Upon this slender thread Londoners were left dependent for such measures as might afford them some protection against the impending epidemic. No other help was at hand. Nor was there much time for help to be organised or preparations made, for cholera had reached Egypt and Constantinople, and by June, 1848, had crept forward to St. Petersburg. Isolated suspicious cases occurred in London in the summer of 1848,[35] then an undoubted case in Southwark on the 22nd of September, and then more undoubted cases, and the disease had secured a footing. As the winter approached it died down and ceased, having carried off some 468 victims. The Privy Council had appointed a General Board of Health, and early in November the Board issued regulations directing the Guardians to take the necessary measures for the cleansing of houses, the abatement of nuisances, and generally for the removal of all matters injurious to health. To direct is one thing, to get obeyed is another, and with some few exceptions, these directions were disregarded. Partly, the fault was Parliament's. The Act, by naming various local authorities, had created a divided power, and consequently a divided responsibility, which resulted in inaction, neglect, delay, and loss of life; and though the General Board of Health might require the Boards of Guardians and other local bodies to put the regulations into force, they had no power to compel them to do so, and in default of such power the General Board of Health was almost helpless. The cessation of the disease proved to be only temporary. Scarcely was 1849 entered on than the epidemic broke out again, steadily gathering momentum as the summer went on. In Bethnal Green there was an outbreak in the night--sudden and panic-striking--"consternation and alarm were spread abroad--the hurried passing and re-passing of messengers, and the wailing of relatives, filled the streets with confusion and woe, and impressed all with a deep sense of awful calamity." And the epidemic spread and spread until in one week in September (1849) the deaths from it amounted to 2,026.[36] Were the full facts known, the mortality was doubtless far higher. And then the epidemic began rapidly to abate, and by the end of the year had ceased, having slain some 14,600 victims.[37] Numerous and important were the lessons inculcated by this disastrous epidemic. It afforded the most definite evidence that had yet been obtained of the influence upon health of local conditions and pre-disposing causes. It showed that in the most violent and extensive outbreaks of the pestilence its virulence was invariably confined to circumscribed localities. It showed that the habitat of cholera and the habitat of fever were one and the same.