Chapter IX

ASIATIC CHOLERA.

The Indian or Asiatic cholera, which first showed itself on British soil in one or more houses on the Quay of Sunderland in the month of October, 1831, was a “new disease” in a more real sense than anything in this country since the sweating sickness of 1485. The English profession had been hearing a good deal about it for some years before it reached our shores. The outbreak in Lower Bengal in 1817, from which the modern history of cholera dates, had been the subject of reports and essays by Anglo-Indian physicians and surgeons; an extensive prevalence of it in the Madras Presidency shortly after, as well as in Mauritius in 1819 and 1829, had been observed by other medical men in the service of the East India Company or of the British army or navy. Many who had seen cholera in India, and some who had written upon it, returned to England in due course, so that the formidable new pestilence of the East began to be heard of in medical circles at home. Various essays upon it issued from the English press between 1821 and 1830[1475]; and in 1825 it appeared for the first time, and at considerable length, in the pages of an English systematic treatise, the new edition of Dr Mason Good’s ‘Study of Medicine.’

Previous to 1829, Asiatic cholera had obtained no footing in Europe. The first great movement westwards from India through Central Asia, which was continuous with the memorable eruption in Bengal after the rains of 1817, had reached to Astrakhan, at the mouths of the Volga, and had there caused the deaths of some 144 persons in September, 1823. Another progress westwards from India, after an interval of six years, reached the soil of European Russia in the Government of Orenburg in August 1829, the mortality in the whole province during the autumn and winter (to February, 1830) amounting to about one thousand. A much more severe epidemic of it arose in the summer of 1830 in the town and province of Astrakhan (supposed to have been introduced by an infected brig from Baku), which spread with enormous rapidity, destroying in the course of a month some four thousand in Astrakhan itself and upwards of twenty thousand in other parts of the province[1476]. Thus established in the basin of the Volga, Asiatic cholera overran the whole of Russia. Before the spring of 1831 it had entered Hungary and Poland, and in the end of May had reached Danzig and other German ports on the Baltic and North Seas. Lord Heytesbury, the British Ambassador at St Petersburg, had sent home a despatch upon it early in 1831; in April, the Admiralty issued orders for a strict quarantine of all arrivals from Russia at British ports, which were afterwards extended to arrivals from all ports abroad invaded or threatened by cholera. On 20 June a royal proclamation ordering various precautions was issued, and next day a Board of Health was gazetted, composed of leading physicians in London and of the medical heads of departments, with Sir Henry Halford as president. Local Boards of Health were formed voluntarily in many parts of the country during the summer of 1831. Two medical men were at the same time commissioned by the Government to proceed to Russia to study the disease there, their letters to the Board of Health commencing from the 1st of July. The growing interest in the disease as it came nearer called forth another crop of writings, some of them based on old Indian experience, others speculative[1477]. The most important of these was the treatise by Orton, which had been published in its original form at Madras in 1820. Writing from Yorkshire in August, 1831, he surmised (with a proviso that no one could say confidently what might happen) that Asiatic cholera might be expected to be a mild visitation upon Britain at large, falling most upon the large manufacturing towns in which typhus was common, but that it would be “far otherwise” with Ireland owing to its chronic poverty, distress and over-population. By a singular chance the only town which he specially mentioned in England was Sunderland, where, he had been told by Dr Clanny, there had been an unusual number of cases of malignant cholera nostras in the early part of the autumn: “it is greatly to be feared,” he said, “that those are but the skirts of the approaching shower[1478].”

In other places besides Sunderland there had been perhaps more than the usual amount of summer diarrhoea in 1831. Dr Burne, in his London dispensary reports, entered on the 2nd and 16th July an unusual prevalence of “dysenteric diarrhoea and cholera,” and cases of scarlet fever of an “adynamic” type or with a tendency to fatal collapse[1479]. (Clanny observed the same type of scarlatina at Sunderland along with some typhus.) Choleraic disorders were uncommonly rife on board the ships of war in the Medway[1480]. A succession of twenty-four cases at Port Glasgow, from 2 July to 2 August, chiefly among workers in Riga flax, gave rise to an alarm of the real Asiatic cholera, the more readily that the first case was fatal (the only death)[1481]. Similar alarms arose at Leith and Hull.

Asiatic Cholera at Sunderland in October, 1831.

In the end of July and in August, Sunderland and the adjoining villages and farms in the valley of the Wear were visited with “a very general prevalence of the indigenous cholera of the country, bearing in most instances its usual leading feature—that of excessive bilious discharges[1482].” Few, who were not attacked with actual cholera nostras, were altogether free, it was said, from diarrhoea or disordered digestion. Many of the choleraic cases were unusually malignant, of which the following are instances:

Allison, aged fifty, a painter of earthenware residing in a low situation on the bank of the Wear two miles above the town, was attacked at 4 a.m. on the 5th of August with vomiting and purging of a watery whitish fluid, like oatmeal and water. His hands and feet were cold, his skin covered with clammy sweat, his face livid and the expression anxious, his eyes sunken, his lips blue, thirst excessive, his breath cold, his voice weak and husky, and his pulse almost imperceptible. He passed into a stage of reactive fever and got well. Arnott, a farm-labourer on the opposite bank of the Wear from the man Allison, was seized at 2 a.m. on the 8th August with precisely the same symptoms, and died in twelve hours. Neither he nor Allison had any intercourse or relation with seamen or the shipping of Sunderland[1483]. Another case on the 8th of August came to light afterwards. A woman in the village of West Bolden, four miles from Sunderland, on the Newcastle road, was found by a surgeon from the town to be suffering from choleraic sickness, of which she died twelve hours from its onset[1484].

A week after these cases in the country not far from Sunderland, there occurred the death, on 14 August, of one of the Wear pilots named Henry. He had been troubled with diarrhoea for some time before, but not so as to keep him from his occupation. Having gone down in the direction of Flamborough Head to look for ships, he picked up a vessel between that and the Wear, piloted her in, and, a few days after, piloted her out again. The identity of the vessel was never traced, but it was alleged that she had come from an infected port abroad. The last time Henry was in his boat he was seized with violent vomiting and purging, and died at his house after an illness of twenty hours. A brother pilot, who looked in at the house on the day of his death, fell into a similar choleraic disorder, but recovered[1485]. On the 28th of August a shipwright died of the same; also about the end of August two persons at a distance of four or five miles from Sunderland. In September, it is said, there were other cases and fatalities. Early in October the authentic particulars of cholera in Sunderland begin. Dixon attended one case, which was fatal on the 9th October. Another case, which came to light three months after, was that of a girl of twelve, named Hazard, residing on the Fish Quay, who was well enough on Sunday the 16th October to have been twice at church. She was seized in the middle of the night following with the sudden and appalling symptoms of choleraic disease and died on the Monday afternoon[1486]. A few doors off on the same quay lived a keelman named Sproat, aged sixty; he occupied a large, clean, well-ventilated room on the first-floor of a house in the most open part of the quay, opposite to a crowded part of the anchorage. He was in failing health, and had been troubled with diarrhoea for a week or ten days previous to the 19th October, on which day he had to give up work. Next day, Thursday, the 20th, a surgeon who had been sent for found him vomiting and purging, but not at all collapsed, with no thirst, and in good spirits. He improved so much that on Friday he had toasted cheese for supper and on Saturday a mutton chop for dinner, after which he went out to his keel on the river for a few minutes. On his return he was seized with rigor, cramps, vomiting and purging. Medical aid was not sent for until seven on Sunday morning, when he was found in a sinking state, pulseless, speaking in a husky whisper, his face livid and pinched, his limbs cramped, the purgings like “meal washings.” He continued like that for three days, and died on Wednesday, the 26th October, at noon.

This came to be reckoned the first death from Asiatic cholera in England.

His grandchild, a girl of eleven, while moving about the room an hour after the death, was suddenly seized with faintness, pains in the stomach-region, vomiting and purging of watery matters; she was taken to the Infirmary and soon got well. The day after his father’s death, Thursday, the 27th October, William Sproat, junior, a fine athletic young keelman, who had attended on his parent during his illness, was found lying in a low damp cellar near to the Fish Quay, suffering from choleraic symptoms; he had been ill only a few hours, and was removed (with his daughter as above) to the Infirmary the same evening. He became gradually worse: on the 30th he was continually throwing himself about, moaning and biting the bedclothes; on the 31st he was lying on his back comatose, his eyes open, the pupils wide and insensible, and the breathing stertorous, in which state he died the same day. An old nurse at the Infirmary (Turnbull) helped to place the body in the coffin, went to bed in a state of considerable fear, and was seized at one in the morning with symptoms of cholera, of which she died after a few hours.

Meanwhile there had been two other fatal cases unconnected with the Sproats or the Fish Quay. On the quay of Monk Wearmouth, across the river, lived a shoemaker named Rodenburg, aged thirty-five. He occupied a poor hovel and had a large family, but he was in good work and wages. On Sunday, the 30th October, he had pork for dinner, and what was left of it for supper. In the middle of the night he was seized with vomiting, and with purging of a fluid like water-gruel in vast quantities; when visited by the medical men, he spoke in a husky whisper, his nails were blue, his skin livid, covered by cold sweat, his limbs cramped. The spasms ceased about nine o’clock on Monday morning; about noon he asked to be raised in bed, and died as they were raising him. On the very same night, between Sunday and Monday, a keelman named Wilson, who lived with his wife in a decent room in the High Street, and had attended the Methodist chapel on Sunday, was seized with cholera at 4 a.m. on Monday, and died the same afternoon at three.

These six cases within a few days, all fatal but that of the girl of eleven, looked like the real Asiatic disease. Kell, an army assistant-surgeon stationed at Sunderland with the reserve companies of the 82nd Regiment, had suspected that the earlier case of the pilot Henry was true Asiatic cholera (which he had seen in Mauritius in 1829), and had written to the Board of Health. At a meeting of the faculty at the Infirmary on the morning after the admission of Sproat junior and his child (28th October), Kell urged upon them that the disease was Asiatic cholera, but all the twelve present, save Dr Clanny, who was in the chair, maintained that it was common indigenous cholera. However, when the younger Sproat died, and the nurse after him, and two others in different parts of the town, a full meeting of medical men at the Exchange came unanimously to the opinion that these were cases of “spasmodic cholera.” A meeting of the Board of Health and leading citizens was at once held, who were informed that, in the unanimous opinion of the medical gentlemen of the town, “spasmodic cholera prevailed in Sunderland.” The authorities in London having been kept informed (principally by Kell), a surgeon of Indian experience was sent down by the Board of Health on the 5th November, and a colonel by the lords of the Council on the 6th, to act as commissioners.

It happened that no more cases occurred for three days after the death of the nurse at the Infirmary; so that the doctors, like Pharaoh in the intervals between the plagues of Egypt, were beginning to repent of their diagnosis. The shipping trade of Sunderland was threatened by these newspaper alarms, and by the presence of two Government commissioners in the town; while Kell was demanding a ship of war off the mouth of the Wear, and a battery on shore, to make the quarantine respected. The Marquis of Londonderry, interested in the coal-trade, wrote to the Standard that the alarm was false. The magistrates, shipowners and leading residents, who had met on the 9th November to raise money for a cholera hospital, assembled again in various public meetings or caucuses on the 10th and 11th, and passed resolutions that there was no Indian or other foreign imported cholera in Sunderland, that it was a wicked and malicious falsehood to say there was, and that there was no need of quarantine on the Wear. One of these meetings was attended by fifteen medical men (most of them from the residential suburb of Bishop Wearmouth), who severally expressed the opinion in various terms, that the recent fatal cases were aggravated cases of English cholera, not contagious or infectious, while three more sent letters backing up Lord Londonderry and the shipowners. On the 12th of November, twenty-seven medical men signed a declaration to the same effect. Some of these remained unconvinced by the progress of events, Dixon arguing as late as 23 January, 1832, that the epidemic in Sunderland, which was by that time over, had been one of “spontaneous malignant cholera.”

Two new seizures occurred on the 7th November, none on the 8th, seven on the 9th, one on the 10th, and so on for fully six weeks longer until Christmas, when the cases became very occasional, so that on the 9th of January, 1832, Sunderland was declared by the Board of Health to be free of cholera. The largest number of seizures reported on one day was nineteen on the 8th of December; on the 10th of that month there were sixty-three cases under treatment at once; the whole number of cases from 23rd October to 31st December was 418, of which 202 were fatal; the whole deaths at Sunderland by the cholera of 1831-32 are given at 215, so that the epidemic exhausted itself there before it had well begun elsewhere in the country. The effect of it upon the death-rate is shown in a comparison of the burials for November and December in three successive years[1487]:

Burials in the parish of Sunderland.

November December

1829 29 44

1830 39 76

1831 122 127

The way by which the virus entered Sunderland was never traced. It was known, however, that deaths from cholera had occurred among the crews of Sunderland ships lying at Cronstadt and Riga; and as it was the practice for vessels owned in Sunderland to come home from their summer trading towards the end of the season, so as to lay up during the winter, it was suspected that the clothes of some of the dead men had been brought over and sent ashore. The quarantine in the Wear was far from effective: the station was higher up the river than the loading moorings, so that suspected ships had to pass through a crowd of ordinary shipping to get to it. It appears that hardly any ships were quarantined, except some from Dutch ports where no cholera then existed.

This first experience of Asiatic cholera on British soil brought out very clearly one character of the infection which was seen to attend it everywhere during the following year, and has always attended it in every subsequent invasion of the disease. The virus, for all its opportunities, showed a marked preference for, an almost exclusive selection of the lowest and least cleanly localities, and a considerable preference for persons of drunken or negligent habits. Sunderland consisted of three parts—the parish so named, the parish of Bishop Wearmouth, which was the west end of Sunderland or the residential quarter of the wealthier class, and across the river the parish of Monk Wearmouth, with the adjoining Shore. The cholera was almost wholly confined to Sunderland proper; Ainsworth says that no cases occurred, to his knowledge, in the parish of Bishop Wearmouth, and not above six in Monk Wearmouth; another gave six or eight cases in each of these parishes, but increased the estimate to eighteen or twenty in each according to later information. Bishop Wearmouth stood about seventy feet higher than the highest part of Sunderland; it was well built, and its population of 14,462 (with 363 more in the Pans), included the whole of the wealthier class with the trades dependent on them. Monk Wearmouth, with a population of 1498, and the adjoining Shore with a population of 6051, were irregularly built on the north bank, and occupied by the same class (keelmen, sailors, labourers and workmen in the coal, iron and shipping trades) as Sunderland itself; but for some reason, connected perhaps with its soil and elevation, it escaped with a very few cases of cholera[1488]. The parish of Sunderland, with a population of 18,916, was not all visited equally. The focus of the cholera, says Ainsworth, was the town moor, a large piece of pasture-land stretching to the sea-shore at the south-east end of the town, having a subsoil tenacious of water, marshy in the winter months, and its roads almost impassable. Upon this open space was deposited, and left to accumulate for weeks together, the filth from the narrow lanes and passages of the low-lying and crowded quarter at the seaward end of the parish, to the south of the High Street. Some of the streets occupied by the poorer class consisted of old residences of the well-to-do, now divided into tenements. Certain streets had as many as a dozen or twenty common middens, “let in” to the street fronts of houses and covered by trap-doors, in which the domestic refuse and sweepings of the street were collected as a source of profit, and sold at stated times to farmers for manure. Most of the attacks happened in this low-lying part of Sunderland, with a soil and foundations sodden with filth, houses overcrowded and badly ventilated, and its residents subject to the alternations of excess and want (with much pawning of clothes, &c.) peculiar to a port from which one or two hundred sail would leave with a fair wind or arrive in the river together[1489]. About four hundred were attacked in a population of eighteen thousand during a space of two months. The cases among the wealthier classes were nearly all in the households of medical men:—the mother of one doctor, living with him, died of Asiatic cholera, the wife of another came safely through an attack, one or more medical men had the symptoms in one degree or another. In the end of November, five old people in the poor’s house were fatally attacked all at once, in different parts of the building. A cholera hospital had been provided at an early stage of the outbreak, but the relatives of those attacked seldom permitted their removal to it, a prejudice against it having been aroused by the post-mortem examination of the first victims. Most of the cases were accordingly treated at their homes, which were “always crowded to excess by the immediate attendants or relatives, and by others from mere curiosity.” A fund of two thousand pounds was raised for the distressed families, to which the Government gave one hundred. Sunderland became for two or three weeks a centre of interest to medical men, who came to see the cholera from various parts of England, Ireland and Scotland, while MM. Magendie and Guillot came from Paris, and M. Dubuc from Rouen.

The symptoms and morbid anatomy of cholera as it was known in India were seen without ambiguity in the Sunderland epidemic. In a few cases death followed very quickly without the distinctive intestinal symptoms; but usually the unmistakeable thing was a sudden seizure, often in the night after a hearty supper, marked by profuse “meal-and-water” or “rice-and-water” purging, by vomiting, faintness or sinking at the pit of the stomach, thirst, pulselessness, cramps of the limbs, restless tossing, coldness, blueness and clamminess of the surface, and shrunken features. The facies Hippocratica had not been seen on so extensive a scale in England since the sweating sickness of three hundred years before. The end was sometimes in deep coma, at other times in delirium with convulsive or spasmodic movements. The chief point in the morbid anatomy was the engorgement of the lungs, great veins, and right side of the heart, from which the disease was named “cholera asphyxia.” The blood was thick and tarry[1490].

Extension of Cholera to the Tyne, December, 1831.

Before Sunderland had been declared by the Board of Health to be free of cholera, on the 7th of January, 1832, the infection had gained a footing in Newcastle, Gateshead, North Shields, Houghton-le-Spring, and some places on the road to Edinburgh. The mildness of that winter was somewhat favourable to its diffusion; in November there had been some days of severe frost in the midst of generally mild weather, December was warmer than usual, the pastures being green and spring-like, while January was warm and dry almost beyond precedent. The first cases in new centres were usually tramps or others who had come from Sunderland[1491]; but there were some puzzling attacks. Thus Dixon says that on 12th December, 1831, he visited a woman of fifty who died of cholera after twelve hours, “in a lonely district unconnected in situation with any previously infected place,” and where there had been no personal liability to contagion; a young man lodging in the house died three days after with the same symptoms.

At Newcastle, as at Sunderland, fatal cases of choleraic disease were discovered from the beginning of autumn; one such, on 4 August, at the village of Team, two miles to the south-west of Newcastle, was said to have been as little of the nature of bilious cholera, and as truly spasmodic cholera, as those in the subsequent great epidemic. Another suspicious death occurred a little below Newcastle on the 26th October, the same day as the first acknowledged death from the Asiatic disease in Sunderland. A month passed before the next death, marked by spasmodic and non-bilious symptoms, occurred at Newcastle—on the 26th November.

At length, on the 7th of December, 1831, the Asiatic cholera was declared to be in the town. The earliest cases of it were found in low-lying poor houses along the river[1492]. Gateshead, on the south bank of the Tyne, had only two cases until a day or two before Christmas; at length, on Christmas-day, there was a sudden explosion of the infection simultaneously at many points.

“On the 25th [December, 1831] about one o’clock,” wrote Brady[1493], “we were assailed by a third and fourth example of the disease, and before the next morning at ten o’clock, very considerable numbers had fallen sacrifices to its pestilential ravages. Within a space of twelve hours it spread itself over a diameter of two miles, and appeared to pay but very little distinction to altitude of situation, for the higher parts of the town were laid under its stroke in an equal degree, or nearly so, with the lower. Pipewellgate, Hillgate, the banks above Pipewellgate, Oakwellgate, the lanes leading from it, Jackson’s chare, Nun’s Lane, Wreckington, Gateshead Low Fell, Low Team—situations as different in their external character as can well be conceived—were all indiscriminately exposed to its fury.”

Greenhow’s summary of this remarkable explosion on the afternoon and night of Christmas-day is that “at nearly fifty different points cases occurred almost at the same instant.” The attack at Gateshead was short and severe; at Newcastle it was less concentrated and of longer duration, affecting the population in the low and dissolute localities along the river, such as Sandgate and the Close, while there were two or three fatalities about the 6th January among the wealthier residents. The hospital cases in Newcastle and Gateshead to the 9th of February were:

Cases Deaths

Sandgate Hospital 55 23

Castle Hospital 12 8

St John’s and St Andrew’s 15 8

Gateshead Hospital 36 21

118 60

As at Sunderland, the bulk of the cases were treated at their homes—1330 cases, with 437 deaths, to the 9th of February. As the whole number of deaths at Newcastle and Gateshead, while the cholera of 1832 lasted, was 801 in the returns to the Board of Health, it would appear that the epidemic had dragged on through the spring and perhaps the summer, which were its seasons elsewhere.

The colliers’ villages on both sides of the Tyne for two or three miles above and below Newcastle and Gateshead were sharply visited at the same time. Below Newcastle, on the north bank, it invaded Dent’s Hole, a dirty narrow lane along the margin of the river, overhung by its banks, filled with mud and filth rising in heaps above the thresholds of the houses; also on the same side, Walker, Howden-Pans, and so on to North Shields; on the south side below Gateshead it visited Felling and other villages. South Shields and Westoe escaped for several weeks, but at length about the 20th of February the epidemic began there and caused 147 deaths before it ceased.

Some of the worst village outbreaks occurred above Newcastle on both sides of the river. Swalwel, a low dirty village of iron-workers, near the confluence of the Derwent with the Tyne had a very virulent attack. Dunston, another low-lying village on the south bank, two miles above Gateshead, subject to inundation from the small tributary stream running through it, had twenty-three deaths among the 400 inhabitants in about a fortnight, most of the victims being old, dissipated and debilitated. On the other hand, Whickam Fell, standing on the hill between Dunston and Swalwel, escaped with only one case, while Bensham, another elevated village between Gateshead and Dunston, escaped altogether; just as Byker, a high-lying village on the north bank, only half a mile from Dent’s Hole, had but a single mild case.

On the north bank above Newcastle the disease was most severe in the villages of Bell’s Close, Lemington and Newburn. The epidemic in the last of these was indeed unparalleled. As in all the other villages attacked, the epidemic was soon over, but not before two-thirds of the inhabitants had suffered either from choleraic diarrhoea or cholera proper. Newburn was a village of some 131 houses, built in the face of the high north bank of the river five miles above Newcastle, its population being 550. The houses stood in two rows, one above the other, the church and churchyard standing in open ground midway between the lower and upper streets of the village; a small stream ran through it to the Tyne. The inhabitants were mostly wherrymen, coal labourers, or glassworkers; they were a healthy community, above indigence, housed in clean, neat, comfortably furnished clay-floored cottages. The first case of cholera, in a man who lived close to the brook, proved fatal on the 4th of January, 1832. There was no new case until the 10th, after which there were several deaths every day. From the night of the 15th until noon of the 16th fifty were attacked, twelve or thirteen of them with the worst kind of spasmodic cholera, the rest with diarrhoea. By the 2nd of February the epidemic was over. Three hundred and twenty had either cholera or cholerine, of whom fifty-seven died (the Board of Health return gives 274 cases and 65 deaths to 25 January), the daily deaths having been as follows[1494]:

Cholera in Newburn, near Newcastle, 1832.

Deaths

Jan. 4 1

11 4

12 3

13 4

14 6

15 5

16 6

17 3

18 5

19 3

20 3

21 2

22 3

23 2

24 2

25 1

26 2

27 1

28 } 1

29

The other chief centres of cholera in the northern coal district, besides those mentioned, were Houghton-le-Spring and Hetton (which had together 311 cases and 66 deaths to the 28 of January), the colliery village of Earsden, and the port of Tynemouth.

The Cholera of 1832 in Scotland.

It was not until April that the infection began to show itself on the same scale in other parts of England. The next parts of the kingdom to be invaded after the Wear and the Tyne were the coal and iron districts of East Lothian and Lanarkshire, the cities of Edinburgh and Glasgow becoming infected soon after. A fatal case, in a destitute tramping sailor occurred at Doncaster, in the beginning of January, but led to no outbreak; two fatal cases occurred at Morpeth about the same time, the second of the two in a bagman who had just spent three days making his rounds in Newcastle and the infected villages near it. It was on the high road to Edinburgh, at Haddington, Tranent and Musselburgh, that the next focus of cholera was established. Previous to the 14th of January there had been 47 cases, with 18 deaths, in and near Haddington, among the miners and others of the labouring class. At Tranent, seven miles nearer Edinburgh on the main road, with a population of 1700 miners and labourers, a boy died of cholera on the 18th January, the infection spreading so rapidly that before the 25th there had been 61 attacks with 26 deaths, which rose to 205 attacks and 60 deaths by the 8th of February. A few cases occurred also at North Berwick and a good many at Preston Pans; while Musselburgh became the scene of one of the most deadly outbreaks in the whole history.

Musselburgh, with Fisherrow, was not then the place of villas which it afterwards became, but was occupied by a working class, who combined the three industries of coal-mining, weaving or other factory work, and fishing. To add to the ordinary insanitary risks of such a combination, some fifteen hundred hands had been out of work for two months, and were in “a state of great misery.” The first case of cholera appeared there on Wednesday, the 18th January, three days after the first death at Tranent. The virulence and certainty of the infection will appear from the following by D. M. Moir, the distinguished author of Mansie Waugh and other writings in prose or verse, who practised his profession at Musselburgh:

“A girl at Musselburgh, whose mother kept a lodging-house, was found in a state of complete collapse on the morning of Thursday, the 19th January—the day after the first appearance of the pestilence. She died on that afternoon, between five and six, and was buried by moonlight the same evening.... The mother during the night of Saturday was also similarly seized, and fell a victim on the following noon. Her sister, who had walked from Leith on the same morning to condole with her in her family distress, was immediately affected on entering the house; but her symptoms being overlooked in the misery around her, medical assistance was not called in, until, on the return of the nieces from the interment, their aunt was discovered dead on the floor of the dwelling. Her husband, Baxter, a man of intemperate habits, came out to enquire into her fate; and immediately on his return home to Leith was seized with the distemper and died.”

In three weeks there were more deaths from cholera than from all causes in the whole of an ordinary year. To the 22nd of February, just over a month from its outbreak, the disease had attacked 435, of whom 193 died. The medical profession (the senior of whom was a man of original talent, Thomas Brown, author of an essay on smallpox, in 1808, and one on the Indian cholera in 1824), were greatly taxed by the numerous calls upon them: Moir met one night a young colleague who complained of feeling ill, and was advised by the former to go home at once; he continued his rounds for an hour longer, and died of cholera next morning. Edinburgh, only five miles distant, was in constant communication with Musselburgh; and at length three or four cases appeared in the city in persons who had been at the infected place. The Edinburgh cases, however, did not multiply rapidly; to the 8th of February, there had been 8 cases with four deaths; to the 28th of February, 35 cases, with 18 deaths; to the 20th of March, 39 cases, with 20 deaths. On the other hand, the suburb of Water of Leith, had 48 cases, with 23 deaths at the same date. On the 6th April, 1832, the figures for Edinburgh and certain of its suburbs respectively were:

Cases Deaths

Portobello 44 24

Water of Leith 58 30

Canonmills 18 12

Duddingston 10 3

Edinburgh 62 38

Of the border towns, Hawick was infected on the 14th January, probably from Morpeth, and had a not very extensive epidemic, of somewhat mild type[1495]. Coldstream, on the Tweed, a few miles above Berwick, had 109 cases and 37 deaths to the 20th of March.

Meanwhile the infection had sought out the weak spots in the west of Scotland—the mining and weaving villages in Lanarkshire, the city of Glasgow and the manufacturing town of Paisley. On Sunday, the 22nd January, a boy was taken ill in church at Kirkintilloch (a village on the Forth and Clyde canal, seven miles north-east of Glasgow), and died next morning: that was the first case in the west of Scotland. Cases multiplied in Kirkintilloch, so that by the 6th of March there had been thirty-two deaths, but no more for the rest of the season. A few days after the boy was seized in church there, a first case occurred in the mining village of Coatbridge, six or seven miles to the south-east, in an old man living in a “back land” in very poor circumstances, who had not been in Kirkintilloch nor had communication with such as had been there; other cases followed slowly, and at length there was a more severe outbreak.

Glasgow at once took precautions. A Board of Health had been formed there early in the summer of 1831. In February, it had command of £8000 raised by voluntary subscriptions, and it made provision of 236 cholera beds in five hospitals. The theatres were closed, and “evening sermons” discouraged; while all the passenger boats (for a time also the goods barges) on the Forth and Clyde canal, and on the Monkland canal (near to which was Coatbridge) were stopped. District committees were formed in all parts of the city.

The first victim was Janet Lindsay, a drunken old woman who lodged with widow Proudfoot and her daughter in Todd’s Close, Goosedubs; she was asthmatic, and had not been beyond the Goosedubs for weeks. Her seizure, with vomiting and purging, was on the afternoon of Thursday, 9th February, and her death on Saturday morning. Also on the 9th February, in the suburb of Woodside, remote from Goosedubs, the infant of one McGie was attacked with cholera, suffered much from cramps on the 10th and died on the 11th, the father, mother and others of the family afterwards suffering from cholera. The third case, fatal in a few hours, appeared early in the morning of Friday the 10th in a boy living in Millroad Street, a mile east of the Goosedubs, who had been subject to diarrhoea for some weeks. The fourth victim was a gardener in Macalpine Street, a locality also remote from the Goosedubs and in the opposite direction from Millroad Street, who had walked three miles to Pollokshaws on the 9th, and had partaken of tea with friends at Crossmyloof on his way back, in excellent health: he was seized at midnight with purging, and died on the afternoon of the second day. The fifth case was in Partick on the 11th, the sixth in Bridgegate on the 12th, not far from the close in the Goosedubs where the first case had occurred. On the 17th the first of many cases occurred in Paisley, and on the same day there was a case at Maryhill (population of some 500), followed by six more before the next afternoon. Thus there were, besides the case of cholera in the very heart of old Glasgow, half-a-dozen other cases the same day or in the next day or two, at scattered points all round the city. About fifty of the neighbours had visited Janet Lindsay in Todd’s Close, and some had helped to lay her out. The next case in the close was of a woman who had stopped in the street to talk with the widow Proudfoot shortly after the body had been removed; this woman was seized at seven next morning (Sunday, the 12th Feb.), and died in the hospital after twenty-four hours. Three days passed, and then there occurred two other cases, both fatal, in Todd’s Close, one of them being the widow Proudfoot herself, who refused to be taken to the hospital, and would receive no other medicine or cordial but whisky. No other cases occurred in the close for several weeks; but within a range of two hundred yards of it there were 46 cases from the 13th to the 29th of February. It was, indeed to this region of Glasgow, the Goosedubs and the Wynds, that the infection was chiefly confined for the first few weeks; it was especially severe in Francis’s Close, Broomielaw, a collection of small wretched hovels, in which some twenty died of cholera[1496]. The state of the three old Wynds of Glasgow and of other the like localities has been already referred to under a date a year or two before the outbreak of cholera (supra p. 598).

No better instance could be given of the inscrutable ways in which the infection of cholera found out the weak places and the likely subjects than the explosion in the Glasgow Town’s Hospital or pauper infirmary on the 22nd of February, some twelve days after the first cases in various parts of the city and suburbs.

The infirmary, built in two blocks on the north bank of the Clyde, contained 395 inmates occupying 296 beds, some 60 or 70 of whom were insane or fatuous. The fatuous lived in ground-floor cells of the north block, from seven to eleven feet square, with a stone vaulted roof, a stone floor, no fireplace, damp from situation and want of sun, but all the more damp from being often washed owing to the uncleanly habits of the inmates. At eight on the morning of the 22nd February two fatuous paupers in adjoining cells were found cold and pulseless; they had vomited and purged during the night, although they had been well the evening before; each of the two cells had three beds with five occupants. One of the two seized died next day, the other recovered in a week, having had severe spasms and a degree of collapse. Cases appeared almost at the same time in various parts of the building, most of them in scattered individuals, but in one instance in as many as five together in a garret holding twenty-two. From the 22nd February to the 9th of March there were 64 attacks of cholera in this pauper institution[1497]. Besides the five deaths in the Sunderland Workhouse, this was the first of many instances of the remarkable invasion of such institutions.

Until July the infection had been limited in Glasgow to certain of the lowest localities, and even in these it had declined almost to extinction in the last week of May. As the summer advanced it increased somewhat again, and in the first days of August it took a sudden start, reaching a maximum of 181 attacks in one day, and 817 in a week. It was no longer confined to the poorest districts, but became diffused all over Glasgow, so that “there was scarcely a street where one or more cases did not occur.” From this enormous prevalence in August, it declined again in September, but once more took a start in the last few days of that month and in the first week or two of October. The last outburst was ascribed to the effects of the Glasgow public holiday on 28 September, to celebrate the passing of the Reform Bill for Scotland, but the course of the epidemic clearly followed the season, being precisely parallel in Edinburgh, in Dumfries and in the coast towns of Fife. From the middle of October, the disease declined rapidly and was extinct before the middle of November. The following table shows week by week the number of new cases reported daily to the Board of Health, and the deaths in each week[1498].

Cholera in Glasgow, 1832 (population 202,426).

Week ending New cases Deaths

Feb. 19 62 21

26 113 46

Mar. 4 68 39

11 85 60

18 94 50

25 150 61

April 1 138 74

8 112 57

15 99 50

22 120 60

29 71 40

May 6 71 39

13 73 39

20 41 31

27 21 11

June 3 6 7

10 45 17

17 72 39

24 168 70

July 1 127 72

8 131 62

15 143 68

22 229 101

29 218 113

Aug. 5 817 356

12 699 339

19 483 228

26 419 178

Sept. 2 231 122

9 117 50

16 60 31

23 84 33

30 165 90

Oct. 7 310 140

14 173 95

21 95 58

28 47 29

Nov. 4 41 18

11 10 11

Total 6208 3005

The effect of the epidemic upon the general mortality of Glasgow is shown in the table of deaths from all causes and from cholera month by month, compiled from the burial registers, which make the cholera deaths 161 more than the returns to the Board of Health.

Glasgow Mortality in 1832.

All deaths Cholera deaths

Jan. 824 —

Feb. 874 87

March 955 264

April 816 229

May 677 125

June 783 196

July 990 441

Aug. 1755 1222

Sept. 749 243

Oct. 755 334

Nov. 529 25

Dec. 571 —

10,278 3166

While the cholera lasted (12 Feb.-11 Nov.) the burials from all other or ordinary causes were 4958; in the corresponding nine months of 1831 they were 4862, having been excessive in that year owing to fever. The baptisms from 15 December, 1831, to 14 December, 1832, were 3388; so that the cholera alone destroyed nearly as many lives, chiefly adult, as there were children born in the year.

Upwards of a thousand of the cases were treated at the Albion Street Hospital, under the direction of Dr Lawrie, who had had a large experience of cholera in India. His statistics are as follows[1499]:

Albion Street Cholera Hospital, Glasgow, Feb.-Sept. 1832.

Males Females Both sexes Percentages of deaths

Cases Deaths Cases Deaths Cases Deaths

370 251 662 419 1032 670 64·9

Ages Cases Deaths Percentages of deaths

0-7 43 25 58·1

7-20 93 47 50·5

20-30 231 112 48·8

30-40 211 137 64·9

40-50 204 136 66·1

50-60 116 95 81·0

Over 60 134 120 89·5

Monthly Cases and Deaths.

Cases Deaths Percentages of deaths

Feb. 40 33 82·5

March 97 69 71·1

April 122 81 66·3

May 56 40 71·4

June 126 94 74·5

July 240 143 59·5

Aug. 273 176 64·4

Sept. 64 33 51·5

The noteworthy points are: first, the great excess of women admitted, which was observed also at Edinburgh; secondly, the higher rate of fatality at the two extremes of life, which is the rule in some other infections; and thirdly, the lower ratio of deaths to cases during the height of the epidemic in the end of summer, which is explained, as Craigie remarked for Edinburgh, simply by the fact that the infection was no longer in the worst localities, but was attacking “a greater number of persons, and consequently much better constitutions.”

The Glasgow cholera of 1832 was far more destructive than that of Edinburgh per head of the population, according to the following:

Glasgow Edinburgh

Population 202,426 136,301

Attacks of Cholera 6208 1886

Deaths by Cholera 3005 1065

The fluctuations of the epidemic in the two cities were closely parallel. In Edinburgh from the middle of February to the middle of June the new cases usually ranged from five to ten or fifteen a day, with an occasional excess, as on the 29th of April when there were twenty-six persons seized. As in Glasgow, there was a marked lull in the end of May and beginning of June, after which the seizures became more common and remained somewhat steady to the end of July, some days having as many as twenty attacks. The largest number in one day in August was nineteen, the September maximum sixteen (on the 28th). Edinburgh thus missed the enormous outburst that Glasgow had in August, while the September experiences were much the same in the two cities. The first week of October, which was the time of a second maximum in Glasgow (far below that of August), was the worst time of the whole epidemic in Edinburgh, the cases coming from all parts of the city, as in Glasgow they had done in August.

Successive days of most extensive Cholera in Edinburgh, 1832.

New cases

Oct. 1 22

2 23

3 44

4 45

5 23

6 30

7 27

8 18

9 13

10 26

This gives 214 cases in the week ending 7th October, as compared with Glasgow’s 310 in the same week.

At the Castle Hill Cholera Hospital, 318 were admitted and 187 died. The ages, with the rates of fatality at each age-period, agree closely with those already given for the chief hospital in Glasgow. The smaller ratio of hospital fatality in the second half of the epidemic was perhaps more marked in Edinburgh: 119 cases, with 85 deaths, from the opening of the hospital to 5 July; 199 cases, with 97 deaths, from 5 July to the closing of the hospital. That larger proportion of recoveries may have been due in part, Craigie thinks, to better methods of treatment; but, in his opinion, it was mainly owing to the greater number of strong constitutions among those attacked over a wider area of the city.

Beyond the statistics and other particulars for Glasgow and Edinburgh, and the minute accounts of the first outbreaks in the beginning of the year, there is little exactly recorded of the cholera of 1832 in the rest of Scotland; but the following table, compiled according to counties from the alphabetical list of the London Board of Health, will serve to show the epidemic in outline.

Deaths by Asiatic Cholera in Scotland, 1832.

Counties Deaths No. of places attacked Places with highest mortalities in each county

Caithness 96 iii Wick 69, Thurso 26, Latheron 1

Sutherland — —

Ross and Cromarty 102 vii Tain 55, Dingwall 17, Avoch 12, Cromarty 11, Several villages no return

Inverness-shire 191 iii Inverness 177

Nairnshire 5 i Nairn 5

Moray — —

Banffshire 15 i Rathven (Buckie) 15

Aberdeenshire 108 ii Aberdeen and Footdee 99, Collieston 9

Kincardine — —

Forfarshire 552 iv Dundee 512, Cupar Angus 17, Arbroath 13, Liff and Benvie 10

Perthshire 81 v Perth 66, Auchterarder 7, Kenmore 4, Tulliallan 3

Fife and Kinross 301 xii Cupar and district 108, Kirkaldy and Dunnikier 104, Dysart 39, Wester Wemyss 17, Kinghorn 15, Burntisland 13, Anstruther 10, Leven 14, St Andrews 5

East Lothian 213 vii Tranent 78, Haddington 65, Dunbar etc. 38, Prestonpans 28

Berwickshire 41 Coldstream 41

Midlothian 1780 xiii Edinburgh 1065, Suburbs of, 146, Leith 267, Musselburgh and Fisherrow 202, Newhaven 52, Portobello 33

Linlithgowshire — —

Clackmannanshire 75 i Clackmannan 75

Stirlingshire 247 x Alloa 72, Stirling 35, Falkirk 36, Larbert 31, Balfron 28, St Ninian’s 15, Bothkenner 10, Carriden 13, Grangemouth 8

Lanarkshire 3575 xii Glasgow 3005, Pollokshaws 143, Govan 77, Old Monkland 125, Rutherglen 65

Renfrewshire 1001 xi Paisley 444, Greenock 436, Port Glasgow 69

Dumbartonshire 86 iii Dumbarton 67, Bonhill 13, Helensburgh 6

Bute 14 i Rothesay 14

Argyle 35 ii Inverary 25, Campbelltown 10

Ayrshire 466 x Kilmarnock 205, Ayr 190, Dairy 22, Irvine 19

Kirkcudbrightshire 133 iv Troqueer (Maxwelltown) 125, Kirkcudbright 3

Dumfriesshire 441 v Dumfries 418, Caerlaverock 15

Roxburghshire 34 i Hawick 34 (second outbreak only).

Near Glasgow numerous centres of cholera were established, among which Paisley, Greenock and Dumbarton suffered heavily during the same space as Glasgow, from February to November. Rothesay, Campbelltown and Inverary had epidemics in spring or early summer. In June and July the infection was carried effectually into Ayrshire (an earlier importation to Doura, near Kilwinning, in March, having proved abortive) and caused great mortalities at Kilmarnock[1500] and Ayr[1501], as well as much alarm and a good many deaths at Dalry, Irvine and Loudoun. In the latter half of September a most disastrous outbreak began in Dumfries and in the neighbouring Maxwelltown[1502].

The epidemic in Leith and Newhaven proceeded at the same time as in Edinburgh. Another important centre was the midland coal-field of Stirlingshire and Lanarkshire, where the mortality was mostly autumnal. Perth had been reached early in March, Dundee at the end of April, the latter having a visitation on the same scale as Glasgow, Edinburgh, Paisley and Greenock. From Dundee, Cupar Fife was infected about the middle of August, and had a severe epidemic almost confined to paupers[1503]. In the autumn there was much cholera among the fishing population from Thurso to Dunbar and Berwick. Inverness had been infected early in May, and was probably the centre from which the disease spread in the end of summer, during the herring fishery, to the coast towns and fishing villages, as well as to Tain and Dingwall. Only a few of these places made returns to the Board of Health; but it is probable from what Hugh Miller relates of the villages near Cromarty that the disease had been more widely spread. That author has described the condition of things in his native town. Its landlocked bay had been made a quarantine station, and was full of shipping flying the yellow flag. Cholera had “more than decimated” the villages of Portmahomak and Inver, and was prevalent in the parishes of Nigg and Urquhart, with the towns of Inverness, Nairn, Avoch, Dingwall and Rosemarkie. The numerous dead at Inver were buried in the sand, infected cottages had been burned down, the infected hamlets of Hilton and Balintore had been shut off from the neighbouring country by a cordon[1504]. The citizens of Cromarty, hitherto untouched, followed the advice of Miller at a public meeting and took the law into their own hands, guarding all the approaches to their peninsula and subjecting all arrivals to fumigation with sulphur and to some undescribed application of chloride of lime. The infection, however, got in by an unguarded channel. A Cromarty fisherman had died of cholera at Wick; his clothes had been ordered to be burned, but a brother of the dead man, who was in Wick at the time, secured some of them and brought them home. He kept them in his chest for a month before he ventured to open it. Next day he was seized with cholera and died in two days. Thereafter the disease crept about the streets and lanes for weeks, striking down both the hale and the worn-out. Pitch and tar were kept burning during the night at the openings of the infected lanes; the clothes of the dead were burned; many of the fishers left their cottages and lived in the caves on the hill until the danger was past[1505].

Among the numerous fishing villages of the Moray Firth, Buckie is the only one given as severely touched by the infection (fifteen deaths). Only one small village of the Aberdeenshire coast, Collieston, is known to have had cholera (nine deaths)[1506]. The Aberdeen epidemic was not severe, and appears to have been mostly in the fishers’ quarter. The Montrose district escaped altogether in 1832; but in June, 1833, the true Asiatic cholera broke out in the fishing villages of Ferryden and Boddin, on the opposite shore of the South Esk from Montrose. Arbroath had a few deaths in August, 1832, while several of the small towns on the coast of Fife had from that time to the end of the year visitations which were only less alarming than those on the south side of the Firth of Forth at the beginning of the year. To sum up the epidemic in Scotland, it caused nearly ten thousand deaths, of which Glasgow and its suburbs had about one-third, Edinburgh, Leith, Dundee, Greenock, Paisley and Dumfries, another third, while a large part of the remainder occurred among the mining and fishing populations[1507].

The Cholera of 1832 in Ireland.

The forecast of Orton in the summer of 1831, that Ireland would be the chosen soil of the Asiatic pestilence owing to the state of misery, at that time, of the mass of its people, was realized in a measure. But the cholera in Ireland, as elsewhere in Europe, showed itself chiefly as an urban disease, falling disastrously upon the poorest quarters of Dublin, Limerick, Cork, Galway, Sligo, Drogheda and other towns, but by no means seriously upon the immense population who occupied the country cabins. Scotland, indeed, had a higher ratio of cholera deaths than Ireland per head of the population; whereas Dublin had nearly twice as many deaths as Glasgow, their populations being almost exactly equal (about 200,000), and Cork had nearly the same number as Liverpool. The following table gives the comparison of the three divisions of the United Kingdom, including the cholera deaths of 1831 in England, but not those of 1833, which were more numerous in Ireland than elsewhere.

Population in 1831 Cholera deaths

England and Wales 13,897,187 21,882

Ireland 7,784,539 20,070

Scotland 2,365,114 9592

The first undoubted case of Asiatic cholera was found in Dublin on 22 March, 1832. On the 25th of that month, Harty, who was physician to all the Dublin prisons, notified to the Board of Health cases in the Richmond Bridewell which he believed to be true spasmodic or malignant cholera[1508]. It was reported from Cork on the 12th of April, from Belfast on the 14th, Tralee on the 28th, Galway on the 12th of May, Limerick on the 14th, Tuam the 4th of June, Waterford the 1st of July, but not until 21 August from Wexford and about the same time from Londonderry. Doubtless remoteness from the ordinary routes of vagrants was the reason why the infection was later in some places, such as Wexford. The old Liberties of Dublin, which harboured crowds of beggars in dilapidated tenement-houses, became a focus of virulent infection. As the summer advanced whole families in some of the most wretched lanes were cut off; news from Dublin on 29 June says that the pestilence was worst in Sycamore Alley, in a single house of which twenty persons had died in the course of four or five days[1509]. Certain streets sent fifty patients to the Cholera Hospital for one sent by other streets that were seemingly no better off[1510]. The great hospital in Grange Gorman Lane, capable of holding 700 and sometimes occupied by 500, would on some nights or early mornings (from midnight to 7 a.m.) receive forty or fifty new cases, and within a week would be having at the same hours only two applications. During four successive days it admitted a total of 285 cases, during the next four days 497 cases, and during four days a fortnight later only 134 cases. The worst time was from the 10th to the 14th of July, when 615 were admitted. A day or two of rain seemed always to send up the number of cases carried to the hospital[1511]. Until the beginning of June hardly anyone under fifteen was attacked; but in July the attacks of children were about one in thirteen or fourteen of adults, a case of pure cholera having been observed in an infant three weeks old. As at Glasgow and Edinburgh, more women than men were taken to the hospital (138·17 females to 100 males)[1512].

As the infection spread in Dublin during the early summer a panic arose in the city, and alarm over the whole province of Leinster. Runners, as in the old times of the torch of war, were to be seen hurrying everywhere through the neighbouring counties carrying a smouldering peat, of which they left a small portion at every cabin in their direct line, with a sacred obligation upon the inmates to carry the charm to seven other houses, and the following exhortation: “The plague has broken out; take this, and while it burns offer up seven paters, three aves, and a credo in the name of God and the holy St John that the plague may be stopped”! Men, women and children scoured the country with the charmed turf in every direction, “each endeavouring to be foremost in finding unserved houses.” One man in the Bog of Allen had to run thirty miles before he had discharged the obligation laid upon him[1513]. It does not appear, however, that the infection was at all general among the scattered cabins, hamlets or even considerable villages. In the rural parts of Wicklow there were only eight deaths from it, in Fermanagh four, in county Derry three, in Armagh thirteen, in Carlow none until the next year. In Clare the deaths in country districts were more than twice as many as in Ennis and other towns of the county. In Sligo county, again, there were only 62 deaths among the peasantry to 698 in the towns, nearly the whole of the latter total belonging to the county town and seaport. The epidemic in Sligo town was one of the worst in Ireland. It was reported that forty or fifty were buried in one day in a trench, one-half of them without coffins but wrapped in tarred sailcloth. It is said, also, that seven of the medical men died of cholera in the course of three months[1514]. Thousands of the population, which numbered about 14,000, fled from the town, the wealthier paying large sums for a room or two in a country cottage, the poorer living in tents or sleeping under the hedges. In August the guard of the mail coach which ran from Sligo by way of Strabane to Londonderry was taken with cholera on the road and died at the latter town, no case having occurred in Londonderry up to that time[1515].

The outbreak at Drogheda was as sudden and disastrous as at Sligo. At Belfast also the disease began with enormous fatality, but, according to the table, the deaths eventually were few in proportion to the attacks. The other towns which had highest mortalities were Cork, Limerick, Galway and Kilkenny—all seaports except the last. In Waterford the great outbreak was delayed until 1833.

Many of the counties had more deaths among the peasantry in 1833 than in 1832, Limerick county in particular. The following instance is related of a small hamlet about a mile to the south-east of Armagh:

The hamlet consisted of five or six dwellings on both sides of the road. On the 19th July, 1833, a man in delicate health, who had received a jar of sea-water two days before, and had drunk three or four pints of it, was seized with cramps, and blueness and collapse, after the purging induced by the sea-water; he died on the 20th and was buried on the 21st. His brother, who lived next door under the same roof, was seized with cholera on the evening of the 21st, having attended the funeral, and died comatose after five or six days’ illness. A man who lived across the road, and had also been at the funeral of No. 1, was seized with cholera the same evening (21st), and died in forty-eight hours. On the night of his burial his son aged thirteen and a married daughter who lived in the house were seized, the boy dying the same night “very black,” and the daughter after a lingering illness of five or six days. The only other attacked was a girl, who recovered under treatment by bleeding &c.[1516]

In 1833 the whole number of deaths assigned to cholera in country places was 2,756, while 2,552 deaths were reported from the towns. It appears to be accepted (by Wilde) that true Asiatic cholera lingered in Ireland until 1834, and that it had caused a considerable part of the 4,419 deaths assigned to “cholera” under that year in the Census of 1841. There is one reference to undoubted cases of the Asiatic type in 1834 in Ross, Nenagh and other places in the same district[1517].

Assuming that all the deaths so called in the three years 1832, 1833 and 1834 were true Asiatic cholera, that imported infection accounted for 1 in 5·68 deaths from all causes in Munster, 1 in 5·98 in Leinster, 1 in 9·86 in Connaught and 1 in 15·15 in Ulster. The proportion of attacks to fatalities in eight of the principal towns in the following table varies much, Belfast having comparatively few deaths for all its many cases, and Kilkenny three deaths to about five cases: these differences must have depended upon the number of cases of “cholerine” or diarrhoea which attended the true “spasmodic” or collapse-cholera, and may or may not have been counted in the returns.

Deaths from Asiatic Cholera in Ireland, 1832-33.

1832 1833

Country deaths Town deaths Country deaths Town deaths No. of places with Cholera

Leinster

Carlow — — 64 116 vi

Dublin 460 187 32 17 xxiv

Dublin City — 5632 — 166

Kildare 108 72 55 104 xi

Kilkenny 91 14 130 29 ix

Kilkenny City — 296 — 144

King’s 40 288 10 — v

Longford 22 63 — — iii

Louth 115 189 — — viii

Meath 61 105 81 113 vii

Drogheda Town — 491 — —

Queen’s 17 111 16 — iv

Westmeath 18 121 84 5 iv

Wexford 126 362 24 150 v

Wicklow 8 40 — 23 iv

Munster

Clare 453 281 166 8 xiii

Cork 325 1028 466 240 xxxv

Cork City — 1385 — 234

Kerry 87 440 109 181 viii

Limerick 82 4 668 173 xvi

Limerick City — 1105 — —

Tipperary 198 910 224 208 xii

Waterford 52 52 48 79 ix

Waterford City — 24 — 245

Ulster

Antrim 70 66 — 75 v

Belfast Town — 418 — —

Armagh 13 57 2 — vi

Cavan 21 11 70 51 vi

Donegal 37 139 141 — vii

Down 110 423 65 37 xiv

Fermanagh 4 50 — 9 iv

Londonderry 3 222 — — iv

Monaghan 64 50 13 43 iv

Tyrone 100 193 17 9 ix

Connaught

Galway 141 430 82 — xii

Galway Town — 596 — —

Leitrim 1 — 101 — vi

Mayo 151 325 12 68 xi

Roscommon 47 105 38 25 vii

Sligo 62 698 25 — iv

The Cholera of 1832 in England.

The certainty that Asiatic cholera was at Sunderland in November and at Newcastle in December, 1831, led to quarantine of ships arriving in the Thames from the Wear and the Tyne. The early numbers of the ‘Cholera Gazette’ published lists of vessels from these northern coal ports detained at Stangate Creek on the Medway[1518]. At length about the middle of February, 1832, three suspicious cases occurred together in Rotherhithe, one of them being of a man who had been scraping the bottom of a Sunderland vessel. Other cases came close upon these in the parishes on both sides of the Thames from Rotherhithe and Limehouse to Lambeth and Chelsea, especially in the Southwark parishes.

The diagnosis of Asiatic cholera was vehemently contested for several weeks by a section of the profession, who frequented the Westminster Medical Society and had for their organ the ‘London Medical and Surgical Journal.’ The slow progress of the disease at first, and the apparent extinction of it for a week or two at the end of May (as at Glasgow and elsewhere in Scotland in the same weeks) encouraged these doubts, although the 994 fatalities in 1848 cases from 14 February to 15 May were quite unlike any experience of cholera nostras. After the river-side parishes, cases were reported most from other crowded parts, such as St Giles’s in the Fields. From the middle of June the infection became more severe and widely spread, still making the river-side parishes its chief seat, but extending beyond Southwark on one side, and on the north side to such localities as Fetter Lane, Field Lane and parts of the City. From the 15th of June to the 31st October the cases in London were 9142 and the deaths 4266; in November and December only thirty more cases were known, of which one half were fatal. The total for the year in London came to 11,020 cases with 5275 deaths. This was admitted to have been for Asiatic cholera a slight and partial visitation of the metropolis. London with a population of a million and a half had actually fewer deaths than Dublin with its two hundred thousand inhabitants. Paris had more cholera deaths in one week of April (5523 deaths, April 8-14) than London had in all the year.

The Asiatic Cholera of 1831-32 in England.

Deaths No. of places attacked Places with highest mortalities in each county

London 5275

Surrey, part of — —

Kent 135 xi Minster (Sheerness) 38

Sussex — —

Hampshire 91 ii Portsmouth 86, Southampton no return

Berkshire 52 iv Wantage 27

Middlesex, part of 62 iv Uxbridge 34, Edmonton 11

Buckinghamshire 105 iv Aylesbury 60, Olney 22

Oxfordshire 219 xii Oxford 86, Bicester 64

Northamptonshire — —

Huntingdonshire 45 iii Fenstanton 21, Ramsey 20, St Ives 4

Bedfordshire 40 ii Bedford 36

Cambridgeshire 208 iv Whittlesea 97, Ely 61, Wisbech 41

Essex 38 iv Barking 18, Chelmsford 10

Suffolk 1 i Woodbridge 1

Norfolk 232 vi Norwich 129, Lynn 49, Denver 27, Yarmouth no return

Wiltshire 14 ii Chippenham 9, Farley 5, Salisbury no return

Dorset 19 ii Bridport 16, Charmouth 3

Devon 1901 xxvii Plymouth 702, Devonport 228, East Stonehouse 133, Exeter 386

Cornwall 308 xi St Paul 81, Penzance 64

Somerset 142 v Paulton 66, Bath 49, Tiverton 23

Gloucestershire 932 viii Bristol 630, Clifton 64, Gloucester 123, Tewkesbury 76, Upton 34

Herefordshire — —

Shropshire 158 vii Shrewsbury 75, Oldbury 37, Madeley 27

Staffordshire 1870 xiv Bilston 693, Tipton 281, Sedgley 231, Wolverhampton 193, King’s Winsford 83, Wednesbury 78, Walsall 77, Newcastle-u.-Lyme 60, W. Bromwich 59, Darlaston 57, Stoke 46

Worcestershire 579 xi Dudley 77, Worcester 79, Kidderminster 67, Droitwich 63, Redditch 38

Warwickshire 188 xii Nuneaton 56, Coleshill 32, Birmingham 21

Leicestershire 5 i Castle Donington 5

Rutland — —

Lincolnshire 80 viii Gainsborough 41, Owston 17

Nottinghamshire 352 vii Nottingham and suburbs 322, Newark 25

Derbyshire 16 i Derby 16

Cheshire 111 vi Northwich 30, Stockport 29, Runcorn 18, Nantwich 14, Chester 14, Brimmington 6

Lancashire 2835 xiv Liverpool 1523, Manchester 706, Salford 216, Warrington 168, Lancaster 114, Wigan 30

West Riding, York 1416 xxvii { { Leeds 702, Sheffield 402, Hull 300, York 185, Wakefield 62, Rotherham 34, Selby 32, Goole 36, Bradford 30, Whitby 27, Doncaster 26

East Riding, York 507 iiii

North Riding, York 47 ii

Durham 850 viii Sunderland 215, Gateshead 148, S. Shields 147, Stockton 126, Jarrow and Hebburn 70, Hetton &c. 97

Northumberland 1394 xiv Newcastle 801, Villages near 259, N. Shields &c. 98, Berwick 84, Tweedmouth 72, Blyth 42

Cumberland 702 vii Carlisle 265, Whitehaven 244, Workington 119, Maryport 42, Cockermouth 25, Allonby 4

Westmoreland 68 i Kendal 68

Monmouth 15 ii Newport 13, Abergavenny 2

South Wales 343 vii Merthyr Tydvil 160, Swansea 152, Haverfordwest 16

North Wales 140 viii Denbigh 47, Carnarvon 30, Flint 18, Newtown 17

Isle of Man 146 i Douglas 146

It will appear from the annexed table (here compiled according to counties for the first time) that the cholera of 1832 visited most parts of England. The dates of outbreak at each place (omitted in the table) show that its great seasons everywhere, except at Sunderland, Newcastle and Musselburgh, were the summer and autumn. New centres or foci of infection were made in all directions, and in a good many small places there were epidemics which produced much alarm although the figures look insignificant in the statistical table. Some counties, such as Leicestershire, Herefordshire, Derbyshire, Northamptonshire, Lincolnshire, Suffolk, Sussex, Dorset, Wiltshire, and several of the Welsh counties, escaped with a few cases at perhaps one village or town. Some towns, such as Birmingham, Cheltenham, Cambridge and Hereford, had only a few cases (or none) in 1832 as in the later epidemics in England. Most of the towns which now head the list of high death-rates by common summer diarrhoea, chiefly infantile (as in the preceding chapter), had only a few imported cases but no real epidemic extension; these were Preston, Blackburn, Bury, Rochdale, Oldham, Bolton, Halifax, Leicester and Coventry; while Bradford, Stockport and Wigan had comparatively few. The greater epidemics, besides those which started the disease at Sunderland and Newcastle, were, in order of time, at Hull and Goole, Liverpool, Manchester, Warrington, Leeds, Sheffield, Nottingham, Bristol, Plymouth, with Devonport and Stonehouse, Southampton, Portsmouth, Exeter, Salisbury, various towns of the Black Country in South Staffordshire, Dudley, Merthyr Tydvil, Carlisle, Whitehaven, with other ports of the Cumberland coal-fields, and Douglas in the Isle of Man. Devonshire, Cornwall, the West Riding of Yorkshire, Worcestershire and Warwickshire had each a large number of minor centres, besides the greater foci at Plymouth and Exeter, and at Leeds and Sheffield. The severity of the disease in some parts of England called forth a few special accounts, from which certain representative details may be taken.

The most disastrous outbreak in all England was at Bilston, in the centre of the Black Country, near Wolverhampton[1519]. The first cases in that part of England were at Dudley early in June, in some travelling German broom-sellers. In the end of June a canal boatman from Manchester died of cholera in his boat four miles from Wolverhampton; the boat was sunk. In the first week of July another canal boatman died of cholera at Tipton, after returning from Liverpool. The infection became established during July in the parish of Tipton, thickly peopled with miners and iron-workers[1520]. At length on the 4th of August a case occurred in the adjoining town of Bilston, about two and a half miles to the south-east of Wolverhampton.

Bilston was a town of 14,492 inhabitants, nearly all of the working class. It was irregularly built on high ground, full of forges and surrounded by mines. Its soil was perfectly dry “from the water having been drawn off for the purpose of getting the mines[1521].” The streets were for the most part wide and open; many houses stood in courts and back yards, but the town was so irregularly built as not to be densely crowded. The Birmingham and Staffordshire Canal passed through the whole length of the township, and there was one small brook traversing the town. The people usually earned good wages, but trade had been depressed since March, 1832. There was a good deal of drunkenness among them, and a peculiar addiction to the sports for which the Black Country is still celebrated, including at that time bull-baiting. The public health was in general good, the deaths having been 23 in May, 31 in June, and 25 in July. The churchyard of the original chapel was full; a new chapel had been built, and a burial-ground consecrated, in 1831. Bilston wake had been held on 29th July, 1832, with the usual orgies notwithstanding the depression of trade. On the night of Friday the 3rd of August a married woman in Temple Street, occupying a poor and filthy house, who had supped heartily on pig’s fry and had drunk freely of small beer, was seized with purging, which turned to fatal spasmodic cholera. Within an hour medical aid was sought for two more cases of the same in poor and filthy houses in Bridge Street and Hall Street, about four hundred yards from each other and from the house in Temple Street. At the back of the latter was a most offensive pigsty, and beyond the pigsty a poor cottage in which lived a widow and four children; cholera attacked them, two of the children dying on the 6th August and another on the 7th. The night of the 9th of August was most oppressively hot. In the week ending the 10th August there had been 150 cases and 36 deaths from cholera. On the 10th the disease appeared in a new quarter to the west, called Wynn’s Fold; the 12th was again an oppressively hot day, followed by rain over-night. On the 14th the disease began its ravages in Etlingshall Lane, at the western end of the township, a mile from the scene of the first outbreak. The attacks in the week ending 17 August had risen to 616 and the deaths to 133. On the 16th it was remarked that the flies had disappeared and the swallows with them; both came back together when the epidemic was declining. Whole families were now being cut off, father, mother and perhaps three children. Mr Leigh, the curate of the parish, went on the 18th to Birmingham to secure a supply of coffins and medical aid, the medical men of the town being worn out (two of them died a few days after). The deaths between the 19th and 26th of August numbered 309. On the latter date a dispensary was opened, after which the proportion of fatalities to attacks became less. On the 18th of September, the last death occurred, and the epidemic was over, having attacked 3568 in a population of 14,492, and destroyed 742, of whom 594 were over ten years of age. The following is the complete bill:

Cholera at Bilston, 1832.

Week ending Attacks Death Deaths under ten years

Aug. 10 150 36 5

17 616 133 23

24 924 298 58

31 832 184 34

Sept. 7 694 62 18

14 250 23 6

21 102 6 4

3568 742 148

No fewer than 450 Bilston children under the age of twelve were left orphans by the cholera; for them a national subscription was made to the amount of £8536. 8s. 7d., and applied to the building and support of a Cholera Orphan School, which was opened on the 3rd of August, 1833, the first anniversary of the outbreak of cholera in the town.

In the adjoining parish of Sedgley, although the deaths were only 290 in a larger population (20,577), the infection was as severe in certain places. “Sometimes a whole hamlet seemed to be smitten all at once, so that, in some of the streets, or rather rows of tenements, there was scarcely a house without one sick, or dying, or dead.” At Tipton, in one family of 14 no fewer than 12 died; and in eight different tenements every inhabitant was swept off. At Dudley one had a narrow escape of being buried alive. In twelve parishes or townships, with a population of 160,000, cholera attacked about 10,000 and cut off about 2000. The effects of the pestilence were all the more terrible from its swiftness, for in each parish it was in full vigour not above a month. The population of miners and iron-workers, a rough set addicted to brutal sports and to drunkenness, could not believe that brandy was not a specific, and made it circulate at funerals to fortify against infection. A reformation of morals and revival of religion is said to have followed the scourge[1522]. The following is the list of chief centres in the Black Country:

Cholera deaths

Bilston 693

Tipton 281

Sedgley 231

Dudley 277

Wolverhampton 193

King’s Winford 83

Wednesbury 78

Walsall 77

Newcastle-under-Lyme 60

West Bromwich 59

Darlaston 57

Stoke-on-Trent 46

Wolverhampton, which was one of the chief Staffordshire centres of the next cholera in 1849, got off somewhat easily in 1832 with 576 attacks (193 deaths), or one in forty of the population.

It was most common and fatal in a lane called Caribee Island, a narrow filthy cul-de-sac with an open stagnant ditch down the middle, inhabited chiefly by poor Irish. The influence of ground soaked with sewage was shown also in the frequency of cases of cholera among persons in easy circumstances in the residential locality of Darlington Street—“a wide airy street consisting of two rows of houses at its upper end, nearest the centre of the town, but of only one at the lower part, where it is a raised causeway, open on one side to the gardens and meadows beyond. The lower rooms of the houses, being below the level of the street, are consequently very damp; and within a few yards of the backs of these houses runs a wide ditch, the main sewer of that side of the town, which is dammed up and diverted into several large cesspools, or receptacles for the mud and filth which it deposits. These, in warm weather, emit such offensive exhalations as to be almost intolerable to the persons who live near them.... It is singular that this was the only part of the town in which persons in easy circumstances took the disease[1523].”

The cholera had reached Liverpool in the end of April (perhaps from Hull and York), and attacked 4912 in a population of 230,000, causing 1523 deaths before the end of autumn. The very large number of cellar-dwellings and back-to-back houses in the town at that time favoured the infection; but Liverpool was on all subsequent occasions one of the worst centres. Two incidents in 1832 are connected with ships.

On 18 May, 1832, the ‘Brutus,’ of 384 tons, sailed from Liverpool for Quebec, with a crew of 19, and 330 emigrants who were pauper families from agricultural districts sent to Canada at the cost of their respective poor-law Unions. The emigrants were ill-provided with bedding and clothes, and the ship was under-provisioned. Two days after sailing, or seven days, or nine days (accounts differing), a case of cholera occurred in an adult, who recovered. Other cases quickly followed, with enormous fatality, until the deaths reached 24 in a day. On the 3rd of June the captain put back for Liverpool, his provisions having run short, and his drugs (laudanum) being exhausted. By the time the ship reached Liverpool there had been 117 cases of cholera (of which four were among the crew) and 81 deaths, seven cases remaining at her arrival, of which two ended fatally, making the deaths 83[1524].

Another Liverpool incident is noteworthy:

“One morning a mate and one or two men, who had gone to bed the preceding evening in good health on a vessel lying in one of the Liverpool docks, were found suffering from cholera. The men were immediately removed to a hospital and the vessel ordered into the river; when another vessel, with a healthy crew took its situation in the dock: the next morning all the hands on board the second vessel fell sick of the cholera. Upon examining the dock in this part, a large sewer was found to empty itself immediately under the spot where these vessels had been placed[1525].”

One of the ablest accounts of the cholera of 1832 was that by Dr Gaulter, of Manchester. The deaths there were 706, and 216 in Salford; but it appeared surprising that, being so many and widely spread, they should not have been many more.

An inspection by the local Board of Health two months before the first case appeared “disclosed in the quarters of the poor—a name that might be almost taken [at that time] as a synonym with that of the working classes—such scenes of filth and crowding and dilapidation, such habits of intemperance and low sensuality, and in some districts such unmitigated want and wretchedness,” that the picture correctly drawn seemed to many a malicious libel. From that picture, “it was certainly to have been expected that nearly the whole mass of the working population would have been swept away by the disease.” There were few good sewers, and it would have required £300,000 to sewer Manchester thoroughly. As it was, the infection progressed slowly from the first case on 17th May until the end of July[1526]. It was the same in Salford, where it “crept about slowly for three or four weeks attacking solitary individuals or single families in streets and situations the most distant and unconnected, and then suddenly fixing itself in the lower and most populous part of the town.” It was in the end of July and beginning of August that the sharp outburst took place in Manchester also. An old soldier well known in the streets as a seller of matches, who “could take a pint of rum without winking,” died of cholera in Allen’s Court. His body was allowed to lie in the house two days and a half. In four houses of Allen’s Court, 17 cases occurred within forty-eight hours, of which 14 were fatal; this court was afterwards known as Cholera Court. In the same few days the infection was most deadly in Back Hart Street, “infamous as a nest of vagabonds and harlots,” and in a street behind it, in which nearly the whole of fourteen attacks ended fatally. Blakely Street, a bad fever locality in the time of Ferriar (supra, p. 150), had the most malignant kind of cholera in its lodging-houses. It was remarked that few of the factory hands took it: of 1520 employed in Birley and Kirk’s mill, only 4 were attacked during the epidemic; more women than men took cholera, and generally those that were employed about dwelling-houses were the victims[1527].

The whole cholera bill at Manchester was as follows:

Progress of the Epidemic.

Attacks

May 4

June 37

July 108

August 650

Sept. 261

Oct. 172

Nov. 33

Dec. 2

Jan. 2

Ages of the patients.

Attacks Deaths

1-15 199 101

15-25 153 53

25-35 264 98

35-45 192 93

45-55 197 116

55-65 120 85

65-80 85 68

Three cholera hospitals were provided in Manchester, at which about one-half of all the cases were received:

Cases Deaths

Swan Street Hospital 443 234

Knott Mill Hospital 242 122

Chorlton on Medlock Hospital 29 17

At their homes 697 335

In Salford all the patients were treated at their homes—644 with 197 deaths; there were also 60 cases among the prisoners in the New Bailey, with 19 deaths.

The Swan Street Hospital was the occasion of a remarkable cholera riot on the 2nd of September. A mob numbering several thousand persons filled the streets near the hospital; in the thick of it was carried a small coffin, from which the headless trunk of a child was taken at intervals and shown to the crowd. The child had died of cholera in the hospital and the body had been examined post mortem. Some rumours of this had gone abroad, the body was exhumed, and was found unaccountably mangled. This was the time when intense feeling had been roused all over the country by the procuring of bodies for anatomical dissection, the prejudice extending to the ordinary pathological inspection also. At Sunderland the holding of two or three necropsies had turned the people against the Cholera Hospital. At Dublin there was a rigid rule that no body was to be examined after death in the great cholera hospital of some 700 beds. The body of the child exhumed at Manchester had been found with the head severed, and the rioters declared that it had been murdered. They broke into the hospital, carried off the patients to their homes, and wrecked the furniture and fittings of the wards. The military was at length called out to clear the streets[1528].

The epidemic of cholera at Bristol reproduced most of the incidents at other places. There had been numerous suspicious cases of choleraic disease in the early summer, including an outbreak in the gaol in the first week of July.

The first unequivocal cases occurred on the 11th July in a filthy court, in strangers from Bath where there was then no cholera. About the same time the infection showed itself at several places apart, especially in the destitute suburb of St Philip, in the south-east of the city. One of the worst centres was the city Poorhouse, in which 268 cases with 94 deaths occurred from the 24th July to the 20th August. The largest number of seizures on one day was 79 on the 17th August, the largest number of deaths 33 on the 15th. After that it gradually declined, and was over by the middle of November. The attacks reported were 1612, the deaths 626; but these figures came short of the truth, as many cases were not reported, and the burials from all causes were in excess of the average for the season after deducting the reported cholera deaths. Although it fell at Bristol, as elsewhere, upon the poorest quarters and the most abandoned or destitute class, yet it showed caprices among these. Marsh Street, the abode of the lower Irish, and one of the most thickly peopled parts of the city, was the last place visited. Lewin’s Mead, a low and crowded quarter, had only a few scattered cases[1529].

Little is known of the great epidemic in Plymouth, Devonport, and East Stonehouse, beyond the gross result that it caused 1063 deaths in the town and the two dockyards[1530]. Of the outbreak at Southampton not even the figures are known, the only important omission, besides the epidemic at Salisbury, in the whole of the cholera of 1832. On the other hand the Exeter cholera has been related at greater length than any[1531].

It was mainly an autumnal outbreak, the largest number of attacks on one day being 89 on the 13th August, and the maximum daily burials 30 a few days before. The total attacks were 1135, the deaths 345; they were chiefly in the south-western suburb of the city, among the poorer class, the two St Mary parishes having 3·65 and 3·26 per cent. of their population attacked, the parish of St George 3·41, St John 2·73, and Trinity 1·54, while two whole parishes had no cases.

Somewhat late in the autumn the infection spread through Cornwall. Its general prevalence was also late in the South Wales mining district (insignificant compared with its enormous ravages there in the next cholera of 1849) and in Carlisle, in Whitehaven and the other seaports of Cumberland. Hartlepool, for all its nearness to the original centre of cholera infection in Sunderland, was one of the last places to be infected, in the autumn of 1832[1532].

The Central Board of Health made no report upon the cholera of 1832, unless a document sent to the king (William IV.) may have consisted of something more than the alphabetical list of infected places, with dates and numbers, which Sir James Clark found some years after in a drawer of the royal library. But some lessons of the epidemic were obvious without the aid of an official report. The late summer and autumn was undoubtedly its chief season—except in places where the poison had, as it were, spent itself in the winter or early spring, such as Sunderland and Musselburgh. A subsidence and seeming extinction of the epidemic in spring and early summer was observed at Glasgow and Edinburgh as well as in London; but it was far otherwise in Paris, where sixteen thousand deaths occurred in the single month of April[1533]. As to locality, the infection seemed to prefer low grounds, such as the shore quarters of seaports and the banks of rivers. The town moor of Sunderland, around which the infection found its first habitat in Britain, appeared to be a typical cholera soil—a wet bottom of tenacious clay, almost impassable in winter from the water standing in it, the surface covered with heaps of excremental and other refuse from the crowded lanes near it. But the greatest centre of cholera in England in 1832, the town of Bilston, seemed to be the reverse of this—a rising ground from which the water had been drained away by the numerous mines of coal, iron and limestone all round it. Again, in towns or villages built upon a slope or on heights and hollows, such as Gateshead, Newburn and Collieston (most of all in Quebec on the steep bank of the St Lawrence), the infection did not confine itself to the lower part only. But it was remarked that among the Tyneside villages several on high ground escaped altogether, although within a mile or two of others severely visited. This question of elevation comes up more definitely in the cholera of 1849.

Another obvious thing in the epidemic of 1832 was that many of the first victims were among the destitute, drunken or reckless class. But there were innumerable exceptions, notably in Paris, where the multitude of victims included several peers, deputies, diplomatic personages and the prime minister.

One of the most striking things in the habits or preferences of cholera in 1832 was the early and unaccountable selection of the inmates of lunatic asylums, the fatuous paupers of workhouses, prisoners, or other immured persons badly housed and ill-fed. In most of these cases it was a mystery how the poison of cholera had got inside the walls. The earliest important instance was that of the Town Hospital or pauper infirmary of Glasgow. Other instances were the lunatic wards of Haslar Hospital, Hanwell asylum, Bethnal Green lunatic asylum, Lancaster county asylum, the Manchester New Bailey, situated in Salford, Coldbath Fields Prison, London, Clerkenwell workhouse (65 deaths), Bristol poorhouse (94 deaths). In the remote Westmoreland village of Hawkshead, thirteen miles from Kendal, cholera appeared unaccountably among the sixteen inmates of the poorhouse, attacking eight of them with sudden and severe symptoms so that four died; it was impossible to trace the introduction of the virus, but the poorhouse was nearly surrounded with stagnant water[1534].

Hardly anything was more keenly debated than the question as to how cholera spread. It was not difficult to find some instances of infection seemingly got from contact with living or dead cholera bodies: cases suggestive of that occurred at Sunderland at the outset, and later in Ireland more especially[1535]. In the Swan Street cholera hospital at Manchester, eight nurses took the infection, of whom four died. But on the whole the immunity of nurses (as in the Great Gorman Lane hospital of Dublin) and of medical men was remarkable. Although constantly in the presence of cholera patients, sometimes lingering over them, as in the operation of blood-letting, very few took the disease. In Manchester only one medical practitioner was known to have had an attack, a mild one. Gaulter says that Dr Alsop, of Birmingham, and Mr Keane, of Warrington, were the only two medical men known to him to have died of cholera in England; but two of the Bilston doctors died in the height of the epidemic there, one died at Musselburgh, seven at Sligo, and two at Enniskillen. The truth of the matter in cholera appeared to be the same as in plague and yellow fever, the two great infections that resembled cholera most closely as soil-poisons: namely, that contagion from the persons of the sick was a contingency, as Rush, of Philadelphia, had taught for yellow fever in the end of last century, and Blane had taught after him. A London writer stated this very fairly in 1832[1536]:

“I believe that this disease, like many other epidemic diseases, although communicable by miasma in the atmosphere, and originating or being producible from a peculiar state of that acting upon the earth, is sometimes contagious (or communicable from person to person) and sometimes not contagious. I believe the contagious nature of the disease depends: first, upon the number accumulated in one place, and the unhealthiness or ill-ventilated state of that place; or, in other words, upon the degree in which the miasma is condensed; secondly, upon the length of time a person remains exposed to the poison; third, upon the debility, or morbid irritability, and consequent susceptibility of the person’s frame, especially of the abdominal viscera.” The miasmata of an apartment, to be strong enough to become contagious, must arrive at a certain degree of concentration.

Cholera was, at all events, very different from typhus fever in the point of contagiousness: for in the epidemics of the latter many medical men fell victims, and the susceptibility to contagion was greater in proportion to the health and vigour of those who mixed with the sick.

It was well understood in 1832 that foul linen, bedding and clothes were a most certain means of carrying the poison, especially if they had been kept concealed for a time, or packed away in a chest or bundle. This was precisely the old experience of plague. The theory that the poison of cholera was conveyed in the drinking-water, of which illustrations were collected in 1849 and 1854, was not applied to any of the particular outbreaks in 1832. But one writer made a guess at it, assuming, as Snow did in 1849 and 1854, that the stomach and bowels were the organs by which the virus entered the system:

“From an attentive observation of the course this epidemic has taken in those places and countries which it has hitherto visited, I have been induced to draw the conclusion that a noxious matter or poison, being generated in the earth, has been diffused in the different springs in such situations [therefore he suggests the filtering of water through charcoal], and that this matter, being conveyed into the stomach with the fluid in question, produces that train of symptoms which, commencing in this organ, afterwards extends with more or less rapidity to the rest of the body[1537].”