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The highest number of cases proportional to population were in
the North River, Dockyard, and St. George's Wards, and the lowest
in the Central, Herbert, and Burrage Wards. North Woolwich has
for the past five years had a specially high incidence of diarrhoea.
Table 3 shows the condition of the houses affected as regards
crowding and cleanliness. Only 11 houses were found to have more
than 2 persons to a room, but 45 more were found to have more than
1½ persons to a room, 39, or 18 per cent. were found more or less dirty.
Table IV. shows the manner of feeding of all cases under one
year of age. Only 15, or 12 per cent. were fed on the breast alone,
and 10, or 8 per cent. on breast, and other food. The remaining 82
per cent. were fed on fresh cow's, or Nestle's condensed milk, one
only having milk bought as sterilized milk. Thus 20 per cent. were
fed wholly or partially on the breast. In an inquiry made last year,
it appeared that of average children, 82 per cent. were fed wholly or
partially on the breast. It follows that an artificially fed child is 18
times more likely to be affected with diarrhoea than a child fed only
or partially at the breast. In my report on summer diarrhoea previously
referred to, I estimated that an artificially fed child was 45
times more likely to die of diarrhoea than a breast fed child.
Table Y. shows the cause of weaning of 120 cases which were
weaned under the age of six months. It appears from this Table
that only 7 children were weaned on account of the mother going to
work. 98 children were weaned owing to the failure of the milk,
from death, or illness of the mother, or from other cause.
Action taken. All the cases notified were visited—most by the
Lady Inspector, and a large number also by myself. A leaflet of
instructions was left and explained. This leaflet is appended to the
Report. On it instructions are given as to cleanliness, feeding of
infants, disinfection, and other matters. Mothers were particularly
directed to wash their hands before preparing baby's food. If any
insanitary conditions were found at the house the usual steps were
taken for remedying them.
Source of Infection. Some probable source of infection was discovered
in 41 cases, viz.: mother in 2; sister, 2; brother, 3; wife, 1;
lodger, 6; neighbour, 19; visitor, 1; imported from outside the
Borough, 1. Flies were specially complained of in 2 cases.
Duration of Illness. The average duration of illness in the cases
that recovered was six and one-third days, and in those that died
eleven and one-half.
Results of Notification. It is always difficult to estimate the
results of a sanitary measure taken. Improvement may be due to
many causes, and not necessarily to the one under consideration.
Failure to obtain improvement, on the other hand, may occur through
opposing conditions, in spite of the particular sanitary measure
having had its due effect. As far as can be judged, however, the
effect of notification, and the accompanying steps, have been decidedly