ON THE
                         MODE OF COMMUNICATION
                                   OF
                                CHOLERA.


                                    BY

                             JOHN SNOW, M.D.,

 MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, FELLOW OF THE ROYAL MED. AND
    CHIR. SOCIETY, FELLOW AND VICE-PRESIDENT OF THE MEDICAL SOCIETY OF
                                 LONDON.


                      Second Edition, much Enlarged.


                                 LONDON:
                  JOHN CHURCHILL, NEW BURLINGTON STREET.

                                M.DCCC.LV.




                                LONDON:

                  T. RICHARDS, 37 GREAT QUEEN STREET.




                     PREFACE TO THE SECOND EDITION.


The first edition of this work, which was published in August 1849, was
only a slender pamphlet. I have, since that time, written various papers
on the same subject, which have been read at the Medical Societies, and
published in the medical journals. The present edition contains the
substance of all these articles, together with much new matter, the
greater part of which is derived from my own recent inquiries.

I take this opportunity of expressing my thanks to the Registrar-General
for the facilities afforded me in making these inquiries.

I feel every confidence that my present labours will receive the same
kind consideration from the Medical Profession which has been accorded
to my former endeavours to ascertain the causes of cholera.

  Sackville Street, Piccadilly,
      11 December, 1854.




                               CONTENTS.


                                                                    PAGE

 Outline of the history of cholera                                     1

 Cases proving its communication from person to person                 3

 Cholera not communicated by means of effluvia                         9

 The pathology of cholera indicates the manner in which it is
   communicated                                                       10

 Analysis of the blood and evacuations in cholera      11 and         14

 Cholera is propagated by the morbid poison entering the alimentary
   canal                                                              15

 Evidence of this mode of communication in the crowded habitations
   of the poor                                                        17

 —— amongst the mining population                                     19

 Instances of the communication of cholera through the medium of
   polluted water, in Horsleydown                                     23

 —— at Albion Terrace, Wandsworth Road                                25

 —— at Ilford and near Bath                                           32

 —— at Newburn on the Tyne                                            33

 —— at Cunnatore                                                      35

 —— in the Black Sea Fleet                                            36

 —— in the neighbourhood of Broad St., Golden Sq.                     38

 —— at Hampstead West End (the water being carried from Broad
   Street)                                                            44

 Explanation of the Map showing the situation of the deaths in and
   around Broad Street, Golden Square                                 45

 Table of attacks and deaths near Golden Square                       49

 Outbreak of cholera at Deptford caused by polluted water             55

 Communication of cholera by means of the water of rivers which
   receive the contents of the sewers                                 56

 Influence of the water supply on the epidemic of 1832, in London     57

 Table showing the mortality from cholera, and the water supply       58

 Influence of the water supply on the epidemic of 1849, in London     60

 Table showing this influence                                         62

 Communication of cholera by Thames water in the autumn of 1848       66

 New water supply of the Lambeth Company                              68

 Effect of this new supply in the epidemic of autumn 1853             69

 Tables showing this effect      71 and                               73

 Intimate mixture of the water supply of the Lambeth with that of
   the Southwark and Vauxhall Company                                 74

 Opportunity thus afforded of gaining conclusive evidence of the
   effect of the water supply on the mortality from cholera           75

 Account of inquiry for obtaining this evidence                       77

 Result of the inquiry as regards the first four weeks of the
   epidemic of 1854                                                   79

 —— the first seven weeks of the same epidemic                        82

 Tables illustrating these results      84,                           85

 Inquiry of the Registrar-General respecting the effect of the
   water supply of the above-mentioned Companies during the later
   period of the epidemic                                             87

 Comparison of the mortality of 1849 and 1854, in the districts
   supplied by the above-named Companies                              89

 Effect of the water supply on the mortality from cholera amongst
   the inmates of workhouses and prisons                              91

 Cholera in the district of the Chelsea Water Company                 93

 Effect of dry weather to increase the impurity of the Thames         95

 Relation between the greater or less mortality from cholera in
   London and the less or greater elevation of the ground             97

 This relation shown to depend on the difference of water supply at
   different elevations                                             _ib._

 Effect of water supply on the mortality of cholera in Birmingham,
   Leicester, etc.                                                    98

 —— in Exeter                                                         99

 —— in Hull                                                          100

 —— in York                                                          101

 —— in Dumfries, etc.                                                102

 —— in Nottingham and Glasgow                                        103

 —— in Paris and Newcastle-upon-Tyne                                 104

 Limited inquiry respecting the effect of the water supply at
   Newcastle                                                         107

 Assent of the medical profession to the influence of polluted
   water on the mortality from cholera                               109

 True explanation of this influence                                  110

 Answers to certain objections                                       111

 Circumstances connected with the history of cholera explained by
   the principles advocated in this treatise, as,—

       The duration of the epidemic in each place usually bears a
         direct relation to the number of the population             115

       The effect of season on the prevalence of cholera             117

       Proportion of the sexes who die of cholera at different
         periods of an epidemic, and under different circumstances   119

       Proportion of deaths from cholera in certain occupations      121

 Evidence that plague, yellow fever, dysentery, and typhoid fever
   are communicated in the same way as cholera                       125

 Instances in which ague was caused by impure water                  129

 Measures required for the prevention of cholera and other diseases
   which are communicated in the same way                            133

 Appendix, containing a list of the deaths from cholera which were
   registered in the four weeks ending 5th August 1854, together
   with the water supply of the houses in which the fatal attacks
   took place, in all the sub-districts to which the supply of
   either the Southwark and Vauxhall or the Lambeth Water Company
   extends                                                           138




                                 MAPS.


Map 1. Showing the deaths from cholera in Broad Street, Golden Square,
and the neighbourhood, from 19th August to 30th September 1854. A black
mark or bar for each death is placed in the situation of the house in
which the fatal attack took place. The situation of the Broad Street
Pump is also indicated, as well as that of all the surrounding Pumps to
which the public had access.

Map 2. Showing the boundaries of the Registrar-General’s districts on
the south side of the Thames in London, and also the water supply of
those districts.




                                 ON THE
                   MODE OF COMMUNICATION OF CHOLERA.


The existence of Asiatic Cholera cannot be distinctly traced back
further than the year 1769. Previous to that time the greater part of
India was unknown to European medical men; and this is probably the
reason why the history of cholera does not extend to a more remote
period. It has been proved by various documents, quoted by Mr. Scot,[1]
that cholera was prevalent at Madras in the year above mentioned, and
that it carried off many thousands of persons in the peninsula of India
from that time to 1790. From this period we have very little account of
the disease till 1814, although, of course, it might exist in many parts
of Asia without coming under the notice of Europeans.

In June 1814, the cholera appeared with great severity in the 1st bat.
9th regt. N.I., on its march from Jaulnah to Trichinopoly; while another
battalion, which accompanied it, did not suffer, although it had been
exposed to exactly the same circumstances, with one exception. Mr.
Cruikshanks, who attended the cases, made a report, which will be
alluded to further on.

[Sidenote: ON THE MODE OF COMMUNICATION OF CHOLERA.]

In 1817, the cholera prevailed with unusual virulence at several places
in the Delta of the Ganges; and, as it had not been previously seen by
the medical men practising in that part of India, it was thought by them
to be a new disease. At this time the cholera began to spread to an
extent not before known; and, in the course of seven years, it reached,
eastward, to China and the Philippine Islands; southward, to the
Mauritius and Bourbon; and to the north-west, as far as Persia and
Turkey. Its approach towards our own country, after it entered Europe,
was watched with more intense anxiety than its progress in other
directions. It would occupy a long time to give an account of the
progress of cholera over different parts of the world, with the
devastation it has caused in some places, whilst it has passed lightly
over others, or left them untouched; and unless this account could be
accompanied with a description of the physical condition of the places,
and the habits of the people, which I am unable to give, it would be of
little use.

There are certain circumstances, however, connected with the progress of
cholera, which may be stated in a general way. It travels along the
great tracks of human intercourse, never going faster than people
travel, and generally much more slowly. In extending to a fresh island
or continent, it always appears first at a sea-port. It never attacks
the crews of ships going from a country free from cholera, to one where
the disease is prevailing, till they have entered a port, or had
intercourse with the shore. Its exact progress from town to town cannot
always be traced; but it has never appeared except where there has been
ample opportunity for it to be conveyed by human intercourse.

There are also innumerable instances which prove the communication of
cholera, by individual cases of the disease, in the most convincing
manner. Instances such as the following seem free from every source of
fallacy.

I called lately to inquire respecting the death of Mrs. Gore, the wife
of a labourer, from cholera, at New Leigham Road, Streatham. I found
that a son of the deceased had been living and working at Chelsea. He
came home ill with a bowel complaint, of which he died in a day or two.
His death took place on August 18th. His mother, who attended on him,
was taken ill on the next day, and died the day following (August 20th).
There were no other deaths from cholera registered in any of the
metropolitan districts, down to the 26th August, within two or three
miles of the above place; the nearest being at Brixton, Norwood, or
Lower Tooting.

The first case of decided Asiatic cholera in London, in the autumn of
1848, was that of a seaman named John Harnold, who had newly arrived by
the _Elbe_ steamer from Hamburgh, where the disease was prevailing. He
left the vessel, and went to live at No. 8, New Lane, Gainsford Street,
Horsleydown. He was seized with cholera on the 22nd of September, and
died in a few hours. Dr. Parkes, who made an inquiry into the early
cases of cholera, on behalf of the then Board of Health, considered this
as the first undoubted case of cholera.

Now the next case of cholera, in London, occurred in the very room in
which the above patient died. A man named Blenkinsopp came to lodge in
the same room. He was attacked with cholera on the 30th September, and
was attended by Mr. Russell of Thornton Street, Horsleydown, who had
attended John Harnold. Mr. Russell informed me that, in the case of
Blenkinsopp, there were rice-water evacuations; and, amongst other
decided symptoms of cholera, complete suppression of urine from Saturday
till Tuesday morning; and after this the patient had consecutive fever.
Mr. Russell had seen a great deal of cholera in 1832, and considered
this a genuine case of the disease; and the history of it leaves no room
for doubt.

The following instances are quoted from an interesting work by Dr.
Simpson of York, entitled “Observations on Asiatic Cholera”:—“The first
cases in the series occurred at Moor Monkton, a healthy agricultural
village, situated to the north-west of York, and distant six miles from
that place. At the time when the first case occurred, the malady was not
known to be prevailing anywhere in the neighbourhood, nor, indeed, at
any place within a distance of thirty miles.

“John Barnes, aged 39, an agricultural labourer, became severely
indisposed on the 28th of December 1832; he had been suffering from
diarrhœa and cramps for two days previously. He was visited by Mr.
George Hopps, a respectable surgeon at Redhouse, who, finding him
sinking into collapse, requested an interview with his brother, Mr. J.
Hopps, of York. This experienced practitioner at once recognised the
case as one of Asiatic cholera; and, having bestowed considerable
attention on the investigation of that disease, immediately enquired for
some probable source of contagion, but in vain: no such source could be
discovered. When he repeated his visit on the day following, the patient
was dead; but Mrs. Barnes (the wife), Matthew Metcalfe, and Benjamin
Muscroft, two persons who had visited Barnes on the preceding day, were
all labouring under the disease, but recovered. John Foster, Ann Dunn,
and widow Creyke, all of whom had communicated with the patients above
named, were attacked by premonitory indisposition, which was however
arrested. Whilst the surgeons were vainly endeavouring to discover
whence the disease could possibly have arisen, the mystery was all at
once, and most unexpectedly, unravelled by the arrival in the village of
the son of the deceased John Barnes. This young man was apprentice to
his uncle, a shoemaker, living at Leeds. He informed the surgeons that
his uncle’s wife (his father’s sister) had died of cholera a fortnight
before that time, and that, as she had no children, her wearing apparel
had been sent to Monkton by a common carrier. The clothes had not been
washed; Barnes had opened the box in the evening; on the next day he had
fallen sick of the disease.

“During the illness of Mrs. Barnes, her mother, who was living at
Tockwith, a healthy village five miles distant from Moor Monkton, was
requested to attend her. She went to Monkton accordingly, remained with
her daughter for two days, washed hey daughter’s linen, and set out on
her return home, apparently in good health. Whilst in the act of walking
home she was seized with the malady, and fell down in collapse on the
road. She was conveyed home to her cottage, and placed by the side of
her bedridden husband. He, and also the daughter who resided with them,
took the malady. All the three died within two days. Only one other case
occurred in the village of Tockwith, and it was not a fatal case.” (p.
136.)

“A man came from Hull (where cholera was prevailing), by trade a
painter; his name and age are unknown. He lodged at the house of Samuel
Wride, at Pocklington; was attacked on his arrival on the 8th of
September, and died on the 9th. Samuel Wride himself was attacked on the
11th of September, and died shortly afterwards. These comprise the first
cases.

“The next was that of a person named Kneeshaw, who had been at Wride’s
house. But as this forms one of a series connected with the former,
furnished by Dr. Laycock, who has very obligingly taken the trouble to
verify the dates and facts of the latter part of the series, it will be
best to give the notes of these cases in that gentleman’s own words.

“‘My dear Dr. Simpson,—Mrs. Kneeshaw was attacked with cholera on
Monday, September 9th, and her son William on the 10th. He died on
Saturday the 15th; she lived three weeks; they lived at Pocklington. On
Sunday, September 16th, Mr. and Mrs. Flint, and Mr. and Mrs. Giles
Kneeshaw, and two children, went to Pocklington to see Mrs. Kneeshaw.
Mrs. Flint was her daughter. They all returned the same day, except Mr.
M. G. Kneeshaw, who stayed at Pocklington, until Monday, September 24th,
when he returned to York. At three o’clock on the same day, he was
attacked with cholera, and died Tuesday, September 25th, at three
o’clock in the morning. [There had been no cholera in York for some
time.] On Thursday, September 27th, Mrs. Flint was attacked, but
recovered. On Saturday, September 29th, her sister, Mrs. Stead, came
from Pocklington to York, to attend upon her; was attacked on Monday,
October the 1st, and died October the 6th.

“‘Mrs. Hardcastle, of No. 10, Lord Mayor’s Walk, York, was attacked with
cholera on October 3rd, and died the same day. Miss Agar, residing with
her, died of cholera on October 7th. Miss Robinson, who had come from
Hull to take care of the house, after the death of Mrs. Hardcastle and
Miss Agar, was attacked, and died on October 11th. Mr. C. Agar, of
Stonegate, York, went to see Mrs. Hardcastle on October 3rd, was
attacked next day, and died October 6th, early in the morning. On
Monday, October 8th, Mrs. Agar, the mother of Mr. C. Agar, was attacked,
and on the same day, one of the servants; both recovered. They had lived
with Mr. Agar. All the above dates and facts I have verified.

                             “‘I am, dear Dr. Simpson, yours very truly,
                                                         “‘T. LAYCOCK.

  “‘Lendal, December 1st, 1849.’” (p. 160.)

Several other instances of the communication of cholera, quite as
striking as the above, are related in Dr. Simpson’s work.

The following account of the propagation of cholera has been published,
along with several other histories of the same kind, in a pamphlet by
Dr. Bryson.[2]

“Mr. Greene, of Fraserburgh, gives the following account of the
introduction of cholera into two villages in Scotland. Two boats, one
belonging to Cairnbulgh and the other to Inveralochy, met at Montrose,
and their crews on several occasions strolled through the town in
company, although aware that it was at that time infected with cholera.
On their passage homeward, they were obliged to put into Gourdon, where
one man belonging to the Cairnbulgh boat died on the 22nd of September,
after an illness of fourteen hours, with all the symptoms of cholera.
Several of the men of both boats were at the same time attacked with
serous diarrhœa, of which three of them had not recovered when they
reached their respective homes; nor indeed until the first cases of the
epidemic broke out in the villages.

“In Inveralochy the first case appeared on the 28th of September, three
or four days after the arrival of the boat; the sufferer, the father of
one of the crew, had been engaged in removing the cargo along with other
members of his family. Two other cases occurred in this family; one on
the 30th of September, and one on the 1st of October.

“In Cairnbulgh, the first cases appeared on the 29th and 30th of
September respectively, and both patients had also been engaged in
removing the cargo of the boat (shell-fish) belonging to that village.
No other cases appeared until the 3rd of October; so that from the 28th
of September to the 3rd of October none were attacked in either village,
but those who had come in contact with the suspected boats, or their
crews.

“The subsequent cases were chiefly among relatives of those first
attacked; and the order of their propagation was as follows. In
Inveralochy, the first case was the father of a family; the second, his
wife; the third, a daughter living with her parents; the fourth, a
daughter who was married and lived in a different house, but who
attended her father and mother during their illness; the fifth, the
husband of the latter; and the sixth, his mother. Other cases occurred
at the same time, although they were not known to have communicated with
the former. One of them was the father of a family; the second his son,
who was seized the day after his father, and a daughter the next day.”

The following instances of communication of cholera are taken from
amongst many others in the “Report on Epidemic Cholera to the Royal
College of Physicians”, by Dr. Baly.

“Stockport. (Dr. Rayner and Mr. J. Rayner, reporters). Sarah Dixon went
to Liverpool, September 1st, to bury her sister, who had died of cholera
there; returned to Stockport on September 3rd; was attacked with cholera
on the 4th; was taken home by her mother to her mother’s house, a
quarter of a mile distant; was in collapse, but recovered. Her mother
was attacked on the 11th, and died. The brother, James Dixon, came from
High Water to see his mother, and was attacked on the 14th.

“Liverpool. (Mr. Henry Taylor, reporter.) A nurse attended a patient in
Great Howard Street (at the lower part of the town), and on her return
home, near Everton (the higher part of the town), was seized, and died.
The nurse who attended her was also seized, and died. No other case had
occurred previously in that neighbourhood, and none followed for about a
fortnight.

“Hedon. (Dr. Sandwith, reporter.) Mrs. N. went from Paul, a village
close to the Humber, to Hedon, two miles off, to nurse her brother in
cholera; the next day, after his death, went to nurse Mrs. B., also at
Hedon; within two days was attacked herself; was removed to a
lodging-house; the son of the lodging-house keeper was attacked the next
day, and died. Mrs. N.’s son removed her back to Paul; was himself
attacked two days afterwards, and died.”

It would be easy, by going through the medical journals and works which
have been published on cholera, to quote as many cases similar to the
above as would fill a large volume. But the above instances are quite
sufficient to show that cholera can be communicated from the sick to the
healthy; for it is quite impossible that even a tenth part of these
cases of consecutive illness could have followed each other by mere
coincidence, without being connected as cause and effect.

Besides the facts above mentioned, which prove that cholera is
communicated from person to person, there are others which show, first,
that being present in the same room with a patient, and attending on
him, do not necessarily expose a person to the morbid poison; and,
secondly, that it is not always requisite that a person should be very
near a cholera patient in order to take the disease, as the morbid
matter producing it may be transmitted to a distance. It used to be
generally assumed, that if cholera were a catching or communicable
disease, it must spread by effluvia given off from the patient into the
surrounding air, and inhaled by others into the lungs. This assumption
led to very conflicting opinions respecting the disease. A little
reflection shews, however, that we have no right thus to limit the way
in which a disease may be propagated, for the communicable diseases of
which we have a correct knowledge spread in very different manners. The
itch, and certain other diseases of the skin, are propagated in one way;
syphilis, in another way; and intestinal worms in a third way, quite
distinct from either of the others.

A consideration of the pathology of cholera is capable of indicating to
us the manner in which the disease is communicated. If it were ushered
in by fever, or any other general constitutional disorder, then we
should be furnished with no clue to the way in which the morbid poison
enters the system; whether, for instance, by the alimentary canal, by
the lungs, or in some other manner, but should be left to determine this
point by circumstances unconnected with the pathology of the disease.
But from all that I have been able to learn of cholera, both from my own
observations and the descriptions of others, I conclude that cholera
invariably commences with the affection of the alimentary canal. The
disease often proceeds with so little feeling of general illness, that
the patient does not consider himself in danger, or even apply for
advice, till the malady is far advanced. In a few cases, indeed, there
are dizziness, faintness, and a feeling of sinking, before discharges
from the stomach or bowels actually take place; but there can be no
doubt that these symptoms depend on the exudation from the mucous
membrane, which is soon afterwards copiously evacuated. This is only
what occurs in certain cases of hæmorrhage into the alimentary canal,
where all the symptoms of loss of blood are present before that fluid
shows itself in the evacuations. In those rare cases, called “cholera
sicca,” in which no purging takes place, the intestines have been found
distended with the excretion peculiar to the disease, whenever an
examination of the body has taken place after death. In all the cases of
cholera that I have attended, the loss of fluid from the stomach and
bowels has been sufficient to account for the collapse, when the
previous condition of the patient was taken into account, together with
the suddenness of the loss, and the circumstance that the process of
absorption appears to be suspended.

The symptoms which follow the affection of the alimentary canal in
cholera are exactly those which this affection is adequate, and, indeed,
could not fail to produce. The analyses which have been made of the
blood of cholera patients, show that the watery fluid effused into the
stomach and bowels is not replaced by absorption, or is replaced only to
a small extent. The analyses of Dr. O’Shaughnessy and others, during the
cholera of 1831–32, show that the amount of water in the blood was very
much diminished in proportion to the solid constituents, and that the
salts of the blood were also diminished. The analyses of Dr. Garrod and
Dr. Parkes, in the spring of 1849, were more numerous and exact.[3] The
amount of water in the blood of healthy persons is on the average 785
parts in 1000; whereas, in the average of the analyses performed by Drs.
Garrod and Parkes, it was only 733 parts, while the amount of solid
constituents of the blood, relatively to the water, was increased from
215—the healthy standard—to 267. The globules, together with the albumen
and other organic constituents of the serum, amount in the healthy state
to 208 parts in 1000, while in the blood of cholera patients they
amounted to 256 parts. The saline constituents in 1000 parts of blood
are somewhat increased, on account of the great diminution of water;
but, when estimated in relation to the other solid ingredients, or to
the whole quantity existing in the healthy body, the amount is
diminished. Dr. Garrod is of the opinion that a chemical analysis will
determine whether or not a specimen of blood has been derived from a
cholera patient.

The stools and vomited matters in cholera consist of water, containing a
small quantity of the salts of the blood, and a very little albuminous
substance. The change in the blood is precisely that which the loss by
the alimentary canal ought to produce; and, indeed, it is physically
impossible that the alteration in the blood can be caused in any other
way. The sweating which takes place in an advanced stage of the disease
may increase the density of the blood to a trifling extent; but it does
not come on till the blood is already altered, and it is only a
consequence of the diminished force of the circulation, like the
sweating met with in collapse from hæmorrhage or severe injuries, and in
faintness from venesection.

The loss of water from the blood causes it to assume the thick tarry
appearance, so well known to all who have opened a vein in cholera. The
diminished volume of the blood causes many of the symptoms of a true
hæmorrhage, as debility, faintness, and coldness; while these effects
are much increased by its thick and tenacious condition, which impedes
its passage through the pulmonary capillaries, thereby reducing the
contents of the arteries throughout the system to the smallest possible
amount, as indicated by the small thready pulse. The interruption to the
pulmonary circulation occasioned by the want of fluidity of the blood,
is the cause of the distressing feeling of want of breath. Proofs of the
obstructed circulation through the lungs generally remain after death,
in the distended state of the pulmonary arteries and right cavities of
the heart. The deficient supply of blood to the various organs, and its
unfitness to pass through the capillaries, are the cause of the
suppression of the renal, biliary, and other secretions. The cramps
appear to consist chiefly of reflex action, caused by the irritation,
and probably the distension, of the bowels.

If any further proof were wanting than those above stated, that all the
symptoms attending cholera, except those connected with the alimentary
canal, depend simply on the physical alteration of the blood, and not on
any cholera poison circulating in the system, it would only be necessary
to allude to the effects of a weak saline solution injected into the
veins in the stage of collapse. The shrunken skin becomes filled out,
and loses its coldness and lividity; the countenance assumes a natural
aspect; the patient is able to sit up, and for a time seems well. If the
symptoms were caused by a poison circulating in the blood, and
depressing the action of the heart, it is impossible that they should
thus be suspended by an injection of warm water, holding a little
carbonate of soda in solution.

It has often been contended that the collapse of cholera cannot be the
mere result of the purging and vomiting, because, in some of the most
rapid and malignant cases, the amount of the stools and vomited fluid is
less than in milder and more protracted ones, or even in some cases in
which the patients recover. But, in the most rapid and malignant cases,
there is sufficient loss of aqueous fluid by the alimentary canal to
alter the blood into the thick tenacious state peculiar to this disease;
and the fact of more purging occurring in other cases which are more
protracted, only proves that, in these latter, absorption from the
stomach and intestines has not been altogether arrested, or that the
stools have been diluted with fluids drank by the patient. The loss of
fluid in every case of fully developed cholera must be sufficient to
cause the thickened state of the blood, which is the cause of the algide
symptoms; and the amount of malignancy of the case must depend chiefly
on the extent to which the function of absorption is impaired.

If absorption were altogether arrested in every case of cholera from the
beginning, the amount of discharge from the alimentary canal would not
equal that of a fatal hæmorrhage, for the thickened blood which remains
is certainly not able to maintain life so well as the same quantity of
healthy blood. Indeed, it is easy to calculate the amount of fluid
separated from the blood, by means of the analyses previously quoted,
and others which have been made of the cholera stools. In some analyses
of these evacuations made by Dr. Parkes,[4] the average composition in
1,000 parts was found to be 982.4 water and 17.6 solids; consequently,
the problem is merely to find how much of such a fluid requires to be
subtracted from blood consisting of water 785 and solids 215, in 1000
parts, in order to reduce it to blood consisting of water 733 and solids
267. The answer to this problem is that 208.5 parts would require to be
subtracted from 1000 parts of blood. M. Valentin has estimated the
average amount of blood in the human adult at thirty pounds; and,
therefore, the whole quantity of fluid that requires to be effused into
the stomach and bowels, in order to reduce the blood of a healthy adult
individual to the condition in which it is met with in the collapse of
cholera is, on the average, 100 ounces, or five imperial pints. This
calculation may be useful as indicating the amount of fluid which ought
not to be exceeded in the injection of the blood vessels.


Diseases which are communicated from person to person are caused by some
material which passes from the sick to the healthy, and which has the
property of increasing and multiplying in the systems of the persons it
attacks. In syphilis, small-pox, and vaccinia, we have physical proof of
the increase of the morbid material, and in other communicable diseases
the evidence of this increase, derived from the fact of their extension,
is equally conclusive. As cholera commences with an affection of the
alimentary canal, and as we have seen that the blood is not under the
influence of any poison in the early stages of this disease,[5] it
follows that the morbid material producing cholera must be introduced
into the alimentary canal—must, in fact, be swallowed accidentally, for
persons would not take it intentionally; and the increase of the morbid
material, or cholera poison, must take place in the interior of the
stomach and bowels. It would seem that the cholera poison, when
reproduced in sufficient quantity, acts as an irritant on the surface of
the stomach and intestines, or, what is still more probable, it
withdraws fluid from the blood circulating in the capillaries, by a
power analogous to that by which the epithelial cells of the various
organs abstract the different secretions in the healthy body. For the
morbid matter of cholera having the property of reproducing its own
kind, must necessarily have some sort of structure, most likely that of
a cell. It is no objection to this view that the structure of the
cholera poison cannot be recognised by the microscope, for the matter of
small-pox and of chancre can only be recognised by their effects, and
not by their physical properties.

The period which intervenes between the time when a morbid poison enters
the system, and the commencement of the illness which follows, is called
the period of incubation. It is, in reality, a period of reproduction,
as regards the morbid matter; and the disease is due to the crop or
progeny resulting from the small quantity of poison first introduced. In
cholera, this period of incubation or reproduction is much shorter than
in most other epidemic or communicable diseases. From the cases
previously detailed, it is shown to be in general only from twenty-four
to forty-eight hours. It is owing to this shortness of the period of
incubation, and to the quantity of the morbid poison thrown off in the
evacuations, that cholera sometimes spreads with a rapidity unknown in
other diseases.

The mode of communication of cholera might have been the same as it is,
even if it had been a disease of the blood; for there is a good deal of
evidence to show that plague, typhoid fever, and yellow fever, diseases
in which the blood is affected, are propagated in the same way as
cholera. There is sufficient evidence also, I believe, in the following
pages, to prove the mode of communication of cholera here explained,
independently of the pathology of the disease; but it was from
considerations of its pathology that the mode of communication was first
explained, and, if the views here propounded are correct, we had a
knowledge of cholera, before it had been twenty years in Europe, more
correct than that of most of the older epidemics; a knowledge which,
indeed, promises to throw much light on the mode of propagation of many
diseases which have been present here for centuries.

The instances in which minute quantities of the ejections and dejections
of cholera patients must be swallowed are sufficiently numerous to
account for the spread of the disease; and on examination it is found to
spread most where the facilities for this mode of communication are
greatest. Nothing has been found to favour the extension of cholera more
than want of personal cleanliness, whether arising from habit or
scarcity of water, although the circumstance till lately remained
unexplained. The bed linen nearly always becomes wetted by the cholera
evacuations, and as these are devoid of the usual colour and odour, the
hands of persons waiting on the patient become soiled without their
knowing it; and unless these persons are scrupulously cleanly in their
habits, and wash their hands before taking food, they must accidentally
swallow some of the excretion, and leave some on the food they handle or
prepare, which has to be eaten by the rest of the family, who, amongst
the working classes, often have to take their meals in the sick room:
hence the thousands of instances in which, amongst this class of the
population, a case of cholera in one member of the family is followed by
other cases; whilst medical men and others, who merely visit the
patients, generally escape. The _post mortem_ inspection of the bodies
of cholera patients has hardly ever been followed by the disease that I
am aware, this being a duty that is necessarily followed by careful
washing of the hands; and it is not the habit of medical men to be
taking food on such an occasion. On the other hand, the duties performed
about the body, such as laying it out, when done by women of the working
class, who make the occasion one of eating and drinking, are often
followed by an attack of cholera; and persons who merely attend the
funeral, and have no connexion with the body, frequently contract the
disease, in consequence, apparently, of partaking of food which has been
prepared or handled by those having duties about the cholera patient, or
his linen and bedding.

[Sidenote: PREVALENCE OF CHOLERA IN THE MINING DISTRICTS.]

Deficiency of light is a great obstacle to cleanliness, as it prevents
dirt from being seen, and it must aid very much the contamination of the
food with the cholera evacuations. Now the want of light, in some of the
dwellings of the poor, in large towns, is one of the circumstances that
has often been commented on as increasing the prevalence of cholera.

The involuntary passage of the evacuations in most bad cases of cholera,
must also aid in spreading the disease. Mr. Baker, of Staines, who
attended two hundred and sixty cases of cholera and diarrhœa in 1849,
chiefly among the poor, informed me, in a letter with which he favoured
me in December of that year, that “when the patients passed their stools
involuntarily the disease evidently spread.” It is amongst the poor,
where a whole family live, sleep, cook, eat, and wash in a single room,
that cholera has been found to spread when once introduced, and still
more in those places termed common lodging-houses, in which several
families were crowded into a single room. It was amongst the vagrant
class, who lived in this crowded state, that cholera was most fatal in
1832; but the Act of Parliament for the regulation of common
lodging-houses, has caused the disease to be much less fatal amongst
these people in the late epidemics. When, on the other hand, cholera is
introduced into the better kind of houses, as it often is, by means that
will be afterwards pointed out, it hardly ever spreads from one member
of the family to another. The constant use of the hand-basin and towel,
and the fact of the apartments for cooking and eating being distinct
from the sick room, are the cause of this.

The great prevalence of cholera in institutions for pauper children and
pauper lunatics, whenever it has gained access to these buildings, meets
with a satisfactory explanation according to the principles here laid
down. In the asylum for pauper children at Tooting, one hundred and
forty deaths from cholera occurred amongst a thousand inmates, and the
disease did not cease till the remaining children had been removed. The
children were placed two or three in a bed, and vomited over each other
when they had the cholera. Under these circumstances, and when it is
remembered that children get their hands into everything, and are
constantly putting their fingers in their mouths, it is not surprising
that the malady spread in this manner, although I believe as much
attention was paid to cleanliness as is possible in a building crowded
with children. Pauper lunatics are generally a good deal crowded
together, especially in their sleeping wards, and as the greater number
of them are in a state of imbecility, they are no more careful than
children in the use of their hands. It is with the greatest difficulty
that they can be kept even moderately clean. As might be expected,
according to the views here explained, the lunatic patients generally
suffered in a much greater proportion than the keepers and other
attendants.

The mining population of Great Britain has suffered more from cholera
than persons in any other occupation,—a circumstance which I believe can
only be explained by the mode of communication of the malady above
pointed out. Pitmen are differently situated from every other class of
workmen in many important particulars. There are no privies in the
coal-pits, or, as I believe, in other mines. The workmen stay so long in
the mines that they are obliged to take a supply of food with them,
which they eat invariably with unwashed hands, and without knife and
fork. The following is a reply which I received from a relative of mine
connected with a colliery near Leeds, in answer to an inquiry I made:—

“Our colliers descend at five o’clock in the morning, to be ready for
work at six, and leave the pit from one to half-past three. The average
time spent in the pit is eight to nine hours. The pitmen all take down
with them a supply of food, which consists of cake, with the addition,
in some cases, of meat; and all have a bottle, containing about a quart
of ‘drink’. I fear that our colliers are no better than others as
regards cleanliness. The pit is one huge privy, and of course the men
always take their victuals with unwashed hands.”

It is very evident that, when a pitman is attacked with cholera whilst
at work, the disease has facilities for spreading among his
fellow-labourers such as occur in no other occupation. That the men are
occasionally attacked whilst at work I know, from having seen them
brought up from some of the coal-pits in Northumberland, in the winter
of 1831–2, after having had profuse discharges from the stomach and
bowels, and when fast approaching to a state of collapse.

Dr. Baly, who has done me the honour of giving a very full and impartial
account of my views in his “Report on Cholera to the College of
Physicians”, makes the objection to what I have said about the colliers,
that the women and children who do not work in the mines, were attacked
in as large numbers as the men. I believe, however, that this is only
what ought to occur from the propagation of the cholera in the crowded
dwellings of the pitmen, in the manner previously explained. The only
effect of its communication in the pits would be, that the men and boys
in a family would have the cholera a day or two earlier than the women
and children; and if a special inquiry were made on this point, this
would probably be found to be the case. It has often been said that, if
cholera were a communicable disease, women ought to suffer in much
greater numbers than the men, as they are employed in nursing the sick.
I leave this objection and Dr. Baly’s to combat each other.

It is very probable that, when cholera occurs amongst people who are
employed in the preparation or vending of provisions, the disease may be
spread by this means, although from the nature of the subject it is
hardly to be expected that the fact would be discovered. The following
cases, perhaps, afford as decisive proof of this variety of
communication of cholera as can be expected. In the beginning of 1850, a
letter appeared in the _Provincial Medical and Surgical Journal_, from
Mr. John C. Bloxam, in the Isle of Wight, being an answer to the inquiry
on cholera by Mr. Hunt. Among other interesting information, Mr. Bloxam
stated, that the only cases of cholera that occurred in the village of
Carisbrook, happened in persons who ate of some stale cow-heels, which
had been the property of a man who died in Newport, after a short and
violent attack of cholera. Mr. Bloxam kindly made additional personal
inquiries into the case, in consequence of questions I put to him, and
the following is a summary of the information contained in his letter:—

[Sidenote: COMMUNICATION OF CHOLERA BY POLLUTED WATER.]

The man from whose house the cow-heels were sent for sale died on
Monday, the 20th of August. It was the custom in the house to boil these
articles on Monday, Wednesday, and Friday; and the cow-heels under
consideration were taken to Carisbrook, which is a mile from Newport,
ready boiled, on Tuesday the 21st. Eleven persons in all partook of this
food, seven of whom ate it without any additional cooking. Six of these
were taken ill within twenty-four hours after eating it, five of whom
died, and one recovered. The seventh individual, a child, who ate but a
small quantity of the cow-heels, was unaffected by it. Four persons
partook of the food after additional cooking. In one case the cow-heels
were fried, and the person who ate them was taken ill of cholera within
twenty-four hours afterwards, and died. Some of the food was made into
broth, of which three persons partook while it was warm; two of them
remained well, but the third person partook again of the broth next day,
when cold, and, within twenty-four hours after this latter meal, she was
taken ill with cholera, of which she died. It may be proper to mention,
although it is no unusual circumstance for animal food to be eaten in
hot weather when not quite fresh, that some of the persons perceived the
cow-heels to be not so fresh as they ought to have been at the time they
were eaten, and part of them had to be thrown away a day or two
afterwards, in consequence of being quite putrid.

It is not unlikely that some of the cases of cholera which spring up
without any apparent connection with previous cases, may be communicated
through articles of diet. It is the practice of the poor people, who
gain a living by selling fruit and other articles in the streets, to
keep their stock in the very crowded rooms in which they live, and, when
visiting the out-patients of a medical charity a few years ago, I often
saw baskets of fruit pushed under the beds of sick patients, in close
proximity with the chamber utensils. I need hardly say that if cases of
disease were propagated in this way, it would be quite impossible to
trace them.


If the cholera had no other means of communication than those which we
have been considering, it would be constrained to confine itself chiefly
to the crowded dwellings of the poor, and would be continually liable to
die out accidentally in a place, for want of the opportunity to reach
fresh victims; but there is often a way open for it to extend itself
more widely, and to reach the well-to-do classes of the community; I
allude to the mixture of the cholera evacuations with the water used for
drinking and culinary purposes, either by permeating the ground, and
getting into wells, or by running along channels and sewers into the
rivers from which entire towns are sometimes supplied with water.

In 1849 there were in Thomas Street, Horsleydown, two courts close
together, consisting of a number of small houses or cottages, inhabited
by poor people. The houses occupied one side of each court or alley—the
south side of Trusscott’s Court, and the north side of the other, which
was called Surrey Buildings, being placed back to back, with an
intervening space, divided into small back areas, in which were situated
the privies of both the courts, communicating with the same drain, and
there was an open sewer which passed the further end of both courts.
Now, in Surrey Buildings the cholera committed fearful devastation,
whilst in the adjoining court there was but one fatal case, and another
case that ended in recovery. In the former court, the slops of dirty
water, poured down by the inhabitants into a channel in front of the
houses, got into the well from which they obtained their water; this
being the only difference that Mr. Grant, the Assistant-Surveyor for the
Commissioners of Sewers, could find between the circumstances of the two
courts, as he stated in a report that he made to the Commissioners. The
well in question was supplied from the pipes of the Southwark and
Vauxhall Waterworks, and was covered in on a level with the adjoining
ground; and the inhabitants obtained the water by a pump placed over the
well. The channel mentioned above commenced close by the pump. Owing to
something being out of order, the water had for some time occasionally
burst out at the top of the well, and overflowed into the gutter or
channel, afterwards flowing back again mixed with the impurities; and
crevices were left in the ground or pavement, allowing part of the
contents of the gutter to flow at all times into the well; and when it
was afterwards emptied, a large quantity of black and highly offensive
deposit was found.

The first case of cholera in this court occurred on July 20th, in a
little girl, who had been labouring under diarrhœa for four days. This
case ended favourably. On the 21st July, the next day, an elderly female
was attacked with the disease, and was in a state of collapse at ten
o’clock the same night. This patient partially recovered, but died of
some consecutive affection on August 1. Mr. Vinen, of Tooley Street, who
attended these cases, states that the evacuations were passed into the
beds, and that the water in which the foul linen was washed would
inevitably be emptied into the channel mentioned above. Mr. Russell, of
Thornton Street, Horsleydown, who attended many of the subsequent cases
in the court, and who, along with another medical gentleman, was the
first to call the attention of the authorities to the state of the well,
says that such water was invariably emptied there, and the people admit
the circumstance. About a week after the above two cases commenced, a
number of patients were taken ill nearly together: four on Saturday,
July 28th, seven or eight on the 29th, and several on the day following.
The deaths in the cases that were fatal took place as follows:—one on
the 29th, four on the 30th, and one on the 31st July; two on August 1st,
and one on August the 2nd, 5th, and 10th respectively, making eleven in
all. They occurred in seven out of the fourteen small houses situated in
the court.

The two first cases on the 20th and 21st were probably caused by the
cholera evacuations contained in the Thames water, as it came from the
waterworks, and they may be considered to represent about the average
amount of cases for the neighbourhood, there having been just that
number in the adjoining court, about the same time. But in a few days,
when the dejections of these patients must have become mixed with the
water the people drank, a number of additional cases commenced nearly
together. The patients were all women and children, the men living in
the court not having been attacked; they may have been out at work all
day and not have drank the water, but as the surviving inhabitants
nearly all left the place immediately after the above mortality
occurred, I was not able to ascertain whether this was so or not.

In Albion Terrace, Wandsworth Road, there was an extraordinary mortality
from cholera in 1849, which was the more striking as there were no other
cases at the time in the immediate neighbourhood; the houses opposite
to, behind, and in the same line, at each end of those in which the
disease prevailed, having been free from it. The row of houses in which
the cholera prevailed to an extent probably at that time quite
unprecedented in this country, constituted the genteel suburban
dwellings of a number of professional and tradespeople, and are most of
them detached a few feet from each other. They were supplied with water
on the same plan. In this instance the water got contaminated by the
contents of the house-drains and cesspools. The cholera extended to
nearly all the houses in which the water was thus tainted, and to no
others.

[Sidenote: THE OUTBREAK OF CHOLERA AT ALBION TERRACE.]

These houses were numbered from 1 to 17, in Albion Terrace, and were
supplied with water from a copious spring in the road in front of the
terrace, the water of which was conducted, by a brick barrel-drain
between Nos. 7 and 8, to the back of the houses, and then flowed right
and left, to supply tanks in the ground behind each house, the tanks
being made of brickwork and cement, covered with a flat stone, and
connected with each other by stoneware pipes six inches in diameter. A
leaden pipe conveyed water from each tank to a pump situated in the back
kitchen. There was a cesspool behind each house, under the privy, and
situated four feet from the water-tank. The ground was opened behind the
houses No. 1 and No. 7, and the drains examined under the
superintendence of Mr. Grant, the Assistant-Surveyor to the
Commissioners of Sewers. The cesspools at both these places were quite
full, and the overflow-drain from that at No. 1 choked up. At this house
the respective levels of the cesspool and the water-tank were measured,
and the top of the overflow-drain from the cesspool was found to be
fifteen inches above the top of the tank, and the intervening ground was
very wet. The overflow-drain mentioned above had no bottom, or one so
soft that it could be penetrated with a stick; and it crossed, at right
angles, above the earthenware pipe of the water-tank, the joints of
which were leaky, and allowed the water to escape. Behind No. 7, Mr.
Grant found a pipe for bringing surplus water from the tanks,
communicating with a drain from the cesspool; and he found a flat brick
drain laid over the barrel-drain before mentioned, which brought the
water from the spring. It appears, from a plan of the property, that
this drain, which was continued in a direction towards the sewer in
Battersea Fields, brought surface-drainage from the road, and received
the drains from the cesspools, the house-drains from the sinks in the
back kitchens, and the surplus water, or some of it, from the tanks.
There was every reason to believe that this drain was stopped up, but
that was not ascertained: at all events it was unable to convey the
water flowing into it during the storm on July 26th, as it burst near
the house No. 8, and inundated the lower premises of that and the
adjoining house, No. 9, with fœtid water; and it was from this time that
the water, which had occasionally been complained of before, was found
by most of the people in these seventeen houses to be more or less
impure or disagreeable. The water broke out of the drain again at No. 8,
and overflowed the kitchens, during a heavy rain on August 2nd. It
should be particularly remarked, that the tanks were placed on the same
level, so that pumping from one would draw water from the others, and
that any impurity getting into one tank would consequently be imparted
to the rest.

The first case of cholera occurred at No. 13, on July 28th (two days
after the bursting of the drain), in a lady who had had premonitory
symptoms for three or four days. It was fatal in fourteen hours. There
was an accumulation of rubbish in the cellar of this house, which was
said to be offensive by the person who removed it; but the proprietor of
the house denied this. A lady at No. 8 was attacked with choleraic
diarrhœa on July 30th: she recovered. On August 1st, a lady, aged
eighty-one, at No. 6, who had had some diarrhœa eight or ten days
before, which had yielded to her own treatment, was attacked with
cholera: she died on the 4th with congested brain. Diarrhœa commenced on
August 1st in a lady aged 60, at No. 3; collapse took place on the 5th,
and death on the 6th. On August 3rd, there were three or four cases, in
different parts of the row of houses, and two of them terminated fatally
on the same day. The attacks were numerous during the following three or
four days, and after that time they diminished in number. More than half
the inhabitants of the part of the terrace in which the cholera
prevailed, were attacked with it, and upwards of half the cases were
fatal. The deaths occurred as follows; but as some of the patients
lingered a few days, and died in the consecutive fever, the deaths are
less closely grouped than the seizures. There was one death on July
28th, two on August 3rd, four on the 4th, two on the 6th, two on the
7th, four on the 8th, three on the 9th, one on the 11th, and one on the
13th. These make twenty fatal cases; and there were four or five deaths
besides amongst those who were attacked after flying from the place.

The fatal cases were distributed over ten out of the seventeen houses;
and Mr. Mimpriss of Wandsworth Road, who attended many of the cases, and
to whose kindness I am indebted for several of these particulars, stated
that cases occurred in the other seven houses, with the exception of one
or two that were empty, or nearly so. There were five deaths in the
house No. 6; and one of a gentleman the day after he left it, and went
to Hampstead Heath. The entire household, consisting of seven
individuals, had the cholera, and six of them died.

There is no data for showing how the disease was communicated to the
first patient, at No. 13, on July 28th; but it was two or three days
afterwards, when the evacuations from this patient must have entered the
drains having a communication with the water supplied to all the houses,
that other persons were attacked, and in two days more the disease
prevailed to an alarming extent.

I had an opportunity of examining some of the water removed by Mr. Grant
from the tanks behind the houses No. 1 and No. 7, and also some of the
deposit which lay in the tanks to the depth of from six to nine inches.
The water was offensive, and the deposit possessed the odour of privy
soil very distinctly. I found in it various substances which had passed
through the alimentary canal, having escaped digestion, as the stones
and husks of currants and grapes, and portions of the thin epidermis of
other fruits and vegetables.

Many of the patients attributed their illness to the water. This is here
mentioned to show that they had drank of it, and at the same time found
that it was impure. As explaining how persons might drink of such water
before finding out its impurity, it may be stated that the grosser part
of the material from drains and cesspools has a tendency, when mixed
with water, to settle rapidly to the bottom. The only houses supplied
with the same water, after passing the tanks in Albion Terrace, were
four in Albion Street; but three of these had been empty for months, and
the fourth was inhabited by a gentleman who always suspected the water,
and would not drink it. There were two or three persons attacked with
cholera amongst those who came to nurse the patients after the water was
condemned, and who, consequently, did not drink it; but these persons
were liable, in waiting on the patient, to get a small portion of the
evacuations into the stomach in the way first pointed out; and there
might be food in the houses, previously prepared with the tainted water.
It is not here implied that every one of the cases in Albion Terrace was
communicated by the water, but that far the greater portion of them
were; that, in short, it was the circumstance of the cholera evacuations
getting into the water, which caused the disease to spread so much
beyond its ordinary extent.

[Sidenote: IRRUPTIONS OF CHOLERA IN ROTHERHITHE.]

The mortality in Albion Terrace was attributed by Dr. Milroy, in a
published report to the General Board of Health, chiefly to three
causes: first, to an open sewer in Battersea Fields, which is four
hundred feet to the north of the terrace, and from which the inhabitants
perceived a disagreeable odour when the wind was in certain directions;
secondly, to a disagreeable odour from the sinks in the back kitchens of
the houses, which was worse after the storm of July 26; and lastly, to
the accumulation in the house No. 13, before alluded to. With respect to
the open sewer, there are several streets and lines of houses as much
exposed to any emanations there might be from it, as those in which the
cholera prevailed; and yet they were quite free from the malady, as were
also nineteen houses situated between the sewer and Albion Terrace. As
regards the bad smells from the sinks in the kitchen, their existence is
of such every day and almost universal prevalence, that they do not help
to explain an irruption of cholera like that under consideration;
indeed, offensive odours were created in thousands of houses in London
by the same storm of rain on July 26th; and the two houses in which the
offensive smell was greatest, viz. Nos. 8 and 9—those which were flooded
with the contents of the drain—were less severely visited with cholera
than the rest; the inhabitants having only had diarrhœa, or mild attacks
of cholera. The accumulation in the house No. 13 could not affect the
houses at a distance from it. It remains evident then, that the only
special and peculiar cause connected with the great calamity which befel
the inhabitants of these houses, was the state of the water, which was
followed by the cholera in almost every house to which it extended,
whilst all the surrounding houses were quite free from the disease.
Indeed, the General Board of Health attributed the mortality at this
place to the contamination of the water, in a manifesto which they
published not long after Dr. Milroy’s report.[6]

Dr. Lloyd mentioned some instances of the effects of impure water at the
South London Medical Society, on August 30th, 1849.[7] In Silver Street,
Rotherhithe, there were eighty cases, and thirty-eight deaths, in the
course of a fortnight early in July of that year, at a time when there
was very little cholera in any other part of Rotherhithe. The contents
of all the privies in this street ran into a drain which had once had a
communication with the Thames; and the people got their supply of water
from a well situated very near the end of the drain, with the contents
of which the water got contaminated. Dr. Lloyd informed me that the
fetid water from the drain could be seen dribbling through the side of
the well, above the surface of the water. Amongst other sanitary
measures recommended by Dr. Lloyd was the filling up of the well; and
the cholera ceased in Silver Street as soon as the people gave over
using the water. Another instance alluded to by Dr. Lloyd, was Charlotte
Place, in Rotherhithe, consisting of seven houses, the inhabitants of
which, excepting those of one house, obtained their water from a ditch
communicating with the Thames, and receiving the contents of the privies
of all the seven houses. In these houses there were twenty-five cases of
cholera, and fourteen deaths; one of the houses had a pump railed off,
to which the inhabitants of the other houses had no access, and there
was but one case in that house.

The following instance, as well as some others of a similar kind, is
related in the “Report of the General Board of Health on the Cholera of
1848 and 1849.”

“In Manchester, a sudden and violent outbreak of cholera occurred in
Hope Street, Salford. The inhabitants used water from a particular
pump-well. This well had been repaired, and a sewer which passes within
nine inches of the edge of it became accidentally stopped up, and leaked
into the well. The inhabitants of thirty houses used the water from this
well; among them there occurred nineteen cases of diarrhœa, twenty-six
cases of cholera, and twenty-five deaths. The inhabitants of sixty
houses in the same immediate neighbourhood used other water; among these
there occurred eleven cases of diarrhœa, but not a single case of
cholera, nor one death. It is remarkable, that, in this instance, out of
the twenty-six persons attacked with cholera, the whole perished except
one.”—Page 62.

[Sidenote: THE OUTBREAK OF CHOLERA AT NEWBURN, ON THE TYNE.]

Dr. Thomas King Chambers informed me, that at Ilford, in Essex, in the
summer of 1849, the cholera prevailed very severely in a row of houses a
little way from the main part of the town. It had visited every house in
the row but one. The refuse which overflowed from the privies and a
pigsty could be seen running into the well over the surface of the
ground, and the water was very fetid; yet it was used by the people in
all the houses except that which had escaped cholera. That house was
inhabited by a woman who took linen to wash, and she, finding that the
water gave the linen an offensive smell, paid a person to fetch water
for her from the pump in the town, and this water she used for culinary
purposes, as well as for washing.

The following circumstance was related to me, at the time it occurred,
by a gentleman well acquainted with all the particulars. The drainage
from the cesspools found its way into the well attached to some houses
at Locksbrook, near Bath, and the cholera making its appearance there in
the autumn of 1849, became very fatal. The people complained of the
water to the gentleman belonging to the property, who lived at Weston,
in Bath, and he sent a surveyor, who reported that nothing was the
matter. The tenants still complaining, the owner went himself, and on
looking at the water and smelling it, he said that he could perceive
nothing the matter with it. He was asked if he would taste it, and he
drank a glass of it. This occurred on a Wednesday; he went home, was
taken ill with the cholera, and died on the Saturday following, there
being no cholera in his own neighbourhood at the time.

There is no spot in this country in which the cholera was more fatal
during the epidemic of 1832 than the village of Newburn, near
Newcastle-upon-Tyne. We are informed, in an excellent paper on the
subject by Dr. David Craigie,[8] that exactly one-tenth of the
population died. The number of the inhabitants was five hundred and
fifty; of these, three hundred and twenty suffered from the epidemic,
either in the form of diarrhœa or the more confirmed disease, and the
deaths amounted to fifty-five. Being aware of this mortality, I wrote,
about the beginning of the year 1849, to a friend in Newcastle—Dr.
Embleton—to make inquiries respecting the water used at Newburn, and he
kindly procured me some information from the Rev. John Reed, of Newburn
Vicarage, which I received in February, as well as an answer from Mr.
Davison, surgeon, of Newburn, to whom I had written in the meantime. I
learnt from these communications that the people were supplied with
water in 1832, as they still were, from three wells, two of which were
very little used, and that the water in the third well was derived from
the workings of an old coal-mine near the village. The water of this
well, as I was informed, although generally good when first drawn,
became putrid after being kept two days. It was considered that the
evacuations of the people could not get into any of the wells; but the
vicar thought that the water of a little brook which runs past the
village, and falls into the Tyne immediately afterwards, might find its
way into that well which is chiefly resorted to. Putrefaction, on being
kept a day or two, is so much the character of water containing animal
matter, that, after receiving confirmation of my views respecting the
communication of cholera by water from many other places, I wrote to Mr.
Davison again on the subject, and he kindly took a great deal of trouble
to investigate the matter further. He informed me that the brook was
principally formed by water which was constantly pumped from coal-pits
in the neighbourhood. About half a mile before reaching Newburn it
received the refuse of a small village, and between that village and
Newburn it ran through a privy used by the workmen of a steel factory.
In Newburn this brook received the contents of the open drains or
gutters from the houses. The drain which conveyed water from a coal mine
or drift not worked for a great number of years, to the well mentioned
above, passed underneath the brook at one part of its course, and from
that point ran alongside of the brook to the well,—a distance of about
three hundred yards. Mr. Davison said that it was disputed whether there
was any communication between the drain and the brook, but that it was
highly probable that there might be; and that an occurrence which took
place a few months previously seemed to prove that there was. Some
gas-water from the steel manufactory mentioned above got by accident
into the brook, and some of the people affirmed that the water in the
well was strongly impregnated with it.

The first case of cholera in Newburn was that of a young man living
close to the brook, about a hundred yards above the place at which it
passes the well. He was taken ill on the 29th December, 1831, and died,
in the stage of consecutive fever, on January 4th, 1832. There were some
cases of diarrhœa in the village, but no new cases of cholera till the
night of January the 9th, during which night and the following morning
thirteen persons were taken ill. During the night of the 12th four
persons were attacked; by the 15th there were fourteen new cases, and on
this day the late vicar died—the Rev. John Edmonston. By the next day at
noon there were at least fifty new cases. A few days after this the
disease began to subside, and by the 2nd of February had almost
disappeared. As several days elapsed between the first case of cholera
and the great outbreak, it is probable that the water in which the
soiled linen must have been washed, and which would necessarily run into
the brook, was the means of communicating the disease to the thirteen
persons taken ill on the night between the 9th and 10th of January;
unless, indeed, the intermediate cases of diarrhœa could transmit the
disease.

The following passage is from the report of Mr. Cruikshanks on the
outbreak of cholera in 1814, previously alluded to as occurring in a
battalion on its march from Jaulnah to Trichinopoly.

“It was the belief of the natives, strenuously fostered and inculcated
by their spiritual guides, that the epidemic was the immediate
consequence of the wrath of Heaven, outraged and insulted by the
pollution of certain sacred tanks, situated at the village of Cunnatore,
in which sepoys of low caste and camp followers had indiscriminately
bathed. Such we may not regard as affording a very satisfactory solution
of the difficulty; yet it leads, I think, directly to the true point of
inquiry. At Cunnatore, the force was so encamped, that while the 5th
Native Infantry on the right had their supplies of water from wells, the
puckallies of the 9th Native Infantry procured water for that battalion
from tanks situated on low ground on the left of the line. The fact,
that the disease first broke forth in a day or two after passing
Cunnatore; the prevailing opinion of the natives, that it originated
there, and that somehow it was connected with the tanks; a desire to
discover some one cause confined in its influence and operation to one
out of the two battalions; lastly, the difficulty or impossibility of
lighting on any other; all these led to inquiry, and to ascertaining
with a considerable degree of certainty, that each battalion was
supplied with water from a source distinct from the other.”[9] The
cholera was said not to be at Cunnatore at the time the infantry were
encamped there, but this was probably a mistake.

[Sidenote: CHOLERA IN THE BLACK SEA FLEET.]

The following quotation is from a letter by a medical officer in the
Black Sea fleet, dated Baljik, August 23, 1854, and published in the
_Medical Times and Gazette_ of September 30th.

“A week after the return of the fleet to Baljik, on the 7th of August,
about four thousand French troops encamped on the heights abreast our
anchorage. These were part of the first division of the army that had
marched to Kostenje, about ten days before. By it the first blood had
been drawn on the part of the allied army. The loss in battle was small,
but they had encountered an enemy more terrible than the Russians. The
cholera had broken out among them, and attacking four hundred on the
first night had destroyed sixty. The total loss had been something
incredible. It was said, that out of eleven thousand men, not less than
five thousand had perished in a few days. This dreadful calamity was
attributed to drinking water from wells that had been poisoned by
throwing in putrid carcases.

“Putting aside the question of intentional poisoning, which always
presents itself as the most ready way of accounting for such
destruction, perhaps some support to the theory, that water is the
medium by which cholera poison is conveyed, may be found in this
circumstance, and in another of which I was witness. These soldiers,
wearied by marching from a focus of cholera infection, were seen, many
of them, washing their persons and clothing in the stream from which all
the French ships of war, and the majority of the English fleet, obtained
their supply of water. This was going on on the 7th and 8th, and, on the
nights of the 9th and 10th, the disease burst out with great violence
among the crews of several ships.

“Some English ships were the first to suffer, on the night of the 9th,
and they proceeded to sea next morning. On the night of the 10th, other
English ships, and some of the French, began to suffer; and the latter
in an almost unparalleled manner.

“The two admirals’ ships, _Montebello_ and _Ville de Paris_, were
terribly affected. On the previous day they had been in as healthy a
state as usual; and in the night the cholera attacked, in the former,
two hundred men, of whom forty lay dead in the morning; and in the
_Ville de Paris_ there were also many deaths. The French fleet sailed on
the afternoon of the 11th; and the following morning saw the English
ships also at sea.


“On this day (the 14th), about noon, the _Britannia_, which had left
port in a favourable condition, was attacked suddenly, and in twenty
hours upwards of fifty of her crew had expired. We knew nothing of the
calamity that had overwhelmed our leader until the following morning,
when ‘reports of the sick’ were sent from each ship to the admiral. By
this time (the evening of the 16th), eighty had died, and more than two
hundred remained in greater or less danger.

“The night of the 16th must have been one of great consternation on
board her. The epidemic went on with unchecked violence; the officers
were voluntarily attending on the sick; and the very few of the crew who
had not been attacked, or who were not assisting their unfortunate
messmates, were found quite insufficient to perform the duties of a ship
when under sail; and the admiral, therefore, determined to return to
Baljik, taking with him the _Trafalgar_ and _Albion_, also badly
affected.

“The crew of the _Britannia_ were at once sent away from the ship, in
small parties, into the numerous transports that remained idle; and it
appears that, by this procedure, the epidemic influences operating among
them have been greatly moderated, if not extirpated.”

[Sidenote: THE CHOLERA NEAR GOLDEN SQUARE.]

The most terrible outbreak of cholera which ever occurred in this
kingdom, is probably that which took place in Broad Street, Golden
Square, and the adjoining streets, a few weeks ago. Within two hundred
and fifty yards of the spot where Cambridge Street joins Broad Street,
there were upwards of five hundred fatal attacks of cholera in ten days.
The mortality in this limited area probably equals any that was ever
caused in this country, even by the plague; and it was much more sudden,
as the greater number of cases terminated in a few hours. The mortality
would undoubtedly have been much greater had it not been for the flight
of the population. Persons in furnished lodgings left first, then other
lodgers went away, leaving their furniture to be sent for when they
could meet with a place to put it in. Many houses were closed
altogether, owing to the death of the proprietors; and, in a great
number of instances, the tradesmen who remained had sent away their
families: so that in less than six days from the commencement of the
outbreak, the most afflicted streets were deserted by more than
three-quarters of their inhabitants.

There were a few cases of cholera in the neighbourhood of Broad Street,
Golden Square, in the latter part of August; and the so-called outbreak,
which commenced in the night between the 31st August and the 1st
September, was, as in all similar instances, only a violent increase of
the malady. As soon as I became acquainted with the situation and extent
of this irruption of cholera, I suspected some contamination of the
water of the much-frequented street pump in Broad Street, near the end
of Cambridge Street; but on examining the water, on the evening of the
3rd September, I found so little impurity in it of an organic nature,
that I hesitated to come to a conclusion. Further inquiry, however,
showed me that there was no other circumstance or agent common to the
circumscribed locality in which this sudden increase of cholera
occurred, and not extending beyond it, except the water of the above
mentioned pump. I found, moreover, that the water varied, during the
next two days, in the amount of organic impurity, visible to the naked
eye, on close inspection, in the form of small white, flocculent
particles; and I concluded that, at the commencement of the outbreak, it
might possibly have been still more impure. I requested permission,
therefore, to take a list, at the General Register Office, of the deaths
from cholera, registered during the week ending 2nd September, in the
sub-districts of Golden Square, Berwick Street, and St. Ann’s, Soho,
which was kindly granted. Eighty-nine deaths from cholera were
registered, during the week, in the three sub-districts. Of these, only
six occurred in the four first days of the week; four occurred on
Thursday, the 31st August; and the remaining seventy-nine on Friday and
Saturday. I considered, therefore, that the outbreak commenced on the
Thursday; and I made inquiry, in detail, respecting the eighty-three
deaths registered as having taken place during the last three days of
the week.

On proceeding to the spot, I found that nearly all the deaths had taken
place within a short distance of the pump. There were only ten deaths in
houses situated decidedly nearer to another street pump. In five of
these cases the families of the deceased persons informed me that they
always sent to the pump in Broad Street, as they preferred the water to
that of the pump which was nearer. In three other cases, the deceased
were children who went to school near the pump in Broad Street. Two of
them were known to drink the water; and the parents of the third think
it probable that it did so. The other two deaths, beyond the district
which this pump supplies, represent only the amount of mortality from
cholera that was occurring before the irruption took place.

With regard to the deaths occurring in the locality belonging to the
pump, there were sixty-one instances in which I was informed that the
deceased persons used to drink the pump-water from Broad Street, either
constantly or occasionally. In six instances I could get no information,
owing to the death or departure of every one connected with the deceased
individuals; and in six cases I was informed that the deceased persons
did not drink the pump-water before their illness.

The result of the inquiry then was, that there had been no particular
outbreak or increase of cholera, in this part of London, except among
the persons who were in the habit of drinking the water of the
above-mentioned pump-well.

I had an interview with the Board of Guardians of St. James’s parish, on
the evening of Thursday, 7th September, and represented the above
circumstances to them. In consequence of what I said, the handle of the
pump was removed on the following day.

Besides the eighty-three deaths mentioned above as occurring on the
three last days of the week ending September 2nd, and being registered
during that week in the sub-districts in which the attacks occurred, a
number of persons died in Middlesex and other hospitals, and a great
number of deaths which took place in the locality during the last two
days of the week, were not registered till the week following. The
deaths altogether, on the 1st and 2nd of September, which have been
ascertained to belong to this outbreak of cholera, were one hundred and
ninety-seven; and many persons who were attacked about the same time as
these, died afterwards. I should have been glad to inquire respecting
the use of the water from Broad Street pump in all these instances, but
was engaged at the time in an inquiry in the south districts of London,
which will be alluded to afterwards; and when I began to make fresh
inquiries in the neighbourhood of Golden Square, after two or three
weeks had elapsed, I found that there had been such a distribution of
the remaining population that it would be impossible to arrive at a
complete account of the circumstances. There is no reason to suppose,
however, that a more extended inquiry would have yielded a different
result from that which was obtained respecting the eighty-three deaths
which happened to be registered within the district of the outbreak
before the end of the week in which it occurred.

The additional facts that I have been able to ascertain are in
accordance with those above related; and as regards the small number of
those attacked, who were believed not to have drank the water from Broad
Street pump, it must be obvious that there are various ways in which the
deceased persons may have taken it without the knowledge of their
friends. The water was used for mixing with spirits in all the public
houses around. It was used likewise at dining-rooms and coffee-shops.
The keeper of a coffee-shop in the neighbourhood, which was frequented
by mechanics, and where the pump-water was supplied at dinner time,
informed me (on 6th September) that she was already aware of nine of her
customers who were dead. The pump-water was also sold in various little
shops, with a teaspoonful of effervescing powder in it, under the name
of sherbet; and it may have been distributed in various other ways with
which I am unacquainted. The pump was frequented much more than is
usual, even for a London pump in a populous neighbourhood.

There are certain circumstances bearing on the subject of this outbreak
of cholera which require to be mentioned. The Workhouse in Poland Street
is more than three-fourths surrounded by houses in which deaths from
cholera occurred, yet out of five hundred and thirty-five inmates only
five died of cholera, the other deaths which took place being those of
persons admitted after they were attacked. The workhouse has a pump-well
on the premises, in addition to the supply from the Grand Junction Water
Works, and the inmates never sent to Broad Street for water. If the
mortality in the workhouse had been equal to that in the streets
immediately surrounding it on three sides, upwards of one hundred
persons would have died.

There is a Brewery in Broad Street, near to the pump, and on perceiving
that no brewer’s men were registered as having died of cholera, I called
on Mr. Huggins, the proprietor. He informed me that there were above
seventy workmen employed in the brewery, and that none of them had
suffered from cholera,—at least in a severe form,—only two having been
indisposed, and that not seriously, at the time the disease prevailed.
The men are allowed a certain quantity of malt liquor, and Mr. Huggins
believes they do not drink water at all; and he is quite certain that
the workmen never obtained water from the pump in the street. There is a
deep well in the brewery, in addition to the New River water.

At the percussion-cap manufactory, 37 Broad Street, where, I understand,
about two hundred workpeople were employed, two tubs were kept on the
premises always supplied with water from the pump in the street, for
those to drink who wished; and eighteen of these workpeople died of
cholera at their own homes, sixteen men and two women.

Mr. Marshall, surgeon, of Greek Street, was kind enough to inquire
respecting seven workmen who had been employed in the manufactory of
dentists’ materials, at Nos. 8 and 9 Broad Street, and who died at their
own homes. He learned that they were all in the habit of drinking water
from the pump, generally drinking about half-a-pint once or twice a day;
while two persons who reside constantly on the premises, but do not
drink the pump-water, only had diarrhœa. Mr. Marshall also informed me
of the case of an officer in the army, who lived at St. John’s Wood, but
came to dine in Wardour Street, where he drank the water from Broad
Street pump at his dinner. He was attacked with cholera, and died in a
few hours.

I am indebted to Mr. Marshall for the following cases, which are
interesting as showing the period of incubation, which in these three
cases was from thirty-six to forty-eight hours. Mrs. ——, of 13 Bentinck
Street, Berwick Street, aged 28, in the eighth month of pregnancy, went
herself (although they were not usually water drinkers), on Sunday, 3rd
September, to Broad Street pump for water. The family removed to
Gravesend on the following day; and she was attacked with cholera on
Tuesday morning at seven o’clock, and died of consecutive fever on 15th
September, having been delivered. Two of her children drank also of the
water, and were attacked on the same day as the mother, but recovered.

Dr. Fraser, of Oakley Square, kindly informed me of the following
circumstance. A gentleman in delicate health was sent for from Brighton
to see his brother at 6 Poland Street, who was attacked with cholera and
died in twelve hours, on 1st September. The gentleman arrived after his
brother’s death, and did not see the body. He only stayed about twenty
minutes in the house, where he took a hasty and scanty luncheon of
rumpsteak, taking with it a small tumbler of brandy and water, the water
being from Broad Street pump. He went to Pentonville, and was attacked
with cholera on the evening of the following day, 2nd September, and
died the next evening.

Dr. Fraser also first called my attention to the following
circumstances, which are perhaps the most conclusive of all in proving
the connexion between the Broad Street pump and the outbreak of cholera.
In the “Weekly Return of Births and Deaths” of September 9th, the
following death is recorded as occurring in the Hampstead district: “At
West End, on 2nd September, the widow of a percussion-cap maker, aged 59
years, diarrhœa two hours, cholera epidemica sixteen hours.”

I was informed by this lady’s son that she had not been in the
neighbourhood of Broad Street for many months. A cart went from Broad
Street to West End every day, and it was the custom to take out a large
bottle of the water from the pump in Broad Street, as she preferred it.
The water was taken on Thursday, 31st August, and she drank of it in the
evening, and also on Friday. She was seized with cholera on the evening
of the latter day, and died on Saturday, as the above quotation from the
register shows. A niece, who was on a visit to this lady, also drank of
the water; she returned to her residence, in a high and healthy part of
Islington, was attacked with cholera, and died also. There was no
cholera at the time, either at West End or in the neighbourhood where
the niece died. Besides these two persons, only one servant partook of
the water at Hampstead West End, and she did not suffer, or, at least,
not severely. There were many persons who drank the water from Broad
Street pump about the time of the outbreak, without being attacked with
cholera; but this does not diminish the evidence respecting the
influence of the water, for reasons that will be fully stated in another
part of this work.

[Illustration: _MAP 1._]

The deaths which occurred during this fatal outbreak of cholera are
indicated in the accompanying map, as far as I could ascertain them.
There are necessarily some deficiencies, for in a few of the instances
of persons who died in the hospitals after their removal from the
neighbourhood of Broad Street, the number of the house from which they
had been removed was not registered. The address of those who died after
their removal to St. James’s Workhouse was not registered; and I was
only able to obtain it, in a part of the cases, on application at the
Master’s Office, for many of the persons were too ill, when admitted, to
give any account of themselves. In the case also of some of the
workpeople and others who contracted the cholera in this neighbourhood,
and died in different parts of London, the precise house from which they
had removed is not stated in the return of deaths. I have heard of some
persons who died in the country shortly after removing from the
neighbourhood of Broad Street; and there must, no doubt, be several
cases of this kind that I have not heard of. Indeed, the full extent of
the calamity will probably never be known. The deficiencies I have
mentioned, however, probably do not detract from the correctness of the
map as a diagram of the topography of the outbreak; for, if the locality
of the few additional cases could be ascertained, they would probably be
distributed over the district of the outbreak in the same proportion as
the large number which are known.

The dotted line on the map surrounds the sub-districts of Golden Square,
St. James’s, and Berwick Street, St. James’s, together with the
adjoining portion of the sub-district of St. Anne, Soho, extending from
Wardour Street to Dean Street, and a small part of the sub-district of
St. James’s Square enclosed by Marylebone Street, Titchfield Street,
Great Windmill Street, and Brewer Street. All the deaths from cholera
which were registered in the six weeks from 19th August to 30th
September within this locality, as well as those of persons removed into
Middlesex Hospital, are shown in the map[10] by a black line in the
situation of the house in which it occurred, or in which the fatal
attack was contracted.

In addition to these the deaths of persons removed to University College
Hospital, to Charing Cross Hospital, and to various parts of London, are
indicated in the map, where the exact address was given in the “Weekly
Return of Deaths,” or, when I could learn it by private inquiry.

The pump in Broad Street is indicated on the map, as well as all the
surrounding pumps to which the public had access at the time. It
requires to be stated that the water of the pump in Marlborough Street,
at the end of Carnaby Street, was so impure that many people avoided
using it. And I found that the persons who died near this pump in the
beginning of September, had water from the Broad Street pump. With
regard to the pump in Rupert Street, it will be noticed that some
streets which are near to it on the map, are in fact a good way removed,
on account of the circuitous road to it. These circumstances being taken
into account, it will be observed that the deaths either very much
diminished, or ceased altogether, at every point where it becomes
decidedly nearer to send to another pump than to the one in Broad
Street. It may also be noticed that the deaths are most numerous near to
the pump where the water could be more readily obtained. The wide open
street in which the pump is situated suffered most, and next the streets
branching from it, and especially those parts of them which are nearest
to Broad Street. If there have been fewer deaths in the south half of
Poland Street than in some other streets leading from Broad Street, it
is no doubt because this street is less densely inhabited.

In some of the instances, where the deaths are scattered a little
further from the rest on the map, the malady was probably contracted at
a nearer point to the pump. A cabinet-maker, who was removed from
Philip’s Court, Noel Street, to Middlesex Hospital, worked in Broad
Street. A boy also who died in Noel Street, went to the National school
at the end of Broad Street, and having to pass the pump, probably drank
of the water. A tailor, who died at 6, Heddon Court, Regent Street,
spent most of his time in Broad Street. A woman, removed to the hospital
from 10, Heddon Court, had been nursing a person who died of cholera in
Marshall Street. A little girl, who died in Ham Yard, and another who
died in Angel Court, Great Windmill Street, went to the school in
Dufour’s Place, Broad Street, and were in the habit of drinking the
pump-water, as were also a child from Naylor’s Yard, and several others,
who went to this and other schools near the pump in Broad Street. A
woman who died at 2, Great Chapel Street, Oxford Street, had been
occupied for two days preceding her illness at the public washhouses
near the pump, and used to drink a good deal of water whilst at her
work; the water drank there being sometimes from the pump and sometimes
from the cistern.

The limited district in which this outbreak of cholera occurred,
contains a great variety in the quality of the streets and houses;
Poland Street and Great Pulteney Street consisting in a great measure of
private houses occupied by one family, whilst Husband Street and Peter
Street are occupied chiefly by the poor Irish. The remaining streets are
intermediate in point of respectability. The mortality appears to have
fallen pretty equally amongst all classes, in proportion to their
numbers. Masters are not distinguished from journeymen in the
registration returns of this district, but, judging from my own
observation, I consider that out of rather more than six hundred deaths,
there were about one hundred in the families of tradesmen and other
resident householders. One hundred and five persons who had been removed
from this district died in Middlesex, University College, and other
hospitals, and two hundred and six persons were buried at the expense of
St. James’s parish; the latter number includes many of those who died in
the hospitals, and a great number who were far from being paupers, and
would on any other occasion have been buried by their friends, who, at
this time, were either not aware of the calamity or were themselves
overwhelmed by it. The greatest portion of the persons who died were
tailors and other operatives, who worked for the shops about Bond Street
and Regent Street, and the wives and children of these operatives. They
were living chiefly in rooms which they rented by the week.

The following table exhibits the chronological features of this terrible
outbreak of cholera.


                               =TABLE I.=

                  Date.      No. of Fatal Attacks. Deaths.
             August       19                     1       1
                  „       20                     1       0
                  „       21                     1       2
                  „       22                     0       0
                  „       23                     1       0
                  „       24                     1       2
                  „       25                     0       0
                  „       26                     1       0
                  „       27                     1       1
                  „       28                     1       0
                  „       29                     1       1
                  „       30                     8       2
                  „       31                    56       3
             September     1                   143      70
                  „        2                   116     127
                  „        3                    54      76
                  „        4                    46      71
                  „        5                    36      45
                  „        6                    20      37
                  „        7                    28      32
                  „        8                    12      30
                  „        9                    11      24
                  „       10                     5      18
                  „       11                     5      15
                  „       12                     1       6
                  „       13                     3      13
                  „       14                     0       6
                  „       15                     1       8
                  „       16                     4       6
                  „       17                     2       5
                  „       18                     3       2
                  „       19                     0       3
                  „       20                     0       0
                  „       21                     2       0
                  „       22                     1       2
                  „       23                     1       3
                  „       24                     1       0
                  „       25                     1       0
                  „       26                     1       2
                  „       27                     1       0
                  „       28                     0       2
                  „       29                     0       1
                  „       30                     0       0
             Date unknown                       45       0
                                               ———     ———
                       Total                   616     616

The deaths in the above table are compiled from the sources mentioned
above in describing the map; but some deaths which were omitted from the
map on account of the number of the house not being known, are included
in the table. As regards the date of attack, I was able to obtain it
with great precision, through the kindness of Mr. Sibley, in upwards of
eighty deaths which occurred in Middlesex Hospital; for the hour of
admission was entered in the hospital books, as well as the previous
duration of the illness. In a few other cases also I had exact
information of the hour of attack, and in the remainder I have
calculated it by subtracting the duration of the illness from the date
of death. Where the illness did not exceed twelve hours, the attack was
considered to have commenced the same day; where the illness exceeded
twelve, and did not exceed thirty-six hours, the attack was put down to
the previous day, and so on. Where the illness exceeded forty-eight
hours, its duration is generally given in days, which were subtracted
from the date of the attack. Although this plan does not always give the
precise date of attack, it reaches within a few hours of it, and is as
valuable perhaps as if the exact day were given, unless the hour as well
as the day could be introduced into the table. Where premonitory
diarrhœa is stated to have existed, the period of its duration is
deducted from the date of death, and, in fact, the time of attack is
fixed at the first commencement of indisposition, except in two or three
instances in which the patient was labouring under another disease, as
phthisis or typhus fever. There are forty-five cases in which the
duration of the illness was not certified, or entered in the books of
the registrars, and the time of attack in these cases is consequently
unknown. These persons nearly all died in the first days of September,
in the height of the calamity, and it is almost certain that they were
cut off very quickly, like the others who died at this time.

It is pretty certain that very few of the fifty-six attacks placed in
the table to the 31st August occurred till late in the evening of that
day. The irruption was extremely sudden, as I learn from the medical men
living in the midst of the district, and commenced in the night between
the 31st August and 1st September. There was hardly any premonitory
diarrhœa in the cases which occurred during the first three days of the
outbreak; and I have been informed by several medical men, that very few
of the cases which they attended on those days ended in recovery.

The greatest number of attacks in any one day occurred on the 1st of
September, immediately after the outbreak commenced. The following day
the attacks fell from one hundred and forty-three to one hundred and
sixteen, and the day afterwards to fifty-four. A glance at the above
table will show that the fresh attacks continued to become less numerous
every day. On September the 8th—the day when the handle of the pump was
removed—there were twelve attacks; on the 9th, eleven; on the 10th,
five; on the 11th, five; on the 12th, only one; and after this time,
there were never more than four attacks on one day. During the decline
of the epidemic the deaths were more numerous than the attacks, owing to
the decease of many persons who had lingered for several days in
consecutive fever.

[Sidenote: THE PUMP-WELL IN BROAD STREET, GOLDEN SQUARE.]

There is no doubt that the mortality was much diminished, as I said
before, by the flight of the population, which commenced soon after the
outbreak; but the attacks had so far diminished before the use of the
water was stopped, that it is impossible to decide whether the well
still contained the cholera poison in an active state, or whether, from
some cause, the water had become free from it. The pump-well has been
opened, and I was informed by Mr. Farrell, the superintendent of the
works, that there was no hole or crevice in the brickwork of the well,
by which any impurity might enter; consequently in this respect the
contamination of the water is not made out by the kind of physical
evidence detailed in some of the instances previously related. I
understand that the well is from twenty-eight to thirty feet in depth,
and goes through the gravel to the surface of the clay beneath. The
sewer, which passes within a few yards of the well, is twenty-two feet
below the surface. The water at the time of the cholera contained
impurities of an organic nature, in the form of minute whitish flocculi,
visible on close inspection to the naked eye, as I before stated. Dr.
Hassall, who was good enough to examine some of this water with the
microscope, informed me that these particles had no organised structure,
and that he thought they probably resulted from decomposition of other
matter. He found a great number of very minute oval animalcules in the
water, which are of no importance, except as an additional proof that
the water contained organic matter on which they lived. The water also
contained a large quantity of chlorides, indicating, no doubt, the
impure sources from which the spring is supplied. Mr. Eley, the
percussion-cap manufacturer of 37 Broad Street, informed me that he had
long noticed that the water became offensive, both to the smell and
taste, after it had been kept about two days. This, as I noticed before,
is a character of water contaminated with sewage. Another person had
noticed for months that a film formed on the surface of the water when
it had been kept a few hours.

I inquired of many persons whether they had observed any change in the
character of the water, about the time of the outbreak of cholera, and
was answered in the negative. I afterwards, however, met with the
following important information on this point. Mr. Gould, the eminent
ornithologist, lives near the pump in Broad Street, and was in the habit
of drinking the water. He was out of town at the commencement of the
outbreak of cholera, but came home on Saturday morning, 2nd September,
and sent for some of the water almost immediately, when he was much
surprised to find that it had an offensive smell, although perfectly
transparent and fresh from the pump. He did not drink any of it. Mr.
Gould’s assistant, Mr. Prince, had his attention drawn to the water, and
perceived its offensive smell. A servant of Mr. Gould who drank the
pump-water daily, and drank a good deal of it on August 31st, was seized
with cholera at an early hour on September 1st. She ultimately
recovered.

Whether the impurities of the water were derived from the sewers, the
drains, or the cesspools, of which latter there are a number in the
neighbourhood, I cannot tell. I have been informed by an eminent
engineer, that whilst a cesspool in a clay soil requires to be emptied
every six or eight months, one sunk in the gravel will often go for
twenty years without being emptied, owing to the soluble matters passing
away into the land-springs by percolation. As there had been deaths from
cholera just before the great outbreak not far from this pump-well, and
in a situation elevated a few feet above it, the evacuations from the
patients might of course be amongst the impurities finding their way
into the water, and judging the matter by the light derived from other
facts and considerations previously detailed, we must conclude that such
was the case. A very important point in respect to this pump-well is
that the water passed with almost everybody as being perfectly pure, and
it did in fact contain a less quantity of impurity than the water of
some other pumps in the same parish, which had no share in the
propagation of cholera. We must conclude from this outbreak that the
quantity of morbid matter which is sufficient to produce cholera is
inconceivably small, and that the shallow pump-wells in a town cannot be
looked on with too much suspicion, whatever their local reputation may
be.

[Sidenote: PUMP-WELL, BROAD ST., GOLDEN SQ.]

Whilst the presumed contamination of the water of the Broad Street pump
with the evacuations of cholera patients, affords an exact explanation
of the fearful outbreak of cholera in St. James’s parish, there is no
other circumstance which offers any explanation at all, whatever
hypothesis of the nature and cause of the malady be adopted. Many
persons were inclined to attribute the severity of the malady in this
locality to the very circumstance to which some people attribute the
comparative immunity of the city of London from the same disease, viz.,
to the drains in the neighbourhood having been disturbed and put in
order about half a year previously. Mr. Bazelgette, however, pointed
out, in a report to the commissioners, that the streets in which the new
sewers had been made suffered less than the others; and a reference to
the map will show that this is correct, for I recollect that the streets
in which the sewers were repaired about February last, were Brewer
Street, Little Pulteney Street, and Dean Street, Soho. Many of the
non-medical public were disposed to attribute the outbreak of cholera to
the supposed existence of a pit in which persons dying of the plague had
been buried about two centuries ago; and, if the alleged plague-pit had
been nearer to Broad Street, they would no doubt still cling to the
idea. The situation of the supposed pit is, however, said to be Little
Marlborough Street, just out of the area in which the chief mortality
occurred. With regard to effluvia from the sewers passing into the
streets and houses, that is a fault common to most parts of London and
other towns. There is nothing peculiar in the sewers or drainage of the
limited spot in which this outbreak occurred; and Saffron Hill and other
localities, which suffer much more from ill odours, have been very
lightly visited by cholera.

[Sidenote: IRRUPTION OF CHOLERA AT DEPTFORD.]

Just at the time when the great outbreak of cholera occurred in the
neighbourhood of Broad Street, Golden Square, there was an equally
violent irruption in Deptford, but of a more limited extent. About
ninety deaths took place in a few days, amongst two or three score of
small houses, in the north end of New Street and an adjoining row called
French’s Fields. Deptford is supplied with very good water from the
river Ravensbourne by the Kent Water Works, and until this outbreak
there was but little cholera in the town, except amongst some poor
people, who had no water except what they got by pailsful from Deptford
Creek—an inlet of the Thames. There had, however, been a few cases in
and near New Street, just before the great outbreak. On going to the
spot on September 12th and making inquiry, I found that the houses in
which the deaths had occurred were supplied by the Kent Water Works, and
the inhabitants never used any other water. The people informed me,
however, that for some few weeks the water had been extremely offensive
when first turned on; they said it smelt like a cesspool, and frothed
like soap suds. They were in the habit of throwing away a few pailsful
of that which first came in, and collecting some for use after it became
clear. On inquiring in the surrounding streets, to which this outbreak
of cholera did not extend, viz., Wellington Street, Old King Street, and
Hughes’s Fields, I found that there had been no alteration in the water.
I concluded, therefore, that a leakage had taken place into the pipes
supplying the places where the outbreak occurred, during the intervals
when the water was not turned on. Gas is known to get into the
water-pipes occasionally in this manner, when they are partially empty,
and to impart its taste to the water. There are no sewers in New Street
or French’s Fields, and the refuse of all kinds consequently saturates
the ground in which the pipes are laid. I found that the water collected
by the people, after throwing away the first portion, still contained
more organic matter than that supplied to the adjoining streets. On
adding nitrate of silver and exposing the specimens to the light, a
deeper tint of brown was developed in the former than in the latter.


All the instances of communication of cholera through the medium of
water, above related, have resulted from the contamination of a
pump-well, or some other limited supply of water; and the outbreaks of
cholera connected with the contamination, though sudden and intense,
have been limited also; but when the water of a river becomes infected
with the cholera evacuations emptied from on board ship, or passing down
drains and sewers, the communication of the disease, though generally
less sudden and violent, is much more widely extended; more especially
when the river water is distributed by the steam engine and pipes
connected with waterworks. Cholera may linger in the courts and alleys
crowded with the poor, for reasons previously pointed out, but I know of
no instance in which it has been generally spread through a town or
neighbourhood, amongst all classes of the community, in which the
drinking water has not been the medium of its diffusion. Each epidemic
of cholera in London has borne a strict relation to the nature of the
water supply of its different districts, being modified only by poverty,
and the crowding and want of cleanliness which always attend it.

[Sidenote: THE EPIDEMIC OF 1832.]

The following table shows the number of deaths from cholera in the
various districts of London in 1832, together with the nature of the
water supply at that period. (See next page.)[11]

This table shows that in the greater part of Southwark, which was
supplied with worse water than any other part of the metropolis, the
mortality from cholera was also much higher than anywhere else. The
other south districts, supplied with water obtained at points higher up
the Thames, and containing consequently less impurity, were less
affected. On the north of the Thames, the east districts, supplied, in
1832, with water from the river Lea, at Old Ford, where it contained the
sewage of a large population, suffered more than other parts on the
north side of London. Whitechapel suffered more than the other east
districts; probably not more from the poverty and crowded state of the
population, than from the great number of mariners, coalheavers, and
others, living there, who were employed on the Thames, and got their
water, whilst at work, direct from the river. There were one hundred and
thirty-nine deaths from cholera amongst persons afloat on the Thames.
The cholera passed very lightly over most of the districts supplied by
the New River Company. St. Giles’ was an exception, owing to the
overcrowding of the common lodging-houses in the part of the parish
called the Rookery. The City of London also suffered severely in 1832.
Now when the engine at Broken Wharf was employed to draw water from the
Thames, this water was supplied more particularly to the City, and not
at all to the higher districts supplied by the New River Company. This
would offer an explanation of the high mortality from cholera in the
City at that time, supposing the engine were actually used during 1832;
but I have not yet been able to ascertain that circumstance with
certainty. I know, however, that it was still used occasionally some
years later.


                              =TABLE II.=

 ┌────────────────────┬───────────┬────────┬───────────┬──────────────────────┐
 │                    │           │ Deaths │Deaths from│                      │
 │     Districts.     │Population.│  from  │Cholera in │    Water Supply.     │
 │                    │           │Cholera.│  10,000   │                      │
 │                    │           │        │  living.  │                      │
 ├────────────────────┼───────────┼────────┼─────┬─────┼──────────────────────┤
 │                    │           │        │     │     │Southwark Water Works,│
 │St. George the      │           │        │     │     │  from Thames at      │
 │  Martyr, Southwark}│     77,796│     856│  110│     │  London Bridge. No   │
 │                    │           │        │     │     │  filter or settling  │
 │                    │           │        │     │     │  reservoir.          │
 │St. Olave’s,        │     „     │   „    │  „  │     │          „           │
 │  Southwark}        │           │        │     │     │                      │
 │St. Saviour’s,      │     „     │   „    │  „  │     │          „           │
 │  Southwark}        │           │        │     │     │                      │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │Chiefly by Lambeth    │
 │                    │           │        │     │     │  Water Works, from   │
 │Christchurch,       │     13,705│      35│  25}│     │  Thames opposite     │
 │  Southwark         │           │        │     │     │  Hungerford Market.  │
 │                    │           │        │     │     │  No filter or        │
 │                    │           │        │     │     │  settling reservoir. │
 │Lambeth             │     87,856│     337│  38}│     │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │Chiefly by South      │
 │                    │           │        │     │     │  London Water Works, │
 │Newington           │     44,526│     200│  45}│     │  from Thames at      │
 │                    │           │        │     │     │  Vauxhall Bridge.    │
 │                    │           │        │     │     │  Reservoirs. No      │
 │                    │           │        │     │     │  filter.             │
 │Camberwell          │     28,231│     107│  37}│     │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │South London Water    │
 │Bermondsey          │     29,741│     210│  70}│     │  Works, & Tidal      │
 │                    │           │        │     │     │  Ditches.            │
 │Rotherhithe         │     12,875│      19│  14}│     │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │East London           │
 │Bethnal Green       │     62,018│     170│  27}│ 42{ │  Waterworks, from    │
 │                    │           │        │     │     │  tidal part of river │
 │                    │           │        │     │     │  Lea at Old Ford.    │
 │St.                 │     38,505│     123│  31}│  „  │          „           │
 │  George-in-the-East│           │        │     │     │                      │
 │Poplar              │     25,066│     107│  42}│  „  │          „           │
 │Stepney             │     78,826│     225│  28}│  „  │          „           │
 │Whitechapel[12]     │     52,848│     470│  88}│  „  │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │New River Company,    │
 │                    │           │        │     │     │  from various        │
 │                    │           │        │     │     │  springs, and river  │
 │                    │           │        │     │     │  Lea in              │
 │Clerkenwell         │     47,634│      65│  13}│ 34{ │  Hertfordshire; and  │
 │                    │           │        │     │     │  occasionally from   │
 │                    │           │        │     │     │  Thames at Broken    │
 │                    │           │        │     │     │  Wharf, near         │
 │                    │           │        │     │     │  Blackfriar’s Bridge.│
 │St. Giles           │     52,907│     280│  52}│  „  │          „           │
 │Holborn             │     27,334│      46│  16}│  „  │          „           │
 │Islington           │     37,316│      39│  10}│  „  │          „           │
 │London City         │     55,798│     359│  64}│  „  │          „           │
 │East and West London│ No return.│        │    }│  „  │          „           │
 │St. Luke’s          │     46,642│     118│  25}│  „  │          „           │
 │Strand              │      9,937│      37│  37}│  „  │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │New River and East    │
 │Hackney             │      7,326│       8│ 10 }│     │  London Water        │
 │                    │           │        │     │     │  Companies.          │
 │Shoreditch          │     68,564│      57│  8 }│     │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │Chelsea Water Works,  │
 │Westminster         │    124,585│     325│   26│     │  from Thames at      │
 │                    │           │        │     │     │  Chelsea. Reservoirs │
 │                    │           │        │     │     │  and filters.        │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │Chelsea Water Works   │
 │                    │           │        │     │     │  and Grand Junction  │
 │St. George, Hanover │           │        │     │     │  Water Works, also   │
 │  Sq.               │     58,209│      74│  12}│ 15{ │  supplying water from│
 │                    │           │        │     │     │  Thames at Chelsea,  │
 │                    │           │        │     │     │  and having settling │
 │                    │           │        │     │     │  reservoirs.         │
 │Kensington          │     75,130│     134│  17}│  „  │          „           │
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │West Middlesex Water  │
 │St. Marylebone      │    122,206│     224│   20│     │  Works, from Thames  │
 │                    │           │        │     │     │  at Hammersmith.     │
 │                    │           │        │     │     │  Settling reservoirs.│
 ├────────────────────┼───────────┼────────┼─────┼─────┼──────────────────────┤
 │                    │           │        │     │     │West Middlesex, New   │
 │St. Pancras         │    103,548│     111│   10│     │  River, and Hampstead│
 │                    │           │        │     │     │  Water Works.        │
 └────────────────────┴───────────┴────────┴─────┴─────┴──────────────────────┘

[Sidenote: THE EPIDEMIC OF 1849.]

Westminster suffered more in 1832 than St. George, Hanover Square, and
Kensington, which at that time had the same water. This arose from the
poor and crowded state of part of its population. The number of cases of
cholera communicated by the water would be the same in one district as
in the other; but in one district the disease would spread also from
person to person more than in the others.

Between 1832 and 1849 many changes took place in the water supply of
London. The Southwark Water Company united with the South London Water
Company, to form a new Company under the name of the Southwark and
Vauxhall Company. The water works at London Bridge were abolished, and
the united company derived their supply from the Thames at Battersea
Fields, about half a mile above Vauxhall Bridge. The Lambeth Water
Company continued to obtain their supply opposite to Hungerford Market;
but they had established a small reservoir at Brixton.

But whilst these changes had been made by the water companies, changes
still greater had taken place in the river, partly from the increase of
population, but much more from the abolition of cesspools and the almost
universal adoption of waterclosets in their stead. The Thames in 1849
was more impure at Battersea Fields than it had been in 1832 at London
Bridge. A clause which prevented the South London Water Company from
laying their pipes within two miles of the Lambeth Water Works was
repealed in 1834, and the two Companies were in active competition for
many years, the result of which is, that the pipes of the Lambeth Water
Company and those of the Southwark and Vauxhall Company pass together
down all the streets of several of the south districts. As the water of
both these Companies was nearly equal in its impurity in 1849, this
circumstance was of but little consequence at that time; but it will be
shown further on that it afterwards led to very important results.

On the north side of the Thames the Water Companies and their districts
remained the same, but some alterations were made in the sources of
supply. The East London Water Company ceased to obtain water at Old
Ford, and got it from the river Lea, above Lea Bridge, out of the
influence of the tide and free from sewage, except that from some part
of Upper Clapton. The Grand Junction Company removed their works from
Chelsea to Brentford, where they formed large settling reservoirs. The
New River Company entirely ceased to employ the steam engine for
obtaining water from the Thames. The supply of the other Water Companies
remained the same as in 1832.

The accompanying table (No. 3), shows the mortality from cholera in the
various registration districts of London in 1849, together with the
water supply. The annual value of house and shop-room for each person is
also shown, as a criterion, to a great extent, of the state of
overcrowding or the reverse. The deaths from cholera and the value of
house room, are taken from the “Report on the Cholera of 1849,” by Dr.
Farr, of the General Register Office. The water supply is indicated
merely by the name of the Companies. After the explanation given above
of the source of supply, this will be sufficient. It is only necessary
to add, that the Kent Water Company derive their supply from the river
Ravensbourne, and the Hampstead Company from springs and reservoirs at
Hampstead.


                               =TABLE III,=

     Showing the mortality from Cholera, and the Water Supply, in the
 Districts of London, in 1849. The Districts are arranged in the order of
                      their Mortality from Cholera.

 ┌─────────────┬──────────┬────────┬─────────┬──────┬─────────────────────────┐
 │             │          │        │         │Annual│                         │
 │             │          │        │         │value │                         │
 │             │          │        │         │  of  │                         │
 │             │Population│ Deaths │Deaths by│House │                         │
 │  District.  │  in the  │  from  │ Cholera │& Shop│      Water Supply.      │
 │             │middle of │Cholera.│to 10,000│ room │                         │
 │             │  1849.   │        │inhabits.│  to  │                         │
 │             │          │        │         │ each │                         │
 │             │          │        │         │person│                         │
 │             │          │        │         │in £. │                         │
 ├─────────────┼──────────┼────────┼─────────┼──────┼─────────────────────────┤
 │             │          │        │         │      │Southwark and Vauxhall   │
 │Rotherhithe  │    17,208│     352│      205│ 4.238│  Water Works, Kent Water│
 │             │          │        │         │      │  Works, & Tidal Ditches.│
 │St. Olave,   │    19,278│     349│      181│ 4.559│Southwark and Vauxhall.  │
 │  Southwark  │          │        │         │      │                         │
 │St. George,  │    50,900│     836│      164│ 3.518│Southwark and Vauxhall,  │
 │  Southwark  │          │        │         │      │  Lambeth.               │
 │Bermondsey   │    45,500│     734│      161│ 3.077│Southwark and Vauxhall.  │
 │St. Saviour, │    35,227│     539│      153│ 5.291│Southwark and Vauxhall.  │
 │  Southwark  │          │        │         │      │                         │
 │Newington    │    63,074│     907│      144│ 3.788│Southwark and Vauxhall,  │
 │             │          │        │         │      │  Lambeth.               │
 │Lambeth      │   134,768│    1618│      120│ 4.389│Southwark and Vauxhall,  │
 │             │          │        │         │      │  Lambeth.               │
 │Wandsworth   │    48,446│     484│      100│ 4.839│Pump-wells, Southwark and│
 │             │          │        │         │      │  Vauxhall, river Wandle.│
 │Camberwell   │    51,714│     504│       97│ 4.508│Southwark and Vauxhall,  │
 │             │          │        │         │      │  Lambeth.               │
 │West London  │    28,829│     429│       96│ 7.454│New River.               │
 │Bethnal Green│    87,263│     789│       90│ 1.480│East London.             │
 │Shoreditch   │   104,122│     789│       76│ 3.103│New River, East London.  │
 │Greenwich    │    95,954│     718│       75│ 3.379│Kent.                    │
 │Poplar       │    44,103│     313│       71│ 7.360│East London.             │
 │Westminster  │    64,109│     437│       68│ 4.189│Chelsea.                 │
 │Whitechapel  │    78,590│     506│       64│ 3.388│East London.             │
 │St. Giles    │    54,062│     285│       53│ 5.635│New River.               │
 │Stepney      │   106,988│     501│       47│ 3.319│East London.             │
 │Chelsea      │    53,379│     247│       46│ 4.210│Chelsea.                 │
 │East London  │    43,495│     182│       45│ 4.823│New River.               │
 │St. George’s,│    47,334│     199│       42│ 4.753│East London.             │
 │  East       │          │        │         │      │                         │
 │London City  │    55,816│     207│       38│17.676│New River.               │
 │St. Martin   │    24,557│      91│       37│11.844│New River.               │
 │Strand       │    44,254│     156│       35│ 7.374│New River.               │
 │Holborn      │    46,134│     161│       35│ 5.883│New River.               │
 │St. Luke     │    53,234│     183│       34│ 3.731│New River.               │
 │Kensington   │          │        │         │      │West Middlesex, Chelsea, │
 │  (except    │   110,491│     260│       33│ 5.070│  Grand Junction.        │
 │  Paddington)│          │        │         │      │                         │
 │Lewisham     │    32,299│      96│       30│ 4.824│Kent.                    │
 │Belgrave     │    37,918│     105│       28│ 8.875│Chelsea.                 │
 │Hackney      │    55,152│     139│       25│ 4.397│New River, East London.  │
 │Islington    │    87,761│     187│       22│ 5.494│New River.               │
 │St. Pancras  │   160,122│     360│       22│ 4.871│New River, Hampstead,    │
 │             │          │        │         │      │  West Middlesex.        │
 │Clerkenwell  │    63,499│     121│       19│ 4.138│New River.               │
 │Marylebone   │   153,960│     261│       17│ 7.586│West Middlesex.          │
 │St. James,   │    36,426│      57│       16│12.669│Grand Junction, New      │
 │  Westminster│          │        │         │      │  River.                 │
 │Paddington   │    41,267│      35│        8│ 9.349│Grand Junction.          │
 │Hampstead    │    11,572│       9│        8│ 5.804│Hampstead, West          │
 │             │          │        │         │      │  Middlesex.             │
 │Hanover Sq. &│    33,196│      26│        8│16.754│Grand Junction.          │
 │  May Fair   │          │        │         │      │                         │
 ├─────────────┼──────────┼────────┼─────────┼──────┼─────────────────────────┤
 │London       │ 2,280,282│   14137│       62│      │                         │
 └─────────────┴──────────┴────────┴─────────┴──────┴─────────────────────────┘

A glance at the table shows that in every district to which the supply
of the Southwark and Vauxhall, or the Lambeth Water Company extends, the
cholera was more fatal than in any other district whatever. The only
other water company deriving a supply from the Thames, in a situation
where it is much contaminated with the contents of the sewers, was the
Chelsea Company. But this company, which supplies some of the most
fashionable parts of London, took great pains to filter the water before
its distribution, and in so doing no doubt separated, amongst other
matters, the greater portion of that which causes cholera. On the other
hand, although the Southwark and Vauxhall and the Lambeth Water
Companies professed to filter the water, they supplied it in a most
impure condition. Even in the following year, when Dr. Hassall made an
examination of it, he found in it the hairs of animals and numerous
substances which had passed through the alimentary canal. Speaking of
the water supply of London generally, Dr. Hassall says:—

“It will be observed, that the water of the companies on the Surrey side
of London, viz., the Southwark, Vauxhall, and Lambeth, is by far the
worst of all those who take their supply from the Thames.”[13]

In the north districts of London, which suffered much less from cholera
than the south districts, the mortality was chiefly influenced by the
poverty and crowding of the population. The New River Company having
entirely left off the use of their engine in the city, their water,
being entirely free from sewage, could have had no share in the
propagation of cholera. It is probable also, that the water of the East
London Company, obtained above Lea Bridge, had no share in propagating
the malady; and that this is true also of the West Middlesex Company,
obtaining their supply from the Thames at Hammersmith; and of the Grand
Junction Company, obtaining their supply at Brentford. All these Water
Companies have large settling reservoirs. It is probable also, as I
stated above, that the Chelsea Company in 1849, by careful filtration
and by detaining the water in their reservoirs, rendered it in a great
degree innocuous.

Some parts of London suffered by the contamination of the pump-wells in
1849, and the cholera in the districts near the river was increased by
the practice, amongst those who are occupied on the Thames, of obtaining
water to drink by dipping a pail into it. It will be shown further on,
that persons occupied on the river suffered more from cholera than
others. Dr. Baly makes the following inquiry in his Report to the
College of Physicians.[14]

“How did it happen, if the character of the water has a great influence
on the mortality from cholera, that in the Belgrave district only 28
persons in 10,000 died, and in the Westminster district, also supplied
by the Chelsea Company, 68 persons in 10,000; and, again, that in the
Wandsworth district the mortality was only 100, and in the district of
St. Olave 181 in 10,000 inhabitants—both these districts receiving their
supply from the Southwark Company?”

The water of the Chelsea Company has been alluded to above, but whether
this water had any share in the propagation of cholera or not, it is
perfectly in accordance with the mode of communication of the disease
which I am advocating, that it should spread more in the crowded
habitations of the poor, in Westminster, than in the commodious houses
of the Belgrave district. In examining the effect of polluted water as a
medium of the cholera poison, it is necessary to bear constantly in mind
the more direct way in which the poison is also swallowed, as I
explained in the commencement of this work. As regards St. Olave’s and
Wandsworth, Dr. Baly was apparently not aware that, whilst almost every
house in the first of these districts is supplied by the water company,
and has no other supply, the pipes of the company extend to only a part
of the Wandsworth district, a large part of it having only pump-wells.

The epidemic of 1849 was a continuance or revival of that which
commenced in the autumn of 1848, and there are some circumstances
connected with the first cases which are very remarkable, and well
worthy of notice. It has been already stated (page 3) that the first
case of decided Asiatic cholera in London, in the autumn of 1848, was
that of a seaman from Hamburgh, and that the next case occurred in the
very room in which the first patient died. These cases occurred in
Horsleydown, close to the Thames. In the evening of the day on which the
second case occurred in Horsleydown, a man was taken ill in Lower Fore
Street, Lambeth, and died on the following morning. At the same time
that this case occurred in Lambeth, the first of a series of cases
occurred in White Hart Court, Duke Street, Chelsea, near the river. A
day or two afterwards, there was a case at 3, Harp Court, Fleet Street.
The next case occurred on October 2nd, on board the hulk _Justitia_,
lying off Woolwich; and the next to this in Lower Fore Street, Lambeth,
three doors from where a previous case had occurred. The first thirteen
cases were all situated in the localities just mentioned; and on October
5th there were two cases in Spitalfields.

Now, the people in Lower Fore Street, Lambeth, obtained their water by
dipping a pail into the Thames, there being no other supply in the
street. In White Hart Court, Chelsea, the inhabitants obtained water for
all purposes in a similar way. A well was afterwards sunk in the court;
but at the time these cases occurred the people had no other means of
obtaining water, as I ascertained by inquiry on the spot. The
inhabitants of Harp Court, Fleet Street, were in the habit, at that
time, of procuring water from St. Bride’s pump, which was afterwards
closed on the representation of Mr. Hutchinson, surgeon, of Farringdon
Street, in consequence of its having been found that the well had a
communication with the Fleet Ditch sewer, up which the tide flows from
the Thames. I was informed by Mr. Dabbs, that the hulk _Justitia_ was
supplied with spring water from the Woolwich Arsenal; but it is not
improbable that water was occasionally taken from the Thames alongside,
as was constantly the practice in some of the other hulks, and amongst
the shipping generally.

When the epidemic revived again in the summer of 1849, the first case in
the sub-district “Lambeth; Church, 1st part,” was in Lower Fore Street,
on June 27th; and on the commencement of the epidemic of the present
year, the first case of cholera in any part of Lambeth, and one of the
earliest in London, occurred at 52, Upper Fore Street, where also the
people had no water except what they obtained from the Thames with a
pail, as I ascertained by calling at the house. Many of the earlier
cases this year occurred in persons employed amongst the shipping in the
river, and the earliest cases in Wandsworth and Battersea have generally
been amongst persons getting water direct from the Thames, or from
streams up which the Thames flows with the tide. It is quite in
accordance with what might be expected from the propagation of cholera
through the medium of the Thames water, that it should generally affect
those who draw it directly from the river somewhat sooner than those who
receive it by the more circuitous route of the pipes of a water company.


[Sidenote: THE EPIDEMIC OF 1853, IN LONDON.]

London was without cholera from the latter part of 1849 to August 1853.
During this interval an important change had taken place in the water
supply of several of the south districts of London. The Lambeth Company
removed their water works, in 1852, from opposite Hungerford Market to
Thames Ditton; thus obtaining a supply of water quite free from the
sewage of London. The districts supplied by the Lambeth Company are,
however, also supplied, to a certain extent, by the Southwark and
Vauxhall Company, the pipes of both companies going down every street,
in the places where the supply is mixed, as was previously stated. In
consequence of this intermixing of the water supply, the effect of the
alteration made by the Lambeth Company on the progress of cholera was
not so evident, to a cursory observer, as it would otherwise have been.
It attracted the attention, however, of the Registrar-General, who
published a table in the “Weekly Return of Births and Deaths” for 26th
November 1853, of which the following is an abstract, containing as much
as applies to the south districts of London.


                              =TABLE IV.=

 ┌─────────────┬─────────────────────┬───────────────────────────┬────────────┐
 │    Water    │ Sources of Supply.  │  Aggregate of Districts   │ Deaths in  │
 │ Companies.  │                     │  supplied chiefly by the  │  100,000   │
 │             │                     │   respective Companies.   │inhabitants.│
 ├─────────────┼─────────────────────┼────────────┬──────────────┼────────────┤
 │      „      │          „          │            │  Deaths by   │            │
 │             │                     │            │Cholera in 13 │            │
 │             │                     │            │ wks. ending  │            │
 │             │                     │Population. │   Nov. 19.   │     „      │
 ├─────────────┼─────────────────────┼────────────┼──────────────┼────────────┤
 │(1) Lambeth  │Thames, at Thames    │            │              │            │
 │  and (2)    │  Ditton and at      │            │              │            │
 │  Southwark  │  Battersea          │            │              │            │
 │  and        │                     │            │              │            │
 │  Vauxhall   │                     │     346,363│           211│          61│
 │             │                     │            │              │            │
 │Southwark and│Thames, at Battersea │            │              │            │
 │  Vauxhall   │                     │     118,267│           111│          94│
 │             │                     │            │              │            │
 │(1) Southwark│Thames, at Battersea;│            │              │            │
 │  and        │  the Ravensbourne,  │            │              │            │
 │  Vauxhall,  │  in Kent, & ditches │            │              │            │
 │  (2) Kent   │  and wells          │      17,805│            19│         107│
 └─────────────┴─────────────────────┴────────────┴──────────────┴────────────┘

It thus appears that the districts partially supplied with the improved
water suffered much less than the others, although, in 1849, when the
Lambeth Company obtained their supply opposite Hungerford Market, these
same districts suffered quite as much as those supplied entirely by the
Southwark and Vauxhall Company, as was shown in table III, p. 62. The
Lambeth water extends to only a small portion of some of the districts
necessarily included in the group supplied by both Companies; and when
the division is made a little more in detail, by taking sub-districts
instead of districts, the effect of the new water supply is shown to be
greater than appears in the above table. The Kent Water Company was
introduced into the table by the Registrar-General on account of its
supplying a small part of Rotherhithe. The following interesting remarks
appeared, respecting this portion of Rotherhithe, in the “Weekly Return”
of December 10, 1853:—

[Sidenote: THE EPIDEMIC OF 1853.]

“_London Water Supply._—The following is an extract from a letter which
the Registrar-General has received from Mr. Pitt, the Registrar of
Rotherhithe:—

“‘I consider Mr. Morris’s description of the part of the parish through
which the pipes of the Kent Water Company were laid in 1849, is in the
main correct; for though the Company had entered the parish, the water
was but partially taken by the inhabitants up to the time of the fearful
visitation in the above year.

“‘With respect to the deaths in 1849, they were certainly more numerous
in the district now generally supplied by the Kent Company than in any
other part of the parish. I only need mention Charlotte Row, Ram Alley,
and Silver Street,—places where the scourge fell with tremendous
severity.

“‘Among the recent cases of cholera, not one has occurred in the
district supplied by the Kent Water Company.

“‘The parish of Rotherhithe has been badly supplied with water for many
ages past. The people drank from old wells, old pumps, open ditches, and
the muddy stream of the Thames.’

“In 1848–9 the mortality from cholera in Rotherhithe was higher than it
was in any other district of London. This is quite in conformity with
the general rule, that when cholera prevails, it is most fatal where the
waters are most impure.”


The following table (which, with a little alteration in the arrangement,
is taken from the “Weekly Return of Births and Deaths” for 31st December
1853) shows the mortality from cholera, in the epidemic of 1853, down to
a period when the disease had almost disappeared.

The districts are arranged in the order of their mortality from Cholera.


                               =TABLE V.=

 ┌──────────────────────┬──────────┬──────┬───────┬───────────────────────────┐
 │                      │          │Deaths│       │                           │
 │                      │          │  by  │       │                           │
 │                      │          │Chol. │Deaths │                           │
 │                      │Population│in 17 │  by   │                           │
 │      Districts.      │ in 1853  │wks., │Cholera│       Water Supply.       │
 │                      │ (estim.) │ Aug. │  to   │                           │
 │                      │          │21 to │100,000│                           │
 │                      │          │ Dec. │living.│                           │
 │                      │          │ 17,  │       │                           │
 │                      │          │1853. │       │                           │
 ├──────────────────────┼──────────┼──────┼───────┼───────────────────────────┤
 │Bermondsey            │    48,128│    73│    150│Southwark & Vauxhall.      │
 │S. Saviour, Southwark │    35,731│    52│    146│Southwark and Vauxhall,    │
 │                      │          │      │       │  Lambeth.                 │
 │S. George,  Southwark │    51,824│    74│    143│Southwark and Vauxhall,    │
 │                      │          │      │       │  Lambeth.                 │
 │St. Olave             │    19,375│    26│    134│Southwark & Vauxhall.      │
 │Rotherhithe           │    17,805│    20│    112│South. & Vaux., Kent.      │
 │Whitechapel           │    79,759│    78│     95│East London.               │
 │Newington             │    64,816│    37│     57│Southwark and Vauxhall,    │
 │                      │          │      │       │  Lambeth.                 │
 │Kensington,—except    │    73,699│    40│     53│West Middlesex, Chelsea,   │
 │  Paddington          │          │      │       │  Grand Junction.          │
 │Wandsworth            │    50,764│    26│     51│South. & Vaux., Pump-wells,│
 │                      │          │      │       │  River Wandle.            │
 │St. George (East)     │    48,376│    21│     43│East London.               │
 │Camberwell            │    54,667│    22│     40│Southwark and Vauxhall,    │
 │                      │          │      │       │  Lambeth.                 │
 │Stepney               │   110,775│    40│     34│East London.               │
 │Lambeth               │   139,325│    48│     34│Lambeth, Sou. & Vaux.      │
 │Greenwich             │    99,365│    32│     31│Kent.                      │
 │Marylebone            │   157,696│    48│     30│West Middlesex.            │
 │Westminster           │    65,609│    19│     27│Chelsea.                   │
 │St. James, Westminster│    36,406│     9│     25│Grand Junction, New River. │
 │Hackney               │    58,429│    13│     22│New Riv., East London.     │
 │Paddington            │    46,305│    10│     22│Grand Junction.            │
 │Shoreditch            │   109,257│    23│     21│New Riv., East London.     │
 │Bethnal Green         │    90,193│    18│     20│East London.               │
 │Poplar                │    47,162│     9│     17│East London.               │
 │West London           │    28,840│     4│     14│New River.                 │
 │Hanover Square and May│    33,196│     5│     12│Grand Junction.            │
 │  Fair                │          │      │       │                           │
 │Islington             │    95,329│    12│     12│New River.                 │
 │Chelsea               │    56,538│     6│     11│Chelsea.                   │
 │East London           │    44,406│     4│      9│New River.                 │
 │London City           │    55,932│     5│      9│New River.                 │
 │Clerkenwell           │    64,778│     5│      8│New River.                 │
 │Belgrave              │    40,034│     3│      7│Chelsea.                   │
 │St.                   │    24,640│     1│      5│New River.                 │
 │  Martin-in-the-Fields│          │      │       │                           │
 │St. Pancras           │   166,956│     8│      5│New River, Hampstead, West │
 │                      │          │      │       │  Middlesex.               │
 │St. Luke              │    54,055│     2│      4│New River.                 │
 │Lewisham              │    34,835│     1│      3│Kent.                      │
 │Holborn               │    46,571│     1│      2│New River.                 │
 │St. Giles             │    54,214│     1│      2│New River.                 │
 │Strand                │    44,460│      │       │New River.                 │
 │Hampstead             │    11,986│      │       │Hampst., West Mid’sex.     │
 ├──────────────────────┼──────────┼──────┼───────┼───────────────────────────┤
 │                      │ 2,362,236│   796│       │                           │
 └──────────────────────┴──────────┴──────┴───────┴───────────────────────────┘

[Sidenote: THE EPIDEMIC OF 1853, IN LONDON.]

It will be observed that Lambeth, which is supplied with water in a
great measure by the Lambeth Company, occupies a lower position in the
above table than it did in the previous table showing the mortality in
1849. Rotherhithe also has been removed from the first to the fifth
place; owing, no doubt, to the portion of the district supplied with
water from the Kent Water Works, instead of the ditches, being
altogether free from the disease, as was noticed above.

As the Registrar-General published a list of all the deaths from cholera
which occurred in London in 1853, from the commencement of the epidemic
in August to its conclusion in January 1854, I have been able to add up
the number which occurred in the various sub-districts on the south side
of the Thames, to which the water supply of the Southwark and Vauxhall,
and the Lambeth Companies, extends. I have presented them in the table
opposite, arranged in three groups.


                              =TABLE VI.=

 ┌───────────────┬──────────────┬──────────────┬──────────────┬───────────────┐
 │               │              │ Deaths from  │  Deaths by   │               │
 │Sub-Districts. │Population in │  Cholera in  │  Cholera in  │ Water Supply. │
 │               │    1851.     │    1853.     │ each 100,000 │               │
 │               │              │              │   living.    │               │
 ├───────────────┼──────────────┼──────────────┼──────────────┼───────────────┤
 │               │              │              │              │Southwark and  │
 │St. Saviour,   │19,709        │45            │227           │  Vauxhall     │
 │  Southwark    │              │              │              │  Water Company│
 │               │              │              │              │  only.        │
 │St. Olave      │8,015         │19            │237           │       „       │
 │St. John,      │11,360        │7             │61            │       „       │
 │  Horsleydown  │              │              │              │               │
 │St. James,     │18,899        │21            │111           │       „       │
 │  Bermondsey   │              │              │              │               │
 │St. Mary       │13,934        │27            │193           │       „       │
 │  Magdalen     │              │              │              │               │
 │Leather Market │15,295        │23            │153           │       „       │
 │Rotherhithe[15]│17,805        │20            │112           │       „       │
 │Wandsworth     │9,611         │3             │31            │       „       │
 │Battersea      │10,560        │11            │104           │       „       │
 │Putney         │5,280         │              │              │       „       │
 │Camberwell     │17,742        │9             │50            │       „       │
 │Peckham        │19,444        │7             │36            │       „       │
 │               │              │              │              │               │
 │               │              │              │              │Lambeth Water  │
 │Christchurch,  │              │              │              │  Company, and │
 │  Southwk.     │16,022        │7             │43            │  Southwark and│
 │               │              │              │              │  Vauxhall     │
 │               │              │              │              │  Company      │
 │Kent Road      │18,126        │37            │204           │       „       │
 │Borough Road   │15,862        │26            │163           │       „       │
 │London Road    │17,836        │9             │50            │       „       │
 │Trinity,       │20,922        │11            │52            │       „       │
 │  Newington    │              │              │              │               │
 │St. Peter,     │29,861        │23            │77            │       „       │
 │  Walworth     │              │              │              │               │
 │St. Mary,      │14,033        │5             │35            │       „       │
 │  Newington    │              │              │              │               │
 │Waterloo (1st  │14,088        │1             │7             │       „       │
 │  part)        │              │              │              │               │
 │Waterloo (2nd  │18,348        │7             │38            │       „       │
 │  part)        │              │              │              │               │
 │Lambeth Church │18,409        │9             │48            │       „       │
 │  (1st part)   │              │              │              │               │
 │Lambeth Church │26,784        │11            │41            │       „       │
 │  (2nd part)   │              │              │              │               │
 │Kennington (1st│24,261        │12            │49            │       „       │
 │  part)        │              │              │              │               │
 │Kennington (2nd│18,848        │6             │31            │       „       │
 │  part)        │              │              │              │               │
 │Brixton        │14,610        │2             │13            │       „       │
 │Clapham        │16,290        │10            │61            │       „       │
 │St. George,    │15,849        │6             │37            │       „       │
 │  Camberwell   │              │              │              │               │
 │               │              │              │              │               │
 │Norwood        │3,977         │              │              │Lambeth Water  │
 │               │              │              │              │  Company only.│
 │Streatham      │9,023         │              │              │       „       │
 │Dulwich        │1,632         │              │              │       „       │
 ├───────────────┼──────────────┼──────────────┼──────────────┼───────────────┤
 │First 12       │167,654       │192           │114           │Southwk. &     │
 │  sub-districts│              │              │              │  Vaux.        │
 ├───────────────┼──────────────┼──────────────┼──────────────┼───────────────┤
 │Next 16        │301,149       │182           │60            │Both Companies │
 │  sub-districts│              │              │              │               │
 ├───────────────┼──────────────┼──────────────┼──────────────┼───────────────┤
 │Last 3         │14,632        │              │              │Lambeth Comp.  │
 │  sub-districts│              │              │              │               │
 └───────────────┴──────────────┴──────────────┴──────────────┴───────────────┘

Besides the general result shown in the table, there are some particular
facts well worthy of consideration. In 1849, when the water of the
Lambeth Company was quite as impure as that of the Southwark and
Vauxhall Company, the parish of Christchurch suffered a rather higher
rate of mortality from cholera than the adjoining parish of St. Saviour;
but in 1853, whilst the mortality in St. Saviour’s was at the rate of
two hundred and twenty-seven to one hundred thousand living, that of
Christchurch was only at the rate of forty-three. Now St. Saviour’s is
supplied with water entirely by the Southwark and Vauxhall Company, and
Christchurch is chiefly supplied by the Lambeth Company. The pipes and
other property of the Lambeth Company, in the parish of Christchurch,
are rated at about £316, whilst the property of the Southwark and
Vauxhall Company in this parish is only rated at about £108. Waterloo
Road, 1st part, suffered almost as much as St. Saviour’s in 1849, and
had but a single death in 1853; it is supplied almost exclusively by the
Lambeth Company. The sub-districts of Kent Road and Borough Road, which
suffered severely from cholera, are supplied, through a great part of
their extent, exclusively by the Southwark and Vauxhall Company; the
supply of the Lambeth Company being intermingled with that of the other
only in a part of these districts, as may be seen by consulting the
accompanying map (No. 2). The rural districts of Wandsworth and Peckham
contain a number of pump-wells, and are only partially supplied by the
Water Company; on this account they suffered a lower mortality than the
other sub-districts supplied with the water from Battersea Fields. In
the three sub-districts to which this water does not extend, there was
no death from cholera in 1853.

[Illustration: MAP 2.]

[Sidenote: THE NEW WATER SUPPLY OF THE LAMBETH COMPANY.]

Although the facts shown in the above table afford very strong evidence
of the powerful influence which the drinking of water containing the
sewage of a town exerts over the spread of cholera, when that disease is
present, yet the question does not end here; for the intermixing of the
water supply of the Southwark and Vauxhall Company with that of the
Lambeth Company, over an extensive part of London, admitted of the
subject being sifted in such a way as to yield the most incontrovertible
proof on one side or the other. In the sub-districts enumerated in the
above table as being supplied by both Companies, the mixing of the
supply is of the most intimate kind. The pipes of each Company go down
all the streets, and into nearly all the courts and alleys. A few houses
are supplied by one Company and a few by the other, according to the
decision of the owner or occupier at that time when the Water Companies
were in active competition. In many cases a single house has a supply
different from that on either side. Each Company supplies both rich and
poor, both large houses and small; there is no difference either in the
condition or occupation of the persons receiving the water of the
different Companies. Now it must be evident that, if the diminution of
cholera, in the districts partly supplied with the improved water,
depended on this supply, the houses receiving it would be the houses
enjoying the whole benefit of the diminution of the malady, whilst the
houses supplied with the water from Battersea Fields would suffer the
same mortality as they would if the improved supply did not exist at
all. As there is no difference whatever, either in the houses or the
people receiving the supply of the two Water Companies, or in any of the
physical conditions with which they are surrounded, it is obvious that
no experiment could have been devised which would more thoroughly test
the effect of water supply on the progress of cholera than this, which
circumstances placed ready made before the observer.

The experiment, too, was on the grandest scale. No fewer than three
hundred thousand people of both sexes, of every age and occupation, and
of every rank and station, from gentlefolks down to the very poor, were
divided into two groups without their choice, and, in most cases,
without their knowledge; one group being supplied with water containing
the sewage of London, and, amongst it, whatever might have come from the
cholera patients, the other group having water quite free from such
impurity.

[Sidenote: EPIDEMIC OF 1854, IN THE SOUTH DISTRICTS OF LONDON.]

To turn this grand experiment to account, all that was required was to
learn the supply of water to each individual house where a fatal attack
of cholera might occur. I regret that, in the short days at the latter
part of last year, I could not spare the time to make the inquiry; and,
indeed, I was not fully aware, at that time, of the very intimate
mixture of the supply of the two Water Companies, and the consequently
important nature of the desired inquiry.

When the cholera returned to London in July of the present year,
however, I resolved to spare no exertion which might be necessary to
ascertain the exact effect of the water supply on the progress of the
epidemic, in the places where all the circumstances were so happily
adapted for the inquiry. I was desirous of making the investigation
myself, in order that I might have the most satisfactory proof of the
truth or fallacy of the doctrine which I had been advocating for five
years. I had no reason to doubt the correctness of the conclusions I had
drawn from the great number of facts already in my possession, but I
felt that the circumstance of the cholera poison passing down the sewers
into a great river, and being distributed through miles of pipes, and
yet producing its specific effects, was a fact of so startling a nature,
and of so vast importance to the community, that it could not be too
rigidly examined, or established on too firm a basis.

I accordingly asked permission at the General Register Office to be
supplied with the addresses of persons dying of cholera, in those
districts where the supply of the two Companies is intermingled in the
manner I have stated above. Some of these addresses were published in
the “Weekly Returns,” and I was kindly permitted to take a copy of
others. I commenced my inquiry about the middle of August with two
sub-districts of Lambeth, called Kennington, first part, and Kennington,
second part. There were forty-four deaths in these sub-districts down to
12th August, and I found that thirty-eight of the houses in which these
deaths occurred were supplied with water by the Southwark and Vauxhall
Company, four houses were supplied by the Lambeth Company, and two had
pump-wells on the premises and no supply from either of the Companies.

As soon as I had ascertained these particulars I communicated them to
Dr. Farr, who was much struck with the result, and at his suggestion the
Registrars of all the south districts of London were requested to make a
return of the water supply of the house in which the attack took place,
in all cases of death from cholera. This order was to take place after
the 26th August, and I resolved to carry my inquiry down to that date,
so that the facts might be ascertained for the whole course of the
epidemic. I pursued my inquiry over the various other sub-districts of
Lambeth, Southwark, and Newington, where the supply of the two Water
Companies is intermixed, with a result very similar to that already
given, as will be seen further on. In cases where persons had been
removed to a workhouse or any other place, after the attack of cholera
had commenced, I inquired the water supply of the house where the
individuals were living when the attack took place.

The inquiry was necessarily attended with a good deal of trouble. There
were very few instances in which I could at once get the information I
required. Even when the water-rates are paid by the residents, they can
seldom remember the name of the Water Company till they have looked for
the receipt. In the case of working people who pay weekly rents, the
rates are invariably paid by the landlord or his agent, who often lives
at a distance, and the residents know nothing about the matter. It
would, indeed, have been almost impossible for me to complete the
inquiry, if I had not found that I could distinguish the water of the
two companies with perfect certainty by a chemical test. The test I
employed was founded on the great difference in the quantity of chloride
of sodium contained in the two kinds of water, at the time I made the
inquiry. On adding solution of nitrate of silver to a gallon of the
water of the Lambeth Company, obtained at Thames Ditton, beyond the
reach of the sewage of London, only 2·28 grains of chloride of silver
were obtained, indicating the presence of ·95 grains of chloride of
sodium in the water. On treating the water of the Southwark and Vauxhall
Company in the same manner, 91 grains of chloride of silver were
obtained, showing the presence of 37·9 grains of common salt per gallon.
Indeed, the difference in appearance on adding nitrate of silver to the
two kinds of water was so great, that they could be at once
distinguished without any further trouble. Therefore when the resident
could not give clear and conclusive evidence about the Water Company, I
obtained some of the water in a small phial, and wrote the address on
the cover, when I could examine it after coming home. The mere
appearance of the water generally afforded a very good indication of its
source, especially if it was observed as it came in, before it had
entered the water-butt or cistern; and the time of its coming in also
afforded some evidence of the kind of water, after I had ascertained the
hours when the turncocks of both Companies visited any street. These
points were, however, not relied on, except as corroborating more
decisive proof, such as the chemical test, or the Company’s receipt for
the rates.

A return had been made to Parliament of the entire number of houses
supplied with water by each of the Water Companies, but as the number of
houses which they supplied in particular districts was not stated, I
found that it would be necessary to carry my inquiry into all the
districts to which the supply of either Company extends, in order to
show the full bearing of the facts brought out in those districts where
the supply is intermingled. I inquired myself respecting every death
from cholera in the districts to which the supply of the Lambeth Company
extends, and I was fortunate enough to obtain the assistance of a
medical man, Mr. John Joseph Whiting, L.A.C., to make inquiry in
Bermondsey, Rotherhithe, Wandsworth, and certain other districts, which
are supplied only by the Southwark and Vauxhall Company. Mr. Whiting
took great pains with his part of the inquiry, which was to ascertain
whether the houses in which the fatal attacks took place were supplied
with the Company’s water, or from a pump-well, or some other source.

Mr. Whiting’s part of the investigation extended over the first four
weeks of the epidemic, from 8th July to 5th August; and as inquiry was
made respecting every death from cholera during this part of the
epidemic, in all the districts to which the supply of either of the
Water Companies extends, it may be well to consider this period first.
There were three hundred and thirty-four deaths from cholera in these
four weeks, in the districts to which the water supply of the Southwark
and Vauxhall and the Lambeth Company extends. Of these it was
ascertained, that in two hundred and eighty-six cases the house where
the fatal attack of cholera took place was supplied with water by the
Southwark and Vauxhall Company, and in only fourteen cases was the house
supplied with the Lambeth Company’s water; in twenty-two cases the water
was obtained by dipping a pail directly into the Thames, in four
instances it was obtained from pump-wells, in four instances from
ditches, and in four cases the source of supply was not ascertained,
owing to the person being taken ill whilst travelling, or from some
similar cause. The particulars of all the deaths which were caused by
cholera in the first four weeks of the late epidemic, were published by
the Registrar-General in the “Weekly Returns of Births and Deaths in
London,” and I have had the three hundred and thirty-four above
enumerated reprinted in an appendix to this edition, as a guarantee that
the water supply was inquired into, and to afford any person who wishes
it an opportunity of verifying the result. Any one who should make the
inquiry must be careful to find the house where the attack took place,
for in many streets there are several houses having the same number.

According to a return which was made to Parliament, the Southwark and
Vauxhall Company supplied 40,046 houses from January 1st to December
31st, 1853, and the Lambeth Company supplied 26,107 houses during the
same period; consequently, as 286 fatal attacks of cholera took place,
in the first four weeks of the epidemic, in houses supplied by the
former Company, and only 14 in houses supplied by the latter, the
proportion of fatal attacks to each 10,000 houses was as follows.
Southwark and Vauxhall 71. Lambeth 5. The cholera was therefore fourteen
times as fatal at this period, amongst persons having the impure water
of the Southwark and Vauxhall Company, as amongst those having the purer
water from Thames Ditton.

It is extremely worthy of remark, that whilst only five hundred and
sixty-three deaths from cholera occurred in the whole of the metropolis,
in the four weeks ending 5th August, more than one half of them took
place amongst the customers of the Southwark and Vauxhall Company, and a
great portion of the remaining deaths were those of mariners and persons
employed amongst the shipping in the Thames, who almost invariably draw
their drinking water direct from the river.

It may, indeed, be confidently asserted, that if the Southwark and
Vauxhall Water Company had been able to use the same expedition as the
Lambeth Company in completing their new works, and obtaining water free
from the contents of sewers, the late epidemic of cholera would have
been confined in a great measure to persons employed among the shipping,
and to poor people who get water by pailsful direct from the Thames or
tidal ditches.

The number of houses in London at the time of the last census was
327,391. If the houses supplied with water by the Southwark and Vauxhall
Company, and the deaths from cholera occurring in these houses, be
deducted, we shall have in the remainder of London 287,345 houses, in
which 277 deaths from cholera took place in the first four weeks of the
epidemic. This is at the rate of nine deaths to each 10,000. But the
houses supplied with water by the Lambeth Company only suffered a
mortality of five in each 10,000 at this period; it follows, therefore,
that these houses, although intimately mixed with those of the Southwark
and Vauxhall Company, in which so great a proportional mortality
occurred, did not suffer even so much as the rest of London which was
not so situated.

In the beginning of the late epidemic of cholera in London, the Thames
water seems to have been the great means of its diffusion, either
through the pipes of the Southwark and Vauxhall Company, or more
directly by dipping a pail in the river. Cholera was prevailing in the
Baltic Fleet in the early part of summer, and the following passage from
the “Weekly Returns” of the Registrar-General shows that the disease was
probably imported thence to the Thames.

“Bermondsey, St. James. At 10, Marine Street, on 25th July, a mate
mariner, aged 34 years, Asiatic cholera 101 hours, after premonitory
diarrhœa 16¹⁄₂ hours. The medical attendant states: ‘This patient was
the chief mate to a steam-vessel taking stores to and bringing home
invalids from the Baltic Fleet. Three weeks ago he brought home in his
cabin the soiled linen of an officer who had been ill. The linen was
washed and returned.’”

The time when this steam-vessel arrived in the Thames with the soiled
linen on board, was a few days before the first cases of cholera
appeared in London, and these first cases were chiefly amongst persons
connected with the shipping in the river. It is not improbable therefore
that a few simple precautions, with respect to the communications with
the Baltic Fleet, might have saved London from the cholera this year, or
at all events greatly retarded its appearance.

As the epidemic advanced, the disproportion between the number of cases
in houses supplied by the Southwark and Vauxhall Company and those
supplied by the Lambeth Company, became not quite so great, although it
continued very striking. In the beginning of the epidemic the cases
appear to have been almost altogether produced through the agency of the
Thames water obtained amongst the sewers; and the small number of cases
occurring in houses not so supplied, might be accounted for by the fact
of persons not keeping always at home and taking all their meals in the
houses in which they live; but as the epidemic advanced it would
necessarily spread amongst the customers of the Lambeth Company, as in
parts of London where the water was not in fault, by all the usual means
of its communication. The two subjoined tables, VII and VIII, show the
number of fatal attacks in houses supplied respectively by the two
Companies, in all the sub-districts to which their water extends. The
cases in table VII, are again included in the larger number which appear
in the next table. The sub-districts are arranged in three groups, as
they were in table VI, illustrating the epidemic of 1853.

In table VIII, showing the mortality in the first seven weeks of the
epidemic, the water supply is the result of my own personal inquiry, in
every case, in all the sub-districts to which the supply of the Lambeth
Company extends; but in some of the sub-districts supplied only by the
Southwark and Vauxhall Company, the inquiry of Mr. Whiting having
extended only to 5th August, the water supply of the last three weeks is
calculated to have been in the same proportion by the Company, or by
pump wells, etc., as in the first four weeks,—a calculation which is
perfectly fair, and must be very near the truth. The sub-districts in
which the supply is partly founded on computation, are marked with an
asterisk.

The numbers in table VIII differ a very little from those of the table I
communicated to the _Medical Times and Gazette_ of 7th October, on
account of the water supply having since been ascertained in some cases
in which I did not then know it. The small number of instances in which
the water supply remains unascertained are chiefly those of persons
taken into a workhouse without their address being known.


                              =TABLE VII.=

    The mortality from Cholera in the four weeks ending 5th August.

 ┌──────────────┬──────────┬───────┐
 │              │          │Deaths │
 │              │          │from in│
 │              │          │  the  │
 │Sub-Districts.│Population│ four  │
 │              │ in 1851. │ weeks │
 │              │          │ending │
 │              │          │  5th  │
 │              │          │August.│
 ├──────────────┼──────────┼───────┤
 │              │          │       │
 │      „       │    „     │   „   │
 │              │          │       │
 │              │          │       │
 ├──────────────┼──────────┼───────┤
 │St. Saviour,  │    19,709│     26│
 │  Southwark   │          │       │
 │St. Olave,    │     8,015│     19│
 │  Southwark   │          │       │
 │St. John,     │    11,360│     18│
 │  Horsleydown │          │       │
 │St. James,    │    18,899│     29│
 │  Bermondsey  │          │       │
 │St. Mary      │    13,934│     20│
 │  Magdalen    │          │       │
 │Leather Market│    15,295│     23│
 │Rotherhithe   │    17,805│     26│
 │Battersea     │    10,560│     13│
 │Wandsworth    │     9,611│      2│
 │Putney        │     5,280│      1│
 │Camberwell    │    17,742│     19│
 │Peckham       │    19,444│      4│
 │              │          │       │
 │Christchurch, │    16,022│      3│
 │  Southwk.    │          │       │
 │Kent Road     │    18,126│      8│
 │Borough Road  │    15,862│     21│
 │London Road   │    17,836│      9│
 │Trinity,      │    20,922│     14│
 │  Newington   │          │       │
 │St. Peter,    │    29,861│     20│
 │  Walworth    │          │       │
 │St. Mary,     │    14,033│      5│
 │  Newington   │          │       │
 │Waterloo Road │    14,088│      5│
 │  (1st)       │          │       │
 │Waterloo Road │    18,348│      5│
 │  (2nd)       │          │       │
 │Lambeth Church│    18,409│      5│
 │  (1st)       │          │       │
 │Lambeth Church│    26,784│     10│
 │  (2nd)       │          │       │
 │Kennington    │    24,261│     11│
 │  (1st)       │          │       │
 │Kennington    │    18,848│      3│
 │  (2nd)       │          │       │
 │Brixton       │    14,610│      1│
 │Clapham       │    16,290│      5│
 │St. George,   │    15,849│      9│
 │  Camberwell  │          │       │
 │              │          │       │
 │Norwood       │     3,977│       │
 │Streatham     │     9,023│       │
 │Dulwich       │     1,632│       │
 │Sydenham      │     4,501│       │
 ├──────────────┼──────────┼───────┤
 │              │   486,936│    334│
 └──────────────┴──────────┴───────┘

 ┌──────────────┬──────────────────────────────────────────────────────┐
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 │Sub-Districts.│                    Water Supply.                     │
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 ├──────────────┼─────────┬────────┬───────────┬────────┬──────────────┤
 │              │Southwark│        │           │ River  │              │
 │      „       │    &    │Lambeth.│Pump-wells.│Thames, │Unascertained.│
 │              │Vauxhall.│        │           │ditches,│              │
 │              │         │        │           │  etc.  │              │
 ├──────────────┼─────────┼────────┼───────────┼────────┼──────────────┤
 │St. Saviour,  │       24│        │           │       2│              │
 │  Southwark   │         │        │           │        │              │
 │St. Olave,    │       15│        │           │       2│             2│
 │  Southwark   │         │        │           │        │              │
 │St. John,     │       17│        │           │       1│              │
 │  Horsleydown │         │        │           │        │              │
 │St. James,    │       23│        │           │       6│              │
 │  Bermondsey  │         │        │           │        │              │
 │St. Mary      │       19│        │           │       1│              │
 │  Magdalen    │         │        │           │        │              │
 │Leather Market│       23│        │           │        │              │
 │Rotherhithe   │       17│        │           │       9│              │
 │Battersea     │       10│        │          1│       2│              │
 │Wandsworth    │         │        │           │       2│              │
 │Putney        │         │        │          1│        │              │
 │Camberwell    │       19│        │           │        │              │
 │Peckham       │        4│        │           │        │              │
 │              │         │        │           │        │              │
 │Christchurch, │        2│       1│           │        │              │
 │  Southwk.    │         │        │           │        │              │
 │Kent Road     │        7│       1│           │        │              │
 │Borough Road  │       20│       1│           │        │              │
 │London Road   │        5│       4│           │        │              │
 │Trinity,      │       14│        │           │        │              │
 │  Newington   │         │        │           │        │              │
 │St. Peter,    │       20│        │           │        │              │
 │  Walworth    │         │        │           │        │              │
 │St. Mary,     │        5│        │           │        │              │
 │  Newington   │         │        │           │        │              │
 │Waterloo Road │        5│        │           │        │              │
 │  (1st)       │         │        │           │        │              │
 │Waterloo Road │        5│        │           │        │              │
 │  (2nd)       │         │        │           │        │              │
 │Lambeth Church│        2│       1│           │       1│             1│
 │  (1st)       │         │        │           │        │              │
 │Lambeth Church│        7│       2│           │        │             1│
 │  (2nd)       │         │        │           │        │              │
 │Kennington    │        9│       1│          1│        │              │
 │  (1st)       │         │        │           │        │              │
 │Kennington    │        3│        │           │        │              │
 │  (2nd)       │         │        │           │        │              │
 │Brixton       │         │       1│           │        │              │
 │Clapham       │        4│        │          1│        │              │
 │St. George,   │        7│       2│           │        │              │
 │  Camberwell  │         │        │           │        │              │
 │              │         │        │           │        │              │
 │Norwood       │         │        │           │        │              │
 │Streatham     │         │        │           │        │              │
 │Dulwich       │         │        │           │        │              │
 │Sydenham      │         │        │           │        │              │
 ├──────────────┼─────────┼────────┼───────────┼────────┼──────────────┤
 │              │      286│      14│          4│      26│             4│
 └──────────────┴─────────┴────────┴───────────┴────────┴──────────────┘


                             =TABLE VIII.=

     Mortality from Cholera in the seven weeks ending 26th August.

 ┌──────────────┬──────────┬───────┐
 │              │          │Deaths │
 │              │          │ from  │
 │              │          │Cholera│
 │              │Population│in the │
 │Sub-Districts.│ in 1851. │ seven │
 │              │          │ weeks │
 │              │          │ending │
 │              │          │ 26th  │
 │              │          │August.│
 ├──────────────┼──────────┼───────┤
 │              │          │       │
 │      „       │    „     │   „   │
 │              │          │       │
 │              │          │       │
 ├──────────────┼──────────┼───────┤
 │*St. Saviour, │    19,709│    125│
 │  Southwark   │          │       │
 │*St. Olave,   │     8,015│     53│
 │  Southwark   │          │       │
 │*St. John,    │    11,360│     51│
 │  Horsleydown │          │       │
 │*St. James,   │    18,899│    123│
 │  Bermondsey  │          │       │
 │*St. Mary     │    13,934│     87│
 │  Magdalen    │          │       │
 │*Leather      │    15,295│     81│
 │  Market      │          │       │
 │*Rotherhithe  │    17,805│    103│
 │*Battersea    │    10,560│     54│
 │Wandsworth    │     9,611│     11│
 │Putney        │     5,280│      1│
 │*Camberwell   │    17,742│     96│
 │*Peckham      │    19,444│     59│
 │              │          │       │
 │Christchurch, │    16,022│     25│
 │  Southwk.    │          │       │
 │Kent Road     │    18,126│     57│
 │Borough Road  │    15,862│     71│
 │London Road   │    17,836│     29│
 │Trinity,      │    20,922│     58│
 │  Newington   │          │       │
 │St. Peter,    │    29,861│     90│
 │  Walworth    │          │       │
 │St. Mary,     │    14,033│     21│
 │  Newington   │          │       │
 │Waterloo Road │    14,088│     10│
 │  (1st)       │          │       │
 │Waterloo Road │    18,348│     36│
 │  (2nd)       │          │       │
 │Lambeth Church│    18,409│     18│
 │  (1st)       │          │       │
 │Lambeth Church│    26,748│     53│
 │  (2nd)       │          │       │
 │Kennington    │    24,261│     71│
 │  (1st)       │          │       │
 │Kennington    │    18,848│     38│
 │  (2nd)       │          │       │
 │Brixton       │    14,610│      9│
 │*Clapham      │    16,290│     24│
 │St. George,   │    15,849│     42│
 │  Camberwell  │          │       │
 │              │          │       │
 │Norwood       │     3,977│      8│
 │Streatham     │     9,023│      6│
 │Dulwich       │     1,632│       │
 │Sydenham      │     4,501│      4│
 ├──────────────┼──────────┼───────┤
 │              │   486,936│   1514│
 └──────────────┴──────────┴───────┘

 ┌──────────────┬──────────────────────────────────────────────────────┐
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 │Sub-Districts.│                    Water Supply.                     │
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 │              │                                                      │
 ├──────────────┼─────────┬────────┬───────────┬────────┬──────────────┤
 │              │Southwark│        │           │ River  │              │
 │      „       │    &    │Lambeth.│Pump-wells.│Thames, │Unascertained.│
 │              │Vauxhall.│        │           │ditches,│              │
 │              │         │        │           │  etc.  │              │
 ├──────────────┼─────────┼────────┼───────────┼────────┼──────────────┤
 │*St. Saviour, │      115│        │           │      10│              │
 │  Southwark   │         │        │           │        │              │
 │*St. Olave,   │       43│        │           │       5│             5│
 │  Southwark   │         │        │           │        │              │
 │*St. John,    │       48│        │           │       3│              │
 │  Horsleydown │         │        │           │        │              │
 │*St. James,   │      102│        │           │      21│              │
 │  Bermondsey  │         │        │           │        │              │
 │*St. Mary     │       83│        │           │       4│              │
 │  Magdalen    │         │        │           │        │              │
 │*Leather      │       81│        │           │        │              │
 │  Market      │         │        │           │        │              │
 │*Rotherhithe  │       68│        │           │      35│              │
 │*Battersea    │       42│        │          4│       8│              │
 │Wandsworth    │        1│        │          2│       8│              │
 │Putney        │         │        │          1│        │              │
 │*Camberwell   │       96│        │           │        │              │
 │*Peckham      │       59│        │           │        │              │
 │              │         │        │           │        │              │
 │Christchurch, │       11│      13│           │        │             1│
 │  Southwk.    │         │        │           │        │              │
 │Kent Road     │       52│       5│           │        │              │
 │Borough Road  │       61│       7│           │        │             3│
 │London Road   │       21│       8│           │        │              │
 │Trinity,      │       52│       6│           │        │              │
 │  Newington   │         │        │           │        │              │
 │St. Peter,    │       84│       4│           │        │             2│
 │  Walworth    │         │        │           │        │              │
 │St. Mary,     │       19│       1│          1│        │              │
 │  Newington   │         │        │           │        │              │
 │Waterloo Road │        9│       1│           │        │              │
 │  (1st)       │         │        │           │        │              │
 │Waterloo Road │       25│       8│          1│       2│              │
 │  (2nd)       │         │        │           │        │              │
 │Lambeth Church│        6│       9│           │       1│             2│
 │  (1st)       │         │        │           │        │              │
 │Lambeth Church│       34│      13│          1│        │             5│
 │  (2nd)       │         │        │           │        │              │
 │Kennington    │       63│       5│          3│        │              │
 │  (1st)       │         │        │           │        │              │
 │Kennington    │       34│       3│          1│        │              │
 │  (2nd)       │         │        │           │        │              │
 │Brixton       │        5│       2│           │        │             2│
 │*Clapham      │       19│        │          5│        │              │
 │St. George,   │       30│       9│          2│        │             1│
 │  Camberwell  │         │        │           │        │              │
 │              │         │        │           │        │              │
 │Norwood       │         │       2│          1│       5│              │
 │Streatham     │         │       1│          5│        │              │
 │Dulwich       │         │        │           │        │              │
 │Sydenham      │         │       1│          2│        │             1│
 ├──────────────┼─────────┼────────┼───────────┼────────┼──────────────┤
 │              │     1263│      98│         29│     102│            22│
 └──────────────┴─────────┴────────┴───────────┴────────┴──────────────┘

The following is the proportion of deaths to 10,000 houses, during the
first seven weeks of the epidemic, in the population supplied by the
Southwark and Vauxhall Company, in that supplied by the Lambeth Company,
and in the rest of London.


                              =TABLE IX.=

 ┌──────────────────────────────┬────────────┬────────────┬────────────┐
 │                              │ Number of  │Deaths from │ Deaths in  │
 │                              │  houses.   │  Cholera.  │each 10,000 │
 │                              │            │            │  houses.   │
 ├──────────────────────────────┼────────────┼────────────┼────────────┤
 │Southwark and Vauxhall Company│      40,046│       1,263│         315│
 │Lambeth Company               │      26,107│          98│          37│
 │Rest of London                │     256,423│       1,422│          59│
 └──────────────────────────────┴────────────┴────────────┴────────────┘

The mortality in the houses supplied by the Southwark and Vauxhall
Company was therefore between eight and nine times as great as in the
houses supplied by the Lambeth Company; and it will be remarked that the
customers of the Lambeth Company continued to enjoy an immunity from
cholera greater than the rest of London which is not mixed up as they
are with the houses supplied by the Southwark and Vauxhall Company.

As regards the period of the epidemic subsequent to the 26th August to
which my inquiry extended, I have stated that the Registrar-General
requested the District Registrars to make a return of the water supply
of the house of attack in all cases of death from cholera. Owing to
difficulties such as I explained that I had met with in the beginning of
my inquiry, the Registrars could not make the return in all cases, and
as they could not be expected to seek out the landlord or his agent, or
to apply chemical tests to the water as I had done, the water supply
remained unascertained in a number of cases, but the numbers may
undoubtedly be considered to show the correct proportions as far as they
extend, and they agree entirely with the results of my inquiry
respecting the earlier part of the epidemic given above.

The Registrar-General published the returns of the water supply, which
he had obtained from the District Registrars, down to 14th October, in a
table which is subjoined. As the whole of the south districts of London
were included in the inquiry of the Registrar-General, the deaths in the
Greenwich and Lewisham districts, which are supplied by the Kent Water
Company, and did not enter into my inquiry, are included in the table,
but they do not in the least affect the numbers connected with the other
companies.


                               =TABLE X.=

 ┌────────────┬─────────┬────────────────────────────────────────────────────┐
 │            │ Deaths  │                                                    │
 │Week ending.│  from   │                   Water Supply.                    │
 │            │Cholera. │                                                    │
 ├────────────┼─────────┼─────────┬─────────┬─────────┬─────────┬────────────┤
 │            │         │Southwk. │         │  Kent   │ Pumps,  │    Not     │
 │     „      │    „    │   and   │Lambeth. │Company. │and other│ascertained.│
 │            │         │Vauxhall.│         │         │sources. │            │
 ├────────────┼─────────┼─────────┼─────────┼─────────┼─────────┼────────────┤
 │September 2.│      670│      399│       45│       38│       72│         116│
 │  „       9.│      972│      580│       72│       45│       62│         213│
 │  „      16.│      856│      524│       66│       48│       44│         174│
 │  „      23.│      724│      432│       72│       28│       62│         130│
 │  „      30.│      383│      228│       25│       19│       24│          87│
 │October   7.│      200│      121│       14│       10│        9│          46│
 │  „      14.│      115│       69│        8│        3│        6│          29│
 ├────────────┼─────────┼─────────┼─────────┼─────────┼─────────┼────────────┤
 │            │     3920│     2353│      302│      191│      279│         795│
 └────────────┴─────────┴─────────┴─────────┴─────────┴─────────┴────────────┘

Now 2,353 deaths in 40,046 houses, the number supplied by the Southwark
and Vauxhall Company, are 537 deaths to each 10,000 houses; and 302
deaths to 26,107, the number of houses supplied by the Lambeth Company,
are 115 deaths to each 10,000 houses; consequently, in the second seven
weeks of the epidemic, the population supplied by the Southwark and
Vauxhall Company continued to suffer nearly five times the mortality of
that supplied with water by the Lambeth Company. If the 795 deaths in
which the water supply was not ascertained be distributed equally over
the other sources of supply in the above table (No. X), the deaths in
houses supplied by the Southwark and Vauxhall Company would be 2,830,
and in houses supplied by the Lambeth Company would be 363. By adding
the number of deaths which occurred in the first seven weeks of the
epidemic, we get the numbers in the subjoined table (No. XI), where the
population of the houses supplied by the two water companies is that
estimated by the Registrar-General.[16]


                              =TABLE XI.=

 ┌─────────────────┬────────────────┬─────────────────┬────────────────┐
 │                 │ Population in  │Deaths by Cholera│Deaths in 10,000│
 │                 │     1851.      │in 14 wks. ending│    living.     │
 │                 │                │     Oct 14.     │                │
 ├─────────────────┼────────────────┼─────────────────┼────────────────┤
 │London           │       2,362,236│           10,367│              43│
 │                 │                │                 │                │
 │West Districts   │         376,427│            1,992│              53│
 │North Districts  │         490,396│              735│              14│
 │Central Districts│         393,256│              612│              15│
 │East Districts   │         485,522│            1,461│              30│
 │South Districts  │         616,635│            5,567│              90│
 │                 │                │                 │                │
 │Houses supplied  │                │                 │                │
 │  by Southwark   │         266,516│            4,093│             153│
 │  and Vauxhall   │                │                 │                │
 │  Company        │                │                 │                │
 │Houses supplied  │                │                 │                │
 │  by Lambeth     │         173,748│              461│              26│
 │  Company        │                │                 │                │
 └─────────────────┴────────────────┴─────────────────┴────────────────┘

We see by the above table that the houses supplied with the water from
Thames Ditton, by the Lambeth Company, continued throughout the epidemic
to enjoy an immunity from cholera, not only greater than London at
large, but greater than every group of districts, except the north and
central groups.

In the next table (No. XII), the mortality from cholera in 1849 is shown
side by side with that of 1854, in the various sub-districts to which
the supply of the two water companies with which we are particularly
interested extends. The mortality of 1854 is down to October 21, and is
extracted from a table published in the “Weekly Return of Births and
Deaths” of October 28; that of 1849 is from the “Report on Cholera” by
Dr. Farr, previously quoted. The sub-districts are arranged in three
groups as before, the first group being supplied only by the Southwark
and Vauxhall Company, the second group by this Company and the Lambeth,
and the third group by the Lambeth Company only. It is necessary to
observe, however, that the supply of the Lambeth Company has been
extended to Streatham, Norwood, and Sydenham, since 1849, in which year
these places were not supplied by any water company. The situation and
extent of the various sub-districts are shown, together with the nature
of the water supply, in Map 2, which accompanies this work.


                              =TABLE XII.=

 ┌─────────────────┬─────────────────┬─────────────────┬─────────────────┐
 │ Sub-Districts.  │   Deaths from   │   Deaths from   │  Water Supply.  │
 │                 │Cholera in 1849. │Cholera in 1854. │                 │
 ├─────────────────┼─────────────────┼─────────────────┼─────────────────┤
 │St. Saviour,     │                 │                 │Southwark &      │
 │  Southwark      │              283│              371│  Vauxhall       │
 │                 │                 │                 │  Company only.  │
 │St. Olave        │              157│              161│        „        │
 │St. John,        │              192│              148│        „        │
 │  Horsleydown    │                 │                 │                 │
 │St. James,       │              249│              362│        „        │
 │  Bermondsey     │                 │                 │                 │
 │St. Mary Magdalen│              259│              244│        „        │
 │Leather Market   │              226│              237│        „        │
 │Rotherhithe[17]  │              352│              282│        „        │
 │Wandsworth       │               97│               59│        „        │
 │Battersea        │              111│              171│        „        │
 │Putney           │                8│                9│        „        │
 │Camberwell       │              235│              240│        „        │
 │Peckham          │               92│              174│        „        │
 │                 │                 │                 │                 │
 │                 │                 │                 │Lambeth Company, │
 │Christchurch,    │              256│              113│  and Southwark  │
 │  Southwark      │                 │                 │  and Vauxhall   │
 │                 │                 │                 │  Compy.         │
 │Kent Road        │              267│              174│        „        │
 │Borough Road     │              312│              270│        „        │
 │London Road      │              257│               93│        „        │
 │Trinity,         │              318│              210│        „        │
 │  Newington      │                 │                 │                 │
 │St. Peter,       │              446│              388│        „        │
 │  Walworth       │                 │                 │                 │
 │St. Mary,        │              143│               92│        „        │
 │  Newington      │                 │                 │                 │
 │Waterloo Road    │              193│               58│        „        │
 │  (1st)          │                 │                 │                 │
 │Waterloo Road    │              243│              117│        „        │
 │  (2nd)          │                 │                 │                 │
 │Lambeth Church   │              215│               49│        „        │
 │  (1st)          │                 │                 │                 │
 │Lambeth Church   │              544│              193│        „        │
 │  (2nd)          │                 │                 │                 │
 │Kennington (1st) │              187│              303│        „        │
 │Kennington (2nd) │              153│              142│        „        │
 │Brixton          │               81│               48│        „        │
 │Clapham          │              114│              165│        „        │
 │St. George,      │              176│              132│        „        │
 │  Camberwell     │                 │                 │                 │
 │                 │                 │                 │                 │
 │Norwood          │                2│               10│Lambeth Company  │
 │                 │                 │                 │  only.          │
 │Streatham        │              154│               15│        „        │
 │Dulwich          │                1│                 │        „        │
 │Sydenham         │                5│               12│        „        │
 ├─────────────────┼─────────────────┼─────────────────┼─────────────────┤
 │First 12         │             2261│             2458│Southwk. &       │
 │  sub-districts  │                 │                 │  Vauxhall.      │
 ├─────────────────┼─────────────────┼─────────────────┼─────────────────┤
 │Next 16          │             3905│             2547│Both Companies.  │
 │  sub-districts  │                 │                 │                 │
 ├─────────────────┼─────────────────┼─────────────────┼─────────────────┤
 │Last 4           │              162│               37│Lambeth Company. │
 │  sub-districts  │                 │                 │                 │
 └─────────────────┴─────────────────┴─────────────────┴─────────────────┘

[Sidenote: THE CHOLERA OF 1849 COMPARED WITH THAT OF 1854.]

The table exhibits an increase of mortality in 1854 as compared with
1849, in the sub-districts supplied by the Southwark and Vauxhall
Company only, whilst there is a considerable diminution of mortality in
the sub-districts partly supplied by the Lambeth Company. In certain
sub-districts, where I know that the supply of the Lambeth Water Company
is more general than elsewhere, as Christchurch, London Road, Waterloo
Road 1st, and Lambeth Church 1st, the decrease of mortality in 1854 as
compared with 1849 is greatest, as might be expected. Waterloo Road 1st,
which suffered but little from cholera in the present year, is chiefly
composed of very dirty narrow streets, in the neighbourhood of Cornwall
Road and the New Cut, inhabited by very poor people; and Lambeth Church
1st, which suffered still less, contains a number of skinyards and other
factories, between Lambeth Palace and Vauxhall Bridge, which have often
been inveighed against as promoting the cholera. The high mortality of
the Streatham district in 1849 was caused by the outbreak of cholera in
Drouett’s Asylum for pauper children, previously mentioned.

Whilst making inquiries in the south districts of London, I learned some
circumstances with respect to the workhouses which deserve to be
noticed. In Newington Workhouse, containing 650 inmates, and supplied
with the water from Thames Ditton, there had been but two deaths from
cholera amongst the inmates down to 21st September, when the epidemic
had already greatly declined. In Lambeth Workhouse, containing, if I
remember rightly, nearly 1,000 inmates, and supplied with the same
water, there had been but one death amongst the inmates when I was there
in the first week of September. In St. Saviour’s workhouse, which is
situated in the parish of Christchurch, and is supplied with water by
the Lambeth Company, no inmate died of cholera before I called in the
first week of September. On the other hand, in the workhouse of St.
George, Southwark, supplied with the water of the Southwark and Vauxhall
Company, six inmates died out of about 600 before the 26th August, when
the epidemic had only run one-third of its course. The mortality was
also high amongst the inmates of St. Olave’s Workhouse, supplied with
water by the Southwark and Vauxhall Company, but I do not know the
number who died. I trust, however, that the Registrar

[Sidenote: HORSEMONGER LANE GAOL.]

General, in giving an account of the recent epidemic, will make a return
of the deaths amongst the inmates of the various workhouses and other
institutions on the south side of the Thames, together with the water
supply of the buildings. Bethlehem Hospital, the Queen’s Prison,
Horsemonger Lane Gaol, and some other institutions, having deep wells on
the premises, scarcely suffered at all from cholera in 1849, and there
was no death in any of them during the part of the recent epidemic to
which my inquiry extended.


[Sidenote: DISTRICT OF CHELSEA WATER COMPANY.]

On the north side of the Thames the mortality during the recent epidemic
seems to have been influenced more by the relative crowding and want of
cleanly habits of the people, and by the accidental contamination of the
pump-wells, than by the supply of the water companies. The water of the
New River Company could have no share in the propagation of cholera, as
I explained when treating of the epidemic of 1849; and the extensive
districts supplied by this company have been very slightly visited by
the disease, except in certain spots which were influenced by the causes
above mentioned. The water of the East London Company is also free from
the contents of sewers, unless it be those from the neighbourhood of
Upper Clapton, where there has been very little cholera. The districts
supplied by this company have been lightly visited, except such as lie
near the Thames, and are inhabited by mariners, coal and
ballast-heavers, and others, who are employed on the river. Even Bethnal
Green and Spitalfields, so notorious for their poverty and squalor, have
suffered a mortality much below the average of the metropolis. The Grand
Junction Company obtain their supply at Brentford, within the reach of
the tide and near a large population, but they detain the water in large
reservoirs, and their officers tell me they filter it; at all events,
they supply it in as pure a state as that of the Lambeth Company
obtained at Thames Ditton, and their districts have suffered very little
from cholera except at the spot where the irruption occurred from the
contamination of the pump-well in Broad Street, Golden Square. The West
Middlesex Company, obtaining their supply from the Thames at
Hammersmith, have also very large reservoirs, and the districts they
supply have suffered but little from cholera, except the Kensington
brick fields, Starch Green, and certain other spots, crowded with poor
people, chiefly Irish.

[Sidenote: CHOLERA IN THE DISTRICT OF THE CHELSEA WATER COMPANY.]

The districts supplied by the Chelsea Company have suffered a much
greater mortality, during the recent epidemic, than the average of the
whole metropolis, as the subjoined table (No. XIII) shows. But the
mortality in these districts is only half as great as in the houses
supplied by the Southwark and Vauxhall Company, who obtain their supply
from the Thames just opposite the spot where the Chelsea Company obtain
theirs. The latter company, however, by detaining the water in their
reservoirs, and by filtering it, are enabled to distribute it in a state
of comparative purity; but I had ample opportunities of observing, in
August and September last, that this was far from being the state of the
water supplied by the Southwark and Vauxhall Company. Many of the people
receiving this latter supply were in the habit of tying a piece of linen
or some other fabric over the tap by which the water entered the butt or
cistern, and in two hours, as the water came in, about a tablespoon of
dirt was collected, all in motion with a variety of water insects,
whilst the strained water was far from being clear. The contents of the
strainer were shown to me in scores of instances. I do not, of course,
attribute the cholera either to the insects or the visible dirt; but it
is extremely probable that the measures adopted by the Chelsea Company
to free the water from these repulsive ingredients, either separated or
caused the destruction of the morbid matter of cholera. It is very
likely that the detention of the water in the company’s reservoirs
permitted the decomposition of the cholera poison, and was more
beneficial than the filtering, for the following reasons. The water used
in Millbank Prison, obtained from the Thames at Millbank, was filtered
through sand and charcoal till it looked as clear as that of the Chelsea
Company; yet, in every epidemic, the inmates of this prison suffered
much more from cholera than the inhabitants of the neighbouring streets
and those of Tothill Fields Prison, supplied by that company.[18] In the
early part of August last, the use of the Thames water was entirely
discontinued in Millbank Prison, and water from the Artesian well in
Trafalgar Square was used instead, on the recommendation of Dr. Baly,
the physician to the prison. In three or four days after this change,
the cholera, which was prevailing to an alarming extent, entirely
ceased.


                             =TABLE XIII.=

 ┌────────────────────────────────────┬──────────┬─────────────────────┐
 │                                    │Population│  Deaths by Cholera  │
 │                                    │ in 1851. │                     │
 ├────────────────────────────────────┼──────────┼──────────┬──────────┤
 │                                    │          │In 15 wks.│ To every │
 │                 „                  │    „     │  ending  │  10,000  │
 │                                    │          │ October  │ living.  │
 │                                    │          │   21.    │          │
 ├────────────────────────────────────┼──────────┼──────────┼──────────┤
 │Chelsea, south                      │    19,050│       122│        64│
 │Chelsea, north-west                 │    17,669│        99│        56│
 │Chelsea, north-east                 │    19,819│        71│        36│
 │Belgrave                            │    40,034│       238│        59│
 │St. John, Westminster               │    34,295│       173│        50│
 │St. Margaret, Westminster           │    31,314│       238│        76│
 ├────────────────────────────────────┼──────────┼──────────┼──────────┤
 │Total of districts supplied by the  │   162,181│       941│        56│
 │  Chelsea Water Company             │          │          │          │
 │Houses supplied by the Southwark and│   266,516│     2,900│       108│
 │  Vauxhall Company                  │          │          │          │
 │LONDON                              │ 2,362,236│    10,530│        45│
 │London, except the houses supplied  │          │          │          │
 │  by the Chelsea Company, and by the│ 1,933,539│     6,689│        34│
 │  Southwark & Vauxhall Compy.       │          │          │          │
 └────────────────────────────────────┴──────────┴──────────┴──────────┘

The quantity of impurity in the Thames was greatly increased during the
late autumn, by the long course of dry weather. From 5th August to 12th
September, a period of more than five weeks, only 0·29 of an inch of
rain fell at Greenwich, as appears by the report of the Astronomer
Royal. The stream of the Thames above the reach of the tide became so
slender, that it was difficult to navigate barges above Richmond. The
Thames in London is a very large body of water, and if the whole of it
flowed away into the sea every day, the liquid which flows down the
sewers in twelve hours would form but a very small part of it; but it
must be remembered that the quantity of water which passes out to sea,
with the ebb of every tide, is only equal to that which flows over
Teddington Lock, and from a few small tributary streams. In hot dry
weather this quantity is moreover greatly diminished by the evaporation
taking place from the immense surface of water exposed between Richmond
and Gravesend, so that the river becomes a kind of prolonged lake, the
same water passing twice a day to and fro through London, and receiving
the excrement of its two millions and more of inhabitants, which keeps
accumulating till there is a fall of rain. In time of cholera, the
evacuations of the patients keep accumulating in the river along with
the other impurities; and it is probably in this way that the dry
weather with a high barometer aids in promoting cholera, as it has often
been observed to do.

[Sidenote: IMPURITY OF THE THAMES.]

I thought at first that the quantity of common salt, previously
mentioned as being present in the water of the Southwark and Vauxhall
Company, consisted entirely of the salt which had passed down the sewers
into the river, for I had no idea that any admixture of sea water
reached as high as Battersea Fields. Mr. Quick, the engineer of the
above Company, informed me, however, that an impregnation of salt water
does extend as far after a long course of dry weather. It is obvious
that a dry season, whilst it increases the quantity of impurity in the
Thames, must also cause the sea water to flow further inland than at
other times. I did not examine the water of the Thames in August or
September, but I have done so now, at the latter part of November, and I
am inclined to think that even yet a slight admixture of sea water may
reach to Battersea Fields with every tide. I found 5·8 grains of
chloride of sodium per gallon in water obtained at Hungerford Market, at
half-flow of the tide, on 19th November, and 19·1 grains per gallon, in
water obtained at the same place, on 27th November, at an hour and a
half before high water; whilst water obtained at London Bridge, on 28th
November, at high water, contained 63·3 grains per gallon.

A specimen of water obtained on 21st November, from a house supplied by
the Southwark and Vauxhall Company, contained 28·8 grains of common salt
per gallon, or about three-quarters as much as it contained in
September, when the quantity was 37·9 grains. It is very obvious from
the above analyses, that the Water Company obtain their supply from the
Thames at high water, or nearly so, although this is the time of the
tide when the water contains the greatest amount of impurity. It is
quite certain that the sea water cannot reach to Thames Ditton, any more
than the contents of the London sewers, and therefore, whatever may be
its source, the quantity of chloride of sodium in the water is quite
conclusive as regards the purpose for which I examined into it, viz., to
distinguish between the water of the two Companies.

When the water of the Southwark and Vauxhall Company was examined by
Messrs. Graham, Miller, and Hofmann, at the latter part of January 1851,
it contained only 1·99 grains of chloride of sodium, or about
one-twentieth as much as it contained last September, and one-fifteenth
as much as on 21st November 1854.[19]


[Sidenote: ALLEGED EFFECT OF LEVEL.]

Dr. Farr discovered a remarkable coincidence between the mortality from
cholera in the different districts of London in 1849, and the elevation
of the ground; the connection being of an inverse kind, the higher
districts suffering least, and the lowest suffering most from this
malady. Dr. Farr was inclined to think that the level of the soil had
some direct influence over the prevalence of cholera, but the fact of
the most elevated towns in this kingdom, as Wolverhampton, Dowlais,
Merthyr Tydvil, and Newcastle-upon-Tyne, having suffered excessively
from this disease on several occasions, is opposed to this view, as is
also the circumstance of Bethlehem Hospital, the Queen’s Prison,
Horsemonger Lane Gaol, and several other large buildings, which are
supplied with water from deep wells on the premises, having nearly or
altogether escaped cholera, though situated on a very low level, and
surrounded by the disease. The fact of Brixton, at an elevation
fifty-six feet above Trinity high-water mark, having suffered a
mortality of 55 in 10,000, whilst many districts on the north of the
Thames, at less than half the elevation, did not suffer one-third as
much, also points to the same conclusion.

I expressed the opinion in 1849,[20] that the increased prevalence of
cholera in the low-lying districts of London depended entirely on the
greater contamination of the water in these districts, and the
comparative immunity from this disease of the population receiving the
improved water from Thames Ditton, during the epidemics of last year and
the present, as shown in the previous pages, entirely confirms this view
of the subject; for the great bulk of this population live in the lowest
districts of the metropolis.


The prevalence of cholera has been very much under the influence of the
water supply in other towns besides London. The cholera has prevailed to
a considerable extent in the crowded habitations of the poor in
Liverpool and some other towns, where the general supply of water was
not in fault, but I know of no instance in which it has spread through
all classes of the community, except where the general supply of water
has been contaminated with the contents of the drains and sewers; and
all the towns with which I am acquainted that have enjoyed an almost
complete immunity from this disease, have a water supply quite free from
any chance of contamination. Birmingham, Bath, Cheltenham, and Leicester
have nearly escaped the cholera in every epidemic. The few cases that
have occurred being chiefly those of persons newly arrived from places
where the disease was prevailing, and a few others who came in
communication with them. All these towns have a supply of water quite
free from connection with the drains and sewers, and the small rivers
which flow through them are so impure that it would be impossible to
drink the water. Leicester is crowded with a poor population, and has
hardly any physical advantage except its water supply.

[Sidenote: CHOLERA IN EXETER.]

The first cases of cholera in Exeter in 1832, were three in the same
day, besides one in St. Thomas’s, a suburb of Exeter, in a gentleman
just arrived from London, where the disease was prevailing. The other
three were a woman and her two children; the former, with one of her
children, had returned from Plymouth the previous day, where she had
been nursing a child that had died of the cholera. Within five days from
this time, there were seven fresh cases in as many different parts of
the town, amongst persons having no intercourse with each other or the
first cases. The disease soon became very prevalent, and in three months
there were 1,135 cases, and 345 deaths. Exeter is situated on ground
which rises from the edge of the river to an elevation of one hundred
and fifty feet. In 1832 the inhabitants were chiefly supplied with river
water by water-carriers, who conveyed it in carts and pails. Dr.
Shapter, from whose work[21] the above particulars are obtained, kindly
furnished me with information concerning the sewers, and with maps of
their position. The water-carriers, by whom Exeter was very greatly
supplied, obtained their water almost exclusively from certain streams
of water, diverted from the river in order to turn water-mills; and one
of the chief sewers of the town, which receives such sewage as might
come from North Street, in which the first cases of cholera occurred,
empties itself into the branch from the river which divides into the two
mill-streams just mentioned. It must be remarked that the parish of St.
Edmund, in which these streams of water were situated, had a lower
mortality from cholera than other parts of the town like it, densely
populated and on low ground near the river. Dr. Shapter attributes this
lower rate of mortality, and I believe rightly, to St. Edmund’s being
freely intersected by running streams of water. The people would
probably not drink more of the water than in parts of the town where it
was less plentiful, and had to be paid for, but they would have much
better opportunities for personal cleanliness: so that whilst they would
be exposed to only the same number of scattered cases, they would be
less likely to have the malady spreading through families, and by
personal intercourse. After the cholera of 1832, measures were taken to
afford a better supply of water to Exeter; not, so far as I can find by
Dr. Shapter’s work, that its impurity was complained of, but because of
its scarcity and cost. Waterworks were established on the river Exe, two
miles above the town, and more than two miles above the influence of the
tide. Exeter has since been very plentifully supplied with this water,
and Dr. Shapter informed me that in 1849 there were only about twenty
cases of cholera, nearly half of which occurred in strangers coming into
the town, and dying within two or three days after their arrival. This
last summer there was only one death from cholera in Exeter.

[Sidenote: CHOLERA IN HULL.]

We will now consider the town of Hull, in which, together with other
sanitary measures adopted since 1832, there has been a new and more
plentiful supply of water, but with a far different result to that at
Exeter. In 1832 Hull was scantily supplied with water conveyed in pipes
from springs at Anlaby, three miles from the town. About 1844, new
waterworks were established to afford a more plentiful supply. These
works were situated on the river Hull, at Stoneferry, two miles and
three quarters from the confluence of that river with the Humber. About
half the sewage of the town is delivered into the river of the same
name, the rest being discharged into the Humber, as appears from
information and a map kindly furnished me in 1849 by Dr. Horner of Hull,
who was making great efforts to have better water obtained for the town.
The tide flows up the river many miles past the waterworks, carrying up
with it the filth from the sewers. The supply of water was, to be sure,
obtained when the tide was down, but as the banks of the river are
clothed with sedges in many parts, and its bottom deep with mud, the
water can never be free from sewage. Moreover, there are some parts of
the river above Stoneferry much deeper than the rest, and where the
deeper water is, according to the testimony of boatmen, nearly stagnant;
thus allowing the water carried up by the tide to remain and gradually
mix with that afterwards flowing down. There are also boats, with
families on board, passing up the river to the extent of five thousand
voyages in the year. The water when taken from the river was allowed to
settle in the reservoir for twenty-four hours, and was then said to be
filtered before being sent to the town. In 1832 the cholera was confined
almost exclusively to the poor, and the deaths amounted to three
hundred.

In 1849 the deaths in Hull (including the suburb of Sculcoates) were
1834, although 8,000 or 10,000 left the town, it is said, to avoid the
ravages of the disease. Dr. Horner informed me that the deaths occurred
amongst all classes of the community, and that the town was much better
drained in 1849 than in 1832.

[Sidenote: CHOLERA IN YORK.]

When the cholera made its appearance at York, about the middle of July
1849, it was at first chiefly prevalent in some narrow streets near the
river, called the Water Lanes. The inhabitants of this spot had been in
the habit, from time immemorial, of fetching their water from the river
at a place near which one of the chief sewers of the town empties
itself; and recently a public necessary had been built, the contents of
which were washed every morning into the river just above the spot at
which they got the water. In a short time from twenty to thirty deaths
occurred in this locality; but the medical men considering the impure
water injurious, the people were supplied from the waterworks, with
water obtained from the river at a point some distance above the town,
and the cholera soon ceased nearly altogether in this part of the city,
but continued to spread in some other parts. The cholera having thus
abated in the Water Lanes, the gratuitous supply of water was cut off,
and the people went to the river as before. There were still cases of
cholera in the town, and it soon broke out again in this locality, and
in the first few days of September eight deaths occurred among the
persons who used water obtained direct from the river. The tap for
general use was again opened, and the river water interdicted, and the
cholera again ceased, and did not recur. These circumstances were
communicated to me by a friend on whose accuracy I can rely.

The inhabitants of Dumfries drink the water of the river Nith, which
flows through the town, and into which the sewers discharge their
contents, which float afterwards to and fro with the tide. In 1832 there
were 418 deaths from cholera out of a population of 11,606, being at the
rate of 360 in 10,000, or 1 in every 28 of the inhabitants. The cholera
again visited Dumfries at the close of 1848, and carried off 431
persons, or 1 in every 32, out of a population now numbering 14,000; so
that the mortality was excessive on both occasions.

Preston and Oldham, in Lancashire, are supplied with water from surface
drainage on the neighbouring hills, and there was scarcely any cholera
at either of these places in 1849. The greater part of the town of
Paisley is supplied in a similar way; and I was informed that the cases
of cholera which occurred there in 1849 were confined to a quarter of
the town to which this supply of water does not extend. Nottingham is
supplied with filtered water obtained from the river Trent, some
distance above the town. In 1832 this supply did not extend to all the
inhabitants, and the cholera was somewhat prevalent amongst the poor, of
whom it carried off 289; the population of the town being 53,000. After
that time the water was extended copiously to all the inhabitants, and
there were but thirteen deaths from the epidemic in 1849. The local
Sanitary Committee placed the supply of water amongst the chief causes
of this immunity from cholera, and I believe justly. There were but
seven deaths from cholera in Nottingham last summer.

[Sidenote: CHOLERA IN GLASGOW.]

Glasgow has been supplied, since the early part of the present century,
with the water of the Clyde, obtained a little way above the town, but
within the influence of the tide, and consequently mixed with the
contents of the sewers. It is imperfectly filtered through sand. In
1847, however, the parish of Gorbals, which forms the south part of
Glasgow, was furnished with a supply of water collected on the
neighbouring hills; and Dr. Leech, of Glasgow, speaks as follows
respecting the influence of this water on the prevalence of cholera:
“During the late cholera there was a remarkable circumstance, which
deserves notice as compared with the epidemic of 1832. Since the former
period, the population of Glasgow, south of the Clyde, has nearly
doubled; and with this exception, and the introduction of the soft-water
supply, the circumstances might be considered as the same at both
periods. In one district, the parish of Gorbals, the attack in 1832 was
fearful; while Glasgow, north of the Clyde, also suffered severely.
During the late epidemic [that of 1848–49], Gorbals parish furnished
comparatively a small number of cases; while the epidemic in other parts
of Glasgow was very severe. The unanimous opinion of the Medical Society
was, that this comparative immunity was to be attributed to the
soft-water supply.”[22]

[Sidenote: CHOLERA IN NEWCASTLE.]

I was informed that when the cholera was prevalent in Glasgow last
winter, the parish of Gorbals again enjoyed a similar immunity from the
disease.

The following passage respecting the water supply of Paris is from Dr.
Farr’s “Report to the Registrar-General on the Cholera of 1848–49”:—“The
supply of Paris is from various sources, but four-fifths of the water is
from the Canal de l’Ourque, which, by the decision of Napoleon, was also
appropriated to navigation. The water for some years, and in 1832, when
the epidemic was so fatal, was drawn from the dirty basin in which the
boats and barges of the canals rested; but is now drawn from the canal
before it enters the basin.... The mortality of cholera in Paris was
excessive, and in 1832 varied from 80, of 10,000 inhabitants, in the
elegant Chaussée d’Antin and in Montmartre on the heights, to 530 and
520 in the low quartiers of the Hôtel de Ville and the Cité.” (p.
lxxviii.)

The town of Newcastle-upon-Tyne affords a remarkable instance of the
influence of the water supply on the prevalence of cholera. In 1831–32
there were no waterworks at Newcastle; it was supplied, in an
insufficient manner, with spring water, which generally had to be
carried some distance to the houses from “pants” in the streets. The
epidemic was pretty severe at this time. From November 1831 to November
1832 there were 801 deaths from cholera out of a population of 42,760.
The disease prevailed chiefly amongst the poor, and was worst in the
least elevated parts of the town, near the river. Subsequently to 1832,
waterworks were established on the river Tyne, a little above the town;
but these were abandoned, in 1848, in favour of a supply from a rivulet
and springs at Whittle Dean, about ten miles distant. In 1849, there
were but 295 deaths from cholera in a population then increased to
71,847. In the beginning of July 1853, two months before the
reappearance of cholera in England, the Whittle Dean Water Company found
their proper sources insufficient for the demands of the population and
the various factories, and they made use of the former waterworks,
mentioned above, to obtain water from the Tyne. The point at which they
obtained water from the river, is scarcely a mile above Newcastle, and
the tide flows for six miles above the town, carrying the contents of
the sewers with it. There are also villages, containing several
thousands of colliers and ironfounders, on the banks of the Tyne, above
the waterworks. The water from the Tyne was mixed, without filtration,
with that from Whittle Dean, to the extent of one-third; and the mixed
water, so supplied, was discoloured, and contained the large quantity of
7·1 grains of organic matter per gallon.

In the autumn of 1853, the cholera was prevailing extensively at
Hamburgh, and in nearly all the ports of the Baltic, whence a number of
ships were arriving every day in the Tyne. The first cases of cholera
commenced, with diarrhœa, on the 27th and 28th August, at Bell Quay, on
the banks of the Tyne, three miles below Newcastle. One of the patients
from Bell Quay was taken worse whilst on a visit to her mother at
Newcastle: she died on 2nd September. Her mother was taken ill the same
evening, and died on the following day. Other cases occurred in
Newcastle on the 1st and 2nd of September, having no connexion with
these. A ship from Bremen was lying at Bell Quay, opposite the house
where the first cases occurred; but there had been no illness on board
this ship, and the precise way in which the cholera was introduced on
this occasion, is not known.

The disease soon spread to an extent almost unprecedented in this
country: by the 15th of September the deaths exceeded a hundred a day.
In nine weeks there were 1,533 deaths from cholera in a population of
86,114, being 178 to each 10,000 inhabitants; but the greater number of
these deaths occurred in a few days, as 1001 took place from the 13th to
the 23rd Sept. inclusive.[23]

Gateshead, which is situated opposite to Newcastle, on the other side of
the Tyne, is supplied with the same water; and in 1849 it shared with
that town a comparative immunity from cholera, whilst in the autumn of
1853, 433 persons died of that disease out of a population of 26,000, or
thereabouts, being 166 to each 10,000 inhabitants.

The lowest streets in Newcastle and Gateshead are about five feet above
high-water mark; and only a few streets are situated at this level, for
the banks rise very abruptly, at a little distance from the river, on
both sides. A great portion of each town is elevated nearly 200 feet
above the river, and some parts are nearly 300 feet high; yet the Water
Company supplies all these districts, and all were severely visited by
the cholera, which on this occasion spared no class of the community. In
the districts which are most crowded, the mortality was greatest, the
deaths being much more numerous in the parishes which contained a great
number of tenements consisting of a single room, than in those which
consisted chiefly of houses occupied by one family.[24] This, however,
is quite in accordance with the principles which I am throughout
endeavouring to explain. A great deal of stress is laid, very properly,
by the Commissioners who have reported respecting this outbreak, on the
ill-arranged buildings, the defective drainage, and want of privy
accommodation, in Newcastle; but it must be remembered that all these
evils existed in 1849, when Newcastle escaped with less cholera than
most towns,—to a greater extent than they did in 1853, for many
improvements had taken place in the meantime.

In consequence of a great outcry on the part of the public, who
naturally connected the great fatality of cholera in some measure with
the turbidity and offensive smell of the drinking water, the Company
entirely ceased to draw water from the Tyne on the 15th September; and
although the Tyne water was not entirely out of the pipes for a day or
two, the deaths, which had been rapidly increasing, began to diminish on
the 17th, and were lessened considerably by the 20th. The following is
the course of the mortality in Newcastle, in the most fatal part of the
epidemic; and it began to decline at exactly the same time in Gateshead:

          September 12 13 14  15  16  17  18  19 20 21 22  23
          DEATHS    38 59 90 106 114 103 103 111 85 68 82 60.

The late General Board of Health directed one of their medical
inspectors, Dr. Waller Lewis, to make minute inquiry as to the relative
effects produced by the use of pure spring water, and that of the Water
Company, during the epidemic of cholera in Newcastle; and it is much to
be regretted that the inquiry was not carried out. To have conducted the
inquiry through the whole of Newcastle and Gateshead would not have
entailed a quarter as much labour as my investigations in Lambeth,
Newington, and the Borough. Dr. Lewis called on Mr. Main, the secretary
of the Water Company, and they made an inquiry in certain houses, taken
at random, through three streets, and also in Greenhow Terrace, where a
severe outbreak of cholera had occurred, although it was not supplied by
the Company, but had what was reported to be good spring water. Dr.
Lewis gave up the inquiry because he could not find two places exactly
alike in all their physical conditions,—one place supplied with spring
water, the other by the Company. He made no report of what he had done;
but Mr. Main sent a paper on the subject of this commenced inquiry to
the Pathological Society of Newcastle, an abstract of which appeared in
the “Medical Times and Gazette”.

By adding Greenhow Terrace to the streets partly supplied by the
Company, and by including cases of cholera, fatal or otherwise, with
those of mere diarrhœa, Mr. Main was able to show a result apparently in
favour of the Company’s water. He was good enough, however, to send me a
copy of his paper, which contains the details of the inquiry as far as
it extended; and I found, on perusing it, that, leaving out Greenhow
Terrace, which is not supplied by the Company at all, there was no case
of cholera, either fatal or otherwise, and no case, even of approaching
cholera, in any house which was not supplied with the Company’s water.
All the deaths and all the cholera occurred in the houses having this
water, whilst in the houses having only pump-water, there was simply
diarrhœa. In the workhouse, supplied by the Water Company, and having
five hundred and forty inmates, there were twelve cases of cholera, or
approaching cholera, and seven deaths; whilst in the military barracks,
supplied from wells on the premises, and having five hundred and
nineteen inmates, although there was a good deal of harmless diarrhæa,
there was no cholera, nor any case of approaching cholera.

[Sidenote: CHOLERA AT MOSCOW.]

The communication of cholera by means of the water is well illustrated
by the instance of Moscow, which was severely visited by that disease in
1830; but much less severely in the second epidemic. Subsequently to
1830 the greater part of the town, which is situated to the north of the
Moscow river, obtained a supply of excellent water, conducted in pipes
from springs at a distance; and the cholera in 1847 was chiefly confined
to those parts of the town which lie to the south of the river, to which
the new supply of water did not extend, and where the people had still
only impure river water to drink.[25]

The above instances are probably sufficient to illustrate the
widely-spread influence which the pollution of the drinking water exerts
in the propagation of cholera.

[Sidenote: DIFFUSION OF THE CHOLERA POISON IN WATER.]

After the Registrar-General alluded, in the “Weekly Return” of 14th
October last, to the very conclusive investigation of the effects of
polluted water in the south districts of London, there was a leading
article, in nearly all the medical periodicals,[26] fully admitting the
influence of the water on the mortality from cholera. It may therefore
be safely concluded that this influence is pretty generally admitted by
the profession. It must not be disguised, however, that medical men are
not yet generally convinced that the disease is actually communicated
from person to person by the morbid matter being swallowed in the
drinking water, or otherwise. It used to be the custom of medical
authors to speak of three kinds of causes of a disease, viz.
predisposing, exciting, and proximate causes. The proximate causes have
been given up, as being the diseases themselves; but authors still
divide causes into predisposing and exciting ones. It may be remarked,
however, that in treating of certain communicable diseases, the cause of
which is thoroughly understood, as syphilis and the itch, predisposing
causes are never mentioned; and that they are rarely alluded to in
treating of small-pox, measles, and scarlet fever, whilst they continue
to be appealed to in explanation of the various continued fevers.[27]
Now many medical men, whilst they admit the influence of polluted water
on the prevalence of cholera, believe that it acts by predisposing or
preparing the system to be acted on by some unknown cause of the disease
existing in the atmosphere or elsewhere. The following amongst other
reasons prove, however, that opinion cannot long halt here, and that, if
the effect of contaminated water be admitted, it must lead to the
conclusion that it acts by containing the true and specific cause of the
malady.

In my inquiries in the south districts of London I met with several
instances in which persons, especially maidservants and young men, died
of cholera within a few days after coming from the country to a house
supplied with water by the Southwark and Vauxhall Company. The Registrar
of Waterloo Road (2nd) remarked as follows on this point, on 26th August
last:—“This is the third successive case of fatal cholera, where the
patients have recently come from the country. Similar instances have
frequently attracted the Registrar’s notice.” I found that the houses in
which these cases occurred were supplied by the above-named Company. The
outbreak of cholera in the Baltic fleet, related at page 36, occurred
within forty-eight hours after the polluted water had been taken on
board. And lastly, if the contaminated water merely acted by
predisposing or preparing the system to be affected by some other cause,
it would be impossible to explain why nearly all the persons drinking it
should be attacked together, in cases where a pump-well or some other
limited supply is polluted, while the population around experience no
increase of the malady.

All the evidence proving the communication of cholera through the medium
of water, confirms that with which I set out, of its communication in
the crowded habitations of the poor, in coal-mines and other places, by
the hands getting soiled with the evacuations of the patients, and by
small quantities of these evacuations being swallowed with the food, as
paint is swallowed by house painters of uncleanly habits, who contract
lead-colic in this way.


There are one or two objections to the mode of communication of cholera
which I am endeavouring to establish, that deserve to be noticed.
Messrs. Pearse and Marston state, in their account of the cases of
cholera treated at the Newcastle Dispensary in 1853, that one of the
dispensers drank by mistake some rice-water evacuation without any
effect whatever.[28] In rejoinder to this negative incident, it may be
remarked, that several conditions may be requisite to the communication
of cholera with which we are as yet unacquainted. Certain conditions we
know to be requisite to the communication of other diseases. Syphilis we
know is only communicable in its primary stage, and vaccine lymph must
be removed at a particular time to produce its proper effects. In the
incident above mentioned, the large quantity of the evacuation taken
might even prevent its action. It must be remembered that the effects of
a morbid poison are never due to what first enters the system, but to
the crop or progeny produced from this during a period of reproduction,
termed the period of incubation; and if a whole sack of grain, or seed
of any kind, were put into a hole in the ground, it is very doubtful
whether any crop whatever would be produced.

[Sidenote: EXPERIMENTS OF DR. THIERSCH ANSWERS TO CERTAIN OBJECTIONS.]

Dr. Thiersch is of opinion, as appears by a discussion which has
recently taken place at Munich, that the cholera evacuations are not at
first capable of generating the disease; but that a decomposition takes
place in them, and that in from six to nine days they become in a state
to induce cholera. He founds this opinion on experiments which he
performed by giving small quantities of the cholera evacuations to white
mice. Although it is not contrary to all analogy that some change or
development should take place in the cholera poison in the interval
between its leaving one person and entering another, it is most probable
that the fatal bowel complaint produced in white mice by Dr. Thiersch
was not a specific disease, but the ordinary effect of putrifying
ingesta. Many of the best attested instances of the communication of
cholera are those, such as were related at the commencement of this
work, where the patient is attacked in from twenty-four to forty-eight
hours after first being near another patient, and although an interval
of a week or so, often elapses between one case of the disease and those
which follow, it is extremely probable that, in these instances, the
evacuations remain the greater part of this time in a dry state on the
soiled linen, without undergoing any change.

An objection that has repeatedly been made to the propagation of cholera
through the medium of water, is, that every one who drinks of the water
ought to have the disease at once. This objection arises from mistaking
the department of science to which the communication of cholera belongs,
and looking on it as a question of chemistry, instead of one of natural
history, as it undoubtedly is. It cannot be supposed that a morbid
poison, which has the property, under suitable circumstances, of
reproducing its kind, should be capable of being diluted indefinitely in
water, like a chemical salt; and therefore it is not to be presumed that
the cholera poison would be equally diffused through every particle of
the water. The eggs of the tape-worm must undoubtedly pass down the
sewers into the Thames, but it by no means follows that everybody who
drinks a glass of the water should swallow one of the eggs. As regards
the morbid matter of cholera, many other circumstances, besides the
quantity of it which is present in a river at different periods of the
epidemic, must influence the chances of its being swallowed, such as its
remaining in a butt or other vessel till it is decomposed or devoured by
animalcules, or its merely settling to the bottom and remaining there.
In the case of the pump-well in Broad Street, Golden Square, if the
cholera poison was contained in the minute whitish flocculi, visible on
close inspection to the naked eye, some persons might drink of the water
without taking any, as they soon settled to the bottom of the vessel.

[Sidenote: THEORIES OF THE CAUSE OF CHOLERA.]

It is not necessary to oppose any other theories in order to establish
the principles I am endeavouring to explain, for the field I have
entered on was almost unoccupied. The best attempt at explaining the
phenomena of cholera, which previously existed, was probably that which
supposed that the disease was communicated by effluvia given off from
the patient into the surrounding air, and inhaled by others into the
lungs; but this view required its advocates to draw very largely on what
is called predisposition, in order to account for the numbers who
approach near to the patient without being affected, whilst others
acquire the disease without any near approach. It also failed entirely
to account for the sudden and violent outbreaks of the disease, such as
that which occurred in the neighbourhood of Golden Square.

Another view having a certain number of advocates is, that cholera
depends on an unknown something in the atmosphere which becomes
localized, and has its effects increased by the gases given off from
decomposing animal and vegetable matters. This hypothesis is, however,
rendered impossible by the motion of the atmosphere, and, even in the
absence of wind, by the laws which govern the diffusion of aeriform
bodies; moreover, the connection between cholera and offensive effluvia
is by no means such as to indicate cause and effect; even in London, as
was before mentioned, many places where offensive effluvia are very
abundant have been visited very lightly by cholera, whilst the
comparatively open and cleanly districts of Kennington and Clapham have
suffered severely. If inquiry were made, a far closer connection would
be found to exist between offensive effluvia and the itch, than between
these effluvia and cholera; yet as the cause of itch is well known, we
are quite aware that this connection is not one of cause and effect.

Mr. John Lea, of Cincinnati, has advanced what he calls a geological
theory of cholera.[29] He supposes that the cholera poison, which he
believes to exist in the air about the sick, requires the existence of
calcareous or magnesian salts in the drinking water to give it effect.
This view is not consistent with what we know of cholera, but there are
certain circumstances related by Mr. Lea which deserve attention. He
says that, in the western districts of the United States, the cholera
passed round the arenacious, and spent its fury on the calcareous
regions; and that it attacked with deadly effect those who used the
calcareous water, while it passed by those who used sandstone or soft
water. He gives many instances of towns suffering severely when river
water was used, whilst others, having only soft spring water or rain
water, escaped almost entirely; and he states that there has been
scarcely a case of cholera in families who used only rain water. The
rivers, it is evident, might be contaminated with the evacuations,
whilst it is equally evident that the rain water could not be so
polluted. As regards sand and all sandstone formations, they are well
known to have the effect of oxidizing and thus destroying organic
matters; whilst the limestone might not have that effect, although I
have no experience on that point. The connection which Mr. Lea has
observed between cholera and the water is highly interesting, although
it probably admits of a very different explanation from the one he has
given.


[Sidenote: DURATION OF CHOLERA IN DIFFERENT PLACES.]

There are certain circumstances connected with the history of cholera
which admit of a satisfactory explanation according to the principles
explained above, and consequently tend to confirm those principles. The
first point I shall notice, viz., the period of duration of the epidemic
in different places, refers merely to the communicability of the
disease, without regard to the mode of communication. The duration of
cholera in a place is usually in a direct proportion to the number of
the population. The disease remains but two or three weeks in a village,
two or three months in a good-sized town, whilst in a great metropolis
it often remains a whole year or longer. I find from an analysis which I
made in 1849 of the valuable table of Dr. Wm. Merriman, of the cholera
in England in 1832,[30] that fifty-two places are enumerated in which
the disease continued less than fifty days, and that the average
population of these places is 6,624. Forty-three places are likewise
down in which the cholera lasted fifty days, but less than one hundred;
the average population of these is 12,624. And there are, without
including London, thirty-three places in which the epidemic continued
one hundred days and upwards, the average population of which is 38,123;
or if London be included, thirty-four places, with an average of 78,823.
The following short table will show these figures in a more convenient
form:—

          No. of Places. Duration in Days. Average Population.
          52                  0 to 50                    6,624
          43               50 to 100000                 12,624
          33}             100 and upwards             { 38,123
          34}                    „                    { 78,823

There was a similar relation in 1849 between the duration of the cholera
and the population of the places which it visited; a relation which
points clearly to the propagation of the disease from patient to
patient; for if each case were not connected with a previous one, but
depended on some unknown atmospheric or telluric condition, there is no
reason why the twenty cases which occur in a village should not be
distributed over as long a period as the twenty hundred cases which
occur in a large town.

Even the duration of the cholera in a street, when compared to its
duration in the individual houses, points to the same conclusion. A
table has been published[31] in the report of the late discussion on
cholera at Munich, which shows that whilst the epidemic remained three
or four weeks in a street, it only remained six or seven days in houses
where several people were attacked. Dr. Pettenkofer remarks, that “if
the proximate cause of the disease had been generally diffused over a
certain number of streets or a certain district, and its invasion had
been opposed by individual disposition alone, one might have expected
that both the cases of disease and the instances of death would have
occurred in single houses, where many such appeared together, at similar
periods of time throughout the whole street; but, supposing that the
proximate cause of the disease was not general, but local, then it would
act in such a manner that the period of time within which the disease
would show itself in single houses would be very different from that
which was applicable to the entire street.” The local cause in a house
we know to be the illness of some individual, who, in many cases, has
newly arrived from some place where the disease was prevailing.

[Sidenote: EFFECT OF SEASON ON THE PREVALENCE OF CHOLERA.]

Each time when cholera has been introduced into England in the autumn,
it has made but little progress, and has lingered rather than flourished
during the winter and spring, to increase gradually during the following
summer, reach its climax at the latter part of summer, and decline
somewhat rapidly as the cool days of autumn set in. In most parts of
Scotland, on the contrary, cholera has each time run through its course
in the winter immediately following its introduction. I have now to
offer what I consider an explanation, to a great extent, of these
peculiarities in the progress of cholera. The English people, as a
general rule, do not drink much unboiled water, except in warm weather.
They generally take tea, coffee, malt liquor, or some other artificial
beverage at their meals, and do not require to drink between meals,
except when the weather is warm. In summer, however, a much greater
quantity of drink is required, and it is much more usual to drink water
at that season than in cold weather. Consequently, whilst the cholera is
chiefly confined in winter to the crowded families of the poor, and to
the mining population, who, as was before explained, eat each other’s
excrement at all times, it gains access as summer advances to the
population of the towns, where there is a river which receives the
sewers and supplies the drinking water at the same time; and, where
pump-wells and other limited supplies of water happen to be contaminated
with the contents of the drains and cesspools, there is a greater
opportunity for the disease to spread at a time when unboiled water is
more freely used.

In Scotland, on the other hand, unboiled water is somewhat freely used
at all times to mix with spirits; I am told that when two or three
people enter a tavern in Scotland and ask for a gill of whiskey, a jug
of water and tumbler-glasses are brought with it. Malt liquors are only
consumed to a limited extent in Scotland, and when persons drink spirit
without water, as they often do, it occasions thirst and obliges them to
drink water afterwards.

There may be other causes besides the above which tend to assist the
propagation of cholera in warm, more than in cold weather. It is not
unlikely that insects, especially the common house-flies, aid in
spreading the disease. An ingenious friend of mine has informed me that,
when infusion of quassia has been placed in the room for the purpose of
poisoning flies, he has more than once perceived the taste of it on his
bread and butter.

Dr. Farr gives the following very important information respecting the
sex of persons who died of cholera at different periods of the
epidemic.[32]

“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 612, females 493; or in the proportion of 100 to 80....

“As a general rule, when the mortality from cholera attained a very high
rate, the number of deaths among females exceeded the deaths among
males.

“In London a remarkable change was observed in the proportion of the
sexes affected in the course of the epidemic. In four weeks of October
1848, the deaths of 80 males and of 42 females by cholera were
registered; in the thirteen last weeks of the year the deaths of 258
males and 210 females were registered; and there was an excess of males
at all ages, but particularly in the ten years of age 15–25. In the
quarter ending March 1849, the deaths of males amounted to 250, of
females to 266: at the age of 25 and upwards the excess of deaths among
females was considerable. In June, at the commencement of the great
outbreak, the males again furnished the most numerous victims. At the
close of July the females died in greater numbers than the males, and
continued to do so to the end. In the week that the mortality was
highest, the deaths of 895 males and of 1131 females were returned. In
the September quarter the deaths of males under the age of 25 exceeded
the deaths of females; but after that age the proportions were
reversed.”

[Sidenote: PROPORTION OF THE SEXES WHO DIE OF CHOLERA.]

The greater part of the female population remain almost constantly at
home, and take their meals at home, whilst a considerable number of the
men move about in following their occupations, and take both food and
drink at a variety of places; consequently, in the early part of an
epidemic, when the disease only exists in a few spots, the male part of
the population is most liable to come within the operation of the morbid
poison; but at a later period of the epidemic, when the cholera is more
generally diffused, it may reach those who stay at home as readily as
those who move about; and in addition to the risk which the women share
with the men, they have the additional one of being engaged in attending
on the sick.

It is a confirmation of this view of the matter that, when the cholera
poison is distributed through the pipes of a Water Company, the above
rule does not hold good, but a contrary one prevails, owing, probably,
to females being less in the habit of drinking beer than men, and being
therefore more likely to drink water. Of the 334 deaths detailed in the
Appendix to this work (286 of them amongst the customers of the
Southwark and Vauxhall Water Company), only 147 were males, whilst 187
were females. The deaths occurred in the first four weeks of the recent
epidemic. On the other hand, out of the 229 deaths from cholera which
occurred in all the rest of London during this period, 140 were males
and only 89 females. When the mortality of the whole of the metropolis
during this period is taken together, there is a slight preponderance on
the part of the males; the numbers being,—males 287, females 276: total
563.

The deaths from cholera in England in 1849 were 53,293; of those,
14,718, or 27 per cent. of the whole, occurred in children under 15
years of age. Of the 334 deaths which are recorded in the Appendix to
this work, 127, or 38 per cent., are those of children under 15, whilst
of the remaining 229 which occurred in the rest of London during the
first four weeks of the epidemic, only 61, or 26 per cent., took place
before the age of 15,—a proportion nearly the same as in the whole of
England in 1849. The higher proportion of deaths amongst children in the
houses supplied with the impure water from the Thames at Battersea
Fields, probably arose from the circumstance that children are very fond
of drinking water in warm weather. I often heard such remarks as the
following, in making my inquiries in the south districts of London:—“My
children like water better than tea or anything else, I cannot keep them
away from the water-butt;” or, “the child that is dead used to drink a
great deal of that water, she was big enough to reach to the butt
herself.”

Dr. Guy, physician to King’s College Hospital, made a table showing the
occupations of 4,312 males, of fifteen years of age and upwards, who
died of cholera in London in the epidemic of 1848–49; together with the
ratio which the deaths bear to the living, as well as it could be
ascertained from the census of 1841. I have not room for the whole
table, but have selected the occupations which suffered most, and those
which suffered least. The following abstract of Dr. Guy’s table contains
all the occupations where the deaths from cholera equalled one-fiftieth
of the number living, and all those in which the deaths did not exceed
one in two hundred and fifty living.

[Sidenote: PROPORTION OF DEATHS IN DIFFERENT OCCUPATIONS.]

In some of the occupations which show a high relative mortality, the
number of living is too small to allow of any reliable statistical
result, and the relative mortality is probably due to accidental
circumstances quite unconnected with the occupation. In other cases,
however, the numbers are so considerable as to indicate something more
than accident. The 299 sailors, for instance, constituted one
twenty-fourth of the whole estimated number in that occupation. The 7
ballast-heavers form just the same proportion of the whole in that
occupation, and the 53 coalporters and coalheavers constituted one in 32
of those so employed. Now all those persons lived or were employed on
the river, where it is the habit to drink water drawn by pailfuls from
the side of the ship. The 67 hawkers are one in 22 of the whole number.
These persons are constantly moving about, and are in the habit of
living in crowded lodging-houses, and consequently must be extremely
liable to contract any communicable disease. Tanners nearly all live in
Bermondsey and Lambeth, supplied in 1849 with none but very impure
water, as was previously explained. The weavers probably suffered the
high rate of mortality from the crowding of their apartments in
Spitalfields, and the uncleanness of their habits.

The persons who suffered less from cholera than any other part of the
male population, are footmen and men-servants; and it is impossible to
conceive a class less exposed to the disease. They live in the best
parts of London, and go from home much less than their masters. The low
rate of mortality amongst medical men and undertakers is worthy of
notice. If cholera were propagated by effluvia given off from the
patient, or the dead body, as used to be the opinion of those who
believed in its communicability; or, if it depended on effluvia lurking
about what are by others called infected localities, in either case
medical men and undertakers would be peculiarly liable to the disease;
but, according to the principles explained in this treatise, there is no
reason why these callings should particularly expose persons to the
malady.


                              =TABLE XIV.=

 ┌───────────────────────────────────────────────────┬────────┬────────┐
 │                                                   │ No. of │ Ratio. │
 │                                                   │Deaths. │        │
 ├───────────────────────────────────────────────────┼────────┼────────┤
 │Agents                                             │      12│1 in 49 │
 │Bricklayers and builders                           │      14│1 „  39 │
 │Cowkeepers, dairymen, and milkmen                  │       8│1 „  20 │
 │Egg merchants                                      │       5│1 „   6 │
 │Fishmongers                                        │      11│1 „  20 │
 │Fruiterers and greengrocers                        │      12│1 „  28 │
 │Jobmasters, livery-stable keepers                  │       5│1 „  37 │
 │Oilmen                                             │      13│1 „  46 │
 │Paper-makers                                       │       2│1 „  15 │
 │Poulterers                                         │       3│1 „  32 │
 │Sail-makers                                        │       2│1 „  30 │
 │Turners                                            │       2│1 „  50 │
 │Ballast-heavers                                    │       7│1 „  24 │
 │Coal-porters and coalheavers                       │      53│1 „  32 │
 │Dustmen and scavengers                             │       6│1 „  39 │
 │Founders                                           │      10│1 „  12 │
 │Hawkers, etc.                                      │      67│1 „  22 │
 │Lithographers                                      │       3│1 „  48 │
 │Modellers                                          │       3│1 „  41 │
 │Polishers                                          │       4│1 „  36 │
 │Sailors, including Greenwich pensioners            │     299│1 „  24 │
 │Tanners                                            │      22│1 „  39 │
 │Weavers                                            │     102│1 „  36 │
 │                                                   │        │        │
 │Physicians, surgeons, & general practitioners      │      16│1 „ 265 │
 │Magistrates, barristers, conveyancers, and         │      13│1 „ 375 │
 │  attorneys                                        │        │        │
 │Merchants                                          │      11│1 „ 348 │
 │Auctioneers                                        │       1│1 „ 266 │
 │Saddlers                                           │       1│1 „ 250 │
 │Brass-finishers                                    │       3│1 „ 318 │
 │Coach-makers                                       │      16│1 „ 262 │
 │Cork-cutters                                       │       2│1 „ 279 │
 │Footmen and men-servants                           │      25│1 „ 1572│
 │Jewellers, goldsmiths, and silversmiths            │       6│1 „ 583 │
 │Millwrights                                        │       2│1 „ 266 │
 │Tallow-chandlers                                   │       2│1 „ 430 │
 │Type-founders                                      │       1│1 „ 390 │
 │Undertakers                                        │       2│1 „ 325 │
 │Warehousemen                                       │       8│1 „ 472 │
 │Watchmakers                                        │      11│1 „ 364 │
 │Wheelwrights                                       │       8│1 „ 294 │
 └───────────────────────────────────────────────────┴────────┴────────┘

[Sidenote: ABSENCE OF DRAINAGE INCREASES CHOLERA.]

There is one remarkable circumstance connected with Dr. Guy’s table. One
master-brewer died of cholera, being 1 in 160 of the trade; but no
brewer’s man or brewer’s servant is mentioned as having died of this
malady, although these men must constitute a very numerous body in
London. There must be a few thousands of them. I have, indeed, met with
the deaths of two or three of these persons, in looking over the returns
of some of the most fatal weeks in 1849; but the brewers’ men seem to
have suffered very slightly both in that and the more recent epidemics.
The reason of this probably is, that they never drink water, and are
therefore exempted from imbibing the cholera poison in that vehicle.

The great prevalence of cholera along the course of rivers has been well
known for a quarter of a century; and it meets with a satisfactory
explanation from the mode of communication of the disease which I am
inculcating. Rivers always receive the refuse of those living on the
banks, and they nearly always supply, at the same time, the drinking
water of the community so situated. It has sometimes been objected to
the propagation of the disease by the water of rivers, that the epidemic
travels as often against the stream as with it. The reply to this is,
that people travel both against the stream and with it, and thus convey
the malady from village to village and from town to town on the banks,
whilst the water serves as a medium to propagate the disease amongst
those living at each spot, and thus prevents it from dying out through
not reaching fresh victims.

The principles I have laid down afford a satisfactory explanation of the
circumstances, that absence of drainage promotes the prevalence of
cholera, and that it flourishes better on a clay soil than on primitive
rocks, sandstone, or gravel. Without drainage, the refuse of the
population permeates the ground, and gains access to the pump-wells.
Merthyr Tydvil, with 52,863 inhabitants, is entirely without drainage,
and the people derive their supply of water from pump-wells. This place
has suffered severely from cholera in every epidemic. In 1849 there were
1,682 deaths from this disease, being 234 to each 10,000 inhabitants,—a
rate of mortality as high as in Hull and certain of the south districts
of London, where the morbid poison of cholera was distributed by the
steam-engines of the water companies. The primitive rocks, sandstone,
and gravel, generally cause the purification of the water by the
separation or oxidation of organic matters, whilst clay does not exert
this salutary influence to the same extent.


Since the latter part of 1848, when I first arrived at my present
conclusions respecting the mode of communication of cholera, I have
become more and more convinced that many other diseases are propagated
in the same way.

When the plague visited this country, it was most fatal in London, York,
Winchester, and certain other towns having a river of fresh water
passing through them. It resembled cholera also in being twice as fatal
in the districts on the south of the Thames as in those on the north.
The following passage from Stow’s “Survey”, published in 1633, shows the
way in which Southwark was supplied with water about the time of the
great visitations of plague: “Southwark useth chiefly the water of the
Thames, that falls into a great pond at St. Mary Overies, that drives a
mill called St. Saviour’s Mill, the owner whereof is one Mr. Gulston.
The revenue thereof is supposed by some to be worth 1,300_l._ a year.”

[Sidenote: MODE OF PROPAGATION OF THE PLAGUE.]

Although some of the lower parts of the City were supplied with water
from the Thames, at the latter part of the sixteenth and throughout the
seventeenth century, yet the greater part of London north of the Thames
was supplied by fountains and conduits, conveying spring water from a
distance. The following quaint but poetic account of the conduits of
London cannot fail to be interesting: “As nature, by veins and arteries,
some great and some small, placed up and down all parts of the body,
ministereth blood to every part thereof; so was that wholesome water,
which was necessary for the good of London, as blood is for the good and
health of the body, conveyed by pipes, wooden or metalline, as by veins,
to every part of this famous city.... They were lovely streams indeed
that did refresh that noble city, one of which was always at work
pouring out itself when the rest lay still. Methinks these several
conduits of London stood like so many little but strong forts, to
confront and give check to that great enemy, fire, as occasion should
be. There, methinks, the water was intrenched and in-garrisoned. The
several pipes and vehicles of water that were within these conduits, all
of them charged with water, till by turning of the cock they were
discharged again, were as so many soldiers within these forts, with
their musketry charged, ready to keep and defend these places. And look
how enemies are wont to deal with these castles, which they take to be
impregnable, and despair of every getting by them,—that is, by
attempting to storm them by a close siege: so went the fire to work with
these little castles of stone, which were not easy for it to burn down
(witness their standing to this day); spoiled them, or almost spoiled
them, it hath for the present, by cutting off those supplies of water
which had vent to flow to them, melting those leaden channels by which
it had been conveyed, and thereby, as it were, starving those garrisons
which it could not take by storm. As if the fire had been angry with the
poor old tankard-bearers, both men and women, for propagating that
element which was contrary to it, and carrying it upon their shoulders,
as it were, in state and triumph, it hath even destroyed their trade,
and threatens to make them perish by fire who had wont to live by
water.”[33]

Dr. Farr makes the following remarks on the plague, in his report on the
cholera of 1848–9: “It is endemic in the Delta of the Nile, and
periodically decimates the population of Cairo and Alexandria.... It
grows gradually less fatal up the Nile, and is less frequent and
destructive in Upper than in Lower Egypt, in the high lands and in the
desert, than on the low lands on the shores of the Mediterranean.”
Speaking of Cairo, he says: “Through the midst of it passes the Great
Canal, into which the sewers are discharged over carrion, excretion, and
mud. At the yearly overflow of the Nile, its waters, filling this canal,
are distributed over the city, and drunk by its wretched inhabitants.”

The plague resembles cholera in being much promoted by crowding and want
of personal cleanliness. The natives of Gurhwal, a province in the
north-west of British India, in which the plague has been present for
the last thirty years, believe that it may be transmitted from one place
to another in articles of diet, such as a jar of ghee.[34]

[Sidenote: MODE OF PROPAGATION OF YELLOW FEVER.]

Yellow fever, which has been clearly proved by Dr. M’William and others
to be a communicable disease, resembles cholera and the plague in
flourishing best, as a general rule, on low alluvial soil, and also in
spreading greatly where there is a want of personal cleanliness. This
disease has more than once appeared in ships sailing up the river Plate,
before they have had any communication with the shore. The most probable
cause of this circumstance is, that the fresh water of this river, taken
up from alongside the ship, contained the evacuations of patients with
yellow fever in La Plata or other towns.

It was long ago observed, that dysentery was apparently propagated by
the drinking of water containing excrementitious matters.[35] The
frequent appearance of this disease in Millbank prison, when the Thames
water was used, is a confirmation of this; and Dr. Bryson has lately
related a number of instances where both dysentery and fever seemed to
be occasioned by the water of the Yangtse-Kiang, the Canton river, and
other rivers of China.[36] What very much confirms this view of the
case, is, that nearly all the patients were afflicted with great numbers
of intestinal worms (_lumbrici_); for it cannot be supposed that the
worms could proceed from malaria, miasmata, or any of the causes which
are frequently believed to occasion dysentery and fever. The eggs of the
lumbrici were no doubt contained in great numbers in the water of the
densely populated Chinese rivers.

There are many facts which indicate that one at least of the continued
fevers—the typhoid fever with ulceration of the small intestines—is also
propagated in the same way as cholera. Dr. Jenner called my attention
some time ago to an instance occurring at the village of North Boston,
Erie County, N.Y., in which typhoid fever was probably communicated to a
number of families by the contamination of the water of a well which
they used.[37] The epidemic which prevailed so extensively at Croydon
two years ago was of this character, as was verified by a Committee of
the Epidemiological Society, of which Drs. Sankey, Jenner, and A. P.
Stewart were members. Mr. Carpenter, of Croydon, has lately shown very
ably that this epidemic was connected with the pollution of the
pump-wells of the town, owing to the disturbance of the ground, and of
many old cesspools during the drainage operations of the Local Board of
Health.[38] The Board had supplied the town with good water from a deep
well in the chalk, but the population had a prejudice against it and
persisted in resorting to the water of the shallow pump-wells. In the
autumn of last year diarrhœa was very prevalent in Croydon, and Mr.
Carpenter found that this also was caused by the impure water of the
pump-wells. Nine-tenths of the people of Croydon were drinking the new
water supplied by the Board of Health, but, out of thirty-two patients
with diarrhœa who came under the notice of Mr. Carpenter, twenty-five
were drinking well-water entirely, five drank water from both sources,
and the other two could not decidedly say that they had not drank
well-water.

Intermittent fevers are so fixed to particular places that they have
deservedly obtained the name of endemics. They spread occasionally,
however, much beyond their ordinary localities, and become epidemic.
Intermittent fevers are undoubtedly often connected with a marshy state
of the soil; for draining the land frequently causes their
disappearance. They sometimes, however, exist as endemics, where there
is no marshy land or stagnant water within scores of miles. Towards the
end of the seventeenth century, intermittent fevers were, for the first
time, attributed by Lancisi to noxious effluvia arising from marshes.
These supposed effluvia, or marsh miasmata, as they were afterwards
called, were thought to arise from decomposing vegetable and animal
matter; but, as intermittent fevers have prevailed in many places where
there was no decomposing vegetable or animal matter, this opinion has
been given up in a great measure; still the belief in miasmata or
malaria of some kind, as a cause of intermittents, is very general. It
must be acknowledged, however, that there is no direct proof of the
existence of malaria or miasmata, much less of their nature.

[Sidenote: CAUSE OF INTERMITTENT FEVERS.]

That preventive of ague, draining the land, must affect the water of a
district quite as much as it affects the air, and there is direct
evidence to prove that intermittent fever has, at all events in some
cases, been caused by drinking the water of marshes. In the “General
Report of the Poor Law Commissioners on the Sanitary Condition of Great
Britain,”[39] Mr. Wm. Blower, surgeon, of Bedford, states that typhus
and ague, which had long infested the village of Wootton, near Bedford,
had been much diminished by digging a few wells, and obtaining good
water. He also states that, in the neighbouring parish of Houghton,
almost the only family which escaped ague, at one time, was that of a
respectable farmer who used well-water, whilst all the other families
had only ditch water.

M. Boudin[40] relates a very marked instance in which intermittent, and
apparently also remittent, fever were caused by drinking marsh water. It
is as follows:—

“In July 1834, 800 soldiers, all in good health, embarked on the same
day in three transports at Bona, in Algeria, and arrived together at
Marseilles; they were exposed to the same atmospheric influences, and
were, with one essential difference, supplied with the same food, and
subjected to the same discipline. On board one of the vessels were 120
soldiers: of these, 13 died on the passage, from a destructive fever,
and 98 more were taken to the military hospital of the lazaretto at
Marseilles, presenting all the pathological characters proper to marshy
localities. On seeing the physiognomy of these patients, altogether so
unusual for Marseilles, one would have said that the Gulf of Mexico, the
Delta of the Ganges, and the marshes of Senegal and of Holland, had
supplied passengers to this ship. In short, by the side of a simple
intermittent, there was a pernicious fever. On an inquiry being
instituted, it was ascertained that on board the affected ship the water
supplied for the soldiers, owing to the haste of the embarkation, had
been taken from a marshy place near Bona; whilst the crew, not one of
whom was attacked, were supplied with wholesome water. It further
appeared that the nine soldiers who had escaped had purchased water of
the crew, and had consequently not drunk the marsh water. Not a single
soldier or sailor of the other two transports, who were supplied with
pure water, suffered.”

Mr. Grainger, who quotes the above circumstance in his Appendix to the
Report on Cholera, also says:[41] “Dr. Evans, of Bedford, related to me
an equally well-marked instance. A few years ago, he was staying at
Versailles, with his lady, when they both became affected with the ague,
and, on inquiry, the following facts were disclosed. The town of
Versailles is supplied with water for domestic purposes from the Seine,
at Marli. At the time in question, a large tank, supplying one
particular quarter, was damaged, and the mayor, without consulting the
medical authorities, provided a supply of water, consisting of the
surface-drainage of the surrounding country, which is of a marshy
character. The regular inhabitants would not use this polluted water;
but Dr. and Mrs. Evans, who were at an hotel, drank of it unwittingly,
and it was also used by a regiment of cavalry. The result was, that
those who drank the water suffered from intermittent fever of so severe
a type, that seven or eight of the soldiers, fine young men, died on one
day, Sept. 1, 1845. On a careful investigation it was ascertained that
those only of the troops who had drunk the marsh water were attacked;
all the others, though breathing the same atmosphere, having escaped, as
did also the townspeople.”

In all the instances I have just quoted, the cause of ague, whatever it
may be, was swallowed with the water, not inhaled with the air; and on
questioning two patients, ill with this complaint, in St. George’s
Hospital, after harvesting in Kent, they told me that they had often
been obliged to drink water from the ditches. The disease of the liver
and spleen, to which persons are subject after attacks of intermittent
fever, also confirms the view that its material cause enters the system
by the alimentary canal, and not by the lungs; and it is of importance
to remark, that Hippocrates observed, that drinking stagnating waters
caused hard swellings of the spleen.[42]

Whether the unknown cause of ague has been produced in the system of a
previous patient, like the pus of small-pox and the eggs of tape-worm,
or whether it has been produced externally, there is, at present, no
sufficient evidence to show. In the case first supposed, the disease
would be a communicable one, in the second it would not.

There is one circumstance which seems to indicate that the specific
cause of intermittent fevers undergoes a development or multiplication
within the system of the patient,—it is, that a period of dormancy, or
incubation, has been observed, in many cases, between the visit to the
unhealthy locality and the illness which followed; for, as I have
already remarked, every poisonous or injurious substance causes symptoms
as soon as it has been absorbed in sufficient quantity.

The communication of ague from person to person has not been observed,
and supposing this disease to be communicable, it may be so only
indirectly, for the _materies morbi_ eliminated from one patient may
require to undergo a process of development or procreation out of the
body before it enters another patient, like certain flukes infesting
some of the lower animals, and procreating by alternate generations.


The measures which are required for the prevention of cholera, and all
diseases which are communicated in the same way as cholera, are of a
very simple kind. They may be divided into those which may be carried
out in the presence of an epidemic, and those which, as they require
time, should be taken beforehand.

The measures which should be adopted during the presence of cholera may
be enumerated as follows:—

1st. The strictest cleanliness should be observed by those about the
sick. There should be a hand-basin, water, and towel, in every room
where there is a cholera patient, and care should be taken that they are
frequently used by the nurse and other attendants, more particularly
before touching any food.

2nd. The soiled bed linen and body linen of the patient should be
immersed in water as soon as they are removed, until such time as they
can be washed, lest the evacuations should become dry, and be wafted
about as a fine dust. Articles of bedding and clothing which cannot be
washed, should be exposed for some time to a temperature of 212° or
upwards.

[Sidenote: MEASURES REQUIRED FOR THE PREVENTION OF CHOLERA.]

3rd. Care should be taken that the water employed for drinking and
preparing food (whether it come from a pump-well, or be conveyed in
pipes) is not contaminated with the contents of cesspools, house-drains,
or sewers; or, in the event that water free from suspicion cannot be
obtained, it should be well boiled, and, if possible, also filtered.

Works are in progress for supplying a great part of London with water
from the Thames, obtained, like that of the Lambeth Company, above
Teddington Lock. Although this is not the best possible source for
supplying a large town, it is a great improvement on the practice of
many of the water companies; and the water, owing to filtration, and
especially to its detention in large reservoirs, will probably be quite
salubrious: at all events it will be much safer than that of the shallow
pump-wells of London, which are fed from very polluted sources. It is
very desirable that the handles of nearly all the street-pumps of London
and other large towns should be fastened up, and the water used only for
such purposes as watering the streets. A proper supply of water for the
shipping in the Thames is much wanted. Water acquires a flat taste by
being boiled; but if it is filtered after it becomes cold, it gets
re-aerated, and the flat or vapid taste is entirely removed.

4th. When cholera prevails very much in the neighbourhood, all the
provisions which are brought into the house should be well washed with
clean water, and exposed to a temperature of 212° Fahr.; or at least
they should undergo one of these processes, and be purified either by
water or by fire. By being careful to wash the hands, and taking due
precautions with regard to food, I consider that a person may spend his
time amongst cholera patients without exposing himself to any danger.

5th. When a case of cholera or other communicable disease appears among
persons living in a crowded room, the healthy should be removed to
another apartment, where it is practicable, leaving only those who are
useful to wait on the sick.

6th. As it would be impossible to clean out coal-pits, and establish
privies and lavatories in them, or even to provide the means of eating a
meal with anything like common decency, the time of working should be
divided into periods of four hours instead of eight, so that the pitmen
might go home to their meals, and be prevented from taking food into the
mines.

7th. The communicability of cholera ought not to be disguised from the
people, under the idea that the knowledge of it would cause a panic, or
occasion the sick to be deserted.

British people would not desert their friends or relatives in illness,
though they should incur danger by attending to them; but the truth is,
that to look on cholera as a “catching” disease, which one may avoid by
a few simple precautions, is a much less discouraging doctrine than that
which supposes it to depend on some mysterious state of the atmosphere
in which we are all of us immersed and obliged to breathe.

The measures which can be taken beforehand to provide against cholera
and other epidemic diseases, which are communicated in a similar way,
are—

8th. To effect good and perfect drainage.

9th. To provide an ample supply of water quite free from contamination
with the contents of sewers, cesspools, and house-drains, or the refuse
of people who navigate the rivers.

10th. To provide model lodging-houses for the vagrant class, and
sufficient house room for the poor generally.

The great benefit of the model lodging-houses arises from the
circumstance that the apartments for cooking, eating, and sleeping, are
distinct, and that all the proper offices which cleanliness and decency
require are provided. The very poor who choose to avail themselves of
these institutions, suffer a rate of mortality as low as that of the
most opulent classes. The public washhouses, which enable poor persons
to wash the soiled linen of the sick or the healthy, without doing it in
the midst of the plates and dishes and provisions of the family, are
well calculated to prevent the spread of disease.

11th. To inculcate habits of personal and domestic cleanliness among the
people everywhere.

12th. Some attention should undoubtedly be directed to persons, and
especially ships, arriving from infected places, in order to segregate
the sick from the healthy. In the instance of cholera, the supervision
would generally not require to be of long duration.

In the autumn of 1853, certain German emigrants, on their way to
America, who had crossed the sea from Hamburgh and Rotterdam, where
cholera was prevailing, to the port of Hull, and had gone thence, by
rail, to Liverpool, were seized with cholera (some of them fatally) in
the latter town; and it is most likely to the well-regulated Emigrant’s
Home, in which these cases occurred, that the town of Liverpool owed its
freedom from the epidemic at that time. And a little medical
supervision, and the detention of some of the emigrants for a short time
in Liverpool, before their embarcation, would probably have prevented
the great mortality which occurred in some of the emigrant ships during
their passage to America.

The measures which are intended to prevent disease should be founded on
a correct knowledge of its causes. For want of this knowledge, the
efforts which have been made to oppose cholera have often had a contrary
effect. In 1849, for instance, the sewers of London were frequently
flushed with water,—a measure which was calculated to increase the
disease in two ways: first, by driving the cholera evacuations into the
river before there was time for the poison to be rendered inert by
decomposition; and second, by making increased calls on the various
companies for water to flush the sewers with,—so that the water which
they sent to their customers remained for a shorter time in the
reservoirs before being distributed. It should be remarked, also, that
the contents of the sewers were driven into the Thames by the flushing,
at low water, and remained flowing up the stream for four or five hours
afterwards. Flushing the sewers was not repeated during the recent
epidemic, but increased quantities of water were distributed by some of
the Companies, and at more frequent intervals, causing the water-butts
to overflow for hours together into the drains, and producing nearly the
same effect as flushing the sewers; in addition to which, the water in
the butts of the Southwark and Vauxhall Company’s customers was
prevented from settling, as it might have done if less frequently
disturbed.

I feel confident, however, that by attending to the above-mentioned
precautions, which I consider to be based on a correct knowledge of the
cause of cholera, this disease may be rendered extremely rare, if indeed
it may not be altogether banished from civilized countries. And the
diminution of mortality ought not to stop with cholera. The deaths
registered under the name of typhus consist chiefly of the typhoid fever
mentioned above. Its victims are composed chiefly of persons of adult
age, who are taken away from their families and connections. In 1847
upwards of 20,000 deaths were registered in England from typhus, and in
1848 upwards of 30,000 deaths. It is probable that seven times as many
deaths have taken place from typhus as from cholera, since the latter
disease first visited England in 1831; and there is great reason to hope
that this mortality may in future be prevented by proper precautions,
resulting from a correct knowledge of the mode of communication of the
malady.




                               APPENDIX,

  Containing the number of deaths from cholera registered in the four
    weeks ending 5th August, 1854, together with the supply of water in
    the houses in which the fatal attacks took place, in all the
    sub-districts to which the water supply of either the Southwark and
    Vauxhall or the Lambeth Company extends. (See Table VII, page 84.)
    The registers of deaths are copied from the Weekly Returns of the
    Registrar-General.


                ST. SAVIOUR, SOUTHWARK. _Christchurch._

At 34, Charlotte Street, on 29th July, a stock-maker, aged 29, “Asiatic
cholera 18 hours”

                                                              _Lambeth._

At 45, Gravel Lane, on 1st August, the widow of a farmer, aged 48,
“cholera 12 hours”

                                                 _Southwark & Vauxhall._

At 1, Alpha Place, on 1st August, a barrister’s clerk, aged 57, “cholera
24 hours”

                                               _Southwark and Vauxhall._


                 ST. SAVIOUR, SOUTHWARK. _St. Saviour._

At 1, Park Street, on 25th July, the wife of a labourer, aged 35,
“Asiatic cholera 14¹⁄₂ hours”

                                                 _Southwark & Vauxhall._

At 40, Bankside, on 25th July, the son of a locksmith, aged 5 years,
“cholera 12 hours”

                                               _Southwark and Vauxhall._

At same house, on 26th July, the daughter of a locksmith, aged 9 yrs.,
“cholera 12 hours”

                                               _Southwark and Vauxhall._

At same house, on 28th July, the daughter of a locksmith, aged 13 yrs.,
“cholera 12 hours”

                                               _Southwark and Vauxhall._

At 97, Bridge Road, on 28th July, a hatter, aged 36, “Asiatic cholera 24
hours”

                                               _Southwark and Vauxhall._

At 49, Great Guildford Street, on 29th July, a coal-porter, aged 44,
“cholera 12 hours”

                                               _Southwark and Vauxhall._

At 20, Zoar Street, on 31st July, a female, formerly a domestic servant,
aged 79, “diarrhœa 2 days, cholera 12 hours”

                                               _Southwark and Vauxhall._

At 22, America Street, on Aug. 1, the wife of an engine-driver, aged 38,
“cholera 12 hours”

                                               _Southwark and Vauxhall._

At 5, Pleasant Place, August 1, the daughter of a coal-porter, aged 5
years, “Asiatic cholera 13 hours”

                                               _Southwark and Vauxhall._

At 10, Castle Street, on 1st August, the son of an engineer, aged 7
years, “cholera 12 hours”

                                               _Southwark and Vauxhall._

At 36, New Park Street, on 1st August, the son of an artist, aged 2
years, “Asiatic cholera 10¹⁄₂ hours”

                             _Thames water from the tank of a saw-mill._

At 54¹⁄₂, Great Guildford St., on 2nd Aug., a labourer aged 51, “Asiatic
cholera 47 hours”

                                               _Southwark and Vauxhall._

At the same house, same day, the wife of a labourer, aged 48, “Asiatic
cholera 12¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 2, Emerson Place, on 3rd August, the wife of an engineer, aged 30,
“cholera 2 days”

                                               _Southwark and Vauxhall._

At 29, Norfolk St., on 2d Aug., the son of a labourer, aged 3 years,
“Asiatic cholera 12¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 68, Great Guildford St., on 3rd Aug., the widow of a labourer, aged
40, “cholera 19 hours”

_Southwark and Vauxhall._

At 10, Castle Street, on 3rd August, the daughter of a labourer, aged 4
years, “cholera 12 hours”

                                               _Southwark and Vauxhall._

At White Hart Inn Yard, on 3rd August, the wife of a porter, aged 49,
“cholera 14 hours”

                                               _Southwark and Vauxhall._

At 22, America Street, on 3rd August, an engine-driver, aged 35,
“cholera 9 hours”

                                               _Southwark and Vauxhall._

At 15, Essex Street, on 4th August, a packer, aged 65, “diarrhœa 4 days,
cholera 11 hours”

                                               _Southwark and Vauxhall._

At 17, Southwark Square, on 3rd August, the wife of an engineer, aged
31, “diarrhœa 1 day, cholera 3 days”

                                               _Southwark and Vauxhall._

At 31, York Place, 5th Aug., the daughter of a labourer, aged 5 yrs.
“Asiatic cholera, 11¹⁄₂ hours”

                                                 _Southwark & Vauxhall._

At 50, Great Guildford Street, on 4th August, a baker’s shopwoman, aged
21, “Asiatic cholera”

                                                 _Southwark & Vauxhall._

At 10, Russell Place, on 5th August, the widow of a steam-boat stoker,
aged 38, “diarrhœa 4 weeks, Asiatic cholera 20 hours”

                                               _Southwark and Vauxhall._

At 14, Keppel St., 31st July, the daughter of a cooper, aged 4 years,
“Asiatic cholera 12 hours”

                                                 _Southwark & Vauxhall._

At 3, Bank End, on 2nd August, a widow of a coach-trimmer, aged 73,
“Asiatic cholera 14 hours”

                  _Thames water from tank at Messrs. Barclay & Perkins._


                   ST. OLAVE, SOUTHWARK. _St. Olave._

At St. Thomas’s Hospital (from Grey Eagle Street, Spitalfields), on 27th
July, a labourer, aged 32, “rheumatism, cholera 20 hours”. This patient,
named John Moull, was admitted with rheumatism on 25th July. Water
supply of hospital

                _Southwark and Vauxhall and pump-wells on the premises._

At 5, Marble Court, July 28, the son of a basket maker, aged 4 years,
“malignant cholera 12 hours”

                                               _Southwark and Vauxhall._

At the same house, July 30, a stonemason’s daughter, aged 2 yrs.,
“choleraic diarrhœa 2 days”

                                                 _Southwark & Vauxhall._

At 3, Gimber’s Rents, July 31, a labourer’s daughter, 13 months,
“Asiatic cholera 7 hours”

                                               _Southwark and Vauxhall._

At Guy’s Hospital, July 30, a dressmaker, aged 19, “cholera”; admitted
with cholera from 2, Port Place, Walworth Common

                                               _Southwark and Vauxhall._

At 3, Gimber’s Rents, Aug. 1, a labourer’s daughter, 3 years, “Asiatic
cholera 48 hours”

                                                 _Southwark & Vauxhall._

On board the “Prince Cobourg”, Cotton’s Wharf, on August 2nd, a seaman,
aged 38, “Asiatic cholera 14 hours”

                                             _Most likely Thames water._

At 5, Marble Court, August 1, the daughter of a basket maker, aged 1
year and 4 months, “cholera, congestion of brain”

                                               _Southwark and Vauxhall._

At 6, Darley’s Buildings, August 2, the daughter of a labourer, 2 yrs.,
“Asiatic cholera 14 hrs.”

                                                  _Southwk. & Vauxhall._

At Guy’s Hospital, on August 1st, a sailor, aged 16, “cholera”; admitted
with cholera from a ship in the Thames

                                             _Most likely Thames water._

At Guy’s Hospital, on 2nd August, a bookbinder, aged 30, “cholera”; was
taken ill in the train on his way from Portsmouth

                                         _Water supply not ascertained._

At Guy’s Hospital, on 3rd August, the daughter of a block-turner, aged
11 yrs., “cholera”; admitted with cholera from 7, Mint Street,
Southwark.

                                               _Southwark and Vauxhall._

At St. Thomas’s Hospital, supposed from Red Cross Street, Southwark, on
31st July, a charwoman, aged 50, “cholera”

                                         _Water supply not ascertained._

At St. Thomas’s Hospital, from (28) Cole Street, Dover Road, on 2nd
August, a cab-driver, aged 40, “cholera”; admitted with cholera

                                               _Southwark and Vauxhall._

At St. Thomas’s Hospital, from (1 Star Place) Star Corner, Bermondsey,
on 3rd August, a baker, aged 27, “cholera”; admitted with cholera.

                                               _Southwark and Vauxhall._

At 10, Tattle Court, on 4th August, a labourer, aged 46, “Asiatic
cholera 12 hours”

                                               _Southwark and Vauxhall._

At 11, Green Bank, on 4th August, the daughter of a pavior, aged 3
years, “Asiatic cholera 18 hours.”

                                                 _Southwark & Vauxhall._

At 24, Mellor Street, on 3rd August, a butcher, aged 73, “cholera 18
hours”

                                               _Southwark and Vauxhall._

At 194, Tooley Street, Aug. 5th, the son of a railway porter, aged 16
months, “cholera”

                                               _Southwark and Vauxhall._


             ST. OLAVE, SOUTHWARK. _St. John, Horsleydown._

At 8, Charles Street, July 20, a carman, aged 42, “diarrhœa 3 days,
Asiatic cholera 22 hours”

                                                 _Southwark & Vauxhall._

At 19, Bermondsey St., July 26, a labourer’s daughter, aged 5 yrs.,
“cholera Asiatica 4¹⁄₂ hours”

                                                 _Southwark & Vauxhall._

At 4, Abdy Street, on 29th July, a corn-turner, aged 60, “Asiatic
cholera, with premonitory diarrhœa, 18 hours”

                                               _Southwark and Vauxhall._

At 12, Bermondsey Street, July 29, a railway porter, aged 34, “malignant
cholera 12 hours”

                                                 _Southwark & Vauxhall._

At 5, Gibbon’s Rents, July 29, wife of a railway porter, aged 39,
“malignant cholera 16 hours”

                                                 _Southwark & Vauxhall._

At 18, Parish Street, July 29, a carpenter’s labourer, aged 19,
“diarrhœa 4 days, cholera 3 days”

                                                 _Southwark & Vauxhall._

At the Union Workhouse, on 30th July, a labourer, aged 40, “Asiatic
cholera 24 hours”; admitted with cholera from 4, Bethel Place, Vine Yard

                                               _Southwark and Vauxhall._

At the Union Workhouse, on 31st July, an apprentice to the sea, aged 16,
“Asiatic cholera 36 hours”; admitted with cholera from on board ship

                                             _Most likely Thames water._

At 5, Bethel Place, July 30, the wife of a corn-turner, aged 35,
“Asiatic cholera 4 hours”

                                               _Southwark and Vauxhall._

At the same house, Aug. 1, daughter of a corn-turner, aged 1 year,
“Asiatic cholera 3 days”

                                               _Southwark and Vauxhall._

At 8, Gibbon’s Rents, Aug. 1, the wife of a carpenter, aged 32, “Asiatic
cholera 12 hours”

                                               _Southwark and Vauxhall._

At 6, Gordon Terrace, on 1st August, the daughter of a coal-porter, aged
2 years and 7 months, “Asiatic cholera 4 hours”

                                               _Southwark and Vauxhall._

At the Union Workhouse, on 1st August, a slater, aged 56, “Asiatic
cholera 24 hours”; admitted with cholera from 4, Magdalen Court, Tooley
Street

                                                 _Southwark & Vauxhall._

At the Union Workhouse, on 3rd August, the wife of a labourer, aged 30,
“Asiatic cholera 4 days”; admitted with cholera from 4, Bethel Pl., Vine
Yd.

                                                 _Southwark & Vauxhall._

At 22, Magdalen Street, Aug. 1, a single woman, aged 53, “cholera 24
hours”

                                               _Southwark and Vauxhall._

At 3, Freeman’s Lane, on 2nd August, a labourer, aged 25, “premonitory
diarrhœa, with sickness, 24 hours; Asiatic cholera 9 hours”

                                               _Southwark and Vauxhall._

At 2, Charles Street, July 30, the widow of a hatter, aged 62, “cholera
11 hours”

                                               _Southwark and Vauxhall._

At 4, Charles Street, Aug. 4, a female, aged 45, “diarrhœa 7 days,
English cholera 12 hours”

                                                 _Southwark & Vauxhall._


                        BERMONDSEY. _St. James._

On board the ship “Ouse”, off Bermondsey, July 9, a mariner, aged 50,
“cholera 16 hours”

                                             _Most likely Thames water._

At 5, Gibson’s Cottages, on 18th July, the son of a chair-marker, aged 5
years, “choleraic diarrhœa 2 days, collapse 1 day”

                                               _Southwark and Vauxhall._

At 4, Bermondsey Wall, on 23rd July, the daughter of a bookseller, aged
4 years, “cholera 9 hours”

                         _Thames water, by dipping a pail in the river._

At 4, Bermondsey Wall, July 24, a sawyer’s daughter, aged 3 yrs.,
“cholera 20 hours”

                                      _Thames water, by dipping a pail._

At 9, Pleasant Row, July 25th, the wife of a labourer, aged 55, “chronic
disease of liver 2 years, choleraic diarrhœa 16 hours”

                                               _Southwark and Vauxhall._

At 10, Marine Street, on 24th July, a mate, mariner, aged 34, “Asiatic
cholera 101 hours, after choleraic diarrhœa 16¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 10, Marine Street, on 24th July, a mariner, aged 27, “Asiatic cholera
13 hours, after premonitory diarrhœa 2¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 4, Bermondsey Wall, July 27, a sawyer, aged 62, “cholera 32 hours”

                                      _Thames water, by dipping a pail._

At 6, Perseverance Court, on 28th July, the wife of a hawker, aged 30,
“cholera 24 hours, no premonitory symptoms”

                                               _Southwark and Vauxhall._

At 8, Foxlow Street, on 29th July, the daughter of a labourer, aged 18
years, “diarrhœa some days, cholera 13 hours”

                                               _Southwark and Vauxhall._

At 14, Gedling Terrace, Aug. 2, a carman’s daughter, aged 2 years,
“cholera maligna 4 days”

                                                 _Southwark & Vauxhall._

At 22, George Row, August 3, a stonemason, aged 30, “cholera maligna 10
hours”

                                               _Southwark and Vauxhall._

At Bermondsey Wall, on 3rd August, the wife of a publican, aged 34,
“Asiatic cholera 19 hours”

                                      _Thames water, by dipping a pail._

At 6, Pleasant Row, on 3rd August, the daughter of a currier deceased,
aged 5 years, “Asiatic cholera 7 hours”

                                               _Southwark and Vauxhall._

At 3, Parker’s Terrace, on 3rd August, the son of an oil-cooper, aged 1
year, “diarrhœa 10 days, cholera 2 days”

                                               _Southwark and Vauxhall._

At 36, Ernest Street, on 4th August, the wife of an engineer, aged 37,
“premonitory diarrhœa 24 hours, cholera 41 hours”

                                               _Southwark and Vauxhall._

At 1, Bermondsey Wall, on 4th August, the son of a mariner, aged 2
years, “diarrhœa 10 days, cholera 2 days”

                                      _Thames water, by dipping a pail._

At 5, George Row, Aug. 2, the son of a lighterman, aged 3 yrs.,
“choleraic diarrhœa 3¹⁄₂ days”

                                               _Southwark and Vauxhall._

At Water Lane, on 29th July, a domestic servant, aged 23, “cholera 10¹⁄₂
hours”

                                               _Southwark and Vauxhall._

At 16, Marine Street, on 30th July, the daughter of a labourer, aged 9
yrs., “cholera 11 hrs.”

                                                 _Southwark & Vauxhall._

At 8, Printer’s Place, July 30, the widow of a publican, aged 70,
“Asiatic cholera 15 hours”

                                                 _Southwark & Vauxhall._

At 4, Green Walk, on Aug. 1, the wife of a hoop-bender, aged 47,
“Asiatic cholera 7 days”

                                               _Southwark and Vauxhall._

At 5, John Place, on 1st August, a leather-dresser, aged 54, “Asiatic
cholera 22 hours”

                                               _Southwark and Vauxhall._

At 16, Marine Street, on 2nd August, the wife of a labourer, aged 51,
“cholera 30 hours”

                                               _Southwark and Vauxhall._

At 2, Metcalf Court, on 1st August, the son of a labourer, aged 2 years
and 6 months, “measles 14 days, diarrhœa 1 week, cholera 2 days”

                     _Beg Southwark and Vauxhall water from neighbours._

At 3, Frederick Place, on 2nd August, a cooper, aged 40 years, “Asiatic
cholera”

                                               _Southwark and Vauxhall._

At 5, Somerset Place, on 2nd August, the daughter of a labourer, aged 3
years, “diarrhœa 18 hours, cholera 12 hours”

                                               _Southwark and Vauxhall._

At Mill Street, on 3rd August, the wife of a master tin-plate worker,
aged 27 years, “diarrhœa 4 hours, cholera 16 hours”

                                               _Southwark and Vauxhall._

At 14, Gedlin Terrace, 31st July, the son of a carman, aged 4 yrs.,
“malignant cholera 13 hours”

                                                 _Southwark & Vauxhall._


                    BERMONDSEY. _St. Mary Magdalen._

At 13, Abbey Street South, July 25, a trotter-cleaner, aged 18 years,
“cholera 16 hours”

                                               _Southwark and Vauxhall._

At 2, Long Walk, on 26th July, the son of a labourer, aged 2 yrs.,
“diarrhœa choleraic 15 hours”

                                                 _Southwark & Vauxhall._

At 2, Providence Place, on 28th July, the wife of a leather-dresser,
aged 56, “diarrhœa 4 hours, cholera 20 hours”

                                               _Southwark and Vauxhall._

At 3, Providence Place, on 28th July, the wife of a currier, aged 58,
“diarrhœa 3 hours, cholera 18 hours”

                                               _Southwark and Vauxhall._

At 13, Willow St., on 2nd Aug., the daughter of a warehouseman, aged 4
yrs., “cholera morbus”

                                                 _Southwark & Vauxhall._

At 14, Fendall St., Aug. 4, the son of a leather-dresser, aged 5 yrs.,
“Asiatic cholera 10 hours”

                                                 _Southwark & Vauxhall._

At 2, Finimore’s Court, on 3rd August, a labourer, aged 74, “Asiatic
cholera”

                                               _Southwark and Vauxhall._

At 54, Little George St., Aug. 4, son of a labourer, aged 2 yrs.,
“cholera maligna, 40 hrs”

                                                 _Southwark & Vauxhall._

At the Workhouse, on July 29, the son of a pen-cutter, aged 9 yrs.,
“Asiatic cholera 19 hours. Died 7 hours after admission.” From 12, Minto
Street.

                                               _Southwark and Vauxhall._

At 25, Maltby Street, July 28, the widow of a solicitor’s clerk, aged
65, “Asiatic cholera”.

                                               _Southwark and Vauxhall._

At the Workhouse, on 31st July, a shoemaker, aged 46, “Asiatic cholera
11 hours after admission in state of collapse”. From 99, Russell Street.

                                               _Southwark and Vauxhall._

At 19, Grange Walk, on 31st July, a blacksmith, aged 21, “cholera 15
hours”

                                               _Southwark and Vauxhall._

At 36, Abbey Street, on 30th July, the daughter of a labourer, aged 2
years, “cholera 3 days, congestion of brain, convulsions 12 hours”

                                               _Southwark and Vauxhall._

At 13, Abbey Street, on 29th July, the daughter of a labourer, aged 2
years, “cholera 56 hours, diarrhœa 2 days”

                                               _Southwark and Vauxhall._

At 5, Russell Street, on 1st August, a porter, aged 64, “Asiatic
cholera”

                                               _Southwark and Vauxhall._

At the Workhouse, on 2nd August, a sailor, aged 32, “Asiatic cholera, 21
hours after admission in a state of collapse”. From ship “Malvern”

                                             _Most likely Thames water._

At 3, Long Walk, on 30th July, the son of a carpenter, aged 2 years,
“cholera 2 days, secondary fever 2 days”

                                               _Southwark and Vauxhall._

At 49, Page’s Walk, on 1st August, the wife of a deal-porter, aged 31,
“cholera maligna 10 hours, diarrhœa 4 hours”

                                               _Southwark and Vauxhall._

At the Workhouse, on 2nd August, the daughter of a labourer, aged 7
years, “Asiatic cholera (30 hours) after admission in a state of
collapse”. From 7, Chapel Place, Long Lane

                                               _Southwark and Vauxhall._

At 41, Brunswick Court, on 3rd August, a servant, aged 28, “cholera 48
hours”

                                               _Southwark and Vauxhall._


                     BERMONDSEY. _Leather Market._

At 4, Princes Place, Crosby Row, on 19th July, the daughter of a
journeyman cordwainer, aged 4 years, “English cholera, 12 hours”

                                               _Southwark and Vauxhall._

At 17, King’s Place, Crosby Row, on 28th July, the wife of a labourer,
aged 29 years, “Asiatic cholera 24 hours”

                                               _Southwark and Vauxhall._

At 25, Smith’s Buildings, 30th July, the daughter of a labourer, aged 3
yrs., “cholera 19 hours”

                                                 _Southwark & Vauxhall._

At 15, Brook Street, on 31st July, the son of a journeyman tanner, aged
20 months, “cholera 15 hours”.

                                               _Southwark and Vauxhall._

At 27, Nelson Street, July 31, the wife of a labourer, aged 35, “Asiatic
cholera 18 hours”

                                               _Southwark and Vauxhall._

At 5, Richardson Street, on 30th July, the son of a journeyman
leather-dresser, aged 18 years, “diarrhœa 7 days, Asiatic cholera 15
hours”

                                               _Southwark and Vauxhall._

At 2, Staple Street, on 2nd August, the daughter of a journeyman
cordwainer, aged 6 years, “cholera 11 hours”

                                               _Southwark and Vauxhall._

At 185, Long Lane, on 3rd August, the wife of a journeyman tanner, aged
26 years, “cholera biliosa 12 hours”

                                               _Southwark and Vauxhall._

At 1, Elizabeth Place, Baalzephon Street, on 2nd Aug., the son of a
journeyman cordwainer, aged 1 year, “diarrhœa 1 day, Asiatic cholera 1
day”

                                               _Southwark and Vauxhall._

At 3, Alfred Place, Nelson Street, on 2nd August, the daughter of a
cordwainer, aged 17 years, “Asiatic cholera 12 hours”

                                               _Southwark and Vauxhall._

At 101, Snow’s Fields, Aug. 3, a journeyman carpenter, aged 63, “Asiatic
cholera 12 hours”

                                               _Southwark and Vauxhall._

At 2, Staple Street, on 3rd August, the son of a journeymen cordwainer,
aged 4 years, “cholera 48 hours, premonitory diarrhœa 3 days”

                                               _Southwark and Vauxhall._

At 7, Little Charlotte Row, Nelson Street, on 1st August, the son of a
carman, aged 1¹⁄₂ years, “cholera 12 hours”

                                               _Southwark and Vauxhall._

At the same house, on the same day, the son of a carman, aged 3 yrs.,
“cholera 12 hours”

                                                 _Southwark & Vauxhall._

At 8, Minto Street, on 2nd August, the son of a journeyman tanner, aged
3 yrs., “diarrhœa 3 days, cholera 24 hours, secondary fever 2 days”

                                               _Southwark and Vauxhall._

At 23, Baalzephon Street, on 4th August, the son of a journeyman
wire-weaver, aged 1¹⁄₂ years, “diarrhœa 2 days, Asiatic cholera 36
hours”

                                               _Southwark and Vauxhall._

At 53, Long Lane, on 3rd August, a stay-maker, aged 52, “diarrhœa,
Asiatic cholera”

                                               _Southwark and Vauxhall._

At 4, Grange Road, on 4th August, the son of a journeyman tanner, aged 4
years, “Asiatic cholera 11 hours”

                                               _Southwark and Vauxhall._

At 1, Wood’s Place, Grange Road, on 4th August, a labourer, aged 24,
“cholera 12 hours, premonitory diarrhœa 3 hours”

                                               _Southwark and Vauxhall._

At 16, Alfred Place, Nelson Street, on 3rd August, the daughter of a
journeyman bricklayer, aged 1 year, “dentition, diarrhœa, cholera,
convulsions”

                                                 _Southwark & Vauxhall._

At 15, Wyld’s Rents, on 15th August, the wife of a journeyman baker,
aged 27, “cholera Asiatica 17 hours, collapse, premonitory diarrhœa 8
hours”

                                                 _Southwark & Vauxhall._

At 7, Alfred Street, on 5th Aug., a journeyman tanner, aged 63,
“cholera, collapse 62 hours, premonitory diarrhœa 12 hours, consecutive
fever 12 hours”

                                                 _Southwark & Vauxhall._

At 7, Brook Street, on 3rd Aug., a journeyman tanner, aged 40, “cholera,
collapse 12 hours, premonitory diarrhœa 7 hours”

                                               _Southwark and Vauxhall._


                  ST. GEORGE, SOUTHWARK. _Kent Road._

At 7, Layton’s Buildings, July 29, a tailor, aged 20, “cholera 17 hours”

                                               _Southwark and Vauxhall._

At 2, Dobb’s Cross, July 30, the son of a shop-keeper, aged 10 yrs.,
“cholera Asiatic 24 hours”

                                                 _Southwark & Vauxhall._

At 81, Ann Street, July 29, the son of a labourer, aged 12 years,
“cholera 8 hours”

                                               _Southwark and Vauxhall._

At 28, Wickham Pl., Aug. 2, son of a brush-mkr., aged 2¹⁄₂ yrs.,
“choleraic diarrhœa 24 hours.”

                                                 _Southwark & Vauxhall._

At 2, Russell Place, Aug. 2, the widow of a labourer, aged 55, “Asiatic
cholera 21 hours”

                                               _Southwark and Vauxhall._

At 9, Tennis Place, 3rd of August, the widow of a sawyer, aged 67 years,
“diarrhœa 36 hours, cholera 14 hours”

                                               _Southwark and Vauxhall._

At 13, George St., Aug. 2, the wife of a shoemkr., aged 35, “diarrhœa,
cholera, convulsions”

                                               _Southwark and Vauxhall._

At 7, Noel Street, Aug. 4, the widow of a porter, aged 65 years,
“Asiatic cholera 39 hours”

                                                              _Lambeth._


                 ST. GEORGE, SOUTHWARK. _Borough Road._

At the Workhouse, from Savage’s lodging-house, Mint Street, 29th of
July, a female servant, aged 28 years, “cholera”

                                               _Southwark and Vauxhall._

At 6, Ebden Court, Pearl Row, 27th of July, the daughter of a butcher,
aged 3 years, “Asiatic cholera 10 hours”

                                               _Southwark and Vauxhall._

At 24, Gun St., July 23, the wife of a bookbinder, aged 36, “Asiatic
cholera 24 hours”

                                               _Southwark and Vauxhall._

At 5, Nelson Pl., July 28, the son of a butcher, aged 5 weeks,
“choleraic diarrhœa 3 days”

                                                 _Southwark & Vauxhall._

At the Workhouse, July 29, a hawker, aged 44, “cholera (very bad)”; an
inmate

                                               _Southwark and Vauxhall._

At 2, Union Street, July 27, the widow of a master shoemaker, aged 73,
“diarrhœa 7 days, cholera Asiatica 8 hours”

                                                              _Lambeth._

At 10, Lombard Street, July 29, the daughter of a labourer, aged 2
years, “diarrhœa 4 hours, cholera maligna, 24 hours”

                                               _Southwark and Vauxhall._

At the same house, August 1, the daughter of a labourer, aged 4 years,
sister of above, “cholera maligna 12 hours”

                                               _Southwark and Vauxhall._

At 1, Burton’s Buildings, Friar Street, August 2, the daughter of a
coppersmith, aged 9 years, “cholera 3 days, fever 2 days”

                                               _Southwark and Vauxhall._

At the Workhouse, from Hooper’s lodging-house, 9, Angel Place, July 30,
a labourer, aged 36, “cholera Asiatica”

                                               _Southwark and Vauxhall._

At the Workhouse, brought in from 29, Wilmot’s Buildings, August 1, a
labourer, aged 29, “cholera Asiatic about 12 hours”

                                               _Southwark and Vauxhall._

At 35, Green Street, 31st of July, the wife of a horse-slaughterman,
aged 64, “hepatitis 14 days, gall stones, Asiatica cholera 24 hours”

                                               _Southwark and Vauxhall._

At the Workhouse, Aug. 3, a widow, aged 70, “cholera Asiatica about 12
hours”; inmate

                                                 _Southwark & Vauxhall._

At the Workhouse, from King’s lodging-house, Mint Street, 3rd August, a
hawker, aged 45 years, “cholera Asiatica”

                                               _Southwark and Vauxhall._

At the Workhouse, Aug. 3, a coppersmith, aged 52, “cholera Asiatica 2
days”, from 15, John St., Suffolk Street

                                               _Southwark and Vauxhall._

At 30, Hill St., Aug. 1, the daughter of an engineer, aged 2 years,
“cholera 12 hours”

                                               _Southwark and Vauxhall._

At 83, Southwark Bridge Rd., Aug. 1, solicitor’s clerk, aged 21,
“cholera 19 hours”

                                               _Southwark and Vauxhall._

At 23, George St., Aug. 3, the wife of a labourer, aged 19, “cholera
maligna 15 hours”

                                               _Southwark and Vauxhall._

At the Workhouse, brought in by the police from the station-house at
Stones End, Aug. 4, a servant, aged 50, “cholera Asiatica”

                                                      _Not ascertained._

At 1, Little Suffolk Street, Aug. 4, the daughter of a hammerman, aged 3
years, “remittent fever 7 days, cholera 20 hours”

                                               _Southwark and Vauxhall._

At 5, Bean Street, Aug. 5, a female servant, aged 28, “diarrhœa 24
hours, cholera 30 hours”

                                                 _Southwark & Vauxhall._


                 ST. GEORGE, SOUTHWARK. _London Road._

At 60, Tower Street, July 16, the wife of a butcher, aged 26, “Asiatic
cholera 13 hours”

                                               _Southwark and Vauxhall._

At 12, East Pl., West Sq., July 29, an ostler, aged 42, “diarrhœa 6
days, cholera maligna 14 hours”

                                                              _Lambeth._

At 32, Duke Street, Aug. 1, the son of a smith, aged 5 years, “Asiatic
cholera 36 hours”

                                                              _Lambeth._

At 11, London Road, July 31st, a servant, aged 17, “Asiatic cholera 24
hours”

                                               _Southwark and Vauxhall._

At Spiller’s Ct., Webber Row, Aug. 1, the daughter of a charwoman, aged
18 months, “chronic diarrhœa 2 months, cholera 24 hours”

                                               _Southwark and Vauxhall._

At 2, Short St., Tower St., Aug. 2, a coal-porter, aged 32, “cholera 3
days”

                                                              _Lambeth._

At 8, Princes Court, Princes Street, on the 3rd of August, the son of a
butcher, aged 5¹⁄₂ years, “cholera 8 hours”

                                               _Southwark and Vauxhall._

At 105, Blackfriars Road, Aug. 1, a compositor, aged 32, “diarrhœa,
cholera 14 hours”

                                               _Southwark and Vauxhall._

At 3, Duke Street, Tower Street, August 4th, the son of a civil engineer
(deceased), “consumption 9 months, cholera 8 hours”

                                                              _Lambeth._


                         NEWINGTON. _Trinity._

At 58, Brandon Street, July 26, a house-painter, aged 24, “Asiatic
cholera 40 hours”

                                               _Southwark and Vauxhall._

At 3, Winter Terrace, July 31, the wife of an engineer, aged 27,
“cholera 26 hours”

                                               _Southwark and Vauxhall._

At 16, Swan St., Aug. 1, the son of a carpenter, aged 8 years, “cholera
maligna 14 hours”

                                                 _Southwark & Vauxhall._

At 6, St. Andrew’s Rd., Aug. 1, a waiter, aged 35, “diarrhœa 3 days,
cholera maligna 12 hours”

                                                 _Southwark & Vauxhall._

At 175, Kent St., Aug. 2, the son of a clothier, aged 7 years,
“malignant cholera 23 hours”

                                                 _Southwark & Vauxhall._

At 66, Brunswick St., Aug. 3, the wife of an engineer, aged 35, “cholera
1 week, exhaustion”

                                                 _Southwark & Vauxhall._

At 64, Trinity Square, August 2, a milliner, aged 32, “cholera maligna
30 hours”

                                               _Southwark and Vauxhall._

At 3, Etham Place, Aug. 3, a paperhanger, aged 42, “cholera Asiatica
6¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 54, Great Dover Rd., Aug. 3, the widow of a wine merchant, aged 64,
“English cholera 23 hours, collapse 12 hours”

                                               _Southwark and Vauxhall._

At 182, Kent Street, August 4th, a labourer, aged 23 years, “diarrhœa 17
hours, cholera Asiatica 8 hours, collapse”

                                               _Southwark and Vauxhall._

At 99, Uxbridge Street, Aug. 4, the son of a jeweller, aged 3 years,
“diarrhœa 27 hours, Asiatic cholera 24 hours, collapse”

                                               _Southwark and Vauxhall._

At the same house, on the same day, the daughter of a jeweller, aged 1
year, “Asiatic cholera 28 hours, collapse”

                                               _Southwark and Vauxhall._

At 11, Swan Street, August 5, the wife of a collecting clerk, aged 42,
“chronic bronchitis 5 years, English cholera 3 days, collapse 18 hours”

                                               _Southwark and Vauxhall._

At 58, Brandon St., Aug. 4, the widow of a house-painter, aged 26,
“Asiatic cholera 4 days”

                                               _Southwark and Vauxhall._


                   NEWINGTON. _St. Peter, Walworth._

At 7, Berkeley Terrace, the 25th of July, the wife of a mercantile
clerk, aged 35 years, “Asiatic cholera 14 hours”

                                               _Southwark and Vauxhall._

At 8, Townley Place, on the 29th of July, the son of a journeyman
shoemaker, aged 6¹⁄₂ years, “cholera 19 hours”

                                               _Southwark and Vauxhall._

At 8, Richmond Street, July 28th, the daughter of a labourer, aged 5
years, “choleraic diarrhœa 3 days, cerebral effusion 2 days”

                                               _Southwark and Vauxhall._

At 6, John Street, East Street, July 29th, the widow of a carman, aged
83, “cholera Anglica 27 hours, old age”

                                               _Southwark and Vauxhall._

At 29, Pilgrim Street, on the 1st of August, the daughter of an ostler,
aged 18 months, “Asiatic cholera 8 hours”

                                               _Southwark and Vauxhall._

At 8, Townley Place, August 1st, the daughter of a journeyman shoemaker,
aged 8 years, “cholera Asiatica about 16 hours”

                                               _Southwark and Vauxhall._

At 29, Beckford Row, Aug. 1, the wife of a greengrocer, aged 46 years,
“cholera Asiatica 16 hours, collapse 11 hours”

                                               _Southwark and Vauxhall._

At 15, Smith Street, Aug. 3, the wife of a baker, aged 20, “Asiatic
cholera 8 hours”

                                               _Southwark and Vauxhall._

At 1, John Street, Walworth Common, August 2, the wife of a glue-maker,
aged 54, “diarrhœa 2 days, cholera 22 hours”

                                               _Southwark and Vauxhall._

At 2, Milk Street, on the 2nd of August, the daughter of a journeyman
shoemaker, aged 6 years, “Asiatic cholera 30 hours”

                                               _Southwark and Vauxhall._

At 7, Blucher St., Aug. 2, a gentleman, aged 36, “cholera Asiatica 20
hours, collapse”

                                               _Southwark and Vauxhall._

At 28, Bronti Place, August 2nd, the wife of a letter carrier, aged 46,
“cholera Asiatica 28 hours, collapse 24 hours”

                                               _Southwark and Vauxhall._

At 2, Totham Place, Boundary Lane, August 2nd, the widow of a journeyman
bricklayer, aged 63, “Asiatic cholera 18 hours”

                                               _Southwark and Vauxhall._

At 2, Sarah Terrace, Hill Street, August 2nd, the son of a clerk in the
Post Office, aged 5¹⁄₂ years, “epidemic cholera 7 hours”

                                               _Southwark and Vauxhall._

At 99, Hill Street, on the 3rd of August, the daughter of a traveller,
aged 1 year and 10 months, “malignant cholera 9 hours”

                                               _Southwark and Vauxhall._

At 18, West Street, Aug. 4, a needlewoman, aged 22, “cholera maligna 12
hours”

                                               _Southwark and Vauxhall._

At 26, Penton Row, Aug. 1, an auctioneer, aged 39, “diarrhœa 52 hours,
cholera 9 hours”.

                                                 _Southwark & Vauxhall._

At 21, Park Road, August 5th, an iron-planer, aged 43, “cholera 4 days”

                                               _Southwark and Vauxhall._

At 19, James Place, Hill Street, Aug. 5, a gentleman, aged 89,
“choleraic diarrhœa 6 days”

                                                 _Southwark & Vauxhall._

At the same house, same day, the wife of the above, aged 50, “Asiatic
cholera 12 hours”

                                                 _Southwark & Vauxhall._


                         NEWINGTON. _St. Mary._

At 4, Parsonage Row, July 30, a gentlewoman, aged 40, “Asiatic cholera
16 hours”

                                               _Southwark and Vauxhall._

At 31, Weymouth Street, July 28, the wife of a chairmaker, aged 34,
“Asiatic cholera 12 hrs.”

                                                 _Southwark & Vauxhall._

At 8, Church St., July 30, the daughter of a chairmaker, aged 17 months,
“cholera 10 hours”

                                               _Southwark and Vauxhall._

At 8, Peacock Sq., July 31, the widow of a seaman, aged 59, “cholera 12
hours, typhus 4 days”

                                                 _Southwark & Vauxhall._

At 19, Waterloo Pl., Aug. 2, the son of a shoemaker, aged 8 years,
“cholera 12 hours”

                                               _Southwark and Vauxhall._


                   LAMBETH. _Waterloo (First Part)._

At Curtis Hatch, on 29th July, a Baptist minister, aged 52, “diarrhœa 3
days, Asiatic cholera and collapse 18 hours”. The informant stated that
deceased, whom he had long known, called at his house about seven in the
morning before his death; he was then very ill. He lived at 7, Lower
Anne Street, Waterloo Road, where the supply was

                                               _Southwark and Vauxhall._

At 4, Hammond’s Place, on 30th July, the wife of a labourer, aged 72,
“diarrhœa 24 hours, malignant cholera 12 hours”

                                               _Southwark and Vauxhall._

At 4, Queen Street, July 31st, late a brewer’s servant, aged 76,
“cholera 1 day”

                                               _Southwark and Vauxhall._

At 41, Brad Street, August 1st, the wife of a printer, aged 51, “cholera
26 hours”

                                               _Southwark and Vauxhall._

At 3, Hammond’s Place, on August 5th, the daughter of a smith, aged 6
years, “diarrhœa and malignant cholera 12 hours”

                                               _Southwark and Vauxhall._


                   LAMBETH. _Waterloo (Second Part)._

At 23, Howley Place, July 29, the wife of a carman, aged 58, “cholera
about 11 hours”

                                               _Southwark and Vauxhall._

At 18, Vine Terrace, on 31st July, a butcher, aged 19, “Asiatic cholera
18 hours”

                                               _Southwark and Vauxhall._

At 36, Isabella St., July 30, a hammerman at a factory, aged 39,
“Asiatic cholera 68 hours”

                                                 _Southwark & Vauxhall._

At 12, Harriet Street, on 2nd August, a miller, aged 17, “cholera
Asiatica 17 hours”

                                               _Southwark and Vauxhall._

At 9, Griffin Street, Aug. 4, the wife of a bricklayer, aged 75,
“Asiatic cholera 48 hours”

                                               _Southwark and Vauxhall._


                LAMBETH. _Lambeth Church (First Part)._

At 52, Upper Fore Street, on July 20th, the wife of a bricklayer’s
labourer, aged 23, “cholera 12 hours”

                                      _Thames water, by dipping a pail._

At 6, Newport Street, on 30th July, the wife of a porter, aged 37,
“cholera 8 hours”

                                                              _Lambeth._

At 32, South St., July 31, a timber-merchant’s widow, aged 67, “Asiatic
cholera 15 hours”

                                               _Southwark and Vauxhall._

At 3, Mount Place, Kennington Road, on 31st July, a wine merchant, aged
35, “Asiatic cholera 16 hours”; address not found

                                                      _Not ascertained._

At 7, Vauxhall Row, Aug. 2, the son of a bricklayer, aged 4 years,
“cholera 16 hours”

                                               _Southwark and Vauxhall._


                LAMBETH. _Lambeth Church (Second Part)._

At 26, New St., July 28, the wife of a labourer, aged 29, “diarrhœa 3
days, cholera 12 hours”

                                               _Southwark and Vauxhall._

At 29, Park Street, July 29, an eating-house keeper, aged 39, “cholera
9¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 79, Wickham Street, August 1, the daughter of an engineer, aged 1
year, “choleraic diarrhœa, exhaustion”

                                                              _Lambeth._

At 24, Caroline Street, on 31st July, the son of a labourer, aged 14
years, “cholera 11 hours”

                                                              _Lambeth._

At the Workhouse, on 2nd August, a washerwoman, aged 23, “Asiatic
cholera”; admitted in a dying state; address not known

                                                      _Not ascertained._

At 60, Park Street, on 2nd August, the wife of a lathrender, aged 31,
“cholera 2 days, consecutive fever 5 days”

                                               _Southwark and Vauxhall._

At 4, High St., Vauxhall, Aug. 3, a musician, aged 35, “malignant
cholera after 2 days diarrhœa, 6 days secondary fever, with cerebral
congestion.”

                                               _Southwark and Vauxhall._

At Vauxhall Gardens, on 2nd August, a widow, aged 56, “cholera 16 hours”

                                               _Southwark and Vauxhall._

At 33, East Street, on 3rd Aug., a carpenter, aged 40, “diarrhœa 7 days,
cholera 3 days”

                                               _Southwark and Vauxhall._

At 19, Bennett’s Buildings, on 4th August, the daughter of a carpenter,
aged 2 years, “cholera Asiatica 12 hours”

                                               _Southwark and Vauxhall._


                  LAMBETH. _Kennington (First Part)._

At 6, William Street, Clapham Road, on 26th July, the son of a
carpenter, aged 2 years, “Asiatic cholera 12 hours”

                                                              _Lambeth._

At 3, Dudley Place, Clapham Road, on 24th July, the wife of a
bookseller, aged 42, “sero-spasmodic cholera 15 hours”

                                               _Southwark and Vauxhall._

At 7, Henry Street, Dorset Street, Clapham Road, on 28th July, the
daughter of a butcher, aged 4 years, “cholera sero-spasmodica 15 hours”

                                                            _Pump-well._

At 23, Cambridge Terrace, Clapham Road, on 30th July, the daughter of a
commercial traveller, aged 20, “choleraic diarrhœa 24 hours”

                                               _Southwark and Vauxhall._

At 3, Belmont Place, Wandsworth Road, on 29th July, the daughter of a
railway-guard, aged 8 years, “cholera 10¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 9, Regency Place, White Hart Street, on 31st July, the widow of a
brass-worker, aged 44, “cholera 30 hours”

                                               _Southwark and Vauxhall._

At 1, Bowling Green Mews, on 28th July, the daughter of a chairmaker,
aged 8 years, “cholera 13 hours”

                                               _Southwark and Vauxhall._

At 61, Prince’s Square, July 31, widow of a linen-agent, aged 42,
“Asiatic cholera 15 hours”

                                               _Southwark and Vauxhall._

At 4, Southville, Wandsworth Road, on 2nd August, a paperhanger, aged
26, “Asiatic cholera, premonitory diarrhœa 24 hours, collapse 24 hours”

                                                 _Southwark & Vauxhall._

At 5, South Lambeth, Aug. 4, the wife of an equestrian, aged 39,
“cholera Asiatica 36 hours”

                                                 _Southwark & Vauxhall._

At 19, Mansion House Street, Kennington, on 3rd August, formerly a
dressmaker, aged 36, “cholera Asiatica 6 hours, premonitory diarrhœa 2
days”

                                                 _Southwark & Vauxhall._


                   LAMBETH. _Kennington (2nd Part)._

At 14, Robertson Place, Stockwell, on 3rd August, the wife of a
carpenter, aged 35, “Asiatic cholera 5 hours”

                                               _Southwark and Vauxhall._

At 2, James Street, on 5th August, the son of a bricklayer, aged 7 yrs.,
“cholera 7 hours”

                                               _Southwark and Vauxhall._

At 1, Somerset Place, Aug. 3, a gentleman, aged 56, “spasmodic cholera
12 hours”

                                               _Southwark and Vauxhall._


                          LAMBETH. _Brixton._

At 2, Sussex Road, July 14th, the widow of a coachman, aged 53,
“diarrhœa 6 days, English cholera 3 days”

                                                              _Lambeth._


               LAMBETH. _Norwood._—No death from cholera.


                         WANDSWORTH. _Clapham._

At 5, Cook’s Buildings, Park Road, on 29th July, the daughter of a
sawyer, aged 3 years, “cholera 12 hours, diarrhœa 3 days”

                                               _Southwark and Vauxhall._

At 4, Howard Street, Wandsworth Road, July 30, a labourer, aged 74,
“cholera 52 hours”

                                                 _Southwark & Vauxhall._

At 1, Waterloo Retreat, Bromell’s Road, July 29, a gardener, aged 46,
“cholera 12 hours”

                                                            _Pump-well._

At High Street, July 31, a domestic servant, aged 28, “cholera 52 hours”

                                               _Southwark and Vauxhall._

At 13, Prospect Place, Wandsworth Road, on 2nd August, a Government
clerk, aged 50, “malignant cholera 4 days, diarrhœa 48 hours, collapse”.

                                _Southwark and Vauxhall, and pump-well._


                        WANDSWORTH. _Battersea._

At 6, Church Road, July 19, the wife of a house-agent, aged 48, “Asiatic
cholera 48 hours”

                                               _Southwark and Vauxhall._

At Nine Elms, on 26th July, the widow of a cooper, aged 79, “cholera 18
hours”

                                               _Southwark and Vauxhall._

At Albert Villas, on 27th July, the son of a clerk in the Customs, aged
2 years, “premonitory diarrhœa a month, Asiatic cholera 16 hours,
consecutive fever 30 hours, convulsions 2 hours”

                                               _Southwark and Vauxhall._

At Lavender Hill, on 25th July, the wife of a gentleman, aged 46,
“premonitory diarrhœa 20 hours, cholera 16 hours”

                                                            _Pump-well._

At 25, Little Europa Place, on 30th July, the wife of a gardener, aged
50 years, “Asiatic cholera 33 hours”

                                               _Southwark and Vauxhall._

At York Road, on 31st July, the daughter of a gardener, aged 12 years,
premonitory diarrhœa neglected 8 hours, “Asiatic cholera, 11 hours”

                                               _Southwark and Vauxhall._

At 18, York Street, Battersea Fields, on 29th July, the son of a
boiler-maker, aged 1 year and 7 months, “cholera 10 hours”

                                      _Thames water supplied by a cart._

At Canterbury Place, York Road, on 2nd August, the wife of a bricklayer,
aged 35, “diarrhœa unattended 2 days, Asiatic cholera 12 hours”

                                               _Southwark and Vauxhall._

At 33, Little Europa Place, on 2nd August, a labourer, aged 48,
“premonitory diarrhœa 4 hours, cholera 16 hours”

                                               _Southwark and Vauxhall._

At Falcon Lane, on 3rd August, the daughter of a chemist deceased, aged
14 years, “premonitory diarrhœa 4 hours, cholera 24 hours”

         _Water from a ditch into which the cesspools empty themselves._

At Lavender Road, on 3rd August, a clockmaker, aged 47, “Asiatic
cholera”

                                               _Southwark and Vauxhall._

At York Road, August 4, the daughter of a gardener, aged 21, “cholera
maligna 11 hours”

                                               _Southwark and Vauxhall._

At 30, Ægis Terrace, Battersea Fields, on 2nd August, the son of a
horse-dealer, aged 12 years, “cholera 15 hours”

                                               _Southwark and Vauxhall._


                       WANDSWORTH. _Wandsworth._

At Armoury Yard, on 3rd August, the daughter of a labourer, aged 4
years, “measles 6 days, cholera 6 hours”

                                        _Thames water fetched in pails._

At Apothecaries’ Row, 5th Aug., the son of a sawyer, aged 10, “cholera
12 hours”

                                           _Thames water and pump-well._


                         WANDSWORTH. _Putney._

At Cooper’s Arms Lane, on 5th August, a bricklayer’s labourer, aged 38,
“premonitory diarrhœa 9 hours, cholera 15 hours”

                                                            _Pump-well._


            WANDSWORTH. _Streatham._ No death from cholera.


             CAMBERWELL. _Dulwich._ No death from cholera.


                       CAMBERWELL. _Camberwell._

At 1, Rose Cottages, Waterloo Street, on 23rd July, the daughter of a
proctor’s clerk, aged 8 years, “cholera Asiatica 15 hours”

                                               _Southwark and Vauxhall._

At the same house, on same day, the sister of the above, aged 1 year,
“cholera Asiatica 9 hours”

                                                 _Southwark & Vauxhall._

At Garden Cottage, Harris Street, on 22nd July, a carman, aged 49,
“cholera 16 hours”

                                               _Southwark and Vauxhall._

At 17, James Street, on 26th February, the daughter of a single woman,
aged 14 days, “natural exhaustion from choleraic diarrhœa” (Inquest.)

                                               _Southwark and Vauxhall._

At Ann’s Place, George Street, on 2nd August, the daughter of a
coachman, aged 4 years, “cholera 8 hours”

                                               _Southwark and Vauxhall._

At 9, Martha Street, on 3rd August, a fish-hawker, aged 62, “cholera 24
hours”

                                               _Southwark and Vauxhall._

At 8, Cork Street, on 4th August, the wife of a labourer, aged 33,
“cholera 32 hours”

                                               _Southwark and Vauxhall._

At the Workhouse, on 29th July, a nurse, aged 60 years, “cholera 24
hours”. From 5, Martin’s Road, Peckham

                                               _Southwark and Vauxhall._

At 57, James Street, on 5th August, the wife of a waiter, aged 33,
“cholera 17 hours”

                                               _Southwark and Vauxhall._

At Camberwell House, on 1st August, a male, aged 69 years, “exhaustion
from mania 3 months, cholera 24 hours”

                                               _Southwark and Vauxhall._

At Camberwell House, on 1st August, a mariner, aged 53 years, “general
paralysis 11 months, cholera 17 hours”

                                               _Southwark and Vauxhall._

At 13, Waterloo Street, on 30th July, the son of a labourer, aged 4
yrs., “cholera 7 hours”

                                               _Southwark and Vauxhall._

At 3, Caroline Place, Wyndham Road, on 31st July, the daughter of a
brewer’s servant, aged 1 year, “cholera 9 hours”

                                               _Southwark and Vauxhall._

At Camberwell House, Lunatic Asylum, on 28th July, a male, aged 32,
“epilepsy 7 years, cholera 8 hours”

                                               _Southwark and Vauxhall._

At Camberwell House, Lunatic Asylum, on 29th July, a labourer, aged 43,
“general paralysis 2 years, cholera 18 hours”

                                               _Southwark and Vauxhall._

At Camberwell House, on 29th July, a servant, aged 47, “cholera 26
hours”

                                               _Southwark and Vauxhall._

At 30, Clarendon Street, on 30th July, a grocer, aged 56, “Asiatic
cholera 9 hours”

                                               _Southwark and Vauxhall._

At 1, Absolom Place, South Street, on 2nd August, a girl, aged 21
months, “diarrhœa 48 hours, cholera 21 hours”

                                               _Southwark and Vauxhall._

At 17, Cork Street, on 1st August, the son of a painter, aged 1 year,
“diarrhœa 2 days, cholera 1 day”

                                               _Southwark and Vauxhall._


                         CAMBERWELL. _Peckham._

At 5, Martin’s Road, July 27th, the wife of a labourer, aged 40,
“cholera maligna 16 hours”

                                               _Southwark and Vauxhall._

At the same house, on 29th July, the daughter of a labourer, aged 2
yrs., “cholera 28 hours”

                                                 _Southwark & Vauxhall._

At 33, Rye Lane, on 30th July, a domestic servant, aged 23, “cholera
5¹⁄₂ hours”

                                               _Southwark and Vauxhall._

At 2, Nun Green, Nunhead, on August 4, the daughter of a potter’s
labourer, aged 4 years, “cholera 48 hours”

                                                 _Southwark & Vauxhall._


                       CAMBERWELL. _St. George._

At Binfield House, Windmill Lane, July 28, the son of a labourer, aged 4
years, “cholera 16 hours”

                                               _Southwark and Vauxhall._

At 2, Waterloo Place, Coburg Road, July 31, a girl, aged 3 months,
“cholera 20 hours”

                                                              _Lambeth._

At 1, Oakley Ter., Old Kent Rd., July 29, the wife of an oilman, aged
30, “Asiatic cholera”

                                                 _Southwark & Vauxhall._

At the same house, Aug. 1, the son of an oilman, aged 8 weeks, “cholera
maligna 3 days”

                                               _Southwark and Vauxhall._

At 6, Brown’s Terrace, Wyndham Road, Aug. 3, the son of a labourer, aged
3 months, “infantile cholera 6 days”

                                               _Southwark and Vauxhall._

At 27, Thomas Street, Wyndham Road, Aug. 4, the widow of a labourer,
aged 68, “diarrhœa 6 days, cholera 4 days”

                                               _Southwark and Vauxhall._

At 7, Rosemary Terrace, Southampton Street, Aug. 5, the son of a
labourer, aged 7 years, “Asiatic cholera 15 hours”

                                               _Southwark and Vauxhall._

At 5, Chatham Place, Windmill Lane, August 3rd, a plumber, aged 60,
“diarrhœa 2 days, cholera 2 days”

                                               _Southwark and Vauxhall._

At 7, Gloucester Pl., Old Kent Rd., Aug. 4, a carman, aged 19, “Asiatic
cholera 15 hours”

                                                              _Lambeth._


                      ROTHERHITHE. _Rotherhithe._

At 2, Albert Place, Union Road, July 8, the wife of a coffee-shopkeeper,
aged 32, “cholera 30 hours”

                                               _Southwark and Vauxhall._

At 7, Spread Eagle Court, July 22nd, the wife of a labourer, aged 25,
“cholera 12 hours”

                                                 _Southwark & Vauxhall._

At 19, Spread Eagle Court, July 24th, the daughter of a labourer, aged 1
year and 9 months, “cholera 20 hours”

                                               _Southwark and Vauxhall._

At 4, John’s Place, July 25th, a blacksmith, aged 41, “cholera 10 hours”

_Water pumped from beneath the Thames Tunnel, by the Engine of the Thames
Tunnel Company._

At 1, John’s Place, July 27th, the wife of a biscuit baker, aged 45,
“cholera 26 hours”

                                                        _Same as above._

At 5, John’s Place, July 25, the son of a baker, aged 4 years, “cholera
24 hours”

                                                        _Same as above._

At 89, Adam Street, on the 28th July, the widow of a blacksmith, aged 36
years, “diarrhœa 24 hours, cholera 16 hours”

                                               _Southwark and Vauxhall._

At 5, King St., July 29th, the wife of a labourer, aged 40, “cholera
2¹⁄₂ days”

                                               _Southwark and Vauxhall._

At Charlotte Place, Charlotte Row, July 29, the son of a barge-builder,
aged 3 years, “cholera 3 days”

                                                          _Tidal ditch._

At 5, Slater’s Alley, July 29, a labourer, aged 33, “cholera 3¹⁄₂ days”

                       _Thames Tunnel water, fetched from John’s Place._

At 18, Upper Queen Street, Aug. 2, the daughter of a labourer, aged 7
years, “cholera 2 days, typhoid fever 7 days”

                                               _Southwark and Vauxhall._

At 1, Thetford Place, August 1, the son of a labourer, aged 7 years,
“cholera 7 hours”

                                               _Southwark and Vauxhall._

On board ship in the Surrey Canal Dock, August 2, a mariner, aged 65,
“Asiatic cholera 18 hours”

                                             _Most likely Thames Water._

On board the brig “Borcas”, of Sunderland, in the river Thames, Aug. 2,
the wife of a master mariner, aged 38, “cholera 13¹⁄₂ hours”

                                             _Most likely Thames Water._

At 20, Spread Eagle Court, Aug. 1, a labourer, aged 28, “cholera 16
hours”

                                               _Southwark and Vauxhall._

At 7, Midway Pl., Aug. 1, the daughter of a domestic servant, aged 3
years, “measles 14 days, Asiatic cholera 18 hours”

                                               _Southwark and Vauxhall._

At 12, St. Helena Pl., Aug. 1, the wife of a carpenter, aged 31, “morbus
cordis 5 years, Asiatic cholera 24 hours”

                                               _Southwark and Vauxhall._

At 18, Stanley Terrace, August 1, the son of a mercantile clerk, aged 2
years, “premonitory diarrhœa 3 hours, Asiatic cholera 5 hours”

                                               _Southwark and Vauxhall._

At York St., near Swan Lane, Aug. 1, the son of a carpenter, aged 3
yrs., “cholera 12 hours”

                                                 _Southwark & Vauxhall._

At York Street, near Swan Lane, on 3rd August, a carpenter, aged 38,
“cholera 8 hours”

                                               _Southwark and Vauxhall._

At 8, Norfolk Place, August 4, the son of a labourer, aged 5 years,
“cholera 8 hours”

                                                 _Southwark & Vauxhall._

At 16, Charlotte Row, Aug. 3, the wife of a waterman, aged 57, “cholera
20 hours”

                                                          _Tidal ditch._

At 3, Plough Bridge, Aug. 3, the daughter of a warehouseman, aged 12,
“Asiatic cholera 12 hours”

                                                         _Surrey Canal._

At 53, Clarence Street, Aug. 4, the wife of a labourer, aged 48,
“cholera 14 hours”

                                                 _Southwark & Vauxhall._

At York St., near Swan Lane, Aug. 5, the son of a carpenter, aged 1
year, “cholera 3 days”

                                                 _Southwark & Vauxhall._

At 9, New St., Neptune St., Aug. 5, the wife of a brushmaker, aged 57,
“cholera 3 days”

                                                 _Southwark & Vauxhall._

              LEWISHAM. _Sydenham._—No death from cholera.


                                THE END.


                  T. RICHARDS, 37 GREAT QUEEN STREET.

-----

Footnote 1:

  Report on the Epidemic Cholera, 1824, p. 5.

Footnote 2:

  On the Infectious Origin and Propagation of Cholera.

Footnote 3:

  See “London Journal of Medicine,” May, 1849.

Footnote 4:

  London Journal of Medicine, loc. cit.

Footnote 5:

  In the so-called secondary fever there is toxicohæmia, arising from
  suppressed excretion by the kidneys.

Footnote 6:

  See “London Gazette”, 18th Sept. 1849.

Footnote 7:

  See Report in “Med. Gaz.”, vol. ii, 1849, p. 429.

Footnote 8:

  Edin. Med. and Sur. Jour., vol. xxxvii.

Footnote 9:

  Scot, “Report on the Epidemic Cholera”, p. 237.

Footnote 10:

  The particulars of each death connected with this outbreak were
  published in the “Weekly Returns” of the Registrar-General to 16th
  September, and I procured the remainder through the kindness of the
  Registrar-General and the District Registrars.

Footnote 11:

  The deaths are obtained from the “First Report of the Metropolitan
  Sanitary Commission”, 1847; and the water supply, chiefly from a work
  entitled “Hydraulia”, by William Matthews, 1835.

Footnote 12:

  A small part of the Whitechapel District is supplied with New River
  water.

Footnote 13:

  A Microscopic Examination of the Water supplied to London. London:
  1850.

Footnote 14:

  P. 207. In the table at page 206, Dr. Baly has fallen into the mistake
  of supposing that the Lambeth Water Company obtained their supply from
  Thames Ditton in 1849. It was not till 1852 that their works were
  removed to that place. Dr. Baly has also mistaken the name and
  identity of all the three Companies which supply the south districts
  of London with water.

Footnote 15:

  A part of Rotherhithe was supplied by the Kent Water Company; but
  there was no cholera in this part.

Footnote 16:

  Weekly Return, Oct. 14, p. 433.

Footnote 17:

  A small part of Rotherhithe is now supplied by the Kent Water Company.

Footnote 18:

  In 1849, there were forty-eight deaths from cholera in Millbank
  prison, amounting to 4·3 per cent. of the average number of prisoners.
  In Tothill Fields prison there were thirteen deaths among eight
  hundred prisoners, or 1·6 per cent. The other prisons on the north
  side of the Thames are supplied either by the New River Company, or
  from pump-wells, and there was but one death from cholera in all of
  them; that death took place in Newgate.

Footnote 19:

  Report by the Government Commission on the Chemical Quality of the
  Supply of Water to the Metropolis. (177.)

Footnote 20:

  Medical Gazette, vol. xliv, p. 749.

Footnote 21:

  History of the Cholera in Exeter in 1832.

Footnote 22:

  Report of the General Board of Health on the Supply of Water to the
  Metropolis, 1850, p. 55.

Footnote 23:

  See Report of Commissioners on the Cholera at Newcastle, etc., p. 474.

Footnote 24:

  Opus cit., p. xxv.

Footnote 25:

  Report of Swedish Commissioners, quoted in the Second Report of the
  Metropolitan Sanitary Commission, 1848.

Footnote 26:

  Medical Times and Gazette, Lancet, and Association Journal.

Footnote 27:

  Various conditions are requisite for the production of a disease, as
  they are for the production of a crop of wheat or turnips; but it is
  not necessary to dignify these conditions with the name of causes.

Footnote 28:

  Medical Times and Gazette, 1854, vol. i, p. 182.

Footnote 29:

  Cholera, with Reference to the Geological Theory. Cincinnati, 1850.

Footnote 30:

  Trans. of Roy. Med. and Chir. Soc., 1844.

Footnote 31:

  Med. Times and Gazette, Nov. 25th, 1854.

Footnote 32:

  Report on the Cholera of 1848–49, p. xl.

Footnote 33:

  Rolle’s Account of the Burning of London in 1666.

Footnote 34:

  Official Reports on the Province of Kumaon, by J. H. Batten, Esq.,
  C.E. Agra, 1851.

Footnote 35:

  Dr. Cheyne on Dysentery, Dublin Hospital Reports, vol. iii.

Footnote 36:

  Statistical Reports on the Health of the Navy. Part II. 1853.

Footnote 37:

  See Clinical Reports of Continued Fever, by Austin Flint, M.D.:
  Buffalo, 1852, p. 380. Also Med. Times and Gazette, March 12, 1853, p.
  261.

Footnote 38:

  Association Journal, October 6, 1854.

Footnote 39:

  8vo., 1842, p. 66.

Footnote 40:

  Essai de Géographie Médicale, p. 52.

Footnote 41:

  Page 94.

Footnote 42:

  De Aere, Aquis, et Locis.

------------------------------------------------------------------------




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                         C. REMIQIUS FRESENIUS.

ELEMENTARY INSTRUCTION IN CHEMICAL ANALYSIS, AS PRACTISED IN THE
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                                   I.

A MANUAL OF CHEMISTRY; with numerous Illustrations on Wood. Fifth
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INTRODUCTION TO QUALITATIVE ANALYSIS. Post 8vo. cloth, 2_s._

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                                   I.

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32mo. cloth, 2_s._ 6_d._; roan tuck (for the pocket), 3_s._ 6_d._


  “Never was half-a-crown better spent than in the purchase of this
  ‘_Thesaurus Medicaminum_.’ This little work, with our visiting-book
  and stethoscope, are our daily companions in the carriage.”—_Dr.
  Johnson’s Review._


                          SIR WM. PYM, K.C.H.,

INSPECTOR-GENERAL OF ARMY HOSPITALS.

OBSERVATIONS UPON YELLOW FEVER, with a Review of “A Report upon the
Diseases of the African Coast, by Sir WM. BURNETT and Dr. BRYSON,”
proving its highly Contagious Powers. Post 8vo. 6_s._


                             DR. RADCLIFFE,

            ASSISTANT PHYSICIAN TO THE WESTMINSTER HOSPITAL.

                                   I.

EPILEPSY, AND OTHER AFFECTIONS OF THE NERVOUS SYSTEM which are marked by
Tremor, Convulsion, or Spasm: their Pathology and Treatment. 8vo. cloth,
5_s._


  “This sketch will serve to make our readers aware of the important
  nature of the book under notice. Sufficient has been said to show the
  grounds upon which Dr. Radcliffe hopes to effect a complete revolution
  in all matters relating to the pathology and treatment of epilepsy and
  the cognate disorders, and to stimulate inquirers to read the book
  itself.”—_The Lancet._


                                  II.

PROTEUS; OR, THE LAW OF NATURE. 8vo. cloth, 6_s._

                                  III.

THE PHILOSOPHY OF VITAL MOTION. 8vo. cloth, 6_s._


                         DR. F. H. RAMSBOTHAM,

PHYSICIAN TO THE ROYAL MATERNITY CHARITY, ETC.

THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND SURGERY.
Illustrated with One Hundred and Twenty Plates on Steel and Wood;
forming one thick handsome volume. Third Edition. 8vo. cloth, 22_s._


  “Dr. Ramsbotham’s work is so well known, and so highly approved by the
  profession as a work of reference and authority in obstetric medicine
  and surgery, that we need do little more than direct the attention of
  our readers to the publication of a third edition. With regard to the
  engravings, they are so numerous, so well executed, and so
  instructive, that they are in themselves worth the whole cost of the
  book.”—_Medical Gazette._


                            DR. RAMSBOTHAM,

          CONSULTING PHYSICIAN TO THE ROYAL MATERNITY CHARITY.

PRACTICAL OBSERVATIONS ON MIDWIFERY, with a Selection of Cases. Second
Edition. 8vo. cloth, 12_s._


                      DR. RANKING & DR. RADCLIFFE.

HALF-YEARLY ABSTRACT OF THE MEDICAL SCIENCES; being a Practical and
Analytical Digest of the Contents of the Principal British and
Continental Medical Works published in the preceding Half-Year; together
with a Critical Report of the Progress of Medicine and the Collateral
Sciences during the same period.

Volumes I. to XX., 6_s._ 6_d._ each.


  “The sifting which the journals and other medical works undergo, and
  the judicious selection from their pages of points of practical
  interest, and of discoveries of importance in the collateral sciences,
  form an important part of the duty of the editor; and, after a careful
  examination of Dr. Ranking’s volumes, we are bound to state that the
  duty has been most ably performed.”—_Provincial Medical Journal._


                          DR. DU BOIS REYMOND.

ANIMAL ELECTRICITY; Edited by H. BENCE JONES, M.D., F.R.S. With Fifty
Engravings on Wood. Foolscap 8vo. cloth, 6_s._


  “This small volume is a valuable addition to our scientific
  literature. Those who read with attention will learn many
  most important facts from this work, but it demands such
  attention.”—_Athenæum._

  “The name of M. Du Bois Reymond is probably known to most of our
  readers, as that of a zealous investigator into Animal
  Electricity. We have now had the opportunity of witnessing some of
  the most interesting of these experiments. We beg to tender our
  thanks to Dr. Bence Jones for this very seasonable publication,
  and for the very efficient mode in which he has performed the
  task.”—_Medico-Chirurgical Review._


                   MR. EVANS RIADORE, F.R.C.S, F.L.S.

                                   I.

ON SPINAL IRRITATION, THE SOURCE OF NERVOUSNESS, INDIGESTION, AND
FUNCTIONAL DERANGEMENTS OF THE PRINCIPAL ORGANS OF THE BODY; with Cases,
illustrating the Importance of attending to the peculiar Temperature of
the Patient, and the most successful Mode of Treatment, and on the
legitimate Remedial Use of Water. Post 8vo. cloth, 5_s._ 6_d._

                                  II.

THE REMEDIAL INFLUENCE OF OXYGEN, NITROUS OXYDE, AND OTHER GASES,
ELECTRICITY, AND GALVANISM. Post 8vo. cloth, 5_s._ 6_d._


                             MR. ROBERTON,

FORMERLY SENIOR SURGEON TO THE MANCHESTER AND SALFORD LYING-IN HOSPITAL.

ON THE PHYSIOLOGY AND DISEASES OF WOMEN, AND ON PRACTICAL MIDWIFERY.
8vo. cloth, 12_s._


  “We honestly recommend this work to our readers as one calculated to
  interest them in the highest degree.”—_Provincial Medical and Surgical
  Journal._

  “We recommend this work very strongly to all engaged in obstetric
  practice, or interested in ethnological studies. It possesses
  practical utility and physiological interest, combined with the fruits
  of a large experience, great power of observation, and an extensive
  and varied erudition.”—_Medical Gazette._


                          DR. W. H. ROBERTSON,

                 PHYSICIAN TO THE BUXTON BATH CHARITY.

                                   I.

THE NATURE AND TREATMENT OF GOUT. 8vo. cloth, 10_s._ 6_d._


  “We cannot conclude this notice of Dr. Robertson’s treatise without
  cordially recommending it as a sound and practical work, fitted for
  reference, both as a work of information on the subject and as a guide
  to practice.”—_Provincial Medical Journal._


                                  II.

A TREATISE ON DIET AND REGIMEN. Fourth Edition. 2 vols. post 8vo. cloth,
12_s._


  “It is scarcely necessary that we should add our hearty recommendation
  of Dr. Robertson’s treatise, not merely to our medical readers, but to
  the public, over whom they have an influence. It is one of the few
  books which is legitimately adapted, both in subject and manner of
  treatment, to both classes.”—_British and Foreign Medico-Chirurgical
  Review._


                               DR. ROTH.

ON MOVEMENTS. An Exposition of their Principles and Practice, for the
Correction of the Tendencies to Disease in Infancy, Childhood, and
Youth, and for the Cure of many Morbid Affections in Adults. Illustrated
with numerous Engravings on Wood. 8vo. cloth, 10_s._


                            DR. ROWE, F.S.A.

NERVOUS DISEASES, LIVER AND STOMACH COMPLAINTS, LOW SPIRITS,
INDIGESTION, GOUT, ASTHMA, AND DISORDERS PRODUCED BY TROPICAL CLIMATES.
With Cases. Thirteenth Edition. 8vo. 5_s._ 6_d._


  “Dr. Rowe, the first edition of whose work appeared in 1820, claims,
  with justice, a priority of authorship over many other writers in this
  field of inquiry.”—_Lancet._


                           DR. ROYLE, F.R.S.

A MANUAL OF MATERIA MEDICA AND THERAPEUTICS. With numerous Engravings on
Wood. Second Edition. Fcap. 8vo. cloth, 12_s._ 6_d._


  “This is another of that beautiful and cheap series of Manuals
  published by Mr. Churchill. The execution of the woodcuts of plants,
  flowers, and fruits is admirable. The work is indeed a most valuable
  one.”—_British and Foreign Medical Review._


                              DR. SHAPTER.

                                   I.

THE CLIMATE OF THE SOUTH OF DEVON, AND ITS INFLUENCE UPON HEALTH. With
short Accounts of Exeter, Torquay, Teignmouth, Dawlish, Exmouth,
Sidmouth, &c. Illustrated with a Map geologically coloured. Post 8vo.
cloth, 7_s._ 6_d._


  “This volume is far more than a guide-book. It contains much
  statistical information, with very minute local details, that may be
  advantageously consulted by the medical man before he recommends any
  specific residence in Devonshire to his patient.”—_Athenæum._


                                  II.

THE HISTORY OF THE CHOLERA IN EXETER IN 1832. Illustrated with Map and
Woodcuts. 8vo. cloth, 12_s._


                              MR. SAVORY,

                 MEMBER OF THE SOCIETY OF APOTHECARIES.

A COMPENDIUM OF DOMESTIC MEDICINE, AND COMPANION TO THE MEDICINE CHEST;
comprising Plain Directions for the Employment of Medicines, with their
Properties and Doses, and Brief Descriptions of the Symptoms and
Treatment of Diseases, and of the Disorders incidental to Infants and
Children, with a Selection of the most efficacious Prescriptions.
Intended as a Source of Easy Reference for Clergymen, and for Families
residing at a Distance from Professional Assistance. Fourth Edition.
12mo. cloth, 5_s._


                               MR. SHAW.

THE MEDICAL REMEMBRANCER; OR, BOOK OF EMERGENCIES: in which are
concisely pointed out the Immediate Remedies to be adopted in the First
Moments of Danger from Poisoning, Drowning, Apoplexy, Burns, and other
Accidents; with the Tests for the Principal Poisons, and other useful
Information. Third Edition. 32mo. cloth, 2_s._ 6_d._


  “The plan of this little book is well conceived, and the execution
  corresponds thereunto. It costs little money, and will occupy little
  room; and we think no practitioner will regret being the possessor of
  what cannot fail, sooner or later, to be useful to him.”—_British and
  Foreign Medical Review._


                            MR. SKEY, F.R.S.

OPERATIVE SURGERY; with Illustrations engraved on Wood. 8vo. cloth,
18_s._


  “Mr. Skey’s work is a perfect model for the operating surgeon, who
  will learn from it not only when and how to operate, but some more
  noble and exalted lessons, which cannot fail to improve him as a moral
  and social agent.”—_Edinburgh Medical and Surgical Journal._

  “We pronounce Mr. Skey’s ‘Operative Surgery’ to be a work of the very
  highest importance—a work by itself. The correctness of our opinion we
  trustfully leave to the judgment of the profession.”—_Medical
  Gazette._


                              DR. SPURGIN.

LECTURES ON MATERIA MEDICA, AND ITS RELATIONS TO THE ANIMAL ECONOMY.
Delivered before the Royal College of Physicians. 8vo. cloth, 5_s._
6_d._


  “Dr. Spurgin has evidently devoted much time and labour to the
  composition of these lectures; and the result is, that he has produced
  one of the most philosophical essays on the subject of “Materia
  Medica” existing in the English language.”—_Psychological Journal._


                          DR. W. TYLER SMITH,

PHYSICIAN-ACCOUCHEUR TO ST. MARY’S HOSPITAL.

                                   I.

THE PATHOLOGY AND TREATMENT OF LEUCORRHŒA. With Engravings on Wood. 8vo.
cloth, 6_s._ 6_d._

                                  II.

THE PERIODOSCOPE, a new Instrument for determining the Date of Labour,
and other Obstetric Calculations, with an Explanation of its Uses, and
an Essay on the Periodic Phenomena attending Pregnancy and Parturition.
8vo. cloth, 4_s._


  “We anticipate for the work that which it deserves for its novelty,
  ingenuity, and utility—a wide circulation. It should be in the hands
  of all medical men who practise midwifery.”—_Medical Gazette._


                               DR. SNOW.

ON THE MODE OF COMMUNICATION OF CHOLERA. Second Edition, much Enlarged,
and Illustrated with Maps. 8vo. cloth, 7_s._


                              MR. SQUIRE,

CHEMIST ON HER MAJESTY’S ESTABLISHMENT.

THE PHARMACOPŒIA, (LONDON, EDINBURGH, AND DUBLIN) arranged in a
convenient TABULAR FORM, both to suit the Prescriber for comparison, and
the Dispenser for compounding the formulæ; with Notes, Tests, and
Tables. 8vo. cloth, 12_s._


  “Mr. Squire has rendered good service to all who either prescribe or
  dispense medicines by this work. He has succeeded in bringing together
  the similar formulæ for ready comparison and reference. The work
  offers a striking comment on the necessity of uniformity in the
  strength and preparation of all medicines which are used in the United
  Kingdom.”—_Lancet._

  “A very valuable work. Mr. Squire’s volume combines the formulæ of the
  three Pharmacopœias, and at one glance shows the difference of the
  official preparations of the three kingdoms.”—_Medical Times._

  “A most convenient and well-arranged work; it will be found of very
  great utility, both to the prescriber and to the dispenser.”—_Medical
  Gazette._


             J. STEPHENSON, M.D, & J. M. CHURCHILL, F.L.S.

MEDICAL BOTANY; OR, ILLUSTRATIONS AND DESCRIPTIONS OF THE MEDICINAL
PLANTS OF THE PHARMACOPŒIAS; comprising a popular and scientific Account
of Poisonous Vegetables indigenous to Great Britain. Edited by GILBERT
BURNETT, F.L.S., Professor of Botany in King’s College.

In three handsome royal 8vo. volumes, illustrated by Two Hundred
Engravings, beautifully drawn and coloured from nature, cloth lettered.

_Reduced from £6. 6s. to £4._


  “The most complete and comprehensive work on Medical
  Botany.”—_Pharmaceutical Journal._

  “So high is our opinion of this work, that we recommend every student
  at college, and every surgeon who goes abroad, to have a copy, as one
  of the essential constituents of his library.”—_Dr. Johnson’s
  Medico-Chirurgical Review._


                             DR. STEGGALL.

STUDENTS’ BOOKS FOR EXAMINATION.

                                   I.

A MEDICAL MANUAL FOR APOTHECARIES’ HALL AND OTHER MEDICAL BOARDS.
Eleventh Edition. 12mo. cloth, 10_s._

                                  II.

A MANUAL FOR THE COLLEGE OF SURGEONS; intended for the Use of Candidates
for Examination and Practitioners. Second Edition. 12mo. cloth, 10_s._

                                  III.

GREGORY’S CONSPECTUS MEDICINÆ THEORETICÆ. The First Part, containing the
Original Text, with an Ordo Verborum, and Literal Translation. 12mo.
cloth, 10_s._

                                  IV.

THE FIRST FOUR BOOKS OF CELSUS; containing the Text, Ordo Verborum, and
Translation. Second Edition. 12mo. cloth, 8_s._

⁂ The above two works comprise the entire Latin Classics required for
Examination at Apothecaries’ Hall.

                                   V.

A TEXT-BOOK OF MATERIA-MEDICA AND THERAPEUTICS. 12mo. cloth, 7_s._

                                  VI.

FIRST LINES FOR CHEMISTS AND DRUGGISTS PREPARING FOR EXAMINATION AT THE
PHARMACEUTICAL SOCIETY. 18mo. cloth, 3_s._ 6_d._


                       DR. ALFRED TAYLOR, F.R.S.,

LECTURER ON MEDICAL JURISPRUDENCE AND CHEMISTRY AT GUY’S HOSPITAL.

                                   I.

A MANUAL OF MEDICAL JURISPRUDENCE. Fifth Edition. Fcap. 8vo. cloth,
12_s._ 6_d._


  “We recommend Dr. Taylor’s work as the ablest, most comprehensive,
  and, above all, the most practical useful book which exists on the
  subject of legal medicine. Any man of sound judgment, who has mastered
  the contents of Taylor’s ‘Medical Jurisprudence,’ may go into a Court
  of Law with the most perfect confidence of being able to acquit
  himself creditably.”—_Medico-Chirurgical Review._

  “Dr. Taylor possesses the happy art of expressing himself on a
  scientific topic in intelligible language. The size of his Manual fits
  it to be a circuit companion.”—_Law Times._


                                  II.

ON POISONS, in relation to MEDICAL JURISPRUDENCE AND MEDICINE. Fcap.
8vo. cloth, 12_s._ 6_d._


  “An excellent and valuable manual. We predict for it a very favourable
  reception by the profession. It contains all that kind of information
  which a medical man will be glad to have access to when he has the
  prospect of appearing in the witness-box.”—_Edinburgh Medical
  Journal._


                        MR. TAMPLIN, F.R.C.S.E.,

SURGEON TO, AND LECTURER ON DEFORMITIES AT, THE ROYAL ORTHOPÆDIC
HOSPITAL.

LATERAL CURVATURE OF THE SPINE: its Causes, Nature, and Treatment. 8vo.
cloth, 4_s._


                    DR. THEOPHILUS THOMPSON, F.R.S.,

 PHYSICIAN TO THE BROMPTON HOSPITAL FOR CONSUMPTION AND DISEASES OF THE
                                 CHEST.

CLINICAL LECTURES ON PULMONARY CONSUMPTION. With Plates. 8vo. cloth,
7_s._ 6_d._


  “The extracts we have already made are sufficient to show the
  practical character of Dr. Thompson’s work. The volume abounds in
  useful and instructive matter, and displays Dr. Thompson’s talents in
  a very favourable light.”—_Dublin Medical Press._


                 HENRY THOMPSON, M.B. LOND., F.R.C.S.,

      SURGEON TO THE MARYLEBONE AND TO THE BLENHEIM DISPENSARIES.

STRICTURE OF THE URETHRA; its Pathology and Treatment. The last
Jacksonian Treatise of the Royal College of Surgeons. With Plates. 8vo.
cloth, 10_s._


                               DR. TILT.

                                   I.

ON DISEASES OF WOMEN AND OVARIAN INFLAMMATION IN RELATION TO MORBID
MENSTRUATION, STERILITY, PELVIC TUMOURS, AND AFFECTIONS OF THE WOMB.
Second Edition. 8vo. cloth, 9_s._


  “We rejoice to see that physicians of weight and authority are
  beginning to look beyond the os and cervix uteri for the causes of
  disease in these parts. Already a reformation somewhat analogous to
  what Abernethy effected for surgical diseases has commenced, and we
  feel assured that Dr. Tilt’s work will powerfully co-operate in
  helping it forward, and in placing the pathology and therapeutics of
  diseases of the female generative organs upon a sound and permanent
  basis.”—_Dublin Quarterly Review._


                                  II.

ON THE PRESERVATION OF THE HEALTH OF WOMEN AT THE CRITICAL PERIODS OF
LIFE. Foolscap 8vo. cloth, 4_s._ 6_d._


                           MR. TOD, M.R.C.S.

A DISQUISITION ON CERTAIN PARTS AND PROPERTIES of the BLOOD. With
Illustrative Woodcuts. 8vo., 10_s._ 6_d._


                      DR. ROBERT B. TODD, F.R.S.,

PHYSICIAN TO KING’S COLLEGE HOSPITAL.

CLINICAL LECTURES ON PARALYSIS, DISEASES OF THE BRAIN, and other
AFFECTIONS of the NERVOUS SYSTEM. Foolscap 8vo. cloth, 6_s._


  “The work will soon be in the hands of every practitioner who desires
  to be informed of the present state of knowledge in regard to diseases
  of the nervous system. It is exceedingly easy reading, and replete
  with just such information as the scientific practitioner
  requires.”—_Medical Times and Gazette._


                               MR. TUKE.

DR. JACOBI ON THE CONSTRUCTION AND MANAGEMENT OF HOSPITALS FOR THE
INSANE. Translated from the German. With Introductory Observations by
the Editor. With Plates. 8vo. cloth, 9_s._


                             DR. TURNBULL,

             PHYSICIAN TO THE LIVERPOOL NORTHERN HOSPITAL.

                                   I.

A TABULAR VIEW AND SYNOPSIS OF THE PHYSICAL SIGNS AND DIAGNOSIS OF THE
DISEASES OF THE LUNGS. With Woodcuts, mounted on cloth, 5_s._ boards.


  “This tabular view, affording a coup d’œil of the various auscultatory
  &c. phenomena discoverable in health and disease, will prove useful to
  many practitioners, as well as students, in their investigation of
  thoracic maladies.”—_Medico-Chirurgical Review._


                                  II.

AN INQUIRY HOW FAR CONSUMPTION IS CURABLE; WITH OBSERVATIONS ON THE
TREATMENT AND ON THE USE OF COD-LIVER OIL AND OTHER REMEDIES. Second
Edition. 8vo. cloth, 4_s._


                             DR. UNDERWOOD.

TREATISE ON THE DISEASES OF CHILDREN. Tenth Edition, with Additions and
Corrections by HENRY DAVIES, M.D. 8vo. cloth, 15_s._

VESTIGES OF THE NATURAL HISTORY OF CREATION. Tenth Edition. Illustrated
with 100 Engravings on Wood. 8vo. cloth, 12_s._ 6_d._

BY THE SAME AUTHOR.

EXPLANATIONS: A SEQUEL TO “VESTIGES.” Second Edition. Post 8vo. cloth,
5_s._


                             DR. VAN OVEN.

ON THE DECLINE OF LIFE IN HEALTH AND DISEASE; being an Attempt to
Investigate the Causes of LONGEVITY, and the Best Means of Attaining a
Healthful Old Age. 8vo. cloth, 10_s._ 6_d._


                             DR. WAGSTAFF.

ON DISEASES OF THE MUCOUS MEMBRANE OF THE THROAT, and their Treatment by
Topical Medication. Post 8vo. cloth, 4_s._ 6_d._


                          MR. WADE, F.R.C.S.,

             SENIOR SURGEON TO THE WESTMINSTER DISPENSARY.

STRICTURE OF THE URETHRA; its Complications and Effects. With Practical
Observations on its Causes, Symptoms, and Treatment; and on a Safe and
Efficient Mode of Treating its more Intractable Forms. 8vo. cloth, 5_s._


  “Mr. Wade is well known to have paid great attention to the subject of
  stricture for many years past, and is deservedly looked upon as an
  authority on this matter.”—_Medical Times and Gazette._


                              DR. WALLER,

LECTURER ON MIDWIFERY AT ST. THOMAS’S HOSPITAL.

ELEMENTS OF PRACTICAL MIDWIFERY; OR, COMPANION TO THE LYING-IN ROOM.
With Plates. Third Edition. 18mo. cloth, 3_s._ 6_d._


  “Students and practitioners in midwifery will find it an invaluable
  pocket companion.”—_Medical Times and Gazette._


                      MR. HAYNES WALTON, F.R.C.S.,

           SURGEON TO THE CENTRAL LONDON OPHTHALMIC HOSPITAL.

OPERATIVE OPHTHALMIC SURGERY. With Engravings on Wood. 8vo. cloth,
18_s._


  “We have carefully examined the book, and can consistently say, that
  it is eminently a practical work, evincing in its author great
  research, a thorough knowledge of his subject, and an accurate and
  most observing mind.”—_Dublin Quarterly Journal._


                              DR. WARDROP.

ON DISEASES OF THE HEART. 8vo. cloth, 12_s._


                        DR. EBEN. WATSON, A.M.,

LECTURER ON THE INSTITUTES OF MEDICINE IN THE ANDERSONIAN UNIVERSITY,
GLASGOW.

ON THE TOPICAL MEDICATION OF THE LARYNX IN CERTAIN DISEASES OF THE
RESPIRATORY AND VOCAL ORGANS. 8vo. cloth, 5_s._


                               DR. WEGG.

OBSERVATIONS RELATING TO THE SCIENCE AND ART OF MEDICINE. 8vo. cloth,
8_s._


  “We have much pleasure in stating, that the work is highly
  instructive, and proclaims its author to be a sober, sound, and able
  physician.”—_London Journal of Medicine._


                    MR. T. SPENCER WELLS, F.R.C.S.,

               LATE ASSISTANT SURGEON IN MALTA HOSPITAL.

PRACTICAL OBSERVATIONS ON GOUT AND ITS COMPLICATIONS, and on the
Treatment of Joints Stiffened by Gouty Deposits. Foolscap 8vo. cloth,
5_s._


                        DR. WHITEHEAD, F.R.C.S.,

SURGEON TO THE MANCHESTER AND SALFORD LYING-IN HOSPITAL.

                                   I.

ON THE TRANSMISSION FROM PARENT TO OFFSPRING OF SOME FORMS OF DISEASE,
AND OF MORBID TAINTS AND TENDENCIES. 8vo. cloth, 10_s._ 6_d._

                                  II.

THE CAUSES AND TREATMENT OF ABORTION AND STERILITY: being the result of
an extended Practical Inquiry into the Physiological and Morbid
Conditions of the Uterus, with reference especially to Leucorrhœal
Affections, and the Diseases of Menstruation. 8vo. cloth, 12_s._


  “The work is valuable and instructive, and one that reflects much
  credit alike on the industry and practical skill of the
  author.”—_Medico-Chirurgical Review._


                    MR. WILLIAM R. WILDE, F.R.C.S.I.

AURAL SURGERY, AND THE NATURE AND TREATMENT OF DISEASES OF THE EAR. 8vo.
cloth, 12_s._ 6_d._


  “We have no hesitation in expressing our opinion that the book is by
  far the best treatise on Aural Surgery which has yet appeared in any
  language.”—_Medical Times and Gazette._


                      DR. JOHN CALTHROP WILLIAMS,

LATE PHYSICIAN TO THE GENERAL HOSPITAL, NOTTINGHAM.

PRACTICAL OBSERVATIONS ON NERVOUS AND SYMPATHETIC PALPITATION OF THE
HEART, as well as on Palpitation the Result of Organic Disease. Second
Edition, 8vo. cloth, 6_s._


  “From the extracts we have given, our readers will see that Dr.
  Williams’s treatise is both able and practical.”—_Medical Times._

  “The work is calculated to add to the author’s reputation, and it is
  creditable to the provincial practitioners of England that so useful a
  treatise should have emanated from one of their body.”—_Dublin Medical
  Press._


                            DR. J. WILLIAMS.

                                   I.

INSANITY: its Causes, Prevention, and Cure; including Apoplexy,
Epilepsy, and Congestion of the Brain. Second Edition. Post 8vo. cloth,
10_s._ 6_d._

                                  II.

ON THE ANATOMY, PHYSIOLOGY, AND PATHOLOGY OF THE EAR; being the Prize
Essay in the University of Edinburgh. With Plates. 8vo. cloth, 10_s._
6_d._


                           DR. JAMES WILSON.

THE PRINCIPLES AND PRACTICE OF THE WATER CURE, and HOUSEHOLD MEDICAL
SCIENCE, in Conversations on Physiology, on Pathology, or the Nature of
Disease, and on Digestion, Nutrition, Regimen, and Diet. 8vo. cloth,
10_s._ 6_d._


                          DR. G. C. WITTSTEIN.

PRACTICAL PHARMACEUTICAL CHEMISTRY: An Explanation of Chemical and
Pharmaceutical Processes, with the Methods of Testing the Purity of the
Preparations, deduced from Original Experiments. Translated from the
Second German Edition, by STEPHEN DARBY. 18mo. cloth, 6_s._


                       MR. ERASMUS WILSON, F.R.S.

                                   I.

THE ANATOMIST’S VADE-MECUM: A SYSTEM OF HUMAN ANATOMY. With numerous
Illustrations on Wood. Sixth Edition. Foolscap 8vo. cloth, 12_s._ 6_d._


  “As a satisfactory proof that the praise we bestowed on the first
  edition of this work was not unmerited, we may observe it has been
  equally well thought of in foreign countries, having been reprinted in
  the United States and in Germany. In every respect, this work, as an
  anatomical guide for the student and the practitioner, merits our
  warmest and most decided praise.”—_Medical Gazette._


                                  II.

DISEASES OF THE SKIN: A Practical and Theoretical Treatise on the
DIAGNOSIS, PATHOLOGY, and TREATMENT OF CUTANEOUS DISEASES. Third
Edition. 8vo. cloth, 12_s._

THE SAME WORK; illustrated with finely-executed Engravings on Steel,
accurately coloured. 8vo. cloth, 30_s._


  “The work is very considerably improved in the present edition. Of the
  plates it is impossible to speak too highly. The representations of
  the various forms of cutaneous disease are singularly accurate, and
  the colouring exceeds almost anything we have met with in point of
  delicacy and finish.”—_British and Foreign Medical Review._


                                  III.

HEALTHY SKIN: A Treatise on the Management of the Skin and Hair in
relation to Health. Fifth Edition. Foolscap 8vo. 2_s._ 6_d._


  “The student will be delighted to find his labours so much
  facilitated; and a few hours of agreeable society with a most
  pleasantly-written book will do more to make him acquainted with a
  class of obscure diseases than all that has been previously written on
  the subject.”—_Lancet._


                                  IV.

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                          TRANSCRIBER’S NOTES


 1. Silently corrected obvious typographical errors and variations in
      spelling.
 2. Silently corrected palpable typographical errors; retained
      non-standard spellings and dialect.
 3. Reindexed footnotes using numbers and collected together at the end
      of the last chapter.
 4. Enclosed italics font in _underscores_.
 5. Enclosed blackletter font in =equals=.
 6. Denoted superscripts by a caret before a series of superscripted
      characters enclosed in curly braces, e.g. 14^{to}.