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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 epidemic diarrhœa.
In other words Epidemic Diarrhoea is a so called " filthdisease,"
and preventable by improved sanitation and public
hygiene in the broadest meaning of the terms.
These diarrhoeal diseases would be largely prevented by
attention to the following three matters—particularly during
the summer months—(1) feeding of infants, instruction on
and regulation of children's feeding; (2) purification of the ground
and streets; and 3 ) purification as far as practicable of the milk
supply. I should like to find that sterilized milk is much more
widely used, and more care generally taken in respect to the
milk supply.
The whole question of the causes and prevention of Epidemic
Diarrhœa is one of such importance in a district like Finsbury
that I have paid special attention to the subject during the year.
At present there are two matters in particular to which reference
should be made. The first has relation to the effect of soil
temperature, and the second to the milk supply.
(a) Epidemic Diarræa and Soil Temperatures.— Ballard's
views on the relationship of earth temperature and Epidemic
Diarrhœa are as follows :—
(a) The summer rise of diarrhœal mortality does not commence
until the mean temperature recorded by the four-foot earth thermometer
has attained somewhere about 56° F., no matter what may
have been the temperature previously attained by the atmosphere or
recorded by the one-foot earth thermometer.
(b) The maximum diarrhœal mortality of the year is usually
attained in the week in which the temperature recorded by the fourfoot
earth thermometer attains its mean weekly maximum.
(c) The decline of the diarrhœal mortality coincides with
the decline of the temperature recorded by the four-foot earth
thermometer, which temperature declines much more slowly than