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Notification of Diarrhoea.—In Woolwich a system of notifying diarrhoea during the summer
quarter has now been in force since 1905. If similar effort to ascertain the facts were made elsewhere
material of great value would soon be available. Dr. Sidney Davies, medical officer of health of Woolwich,
has prepared a report on 844 cases notified in the years 1905-8, and he indicates some of the
directions in which advances in knowledge may be looked for.
Two interesting points, raised by Dr. Davies, may be here referred to. With regard to evidence
of protection afforded by a first attack, the Woolwich figures show that there were notified a second
time three children in 1906, one in 1907, and again only one in 1908. If the attack-rates of each year
be applied to the populations attacked and escaping in the previous year, it will be found that the
numbers three and one and one are those which might have been predicted on the supposition that
the question was one of mere chance. Thus, at most, it could only have been expected that two children,
attacked in 1906 or in 1907, would have again been notified in 1907 or 1908. The fact that
there was only one such case in each of those years does not justify the conclusion that a first attack
affords protection. A further point made is the lack of evidence of special incidence of diarrhoea
in the neighbourhood of dung-pits. This tallies with similar observations on a larger scale made by
Dr. T. Orme Dudfield in Kensington, and by Dr. Harris in Islington, and again with inquiries made
in 1908 with the co-operation of Dr. Porter in Finsbury (See Report on Flies, 1908, p. 5). The fact
has special interest in connection with the question as to whether flies act as carriers, having in view
the close association of Masca domestica with collections of stable manure.
Direct infectivity.—In conclusion, it may be remarked that a subject which especially demands
study is, how far infectivity from case to case plays a part in determining prevalence of diarrhoea.
Dr. Ballard said the disease "is usually regarded as non-communicable"; but he added, "communicability
is a quality not unknown among cases of epidemic diarrhoea." He cited some remarkable
observations made on this subject by Dr. Bruce Low, and these are often quoted. It is deserving
of note, therefore, that the outbreaks occurred in country districts, and three of the four in May
February, and December respectively. The fourth, it is true, prevailed from September 8th to the
beginning of December, 1886, but this is late for summer diarrhoea, which attained its maximum in
that year in the third week of July.
Dr. Niven (Annual Report, 1904) has, however, made a study of instances of possible case
to case infection in Manchester, and quite recently a critical review of the whole question has been
made by Dr. Sandilands (Proc. Roy. Soc. of Med., 1910). The difficulty which has to be faced is
that of determining, in the event of several members of a family being attacked by diarrhoea, whether
one has infected the other, or whether all are alike attributable to some common cause. There is
evidence, bearing on the question, from institutions, but this evidence is very conflicting. (See, for
example, a paper by Dr. Ralph Vincent, " The Etiology of Zymotic Enteritis," 1910.) Further
observations are much needed : the belief that case to case infection has large importance is commonly
entertained, but the arguments against this view cannot be ignored. The question in dispute is
intimately bound up with that as to the part played by the fly. Until a final decision is arrived at
it is well not to forget that prevention involves, as the President of the Royal College of Physicians
has said, "something more than the circumvention of a bacillus." It may well be argued that if this
holds good of diseases of so called "established bacteriology," it may not unprofitably be kept in
mind also in connection with diarrhœa.
There are three considerations which especially emphasize the importance of strengthening
resistance and influencing general conditions of environment. Firstly, fatal diarrhoea mainly occurs
in young infants, in whom the incidence is especially marked, in the heavily invaded towns at any
rate, at a particular age, say from three to six months. Secondly, fatal diarrhoea preponderatingly
occurs in particular hot weeks, and, thirdly, heavy death-rates from diarrhoea are closely associated
with special domestic and social conditions.
Dr. Newman (Infant Mortality, 1906) says it has not been necessary, in the intervening years
since 1858, greatly to modify the view then expressed, by Sir John Simon, that " infants perish
under the neglect and mismanagement which their mothers' occupation implies." This opinion is,
on the whole, confirmed by recent experience, which goes to show that much more can be accomplished
by combating the special domestic and social evils in question, than by attacking either a hypothetical
organism or its supposed carrier the house-fly.
Part 2.—A Statistical Record op the Results op Routine Inspection of Beds in Common
Lodging Houses for Vermin.
During 1908 an attempt was made to record week by week, on a uniform basis, the extent to
which beds in common lodging houses yielded evidence of the presence of fleas, bugs, and [lice.
In each of eleven inspectors' districts ten beds were examined daily, on five days out of seven
making a total of 550 beds weekly, In the case of each bed the sheets were carefully scrutinised
for lice and the beds were divided into four classes—
Those on which one louse was discovered.
Those on which two lice were discovered.
Those on which three lice were discovered.
Those on which more than three lice were discovered.
The percentage of beds belonging to the last class varied from nearly 8 per cent. in February, to
about 2 per cent. in June. The actual numbers relating to these (the very verminous beds) are small,
and for the purpose of determining the seasonal prevalence of lice it is preferable to deal with the
much larger figures obtained by grouping together all four classes above named. The figures giving