Chapter IX: Asiatic Cholera (1)

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}
29} 1

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 New
ending 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
Aug. 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 Cholera
deaths 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
Cases Deaths Cases Deaths Cases Deaths of deaths

370 251 662 419 1032 670 64·9

Percentages
Ages Cases Deaths 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._

Percentages
Cases Deaths 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._

No. of
places Places with highest mortalities
Counties Deaths attacked 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].