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came in after the commencement of patient's illness. Patient's work took him to various districts Id
the county of London, sometimes outside the boundary; nothing definite could, however, be ascertained
concerning his movements during the few days preceding his illness. It was certain, however, that he
had not slept away from home. On September 22nd he ate some liver and bacon. On the 23rd
diarrhoea commenced. The next day he felt better, but the diarrhoea returned in the evening. On the
25th he went to work, but was compelled to return Lome on account of severe diarrhoea, accompanied
by vomiting. On the 26th the motions was blood-stained; voice not characteristic of cholera; he
became collapsed, and died at 10 p.m.
Throughout his illness there was abdominal pain, but no complaint was made by patient of cramps
in his limbs. There was no other case of similar illness in neighbouring tenements.
Post mortem the intestines were found injected throughout their whole length, there was a little
fluid in the peritoneal cavity. There were submucous hemorrhages in the lower ileum and the large
intestine. This extravasation was very extensive in the head of the caecum. A portion of the lower
ileum was taken to Dr. Klein.
Report by Dr. Klein—"The mucous membrane was deeply congested, the Payer's patches and
solitary follicles prominent and deeply congested; the contents of the ileum a brownish fluid. On
microscopical examination numerous epithelial flakes could be distinguished. Crowds of different
bacteria present, among them a fair number of commas and S-shaped forms. Peptone salt cultures
yielded crops of commas giving markedly the cholera-red reaction. The peculiar character of these
commas was this: that while in gelatine plate cultivations the colonies were of the general character of
the choleraic commas except that the liquefaction proceeded very slowly, in gelatine stab cultures they
did not produce liquefaction. In agar and other media they did not differ from the typical cholera
commas."
Case 13.
A. K (male), set. 53, vagrant, lodging-house, Campbell-road, Islington.
Patient had stayed on and off at the above address for some weeks. On the 19th September he
went to Wood-green, returning to Islington at night; a day or two later he went to St. Mary Cray, and
slept at a lodging-house there, the address of which he could not give. He had while at St. Mary Cray
eaten some damsons and boiled pork, but had not had any shell fish. On the 23rd he returned from
St. Mary Cray to Islington, and at 8 p.m. on that day was seized with abdominal pain, vomiting, diarrhoea,
and cramps in the limbs. At 11 p.m., on admission to the infirmary, he was much collapsed, and was
suffering from severe vomiting and diarrhoea; the stools were described by the nurse as "like ricewater
an hour or two later he began to improve, and quickly rallied, and on the following day was
quite convalescent. There was no other case of similar illness in the Islington lodging-house. No
bacteriological examination was made in this case, as the stools had not been preserved.
Case 14.
H. C. (female) set. 74.
An inmate of the Greenwich Union Workhouse, who was taken ill on her way from the workhouse
to Royal-street, Lambeth.
Patient left the workhouse on October the 10th to spend the day at the above address. She had
been suffering early on the morning of the 10th from mild diarrhoea; later, severe purging and vomiting
coming on, she was unable to return to Greenwich. Her symptoms became more severe when she
arrived at the house of her niece at Royal-street, Lambeth. She was cold, collapsed, but not actually
blue, her voice was not altered, and she had no definite cramps; she died on the morning of the llth
October.
A post-mortem examination was made, and the small intestine was found somewhat injected
throughout, and containing a grumous liquid which was very faintly bile tinged. A piece of the ileum
was taken to Dr. Klein.
Report by Dr. Klein—"On microscopic examination, crowds of bacilli were found, some short,
others long cylinders, and some filamentous, also some few forms that looked not unlike commas.
Cultivations proved entirely negative qua commas."
A number of cases of diarrhoeal disease having developed among inmates of the Greenwich Union
Workhouse, an enquiry was instituted into the outbreak by the Local Government Board. The report
on the result of this inquiry is not yet published. It is sufficient, as far as case 14 is concerned, to say
that the disease was not found to be cholera.
Case 15.
A. L. (female) set. 43, Great Peter-street, Westminster.
Wife of an employe at the gasworks. She had not been away from home for a week before her
illness. On the 12th and 13th October patient suffered from cramps in the legs, and on the 15th
diarrhoea commenced. On the 16th she vomited for the first time, and her condition became rapidly
worse, and she died at 11 a.m. The details which could be obtained concerning patient's previous
history were very meagre. No medical man attended her during her illness. The practitioner who saw
the body shortly after death made a post-mortem examination, and found the small intestine reddened
with injection. He formed the opinion that the death was from natural causes, and might be due to
cholera. A coroner's jury expressed the hope that a bacteriological examination would be made. A
piece of the ileum was sent to Dr. Klein.
Report by Dr. Klein—"Dr. Hamer brought to me a piece of ileum. This was much congested,
and contained brownish blood-stained fluid. No definite commas amongst crowds of bacteria. Cultivations
entirely negative qua comma bacilli."
Case 16.
E. 0. (female), set. 14. Bookfolder, Merlin's-place, Clerkenwell.
October 20th, pain in abdomen and shivering came on, followed by frequent vomiting. On 21st
the vomiting continued, and was accompanied by diarrhoea. Motions light-coloured. On the 22nd
delirious, still vomiting. On 23rd patient was admitted into St. Bartholomew's Hospital. Patient was
then much collapsed with cold extremities. Died same night.