others which have yet to be exhibited by me, a working hypothesis or provisional explanation that would best accord with the totality of the evidence in my possession, bearing on the production of epidemic diarrhoea may be stated as follows: That the essential cause of diarrhoea resides ordinarily in the superficial layers of the earth where it is intimately associated with the life processes of some micro-organism not yet detected, captured, or isolated. That the vital manifestations of such organism are dependent among other things, perhaps principally, upon conditions of season and on the presence of dead organic matter which is its pabulum. That on occasion such micro-organism is capable of getting abroad, from its primary habitat the earth, and having become air-borne, obtains opportunity for fastening on non-living organic material, and of using such organic material both as nidus and as pabulum, in undergoing various phases of its life history. That in food, inside as well as outside of the human body, such micro-organism finds, especially at certain seasons, nidus and pabulum convenient for its development, multiplication, or evolution. That from food as also from the contained organic matter of particular soils, such micro-organism can manufacture by the chemical changes wrought therein through certain of its life processes, a substance which is a virulent chemical poison; and that this chemical substance is, in the human body, the material cause of epidemic diarrhoea. It will be observed that this provisional hypothesis is sufficiently elastic to include as a common cause of diarrhoea chemical products of bacterial life manufactured indifferently within or outside the human body. Elasticity to this extent of a provisional hypothesis has been necessary for the reason that in the present state of our knowledge certain cases and groups of cases of diarrhoea not distinguishable from epidemic summer diarrhoea, have now and again been found to possess the faculty of being directly communicable from person to person. It will be obvious that in the stools of such infective cases of diarrhoea the hypothetical organism causative of the malady may be looked for with good hope of success. (407) Practical Action to be Taken as Preventive of Diarrhea. The practical action a Medical Officer of Health should take in regard to diarrhoea is, in the first place, to ascertain from mortality statistics and from any registers of sickness which are accessible the localities and houses in which year by year diarrhoea mostly prevails. He will find that as a rule the same houses are attacked with remarkable regularity; to these houses he will direct his attention, and study drainage, water-supply and their general sanitary conditions. One of the main objects of his research will be the conditions under which food is stored. In the homes of artisans and the poorer class in cities, those who can afford but two or three rooms, it is useless to talk of a "pantry," the household food is put into a cupboard or simply exposed in the dwelling, or it may be sleeping room. In such cases contamination of the food is almost impossible to prevent, but much may be hoped from the people themselves. If the people of this class had the necessary knowledge, they would understand that it is unwise to buy in any stock of food of a fermentable character, such as sausages, meat, or milk; food only just sufficient for the day should be bought, the milk be at once boiled, and no food eaten without thorough cooking. In the better class of houses, besides the general details of drainage, ventilation, &c., special attention should be paid to the situation of the pantry, and it should be particularly noted whether the incoming air passes over any drain or foul collection of matter. The writer has known the air pouring into pantries and safes where food is kept derived from defective water closets, from close yards trapped with imperfect bell traps and from similar places. In some districts medical officers of health have distributed leaflets containing instructions to the people how to preserve their children and themselves from diarrhoea. They are told not to give their children any milk but that which has been boiled, to keep their food in a proper place, mothers never to suckle their children without first cleansing well the nipple, and when diarrhoea actually occurs to thoroughly disinfect the excreta. There can be little doubt that a certain proportion of the people to whom these leaflets are delivered, read and profit by the instruction. |