On the mode of communication of cholera

by John Snow

I called lately to inquire respecting the death of Mrs. Gore, the wife of a labourer, from cholera, at New Leigham Road, Streatham. I found that a son of the deceased had been living and working at Chelsea. He came home ill with a bowel complaint, of which he died in a day or two. His death took place on August 18th. His mother, who attended on him, was taken ill on the next day, and died the day following (August 20th). There were no other deaths from cholera registered in any of the metropolitan districts, down to the 26th August, within two or three miles of the above place; the nearest being at Brixton, Norwood, or Lower Tooting.

The first case of decided Asiatic cholera in London, in the autumn of 1848, was that of a seaman named John Harnold, who had newly arrived by the Elbe steamer from Hamburgh, where the disease was prevailing. He left the vessel, and went to live at No. 8, New Lane, Gainsford Street, Horsleydown. He was seized with cholera on the 22nd of September, and died in a few hours. Dr. Parkes, who made an inquiry into the early cases of cholera, on behalf of the then Board of Health, considered this as the first undoubted case of cholera.

Now the next case of cholera, in London, occurred in the very room in which the above patient died. A man named Blenkinsopp came to lodge in the same room. He was attacked with cholera on the 30th September, and was attended by Mr. Russell of Thornton Street, Horsleydown, who had attended John Harnold. Mr. Russell informed me that, in the case of Blenkinsopp, there were rice-water evacuations; and, amongst other decided symptoms of cholera, complete suppression of urine from Saturday till Tuesday morning; and after this the patient had consecutive fever. Mr. Russell had seen a great deal of cholera in 1832, and considered this a genuine case of the disease; and the history of it leaves no room for doubt.

The following instances are quoted from an interesting work by Dr. Simpson of York, entitled “Observations on Asiatic Cholera”:—“The first cases in the series occurred at Moor Monkton, a healthy agricultural village, situated to the north-west of York, and distant six miles from that place. At the time when the first case occurred, the malady was not known to be prevailing anywhere in the neighbourhood, nor, indeed, at any place within a distance of thirty miles.

“John Barnes, aged 39, an agricultural labourer, became severely indisposed on the 28th of December 1832; he had been suffering from diarrhœa and cramps for two days previously. He was visited by Mr. George Hopps, a respectable surgeon at Redhouse, who, finding him sinking into collapse, requested an interview with his brother, Mr. J. Hopps, of York. This experienced practitioner at once recognised the case as one of Asiatic cholera; and, having bestowed considerable attention on the investigation of that disease, immediately enquired for some probable source of contagion, but in vain: no such source could be discovered. When he repeated his visit on the day following, the patient was dead; but Mrs. Barnes (the wife), Matthew Metcalfe, and Benjamin Muscroft, two persons who had visited Barnes on the preceding day, were all labouring under the disease, but recovered. John Foster, Ann Dunn, and widow Creyke, all of whom had communicated with the patients above named, were attacked by premonitory indisposition, which was however arrested. Whilst the surgeons were vainly endeavouring to discover whence the disease could possibly have arisen, the mystery was all at once, and most unexpectedly, unravelled by the arrival in the village of the son of the deceased John Barnes. This young man was apprentice to his uncle, a shoemaker, living at Leeds. He informed the surgeons that his uncle’s wife (his father’s sister) had died of cholera a fortnight before that time, and that, as she had no children, her wearing apparel had been sent to Monkton by a common carrier. The clothes had not been washed; Barnes had opened the box in the evening; on the next day he had fallen sick of the disease.

“During the illness of Mrs. Barnes, her mother, who was living at Tockwith, a healthy village five miles distant from Moor Monkton, was requested to attend her. She went to Monkton accordingly, remained with her daughter for two days, washed hey daughter’s linen, and set out on her return home, apparently in good health. Whilst in the act of walking home she was seized with the malady, and fell down in collapse on the road. She was conveyed home to her cottage, and placed by the side of her bedridden husband. He, and also the daughter who resided with them, took the malady. All the three died within two days. Only one other case occurred in the village of Tockwith, and it was not a fatal case.” (p. [136].)

“A man came from Hull (where cholera was prevailing), by trade a painter; his name and age are unknown. He lodged at the house of Samuel Wride, at Pocklington; was attacked on his arrival on the 8th of September, and died on the 9th. Samuel Wride himself was attacked on the 11th of September, and died shortly afterwards. These comprise the first cases.

“The next was that of a person named Kneeshaw, who had been at Wride’s house. But as this forms one of a series connected with the former, furnished by Dr. Laycock, who has very obligingly taken the trouble to verify the dates and facts of the latter part of the series, it will be best to give the notes of these cases in that gentleman’s own words.

“‘My dear Dr. Simpson,—Mrs. Kneeshaw was attacked with cholera on Monday, September 9th, and her son William on the 10th. He died on Saturday the 15th; she lived three weeks; they lived at Pocklington. On Sunday, September 16th, Mr. and Mrs. Flint, and Mr. and Mrs. Giles Kneeshaw, and two children, went to Pocklington to see Mrs. Kneeshaw. Mrs. Flint was her daughter. They all returned the same day, except Mr. M. G. Kneeshaw, who stayed at Pocklington, until Monday, September 24th, when he returned to York. At three o’clock on the same day, he was attacked with cholera, and died Tuesday, September 25th, at three o’clock in the morning. [There had been no cholera in York for some time.] On Thursday, September 27th, Mrs. Flint was attacked, but recovered. On Saturday, September 29th, her sister, Mrs. Stead, came from Pocklington to York, to attend upon her; was attacked on Monday, October the 1st, and died October the 6th.

“‘Mrs. Hardcastle, of No. 10, Lord Mayor’s Walk, York, was attacked with cholera on October 3rd, and died the same day. Miss Agar, residing with her, died of cholera on October 7th. Miss Robinson, who had come from Hull to take care of the house, after the death of Mrs. Hardcastle and Miss Agar, was attacked, and died on October 11th. Mr. C. Agar, of Stonegate, York, went to see Mrs. Hardcastle on October 3rd, was attacked next day, and died October 6th, early in the morning. On Monday, October 8th, Mrs. Agar, the mother of Mr. C. Agar, was attacked, and on the same day, one of the servants; both recovered. They had lived with Mr. Agar. All the above dates and facts I have verified.