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In view of the occurrence of localised outbreaks of cholera in England in 1893, and in order
to obtain early knowledge of any local prevalence of diarrhœal disease, the Local Government Board
in July, 1894, suggested to sanitary authorities the desirableness of requiring, during the quarter
ending September, the notification of cases of diarrhoea in their districts. The following letter was
addressed to London sanitary authorities with this object—
Local Government Board, Whitehall,
Sir, July 16th, 1894.
I am directed by the Local Government Board to state that cholera, from which certain parts of
Europe has never been entirely free since the summer of 1892, again shows some signs of recrudescence
on the Continent.
In the late summer and autumn months of 1892 and 1893 the disease reached our shores. In 1892
it failed to extend to any persons beyond those arriving in our midst from abroad, but last year it led to
a number of localised outbreaks which, happily, were of trivial extent compared with previous cholera
visitations to this country.
In those localities where cholera made some headway it was found that there had been antecedent
diarrhoea, generally quite excessive in amount, often choleraic in type; the existence of this unusual
diarrhoea being only discovered when diarrhoea was under section 7 of the Infectious Diseases (Notification)
Act, 1889, added to the diseases notifiable under that statute. But notification of diarrhoea was
rarely, if ever, adopted until after the advent of cholera, when the information to be derived from it could
not be utilised to prevent that disease from gaining a footing whilst in its least recognisable form.
Under these circumstances the Local Government Board have thought it advisable to remind
sanitary authorities that the utmost vigilance should be exercised within their respective districts to
control any diarrhoea which may be suspicious, either in character or in amount, during the present and
forthcoming season, and, with view of facilitating action in this direction, the Board would give favourable
consideration to any applications that may be addressed to them for their approval to add diarrhoea
to the list of notifiable diseases until the termination of the current quarter. In making any such
application each sanitary authority will doubtless consider how far it may be desirable, in the first
instance at least, to limit notification of diarrhœa to attacks occurring over one year of age.
I am, Sir,
Your obedient servant,
(Signed) Hugh Owen,
Secretary.
Notification of diarrhoea was, as the result of this communication, required by the sanitary
authorities of St. George Hanover-square and St. Giles. The number of cases notified in these
districts was 101 and 98, respectively. Notification was also required in the district of Whitechapel,
but it does not appear that the District, Board obtained the confirmation of its resolution by the
Local Government Board. In the first two districts the requirement was limited to persons over one
year and in the last to persons over two years of age.
Cholera.
In 1894 32 deaths were registered, the cause of which was attributed to "cholera" or
"choleraic diarrhœa." This number is less than the number in any year since 1841 included under
this heading or that of "cholera" or "simple cholera" in the returns of the Registrar-General.
In 1894 the methods of dealing with suspected cases of cholera, which had been put in force in
* See footnote (†), page 7.