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 diarrhoea, 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:

It may be stated first simply as hypothesis, that the C. is propagated epidemically by a material substance. This matter may be called choirine. [CHOLRINE.] Then the elements of the discase 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

past, and then, if death intervene not, subsides slowly in consecutive fever, lingering until the danger is over, and the patient restored to health. This is a type of the course which the epidemic takes in a community. The rapidity both of growth and decline here depends on the means of diffusion, as well as on the activity of the diffused cholrine. High temperature has a sensible effect. The duration of the epidemic also depends on the magnitude of the community; thus it goes through a house in less time than through a great inst. ; in less time through a small town than through a large city. It may in this respect be compared with a conflagration, which spreads rapidly through houses put in communication with each other by inflammable materials, and dies out sooner in a small than in a great city-where the embers smoulder for a long time, and unless extinguished are liable to break out in successive eruptions.

It contains a T. showing the occupations of many who died from C. in 1866. From this T. is taken the following list of professions and trades, and the numbers belonging to them who died :

1 clergyman, 4 Protestant ministers, and 2 other religious teachers; 3 solicitors, but no barrister; 2 physicians, 3 surgeons, 7 druggists; 2 authors, editors, or writers; 2 artists; 10 musicians; 4 schoolmasters; 9 hotel-keepers, 27 publicans, 6 beersellers; 3 merchants, 1 banker; 41 clerks, 31 commercial travellers; 36 railway officers and men; 12 cabmen, 18 carriers, carters, or draymen; 56 barge, lighter, watermen; 203 seamen in merchant service; 4 land proprietors, 58 farmers, 152 agricultural labourers; 27 gardeners; 3 booksellers, 10 printsellers; 3 watchmakers; 47 engine and machine makers; 14 coachmakers; 21 builders, 116 carpenters, 67 bricklayers, 49 masons, 18 plasterers, 47 plumbers, 34 cabinet makers; 3 undertakers; 10 wheelwrights; 7 woollen cloth manufacturers; 10 hairdressers, 62 tailors, 111 shoemakers, 10 ropemakers; 9 cowkeepers or milksellers, 45 butchers, 10 fishmongers, 21 bakers, 14 greengrocers; 10 sugar-refiners, 19 grocers; 6 tallow-chandlers; 9 curriers; 40 sawyers, 23 coopers; 254 coal miners, 3 copper or tin miners, 12 iron miners; 22 coalheavers, 13 gas-works servants; 25 brickmakers, 36 railway labourers, 16 navvies; 6 earthenware makers, 4 glassmakers; 15 salt manufacturers; 23 copper manufacturers, 17 tin manufacturers; 5 lead manufacturers; 147 iron manufacturers, 89 blacksmiths, 22 boiler makers; 689 labourers; 17 emigrants; 14 gentlemen; 5 prisoners. In reference to 2960 male deaths no occupation was stated.

Regarding the female deaths, the great majority were returned as wives, daughters, widows, etc.; but among those in which the occupation was stated were the following: 10 innkeepers' wives, 35 publicans' wives, 20 farmers' wives, 15 butchers' wives, 85 shoemakers' wives; 5 were schoolmistresses; 147 domestic servants; 24 nurses, 63 charwomen; 10 hawkers and pedlars, 14 cotton manufacturers, II milliners, 49 seamstresses; 19 laundresses. The real test of relative mort. can only be applied where the number of persons engaged in any particular occupation is known. Such a T. is furnished in the Report. The range of mort. is considerable, and Dr. Farr considers this to be mainly due to the sanitary condition of the locality in which the occupation is carried on." He adds: The mort. of salt-workers, copper-workers, and sugar-refiners was high. Now of 2016 men engaged in the salt manufactures of Eng. 1237 live in Northwich; 2236 of 3827 copper manufacturers live in Swansea, Neath, and Llanelly; and 1373 out of 2790 sugar-refiners live in the heart of East Lond. In all these districts the epidemic raged with great severity among all classes of the pop.; and it is clear that if the occupations had been pursued in other places no such mort. would have occurred. The comfortable English clergymen, the farmers, and the agricultural labourers in open districts suffer little, because they live in happier sanitary regions.

Some curious facts are given regarding sex and age, in relation to deaths from Cholera. "The fatality of an epidemic depends not only on external conditions, but also on the internal organization. It is found by experience that the two sexes at different ages are not affected to the same extent by all diseases, either because by the habits of life they are not exposed to the same extent to the causes of disease, or because the power of resisting the operation of those causes varies." The 3 epidemics of Cholera (including that of 1831-2) supply data for determining the mort. of C. at different ages in the two sexes: for the deaths have amounted to 102, 186, inclusive of about 14,418 deaths by the epidemic, which were regis. under the head of diarrhoea. "It is important to include these outside deaths in estimating the effect of age, inasmuch as the occult form of the disease is not met with in equal proportions at all ages.' The characteristic symptoms are not so well marked in early infancy or in the second infancy of old age; and "the reason of this is, that the muscular and nervous systems being then less active, and giving rise to less convulsive and violent symptoms, the medical attendants return the cases as diarrhoea." At all ages above 5 and under 55, the number of such cases of occult choleraic diarrhoea is not considerable; while under the age of 5 years, according to this estimate, 4 cases of diarrhoea must be added to every 6 deaths regis. from C., to get the actual deaths by the epidemic. At the age of 75 and upwards also there is a large addition of these occult cases. "After correction we find the mean mort. in the 3 epidemics was, of males 180, females 17.8, to 10,000 living at all ages." The addition for occult cases was nearly the same, or 2.6 to the male, and 25 to the female mort.

The mort. is higher in boys than in girls at all ages under 15; at the ages of reproduction, 25-45, the mort. of women, many of them pregnant, exceeds the mort. of men ; but at the ages after 65 the mort. of men exceeds the mort. of women. Dr. Farr considers there is evidently a law of mort, involved in the age, independently of the sex. Thus in the first three lustres of life, the deaths of boys to 10,000 living were 31.8, 13.2, and 7'6; of girls, 284, 126, 6'4; and the mean mort. of the two sexes at the same ages were 30*1, 129, and 70, which differ little from the series 30°1, 14 ̊5, and 7'0,-numbers obtained by assuming that the mort. is inversely as the age, and decreases about 14 p.c. for every year

of age, or is less than half at 5-10, and less than a fourth at 10-15, what it was in the first
5 years of life. After the age of puberty, or from the age of 15 to 25, the mort. also
increases very little; it is 81 for males, and 7.8 for females; and at the 6 decennial ages
extending from 25 to 85 the mort. increases from 15'4 to 43'6 at a very constant ratio,
as is seen on comparing the calculated series [DISEASES, HYPOTHESES CONCERNING]
with that observed in both sexes. This is shown more clearly in the following T.

Thus, to 10,000 men living at the age 25 and under 35, the deaths by C. and choleraic
diarrhoea, as above defined, were 15'2; to 10,000 women the deaths were 156; and the
mean mort. of the two sexes in equal numbers is expressed by 154. The mean deaths
by C. at the next age (35-45) were 19.8 to 10,000 living, and so on.

We are told that the resistance which the body offers at different ages may be of two
kinds it may resist an invasion, and, as in unsuccessful vaccination and in unsuccessful
inoculation, not take a disease, as it is called; or it may take the disease, and live through
it, or succumb to it, in variable proportions. All the cases of C. have never been regis.
in any epidemic, and it is impossible to determine directly what relative numbers are
attacked at each age. The deaths out of 3635 cases of C. at different ages were in-
vestigated by the Scientific Committee of the Board of Health, and the result showed
that, given 100 men attacked at the age 25-35, about 36 died; while of 100 attacked at
the age 35-45, about 44 died; and generally the mort. of persons actually attacked
increases as age advances, according to a determinable law. The following T. shows the
relative proportion of attacks of men and women at 3 different ages of life:

The Deaths in relation to the attacks are shown in the following T.:

This T. is partly based upon the observations of the Scientific Committee of the Board

of Health on the epidemic of 1854.

Regarding the duration of fatal cases, Dr. Farr remarks, that "the greater the dose of

any poison, the more fatal it is, and the more rapidly it is fatal. By parity of reasoning it may be presumed that the more destructive an epidemic is, the more rapid are the cases in their course. The mort. by C. in the epidemic of 1849 was at the rate of 30 in 10,000, and the mean duration of the fatal cases was 50 hours. The mort. by C. in 1866 was only at the rate of 7 in 10,000; the duration of fatal cases was 61 hours.

Regarding the days of the week most fatal in C. during the epidemic of 1866, the fewest deaths occurred on Saturday; the next fewer on Sunday. The greatest number occurred on Wednesday, and the next greater on Tuesday. In 1849 the deaths on Tuesday and Saturday stood highest; on Thursday and Friday lowest. The popular belief as to unlucky Friday did not apply, as Dr. Farr has already pointed out, to either of these epidemics. He adds, with great sagacity, "If the temperate or intemperate habits of any of the working classes of Lond. had any effect on this series of facts, they therefore raised the deaths on Monday, lowered them on Friday."

We cannot follow this able and instructive Report further. We have indeed quoted from it in several other portions of this art. ; and we shall quote from it in other parts of this work.. Its learned author concludes: "To render the generation of great epidemics of C. rare, nay, impossible, India has only to carry out the measures which have proved efficacious in England."

In Dec., 1868, the Scientific Reviw contained the following:

Cholera Fungus.-After a long series of botanical researches, Prof. Ernest Hallier, of the University of Jena, has convinced himself of the presence in the excreta of C. patients of a microscopic fungus which exist in them in considerable quantities. On submitting this minute plant to a careful microscopical examination, the distinguished botanist found that it has all the characters of Urocistus oryse, which in India is found sometimes in the rice plantations. Prof. Hallier then manured some rice plants with the excreta in question, and finds that they perish rapidly. A whole plantation may be thus destroyed by the Urocistus in a very short space of time.

In 1869 the Experience T. No. 2 was pub. This being based upon the mort. experience of a number of Brit. ins. offices, will also embrace the mort from C., as also from D., so far as these diseases affected the class of lives ins. in the offices contributing their experience. Sir William Jenner said before the Brit. Medical Asso. in 1869 :

With reference to C., the special facts collected by Dr. Snow prove that one of the great agents in the diffusion of C. was drinking water; that every virulent local outbreak in a limited district was clearly coincident with the pollution of the drinking water supply of that district; and that persons living at a distance, if by accident they drank of the polluted water, suffered as certainly as if they dwelt in the district specially affected. The conclusion which follows from the facts collected by Dr. Snow is that, the conditions existing, be they atmospheric or other, which determine the epidemic disposition to C., the presence of minute portions of C. excreta in the water supplied to a district for drinking purposes will be followed by an outbreak of C. in that district. Careful investigations into the circumstances attending local virulent outbreaks of C. during the last epidemic have proved the truth of that conclusion. I will refer to two such investigations only, namely, Mr. Netten Radcliffe's admirable researches into the relation between the water supply and the spread of C. in Lond., and to Dr. Bellot's most conclusive obs. on impure water as a cause of C. in Holland. Dr. Snow's investigations traced special individual cases and local outbreaks to one existing cause. Mr. Radcliffe's researches bear especially on the influence of the polluted water in determining excess of mort. in a large district of a great city. Dr. Bellot's facts show that those towns and those parts of a town in Holland in which there was the greatest facility for the contamination of the water supply by C. dejections were those which suffered by far the most severely. The spread of typhoid fever by contamination of the drinking water supply is, if possible, less disputable than is the spread of C. by the same means.

Dr. Guy, in his valuable work, Public Health, pub. 1870, has pointed out that between the epidemics of Cholera and plague there is an unmistakable resemblance. They are, he says, evidently diseases of the same class. The figures on the death registers rise to an unwonted height in certain years only. They harmonize with the theory of an imported disease. But there is this difference. The C. of 1854 attained its maximum in 8 weeks, and subsided in 13; while the plague (of 1665) took 22 weeks and 17 weeks to accomplish the same feats. The figures for the C. are suggestive of a disease carried chiefly in currents of air; those for the plague of one spreading more slowly by direct contact, and exposure of the healthy to the sick. He adds:

This disease too, like others of its class, is most fatal when it first breaks out, least fatal when it is passing away. How it selects its victims we do not know, and cannot expect to learn. Some whom it kills quickly seem in the rudest health, others who are longer dying are obviously less vigorous. Whether a man is to succumb or recover probably depends in part on the strength of the dose, but in part upon his having or not having some unsound organ which will not bear the congestion of the cold, or the quickened circulation of the hot, stage. The intemperate man is taken always at a disadvantage, and the chances of escape lessen with age. Another fact must be specially noted, as common to all epidemics-the poison, when it does not kill by sudden shock, remains for a variable period, in some shorter, in others longer, inert. The seed is sown, but takes time to germinate. The interval of real or apparent inaction is known as the period of incubation. It is not easy to fix the limits in these maladies. In C. it is thought to extend from three days to a week; in typhus fever from a few minutes or hours to a few weeks or months. The fact that there is this period of inaction, or incubation, helps to explain some apparent anomalies. The C., considered as a type of the class to which it belongs, has one or two other characters worth noting. It has been more than once preceded by the milder epidemic, influenza; it has given something of its own character to other diseases prevailing before, during, and after its own visitations; it has seemed to require time to develope itself in the several places which it attacks, for several weeks will sometimes elapse before the weekly deaths exceed one or two; and it is certainly, as a general rule, fostered and promoted by overcrowding and uncleanliness.

Regarding the alleged similarity of C. to the plague, leaving the medical aspect of the case out of consideration, the statistical results hardly justify this view. The four great outbreaks of the plague of the 17th century in Lond. were: