Malta. The cholera appeared for the first time in 1837, when various other places in the Mediterranean were infected. Out of a population of about 120,000, more than 4,000 perished. So great was the dread of contagion, that the native medical men refused to approach the sick.

In 1850, the island was again visited. While the disease lasted, a strict quarantine was enforced upon arrivals from other infected places, as Marseilles, Cephalonia, &c.

In 1854 and 1855, when the disease was most widely spread throughout southern Europe, it never became epidemic in Malta, notwithstanding the suspension of all quarantine in consequence of the Crimean war, and the incessant arrival of ships of war, transports, and other vessels from infected ports, often having invalids on board, and the landing of the sick and wounded from the Crimea, then infected with the malady.

Gibraltar.-It was first visited by the cholera in 1834, the year when the disease for the first time appeared in Spain and in Morocco. There was a slight recurrence in 1849, and again in 1854 and 1855, on which latter occasions it prevailed much more severely in the adjacent districts of Spain than on the Rock. The frequent arrival of vessels on their way to and from the Bosphorus during the Russian war, when all impediments to intercourse were of course removed, does not seem to have occasioned any amount of imported disease, or to have injuriously affected the health of the community.

In the year previous to the war, viz., in 1853, Spain established rigorous restrictions against Gibraltar, in consequence, not of any alleged disease on the Rock, but merely because the authorities there were unwilling to keep up a strict quarantine upon all arrivals, whether healthy or not, from England, where a severe outbreak of cholera had recently occurred at Newcastle. The inconvenience and distress occasioned among the population of Gibraltar by this extreme measure was more than once brought before the notice of the House of Commons. The Government, in consequence, sent out at the time the late Dr. Baly, to inquire into the circumstances of the case, and in the hope that the Spanish Government might adopt a more lenient system of sanitary defence. But no practical result followed from his representations.

Spain. Notwithstanding the vigilance and severity of her quarantine system, Spain has suffered two, if not three, distinct visitations of the cholera. In 1834, almost every great city was attacked, and in most of them with great loss of life. Again, in 1854, and throughout a great portion of 1855, the country was ravaged in almost every province by the pestilence. It was during this visitation, that different towns and districts established strict cordons around any neighbouring towns and districts which had become infected, in the hope of confining the pestilence, and securing themselves from invasion. But such was the amount of distress among the poorer inhabitants, consequent upon this procedure (which, moreover, generally proved of no avail in arresting the progress of the disease), that the

Government forbade its continuance by a royal proclamation, in respect at least of its own population.

Besides these two general epidemics, many of the large seaport towns of Spain suffered from cholera in 1858 and in 1859.

More stringent and severe than even that adopted in Spanish ports, was the quarantine system in the kingdom of Naples under the Bourbon Government. In spite of the Draconic rigour of the regulations, the violation of which was declared to be felony and punishable with death, neither Sicily nor the mainland escaped disastrous visitations of the pestilence, in 1836 and 1837 on the first occasion, and subsequently in 1854 and 1855. Few outbreaks have been attended with more fatal consequences than that of Palermo, in 1837, and that of Messina, in 1855. The city of Naples-and Rome may be mentioned along with it-has sustained two, if not three, distinct epidemics of the pestilence.

With respect to Marseilles, and other Mediterranean ports of France, it appears that they have experienced three, if not four, invasions of epidemic cholera; and the disease has generally been extremely fatal. During the last ten or twelve years, the quarantine system of France has been considerably relaxed, I believe; but it is certain that the more rigorous regulations formerly in force did not succeed in excluding the disease.

The only other country which now remains to be mentioned is Austria, as respects her maritime provinces on the Adriatic.

As far as I am aware, the disease has not yet appeared at any point of her coast, notwithstanding the frequent communication of Trieste with Alexandria by the Austrian Lloyd steamers, and of Venice and various places in Dalmatia with Ancona and other infected places on the Italian coast.* I am unable to give any particulars respecting her quarantine system, or of the results of it in reference to former epidemics of cholera, as Trieste was the only great commercial port in the Mediterranean of which no mention is made in the papers of the committee of the Association, no replies having been received from our consul then resident there.

The preceding narrative, however incomplete it confessedly is, may assist the reader in understanding the nature and working of the existing system of quarantine in the ports of the Mediterranean. It will also enable him to note its effects as a measure of sanitary defence and protection, during a season of epidemic danger. On the one hand, he will observe the immunity hitherto of Sicily, Greece, and the north coast of Africa; and, on the other hand, he will remark the invasion of Malta, many of the ports of Spain, France, Italy, and the Euxine, &c., notwithstanding the vigilant adoption of quarantine restrictions. But it is too early to draw any definite conclusions on the subject. The epidemic will probably not come to an end in the present season, and we must therefore wait and watch its future

*It subsequently appeared that Trieste had not escaped; when the disease first manifested itself there, has not been made public.

history, before we venture to generalise or form a confident opinion. The present paper, as already said, is merely intended to be a narrative of events, and to afford materials for future reference and for the impartial discussion of the question.

Precautions against Cholera. By HENRY JACKSON.

My object in writing the following notes is to bring before the Association a statement of the preparations which were made (and carried out) in the Sheffield Union, to meet the expected invasion of Cholera in 1849.

The experience derived from the outbreak of cholera in 1832 had been so melancholy, that it seemed desirable that some other means should be adopted for the prevention of the disease, than those which had excited so much consternation in the minds of the people of Sheffield in that year. Amongst these I enumerate the daily publication at the Town Hall of the returns, by which the minds of the people were kept in a constant state of alarm, the passage of flaming tar barrels through the streets-the sight of the cholera baskets in which patients suffering from diarrhoea or premonitory symptoms were carried to the hospital of the district.

The hospital surgeons were required to attend night and day on inmates of the hospitals, and to receive all cases reported to them by the visitors.

The visitors and the hospital surgeons were required to send daily reports to the sanitary committee.

Six dispensaries were established for the distribution of medicine at all hours, to applicants.

Nurses were engaged at one guinea per week, on board wages.

August 23.-A considerable increase in the number of cases of diarrhoea and dysentery having been reported, the dispensaries were opened.

August 27.-The committee authorised the occupation of a house in Mill Sands, to be used as a hospital, and called the attention of the Board of Highways to the condition of certain streets.

August 29.-212 applications for medicine having been made at the dispensaries, two medical men were added to the ordinary staff, and ex-hospital surgeons were appointed. The salary of the visitors was raised to two guineas per diem. It was also directed that interments should take place within 24 hours of the time of death by cholera, and that the tolling of the "passing bell" should be discontinued. It was also decided that 24 hours should be a sufficient notice for the removal of nuisances.

Swine question. Two additional inspectors were appointed. September 4.-Three night surgeons were placed on duty, or rather, their appointment confirmed. Two qualified dispensers were appointed at salaries of 40s. and 35s. per week. The Home of

Refuge was reported as fit for use, and the Hospital for Diarrhoea nearly so.

September 7.-A house was taken for the reception of cases of cholera-another hospital surgeon was appointed, and also two more visitors. During the preceding week there had been 1,582 cases of diarrhoea and premonitory symptoms of cholera, but only one of those who had applied for medicine had died. Inquiry was made about the sanitary condition of certain houses.

September 10.-A sub-committee was appointed to arrange for a supply of pure water to Allercliffe.

Two more medical officers and three dispensers were appointed, and auxiliary dispensaries were ordered to be established in the neighbouring villages.

At this time there were six hospital surgeons; three on duty from 7 P. M. to 7 A. M.; three from 7 A. M. to 7 P. M.

September 14.-Two more medical officers were appointed, and orders given for the purifying and cleansing of Allercliffe.

September 25.--The number of cases of diarrhoea having decreased, the services of four of the visitors were discontinued.

Sanitary measures were ordered in all parts of the Union.

October 1.-The committee called upon the Water Company to furnish a supply of water during a period of eight hours at least in each day; stating that a considerable number of deaths in the winter had been caused by an insufficient supply of pure water and the consequent use of the impure water of the river.

October 4.-The committee met Dr. Sutherland, and explained to him the sanitary measures which had been adopted.

October 9.-Four only of the extraordinary medical officers remained on duty-the salaries of the dispensers were diminished, and some of the dispensaries were given up.

On February 25, 1850, the House of Recovery and the diarrhoea wards were finally closed:

Adopting the view that these alarming measures acted prejudicially on health, the sanitary committee, on the expected invasion of cholera in 1849, took steps to meet it by the following measures:-August 20. The committee met to organise a visitation from house to house, in case of the appearance of cholera. The union was divided into two districts, the town and the country, and the town again subdivided into north and south. It was resolved to establish two hospitals, one in each subdivision of the town, for the reception of patients suffering from diarrhoea and the premonitory symptoms of cholera, and also a house of refuge for the healthy members of households visited by the cholera. The ordinary medical offices of the several districts of the union were appointed visitors, and their salary was

fixed at £1 1s. per diem. The medical officer of the poorhouse was appointed visitor of the house, and of the house of refuge; and provision was made for the temporary increase of the staff as necessity required; and medical officers were appointed at a salary of £2 2s. per diem to the two hospitals.

The duties of the visitors were-to visit every infected and unhealthy district once in every eight hours; to examine every inmate in each house, in order to ascertain the state of health; in cases of cholera, to prescribe immediately; to report to the hospital surgeons of the district; to cause the immediate removal to the house of refuge of the healthy inmates; and to direct the removal of patients.

Suggestions to Municipal and other Public Boards, on the most efficient means of meeting the impending visitation of Spasmodic Cholera. By P. O'Callaghan.

In the year 1832 I happened to have medical charge of the garrison of Limerick, under the district superintendence of the late Sir James Pitcairn, during the memorable outbreak of spasmodic cholera. I believe the number of cholera cases in that garrison was nearly a third of those in the whole of the troops serving in Ireland at that time. My responsible and arduous duties on that occasion gave me the most favourable opportunities for studying this extraordinary disease, not only in the military hospitals but likewise in the crowded civil establishments and refuges extemporised for the reception of the numerous cases of cholera in that populous city; and much subsequent experience and observation enabled me to test the value of the practical knowledge thus acquired.

Long before the idea was accepted, or even generally entertained, by the medical profession, I satisfied myself that the cholera was not a contagious disease, and that it was incapable of reproduction from the human body, either alive or dead. I was also convinced that it was produced by a subtle atmospheric poison, borne along in suspension in the air, but not in chemical solution. It would on this supposition be likely to invade localities capriciously as it were, and in various degrees of intensity; and in general would be more under medical control in its advent and retrocession, because the poison would be in those times in smaller quantity and more diluted. I have been further convinced that this singular poison is material, and that its specific gravity is a little greater than the atmosphere, although it may be wafted forcibly in its stronger currents; for I have observed that it had always a tendency to subsidence in calm and stagnant states of the air.

This latter supposition will serve to explain many of its strange phenomena. For instance, I have remarked that most persons were attacked towards morning, after they had lain several hours in a horizontal position, near the floors of their apartments, and probably immersed in the most polluted portions of the vitiated air during that time.