3
187 inmates in the house at successive periods, that the severe outbursts of fever, when it has really assumed formidable pro- portions, have been directly chargeable on sanitary defects in the house which ought never to have been allowed to exist. In 1856, for instance, when so many as nineteen cases had to be sent within two months to the Fever Hospital, there can be no doubt that the mischief was caused by great over- crowding and a scandalous neglect of the commonest rules of cleanliness, ventilation, &c., both in the body of the house and more particularly in the casual and relief wards. The enlarge- ment of the buildings, and the other sanitary reforms which were thereupon carried out at the instance of the surgeon, to- gether with the fact that the fever patients were always sent off as rapidly as possible to the Fever Hospital, sufficed to cut short the epidemic ; and thenceforward only scattered cases of fever, most of them probably typhoid, made their appearance till 1862, when a great overcrowding of the house having been most improperly permitted, typhus fever again raged with great violence, and twenty-five were sent to the Fever Hospital. The surgeon again interfered, an exodus of many inmates was or- dered, and the fever ceased. During 1863 only two cases, pro- bably typhoid (at long intervals from each other) occurred; but, during 1864, the old vicious overcrowding system having been again adopted to a very dangerous extent, typhus fever again appeared with virulence, at least seven inmates con- tracting it from about twenty cases which had been admitted, although prompt removal to the Fever Hospital was adopted. The same improper system of overcrowding has been followed in the present year, and six inmates have contracted fever from four patients who had been admitted in a state of infection. It is obvious that, in their eagerness to conduct parochial relief as much as possible within the walls of the workhouse, the guardians have refused to act upon considerations which they must be well aware of. They have acknowledged the dangerously contagious character of typhus fever by ordering the removal of declared cases of it to the Fever Hospital; and yet, knowing as they do the impossibility of preventing the admission of many cases in the undeclared stage, they have allowed an amount of overcrowding and a deficiency of venti- lation to exist in the wards which might have caused a spread of typhus (among the patients exposed for a day or two to the contagion) which would have decimated the inmates, and which really has produced very lamentable effects. Apart from the typhus cases, it must be remarked that the records show a considerable amount of typhoid fever spread over the whole nine years; but that of late years there seem to have been few or no cases which originated in the building. This speaks, so far, in favour of the present sanitary state of the house; but, on the other hand, we are informed that erysipelas has been frequent (though fortunately not often fatal), and that measles and scarlatina have been extremely common. Measles has caused three deaths per annum on the average of seven years. Of childbed fever there have been six cases in nine years, three of them fatal ; after the occurrence of a case the lying-in ward has always been closed for a time and thoroughly purified. But for great vigilance on the part of the surgeon, there can be little doubt that in times when it is full the lying-in ward would become the scene of alarming outbreaks of puerperal fever. And now let us sum up the results of our observation. The Strand Union infirmary has but one redeeming feature-the care and skill of the surgeon and of the master and matron, and the improvements in ward management which the zeal of these officers and the benevolence of the lady visitors have effected. The buildings are atrociously bad as a residence for sick per- sons, and they are incapable of real improvement by any cobbling process. The nursing is utterly insufficient; nor will the introduction of one paid nurse, which we understand is about to take place, effect any considerable improvement, any more than it has done at Shoreditch. Such a limited measure of reform is a mere farce. Proper classification is impossible. The insane are miserably ill-provided with lodgment, and not at all provided with the occupations proper to their condition. And, finally, there is a board of guardians composed of men who are doubtless excellent in their private capacity, but who, as a board, have neglected some of the most ordinary sanitary precautions, who exact a fabulous and impossible task from their miserably underpaid surgeon, and who, with one or two exceptions, have unfortunately placed themselves on the side of resistance to the reforms suggested by medical science, and indeed by common humanity. It is impossible to account for such resistance by any other supposition than this, that they have altogether failed to appreciate the position of special re- sponsibility in which they are placed as guardians of one of the most miserably diseased collections of humanity which even the London workhouses could show. They partly cannot, and partly will not, see that they are directors of a great hospital, and that it rests with themselves to occupy a prominent posi- tion, either in public estimation or public condemnation, ac- cording to the way in which they administer this great trust. The practical conclusions to which we are finally conducted are these : that the Strand infirmary ought to be rebuilt on modern principles, on a healthy site; and that the present governing body ought to be greatly modified, if it is to con- tinue to administer the affairs of a great pauper hospital. SHOREDITCH WORKHOUSE AND ITS INFIRMARY. THE report which we recently published as the result of the investigation into the condition of the infirmary of this work- house, has been met by angry denials of the accuracy of our statements. We are prepared, however, to substantiate those statements, and we have further to add that that report was drawn up in a spirit of moderation and considerateness towards the guardians and the officials. It is our earnest desire that these investigations shall be followed by practical improve- ments, and a real amelioration of the condition of the sick poor. Hence we carefully avoid what may be called merely an exposure of any officials or of any body. It is no part of our scheme to write attractive reports, or to make sensational an- nouncements. We are conscious that these reports, founded as they are upon details gathered in rapid investigations, and on facts observed in one or two visits to institutions of considerable magnitude and complication, are yet minutely dissected and criticized with severity by the officials who may feel themselves indirectly or directly reflected upon. We are fully aware of this ; it is what we expect and desire. And the more earnestly the respective boards of guardians set themselves to the com- parison of our view of the facts with their own previous im- pressions, the better satisfied we feel, for the greater will be the profit to the poor. We are not very sensitive as to being con- victed of inaccuracy in certain minute details of management; for as a good deal of the information which we obtain is neces- sarily procured by questions put to the officials, who answer more or less hurriedly and more or less completely, it is obviously occasionally in their power subsequently to point out an error or an omission, generally due to the hurriedness or incomplete- ness of their own replies. Thus when the clerk of the Shore- ditch Workhouse complains in The Times that while censuring the treatment of the imbeciles and lunatics at home, we omitted to say that "such of them as can be" were, at weekly intervals, taken out in vans to the forest, &c., we have only to reply that, while the one circumstance by no means excuses the other, the reason for not mentioning it was, that no such information was given, and that we learn this circumstance, which is so oddly pleaded in extenuation, for the first time from this letter. But that about which we are very earnest is the thorough accuracy, and moderation, and reliableness of the reports of what we saw, and the facts which we ascertained. Hence, when the visiting committee of the guardians take upon them- selves to report that " the best use has been made by the Commission of the present unfinished and incompletely fur- nished state of the house to write an article bordering upon the sensational," we feel it our duty to prove to them that they are wrong ; and we find it necessary to show that that report is not only not beyond the mark in describing the abuses and neglect in this infirmary, but was purposely kept below it; because we have an impression that the intentions of the guardians and the visiting committee here are really humane and liberal-an impression fully confirmed by the statement of Mr. Farnall, and because, while it was necessary to show them what sort of things are really going on under their eyes, possibly without their cognizance, we desired only to say enough to prove that we had probed the individual cases, and to provoke

SHOREDITCH WORKHOUSE AND ITS INFIRMARY

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inmates in the house at successive periods, that the severeoutbursts of fever, when it has really assumed formidable pro-portions, have been directly chargeable on sanitary defectsin the house which ought never to have been allowed toexist. In 1856, for instance, when so many as nineteen caseshad to be sent within two months to the Fever Hospital, therecan be no doubt that the mischief was caused by great over-crowding and a scandalous neglect of the commonest rules ofcleanliness, ventilation, &c., both in the body of the house andmore particularly in the casual and relief wards. The enlarge-ment of the buildings, and the other sanitary reforms whichwere thereupon carried out at the instance of the surgeon, to-gether with the fact that the fever patients were always sentoff as rapidly as possible to the Fever Hospital, sufficed to cutshort the epidemic ; and thenceforward only scattered cases offever, most of them probably typhoid, made their appearancetill 1862, when a great overcrowding of the house having beenmost improperly permitted, typhus fever again raged with greatviolence, and twenty-five were sent to the Fever Hospital. The

surgeon again interfered, an exodus of many inmates was or-dered, and the fever ceased. During 1863 only two cases, pro-bably typhoid (at long intervals from each other) occurred;but, during 1864, the old vicious overcrowding system havingbeen again adopted to a very dangerous extent, typhus feveragain appeared with virulence, at least seven inmates con-tracting it from about twenty cases which had been admitted,although prompt removal to the Fever Hospital was adopted.The same improper system of overcrowding has been followedin the present year, and six inmates have contracted fever fromfour patients who had been admitted in a state of infection.

It is obvious that, in their eagerness to conduct parochialrelief as much as possible within the walls of the workhouse,the guardians have refused to act upon considerations whichthey must be well aware of. They have acknowledged thedangerously contagious character of typhus fever by orderingthe removal of declared cases of it to the Fever Hospital; andyet, knowing as they do the impossibility of preventing theadmission of many cases in the undeclared stage, they haveallowed an amount of overcrowding and a deficiency of venti-lation to exist in the wards which might have caused a spreadof typhus (among the patients exposed for a day or two to thecontagion) which would have decimated the inmates, and whichreally has produced very lamentable effects.Apart from the typhus cases, it must be remarked that the

records show a considerable amount of typhoid fever spreadover the whole nine years; but that of late years there seemto have been few or no cases which originated in the building.This speaks, so far, in favour of the present sanitary state ofthe house; but, on the other hand, we are informed thaterysipelas has been frequent (though fortunately not oftenfatal), and that measles and scarlatina have been extremelycommon. Measles has caused three deaths per annum on theaverage of seven years. Of childbed fever there have been sixcases in nine years, three of them fatal ; after the occurrenceof a case the lying-in ward has always been closed for a timeand thoroughly purified. But for great vigilance on the partof the surgeon, there can be little doubt that in times when itis full the lying-in ward would become the scene of alarmingoutbreaks of puerperal fever.And now let us sum up the results of our observation. The

Strand Union infirmary has but one redeeming feature-thecare and skill of the surgeon and of the master and matron, andthe improvements in ward management which the zeal of theseofficers and the benevolence of the lady visitors have effected.The buildings are atrociously bad as a residence for sick per-sons, and they are incapable of real improvement by anycobbling process. The nursing is utterly insufficient; nor willthe introduction of one paid nurse, which we understand isabout to take place, effect any considerable improvement, anymore than it has done at Shoreditch. Such a limited measureof reform is a mere farce. Proper classification is impossible.The insane are miserably ill-provided with lodgment, and notat all provided with the occupations proper to their condition.And, finally, there is a board of guardians composed of menwho are doubtless excellent in their private capacity, but who,as a board, have neglected some of the most ordinary sanitaryprecautions, who exact a fabulous and impossible task fromtheir miserably underpaid surgeon, and who, with one or twoexceptions, have unfortunately placed themselves on the sideof resistance to the reforms suggested by medical science, andindeed by common humanity. It is impossible to account forsuch resistance by any other supposition than this, that theyhave altogether failed to appreciate the position of special re-sponsibility in which they are placed as guardians of one of the

most miserably diseased collections of humanity which eventhe London workhouses could show. They partly cannot, andpartly will not, see that they are directors of a great hospital,and that it rests with themselves to occupy a prominent posi-tion, either in public estimation or public condemnation, ac-cording to the way in which they administer this great trust.The practical conclusions to which we are finally conducted

are these : that the Strand infirmary ought to be rebuilt onmodern principles, on a healthy site; and that the presentgoverning body ought to be greatly modified, if it is to con-tinue to administer the affairs of a great pauper hospital.

SHOREDITCH WORKHOUSE AND ITSINFIRMARY.

THE report which we recently published as the result of theinvestigation into the condition of the infirmary of this work-house, has been met by angry denials of the accuracy of ourstatements. We are prepared, however, to substantiate thosestatements, and we have further to add that that report wasdrawn up in a spirit of moderation and considerateness towardsthe guardians and the officials. It is our earnest desire thatthese investigations shall be followed by practical improve-ments, and a real amelioration of the condition of the sickpoor. Hence we carefully avoid what may be called merely anexposure of any officials or of any body. It is no part of ourscheme to write attractive reports, or to make sensational an-nouncements. We are conscious that these reports, foundedas they are upon details gathered in rapid investigations, and onfacts observed in one or two visits to institutions of considerable

magnitude and complication, are yet minutely dissected andcriticized with severity by the officials who may feel themselvesindirectly or directly reflected upon. We are fully aware ofthis ; it is what we expect and desire. And the more earnestlythe respective boards of guardians set themselves to the com-parison of our view of the facts with their own previous im-pressions, the better satisfied we feel, for the greater will be theprofit to the poor. We are not very sensitive as to being con-victed of inaccuracy in certain minute details of management;for as a good deal of the information which we obtain is neces-sarily procured by questions put to the officials, who answermore or less hurriedly and more or less completely, it is obviouslyoccasionally in their power subsequently to point out an error oran omission, generally due to the hurriedness or incomplete-ness of their own replies. Thus when the clerk of the Shore-ditch Workhouse complains in The Times that while censuringthe treatment of the imbeciles and lunatics at home, we omittedto say that "such of them as can be" were, at weekly intervals,taken out in vans to the forest, &c., we have only to replythat, while the one circumstance by no means excuses the other,the reason for not mentioning it was, that no such informationwas given, and that we learn this circumstance, which is sooddly pleaded in extenuation, for the first time from this letter.But that about which we are very earnest is the thoroughaccuracy, and moderation, and reliableness of the reports ofwhat we saw, and the facts which we ascertained. Hence,when the visiting committee of the guardians take upon them-selves to report that " the best use has been made by theCommission of the present unfinished and incompletely fur-nished state of the house to write an article bordering uponthe sensational," we feel it our duty to prove to them thatthey are wrong ; and we find it necessary to show that that

report is not only not beyond the mark in describing the abusesand neglect in this infirmary, but was purposely kept below it;because we have an impression that the intentions of the

guardians and the visiting committee here are really humaneand liberal-an impression fully confirmed by the statement ofMr. Farnall, and because, while it was necessary to show themwhat sort of things are really going on under their eyes, possiblywithout their cognizance, we desired only to say enough toprove that we had probed the individual cases, and to provoke

188

them to liberal reorganization and minute supervision, without In our report we went on to say-saying a word that could be avoided of a painful character. In " In other respects the nursing was equally deficient. Thethe presence of the open and violent charge of exaggeration dressings were roughly and badly applied. Lotions and water-

brought by the visiting committee, and urged by the clerk, it dressings were applied in rags, which were allowed to dry andis necessary to give some further details, and we will confine

stick. We saw sloughing ulcers and cancers so treated. In-

, . , . , ..

’ fact, this was the rule. Bandages seemed to be unknown.ourselves to the simplest statement of facts. But the general character of the nursing will be appreciatedOur allegations of neglect and mismanagement were illus- by the detail of the one fact, that we found in one ward two

trated by, and partly founded upon, certain stated cases. Let paralytic patients with frightful sloughs of the back : theyus see whether the guardians are fairly entitled to say that the were both dirty, and lying on hard straw mattres.3e,,;; the oneaccount was exaggerated. We wrote as follows concerning the dressed only with a rag steeped in chloride-of lime solution,

-

’= the other with a rag thickly covered with ointment. Thisadministration of medicines, surely a crucial matter in sick latter was a fearful and very extensive sore, in a state of abso-wards :- lute putridity ; the buttocks of the patient were covered with

" Medicines are administered in this house with shameful i filth and excoriated, and the stench was masked by strewing

. Medicines are administered in this house with fu dry chloride of lime on the floor under the bed.A spectacleirregularity. The result of our inquiries showed, that of nine dry chloride of lime more discreditable cannot be imagined.consecutive patients, only four were receiving their medicines Both these patients have since died: no inquest has been heldregularly. A poor fellow lying very dangerously ill with gan- on either." grene of the leg had had no medicine for three days, because, ’....’as the male ’nurse’ said, his mouth had been sore. The doctor No doubt this discloses a sad state of things ; but we shouldhad not been made acquainted either with the fact that the have been wanting in moral courage, and should have failedman’s mouth was sore or that he had not had the medicines in our duty, had we omittecl to note these facts. What weordered for him. A female, also very ill, had not had her have written above is the bare truth, and much might havemedicine for two days, because the very infirm old lady in the next bed, who it seemed was appointed by the nurse to fulfil been added to this picture. We challenge contradiction ofthis duty, had been too completely bed-ridden for the last few any of the details. We have read carefully the " reports"days to rise and give it to her. Other patients had not had made to the guardians ; they are of course unavailing to con-their medicines because they had diarrhcea; but the suspension traclict any of these statements of what we saw. They are par-had not been made known to the doctor, nor had medicine ticularly unfortunate in the attempt to qualify them. Thebeen given to them for their diarrhoea. The nurses generally statement that "frequently changed straw beds are constantlyhad the most imperfect idea of their duties in this respect. statement that "frequently changed straw beds are constantly

"

One nurse plainly avowed that she gave medicines three times used in such cases, and are more wholesome than flock or coir, "

a day to those who were very ill, and twice or once a day as simply begs the whole question arising out of the leaving athey improved. The medicines were given all down a ward in patient with a terrible sloughing back lying flat upon a hard beda cup; elsewhere in a gallipot. The nurse said she poured of any sort, with a piece of thin rag upon the sore. The onlyout the medicine, and fudged according. correction made is that "’the were made of chlorideout the medicine, and judged according.’" correction made is that the dressings were made of chlorideWe now repeat and re-affirm every one of these statements of lime and prepared chalk, and no ointment of any kind had

denounced as "sensational." We repeat them in the most posi- ever been applied to their backs." This at once confirms andtive manner ; we re-affirm them with the most solemn serious- aggravates our original statement. The rag wetted with theness, and are prepared to prove them in every particular. Far " prepared chalh lotion had so dried that the "preparedfrom being exaggerated, they are toned down. We omitted to chalk" had alone remained, and looked like the dry chalksay that at a second visit, ten days after our first, not only was ointment. Such a vindication seems no less than an openthe general neglect and irregularity in no way that we could confession.discover ameliorated, notwithstanding that we had exposed The statement of the master that " necessary bandages areit in the presence of officials, but these particular cases, in the hands of the paid nurse, and are used when and wherewhich we had pointed out at the time as gross instances of found necessary," is, again, a bitter commentary upon theneglect, were still suffering under similar mismanagement. management; since this is the only answer that can be madeThus the infirm old dame who was supposed to be charged by to our assertion, which we now repeat, that we did not see onethe nurse with the duty of administering the medicines to the bandage applied throughout the whole of the establishment,woman in question was lying in bed, and on another bed was and that all the numerous " wet dressings" were simply tiedsitting a noisy lunatic or imbecile, who started up and began on by pieces of rag or string, and were sticking to the wounds,running wildly about directly we entered the ward, and was having no waterproof tissue over them of any sort. We re-

thereupon authoritatively ordered by this bed-ridden old lady iterate every statement in the above-quoted paragraph, andto sit down. She was, forsooth, in charge of this imbecile now, are prepared to prove them all. But since the guardians andas well as of her sick friend on the other side of the door. We their officers have thought it well, instead of setting earnestlymay add that the irregularity and inefficiency of the adminis- to work to put their house in order, to give out that we havetration of medicines by the day-nurses are, in our opinion, only three examples, of which they say, moreover, the accountterribly aggravated by the total absence of night-nursing. is exaggerated, on which to rest our censure, we will mentionImagine a system of nursing which presupposes that helpless some further cases, to which the recent report did not allude.patients will not require medicine, food, beef-tea, perhaps In one male ward we came upon a haggard and wild-look-brandy administered to them in the night. Imagine a whole ing man sitting up in bed. He was incoherent and restless,wardful of patients, of whom numbers are helpless and bed- and apparently did not understand what was said to him orridden, left habitually without any nurse sitting up in any of what was going on around him. He had an ulceration on thethe wards to watch over them, and without even a shelf for leg. It was bare of any dressing whatever. There was butfood and medicine near the bed. This, indeed, is a theme little discharge from the sore, but the sheets were thick withwhich a sensation writer might envy. Let us ask the board dry, crusted, purulent matter. It was difficult to say howof directors of any public hospital in London whether they can long it was since the sheets had been changed; we should havesuppose their hospitals to exist at all without a system of said a fortnight at least. The wardman, when summoned,night-nursing. Let us ask any human being to consider what said boldly "Yesterday." He adhered obstinately to thissuch a system implies of habitual neglect, of continued and statement until shamed out of it, when he said that he thoughtpatient suffering, of needless discomfort, of wasted oppor- it was so. He explained that " he could do nothing with thetunities of recovery. We need not dwell upon them : in our man;" for he refused medicine and food, and tore off his

report we did not allude to them ; we wrote only, " there are bandages. It is difficult to exaggerate the total neglect of thisno night-nurses"-a statement of the facts which we appre- poor fellow or its disastrous consequences. We learnt that he

hend to be anything but sensational. had till recently been a tradesman in the neighbourhood, and

189

that his name was still over the shop-door. He had met withreverses of fortune ; and he was here rapidly passing throughthe stages which lead to incurable insanity, and was utterlyneglected. In the same ward we saw a man with advanced

hip-joint disease, several sinuses discharging, the diseased legbent up, and displaced over the other. He was lying on a bedwithout sheets; his clean sheet was produced doubled up fromunder the pillow. There was neither cushion nor splints, norany other dressing than a bit of half-dry rag laid over thesores. It is surely unnecessary to continue, though we couldadd to the list. The guardians will vainly delude themselveswith any belief that things are other than as we have describedthem. What our eyes have seen we know to be true.

They are very wrong in supposing or in stating that wehave not made ample allowance for the temporary inconve-niences due to the building of new premises. No other con-sideration could have justified us in passing over in silence theutter and mischievous want of classification of the patients.Sick idiots and epileptics, acute and chronic medical and sur-gical cases, and the bed-ridden and infirm, are mixed up in totalconfusion, and with a want of order and system which, as we be-lieve, a little more care might easily obviate even under presentcircumstances. It was nothing else than the Knowledge of thistemporary pressure for room-a pressure which we expresslyacknowledged-which prevented us from speaking very stronglyindeed of the placing nearly three hundred inmates, includinga large number of infirm and all the imbecile and insane women,away at Wapping, where the house is abominably ill-built andextremely miserable, the drains foul-smelling, the privies dis-gustingly bad ; where they are far away from the medicalofficer, who sees them but twice a week; where there is onlyone airing-ground for the infirm, the imbecile, and the epi-leptic, and this the drying-ground for the clothes from thelaundry. None of the abuses to which we alluded in our last

report, or in this appendix to it, are in any way connectedwith building operations.

Finally, to save time, and to assure the guardians and thePoor-law Board of the opinions which we hold of this house,we beg to refer to our last report at length. We adhere im-plicitly to our expressed judgment, and are prepared amply tojustify it.

THE PROGRESS OF CHOLERA.

CHOLERA is steadily extending along the basin of the Medi-terranean. Cyprus has been invaded. Telegrams from Triestedated the 28th ult. state that forty or fifty fatal cases of theepidemic were occurring in the island daily. The disease hasalso appeared at Delos, in the midst of the Ægean. Threecases were reported at the above date.The rumour that cholera had broken out in Malta, mentioned

in our last impression, proves to be correct. The accountswhich have reached this country are exceedingly imperfect,but the following cases and deaths have been reported :-

On the 27th only one case of the disease was reported to haveoccurred amongst the military; and seven of the fresh caseswhich were returned on this day happened in Valetta. Theoutbreak appears to be general throughout the island, several

cases having been returned from distant villages. Two cases

are also said to have occurred in the island of Gozo.Active steps are being taken by the authorities, military

and local, to hold the disease in check, and to prevent needlessalarm amongst; the population. The band is to be dispensedwith at military funerals, and the Roman-catholic bishop hasdirected that no bell shall accompany any viaticum issuingafter the second A ve Maria;while during the day-time thelarge and noisy bell shall be superseded by a small one. Fur-

ther, the ecclesiastical authorities have prohibited the inter-ment of persons dead from cholera within the churches ofValetta and the Three Cities. Several regiments have beenremoved from their barracks in Valetta and encamped outside

the walls. The men were manifestly benefited by the change.If a rigid quarantine could exclude cholera, Malta ought to

have been saved. But it would seem that in this as in pre-vions outbreaks of the epidemic within the Mediterraneanbasm, the disease has cropped up in the island in denance ofquarantine regulations pushed beyond the verge of absurdity.The extreme folly of quarantine, as practised in the Medi-

terranean ports, is shown by the fact that Alexandria, thepresumed focus of infection for the Mediterranean, in the pre-sent outbreak, has become alarmed lest it should suffer injuryby the introduction of the disease from other infected ports.The authorities have set about putting their lazaretto inorder, and have decreed that all arrivals from Malta, Turkey,and other suspected European ports shall be subjected to a,

strict quarantine !Cholera has appeared in Sicily, notwithstanding the rigorous

enactments of the Sicilian boards of health. Some cases ofthe disease have occurred in Catania and Palermo, and causedthe wildest alarm among the population.

Several cases of cholera have also occurred in Marseilles.The news from Constantinople shows that the epidemic is

general throughout the city, and that Scutari and the villageson both sides of the Bosphorus are infected. During the weekending the 26th of July the number of deaths from the diseaseamounted to 723, out of a population of nearly 1,000,000 souls.On the 25th of July the deaths were 177. A well-conceivedsanitary service has been organized, and provision made for thealimentation of the poor. Immense efforts are being made forthe purification of the streets, common sewers, and khans, andfor the prevention of overcrowding in the latter; and tempo-rary hospitals and pharmacies have been opened in all partsof the city. An excellent circular of instructions for theguidance of the inhabitants has been issued by the medicalcommission in charge of the sanitary service. Business, bothpublic and private, has been paralysed by the outbreak,although its magnitude has been greatly exaggerated by popu-lar alarm.

In Alexandria the epidemic would seem to have well-nighdied out, as no returns of deaths have reached this countrysince the 26th ult., on which day two deaths from cholerawere orlicially recorded.The mortality in Cairo is rapidly declining. On the 16th of

July the deaths from cholera numbered 109; on the 25th theyhad fallen to 25; on the 26th they were 38.The following is a statement of the deaths from cholera at

Smyrna from June 24th to July 21st, 1865:-