13. In Nottinghamshire 2 deaths took place in East Retford ; 3 in Basford, and 3 in Newark. In Derbyshire 5 fatal cases occurred in Derby ; 2 in Ashborne, and 2 in Bakewell.

8. North Western Division.' — Cholera was prevalent in this division in 1848, it having been fatal in 227 cases, chiefly in the latter half of the year. The number of deaths in each month was, in January 3 ; and in each of the succeeding months, 2, 7,7, 10, 7, 52, 41, 31, 35, 12, 20, respectively. In Cheshire it was fatal to 7 persons in Stockport; 10 in Macclesfield; 2 in Altrincham; 4 in Northwich on the River Weaver; 8 in Wirrall, situated on the coast, and including the town of Birkenhead ; and 5 in Great Boughton, including Chester on the River Dee. In Lancashire the districts on the coast in which cholera was chiefly fatal were, Liverpool 33 deaths; West Derby 16 ; Ormskirk 2 ; Ulverston 2 ; and Preston oit the Ribble 2. Also, in Prescot 2 ; Wigan 4 ; Leigh 5 ; Bolton 10 ; Bury 9 ; Chorlton 2 2 ; Salford 7 ; Man- chester 21 ; Ashton 18; Oldham 8; Rochdale 6 ; Haslingden 4; Burnley 2 ; Black- burn 12, and Chorley 3.

9. York Division. — Cholera, which was prevalent in the early part of the year 1848, increased perceptibly after June, and by the end of the year caused the deaths of 207 persons. There were in January 5 fatal cases, and 2, 8, 6, 6, 4, 24, 25, 33, 49, 24, 21, in the following 11 months. Of the districts bordering on the coast there were in Hull 20 deaths; Scnlcoates 8 ; Scarborough 4; Skirlaugh 3; and Patrington 2. York furnished 14 cases ; Selby 6, of which 4 were quickly fatal, viz., in 12 hours, 12 hours, 16 hours, and 24 hours respectively; Settle 2; Pateley Bridge 3; Otley 6; Keighley 4; Todmorden 6; Saddleworth 7; Huddersfield 7; Halifax 8; Bradford 28 ; Hunslet 12 ; Leeds 6 ; Dewsbury 15 ; Wakefield 5 ; Pontefract 7 ; Ecclesfield 4 ; Wortley 2 ; Sheffield 3 ; Doncaster 3 ; Driffield 6; Maldon 4; and Whitby 2.

10. Northern Division. — With the exception of March and May cholera pre- vailed during each month of the year 1848, and was fatal to 163 persons, viz., in January 4; February 1 ; April 2 ; June 5 ; and 7, 12, 10, 17, 3 6, 69, in the subse- quent 6 months. Cholera appeared at Sunderland in an epidemic form on October 4th, and was fatal to a mariner aged 56 on board the ship “ Valiant,” after an attack of 9 hours’ duration ; he is represented as having been drunk on the previous day. On October 12th the next death took place; it was followed by two others on October 14th ; from this time its prevalence increased, and it was chiefly fatal among coal-miners and mariners : the duration of most of the attacks was short, and varied from 6 hours to 3 days. The last death was that of a coal-miner’s son, aged 1 year, on December 26th, at the colliery Monkwearmouth, where 20 fatal cases occurred out of the 37 deaths from cholera registered in the Sunderland district.

In South Shields there were 7 deaths ; in Stockton 8 ; Darlington 2 ; Teesdale 2 ; Durham 5 ; and Gateshead 3.

In Northumberland cholera was most fatal in the districts on the coast ; it destroyed 32 lives at Tynemouth, commencing on October 3rd in a keelman’s daughter, aged 1,

c 2

XX

1849. Cholera in England.

at Skipsey’s Quale, North Shields; 3 other cases were fatal in October. In November its prevalence increased, and it became very fatal among keelmen at Quay Cowpen, and mariners and others at Blyth ; instances are recorded of 2 persons in the same family dying. The epidemic continued fatal up to the end of the year; 3 deaths occurred on December 30th, two of which were in the children of a keelman at Quay Cowpen, after attacks of 14 hours’ and 22 hours’ duration. In Newcastle-upon-Tyne cholera was fatal to 12 persons, chiefly in the latter part of the year. In Berwick- upon-Tweed the epidemic was first fatal on December 7th, in a labourer’s widow, aged 79, at Hutts Norham. It continued prevalent throughout December, mostly among fishermen, labourers, and quarrymen : 3 deaths occurred at the workhouse, Berwick ; 6 at Donaldson’s Lodge, Cornhill ; and 4 at Hutts Norham: the total deaths in the district were 19. Morpeth furnished 9 deaths; Castle Ward 3. In Cumberland cholera was chiefly confined to the following districts, viz. : — Brampton 2 deaths; Longtown 3 ; Carlisle 4; Cockermouth 5; and Whitehaven 5.

11. Welsh Division. — Cholera was not fatal until April 1848, when one death took place, and 5, 4, 4, 5, 4, 6, 4, 8, in the subsequent 8 months, making 41 deaths during the year. In South Wales, on the coast, there were in Cardiff 7 deaths; Swan- sea 2 ; and Haverfordwest 2. Also in Merthyr Tydfll 3; and Abergavenny 2. In North Wales, Holywell had 5 deaths; Newtown 2; Wrexham 2; Carnarvon 4; and Anglesey 3.

The deaths from cholera in England were 41 in the week ending October 7 ; and 78, 99, 88, 1 12, in the 4 weeks following; the numbers varying little in the subsequent weeks, were 91, 89,82,71, 84,97, 85> 88. The total number during the year was 1934. Such was the course of the epidemic cholera in England to the close of the year 1848.

CHOLERA IN ENGLAND, 1849.

1849. The tables, pp. 20-107, and the notes, pp. 166-300, show the progress of cholera through the year 1849. The state of the public health was described in the quarterly and weekly returns; and it is now possible, from all these sources, comprising facts recorded and observations written at the time, to trace the effects of the epidemic, and the extent of its ravages through the year.

The deaths in England from cholera were, in January, 658; in February, 371 ; in March, 302 : yet, it was remarked, in the quarterly return, “ although epidemic cholera has been in England since October, 1848, and has prevailed more or less up to the present time in parts of the country, the general mortality has been and is considerably below the average. This is encouraging, and should stimulate all sanatory improve- ments, for summer is the season in which the epidemic is most to he dreaded.* The deaths from cholera in London were 292 in January, 180 in February, 40 in March.

It will be recollected that in October 1848, the epidemic attacked the convicts crowded in the decaying “ Justitia” hulk, lying off the Royal Arsenal wharf, Woolwich, in the immediate vicinity of a common sewer ; subsequently it was fatal to convicts in Millbank Prison and to lunatics in thePeckham House Asylum ; the registrars stated that many of the houses in which patients were attacked were crowded, and in dirty un- drained sites. In the last week of December the epidemic broke out in Mr. Drouet’s Infant Poor Establishment, Surrey Hall, Tooting, where 48 of the 61 deaths registered from cholera in the first week of January occurred. In the week following 69 deaths from cholera were registered at the same establishment. It is stated in a note to the Weekly Return (January 20th 1849), that “ the total deaths which have occurred in the institu- tion, or amongst children who have been removed from it since the appearance of the epidemic, amount to 182, of which 155 were returned as caused by cholera.” The children at ages from 4 to 14, were paupers fanned out, and the building was over- crowded. In the week following 13 persons died of the epidemic cholera in the Holborn Union workhouse, where a few more cases occurred in the subsequent week. Some of the children of this Union were in Drouet’s Establishment. Several of the children belonging to Pancras were removed and died in the workhouse, Camden Town. Mr.

Quarterly Return, No. I, pp. 4, 5, 1849.

XXI

1849. Progress of Cholera.

Holl, after stating that “ three children who died in the workhouse had been brought from Tooting while under the influence of the disease,” adds: — “ The woman, aged 64, died in the infirmary of the workhouse quite unconnected with that part of the house which the children occupied, and not allowed to have any communication with it.” *

Mr. Steib, the registrar of Hackney, registered two deaths from cholera in the same week. “ The former was a decided case of Asiatic cholera in a servant who belonged to the Islington poor-house, and had been brought to Hackney to nurse the sick children. The second was in a girl belonging to the Islington poor-house, who had been brought to Hackney from Drouet’s Asylum, Tooting.” In the week ending February 3rd, 9 out of 10 cases registered in Kensington town occurred in Jennings’ Buildings. In the week ending February 24th, the deaths of the matron, the temporary matron, seven servants, and a girl aged 11, were registered at the Female Refuge for the Destitute, in St. Leonards, Shoreditch; and, in the same week, 16 deaths from cholera were registered in Warburton’s Lunatic Asylum. A great number, then, of the deaths from cholera in the early stage of the epidemic occurred in institutions of various kinds. The work- house of Edmonton and the gaol of Hertford were attacked in January. Two parishes in Norfolk were attacked early in the year. A labourer’s wife, aged 48, died of the disease on January 5 th, at West Rudliam, where four more persons died, and 12 in East Rudham, before February 14th. Eleven of the 17 deaths were in labourers’ families. The parishes are inland, and contained 1 494 inhabitants in 1841. No other deaths from cholera occurred there. At Wakefield, in Yorkshire, there w'as a partial outbreak ; 1 9 deaths from cholera happened between the 9th and 24th of January, 16 of them in the House of Correction. In August the epidemic recurred in this house, and 86 deaths from cholera, 36 from diarrhoea, took place in the year.

The epidemic, which began at Selby in the latter part of 1848, prevailed until February 5th, and was fatal to some persons at Goole. In the Union workhouse of Howden, cholera was fatal to 10 persons between January 5th and February nth. The epidemic was fatal at Gateshead in January and February ; at Sunderland in March and April. The epidemic continued to prevail in Berwick-upon-Tweed; at Shore- houses, Spittal, a fisherman, his wife, and three children died of the disease between January 6th and 12th.

In April the epidemic very much subsided, and only 107 deaths were referred to cholera in England. There were no deaths from the disease upon the 8th, 14th, and 26th ; the only days which enjoyed this exemption in the year. There were in the month only 9 deaths from cholera in London, and the mortality was chiefly in the north-western and northern divisions of England. In May the deaths from cholera were 327 ; the fatal period of the epidemic set in at Liverpool, and went on through June, when the deaths were 2046 in all England- South Wales was now suffering, and at the end of June the deaths from cholera rapidly increased in London. Some alarm was felt, but, practically, little progress was made in the sanatory defences of the country. This was adverted to in the Quarterly Return as well as the mortality which the epidemic might cause : —

“ The epidemic cholera, which reached England in October, 1848, and is now causing many deaths in London, Liverpool, and other places, will, it is true, increase the general mortality in the months of July, August, and September as it did before; but the ravages of cholera, of typhus, and of the insidious influenza, which threaten the country, may be greatly mitigated if the same talent and energy are applied to the im- provement of the public health, as have been applied to other great undertakings in which England has engaged.

“ Registration did not exist in 1832; hut it appears from the returns then made to the Board of Health, that in London 994 persons died of cholera in the first part of the epidemic, extending from February 14 to May 15, 1832; 4266 in the second part, extending from June 15 to October 31; and 15 in November and December. Allowing for defective returns in 1832, it is not probable that the fatality of cholera will be greater in 1849 than it was then ; or that the danger will amount to more than

* Notes to Weekly Table, January 20th, 1849.

xxii 1849. Progress and Decline of Cholera.

this, that for a few weeks an inhabitant of London will incur the same chance of dying in one week as he usually incurs in two or three weeks.” — Report for Quarter ending June 30 th, 1849.

The epidemic broke out at Gloucester in May; two cases were fatal on May 8th, in the sub-district of St. Nicholas. The disease spread, and continued through the following months ; the last death occurred on November nth. In the Union work- house at Keynsham, which lies between Bristol and Bath, an agricultural labourer died on May 5th of a diarrhoea, said to be of 4 weeks' duration ; on the same day a labourer, aged 32, died of cholera after 12 hours’ illness. Between May 6th and May I2th, 9 more paupers died in the Union workhouse. On May nth a solicitor in Keynsham died: the disease then attacked the other inhabitants of the place, and was fatal to 56 persons in May and June, 13 of whom died in the Union workhouse. Clifton and Bristol were attacked in June, the first case occurring at Bristol on June 1st. Cardiff, on the other side of the Bristol Channel, was attacked in May, and Merthyr Tydfil very fatally in June, a few cases only having happened in two sub-districts in May. The deaths from cholera in Liverpool were 18 in March, 19 in April, 96 in May, and 424 in June; in West Derby 6 in May, 92 in June. In Sunderland the deaths which had been 133 in March were 12 in April, o in May, 1 in June. Durham experienced the highest mortality in June ; the deaths from cholera were 3 in March, 2 in April, 15 in May, 75 in June, 31 in July, 8 in August.

In the summer, the epidemic advanced rapidly ; and in all England cholera was fatal to 7570 persons in July, 15872 in August, and 20379 in September; or dividing the quarter into weeks, the deaths in the 13 weeks from the 27th to the 39th inclusive, were 822, 1535, 2202, 2164, 2565, 2959, 4092, 3921, 4691,7148,5444,3458,311(1 2724. The mortality was highest in the 36th week of the year, when cholera alone de- stroyed 7148 !i\es. On Wednesday, September 5th, it was fatal to 1120, on Thursday, September 6th, to 1121 persons. On these two days the epidemic was at its highest point. The deaths on August 31st were 570 ; the increase in September was remark- able: the deaths on Saturday, September 1st, were 739, and on the 9 days following 866, 888, 969, 1120, 1121, 1000, 992, 1058, 891. The fatality of the disease sensibly decreased on September nth; on that and the 9 following days the deaths were 792, 793, 876, 731, 717, 644, 615, 604, 554, and 471, gradually subsiding to 380 on the last dav of the month. The epidemic was at its maximum on August nth in Wales, on September 4th in London, on September 5th— 6th in the West-Midland, the Nortu- Western, and York divisions, on September 1 4th— 1 5 th in the Northern division.

The decline of the epi lemic was more rapid than its increase; while it was fatal to 2°379 persons in September, 4654 died of it in October, 844 in November, and 163 in December. The mortality in October was chiefly in the South-Western, Wfst- Midland, North-Western, York and Northern divisions; in London, the South- Eastern, the Eastern, the North-Midland and Welsh divisions, the mortality was much less considerable: while 54 deaths from cholera occurred in England on the last, day of October, 11 occurred on the last day of November; and on the last day of December 2 persons died, one in Shropshire, and one in Durham.

Diarrhoea was more fatal than cholera in the months of January, February, March, April, and May ; in June the mortality from cholera was twice as great as the mortality from diarrhoea; in July, August, and September the mortality from diarrhoea and cholera increased ; but the mortality from cholera became fourfold that from diarrhoea; in October it was only twice as great; in November the deaths from diarrhoea exceeded in number the deaths from cholera, and in December the deaths from diarrhoea were 592, from cholera 163. The annexed table (p. xxiii) exhibits the deaths in each month from the two forms of disease.

Many of the cases of diarrhoea were such ordinary cases as every year occur ; but diarrhoea is one of the earliest and most common symptoms of cholera, and many cases differed only from cholera in the absence of “spasms,” or of some of the striking rather than the essential symptoms. 12045 of the 18887 deaths referred to diarrhoea were in children under 5 years of age; and the symptoms of cholera as well as of other diseases at that early age undergo considerable modification.

The London Cholera Field , 1849. xxiii

Deaths from Cholera and Diarrhoea in England, in eacli Month of the Year 1849.

	Jan.	Feb.	March.	April.	May.	June.	July.	August.	Sept.	Oct.	Nov.	Dec.
Cholera .	658	371	302	107	327	2046	75 70	15872	20379	4654	844	163
Diarrhoea .	810	698	00 O r>.	666	721	926	2124	3599	4928	2244	871	592
Cholera &) Diarrhoea/	1468	1069	IOIO	773	1048	2972	9694	19471	25307	6898	1715	755

THE LONDON CHOLERA FIELD, 1849.

The distribution of the epidemic over the country may now be shown. London was the centre of a great system of attack which extended to Hertford and Hitchin, West Ham, Romford and Rochford on the north side of the Thames ; to Dartford and Graves- end, Margate and Ramsgate, Dover, Croydon and Brighton, in Kent and Sussex.

The disease, like a smouldering fire, broke out as the temperature advanced in London. The return for the week ending May 12th “ indicated a continued tendency in the public health to improve. The deaths from all causes were 905, or 58 less than the average; the deaths in the week following were 1033; the wind was S.W., rain fell to the extent of *67 inches, and the mean temperature of the air was 54°* 9, which is 2° ’6 above the mean temperature of the week. In all London, only one little girl, aged 5 years, died of cholera in 6 hours.”*

In the week ending May 26th, the deaths in London were only 897. “ The deaths

are fewer than in the corresponding week of any former year since 1846.” Three women, however, died of cholera; one in St. John, Westminster; one a milliner in a large house of business (246 Regent-street); and one, a tailor’s wife, at the German Hospital, Dalston. Two children died of choleraic diarrhcea. The temperature was 56°'9, or i0,9 above the average ; the fall of rain was 1 *37 inches.

In the week ending June 2nd, 895 deaths were registered; 9 from cholera. The mean temperature of the air was now 6oD’3, of the Thames water 63° • 5. The fall of rain was i"6 inches; the wind sluggish N. and S.W. Negative electricity was exhibited during heavy rain on Monday ; positive on Friday and Saturday. The deaths from all causes were 971 ; and 22 were by cholera in the week ending June 9th. The mean temperature of the air was 59°' 7 ; the temperature of the Thames was 6 50 • 7 .

1- The deaths in the week ending June 16th were 912, which is less than the average number; while the deaths in the tubercular class, diseases of the nervous system, and diseases of the respiratory organs declined, zymotic diseases increased ; and cholera was fatal to 42 persons. The temperature of the air was low, 53°’ 5 ; of the Thames 62°. The deaths in the next week were 985, only 22 above the corrected average; 49 were from cholera. The temperature of the air was 590' 2 ; of the Thames 62°.

In the week ending June 30th, 1217 deaths were registered ; 124 by cholera. The cholera was by far the most prevalent on the south side of the Thames. The tem- perature of the air in the beginning of the week was much above the average; the temperature of the Thames was 66° ’6 during the week.

The deaths in the week ending July 7th were only 1070; but cholera increased, and the deaths which it caused were 152. The mean temparature of the air was 62°’ 7 ; on Saturday the thermometer reached 82° in the shade, I03°’ 5 in the sun.

In the second week of July, the mortality first rose sensibly above the average ; the deaths were 1369; and the increase was referrible to cholera, which was the cause of 339 deaths; 102 deaths of children under 15 jears of age, 192 adults of 15 and

* The number of deaths cited in the weekly tables of London invariably refer to the deaths registered in the week. The deaths are registered at a certain interval after their occurrence ; consequently the deaths registered in a week are not all deaths that occur in the week. The deaths occurring on every day are given in the subsequent tables.

XXIV

The London Cholera Field.

under 60, and 45 of aged persons. The northern districts suffered least, the southern most. The air was stagnant, and the wind in the N.N.E. ; the sky was cloudless, and no rain fell. The mean temperature of the air was 66° • 8 ; of the Thames 68° • 7 .

The mortality increased, and the deaths from all causes were 1741 in the third week of July ; 678 of the deaths were by cholera, 1 31 by diarrhoea. The high north districts still enjoyed comparative immunity (7 deaths from cholera) ; the hottest attack was directed to the south side of the Thames, where 443 of the deaths occurred. Poplar, in the east, suffered severely ; 37 deaths from cholera were returned. The mean tem- perature of the week fell to 6o°*5 ; the winds were stirring, the sky was overcast, lightning flashes were seen on the 19th and 20th; the thunder was followed by showers and heavy rain.

July 22nd to July 28. “ Again the return indicates an increase on the excessive mortality of the previous week. The deaths from all causes rose to 1931 ; a num- ber which is almost double the weekly average, and exceeds that of the previous week by nearly 200. Influenza in 1847 raised the mortality more rapidly; the deaths from all causes, in the first 4 weeks of that epidemic, were 1086, 1677, 2454, and 2416; while, in the 4 first weeks of the cholera epidemic, the deaths Irom all causes have been 1070, 1369, 1741, and 1931. The deaths from cholera are 783, from diarrhoea 224. The districts on the south side of the river still form the field on which the disease is most active. There is a slight decrease in the eastern districts.” In the whole of the western and northern districts the deaths are only 68. Cholera is, for the first time, more fatal to females than to males; the deaths having been 383 males, 401 females. The mean temperature is 58°' 9 ; the fall of rain in the week is 2°’ 1 5 inches. The wind is S.W., and moves at a rate of about 100 miles a-day. On the afternoon of the 26th a violent thunder-storm occurred, the flashes of lightning were vivid and in quick suc- cession, followed by loud thunder at intervals of 15 to 20 seconds generally. Rain was falling heavily during the storm.

July 29 to August 4th. The deaths registered from all causes are 1967, from cholera 926. Diarrhoea has decreased ; it is the cause of 179 deaths. “ Other epidemics are under the average, except hooping-cough, which a little exceeds it.” The epidemic is still chiefly on the south side of the Thames, where 621 of the 926 deaths occurred. The temperature of the air (59°* 5) still remains below the average.

The mortality from all causes increased little ; and, in the week following, the mortality from cholera declined. The people generally were ready to believe that the epidemic was giving way; and the efforts which had been commenced without much vigour, and with little confidence in their efficacy by the local authorities, were sus- pended. Looking at the course of the epidemic in 1832, at the preceding low and now high temperature, at the field of operations which had hitherto been very much confined to the south side of the river, and were now extended to the north, it was evident that the danger was increasing, and that more active exertions were required. The registrars were requested to extend their returns; and the weekly tables were accompanied by such observations as, in the emergency, appeared likely to be useful and to save life.

The following extracts from the Weekly Tables exhibit the progress and effects of the epidemic at its height: —

Auanst ^th-Xlth. — The deaths in London during the week ending Saturday, August nth, are 1909. The mortality it somewhat less than it was in the previous week. The deaths from all causes in the last six weeks were 10,0. 1569, 1741, 1931, 1967, and 1909; of which 393, 630, 1002, 1173, 1308, and 1185, were by diseases of the zymotic class. Small-pox, scarlatina, and hooping-cough are comparatively quiescent ; typhus is more fatal than it was. The excess of 901 deaths over the average is due to diarrhoea and cholera, which were fatal to 173 and 823 persons. The deaths from cholera during the last six weeks were 152, 339, 678, 783, 926, and 823. The decrease is gratifying; but it is right to observe that the improvement is chiefly confined to West Loudon, Poplar, St. George Southwark, Newington, Camberwell, and Lambeth. The deaths from cholera in the two last weeks were 29 and 48 in Wandsworth ; 9 and 21 in I’aucras; 4 and 14 in Islington; 3 and 10 in London City; 16 and 35 in Bethnal Green; 15 and 35 in St. Giles. The deaths from all causes on the north side of the Thames (1118) were 89 more than the deaths (1029) of the previous week. The parishes which have not yet been visited must be on their guard. Those in which the epidemic has partially subsided should redouble their precautions. The epidemic of 1832 broke out in three successive eruptions; the first commencing in February, was at its maximum in

XXV

London Weekly Reports , 1849.

April and subsided ; the second rose rapidly from June to July, and sunk again down to the second week of August; its course was very much like that pursued by the present epidemic. The deaths returned by the parish clerks in the three weeks from July 17 to August 7, in 1832, were 968, 793, 661 ; which, allowing for the defects in their returns and for increase of population, are equivalent to 2323, 1903, 1586, or 5812 deaths in 1849, when the deaths registered in the corresponding weeks were 1931, 1967, 1909, or 5807 in the three weeks July 21st to August nth. A third eruption in 1832 broke out at the end of August, and extended to the first weeks of September ; a fourth in 1833.

ft is satisfactory to find that the deaths of 819 out of the 823 persons who died last week of cholera are certified. They were seen by qualified medical attendants. But it is to be feared that the advice was not obtained in time. The accounts of the sudden stoppage of the epidemic by prompt medical treatment and the house-to-house visitation are perhaps over-coloured. But a mortality as high now as in 1832 should not take place: it may be prevented by improvements in the treatment — by arresting the premoni- tory symptoms — by still earlier attention to the general health. Medical men are called when the people are dying; but it is then too late. If the families of the middle and higher classes were seen at intervals during the epidemic by their medical attendants, and a corps of medical officers employed by the Guardians to visit the poor at short intervals, the present epidemic might very probably be cut short, and a third eruption be averted. The precise locality in which almost every victim of cholera lived is given in the present return under each district; would it not be practicable for the authorities to have all these and the neighbouring localities inspected ? If this were done, and proper precautions taken, the tragedy of Albion-terrace, Wandsworth-road, where 17 persons died in two weeks in ten houses, could scarcely recur. The particulars of the 17 deaths will be found in the notes under Wandsworth and Clapham. Another case appears this week in the note under Hampstead. In the house, No. 6, Albion-terrace, Wandsworth, 5 deaths had been registered — a Wesleyan minister’s wife, aged 59 ; his mother, 80 ; a widow, 49 ; and two old servants. This is all we learn from the Clapham Registrar. The Registrar of Hampstead adds, that, during the week, an aged man came with a friend to Hampstead for change of air, — breakfasted, dined, went to London to transact business at the Bank of England, and after his return seemed “ pretty well.” At six o’clock the next morning he felt ill, and had medical advice, but died in eight hours. This old minister was apparently the last of his family, for he had seen his mother, wife, and servants die before him in Albion-terrace, and could not fly from the poison which he carried in his breast. Such desolation could scarcely happen without great negligence on the part of the people them- selves and on the part of the authorities.

August l2tli-if>tli. — It is one of the characters of epidemic diseases, that in some years their fatality is inconsiderable, in other years excessive. Since 1832 and 1833, cases of cholera have appeared in the Tables, — but the deaths in the second week of August during the past five years have fluctuated from 1 to 23. In the week ending Saturday, August 1 8th, the deaths in London were 2230; of which 1230 were by cholera, 188 by diarrhoea. The deaths from all causes in the last seven weeks were 1070, 1369, 1741, 1931, 1967, 1909, and 2230; the deaths from cholera, 152, 339, 678, 783, 926, 823, and 1230. The deaths from cholera exceed those in the previous week by 407; but in that week the mortality declined. The population is about 2,206,000 ; so that nearly 1 in rooo of the inhabitants now die weekly. The deaths from all diseases, except cholera, are 1000, which is the average number of the season; and 539 were at ages under 15, 256 at the ages 15-60, 205 at the age of 60 and upwards. Of the 1230 persons who died from cholera, 318 were under the age of 15, 721 were 15-60, and 191 were 60 and upwards : it carries off an excessive proportion of people in the prime of life. 597 males and 633 females died of the disease last week ; at an earlier period of the epidemic, the deaths of males exceeded those of females. Of 6194 persons who have died of cholera in London since September 1848, 3524 have died on the south side of the Thames. It has now crossed the River. The mortality last week increased in the districts of St. George Southwark, Newington, and Lambeth : it broke out with extraordinary violence in Greenwich ; and on the north side of the Thames — in Stepney, Shoreditch, and Bethnal Green — 55,98, and 125 deaths were registered. The deaths from cholera in the last two weeks were 35 and 125 in Bethnal Green, 21 and 98 in Shoreditch, 24 and 55 in Stepney, 42 and 76 in the districts of the East, West, and City of London, comprehending the jurisdiction of the City properly so called, 7 and 24 in Marylebone, 1 7 and 34 in Westminster district, 5 and 20 in Chelsea.

This excessive mortality must be viewed with great regret. Looking to the authentic reports of the effects of general sanatory measures, and of efficient medical relief placed within the reach, or carried to the homes of the people, it is quite evident that the measures now in operation are unequal to the emer- gency. The classes which have the greatest claim for public succour are not idle, habitual paupers, but tiie hard-working artizan : yet it is stated that in some parishes the arrangements are such that medical relief is not procurable directly from the district medical officers, who are, to the utmost extent of their powers, discharging their painful duties with praiseworthy diligence and humanity. In a disease which so often attacks in the night, and is fatal in twenty-four hours, the poor have to procure orders before they can be treated. Unless some change be made in these simple administrative arrangements, the mortality from cholera may be higher than it has yet been in London.

To render all the assistance which the registration system can afford for the discovery and removal of the causes of cholera, the Registrars were last week requested to state in each case — “ whether the house or street in which the death occurred was close, ill cleansed, over-crowded, or otherwise unfavourable to health.” The results will be found in the Notes [to the Weekly Table], which show, besides, the sex, age, profession, duration of disease, date and place of death — in every fatal case of cholera and of diarrhoea registered during the week.

August iqth-25th. — In the week ending Saturday, August 25th, the deaths registered in London were

XXVI

1849. London Weekly Reports.

2456 ; of which 1272 were by cholera, 240 by diarrhoea. The deaths from all causes in each of the last eight weeks were 1070, 1369, 1741, 1931, 1967, 1909, 2230, 2456; rhe deaths from cholera 152, 339, 678, 783, 926, 823, 1229, and 1272. Although the number of deaths last week is greater than any number yet recorded, it is gratifying to learn that active measures are now in actual operation, or commencing in every district, to combat the great epidemic which has already destroyed 7466 lives in London.

The energy with which parts of our institutions work makes the defects of the rest more evident. On August 9th last, a man was murdered in Bermondsey, and before his death, reported by the coroner, will appear in these returns, one— and it is probable both the persons charged with the murder will be in custody. Steam-ships, the electric telegraph, the heads of the police, and professional agents, specially chosen, were all employed to arrest the destroyers of this life; the columns of the newspapers were tilled with the details of the death. On the same day a stock-broker died at No. 12, Albion-terrace, Wands- worth-road ; a widow lady, and an old domestic servant at No. 6 ; in the five preceding days, in the same terrace, the daughter of a grocer, a child of 5 years of age, had died at No. 1 ; the willow of a coach- proprietor, and a commercial clerk, at No. 2 ; a gentleman’s widow at No. 3 ; a surgeon’s daughter at No. 4 ; a spinster of 4: at No. 5 ; the wife of a dissenting minister, his mother, a widow lady, and a servant at No. 6; a young woman of 2t at No. 10; a gentleman at No. 12, where the stock-broker died; a commercial clerk and a young woman of 19 at No. 13, where a young woman also died on July 28th; a gentleman’s wife at No. 14, who had seen her daughter die there the day before. The 19 persons died of cholera, many of the inhabitants of the Terrace were dispersed ; and the deaths of several have been registered elsewhere. “It appears,” says the Registrar, Mr. Frost, “that at No. 13, where the first death occurred, and where 2 deaths were afterwards registered, the refuse of the house had been allowed to accumulate in one of the vaults (which is a very large one) for about two years, and when removed last week, the stench was almost intolerable, there being about two feet of wet soil, covered with maggots. The drains also had burst, overflowed into the tank, and impregnated the water with which the houses were supplied. On the back ground, in the distance, was an open ditch, into which nearly the whole of the soil of Clapham runs.” As turpentine to flames, so is the exhalation of such cellars, tanks, and sewers, to cholera; it broke out — it diffused itself rapidly — it attacked many; and 19 inhabitants — after some hours of suffering, sickness, and spasms — expired.

The effects of decomposing refuse and water on health were well known — these fatal subsidies to cholera had been heard of every day; yet no steps had been taken for their removal from Albion-terrace in July — no medical police had interfered to disturb the contents of Mr. Biddle’s cellar — and now the 19 masters, servants, parents, children rest in their graves, it appears to be taken for granted that blame attaches to nobody — to nothing — not to the householders themselves — to the Guardians of the district — to the institutions of the country 1 Such mean inanimate instruments of death can be invested with nr. dramatic interest ; but fixing otu eyes on the victims, it is well worth considering whether substantially it is not as much a part of the sound policy of the country that lives like those in Albion-terrace should be saved, as that the murderers of the man in Bermondsey should be hanged.

The revelations of the state of their districts in the Registrars’ notes of this and last week prove that it will be no easy task — not to stay the plague of cholera for it will subside — but to remove the evils which make cholera and all epidemics fatal. The vast task of the physical amelioration of the population demands the energies of the best men in Her Majesty's dominions. When, in the country from which Asiatic cholera came, our armies seemed for a moment worsted, and the empire threatened, the great captain of the age is reported to have addressed to another the memorable words, “ If you do not go I must.” That enemy was distant. We have one now very near, in our streets, of which cholera, a servile minister, has destroyed already 7466 lives in London, and thousands mme in the rest of the kingdom. Who will go out against this enemy ? Is it too powerful or too feeble for the arm of the greatest? W ill no glory crown its conquest? Is the country insensible to its magnitude? Will not all the national strength and resources be put forth to improve the hygienic condition of the people, and to rid England of the causes of the fatality of epidemics? This may yet be done by the Government, if aided by the force of facts, and of enlightened public opinion.

Auqust 26 th to September 1st. — The deaths registered in London in the week ending September 1st were 2796 ; of which 1 663 were by cholera, 234 by diarrhoea. The mortality exceeds that of any previous week. The greatest number ever registered before in any week since 1840, was 2454 deaths, in the week ending December 4, 1847, when the last epidemic of influenza prevailed. In the cholera epidemic of 1832, the parish clerks, in the old Bills of Mortality, returned 1021 burials for the week ending August 28th ; which, allowing for the defects in their returns, and for increase of population, are equivalent to 2430 deaths at the present time. The burials after that week in 1832 declined.

The mortality is nearly three times the average of the season, and is sensibly felt all over the metropolis; but the inhabitants of the north and west districts, and people in the distance, can yet scarcely form a notion of the suffering on the south side the Thames, and, since the middle of August, in the east districts. “The 12th, 13th, and 14th of August,” says one of the Registrars of Bethnal Green, “will long be remembered in this neighbourhood, the outbreak of this fatal disease being without any adequate preparation ; surgeons were wanted in many places at once : the hurried passing and repassing of messengers, and the wailing of relatives tilled the streets with confusion and woe, and impressed on all a deep sense of an awful calamity.”

Cholera has already destroyed, in this epidemic, nine thousand one hundred and twenty-nine lives in London.

As it is one of the purposes of the Registration Act to ascertain the “causes of death,” and of the Weekly Tables, not to gratify idle curiosity, but to point these out to the public, the Registrars have been requested to give all the information they cau respecting the state of every part of their districts. This

London Weekly Reports. xxvii

many of them have taken considerable pains to do, and their notes will, it is hoped, be found serviceable to the guardians and medical inspectors, now and at future times. For it is important to bear in mind that cholera only brings into a strong light the localities, which elaborate calculations in the Annual Reports prove are at all times fatal to the health and life of the inhabitants.

Alter the perils of this terrible week we seem to see land ; but as many thousands of lives may be lost in an epidemic by negligence, so, many thousands may be saved by skill, vigilance, and energy — by more ample supples of water — by the rapid removal of nuisances from the houses and streets — by the prompt administration of medical appliances and other comforts, by the active co-operation of the medical profession, of the Boards of Guardians, of employers, of every householder, of every individual, with the Board of Health and health officers.

On the clay the above remarks were written, Tuesday, September 4th, the mortality in London was highest; 336 persons died of cholera during the day, 314 died on Wed- nesday, 297 on Thursday, 284 on Friday, and 31 1 on Saturday. As the decline of the epidemic was slow, and the registration takes place 3 or 4 days after death, the return for the week ending September 8th was heavier than the return on the week preceding. The mortality was now 3 times as high as the average; many people had lost friends or acquaintances that they had lately seen alive : and the uninterrupted increase inspired feelings of terror in some minds — a general uneasiness in all. Under these circumstances it was deemed right to advert to the epidemic’s decline, which its previous course, the law which governs its progress, its actual operations, and the season of the year — all rendered probable, and next to certain.

The natural tendency of the public mind is to make no timely provision against distant dangers, and to exaggerate dangers present; apathy had now given way to excitement, which the announcement of the next week was unfortunately calculated to increase.

September 2nd to September 8 th. — The Bills of Mortality were commenced in the reign of Queen Elizabeth; and ever since the year 1603, have been published by authority in London. In this respect the English metropolis stands alone; no Weekly Tables of the causes of death of every inhabitant are published in the capital of any other European state. Various motives for the measure have been assigned ; but the fact of continuous publication, from a period anterior to the appearance of newspapers and gazettes, is remarkable and characteristic. It may be fairly referred to the natural inclination of the English people, when they are in trouble, to know the truth ; and to see in figures the precise extent of their losses; although at times the sight might well make the courage of the bravest quail. On the Continent “ precautions have been used ” in publishing the mortality of cholera in 1849 ; and the deaths from all causes have not yet been made known. The parish clerks of London in the seventeenth century, when the plague was at its height, counted the deaths and recorded their supposed causes ; and the citizen, when the death-cart traversed the streets, anxiously studied the bill, surrounded by its gloomy symbolical border, announcing 8297 deaths in a week out of a population of 600,000. In the hands of Price, Heberden, Willis, Bateman, and other statists, these records have disclosed the laws of mortality, and the causes of the insalubrity of the present cities.

One of their immediate advantages, however, is the evidence which they furnish that the most fatal and threatening plagues go through, with some perturbations, certain prescribed orbits ; and after raging for a given number of weeks, disappear. Plague, influenza, and cholera have been vanquished before; and to despair now would be as unreasonable as it was in the beginning of the year to deny that the cholera epidemic was impending. Those officers who are struggling with the triumphant enemy under every disadvantage will yet be victors; for if they have art, they have also nature on their side.

The mortality in the week ending Saturday, September 8th, declined in the west and east districts of London, and increased slightly 111 the north and central districts, so that the deaths registered (1741) on the north side the Thames were 19 less than in the previous week. It was otherwise on the south side the river, where the deaths registered in the week were 1442! The total deaths registered in London were 3183: of males, 1460; females, 1723. The deaths of females exceeded the deaths of males by 263 ; the reverse of the usual proportions. The deaths from cholera were 2026 ; the numbers decreased in the districts of Shoreditch, Bethnal Green, Whitechapel, Stepney, Westminster; increased in Bermondsey, St. George Southwark, Newington, Lambeth, Wandsworth, Camberwell, and Rotherhithe. The epidemic, which had been partially subdued, broke out again with terrible violence in Lambeth, where 279 persons died of cholera in the week.

Mr. Daws, one of the Registrars of Lambeth, who has made careful inquiries on the subject, says : “At least half the cases I have registered were allowed to proceed unchecked, until the most alarming and dangerous symptoms had manifested themselves ; but lately more circumspection seems to have been used. Nevertheless, the cases are still numerous, in which persons seem (from the painless nature of the attack) to be unconscious how highly necessary it is that immediate attention should be paid to it.” People are so much accustomed to associate danger exclusively with pain, that the most fatal symptom unaccom- panied by pain is neglected. They must, however, be taught to look upon paiidess diarrhoea with the anxiety that people in the plague looked upon the swellings, called tokens — which were also pain- less— but with less fear ; for the premonitory symptom now seems to be sent not so much to announce death as to give timely warning, and to call attention to that stage of the malady in which medicine can heal.

xxv iii London Weekly Reports.

As medical skill is of most avail at the beginning and end of a fever, as the effect of the engines is most conspicuous at the outbreak anil end of a conflagration, and as most energy is demanded when the wreck nears the shore, so it is in an epidemic ; which, if it has not been checked at first, may yet be cut short, and combated with effect, as it declines. None of the measures of relief in any district should therefore be discontinued, but be prosecuted with redoubled vigour, until it has been completely subdued; and the districts which have not yet suffered greatly should immediately complete their preparations. For the time is short ; the evils of delay irreparable.

September yth to the l^th. — A daily return of the fatal cases of cholera and diarrhoea was now made to the Registrar-General. The particulars of all the deaths from these causes on Monday, September ioth, were printed on Tuesday, Sep- tember nth, and thus facilitated the house-to-house visitation, which had been set on foot by the Board of Health, and was efficiently carried out in several districts. The mean temperature, which in the two previous weeks had been 64°*o and 64°" i fell to 5 6C • 5 . The wind, which had been north, blew from the south-west. Electricity was as it had been for the two previous weeks, positive and stirring ; frequent flashes of lighining were seen during Monday, Tuesday, and Wednesday evenings. The sky was often overcast, and showers fell.

The deaths in the week fell to 2865 ; of which 1682 were by cholera, 280 by diarrhoea. From this date the epidemic rapidly declined : the deaths from all causes in the 8 weeks following were 1981, 1616, 1290, 1075, 1028,902, 837, and 893; the deaths from cholera in the same weeks were 839, 434, 288, no, 41, 25, II, and 6. The remarks in the table of this last week are: —

In the week ending Saturday, November loth, the deaths registered in the metropolitan districts were 893 ; a number which shows an excess of 56 on the return of the previous week, but a reduction of 269 on the corrected average of five autumns. If the present return be compared with that made in the same week of each of the years 1840-8, it will be found that, with but one exception (in 1841, when the deaths were 841), the mortality ranged formerly from 910 to 1165, and therefore was considerably higher than in last week, though the population in those years was less. The increase of 56 now observed on the week ending November 3, partly arises from pneumonia and bronchitis, the deaths from which become more numerous as the winter advances, having been 104 in the previous week, 127 in the last. The total number of deaths from cholera in the week was only 6 (5 less than in the previous week); in the same week of 1848 there were 62. The steady decline of diarrhoea and dysentery is shown by the numbers of the last five weeks, which were respectively 105, 63, 5 1, 40, and 29. A boy died of diarrhoea in Peter- borough-row, Fulham, whose father had been carried oil' by cholera in September; a boy of the same disease at Brudenell-place, New North road, from an unwholesome condition of the house; and a girl at Maidstone-place, in the house in which a death from cholera, reported in the former week, occurred, and in a locality then described as “ low and ill-drained.” Of the 6 deaths from cholera, one occurred at Water-lane, Homerton ; one at Wealherhead-gardens (Hackney-road), a place low, undrained, and drenched by waste water ; one in Christchurch, St. Saviour; one at Drummond-road, St James, Ber- mondsey ; one in Walworth; and one in Lambeth. A death from apoplexy, on which an inquest was held, occurred in Huntingdon-street, Hoxton The deceased was a female of 65, who for the last four years had lived in an underground cellar, which is only 11 feet in length, 8 feet 6 inches in width, 5 feet 9 inches in height, and sunk 5 feet 7 inches below the surface of the street. A small window scarce gives light or ventilation, and “ the walls ” (says the Registrar) “ are so damp that you might brush the water from them.’’

The mean daily reading of the barometer was above 30 inches on the last three days of the week. The mean of the week was 29*732. The temperature on the last three days was considerably higher than the average of the same days in 7 years. The mean of the week was 50°' 2, which is higher than the average by 4°* 1.

In the three last months of the year 1848, 478 persons died of cholera ; which in the year 1849 destroyed 1 41 37 lives in London. In the year 1849 not less than 3899 deaths were referred to diarrhoea. The deaths from the two causes were 18036. One in 161 of the inhabitants was cut oft" bv the epidemic in its severest form. Of every 10000 persons living 62 were killed by cholera, 17 by diarrhoea. *

While London was suffering, all the region round was assailed ; all the country in the basin of the Tiiames, Suffolk, Norfolk, the south midland counties, and Sussex, were involved in the attack. Some districts suffered severely, others escaped entirely, or, taking the population into account, only lo^t an inconsiderable number of lives. The scale on which the mortality is measured is IOOOO living, and the deaths in London by cholera out of this number were, as we have seen, 72 ; in all England, 33. The

* See Table, j>. exxx, where the mortality of districts in which cholera was most fatal is given, derived from the population enumerated March 31, 1851. The mortality of these districts is frequently alluded to.

Cholera Field round London.

XXIX

population of 1841 is the basis of the calculations; and where the range of mortality is so great as it is in this case, the variation in the rates of increase of population will not materially affect the results. In the metropolitan districts of Surrey the mortality from cholera ranged from Rotherhithe 253 (in 10000 inhabitants is understood throughout) to Wandsworth 122 : out of London, the districts of Eps«'m, Guildford, Farnham, Dorking, Reigate, and Godstone lost only 4 to 6 (in 10000) ; Hambleton and Farnborough lost none; Croydon 34; Richmond 35, Kingston 13, and Chertsey 24, the three latter districts lying on the south bank of the Thames. In Middlesex, on the north side of the Thames, Brentford lost 50, Staines 31 ; Uxbridge 21, Hendon 9, Barnet 20, Edmonton 24. In Hertfortshire, the districts of Hertford and Hitchin suffered severely ; 57 in 10000 were destroyed. Hertford is on the River Lea and near the source of the New River; Hitchin is further north, and is interspersed with hills; 24 deaths from cholera took place in the Hitchin Union workhouse. The first case at Hertford wras in the Union workhouse ; many of the deaths took place in the county gaol, at Butcherley Green and at Old Cross. In the Watford district 25, Hemel Hempstead 18 (in 10000) died of cholera. In Bishop Stortford, Royston, Hat- field, St. Alban, and Berkhampstead the mortality was inconsiderable, ranging from 2 to 7 in 10000. The mortality was equally low in the districts of Buckinghamshire, except Eton, where 20, and Wycombe, where 31 in xoooo died (chiefly at Great Marlow and High Wycombe). The latter districts are on the Thames. Windsor lost 28, and, ascending the Thames, Abingdon 18, Headington 22, Oxford 22, Witney 14. At Wokingham, Bradfield, Wallingford, Woodstock, Faringdon, and Cirencester in Gloucestershire, near the source of the Thames, the mortality was inconsiderable, not exceeding 2 in 10000. The counties of Northampton and Huntingdon escaped with few deaths ; at Northampton 17, Hardingstone 28, Peterborough 19 in 10000 died. Hardingstone adjoins Northampton; the first case occurred in a -boatman; 20 of 24 deaths fronf cholera in this district took place at Piddington. In Bedford 12, in Biggleswade 14 in 10000 died ; the rest of Bedfordshire lost less than 2 in 10000. In Essex, descending on the north side of the Thames, West Ham lost 50, Romford 67, Orsett 28, Rochford 66, Maldon, round the Blackwater River on the east coast, 15, Tendring 27 in 10000. Tendring includes Harwich, where nearly all the cases occurred, chiefly in the families of mariners, fishermen, and dredgermen. The population of Harwich was 3829 in 1841, of whom 69 died of cholera; 25 in the week ending Sep- tember 8. The rest of the county of Essex — except Epping, where 13 in 10000 died — suffered inconsiderably. The same may be said of the whole of the counties of Suffolk and Norfolk. Some districts of Suffolk had no deaths; others had 1 or 2 in 10000; Ipswich lost only 7 in 10000 by cholera, but suffered severely from diarrhoea; Wang- ford 7, Muttord 16 in 10000. The deaths in the latter district were chiefly at Lowes- toft, which is included in the port of Yarmouth. In Yarmouth itself 36, Norwich 6, Mitford7in 10000 died. Two parishes in Docking have already been referred to, p. xxi. Buxton, a parish in the Aylesham district, suffered from a similar circumscribed attack. Norwich and Kings Lynn and Yarmouth suffered a good deal from diarrhoea. In five districts of Norfolk no deaths were referred to cholera, in all the rest except those already named the mortality was inconsiderable. In Cambridgeshire, North Witchford lost 58, Whittlesey 17, Wisbeach 44 in 10000: like Peterborough they are marshy and unhealthy districts, lying about the embouchure of the Ouse and the Nene. The rest of the districts of Cambridgeshire suffered little. Gamhngay in Caxton was the seat of one of the circumscribed attacks, fatal to 12 persons. In Kent, the districts on the south bank of the Thames, and the coast down to the North Foreland, suffered from the epidemic; the deaths in 10000 were, in Dartford 46, North Aylesford (containing North- fleet) 50, Hoo 25, Medway (including Rochester and Chatham) 34, Milton 59, Sheppey (including Sheerness) 50, Faversham 10, Blean 17, Thanet (including Margate and Ramsgate) 65. Of the districts on the coast from the Isle of Thanet to Dungeness, Dover alone was attacked with any severity. The attacks were often circumscribed : thus of 1 17 deaths in Dartford, 35 occurred in the parish of Crayford, 17 deaths in the Union work- house Dartford, and 20 at Waterside. At Dartford a labourer, his wife, and four children were cut off by the pestilence. At Gravesend 1 96 deaths from cholera were registered ; 26 of persons who died on board vessels lying off Gravesend, 34 in the workhouse, 9 in

XXX

Portsmouth and Plymouth Fields.

Passengers’-court, and 8 in Kempthorne-street. “The whole of the surface and under- ground drainage falls into rudely-constructed cesspools.” Of 73 deaths from cholera in North Aylesford 32 were at Northfleet. All the districts in the interior of Kent escaped with few or no deaths. But in Loose, a sub-district of Maidstone, 43 deaths occurred in the parish of East Farleigh, chiefly among the Irish hop-pickers. The remaining deaths in Maidstone amounted to 55. The decrease of the mortality on the high grounds of the county is shown by the districts traversed by the River Medway; ascending that river, in Sheppey the mortality in 10000 was 50, Milton 59, Medway 34, Mailing 11, Maidstone (including the hop-pickers at Loose) 30, Tunbridge 8, Seven- oaks 2.

In Sussex only three districts lost more than 10 in 10000 of the inhabitants; namely, Hastings, where 34, Brighton, where 41, and Steyning, where 17 died of cholera to every 10000 inhabitants enumerated at the previous census. In Cuckfield there was a circumscribed attack.

83; 3 Cuckfield; Hurstperpoint. Pop. 5711. Clio. 14. Diarr. 5. — The whole of the deaths from cholera took place at Pyecombe (one of 7 parishes forming the sub-district), where the epidemic broke out with great malignancy in June. Its first victims were three children of labourers, on the 20th, and a fourth on the 22nd. Four cases terminated fatally on August 1st, and 2 on the following day; a shepherd died on the 6th, and his widow on the 10th. The recorded duration of attack was in some instances remarkably short — 4, 5, and 6 hours — 7 hours being the average.

On this wide field, extending over the counties of Middlesex, Surrey, Kent, Sussex, Berks, Hertford, Buckingham, Oxford, Northampton, Huntingdon, Bedford, Cam- bridge, Essex, Suffolk, and Norfolk, the epidemic committed great ravages: and 18502 lives were destroyed by cholera alone. But its successes were only partial ; of 241 5 1 59 persons and more living, 16285 lost their lives in 36 London and 18 country districts, having an area of 1144 square miles; while only 2217 persons died in a population of 2843183 on 13370 square miles. The poison, or whatever it was, pervaded the whole field ; for in almost every district it caused one or more deaths, either in the aggravated form or in the masked shape of diarrhoea.

PORTSMOUTH CHOLERA FIELD.

Portsmouth, Southampton, and Salisbury, formed the basis of a less extensive attack ; but to 10000 living enumerated in 1841,* Portsea Island lost 107, Alverstoke (Gosport) 93, Southampton 88, the adjoining district of South Stoneham 27, Romsey 14, the Isle of Wight 36 (where nearly all of the deaths occurred in the low ports on the north slope of the island, in Cowes, Newport, and Ryde), Winchester 18, Salisbury 174, the two adjoining districts of Alderbury 19, Wilton 12, Devizes 30. In all the other districts of Hampshire and Wiltshire the mortality was inconsiderable, although nearly all were visited in one form or other: 1251 deaths occurred in Portsea Island, Alver- stoke, Southampton, the Isle of Wight, and Salisbury, to 1457 n living in 1841, on an area of 163 square miles; while on the rest of the two counties only 309 died of cholera to a population enumerated in 1841 at 449109 on an area of 2584 square miles: so circumscribed was the fatal working of the malady.

PLYMOUTH CHOLERA FIELD.

Plymouth is the centre of a cholera field which extends along the southern coast of England from Purbeck Bay, in Dorsetshire, to the Laud’s End. No deaths from cholera were registered in Shaftesbury, Sturminster, Blandford, Wimborne, or Bea- minster districts, in the interior of Dorsetshire; owe death was registered in Sher- borne, and owe in Warcham, on the coast. In Dorchester, separated from the sea by the Black Down, 16 deaths occurred, 10 at Fordington, 2 at Holloway-row, 1 at Bohmston Stinsford, 2 at Piddlctown, 1 at Stafford; 11 deaths were recorded at Bridport on the coast; and at the ports of Poole and Weymouth the mortality was 26 and 32 in IOOOO. Proceeding along the sea-side districts of Devon, certain small detached places on the coast were visited severely : thus at Torquay there were 72 deaths, Brixham 75 deaths; 11 at South Brent, 13 at Modbury; in Exeter the deaths were 44, the mortality 14 in 10000. At Plymouth, East Sonehouse, Stoke

* A Table of the Mortality in many of these districts, calcnluted from the population enumerated in 1851, is gwen at page exxx.

Bristol Cholera Field.

XXXI

Damerel, and the surrounding districts of Plympton St. Mary, Tavistock, St. Germans, and Liskeard, round the harbour — the Tamar and the Tavy — 2381 cases of cholera were fatal.* The mortality in the 4 districts lying against the sea was excessive, and approached 2 per cent, of the population. Whole families were swept away. Many emigrant ships sail from Plymouth, and others touch there. The epidemic was diffused among the unhappy emigrants, and many perished. The “ American Eagle,” on board of which 6 deaths from cholera occurred, attracted attention at an early period, and was visited by officers of the Board of Health. The healthy districts of North Devon had few or no deaths. Barnstaple and Bfracombe were exceptions ; these two ports had several deaths, which made the mortality from cholera in the Barnstaple district 14 in xoooo. This belongs properly to the Bristol Channel field. The action of the epi- demic was prolonged down the south coast of Cornwall, and fell with intense violence on certain spots. At Mevagissey, in St. Austell, 126 deaths from cholera were recorded out of a population in 1841 of 2310. The mortality of St. Austell was 43, Truro 19, Falmouth 34, Redruth 28, the Scilly Islands 15 in 10000. The districts of Stratton, Camelford, Launceston, Bodmin, St. Columb, Helston, and Penzance escaped: the mortality in these large and populous districts was quite inconsiderable.

BRISTOL CHOLERA FIELD.

The country on both sides of the Bristol Channel was attacked by the epidemic. Bristol was one of the centres of attack; Merthyr Tydfil, in Glamorganshire, the other. Bristol is surrounded on the north side by the Clifton district, which extends to the Channel ; and is separated to the south from Bedminster, in Somer- setshire, by the river Avon. The mortality in the Bristol district was 90, the Clifton district 75, the Bedminster district 74 in iocoo. Ascending the Severn, the mor- tality in the Thornbury district was 5, in Dursley 35, Wheatenhurst 21, Gloucester 44, Tewkesbury 39. Here it may be convenient to trace the epidemic up the Severn, out of the bounds of the Bristol field, through Worcestershire, Shropshire, and Montgomeryshire. The mortality in Upton-on-Severn was 8, Worcester 16, Martley '8, Droitwich 13, Kidderminster 4, Bridgenorth 47, Madeley 23, Shrewsbury 54, Atcham 8, Montgomery 18, Newtown, extending up to the sources of the Severn, 3. Nearly all the deaths in the Dursley district occurred at Wotton-under-Edge and Kings- wood, among labourers, weavers, and their families. Of the 13 deaths from cholera in Upton-on-Severn, 8 were in the Union workhome. The Bridgnorth district consists of three sub-districts : in the Bridgnorth sub-district, with 6199 inhabitants, 70 deaths occurred, in Worfield 5, in Chetton none. Of 15 deaths in the Atcham district, 13 occurred in the Union House at the Cross Houses; 34 of the 37 deaths in the Mont- gomery district were in Pool. None of the other districts of Gloucestershire, Worces- tershire, Shropshire, or Montgomeryshire, were assailed with any sensible effect by tne epidemic, if we except Stourbridge, which is involved — as well perhaps as Madeley, Bridgenorth, and Shrewsbury — in the Wolverhampton field. No deaths were returned in the districts of Tetbury, Northleach, Stow-on-the-Wold, Wmchcomb, in Gloucestershire; in any district of Herefordshire, except Leominster, where 1 death from cholera was recorded ; in Ludlow or Clun, in Shropshire ; in Evesham, Tenbury, or Pershore, in Worcestershire. All these districts escaped. The deaths from diarrhoea in Hereford were 21 ; in the other districts few or none. I11 Northleach, having 10661 inhabitants, in 1841, no death either from diarrhoea or cholera was registered.

In Somersetshire, proceeding from Bedminster, the mortality was 35 in 10000 in Keynsham, 13 in Bath, 39 in Clutton, 13 in Wells, 23 in Shepton Mallet, 74 in Bridgewater on the Parrot, and 18 in Taunton on the Tone, which flows into the Parrot. In Langport, higher up the Parrot, no death from cholera was registered ; and generally the interior districts, as well as Williton and Wellington on the Channel coast, leading to the healthy districts of Exmoor Forest, were left unscathed.

Crossing the Bristol Channel, we arrive in Glamorganshire on —

* See an exceedingly interesting and instructive account of the epidemic in a sub-dislrict of Plympton St. Mary, by A. C. Maclaren ; “ M'Culloch and Maclaren on Cholera,” 1850.

XXXll

Merthyr Tydfil.

\ THE MERTHYR TYDFIL CHOLERA FIELD. '

In the Cardiff district, embracing the feet of the great coal and iron district, the mortality was 90 in 10000; Merthyr Tydfil, further in the interior, 234; in Bridgend, lower down the Channel, the mortality was 41, Neath 169, Swansea 68. Round Car- marthen Bay, in Carmarthenshire, the mortality in Llanelly was 22, in Carmarthen 38 in 10000; in the interior, Llandilofawr 23, and Llandovery 10 in 10000. Ascend- ing the Usk, Newport lost 75, Pontypool 28, Abergavenny 86, Crickhowel 54, Breck- nock, round the sources of the Taf and (he Usk, 4 in 10000 inhabitants. The districts on the lower section of the Wye, which enters the Severn above the Channel, suffered little more than Herefordshire and Radnorshire; the deaths in the Chepstow district were 1, Monmouth 9 in 10000. A few deaths from cholera were registered in Pembrokeshire. No deaths from cholera, few from diarrhoea, were registered in Cardigan, Newcastle-on-Emlvn, Aberayron, Aberystwith or Tregaron, in Cardigan- shire; Presteigne or Rhayader, in Radnorshire; Machynlleth, in Montgomeryshire; Llanrwst, in Denbighshire ; Bala or Dolgelly in Merionethshire ; Conway, in Car- narvonshire. Except the districts named, Holywell and Flint, on the Dee, Amlwch and Holyhead, in Anglesea, were the only districts in Wales where cholera produced any number of deaths.

In Cardiff 2 male infants died of cholera on January 3rd and February nth, after attacks lasting 12 days and 3 days respectively : epidemic cholera did not appear until May 13th, when it was fatal to a navigator, aged 19, at 39 Bridge-street, after an attack of 24 hours’ duration, preceded by diarrhoea for 3 days. Towards the end of May a considerable increase of mortality took place, and the epidemic was at its height on June 7, when 14 persons died, and during the month it was fatal to 135 persons. The Registrar of the Cardiff sub-district, in his return for the quarter ending June, 1849, in alluding to the increase of the number of deaths, says: — “This mortality may in some degree be ascribed to inadequate drainage, partly to the letting out of a canal which passes through the town, thereby exposing the mud and matter at the bottom to the action of the sun, but still more to the very crowded state of the streets and houses in the poorer localities, to which the disease (cholera) has thus far chiefly confined itself.” In July the number of deaths fell to 69, but rose again to 91 during August ; in September 55 persons died; in October 3 ; and the epidemic finally disappeared alter being fatal to a labourer’s widow, aged 83, at Great Frederick-street, on Novem- ber 19, and to a carpenter’s son, aged 5 months, at Homfray-street, on December 7th. During the year 1849 cholera destroyed 396 lives (206 males; 190 females), being at the rate of 90 deaths to every 10000 persons living. Diarrhoea was latal to 75 persons (43 males; 32 females), being at the rate of 17 to every 10000 persons living.

Merthyr Tydfil, with the exception of Hull, suffered more severely from cholera than any district in the kingdom. Its first appearance was on May 21st, when a labourer’s son, aged 4, died after an attack of 14 hours’ duration, at Heolygillor, and by the end of the month it was fatal to 16 persons. In June a rapid spread of the epidemic look- place; on June 7th and 9th the daily deaths amounted to 22, and 349 persons died during the month. In July the number of fatal attacks was 539, and as many as 32 persons died on July 26. In August the epidemic w-as at its height ; the daily mor- tality reached 36 on August 2nd; as many as 30 died on August 15th; during the month it was fatal to 548 persons. In September the deaths fell to 190, and further declined to 37 in October. In November 3 persons died; the last fatal case being that of a miner’s widow, aged 73, at Fynnon Tydfil, on November 21st. The fol- lowing places suffered severely from cholera : — Pont-y-Pridd, Llanwonno ; Pedwranfach ; Caedraw ; George Town; Market-field; Pont-y-Storehouse ; Penydarran ; Cae Pant Twvll ; Quarry-row; Cefn Coed, C\ mmer ; Fynnon Tydfil; New Souih Wales, Dow- lais ; High street and Well-street, Dowiais ; Hirwain, Peuderyn. Cholera was fatal to 1682 persons (884 males; 798 females), being at the rate of 234 deaths to every 10000 persons living ; diarrhoea was not fatal to more than 97 persons (53 males; 44 females), being at the rate of 14 deaths to every 10000 persons living.

In Neath 2 persons died of cholera in February 1849; but it was not until May

Wolverhampton Cholera Field. xxxiii

2 1 st that the epidemic began to be fatal, when it appeared among the labouring population at Aberdylais, Blaen Louddan. Throughout June the epidemic prevailed, and 80 persons died during the month. After the first week of July a rapid in- crease of mortality occurred; on July 17th as many as 18 persons died, and on several days it was fatal to 16 persons daily ; during the month 296 deaths took place. The mortality continued high during the first three weeks of August, and the deaths in the month amounted to 260 ; the deaths declined to 84 in September, and to 10 in October. The last fatal attack took place on November 10th, when a labourer, aged 47, died after an illness of 13 hours, at Lonlase, Llansamlet Higher.

During the year 1849 cholera was fatal in Neath to 738 persons (353 males; 385 females), being at the rate of 169 deaths to every 10000 persons living. Diarrhoea destroyed 61 lives (28 males; 33 females), being at the rate of 14 deaths to every 10000 persons living.

A table is given in another part of the Report showing the progress of the epidemic during each day of its prevalence in the districts of Cardiff, Merthyr Tydfil, and Neath.

THE WOLVERHAMPTON CHOLERA FIELD.

At the southern extremity of Staffordshire, on a space 12 miles square, 3275 persons died of cholera and of diarrhoea. The mortality from cholera was in the district of Wolverhampton 137, Walsall 54, West Bromwich 48, Dudley 48, Stourbridge ex- tending into Worcestershire, 65 in 10000. It is the Midland coal-field. The Potteries to the north, comprising Wolstanton, Stoke-upon-Trent, and Newcastle-under-Lyme, where the mortality was considerable, and Nantwich in Cheshire, Shrewsbury, and Bridgenorth to the west, Coventry to the east, may be considered out-lying districts, connected more or less with this field, which is in direct communication with Liverpool and Manchester. The field is near the centre of England; and it is worthy of remark, that the outbreak of the great epidemic may be set down so late as July for Wolverhampton, August for the other central districts. The districts immediately surrounding those infected escaped unscathed : thus the mortality in 10000 was only 5 in Penkridge, 2 in Lichfield, 2 in Tamworth, 2 in Burton-on-Trent, 1 in Cheadle, 1 in Leek, 4 in Stone, 1 in Stafford. In Uttoxeter, with 14932 inhabitants, no death from cholera, and only 1 from diarrhoea occurred. Warwickshire, with the ex- ception of Coventry and Foleshill in its vicinity, suffered as little as the exempted districts of Staffordshire ; the mortality from diarrhoea in Birmingham and Aston was however considerable. In Atherstone and Solihull there was no death from cholera; in Meriden 1, Nuneaton 2, Rugby 1, Stratford-on-Avon 2, Alcester 1, Shipton- on-Stour 1, Southam 1. Rutlandshire and Leicestershire enjoyed an extraordinary immunity : in Melton Mowbray there was no death from cholera, only 8 from diarrhoea; in Leicester 2 from cholera, 75 from diarrhoea. Six of the districts of Lincolnshire scarcely suffered at all; the deaths ranged only from 1 to 3 in 10000. Gainsborough, on the Trent, flowing into the Humber, was visited heavily; the deaths from cholera were 246, diarrhoea 63 ; the mortality from cholera was 91 in 10000. Caistor lies south of the Humber over against Hull, and the mortality was 1 1 ; in Glandford Brigg 9 in 10000. In Lincoln the mortality was only 2 from cholera, 12 from diarrhoea in 10000. Nottinghamshire escaped with few deaths; the mortality from cholera was in East Retford 10, Newark 10, Bingham 9, Basford 7, Radford 3, Nottingham 3 in 10000. In Nottingham the mortality was 18, in Radford 17 in 10000 from diarrhoea. In the district of Southwell, including part of Sherwood Forest, no death Irom cholera occurred among the 25014 inhabitants. Derbyshire suffered still less than Nottinghamshire ; the mortality in the district of Derby was 5 in 10000 from cholera, 11 from diarrhoea. In the rest of the county the mortality was inconsiderable.

THE LIVERPOOL CHOLERA FIELD.]

The epidemic fixed itself firmly in Liverpool as early as March, and around this centre infested several of the districts of Cheshire and Lancashire; the mortality diminishing in the distance. Thus the mortality in iooco was 167 in Liverpool, 82 in West Derby, 40 in Prescot, 22 in Ormskirk, "5 in Wigan, 19 in Warrington,

d

xxxiv Liverpool Cholera Field.

4 only in Leigh, 13 in Bolton, 7 in Bury, 7 in Worsley. Here the epidemic assumes a somewhat more severe form ; the mortality was at the rate of 40 in 10000 in Manchester, 28 in Salford, 30 in Chorlton. The mortality was 27 in 10000 in Lancaster : in the remaining districts the mortality was inconsiderable. Crossing the Mersey, the mor- tality in iocoo was 44 in Wirral, including Birkenhead ; 19 in Great Boughton, including Chester, on the Dee; 36 in Runcorn, on the south bank of the Mersey ; 1 6 in Northwich, on the Weaver, flowing into the Mersey. In Stockport only 8, Maccles- field 6, Congleton in 10000 died of cholera.

It will be right to give here a more particular account of the ravages of the epidemic in the populations of Liverpool and Manchester.

Liverpool suffered two visitations of epidemic cholera ; the first was comparatively slight, prevailing from the end of July to the close of 1848, and was fatal during that year to 33 persons, of whom 12 were males and 21 females, mostly children of labourers and artisans. In 1849 no fatal attack is recorded until January 9, when a widow, aged 76, died at No. 1 Court, Upper Pownall-street, of cholera and consecutive fever, 7 days’ duration. On January 15th, a sawyer’s wife, aged 44, died at 32, Eldon-street ; the death of her husband followed, on January 21st, after an attack of 19 hours’ duration. The next two cases occurred at 14, Hornby-street, on January 29th and 30th, of a sawyer’s wife, agpd 42, and an unmarried female aued 21. Diarrhoea was fatal to 29 persons during January. In February 7 deaths took place from cholera, occurring at intervals of a few days. Diarrhoea, which became more prevalent towards the latter part of the month, destroyed 36 lives. In March the deaths from cholera increased to 18, chiefly occurring in the courts of Arley, Oriel, and Chisenhall-streets, and also in the workhouse in the Mount Pleasant sub-district. The first death in the cholera hospital, Queen Anne-street, was on March 1st, when a labourer’s wife, aged 30, died, after an attack lasting four days ; and another labourer’s wife, aged 30, died in a van near the cholera hospital on March 25th. Diarrhoea remained nearly stationary during this and the two following months. In Apiil there were 19 deaths from cholera, 5 of them occurring in the cholera hospital, Queen Anne-street, and 3 in the workhouse. In May the mortality from cholera increased to 96, and the epidemic had now completely established itself, increasing daily in each of the sub-districts. In June 424 fatal attacks are recorded, and the daily number varied from 5 on June 6th, to 25 on June 29th. In July 1085 were added to the deaths pre- viously recorded. On one day, July 18th, the number of fatal cases was 59, the average during the month being 35 daily. In August the epidemic greatly increased, and the daily mortality reached 84 on August 13th, this being its maximum. Its decline now became perceptible, although it was not regularly progressive. Thus the deaths declined to 31 on August 30th, and afterwards increased for a few days, until, on September 5, no fewer than 66 deaths took place. From this point its decline became more steady, the deaths, which amounted to 1575 in August, were reduced to 874 in September, and further declined to 62 in October, 58 of which took place prior to October 12, when the epidemic, which had been so fearfully prevalent among the labouring, maritime, and trading classes, might be regarded as at an end, 2 deaths only taking place in November and 6 in December. Cholera hospitals were established in Vauxhall-road, in the Dale-street sub-district, in Ansdell-street, in the St. Thomas sub- district, and in Queen Anne-street in Islington sub-district. Many deaths took place in these hospitals, and also in the workhouse in the Mount Pleasant sub-district. A book- binder, his wife, and son died at 3 Dukinfield-street, on August 15th, a female relative, aged 2, having previously died in the same house on August 13th. Many instances occurred of more than one member of the same family dying. During the year 1649 cholera was fatal to 4173 persons (1895 males, 2278 females), being at the rate of 167 deaths to every 10000 persons estimated as living in 1849. The deaths from diarrhoea amounted 10 981 (459 males, 522 females), or 39 deaths to every IOOOO persons living.*

* A Report on the Health of the Town of Liverpool during the years 1847-50, by the Health Officer, W. H. Duncan, M.D., has appeared since this paragraph was written: it contains an interesting account of the epidemic.

Manchester.

xxxv

In West Derby (surrounding Liverpool) no case of epidemic cholera appeared prior to March 29th, when an anchorsmith’s son, aged 5, died at 3, Abstinence-street, after an attack of 21 hours’ duration. The next 2 cases followed on April 7th, at Henderson- street, where a mariner’s wife aged 24, and a spinster aged 26, died after attacks lasting 17 hours and 15 hours; both are said to have been in a state of collapse when first seen by the medical attendant, as was a cordwainer’s wife aged 30, who next died, on Aprilnth,at 14 cellar, Henderson-street, after an attack of 28 hours’ duration. Eightother deaths occurred at intervals up to the end of May. Early in June the epidemic began to spread, and the daily deaths amounted to 1 1 on June 21st, and the mortality during the month was 92. No considerable increase in the number of deaths took place until the middle of July, when they became more frequent, and amounted to 245 during the month; they increased to 409 during August. In the early part of September cholera continued to increase, and attained its maximum severity on September 5th, when it was fatal to 27 persons. It declined slowly during the following 10 days, anil after- wards more rapidly, until, on October 9th, only 1 death occurred ; another followed on October 2 2nd, and on October 29th the last fatal base of cholera is recorded in the death of a mariner, aged 49, in the cholera hospital. In another part of the Report a table will be found showing the deaths in Liverpool and West Derby combined, on each day of the four months during which the epidemic was most prevalent.

During the year 1849, 1135 persons (488 males, 647 females) died from cholera, which was at the rate of 82 deaths to every 10000 of the population. Diarrhoea was fatal to 279 persons (141 males, 138 females), being 20 to every 10000 persons living. In the sub-district of Toxteth Park, which comprises less than half the population of the whole district, 91 2 deaths (383 males, 529 females) from cholera and diarrhoea were registered. The cholera hospital was in this sub-district.

Manchester , Chorlton, and Salford form a group of districts lving contiguous ; and a table is given elsewhere, showing the deaths from cholera and diarrhoea in the three districts combined, on each day of the four months during which the epidemic was most fatal : it will be seen that the mortality was very high throughout September, and the first few days of October : on several occasions the deaths exceeded 40 daily; and on September 14th, 45 fatal cases occurred.

It is worthy of note that in the whole of England the deaths from cholera were nearly three times as numerous as those from diarrhoea; while in this group of districts the mortality from these diseases was nearly equal, viz., from cholera 1395 ; diarrhoea, 1331; and while cholera destroyed 594 males, and 801 females, diarrhoea was fatal to 701 males, and 630 females.

In Manchester* no fatal case of epidemic cholera occurred until June nth, 1849, when a packer, aged 20, died of an attack of diarrhoea 20 hours, and cholera 21 hours, at Bird-in-hand, Redfern-street ; the next four cases took place on June 25th, 26th, 28th, 29th ; of which three were at the workhouse, Canal-street, and one at No. 7, Nield-street ; the attacks being of short duration. Not more than 6 deaths happened during the first three weeks of July ; after this an increase was observed, and the deaths during the month amounted to 23; diarrhoea became very pre- valent, and was fatal to 149 persons. No further increase in the mortality occurred in the early part, of August; towards the end of the month, however, the epidemic began to spread. The deaths amounted to 93 during August, and diarrhoea was also very fatal, causing 208 deaths. The deaths from cholera were further augmented by 622 during September, when they averaged 20 daily, and on September 11 amounted to 34. The mortality continued very high until after October 4th, and no fewer than 27 fatal cases happened on October 2nd; after this its decline became more marked, and the deaths throughout October did not exceed 147 : to this number only seven were added during November, the last being on November 23rd, when a cordwainer’s daughter, aged 7, died at 3 Back Hatters’-lane, after an attack of 16 hours’ duration : no other fatal case is recorded afterwards during the year.

* For a valuable and elaborate account of the progress of cholera, see “History of Cholera in Man- chester,” by J. Leigh, Esq., M.R.C.S., one of the Registrars, and Ner Gardiner, Esq., Superintendent- Registrar of Manchester.

d 2

XXXVI

Hull Cholera Field.

Cholera destroyed 878 lives (374 males ; 504 females) in 1849, being at the rate of about 40 deaths to every 10000 persons living. Diarrhoea was fatal to 765 persons (404 males; 361 females), or 35 deaths to every 10000 persons living. Cholera did not visit Manchester until full three months after it had prevailed in Liverpool; it was also much less fatal. For while in Liverpool there was one death to every 60 persons living ; in Manchester there were 252 persons living to every fatal case of cholera.

In Salford, as in Manchester and Chorlton, the cholera epidemic did not appear until June, 1849. At 5 Paradise-row, on June 24, a colour-mixer, aged 57, died of cholera live days’ duration, and typhus gravior two days; on June 27, a porter’s daughter, aged 5, died at Cleminson-street, of cholera after an attack of 12 hours’ duration. In July seven fatal attacks occurred at intervals, and the deaths from diarrhoea, which were 6 in June, increased to 2 6 in July. After August 1 2 th , both cholera and diarrhoea became more prevalent, and the deaths during the month were respectively 50 and 91. Throughout September cholera continued at its height: the number of deaths on September 1st was 6; on September 13th they increased to 9, which was the highest number in any one day ; on the last three days of the month the deaths were 7, 6, and 8 respectively : the mortality during the month was, cholera 148 deaths ; diarrhoea 62. After the first week in October the epi- demic subsided more rapidly, and the last death took place on October 19th, at Back Oak-street, when a shoemaker’s wife, aged 33, died of cholera of 3 days’ duration, effusion on brain 1 day. The deaths during October were of cholera 30 ; diarrhoea 31. In November diarrhoea was fatal to 9 persons, and in December to 6. The fatal attacks of cholera in most cases were of short duration, and in a great number of instances ranged from 6 to 12 hours. During 1849 cholera destroyed 237 lives (98 males; 1 39 females) ; and diarrhoea was fatal to 261 persons (141 males; 120 females).

In Chorlton, cholera was very prevalent in July, 1848, among young children in the ITulme sub-district, though it was apparently only the ordinary summer cholera ; but on December 1st, a female servant, aged 24, died at 2 Knibbs-place, Victoria Park, of cholera, attended with purging, vomiting, cramps, and collapse, 24 hours’ duration.

In 1849 no fatal case of cholera is recorded until June 1st, when a female, aged 27, died at 57 Park-street, of cholera and apoplexy, 36 hours’ duration ; on June 4, a female factory-hand, aged 28, died at Timothy-street, Eccles, after an attack lasting 12 hours. 2 other deaths occurred during June; and towards th elatter part of July the epidemic began to spread, and was fatal to 1 5 persons during the month ; diar- rhoea was still more prevalent, and caused 57 deaths in July. In August cholera caused 67 deaths, and diarrhoea 70. During September the epidemic was at its height: the greatest number of persons dying of cholera in one day was 13 on Sep- tember 1 8th, and during the month it was fatal to 163 persons. After the first week in October a perceptible decrease took place, and no death occurred after October 25th, excepting that of a weaver, aged 65, at the Union workhouse, Hulme, on December 25th, of debility consequent on cholera. Many instances are recorded of more than one death happening in the same family ; and at No. 3, Islington-place, 4 .adult persons died. At the Union workhouse numerous deaths, both from cholera and diarrhoea, took place. The deaths from diarrhoea exceeded those from cholera, viz., cholera 280 (122 males; 158 females); diarrhoea 305 (156 males; 149 females).

THE HULL CHOLERA FIELD.

In Yorkshire cholera destroyed 6346 lives, and 1955 deaths were ascribed to diarrhoea. This great county extends over the basin of the Ouse, which constitutes, by its junction with the Trent, the Humber, on the north side of which lies the port of Hull, the gate of the commerce of Leeds and the woollen districts. The mortality in the district of Hull was 241 ; Sculcoates, round Hull, 152 ; Beverley, north of Sculcoates, 1 1 in 10000. In the four coast districts, Patrington, Skirlaugh, Driffield, and Bridlington comprising Holdcrness, and lying higher than Hull, the mortality was only 5,4, 1, and 6 in 10000. Up the Ouse, Howden lost 41, Selby 73, York 36; Pocklington, west of York, 24 in 1 0000. Hull is intimately connected with the district of Leeds by the railway passing through Selby, by the roads and the River Ouse. The mortality in the district of Leeds

Hull and Sculcoates.

xxxv u

was 145, and only inferior to that of Hull and Sculcoates. In Hunslet, adjoining Leeds, the mortality was also great, 102. Dewsbury, Wakefield, Pontefract, and Eccles- field, south of Leeds, suffered less. In Goole the mortality was 59, Thorne 46, Doncaster 24, Rotherham 10, Sheffield 13, Ecclesall-Bierlow n, Wortley 2 in 10000. These districts are south of the Ouse, and are chiefly on the Don. The districts on the Nidd, the Ure, the Swale, and the Derwent, the other tributaries of the Ouse and Humber, exhibit few or no deaths. The mortality in Huddersfield was 5,* Todmorden 4, Saddleworth and Pateley Bridge 3, Halifax, Keighley, Otley, Ripon, Skipton, 2 in 10000. Cholera produced no deaths in Sedbergh or Settle on the high grounds. In the North Riding the mortality was, 6 in Thirsk, 5 in Whitby, 4 in Scarborough, 3, 2, or 1 in eight districts; none in Helmsley, Leyburn or Reeth. In October, as the great epidemic was declining, a sudden outbreak occurred in the district of Knaresborough, where the mortality was 19 in 10000.

The ravages of the epidemic in Hull, Sculcoates, Leeds, and Hunslet must be more particularly described.

Hull , in proportion to its population, suffered more from cholera than any district in the kingdom. The epidemic appeared here in the autumn of 1848, and was fatal to 4 persons in September, to 13 in October, and to one in each of the follow- ing two months. A fatal case was recorded in a mariner, aged 36, at Anne-street, Myton, on March 9th, 1849, after an attack of 4 days’ duration. A month inter- vened before any other case took place. On April 9th a labourer’s widow, aged 62, died at 2, Joseph’s-place, Anne-street, after an attack lasting 2 days. Four weeks elapsed before any other death occurred, when a fisherman’s son, aged 6, was attacked on May 7th, at 19 Mill-street, and died after an illness of 12 hours. In June 2 deaths took place. In July cholera broke out in Little Passage-street, and was fatal to 3 females on July 7th, 8th, 9th, after attacks of short duration. In the course of the month 36 fatal attacks are recorded. No material spread of the epidemic was observed until August 1 3, from which date it began to increase, and the mortality during the month amounted to 254. In the first two weeks of September cholera was at its height, destroying 69 lives on September 6th ; it was fatal during the month to 843 persons. After the first week in October but few deaths occurred, and only 40 fatal cases happened throughout the month, the last being on October 30th, when a farmer’s wife, aged 70, died at 22, Sewer-lane. In many instances two or more deaths took place in the same family ; and during the latest prevalence of the epidemic it was fatal to a lath-render’s wife, daughter and son, on October 6th, at Spring-street, Myton, after attacks of 24 hours, 12 hours, and 5 hours respectively.

Among the places severely visited by cholera were Middle-street, Mill-street, Ade- laide-street, Vagrant Office Humber-bank, English-street, High-street, Myton-gate, Humber-street, the neighbourhoods of Blackfriar-gate and Whitefriar-gate, Cleveland- street Groves, Chaffers-allev. Cholera was fatal, in 1849, to 1178 persons (571 males ; 607 females), being at ihe rate of 24 r deaths to every 10000 persons living. Diarrhoea destroyed 194 lives (91 males ; 103 females), being 40 deaths to every 10000 inhabitants.

In Sculcoates , adjoiningHull, a female servant, aged 39, is stated to have died of cholera, on February 1st, 1849, at Popple-street, Drypool, after an attack lasting 12 days. On April 19th, a sailmaker, of intemperate habits, died of cholera and diarrhoea at Bethel- place, Caroline-street, Hull. No other death is recorded until July 23rd and 24th, when, in addition to a mariner, aged 33, at Kingston-place, it was fatal to a factory overlooker, aged 41, his wife, aged 39, and his daughter, aged 13, at 6 Cottonmill- street : by the end of the month 9 deaths occurred. In August 1 5 1 fatal cases took place, and the epidemic was at its height on September 6th (same day as in Hull), when it destroyed 28 lives. During the following week the mortality continued high : on two occasions the deaths amounted to 27 daily. Its decline became more percepti- ble towards the end of the month, in the course of which 464 fatal cases took place. In the first five days of October the deaths were uniformly 4 daily. The last death

* The Report of Dr. John Taylor, on the Epidemic Cholera in Huddersfield, is a model which the local inquirer should consult.

xxxviii Leeds, Hunslet , Tynemouth.

occurred on October 19, at New Village, (Nottingham, in a carpenter, aged 28, after an attack of 18 hours’ duration.

A table is given in another part of this Report, in which the progress of cholera and diarrhoea, in Hull and Sculcoates combined, is shown on each day of the four months during which the epidemic prevailed. In Sculcoates 656 persons (297 males; 359 females) died of cholera, being at the rate of 152 deaths to every 10000 of the popu- lation. Diarrhoea was fatal to 144 persons (74 males ; 70 females), being 33 deaths to every 10000 persons living.

In Leeds , and also in the adjoining district of Hunslet, epidemic cholera first appeared about the middle of June, was at its height during the first two weeks in September, and finally disappeared in the last week of November. From the contiguity of the two districts, and from the simultaneous appearance and departure of the epidemic, they may he spoken of in conjunction ; and a table is given elsewhere exhibiting the progress of cholera and diarrhoea each day during the months when it was most fatal.

The first two fatal cases of cholera took place in Leeds on June 14th, in a cap-manu- facturer, aged 39, at 16 Market-street, after an attack of 12 hours’ duration ; and in a stuff- weaver’s son, aged 9, at 32 Brass-street, cholera 6 days, and typhus 3 days. His brother, aged 7, next died, on June 15, of cholera 5 days, typhus 2 days. Two other deaths in Leeds and 3 in Hunslet took place during the month. In July only 4 deaths occurred at intervals up to the 17th ; the mortality then began to increase, and the fatal cases amounted to 23 during the month. On August 10th a stdl further spread of the epidemic commenced. On August 30th as many as 32 deaths happened, and in the course of the month it wras fatal to 426 persons.

The mortality was at its height during the first two weeks of September, and on two occasions the daily deaths reached 89, viz., on September 7th and 9th; it then declined slowly for a few days, but afterwards more rapidly, and after destroying 1543 lives during September, the number fell to 309 in October : the epidemic entirely ceased in November, during which month it was not fatal to more than 14 persons. The last death in Leeds was that of a hairdresser, aged 36, at Swinegate, on November 27, alter an attack of 2 days’ duration. In Hunslet the last 2 deaths took place on November 29th, when cholera was fatal to a butcher’s daughter, aged 15, at Stocks-hill, after an attack of 16 hours, and to a joiner, aged 42, at Stanningley-road, Wortley.

The following places in Leeds may be mentioned as having suffered much from cholera: — Grantham-street (No. I in this street was used as an hospital for cholera patients), Cavalier-street, Accommodation-road, Marsh-lane, Richmond-street and road, Wellington-yard, York-street, Acorn-street, Byron-street, High-street, Bateson- street, where 3 persons died on August 28th, at No. 7, and Stainburn-square. In Hunslet the epidemic severely visited Upper and Lower Wortley, Seacroft, Halton, Rothwell, Mint Holbeck ; Moor-street, Sdver-street, where 3 female children died at No. 1 3, in the first week of September ; Water-street, Thwaite-gate, Carr-place, Low- road, and Pitfield-street. The number of deaths in Leeds was : — Cholera, 1439 (649 males; 790 females) ; diarrhoea, 267 (124 males ; 143 females). In Hunslet ; cholera, 884(433 males; 451 females); diarrhoea, 120 (38 males; 62 females). To every 1 OOOO persons living in Leeds there were from cholera 145 deaths ; and from diarrhoea 27 deaths. In Hunslet the proportion was — from cholera 102 deaths, and from diarrhoea 14 deaths, to every 10000 of the population.

THE TYNEMOUTH CHOLERA FIELD.

On both sides of the Tyne, and up the Tees, the epidemic entered Durham and Northumberland, devastating the ports and the coal districts. Ascending the north banks of the Tyne, the mortality was 129 in Tynemouth (including North Shields) ; 41 in Newcastle-upon-Tyne; 12 in Castle Ward, the surrounding district. On the south side of the Tyne the mortality in South Shields was 69 ; in Gateshead, against Newcastle, 66 in iocoo. Higher up the Tvne, and round the soum-s of its chief tribu- taries, the mortality was in Hexham 5 ; in Haltwhistle 3 ; in Bellingham none. Morpeth, Alnwick, and Berwick on the coast suffered to some extent ; in Belford the mortality was only 5 ; Glendale 8 in 10000 : there was no death either from cholera or diarrhoea

Mortality of Males and Females. xxxix

in Rothbury, extending to the forests and moors around the sources of the Coquet. Teesdale presents one of those sharp contrasts which we have so often seen. In Barnard Castle, with a population of 8591, the epidemic killed a carpet-weaver, aged 23, on August 17th; 137 more persons before November 7th. Two or three members of the same family were in many instances seized and destroyed. The 4954 inhabitants of Staindrop, and the 6028 dwellers in Middleton entirely escaped, although the three sub-districts are in the same district.

It is necessary to give a more particular account of the course of the epidemic in Tynemouth and Newcastle-upon-Tyne.

Tynemouth suffered in 1848 from epidemic cholera, which commenced on October 10th, and destroyed 28 lives by the close of the year, in addition to a few from summer cholera, which took place at intervals during an earlier period. In January, 1849, cholera subsided after causing 5 deaths. Three deaths took place in Pumpwell-lane, on March 22nd, 25th, and 27th. In April, 2 deaths occurred. No other case is recorded until July 1st, when the epidemic again appeared, and was fatal to a mariner’s wife, aged 53, at Dawson’s Quay, after an attack lasting 13 hours. During July 11 deaths occurred. In August the epidemic greatly increased ; the deaths during the month amounted to 167, and further increased to 429 during September. Ttie daily mortality reached 26 on September 12th and 15th; but on September 19th, 20th, and 2 1 st the number of deaths averaged only 6 daily; but afterwards increased to 22 on October 2nd; when the subsidence of the epidemic became more steady, and the deaths during the month fell to 180; during November only 18 deaths took place, cholera ceasing to be fatal after November 26th. Cholera was fatal during the year 1849 to 81 5 persons (384 males ; 43 1 females), being at the rate of 1 29 deaths to every 10000 persons living. Diarrhoea was fatal to 89 persons (46 males ; 43 females), being at the rate of 14 deaths to every 10000 persons living. A table is given in another part of the Report, showing the progress of the epidemic during each day of its prevalence in Tynemouth, and the adjoining districts of South Shields, Newcastle-upon-Tyne, and Sunderland.

In Newcastle-upon-Tyne cholera was prevalent in the latter part of 1848 ; 7 fatal cases occurred subsequent to October 16th. During the first 9 days of January, 1849, there were 12 deaths; in the succeeding n days only 3 fatal attacks are recorded; a sudden increase then took place, and from January 21st to 31st, the number of deaths was 26. During February 22 deaths occurred; 30 in March, and n in April. In May the only death was that of a weaver’s wife, aged 46, at Gardner’s-building, on May 1 5th, after an attack of 14 hours’ duration. The epidemic, for a time, discontinued its ravages, and during the whole of June no fatal case is recorded ; on July 4th, how- ever, a joiner’s daughter, aged 6, died, at Dent’s-hole, after an attack lasting 3 days ; this was followed on July 30th, by the death of a miller’s son, aged 18 months, of measles 6 days, and cholera 3 days’ duration. During August 28 deaths occurred, and in September the epidemic was at its height, and the deaths during the month amounted to 127, the greatest number occurring on September 5th, when 14 persons died. In October the deaths fell to 30; and in November to 3, the last being on November 16th, at Stepney-square. During the year 1849 cholera was fatal to 295 persons (147 males ; 148 females), the mortality was at the rate of 41 deaths to every 10000 persons living. Diarrhoea was fatal to 1 17 persons (61 males ; 56 females), being at the rate of 16 deaths to every 10000 persons living.

INFLUENCE OF SEX ON THE MORTALITY FROM CHOLERA.

The deaths from cholera among males were 26,108, females 27,185 ; it consequently destroyed 1077 more females than males. The proportions were reversed in diarrhoea, which was fatal to 9637 males, and to 9250 females. The population of England and Wales returned at the Census without revision was on March 31, 1851, males 8,762,588 ; females 9,160,180. And correcting for increase of population, the mortality from cholera at all ages in 1 849 was —

Males 30^2 to 10000 living, or 1 in 331.

Females 30'0 to 10000 living, or 1 in 333.

xl Mortality of Males and Females.

The mortality is thus a shade less among females than it is among males; but the difference is much less than it is from all other fatal diseases in ordinary years ; when the total deaths among males is invariably greater than the deaths among females. Thus in the year 1848 the deaths of males from all causes amounted to 202,949, °f females to 196,851. And in the seven years 1838-44 the annual rate of mortality among males was 2'2"]0, females 2'ic>4 per cent.

In the Middlesex districts of London 3388 males, and 3612 females, died of cholera; in the Surrey districts the discrepancy was much greater, for 2814 males and 3509 females died of the disease. In many districts of the kingdom the mortality was much more fatal to males than to females. In some districts the disease was most fatal to females. Thus the deaths in Dartford (Kent) were males 68, females 49 ; and the deaths of males exceeded the deaths of females in other districts on the river and coasts of that county. In Portsea and Alverstoke 343 males and 351 females died of cholera; in Yarmouth 53 males and 34 females; Norwich n males and 27 females; Salis- bury 88 males, and 77 females; Plymouth, Plympton St. Mary, East Sionehouse, and Stoke Damerel, 907 males and 966 females; Bedminster, Bristol, and Clifton, 695 males and 740 females. In Gloucester, as well as in Wheatenhurst, Stroud, and Tewkesbury, the number of males that died exceeded the females in the proportion of 1331096. The same or a greater discrepancy occurred at Madeley and Shrews- bury, where 106 males and 71 females died. Upon the other hand, 94 males and 147 females died of cholera at Newcastle-under- Lyme. In Stoke-upon-Trent, Wolverhamp- ton, West Bromwich, and Dudley, the deaths of males considerably exceeded the deaths of females in number. In Boston, Lincolnshire, 25 males and 10 females died of cholera; in Caistor 24 males and 5 females ; in Gainsborough no males and 136 females. In Liverpool, Manchester, and the adjacent districts, the deaths of females exceeded the deaths of males in number. 1895 males and 2278 females died from cholera in Liver- pool. The mortality was at the rate of 154 to 10000 in males, and 180 to 10000 in females; about one-fifth greater therefore in the female than in the male sex. In Knaresborough 33 males and 20 females; Huddersfield 33 males and 19 females died of cholera; in Leeds and Hunslet, on the other hand, 1082 males and 1241 females died of the epidemic. In Wakefield 145 males, 96 females; Rotherham 20 males, 10 females; Thorne 42 males and 28 females; Pocklington, Howden, and Beverley, near Hull, 76 males, 39 females; in Hull and Sculcoates 868 males, 966 females — the deaths of the latter being 98 in excess. In Tynemouth and South Shields, Sunderland and Chester- le-Street, the deaths of females were in excess ; in Newcastle-upon-Tyne nearly equal. In Cockermouth and Whitehaven the deaths of males were 152, females 209. In the Welsh districts — Abergavenny, Pontypool, Cardiff, and Merthyr Tydfil — the deaths of males were in excess.

It is worthy of remark, that at the beginning of the epidemic the deaths of males exceeded the deaths of females very considerably ; the numbers in the months of October, November, and December, 1848, were, males 61 2, females 493 ; or in the pro- portion of 100 to 80. In the prior nine months of that year before the great epidemic had set in,