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most likely to break out. The remarkable feature of the present
epidemic is its course. At first it was very much confined to certain
districts at the East of London, where investigation has shown that a
local cause existed, on the removal of which the disease steadily and
quickly declined. But while lessening in that part of the metropolis
which had been supplied with contaminated water, it has become more
generally diffused over London, parts previously free from attack have
been invaded, and now no parish can be regarded as even comparatively
safe. Every case that happens therefore, scattered as the cases are,
must be regarded, and is regarded by me, as a possible focus from
which the disease may be spread through a neighbourhood; and I
have consequently felt it my duty to do all in my power to extinguish
the first small spark wherever it has happened to fall. Happily my efforts
have hitherto been successful, a fact which I attribute in great measure
to the early information I have, up to the present time, received from
my professional brethren, especially from those whose practice takes
them among the poorer classes of our population. The uncertainty
which just now prevails as to the progress of the disease is calculated
to inspire some uneasiness as to our prospects. The disease certainly
is not following the ordinary course of decline, indeed the tendency at
present is towards increase, as if the outbreak in the East of London
had been but a special local development,under peculiar circumstances, of
what has been steadily spreading by slow steps over the metropolis.
The prospect is not cheering, but we must look at it fairly, and act
judiciously, varing our proceedings as the circumstances of the case
appear to require from time to time. In the intervals of the meetings
of the Committee, I have thus taken upon myself, now and then, to
vary the arrangements which they had made, both as respects the
re-engagement of assistance which they had considered no longer
necessary, and in the discontinuance of that for which I had no
immediate occasion. I have every reason to be thankful under the
great anxieties I have to encounter, for the confidence they have
manifested in my judgment in matters where I have in this way
exceeded the limits of their direction. I believe they feel, as I do
myself, that a broad margin of discretionary power must be left in my
hands.
Since the date of the last report, I have received information of S3
new cases of fully developed cholera, and 46 of choleraic diarrhoea
among the class of persons usually met with as patients either of a
parochial or dispensary surgeon. Notice of nine additional private