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66
The establishment is used as a training place for nurses and
an institution where children are put out to live. Practically all
the children are illegitimate. The staff consisted of the matron,
a trained nurse and 18 probationers or pupils. A doctor attends
almost daily, and of course more frequently when an illness occurs.
At the end of last August, when the outbreak of Diarrhoea
occurred, there were 30 infants there.
The milk is supplied in sealed cans by a well-known and
highly respected dairy company. The drains had recently been
examined and relaid.
Up to the last week in August the place had been remarkably
free of Diarrhoea, but on August 28th, a child aged 5 months
was taken violently ill with Diarrhoea and Vomiting and died on
September 2nd. On August 29th, the second case occurred.
On September 1st, 2 cases occurred; on September 2nd, 2 cases;
on September 3rd, 4 cases; on September 4th, 2 cases; September
7th, 1 case, and September 9th, 1 case. Altogether 14 children
out of 30 were attacked with severe Diarrhoea, and 8 died.
During the first week in September, 9 out of the 19 nurses
suffered from Diarrhoea, but they all recovered.
The propositions formulated by Ballard in 1887 as a working
hypothesis that, would best accord with the totality of the evidence
then, still hold good to a very great extent. He held that the
essential cause of Diarrhoea resides ordinarily in the superficial
layers of the earth, where it is intimately associated with the lifeprocesses
of some micro-organism not yet detected, captured or
isolated.
The vital manifestations of such organism are dependent,
among other things, perhaps principally, upon conditions of
season and on the presence of dead organic matter which is its
pabulum.
On occasion such micro-organism is capable of getting abroad
from its primary habitat, the earth, and having become air-borne,
obtains opportunity for fastening on non-living organic material
and of using such organic material both as nidus and as pabulum
in undergoing various phases of its life-history.