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29
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 gastro-enteritis) the bulk of which ought certainly
to be attributed to epidemic diarrhoea.
The different counties of England vary very widely in
the proportions 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 thousand births, the enteritis death-rate as 12 per
thousand. But in East Yorkshire, the proportions are
35 per thousand from diarrhoea, and 9 per thousand from
enteritis while in Cumberland they are 10 per thousand
from diarrhœa, and 14 per thousand from enteritis.
Dr. Tatham further points out that the fashion of
discarding the familiar name "diarrhœa" in favour of
such unsatisfactory and unauthorised names as "gastroenteritis,"
"gastric catarrh," &c., 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.