The following T. shows the geographical similarities of the disease of 1854 as compared with that of 1849:

A person living in the coast districts in the same conditions as the coast pop. was thus in 1854 more likely to die of C. in the proportion of 20 to 4 (or 5 to 1) than a person living inland. In 1849 these ratios were 50 to 17 (or 3 to 1). If the coasts are divided into 3 classes, the mort., it will be found, was at the rate of 30 on the E. coast facing the Continent, 10 on the W. coast, and 5 on the S. coast, out of every 10,000 of the pop. Exclusive of the Lond. districts, the mort. by C. in the districts of the E. coast was at the rate of 12 in 10,000. In 1849 the rates of mort. on the E. coast were 53; on the W. coast 49; on the S. coast 39. The 42 districts on the coal-fields of E. and W. suffered severely from the epidemic in 1849, where to 10,000 living the deaths were 46 by C. and 13 by D.; while in 1854 the deaths to 10,000 were 12 by C. and 14 by D. The latter rates include the deaths from C. and D. in Newcastle and Gateshead during the year 1853. Males suffered more than females from C. and D. in 1854, at all ages under 25; at the ages 25 to 45 the females suffered more than the males; at 45 to 55 the mort. rate of males was greater than the mort. rate of females in 1849; but in 1854 the rates were nearly equal. From the ages of 55 to 85 the old women suffered more than the old men ; at the age of 85 and upwards the facts became too few to yield certain results; but they seem to show that proportionably more old men of 85 and upwards die of C. and D. than old women at the same advanced age. The deaths of males from C. in England in 1854 were 9860; of females 10,237. The deaths from D. in the same year were: males 10,211; females 9841. But adding C. and D. together, the following result, remarkable for its uniformity, was obtained: males 20,071; females 20,078.

During this visitation great ravages were committed in Broad-street, Westminster. It was discovered to arise from the impurity of the water in a well in that street. The discovery was in the first instance accidental; but more complete investigation showed that the well was simply poisoned by an influx of sewage and of surface drainage, percolating through the crevices of the bricks forming the lining of the well. It was also very fatal in Soho, and in some of the south parts of Lond.

Dr. Farr, reviewing, in the 17th R. of Reg.-Gen., the rise and progress of the C. outbreak of 1854, says:

It is impossible to overlook the diarrhoea which has gone on gradually increasing in fatality since the year 1838, when 2482 deaths were referred to that cause; while in 1847 the deaths by diarrhoea were 11,595; in 1848 nearly the same number; in 1849 the deaths by diarrhoea were 17,831; thus making the deaths by C. and D. in the epidemic year 71,104, or 72,180 if we add the cases of persons attacked while labouring under other fatal diseases. Diarrhoea did not discontinue its ravages after 1849; the deaths in the 3 following years were 11,468, 14,728, and 17,617; in 1853, when C. appeared in the epidemic form, the deaths from diarrhoea fell to 14,192; but in 1854 their number was 20,052. Thus the deaths by C. and D. in this year were 40,149, exclusive of a certain number of deaths which epidemic diarrhoea caused in conjunction with other discases. Diarrhoea is often a symptom of other well-marked diseases; and it is also the effect of a class of medicines; but this diarrhoea which always prevails in hot weather, and has been so common since the year 1846, is evidently a variety of C., proving fatal chiefly to young children and to old people, who do not so commonly exhibit the spasms of C., but have nearly all the other symptoms.

In 1854 there were also pub.: (1) Report on Epidemic Cholera, drawn up, by desire of the Cholera Committee of the College of Physicians, by Drs. W. Baly and W. W. Gull; (2) Minute on Preventative Measures in relation to Epidemic Cholera.

In this year also the C. raged in Italy and Sicily; above 10,000 are said to have died in Naples. It was also very fatal to the allied troops at Varna in the autumn of this year. In 1855 Dr. Sutherland addressed a Letter to the General Board of Health on Epidemic Cholera in the Metropolis in 1854. There was also pub. in this year: (1) Report [to General Board of Health] on the Results of the Different Methods of Treatment pursued in Epidemic Cholera; (2) Report on the Cholera Patients admitted into the Middlesex Hospital during the Year 1854, by Dr. S. W. Sibley; (3) Report on the Cholera Outbreak in the Parish of St. James, Westminster, during the Autumn of 1854; (4) in Stockholm, a Report on the Cholera outbreak in that city in 1853; (5) in Copenhagen, a Report on the Cholera outbreak in that city in 1853.

Dr. Farr says in the 17th R. of Reg.-Gen. pub. 1856 :-"Cholera has prob. always

existed in England, and it was well described by Sydenham in the 17th century; but the epidemic form presents some differences in the symptoms as well as in the extent of its ravages. The chief characteristic is found in the duration of the fatal cases, half of which terminate within one day (24 hours) of the first appearance of decisive symptoms, while half of the cases of common C. terminate in three days, and half the cases of diarrhoea extend over six days."

In 1860 Dr. Begbie pub. in the Edin. Med. Journ. a further Report on the mort. experience of the Scottish Widows Fund, for the 7 years ending 1859. The mort. from C. during that period was at the rate of 1'47 p.c. or less than one-half of that of the previous septennium. Over the entire period of 44 years it had averaged 2:11 p.c. (See 1847 and 1853.)

In 1861 the late Mr. Spens pub. Tables of the Mort. Experience of the Scottish Amicable Life Assu. So. from 1826 to 1860. There were included therein 24 deaths from C., of which 4 occurred between the ages 25 and 35; 8 between 35 and 45 (of which 3 had been insured as hazardous); 5 between 45 and 55 (of which I was a female, and I had been insured as hazardous); 6 between 55 and 65 (of which I had been ins. as hazardous); I in class 75 and upwards.

In 1862 Dr. J. Ġ. Fleming, M.D., the medical adviser of the Scottish Amicable, supplemented the preceding by his useful little book, Medical Statistics of Life Assu., etc. He says, "So far as I am aware, no Brit. assu. co. has pub. any T. or statement to show the proportionate mort. from classes of disease, or from particular diseases, to the number of lives it had at risk." He shows that Mr. Spens's C. statistics relate to 10,255 individuals, "and the sums of the number of lives exposed to risk during each year of age amount to 56, 300." He endeavours to construct some such a table as he speaks of, but finds the difficulties insuperable. We have tried, with a like result. He succeeded, however, in constructing the following T., which presents some important points for comparison; but it includes "Dysentery" with C. and D.

TABLE OF DEATHS FROM CHOLERA, DIARRHEA, and DYSENTERY, AT SIX GROUPS OF AGES:

4'07

6.83

3'99

1*48

Total... 11880 85 4I *104 *064 072 6.67 3'44 5'30 The Standard column did not embrace the then last quinquennium. The Equitable So. C. experience only embraced the outbreak of 1832. [See details at close of this art.] In 1862 Dr. J. G. M. Burt pub. in the Edin. Medical Journ., A Report of the Causes of Death in the North Brit. Life Assu. Co. from the Commencement up to 1860. During this period of 37 years, 1823-60, only 16 cases of C. had arisen. The average duration of life after ins. was 8 years. The per-centage of mort. from C. was 1.22.

In 1864 Dr. Farr pub. the English Mort. T. (No. 3). It had been the subject of remark that no previous mort. T. in Gt. Brit. had embraced mort. results in which epidemic C. had taken any part. It was so. The English tables, Nos. 1 and 2, had been based upon periods remarkably free from the mort. of C. But T. No. 3— being based upon the two censuses of 1841 and 1851, and upon the returns of deaths over a period of 17 years [1838-54] extending to 6,470,720 deaths-embraced not only the mort. of 1849, which was the most fatal year in regard to C. which has been ex|perienced in Gt. Brit. (as will be seen by reference to the T. at the end of this art.), but also the deaths of 1854, the next severe visitation.

The Reg.-Gen. in his 25th R., pub. 1864, says :-"Women of the age of 15 and under 45 were cut off in great numbers in the C. years.' Regarding its effect upon men, the following figures are given. Over a period of 25 years the mean ann. mort. of men of the age of 25-35 was 975, but the mort of men of that age in 1849 (C. year) was 1'236, and in 1850 it was as low as 877 p.c. The range (of variation) was 359. In the one case it was more than 26 p.c. above 975, and in the other 10 p.c. below that mort. rate. Again, at age 55-65 the mean ann. rate for men was 3'136, but in 1849 the rate was 3653; in 1850 it was 2.979: thus the range was 674 at that age.

In June, 1865, the C. was reported to be raging in Alexandria. In July it had materially abated. In Aug. of that year it was very severe in Constantinople; more than 50,000 cases were estimated to have occurred. It subsided after the great fire of 6th Sept. that year. In Aug. 843 deaths were reported from Ancona. Between July and Oct. Marseilles, Paris, and Madrid suffered greatly. In Sept. Toulon and Southampton each suffered. In Germany the epidemic was very severe, and also in Naples.

In 1865 Mr. John Mann, the medical adviser of the Brit. Empire Mut. L., pub. the mort. experience of that office for the first 10 years of its existence-that is, down to 1857 -wherein he says:-"We have to report 13 deaths from C.; yet the experience of the so. includes not only one great epidemic visitation of the scourge, but a second of smaller proportions. Only two of these deaths were females. Of the total number 2 occurred between 20 and 30 years of age; 2 between 30 and 40; 4 between 40 and 50; 3 between 50 and 60; and 2 between 60 and 70." The rate of mort. was 5'06 p.c.; but it was rendered high by embracing two epidemics, viz. 1849 and 1854.

In 1865 there was pub. in N. Y. Report by the Council of Hygiène and Public Health of the Citizens Association of New York upon Epidemic Cholera and Preventative Measures, which contains much information of a practical character.

In Feb. and March, 1866, an International Congress (proposed in the preceding Oct.) was held in Constantinople, for the purpose of considering epidemic C. in its various aspects. Seventeen States took part in the Conference, viz. :-England, France, Prussia, Austria, Russia, Belgium, Holland, Denmark, Sweden, Italy, Greece, Spain, Portugal, the Papal States, Persia, Turkey, and Egypt. These States were represented by 36 delegates. His Highness Aali Pasha, Minister of Foreign Affairs, presided. The points discussed were: (1) the origin and development of C.; (2) the mode of its propagation; (3) measures of preservation-hygiène-restriction; (4) form of resolutions. The conclusion finally adopted was that C. may be propagated, and from great distances; and a number of preventive measures were recommended.

We now reach what may be termed the Fourth Great Cholera Epidemic in Gt. Brit. Asiatic C. had hovered over Europe in 1865, settling down with some severity upon Paris, Marseilles, and some other Continental cities. It also prevailed in England, the regis. deaths from it in the year being 2191; those from diarrhoea reaching the large number of 23,531. On Wednesday the 11th July, 1866, the epidemic began to show itself in an aggravated form in Lond. It continued severe during the remainder of that month, and in Aug. The total deaths from it regis. in Lond., including West Ham and Stratford (not embraced in the Lond. district), were 5973; and from diarrhoea, 3197-total 9170 by the two maladies.

The epidemic was felt all over the kingdom, and while the deaths by it in the Lond. district proper were 5596, the deaths in the other ten divisions of E. and W. were 8782. The рор. of the ten divisions is six times the pop. of Lond., and at the Lond. rates the deaths by C. would have amounted to 33,576. The mort. in the ten divisions was at the rate of 5 in 10,000 against 18 in Lond. The disease, says Dr. Farr, "was only fatal to any considerable extent in certain regions, which may be called Cholera-fields, as here the centres of activity were all in direct communication with each other, and were surrounded by free border-lands." The mort. of all England was at the rate of 7 deaths by C. in 10,000 persons living. In the three Midland divisions-the S. Midland, N. Midland and W. Midland-the deaths by C. were at the rate of 1 in 10,000; in Yorkshire, 2; in the S. Western division, 3; in the S. Eastern and the Eastern divisions, 4; in the Northern division, 5; in the N. Western division (Lancashire and Cheshire), 9; in Lond. 18; in the Welsh division (Wales and Monmouthshire), 18 in every 10,000. It was only in Wales that the disease was to any extent more fatal in 1866 than it was in 1854. The deaths in the U. K. were about 17,793; and the mort. by the disease in the year 1866 was at the rate of 6 deaths in every 10,000 inhabitants. The following are the exact returns for each division of the U. K. :

Dr. Farr says, in reference to this outbreak :

C. was very unequally distributed over England. 14,378 people were slain by the disease in 641 districts; and of that number 10,889 fell in 37 districts of Lond. and in 24 other town districts; 3489 in 342 districts; while in 238 districts no death from C. was recorded. All the districts, with the exception of Wigan and Merthyr Tydfil, were seaport towns or districts in their immediate neighbourhood; the pop. were dense, and were nearly all dwelling on the lower alluvial soils of the kingdom. These correlations have been observed in all the epidemics. The exceptions are accounted for by such peculiar circumstances as the mort. around the Broad-st. Pump [Westminster], in 1854; and in St. Giles', Lond., in 1849; where either the people were excessively dirty and crowded, or took in water large doses of C. matter in a very active state.

Regarding sex and age, the following details will prove interesting :-Deaths 14,378— males, 6995; females, 7383. Of the males 356 died under 1 year, and 1517 under 5 ; 772 between 5 and 10; 395 between 10 and 15; 229 between 15 and 20; 318 between 20 and 25; 824 between 25 and 35; 894 between 35 and 45; 887 between 45 and 55 ; 647 between 55 and 65; 380 between 65 and 75; 122 between 75 and 85; 9 between 85 and 95; and I over 95. Of the females 305 died under 1 year and 1361 under 5; 692 between 5 and 10; 311 between 10 and 15; 223 between 15 and 20; 364 between 20 and 25; 1043 between 25 and 35; 1100 between 35 and 45; 883 between 45 and 55; 704 between 55 and 65; 478 between 65 and 75; 187 between 75 and 85; 34 between 85 and 95; and 3 over 95.

The following T. shows the districts and towns which suffered most severely from the C. epidemic of 1866, arranged in the order of the rate of mort. experienced:

In a Special Supplement to the Weekly Bills, pub. in Dec., 1866, the Reg.-Gen. furnished the following important details regarding this last C. outbreak :-The French returns show that in Paris the epidemic of 1865 reached its maximum in Oct., in which month 4653 deaths were recorded. In the first six months of 1866 only 69 deaths occurred, but in July the deaths suddenly rose to 1743. The proportional number of deaths by C. to every 10,000 of the pop. of Paris in 1865 was 39; in the first seven months of 1866 it was II. In Lond. the deaths by C. in the year 1866 were in the proportion of 18, in Liverpool, of 36 to 10,000 living. In Italy the epidemic began on the 25th of June, 1865, in the province of Turin, and destroyed 12,901 lives during that year, or to every 10,000 of the pop. living in the 35 provinces and the 349 communes that were attacked by C. 35 deaths occurred. It appears that in Italy the town pop. suffered less severely than that of the country, the number of deaths to 10,000 living being 38 in the former and 56 in the latter case. In Naples 2301 deaths are recorded in 1865 out of 446,931 inhabitants, being in the proportion of 52 deaths by C. to 10,000 living. In Vienna the returns date from the 11th Aug. to the 10th of Nov., 1866 --the ratio was 51. In seven Belgian towns, comprising Antwerp, Brussels, Bruges, Ghent, Mons, Liège, and Namur, no less than 11,771 deaths occurred from May 1st to Oct. 15th of the year 1866, out of a pop. of 553,377; or the deaths by C. were in the proportion of 186 to 10,000 living. In Brussels the proportion was 164. In Holland 18,547 deaths occurred in 1866. Taking 15 Dutch cities and towns, including Amsterdam, it appears that 8872 deaths by C. were recorded in the five months from June to Oct. of 1866, being in the proportion of 107 deaths to 10,000 living. In Amsterdam the ratio was 42, while in Utrecht it was 271. Norway, it appears, suffered but slightly from the epidemic in 1866, only 48 deaths are recorded out of a pop. of 1,701,478.

In 1866 the United States, or rather some of the principal cities in the States, suffered from a severe visitation of Asiatic C. In St. Louis, a considerable city on the Mississippi -which by the way sustains some deaths by C. almost every summer-the deaths in that year are said to have reached 200 per day in a pop. diminished by flight to 180,000. During this year there was pub. in Boston, U.S., A Communication from the City Physician on Asiatic Cholera. Is it a Contagious Disease? This report, which is an official document, contains a great deal of valuable information.

In 1867 a "Cholera Conference" was held at Weimar, and there were present many of the leading epidemologists and mycologists, including some from England. An opportunity was afforded for "the interchange of ideas," as the diplomatists say, on this and other important theories, such as the local relations of Cholera to soil as regards its geological character and its conditions of moisture, and the alleged efficacy of dis

infection, the communicability of C., the meteorological aspects of the case, and the like. Whether C. is a fermentation of infinite microscopic self-multiplying organisms in the bowels, drawing the serum from the blood with excruciating spasms, leaving the clot to coagulate throughout the body as in a bruised surface, and thus producing the blue and livid colour which marks the fatal stage of this terrible malady, or whether any other theory be preferred, the practical effects as regards the human subject and the practical means of prevention are in the present state of our knowledge the same. Be the cause of C. what it may, excremental pollution of air and water will develope it anywhere and everywhere, and the abolition of these will remove it.-Vide Dr. Simon's Report to the Privy Council, 1867. In 1867 C. prevailed in Rome, Naples and Sicily in Aug. and Sept., and in some parts of Switzerland in Oct.

In the 28th R. of Reg.-Gen., pub. 1867, Dr. Farr uttered the following words of wisdom and warning-wonderfully applicable to the present moment:

C., like smallpox, is one of those zymotic diseases which exist in all climates: under favourable conditions their products assume an active form, capable of inducing in other bodies the same morbid changes by which they were generated. They estab. the kinship of the human race. Every nation is vitally interested in the sanitary condition of every other nation. Hence the endless discussions about contagion, and as regards C. the futile vexations of quarantine. There are difficulties in the hypothesis, because experiments cannot be performed on human beings as they are in the laboratory of the chemist, or as they may be in veterinary hospitals; but for all practical purposes it may be assumed that the discharges of patients in the epidemic, either casually touching the mouth, or entering in dust and vapour through air or water, induce diarrhoea or C. in a certain proportion of those exposed to their influence. Now Lond. was supplied with the sewage water of a river by several cos. in 1848-49; all, except one, got their water beyond the reach of the Lond. sewage in 1853-54, and the mort. fell proportionally as the water became purer. At the present time the water of all the cos. is comparatively little contaminated by zymotic pollution. The Lond. pumps have also been placed under inspection. The drainage is in rapid progress. Analogy justifies the hope that as the city is purified, and as the means of diffusion are cut off, the destructiveness of the disease will be diminished.

The detection since 1849 of the mode of propagation and of the premonitory stage of C. by English practitioners are among the greatest triumphs of medical science. For as the surgeon cannot restore the shed blood to the heart, but can tie a ligature round an artery, and stop bleeding, so the physician cannot revivify a man in collapse, or restore the serum of his blood, but he can in nine cases out of ten check diarrhoea turning into C.

C. throws men into terrible convulsions, and kills half of its victims in twenty-four hours; but there is a merciful warning of its approaches in probably every instance, the neglect of which is fatal. So it is with the epidemic itself in England. It has hitherto commenced generally about Oct., and has only proved excessively fatal in the following summer. Thus all our towns have six months' notice, and the whole winter for the preparation of defensive works. Every district in the kingdom should at once appoint its health officer.

In 1868 there was pub. by way of supplement to the 29th R. of Reg.-Gen., but in a separate vol., Report on the Cholera Epidemic of 1866 in England. This Report was prepared by Dr. Farr under direction of the Reg.-Gen., and is a most valuable and exhaustive work. Dr. Farr says:

Thus, by the year 1866, from the obs. of the three great plagues, we had learned enough of the causation of C. to justify us in believing that in Lond. it could be confined within narrow limits-in the first place, by preventing any extensive distribution of the C. stuff through water, as the cos., in compliance with the Water Act of 1852, had, it was believed, since 1854 carried out all their purifying filtering works; and in the second place, by the organization of health officers, who could secure attention to the early treatment of premonitory diarrhea, and to the destruction by disinfectants of the C. flux.

These anticipations, from various causes, were not realized, as we have already shown. Dr. Farr deals with these causes individually and collectively, in a most masterly and comprehensive manner. This learned writer says:

substance.

It may be stated first simply as hypothesis, that the C. is propagated epidemically by a material This matter may be called cholrine. [CHOLRINE.] Then the elements of the disease must either have been diffused (1) by personal contact; (2) by transmission through the air; (3) or by dissemination in vapour of sewers; or (4) by the various waters. Now the evidence that C. can be communicated in these ways by cholrine is conclusive. Instances of a C. patient brought to a distant house and communicating forthwith the disease to an inmate are too numerous to be mere coincidences; as the chances by the doctrines of prob. against such numerous coincidences are inconceivably great. But it is evident that as the pop. of every district of Lond. is in free communication with every other district, and is constantly interchanging its residents on both sides of the river, so by this mode of communication cases would be, as indeed they were to a limited extent, freely distributed all over Lond.

I now proceed to call attention to the mort. from C. in the various water-fields of Lond. As their areas correspond with none of the other recognized divisions of Lond., the 135 sub-districts have been distributed into 15 groups, with the various heads corresponding as nearly as possible with the various water-fields. It will be seen that while there is a certain mort. from C. in every condition, the excess above this standard is constantly in proportion to the impurities of the water during the epidemic period. Lond. is now supplied with water by 8 cos. South of the Thames it is supplied by 3 cos.. North of the Thames by 5 cos. . . . The proportion of deaths by C. to 10,000 inhabitants in 1866 will show the relative fatality of the disease.

These deaths were found to be as follows:-Chelsea Co., 4; West Middlesex, 4; Grand Junction, 3; New River, 8; East Lond., 72; Southwark, 7; Kent, 15; Lambeth, 6. Some of the cos.-especially those on the south side of Lond.-overlap each other considerably; and it has been found very difficult to apply this test in such cases. Again, "As water conveys C. matter which multiplies and reproduces itself in the pop., it often opens fresh fountains of disease, which extend their operations beyond the direct limits of the water supply, either through the medium of well-water, or personal contamination, or linen, or sewer vapours."

The Report says: Cholera in an individual goes commonly through a regular series of development; commences with diarrhoea, grows hourly more violent, until the crisis is