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30
The great difference which is apparent between the figures for London and Shoreditch
given above is, without doubt, mainly determined by two factors, firstly, the
very great density of the population per acre in Shoreditch, which is about thrice that
of the metropolis, and secondly, the large proportion of poor persons resident in the
Borough. Poverty and overcrowding, it may be mentioned, are conditions favourable
not only to the prevalence of diarrhœa, but of other diseases which result in a high morality
amongst infants.
During the diarrhoea season this year special enquiries were made with respect to
132 of the deaths certified to have been caused bv diarrhoea or zymotic enteritis
amongst children under two years of age. Attention was particularly directed to the
manner of feeding and the sanitary condition under which they were being reared.
The chief forms of food used were cows' milk with water or barley
water, or cows' milk mixed with something to thicken it, such as boiled
crusts, rice, bread, or some patent infants' food, or condensed milk with water or barley
water and with bread, oatmeal, or some patent food to thicken. In a number of cases
the infants were too young for the form of food administered to them. It is noteworthy
that in eighteen instances the mothers went out to work and the children were
left to the care of others during their absence. With regard to the sanitary surroundings,
in nearly all the houses in which the deaths occurred the drainage arrangements
were satisfactory, or no serious defects were found in connection with them. In
eleven instances exception was taken to the paving of the ground in the vicinity of
the dwellings which was defective. The majority of the houses were in a cleanly condition,
some more so than others, but in only nine were they stated to be unsatisfactory
in this respect.
The infection of diarrhœa, a disease well known as being very fatal in young
infants, is conveyed through the medium of their food. If infants received. as they
ought to, nothing but the breast for the first seven months of the;r existence, their
food is not likely to contain the germs of diarrhoea during that period, as is liable to
happen when artificial feeding is resorted to. It follows, therefore, that the mortality
from diarrhoea amongst infants fed naturally upon the breast is likely to be low. This
assumption is borne out by the results of the enquiries. For of 61 infants under 7
months old who died from diarrhoea, 54, or 88 per cent., were being brought up . by
hand, that is, otherwise than at the breast, whilst it is not free from doubt that the
remainder were solely fed upon the breast.
After weaning, the risk of exposure to the infection of diarrhoea becomes a matter
for serious consideration. This risk can only be obviated1 when diarrhoea is prevalent by
strictest precautions in matters of detail in respect to the quality and purity of the children's
food, its preparation and its administration. Above all things, the utmost possible
cleanliness is absolutely necessary, both in person and dwelling.
MEASLES.
The deaths from measles numbered 60, all of children under five years of age,
of whom 35 were males and 25 females. The deaths were most numerous in Hoxton