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A considerable portion of the report is taken up by theaccount of the origin and progress of the Western diffusionof cholera in 1892 from the pen of Dr. Barry. In com-

piling this admirable article Dr. Barry has levied statisticaltribute from many sources, among others, as he dulyacknowledges, the special correspondent of THE LANCET.Dr. Barry’s paper really constitutes a review of the wholeoutbreak. With reference to its spread, the table showingthe invaded places between the dates of March 31st andNovember 14th, 1892, sets before the eye at a glance the<enormous latitude, in an epidemiological sense, of the pre-valence of the disease. Cholera during that time extendedeastwards to India, Afghanistan, and Mongolia. It over-

spread the Russian Empire in all its portions with more orless virulence, and it appeared in Europe, attacking, in cate-gorical order, European Russia, Turkey, France, Belgium,Germany, England, Holland, Austria; and, amid circum-stances of quarantine horrors which impressed themselvespermanently in the minds of all men, it found its way intothe State of New York, and carried off twelve persons outof the sixteen who were attacked.From Dr. Barry’s appendix it appears that no accurate

dnformation concerning the origin of cholera in Russia can beobtained. Of this Dr. Thorne Thorne merely says: "The storyof the Russian cholera includes some records of the mannerin which waterways serving as lines of human traffic serve alsoas carriers of cholera. The details emphasise the power formischief of a cholera infected water-supply." Tables andcharts are employed to show this, and large extracts are givenfrom Dr. Clemow’s account of the Russian epidemic which wasoriginally published in THE LANCET. From Batoum cholerawas supposed to have been introduced into the Turkish Empire,.and the earliest records seem to indicate importation by per-sons. It is the French outbreak at Nanterre prison whichhas been most puzzling to investigators. In Dr. Barry’s tablethe reputed origin of the infection at Nanterre, the outbreakat which place began on March 31st, 1892, is represented bya mark of interrogation. In the body of the report he writes :"On April 4th an inmate of the Maison Departementale ofNanterre was attacked with choleraic symptoms and diedin twenty-four hours." On April 6th another inmate wasattacked " who had not and could not have had any contactwith the case noted above." The word "obscurity" isfrequently used in connexion with the importation of cholerato this establishment. It has been suggested that the out-break arose from a recrudescence " of past epidemics, anetiological description which is rather vague in its nature.Belgium affords information more precise. Cholera was,as it appears from this report, brought from Havre intoAntwerp, and it spread from that port throughout thecountry, slaying nearly one thousand people. The GermanGovernment had taken extra precautions to prevent an out-break. They controlled the port, regulated the water traffic,and made laws about alien emigration from Russia. Butcholera attacked Hamburg, and, as the report indicates, in

may have been imported by Jews from Russia, or throughFrench ships from Havre. However that may be. it caused8605 deaths in that town alone. England, Holland, Austria.Denmark, Norway, Italy, and North-western Africa are allstated to have derived their infection from Hamburg.The fact3 recorded in Dr. Barry’s appendix, like the

circumstances attending the various localised outbreaks, aretoo diversified to allow the formulation of any definitestatement on the mode of origin of cholera. So far as is

<taught by the present report it is widespread in its discribu-tion, variable in its mode of arrival, and more fatal incertain circumstances than in others ; all of which has beenevident to generations of observers. With regard to its modeof dissemination in a district, a country, or a continent,’the present work can scarcely be said to Lhrow more light.In France the relation of the death-rate to bad water-aapply is shown to be very decided. Districts suppliedby water taken below sewer outfalls had a cholera death-irate fourteen times greater than those supplied by watertaken above such outfall. This was pointed out inTHE LANCET in connexion with the French epidemic.and illustrated with great precision during 1892. The

maps of Germany seem to indicate a large incidenceof the disease along the waterways. The outbreak at

Hamburg spread rapidly, whereas in England in 1892 "inmo instance did the disease extend to any person other thanthose arriving from abroad." It may be the case that insome instances drinking sewage water is the medium of itsspread, or, as this report seems to indicate in the case of

Altona, spread may be due even in the case of filtered suppliesto the lack of "a slimy layer of mud on the surface of thefilter, " which reduces the risk of mischief to a minimum. Butit is evident from the report that these causes do not invariablyact with equal intensity. Dr. Koch’s explanation of the factthat in Hamburg 26 per cent. of the population were at-tacked, and in Altona, an adjoining town, only 4 per cent.-namely, that Altona was protective against the cholera bythe filtration of the water of the Elbe "-is alluded to byDr. Barry at some length, and Dr. Thorne Thorne refers tothis explanation as likely to become historic. An article onthe subject in THE LANCET of Aug. 25th, 1894, shows thata similar difference of mortality rates was demonstrable fromformer epidemics even when the water-supplies were the same.The same article shows also that "cholera has never de-veloped at Altona with the same intensity as at Hamburg,"and points out that it would be a very mischievous error toimagine that Hamburg has become a safe town because itssupply of drinking-water is now carefully filtered. The varia-

bility of the duration of localised cholera outbreaks will alsobe apparent from this report. In some parts the wave passedsuddenly ; in others, as in France, the disease lingered fromthe middle of August till the end of the year. The volumecontains also many important allusions in reference to theEnglish system of cholera administration, the quarantine pro-posals, and remarks by Dr. Thorne Thorne on the auxiliaryscientific investigations which have been undertaken by thisdepartment of the service. We may remark that the statementsand deductions have been illustrated largely by tables, dia-grams, and coloured map. These last are an essential.The report concludes with an article on the antagonisms

of microbes by Dr. Kiein. It contains an account of theexperiments which have been conducted by Dr. Pfeiffer, byM. Haffkine, and by himself, with a view to elucidating thepathogeny of different microbes. Dr. Klein’s view thatanti-cholera inoculation has no protective value against thedisease will doubtless be carefully noted by many investi-gators. Other papers of interest are contributed by Dr.Cautley, Dr. F. W. Andrewes, and by Dr. Sidney Martin,and enhance the value of a report upon which we heartilycongratulate Dr. Thorne Thorne and his staff.

CHOLERA.

SPEAKING generally, we may say that cholera continuesto prevail in Russia, in Galicia and Bukovina, in Holland,and to a limited, though somewhat increased, extent in

certain parts of Germany. From Brussels numerous caseshave been reported, but the little epidemic at Liege isstated to have nearly disappeared ; several cases have

occurred, however, at Tilleur, Jemeppe, Seraing, St. Nicolas,and Neerpelt. As regards our own country we are glad tobe able to report that it remains free from cholera or sus-pected cholera..

Entering somewhat more into detail, we have to chronicletint the official returns from Russia show that there weresome 5518 cases and 2546 deaths in European Russia duringthe week, and that the more seriously infected governmentswere those of Warsaw, Kielce, and Radom.As regards Germany, the returns, as we have said, show

an increase of the disease ; still these figures are, up to thepresent time, far from indicating an epidemic prevalence ofcholera in that country. The disease exists chiefly in EastPrussia, in the Vistula and Netzcand Wasthe territories, inUpper Silesia, district of Potsdam, and the Rhine territory,where cases more or less numerous have made their appear-ance, but the disease may be generally said to have beenof the sporadic type. A sharp circumscribed outbreak is

reported to have occurred at B&uuml;geln, near Marburg, in Hesse,where 12 cases and 3 deaths took place in that village in thecourse of a few hours. In consequence of the appearanceof cholera cases in East Prussia. chiefly in districts near theRiver Weichsel, the Emperor of Germany has been reluctantlycompelled to forbid any popular assemblages and demonstra-tions at the army manoeuvres. The troops have been sub-jected to strict medical inspection. The disease, apparentlyof severe and fatal type, still persists in Galicia and Bukovina.,and it is reported to have made its appearance in nearly halfof the total number of districts in those provinces, and to

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have extended to Lomberg, the Galician capital, and to thedistrict of Bielitz, in Silesia.Reports from Holland show that cases continue to make

their appearance at Amsterdam, Maestricht, Dordrecht,Flushing, Landsmeer, Heer, Heugem, Elsobeek, Nieuwpoort-on-the-Lok, and other places. A case is also reported tohave occurred at Ostend.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORT OF THE MEDICAL OFFICER OF HEALTHOF THE LONDON COUNTY COUNCIL FOR THE

YEAR 1892.

[FIRST NOTICE.]RELATING as it does to the sanitary conditions under

which the greatest aggregation of population which theworld has yet witnessed lives, the report which Mr. ShirleyMurphy has recently presented to the London CountyCouncil assumes a historical interest and importance whicnit would be difficult to overrate. We may say at once thatthe report is worthy in every way of its importance, and fromthe statistical information it contains it is especially wellfitted to form the first volume of the series which it in-

augurates. It will be read with profit and pleasure not onlyby all medical officers of health and sanitary reformers, butalso by those who take an interest in the fluctuations of urbancommunities and the theory with which the name of Malthusis inseparably connected. Commencing with a considerationof the census figures of London during the present century,Mr. Murphy points out how between 1801 and 1841 the

population doubled itself, and that during the next fortyyears a nearly equally remarkable increase took place. Thesefacts, as also the percentage increase at Each census year upto 1891, are well shown by the subjoined table :-

It will be seen by these figures how small a percentageincrease took place in the last decade as compared withprevious decades of this century. After referring to the factthat the population of London is affected by immigrationand emigration as well as by the excess of births over deaths,Mr. Murphy shows that, while during previous decades thepopulation of London was being added to by excess of im-migration over emigration, during the last decade the positionhas been reversed, and London has lost, by the excess ofemigration over immigration, more than 114,000 of the popu-lation it would have had if there had been no immigrationor emigration. From the census figures for 1891 Mr.Murphy demonstrates that the change referred to has beendue chiefly to the falling off of the increase by immigra-tion and not to an increase of emigration. There has alsobeen some falling off in the increase of natives of London.The falling off in immigration has been less maiked amongfemales than males, and the falling off of the increase innatives of London has been more marked among the malesthan females ; the proportion of males to females, however,is Rtitl increasing in London, though to a less extent thanbetween 1871 and 1881. The consideration of the census

figures for London indicates, Mr. Murphy states, the followingconclusions : (1) that immigration into London has greatlydiminished in the decade 1881-90 ; (2) that the reductionis greater in males than females ; and (3) that emigrationhas been greater in this decade than immigration.

Dealing with the sex and age distribution, Mr. Murphysupplies tables showing the proportions of the London

population at the several age periods in each census earsince 1851. By these it seems that as regards the censusyear 1891, although the age distribution at ages over ten wasapproximately similar to that in former census years, therewas, owing to the decrease in the birth-rate-to be referredto later-a diminution in the number of children underten. In the same section of the report tables are given

showing that, although the relative proportion of males tofemales in London is still increasing, the increase does notobtain at all age periods. There were, it appears, for every1000 males at all ages not only fewer males from 20 to 25 yearsin 1891 than 1881, but there were more females at the sameage period per 1000 at all ages in 1891 than in 1881. It isseen, too, if a study of the census figures for 1861, 1871, and1881 be made, that the males at 20-25 were in larger pro-portion than the males at 15-20, "a result undoubtedly dneto migration and almost certainly immigration," while in1891 the proportion of males at 20-25 had fallen below thatof males at 15-20. When, however, the figures as regardsthe females are considered, it is seen that in each of the fourcensus periods-i.e., 1891 included-the proportions at 15-20and 20-25 were in excess of the proportion at 10-15, thusaffording, as Mr. Murphy mentions "a further indicationthat the migration of females into London has been moresustained than that of males."

Changes and Density of Pop-zclation in London SanitaryDistricts.

This portion of Mr. Murphy’s report possesses a peculiarinterest for all Londoners and dwellers in large towns. Ofthe forty-one sanitary districts which comprise administra-tive London tbere are several which, so far from contributingto the general increase of population during the past decade,have exhibited a decided decrease. The decreases referredto are no doubt due almost entirely to the respective districtsbecoming more commercial and less residential in character.(a) The districts in which decreases have taken place duringthe last decennium are well shown by a capital chart,as also are (b) the districts in which the increase ofpopulation between 1881 and 1891 has been less than the excessof births over deaths in 1881 to 1890 ; and (c) the districts inwhich the increase of population between 1881 and 1891 hasbeen greater than the excess of births over deaths in 1881-90.In reference to these districts Mr. Murphy points out thatthose with decrease of population between 1881 and 1891are situated on the north of the Thames ; those in

group (b) to the south as well as to the north ofthe Thames, practically surrounding the first group; rwhile districts in group (c) form an outer circle. Theestimated population of the administrative county of Londonin the middle of 1892 was 4,284,678. and the average densityof population 57 persons to an acre. A table is suppliedin the report before us giving the estimated population ofeach sanitary district in 1892 and the average number ofpersons per acre in each district. From these tables we learnthat the most densely populated districts were St. George,Southwark (211 persons per acre), Whitechapal (197), Shore-ditch (191), and St. Georges-in-the-East (187). It seems thatthe greatest density of population hitherto attained by anydistrict in London since 1811 was in St. Luke in 1861. whenthere were 241 persons per acre. In considering the densityo population from the standpoint of the average number ofpersons occupying one house Mr. Murphy warns his readersthat too much reliance is not to be placed on the figures,owing to the misunderstanding among the census enumeratorsas to what constituted a separate house. The figures-withthis reservatian-show that the greatest number of personsto a house were to be found in the Strand, wherethere were 11’6, St. Luke 10’7, St. Giles 10’6, andCierkenwell 10’4 ; the smallest number were in Lewisham,5’8. A table compiled from the census return for 1891 istcund in. Mr. Murphy’s report, showing the number ofpersons occupying less than five rooms in the several sani-tary districts. From this table it is shown that in Lewishamthere were but 1-7 per cent. of the population occupying oneroom, as against 22’1 per cent. in St. George’s-in-the-East.Judged by the Standard of the proportion of populationliving in two rooms, Lewisham again occupies the place ofhonour with 3 7 per cent., while Clerkenwell comes last with32’1 per cent. The distribution of "overcrowding" in theseveral districts is clearly depicted on a chart which accom-panies the report; but it may be added that Lewisham here,as before, has the smallest proportion of the population (0.85per cent.) living in overcrowded tenements of one room,whilst Whitechapel has the greatest (13’45 per cent.). Itis at once apparent from the chart that the greatest over-crowding occurs in the districts surrounding the city.Marriages.- During 1893 the 37,175 marriages in London

yielded an annual rate of 17’4 per 1000 living, as against17 1, 17’6, and 17-7 in the three previous years. The followingtable indicates the interesting fact that in each decenniam