View report page

London County Council.
cholera in london during 1893.
Report of the Medical Officer of Health on the subject of Cholera in London during
1893, together with Dr. Klein's report on bacteriological examinations made
in connection therewith.
(Printed by order of the Public Health Committee, 22nd January, 1894.)
Public Health Department,
Spring Gardens, 3.W.,
18th January, 1894.
In reporting to the Committee on September 28th as to the steps taken in connection with
cholera during the recess, I stated that inquiry had been made into all instances which came to my
knowledge of persons in London suffering from disease suspected to be Asiatic cholera, and in a few
cases in which it appeared desirable that there should be bacteriological examination, material from such
cases was sent to Dr. Klein.
I addressed a letter on September 8th to the medical officers of health of the London sanitary
districts, informing them that I was authorised to send material to Dr. Klein in cases where
bacteriological examination was desirable, and inviting them to give me notice of suspected cases of
cholera. I received immediate personal information of several such cases, and in addition to the inquiries
thereupon undertaken, a systematic investigation was instituted also into the history and symptoms of
persons notified as suffering from cholera or choleraic diarrhoea, as well as into the cases of death
registered during the latter part of August, September, and the early part of October, and attributed to
cholera or choleraic diarrhoea.
In the large majority of cases investigated the symptoms were those of ordinary summer
diarrhoea of a severe type; in a few instances the existence of marked collapse associated with vomiting
and diarrhoea, and with one or more of the following symptoms—cramps in the limbs, blueness and
shrivelled appearance of extremities, altered voice, rice-water evacuations—suggested the desirability
of bacteriological enquiry as an aid to diagnosis. In cases of death of patients exhibiting symptoms
of this kind a post-mortem examination was also made, and a portion of the lower part of the small
intestine with its contents was submitted to Dr. Klein for report. In other instances stools presenting
the rice-water character obtained from patients who subsequently recovered, were submitted to Dr. Klein
for examination. In one or two instances no material for bacteriological examination was obtainable,
but the clinical symptoms that had been manifested in some of these cases were quite as suggestive as
those which occurred in the cases from which material was obtained and gent to Dr. Klein.
In all instances careful inquiry was made as to a source of infection. In no case was it possible
to trace any connection between the suspicious cases occurring in London and other suspected cases
whether occurring in London or elsewhere; and further in no single instance was there any evidence of
spread of the disease from any of the cases brought under notice. A history was given by two patients
of their having eaten fish which had come from Grimsby; by several patients of having eaten fried fish
and shell fish; and by one patient of having eaten shrimps. In all these cases other persons had
partaken of the particular food specified without ill effect.
The following cases are selected from the total investigated, upwards of fifty in number. Cases
which proved on enquiry to afford no reasonable suspicion of the illness having been Asiatic cholera
have been eliminated. Of the remainder, 16 in number, material from 13 was sent to Dr. Klein; from
two by the Medical Officer of the Local Government Board, from 11 by myself. In four of these cases
Dr. Klein's examination gave positive results. The 16 persons of whose illness account is here given
include persons at various periods of life, but all the four persons, in whose cases positive results were
obtained as the result of bacteriological examination, were over fifty years of age. All the 16 cases
except one belonged to the poorer classes of the community.
I present Dr. Klein's report on the subject of bacteriological examination of cholera, as well as
an abstract of notes of the clinical history of the 16 cases, and of the post-mortem appearances of the
cases which proved fatal. These notes are, in the majority of instances, an abstract of information
obtained by Dr. Hamer from medical officers of health, from the medical attendants or from the friends
of the patients, and are supplemented, when possible, by our own observations. I have to acknowledge
the aid thus afforded me by Dr. John Norton (Westminster), Dr, Millson (Newington), Dr. Verdon
(Lambeth), Dr. Waldo (St. George-the-Martyr), and Dr. Warry (^Hackney).
Case 1.
M. B. (female), set. 50, Marsham-street, Westminster.
A cleaner in the House of Commons. Had been nowhere save between her home and the House
of Commons, and to shops to make necessary purchases. Had latterly been prone to suffer from
diarrhoea, but had been quite free from it for some five weeks before her fatal illness.
She ate fried fish for supper on an evening towards the end of the week ending September 2nd.
On September 3rd and 4th the patient and her daughters ate rabbit and pickled pork, and the daughters
suffered from slight diarrhoea and abdominal pains on September 4th, but had quite recovered on
September 5th. On this day, while at the House of Commons, patient was seized with diarrhoea and
returned home; vomiting and cramps set in and the stools were of the rice-water character. In the
evening she was much collapsed; she died on the evening of September 6th.
No. 141—Price 2d. Sotd by E. Stanford, 26 and 27, Coclcspur-street, Charing-craes, S.W. 4316