1534 CHOLERA IN RUSSIA IN 1892 AND 1893. necessity of taking measures to push forward actively the sanitary works now in contemplation. Finally, and though T have no official figures that I can quote, still I am assured, on good authority, that there have been a few cases of cholera in the Principality of Monaco. Here, again, the meed of better drainage, especially in the Condumine district, is very urgent. With respect to the cholera which prevailed at Toulon and "Nice and in its neighbourhood, the disease was conveyed through the adjacent departments of the Var, the Alpes Mari- - times, and Basses Alpes in a manner that is certainly instructive :as well as interesting. In the month of September there were extensive military manoeuvres throughout the region between Nice and Digne. Such manoeuvres represented the defence of the Alps against a possible Italian invasion. It is not sur- prising, therefore, that the military authorities thought more - about strategical than sanitary measures. This is excusable, as there has been considerable tension of late in the relations ’between Italy and France. Consequently no exceptions were made in calling out the reserves. It did not matter whether -they came from cholera-infected districts or not, the reserves all took their place in the ranks. Previously to the assembling of ’the reserves there had been numerous cases of cholera, not only at Nice, but also at Manosque and at Saint Tulle. The reserves from these districts were incorporated in the 55th and 112th ;Regiments of the Line, and early in September there were ’numerous cases of cholera in both these regiments. The ’manoeuvres were not, however, interrupted. The troops were ordered to march upon the town of Digne in two parallel columns ; but as the columns pushed their way forward they ..had to leave invalided soldiers in almost all the towns or ’villages through which they passed. Thus soldiers suffering ’from cholera were left by one of the columns at Antrevaux, :Annot, and Saint-André ; while the other column, travelling along a parallel but more southerly route, left its sick at ’Castellane and Senez At each of these places the disease broke out among the inhabitants immediately after the troops had passed through the towns. At Castellane a battalion of ’the 55th Regiment suffered so severely from cholera that a halt had to be ordered and the troops encamped on an ’elevated site. I Further on the two roads converge at Barreme, a small ’town, where about 2000 soldiers arrived on Sept. 9th. These men were camped on the highest part of the commune, and gome trenches had been dug to serve as latrines, but the place selected for this purpose was a few yards above the ’ground where there is a spring which provides water for the principal pump of the town. On Sept. 15th cholera broke out among the inhabitants of Barreme who were in the Bhabit of drinking the water from this pump. Those who drank water derived from other sources were absolutely exempt from the disease. Cholera first occurred on the morning of Sept. 15th, just six days after the arrival *of the troops and the fouling of the latrines close to and above the spring. The same evening there were ’29 cases of cholera among the civil population of Barreme, and of this number 14 died after a few hours’ illness. - On the next day there were 45 cases and 22 deaths ; "but more terrible than these figures is the fact that the district affected had only about 150 inhabitants. Thus, half ’the population who drank the water from this particular pump contracted the disease. Succour for the sick was I ’promptly organised, and, as the cause of the epidemic was self-evident, the remedy was quickly and easily applied. The latrines were filled up and disinfected ; and the pump was closed and the inhabitants were for- bidden to use the water. Every house or cottage where ’cases had occurred was disinfected, and the epidemic at once - ceased. There were further cases of cholera beyond Barreme, notably at Mezel and at Digne ; but by the time the troops reached these latter places the alarm concerning the danger "bad already spread them. The inhabitants began to protest, ’and at last even the military authorities were persuaded to take some precautions. The troops were not allowed to <enter the towns, but were compelled to camp outside on <carefully selected sites. Thus it will be seen that the out- ’break of cholera which occurred at Nice and elsewhere was <not confined to these towns, but was carried inland and ’spread in mountainous and sparsely populated districts by the soldiers of the reserve forces. The means by which the infection was conveyed in this case were very clearly shown ; and it is probable that but for the autumn military manoeuvres he towns and villages in question would not have suffered from the disease. CHOLERA IN RUSSIA IN 1892 AND 1893. THE statistics of this year’s epidemic of cholera in Rassia have been completed up to Sept. 4th. For the sake of easy comparison the Medical Department, in its last monthly report, has published in parallel columns with these statistics the figures of last year’s epidemic up to the same date in that year. The figures are of considerable interest, as they show in a very clear manner that those districts which suffered the most severely last year have been visited with the lightest loss in the present year, while those governments which this year have furnished the largest numbers of cases and deaths had, in many cases, escaped altogether up till the date named last year. This tendency of cholera to spare, in the second year of a pandemic outbreak, regions where it had most prevailed in the first year has been observed in earlier epidemics. In the present instance the prin- ciple is most strikingly illustrated in the governments of Astrakhan, Saratof, Voronezh, Samara, Simbirsk, the Don Cossack territory, all the governments of the Caucasus, and the Siberian governments of Tobolsk and Tomsk. On the other hand, Podolia, Kief, Tula, Minsk, Grodno, and some other governments, where cholera was either absent or almost absent last year, have suffered comparatively heavily this year. The totals for the two years show a striking diminution in the second year. The total number of cases recorded in 1893 is approximately one-seventh of those recorded in 1892, and the number of deaths rather less than one-ninth. The mortality rate has thus also declined from 49 6 per cent. in the first eight months of 1892 to 39’1 per cent. in the same period of 1893. Table of Oases of Cholera during the Years 1893 and 189w.
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1534 CHOLERA IN RUSSIA IN 1892 AND 1893.
necessity of taking measures to push forward actively thesanitary works now in contemplation. Finally, and thoughT have no official figures that I can quote, still I am assured,on good authority, that there have been a few cases ofcholera in the Principality of Monaco. Here, again, themeed of better drainage, especially in the Condumine district,is very urgent.With respect to the cholera which prevailed at Toulon and
"Nice and in its neighbourhood, the disease was conveyedthrough the adjacent departments of the Var, the Alpes Mari-- times, and Basses Alpes in a manner that is certainly instructive:as well as interesting. In the month of September there wereextensive military manoeuvres throughout the region betweenNice and Digne. Such manoeuvres represented the defence ofthe Alps against a possible Italian invasion. It is not sur-
prising, therefore, that the military authorities thought more- about strategical than sanitary measures. This is excusable,as there has been considerable tension of late in the relations’between Italy and France. Consequently no exceptions weremade in calling out the reserves. It did not matter whether-they came from cholera-infected districts or not, the reserves alltook their place in the ranks. Previously to the assembling of’the reserves there had been numerous cases of cholera, not onlyat Nice, but also at Manosque and at Saint Tulle. The reservesfrom these districts were incorporated in the 55th and 112th;Regiments of the Line, and early in September there were’numerous cases of cholera in both these regiments. The’manoeuvres were not, however, interrupted. The troops wereordered to march upon the town of Digne in two parallelcolumns ; but as the columns pushed their way forward they..had to leave invalided soldiers in almost all the towns or
’villages through which they passed. Thus soldiers suffering’from cholera were left by one of the columns at Antrevaux,:Annot, and Saint-André ; while the other column, travellingalong a parallel but more southerly route, left its sick at’Castellane and Senez At each of these places the diseasebroke out among the inhabitants immediately after the troopshad passed through the towns. At Castellane a battalion of’the 55th Regiment suffered so severely from cholera that ahalt had to be ordered and the troops encamped on an’elevated site.
IFurther on the two roads converge at Barreme, a small
’town, where about 2000 soldiers arrived on Sept. 9th. Thesemen were camped on the highest part of the commune, andgome trenches had been dug to serve as latrines, but theplace selected for this purpose was a few yards above the’ground where there is a spring which provides water for theprincipal pump of the town. On Sept. 15th cholera brokeout among the inhabitants of Barreme who were in theBhabit of drinking the water from this pump. Those whodrank water derived from other sources were absolutelyexempt from the disease. Cholera first occurred on the
morning of Sept. 15th, just six days after the arrival*of the troops and the fouling of the latrines close toand above the spring. The same evening there were
’29 cases of cholera among the civil population of Barreme,and of this number 14 died after a few hours’ illness.- On the next day there were 45 cases and 22 deaths ;"but more terrible than these figures is the fact that thedistrict affected had only about 150 inhabitants. Thus, half’the population who drank the water from this particularpump contracted the disease. Succour for the sick was I
’promptly organised, and, as the cause of the epidemicwas self-evident, the remedy was quickly and easilyapplied. The latrines were filled up and disinfected ;and the pump was closed and the inhabitants were for-bidden to use the water. Every house or cottage where’cases had occurred was disinfected, and the epidemic at once- ceased.
There were further cases of cholera beyond Barreme,notably at Mezel and at Digne ; but by the time the troopsreached these latter places the alarm concerning the danger"bad already spread them. The inhabitants began to protest,’and at last even the military authorities were persuaded totake some precautions. The troops were not allowed to<enter the towns, but were compelled to camp outside on<carefully selected sites. Thus it will be seen that the out-’break of cholera which occurred at Nice and elsewhere was<not confined to these towns, but was carried inland and’spread in mountainous and sparsely populated districts bythe soldiers of the reserve forces. The means by which theinfection was conveyed in this case were very clearly shown ;and it is probable that but for the autumn military manoeuvreshe towns and villages in question would not have sufferedfrom the disease.
CHOLERA IN RUSSIA IN 1892 AND 1893.
THE statistics of this year’s epidemic of cholera in Rassiahave been completed up to Sept. 4th. For the sake of easycomparison the Medical Department, in its last monthlyreport, has published in parallel columns with these statisticsthe figures of last year’s epidemic up to the same date in thatyear. The figures are of considerable interest, as they showin a very clear manner that those districts which suffered themost severely last year have been visited with the lightestloss in the present year, while those governments which thisyear have furnished the largest numbers of cases and deathshad, in many cases, escaped altogether up till the datenamed last year. This tendency of cholera to spare, in thesecond year of a pandemic outbreak, regions where ithad most prevailed in the first year has been observedin earlier epidemics. In the present instance the prin-ciple is most strikingly illustrated in the governments ofAstrakhan, Saratof, Voronezh, Samara, Simbirsk, the DonCossack territory, all the governments of the Caucasus, andthe Siberian governments of Tobolsk and Tomsk. On theother hand, Podolia, Kief, Tula, Minsk, Grodno, and someother governments, where cholera was either absent or almostabsent last year, have suffered comparatively heavily thisyear. The totals for the two years show a striking diminutionin the second year. The total number of cases recorded in 1893is approximately one-seventh of those recorded in 1892,and the number of deaths rather less than one-ninth. The
mortality rate has thus also declined from 49 6 per cent. inthe first eight months of 1892 to 39’1 per cent. in the sameperiod of 1893.
Table of Oases of Cholera during the Years 1893 and 189w.
1535VITAL srATISTICS.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN thirty-three of the largest English towns 6048 birthsand 5672 deaths were registered during the week endingDec. 9th. The annual rate of mortality in these towns,which had increased from 18’3 to 26’5 per 1000 in the pre-ceding six weeks, further rose last week to 286. InLondon the rate was 31 0 per 1000, while it averaged 27-0in the thirty-two provincial towns. The lowest rates in thesetowns were 11 -3 in Halifax, 14 -4 in Huddersfield, 16 6 inGateshead, 17’8 in Swansea, and 19’8 in Wolverhampton ;the highest rates were 32-6 in Preston, 32’9 in Bristol, 34-6in Burnley, 34-9 in Liverpool, and 35-6 in Bolton. The 5672deaths included 542 which were referred to the principalzymotic diseases, against 496 and 503 in the precedingtwo weeks ; of these, 154 resulted from whooping-cough, 124from diphtheria, 82 from "fever" (principally enteric), 62 frommeasles, 61 from scarlet fever, 41 from diarrhoea, and 18from small-pox. These diseases caused the lowest death-rates in Swansea, Wolverhampton, Halifax and Gateshead,and the highest rates in Leicester, Hull, Plymouth, WestHam, and Croydon. The greatest mortality from measlesoccurred in Leicester and Norwich ; from scarlet fever inNorwich ; from whooping-cough in West Ham, Bilkenhead,Sheffield, Hull and Plymouth ; and from "fever" inSalford and Croydon. The 124 deaths from diphtheria in-cluded 89 in London, 7 in West Ham, 5 in Croydon,3 in Cardiff, and 3 in Leicester. Four fatal cases of small-pox were registered in London, 4 in Birmingham, 4 in Brad-ford, and one each in West Ham, Leicester, Derby, Bolton,Oldham, and Leeds. There were 128 small-pox patientsunder treatment in the Metropolitan Asylum Hospitals andin the Highgate Small-pox Hospital on Saturday last,the 9th inst., against 151, 140, and 141 at the end of the pre-ceding three weeks ; 28 new cases were admitted during theweek, against 21 and 33 in the preceding two weeks.The number of scarlet fever patients in the MetropolitanAsylum Hospitals and in the London Fever Hospital at theend of the week was 3129, against 3129, 3140, and 3183, onthe preceding three Saturdays ; 306 new cases were admittedduring the week, against 363 and 373 in the preceding twoweeks. The deaths referred to diseases of the respiratoryorgans in London, which had increased from 271 to 737in the preceding six weeks, further rose to 841 last week,and were nearly double the corrected average. The causes of96, or 1-7 per cent., of the deaths in the thirty-three townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death were
duly certified in Nottingham, Bolton, Oldham, Newcastle-on-Tyne, and in seven other smaller towns; the largest pro-portions of uncertified deaths were registered in Birmingham,Liverpool, Blackburn, and Huddersfield.
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in the eight Scotch towns, I’which had increased from 18 ’2 to 27’8 per 1000 in the pre-ceding six weeks, declined again to 26 ’0 during the week endingDec. 9th, and was 2-6 per 1000 below the mean rate duringthe same period in the thirty-three large English towns. Therates in the eight Scotch towns ranged from 19 in Leithand 20-1 in Aberdeen to 28-6 in Edinburgh and 36 -0 in Perth.The 732 deaths in these towns included 33 which werereferred to whooping-cough, 13 to diphtheria, 8 to diarrhoea,7 to "fever," 7 to scarlet fever, 5 to small-pox, arjd 3 tomeasles. In all, 76 deaths resulted from these principalzymotic diseases, against 56 and 74 in the preceding twoweeks. These 76 deaths were equal to an annual rateof 2-7 per 1000, which corresponded with the mean rate lastweek from the same diseases in the thirty-three largeEnglish towns. The fatal cases of whooping-cough, whichhad been 25 and 32 in the preceding two weeks, furtherrose to 33 last week, of which 13 occurred in Glasgow,8 in Dundee, and 6 in Edinburgh. The deaths referred todiphtheria, which had been 7 and 15 in the preceding twoweeks, declined to 13 last week, and included 7 in Glasgow,and 2 in Edinburgh, Aberdeen, and Leith. The 7 fatal casesof scarlet fever showed a further slight decline from thenumbers recorded in recent weeks, and included 4 in Glasgowand 2 in Perth. The deaths referred to different foxms of"fever," which had been 2 and 12 in the preceding twoWeeks, declined again to 7 last week, of which 3 occurred in
Glasgow and 3 in Dundee. Four fatal cases of small-pox:were registered in Leith and 1 in Aberdeen. The deaths.referred to diseases of the respiratory organs in these towns,which had been 244 and 270 in the preceding two weeks,declined to 245 last week, but were 94 above the numberrecorded in the corresponding week of last year. The causes.of 78, or nearly 11 per cent., of the deaths in these eighttowns last week were not certified.
HEALTH OF DUBLIN.
The death-rate in Dublin, which had been 286 and 27 t.per 1000 in the preceding two weeks, rose again to 30 6during the week ending Dec. 9th. During the past tenweeks of the current quarter the death-rate in the city has.averaged 26’0 per 1000, against 22-4 in London and 22 5 irt.
Edinburgh. The 205 deaths in Dublin during the week.
under notice showed an increase of 23 upon the numberin the previous week, and included 23 which were referred’.to the principal zymotic diseases, against 18 and 17 in thepreceding two weeks ; of these 23 deaths, 9 resulted from’"fever," 6 from whooping-cough, 5 from measles, 2 from3diarrhoea, 1 from scarlet fever, and not one either from small-pox or diphtheria. The zymotic death-rate was equal to 3 4.per 1000, the rate during the same period being 3 2 in Londonand z6 in Edinburgh. The deaths referred to different forms.of "fever," which had increased from 3 to 7 in the precedingthree weeks, further rose to 9 last week. The fatal cases ofwhooping-cough, which had been 5 in each of the preceding’.two weeks, were 6 last week. The 5 deaths from measles.exceeded the number recorded in any week since May last.The 205 deaths registered in Dublin last week included 433of infants under one year of age and 45 of persons aged-upwards of sixty years ; the deaths of infants showed afurther increase, while those of elderly persons were belowthose recorded in any recent week. Six inquest cases and!8 deaths from violence were registered ; and 71, or more-
than a third, of the deaths occurred in public institutions.The causes of 22, or nearly 11 per cent., of the deaths ic.the city last week were not certified.
VITAL STATISTICS OF LONDON DURING NOVEMBER, 1893.IN the accompanying table will be found summarised,
complete statistics relating to sickness and mortality duringNovember in each of the forty-one sanitary districts of London.With regard to the notified cases of infectious disease in the"metropolis during last month, it appears that the number of persons reported to be suffering from one or other of the-nine diseases in the accompanying table was equal to 20 ’E..-per 1000 of the population, estimated at 4,305,551 personsin the middle of this year. In the preceding three months the-rates had increased from 17-2 to 24 5 per 1000. Among the-various sanitary districts the rates last month were con-
siderably below the average in Hammersmith, St. James West--minster, Hampstead, St. Giles, St. Martin-in-the-Fields,Strand, and Woolwich ; while they showed the largest excess.in Hackney, Clerkenwell. Bethnal Green, Limehouse, Poplar,St. Olave Southwark, and Greenwich. The prevalence of small--pox in London showed a marked increase during November, anaverage of 32 cases weekly being notified, against numbers.declining from 134 to 19 in the preceding five months ; of the155 cases notified during last month, 53 belonged to Kensing--ton, 30 to Poplar, 15 to Paddington, 11 to Chelsea, and 8 toLimehouse sanitary districts. The Metropolitan Asylum’.Hospitals contained 128 small-pox patients at the end ofNovember, against 71 and 81 at the end of the preceding twomonths; the weekly admissions averaged 29, against 1Sand 16 in the preceding two months. The prevalence of.scarlet fever in London showed a marked decline from-that recorded in recent months ; this disease was propor-tionally most prevalent in Hackney, Clerkenwell, BethnalGreen, St. George - in - the - East, Limehouse, St. OlaveSouthwark, Rotherhithe, and Greenwich sanitary districts.The Metropolitan Asylum Hospitals contained 3059 scarlet-fever patients at the end of November, against 2755,2659, and 2633 at the end of the preceding three-
months ; the weekly admissions averaged 385, against293 and 321 in the preceding two months. Diphtheriashowed decreasing prevalence during the month under
notice; among the various sanitary districts this disease-showed the highest pioportional prevalence in Hackney,Clerkenwell, Bethnal Green, Poplar, St. George South--wark, Newington, Battersea, Wandsworth, Camberwell, anc!)
