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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 oryza, 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 cir cumstances 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:
1603, when the deaths from Plague were 36,269; from all causes, 42,042
The great outbreaks of the Cholera (excluding that of 1831-32, of which we have not authentic returns) have been :
1849, when deaths in Lond. were Cholera 14,125; from all causes, 68,755
Mean of those years
Ditto ditto (including diarrhoea)... 13,550
As compared with the deaths from all causes, those from the plague were 69 p.c. Those from C. are less than 14 p.c., and with diarrhoea included less than 18 p.c. Nearly as many died from the plague in 1666 as from all causes (cholera included) in 1849.
The Gresham L. has made a contribution to the statistics of mort. of ins. lives as arising from C. Out of the first 1000 deaths among the ins. in that Co., 7 were reported as having died from C. Out of the second 1000, no less than 32 were attributed to C. In the report of the med. officer of the Co., Mr. A. H. Smee, presented in 1871, it is stated::-"This large increase is no doubt partly due to the epidemic of C. which swept along the shores of the Mediterranean during the summer of 1866."
In 1871, also, Mr. Harben pub. the mort. experience of the Prudential Life during the 4 years 1867-70. The deaths from Diarrhoea, Dysentery and Cholera (classified together) were at the rate of 413 to 10,000 male, and 420 in the like number of female, lives ins.
It is said to have been remarked in Paris and elsewhere, that copper-workers had a remarkable immunity in respect to the C. At a serious outbreak at Bagdad in 1871, all classes are said to have suffered except the workers in copper. We have already shown that copper-smelters suffered severely in Gt. Brit. in 1866.
In the summer of 1872 Mr. John Netten Radcliffe, "one of the medical inspectors who has for some years been charged with the duty of examining the communications with the Lords of the Council, as administrators of the Quarantine Act, and till recently of the Diseases Prevention Act," submitted to Mr. Simon, the medical officer of the Privy Council, a Report upon the Recent Diffusion of Cholera in Europe. This Report, which the Times designates as 66 a very remarkable one, proves, almost to demonstration, that the C. epidemic which has been displaying itself in eruptions more or less serious in Persia, Russia, and other parts of Continental Europe, originated at the annual religious Hindu Fair at Hurdwar, in 1867, at which, it was calculated, "not less than 2,800,000 were present on the great day of the festival," and was carried by or through personal communication with the pilgrims to the various localities in which it has since been heard of. [PLAGUE SPOTS.]
In the Appendix to 33rd R. of Reg.-Gen., pub. 1872, Dr. Farr says:
No greater mistake can be made than to assert of Asiatic C., as is done with a kind of Oriental fatalism, by some popular writers, that C. is under no kind of control. Now it is, I believe, more completely under medical control than any other known epidemic disease; in the first place its propagating fluid is tangible, and can be destroyed; and in the second place the disease almost invariably begins as diarrhoea, which can, in the great majority of cases, be stopped by simple remedies. The disease here never decimates cities, except when its poison is diffused through their potable waters. To the practical applications of these well-ascertained scientific facts, it is due that Asiatic C., which in 1849 destroyed 53,293 lives, in 1854 was only fatal to 20,097, in 1866 to 14,378 lives in E. and W. At the 8th International Statistical Congress, held at St. Petersburg, in Aug. 1872, the questions relating to sanitary statistics involved a discussion on the C. of great interest and animation. Mr. Samuel Brown, in his report on the Congress, read before the Statistical So. of Lond., 19th Nov. 1872, says thereon:
The propositions in the programme, twelve in number, related to a variety of inquiries to be made as to the personal history, health, habits, etc., of the person attacked with the disease; and also as to the manner in which he first caught it, and the results of the medical treatment, and minute questions as to the locality invaded, its sanitary and atmospheric condition, and the mode in which the disease appeared and spread. The subject, together with the report on syphilis, was referred to a Sub-Section, under the presidency of M. Middendorf, and various alterations made in the questions proposed. On being brought before the General Assembly, by Drs. Benezet and Bredow, another lively debate ensued, some being of opinion that the questions were too long and complicated. M. Castiglione proposed that they should be referred to the Permanent Commission to revise; but an amendment was carried, to the effect that medical men and statisticians should take as a guide, as far as possible, the programme now proposed, carry it into effect in the mean time, and report to the next Congress how far it is capable of practical application to throw light on these two calamitous diseases. He (M. Castiglione) also proposed that at the next Congress a larger number of medical men from different countries should be called together, to constitute a separate Section for Medical Statistics. At the present time [Nov. 1872] epidemic C. is making considerable ravages in Austria. During the autumn it prevailed with some severity in Russia. CHOLERA, ASIATIC, DEATHS FROM (Order, ZYMOTIC; Class, Miasmatic).—The deaths from this cause in England present considerable, and very sudden, fluctuations. For the purposes of comparison and future reference, we give the following T. of the deaths regis, over a period of 33 years [a generation]. This T. includes under C. the deaths 35
from English C.; the deaths from Diarrhea are shown separately. The reason for their being included here is abundantly shown in the preceding art.
TABLE SHOWING THE MORT. BY CHOLERA AND DIARRHOEA IN England AND IN London, FROM THE YEAR 1838 DOWNWARDS.
Diarrhea. Cholera. Diarrhoea. Cholera. Diarrhoea. Cholera. Diarrhoea.
[We do not calculate the ratios of deaths to pop. in these later years, because the pop. has to be adjusted in the light of the census of 1871.]
The following additional Tables will be found valuable for future reference :
TABLE SHOWING THE DEATHS FROM CHOLERA AND DIARRHEA IN London AND IN EACH DIVISION of England during the Years 1849, 1854, and 1866.
1849. 1854. 1866. 2,803,989 14,137 10,738 South-Eastern Counties 1,847,661 3209 1581 South-Midland Counties 1,295,515 1517 1229 Eastern Counties....... 1,142,562 879 961 501 South-Western Counties 1,835,714 4564 338 631
1849. 1854. 1866.
913 1240 699 774 1118 1086 953
West-Midland Counties 2,436,568 5174 892 139
Monmouth and Wales...
358 1955 2179 1964
1,151,372 3474 632 610 789 824 1135 1,312,834 4573 939 2493 629 516 561
England and Wales... 20,066,224 53,293 20,097 14,378 18,887 20,052 17,190
584 247 1916 6346 624
764 967 772
TABLE SHOWING DEATHS IN Lond. AND EACH DISTRICT TO 10,000 PERSONS LIVING.
TABLE SHOWING THE DEATHS AND RATE OF MORT. FROM CHOLERA AND DIARRHOEA IN 1849, 1854, AND 1866, OF MALES AND FEMALES AT DIFFERENT AGES.
1849. 1854. 1866. 1849. 1854. 1866. 1849. 1854. 1866. 1849. 1854. 1866.
10'8 6.8 30'0 10'8 6.8 II'I
11 2 8.6 10'2 10'4 7'6
2'9 14'2 9'5 5'9 30°3 10'2 13'0 7'9 40'5 14'0 8.3 2'7 49'5 14'9 9'1 46'7 14'9 9'4 4.8 2'5 1.8 4'6 2'7 2'0 60'4 19'6 12'0 11'4 6'4 4.8 10'6 7°3 5'6 67.8 21.8 10'9 27°2 20'1 14'0 26.8 116 71'7 23'6 1370 54'0 52'3 36'0 52°1 51.8 35'I 7°3 48.7 20'8 17'2 84 7 88.0 637 62°3 77'4 64 2 24'6 33'0 20'0 30'3 77*7 136'1 73.8 79'9 40 4
95 and upwards.. 31'1
[We have endeavoured in this and the preceding art. to deal exhaustively with the subject of C., and for this reason-it is the only element menacing the stability of life ins. offices with which careful management cannot combat. We believe the reader will be led to the conclusion, after a careful perusal of the preceding details, drawn from all available quarters, that C. is now nearly as much under human control as any of the maladies which afflict humanity; and if that be so, L. offices can best consult their own safety by aiding the advancement of enlightened legislation and practice in relation thereto.] CHOLERA, ENGLISH (Gastro-enteritis mucosa).-A milder form of the malady than that usually spoken of as Asiatic or Epidemic C. The English or European form of C. is
accompanied by bile; the Indian is without bile or urine.-Hoblyn. It is supposed to have been this variety which was noticed by Sydenham in 1669.
Dr. Guy speaks of it as having paid our Lond. ancestors visits of five or six weeks in the months of Aug. and Sept. during the 17th century. It is set down by our Reg.-Gen. simply as "C." It appears to be especially aggravated by the circumstances attending an epidemic of Asiatic C. In 1847 the deaths were 52; in 1848 (marking the beginning of an epidemic), 292; in 1849 (C. epidemic), they rose to 6209; and in the following year fell to 55. The preceding returns embrace all the deaths from it in England. CHOLERA FLUX.-See CHOLRINE.
CHOLERA INFANTUM.-A form of disease which has long been prevalent in American cities. It prevailed in Lond. in the summer of 1846. [CHOLERA, ASIATIC.] CHOLERA MALIGNA.-An epidemic malady due to an atmospheric poison, but communicable by infection, characterized by symptoms of collapse allied to asphyxia, and by profuse vomiting and purging. Cholerine is a term applied to the milder form of the disease. Cholera asphyxia is a term used to characterize the state of collapse in fatal cases. CHOLERAIC DIARRHEA.-A cause of death frequently returned to the registrars during the C. epidemics in Gt. Brit. [See CHOLERA, 1849.] CHOLRINE. A material substance, analogous in its nature to the substances which produce, under given circumstances, smallpox, cowpox, syphilis, and erysipelas; and by means of which C. epidemic is diffused. It has been called Cholerine; but Dr. Farr proposed in 1868, with a view to avoid ambiguity, to write it Cholrine. It is very frequently spoken of as the Cholera Flux. Dr. Snow advanced the view in 1849 [CHOLERA, ASIATIC] that the evacuations containing this matter, distributed by contact, or through water, were the sole means of propagating C. Dr. Richardson contends that the C. matter is an "alkaloidal organic poison, which, soluble in water, but admitting of deposit on desiccation, passes easily from one person to another," under the agency of certain peculiar physical states.
Dr. Farr has remarked that it may appear at first sight impossible that the C. flux of one or more patients should produce any effects in the waters of a river like the Thames. But living molecules, endowed with the powers of endless multiplication, are inconceivably minute, and may be counted by millions in a drop of water. Again :
The infection power of cholera liquid is essentially transitory; it is developed in given circumstances in its intenser form, and in a community as well as in an individual-in India as well as in England-it grows as well as declines by a law of its own; it is epidemic only for a time, and by periods of years. It has its seed-time and its harvest in each locality; and the air or the water which on one day is poisonous may a few days after be harmless. There is an essential difference between zymotic venom and a metallic poison like arsenic.
In its weakest form Cholrine produces diarrhoea in a great number of persons; but in every pop. a large number of people appear to resist its influence. They are insusceptible. The cases of attacks of the same person twice in this as in some other zymotic diseases are rare.-Report on Cholera Epidemic, pub. 1868.
CHOREA SANCTI VITI (from the Greek, dancing, hence called skelotyrbe; St. Vitus's Dance). Functional derangements of the motor nerves, resulting in irregular jerking movements, more or less interfering with the voluntary actions. CHOREA, DEATHS FROM (Class, LOCAL; Order, Diseases of Nervous System).—The deaths from this cause are very few in England, and show some fluctuations. In ten consecutive years they were as follows:-In 1858, 53; 1859, 55; 1860, 66; 1861, 71; 1862, 52; 1863, 63; 1864, 73; 1865, 88; 1866, 63; 1867, 50. Over a period of 15 years ending 1864 they averaged rather over 3 to each million of the pop. living. The deaths of 1867 were 21 males and 29 females, spread over the ages of youth and the later middle age. CHOSE IN ACTION [otherwise called Chose in Suspense].---A thing of which the man has not the possession or actual enjoyment, but only a right to recover, by action or other proceeding at law. A well-known rule of the Common Law is that no possibility, right, title, or thing in action can be granted to third parties; for it was thought that a different rule would be the occasion of multiplying litigation—it would in effect be transferring a lawsuit to a mere stranger.-Wharton. A sum insured under a pol. to be paid only on the happening of a particular event was regarded by the Common Law therefore as being incapable of assignment; and this, too, even although the sum ins. is made payable to the executors, administrators, or "assigns " of the ins. The Statute Law has now remedied this, as we have already shown. [ASSIGNMENT OF POL., Life.] CHRISOMES.-One of the regular entries in the early Bills of Mort. was "Chrisomes and Infants," thus substituting the age of the deceased for the disease. Chrism is a Greek
word, signifying an ointment used as an holy unguent to anoint the cloth which infants wore until they were christened-usually at the end of the month. If the child died within that period, it was called a Chrisome. The priests of the Greek and Romish Churches attached importance to this rite. Graunt observes that as the number of deaths put down to this head decreased, the number set down to convulsions increased. By 1726 the designation had disappeared from the Bills.
CHRISTENING INS.-During the reign of Queen Anne-that is, in the early part of the last century a strange mania sprang up in favour of ins. projects of every conceivable variety. Amongst them ins. offices of this class, which, however, appear to have sprung out of