TOULON. TABLE XIII.-NUMBER of Deaths from Cholera in Toulon, according to daily Returns, from the 27th August to the 22nd October 1865. Deaths from APPENDIX. No. 13. On the present diffusion of Cholera in Europe, by Mr. Radcliffe. 81 APPENDIX. No. 14. On Cholera at Southampton, by Dr. Parkes. No. 14.-REPORT by PROFESSOR PARKES, M.D., F. R. S., on the OUTBREAK of CHOLERA in and about SOUTHAMPTON in September and October 1865. CONTENTS OF REPORT. General Statement and Table of Cases. CHAPTER I.-Description of Local Outbreaks. Bitterne. Southampton. Itchen. CHAPTER II.-Conclusions. Diagnosis. Origin. Importation. Local Origin. Epidemic or General Origin. Curative Measures. Ar the end of September and during October 1865 about 60 cases of a disease, characterized in various degrees by the following symptoms, occurred in Southampton and its neighbourhood:-More or vomiting and purging, the discharges being very watery, and often quite rice-water in appearance; then violent cramps in the muscles of the abdomen, arms, and legs; intense thirst; rapid lessening of the force of the heart, with, in some cases, almost complete pulselessness; diminution of animal heat, most marked in the mouth and the extremities; shallow and often difficult respiration; hoarse and then whispering voice; sinking of the eyes and appearance of dark areola round them; shrinking of the skin of the hands and feet; general more or less livid or cyanotic discoloration and loss of elasticity of the skin; suppression of urine. In most, if not in all, of those who recovered, a state of febrile prostration followed on the symptoms just mentioned; viz., moderate elevation of temperature, great feeling of prostration, very feeble pulse, rather dusky skin, and injected eyes, occasional vomiting, and loose greenish and brown stools. In one case a papular eruption was noticed. The urine, after being suppressed for many hours, was passed in moderate quantity; it was only, I believe, examined in one case, and was then albuminous, and deposited great quantities of renal and bladder epithelium. The medical practitioners in Southampton agree that this disease was Asiatic cholera, and was different and (in the opinion of most) distinguishable from cases of common English, summer, or autumnal cholera, as ordinarily seen in Southampton. Evidence on this point will be subsequently given. There occurred altogether between the 22d September and the 4th November 60 cases of this disease in Southampton and its neighbourhood. In addition, two uncertain cases were seen in August, and three or four others in October or early in November, which I have not included, as the diagnosis is not certain. All the 60 cases were seen by competent practitioners, who entertain no doubt whatever of the correctness of the diagnosis. APPENDIX. No. 14. On Cholera at Southampton, by Dr. Parkes. Excluding two lingering cases of 260 and 144 hours, the mean duration was 40.11 hours. This is probably about 12 hours longer than the average duration of fatal cases in India, and arises from the fact that a larger number of cases died after reaction, and a smaller number died during collapse, than would have been the case in India. This disease occurred in several localities separate from each other. The following table contains the whole of the cases known to have occurred in all the districts. The table is arranged in such a way as to give a general view of the chronology of the outbreaks in the different localities. TABLE of DATES and DISTRICTS showing the CASES diagnosed or registered as Diarrhoea on 17th September. Diarrhoea on 27th. Ann Baker T. S. Diarrhoea on 21st September. 41 Died Harry Phillips 21 Died 49 Died Emma Phillips 41 Died: Diarrhoea on 24th. 45 C § Diarrhoea since **Diarrhoea on 29th. ‡‡ Certified as "Cholera Morbus " (English) Daughter of George Gannaway, whom she nursed Died from exhaustion after rallying. This patient lived at Sholing, near, but not on, Weston Common. $ Rallied, and died from exhaustion. ,, Age. Result. Duration in By the term Southampton is meant, in this Report, the district under the control of the Southampton Local Board of Health; it includes the largest and most crowded part of Southampton. St. Denys and Freemantle are suburbs to the north and west within the borough of Southampton, but not under the Local Board of Health. Itchen is a fishing village, separated from Southampton by the Itchen River, on the south bank of which it lies. Bitterne is a village about two miles from Southampton, and also separated from it by the Itchen River. Weston Common, or Botany Bay, is a small hamlet on a common equidistant and about one and a half miles from Bitterne and Itchen, and is likewise separated from Southampton by the Itchen River. Sholing Common is close to Weston Common. I propose to give first an account of the outbreaks in each locality, including such discussion on the origin as can be thus conveniently made, and subsequently to make a general statement, embracing all the facts. APPENDIX. No. 14. On Cholera at Southampton, by Dr. Parkes. CHAPTER I. On the several OUTBREAKS of the DISEASE in different LOCALITIES. § 1. I-Weston Common. As this outbreak seems to have been the earliest, I have placed it first. A row of scattered cottages, running nearly north and south, stands on the slope of a hollow, on a healthy, breezy common, 2,354 yards from the Itchen River, 2,376 yards from the nearest point of Southampton Water, and with an elevation of about 120 feet above the sea. The soil is sandy and gravelly, with clay about 8 to 10 feet below the surface. The population of the hamlet consists of about 244 persons, living in 54 scattered houses. The people are poor, but the whole district has always been considered very healthy; there is no malaria. It will be seen from the table, that five cases occurred here and three died. Of these five cases, three and two deaths occurred in one family of the name of Hill. A sixth case occurred in a neighbouring common (Sholing), which is also studded with detached cottages of the same class as at Weston Common. Case 1.-This patient was seen by Dr. Laing, (assistant to Dr. Orsborn of Bitterne). I did not see him until the attack was passing off. The following account is made up from Dr. Laing's account, and his own and his mother's statement. Henry Hill, æt. 18.-On Thursday 21st September he first had "bowel complaint;" he cannot say how many stools; motions watery, with much griping. On Friday 22nd September, same symptoms. On Saturday 23rd he gave up work. On this day there was frequent vomiting, and there were cramps all Saturday night. On Sunday, vomiting, purging, and cramps in the extremities all day. He was restless and threw off the clothes; his mother found the skin cold; it was not clammy, and did not alter in colour, except there was a little blueness of the hands. The eyes were deeply sunken, to use the mother's phrase "like a dead corpse." There was intense thirst. He did not himself feel cold, On Monday the 25th there were still vomiting, purging, and cramps in the legs, thighs, and arms. Is quite positive that he passed his |