Chapter IX: Asiatic Cholera (2)

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

No. of
places Places with highest
Deaths attacked 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,
East Riding, York 507 iiii { York 185, Wakefield 62, Rotherham
North Riding, York 47 ii { 34, Selby 32, Goole 36, Bradford
{ 30, Whitby 27, Doncaster 26
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 Deaths under
ending Attacks Death 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. 8_s._ 7_d._, 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].”

In the treatment of cholera in 1832 many things were tried. The view
taken of the pathology naturally determined the means of cure. To
check the premonitory diarrhoea was seen to be of the first
importance, and to that end laudanum or other form of opium was the
familiar means. Lawrie, at Glasgow, found it most satisfactory, at a
time when the profession in London were, as he says, denouncing it as
a pernicious error. Towards the end of the epidemic in Dublin, Graves
combined with the opium acetate of lead in large doses (a scruple of
acetate of lead with a grain of opium, divided into twelve pills, one
to be given every half-hour until the rice-water evacuations from the
stomach and bowels began to diminish)[1538]. Some professed to find
great benefit from blood-letting at a sufficiently early stage in the
attack[1539]. The enormous drain of the fluids, leaving the blood
thick or tarry, suggested to some that saline substances would be
beneficial. The saline treatment was indeed the principal subject of
writing during the year 1832. One way was to give saline drugs by the
mouth; another way was to inject into a vein a large quantity of
distilled water with some common salt and bicarbonate of soda
dissolved in it, the vein at the bend of the elbow being usually
chosen to operate on. Some were confident that they had saved lives in
this manner, others were equally clear that salines were useless. One
writer had abandoned salines by the mouth as a “most useless remedy,”
while he had not lost faith in their intravenous injection, four
having recovered out of twenty-three in which he had tried it. At
length, however, the intravenous use of salines was abandoned
also[1540].

It is well known that the greatest of all the lessons taught by cholera was the need of sanitary reform. The disease in its successive visitations so obviously sought out the spots of ground most befouled with excremental and other filth as to bring home to everyone the dangers of the casual disposal of town refuse. It was not until some years after the first visit of cholera that much was done in the way of extending the main drainage of towns, connecting the house-drainage systematically therewith, getting rid of open nuisances in back yards, and protecting the water-supplies from contamination. The Report of the Health of Towns Commission, 1844, was “the great magazine from which sanitary reformers drew their weapons[1541].” In the next few years an active school of sanitarians arose, including Sutherland of Liverpool, Grainger of London, and others. In 1848 was passed the first Public Health Act, administered by a Board of Health, of which Lord Shaftesbury was chairman, Chadwick and Southwood Smith members. London was excepted from the scope of the Act; but the City had a most vigorous medical officer in the person of John Simon, whose reports dealt with public sanitation on broad principles applicable to the capital and the whole kingdom. The movement in favour of sanitation, thus begun, received an irresistible impulse from the cholera of 1849, the lessons of which were as obvious as those of 1832.

The cholera which reached Orenburg in 1829 and Astrakhan in 1830 lingered in one part of Europe or another until 1837, Portugal and Spain having been its chief theatre in 1833, the south of France in 1834, Italy in 1835 and 1836, Austria, the Tyrol, Bavaria and (for the second time) Poland and the Baltic ports in 1837. In England, there was some revival of the seeds of it in 1833, as many as 1454 deaths being put down to Asiatic cholera in London from the 1st of August to the 7th of September. There was an undoubted epidemic of it at the fishing village of Ferryden, near Montrose, in June, 1833 (27 deaths during four weeks in a population of 700), the infection having been brought by one or more of the crew of the smack ‘Eagle’ from the Thames[1542]. In Glasgow a case occurred in Boar Head Close, High Street, on 30 May, 1833, which had the blueness, pinched face, whispering voice and cold clammy skin of Asiatic cholera[1543]. In Ireland there were a good many outbreaks in 1833, especially in villages or hamlets, and it is believed that these were renewed in 1834. But the most singular reappearance of cholera in the British Isles was in the month of December, 1837, some two months after it is believed to have ceased elsewhere in Europe. Outbreaks of true cholera in that month were observed at several places in the south of Ireland-around Bere Haven[1544], at Youghal, at Waterford, and at Dungarvan, where they went so far as to form a board of health[1545]. It was suspected to have been in Limehouse, on the Thames, in November. The most remarkable explosion of it was in the month of January following (1838) among the inmates of the Coventry House of Industry, of whom no fewer than 55 died in the course of four weeks--a mortality from choleraic disease that could hardly be explained on the hypothesis of cholera nostras even if the season had been the proper one[1546].

The Cholera of 1848-49 in Scotland.

The invasion of cholera from India, which reached Britain in the autumn of 1848, had progressed as far as Peshawur and Cabul from 1842 to 1844, and thereafter step by step continuously through Herat, Samarkand, Bokhara, Astrabad and Teheran by the caravan routes. In the beginning of 1847 it entered Russia by the two great interior waterways of the Volga and the Don. Next year, 1848, it reached the German shores of the Baltic and North Seas, and within a few weeks of its appearance at Hamburg, it was found established on British soil at Edinburgh and Leith in the beginning of October. The severe outburst which followed in the south of Scotland was purely a winter epidemic, like that of Durham, Northumberland and East Lothian on the last occasion in the winter of 1831-32. It will not be necessary to give the details of the cholera of 1848-49 so fully as has been done for 1831-32, but merely to notice special points.

The cholera of 1848 broke out almost simultaneously at Newhaven and Edinburgh, on the 1st and 2nd of October, and at Leith on the 9th. At Newhaven nearly the whole population was suffering from diarrhoea, in the midst of which epidemic the true cholera raged for four weeks only, to the 28th October, attacking 30, of whom 20 died. In Leith the deaths were 185 (males 75, females 110). The Edinburgh outbreak lasted until the 18th of January, 1849, causing 801 attacks, with 448 deaths (or 478 deaths, of which 196 were males and 282 females). A cholera hospital was opened in Surgeons’ Square on the 28th of October, the admissions and fatalities to 14th December being as follows:

Females Males Total

Admitted 152 96 248
Died 90 64 154

Of the whole 248 cases, the Grassmarket sent 42, the Cowgate 37, the Canongate 33, College Wynd 16, High Street 14, and numerous scattered localities of the New and Old towns one or more cases each. Severe outbreaks took place also at Niddry, Restalrig and Loanhead, villages close to Edinburgh[1547]. While this limited epidemic was proceeding in and around the capital, the infection appeared in the mining region of Carron at the head of the Firth of Forth, where there were some 400 cases after the 6th of December, and in some other mining villages of the Scotch midlands.

Glasgow was infected on the night of the 11th November, in the suburban district of Springburn, on the north-west of the city close to the Forth and Clyde Canal. The choice of this spot to begin upon was intelligible enough in one way, but singular in another. Springburn had come into existence as a poor village of weavers about the year 1820; before the cholera year of 1832 it had grown to a population of 600, and was thought a likely spot for cholera inasmuch as it was one of the most wretched communities in Scotland. It occupied the site of a half-drained bog below the level of the canal, from which the water percolated into its subsoil; its houses were low, always damp, and full of filth. During all the cholera in Glasgow in 1832 there had not been a case in Springburn until the 6th of September, when a girl of the village came home with it and died; during her brief illness she was visited by the greater part of the villagers, but no other case occurred until six weeks after, on the 15th of October[1548]. At this spot, where the cholera of 1832 may be said to have left off, it began in 1848 with a sudden explosion of numerous attacks scattered all over the locality; a doctor attended twenty-one cases before he found two together in the same house or even in the same lane. There had been forty cases there in November, before any case was discovered in Glasgow; at length it seemed to spread from Springburn all round as if from a centre, while it also lingered there longer than anywhere else in the city and suburbs[1549]. On the 5th of December a case was reported on the south bank of the Clyde, and another on the 9th in the west end. Within a few days the disease fell upon all parts of the city with the suddenness of a thunder shower; it reached a height in the Christmas week, one day, the 30th December, having 158 burials from cholera. After the orgies of the New Year there was a fresh outburst, 235 cases having been reported on the 5th of January. The proportion of fatalities was as high as 60 per cent. at the beginning of the epidemic, 50 per cent. about Christmas and the New Year, and thereafter from 30 to 40 per cent. The epidemic was short and sharp, declining irregularly after the first or second week of January, and ceasing, but for a few dropping cases, about the 8th of March.

The deaths in Glasgow, which included many among the wealthier class and made the festival season of 1848-49 to be long remembered, were about 3800, or 1·06 per cent. of the population (355,800), a higher total but a lower ratio than in 1832, when the deaths, distributed over many more weeks of the year and largely due to two revivals in August and October, were 1·4 per cent. of the population. At Paisley there were 68 deaths from 26 December to 24 February, and at Charlestown 115 deaths all in some five weeks from 15 January to 19 February.

It was in the same season of midwinter that the cholera burst suddenly upon many mining villages of Lanarkshire and Ayrshire.