Chapter IX: Asiatic Cholera (3)

In that unlikely season there was an almost universal prevalence of
diarrhoea. At the mining village of Carnbroe, near Coatbridge, there
were five sudden attacks on the last night of the old year, one of
them fatal. On New Year’s day there were forty attacks, thirteen of
them fatal in a few hours. Terror seized the whole place: one man cut
his throat in sheer fright. Diarrhoea attacked 1100 of the 1200
inhabitants, and turned to spasmodic or rice-water cholera in 240 of
them, of whom 94 died, the rate of fatality being excessive only in
the first few days. By the end of February the epidemic was over.

In the town of Coatbridge, with a population of 4000, the various
grades of sickness were classified as follows:

Vomiting,
purging and Rice-water Deaths by
Diarrhoea cramp purging Cholera Cholera

2659 480 175 107 61

In the town of Hamilton, population 9000, the infection was most
malignant, 440 cases yielding 251 deaths from the 24th of December to
the 7th of March. The same ravages of winter cholera occurred at some
of the Ayrshire ironworks, such as Glengarnock, among a very rough and
drunken class, who were made more than ordinarily reckless and drunken
by this unaccountable visitation. It was also severe in Riccarton and
other mining villages round Kilmarnock, but less prevalent in that
town itself. Dumfries and Maxwelltown, which had been among the last
places visited by the cholera of 1832, were infected in the middle of
November, 1848, about the same time as Springburn near Glasgow. One of
the Dumfries doctors died of rapid cholera on the 10th December, the
parochial board fell into disputes with the faculty, and the infection
proceeded amidst great confusion in the poorest parts of the town,
causing about 250 deaths before Christmas. After that it subsided
quickly[1550].

The other centres in the south of Scotland were Selkirk (13 deaths),
Kelso (Dec. to end of Jan., maximum of 12 attacks in a day) and
Jedburgh, which last had escaped in 1832 but had now a very rapid and
extensive epidemic in its lower parts among drunken people especially.
A few cases occurred at Moffat, in December; a man who was seized in
crossing the hills died in a shepherd’s hut eight miles from Moffat
after twenty-one hours illness[1551].

The only recorded epidemic in the north of Scotland in the proper cholera season, the summer of 1849, was at Dundee. But there was a small outbreak in March and April at Campbelton (41 cases, 14 deaths) and Inverness (23 cases, 12 deaths)[1552].

The infection began in Dundee on the 29th of May, 1849, in Fish
Street, the filthiest part of the town. It prevailed in high and low
situations, but usually in the old localities of typhus fever. One
group of houses, said to have had a population of 100, had 40 deaths.
Dudhope Crescent, consisting of seventeen large five-storied tenement
houses occupied by clean and respectable people, had 57 deaths. In
about a fourth part of all the fatalities, death was from sudden
collapse; this was a feature of the 1849 cholera also in Ireland; but
in Dundee, as elsewhere, there was usually premonitory diarrhoea, and
a very general prevalence of diarrhoea which never came to true
cholera[1553].

The Cholera of 1849 in Ireland.

The cholera of 1849 found Ireland in a state of exhaustion and confusion. The fever and dysentery that followed the great potato famines of 1845 and 1846 were still far from extinct; the workhouses, which had not existed in 1832, were full of paupers. The mortality of nearly half a million in the famine years, and the emigration of perhaps three times as many, had reduced greatly the population of the scattered cabins, hamlets and villages; but the towns were more populous than ever from the immense number of destitute persons that had gravitated to them. In these circumstances it was not surprising that the cholera of 1849 should have been more disastrous than that of 1832. The infection appeared first in Belfast in November, 1848, in a man who had come with his family from Edinburgh and had been admitted into the workhouse. Some thirty cases of cholera among the inmates followed his death, and at length the infection was started at large in the town, probably by a man who had been discharged from the workhouse[1554]. The cholera of 1849 in the capital of Ulster was more fatal than that of 1832, causing 969 deaths in 2705 attacks. Over Ireland generally its great season appears to have been, as in England, the summer, and in part also the spring. Excepting Belfast, the principal cities and towns had fewer deaths than in 1832; Dublin having only 1664 as compared with 5632, Cork 1329, or nearly the same number as in 1832, Limerick 746, which was about a fourth less, Galway less, Waterford about the same as in 1832 and 1833 together, and Drogheda as severe an epidemic as last time. But the smaller towns and the rural districts generally suffered more. The deaths for all Ireland returned to the Board of Health were 19,325, nearly the same total as in 1832; but there were no returns included from Wicklow, Cavan, Fermanagh and Donegal, and it is probable that the returns were otherwise incomplete, the census taken in 1851 giving 30,156 cholera deaths under the year 1849, and 35,989 in the whole decennial period from 1841. The larger total was distributed as follows:

Urban Rural In hospitals In workhouses

10,653 10,656 7964 6716

The number of rural deaths is much larger than in 1832. There were only a few towns with over 2000 inhabitants that escaped--one in Connaught, six in Munster, one out of forty-one in Leinster, while seventeen towns were visited in Ulster. The counties of Dublin, Carlow, Clare and Galway suffered most; of the smaller towns, Tralee and Dingle lost heavily, both among the poor and the rich. The town of Ballinasloe, near the confluence of the Suck with the Shannon, had 756 deaths from 23 April to 19 August, a great part of them in the workhouse. In clinical characters, the cholera of 1849 was noted in Ireland, as in Scotland and England, for the high proportion of sudden fatalities, about one-third, without the warnings of diarrhoea or the usual choleraic symptoms. It was remarked also that many children under the age of seven died of cholera, about one in ten of all ages. There was a second season in 1850, with 1768 deaths (according to the census), but hardly comparable to the return of cholera in 1833 in the country districts more particularly.

The Cholera of 1849 in England.

The brief but very severe epidemic of cholera in the south of Scotland in midwinter was all over and done with for good before the disease really began in England. Hull, which had a few cases on board ship in the end of 1848, about the same time as the infection began to rage in Edinburgh and Leith, was spared its great visitation, the greatest in all England, until the late summer and autumn[1555]. The progress of the infection in London also was strangely different from that in Scotland. There were undoubted cases in Bethnal Green and other out-parishes in the autumn of 1848, and there seemed no reason why the infection should not run through the population and exhaust itself at once, as in Glasgow. But it will appear from the following table of the deaths in London that the real outburst was delayed until the summer and autumn of 1849:

Cholera
deaths

1848
Sept. 11
Oct. 122
Nov. 215
Dec. 131

1849
Jan. 262
Feb. 181
March 73
April 9
May 13
June 246
July 1952
Aug. 4251
Sept. 6644
Oct. 464
Nov. 27

Although a certain number of deaths were returned in October and November, 1848, they came in twos or threes from many parishes of the metropolis and made no great impression upon any one locality. It was not until the beginning of December that the presence of cholera was fully realized, owing to an extraordinary explosion of the disease in a huge pauper institution at Tooting. The school contained about a thousand children, of whom some three hundred took Asiatic cholera, with one hundred and eighty deaths, in the course of three or four weeks: this was the whole cholera mortality that the parish of Streatham had from first to last. In the spring months the cases declined all over London in a very remarkable way, so that it looked for a time as if the infection were extinct, just as in 1832. But in June there was a revival, and thereafter a steady increase to the maximum of 6644 deaths in September. The table given under the year 1866 shows upon what parishes the mortality fell most--those of Southwark, Bermondsey, Rotherhithe, Greenwich, Newington, Lambeth and Battersea on the south side, of Westminster, the City and Liberties, Shoreditch, Bethnal Green and Whitechapel on the north side of the Thames. It was a more severe visitation per head of the inhabitants than that of 1832, cutting off many beyond the limits of the destitute and reckless class who were its most usual victims on the first occasion. Many of the respectable class of workmen and small shopkeepers were among the victims. Several medical men died of it, including one well-known surgeon, Mr Aston Key, at his house in St Helen’s Place, Bishopsgate, on 23 August, after a few hours’ illness. As in Ireland, and at Dundee, an unusually large proportion of the London deaths, perhaps a fourth part, were from sudden collapse and blueness, without premonitory diarrhoea or predominant intestinal symptoms. Opinion was strongly against contagiousness in this epidemic. There were 478 cases treated in St Bartholomew’s Hospital, but not one of the nurses took cholera.

The infection seemed to find out the insanitary spots and to act miasmatically upon the residents. The common remark in all parts of England, Scotland and Ireland was that the localities that suffered most from the typhus fever of 1847-48 suffered most also from cholera. The one black spot in Kensington was a poor district on the north side of the parish known as the Potteries, where an immense number of pigs were kept.

One of the most remarkable features of the cholera-seasons of 1848-49 was the extensive prevalence of common bowel-complaints. Evidence of this has been given for the south of Scotland just before or during the cholera of midwinter, a season when diarrhoea is not usual. It was equally remarked in England in the course of 1849. In the Taunton workhouse, where true Asiatic cholera broke out in November, there had been many cases of bowel-complaint, as well as of fever, in the spring (7 deaths from dysentery and diarrhoea, 5 from fever). In the Exeter workhouse there were eighteen deaths from dysentery in the end of the year, although there is nothing said of cholera, which caused only 44 deaths in the whole city. The efforts of the inspectors sent by the Board of Health were in great part directed to finding out the cases of “premonitory” diarrhoea, by house-to-house visitation, and insisting upon the importance of checking it before it could turn to true cholera. Leeds will serve as an example of English towns. In an incomplete survey after the month of July there were found 5129 cases of simple diarrhoea, 1484 cases of dysentery, 1273 cases of choleraic diarrhoea, and 1090 cases of true cholera[1556]. It was something of a paradox that, with such excessive prevalence of ordinary bowel-complaints, an unusual proportion of the cases of true cholera proved quickly fatal with symptoms of collapse and asphyxia only.

Just as the first startling indication of the presence of Asiatic cholera in London was the enormous fatality in the pauper school at Tooting in the winter, so in some other towns the infection seemed to pick out workhouses or prisons to begin upon. At Belfast there were forty cases in the workhouse before there was one in the town. At Liverpool there were 28 cholera deaths in the first quarter of 1849, of which 8 were in the workhouse. At Wakefield, 19 died of cholera in January, 16 of these in the House of Correction. Among the people at large the infection made little progress until the summer. In the first and second quarters of the year it is heard of, but to a moderate extent, in the towns and colliery districts of Durham and Northumberland, which were the scene of its earliest outbreak in the winter of 1831-32. It was also beginning in the poorest and filthiest parts of Liverpool, Bristol and Plymouth. Its great season all over England was July, August and September, the incidence of the disease according to counties being shown in the table. The right-hand column, showing the number of deaths at the principal centres in each county, must serve for a conspectus of the epidemic.

_Cholera Mortality in England and Wales in 1849._

Death-rate
per
1000
Deaths inhab. Principal centres in each county

England and Wales 53293 3·0
London 14137 6·2 Lambeth 1618, Newington 907,
Bermondsey 734, Southwark 1704
Surrey, part of 255 1·3
Kent, part of 1208 2·5 Gravesend, Milton, Rochester,
Chatham, Margate, Ramsgate,
Maidstone
Sussex 346 1·1 Hastings
Hampshire 1245 3·2 Portsmouth 568, Southampton 240
Berkshire 148 ·8
Middlesex 406 2·7 Edmonton, Barnet
Hertfordshire 323 1·9 Hitchin 127, Hertford 81, Watford
45
Buckinghamshire 175 1·2 Marlow, Wycombe 100
Oxfordshire 117 ·7 Oxford 44, Witney 33
Northamptonshire 141 ·7 Northampton 49, Peterborough 49
Huntingdonshire 14 ·2
Bedfordshire 72 ·6 Bedford 37, Biggleswade 28
Cambridgeshire 269 1·4 Wisbech 138, North Witchford 85
Essex 580 1·7 West Ham 134, Romford 163,
Rochford 105, Harwich
Suffolk 79 ·2 Ipswich 18, Mutford 27
Norfolk 223 ·5 Yarmouth 87, Norwich 38
Wiltshire 320 1·3 Salisbury 165, Devizes 67
Dorset 122 ·7 Weymouth 59, Poole 31
Devon 2366 4·2 Plymouth 830, Stonehouse 171,
Stoke Damerel 721, Plympton St
Mary 151, Tavistock 140,
Totnes 107
Cornwall 835 2·4 St Germans 236, Liskeard 132, St
Austell 135, Redruth 133
Somerset 923 2 Bridgewater 235, Keynsham 77, Bath
90, Bedminster 281
Gloucestershire 1465 3·5 Bristol 591, Tewkesbury 59,
Gloucester 119, Clifton 563,
Dursley 58
Herefordshire 1 ·01
Shropshire 316 1·3 Bridgnorth 75, Shrewsbury 116
Staffordshire 2672 4·4 Newcastle-under-Lyme 241,
Wolverhampton (incl. Bilston,
Tipton, Sedgley) 1365, Stoke
103, W. Bromwich 250, Dudley
412, Walsall 186
Worcestershire 432 1·7 Stourbridge 314
Warwickshire 293 ·6 Coventry 202, Birmingham 29,
Warwick 20
Leicestershire 8 ·08 Loughborough 7, Leicester 2
Rutlandshire 7 ·4
Lincolnshire 372 ·9 Gainsborough 246, Boston 35,
Grimsby 29
Nottinghamshire 137 ·5 East Retford 21, Basford 42,
Nottingham 18
Derbyshire 50 ·06 Derby 18
Cheshire 653 1·6 Nantwich 181, Runcorn 82,
Stockport 72, Birkenhead 139
Lancashire 8184 4·1 Liverpool and W. Derby 5308, Wigan
503, Manchester 878, Chorlton
280, Salford 237
West Riding 4151 3·2 Huddersfield 52, Bradford 426,
Hunslet 884, Dewsbury 224,
Wakefield 241, Pontefract &c.
238, Leeds 1439
East Riding 2140 8·7 Hull and Sculcoates 1834, York
174, Pocklington 37, Howden 58
North Riding 47 ·2 Whitby 10
Durham 1642 4·2 Darlington 4, Stockton 248, Durham
192, Hartlepool,
Chester-le-Street 134,
Sunderland 363, Gateshead 257,
S. Shields 201
Northumberland 1417 4·8 Newcastle 295, Tynemouth 815,
Alnwick 142
Cumberland 419 2·2 Carlisle 51, Cockermouth 282,
Whitehaven 79
Westmoreland 1 ·02
Monmouth 775 4·1 Newport 246, Pontypool 69,
Abergavenny 438
S. Wales 3544 6·1 Merthyr Tydvil 1682, Cardiff 396,
Neath 738, Llanelly 45,
Swansea 262, Carmarthen 142,
Crickhowell 95
N. Wales 245 ·6 Holywell 86, Montgomery 37,
Carnarvon 21

The highest rates in the table are for the East Riding, owing to Hull (24·1), for South Wales, owing to Merthyr Tydvil (23·4), for Northumberland and Durham, for Staffordshire, owing to the iron district round Wolverhampton, for Devonshire, owing to Plymouth, for Lancashire, owing to Liverpool, and for Monmouth, owing to a few mining places. The miners suffered most, the lower class in the seaports next most severely. The Black Country in the south of Staffordshire, which had been the worst centre of the 1832 cholera, was again one of its chief centres in 1849, the mortality falling most, as before, upon the town of Bilston, and next to it upon Willenhall and Wolverhampton. But a great rival to the Staffordshire coal and iron mining had sprung up since 1832 in Glamorgan; and it was in this comparatively new region of miners that cholera in 1849 reproduced the Black Country horrors of 1832 and, indeed, surpassed them.

Merthyr Tydvil had sprung up more like a vast miners’ camp than like a
well-ordered municipality. Along the eastern side of the Taff valley,
on the slopes and in bottoms of the hills, but everywhere at an
elevation of some four or five hundred feet above the level of Cardiff
docks, were numerous groups of mean-looking miners’ cottages, with
their attendant ale-houses, small retail shops, schools and
meeting-houses. This peculiar township had drawn to itself the special
notice of the Health of Towns Commission in 1844: “From the poorer
inhabitants (who constitute the mass of the population) throwing all
slops and refuse into the nearest open gutter before their houses,
from the impeded course of such channels, and the scarcity of privies,
some parts of the town are complete networks of filth emitting noxious
exhalations.... During the rapid increase of the town no attention
seems to have been paid to its drainage.”

In this district the registrar had returned 162 deaths from “cholera”
in the year 1841, which must have been from an unusually severe type
of cholera nostras or British cholera. A first case of Asiatic cholera
occurred at Cardiff in a sailor on the 13th of May, 1849, a week after
there was a case at Lower Merthyr, and a week after that another at
Upper Merthyr. In the course of the summer the ravages of the disease
were enormous in the hilly mining regions of the interior of Glamorgan
and Monmouth, as well as severe in the seaports:

Merthyr Tydvil 1682
Cardiff 396
Neath 738
Swansea 262
Abergavenny district 438
Pontypool 69
Newport 246

The peculiar selection of the mining townships was well shown in the
district of Abergavenny: of 378 deaths from cholera in the third
quarter of 1849, only 9 occurred in Abergavenny town, while 157 were
at the iron-works of Tredegar and 210 at those of Aberystruth, just
as, in the winter preceding, the villages of the iron-works all round
Kilmarnock had been ravaged by cholera while there was little of it in
that town itself.

Another chief centre of cholera in 1849 was the port of Hull. Including the district of Sculcoates, it had the following enormous mortalities from cholera in four weeks of September: 398, 507, 524 and 171, the whole epidemic from July to the 18th of October producing 2534 deaths[1557]. Its neglect of scavenging became a classical instance of the favouring conditions of cholera. An open space at Witham called the “muckgarths,” from the refuse deposited upon it, was one of the worst centres, just as the town moor of Sunderland, used for the same purpose, had been in 1831[1558]. In the other ports, Liverpool, with West Derby, Bristol with Clifton, and Plymouth with East Stonehouse and Devonport, the infection was most severe (see Table), and was observed to choose the poorest streets, lanes and houses, where there had been most typhus for a year or two before[1559]. On the Tyne, the greatest centre on this occasion was not Newcastle, but Tynemouth. The city of Durham, which escaped the cholera of 1832, had a severe visitation. The chief inland centres, besides the mining districts of Staffordshire and Glamorgan, were Manchester and the cloth-making towns of Airedale,--Leeds, Hunslet, Bradford, Dewsbury, and some others in the West Riding. Most of the Lancashire towns occupied with the cotton industry again escaped with little cholera--Preston, Clitheroe, Oldham, Bury, Rochdale, Bolton, Blackburn, Ashton and Chorley. Wigan had nearly twenty times as many deaths as in 1832; on the other hand Sheffield had only a quarter of its former cholera mortality, while Nottingham and Norwich had this time very little. Birmingham, Leicester, Cheltenham, Hereford, Stafford, Ipswich, Cambridge and Colchester were again almost or altogether free from infection. The agricultural counties, notably the Eastern counties, escaped once more with few centres of infection, and these unimportant. Cumberland as a whole had fewer deaths than in 1832, while Cockermouth had more. Exeter, which was severely visited on the former occasion, escaped almost wholly, while Totnes and Tavistock, with the surrounding Dartmoor country and other towns in Devon, had epidemics of the first degree for their size. In England as a whole the cholera of 1849 was more severe relatively to the numbers living than that of 1832, its great centres having been the same, or of the same kind, on both occasions[1560].

The cholera of 1849 reproduced very closely the former characteristics. The attacks were often in the night, especially in persons who had supped heartily on the coarser kinds of savoury meat. With the same undoubted preference for the poorer and more filthy quarters of towns, the infection showed also a certain apparent caprice in fixing on some places and avoiding others.

Thus at Leeds it was most malignant in the locality of York Street and
Marsh Lane (an old centre of plague and typhus), which had lately been
drained at a cost of some thousands of pounds, “whilst in the
adjoining district, which lies nearly level with the river, and will
scarcely admit of any sewerage, I have not heard,” writes the
registrar, “of a single case of cholera”--an experience similar to
that of a low-lying district of Bristol in 1832. At Liverpool, where
much had been undertaken for sanitation since the disastrous Irish
fever of 1847-48, the cholera appeared to Dr Duncan, the medical
officer of health, to attack sewered and unsewered streets
impartially. Another singular thing, which used to be noticed in the
plague and is observed in the malarial fevers of towns abroad, was the
choice of one side of a street only: thus, at Rotherhithe, in a street
where numerous deaths occurred, they were nearly all one side of the
street, in houses occupied by respectable private families, only one
house having been infected on the other side; at Bedford, two streets
showed the same thing.

In London, the least elevated parishes on both sides of the Thames were again its chief seats. Dr Farr, the superintendent of statistics, deduced the law that the death-rate from cholera in London was inversely as the altitude of the parish, and he showed, by a somewhat rough grouping of the cholera deaths, that the law applied to all England[1561]. An empirical generality such as that may have some value; but it is the exceptions to it that show the inward meaning of the fact.

Merthyr Tydvil, which was the worst cholera-spot in England with the
possible exception of Hull, was five hundred feet above the level of
Cardiff, its seaport, where the death-rate was much lower. Neath,
also, had much more cholera than Swansea. Newcastle-under-Lyme,
situated near the source of the Trent, and the highest town in the
course of that river, had a far more severe visitation of cholera than
any other town upon it all the way to its mouth. At Tavistock among
the Dartmoor hills, cholera “sat for many a week,” as Kingsley says,
“amid the dull brown haze, and sunburnt bents and dried-up
watercourses, of white dusty granite.” But the poorer and more
populous part of Tavistock was a somewhat peculiarly shut-in basin,
which was “very often involved in fog during the night.” The town had
escaped cholera in 1832, but one of its physicians, writing in 1841,
and recalling its dreadful plague of 1626, did not feel sure that it
would escape if cholera came back[1562]. Again, one thinks of
Salisbury as standing among high downs; but it had a wet subsoil, bad
sewerage, and bad water supply, and in 1849 it had 200 deaths from
cholera among all classes in two months[1563].

In the not very extensive outbreak at Sheffield, one of its chosen
seats was an elevated district called the Park, inhabited by colliers.
At Bedlington colliery, near Morpeth, the cholera deaths in November
were in the miners’ houses on the hill side. The elevated, airy and
clean village of Loanhead, near Edinburgh, had 46 deaths in its
population of 1200, during a few weeks of midwinter. In Dundee, built
upon a steep slope at the waterside, there were bad centres of cholera
in the higher parts as well as in the lower.

The determining thing appears to have been not so much the elevation as the configuration of the ground; any basin, or cup, or shelving terrace, any natural collecting-ground of moisture and organic refuse in the soil, may become a seat of cholera, whether it be at the sea-level or several hundred feet above it, provided it have a sufficient number of human occupants and a mode of drainage inadequate to its peculiar needs. Such was the situation of Merthyr Tydvil, of Neath, of Newcastle-under-Lyme, of Tavistock, of some colliery villages, and of certain localities in towns such as Dundee. Such, of course, was also the situation of the London parishes next the river on the south and east, of Hull, of Plymouth, of Liverpool, and of other seaports on estuaries. Neither altitude nor configuration means anything for cholera unless the ground itself be full of rotting filth. In all England and Scotland the cholera chose, as if by an unerring instinct, those not very extensive mining parts of the counties of Stafford, Glamorgan, Durham, Lanark and Ayr, which had as many hundreds of inhabitants to the square mile, and as little provision for the safe disposal of their excrements, as those village communities of Lower Bengal in which the infection had become established since 1817 as if it were an annual product of the soil.

The Report of the Board of Health brought to light many instances in which it seemed probable that cholera had been favoured, if not induced, by the water of wells contaminated with organic filth soaking through the ground or entering with the surface water. This was especially the case at Merthyr Tydvil. It was during the next cholera, that of 1854, that the question of contaminated water came into great prominence, in connexion both with wells and with the vast volumes of water supplied through the mains of water companies.

The Cholera of 1853 at Newcastle and Gateshead.

The third visitation of Great Britain and Ireland by Asiatic Cholera was in 1853-54. There had been none of it in any part of the kingdom since 1850; but it is not so clear that all other European countries, especially Poland, were equally free from it. Whether due to a new approach from Asia, or to a rekindling of smouldering fires, cholera appeared in the Baltic ports in the summer of 1853, and soon after reached the Tyne. For the third time a severe but localized epidemic was the prelude--this time at Newcastle and Gateshead, just as in 1848 at Edinburgh, Glasgow and the south of Scotland, and in 1831 at Sunderland and Newcastle.

In the cholera of 1849, which was the most general and the most severe visitation that England has had, Newcastle escaped with a light visitation and Gateshead with a moderate or average one, while Tynemouth (with North Shields) had about twice as many deaths as Newcastle and Gateshead together (12·9 deaths per 1000 inhabitants). In 1853 it was the turn of Newcastle--for no better reason, perhaps, than its escape last time. The very thorough and masterly inquiry by Messrs Simon, Bateman and Hume did, indeed, reveal a most unwholesome state of things; but the town was no worse or only a little worse than in 1849, when the cholera had dealt lightly with it, and it was probably an average sample of the insanitary condition of the greater English industrial towns in the time of their rapid growth and before the period of well-ordered local government had arrived. In some parts, such as Sandgate, the dwellings of the labouring class were “not fit to live in”; in the newer mean suburbs, it was found, as in Glasgow twenty years before, that cellars had become the dwelling-places of a class who in former times lived above ground. Those who had been dispossessed by the railways and other public structures had not been provided for elsewhere; so that, with more trade and better wages, the working class were worse housed than before. Overcrowding, for which the ports on the Tyne and Wear are still pre-eminent, was then most excessive. Only the better-class houses had the water laid on. Excremental offences to sight and smell were everywhere. There was a system of main sewers, passably good; but house-drainage or connexions with the main drains were quite casual. The scavenging of the town was greatly neglected. Piggeries, slaughter-houses and other such nuisances, were uncontrolled. The burial-grounds were over-full. With all this the death-rate of Newcastle could be low enough in a good year, such as 1844, when it was 20·9 per 1000; in the year of the Irish fever, 1847, it rose to 32·8; and in other years it fluctuated between those extremes, according to the nature of the seasons[1564].

The cholera of 1853 was a sudden explosion in the heavy stagnant atmosphere of the month of September. No one knew where the infection came from; there were, of course, ships arriving from the Baltic, but no particular source was ever traced. On the 30th or 31st of August, a case occurred of the rapidly fatal kind; before a week there were about a hundred attacks daily all over the town. From the 13th of September the deaths in Newcastle mounted up rapidly as follows:

Cholera
deaths

Sept. 13 59
14 90
15 106
16 114
17 103
18 103
19 111
20 85
21 68
22 82
23 60
24 56

In the thirty days of September there were 1371 deaths, and some one or two hundreds more in the first part of October, when the infection ceased almost abruptly, the total of deaths to the 4th of November having been 1533. During the same time Gateshead with a population of 26,000, had 433 deaths, or in a ratio nearly equal to that of Newcastle. On the other hand Tynemouth, with a population of 30,000, had only twelve deaths, several of them in vagrants or other arrivals from Newcastle, the rest in a cluster of pitmen’s cottages on the outskirts of North Shields.

It was freely rumoured at the time, and was even repeated with much
unction in so dry and deliberate a work as the report of the
Registrar-General, that the cholera at Newcastle and Gateshead in
September, 1853, was owing to the sudden contamination of the town’s
water with sewage. The facts about the water-supply are as follows:
Previous to 1848, Newcastle was supplied with Tyne water pumped up at
Elswick, and passed through the settling tanks and filtering beds. In
1848 the Whittle Dean Water Company, incorporated in 1845, had their
new supply ready, and the old company, with its pumping station at
Elswick, was superseded. The new supply was collected from landward
sources, and was apt to be peaty. There was a great demand upon it,
especially for public works (it was supplied to comparatively few
houses), so that the distribution in 1853 had increased 2½ times since
the company began in 1848. They had extended their collecting area to
meet this demand; but, owing probably to the drought, they found it
necessary on the 6th of July, 1853, to resort to the old
pumping-station at Elswick for about a third part of all the water
that flowed daily through the mains. This had gone on for eight weeks
before the epidemic began, and was promptly discontinued on 15
September, as soon as the possible danger from Tyne water was
realized. The pumping-station was higher up the river than the only
one of the Newcastle sewers that discharged in its vicinity. There
were complaints about the water, but these appear to have been chiefly
of the peaty colour or flavour, which came from the Whittle Dean part
of the mixture. The water from the mains was not equally bad at all
points, as if the suspected contamination might have occurred in its
transit through the town. Also the water of some wells was complained
of as offensive at the same time, which was the season of the year
when the springs are lowest. Gateshead was also supplied by the mains
of the Whittle Dean Company. It is clear from the report of the
Commissioners that they considered the water of Newcastle and
Gateshead to have been a very subordinate factor, if a factor at all,
in the epidemic of cholera.

The Cholera of 1854 in England.

The great epidemic at Newcastle and Gateshead was over by November, 1853, those towns having no share in the general epidemic in England in 1854, although it visited their near neighbour Tynemouth. The interest of the cholera of 1854 centres chiefly in London[1565]. Few of the great foci of infection in 1849 were visited severely. Liverpool, which never escaped, had a moderate epidemic, Merthyr Tydvil also had about a fourth part of its 1849 mortality, Dudley had the disease somewhat severely, while some towns, such as Norwich, Wisbech and Sheffield, had more than usual. But Plymouth, Hull, Bristol, Manchester, Leeds, the towns of the Black Country and nearly all the populous places that had suffered heavily either in 1832 or in 1849, or on both occasions, escaped in 1854 with little cholera or none[1566]. The table shows the incidence of the epidemic (as well as that of 1866) according to counties.

_Cholera Mortality in England and Wales in 1854 and 1866._

1854 1866
Rate Rate
per per
Deaths 1000 Deaths 1000

England and Wales 20097 14378
-----------------------------------------------
London 10738 4·3 5596 1·9
Surrey, part of 252 1·2 82
Kent, part of 1056 2·1 284
Sussex 94 ·3 79
Hampshire 130 ·3 417 ·9
Berkshire 49 ·2 3
Middlesex, part of 380 2·4 51
Hertfordshire 97 ·5 9
Buckinghamshire 68 ·5 10
Oxfordshire 183 1·0 4
Northamptonshire 152 ·7 7
Huntingdonshire 18 ·3 1
Bedfordshire 61 ·4 22
Cambridgeshire 270 1·3 7
Essex 513 1·4 471 1·0
Suffolk 67 ·2 15
Norfolk 381 ·8 15
Wiltshire 60 ·2 11
Dorset 45 ·2 6
Devon 188 ·3 525 ·9
Cornwall 24 ·06 21
Somerset 21 ·04 68
Gloucestershire 260 ·6 39
Herefordshire 1 ·01 2
Shropshire 13 ·05 17
Staffordshire 426 ·6 30
Worcestershire 103 ·4 36
Warwickshire 89 ·2 15
Leicestershire 14 ·06 3
Rutlandshire 9 ·08 --
Lincolnshire 134 ·3 48
Nottinghamshire 80 ·3 1
Derbyshire 17 ·06 20
Cheshire 141 ·3 391
Lancashire 1775 ·8 2600 1·0
West Riding 470 ·3 283
East Riding 70 ·3 54
North Riding 84 ·4 21
Durham[1567] 2·9 352 ·6
Northumberland[1568] 5·7 224
Cumberland 35 ·2 32
Westmoreland 1 ·02 1
Monmouth 18 ·1 204
South Wales 887 1·4 2033 2·9
North Wales 34 ·08 256

Principal centres in each county
1854 1866

England and Wales

London South of Thames, Eastern Eastern parishes 3691
parishes
Surrey, part of
Kent, part of
Sussex
Hampshire Portsea Island 20, Portsea Island 129,
Southampton 48 Southampton 41
Berkshire
Middlesex, part of Brentford 196
Hertfordshire
Buckinghamshire
Oxfordshire
Northamptonshire Towcester 86
Huntingdonshire
Bedfordshire
Cambridgeshire Wisbech 176, Ely 46
Essex West Ham 124, Romford West Ham 389
113, Maldon 102
Suffolk
Norfolk Norwich 193, Yarmouth 41
Wiltshire
Dorset
Devon Plymouth 59, Stonehouse Exeter and St Thomas 247,
15, Devonport 2, Newton Abbot 57,
Bideford 46 Totnes 146
Cornwall
Somerset
Gloucestershire Bristol 76, Clifton 92,
Gloucester 48
Herefordshire
Shropshire
Staffordshire Dudley 256,
Wolverhampton 80

Worcestershire Worcester 45
Warwickshire
Leicestershire
Rutlandshire
Lincolnshire Great Grimsby 68
Nottinghamshire Worksop 27,
Nottingham 16
Derbyshire
Cheshire Chester
Lancashire Liverpool 1084, W. Derby Liverpool and W. Derby
206, Wigan 158 2122, Wigan 137

West Riding Sheffield 126, Dewsbury
66, Leeds 48
East Riding Hull 27
North Riding Whitby 33, Guisboro’ 30
Durham Stockton, Auckland,
Durham
Northumberland Newcastle 1431, Gateshead
525, Tynemouth 203
Cumberland
Westmoreland
Monmouth
South Wales Merthyr Tydvil 455, Swansea 521, Neath 520,
Cardiff 255, Neath 54, Llanelly 232, Merthyr
Brecon 54 Tydvil 229
North Wales

The London cholera of 1854, like that of 1832 and of 1849, fell most upon the southern (Southwark etc.), eastern and southeastern parishes (Table, p. 858). But it fell somewhat unequally upon these; and for Southwark and Lambeth the water supply was seized upon as the thing that made the difference. There were two water companies in South London, the Lambeth company and the Southwark and Vauxhall company. The parish of Christ Church, Lambeth, chiefly supplied by the Lambeth company, had a death-rate from cholera in 1854 of only 0·43 per 1000 inhabitants; whereas the parish of St Saviour, supplied by the Southwark and Vauxhall company, had a death-rate of 2·27 per 1000. In 1849 there had been no such disparity between them, the death-rate of Christ Church being if anything the higher of the two. Now it happened that in the interval of the two epidemics of cholera the Lambeth company had removed their intake works from opposite Hungerford Market to Thames Ditton, whilst the Southwark and Vauxhall company still continued to draw their supply from the Thames near Vauxhall. Here was a fine instance of the logical method of difference. Farther, within the parish of Christ Church itself, it was sought to show that the cholera followed the lines of old water supplies, and did not follow the mains from Thames Ditton. After 1854 the Southwark and Vauxhall company also made their intake at Thames Ditton. According to the water-hypothesis of cholera, it is not surprising, as we shall duly find, that the whole of the South London parishes, which had been the chief seats of the cholera in 1832, 1849, and 1854, escaped in 1866 with a very slight visitation. Newcastle was another chosen instance of cholera distributed by the water mains; but, as we have seen, that was improbable. Another instance was Exeter: its water supply in 1832, when part of it had a disastrous epidemic of cholera, was taken from the Exe, and was impure; in 1849, when it had only a tenth part of its last cholera mortality, its water supply had been greatly improved; in 1854 it had 10 deaths; but in 1866, Exeter with the registration district of St Thomas had 247 deaths, and Totnes had 146,--for their size about the most severely visited towns in England.

In the London cholera of 1854 a very sudden and simultaneous explosion in the district of Soho attracted much notice[1569]. The district stands high, which did not save it from being the scene of the first outbreak in the great plague of 1665. In the subdistricts of St Anne, Golden Square and Berwick Street, with a population of 42,000, many of them well-to-do families, there were 537 deaths from cholera, a rate of 12·8 per 1000, contrasting with the rate of 6 per 1000 for all London. The attacks and fatalities were remarkably numerous for one or two days, falling at once thereafter to about a half. There was a pump in Broad Street, in the centre of this district, which was supposed to have dispersed cholera broadcast in its contaminated water; a death had occurred in Swain’s Lane, at the foot of Highgate Hill, of a person who had drank the water of the Broad Street pump. The whole incident was seized upon and worked up by Dr Snow, who had written a speculative essay in 1849 upon the probability of cholera being conveyed by water, according to the similar theory of Parkin in 1832[1570]. The Board of Health, having very full data before them of the Soho outbreak in all its aspects (including a whole biological treatise upon the organisms found in water), did not adopt Snow’s conclusion, although he had enthusiastic followers at the time, and has probably more now[1571]:

“In explanation of the remarkable intensity of this outbreak within
very definite limits, it has been suggested by Dr Snow that the real
cause of whatever was peculiar in the case lay in the general use of
one particular well, situate at Broad Street in the middle of the
district, and having (it was imagined) its waters contaminated by the
rice-water evacuations of cholera patients. After careful inquiry we
see no reason to adopt this belief. We do not find it established that
the water was contaminated in the manner alleged; nor is there before
us any sufficient evidence to show whether inhabitants of the
district, drinking from that well, suffered in proportion more than
other inhabitants of the district who drank from other sources.”

The Cholera of 1853-54 in Scotland and Ireland.

The cholera of 1853-54 in Scotland has not been so fully recorded as either of the two preceding epidemics. It is said to have caused about six thousand deaths, of which 3892 were in Glasgow alone, and a considerable part of the remainder in Edinburgh and Dundee. The infection began to appear in the end of September, having been derived probably from the dreadful explosion at Newcastle. A few early cases occurred at Dunse, in Berwickshire. On the 16th September, 1853, the old Cholera Hospital at Edinburgh, in Surgeons’ Square, was opened, but received only 45 cases until the beginning of June, 1854, when it was closed. In the autumn of 1854 the real epidemic began, the hospital being re-opened on 24th August, from which date until the 30th November the admissions were 198. These hospital figures indicate for Edinburgh a milder epidemic than that of the winter of 1848, which was itself milder than that of 1832. The cases came mostly from the very same localities of the old town as in 1848. There were 145 females to 97 males; the deaths were 117 in 243 cases admitted[1572].

The epidemic at Dundee was a late autumnal or winter one, in the end of 1853, and of great severity, the mortality having probably exceeded 500. The Glasgow epidemic had a course very nearly parallel to that of 1832, and quite unlike the extraordinary winter explosion of 1848-9. It began, indeed, in winter--about the 15th of December, 1853, and had caused 849 deaths to the 27th of February; there was a sharp rise of the mortality from the 13th to the 24th of March, the total deaths to that date being 1306. As in 1832, the infection appeared to die out in the late spring and early summer; but in June it revived and increased in virulence until August, after which it subsided gradually until November, the whole mortality having been 3892, or ·98 per cent. of the population, nearly the same ratio as in 1848-9, (1·06) and a lower ratio than in 1832 (1·4). The first part of the epidemic fell chiefly on the north and east of the city, the second part, in summer and autumn, was all over the city, as in 1832, and among all classes, as in the winter of 1848-49, but perhaps less disastrously in the best quarters of the city than the last had been. The cholera hospital received a comparatively small part of all the cases--600 of cholera, 253 of diarrhoea, the deaths being 306, or less than a tenth part of the whole mortality[1573].

It is probable that the mortalities in Scotland on this occasion, besides those in Glasgow, Edinburgh and Dundee, were neither so general nor so great as in 1832. One remarkable outbreak happened at the village of Symington, in Ayrshire: in a population of 240 there were 110 attacks and 30 deaths; nearly all the cases were in houses on one side of the village street, which got their water from a public well; the houses on the other side, having private wells (and differing, doubtless, in other respects), were notably free from the infection[1574].

The cholera of 1854 was unimportant in Ireland. Cases appeared among emigrants on board ships in Belfast Lough and at Queenstown in the end of 1853, but no diffusion took place until 1854, and then only to a moderate extent. It is supposed that some 1706 persons died of it in Ireland in that year, according to the retrospective figures of the census of 1861; but a good many deaths from “cholera” were returned for every year of the decennium, so that it is improbable that the whole 1706 in 1854 were of the true Asiatic type. Ulster had 895 of these, Leinster 453, Munster 324, and the whole of Connaught only 34[1575].

The Cholera of 1865-66.

Asiatic cholera reached Europe by a new route in 1865--by the way of Egypt with the pilgrims returning from the Hâj at Mecca. In the course of the autumn it appeared at Southampton and caused 35 deaths from 24 September to 4 November. A strange extension from Southampton (or from Weymouth) took place to the village of Theydon Bois in Epping Forest, where nine deaths were traced to one house from 28 September to 31 October, unhappily including the death of a most estimable medical gentleman who tasted the water of a well into which the evacuations of the sick had probably percolated.

The cholera having become established on the continent of Europe in the end of 1865, was brought into England by emigrants passing from Hull and Grimsby to Liverpool on their way to America. On board one of the emigrant steamships, the ‘England,’ a very severe epidemic arose in mid-Atlantic in April. Liverpool had once more a severe epidemic (2122 deaths); but the only other important centres in England, besides London, were Swansea, Neath, Llanelly and Merthyr Tydvil, Chester and Northwich, a group of towns on the Exe in Devonshire, and Portsmouth with other places in Hampshire. Still, the deaths in all England made the large total of 14,378, no county excepting Rutland being absolutely free. That means that the infection, although widely diffused, now wanted the conditions favourable to its development and effectiveness; and that, again, seems to mean that a vast improvement had been made in the sewering of towns, in scavenging, and in all other matters of municipal police by which the soil of inhabited spots is preserved from saturation with excremental and other filth.

The interest of the cholera of 1866 centres in London, and chiefly in the fact that three-fourths of the deaths, to the number of 3696, took place in the eastern parishes, Whitechapel, Bethnal Green, Poplar, Stepney, Mile End, St George’s in the East, and Greenwich. These had in former epidemics a fair share; but hitherto they had been surpassed by the Southwark parishes and others on the south of the Thames from Battersea to Rotherhithe, and nearly equalled by Shoreditch and the Liberties of the City. The comparative table of the four great choleras of London shows how remarkably the infection in 1866 had left its old principal seats, remaining, as if a residue, only in the East End, with death-rates comparable to those of 1849.

_Comparative view of the Four Epidemics of Cholera in the several parishes of London_[1576].

1832 1849 1854 1866
(17 wks. end. 4 Nov.)

Rate Rate Rate Rate
per Deaths per Deaths per Deaths per Deaths
10,000 10,000 10,000 10,000

Kensington 10 52 24 260 35 490 3·7 85
Chelsea 80 272 46 247 47 300 3·3 22
St George, Hanover Sq. 10 74 18 131 38 295 1·7 18
Westminster 50 450 68 437 60 423 6·2 43
St Martin in the Fields -- -- 37 91 24 58 4·2 10
St James, Westminster -- -- 16 57 152 485 3·5 13
Marylebone 30 355 17 261 16 347 3·0 54
Hampstead -- -- 8 9 11 14 ·8 2
Pancras 20 230 22 360 13 248 6·0 138
Islington 10 39 22 187 8 97 4·3 120
Hackney 2 8 25 139 11 73 10·6 103
St Giles 50 280 53 285 21 115 9·2 49
Strand 1 26 35 156 24 111 6·6 29
Holborn 10 46 35 161 5 25 5·2 22
Clerkenwell 10 65 19 121 9 59 7·0 45
St Luke 30 118 34 183 9 52 8·1 46
East City } 45 182 23 85 15·7 59
West City } 50 605 96 429 10 126 18·8 60
City } 38 207 14 71 5·0 20
Shoreditch 10 57 76 789 20 237 10·7 139
Bethnal Green 50 345 90 789 20 192 60·4 611
Whitechapel 110 736 64 506 40 330 84·2 909
St George in the East 30 123 42 199 30 154 87·9 385
Stepney 50 358 47 501 32 388 107·6 559
Mile End Old Town -- -- -- -- -- -- 67·7 501
Poplar 40 101 71 313 38 208 90·8 837
St Saviour } 120 1128 153 539 134 495 7·4 32
St Olave } 181 349 162 315 8·5 21
Bermondsey 70 210 161 734 158 845 5·3 35
St George, Southwark -- -- 164 836 101 546 6·6 38
Newington 40 200 144 907 101 696 2·8 26
Lambeth 40 337 120 1618 63 941 6·5 114
Wandsworth 10 46 100 484 77 422 4·8 40
Camberwell 30 107 97 504 91 553 5·6 46
Rotherhithe 10 19 205 352 147 285 8·7 25
Greenwich 20 149 75 718 53 576 19·5 284
Lewisham -- -- 30 96 20 81 6·1 56
Stratford -- -- -- -- -- -- 77·6 --
West Ham -- -- -- -- -- -- 49·3 --
Leyton -- -- -- -- -- -- 13·1 --

There was one significant thing associated with the peculiar incidence of the cholera of 1866 upon the East End. The main drainage of London, consisting of a high level and a low level sewer on each side of the Thames, was commenced in 1859, and was formally opened on 4 April, 1865. The two levels on each side of the river made together a length of eighty-two miles; the cost, with pumping station, was £4,200,000. When the cholera of 1866 broke out, only one part of the system was incomplete and not yet in working, namely, the low level main drainage on the northern side, which served the whole of the cholera-stricken parishes from Aldgate to Bow. However, the official mind in this country has somehow become prejudiced against the well-known and usually accepted generalities of von Pettenkofer, which make more of a foul soil in the causation of miasmatic infections, than of contaminated surface water or contaminated water from reservoirs. Accordingly, the somewhat remarkable fact that the East End of London alone retained its old proclivity for choleraic infection was not joined to the fact of its being the only great division of the capital still unsewered, but to the fact that it was supplied by water taken in from the river Lea in Hertfordshire and (it was alleged) insufficiently filtered or otherwise purified at the Old Ford waterworks[1577].

The extension to Scotland in 1866 was late in the season and insignificant compared with former epidemics. It was heard of about the end of summer in Fraserburgh and one or two other ports or fishing places on the East Coast, but it was not until October and November that it attracted notice in the eight principal towns, the whole mortality from it in Glasgow being 53, in Edinburgh 154, in Dundee 105, in Aberdeen 62, in Paisley 2, in Greenock 14, in Leith 95, and in Perth 15. Besides these deaths there were 435 more in smaller towns or villages. The year was a very healthy one, the death-rates of Glasgow, Greenock and Perth having been below the mean of the previous ten years.

In Ireland the cholera of 1866 was even slighter than in Scotland, the only considerable epidemic having been at Belfast.

Cholera has never obtained a footing in London since the epidemic of 1866. In 1873, while the disease was unusually active in some parts of Europe, a few cases occurred in Wapping among Scandinavian emigrants on their way to America, who had been landed for a few days. But the infection did not spread. In 1884, when cholera came from Cochin China to Toulon and Marseilles, two or three cases occurred on board steamships arriving at Cardiff and Liverpool. In 1893, when the disease raged in Hamburg, a number of choleraic cases occurred at Grimsby in August, which were considered certainly Asiatic owing to their high degree of fatality. In August-October, the deaths from cholera, whether cholera nostras or the Asiatic type, or both together, were about thirty in Grimsby, eighteen in Hull, and about fifty more in various other places, chiefly in the south of Yorkshire. The autumn of that year was favourable to bowel-complaints and to enteric fever.

The Antecedents of Epidemic Cholera in India.