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The following case-histories illustrate the very strong probability that diarrhœa under certain
circumstances becomes capable of spreading from the sick to the healthy.
Case 9. On September 1 a boy, aged 2, developed diarrhœa and attended as an out-patient at
St. Mary's Hospital. On September 6 his baby-sister was seized with diarrhœa and vomiting. On
the previous dav, September 5, the baby of a woman in the next room developed an attack of
diarrhœa, which ended fatally on September 29. Since the middle of August this child had been
left during the whole day with the family in which the boy was taken ill on September 1. The
secondary cases appear to have been infected simultaneously by the boy aged 2. One was fed on
cow's milk, the other on Nestle's milk.
In case 14 two young children and their mother developed diarrhœa on the same date, October
8. They took condensed milk in tea, but no cow's milk. On October 15 the baby, aged 2 months—
a healthy, strong child—was seized with diarrhœa and died within forty-eight hours. It was fed on
the breast and occasionally given a little new milk.
Case 13 is of interest because it did not occur in the usual environment, but in a large house in
one of the best parts of Kensington. A baby, aged 8 months, was taken ill with diarrhœa on
October 5, and died on October 13. Five days later a lady, who had removed the soiled napkins
from the sick room and washed them, was seized with violent diarrhœa.
In Case 16 a woman, aged about 55 or 60, living in a basement with her son's family, developed .
diarrhoea on October 20. On October 24 the mother of the family fell ill. Her four children,
including a babv, aged 8 months, developed diarrhœa within the next few days. The baby was fed
on the breast with a little beef tea, but no cow's milk. A child, aged 3 months, living on the ground
floor of the same house, fell ill with diarrhœa on October 29 (five days after the second case in the
basement) and died within three days. This child was fed on condensed milk.
In Case 1 a baby, aged 16 months, living on the ground floor, was attacked with profuse
diarrhœa on September 10, and was treated by a medical man on September 17. A father and a
child aged 2, living on the third floor in the same house, fell ill with diarrhœa on September 23.
The attack in the father was accompanied by vomiting, and he was so bad that his wife does not
know how he continued to work. She herself was taken ill on September 30, and was up all night
with diarrhœa. By a very remarkable coincidence, a woman, age 52, living two doors off on the
same side of the street, was removed to the infirmary on September 25 with the most violent purging
and vomiting. She died within three days, the cause of death on the death certificate being
returned as " Simple enteritis."
The details of Case 2 are as follows: A girl, aged 2, living on the first floor, fell ill at the end
of the first week in September, the approximate date of onset being arrived at from the fact that
she was known to have been suffering from diarrhœa on the day when her mother was confined—
namely, September 9. The child was subsequently notified to me by the almoner of St. Mary's
Hospital. She was looked after by a neighbour, occupying the ground floor in the same house,
until her mother was able to return to her household duties after her confinement. On September
15 the neighbour's son, a boy age 16, was seized with the most violent diarrhœa. On the same day,
or the day following, the sister of the primary case, a girl aged 8, was attacked with diarrhœa. On
September 28 her baby-brother, aged 2, developed diarrhœa, and the following day the mother of
the primary case failed with the same disease in a severe form.
Prevention.—The infection of diarrhœa, whatever may be its source, is almost invariably
conveyed to the person attacked in food, and the food is more frequently contaminated in the home
than elsewhere. All milk should therefore be boiled and kept covered in a cool place. Since infants
fed on condensed milk are many times more liable to fatal diarrhœa than those who are fed on new
milk, the use of tinned milk in the diarrhœa season should be absolutely prohibited. Frequent and
thorough scavenging is another factor in the control of diarrhœa which is of the first importance.
The Medical Officer of the Local Government Board,* as the result of a detailed inquiry, has
shown that towns with the most perfect scavenging arrangements have the least epidemic diarrhœa.
Including the removal of house refuse and street washing under the head of scavenging, he found
that the removal of house refuse was the more important of the two, and suggested that it would
not be possible for local authorities to content themselves much longer with a removal of house
refuse at weekly intervals. On this evidence it must be admitted that so long as the present
system of weekly removal continues one of the most effective weapons for preventing a disease
which caused more than 1,000 deaths in the decennium 1896-1905 is being neglected. In the
City of Westminster daily removal has been substituted for weekly removal without any extra
cost, and in Wimbledon a similar change has been attended by an actual saving in the cost of dust
collection.
* " Public Health", vol. xii., p. 155. Study of Epidemic Diarrhoea, by A. Newsholme, M.D.