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On the Mode of Communication of Cholera

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This is a reproduction of a library book that was digitized by Google as part of an ongoing effort to preserve the information in books and make it universally accessible. https://books.google.com i/vwrr \ u 4# <36604701590015 <36604701590015 $ Bayer. Staatsbibliothek '•ON THE MODE OF COMMUNICATION CHOLERA. JOHN SNOW, M.D., MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, FELLOW OF THE ROYAL MED. AND CHIR. SOCIETY, FELLOW AND VICE- PRESIDENT OF THE MEDICAL SOCIETY OF LONDON, &tctmfc 35»ittcm, tmtrfj GBnlargrtu t 7 I 1.121. Ck.^TlTlCTT LONDON : JOHN CHURCHILL, NEW BUELINOTON STREET. jr-'Wsr M.DCCC.LV. U'i; \n-.ii ... — LONDON I T. RICHARDS. 87 ORKAT QUfcKN STREF:T. mm \ PREFACE TO THE SECOND EDITION. The first edition of this work, which was published in August 1849, was only a slender pamphlet. I have, since that time, written various papers on the same subject, which have been read at the Medical Societies, and published in the medical journals. The present edition contains the substance of all these articles, together with much new matter, the greater part of which is derived from my own recent inquiries. I take this opportunity of expressing my thanks to the Registrar-General for the facilities afforded me in making these inquiries. I feel every confidence that my present labours will receive the same kind consideration from the Medical Profession which has been accorded to my former endeavours to ascertain the causes of cholera. Suckville Street, Piccadilly, 11 December, 1854. CONTENTS. PAGE Outline of the history of cholera .... 1 Cases proving its communication from person to person 3 Cholera not communicated by means of effluvia . 9 The pathology of cholera indicates the manner in which it is communicated . .1.0 Analysis of the blood and evacuations in cholera . 11 and 14 Cholera is propagated by the morbid poison entering the alimentary canal . .15 Evidence of this mode of communication in the crowded habi tations of the poor , . .17 amongst the mining population . 19 Instances of the communication of cholera through the medium of polluted water, in Horsleydown . .23 at Albion Terrace, Wandsworth Road . 25 at Ilford and near Bath . .32 ■ at Newburn on the Tyne . .33 at Cunnatore ..... 35 in the Black Sea Fleet . .36 in the neighbourhood of Broad St., Golden Sq. 38 at Hampstead West End (the water being car ried from Broad Street) . .44 Explanation of the Map showing the situation of the deaths in and around Broad Street, Golden Square . 45 Table of attacks and deaths near Golden Square . 49 Outbreak of cholera at Deptford caused by polluted water . 55 Communication of cholera by means of the water of rivers which receive the contents of the sewers . .56 Influence of the water supply on the epidemic of 1832, in London ....... 57 CONTENTS. PA OK Table showing the mortality from cholera, and the water supply 58 Influence of the water supply on the epidemic of 1849, in London ....... 60 Table showing this influence ..... 62 Communication of cholera by Thames water in the autumn of 1848 . ... .66 New water supply of the Lambeth Company . .68 Effect of this new supply in the epidemic of autumn 1 853 . 69 Tables showing this effect . .71 and 73 Intimate mixture of the water supply of the Lambeth with that of the Southwark and Vauxhall Company . 74 Opportunity thus afforded of gaining conclusive evidence of the effect of the water supply on the mortality from cholera 75 Account of inquiry for obtaining this evidence . 77 Result of the inquiry as regards the first four weeks of the epidemic of the 1854 first seven weeks .... of the same epidemic 79 82 Tables illustrating these results 84, 85 Inquiry of the Registrar-General respecting the effect of the water supply of the above-mentioned Companies during the later period of the epidemic . .87 Comparison of the mortality of 1849 and 1854, in the districts supplied by the above-named Companies . 89 Effect of the water supply on the mortality from cholera amongst the inmates of workhouses and prisons . 9 1 Cholera in the district of the Chelsea Water Company . 93 Effect of dry weather to increase the impurity of the Thames 95 Relation between the greater or less mortality from cholera in London and the less or greater elevation of the ground 97 This relation shown to depend on the difference of water supply at different elevations ..... ib. Effect of water supply on the mortality of cholera in Birming- ester, etc. m in Exeter 99 in Hull . 100 in York . 101 in Dumfries, etc. 102 in Nottingham and Glasgow 103 in Paris and Newcastle upon Ty uo 1(14 CONTENTS. Vll PAGE Limited inquiry respecting the effect of the water supply at Newcastle . .107 Assent of the medical profession to the influence of polluted water on the mortality from cholera . 109 True explanation of this influence . .110 Answers to certain objections . .111 Circumstances connected with the history of cholera explained by the principles advocated in this treatise, as, — The duration of the epidemic in each place usually bears a direct relation to the number of the population 1 1 5 The effect of season on the prevalence of cholera . 117 Proportion of the sexes who die of cholera at different periods of an epidemic, and under different circum stances . .119 Proportion of deaths from cholera in certain occu pations ...... 121 Evidence that plague, yellow fever, dysentery, and typhoid fever are communicated in the same way as cholera . 125 Instances in which ague was caused by impure water . 1 29 Measures required for the prevention of cholera and other dis eases which are communicated in the same way . .133 Appendix, containing a list of the deaths from cholera which were registered in the four weeks ending 5th August 1854, together with the water supply of the houses in which the fatal attacks took place, in all the sub-districts to which the supply of either the Southwark and Vaux- hall or the Lambeth Water Company extends . 138 MAPS. Map 1. Showing the deaths from cholera in Broad Street, Golden Square, and the neighbourhood, from 19th August to 30th Septem ber 1854. A black mark or bar for each death is placed in the situation of the house in which the fatal attack took place. The situation of the Broad Street Pump is also indicated, as well as that of all the surrounding Pumps to which the public had access. Map 2. Showing the boundaries of the Registrar- General's dis tricts on the south side of the Thames in London, and also the water supply of those districts. Pr".reri,>"he Staatsbibliothek MttNCHEN MODE OF COMMUNICATION OF CHOLERA. The existence of Asiatic Cholera cannot be distinctly traced back further than the year 1769. Previous to that time the greater part of India was unknown to European medical men ; and this is probably the reason why the history of cholera does not extend to a more remote period. It has been proved by various documents, quoted by Mr. Scot,* that cholera was prevalent at Madras in the year above mentioned, and that it carried off many thousands of persons in the peninsula of India from that time to 1790. From this period we have very little account of the disease till 1814, although, of course, it might exist in many parts of Asia without coming under the notice of Europeans. In June 1814, the cholera appeared with great severity in the 1st bat. 9th regt. N.I., on its march from Jaulnah to Trichinopoly ; while another battalion, which accom panied it, did not suffer, although it had been exposed to exactly the same circumstances, with one exception. Mr. Cruikshanks, who attended the cases, made a report, which will be alluded to further on. In 1817, the cholera prevailed with unusual virulence at several places in the Delta of the Ganges ; and, as it * Eeport on the Epidemic Cholera, 1824, p. 5. 2 ON THE MODE OF had not been previously seen by the medical men practis ing in that part of India, it was thought by them to be a new disease. At this time the cholera began to spread to an extent not before known ; and, in the course of seven years, it reached, eastward, to China and the Philippine Islands ; southward, to the Mauritius and Bourbon ; and to the north-west, as far as Persia and Turkey. Its ap proach towards our own country, after it entered Europe, was watched with more intense anxiety than its progress in other directions. It would occupy a long time to give an account of the progress of cholera over different parts of the world, with the devastation it has caused in some places, whilst it has passed lightly over others, or left them untouched ; and unless this account could be accompanied with a description of the physical condition of the places, and the habits of the people, which I am unable to give, it would be of little use. There are certain circumstances, however, connected with the progress of cholera, which may be stated in a general way. It travels along the great tracks of human intercourse, never going faster than people travel, and generally much more slowly. In extending to a fresh island or continent, it always appears first at a sea-port. It never attacks the crews of ships going from a country free from cholera, to one where the disease is prevailing, till they have entered a port, or had intercourse with the shore. Its exact progress from town to town cannot always be traced ; but it has never appeared except where there has been ample opportunity for it to be conveyed by human intercourse.
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