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7
judging from the information I obtained of mild cases
occurring in families where children had died. In old people
the disease seems to become again more fatal.
Causes and mode of spread.—Infancy, artificial feeding,
and high temperature, are seen to be three conditions attending
a high diarrhoea mortality. Probably also the occurrence
of these three conditions is necessary for a wide prevalence of
the disease. It is, however, now well known that none of
these conditions are indispensable. Cases of zymotic enteritis
do undoubtedly occur and prove fatal in children entirely
breast fed, in adults, and in the absence of a high temperature.
As its name implies, this is a germ disease, and the presence
of the micro-organism is the only essential factor. High
temperature acts in two ways by favouring the activity of the
germs and diminishing the resistance of the patient. Artificial
feeding also to the extent to which it is less nutritious than
human milk diminishes resistance, but probably the principal
reason why diarrhcea is so prevalent in bottle babies is the
facility that bottle feeding offers for the conveyance of the
infection from one patient to another. A mother who having
attended to some one suffering from diarrhcea without washing
her hands goes and prepares the baby's bottle, is almost
certain to infect the food. Other food besides baby's is likely
to be infected in this way, and no doubt is; thus various
members of a family are infected, just as often occurs when
Enteric Fever attacks a household where cleanliness is lacking.
Then again flies may carry the infection from a patient,
not only to others of the same family, but to neighbouring
households, and infect any food, such as fresh or condensed
milk which is standing unprotected. It may be too that the
food contained in the bottle acts as a good breeding ground
for the infection, causing it to multiply rapidly: this is a
matter for enquiry. Dr. Newsholme accounting for the
liability to diarrhœa of babies fed with condensed milk,