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22
Scarlet Fever has become in recent years a much milder complaint.
Like measles, it falls most heavily on children under five
years of age, which points to the importance of protecting such
children from exposure to infection. Dr. Newsholme states that
"chief among such means of infection is the attendance of children
in the infants' class at school long before the age at which compulsory
school attendance begins."
As far as could be traced no scarlet fever milk outbreak occurred
in the District during 1899, and no school had to be closed on
account of scarlet fever.
Diarrhoea.—Under this term is included all forms of Diarrhcea,
and also gastro-enteritis, for the reason that they are not separable
and probably are due to the same cause.* In all 126 deaths were
attributed to Diarrhoea during 1899, 108 of these were infants under
one year of age. This gives a death-rate for Diarrhoea of 1.9 per
1,000, which is less than the year before, when it was 2.02 per 1,000.
The rate for the whole of London was o.93 per 1,000. So that it will
be seen that Clerkenwell is considerably above the average.
The exact cause of Epidemic Diarrhoea is not at present known.
In a report to the Local Government Board in 1888 Dr. Ballard
attributed the disease to one or more of the following conditions:—
1. Soil and Climatic Conditions.—When the four-foot earth
thermometer reaches 56° F., the summer rise of epidemic
diarrhoea commences. Atmospheric temperature and rainfall
exert an indirect influence as they affect the temperature
of the soil. A loose permeable soil, habitually damp,
and polluted with organic matter and other refuse, due to
"made soils," town refuse or sewage leakage, is particularly
favourable to epidemic diarrhoea. Possibly such
soil contains the ferment or microbes causing the
disease.
*The Royal College of Physicians has recently (1900) laid down that
"gastro enteritis," "muco enteritis," "gastric catarrah," and such synonyms of
epidemic diarrhoea in medical certificates of death should be discarded. The
College of Physicians authorize the use of the terms "Epidemic Enteritis" or
"Zymotic Enteritis" or "Epidemic Diarrhoea," to represent the condition.
There can be no doubt that some such standard will prove of great value in the
future.