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Cholera.
Cholera which had been spreading in south western Russia in the earlier part of the year had by
the middle of the year attacked a number of places to the south of the Caucasus, and extending up the
Volga, invaded Tzaritzin, Saratov and the province of Samara; numerous cases of a diarrhœal disease
appeared also in the suburbs of Paris, causing some 159 deaths in the second quarter of the year.
During July Nizni-Novgorod was attacked. In Paris the diarrhoeal disease continued to spread in the
suburbs, and in this month the Local Government Board prohibited the importation of rags from France,
from ports on the Black Sea and Sea of Azov, and other parts of Turkey, and from the Baltic or North
Sea ports. In the first week of August a fatal case of cholera occurred in St. Petersburg, followed shortly
by a number of cases and deaths, and the disease, which had already invaded the provinces of the Don,
made greater progress in that locality. In the same month cases of cholera in limited number had also
been reported in Rotterdam. In Havre a number of cases of " cholerine " were reported, and on the 23rd
of the month the authorities of Hamburg announced that cholera was prevailing in that city, the number
of cases and deaths to September 10th being stated to be 13,238 and 5,805 respectively, fresh cases
occurring each day to the end of October. During November cases of cholera in the west of Europe
were reported in Calais, Boulogne, Dunkirk, South Holland and Brussels, and cases of choleraic
diarrhoea were reported at L'Orient. During December cases were reported in Paris, Cherbourg, Calais,
Epernay, L'Orient, North Holland and Hamburg.
On August 25th a circular letter was addressed to sanitary authorities in the metropolis by the
Local Government Board, reminding them that in the event of the Board issuing epidemic regulations,
such regulations "would impose on the sanitary authorities theduty of making arrangements for the prevention
and treatment of cholera, and among those arrangements would be comprised the visitation of poorer
houses for the purpose of detecting cholera and diarrhoea, and the provision of medical attendance and
nursing, and of medicine and disinfectants." " The arrangements to be made by the sanitary authorities
would further include the provision of such additional hospitals and places of refuge as might be necessary
for the several parishes and districts, the hospitals being provided for the reception of those cholera
patients who could not properly be treated in their own homes, and the places of refuge for the
lodgment of those persons not actually sick whom it might be right to keep under observation or to
accommodate while their home was either under disinsection or was devoted to a sick person who could
not properly be removed." Allusion was made to a letter addressed by the Board on the previous day
(August 24th) to the Metropolitan Asylums Managers with reference to the provision of accommodation
which could be utilised on the first appearance of cholera in London, but the Board desired " that it
should be clearly understood that, although the managers may make a limited provision of hospital
accommodation it would devolve under the regulations upon each sanitary authority to provide such
hospital accommodation as would, in the event of cholera becoming epidemic in their parish or district,
be requisite for the reception of cases where removal to a hospital is required." The providing of places
of refuge " would be an undivided function of the sanitary authority."
On the following day, August 26th, two memoranda prepared by the Board's medical officer were
forwarded by the Board to the sanitary authorities for their guidance, and the suggestion was made that
each authority should call upon its medical officer of health for a report as to the action it may be
desirable to take, and that a copy of such report should be forwarded without delay to the Board.
On August 29th an order was addressed to Port Sanitary Authorities amending the order of the
28tli August, 1890, and requiring that no person should be permitted to land from a cholera infected
ship, or from a ship certified by the medical officer of health to have passengers on board in a filthy or
otherwise unwholesome condition, unless he satisfy the medical officer of health as to his name, place of
destination, and address of such place. The names and addresses of persons permitted to land were to
be forthwith transmitted to local medical officers of health by the Port Sanitary Authority, with a view
to such persons being kept under observation. The practice of the masters of ships carrying passengers
of this class was to charge a fixed sum for the whole time the passengers were on board and to provide
them food during this time. The detention of such ships necessarily had a deterring effect on
this trade.
On August 31st a further order to Port Sanitary Authorities dealing with the question of bilge
water was issued, and on September 6th a third order consolidating the previous orders appeared.
The steps taken by the Council's Public Health Department are shown in the following report
which was subsequently presented to the Council—
Public Health Department,
19th September, 1892.
I beg to report on the steps which have been taken by the Public Health Department in
connection with the outbreak of cholera in Hamburg and other Continental ports.
On Wednesday, 24th August, the London newspapers contained the account of the outbreak
of cholera in Hamburg. I thereupon called upon the secretary and the medical officer
of the Local Government Board, and made inquiry as to the intentions of the Board with
respect to the administrative arrangements which would be made in the event of cholera
becoming prevalent in London.
The secretary informed me that the Local Government Board had no power to impose
any duties upon the Council; that, as in 1885, the Metropolitan Asylums Board would be
expected to arrange with persons having the control of hospitals, infirmaries, asylums or
workhouses for the use of their institutions for the reception of cases of cholera, this accommodation
to be for the metropolis generally and irrespective of parochial boundaries; and
that the London sanitary authorities would be required to provide any further hospital
accommodation needed for the purposes of their respective districts if the disease became
prevalent.
I pointed out that pending the arrangements which the Metropolitan Asylums Board
would make, it was probable that some cases of cholera might be introduced into London, and