little girl, who had been labouring under diarrhœa for four days. This
case ended favourably. On the 21st July, the next day, an elderly female
was attacked with the disease, and was in a state of collapse at ten
o’clock the same night. This patient partially recovered, but died of
some consecutive affection on August 1. Mr. Vinen, of Tooley Street, who
attended these cases, states that the evacuations were passed into the
beds, and that the water in which the foul linen was washed would
inevitably be emptied into the channel mentioned above. Mr. Russell, of
Thornton Street, Horsleydown, who attended many of the subsequent cases
in the court, and who, along with another medical gentleman, was the
first to call the attention of the authorities to the state of the well,
says that such water was invariably emptied there, and the people admit
the circumstance. About a week after the above two cases commenced, a
number of patients were taken ill nearly together: four on Saturday,
July 28th, seven or eight on the 29th, and several on the day following.
The deaths in the cases that were fatal took place as follows:—one on
the 29th, four on the 30th, and one on the 31st July; two on August 1st,
and one on August the 2nd, 5th, and 10th respectively, making eleven in
all. They occurred in seven out of the fourteen small houses situated in
the court.
The two first cases on the 20th and 21st were probably caused by the
cholera evacuations contained in the Thames water, as it came from the
waterworks, and they may be considered to represent about the average
amount of cases for the neighbourhood, there having been just that
number in the adjoining court, about the same time. But in a few days,
when the dejections of these patients must have become mixed with the
water the people drank, a number of additional cases commenced nearly
together. The patients were all women and children, the men living in
the court not having been attacked; they may have been out at work all
day and not have drank the water, but as the surviving inhabitants
nearly all left the place immediately after the above mortality
occurred, I was not able to ascertain whether this was so or not.
In Albion Terrace, Wandsworth Road, there was an extraordinary mortality
from cholera in 1849, which was the more striking as there were no other
cases at the time in the immediate neighbourhood; the houses opposite
to, behind, and in the same line, at each end of those in which the
disease prevailed, having been free from it. The row of houses in which
the cholera prevailed to an extent probably at that time quite
unprecedented in this country, constituted the genteel suburban
dwellings of a number of professional and tradespeople, and are most of
them detached a few feet from each other. They were supplied with water
on the same plan. In this instance the water got contaminated by the
contents of the house-drains and cesspools. The cholera extended to
nearly all the houses in which the water was thus tainted, and to no
others.
[Sidenote: THE OUTBREAK OF CHOLERA AT ALBION TERRACE.]
These houses were numbered from 1 to 17, in Albion Terrace, and were
supplied with water from a copious spring in the road in front of the
terrace, the water of which was conducted, by a brick barrel-drain
between Nos. 7 and 8, to the back of the houses, and then flowed right
and left, to supply tanks in the ground behind each house, the tanks
being made of brickwork and cement, covered with a flat stone, and
connected with each other by stoneware pipes six inches in diameter. A
leaden pipe conveyed water from each tank to a pump situated in the back
kitchen. There was a cesspool behind each house, under the privy, and
situated four feet from the water-tank. The ground was opened behind the
houses No. 1 and No. 7, and the drains examined under the
superintendence of Mr. Grant, the Assistant-Surveyor to the
Commissioners of Sewers. The cesspools at both these places were quite
full, and the overflow-drain from that at No. 1 choked up. At this house
the respective levels of the cesspool and the water-tank were measured,
and the top of the overflow-drain from the cesspool was found to be
fifteen inches above the top of the tank, and the intervening ground was
very wet. The overflow-drain mentioned above had no bottom, or one so
soft that it could be penetrated with a stick; and it crossed, at right
angles, above the earthenware pipe of the water-tank, the joints of
which were leaky, and allowed the water to escape. Behind No. 7, Mr.
Grant found a pipe for bringing surplus water from the tanks,
communicating with a drain from the cesspool; and he found a flat brick
drain laid over the barrel-drain before mentioned, which brought the
water from the spring. It appears, from a plan of the property, that
this drain, which was continued in a direction towards the sewer in
Battersea Fields, brought surface-drainage from the road, and received
the drains from the cesspools, the house-drains from the sinks in the
back kitchens, and the surplus water, or some of it, from the tanks.
There was every reason to believe that this drain was stopped up, but
that was not ascertained: at all events it was unable to convey the
water flowing into it during the storm on July 26th, as it burst near
the house No. 8, and inundated the lower premises of that and the
adjoining house, No. 9, with fœtid water; and it was from this time that
the water, which had occasionally been complained of before, was found
by most of the people in these seventeen houses to be more or less
impure or disagreeable. The water broke out of the drain again at No. 8,
and overflowed the kitchens, during a heavy rain on August 2nd. It
should be particularly remarked, that the tanks were placed on the same
level, so that pumping from one would draw water from the others, and
that any impurity getting into one tank would consequently be imparted
to the rest.
The first case of cholera occurred at No. 13, on July 28th (two days
after the bursting of the drain), in a lady who had had premonitory
symptoms for three or four days. It was fatal in fourteen hours. There
was an accumulation of rubbish in the cellar of this house, which was
said to be offensive by the person who removed it; but the proprietor of
the house denied this. A lady at No. 8 was attacked with choleraic
diarrhœa on July 30th: she recovered. On August 1st, a lady, aged
eighty-one, at No. 6, who had had some diarrhœa eight or ten days
before, which had yielded to her own treatment, was attacked with
cholera: she died on the 4th with congested brain. Diarrhœa commenced on
August 1st in a lady aged 60, at No. 3; collapse took place on the 5th,
and death on the 6th. On August 3rd, there were three or four cases, in
different parts of the row of houses, and two of them terminated fatally
on the same day. The attacks were numerous during the following three or
four days, and after that time they diminished in number. More than half
the inhabitants of the part of the terrace in which the cholera
prevailed, were attacked with it, and upwards of half the cases were
fatal. The deaths occurred as follows; but as some of the patients
lingered a few days, and died in the consecutive fever, the deaths are
less closely grouped than the seizures. There was one death on July
28th, two on August 3rd, four on the 4th, two on the 6th, two on the
7th, four on the 8th, three on the 9th, one on the 11th, and one on the
13th. These make twenty fatal cases; and there were four or five deaths
besides amongst those who were attacked after flying from the place.
The fatal cases were distributed over ten out of the seventeen houses;
and Mr. Mimpriss of Wandsworth Road, who attended many of the cases, and
to whose kindness I am indebted for several of these particulars, stated
that cases occurred in the other seven houses, with the exception of one
or two that were empty, or nearly so. There were five deaths in the
house No. 6; and one of a gentleman the day after he left it, and went
to Hampstead Heath. The entire household, consisting of seven
individuals, had the cholera, and six of them died.
There is no data for showing how the disease was communicated to the
first patient, at No. 13, on July 28th; but it was two or three days
afterwards, when the evacuations from this patient must have entered the
drains having a communication with the water supplied to all the houses,
that other persons were attacked, and in two days more the disease
prevailed to an alarming extent.
I had an opportunity of examining some of the water removed by Mr. Grant
from the tanks behind the houses No. 1 and No. 7, and also some of the
deposit which lay in the tanks to the depth of from six to nine inches.
The water was offensive, and the deposit possessed the odour of privy
soil very distinctly. I found in it various substances which had passed
through the alimentary canal, having escaped digestion, as the stones
and husks of currants and grapes, and portions of the thin epidermis of
other fruits and vegetables.
Many of the patients attributed their illness to the water. This is here
mentioned to show that they had drank of it, and at the same time found
that it was impure. As explaining how persons might drink of such water
before finding out its impurity, it may be stated that the grosser part
of the material from drains and cesspools has a tendency, when mixed
with water, to settle rapidly to the bottom. The only houses supplied
with the same water, after passing the tanks in Albion Terrace, were
four in Albion Street; but three of these had been empty for months, and
the fourth was inhabited by a gentleman who always suspected the water,
and would not drink it. There were two or three persons attacked with
cholera amongst those who came to nurse the patients after the water was
condemned, and who, consequently, did not drink it; but these persons
were liable, in waiting on the patient, to get a small portion of the
evacuations into the stomach in the way first pointed out; and there
might be food in the houses, previously prepared with the tainted water.
It is not here implied that every one of the cases in Albion Terrace was
communicated by the water, but that far the greater portion of them
were; that, in short, it was the circumstance of the cholera evacuations
getting into the water, which caused the disease to spread so much
beyond its ordinary extent.
[Sidenote: IRRUPTIONS OF CHOLERA IN ROTHERHITHE.]
The mortality in Albion Terrace was attributed by Dr. Milroy, in a
published report to the General Board of Health, chiefly to three
causes: first, to an open sewer in Battersea Fields, which is four
hundred feet to the north of the terrace, and from which the inhabitants
perceived a disagreeable odour when the wind was in certain directions;
secondly, to a disagreeable odour from the sinks in the back kitchens of
the houses, which was worse after the storm of July 26; and lastly, to
the accumulation in the house No. 13, before alluded to. With respect to
the open sewer, there are several streets and lines of houses as much
exposed to any emanations there might be from it, as those in which the
cholera prevailed; and yet they were quite free from the malady, as were
also nineteen houses situated between the sewer and Albion Terrace. As
regards the bad smells from the sinks in the kitchen, their existence is
of such every day and almost universal prevalence, that they do not help
to explain an irruption of cholera like that under consideration;
indeed, offensive odours were created in thousands of houses in London
by the same storm of rain on July 26th; and the two houses in which the
offensive smell was greatest, viz. Nos. 8 and 9—those which were flooded
with the contents of the drain—were less severely visited with cholera
than the rest; the inhabitants having only had diarrhœa, or mild attacks
of cholera. The accumulation in the house No. 13 could not affect the
houses at a distance from it. It remains evident then, that the only
special and peculiar cause connected with the great calamity which befel
the inhabitants of these houses, was the state of the water, which was
followed by the cholera in almost every house to which it extended,
whilst all the surrounding houses were quite free from the disease.
Indeed, the General Board of Health attributed the mortality at this
place to the contamination of the water, in a manifesto which they
published not long after Dr. Milroy’s report.[6]
Dr. Lloyd mentioned some instances of the effects of impure water at the
South London Medical Society, on August 30th, 1849.[7] In Silver Street,
Rotherhithe, there were eighty cases, and thirty-eight deaths, in the
course of a fortnight early in July of that year, at a time when there
was very little cholera in any other part of Rotherhithe. The contents
of all the privies in this street ran into a drain which had once had a
communication with the Thames; and the people got their supply of water
from a well situated very near the end of the drain, with the contents
of which the water got contaminated. Dr. Lloyd informed me that the
fetid water from the drain could be seen dribbling through the side of
the well, above the surface of the water. Amongst other sanitary
measures recommended by Dr. Lloyd was the filling up of the well; and
the cholera ceased in Silver Street as soon as the people gave over
using the water. Another instance alluded to by Dr. Lloyd, was Charlotte
Place, in Rotherhithe, consisting of seven houses, the inhabitants of
which, excepting those of one house, obtained their water from a ditch
communicating with the Thames, and receiving the contents of the privies
of all the seven houses. In these houses there were twenty-five cases of
cholera, and fourteen deaths; one of the houses had a pump railed off,
to which the inhabitants of the other houses had no access, and there
was but one case in that house.
The following instance, as well as some others of a similar kind, is
related in the “Report of the General Board of Health on the Cholera of
1848 and 1849.”
“In Manchester, a sudden and violent outbreak of cholera occurred in
Hope Street, Salford. The inhabitants used water from a particular
pump-well. This well had been repaired, and a sewer which passes within
nine inches of the edge of it became accidentally stopped up, and leaked
into the well. The inhabitants of thirty houses used the water from this
well; among them there occurred nineteen cases of diarrhœa, twenty-six
cases of cholera, and twenty-five deaths. The inhabitants of sixty
houses in the same immediate neighbourhood used other water; among these
there occurred eleven cases of diarrhœa, but not a single case of
cholera, nor one death. It is remarkable, that, in this instance, out of
the twenty-six persons attacked with cholera, the whole perished except
one.”—Page 62.
[Sidenote: THE OUTBREAK OF CHOLERA AT NEWBURN, ON THE TYNE.]
Dr. Thomas King Chambers informed me, that at Ilford, in Essex, in the
summer of 1849, the cholera prevailed very severely in a row of houses a
little way from the main part of the town. It had visited every house in
the row but one. The refuse which overflowed from the privies and a
pigsty could be seen running into the well over the surface of the
ground, and the water was very fetid; yet it was used by the people in
all the houses except that which had escaped cholera. That house was
inhabited by a woman who took linen to wash, and she, finding that the
water gave the linen an offensive smell, paid a person to fetch water
for her from the pump in the town, and this water she used for culinary
purposes, as well as for washing.
The following circumstance was related to me, at the time it occurred,
by a gentleman well acquainted with all the particulars. The drainage
from the cesspools found its way into the well attached to some houses
at Locksbrook, near Bath, and the cholera making its appearance there in
the autumn of 1849, became very fatal. The people complained of the
water to the gentleman belonging to the property, who lived at Weston,
in Bath, and he sent a surveyor, who reported that nothing was the
matter. The tenants still complaining, the owner went himself, and on
looking at the water and smelling it, he said that he could perceive
nothing the matter with it. He was asked if he would taste it, and he
drank a glass of it. This occurred on a Wednesday; he went home, was
taken ill with the cholera, and died on the Saturday following, there
being no cholera in his own neighbourhood at the time.
There is no spot in this country in which the cholera was more fatal
during the epidemic of 1832 than the village of Newburn, near
Newcastle-upon-Tyne. We are informed, in an excellent paper on the
subject by Dr. David Craigie,[8] that exactly one-tenth of the
population died. The number of the inhabitants was five hundred and
fifty; of these, three hundred and twenty suffered from the epidemic,
either in the form of diarrhœa or the more confirmed disease, and the
deaths amounted to fifty-five. Being aware of this mortality, I wrote,
about the beginning of the year 1849, to a friend in Newcastle—Dr.
Embleton—to make inquiries respecting the water used at Newburn, and he
kindly procured me some information from the Rev. John Reed, of Newburn
Vicarage, which I received in February, as well as an answer from Mr.
Davison, surgeon, of Newburn, to whom I had written in the meantime. I
learnt from these communications that the people were supplied with
water in 1832, as they still were, from three wells, two of which were
very little used, and that the water in the third well was derived from
the workings of an old coal-mine near the village. The water of this
well, as I was informed, although generally good when first drawn,
became putrid after being kept two days. It was considered that the
evacuations of the people could not get into any of the wells; but the
vicar thought that the water of a little brook which runs past the
village, and falls into the Tyne immediately afterwards, might find its
way into that well which is chiefly resorted to. Putrefaction, on being
kept a day or two, is so much the character of water containing animal
matter, that, after receiving confirmation of my views respecting the
communication of cholera by water from many other places, I wrote to Mr.
Davison again on the subject, and he kindly took a great deal of trouble
to investigate the matter further. He informed me that the brook was
principally formed by water which was constantly pumped from coal-pits
in the neighbourhood. About half a mile before reaching Newburn it
received the refuse of a small village, and between that village and
Newburn it ran through a privy used by the workmen of a steel factory.
In Newburn this brook received the contents of the open drains or
gutters from the houses. The drain which conveyed water from a coal mine
or drift not worked for a great number of years, to the well mentioned
above, passed underneath the brook at one part of its course, and from
that point ran alongside of the brook to the well,—a distance of about
three hundred yards. Mr. Davison said that it was disputed whether there
was any communication between the drain and the brook, but that it was
highly probable that there might be; and that an occurrence which took
place a few months previously seemed to prove that there was. Some
gas-water from the steel manufactory mentioned above got by accident
into the brook, and some of the people affirmed that the water in the
well was strongly impregnated with it.
The first case of cholera in Newburn was that of a young man living
close to the brook, about a hundred yards above the place at which it
passes the well. He was taken ill on the 29th December, 1831, and died,
in the stage of consecutive fever, on January 4th, 1832. There were some
cases of diarrhœa in the village, but no new cases of cholera till the
night of January the 9th, during which night and the following morning
thirteen persons were taken ill. During the night of the 12th four
persons were attacked; by the 15th there were fourteen new cases, and on
this day the late vicar died—the Rev. John Edmonston. By the next day at
noon there were at least fifty new cases. A few days after this the
disease began to subside, and by the 2nd of February had almost
disappeared. As several days elapsed between the first case of cholera
and the great outbreak, it is probable that the water in which the
soiled linen must have been washed, and which would necessarily run into
the brook, was the means of communicating the disease to the thirteen
persons taken ill on the night between the 9th and 10th of January;
unless, indeed, the intermediate cases of diarrhœa could transmit the
disease.
The following passage is from the report of Mr. Cruikshanks on the
outbreak of cholera in 1814, previously alluded to as occurring in a
battalion on its march from Jaulnah to Trichinopoly.
“It was the belief of the natives, strenuously fostered and inculcated
by their spiritual guides, that the epidemic was the immediate
consequence of the wrath of Heaven, outraged and insulted by the
pollution of certain sacred tanks, situated at the village of Cunnatore,
in which sepoys of low caste and camp followers had indiscriminately
bathed. Such we may not regard as affording a very satisfactory solution
of the difficulty; yet it leads, I think, directly to the true point of
inquiry. At Cunnatore, the force was so encamped, that while the 5th
Native Infantry on the right had their supplies of water from wells, the
puckallies of the 9th Native Infantry procured water for that battalion
from tanks situated on low ground on the left of the line. The fact,
that the disease first broke forth in a day or two after passing
Cunnatore; the prevailing opinion of the natives, that it originated
there, and that somehow it was connected with the tanks; a desire to
discover some one cause confined in its influence and operation to one
out of the two battalions; lastly, the difficulty or impossibility of
lighting on any other; all these led to inquiry, and to ascertaining
with a considerable degree of certainty, that each battalion was
supplied with water from a source distinct from the other.”[9] The
cholera was said not to be at Cunnatore at the time the infantry were
encamped there, but this was probably a mistake.
[Sidenote: CHOLERA IN THE BLACK SEA FLEET.]
The following quotation is from a letter by a medical officer in the
Black Sea fleet, dated Baljik, August 23, 1854, and published in the
_Medical Times and Gazette_ of September 30th.
“A week after the return of the fleet to Baljik, on the 7th of August,
about four thousand French troops encamped on the heights abreast our
anchorage. These were part of the first division of the army that had
marched to Kostenje, about ten days before. By it the first blood had
been drawn on the part of the allied army. The loss in battle was small,
but they had encountered an enemy more terrible than the Russians. The
cholera had broken out among them, and attacking four hundred on the
first night had destroyed sixty. The total loss had been something
incredible. It was said, that out of eleven thousand men, not less than
five thousand had perished in a few days. This dreadful calamity was
attributed to drinking water from wells that had been poisoned by
throwing in putrid carcases.
“Putting aside the question of intentional poisoning, which always
presents itself as the most ready way of accounting for such
destruction, perhaps some support to the theory, that water is the
medium by which cholera poison is conveyed, may be found in this
circumstance, and in another of which I was witness. These soldiers,
wearied by marching from a focus of cholera infection, were seen, many
of them, washing their persons and clothing in the stream from which all
the French ships of war, and the majority of the English fleet, obtained
their supply of water. This was going on on the 7th and 8th, and, on the
nights of the 9th and 10th, the disease burst out with great violence
among the crews of several ships.
“Some English ships were the first to suffer, on the night of the 9th,
and they proceeded to sea next morning. On the night of the 10th, other
English ships, and some of the French, began to suffer; and the latter
in an almost unparalleled manner.
“The two admirals’ ships, _Montebello_ and _Ville de Paris_, were
terribly affected. On the previous day they had been in as healthy a
state as usual; and in the night the cholera attacked, in the former,
two hundred men, of whom forty lay dead in the morning; and in the
_Ville de Paris_ there were also many deaths. The French fleet sailed on
the afternoon of the 11th; and the following morning saw the English
ships also at sea.