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Infirmary from 14, Bolton Road, died of diarrhœa on October 11th. For two months from July 1st
the food of infants and adults in the two debased areas of Netting Dale and Bolton Road had been
been exposed to the same tropical heat, but prior to August 31st the Bolton Road district escaped,
whilst Notting Dale suffered a heavy death-rate from diarrhoea. This delay in the onset of the
epidemic in a particular district strongly suggests that diarrhoea is an infective disease, and that the
escape of the Bolton Road area was due to the absence of the infective agent in the neighbourhood
during the earlier weeks of the epidemic.
In the Holland Ward there is an area lying east of Campden Hill Road and south of Notting
Hill Gate, which contains a working class population of several thousand persons with large
numbers of young children and infants. This district, with a row of small cottages in Bulmer
Terrace behind the northern side of Notting Hill Gate is completely cut off on every side from
contact with poor neighbourhoods by extensive areas containing residences of the best class with
large private and public gardens. In the whole district only one death was registered as due to
diarrhoea, and this death in an infant aged 11 months did not occur till September 2nd. Earlier
in the summer an old man aged 92 was removed from a house in the same district to the infirmary,
where he died on July 8th. The death was registered as due to "simple enteritis"; it occurred
before there had been any sustained rise in the atmospheric temperature, and was probably
correctly attributed to diarrhoea of a non-infective type. If this death be neglected, we have a
second instance of a district inhabited by the working classes which escaped attack by fatal
diarrhoea for more than two months, and the facts again admit of the explanation that the absence
of diarrhoea was due to the absence of the necessary infecting agent. On the other hand the
immunity of the district in question may have been in some measure due to social status, since the
inhabitants, though poor, are on the whole markedly superior to the great majority of the working
classes who live in the Golborne and Norland Wards; but if this be so, the conclusion cannot be
avoided that a very low standard of comfort, domestic cleanliness and nursery hygiene is sufficient
to prevent epidemic diarrhœa.
From the table of deatns from diarrhoea in the various Wards it will be seen that only 4 fatal
cases occurred in the Ward of Holland during the epidemic. In one case the death of a man, aged
30 years, was attributed to mucous colitis, from which the patient had suffered for four years. A
second case was that of the old man already mentioned, who was removed from the district in the
Holland Ward, behind Notting Hill Gate, and died in the infirmary at the age of 92, from simple
enteritis.
Some 250 births are registered annually as occurring in Holland Ward, so that the lives at risk
in this district among the child population under 3 years of age may be assumed to have numbered
at least 600, and yet only two children died of diarrhoea, one at the age of 10 months and the other
at the age of 11 months. Under the age of 1 year the mortality was thus equivalent to 8 deaths
per 1000 births as compared with an infantile death rate of 38 per 1000 in the Borough as a whole,
whilst the working classes, among whom the number of young children is comparatively great,
constitute one-third of the total population in this Ward where the mortality from diarrhoea was
so remarkably low. There is no reason to suppose that there is any material difference in the
quality of the milk and other foods supplied to the working classes in different parts of the Borough,
but the crowding together of tamilies in small houses which may contain four or five separate
tenements is much more frequent among the working classes in North Kensington. Under these
circumstances, on the assumption that diarrhaea is an infectious disease, the mortality in the northern
half of the Borough may be explained by the readiness with which the infective agent may be conveyed
from sick persons to the food of healthy children in their immediate neighbourhood. On the
same assumption the immunity of the working classes in Holland Ward may be explained partly by
the absence of the infective agent and partly by the absence of crowding of persons on space and in
houses which materially diminishes the opportunities for infection to spread from the sick to the
healthy.
Prevention of Epidemic Diarrhœa.—Until the causes of summer diarrhoea have been
ascertained, the measures to be adopted for its prevention must be to some extent empirical. The
printed instructions which are given to mothers by the Health Visitors recommend that in hot
weather milk should be sterilised by boiling and kept in a cool place in a clean jug, which is to be
covered in order to prevent contamination by dust and flies. The importance of domestic cleanliness,
of breast feeding and the proper use of cow's milk is impressed on mothers by the Health
Visitor, and the same lessons are taught at the centres for infant consultations. It is on this
teaching and on attention to the sanitary state of homes throughout the year that the prevention of
diarrhoea chiefly depends. The daily removal of house refuse is a sanitary measure of the first
importance which has not yet been undertaken, but which becomes more and more urgent as the
number of housewives increases who are prevented from burning waste vegetable and animal
matter by the substitution of gas stoves for coal fires. Among direct measures may be mentioned
the publication by the Council of a leaflet on the prevention ot diarrhoea which was distributed by
post among 2,000 mothers in 1911, and which will in future be left in the homes and
supplied at the schools for mothers in the late spring and during the summer months.