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the preceding year, were again adopted. I communicated with medical officers of health in London,
informing them that I was authorised to send material to Dr. Klein in cases where bacteriological
examination was desirable, and systematic investigation was again made into the history and symptoms
of persons notified as suffering from cholera or choleraic diarrhoea, and of persons whose deaths were
registered as due to these causes during the period between July and November.
In making these inquiries it was found necessary in three cases to submit material to Dr. Klein,
but in each instance the bacteriological examination gave a negative result.
These three cases were—
(i.) C. N. This man was between 50 and 60 years of age, and was hall porter at the
Egyptian Hall, Piccadilly. He had been to Brighton, returning to London about a week
before the commencement of his illness. On August 7th he drank some "sour milk"; on
the 8th diarrhoea and vomiting set in. At 5 p.m. on the 9th he was admitted to St. George's
Hospital, and was then blue and cold. He complained of cramps, and his voice was husky.
Diarrhoea ceased for a time after admission, but returned on the morning of the 10th; the
stools were "milky." The man died at noon on the 10th August. Dr. Rolleston, who made
the post-mortem examination, found some congestion of the lower coils of the ilium. Dr.
Klein found bacillus coli and proteus vulgaris in the material submitted to him, but no
comma bacilli.
(ii.) R. P., æt. 47, an ornamental metal worker, lived at Eversleigh-street, Battersea,
and worked in Hatton-garden. On August 14th, slight diarrhoea commenced. Patient went
to work, however, on this and the following day, and was in good health and spirits on the
evening of the 15th. He ate some hake for supper. Early in the morning of the 16th purging,
vomiting, and cramps set in. The evacuations were like rice water, and the cramps severe.
Dr. Kempster, the medical officer of health, saw the patient at 5 p.m., and found him
collapsed and blue with subnormal temperature and marked aphonia. Death occurred the
same evening. A post-mortem examination was made, and the small intestine was found to
be slightly reddened and congested. Dr. Klein found that no comma bacilli were present in
the material examined by him.
(iii.) C.B., œt. 62, birch-broom maker, lived at Cowpers-row, Brixton-hill. On the
morning of August 23rd, abdominal pain commenced, and was followed later by diarrhoea and
vomiting. On the 24th, pain and vomiting continued. On the 25th, the patient complained
of cramp in the legs ; he became collapsed, and died the same night. This man had been to
Ramsgate on August 6th, but had not since that date been out of London. Some congestion
of the lower part of the small intestine was found on making a post-mortem examination ; the
intestinal contents were bile stained. Dr. Klein's cultivations "revealed the existence of
bacillus coli, but no commas of any kind."
Dr. Klein, in commenting on these cases, noted that the Battersea case was the only one in
which "to the unaided eye the intestine presented appearances like cholera." He adds, with reference
to this case, that" under the microscope the abundance of detached epithelium and the presence in
and between of rows, streaks and clumps of one kind of bacteria suggested cholera, but these bacteria
were not the cholera commas, culture proved them to be bacillus coli."
The medical officer of health of the Port of London thus reports on the steps taken by the
Port Sanitary Authority in connection with cholera during the year :—
As naturally anticipated, some few cases of cholera and choleraic diarrhoea were dealt with at
Gravesend. Brief details of such cases are of interest.
On the 27th July, the s.s. " Acme," of London, from St. Petersburg, arrived at Gravesend. While
lying at St. Petersburg eight cases of cholera had occurred among her crew. These were all convalescent
on arrival, and the vessel was therefore only detained for a sufficient time to enable disinfection and the
necessary precautionary measures to be carried out.
On the 7th August, the s.s. " Balmore," of Dundee, from St. Petersburg, arrived at Gravesend. She
had five cases of cholera on board on entering the Thames, one of whom died just before reaching
Gravesend. The vessel left St. Petersburg on 31st July. The first case was taken ill on 5th, and
terminated fatally on 6th. The dead body was taken to the port hospital, and a post-mortem enabled
the diagnosis of cholera to be confirmed by bacteriological examination. The four other patients were
admitted into hospital and all recovered. The diagnosis was confirmed bacteriologically in the case of
three of these men, in, the fourth case the result of investigation was negative. On the following day,
the 8th, a case of suspicious diarrhoea, was removed from the same ship, but this was either an abortive
attack or simply severe diarrhoea. The patient rapidly recovered. The ship was released as soon as
the necessary cleansing and disinfection were completed.
On the 15th August, the s.s. "Bedford," of North Shields, from St. Petersburg, arrived and landed
one of the crew suffering from choleraic diarrhœa. The vessel left St. Petersburg on the 6th, and the
patient was taken ill on the 12th with cramps, vomiting, and diarrhoea. The patient was convalescent
on arrival, and the vessel was only detained for thorough disinfection.
On the 17th August, the s.s. "Fountain Abbey," of Cardiff, from Cronstadt, on arrival reported
that she had had cholera on board during the voyage. The vessel was lying at Cronstadt from the
23rd July to the 9th August, the patient being taken to the hospital on the 29th. The vessel was only
detained for disinfection, &c.
On the 21st August, the s.s. "Dwina," of London, from St. Petersburg, reported having had cholera
on board while lying at St. Petersburg. The patient was taken ill on the 16th July, removed to hospital
on the 18th, recovered and returned to his ship on the 22nd, the vessel leaving for London on the
8th August. The patient was in apparently perfect health on arrival. She was detained for the usual
disinfection, cleansing, &c.
On the 25th August, the s.s. "Calabria," of Dundee, from St. Petersburg, reported a case of diarrhoea.
On inquiry it was found that the vessel had sailed from Shields (25th July) for St. Petersburg, arriving
on the 4th August, and leaving again for London on the 17th. Two men were attacked on the 7th and
9th August respectively, with severe symptoms of a distinctly suspicious character. They both
recovered, and were convalescent on arrival. The vessel was disinfected before passing up the river.
On the 30th July the s.s. "China" arrived at Gravesend from St. Petersburg. The master reported
all well, and that there had been no cases of diarrhoea on board during the voyage or stay in foreign
port. As official information had been received from the Local Government Board that three cases of