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95
[1899
This second group of cases ought, he points out, for the most part, to be regarded
as identical with epidemic diarrhœa, inasmuch as their age incidence,
fatality curves, and general epidemiological characters correspond closely with
those of that disease.
In London, during the thirteen weeks ending with September last, the deaths
medically certified as due to diarrhoea numbered 3,798; but in addition there
were registered 2,289 deaths from enteritis, of which 1,880 were from gastroenteritis,
the bulk of which ought certainly to be attributed to epidemic diarrhoea.
The different counties of England vary very widely in the proportion of deaths
returned respectively as due to diarrhoea and to enteritis, presumably in accordance
with local fashion. Thus, for England and Wales as a whole, the
diarrhoea death-rate amongst infants appears as 25 per 1,000 births, the enteritis
death-rate as 12 per 1,000. But in East Yorkshire the proportions are 35 per
1,000 from diarrhoea, and 9 per 1,000 from enteritis, while in Cumberland they
are 10 per 1,000 from diarrhoea, and 14 per 1,000 from enteritis.
Dr. Tatham further points out that the fashion of discarding the familiar name
" diarrhoea " in favour of such unsatisfactory and unauthorised names as " gastroenteritis,"
" gastric catarrh," etc., is of comparatively recent growth. But during
the last fifteen, and especially during the last ten years, the fashion has prevailed
so extensively as entirely to vitiate the diarrhoea mortality returns, which, for
sanitary purposes, are of exceptional importance.
We therefore consider that the present confusion of terms renders it impossible
to determine accurately the prevalence of the disease in special places or at
special times, the extent to which it influences public health in general, and the
effects produced by sanitary measures.
3. We find that there is a widespread objection on the part of medical
practitioners to the employment of the term " diarrhœa" in certifying the cause
of death The term is generally held by the public to imply a mild disease, insufficient
by itself to cause death. This fact explains the reluctance of the
practitioner to employ it on the death certificate, since it may be conceived to
imply a stigma upon his own capacity. It is therefore desirable, if possible, to
substitute for it some name equally accurate, but conveying to the public the idea
of a more serious affection. But we regard it as essential that the idea of
specificity, intended to be conveyed by the term •'epidemic," should be retained,
4. Hence we would recommend the College to authorise the use of the term
" epidemic enteritis " (or, if preferred by the practitioner, " zymotic enteritis " as a
synonym for epidemic diarrhœa (Nomenclature of Diseases, p. 9, ed. 1896). And we
would further recommend that the College should urge the entire disuse
as synonyms of epidemic diarrhœa in medical certificates of death, of such terms
as " gastro enteritis," " muco-enteritis," or " gastric catarrh."
The report of the Committee was adopted by the College.