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suspected to be suffering from the malady. The disease appeared to spread in Europe from two centres,
reaching Russia from the Caucasus, and travelling across the country from south-east to north-west,
and also appearing early in the year in the neighbourhood of Paris, particularly affecting in the first
instance a number of communes in the department of the Seine supplied with water taken from the
river below the outfall of the main sewer of Paris, and then spreading mainly northwards. Havre
was attacked in July, and nearly 500 deaths occurred in that town in the course of a few months. It
may be noted too that more than 100 deaths were reported from Lorient. In Germany the chief
centre of the disease was Hamburg, in which city more than 8,000 deaths occurred during the year.
The Hamburg outbreak assumed special importance in relation to England as the majority of the cases
imported into this country were traceable directly or indirectly to that city.
At the beginning of 1893, though but few cases of cholera were recorded in Europe, there
was evidence of the widespread distribution of the disease. The Hamburg epidemic of 1892 had
come to an end in November of that year, but in December there was a small " after epidemic," and
cases continued to occur during the early weeks of 1893. Sporadic cases were also reported, in
various parts of France, and an outbreak occurred at Grand Port Philippe, a fishing village near
Gravelines ; the disease, moreover, had not wholly died out in Russia.
At the end of January, 1893, two outbreaks occurred which were subsequently made the subject
of report by Professor Koch, the one at a lunatic asylum at Nietleben, and the other, the winter
outbreak at Altona. Throughout February and March reports of attacks of cholera were from time to
time received from parts of Russia, and there was evidence that the province of Podolia was particularly
affected. At the end of March came the news that the French port Lorient, which had suffered in
the preceding year, was again attacked, and rumours were current as to the presence of the disease
in Marseilles. The number of cases in Russia began to show increase as the weather became warmer,
Podolia being still specially involved ; the disease appeared too in the adjoining Austrian territories of
Eastern Galicia. In June sporadic cases were reported from several localities in France,, notably from
Alais, Nimes, and Montpellier, and from parts of Brittany. In this month cholera was reported to
be prevailing in Mecca, and much anxiety was felt lest the pilgrim routes should offer facilities for
the spread of infection westwards. It was stated that some 40,000 pilgrims had passed through Suez
on their journey east to Mecca, and it was feared that the pilgrims on their return would bring cholera
with them. On their way home they would need to pass the quarantine station at El Tor, at which
place it was anticipated cases of the disease would ere long be met with. In July reports of cholera
continued to be received from Mecca, and it was now stated that a number of cases had occurred at
El Tor. The prevalence of the disease appeared to be increasing in Russia and Hungary, and cases were
from time to time reported in France. At the end of the month the resources of the quarantine station
at El Tor were severely strained, some 18,000 pilgrims being then under detention; the number of
actual cases of cholera was not however large. In August the epidemic continued to gain ground.
Reports from St. Petersburg showed increase in the number of cases in the Russian provinces; in
Galicia the disease was spreading. An outbreak occurred at Naples, and from Holland, Germany and
France sporadic cases were reported. These reports continued to be received from the localities previously
involved, and it may be noted that an outbreak occurred early in September at Leghorn, and
later in the month an asylum at Scutari was attacked. Another outbreak was developed too in
Hamburg, some 150 cases being notified in that city during September. The Mecca pilgrimages
terminated at the end of September, and it was then ascertained that while some 44,000 pilgrims had
passed through Suez on their way east, only 30,388 had returned. During October the general decline
in the prevalence of cholera became marked, and in November and December there is little to record.
Cases were reported from Teneriffe, however, before the close of the year, the disease still lingered in
Russia, and an occasional case was heard of elsewhere.
The cholera of 1893 occasioned a much smaller number of deaths than did the epidemic of 1892.
In 1893, as in the previous year, the country especially attacked was Russia, the number of deaths,
41,047, falling however far short of that recorded in 1892, viz., 158,589. The Caucasus, which suffered
severely in 1892 (upwards of 80,000 deaths), was comparatively free from the disease in the succeeding
year, (1,203 deaths) ; in the province of Podolia, however, 7,593 deaths occurred in 1893 as compared
with 2,292 in 1892. In Germany the 1893 outbreak was insignificant in comparison with that of 1892,
when the returns were swelled by the mortality recorded in Hamburg. In France some 3,000 deaths
occurred during 1893.
The occurrences of cholera in England and the steps taken in connection with this disease may
now be briefly stated.
The continued occurrence of sporadic cases of cholera in France determined the issue on June
22nd of a circular letter addressed by the Local Government Board to London sanitary authorities,
asking how far the preliminary action taken last year or since decided on by the authorities was to be
regarded as enabling them without delay to carry out regulations under Section 82 (1) of the Public
Health (London) Act in the event of it being deemed necessary by the Board to issue such regulations.
On June 25th a vessel which had had a case of cholera on board arrived in the Tyne from Nantes,
and during July two cholera-infected vessels arrived in the Thames.
Towards the end of August attention began to be directed to cases of illness occurring in this
country, and on material for bacteriological examination being submitted to Dr. Klein, it transpired that
Grimsby and Hull were attacked by the disease. On the 1 st September the Local Government Board
made an order declaring epidemic regulations to be in force in the urban sanitary districts of Grimsby,
Cleethorpe-with-Thrunscoe and the port sanitary district of Grimsby. On September 2nd a case of
illness occurred in Westminster, which was stated by Dr. Klein a few days later to be Asiatic cholera.
During September and the early part of October cases were reported from a number of localities
throughout the country. For the most part these cases were isolated ones. In some instances there
appeared reason for supposing infection had been conveyed from Grimsby or Hull; in the majority