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The statistics of this important condition are set out fully
in Table XIII. Before the closing years of the nineteenth century
deaths which were undoubtedly due to "epidemic" or "summer"
diarrhoea were often attributed to some other cause—either as
the result of the cause of death which was filled in on the certificate,
or of the manner of allocating the cause of death certified. The
true importance of this condition as a cause of death of infants
and young children is therefore not seen until the period 1896-1900,
when the rate was 39.91 per 1,000 live births. No reduction took
place until the period 1916-1920, when the rate was halved, and
since that date the rate has again been practically halved. In
other words, whereas in this area at the beginning of the century
epidemic diarrhoea caused on an average about 370 deaths of
young children every year, it now causes about 40 deaths. The
actual number of deaths in any year naturally shows great variation.
After a hot dry summer more deaths are supposed to occur
than after a wet summer. Nevertheless, epidemic prevalence of
this disease is now a comparatively trivial affair to what it was
forty years ago.
There is no doubt that increasing attention to the proper
care of the young infant has contributed considerably to this
decline. In this way the establishment of infant welfare clinics
has played a part. Another important factor in the decline
is the reduction of horse-drawn traffic, and consequently in the
amount of stable manure and the number of flies. Urban areas
nearly always have a higher rate of mortality than rural areas, and
in this respect the local rates should be higher than those for less
dense centres of population. It is therefore satisfactory to note
that the West Ham five year rate has been proportionately much
more reduced than the corresponding rate for England and Wales.
A study of the number of deaths which has been caused
yearly by this condition in the last ten years should be sufficient
to convince the reader that, though it does not warrant the attention
of one of the "notorious" or "popular" infections, it is nevertheless
a very potent cause of death. Continued attention by each
individual and by the local authority to the cleanliness of the
district, and continued care on the part of each mother in the feeding
of her infant, are the most likely means of ensuring a further
reduction in the mortality.
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