I. REGULATIONS AS TO DETENTION BY OFFICERS OF CUSTOMS.

Article 2. If any officer of customs, on the arrival of any ship, ascertain from the master of such ship or otherwise, or have reason to suspect, that the ship is infected with cholera, he shall detain such ship, and order the master forthwith to moor or anchor the same in such position as such officer of customs shall direct, and thereupon the master shall moor or anchor the ship accordingly.

Article 3. While such ship shall be so detained no person shall leave the same. Article 4. Such detention by the officer of customs shall cease as soon as the ship has been duly visited and examined by the Medical Officer of Health; or if the ship shall, upon such examination, be found to be infected with cholera, as soon as the same shall be moored or anchored in pursuance of Article 10 of this Order. Provided that if the examination be not commenced within twelve hours after notice given as aforesaid, the ship shall, on the expiration of the twelve hours, be released from detention.

II. REGULATIONS AS TO SANITARY AUTHORITIES.

Article 6. Every Port Sanitary Authority, except as aforesaid, and every other Sanitary Authority within whose district persons are likely to be landed from any ship coming foreign, shall as speedily as practicable, with the approval of the chief officer of customs of the port, fix some place within the jurisdiction or district of the Sanitary Authority where any ship may be moored or anchored, for the purpose of Article 10; and shall make provision for the reception of cholera patients and persons suffering from illness removed under Articles 13 and 14.

Article 7. The Sanitary Authority, on notice being given to them by an officer of customs, under this Order, shall forthwith cause the ship, in regard to which such notice shall have been given, to be visited and examined by their Medical Officer of Health for the purpose of ascertaining whether she is infected with cholera.

Article 8. The Medical Officer of Health, if he has reason to believe that any ship within the jurisdiction or district of a Sanitary Authority, whether examined by the officer of customs or not, is infected with cholera, shall, or if she have come from a place infected with cholera, may visit and examine such ship for the purpose of ascertaining whether she is so infected, and the master of such ship shall permit the same to be so visited and examined.

Article 9. If the Medical Officer of Health, making such examination as aforesaid (whether under Article 7 or 8), shall be of opinion that the ship is infected, he shall give a certificate in duplicate in the following form or to the like effect, and shall deliver one copy to the master and retain the other or transmit it to the Sanitary Authority.

CERTIFICATE.
day of

I hereby certify that I have examined the ship

(or detained at infected with cholera.

Sanitary Authority of

of

now lying in the port of

), and that I find that she is

Medical Officer of Health (or medical practitioner appointed by the

Sanitary Authority).

Article 10. The master of every ship so certified to be infected with cholera shall thereupon moor or anchor her at the place fixed for that purpose under Article 6, and she shall remain there until the requirements of this Order have been duly fulfilled.

Article 11. No person shall leave any such ship until the examination hereinafter mentioned shall have been made.

Article 12. The Medical Officer of Health shall, as soon as possible after any such ship has been certified to be infected with cholera, examine all persons on board the

same, and all persons who shall not be certified by him as hereafter mentioned shall be permitted to land immediately on their giving their names and the places of their destination.

Article 13. Every person certified by the Medical Officer of Health to be suffering from cholera, shall be dealt with under any regulations that may have been made by the Sanitary Authority under Section 125 of the Public Health Act 1875; or where no such regulations shall have been made shall be removed, if the condition of the patient admit of it, to some hospital or place previously appointed for that purpose by the said authority; and no person so removed shall leave such hospital or place until the Medical Officer of Health shall have certified that such person is free from the said disease. If any person suffering from cholera cannot be removed the ship shall remain subject, for the purposes of this order, to the control of the Medical Officer of Health; and the infected person shall not be removed from or leave the ship, except with the consent in writing of the Medical Officer of Health.

Article 14. Any person certified by the Medical Officer of Health to be suffering from any illness which such officer suspects may prove to be cholera, may either be detained on board the ship for any period not exceeding two days, or be taken to some hospital or other place previously appointed by the Sanitary Authority, and detained there for a like period, in order that it may be ascertained whether the illness is or is not cholera. Any such person who while so detained shall be certified by the Medical Officer of Health to be suffering from cholera shall be dealt with as provided by Article 13 of this Order.

Article 15. The Medical Officer of Health shall, in the case of every ship certified to be infected, give directions, and take such steps as appear to him necessary, for preventing the spread of infection, and the master of the said ship shall forthwith carry into execution such directions as shall be so given to him.

Article 16. In the event of any death from cholera taking place on board of such ship while so detained, the master shall, as directed by the Sanitary Authority or the Medical Officer of Health, either cause the dead body to be taken out to sea and committed to the deep, properly loaded to prevent its rising, or shall deliver it into the charge of the said authority for interment, and the authority shall thereupon have the same interred.

Article 17. The master shall cause any articles that may have been soiled with cholera discharges to be destroyed, and the clothing and bedding and other articles of personal use likely to retain infection which has been used by any person who may have suffered from cholera on board such ship, or who having left such ship shall have suffered from cholera during the stay of such ship in any port, to be disinfected or if necessary destroyed; and if the master shall have neglected to do so before the ship arrives in port, he shall forthwith, or upon the direction of the Sanitary Authority or the Medical Officer of Health, cause the same to be disinfected or destroyed, as the case may require; and if the said master neglect to comply with such direction within a reasonable time, the authority shall cause the same to be carried into execution.

Article 18. The master shall cause the ship to be disinfected, and every article therein, other than those last described, which may probably be infected with cholera, to be disinfected or destroyed, according to the directions of the Medical Officer of Health.

Given under the seal of office of the Local Government Board, this twelfth day of July in the year one thousand eight hundred and eighty-three.

CHARLES W. DILKE, President.
HUGH OWEN, Secretary.

NOTICE. The Public Health Act 1875 provides by section 130, that any person wilfully neglecting or refusing to obey or carry out, or obstructing the execution of any regulation made under that section shall be liable to a penalty not exceeding fifty pounds.

Date of publication in the London Gazette, 13th July, 1883.

(400) Order Prohibiting Importation of Rags.

The Order at the time of cholera apprehension in 1885 against the importation of rags from Spain, was to the following effect:

Article 2. From and after the date of this Order, and until the 1st day of November, 1885, no rags from Spain shall be delivered overside nor landed in any port or place in England or Wales.

Article 3. If any rags shall be delivered overside or landed in contravention of this Order, they shall, unless forthwith exported, be destroyed by the person having control over the same, with such precautions as may be directed by the Medical Officer of Health of the Sanitary Authority within whose jurisdiction or district the same may be found.

Article 4. All masters of vessels, consignees, and other persons having control of any rags prohibited under this Order from being delivered overside, except for the purpose of export, or landed, are required to obey these regulations.

Article 5. All officers of customs are empowered to prevent the delivery overside or landing of rags in contravention of this Order.

Article 6. It shall be the duty of the Sanitary Authority to take proceedings against masters of ships, consignees, or other persons having control over any rags who shall wilfully neglect or refuse to obey or carry out, or shall obstruct the execution of any of these regulations.

DIARRHOEA-ENGLISH CHOLERA.

Diarrhoea is a general disease, the leading symptom of which is frequent purging; at present it is not possible to differentiate between acute diarrhoea and English cholera, nor is it possible to definitely state whether two or more essentially different diseases are included under the term "diarrhoea," the latter name being as a matter of fact given to any disease attendant with frequent purgation, and for which there does not appear any local lesion or any specific fever such as typhoid to account for it.

(401) Mortality and Sickness from Diarrhea.

The amount of illness from diarrhoea it is impossible to state, but Dr. Ballard1 gives as the result of his Islington statistics that out of 272,409 cases of sickness treated in charitable institutions 16,479, or 60.5 per cent., were due to diarrhoea. The amount of sickness varies very much in different years, and also the mortality.

During the ten years 1861 to 1870, out of 4,794,500 deaths registered from all causes, 207,256 were ascribed to diarrhoea, and during the ten years 1871 to 1880 out of 5,178,311 deaths

1 "Diarrhoea and Diphtheria," Med. Officers' Supplement, Rep. Local Government Board, 1887.

221,552 were ascribed to diarrhoea. This is equal to 43.2 per 1,000 of all deaths in the first period of ten years, and to 42.7 per 1,000 of all the deaths in the second period (Ballard).

Dr. Ballard suggests that this may not be all the mortality, but only that which is immediate; diarrhoea, like scarlatina, specially interferes with the kidney function, and hence it may lay the foundation of kidney diseases which may at a long period afterwards prove fatal.

(402) Symptoms.

Dr. Ballard summarizes briefly the symptoms as follows:Diarrhoea, vomiting, convulsive phenomena, a bodily temperature at certain periods above, at other periods below what is normal, reduction in quantity or actual suppression of urine, embarrassed breathing, and where looked for commonly physical indications of pulmonary hyperæmia or inflammation, pallor of the surface of the body, loss of bulk and flesh, and exhaustion with its various wellknown clinical features. Occasionally there is jaundice. In two of Dr. Ballard's cases there was a fugitive rash. The diarrhoea may be very slight, there is nothing characteristic about the stools, but as a rule they are at one stage or another of the malady horribly offensive. Convulsions Dr. Ballard views as the most important phenomena of the malady, and when convulsions occur late they indicate a uræmic condition of the blood. The temperature in its course is peculiar and much like that of cholera. At the commencement there appears to be some little febrile disturbance, but sooner or later in the cases about to become fatal, the temperature falls more or less below the normal range, being lower in the morning than in the evening, and even then it mostly fails to attain a normal standard. Towards the end of a fatal case the temperature is apt to rise.

(403) Seasonal Influences.

Dr. Ballard has carefully studied the effect of season. The malady he concludes is not only present among the population every year but in all seasons and at all times of every year; but not in all seasons and times alike.

For example, taking his Islington experience, and dividing the

year into thirteen periods of four weeks each, from the first to the twentieth week he considers a pre-epidemic period, the next five periods belong to the epidemic period, and the last three to the post-epidemic period; or the seasonal influence may be considered in quarters. Of the 15,478 Islington cases, in the first quarter there occurred 8.7 per cent. of all the cases, in the second 168 per cent., in the third 607 per cent., and in the fourth 13.8 per

cent.

In yearly variations of prevalence by far the greatest occur in the "epidemic period." From eleven years of the Islington statistics, Ballard thinks that a higher prevalence than usual in the "post-epidemic period" may be connected with a deficiency of customary prevalence in the preceding "epidemic period,” and he gives tables illustrative of this and other points both with regard to diarrhoea observed in Islington and diarrhoea observed in Redditch; finally concluding that the lateness or earliness of attainment of maximum prevalence in the "epidemic period" has more to do with the "post-epidemic" prevalence than the degree of prevalence in the "epidemic period" has to do with it.

In Buchan and Mitchell's paper1 the general seasonal distribution of deaths is well brought out, and Ballard's conclusions are confirmatory. Buchan's diagram looks like a section of an Alpine mountain, the peak of culminating point being attained in the first week in August, the deaths rapidly running up from zero in May, through June and July to as rapidly diminish down to Ballard's post-epidemic period, but still a little above the average through October, November and December.

The most instructive part of Ballard's study on seasonal influences is that in which he traces the influence on the different ages. Taking the six years 1857 to 1862, 406 per 10,000 of all ages were known to be attacked in the pre-epidemic period, 230-5 in the epidemic, and 37.5 in the post-epidemic period. In the preepidemic period 135.2 per 10,000 of the age period under five, were attacked, and 26.0 of the population over five, hence the proportion was as 52 to 10 during the epidemic period, 8164 per 10,000 under five, and 140 3 over five, that is in the proportion of 58 to 10; while during the post-epidemic period the relation is as 65 is to 10.

1 Journ. of the Scottish Met. Soc., July, 1875.