1832 cholera riots.

Sir—Geoffrey Gill and colleagues (July 21, p 233) provide a fascinating account of the 1832 cholera riots, and, as they point out, unrest was not confined to Liverpool. According to Anning, the Sunderland cholera outbreak in 1831 was preceded by a case in Hull, and the disease may well have been first imported to Yorkshire in rags from continental hospitals used for manuring hop gardens. The devastating effect of the illness, death sometimes following only hours after the first onset of symptoms, is graphically described in the observations of John Snow. The doctors in Snow’s birthplace of York were among the first to take up Thomas Latta’s treatment of intravenous saline for cholera victims, 30 patients being so treated, of whom four survived. Intravenous therapy was also used by John Mackintosh, physician to the Drummond Street cholera hospital in Edinburgh. He reported saline treatment given to 156 patients, of whom 25 survived. Mackintosh’s workload was heavy, added to which he felt compelled to make frequent night visits because of “the young medical gentlemen being worn out, and also from the drunkenness that too often prevailed among the nurses”. In Leeds, 702 inhabitants died from cholera. A temporary facility for cholera victims was stoned by an angry crowd who managed to break several windows. Although, as in Liverpool, there were undoubtedly fears relating to use of bodies for dissection, the instigators of this protest were probably local manufacturers wishing to exert pressure on the Board of Health to relocate the cholera hospital and thereby remove its negative effect on business and trade. Subsequent cholera epidemics in Britain included that of 1854, which provided further evidence to John Snow of the waterborne nature of the disease.