/ r# BEPORT ON CHOLERA. 83 SPECIAL EEPOET ON CHOLERA, Gentlemen, It is now matter of history, that Asiatic cholera, which had for some time been threatening us, appeared in London in the early part of last July, and prevailed in London in an epidemic form from that time until the latter part of November. The gradual convergence of this disease from variouv parts of the continent towards this country, during the earlier part of the year 1865, and especially its appearance in the autumn of that year in Southampton and the neighbourhood, followed by a small but pecularly intense outbreak in the vicinity of the metropolis itself, rendered it exceedingly probable that, even if we escaped a visitation of the disease in 1865, we should still experience one in the course of the year immediately following. In the winter of 1865-66, cholera appeared to have entirely disappeared from this country ; but its poison had been introduced into it, and might still be here, though in a quiescent condition ; further, the disease still prevailed on the continent, and still threatened us from all sides. Early in the year 1866, it was again introduced into Hfl£47 i f 84 England. It was brought by emigrants (en route from Germany to America) into Liverpool, and by shipping into Southampton, Llanelly, and other seaport towns. The details of these and other cases it is not my purpose now to discuss : but the successive outbreaks of cholera *n various seaport towns, rendered it more and more probable that London (also a seaport town) would not long escape. I think it may be certainly said that, with the exception of a few cases of persons coming from infected places abroad with the choleraic poison in their system, few if any cases of genuine epidemic cholera were met with in London in the course of the year 1865. Diarrhoea it is true was unusually fatal during the summer months, but the excess of mortality from this disease was probably due alone to the excessive heat of the season. During the first 6 months too of the year 1866, there was nothing whatever in the mortuary returns of the metropolis, to create alarm In June, indeed, diarrhoea was far less fatal than it had been in the June of 1865, and deaths ascribed to cholera were also less numerous by nearly one-half. In the week ending July 7th, 14 deaths from cholera and choleraic diarrhoea were registered ; but that number was scarcely ominous. In the corresponding week of the previous year 12 choleraic deaths had been registered. From this week however to that ending August 4th, cholera increased with terrible rapidity ; the deaths from cholera in the 5 weeks embraced within this period 85 being successively 14, 32, 346, 904, and 1053. The epidemic had then attained its height; and during the next 5 weeks it diminished almost as remarkably as it had previously increased ; the weekly deaths from it being consecutively 781, 455, 265, 198, 1.57. During the next 7 weeks (including the last 3 weeks of September, and the 4 weeks of October) the mortality from cholera presented but little weekly variation, the deaths for each successive week being respectively 182, 150, 177, 182, 207, 144, and 112. In the course of November the epidemic gradually left us; during the four weeks terminating within this month the deaths fell from 73 to 67, from 67 to 82, and from 82 to 8. A few cholera-deaths were still registered throughout December; but the numbers were so trifling as to render it extremely doubtful whether any of them were dependent on the influence of the true choleraic poison. Altogether 5563 persons died of cholera in London, from the commencemeut of June until the end of December. During the same period 2861 persons were cut off by diarrhoea. (See Tables I. and II.) The late epidemic pressed with very different degrees of severity on the different parts of the metropolis. Indeed, it can only be said to have been really severe in the Eastern districts In them it originated as an epidemic disease, and it attained in them gigantic proportions, while there was still but little of it elsewhere in London ; of the total number of cholera deaths given above, no less than 3925 occurred in this section of the metropolis. Indeed 86 had it not been for the remarkable outburst of the disease in these districts, lasting with intensity for a period of 5 or 6 weeks, the weekly mortality in London from cholera would scarcely in any week of the epidemic have exceeded 200, and would in most weeks have been considerably less. (See Tables I. and II.) The deaths from cholera and from diarrhoea, from the beginning of June until the end of December, in the several groups of districts into which London is divided, •were as follows :— - Cholera Diar. Total. ?West (with a population estimated at 511258) 187 404 591 North ( » . « 686021) 413 579 992 Central ( „ « 359219) 328 390 718 » East ( v « « 607945) 3925 861 4786 a South ( „ • « 873548) I 710 I 627 I 1337 It will be seen from this table, that more persons died from cholera in the Southern districts, than died in any other of the groups of districts, with the exception of the Eastern; but the mortality of the Southern districts in proportion to population was less than that of the Central districts, and not much in excess of that of the Northern. The cholera death-rate however for South London would have been considerably less, had the Greenwich district (including Greenwich, Deptford and Woolwich) been excluded from computation ; for in this district no less than 282 deaths from cholera occur- * The estimates of population, which are for the middle o.f 1866, are taken from the Registrar General's returns. 87 red, leaving for the rest of the Southern districts a total cholera-mortality of 428 only. The following is a list of the Southern districts of London, with their respective total choleraic and diarrhoeal mortalities. TdHmatad Proportion of PonuSn Deaths Deaths combined inmWdleof from from Total - Deaths in # In 7««ft Cholera. Diarrhoea 10.000 IBdo# Population. St. Saviour's 36422 31 37 68 18.7 St. Olave's 18914 20 17 37 19.6 Bermondsey 64310 33 75 108 16.8 St. George* 57498 38 39 77 13.4 Nawington 92680 26 45 71 1.1 Lambeth 174904 113 158 271 15.5 Waruisworth 82979 40 59 99 11.9 Camberwell 81818 46 54 100 12.2 Rotherhithe 28767 26 13 39 13.6 Greenwich 144836 282 91 373 25.7 Lawisham 90420 55 34 89 9.8 The above figures shew that while, as regards mortality from cholera, Newington holds very decidedly the lowest place, and Greenwich even more decidedly the highest * The estimates of population, which are for the middle of 1866, are taken from the Registrar General's returns, 88 place, Camberwell, occupies an intermediate, but comparatively low, position. The same holds good of the combined mortality from cholera and diarrhoea. The first fatal case of cholera in the Parish of Camberwell occurred on the 13th July, at 60, Waterloo Street. This was in the week ending Saturday, July 14th, when the number of cholera-deaths in London amounted to 32. In the next week (that ending July 21st) 7 deaths were ascribed to cholera in Camberwell. This was the week in which the cholera-mortality in London amounted to 346. In the week ending July 28th, the deaths from cholera in Camberwell, were 9 in .number. During the same week there were 904 cholera-deaths registered in the whole of London. In the next week, during which^cholera attained its height in London, there were only 3 deaths from this disease in our Parish. And in the next 3 weeks severally one only. In the week ending September the Ist, there were 5 deaths from cholera; in that ending September Bth, 4 ; in that ending September, 15th, 4 ; in that ending September 29th, 2 ; in that ending October 6th, 3 ; in that ending October 13th, 1 ; in that ending November 3rd, 1 ; in that ending November 10th, 2 ; and in that ending November 17th, 1. Since which time there have been no deaths from cholera. (See Tables 111 and IV. It is not presented that the above enumeration represents all the cases of cholera which ocourred in the Parish ; but it is as accurate a list as possible of all the cases that proved fatal. Yet even in this sense it must not be taken 89 as expressing the exact truth ; for on the one hand it includes all cases returned as English cholera, summer cholera, and choleraic diarrhoea, which may or may not have been cases of the epidemic disease ; while on the other hand it is by no means improbable that some of the deaths ascribed to diarrhoea may have been really due to the influence of the choleraic poison. This consideration is not altogether unimportant, for I have reason to believe that some of the comparatively numerous deaths ascribed to cholera in our parish, during the earlier weeks of the epidemic, were not really due to epidemic cholera. Of most of the cases which occurred prior to the 28th July, and of a few that occurred subsequently to this date, I heard nothing until I received information through the Registrar General's returns. And in consequence of this want of information, most of the early cases were insufficiently investigated, and little was done to arrest the spread of disease from them. Most of the cases which occurred in this Parish were more or less isolated cases with little or no disposition to spread. (See Table VIII.) But there were also several groups of cases, which in a medical point of view were highly interesting and significant. The first of these groups occurred in the family of a fishmonger, living at 1 75, Camberwell Road. In this case, 3 children died of cholera, 2 on the 14th, and 1 on the 21st July. The premises had been kept, we were told, in an uncleanly state : but when they were inspected, they were perfectly clean, and their drainage and water supply were in 90 proper condition. The second group occurred at No. 6, Charles Street, Melon Ground. Here a baker, his wife and child, died of cholera on the 23rd, 25th and 27th July respectively. In this case the premises were not drained, the portion of the Parish in which they are situated not being at that time sewered ; water however was supplied by one of the water companies. The third group of cases was that which occurred in Stockwell Street. The first case of this series was that of a boy who died on the 16th August, at 9, Little Stockwell Street. The second fatal case (that of a garden labourer, aged 31) occurred at 10, Stockwell Street, on the 24th. On the 26th and 27th respectively a woman and her child (who had removed since the 24th from No. 10) died at 14, Stockwell Street ; and on the 30th, another death took place at No 10. On the 29th and 31st respectively, 2 deaths took place at 9, Stockwell Street. On September sth, a woman died at 2, Little Stockwell Street ; on the Bth, a child died at 7, Stockwell Street ; and on the same day, one at No 9 ; lastly, on the 18th, a woman died at No. 2. Stockwell Street comprises about 40 four-roomed houses, occupied and for the most part over-crowded, by Irish labourers and their families. The houses were generally in bad sanitary condition, but they were all more or less perfectly drained, and were all supplied with water from the Kent Water Works. It will be observed that the disease, and the mortality which it occasioned, were limited almost exclusively to the occupants of some 3 or 4 houses^ The fourth group occurred at Foster's Buildings, Neate 91 Street. There had been several cases of diarrhoea (of which one had proved fatal) in this locality; and on the Ist and 7th November respectively, two children of one family died of cholera at No. 6. The houses in Foster's Buildings had water laid on, were well drained, and in fair sanitary condition. The fifth group was that of whioh one case only appears in our own returns. It occurred at 5, Oxford Terrace, Lyndhurst Road, in a house perfectly well drained, and supplied with water, situated in a salubrious part of the Parish, and in the neighbourhood of which there had not been any previous appearance of cholera. On the morning of the 12th November, a baby which had been ailing with diarrhoea was found dead in its bed. It had died of cholera. During the next 2 or 3 days the mother and 2 of her children were attacked with the same disease, and removed to Guy's Hospital, where on the 17th and 18th November they all died. Four surviving children were, on the 15th, removed to the Workhouse, where in the course of a day or two, 2 were seized with symptoms of cholera, from which however they recovered. Of the total number of cholera-deaths registered in Camberwell, 11 occurred in the Camberwell sub-district, 15 in that of St. George's, and 20 in that of Peckham. Dulwich escaped. I may add that of 54 fatal cases of diarrhoea, 8 were returned from Camberwell, 22 from St. George's, and 24 from Peckham. (See Tables 111. and IV) In my report to the Vestry on the 6th of June, in anticipation of the advent of cholera, I recommended that an additional inspector should be temporarily appointed. 92 This recommendation was adopted, and the appointment of Mr. Cooper to the post was confirmed at the ensuing vestry meeting. On Saturday, the 21st July, the Privy Council, in virtue of the powers vested in them by the sth clause of the Diseases' Prevention Act, 1855, issued directions to the Vestries and Boards of the Metropolis. The fact that the order in council had been issued was first made known to the Vestry and to myself by means of the daily papers early in the following week; but already I had, after consultation with the Vestry Clerk, got a Special Meeting of the Sewers and Sanitary Committee called for the evening of the 27th. The order in council was fully discussed at that meeting, and a scheme of action, in accordance with the directions contained in that order, was drawn up to be presented to a Special Meeting of the Vestry, convened for the purpose of considering it on the 31st. At this meeting it was determined, with the object of carrying out the order in council: — first, that a printed bill, giving brief hygienic directions with regard to cholera and diarrhoea, should be extensively circulated : — 2nd, that a circular letter (together with a sufficient number of printed forms and stamped envelopes) which had already been prepared, should be sent to all the Medical Practitioners living in the Parish, requesting them to give daily information in regard to the occurrence of cholera and of diarrhoea : 3rd, that the vestrymen of each ward should act as a committee for their own ward, in order to 93 carry out therein the sanitary requirements of the order in council. The Vestry thus divided itself into 6 wardcommittees. On the 2nd and 3rd August these committees met at the Vestry Hall, and arranged as far as possible their plans of action. The committees decided to meet as often as circumstanoes might require, to take upon themselves for the time being the supervision of all the sanitary work of their respective districts, and to have their head quarters at conveniently situated places, at each of which a special complaint book was to be kept. No. 1 Committee met at the National Schools, New Church Road. No. 2 n m the British Schools, at the rear of Oakley Terrace, Old Kent Road. No. 3 h n the Vestry Hall. No. 4 « h the Infant Schools, Arthur Street, Old Kent Road, No. 5 ii i> the British Schools, High Street, Peckham. No. 6 /; n the Vestry Hall. Either at these preliminary meetings, or very shortly afterwards, the ward-committees nominated gentlemen to act, if they should be called upon to do so, as Medical Visitors within their respective wards. The gentlemen thus nominated were : — for No. 1 ward, Mr. Hague : for No. 2, ward, Dr. Johnson : for No. 3 ward, Mr. F. Chabdt : for No. 4 ward, Dr. Simpson : for No. 5 ward, Dr. Blomfield and Mr. Philp : and for No. 6 ward, Dr. Pinder, Dr. Sinclair, and Dr. Ray. It was determined that their being called upon to act in each ward should depend on the character of the daily returns of health for that ward. Each wardcommittee 94 also entered into arrangements with certain gentlemen having surgeries, to provide at their surgeries cholera-medicines and disinfectants, to be dispensed gratuitously night and day to all applicants. For the most part the gentlemen nominated to act as visitors, were appointed also to provide medicines, &c. gratuitously j an exception being made in the case of Dr. Johnson, whose surgery was not within the district for which he had been nominated visitor. Mr. Baker's shop was therefore selected for the purpose in place of Dr. Johnson's surgery. As soon as the latter appointments had been accepted, printed bills were extensively circulated and posted stating where and on what terms astringent medicines and disinfectants were to be obtained. And these dispensaries were kept open for a period of 10 weeks, which expired on the 23rd October. It should be added that several of the gentlemen, who kept these open dispensaries, attended also chjlera and diarrhoeal patients who applied to them in virtue of their appointment, and that for this extra work extra remuneration was subsequently accorded to them. The scale of remuneration which was adopted, was as follows: — for Medical Visitor, ,£1 Is. per diem; for Assistant Medical Visitor, 10s. 6d. per diem ; for keeping open dispensary, a retaining fee of £1 Is. per week, with payment for medicine supplied at the rate of from 10s. to 12s. per dozen bottles. It was not considered necessary to appoint Medical Visitors, excepting in one ward. It is true that early in the epidemic the number of cholera-deaths registered was 95 sufficiently large to excite the fear that an epidemic of the disease was impending over the Parish But this period had already elapsed before the Vestry Meeting (convened in obedience to the directions of the order in council) had taken place And indeed by the time the committees had assumed active duties, the daily returns of cholera and diarrhoea shewed clearly that there was little diarrhoea and less cholera in any part of the Parish ; and the visits of the Inspectors of Nuisances had proved that, even in the localities in which deaths from cholera had occurred, there was no tendency to spread of disease. The outbreak of cholera in Stockwell Street rendered it necessary to request Dr. Simpson, who had already been nominated, to assume active duties as Medica Visitor for No. 4 ward. His services commenced on August 16th, before the disease had become epidemic in the Street, and were continued until October Bth, a considerable time after the epidemio had disappeared. Further, since, while cholera was prevailing in Stockwell Street, 2 or 3 other isolated cases of the disease appeared in some of the lower neighbourhoods of the same ward, an assistant visitor was appointed whose services were continued for a period of three weeks. Shortly after the formation of the committees, the committee of No. 5 Ward appointed (as all the committees had been empowered to do by the Vestry) a special inspector for the sanitary purposes of their own ward. There were thus from the 13th August four Inspectors of Nuisances, 96 whose duties were thus divided: — one acted for N0. 5 ward, one forwards No. 2 and No. 4, one for wards No. 1 and No 6, and one for ward No. 3. The time of the Inspectors was chiefly employed in making house to house inspections, and in seeing that the works ordered to be done in consequence of their reports were efficiently carried out. But they had also much work of another kind to perform. They saw to the disinfection of premises in which cholera had occurred ; in fact such disinfection, together with the destruction of soiled bedding and articles of dress, and in many cases the removal and arrangements for the burial of dead bodies, were effected under their supervision. I should add that the services of four Inspectors have been retained for at least another twelve months. With regard to the measures taken to relieve the sick and the families of the sick, and to prevent the spread of disease, I may state :— lst. that in all our efforts we were warmly seconded and assisted by the Board of Guardians and their employes : — 2nd. that in all cases (with the exception of several that occurred during the first two weeks of the epidemic, and a few exceptional ones at a later period) the houses in which deaths from cholera had occurred were disinfected, and the soiled bedding, &c, were burnt, and promptly replaced, or the value of them paid to the survivors ; and that in all cases also in which it came to our knowledge that non-fatal cases of cholera had occurred, similar measures were adopted: — 3rd. that nourishment, stimulants and other assistance were freely afforded, in many cases not only to the sick but also to the healthy who were living with the sick, and that in one 97 or two cases nurses were supplied. I may state, in the 4th. place, that one of our earliest efforts was to obtain the use of a suitable building in a central part of the Parish for a Cholera Hospital. There were many difficulties in our way ; but at length we found two buildings that might have been available ; and I believe that had the necessity arisen we should certainly have obtained permission to use one of them. When however the local epidemic broke out in Stockwell Street, a street which lies at the very border of our Parish, we were anxious to acquire, in the immediate neighbourhood of that Street, a house into which the living might be removed from the infected houses, and a second house which might be used as a small Hospital. But we were unable to obtain one for either purpose. Subsequently a small building connected with a factory was fitted up as a Hospital for 2 or 3 patients; and a railway arch was boarded up and converted into a comfortable habitation capable of holding several families. The former building was never called into use; and into the latter there was some difficulty in persuading the inmates of the infected houses to take up their abode for even a short space of time. When however the last death from cholera took place in Stockwell Street, all the remaining inmates of the infected house were removed there, and (I believe in consequence of their removal) no further case of cholera occurred among them. The returns of cholera and diarrhoea, before referred to, were sent daily to the Vestry Hall by many of the Medical Men of the Parish. And it is right to add that 98 they proved exceedingly valuable, both in pointing out where cholera had made its appearance, and in convincing us that throughout the whole period of the prevalence of cholera, there was never anything that could be regarded as an epidemic of diarrhoea. There were only two or three gentlemen's returns indeed which afforded any evidence at all of unusual prevalence of diarrhoea; and these were returns from practitioners who were either Parish Surgeons, or whose Surgeries were advertised for the gratuitous distribution of medicines, or who served at the same time in both of those capacities, and who therefore especially had those additional cases to deal with, in which the dread of cholera had rendered persons attentive to slight diarrhceal affections which at other times would have been regarded as wholly unimportant. It is impossible not to compare the late epidemic of cholera in London with former epidemics, and to speculate on the causes which have rendered it so much less fatal than they were, and which have so much modified the distribution of its fatal outbreaks. It has always happened heretofore, as regards London, that on each occasion when cholera has appeared, there have been two outbreaks occurring in two successive years : of which the first outbreak in the epidemic of 1832-33, the last outbreak in the epidemics of 1848-49 and 1853-54 were the most severe. It has been considered therefore 99 by many, that this reduplication of the outbreak is a kind of law of the disease, and that hence the same phenomenon will mark the late epidemic, and a recurrence of the outbreak is to be looked for during the present year. There is however no reason that I know of, beyond that derived from our own limited metropolitan experience, why an epidemic of cholera should prevail intermittingly over a period of two years, rather than why it should prevail over a period of one year only, or over a period of three or even four years; and, indeed, in other European countries and capitals, the disease has presented all the above varieties of duration. While therefore I think it quite possible that we may have a renewal of the epidemic this Summer, I think it by no means improbable that we shall escape. Taking the past year as the equivalent of that year of each of the former epidemics in which the disease was most fatal, it will be seen that the epidemic of last year was much less severe than any which has preceded it. (See Tables V., VI. and VII.) The actual number of fatal cases of cholera recorded in 1832, was, it is true, less by some 300 than the number of such cases recorded last year ; but that smaller number was furnished by a very much smaller population, and represents in reality a far heavier mortuary rate. In 1849 and 1854 the mortality was not only relatively but actually much greater than that of 1866. But further, not only was the relative mortality frem cholera less in 1 866 than in former years, but the cholera field (to use the Registrar Geneial's 100 expression) had changed. In all former epidemics the South of the metropolis had suffered with disproportionate severity ; in this, the Southern districts, with the exception of Greenwich, suffered very slightly; while the Eastern districts alone seemed exposed to the full violence of the epidemic, and experienced a far heavier visitation of the disease than they had ever previously known. How are these phenomena to be explained ? The natural response to this question would doubtless be, that the important sanitary works, which have been in constant progress throughout the metropolis since the beginning of 1856, have placed the metropolis in a better condition generally to repel the attacks of epidemics, and that the machinery of the metropolitan vestries is more successful than that of former bodies in dealing with these epidemics when they do appear among us. But before a perfectly satisfactory answer can be given to this question, the mode in which the cholera poison is conveyed from the sick to the healthy, so as to impart the disease to the healthy, must be understood. This is not the place to discuss the various theories which have been entertained with regard to the propagation of cholera » but I may call your attention briefly to certain views on this subject which are gaining ground amongst well-informed Physicians, and in which I am disposed to concur. Observations made during the epidemic of 1854, which were referred to by me in my first annual report, tended to shew that cholera is in a very large degree dependent on the use of water impregnated with sewage j a series of very 101 interesting investigations proved that the distribution of cholera in the South of London particularly was, in a very unmistakable manner, coincident with the distribution by the water companies of highly impure water, and that a very remarkable outbreak of cholera in the neighbourhood of Golden Square was almost entirely dependent on the use of the impure-water of a highly esteemed pump — the Broad Street Pump. Again, it is a very remarkable fact, to which the Registrar General has called special attention, that the outbreak in the East of London, which alone gave to the prevalence of Cholera in London last year the dignity of an epidemic, coincided as nearly as possible with the area supplied by the East London Water Company, and as nearly as can now be ascertained with a time at which that Company improperly distributed water derived from an impure and sewage-infected source. Further, investigations (aided by experiments on some of the lower animals) which were made originally in Germany, and were during the late epidemic repeated and extended in this metropolis, seem to shew almost conclusively that the poison which causes the spread of cholera is contained in the evacuations discharged from the bowels of cholera patients, and that this (little if at all active at the moment when the evacuations are discharged) soon assumes so marvellous a degree of virulence that mere traces of it, mixed with large volumes of water, are capable of rendering that water choler-ific in a very high degree ; these investigations seem also to confirm, what had already been suspected by many Physicians, that the infection of cholera is not, like that of typhus and many of the typioal forms of infectious 102 diseases, conveyed by the atmosphere and inhaled into the lungs, but is conveyed by the food and taken into the stomach, upon which and on the bowels it acts as a violent poison. If these views be correct it is easy to understand many facts about cholera, which have hitherto seemed anomalous and inexplicable ; it is easy to understand how it is that Physicians and nurses, and others in attendance on cholera-patients, in cleanly Hospitals, houses and other institutions, so constantly escape the disease, although constantly inhaling their breath- and other exhalations : it is easy to understand how, from the accidental admixture of cholera-poison with their water, the disease may be limited to the area which a single Water Company supplies ; it is easy to understand how by means of a single pump, which has become by chance infected, an outbreak limited to a house or two only may occur ; it is easy to understand how in houses which are overcrowded and uncleanly and among uncleanly persons, especially therefore among the poor, the evacuations from a single case of cholera which has occurred among them may poison their pots and their pans, their persons and their clothes, may thus become mixed with their water and their food, and keep up among them such a continuance of the disease as was experienced in Stockwell Street. Again, if these views be correct, it shews us that the main reasons why cholera proved so much less serious last year then on former occasions, especially why it proved so much less serious amongst us on the South of the River, 103 are that our Water Companies derive their water now from a much purer source than they formerly did, from a source infinitely less liable to contain the germs of cholera j and that our sewage, into which the cholera poison of our cholera patients is chiefly thrown, is now carried for the most part to a distance from London, and in a far less degree than formerly is allowed to stagnate in our cesspools and to percolate into our wells. I cannot however doubt that the close attention which was paid in our own Parish and elsewhere in London to all the cases of cholera which came to our knowledge, which enabled us to disinfect evacuations, and to disinfect or destroy articles impregnated with them, and to advise with those who were chiefly exposed to danger, had a very important influence in preventing the spread of the disease. In conclusion, I should fail I think in my duty if I (who perhaps more than any one else have been in the position to judge of the matter) were not to bear testimony, first, to the admirable way in which the members of the ward-committees performed the important and laborious duties which they had undertaken ; second, to the uniform zeal and efficiency displayed by your Inspectors of Nuisances (both the old Inspectors and those more recently appointed) during the whole period of th© prevalence of cholera ; and lastly, to the valuable assistance so kindly given by the medical practitioners named in the body of this report, I remain, Gentlemen, Your obedient Servant, JOHN S. BRISTOWE, M.D. January, 1867 eeks of 1866. »er. 38 39 40 119 8 19 11 8 17 17 18 24 18 17 27 12 18 98 67 69 eeks of 1866 39 40 12 16 2 36 37 I 28 31 • 55 50 ( 40 48 p 177 IS2 2 * Table I. Diarrhoea in London in the last 31 weeks of 1866. June. July. August September. October. November. December. Total Number of Week. . 22 23 34 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 West Districts 2 7 5 10 11 16 18 37 48 46 31 28 15 12 18 14 11 9 8 8 6 3 4 7 3 6 7 0 3 5 6 404 North Districts .. 5 6 1 6 20 23 37 54 78 79 51 40 21 24 19 11 19 11 8 3 13 8 5 5 9 5 5 4 5 3 1 579 Central Districts .. 5 14 6 5 18 28 31 44 42 31 22 13 18 14 15 17 17 18 5 8 4 5 3 2 3 12 6 2 0 390 East Districts 4 5 6 14 14 26 37 60 123 125 101 63 41 43 44 35 24 18 17 17 11 7 7 7 3 2 0 3 3 1 0 861 South Districts 3 3 4 7 17 19 30 39 56 62 50 41 39 31 37 35 27 12 18 14 17 10 7 11 5 10 2 18 5 7 627 London.. 19 22' 20 43 67 102 150 221 349 354 264 194 129 128 132 liO 98 67 69 47 55 32 28 33 22 26 15 10 25 16 14 2861 Table 11. Cholera in London in the last 31 Weeks of 1866. Number of Week, . 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 3S 39 40 41 *42 48 44 45 46 47 48 49 50 51 52 West Districts 0 2 0 0 2 3 2 11 12 12 8 7 3 & 12 10 14 12 16 30 13 8 3 10 0 0 0.000 187 North Districts ?0100114 6 20 46 38 15 12 15 20 27 28 36 37 38 35 14 871110010 413 Central Districts .. 0 0 0 0 0 13 1 15 32 22 16 13 9 12 20 19 28 31 39 27 14 11 10 5 0 0 0 0 0 0 328 East Districts 1 0 2 0 3 5 20 308 818 916 674 369 198 122 74 77 56 55 50 65 34 26 13 16 14 3 2 1 t 1 1 3925 South Districts 1 0 1 1 0 4 3 20 39 47 39 48 39 46 39 48 33 40 48 35 35 50 38 33 12 4 0 0 1 0 0 710 London.. 2 3 3 1 6 14 32 346 904 1053 781 455 265 198 157 182 151) 177 Ib 2 207 144 112 73 67 32 8 3 1 2 2 1 5563 Table 111. Diarrhoea in Canaberwell in the last 31 weeks of 18(56. June. July. August. September. October. November. December. Total - - — ' — I Number of Week 22 23 24 25 26 27 28 29 SO 31 33 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Dulwiehoooooooooooooooo 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 Camberwell (Sub-district) 00001 0023 1000 00010 0000 0000 00000 Peckham 00000 1312 3 102 12110 1000 0100 01111 24 St.George's 01011 1124 1013 01200 1001 1 0 0 0 0 0 0 0 0 22 Camberwell 0 1012 2459 5 115 13320 2001 1100 01 111 54 Table IV. Cholera in Camberwell in the last 31 weeks of 1866. Number of Week 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Dulwieh 00000 0 0 0 0 0000 00000 0000 0000 00000 0 Camberwell (Sub-district) 00000 0 132 2000 00 100 0000 01 10 00000 11 Peckhamoooooooo4oolls43 0 0 I 1 n 0 0 0 0 0 0 0 0 0 0 20 StGeorge's 0 0 0 0 0 0 0 4 3 1 1 0 0 0 0 0 0 2 2 0 0 0 i 1 00 0 0 0 0 0 15 Camberwell 00000 0179 3111 54402 3100 121 0| 00000 46 Table V. Diarrhoea in London in last 3 1 weeks of the following years of Cholera-epidemics. June. July. August. September. October. November. December. Number of Week 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 48 47 48 49 50 51 52 1848 15 17 21 35 42 57 64 94 173 141 110 81 63 79 61 42 46 44 47 37 23 38 38 26 26 27 24 20 24 15 30 1849 16 20 36 17 30 46 89 131 224 179 173 188 240 234 272 280 238 163 135 91 51 42 31 25 21 16 17 17 14 13 9 1853 21 23 24 33 28 34 54 73 81 110 139 126 137 152 131 78 89 69 71 51 45 41 38 45 36 30 30 31 34 27 18 1854 22 3! 31 38 25 32 46 58 84 142 195 192 214 243 276 232 190 165 98 102 78 46 33 35 31 21 19 19 25 20 16 1865 38 44 93 187 184 301 267 280 252 207 201 116 115 89 90 85 83 92 81 51 62 48 61 37 32 28 24 17 27 17 12 1866 19 22 20 43 67 102 150 221 349 354 264 194 129 128 132 110 98 67 69 47 55 32 28 33 22 26 15 10 25 16 14 Table VI. Cholera in London in last 31 weeks of the following years of Cholera-epidemics. Number of Week. 22 23 24 25 26 27 28 29 30 31 32 33 84 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 &2 1848. 12 5 0 3 7 9 21 26 21 19 17 7 7 7 6 7 4 13 30 45 34 65 62 54 34 20 21 29 31 30 1849 9 22 42 49 124 152 339 678 783 926 823 1230 1272 1663 2026 1682 839 434 288 110 41 25 11 6 8 2 1 0 1 1 0 1853 10 0 3 0 0 3 6 9 4 19 10 18 16 7 16 29 48 66 45 83 96 102 98 72 46 46 28 13 11 10 1854. 2 1110 1 5 26 133 399 644 729 847 1287 2050 1549 1284 754 411 249 163 66 31 23 12 8 7 5 2 3 2 1865 1 1 3 11 11 12 11 18 23 19 11 12 6 4 9 4 3 4 5 2 4 4 2 2 0 0 2 0 0 0 1 1866 2 3 3 1 6 14 32 346 904 1053 781 455 265 198 157 182 150 177 182 207 144 112 73 67 32 8 3 1 2 1 TABLE VII. Cholera in London, in its 5 Groups of Districts, and in Camberwell, in the Cholera-Epidemic years 1832-3, 1849, 1854 and 1866. Dulwich. gXp^teict. Peckham. St. George's. CamberwelL WertDirt. North. Central. East. South. London. •1832-3.. ? P ? P 107 848 632 1140 1720 2196 6536 1 1849.... 1 235 176 92 504 1223 956 1724 3097 7137 14137 1 1854.... 0 245 133 175 553 2051 779 644 1509 5755 10738 1 1866.... 0 11 20 46 188 417 329 3931 712 5577 1 *Notb. — The figures in this line are derived from Mr. Grainger's Report to the General Board of Health, on the epidemic Cholera of 1848 and 1849. The returns for the epidemic of 1832-33 are neither accurate nor consistent. It would seem that the total number of Cholera-deaths during the two years was 6729, of which 5272 occurred in 1832, and 1454 in 1833. 124 TABLE VIII FATAL CHOLERA-CASES IN CAMBERWELL, Registered in week ending: July 7th. . . . Nil. July 14th .. 60, Waterloo Street, July 13th, a Carrier, aged 47 years, " Cholera (18 hours)" Julj 21st .. 25, Providence Place, Wyndham Road, July 13th, Widow of Brewer's Servant, aged 72 years, " Summer Cholera or Diarrhoea (12 hours)" 269, Camberwell New Road, July 19th, a Freeholder, aged 74 years, " English Cholera (exhaustion) (27 hours)" 32, New Church Road, July 20th, Son of Carpenter, aged. 5 years " Cholera, (jlO hours)" 151, Camberwell Road, July 14th, Widow of Cabinetmaker, aged 76 years, " Cholera (25 hoars)" 175, Camberwell Road, July 14th, Son of Fishmonger, aged 2£ years, "Cholera (36 hours)" 175, Camberwell Road, July 14th, Daughter of Fishmonger, aged 7 years, " Cholera (10 hours)" 2, Victoria Place, Old Kent Road, July 18th, Son of Labourer, aged 1 year, "Choleraic Diarrhoea" July 28th .. 10, Champion Terrace, Grove Lane, July 25th, Wife of Builder, aged 55 years, "Malignant Cholera (43 hours)" Hanover House, Brunswick Road, July 28th, Commercial Clerk, aged 26 years " Cholera (11$ hours)" 6, Charles Street, Peckham, July 23rd, Son of Baker, aged 11 years, "Cholera." 6, Charles Street, Peckham, July 25th, Wife of Baker aged 47 years, " Cholera." 6, Charles Street, Peckham, July 27th, Baker, aged 48 years, " Cholera" p 125 July 28th .. 6, Acorn Terrace, Meeting-house Lane, July 26th, Son of Coffee-house Keeper, aged 4 months, " Choleraic- Diarrhoea*' 175, Camberwell Road, July 21st, Daughter of Fishmonger, aged 6 years ** Cholera (24 hours) secondary Fever (8 days)" 3, Thomas Street, Wyndham Road, July 22nd, Son of Bricklayer's Labourer, aged 5 months, " Choleraic Diarrhoea and vomiting (8 days) collapse (3 days)" ? 14a, John Street, Albany Road, July 27th, Wife of Grocer, aged 66 years, "Diarrhoea (1 day) Cholera Asiatics (2 days)" August 4th 8, York Place, Denmark Street, July 20th, Wife of Mercantile Clerk, aged 55 years, "Cholera (30 hours)" 2, Little Queen Street, August 3rd, Son of General Labourer, 7 years, "Spasmodic Cholera (12 hours)" 51, Neate Street, August 3rd, Copper- plate Printer, 27 years, "Diarrhoea (2 days) Cholera Maligna (12 hours)" August 11th.. l t Nelson Street, Wyndham Road, August Bth, Female 6 months, "Choleraic Diarrhoea" August 18th.. 9, Little Stockwell Street, Old Kent Road, August 16th, Son of Railway-coach-maker, 6 years, " Cholera (8 hours)" August 25th . 10, Stockwell Street, Old Kent Road. August 24th, Gardenlabourer, 31 years, "Cholera (39 hours)" Sept. 15t. ... 14, Stockwell Street, Old Kent Road, August 26th, Wife of Garden-labourer, 30 years, " Malignant Cholera 1 ' 14, Stockwell Street, Old Kent Road, August 27th, Daughter of Labourer, 11 weeks, "Cholera (1(3 hours)" 9, Stockwell Street, Old Kent Road, August 29th, Female, 6 months, "Cholera (36 hours)" 10, Stockwell Street, Old Kent Road, August 30th, Son of Garden-labourer, 7 years, " Cholera (48 hours)" 9, Stockwell Street, Old Kent Road, August 31st, Brick, layer 'B Labourer, 35 years, •' Cholera (14 hours)" Sept. Bth . . jo, Alpha Street, September 3rd, Bricklayer's Labourer, 24 years, "Cholera (24 hours)" 2, Little Stockwell Street, Old Kent Road, September sth, Wife of Engineer's Labourer, 44 years, "Cholera (3 days)" 126 Sept. 8th .... 9, Grove Place, Bell-garden Road, September 6th, Navvy, 22 years, "Cholera (60 hours)" 7, Stockwell Street, Old Kent Road, September Bth, Son of Navvy, 3 months, " Cholera" Sept. 15th . . 3, Christiana Place, Victoria Road, September 12th, Wife of Plumber, 62 years, " Cholera" 9, Stockwell Street, Old Kent Road, September Bth, Daughter of Labourer, 10 yean, " Cholera (4 days) 1 ' Amwell Cottage, Park Road, September 9th, Son of Merchant, 8 years, " Derangement of Liver, terminating in Cholera (5 days)" 2, Rtockwell Street, Old Kent Road, September 15th, Widow of Labourer, 40 years " Cholera (II hours)" Sept. 22nd .. jyj/ # Sept.. 29th . . 5, Southampton Street, September 21st, Wife, of Fundholder, 74 years, " Choleraic Diarrhoea (6 days)" 119, New Church Road, September 23rd, Dock-clerk, 26 years, " Cholera (8 hours) Diarrhoea (3 days)" October 6th . 3f3 f pi tt street, October 2nd, Daughter of Wine-«ooper, 11 years, " Cholera (10 hours)" 11, Boy ton Place, New Church Road, September ,30th, Son of Painter and Glazier, 5 years, " Cholera (18 houre) 13, Alfred Terrace, Rotherhithe New Road, September 29th, Labourer, 57 years, " Cholera" October 13th . 2, Woodbine Cottages, Middle Street, Navvy, 25 years "Cholera" October 20th . ML October 27th . jvi/. Nov.. 3rd .. 6, Foster's Buildings, Neate Street, November Ist, Daughter of Twine-spinner, 4 years, "Cholera (IB hours)". Nov. 10th . . 16, Picton Street, November sth, Daughter of Lamplighter, 3 years, " Cholera (30 hours)" 6, Foster's Buildings, Neate Street, November 7th, Son of Twine- spinner, 10 months, " Cholera (3 days)" Nov. 17th .. 5, Oxford Terrace. Lyndhurtt Road, November 12th, Daughter of Flour-salesman, 14 months, " Choleraic Diarrhoea"