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52
It will be seen from the foregoing table that the diarrhoea death-rate was, both in the period
1904-8 and in the year 1909, highest in Shoreditch (1.22 and 0"78 respectively) and lowest in
Hampstead (0.17 and 0.04 respectively). The diarrhœa death-rates in London in each of the four
quarters of the year 1909, were as follows: first quarter, 0.14; second quarter, 0.12; third quarter,
0.79; and fourth quarter, 0.25, per 1,000 persons living.
As previously stated, the meteorological conditions of 1909 were favourable to a low death-rate
from diarrhœal diseases. It is not unlikely that the action of sanitary authorities, through the visits
of their health officers to the homes where births have occurred, may already in some degree be contributing
to the prevention of diarrhoea mortality; for there is abundant evidence that the probability
of attack in infancy is governed in considerable degree by the care of the child. The work of the
health visitor in encouraging the better feeding of infants and conditions of cleanliness in the homes
cannot fail to be effective in this direction.
In the last annual report reference was made to the results obtained in Woolwich by the system
of voluntary notification of cases of diarrhoea, which had been instituted during the summer months
in that district. Dr. Davies now reports that the results were so encouraging that in February, 1909,
the borough council resolved to continue voluntary notification indefinitely, and to extend the period
of notification to June and October, thus making the disease notifiable during five months, instead
of three. Dr. Davies finds reason for thinking that a proportion of the cases which were notified were
due to a previous case in the same or a neighbouring house. The reports of the medical officers of health
of Paddington and Kensington give account of multiple attacks in houses and in certain instances
give reasons for thinking that the disease had been communicated from person to person.
In several annual reports reference is made to the largely accepted view that flies play an
important part in the causation of diarrhoea. The need for further study of this subject is obvious,
and hence observations have been continued in London on the seasonal distribution of the different
genera of flies in the neighbourhood of certain localities where refuse is accumulated. Dr. Hamer's
report on this subject is appended (see Appendix IV).
Two special outbreaks of diarrhoea are recorded in the annual reports. The first occurred in
a rescue home in Chelsea where, Dr. Parkes states, 23 persons out of 31 inmates were attacked with
severe diarrhœa and sickness. The staff numbered eight, all of whom remained well. The evidence
pointed to infection on a particular day in September on which cold mutton and cold gammon of bacon
were eaten at the mid-day meal. One death occurred and bacteriological investigation of the blood
and internal organs of the deceased showed the presence of large numbers of the bacillus of Gaertner.
The other outbreak occurred among the waitresses of a restaurant in Holborn, ten of whom, together
with two men, were attacked with severe vomiting, diarrhoea and fever. Inquiry by Dr. Bond
showed that all of them, with one doubtful exception, had consumed milk in the form of junket, or
custard, or both, and these were the only articles eaten in common. It was impossible to ascertain
the farm from which the milk was derived.
Erysipelas.
The deaths from erysipelas in the Administrative County of London during 1909 (52 weeks)
numbered 1801, as compared with 160 in 1908 (53 weeks).
The age-distribution of such of these deaths as belong to London was as follows —

1 Bee footnote (2), page 45. The fully corrected deaths during 1909 number 176, but the corresponding figures
for previous years are not available. 2 See footnote (2), page 6.
(Continued on next page).