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Zymotic Enteritis or Summer Diarrhoea.—This disease may be described briefly as an acute
inflammation of the lining membrane of the intestines which is infectious or contagious and which
is apt to appear in epidemic form during the Summer months, particularly amongst infants.
Causation.—Although the etiology of zymotic enteritis or Summer diarrhoea is still obscure in
several respects, many facts are known about its predisposing and exciting causes.
The principal predisposing causes are three in number.—
(1) High Mean Atmospheric Temperature.—When, in a town, the temperature of the air is
constantly above 60F., the mortality from the disease is generally high. It has also been
observed that the death rate does not become high until the mean temperature of the earth,
taken at a point four feet from the surface, has attained 56°F. The hotter and drier the Summer,
the greater will be the infant mortality from diarrhoea.
(2) Early Age.—The disease is one of childhood, occurring almost exclusively during the
first two years of life.
(3) A weakened and deranged condition of the lining membrane of the stomach and
intestines.—Babies on the breast are affected less frequently than those who are hand-fed ;
those who are badly nourished and those whose digestive organs are irritated by improper
feeding are especially liable to be infected and to suffer severely.
The exciting cause is a multiplication of micro-organisms in the alimentary canal.
In the causation of this disease it has hitherto been held that there is not a specific microorganism,
as there is in tuberculosis, but that any one or more of a large class of germs may produce
the symptoms. These bacteria multiply enormously, and their products act as severe general
poisons as well as local irritants to the lining membrane of the digestive tract.
In the great majority of cases the germs are introduced along with cow's milk. Milk is a congenial
medium for them to grow in, and they multiply and flourish in it both inside and outside the
child's alimentary canal.
Symptoms.—The disease may be met with in the extremely acute form, called " holera
infantum" because of the close resemblance which its symptoms present to those of real cholera,
or in the less severe variety which resembles a severe attack of dyspeptic diarrhoea and vomiting.
The cases which are met with in Kensington and throughout the country are mostly of the latter
type.
The patient is in the majority of cases a hand-fed baby, sometimes he seems in good health
when the severe symptoms commence. Very often, however, he has been suffering for some time
from digestive disturbance, so that the diarrhoea and vomiting appear as an exacerbation of a chronic
or sub-acute attack.
Before the vomiting and purging begin, the patient is restless and distressed, and his temperature
is raised. After a few hours of discomfort, the child vomits, first undigested food, and later watery
mucus tinged with bile. Any fluid given to allay thirst is at once returned, and soon the diarrhoea
commences. At first, ordinary motions are passed. The motions succeed one another rapidly;
their yellow colour changes to pale green, grey, or brown, and they are very offensive. There may
be ten, twenty, or more motions in the twenty-four hours.
The child loses flesh very rapidly, his eyes sink in, and he is exhausted by the repeated purging
and vomiting.
Treatment and Prevention.—Under suitable treatment, the diarrhoea and vomiting gradually
cease, and the child is convalescent after a week or less. If the case is neglected, or the attack
a severe one, it may prove fatal in a very short time.
It will be convenient to mention here that the milder cases of this disease are difficult to distinguish
from simple diarrhoea or enteritis and the physician sometimes finds it impossible to make
a distinction. As mentioned before, there is not one specific micro-organism responsible for zymotic
enteritis, but any one of a number may produce it; therefore it is impossible to secure a diagnosis
by bacteriological examination as in the case of such diseases as typhoid fever, diphtheria, tuberculosis
and so on. In these circumstances, the available statistics in regard to zymotic eureritis
require to be read with great care, for it is undoubted that many cases of zymotic enteritis are classified
as simple non-infective enteritis or gastro-enteritis whilst, on the other hand, many of these simple
cases of enteritis are classified as belonging to the infective or zymotic form. Subsequent tables
in th:s report, showing the names which have been used by medical men in bringing cases of enteritis
to my notice, serve to demonstrate the difficulty which they experience in deciding on the correct
name to give to cases of enteritis in children.