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twenty-three of diarrhœa were recorded, with five deaths from Icholera, making a total of thirty-one deaths. The outbreak

has, as usual, been fostered by bad sanitary arrangements,especially a polluted water-supply. Have we not yet hadsufficient warning to teach us our duty, or must each townand hamlet be decimated in turn before the attempt is madeto improve their sanitary condition ? ‘?

AMONGST the unhealthy influences of Liverpool are its

slaughterhouses, In the new Improvement Bill their extinc-tion is proposed. A great opposition to this procedure wasattempted a few days ago in the Town Council. The argumentwas that slaughterhouses were not unhealthy; and that bothBirmingham and Manchester were healthier than Liverpool,although they had a much larger number of slaughterhouses.The result of the dicussion was the defeat of the friends of the

slaughterhouses by twenty-nine votes to ten.

THE Vestry of Marylebone, at their meeting last week, gaveexpression to their gratification at the manner in which theofficials (medical and other) had behaved in the recent calami-tous ice accident, and in a special resolution tendered its thanksto Dr. Fuller and Dr. Randall, the medical officers of the work-house.

FATALITY OF CHOLERA EPIDEMICS INLONDON.

THE cessation of the cholera epidemic of 1866 in Londonenables us to complete the view of the relative fatality of theseveral epidemics which we gave in a former number. At thedate of our first article the disease, although it had very greatlydeclined from its maximum intensity, was still destroyingabout two hundred lives a week, so that we were unable to domore than state results approximatively, and with referenceto future possibilities. Now, happily, we can look back uponthe outbreak of 1866, just as we can upon its predecessors, inthe light of an accomplished fact, from which certain deduc-tions may be drawn of more or less interest and value.The epidemic of last year extended over a period of twenty-

three weeks, and during that time 5548 deaths from cholerawere registered within the metropolitan area. The table ofthe comnarative weeklv statistics of the four enidemics which weoriginally gave, closed, as far as 1866 was concerned, with 182deaths in the fortieth week of the year. To complete the series,we append the cholera deaths in the forty-first and succeedingweeks-namely, 207, 144, 112, 73, 67, 32, 8, 3, and 1 in theforty-ninth week, when the epidemic came to an end. It maybe a purely fortuitous coincidence, but it is none the less re-markable, that if we leave out of consideration the premonitoryoutbreaks, we find that in each of the four epidemics the periodof active zymotic duration is embraced within an almost uni-form compass of twenty-three weeks. This circumstance en-ables us fairly to compare the results of the several outbreaks,and thus to measure the relative fatality of the disease atdifferent times.

There can, then, be no doubt that while in individuals cholerais probably as fatal as heretofore, yet in the community regardedas a whole, sanitary measures have been to some extent suc-cessful in circumscribing its ravages, as is shown by the greatlyreduced death-rate in 1866 on that of 1854, as compared withthe smaller difference between the rates of 1854 and 1849.

In a population of 3,000,000, distributed in various degreesof density over 2n area of 77,997 acres, and exhibiting so many

THE LANCET, vol. ii. 1866, p. 414.

widely different characteristics of locality, sanitary condition,occupation, and external circumstances of all kinds, the in-fluence which any one or more of these factors may have uponthe course of epidemic disease is not a matter of easy deter-mination. In some of the London districts the people areclosely packed together, and live on or below the level of theThames ; in others they have space sufficient for the require-ments of health, and are elevated 100, 200, and 300 feet abovethe Thames. Certain places seem always to be in a chronicstate of filth and of poverty; while in others the sanitary in-spectors do their work efficiently, and wealth ahounds. Again,in one quarter fever and other zymotics bave almost a perma-nent home, while at no great distance cases of those diseasesare unfrequent. 258 persons in St. Luke’s, 246 in EastLondon, and 238 in the Strand district are located on one acreof ground; in Lewisham there are 5 ; in Wandsworth, 7; andin Hampstead, 11 persons per acre. Yet on an average of

twenty years the highest rate of mortality from all causes willneither be found coexistent with the greatest density, thelowest elevation, nor the extremest poverty of the inhabitants.The Board of Health, in its Report on Cholera in 1848-49,

came to the conclusion that cholera was governed by the samelaws as other epidemics, and that it attacked in largestnumbers and with most severity the same classes of personsand the same places as typhus, scarlet fever, diarrhoea, andthe entire class of zymotic diseases. Extended observationseems, however, rather to show that, while there is an almostconstant relation between fever and overcrowding, in conjunc-tion with other bad sanitary conditions, cholera is not inva-riably e?t rapport either with other zymotic diseases or withmere physical local characteristics. Dr. Sutherland noticed in1854 " a considerable variation in the relative mortality of thetwo last epidemics in the same districts," and remarked that" although localities presenting certain defective sanitary coil-ditions are the special seats of cholera, such localities some-times escape, or are not always attacked with equal severity."The experience of 1866 still further illustrates this variation.

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The results for 1832-33 must of course be taken curn granosalis, in consequence of the imperfection of the records of thatperiod; although they ought not, we think, to be on thataccount left out of consideration.From the above table it is easy to see that there has been a

remarkable localisation of the severest incidence of the severalepidemics, and this feature ought certainly to have its fullweight in any theory of causation. In their ordinary condi-tions the districts themselves have not undergone sufficientchanges to account for the transposition which has shifted theburden of the epidemic from one group almost entirely toanother. Thus, the districts on the south bank of the Thames,taken collectively, lost 120 out of every 10,000 of their popu-lation in 1849, 87 in 1854, and only 8 in 1866; the East dis-tricts lost at the rate of 66 in 1849, 29 in 1854, and 64 in 1866 ;the Western districts lost 34 in 1849, 51 in 1854, and only 4in 1866.As it would be quite of the question, within our present

limits, to discuss the many influences which have operated,and are daily exemplified in their action, upon the relativemortality of the several London districts, causing such dis-

crepant results, we must be content with pointing out thatcertain principles have been laid down, which, within certainlimits, have derived axiomatic significance. Thus, it has beenshown that, cœteris paribus, the elevation of the soil in Londonhas an almost constant relation with the mortality fromcholera. Again, the powerful effect of different degrees ofpurity, or rather impurity, of the water-supply, has been de-monstrated both by scientific experiment and induction; acombination of these two elements of water-supply and eleva-tion has, in fact, occupied the chief place in the theories ofcausation of cholera which find most general acceptance.

In the Supplement to his Weekly Return, No. 39, of lastyear, Dr. Farr classified all the sub-districts of London accord-ing to their elevation and water-supply, with the deaths fromcholera in the ten weeks ending Sept. 15th; and from the factsso grouped a death-rate was deduced which showed that themortality of the several districts of London from cholera dimi-nished in the several districts supplied with water from thesame sources in proportion to the elevation of the soil on whichthe houses were built.We have been at some pains to extend Dr. Farr’s table by

bringing together the results down to the close of the last epi-demic, and comparing them with those for the epidemics of1849 and 1853-54. The subjoined figures show the compara-tive death-rates to 10,000 inhabitants living at the severalranges of elevation, and in the fields of the different companies’supply in the three cholera epidemics.

In the aggregate cholera was more fatal in London in 1849than in 1854, and in 1854 than in 1866; but, in some cases,our tables show that these conditions were reversed.And with regard to the law of relation between elevation

and cholera-namely, that the mortality varies inversely withthe elevation, although there is some deviation from that lawin all three of the epidemics if taken singly, yet the meanmortality of the three years gives the series 87, 71, 46, 50, 24,21, and 10, which is a descending rate for each upward terraceof elevation in every case excepting the terrace lying between20--40 feet, whereon parts of Whitechapel and Bethnal-greenare situated. If we examine the details for each field of supply,the exceptions to any regular law become frequent: a compli-

cation of factors masks to some extent the operation of onespecific element. Thus the remarkably high mortality on theterrace 60-80 feet, on the south side of the Thames, in 1849, isaccounted for by the outbreak of cholera among the pauperchildren at Drouet’s Farm-house (Streatham), which caused140 deaths in about sixteen days. On the same terrace (60-80feet), on the north side of the Thames, in 1854, the death-ratewas raised to excess by the severity of the epidemic in Golden-square and part of Marylebone. On the terrace 20-40 feet,on the south side of the Thames, in 1854, 178 deaths were re-gistered in the sub-district of Clapham, against 114 in 1849.In all these cases the circumstances were so peculiar as tocounteract the effect of elevation, which is only constant withincertain limits.With regard to the theory of the influence of the water-

supply in the three epidemics, it must suffice to let the resultsin the above table speak for themselves. So much has alreadybeen said in this journal and elsewhere on the subject, that itmay be as well to leave it where it is until we have the specialreport of the Privy Council on the last epidemic, which maypossibly throw further light on this and other theories ofcausation.

CONSTANT WATER-SUPPLY FOR LONDON.

MR. J. F. BATEMAN, C.E., read a paper on this subject at ameeting of the Health Department of the Social Science Asso-ciation on Monday last. Mr. Bateman’s object was to showthat the objections which have been raised against a constant-water-supply were so far from being insuperable that, as in thecase of places mentioned, they had been entirely overcome,with advantage both to the consumer and the provider. Oneof the objections is that the consumption under the constant-supply system is so great that no company or waterworks canmeet the demand; but this solely arises from the amount of £

waste-partly resulting from bad pipes and fittings, and alsoin part from the culpable negligence or wilful extravagance ofconsumers. The daily supply in London, and in Plymouth,Devonport, Shrewsbury, Oxford, and other places supplied onthe intermittent system, averages more than thirty gallonsper head; while in the manufacturing towns of Lancashireand Yorkshire, where there is an unlimited and unstintedsupply, fourteen gallons per head per day are all that is takenfor domestic use ; an additional six or seven gallons per headcovers the supply for all purposes, including trade and manu-factures. Anything beyond the proper normal requirementsof the inhabitants, which would be amply met by from fifteento twenty gallons per head per day, even in a town largelysupplied with baths and waterclosets, is, Mr. Bateman says,chargeable to defective pipes and fittings, or defective arrange-ments. Cambridge, Newcastle-on-Tyne, and Manchester arecited as instances wherein a wasteful expenditure of water hasbeen checked by vigilant inspection and the abolition of badfittings. In many cases the companies or corporations dotheir own plumbing and fitting, with the best possible results;but in Manchester the plumbers of the town were too strongfor the corporation, and a compromise had to be entered into.Mr. Bateman thus points out some of the consequences in-volved in substituting the constant for the intermittent systemof supply :-

" It will be thus seen that where everything is in good order,and both the water provider and the water consumer do theirrespective duties properly, there is no disadvantage to eitherparty by the supply of water on the constant-supply system,while the advantage to the consumer in the facility with whichhe obtains water, and the trifling cost at which it can be intro-duced into his premises, are incomparably greater than can beenjoyed under the other system. Where, however, the inter-mittent system has hitherto prevailed, the desirableness, and,indeed, the practicability, of abandoning it, and adopting theconstant supply, depend very much upon the consumers. Ifthey will submit to such regulations as are necessary for pre-venting waste, there can be no difficulty in introducing constantsupply; it will consume no more waste than the intermittentsystem. The only changes which are required are the abandon-ment of all bad fittings, such as common ground taps, leakycocks, and wasteful waterclosets. The cisterns already exist.ing in houses which have been adapted to the system hithertoemployed may remain if it be the will of the owner or occupierthat they should. If they are large enough they do nowpractically give a constant supply, and it is nly just to the