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of instances the source of infection could not be traced. In the case of Grimsby suspicious increase
in the number of deaths from diarrhoea had it appeared already been manifested in the early part of
August. The total number of notifications of cholera received during the outbreak was 114, and 33
deaths occurred. In Hull the first case was reported on the 24th August, though it is stated in the
annual report of the medical officer of health that the first suspicious case of illness was that of a man
who sickened on the 16th of August. Between the 6th September and the 20th October there were
notified in Hull 17 cases of cholera, 12 proving fatal; 137 cases of choleraic diarrhoea, 4 proving fatal;
and 396 cases of diarrhoea, 112 proving fatal. A few cases occurred in Cleethorpes, near Grimsby ; an
outbreak in connection with a polluted water supply was noted at Ashbourne, in Derbyshire, 15
cases occurring there, and 9 proving fatal; and cases which proved on bacteriological examination
to give positive results occurred at Rotherham, Balby, East Retford, Boston, Morton, Leicester, Cotonhill
Asylum, Derby, Liverpool, Manchester, Croydon, Ilkeston, Great Yarmouth, Tividale, Bingley,
Keighley, Accrington, North Bierley, Rawmarsh, and one or two other places.
During the early part of the year I was in communication with the medical officers of
health of London sanitary districts as to the fitness of any local wells in these districts for supply
of water for domestic purposes, and as to the state of preparedness of these districts in the event of the
appearance of cholera. The question of available hospital accommodation was one which had been specially
considered, and in a few instances it was thought that there would be advantage in obtaining permission
to use certain plots of vacant land in the Council's possession for the erection of temporary hospitals in
case of need. The Council resolved on the recommendation of the Public Health and Housing
Committee on the 9th May—" That, subject to the particular sites being approved by the proper
committees, the Council do approve of facilities being given in case of necessity for the erection of
temporary cholera hospitals on land in its possession."
On the occurrence of the case of cholera in Westminster, I was authorised to send to Dr. Klein
for bacteriological examination, material from persons suffering from Asiatic cholera, and concerning
whose cases this examination was desirable. I accordingly communicated with the London Medical
Officers of Health, inviting them to give me notice of suspected cases of this disease, and I was
subsequently engaged with Drs. Hamer and Young in making inquiry into all cases which were
brought to my knowledge by the medical officers of health, through the returns of notified infectious
diseases, or the death returns of the Registrar-General. In all cases of death, whenever practicable,
post-mortem examinations were made, and whenever such a course appeared desirable, material was
sent to Dr. Klein for bacterial examination. Of the total number of cases investigated, numbering
upwards of fifty, there were 16 cases of illness with regard to which suspicion was entertained, in 13 of
these cases it was possible to employ bacteriological examination as an aid to diagnosis, and in 4
instances such examinations gave positive results. The first of these cases, the Westminster case
above referred to, was that of a cleaner in the House of Commons, who was attacked on September 2nd ;
the second patient was an inmate of the Fulham Union Workhouse, who was attacked on September 10th;
the third patient lived in Kennington-road, and was attacked on September 11th; and the fourth
patient lived in Quinns-square, Waterloo-bridge-road, and was attacked on September 23rd. These
four cases were fatal ones, and it is noteworthy that in each instance the patient was more than
50 years of age. Further details concerning the London cases will be found in the report on cholera
in London in 1893, which is printed as an appendix to this report. (See Appendix II.)
During October reports relative to the occurrence of suspected cases in this country entirely
ceased. In London some anxiety was for a few days felt as to the nature of an outbreak of diarrhoeal
disease in the Greenwich workhouse. An inmate of this institution was taken ill on October 10th on
her way from the workhouse to Royal-street, Lambeth. I made inquiry into the circumstances of her
death, and material for bacteriological examination was forwarded to Dr. Klein. It was then
ascertained that a number of the workhouse inmates had been suddenly attacked with diarrhoea, and
further cases continued for a few days to develop. The disease was however attended by a low rate of
mortality, and Dr. Klein's examination gave negative results both in respect of the original case and
of subsequent cases, from which material was submitted to him.
The report of the medical officer of health of the Port of London contains the following account
of ships infected with cholera in the port during 1893—
(1.) On the 20th July, the s.s. " Altmore," of Aberdeen, from Malliporum, via Marseilles and Havre
arrived at Gravesend, and was cleared by Her Majesty's Customs, and received the certificate of
" pratique." On subsequent examination of the vessel by Dr. Williams a man was found who had been
suffering from severe diarrhoea-vomiting and cramps. The vessel left Marseilles on the 5th after a stay
of two days, during which time the patient had been on shore. The case was so suspicious that the
man, although convalescent, was at once removed to the Port Sanitary Hospital, and the vessel and
effects disinfected. An examination of the dejecta showed the presence of the comma bacillus. This
not only confirmed the presence of Asiatic cholera, but also showed that the patient, though convalescent,
was still capable of disseminating infection. This point was clearly demonstrated during the outbreak
in Hamburg in 1892, and the practical lesson is that all cholera patients must be isolated for some
considerable time, probably not less than ten or twelve days, after complete convalescence—a very serious
consideration in dealing with an outbreak of any large extent.
(2.) On the 29th July, the s.s. "Bona" which had left Bussorah on the 10th June, reported that a
death from cholera had occurred on board on the 19th June. The vessel was disinfected throughout.
(3.) On the 2nd August, Mr. Swales, who was acting on behalf of your authority in case of emergency,
reported a man sick with suspicious symptoms on board the "Elizabeth McLea,"lying at Sheerness. On
examination he was found to be suffering from cholera. He was therefore removed to the Port Sanitary
Hospital in the " David Burnett," and the vessel towed round to the isolation moorings off Denton, and
there disinfected. She left Cherbourg at 10 a.m. on the 31st J uly, the patient being attacked with the
usual symptoms. On bacteriological examination the cholera bacillus was found to be present in his
excreta.
(4.) On the 26th August, the s.s. " Samuel Tyzack," of Sunderland, from St. Petersburg, arrived
at Gravesend, and reported one of the crew suffering from diarrhoea and vomiting. As a precautionary
measure he was removed to the Port Sanitary Hospital, and the vessel fumigated.
(5.) On the 2nd September, the s.s. "Afghan," of Rochester, from Bussorah, arrived at Gravesend,