RESULT OF AN INQUIRY WHETHER CHOLERA CAN BE CONVEYED BY HUMAN INTERCOURSE FROM AN INFECTED TO A HEALTHY LOCALITY; OR, FROM AN INFECTED TO A HEALTHY PERSON : THAT IS, IS CHOLERA A CONTAGIOUS DISEASE? j^v Jf BY DAVID JJACLOUGHLIN, M.D., MEMBER OF THE LECUON OF HONOUB. J. CHURCHILL, • NEW BURLINGTON STREET. V MDCCCLVI. we tO)(pSC j LONDON: T. lUCIIARDS, 37, ORKAT QUBKN STREET. IS CHOLERA A CONTAGIOUS DISEASE? Before entering into the inquiry whether cholera can be conveyed by human intercourse from an infected to a healthy locality, or from an infected to a healthy person — that is, whether cholera is or is not a contagious disease — permit me to say a few words on the symptoms which usher in the disease, and which, heretofore, have been so little attended to ; and also permit me to say a few words on the change which takes place in the constitution of an individual about to be attacked with the premonitory diarrhoea, and which, heretofore, has been also so little attended to. rthe time cholera, as an epidemic, attracted tion in 1817, the vomiting, spasms, etc., alone fixed attention, and received the name of cholera ; the deviations from health which precede this stage were overlooked ; and even diarrhoea was considered as unconnected with cholera. Having had charge of extensive military hospitals in the Peninsula, during the Peninsular War, and having repeatedly seen cholera, almost an epidemic, in these establishments, and having paid attention to the disease ; when cholera appeared in Europe as an epidemic in 1831-2, I doubted that it ever attacked, suddenly, an individual in perfect health, and free from diarrhoea. a 2 4 cholera in 1832, and I had extensive opportunities to study the disease, in the public hospitals, in the ambulances, and in an extensive private practice. But, although my attention, and the attention of friends who acted with me, was directed to the question whether the disease attacked suddenly by vomiting, spasms, etc., we could not discover a single case without its having been ushered in by In 1849, when the disease broke out here as an epidemic, I was placed in charge of the house-to-house visitors belonging to nine unions ; and I had nearly one hundred medical gentlemen acting with me. I met these gentlemen daily; and from the first their attention was directed to the inquiry whether cholera attacks suddenly an individual in perfect health, or whether the disease gives any, and what warning, of its approach. In this way 3,902 cases of cholera, which occurred in the above unions, were inquired into, and every one was found to have been preceded by a diarrhoea for a longer or shorter period ; and a report of this result was made to the General Board of Health. See their Report on Cholera, published in 1850 ; Appendix 8., p. 105. In 1853, cholera having again broken out in this country and on the continent as an epidemic, and aware that neither in this country nor on the continent had the disease been scientifically investigated, and that the profession still believed that ara is a disease independent of, and a superfcei upon, diarrhoea; in the interests of humanity 5 I addressed a letter to the Academic Imperiale de Medecine de France, which was published in their Oompte rendu dcs Seances de V Academie of the 24th September, 1853 ; and I addressed another letter to the Registrar-General here, which appeared in his weekly return of births and deaths of the 24th September, 1853. In these letters it was stated that cholera — that is, vomiting, spasms, etc. — always gives a warning of its approach by a diarrhoea for a few hours, or for a few days, or for a few weeks ; and that, if this diarrhoea is scientifically attended to, the progress of the disease can be arrested, developed cholera can be prevented, and life thereby can be saved. This announcement, that the stage of vomiting, spasms, etc., that the stage of cholera is invariably preceded by a diarrhoea for a few hours, or for a few days, or for a few weeks, is the first intimation which the profession, in any country, had of the connexion which exists between diarrhoea and cholera. After the publication of the above-mentioned letters to the Academic Imperiale de Medecine and to the Registrar-General, the Registrar-General was so kind as to call on all his sub-registrars to state on their certificate, when they reported a death from cholera, whether the individual had been attacked, suddenly, by vomiting, spasms, etc., X' whether the individual had had a diarrhoea preous to the attack of vomiting, spasms, etc. Kbere it was reported that a diarrhoea had exprevious to the attack of vomiting, spasms, the sub -registrars were further directed to 6 O 1 1 O 1 1 state for now many hours, or for now many days, or how many weeks, this diarrhoea had existed, previous to the attack of vomiting, spasms, etc. t Where the sub-registrars reported a case o olera as having occurred without any previous diarrhoea, I made it my duty to inquire into the case, and to report the result to the Registrar- General. During the outbreak of cholera, in London, in 1853, twenty-one cases were reported as cases of cholera without any premonitory diarrhoea. I visited the house where each of these twenty- one cases had occurred, and I there saw the relations or the friends who had attended these cases in their last moments, and in some instances the medical attendant ; and the result was, that I found fifteen of these one-and- twenty cases had had a diarrhoea fora longer or shorter period previous to the attack of vomiting, spasms, etc. I also found that in the sixteenth case, the captain of the vessel, in which the case had occurred, had an interest in denying that his mate was labouring under a diarrhoea, at the time he was attacked with vomiting, spasms, etc. In the seventeenth case, the patient had been admitted into the London Hospital in a state of collapse ; and, as the medical gentleman, who admitted the patient, could obtain no information whether he was or was not labouring under a diarrhoea, at the time he was attacked with vomiting, spasms, etc., he reported the case as one without a premonitory diarrhoea. In the eighteenth case, it was ascertained that this person was ill before she was attacked with vomiting, spasms, etc., but with 7 what, no one could tell. In the nineteenth case, hypercatharsis and death were induced by an overdose of purgative medicine. The twentieth case was one of retrocident gout. The twenty-first case was one of strangulated hernia. Eerefore, in the inquiry in 1853, carried on, as c, by the whole medical profession in London, 3 found that every fatal case of cholera had been preceded by a diarrhoea for a longer or shorter period. In consequence of these researches in 1853, and in consequence of the publication of the Result of an Inquiry into the Invariable Existence of a Premonitory Diarrhoea in Cholera, the profession made more careful investigations into the state of health of their patients, previous to the attack of vomiting, spasms, etc. ; and the result has been that the St. Thomas's, the St. Bartholomew's, the Westminster, the Homoeopathic, the Royal Military Hospital, Chelsea, the St. Mary's, the University College Hospital, and the Middlesex Hospital, ascertained, and have reported to the General Board of Health, that every case of cholera, admitted into their hospitals, in 1854, had been preceded, for a longer or shorter period by a diarrhoea. It follows from the above-mentioned researches that the question is now finally settled, and that it is admitted that every case of cholera is invariably preceded by a diarrhoea for a few hours, or for a few days, or for a few weeks ; and that it is further in accordance with experience, at the bedside, that, if the disease is scientifically attended to, in this diarrhoeal stage, the progress of the disease can be 8 life thereby can be saved. But, although it is now admitted that diarrhoea, for a longer, or shorter period, invariably precedes an attack of vomiting, spasms, etc. — precedes an attack of cholera— yet, before diarrhoea comes on, there is a change which takes place in the constitution of every person about to be attacked by premonitory diarrhoea, and which has not as yet been sufficiently studied, and sufficiently attended to. r allude to the derangement in the functions of stomach and bowels, marked by an increase of flatus, by borborygmus, to which the person is not liable, the borborygmus being more especially noticed between the hours of one, and five, in the morning ; and, when the person is up, and walking about, by his feeling a weight, and pressure, on the sphincter of the anus, and a feeling of insecurity, as if, at any moment the sphincter would give way, and he would soil his clothes. And this derangement in the functions of the stomach and bowels is marked, in those persons who are of a costive habit, and who usually have a passage in their bowels only every second, third, or fourth day, of hard faecal matter, having now a passage in their bowels, every day, of soft faecal matter ; and in those persons who are in the habit of having, everyday, a solid faecal evacuation, having now, daily, two, or more, soft, faecal evacuations. But this derangement in the functions of the stomach and bowels, is made evident to the medical attendant, by one-half, or one-third, or one-fourth, 9 same results now as a full dose would do at any other time ; and by a full dose now inducing diarrhoea, too often followed by fatal cholera. Consequently, on entering into the inquiry whether cholera can be conveyed, by human intercourse, from an infected, to a healthy locality, or from an infected to a healthy individual — that is whether cholera is contagious or not — we must take into consideration this derangement in the functions of the stomach and bowels — and we must ascertain whether this epidemic derangement in the functions of the stomach and bowels did or did not exist, in a locality where epidemic diarrhoea, followed by epidemic cholera, has broken out, before we can pronounce whether cholera has been conveyed or not, into the locality, by human intercourse. But this derangement in the functions of the stomach and bowels, which precedes an outbreak of epidemical diarrhoea, and of epidemic cholera, which has been named by Dr. Williams, of Swansea, ' the premonitory to the premonitory diarrhoea', and to which the attention of the profession was first called in the Result of an Inquiry into the Invariable Existence of a Premonitory Diarrhoea in Cholera, p. 13, has not as yet been sufficiently investigated. And, consequently, until this is done — until the whole train of symptoms which usher in and which mark the disease are ascertained — no one is justified to pronounce whether or not cholera can be conveyed by human intercourse from an infected to a healthy locality, or from an infected to a healthy person — no one is justified to pronounce whether or not cholera is a contagious disease. 10 It has been stated above, that at the time cholera, as an epidemic, attracted attention in 1817, the vomiting, spasms, etc., alone, fixed attention, and tsceived the name of cholera — the deviations from ealth which precede this stage were overlooked, and even diarrhoea was considered as unconnected with cholera; and, without any knowledge of the whole morbid phenomena which constitute the disease, in every country, the vomiting, spasms, etc., have been pronounced to be, or not to be, contagious, according as their fears, or according as their supposed interests, prompted them. Eln 1831-32, when cholera broke out as an epimic in England, itwas assumed, without any knowledge of the pathognomonic symptoms of disease, and without any researches at the bedside into the causes of the disease — it was assumed, I Lat cholera is a highly contagious disease. In 1848-49, when cholera again broke out in England as an epidemic, the General Board of Health, again without any knowledge of the pathognomonic symptoms of the disease, and again without any researches at the bedside, into the cause or causes of the disease, pronounced cholera not to be a contagious disease. But if we examine the documents which they have brought forward to support their views, if we accept these as trustworthy, we arrive at the conclusion that the Board have proved that cholera can be transmitted by human intercourse from an infected to a healthy locality* — can be transmitted from an infected to a healthy person — and, consequently, that cholera is a contagious disease. The Board assumed that the first case of cholera, 11 which occurred in London in 1848, was on the 22nd September, 1848 (see p. 14 of their Keport on Cholera, published in 1850); but they forgot to state that this case occurred in a sailor belonging to the Elbe steamer, which had arrived, two days before, from Hamburgh, where cholera raged ; and that two sailors belonging to this steamer had died of cholera on the voyage from Hamburgh to London. / have the authority of the Captain of the Elbe for this statement. And they also forgot to state that a landsman, who slept in the same room as the sailor at Horsleydown, on the night from the 21st to the 22nd September, 1848, was himself attacked by cholera six days after. I have this detail from the landsman. Therefore, if the fact is correct, that the case which occurred in the sailor on the 22nd September, 1848, was the first case of cholera, which occurred in London, in 1848, it is evident that the disease was imported into London by the steamer Elbe; and therefore the Board have proved that cholera can be conveyed, by human intercourse, from an infected to a healthy locality; therefore they have proved that cholera is a contagious disease. But by referring to the Registrar General's weekly return of births and deaths, we find that one hundred and seventy-nine medical gentlemen certified to the Registrar General that one hundred and seventynine cases of cholera had proved fatal in London from Ist January to the 21st September, 1848. Therefore, the disease was raging in London prior to the 22nd September, 1848 ; and, therefore, the Board of Health were not justified in stating that 12 Brst case of cholera which occurred in London, 48, was on the 22nd September. In 1849 it was suggested to the General Board of Health that the only way to ascertain whether cholera is, or is not, a contagious disease, was to inquire into the state of health of each individual prior to the attack of vomiting, spasms, etc., and to watch the rise and progress of each case as it occurred. But the Board declined to carry out this inquiry ; and in their Report on Cholera, published in 1850, they pronounced, as it has been stated above, without any researches at the bedside, and without any knowledge of the pathognomonic symptoms of the disease, that cholera is not a contagious disease. In 1852, a Sanitary Congress, composed of delegates from the different states of Europe, assembled at Paris. The object this Congress had in view was to inquire into, and to decide, if any, and what modifications, could be made in the international quarantine laws. And at this Congress the question, as to whether cholera can be conveyed by human intercourse from an infected to a healthy locality — or from an infected to a healthy person — whether cholera is or is not a contagious disease — was One party, on the authority of the Report on Cholera published by the General Board of Health, in 1850, who, it has just been seen, had pronounced, without any scientific researches at the bedside, and contrary to their own documents, that cholera is not a contagious disease, one party, I say, mainlined ined that cholera is not a contagious disease, he other party who came there also without 13 side, maintained that cholera is a contagious disease. Therefore, the Congress, to arrive at a result, followed a middle course : each party gave way a little, and the congress modified the quarantine laws relative to cholera — leaving the question whether cholera is or is not a contagious disease where they found it — undecided. In 1853, when cholera re- appeared here as an epidemic, it was again suggested to the General Board of Health that the question as to whether cholera is or is not a contagious disease should be studied in the manner it had been proposed in 1849 ; but the Board again declined to do this. In 1854, when cholera reappeared here, again, as an epidemic, the same suggestions were made to the Board of Health, but with no better success. And the Board have published their Report on the cholera which raged here in 1854 — and, judging from this Report, without having investigated at the bedside the important question which it was their duty specially to investigate — that is, its md still judging from this Report, we arrive at painful conviction that the Board have not even studied at the bedside the rise and progress of the symptoms of the disease — and that consequently they are not acquainted with the pathognomic symptoms of the disease. E1855, when cholera reappeared in London, as an epidemic, it was determined to undertake quiry in the manner it had been so frequently sted to the General Board of Health; and 14 question whether cholera is, or is not, a contagious disease, at rest; and the results of this inquiry are contained in the following pages. In placing these results before the profession, ! am aware that the researches which have been Ertaken and carried out are not sufficiently isive to decide this important question; and tha extensive and more careful researches are PA.s it was impossible for an individual to see and observe every case of cholera as each occurred, it was determined to inquire into the case of every individual who had died of the disease in London in 1855, and with this view the Registrar General's weekly return was taken as a guide to the cases. On referring to these weekly returns, we find that under the denomination of "choleraic diarrhoea"; "infantile cholera"; "English cholera"; " cholera" ; " malignant cholera" ; and " Asiatic cholera"; one hundred and twenty-four persons died in London in 1855. Without attempting to question these several denominations which the disease has here received, these denominations have been accepted, and each case under each denomination inquired into, and the conclusions arrived at are drawn from the aggregate of all the cases of all the denominations. It will be seen that the cases under each denomination are placed together, and according to the date at which they have occurred ; and that each denomination is placed in the order in which it is mentioned above. So that any one wishing to 15 difficulty* Eat are the conclusions which have been I at by this inquiry into the rise and progress c 124 cases of cholera 1 1. That previous to the outbreak of cholera, while the disease rages, and after the outbreak has passed away some time, the epidemic derangement in the functions of the stomach, and bowels, was PThat every case of cholera was preceded by *rhcea, for a longer, or shorter, period. 3. That attacks of diarrhoea, followed by fatal cholera, were induced by errors in diet, as in the case 97, etc., or by an overdose of purgative medicine, as in case 16, etc. 4. That cases of cholera occurred where it was impossible that any communication could have taken place, between an infected and a healthy, individual, as in cases 34, 103, 104, 105, 109, 121, and 123. 5. That it has been impossible to trace the disease from an infected, to a healthy, locality, or from an infected, to a healthy, individual. 6. That, so far as this inquiry has been carried out, we must conclude that an individual may be attacked with cholera without having received the seeds of the disease from an infected locality, or from an infected individual ; and that cholera cannot be conveyed by human intercourse from an infected to a healthy locality, or from an infected to a healthy individual — that is, that cholera is no t a CASES. CHOLERAIC DIARRHCEA. Case No. 1. July Bth, 1855. — Westminster, St. Margaret. At No. 7, Smith's Rents, the son of a shoemaker, aged three years, is reported in the Registrar General's Weekly Return of the 14th July, 1855, to have died on the Bth July, 1855, of choleraic diarrhoea — sixteen hours ill. rhave seen the father and the grandmother of child, and they informed me that the child was weakly, but that he was in his usual health up to eleven o'clock at night, when he vomited, and had a copious evacuation from his bowels ; that his father gave him some brandy and rhubarb, but does not know how much of this last ; that the child went to sleep, and slept, apparently comfortable, till four o'clock, when his bowels acted repeatedly, and suddenly, without any vomiting, till about ten o'clock in the morning, when he was convulsed, and screaming at times, till about two p.m.; and he then sank gradually, and expired at about three o'clock, His hands and face turned slightly blue before death. 17 Neither the father nor the grandmother had observed whether the child had passed water. The father is certain, he says, that the child could not have taken anything disagreeable to his stomach. Other children in the court had diarrhoea, but no one had had cholera, before or since the child's death, in the house or in the court. What role acted the rhubarb in this case % Case No. 2. July 12th, 1855. — In the Registrar General's Weekly Return of Births and Deaths of the 14th July, 1855, a child, female, three months old, is reported to have died on the 12th July, 1855, of choleraic diarrhoea, in twenty-four hours illness, at No. 39, King Street, West London, North. I have been to the house, No. 39, King Street, and I there saw the two women who were with the child to the last. They say that the child was brought up by the hand, and that she did tolerably well till the last week previous to her death, when she began to have a bowel complaint, — that medical advice was obtained, but the diarrhoea was not arrested, — when twenty-four hours before her death she was seized with vomiting, spasms, violent purging, etc., which lasted for above eighteen hours, when she became calm, free from vomiting, spasms, or purging, and gradually sank. For many hours before her death she became very black, to use the words of my informers, all over ; and this darkness increased, if possible, after The child had not been out of the house for 18 IXIcIIX y WvC Xvo j V I\J xXtH LaJ AaL>X kJ v^ 1 11 i taken seriously ill, she complained of a pain in he stomach and bowels, and of a bowel complaint However, she went to bed at her usual hour, am next morning seemed in her usual health ; till the evening, when she began to vomit, and to be ver freely purged, and to have cramps in her limbs Medical assistance was obtained, but she died next morning. This woman had not been visited by any one who laboured under_diarrhcea or cholera ; and since her death no one in the house has had either diarrhoea or cholera. Case No. 6. 23rd, 1855. — Marylebone, Christ Church, No. 7, Earl Street, the son of a clerk, aged three months, is reported in the Registrar General's Weekly Return of Births and Deaths for the 28th July, 1855, to have died, at the above-named address, of choleraic diarrhoea, thirty hours. This child was brought up by hand, and according to the person who had charge of him, was frequently deranged in his bowels. However, two days before his death, he became worse than usual — and after the diarrhoea had lasted above twentyfour hours, he began to scream, occasionally to draw up his limbs suddenly, and to vomit — when a medical gentleman was called in, who pronounced L child in great danger, and he died about een hours after. ¦rrhoea was about in the neighbourhood ; but ild had not been out for above a week before 21 he was taken ill ; and every one in the house was, and all have remained since, perfectly free from diarrhoea or cholera. Case No. 7. (July 23rd, 1855. — Marylebone, St. John's. At 7, Princess Street, the daughter of a tailor, aged me months, is reported, in the Registrar General's Weekly Return for 28th July, 1855, to have died at the above-named house of choleraic diarrhoea. The mother of this child informed me that the child's habit was to have one passage in her bowels daily ; that for a fortnight previous to her being taken ill, she remarked that the child had two, and sometimes three, liquid stools daily, without any pain or uneasiness ; that she believed the looseness was owing to her teething. Ptowever, three days before her death, on going ake her up out of her bed, she found her, to her own words, swimming in a liquid evacuation ; and after having washed her, and made her comfortable, she had another very copious evacuation ; and during the next twelve hours she had several such copious painless evacuations, when she began to vomit and to scream, and draw up her limbs, as if in pain. The medical attendant was sent for, and he prescribed ; but from that moment neither medicines nor food could remain on her stomach ; the moment she took anything she both vomited and purged. She sank on the third day. Re did not pass water for the last twenty- four 3 ; and the mother did not remark that she 22 was particularly discoloured m her skin, before or after death. This child had been taken out before the door, but had not been taken to any house. Diarrhoea was prevailing amongst the children in the neighbourhood, but not in the house where she lived. Case No. 8. Pi 24th, 1855. — See the Registrar General's ly Report, July 28th, 1855. At No. 5, mt Place, Uxbridge Road, on the 24th July, ughter of a servant, aged nine months, chodiarrhoea, forty- eight hours. {I have seen the person who had charge of this hild. The child had been weaned about three weeks. She was thriving, when she was suddenly seized with diarrhoea in the morning early, about four o'clock. This diarrhoea continued all day without any spasms or vomiting ; when both came on in the evening, and persisted off and on all night. Next day the purging, spasms, and vomiting, ceased ; but the child sank next morning. She had had E" ir medical attendance shortly after she was ill, and up to the last moment of her nee. This child had not been taken further than the front of the door where she was at nurse. The house is clean and well aired. There was no case of diarrhoea or cholera in the house, or in the neighbourhood, previous to this child's illness, nor has there been any since her death : therefore she cannot have caught the disease from any one. 23 Case No. 9. July 29th, 1855. — See the Registrar General's Weekly Return, 4th August, 1855. St. George-inthe-East, St. Paul, at 7, Bluegate Street, on the 29 th July, a girl, aged seven months, choleraic diarrhoea, three days. The father informed me that the child had had a diarrhoea for above three weeks ; and that she was much reduced in flesh, when she was attacked by more severe purging and vomiting, and died three days after. The house is in a low neighbourhood ; but no person had diarrhoea or cholera before this child was taken ill, or since ; nor has her mother, who attended the child to the last, in any way suffered. Case No. 10. Eiugust 4th, 1855. — See the Registrar General's ekly Return, 4th August, 1 855. Bethnal Green m, at No. 6, Little York Street, on the 29th July, a female silk weaver, aged nineteen years, choleraic fever, five days. I have seen two females who attended to this girl during her illness, and they informed me that she was taken ill with what was supposed fever about eight days before her death, accompanied with diarrhoea — to which she, and those about her, paid very little attention, until she began to vomit and to complain of pains — when medical aid was obtained, and all done for her that could be done. They say that she was a very hard-working, respectable young woman ; and they have no reason 24 under diarrhoea or cholera, nor was any one in the house ill with either of these, previous to this girl's illness or since her death. These two females state that they never left her from the moment she became dangerously ill till the moment of her death ; and that they even laid out the remains, and placed them in the coffin ; so that had the disease, they say, been a contagious one, they would have caught it. Case No. 11. August kth, 1855. — See the Registrar General's Weekly Return, 4th August, 1855. Bethnal Green, " The Green," at 7, Collingwood Street, on the 20th July, a barman, aged twenty-five, diarrhcea, two days ; choleraic symptoms, sixteen hours. P[ have been to the house where this man died, ich is situated in the lowest of the low districts of London, and is itself occupied by the lowest of the low class of society, and no one could give any account of this man, but that he was taken ill and died there. Plhey admitted that no one had been ill in the use with diarrhcea or cholera before this man was :en ill, nor has any one been ill with diarrhcea cholera since his death. Case No. 12. August Ith, 1855. — See the Registrar General's Weekly Return, 11th August, 1855. Marylebone, Cavendish Square, at 20, Little Marylebone Street, on the 7th August, the widow of a farmer, aged 25 T 11 /» "1 • It appears, by the report of the person in whose house she lived, that she was a sick nurse; that she had been on close attendance on a person who died of phthisis ; that she was much fatigued in consequence ; that while in attendance she had a bowel complaint, which she neglected ; that after she returned home, after the death of the patient the bowel complaint continued ; that still she dk not take care of herself; that about three days before her death she began to vomit and purge also, but not severely ; that on the day after the vomiting first began, on rising out of bed, she was attacked with fainting, and immediately after with cramps, etc.; that the cramps and vomiting were at no time very severe, at least she did noi complain much of either. She died as above stated. This woman had had no communication with any one who laboured under diarrhoea or under cholera ; neither of these diseases was in the house or in the neighbourhood where she resided ; nor had any one been attacked with either in the house where she resided ; and, so far as my informant knows, no one in the neighbourhood had been attacked since her death with either of the above-named diseases. Case No. 13. August 10th, 1855. — See the Registrar General's Weekly Return, 18th August, 1855. At No. 24, Foley Street, Marylebone, All Souls, on the 10th August, the wife of a French polisher, aged fifty-one, choleraic diarrhoea, ten days. 26 Foley Street, where the above-named woman lodged, and she informed me that the woman had been ailing for some months in consequence of a change in life ; that she, however, went about and attended to her household affairs ; that ten days before her death she was seized during the night with diarrhoea, which continued increasing in violence on her till she sank, with, however, little vomiting or pain. She was much reduced in size at the moment of her death, but her skin was not discoloured. No one in the house suffered from diarrhoea before or after the death of this woman ; and her daughter, who washed all the soiled linen, has not had diarrhoea, or been in the slightest way indisposed. Case No. 14. 11th August^ 1855. — See the Registrar General's Weekly Return, 11th August, 1855. Lambeth, Lambeth Church (first part), at 5, Asylum Place, on the sth August, the son of a gardener, aged eighteen months, choleraic diarrhoea. Pave seen this child's mother, and she in-1 me that this boy was subject to diarrhoea tiis birth ; that a week before his death he tacked with diarrhoea again ; but, as he was t to such attacks, this was considered by her r a repetition of what he was subject to ; but wnen he began to vomit and purge violently, she became alarmed, and sent for medical advice. But it was too late : nothing relieved the child. The child had not, the mother said, been beyond the door of her house since his birth ; he had not seen any 27 no one in the house, or, so tiir ns she could learn, in her neighbourhood, laboured under such diseases previous to, or during, or since her child's death. Case No. 15. August 12th, 1855. — See the Registrar General's Weekly Return, 18th August, 1855. At No. 3, Francis Street, Kensington, St. John's, Paddington, on the 12th August, the son of a carman, aged eighteen weeks, died of choleraic diarrhoea, four I have been to the above-named house, and I learn, from a woman who was with the child to the last, that he was brought up by the breast ; that for above two weeks before his death he had diarrhoea ; that about four days before his death he had vomiting and spasms, when medical advice was obtained ; that medicines were administered, which seemed to ease the child ; but that for the last two days he lay quite quiet and seemed in no pain, but gradually sank, and before death his skin became quite discoloured — that is, dark. The child had not, from his birth, been farther than about the door ; and the only case of diarrhoea in the house, and, indeed, in the whole neighbourhood, was my informant's child, who had then a severe diarrhoea, in consequence, she believed, of his being then teething, as the child is now fourteen months old. However, her boy got well shortly after the death of the above-named child, and has continued well up to two days ago, when he was K seized with the same kind of diarrhoea as he ibouring under on the 12th of August last; 28 and she again attributed her child s illness to his cutting a tooth. Here there is nothing to lead us to suppose that the disease (cholera) was caused by contagion or infection ; that is, brought from a person labouring under the disease to this child. Case No. 16. Eust 15th, 1855. — See the Registrar General's iy Return, 18th August, 1855. At No. 14, Street, Isle of Dogs, on the 15 th August, the daughter of an engine smith, aged six years, choleraic diarrhoea, one day. Er mother informs me that the child had rel a severe injury of the head about six weeks 3 the day she was taken ill. On the morning she was taken ill she complained of a great pain in her head ; and she (the mother) gave her a dose of rhubarb and magnesia, which not having operated so soon as she* expected, she gave the child a dose of castor oil, when she had three or four very copious stools. After the last evacuation the child seemed eased ; but on going to her bedside, about an hour after, she found her in strong convulsions, and she never spoke after. She died that evening. The house is healthy ; no bad smells ; nor were there any cases of diarrhoea or of cholera in the house before, during, or since her child's illness and death. Case No. 17. Klίth, 1855. — See the Registrar General's Report 18th Ausrust 1855 Lambeth 29 August, a boy, aged four months, choleraic diarrhoea, twelve hours. tl have been to Lambeth Workhouse, and I was formed that this child and his mother were admitted into the Workhouse on the 15th August, and that he died on the 16th August ; that he was, however, ill with diarrhoea when he and his mother were admitted. The clerk of the Workhouse informed me that this child, and his mother, had come from No. 2, Glasshouse Street, Vauxhall ; but I have been to that street, and there is no " No. 2 " in that street. Nos. 1, 2, 3, and 4, were demolished when the railroad was built, and the houses have not been re-numbered since. And, further, I applied to several persons in that street to know whether a woman and her child had gone to the Workhouse in August; but no one could give me any information. However, the clerk further informed me that no one in the workhouse caught either diarrhoea or cholera from this child. Case No. 18. August 18^, 1855. — See the Registrar General's Weekly Report, 18th August, 1855. St. Saviour's, South wark, at No. 56, Ewer Street, on the 12th August, the daughter of a coal porter, aged four months, choleraic diarrhoea, one week. The father and mother of this child have left the street, but the person who resides now in the house, and who was godmother to the child, and 30 attended her through her illness, stated to me, that the child was brought up by the breast ; that she was seized with diarrhoea about a week before her death ; that this diarrhoea was not attended to by the child's mother, or by her, as they did not believe it of consequence, till the child began to vomit and scream, evidently in pain, when the medica] attendant saw and prescribed, but did not arrest the disease. The child died on the seventh day. No one in the house had diarrhoea or cholera before, or during, the child's illness, or since her death; and the child had never been out of the house from the moment of her birth. Case No. 19. Eust 18^, 1855. — See the Registrar General's Ly Return, 18th August, 1855. Bethnal , " the Green," at No. 2, west, on the 18th August, a carpenter, aged forty-two years, choleraic diarrhoea, seven days. The medical attendant states that the house is bounded back and front by an open drain, the stench from which is certainly injurious to health, especially in hot weather. In the same house his wife now lies in a hopeless state. I have been to the above-named house. I have had a letter from the medical gentleman who attended this man, and I have seen his employer, and a friend and fellow-workman who worked at the same bench with him. From his fellow-workman, who knew him for many years, I received the information that this man was very much subject to diarrhoea ; that he 31 had had the diarrhoea on him for many weeks before the day he was taken so ill ; that he was obliged to leave his work before the usual time; that the medical attendant was sent for the day after. The medical gentleman states, that when he saw him he considered him then labouring under choleraic diarrhoea, and that he rapidly sunk. But the medical gentleman cannot find out from his notes what day he saw the man for the first time. As to this man's wife, from the certificate it would appear that she too was labouring under choleraic diarrhoea ; but I have a letter from the medical gentleman who attended her for some months in consequence of chronic bronchitis, and he informed me that she had been confined about two months before her death, and that he considered her case as hopeless, when another medical gentleman saw her, and attended to her. This gentleman I have also seen, and he told me that this woman was labouring under typhus ; that she was removed to the workhouse after the death of her husband, along with her three children, all labouring under typhus. rwent to the workhouse and I ascertained from books that this woman had died in the workhouse, a few days after her admission, of typhus; and that one of her children had also died of the same disease ; and that the lives of the other children were saved with great difficulty. Therefore, there are no proofs that the husband caught diarrhoea or cholera from any one ; and it is certain he did not communicate the disease to any of his 32 Case No. 20. August 25th, 1855. — See the Kegistrar General's eekly Keturn, 25th August, 1855. St. Pancras, Regent's Park, at No. 4, Gloucester Street, on the 18th August, the wife of a retired bootmaker, aged seventy-six, choleraic diarrhoea, five days. I have seen the person who attended this woman from the moment she was taken ill with diarrhoea till the moment of her death ; and she informed me that this woman had not been out of the house for above a year ; that she felt the weight of age, without having anything serious the matter with her ; that when she first was taken ill with diarrhoea, neither she nor any one of the family were alarmed. After the first day medical attendance was obtained, but she died four days after. No one in the house had diarrhoea or cholera at the time this woman was taken ill ; nor has any one had either of these since her death. The house is well aired and clean; and the family appear to be in affluence and comfort. Case No. 21. August 28th. — See the Registrar General's Weekly Report, 25th Aug., 1855. At No. 7, Hart Street, Covent Garden, the son of a kitchen porter, aged eight months, choleraic diarrhoea, four days. The parents of this child have removed from the above-named house, and have not left their address ; but the landlady of the house informed me that she had assisted to attend this child during her illness ; and she reports that the mother had suddenly lost her milk, in consequence of a fright, above a month 33 I 9 J 5 child was brought up by the hand ; that a fortnight before his death he was labouring under a bowel complaint, which she and his mother believed to depend on teething, and, consequently, did not pay much attention to this diarrhoea ; four days, however, before his death, he was seized with severe vomiting, purging, and cramps, when he was taken to a medical gentleman, who pronounced the child in great danger ; and he did all he could for the child, but in vain : the child died on the fourth day. No person in the house had diarrhoea or cholera before or since the child's death ; and as the child was only taken to the door occasionally for the benefit of fresh air, and had had no communication with any one labouring under diarrhoea or cholera, it is impossible that he can have caught the diarrhoea from any one. Case No. 22. Aug. 28th.— See the R. G. W. R., Ist Sept., 1855. At No. 13, Rose Street, City Road, a female child, aged eight months, of choleraic diarrhoea. I have seen this child's mother, who informed me that the child was one of twins ; that she had been in delicate health from her birth ; that she had an eruption on her body, for which she had been, almost from her birth, under medical treatment ; that for a month or six weeks before her death, she and her twin sister had had, off and on, a diarrhoea, for which they both received medical assistance ; that her twin sister got well ; but that she was suddenly seized with vomiting, cramps, etc., and died in two days after. c 34 breast and partly by hand ; as the mother, a delicate woman, had not sufficient milk for both. These two children had not been out of the house for some weeks previous to being taken ill ; and they had had no communication with any one labouring under diarrhoea or cholera ; no one was ill in the house with either diarrhoea or cholera previous to the illness of these children ; nor has any one been ill since. This woman says, that she heard that several children were ill with diarrhoea at the time her children were unwell. Case No. 23. Sept Ist— See the R. G. W. R., Ist Sept., 1855. At No. 2, London Passage, a male child died of choleraic diarrhoea. I have been to the above-named house, and I find that the family are removed, and no one knows where. A neighbour informed me that the child had been ill several days from diarrhoea, and at last died suddenly. My informant was not aware that any person had been ill in the house from diarrhoea or cholera before this child was taken ill, or since his death. The registrar of the district informed me that the child had been reported to him as a weak child, and that he had died of choleraic diarrhoea ; but he could give no further information relative to this infant, only, that this was the only case of death from choleraic diarrhoea in his district. Case No. 24. Sept 3rd.— See the R. G. W. R., Bth Sept., 1855. At. No. 4, Vincent Street, Limehouse, Stepney, the 35 son of a caulker, aged one year, choleraic diarrhoea, seven days. The child's grandmother informed me that the child was weaned, and that he was teething ; that he was taken with diarrhoea about seven days before his death ; that his mother and herself considered this diarrhoea to depend on teething ; but when the child began to vomit and be in pain, a medical gentleman saw and prescribed for him; but he died on the seventh day. The house is perfectly healthy ; the child was not out of the house for some weeks ; and no one in the |>use, or in the neighbourhood, that she was aware , had diarrhoea or cholera. Case No. 25. Sept Bth.— See the R. G. W. R., Bth Sept., 1855. Westminster, St. Margaret, No. 27, Stafford Place, 3rd Sept., a messenger, aged seventy-four, choleraic diarrnoea. It appears that this man had been for some time in a declining state of health ; and, consequently, very seldom went out of doors ; that he had not left his iuse for some weeks; when, four days previous tc s death, he was seized with diarrhoea ; and for the o first days gave himself and his friends no un< siness. On the morning of the third day he began vomit and purge severely, and to complain of pains in his limbs. Medical advice was obtained, but without avail. He died the next day. No one in the house was ill with diarrhoea or cholera previous to, or during his illness. My informant, who attended him during his illness, and who was much interested in him, was so alarmed 36 with diarrhoea and vomiting; but she herself attributes this attack, under which she suffered for two days, Kre to mental anxiety than to anything else. No ter persons who attended him had had anything the matter with them. Case No. 26. Sept 12th.— See the R. G. W. R., 15th Sept., 1855. At No. 41, Rufford's Buildings, on 12th Sept., the daughter of a boot- closer, aged eight months, choleraic diarrhoea, four days collapse. I have seen this child's mother, and she informed me that the child was teething, but did not appear to suffer much ; that four days before her death she was suddenly seized with diarrhoea, which she (the mother) believed depended on her teething; and, therefore, did not pay much attention to this looseness. Towards the evening the child became worse, and began to scream, as if in pain; she was then taken to the medical attendant, who prescribed; but the child got worse, and died on the fourth day. I The child had been taken out into the open air nost daily, but had not been taken to any house ; r had any one visited at the house where the child is who came from a house where a case of diarrhoea of cholera existed. I She says, further, that she heard of persons having irrhcea in the neighbourhood; but that she had t heard of the existence of any case of cholera. Case No. 27. I Sept. 22m£— See the R. G.W. R., 22nd Sept., 1855. . George in the East, St. Mary, at 8, Christian Street, 37 febris some months, choleraic diarrhoea two days. I have seen the landlady where this man resided, and she says he had been in delicate health for some months — as stated by the medical officer's certificate — when he was seized with diarrhoea, and died on the second day. The house is in a low neighbourhood ; but is clean, and no one has been suffering from diarrhoea or cholera in the house or in the neighbourhood, since the death of this man — nor is she aware that anyone suffered from these two diseases previous to this man's illness. Case No. 28 Sept 22nd.— See the B, G. W. E,., 22nd Sept., 1855. City of London, North West, at Queen's Hotel, St. Martin's-le- Grand, on 19th Sept., 1855, a merchant, aged forty- six, choleraic dysentery, six days, exhaustion. I have seen the mistress of the Queen's Hotel, and she informed me that this gentleman arrived at her hotel apparently in perfect health, and remained so for about four days ; when he began to complain of a diarrhoea which gave him no pain, but appeared to annoy him, merely by the frequent calls to go to the water-closet. In this state he remained for about eight days, going about and attending to his business. The night before his death he was suddenly seized with vomiting, severe purging, followed by cramps, and collapse — and he ceased to live a few hours after. He had every care bestowed upon him possible, and every medical aid that could be had. The mistress of the hotel adds that she does not know from whence the gentlemen came, and knows nothing whatever 38 came from Liverpool, she believes, to attend to his No one in the hotel was ill with diarrhoea or with cholera at the time this gentilman was taken ill ; nor had any one ever been ill in the hotel with these diseases ; nor has anyone had diarrhoea or cholera in the hotel since this gentleman's death. Case No. 29. Sept 22nd.— See the R. G. W. R., 22nd Sept., 1855. At. No. 5, Gilbert Street, St. George, Hanover Square, on the 22nd Sept., the wife of a servant, aged twentyfive, is reported to have died of choleraic diarrhoea, absorption, typhus gravior. I have seen the person at whose house this woman died, and the medical attendant. From this last I learn that this woman was seized with diarrhoea above a fortnight before her death; that after a few days she had severe cramps, vomiting, etc., all the symptoms of cholera, in fact ; that she miscarried during the attack of cholera, and which then abated — that is, the spasms, vomiting, and purging. But she then began to have symptoms of fever, which ultimately terminated in typhus. It is evident that this person had, at first, cholera ; and that the subsequent stage was that of collapse. From the mistress of the house I learn that this woman was a very steady person, that she is not aware that she could have seen or had communication with persons labouring under diarrhoea or cholera, and that no person in the neighbourhood laboured under either of these stages of cholera. Ehe medical attendant says that he did attend sevew 39 ral cases of diarrhoea and of cholera at the same time he attended to this woman, but that she had been for some days ill with diarrhoea when he first saw her, and she was then labouring under spasms and vomiting : therefore he could not have brought the disease Case No. 30. tSept 22nd.— See the R. G. W. R., 22nd Sept., 1855. hitechapel, Aldgate, in the Tower Hospital, on the th Sept., a private of the 54th Regiment, aged rty, choleraic diarrhoea, two days illness. lAs the Detachment belonging to the 54th Regi;nt, and the medical officer in charge, had left the >wer, I applied to, and received the following inmation from the Director- General of Army Hosals, Dr. Smith. It appears from the official report ide to him by the medical officer in charge of the tachment, that seven cases of diarrhoea had been mitted into the hospital during the month. Six these had been attended to previous to the attack vomiting, spasms, etc., and were cured. The aboveaied man neglected to apply for medical aid till he s found in the rear, and brought into the hospital •ouring under cramps and diarrhoea — which soon tsed, and he never rallied. No inquiry was made, it appears, when and where the first symptoms of diarrhoea supervened ; nor were any inquiries made to discover whether this man could have received the seeds of the disease from, or communicated them to, the other men. Case No. 31. Sept. 24^.— See the R. G. W. R., 29th Sept., 1855. 40 on the 24th September, 1855, the daughter of a baker, aged seventeen months, choleraic diarrhoea, four days. II have seen the father and mother of this child, d they inform me that the child was not yet weaned that she was teething ; that she had been ill with a wel complaint, diarrhoea for above four weeks; that c child had had regular medical attendance ; that 3 disease had been considered to depend on teeth»; that four days before her death she began to mit, but not severely ; that the next day this injased, with more frequent purging, and cramps ; it from this time, that is, from the time the cramps me on, she gradually sank, and died on the fourth y after the vomiting first appeared. I This child had not been out of the house for many jeks, no one in the house was ill with diarrhoea or olera, nor had any one labouring under either seen 3 child. Since her death no one in the house has d diarrhoea, or cholera. lAt the time the child was ill with diarrhoea, the rents had heard that persons, in the neighbourhood, d diarrhoea ; but, again, none of these persons had lie near the child. Case No. 32. Sept 29th.— See the R. G. W. R., 29th Sept., 1855. St. George in the East, St. Mary, at 18, St. George Court, on the 29th Sept., the son of a dock labourer, aged six years, choleraic diarrhoea, three hours. I have seen the father of this child, and he informed me that the child went to bed apparently in perfect health; that about three o'clock next morning the child got up, said he felt very ill in his stomach, had 41 cry free stool, felt relieved, and went to bed again ; six, when the father got up, the child had another evacuation, and from that time, till about six in the evening, he was repeatedly relieved in his bowels. At about six in the evening he began to vomit, and Khave cramps, and died about three hours after, erefore, the registrar's return is in error to say that the diarrhoea lasted only three hours. Some of the children in the court had diarrhoea, tt none had cholera, so far as he knows — certainly one died of the disease previous to, or since his l's death. Case No. 33. HSept 29th.— See the R. G. W. R, 29th Sept., 1855. . George in the East, St. Mary, at 31, Henry Street, on the 23rd Sept., the widow of a journeyman tinplate worker, aged thirty, phthisis three months, choleraic diarrhoea, fourteen days. I was informed by the persons who attended this woman, that she had not been out of her house for at least a week previous to being seized with diarrhcea, and that no one in the house had diarrhoea or cholera previous to her illness or since her death. Case No. 34. Nov. 10th.— See the R. G. W. R., 10th Nov., 1855. Westminster, St. Margaret, in the House of Correction, the daughter of a labourer, aged ten months, choleraic diarrhoea. I have been to the House of Correction and have seen the medical attendant, who informs me that this child and her mother were admitted into the house on the 29th October ; that both appeared in perfect 42 health ; that on the sth November the child was attacked with diarrhoea, which was followed on the second day by vomiting, spasms, etc., and the child died on the third day from the commencement of the attack of diarrhoea. KNo case of diarrhoea or of cholera existed then in 3 house, nor has any case occurred since this child's ath in the establishment. INFANTILE CHOLERA. Case No. 35. I July 28th.— See the R. G. W. R., 28th July, 1855. imbeth, Kennington, at No. 21, Treport Place, andsworth Road, on 28th July, the son of a butcher, ed six months, cholera infantum, twenty-eight hours. I The father and mother of this child have left the use where their child died ; but a neighbour and ative of theirs informed me that this child was >ak from his birth; that he was suddenly seized th a bowel complaint, which she, my informant, lieved to be in consequence of teething ; but as the wel complaint became more severe in a few hours, lowed by vomiting, and the child screaming ocsionally, a medical gentleman was sent for: but thing arrested the disease, and the child ceased to c in about twenty-eight hours from the first liquid ioI. E\o one in the house had diarrhoea previous to this d's illness, or since his death. 43 Case No. 36. tJuly 28th.— See R. G. W. R., 28th July, 1855. imbeth, Lambeth Church, second part, at 80, Broad Street, on the 25th July, the son of a house painter, aged one year, teething; diarrhoea, ten days; and convulsions, eight hours. The father of this child informed me that the child had been delicate in his bowels from his birth ; that is, that he was subject to attacks of diarrhoea ; that Raen he was this time first attacked with diarrhoea, c mother did not feel any alarm about the child's (ness, till about the fourth day, when the child be,n to vomit. Medical assistance was obtained, but Ith no relief: the child ultimately died in conilsions. No one in the house, or in the neighboured, so far as the father knows, had been ill of diarrhoea or cholera previous to the child's illness, or has been ill of these diseases since. I The house is in a low, dirty neighbourhood ; and 3 house itself is dirty. Case No. 37. July 30th.— It is reported in the R. G. W. R. of Births and Deaths, 4th August, 1855, that a child, the son of a tailor, aged twenty-six days, died on the 30th July, 1855, of cholera infantum, forty-eight hours ill, at No. 4, Buckle Street, Whitechapel Church. Ehave seen the mother of the child, and she inns me that she was obliged to feed and to nurse the d at the same time, as she had not enough of milk. The child at first did well, but for the last five or six days his bowels became relaxed, and then he begun to vomit and had convulsions, she says, that is, startinar and screaming, as if he was in pain. 44 before the door. No one had diarrhoea or cholera in Case No. 38. Aug. 4^.— See R. G. W. R., 4th Aug., 1855. Shoreditch, Haggerston East, at No. 8, Livermore Road, on the 30th July, the daughter of a labourer, aged seven months, infantile cholera, two days. I have seen this child's mother, and she informs me that the child was brought up by the hand ; that she was a weakly child, and had repeated attacks of diarrhoea ; and that the last time the child was taken ill with diarrhoea, she supposed that this was only one of her usual attacks ; but when the child began to vomit, and to have spasms, she obtained medical advice, but it was too late ; the child died some hours after. The child had not been out of the house for many weeks ; and no one in the house was ill with diarrhoea or with cholera previous to the child's illness, or since her death. Case No. 39. Aug. ith.—See R. G. W. R., 4th Aug., 1855. Shoreditch, Haggerston West, at 16, York Street, on the 25th July, the son of a dressmaker, aged five months, infantile cholera, twenty-four hours. I have seen the mother of this child, and she informed me that the child was brought up by the hand ; that he was weak from his birth, and very liable to attacks of diarrhoea; that he had a diarrhoea for several days previous to the attacks of vomiting, I asms, and purging severely, which carried him off less than twenty-four hours. She also informed 45 me that this child had not been out of the house since his birth ; that he had not been visited by any person who was labouring under diarrhoea or cholera ; that no one in the house had diarrhoea or cholera previous to or since her son's death. Case No. 40. I Aug. 4th.— See E-. G. W. R., 4th Aug., 1855. At ). 9, Eustache Place, Greenwich, Woolwich Dockrd, on the 30th July, the daughter of a farm labourer, ed eight months, cholera infantum, seven days. I This child was brought up by the breast ; the )ther is a very healthy person ; and she informed 5, that when her daughter was first taken ill with irrhcea she supposed the child was teething, and, srefore, did not attend so much as she possibly ought have done to this diarrhoea. However, on the irth day, as the child then began to vomit all she )k, a medical man saw and prescribed for her; tit was unavailing ; the child died on the seventh y from the time she was taken ill. I The house where this child resided is in a low ighbourhood and filthy. In the house, and in the ighbouring house, there are many children; but, fore or since the death of this child, no one has en ill with diarrhoea or cholera. Case No. 41. tiug. nth.— See R. G. W. R., 11th Aug., 1855. Luke, Old Street, at No. 10, James Street, on the Aug., the daughter of a servant, aged four months, rrhoea, fourteen days ; cholera infantum, six days. E'he mother of this child informed me that the d was weakly from her birth ; that she was brought 46 up by liniicl ; t lint she lincl freo uGnt cit t ticks of diarrhoea previous to the last, which carried her off; that the child had not been out of the house since her birth ; had not been visited by any one labouring under diarrhoea or cholera ; that no one in the house had either disease ; and, so far as she had heard, no one in her immediate neighbourhood laboured under either diarrhoea or cholera. Case No. 42. I Aug. Wth.—See the R. G. W. E., 18th Aug., 1855. ; No. 11, Bloomfield Terrace, on the 12th Aug., the a of a sculptor, aged six months, died of infantile olera, two days ill. I This child was brought up by hand; he was a althy child, and was well up to two days before ath ; when he was seized with a bowel complaint, irrhcea, and a few hours after he was carried to the idical attendant for advice. This gentleman preibed; but towards evening the child became worse, 3 diarrhoea was more urgent, and nothing passed t like water ; and now cramps came on, and the or child seemed at times to be in agony, screaming Jd throwing himself about in his bed. From this ac the child grew gradually worse, and he died out two days after being taken ill. His skin was t discoloured either before or after death. The child had never been taken out but before the door. No one in the house, or in the neighbourhood, had diarrhoea or cholera ; and most certainly no one with the disease had come near the child. The nurse blames the smell from Ranelagh sewer as the cause of the child's illness; the smell is at times very offensive from the sewer, and the bad 47 itself is clean and airy. Although she attended the child to the last she has not suffered in any way. Case No. 43. Aug. 11th.— See R. G. W. Returns of B. and D., 18th Aug., 1855. At East London, St. Botolph, No. 7, Skinner Street, Bishopsgate, the son of a provision merchant, aged twenty-three days, is reported in the ieekly return of births and deaths to have died at le above address, of cholera infantum. The child was brought up by the hand and was sickly from his birth, and at last sank after having a kwel complaint for nine days, and the last day conlsions. The child had not been out of the house, nor had any one having a diarrhoea been to the house. Case No. 44. Aug. 19th.— See R. G. W. R., 25th August, 1855. Hackney, at High Street, Homerton, on the 19th August, 1855, the daughter of a grocer, three months, cholera infantum, three days. I have seen the father and mother of this child, and they state that the child was very weakly from birth ; that her mother lost her milk, and consetntly the child was sent out of the house four 3s a day to get the breast, and in the interval the child was fed ; consequently the child did not thrive, and her bowels were often deranged ; that four days before her death she began to vomit, purge severely, and have cramps ; that a medical gentleman did all he, could, but that she died on the fourth day. Ehe father and mother are certain, that the person hose house she was daily carried four times a day 48 her children were also free from diarrhoea ; that she had heard of many persons having diarrhoea at the time the child was taken ill, but no one of these had any communication with her family, and consequently with her child. The house is not clean, and it is in a low neighbourhood. Case No. 45. I Aug. 2Ut.— See R. G. W. R., 25th August, 1855. No. 6, Church Place, on the 21st of August, the lighter of a park labourer, aged eleven months, olera infantum, three days. If have seen this child's mother, who states that the Id was strong and healthy ; that she was brought by the breast ; that three days before her death was taken out, and on returning home the child 3 seized with a bowel complaint, which kept inasing on her all day. In the evening she took her i medical gentleman, who prescribed for her ; but ing the night she was seized with cramps and aiting and severe purging. The next day, a medigentleman saw and prescribed for her, but all in a ; she died on the third day. I Diarrhoea was very prevalent in the neighbourhood, I a man and his child had both severe diarrhoea in house at the time the above child was taken ill ; ; the child was not taken into their rooms, nor did y come into the child's room — in fact, the two lilies had no communication whatever. The mor of the above child does not wash for any one. •» Case No. 46. Aug. sth.See the R. G. W. R., 25th Aug. 1855. 49 xxt J iILLiC vjGOrffG OUrGGC) i^l 0. t/j l_/IICISCa ioOlltil, Oil tllO 23rd August, 1855, the son of a general dealer, aged four months, infantile cholera, eleven days. II have been to the above house, and I have seen c mother of this child. The child was brought up by the breast. About a month before his death his bowels became deranged, that is, he had diarrhoea. She herself (the mother) was not well, the catamenia were on, and she fancied that her milk disagreed with the child. She weaned him ; but the bowel complaint continued getting worse and worse, and for the last fourteen days he was very ill ; cramps and vomiting at last came on, and the child sank. The house where the child died is in a low neighbourhood ; the mother, however, says that, to her knowledge, no case of diarrhoea or of cholera existed in the house with her, or in the neighbourhood — nor had any one having intercourse with persons labouring under cholera, been to the house, and her child had not been out for some weeks — consequently he could not have caught the disease from any one. And, it may be added, that the mother and another person who attended the child, have not suffered, in the least, in their bowels. Case No. 47. Aug. 25th.— See the R. G. W. R, 25th Aug., 1855. Hackney, Stoke Newington, No. 1, Millfield Place, Green Lanes, Aug. 25th, the daughter of a brick-field labourer, aged one year, cholera infantum, one week. I have seen this child's mother, who says that the child had a skin complaint, and that she had been Iry weak from her birth ; that her bowels were frelently out of order, which the mother supposed depended 50 on the teething ; that she brought up the child by the breast, and was very particular as to any light food which the child got ; that about a week before her death she had a return of the diarrhoea, but did not appear to suffer pain. But about twentyfour hours before death she was suddenly attacked with vomiting, spasms, and severe purging, when a medical gentleman saw her, and pronounced her dying. She lived only a few hours after. Diarrhoea was very prevalent amongst the children and grown-up persons in the house and in the neighbourhood, but no case of cholera previous to, or since, her child's death has occurred. The neighbourhood is inhabited by the less fortunate members of society. Case No. 48. Aug. 25th.— See the R. G. W. R., 25th Aug., 1855. Greenwich East, at No. 3, Lovegrove Place, on 22nd August, the son of a captain of a steam-boat, aged three years, cholera infantilis. The mother of this child informed me that he was delicate from his birth, but that the day he was taken ill he was in his usual health, had taken his dinner with the other children as usual; but at about four in the evening his bowels began to act freely, and the discharge was liquid. After two or three motions he began to vomit, and in about six hours from the first motion cramps came on, followed soon after by collapse, and he died the evening following. None of the other children had anything the matter with them at the time this child was taken ill, and they have all remained free from diarrhoea, or cholera, and free from any disease, since. The child had not left the house for weeks, nor 51 had he seen any one labouring under diarrhoea or choler — nor is the mother aware that the disease was in the neighbourhood. The house is in a well- aired and clean neighbourhood, and is itself apparently perfectly clean. The mother complains of no bad smells in the house. Case No. 49. >Aug. 25th.— See the R. G. W. R., 25th Aug., 1855. spney, Shadwell, at Gould Hill Green, on the 22nd igust, the daughter of a bone merchant, aged eleven mths, cholera infantum, two days. I have seen the father and the mother of this child and the medical attendant. From the mother I learned that this child was partly brought up by the breast and partly by the hand; that two days before her death she was attacked with diarrhoea, when medical attendance was obtained. tThe medical gentleman stated that he found this ild labouring under diarrhoea, for which he pre•ibed, and that subsequently vomiting and spasms me on and the child sank. I The child had not been further than the yard; had d no communication with any one labouring under irrhcea or cholera ; that her other children, three in mber, were then in perfect health and free from irrhcea and cholera, and have remained so since, id the husband added, that he and his wife had en before the child's illness in perfect health, and re also so since. Case No. 50. Aug. 25th.-— See the R. G. W. R., 25th Aug., 1855. Islington East, at 15, Brand Street, Holloway, on the 52 year old, diarrhoea, two weeks, cholera infantum. I have seen this child's grandmother, who assisted her daughter in attending to him, and she stated that the child was in good health when he was seized with diarrhoea ; that as the child did not appear to be in pain, she and her daughter believed this diarrhoea was caused by the child's teething, and did not send for medical advice ; but as soon as the child began to vomit and to seem in pain a medical gentleman was sent for, who did all he could ; but the child died. There were, and there are still, sixteen children in four rooms, besides eight grown-up persons ; no one had been ill with diarrhoea or with cholera before this child was taken ill or since his death, either in these four rooms or in the other rooms of the house, and the house is in a low, filthy, and dirty neighbourhood. Case No. 51. July 2nd. — It is reported in the R. G. W. E.., ending 7th July, 1855, that a female child, aged five months, died on the 2nd July, at No. 22, George Street, York Road, Wandsworth, of infantile cholera, after three days illness. I went to the above-named house, and I saw there the persons who had care of the child from her birth, and they informed me that the child was brought up by hand, and that she was delicate from her birth ; her bowels were frequently deranged, and the child did not thrive as children in good health generally do. Three days before her death she was seized with a severer bowel complaint than usual, and sank the third day, not having had much vomiting or cramps. My informant further adds that the child had not left 53 the house since her birth ; and that no person in her house, or in the neighbourhood, had, to her knowledge, either diarrhoea or cholera. Her house is clean and dry, and she complains of no bad smells from the drains. Case No. 52. July 19th.— See the R. G. W. R, 28th July, 1855. Hackney, at 7, Princes Road, Homerton, on the 19th July, the son of a carpenter, aged seven months, cholera infantum. I have seen the mother of this child, and she informs me, that in consequence of sore breasts she was obliged to bring her child up by hand ; that he was a healthy child, and throve, apparently, on the milk diet which she gave him ; that about a week or ten days before his death he was seized with diarrhoea, to which she did not pay much attention, as the child seemed in no pain ; that three days before his death he was seized, during the night, after 12 p.m., with vomiting and severe purging, and towards morning the child screamed a deal ; and, as soon as she could, she sent for her medical attendant, who pronounced the disease to be cholera infantum ; and the child died eight and forty hours after. She adds, that the child had never been out of the house since his birth ; that all the other children in the house were free from diarrhoea or cholera, and have remained so since his death ; that no one labouring under diarrhoea or cholera was within her door previous to the child's illness or since his death ; that she had heard that there were cases of diarrhoea in the neighbourhood, but none of cholera. Her house is perfectly clean and well aired. 54 Case No. 53. Oct. 21st.— See the R. G. W. R., 27th Oct., 1855. At the Coldstream Guards' Hospital, Vincent Square, Westminster, the daughter of the hospital Serjeant, aged nine months, is reported to have died of cholera infantum. II have seen the medical attendant, and the father d mother of this child ; and I was told that the ild was attacked about four in the morning with miting and purging, but not severe at first. Hower, these two symptoms increased in severity ; when, me hours after, the child began to have cramps, d died in fourteen hours from the time she was first ken ill. It appears that the child had never been good health ; that she had chronic bronchitis, and at she had weaned herself about three weeks before IShe had not been out of the yard of the hospital ; d there were neither diarrhoea nor cholera cases in 3 hospital ; and neither the mother nor father, nor air two other children, have had either diarrhoea or R Again, this case appears to me to shew that cholera not an infectious disease. Case No. 54. iSept. 22nd.— See the R. G. W. R., 22nd Sept., 1855. andsworth, Clapham, at No. 4, Union Crescent, ,rk Hall Lane, on the 20th Sept., the son of a Lice constable, aged three years, cholera infantum. I have seen the mother of this child, and she informed me that this child was taken ill, with diarrhoea, five days before his death, in consequence of having 55 diarrhoea lasted two days before spasms came on, followed by collapse. A younger sister of his had had diarrhoea about three weeks before this boy was taken ill ; and with her the mother believed that the diarrhoea was brought on by the child having eaten decayed apples, which she accidentally got hold of; and, therefore, this child could not have communicated the disease to her brother. She recovered, and is now in perfect health. The house where they then resided, and which I have visited, is in a well-aired, healthy district, and is perfectly clean. The mother adds, that her children had no communication with any other children, and that they had not been out of her house and garden for many weeks. Case No. 55. Nov. 10^.— See the R. G. W. X,., 10th Nov., 1855. St. George, Hanover Square, Belgravia, at No. 1, Ebury Square, on the 2nd Nov., the daughter of a slate polisher, aged one month, cholera infantum, one week ; diarrhoea, after the vomiting ceased, four days ; dry nursed. The father and mother of this child have removed, and their address is not known ; but the landlady informed me that the child's mother had sore breasts, and that she wished to bring up the child by hand ; that the child was attacked with vomiting of all her food ; then that a diarrhoea came on ; and that she died, apparently to her, from want of proper food. The child had never left the house since her birth, and no one labouring under diarrhoea or cholera had seen the child ; and no one. has been ill in the house with either since her death. 56 CASES OF ENGLISH CHOLERA. / Case No. 56. June 21th. — I have been this day to No. 49, Old Castle Street, Bethnal Green, Hackney Road, to inquire into the case of a man who is reported in the §R. B. D. of the 12th of May, to have died, on the of May, of English cholera, after fourteen hours ess, age forty-nine. I find that the man, so his sister-in-law told me, had been subject, all his life-time, to occasional attacks of diarrhoea, and at times very severe ; but that he always cured himself by a good dose of brandy, and sometimes pepper in the brandy; though he was a very sober and a well-behaved man. I That this time he was attacked in the usual manner diarrhoea, which lasted some days; and at last miting, spasms, etc., came on, although he had reurse to his usual remedy, and a doctor was sent for, 10 pronounced him hopelessly attacked, and he 3d in a few hours after. He had not been exposed meet or see any one labouring under diarrhoea or olera. As I have said before, he was a sober, steady in, who worked as a carpenter and joiner, and never jquented either ale houses or pot houses. Case No. 57. KTuly 2nd. — A woman, aged thirty-two, is reported the R. G. W. R., 7th July, 1855, to have died, on , 2nd July, of English cholera, after seven days 57 illness, at No. 2, Cumberland Street West, St. Pancras district. I have been to the house where this person died, and I have seen the person in whose house she lived, and who was with her, and attended her from the moment she was taken ill till the moment of her death. And she says that this woman was a most laborious, careful person; that she was a washerwoman for the soldiers of the Horse Guards ; that she was ill, for above two months, with a severe cough and expectoration ; that she would not have medical advice ; that for the last fortnight before she died, she had a bowel complaint, to which she would not attend ; that seven days before her death, she attended I her work as usual ; but, towards evening, she was liged to take to her bed, in consequence of severe miting and purging; that this went on for two ys, when the Medical Officer of the Regiment of Drse Guards saw and prescribed for her ; but on 3 fourth day, that she took to her bed, cramps came , and from that time she gradually sank. (This woman had not been out of her house to visit y one for months ; and there was no case of diarxa or of cholera in the house or in the neighbourod, nor has there been any case of diarrhoea, or of olera, in the neighbourhood since, to her knowledge. Case No. 58. IJuly 3rd. — I have been this day to Woolwich, and No. 24, Richardson's Buildings, to inquire into the c of " English cholera and disease of the heart" >orted in the R. G. W. R. for the week ending 16th June, as having died of the above-named diseases 58 I find that she was ill, with diarrhoea, for above three days, when she was attacked with vomiting and spasms, and died a few hours after ; that medical aid was obtained, but too late to be of any use. It appears that she was one of the unfortunate females who live in those houses; and that consequently she led a very intemperate life. My informant could give no account of this woman's state of health previous to the attack of diarrhoea. They Ked together, and she believed her to be in good alth. No person of her acquaintance had any diarrhoea, or was unwell previous to this woman being taken ill, or since. And my informant herself, who attended her to the last moment, and who remained along with the corpse, has had no diarrhoea, nor has she in any way suffered, although she leads a very irregular life, and drinks more than she eats, to use her own words. Therefore, no contagion can be traced here. I forgot to say that she had not crossed over to Blackwall, or had any communication with the boy who died on the 9th June, 1855, in Mile End Old Town, North Stepney, at No. 14, Alfred Terrace. Case No. 59. Aug. 18th.— See the R. G. W. R., 18th Aug., 1855. Clerkenwell* Pentonville, No. 26, White Lion Place, on the 13th August, a silver chaser, aged thirty-one, English cholera, ten days. This man's family have left Pentonville for the country, but a neighbour and friend of the family, a person who has known this man since he was a child, stated to me that this man was consumptive, that he had been ailing for several years, and that for the last 59 lar he had a cough and expectoration. That he gan to have a diarrhoea about ten days before his ath, when his usual medical attendant saw and escribed for him, but without avail ; the vomiting, asms, and severe purging came on, and he ceased live in about ten days from the moment the diarcea began. No one in the house was ill with diarcea or with cholera, nor had any one been ill up to c time of the family going into the country, or since ey have been there ; and that so far as my inrmant is concerned, she says that she remained th him and his family up to the last moment, but at she has not suffered in any way in consequence. Case No. 60. JAug. 25th.— See the R. G. W. R, 25th Aug., 1855. iwisham, Plumstead, at 41, Banage Grove, on the th August, the wife of a painter and glazier, aged ty-five, English cholera, twenty-one days. II have seen this woman's daughter, and a neighur who attended her from the moment she was ken ill, and I have also had a statement of her case >m the medical gentleman who attended her. It pears that she was taken with vomiting and purg»at first ; that the medical gentleman considered to be a case of what he called English cholera ; at after a few days the purging ceased and the miting increased, and nothing passed by the anus • eight days. She had now intussusceptio, of which 3 died. Therefore this is not a case of cholera. I Her daughter and the female attendant stated that is woman had not left her house for weeks, and that 3 had no communication with any one labouring der diarrhoea or under cholera. 60 Case No. 61. Sept. B^.— -See the R. G. W. R., Bth Sept., 1855. St. George- in- the-East, St. Mary, at 39, Betts Street, on the 31st August, the daughter of a journeyman wheelwright, aged ten months, English cholera. This child was teething, had a diarrhoea for some weeks, and at last sunk, by the father's account, exhausted. No other person had diarrhoea or cholera in the house, or in the neighbourhood, previous to or since her death. Case No. 62. Sept. Bth.— See the R. G. W. R., Bth Sept., 1855. Whitechapel, Aldgate, at No. 8, Hayes Court, Glass House Street, on the Bth of September, the son of a dock labourer, aged eight months, English cholera. The family have removed from the place, and no one knows where they are gone. It is a low, dirty neighbourhood. I saw the landlady where the parents of this child lived. The child was brought up by the breast, but was a delicate child. About a week before his death he was seized with a diarrhoea, which the mother and the landlady believed depended on his teething, when he was suddenly seized with vomiting and cramps ; when a medical gentleman was sent for, but he died in a few hours. The child had not been taken out of the court since his birth, and no child or any other person, so far as my informant knew, had diarrhoea or cholera previous to the child's illness or since. 61 Case No. 63. Ppi 15th.— See the R. G. W. R., 15th Sept., 1855. techapel, Mile End New Town, at No. 43, Unood Street, on the 15th September, the son of a sstic servant, aged five months, English cholera, days. I The family have removed and their address is unown. The landlady with whom they resided says, at this child was a fine healthy boy, was brought up the breast, when he was attacked with diarrhoea, t not to alarm the mother. Then he was suddenly zed with vomiting and spasms, and died in a few KThis family had another child, who was in perfect alth before and after the death of this boy. I She is not aware that there was any case of diaroea or of cholera in the neighbourhood. She is rtain that no one in the house, either before or fcer the child's death, was afflicted with either diarcea or cholera. Case No. 64. tSept 25th.— See the R. G. W. R., 29th Sept., 1855. ickney, No. 16, Victoria Street, Homerton, on the th September, the widow of a ground labourer, ed sixty-six, English cholera, four weeks ; coma, f. have seen the daughter of this person, who atded her to the last, and she says that her mother been ailing for several months, although she did, v and then, go out as a charwoman. That she had owel complaint for at least a month, but to which did not attend ; that four days before her death was attacked with severe vomiting, spasms, and 62 severe purging, and that she became insensible and died three days after. The house which she inhabited is in a low neighbourhood, and is very dirty. But no one was attacked with cholera in the house previous to her being attacked, although several had diarrhoea, nor has any one since. That six days before her death, a man at No. 13 in the same street had died of cholera ; but as she herself was then ill with diarrhoea, she had not left her room to see him, nor had she any communication with him or with any one that had seen him. CASES OF CHOLERA. Case No. 65. In the R. G. W. R., of Saturday, May 19th, 1855, a case of cholera is reported to have occurred on the 15th May, 1855, at Whitechapel North, Crown Court, No. 12, in a child of one year old, cholera, fifty-four hours. I have seen the mother and father of this child;, and they tell me that the child was still at the breast; that he had taken no food that could hurt him ; that he seemed in perfect health, when, about twelve or one, after dinner hour, he was taken with a bowel fiplaint, then sickness at stomach ; that these went the remainder of the day, and at about ten o'clock at night he was attacked with spasms, and died fiftyfour hours after he was first attacked. 63 -L IJ.C OIAI ILL 1 1(1X1. IX vl v LJ l_- L.-xl yJ l4. v \JX. Lll.(_- LOUrt* 110 L II (ICI he had any communication with any one having a diarrhoea or an attack of cholera ; that the whole of the inhabitants of the court are free from diarrhoea or cholera ; that his brothers and sisters, seven in all, were, and are, in perfect health and free from diarrhoea; that the child had always enjoyed perfect health ; that neither the father nor mother had had communication with any one suffering from diarrhoea or from cholera. This, to me, is a true case of spontaneous cholera. I shall return to this house in a fortnight to ascertain whether all the members of the family continue in good health and free from cholera. Case No. 66. June 30th. — Stepney, Mile End Old Town, North. A boy, aged fourteen, the son of a cabinet maker, is reported to have died, on June 9th, of cholera, at No. 14, Alfred Terrace, Mile End Old Town, North Stepney. I have seen the boy's mother, 'and the medical attendant; and the mother informs me, that four days before the boy's death he went to a fair, where he played with the boys of his own age, got heated, and lay in the grass sometimes. During the night he was taken with a bowel complaint, but went about the next day, and even went to his work. Next day his mother took him to an apothecary's shop, where he had some medicines, but which did not stop the diarrhoea ; the next day he became worse, when the medical attendant was sent for, and he found him in 64 cramps, blue, and in perfect collapse. He died a few hours after. The mother is not aware that he was in any place where persons were labouring under diarrhoea or cholera; and he himself, and the remainder of her family, were in perfect health ; and the remainder of 13 family had remained in perfect health since the ath of their brother ; that neither diarrhoea nor olera is prevalent in the neighbourhood ; that this confirmed by the medical attendant, Mr. Hawker, Edward Street, Stepney. Consequently, here it is impossible to trace the disease as arising from contagion. Case No. 67. July 2nd.— See the R G. W. R., 7th July, 1855. At No. 5, Wood Street North, St. Luke's, a child, aged four months (a female), died of cholera on the I have seen the nurse who had charge of the child, and she tells me that she was brought up by hand ; that for a fortnight before her death the child was unwell with a bowel complaint; but nothing more, she thought, than is usual to children brought up by hand. On the morning of the Ist of July she was taken with vomiting and severe purging, and the medical attendant was sent for. The vomiting and purging increased, and on the morning of the 2nd she was seized with spasms, and died in the evening of the 2nd July. The child had not been out of the house for some weeks ; there was no one in the house labouring under diarrhoea or cholera; the house is clean, situated on a gravel soil, and is airy, and without any noxious smell. 65 Case No. 68, July 2nd.— See the R. G. W. R., 7th July, 1855. At No. 18, Charles Street, Westminster, a child, ten weeks old, died, on the 2nd July, 1855, of cholera. Mrs. Stevens, the child's mother, whom I saw, said, that the child was in perfect health up to six days before death ; that his illness began by a bowel com* plaint, which did not, in any way, alarm her, as she had been, accustomed to attend to children, and has seen them, frequently, deranged in their bowels, without any inconvenience, or danger ; that the day before his death he became worse, and she then took him to a medical gentleman, who pronounced him in great danger, and prescribed ; but the child died the next morning. The child was carried out of the house only a few times, and that by herself, and the nurse, and their walk was always in the park ; she had gone to no house with the child, nor had any one else. She had heard that persons, in the neighbourhood, had diarrhoea, but not cholera ; but no one in the house, to her knowledge, had diarrhoea, and certainly not cholera. Case No. 69. July sth.— See the R. G. W. R., 7th July, 1855. On the sth July, the wife of a timber dealer, Mrs. Vining, aged 47, died of cholera, at No. 8, Buckingham Row, Westminster. I have seen the landlady of this house, who attended Mrs. Vining from the moment she was taken ill to t moment of her death, and she tells me, that Mrs. dng was at the change of life, and had been in iferent health for many months ; that for the last night, or three weeks, she had a diarrhoea, which 66 live her no pain, and which she neglected ; that on Le day before her death she took some cider, and me hours after she was seized with violent purging, uniting, and spasms in her limbs, abdomen, etc., and medical gentleman was sent for, who pronounced c case one of cholera ; and she died a few hours I The patient herself attributed the attack of spasms, miting, etc., to the cider she took, and to, nothing $c; but two other persons, who shared the cider th her, did not suffer. Consequently, it is fair to ppose that her disease was not caused by the cider ; ;hough, in the state of health she was in, and labours' under diarrhoea, the cider might have hurried on c disease to its developed stage. My informant told me that no one in the house suffered from diarrhoea, or from cholera, before or since Mrs. Vining's death. And it may be added, that Mrs. Vining had not gone out of the neighbourhood for months, nor had she received visitors for many weeks. Her husband and herself were very quiet people. The husband enjoys perfect health, and has had no diarrhoea. Case No. 70. July \6lh.-See the R. G. W. R., 21st July, 1855, in which there is reported a case of cholera in a child, »boy, nine months old, which occurred in the intnary, Royal Mint Street, 16th July, 1855. I have seen the father of the child. He says, the child was healthy, and brought up by the breast. He was vaccinated about three weeks before his death, and the father says, the child began to droop a few 67 that tor a week previous to his death he had a bowel complaint, but nothing to alarm the mother or himself. At last, about twenty-four hours before his death, he was seized with spasms, and vomiting, and purging, freely, and sank about twenty-four hours after. The child had not been out of the yard since its birth, nor out of the house for above three weeks before his death ; and no one in the house, or in the neighbourhood, had diarrhoea or cholera, to his knowledge ; nor had any one come to the house from one where diarrhoea or cholera prevailed. Case No. 71. tJuly 16th.— At No. 5, Bowl Court, Shoreditch, a y, aged nine months, is reported in the R. G. W. R. have died on the 16th July, 1855, cholera, twentyfour hours. I have seen the person who attended the child along with the mother ; the boy had the breast, but for some days before his death he became unwell with his bowels, having, in fact, a slight diarrhoea ; and, twenty-four hours before death, he began to vomit, Erge, and scream, as if in pain. This continued ne hours, when the doctor was sent for; but the ild died a few hours after the doctor saw him. There were children in the different houses about who had diarrhoea, but no cholera ; nor were any of the children in the same house attacked by diarrhoea, or by cholera, before, or after, this child's death ; and the mother, and my informant, have continued perfectly healthy ever since. Case No. 72. Aug. Mh. — The wife of a baker is reported, in the 68 R. Gr. W. R., of the 11th August, 1855, to have died of cholera, at No. 24, Union Street, Spitalfields. llt appears that this woman had been confined three ;eks, and for a fortnight before her confinement she d not left the house. Her confinement was natural, a dead foetus; she was as well as usual for the rtnight after, when she began to have a bowel comlint, which, however, was so slight as not to alarm y one. Her milk disappeared at the same time ; t about six, or six hours and a half, before her ath, she was suddenly seized with vomiting, spasms, d purging, and she gradually sank, but not in severe pain. She was sensible to the last. The house is healthy; the family well to do; since her death no one in the house has been ill ; and her servant, who attended her to the last, informed me that she never suffered in consequence of her attendance on her mistress. The servant was not aware of any case of diarrhoea or of cholera in the neighbourhood. Here, most cer- Bnly, the case could not have originated from intion. I[ have a letter from Mr. Brown, 2, St. Mary Axe, s medical attendant, who confirms the above report the case ; and says, that he and Dr. Pettigrew, who s called in consultation, considered this a case of )lera. Mr. Brown adds, that while he attended s person he had several cases of severe diarrhoea, ich all did well, and that this was the first case of )lera which he had seen during this season. Case No. 73. fug. Bth.— See the R. G. W. R., Aug. Bth, 1855. Trafalgar Place, Kensington Town, on the Bth 69 Aug., the wife of a carpenter, aged sixty-three years, cholera, seventy-two hours. I have been to Trafalgar Place, and I have seen this person's aunt, who lived with her, and attended her to the last, and this person informed me that her niece was a woman of good general health ; that she had been in perfect health up to the Sunday evening before her death, when she was seized with diarrhoea, and after a few evacuations vomiting came on ; but no one felt alarmed, and no medical gentleman was sent for till the next morning, that is, on Monday. But the diarrhoea and occasional vomiting continued ; and during the night of Monday to Tuesday, she began to complain of pain in her limbs, which were thought at first merely spasms, with which she sometimes was attacked. The next morning, when the medical gentleman saw her, he pronounced her in great danger. She died the next day, Wednesday. This person was a washerwoman by trade ; but her aunt is not aware that she had washed the clothes of any one labouring under diarrhoea, or under cholera; and she is certain she had no intercourse with any one labouring under either diarrhoea, or under cholera ; nor is she aware that any case of either occurred in the neighbourhood. She adds, that neither herself, nor any of the family, or neighbours, who attended her niece to the last, have suffered either from diarrhoea or cholera. This person had dined on veal and bacon ; and at first she thought that they had disagreed with her : in short, that she had an indigestion. Case No. 74. Aug. 1 Uh.— See the R. G. W. R., 11th Aug., 1855. 70 •XTtT J i.l. C 1 » T n J * Wandswortn, Streatham, at Bakers Lane, 2nd. Aug., 1855, a gardener, aged fifty-six, cholera, two days; consecutive fever, three days. II have been to the above address, and I have seen is man's daughter, a woman of about twenty-eight ars old, and she informed me that her father was ken ill on the morning of the 29th July at about ree o'clock, with great pain in his stomach and iwels and with a severe diarrhoea ; that she and her ather got up and gave him warm drinks, applied y heat to his stomach, which eased him considerly; but the bowel complaint continued, with less in however. At about ten o'clock he began to mit and to have cramps in his limbs, when medical 1 was obtained, and all was done for the patient at could be done, but in vain. He died on the fifth y from the time he was first taken ill. This man was a perfectly sober man, and every way a respectable person ; he was occupied as a gardener, and had not left his house and his garden for some weeks, nor had any communication with any one labouring under diarrhoea or cholera. And, so far as my informant knew, no one in the neighbourhood laboured under either diarrhoea or under cholera. Neither my informant, her mother, two other females who attended her father during his illness, nor her three children, have suffered in the least since the death of her father; and they are all in good health this day, Bth April, 1856. Case No. 75. Aug. Uth.— See the R. G. W. R., 18th Aug., 1855. East London, Cripplegate, at Beech Street, the son t printer, aged seven months, died on the 14th at the above address, cholera, three days. 71 I have seen the mother, and she informed me that the child was a strong healthy child up to two months before his death, when it became advisable to wean him, in consequence of her bad health ; as soon as he was weaned he began to droop, his stomach and bowels were constantly out of order. At last, three days before his death, he became much worse ; medical advice was called in, and after taking some medicines prescribed, he began to vomit severely and to be purged at the same time, with evident cramps in his limbs ; and expired the third day. He did not become blue, but was much reduced in flesh. She has three other children, who were, and have continued, free from diarrhoea. Nor had the child left the house for two or three weeks. She was not aware of any one in the neighbourhood having diarrhoea or cholera. Case No. 76. I Aug. leth,— See the R. G. W. R., 18th Aug. 1855. ; 11, Barlow Place, Mile End Old Town, Lower 3pney, Mile End Road, on the 16th Aug., a general )ourer, aged sixty-seven years, cholera, three days, le medical attendant, Mr. Rose, No. 10, Barnes ace, adds — was attacked on the 10th August, but d no medical advice until the 14th, and refused medicines in part. I have seen this man's daughter, who informed me that her father had been for some time in a delicate state of health : that he was attacked with diarrhoea, for which he would not have medical advice ; that when the spasms and vomiting came on, he would not attend to the prescriptions of the medical attendant ; that, so far as she knew, he had not any communication with persons labouring under diarrhoea or cholera; 72 that no one in the house had either diarrhoea or cholera before or since her father's death, nor has she in the slightest way suffered in consequence of her attendance on her father. Case No. 77. Aug. 25th.— See the R. G. W. R, Aug. 25th, 1855. Stepney, Mile End Old Town, Lower, at Queen Street, No. 3, on the 21st August, the wife of a carman, aged thirty, cholera collapse, fifteen hours, after a dinner of roast lamb, and apparently in good health, she was seized about three o'clock on Monday, and died at eight o'clock on Tuesday morning. I have seen the landlady with whom this woman resided. From her description of the case, it would leave doubts that this was a case of cholera. However, no one had cholera or diarrhoea in the house, previous to or since this woman's death. By the landlady's account this woman was a very quiet person, not having left her house or visited any one for many days before she was taken ill. Case No. 78. Aug. 25th— ~ See the R. G. W. R., 25th Aug., 1855. St. Saviour's, Christ Church, at Green Court, on the 21st August, the wife of a journeyman carpenter, aged sixty years. Cholera, diarrhoea, eight days ; collapse, one hour.' This woman's family have removed from this court, but none of the neighbours can say where they have gone. However, one of the neighbours states that this woman had a severe diarrhoea for many days, that at last she was seized with vomiting, severe purging and cramps, and died in a few hours. No one in the 73 house or in the court, so tar as she knows, had either diarrhoea, or cholera, at the time this woman was attacked with the disease ; nor has any one, so far as fe knows, suffered from either of these diseases since c woman's death And as she was never out of the house, it is not probable that this woman caught the disease from any one she might have visited. Case No. 79. Aug. 26th.— See the R. G. W. R., 29th Sept., 1855. Hackney, West, at Orchard Court, Kingsland, the daughter of a general labourer, aged eight months, cholera. I could not see the mother of this child; but a neighbour, who had seen the child, states that a few days before her death the child was allowed to fall on the ground ; and that the mother dates the beginning ff the bowel complaint from that moment, as none of er other children had any diarrhoea. I have seen the medical gentleman who attended this child, and he says he was called to her only when she was in articulo mortis, and that it was a true case of cholera. It appears that several of the children in the same lurt had, previous to this child's illness, and subselently, diarrhoea ; but no case of cholera has ocrred in that court or in the neighbourhood previous to, or subsequent to, this child's death. The house is in a low neighbourhood, and very filthy. Case No. 80. Aug. 28th.— See the R. G. W. R., Ist Sept., 1855. E4, Gore Lane, Kensington, the daughter of a I painter, aged one year, cholera, twenty-four 74 hooping cough for some weeks, that she was attacked with diarrhoea, which lasted nearly a week, when vomiting and spasms came on, and the child died a few hours after these had come on. II have the above information from two of the perns who resided in the next house to where this ild's parents resided, as they have left for Australia. y informants say that they were not aware that the ild had been taken out to any place where cholera diarrhoea raged. KThey are certain that no one in the locality had olera, though there might have been some slight ses of diarrhoea. I All the inmates of the house where this child died ye continued in perfect health. Case No. 81 I Aug. 28M.— See the R. G. W. R., Ist Sept., 1855. ; Southwick Mews, St. John, Paddington, on the th of August, 1855, the wife of a coachman, aged irty-four, died of cholera. I[ have been to this mews, and I find that the husid and the children of this woman have removed, t no one can give any information where they are be found. KA female neighbour, who was with this woman to 3 last, says that she was poorly for many days pre>us to the fatal day — that she believes she had diarrhoea. At about eleven o'clock in the morning she saw her in the yard ; at about three in the afternoon she saw her in bed and in great pain, and vomiting and purging ; and she died that night, at about 75 Eiarrhcea was very prevalent in the neighbourhood, not cholera, to her knowledge. She is not aware she washed for any one but her family, and she >t aware that any of them had diarrhoea. I Another coachman, his wife and children, went into 3 rooms where this Woman had died, a few days ;er her death, and have not suffered in consequence her from diarrhoea or cholera. Case No. 82. lAug. 30tk.— See the R. G. W. E., Ist Sept., 1855. ; No. 11, Alford Road, St. Mary, Paddington, the ughter of a mantua maker, aged one year, of cholera, ree days. I[ have seen the father and mother of this child, I they informed me that their child was in perfect ilth up to three days before her death; that she 3 seized with diarrhoea, which, at first, did not rm them, but the next day, the child being worse, y obtained medical advice, but without any relief the patient. She died on the third day. The Id had not been out of the house, nor had she ;n seen by any one labouring under diarrhoea or )lera. The house, No. 11, Alford Road, is in a fectly healthy quarter of the town ; is well aired, i has no bad smells. Case No. 83. Aug. SOth.— See the R. G. W. R., Ist Sept., 1855. At No. 4, Whitehart Place, Poplar, a female child, aged six years, cholera. KThe mother informs me that her child had been zed with diarrhoea at about eight o'clock in the >rning; that her bowels were frequently relieved 76 for three hours; that she was then seized with severe spasms in her arms and legs ; that she sent for a medical gentleman, who did all he could for her child, but that she died that evening at about seven o'clock. Several children had diarrhoea, she understood, in the neighbourhood ; but none of her other children, or of those of the other persons in the house, had diarrhoea or cholera before, at the time of, or after her child's illness ; nor does she believe that her child had seen or visited in a house where a diarrhoea or cholera case existed. Case No. 84. Aug. 31s£— See the R. G. W. R., Ist Sept., 1855. Hackney, West, No. 2, Victoria Cottages, Halford Road, a female, aged fifty-three, cholera. I have learnt from this person's daughter, and from the landlady of the house, that she was of delicate health through life, especially liable to bowel complaints, and for the last three years she had a chronic disease of the liver. That she had not been out of the house for some weeks previous to her being attacked with diarrhoea — ten or twelve days before her death. When she first was attacked with diarrhoea, she supposed that it was one of her usual attacks, and therefore did not pay much attention to it. Two days before her death she began to be sick at stomach and to be purged more severely, and during the night cramps came on ; when medical advice was obtained, but too late. Ehe house where she resided stands by itself, is aired, and perfectly clean. No one in the house, re her illness, had diarrhoea or cholera, or since 77 E death. And as the family lived very retired, she had the visit of no one labouring under these Case No. 85. Sept. Ist— See the R. G. W. R., Ist Sept., 1855. Fulham, Peterborough Lane, Parson's Garden, a male child, one year old, cholera. JThe family have removed from the neighbourhood, d none of the neighbours could give any informan relative to this child's illness, nor who was the ;dical gentleman who attended him. Case No. 86. Sept Ist— See the R. G. W. R., Ist Sept., 1855. St. Clement Danes, No. 7, Milford Lane, a female, aged sixty-five, cholera. I have been to the above-named house, and I have seen the landlord and the landlady in whose house this woman died, and they informed me that she had been tfor the last three years ; and that she was so weak it she seldom went to the door of the house ; that her illness was a gradual decay of nature ; that about a week before her death she was seized with diarrhoea, to which she at first did not pay attention ; that three days before her death medical advice was obtained, as she had become worse ; that all was done for her that could be done ; but in vain. No one in the house had diarrhoea, or cholera, when she was attacked with diarrhoea ; nor could she have seen any one labouring under the disease, as she could not go out, and no one from without visited her. - And, since her death, no one has been ill in the 78 Case No. 87. I Sept Ist— See the E. G. W. R., Ist Sept., 1855. ; No. 6, Harding Place, a woman, aged seventy-five, cholera. I have seen the landlord and landlady where this Irson lived, and they inform me, that two days fore her death she appeared in perfect health, len she was attacked with diarrhoea, which she did t attend to till spasms and vomiting came on, when nedical gentleman was sent for, who did all he could relieve her ; but she died in eight-and-forty hours ;er being attacked first with diarrhoea. The landlord and landlady inform me that the woman had not been out of the house for several weeks ; that she had seen no one ill of diarrhoea or Solera ; and that since her death no one in the house s suffered from diarrhoea or cholera. Case No. 88. Sept Ist— See the R. G. W. R., Ist Sept., 1855. At No. 6, Essex Street, St. Saviour, a woman, aged sixty-seven, died of cholera. I[ have seen this woman's daughter-in-law, who inmed me that she had eaten hastily, the night she s taken ill with a diarrhcea, of sausages, plumiding, meat, etc. ; that some hours after being in 1 the diarrhoea came on, and went on increasing in quency of the discharge till the middle of the next f, when a medical gentleman saw her and preibed for her ; but towards evening she began to nit and to complain of spasms ; and then gradually ik. This woman had not been out of the house for weeks. She had had no communication with any 79 one who had, or who had had, cholera ; nor were any liolera cases in the neighbourhood, so far as my inrmant knew. Although she had heard that persons in the neighbourhood complained of diarrhoea, no one in the. house had diarrhoea or cholera previous to her mother's illness or since. Case No. 89 Sept. Ist— See the R. G. W. R., Ist Sept., 1855. . Olave,' Guy's Hospital, from No. 10, Cable Row, ent Street, Borough, a female child, one year, cholera. I have been to Guy's Hospital, but they have no record of the above-named child having been ads' mitted, and having died in the Hospital ; nor has the Registrar of the district any record of the case. And I have been unable to find Cable Row, in Kent Street. Therefore, there must have been some error in reporting this death. Case No. 90. Sept. Ist— See the R. G. W. R., Ist Sept., 1855. At St. Paul's, Deptford, No. 4, Victoria Place, Pemroy Street, a female child, aged one year, cholera. I have learned from the mother of this child, that she was brought up partly by hand and partly by the breast ; that the child was teething ; that the day before her death, at about four a.m., she was taken ill with a bowel complaint, which the mother believed was caused by her teething. At about twelve o'clock in the day the child seemed well, but at about three o'clock she began to vomit and to be purged freely, with occasional screaming, as if she were in pain ; and towards twelve o'clock that night she became more composed, but died before six o'clock in the morning. 80 The child had not been out of the house for above a month, and therefore could not have visited any one labouring under diarrhoea or under cholera. None of the other children in the house were ill, or have been ill since, with either diarrhoea or cholera. Therefore this is not a case of contagion. Case No. 91. Sept. la*.— See the R. G. W. R., Ist Sept., 1855. At 48, Woburn Place, St. George, Bloomsbury, a female, aged fifty-three, cholera, five days. I have been to the above-named house, and I have seen this person's sister, a lady well informed, who told me that her sister had been an invalid for about two years ; that she had been very subject to diarrhoea all that time — in fact, so much so, that if she went into a room where gas was used, she was iraraedialely attacked with diarrhoea ; that five days before her death she was suddenly attacked with severe diarrhoea, without any apparent cause ; that the next day vomiting and spasms came on ; and that she died on the fifth day from the first attack of severe diarrhoea. She further states, that her sister had not left the house for many weeks ; that she had had no intercourse with any one labouring under diarrhoea or cholera ; and that no one in the house, previous to or subsequent to the death of her sister, were or have been affected with diarrhoea or cholera. She is not aware that any one of these diseases was prevalent in the neighbourhood at the time of her sister's illness. Case No. 92. 81 At Mile End Old Town, Upper, 64, Greenfield Street, a man aged sixty-two, cholera. The family with whom this man lodged have left the neighbourhood, and no one knows where they are gone, not even the landlord of the house ; and therefore no information relative to this case can be obtained. Case No. 93. Sept Ist— See the R. G. W. R, Ist Sept., 1855. Somers Town, 17, Drummond's Crescent, a man, aged forty-eight, cholera, twelve hours. I have seen this man's widow, and she informed me that she and her family had partaken of a lobster for supper on Friday night, which did not disagree with any one except her husband — who, on the Saturday, stated, repeatedly, to his fellow-workmen, that the lobster had disagreed with him, and that he wished lie had not eaten it. However, he returned home after his work, in appearance in good health, ate his supper as usual, of meat, etc. ; want to bed at about ten o'clock, but during the night he frequently complained of cramps in his legs ; but being subject to cramps, neither he, nor his wife, paid attention to these cramps, except that he got up out of bed to relieve himself by standing up. At about five, a.m., he was seized with diarrhoea most abundantly running from him like water. With some delay medical assistance was obtained, when medicines were administered to him, but which he rejected immediately. When the cramps returned very severely in his legs and arms, and from this moment every thing he took he brought up immediately ; and he continued some hours in this way, till at about five in the evening he died. F 82 _LJlt3 WICIOW IS ilOt t more than usual. This gentleman entertains the •inion that cholera is not necessarily preceded by a arrhcea. However, there is every proof that the sease, cholera, had not been brought into the prison from outside the walls ; and these three cases go far to prove that cholera is not a contagious disease. Case No. 106. lOcl 22nd.— See the R. G. W. R., 27th Oct., 1855. 44, Fleet Lane, on the 22nd Oct., the daughter of a coal dealer, aged six years, died of sporadic cholera, fifteen hours illness. I have seen the father and mother of this child, and they tell me that she was in perfect health up to 90 of pain in her head, and of feeling sick at stomach ; that at about seven she went to the water closet, and had a full motion, relaxed ; that in about half-an-hour she had another, more relaxed, but without pain or uneasiness ; that at the same time she threw up a little, but felt still sick. About half-an-hour after she had a third liquid motion, still without pain or uneasiness. She now lay down and seemed comfortable ; but in about an hour she had a fourth evacuation, and now felt faint ; medical advice was obtained* but nothing relieved her; the vomiting was not severe, but the diarrhoea continued increasing in rapidity and watery. At seven in the evening the medical attendant pronounced her past all hope. She died in about three hours after. I The mother says, that she is not aware that her ughter had any spasms, at least she complained of pain in her limbs ; but of a pain at the pit of the imach. The child was a very placid child, and was ither fretful nor peevish ; and the mother says, she ght have had spasms without complaining, as some ildren would have done. I This child could not have caught the disease from y one. She had not been out of the house for eks before; no case of diarrhoea, or of cholera, isted in the house, or in the neighbourhood, to the her's or mother's knowledge ; nor did any one, to jir knowledge, come to the house from another iere these diseases existed. I must add, that the child's skin was not discoloured before or after death. She had eaten heartily, the clay before her death, of boiled pork and currant 91 V Case No. 107. Oct. 2Zrd.~ See the RG. W. R., 27th Oct., 1855. At No. 16, College Place, Chelsea, north-west, a stonemason, aged fifty-one years, is reported to have died of cholera, on the 23rd Oct., 1855, after thirtytwo hours illness. II have seen this man's wife, and she informs me, at he was taken, on the morning of the 22nd Oct., th a diarrhoea, going once every second or third ur ; that he was sick at stomach once during the y ; that towards the evening, as he felt very weak, 3 medical attendant saw him; but the diarrhoea jmed then to increase, and he continued to get taker and weaker, and sank about thirty-two hours er the first liquid motion. She did not notice tether he passed any water above once during all it time. He had very little vomiting, and she cant say whether he had any cramps, as he was subject cramps ; all she can say is, that he did not appear have more cramps than usual. He did not turn le before or after death. The man had necrosis of the bones of the foot ; had been ailing for the last three years ; had been in St. George's Hospital nine months, and was discharged from there only three weeks before, as he was evidently sinking in consequence of the great discharge from the foot. Is this a decided case of cholera, or one of consecutive diarrhoea X This woman informed me that no diarrhoea or cholera case had occurred in her house ; but that on the same day her husband had been attacked, two neighbours of her's were seized with c t , Oil \J \s 1/ ) 92 rirti/PrOfl I lIPCP I \HTit lIOVQIiTI C II Cl /I Till ¦•fITYI Til 1 1 Tl 1 f"CI I If\ IT with her husband ; nor had he left his house since leaving St. George's Hospital. Case No. 108. Oct. 29th.— See the R. G. W. R., 3rd Nov., 1855. A laundress, aged forty-nine, died, on the 29th Oct., 1855, at the Royal Military Asylum, Chelsea, of cholera spasmodica, after six days illness. I have seen the surgeon to the above-named establishment, and he informs me, that this woman had been labouring under diarrhoea, and sickness at stomach, occasionally, for about three days, before she applied for medical advice. That when she did apply, she was very ill, with both diarrhoea and vomiting ; and that cramps, etc., ultimately came on, and she died, after being ill, in all, six days. No severe case of diarrhoea existed in the asylum, neither before, or since, this woman's death ; nor had there been this year, or since her death, a case of cholera in the establishment ; and, consequently, she could not have caught the diarrhoea by washing the She, herself, attributed her illness, I was informed, to having eaten heartily of a kidney pie, while in Chelsea. The persons about the Asylum, her companions, are not aware that she had visited any one labouring under cholera. 93 CASES OF MALIGNANT CHOLERA. Case No. 109. (July 6th.— See the R. G. W. R., 7th July, 1855. labourer, aged thirty-two, is reported to have died, the 6th of July, 1855, at the Workhouse, Wandsirth, of malignant cholera, having had premonitory irrhcea for one day, certain. Khave been to Wandsworth Workhouse, and I informed, by the clerk, that the man had been admitted, on the 27th June, in consequence of an |;er in his right hand, which prevented him from rking, and, being destitute, he was admitted into the irmary. He continued in good health till the day the sth July, when he was seized with a diarrhoea ; 1 as it got worse in a few hours, the medical officer s sent for ; but he died on the sixth, with all the nptoms of malignant cholera. KThe Wandsworth Workhouse is situated on an rvated position, and is not shut in by buildings. te interior is clean and healthy. I Previous to this case there were neither diarrhoea r cholera cases in the Workhouse ; nor have any ocrred since. And very few cases of either diarrhoea, cholera, have occurred in this union, this year. Case No. 110. Sept Bth.— See the R. G. W. R., Bth Sept., 1855. Hanover Square, at the " Plough " public-house, Brook Mews, on the 3rd Sept., the son of a licensed 94 I This child was in good health up to the moment was seized with diarrhoea, six days before his death, hough he was teething, and was about to be weaned. ) person in the house had diarrhoea or cholera at ? time he became ill, during his illness, or after his ath ; and he himself was not taken to any house lere he could have caught the disease. Case No. 111. I Sept 20th.— See the R. G. W. R., 22nd Sept., 1855. ickney, at 13, Victoria Street, Homerton, on the th Sept., a brickmaker, aged thirty-six, diarrhoea, elve hours ; malignant cholera, twenty-four hours. II have seen the landlady where this man resided, d who attended him along with his wife and other ighbours. She states, that he had a diarrhoea for ove six weeks, which he did not attend to, as he is not in pain. That two days before his death, 3 diarrhoea suddenly increased in frequency, and in out twelve hours he was seized with severe vomiting, spasms, etc., and died in about twenty-four hours after being attacked with vomiting and cramps. This man was a labouring man, who did not idle his time, but attended to his occupation as brickmaker; therefore, he had no opportunity to see or visit any one labouring under diarrhoea or cholera. Before this man's death no case of cholera had occurred in the neighbourhood, although there were several persons complaining of diarrhoea. Case No. 112. Oct. 6th.— See the R. G. W. R., 13th Oct., 1855. 95 On the 6th and 7th Oct., the son and wife of a costermonger, aged, respectively, three, and thirty-one years, cholera maligna, twenty-four and fifty hours. I The head of this family, and his other children, ye removed to another part of the town, address not own. But the master of the workhouse, Chelsea, 10 saw this man, and who had the particulars of the ath of the wife and child, says, that the family rtook, the night before being taken ill, of decayed 1 ; that the mother and child were taken ill, during 3 night, with purging and vomiting ; and ultimately, len medical assistance was called, both were past hope, and died of malignant cholera. The father ,s also indisposed, but ultimately recovered. II have seen the place this family resided in. It is mere hovel, filthy in the extreme, and the neighurhood is a low one ; but no case of cholera had ourred in this place previous to these two cases, or ice. There were a few slight cases of diarrhoea in b court, but none died; and the persons of the urt are not aware that this woman, and her child, d visited any one labouring under the disease. Her ighbours believe that she had not been out of the rd for some weeks. Case No. 113. tOct. Uth.— See the R. G. W. R., 20th Oct., 1855. Ed, on the 11th Oct., 1855, at No. 19, New Peter ¦eet, Westminster, of malignant cholera, the wife a bricklayer's labourer, aged forty. I have seen the daughter of this woman, herself a person of about twenty, and she tells me, that her mother was a washerwoman; that she had been ailing for the last year ; sometimes with palpitations, sometimes 96 with pains in various parts of the body, but that she still continued her work. That, about five days before her death, she was seized at night with diarrhoea, but she had no pain. During the evening of the next day she began to have cramps, which, at first, were very severe ; but, after a few hours, the cramps and purging diminished ; and next day she was free from both, but very weak, and her hands and face became dark ; and she was then told by the medical attendant, she says, that her mother had the black cholera. She died two days after. This woman says, further, that her mother had not washed any clothes belonging to any one ill of diarrhoea or cholera; nor had she, to her knowledge, visited any one having the disease. And, she adds, that she believes it was impossible she could have seen any one having the disease, no case had occurred in the neighbourhood, and she never had been absent from her work. She adds, that her mother attributed her illness to having had her feet wet at the moment the catamenia were about to come on. Every one in the house was, previous to, and since, this woman's death, free from diarrhoea or cholera. And my informant, her daughter, says, she herself never was in better health ; although she had much labour and anxiety in attending on her sick and dying mother. Case No. 114. Oct. 26th.— In the R. G. W. R., 27th Oct., 1855, it is stated, that the son of a fishmonger, aged thirteen years, had died, on the 26th Oct., of malignant cholera, twelve hours illness, at No. 14, Old Pye Street, Westminster. I have been to the house, and I have seen the 97 mother of this boy, and she informed me, that when he got out of bed in the morning, he was obliged to run down to the water-closet, half-dressed. On his return he dressed himself as usual, took his breakfast, did not complain of any uneasiness, and she did not notice whether he returned, during the morning, to the water-closet ; but about one p.m. he was there, when he was seized with severe cramps in his stomach, and was obliged to be helped into the house. She believes that he had vomited, but is not quite certain. He now complained of being unwell, and had several watery stools. At about half-past two he complained of slight cramps in his legs ; medical assistance was obtained, but he gradually sank, and died at about seven o'clock, having had very little vomiting, but frequent watery stools. I The mother is not aware that her son had any inrcourse with persons labouring under diarrhoea, or olera ; no case of either disease was in the neighurhood; her other children are perfectly healthy, d have not had either diarrhoea, or cholera. (Her boy, she says, had always been a very delicate ild, frequently attacked with bowel complaints; d last year, about the same time, he had a very rare attack of diarrhoea, and she was near losing CASES OF ASIATIC CHOLERA. Case No. 115. July 2tth.— See the R. G. W. R., 28th July, 1855. Chelsea, South, at No. 22, Church Street, the wife of G 98 a laundry keeper, aged sixty-four years, diarrhoea, one week; Asiatic cholera, twelve hours; consecutive fever, twenty-four hours. I have seen this woman's son, and his wife, who attended her through her illness. It appears that she had been gradually failing in health ; about ten days before her death she was attacked with diarrhoea, to which she paid no attention, although she was very much alarmed lest she should have cholera. Two days before her death she was suddenly seized with vomiting and severe purging, followed, in a few hours, by very severe cramps, which lasted, off and on, for about twelve or fourteen hours, when she became easy, without any spasms, or purging, or vomiting, and died in about eighteen hours after. She was a laundress by trade, but she herself never washed or touched the clothes ; and they are not aware that any person for whom she washed had had diarrhoea or cholera. Some cases of diarrhoea did occur in her neighbourhood, and two cases of cholera, but she had had no intercourse with either cases. It may be added, that none of the women she employed to wash the clothes have had either diarrhoea or cholera. Case No. 116. July 28th.— See the R. G. W. R., 28th July, 1855. Bethnal Green Church, at 16, Hereford Street, on the 26th July, a brewer's servant, aged thirty-two, cholera Asiatica, fourteen hours and a half. I have seen this man's landlady, who informs me, that the day before his death he was in perfect health ; that he dined off salmon, which disagreed with him ; that a diarrhoea came on during the night; that the 99 next morning he got up and went to the medical attendant, from whom he got some medicines, which k attempted to take, but vomited up the whole imdiately, when cramps came on, and, in the evening, another medical gentleman saw him ; but he died in a few hours after. No one in the house had diarrhoea, or- cholera, previous to this man's illness ; nor has any one been ill with diarrhoea or cholera since. This man was a temperate, well-behaved person ; and the landlady is not aware that he visited any person labouring under diarrhoea, or under cholera. The first medical gentleman who prescribed for this man, says, that he laboured under a true attack of Asiatic cholera. Case No. 117. Aug. 1st — At No. 3, Argyle Eow, Argyle Square, Gray's Inn Lane, St. Pancras, a man, aged sixty-six, is reported, in the R. G. W. R. for 4th Aug., 1855, to have died of Asiatic cholera ; diarrhoea, six days. I have been to the house, and I there saw his daughter-in-law, who informed me, that the man enjoyed good health ; that for above ten days, or may be more, he had a diarrhcea ; that he went several times to consult a medical gentleman, but that the diarrhcea was not stopped. The day before his death he was suddenly seized with vomiting, spasms, etc., and he gradually got worse, although medical aid was obtained ; and he died in less than twenty -four hours from the time he began to vomit. He became very blue all over his body some hours before death, and 100 lileI ile was a grocer, and never went out but to market ; I she is not aware that he had been to any house ere any one was ill with diarrhoea or cholera. No j in his house was ill with either, previous to his ith, or has any one of his family been ill with ler since his death ; and they are not aware of any I being attacked with diarrhoea, or cholera, in the ghbourhood. Case No. 118. fiug. 19th.— See the R. G. W. R., Aug. 25th, 1855. »t London, St. Botolph, at No. 101, Houndsditch, the 19th Aug., a woman, thirty-seven years old, is orted to have died of Asiatic cholera. I have seen the woman who was with her at Amsterdam, and attended her from the moment she was taken ill till she died, and she says, that diarrhoea was very prevalent at Amsterdam ; that several persons in the house where they were on a visit had diarrhoea, but not cholera, to her knowledge. That the morning she and her friend embarked to return to England, they both had diarrhoea, but her friend worse than herself; but neither of them had any pain; they ate very little all day, and went to bed early. It about eleven o'clock at night her friend was d with vomiting and violent purging, and, shortly , with cramps in her legs and arms. She graly got worse, that is to say, fainter and fainter; when the vessel arrived she could hardly speak, was put into a cab to be sent home; but she in the house. She was blue, and much altered d| [ t c ice. 101 My informant got well of the diarrhoea, but has remained weak ever since. She is not aware that her friend had seen, or had had any communication with, persons who had cholera. Herself, her husband, and her late friend's husband, have not been ill since. Case No. 119. Aug. 25th— See the R. G. W. R., 25th Aug., 1855. St. Saviour's, Christ Churchy at No. 14, Church Street, on the 18th Aug., the daughter of a stationer's assistant, aged four years, Asiatic cholera. I have seen this child's mother, and she informed me, that her daughter was seized with diarrhoea two days before her death, which, at first, gave her no uneasiness ; but when the child began to vomit, and to be purged violently, she became alarmed, and sent for her medical attendant, who did all he could, but to no avail : the child died a few hours after he had visited her. The child had not been away from home X months, and had been visited by no one labouring der diarrhoea or under cholera ; and no one in the house, previous to, or during the child's illness, or since the child's death, has laboured under diarrhoea or cholera. Case No. 120. Sept 15th.— See the R. G. W. R., 15th Sept., 1855. Southwark, London Road, at 50, Market Street, 9th Rpt,, a plumber and glazier, aged forty-two, Asiatic ole'ra, sixteen hours. The widow of this man informed me, that her husband worked in the docks ; that he came home, on the Bth Sept., feeling unwell in his inside ; having, in fact, a slight diarrhoea ; that he attempted to go 102 out into the next street, but returned soon, saying, he felt very unwell ; and requested to have some tea and brandy, which he took. Shortly after he began to vomit, to purge violently, and to be in great pain from spasms in his limbs ; that medical aid was obtained, but in vain : he died in less than sixteen hours from the time he came home and said he felt poorly. She is not aware that he had visited any one labouring under diarrhoea, or under cholera ; but he had repeatedly complained of the bad smells which existed where he was at work at the docks ; and the man himself attributed his illness to this cause. Case No. 121. Oct. 9th.— See the E-. G. W. R, 13th Oct., 1855. At the House of Correction, Tothill Fields, 10th Oct., the wife of a stonemason, aged forty-five, died of Asiatic cholera, twelve hours. I have seen the deputy-governor, and the nurse, at the hospital of the establishment. By the deputygovernor, I was informed that this woman had been eleven months in the prison ; that she had communicated with no one out of doors ; that she was considered a person in good health. The nurse said, that she was taken during the night with severe diarrhoea ; that in the morning she was brought down to the hospital ; that towards midday she was seized with spasms, and, in a few hours, her skin became discoloured ; and she died in about twelve hours after having called for assistance. She is not aware whether the woman had had a diarrhoea previous to her being taken ill the night previous to her death. It may here be remarked, that no medical officer resides in the prison ; and that 103 rien any one is taken ill during the night, they have send for one at about a mile from the prison. From the most minute inquiries, it is impossible to trace that the disease was brought into the house, though there are a few cases of diarrhoea in the establishment; therefore, the disease originated in the house. Case No. 122. I Oct. 20th— See the B, G. W. R, 20th Oct. 1855. I George in the East, at 16, St. George's Court, a dock bourer, aged forty- nine, died on the 13th Oct., diarrhoea, eight hours ; Asiatic cholera, thirty-six hours. This man's widow informed me that her husband was a sober, steady man ; that he was in his usual health the day before and up to the time when the diarrhoea came on, which was towards morning. As he was in no pain he did not, for the first few hours, pay much attention to this diarrhoea ; but as soon as he began to vomit and to have spasms, a medical Rntleman was called in, who pronounced it to be attack of cholera. He died in about six-andthirty hours after the vomiting and spasms set in. His widow is not aware that he had seen any one labouring under diarrhoea or cholera. Herself and her children, and the remainder of the families in the house were, previous to, and have remained since his death, in perfect health, free from diarrhoea and Case No. 123. 104 1 i_ a. ' * ~\ * J l. TfrvT *1 1 1 * £ I have seen the medical attendant and the deputy governor. From the last I learn, that the man had been in the prison one month and five days ; that he Bs in good health when he came in, and continued 11 for about three weeks, when he was attacked with diarrhoea. From the medical attendant I learn, that this man was brought into the hospital on the 16th October labouring under diarrhoea, but not severely. Is not aware that the patient had had diarrhoea previous to the day he was sent into the hospital ; the day after his admission into the hospital he was seized with vomiting and spasms, and he gradually passed into the collapsed stage ; and he had, in fact, all the symptoms of Asiatic cholera. There have been seven cases of cholera in this prison, and this is the fourth case that has died in consequence ; but this man had no communication with the other six cases, till brought into the hospital himself, then labouring under the premonitory diarrhoea. It is evident that this man could not have been infected, either by the persons in the prison-room or from any one outside, as he was visited by no one during the time he had been in the house. His diet was, up to the time he was taken ill, the usual prison Case No. 124. Oct. 28th.— See the R. G. W. R., Nov. 3rd, 1855. In the Workhouse, Chelsea North-west, on the 28th 105 October, 1855, a widow, aged seventy-four, Asiatic cholera, thirty hours. I have been to the Workhouse, and from the master I learn, that she had been out four days before her death, and that she had partaken largely of plumpudding, which she said, disagreed with her stomach, and a bowel complaint was the consequence ; which the next day was attended with vomiting, cramps, etc. ; and then medical assistance was called, when it was discovered that she was sinking ; and she died the next day. There were a few cases of slight diarrhoea in the house previous to this case, and she herself was not quite right in her bowels when she partook of the pudding. There was not then, nor has any cholera occurred since, in the house ; and the master informs me that the medical officer cannot believe that the woman caught the disease the day she went out ; they believe that it arose from indigestion. RESULT OF AN INQUIRY \vui:nii:i: CHOLERA CAN BE CONVEYED BY HUMAN INTERCOURSE " PROM AN INFECTED TO A HEALTHY LOCALITY ; OR, FROM AN INFECTED TO A HEALTHY PERSON : THAT IS, IS CHOLERA A CONTAGIOUS DISEASE ? Bt DAVID MACLOUGHLIN, M.D., MEMBER OF THE LEGION OP HONOUR. LONDON: J. CHURCHILL, .NEW BURLINGTON STREET. MDCCCLVI.