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In reference to the causation of diarrhœa, the part played by the artificial feeding of infants
is discussed by many of the medical officers of health, thus in the reports relating to Paddington,
Kensington, Stoke Newington, Strand, St. Luke, and Greenwich this cause is mentioned. In Kensington
the medical officer of health inquired into the circumstances of 43 consecutive deaths of infants
due to diarrhoea, and found only three were suckled by their mothers, while 24 were first children,
a fact suggesting maternal inexperience. In the Strand each of the infants who died from this disease
was bottle-fed. Want of cleanliness either in the dwelling or the streets, the crowding of buildings
on area, find a prominent place among the causes to which the disease is attributed. In his analysis
of the circumstances of the 43 children referred to the medical officer of health of Kensington states
that about half the mothers went out to work. The family occupied the entire house in six instances,
four rooms in four instances, three rooms in eight instances, two rooms in sixteen instances, and one
room in nine instances. The top floor was occupied in fifteen cases, the first floor in ten, the ground
floor in six, and the basement in six cases.
Cholera.
The number of deaths attributed to cholera and choleraic diarrhoea during 1897 was 115, as
compared with 95 in 1896, and the number of cases of "cholera" was 38 during the same period.
In Paddington one case of cholera was notified which the medical officer of health describes as one of
severe diarrhœa and vomiting. "There were other illnesses of an indefinite character among the
members of his family." In Kensington two persons were received who had been passengers on board
the hired transport Nubia from Ceylon to Plymouth, cholera having occurred on board during the
voyage. Notice was sent to the medical officer of health of Kensington, who reports that the passengers
were well on arrival and so continued. One person proceeded to Battersea from the s.s. Britannia from
Bombay, a vessel on which cholera had occurred during the voyage. "The person and premises were
kept under due observation during the period of incubation, without any symptoms of the disease
appearing." The report of the medical officer of health of the Port of London shows that the
s.s. Nubia, referred to above, arrived at Gravesend on the 13th January. On the 1st January, while
the vessel was at Malta, a soldier on board was attacked with cholera and died the same day. On
the 2nd another case occurred which recovered. On the same day another soldier was attacked and
died on the 6th, another man taken ill on the same day died on the 9th, on the 9th another man
was attacked and died after the vessel's arrival at Plymouth. There were also four suspicious cases of
diarrhoea on the 3rd which recovered. The medical officer writes "the troops were carried in the 'tween
decks, a space usually filled with cargo, which was specially fitted for the purpose. The scuppers from
this space instead of running through the side of the ship or being blocked up, as is usual with troopships,
ran straight down into the bilges. This should never be allowed. No openings or pipes should pass
from any space used for living purposes directly into the bilges."
The report of the medical officer of the Port of London also relates particulars of the following
ships, which during their voyage had had cholera on board. On the 18th January the s.s.
Athens, of London, from Alexandria, arrived at Gravesend, when it was found that there had been
during the voyage four cases of sickness, which from their history appeared to be choleraic diarrhœa;
on the 13th March the s.s. Beeswing, of Newcastle, from Buenos Ayres, arrived at Gravesend and
reported a death from cholera on the voyage; on the 21st July the s.s. Wanderer, of Liverpool, from
Calcutta, arrived at Gravesend and reported six cases (two fatal) of cholera during the voyage; and on
the 27th August the s.s. Britannia, of Greenock, from Bombay, arrived at Gravesend, having had two
cases of cholera on board during the voyage. All necessary steps were taken in each case.
During the summer of 1897, as in previous years, inquiry was made by the Public Health
Department concerning cases of cholera and choleraic diarrhoea, and in three instances material was
submitted to Dr. Klein for bacteriological examination, but in each of these instances the results of
such examination were negative so far as the cholera vibrio was concerned.
The three cases were—
(i) A. R. S., æt. 17, living in Somerford-street, Bethnal-green, went as usual to her
work on August 11th. She was employed as a paper-sorter at a wharf in Horseferry-road.
During the dinner hour she ate an ice from a barrow in the street, and then had for dinner
meat pie, greens and potatoes. At supper at 10 p.m. she had bread-and-butter and tomatoes
and some ale, and after supper she went out and is said to have partaken of fried potatoes
and apples. She went to bed at 11.30 p.m. At 1 a.m. on the 12th vomiting and purging
set in, and when the doctor who was summoned saw her at 10.45 a.m., he found her collapsed,
and she died at 4.30 p.m. A post-mortem examination was made on the 13th by the
medical attendant, who found "the brain full of ecchymoses also ecchymoses on the apex of
the heart and in the right auricle; the pericardium was empty, the blood tarry, the lungs
collapsed, the spleen and kidneys congested, and the stomach full of fluid ; the intestinal canal
contained a green, creamy-coloured material with floccules in parts; the bladder was empty."
An inquest was held at the Bethnal-green coroner's court on the 14th, and the jury
found that death was due to English cholera. In some of the notices of the inquest which
appeared in the press the case was, however, stated to have been one of cholera, and some
alarmist rumours were circulated. Dr. Klein was therefore asked to make a bacteriological
examination, and he reported that the cholera vibrio was not found.
(ii.) J. F., æt. 30, of Picton-street, Camberwell, was admitted to the Camberwell
Infirmary between 5 and 6 p.m. on August 21st. Early in the morning of that day he had
been attacked with diarrhoea, vomiting and abdominal pain. Later, in the course of hie
illness, he had some pain in the thighs, but no characteristic cramps. On admission he was
in a state of collapse. The stools after admission became first green and then white and