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the incipient symptoms in these cases made it difficult
for the medical attendant to be quite definite in his
diagnosis and as time slipped on the duty of notification
was forgotten.
Epidemic Diarrhoea.—A small outbreak of epidemic
diarrhoea occurred in Fulham, commencing at the
beginning of October, 1924, and lasting until the end of
January, 1925. This outbreak is worthy of attention,
as the majority of cases occurred during December and
January, two months which are not as a rule associated
with outbreaks of infantile diarrhoea. Altogether 23
cases were notified in October, November and December,
1924, and nine in January, 1925, making a total for the
period of 32. There were 11 deaths, giving a case
mortality of 33-7 per cent. Of the total cases, no
less than 29 were notified by the Fulham Hospital.
It was necessary, firstly, to endeavour to establish
whether these cases were true cases of epidemic diarrhoea,
and secondly, if so, how and where they were becoming
infected. I had three consultations with Dr. Parsons,
Medical Superintendent of the Hospital, on the subject,
and I went carefully through the medical history of all
the cases which occurred during December and January,
that is to say when the outbreak was at its height.
Out of 21 cases which occurred during that period and
were admitted to the Fulham Hospital, I am of the
opinion that nine of these cases would certainly have been
notified as true epidemic diarrhoea had they occurred
as individual cases. The other 12 would not, I think
have been so diagnosed, had it not been that they
occurred in the Hospital or were admitted to the
Hospital during the period of the outbreak. These
latter cases undoubtedly suffered from gastric derangement
and diarrhoea in some degree, but both Dr.
Parsons and I are of the opinion that the diagnosis of
true epidemic diarrhoea was in these cases doubtful.
An interesting point is that in eight of these cases
there appeared to be a definite relationship between
the diarrhoea and an attack of bronchitis, the bronchitis
being the first signs of illness. The history of a case
typical of several which were admitted to the Infirmary
about this time is as follows :—