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death rate compares favourably with previous rates. It should
not however be forgotten that the London rate for 1902 was as
low as 0.53 per 1,000. Hence, there is still much room for
improvement in this particular district. It should be added, in
relation to nomenclature, that of the 83 certificates received 58
were returned as Epidemic Diarrhœa, and 25 as Epidemic
Enteritis. 41 per cent. of the cases occurred in the St. Luke
division, 28 per cent. in South Clerkenwell, and 31 per cent. in
North Clerkenwell.
Epidemic Diarrhæa is chiefly an autumnal disease of urban life,
affecting most largely the children of the industrial classes, and
frequently caused, directly or indirectly, by climate or contaminated
food. Briefly the main causes of this preventable disease
are generally held to be as follows :—
1. Soil and Climatic Conditions.—When the four-foot earth
thermometer reaches 56° F., the summer rise of
Epidemic Diarrhæa commences. Rainfall also exerts an
indirect influence. 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 favourably 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
ventilation 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 dust, dirt and emanations from filth,
is probably a great factor in producing the disease.
Disease-producing organisms are thereby greatly