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frequently caused directly or indirectly by climate or by contaminated
food.
Briefly the main causes of the disease may be set forth as
follows: —
1. Soil and Climatic Conditions,—When the four-foot earth
thermometer reaches 50°F., the summer rise of epidemic
diarrhœa commences. Atmospheric temperature and rainfall
exert an indirect influence as they affect the temperature
of the soil. A loose permeable soil, habitually damp,
and polluted with organic matter and other refuse, due to
"made soils," town refuse or sewage leakage, is particularly
favourable to epidemic diarrhœa. Possibly such
soil contains the ferment or microbes causing the
disease.
2. Density of Population and Buildings.—Aggregation favours,
dispersion over a wide area disfavours the disease.
3. Insanitary Conditions.—Darkness, dirt and defective
tion of a dwelling favour the disease. Accumulation of
domestic refuse in ash-pits, dustbins, or on the street
may also exert a like injurious influence.
4. Food.—The storage of food, particularly milk, in improper
places, exposed to emanations from filth acts prejudicially.
Disease-producing organisms are thereby greatly increased
in the milk which also undergoes organic changes, giving
to the milk poisonous and irritating properties.
5. Maternal Neglect, etc.—Infants brought up by hand or bottle
suffer most heavily from fatal diarrhoea.
In other words Epidemic Diarrhoea is a so called "filth-disease"
and preventable by improved sanitation and public hygiene in the
broadest meaning of the terms.
In my opinion these diarrhoeal diseases would be largely prevented
by attending to the following three matters—particularly during the
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