REVIEW — TROPICAL . MEDICINE, ETC. 39 



(1) Clean milk supplies ; (2) Clean towns with well-organised system of sewage removal, dust Diarrhoea- 

 collection and disposal, and street watering ; (3) Clean homes where sufficient domestic continued 

 hygiene prevails to permit an understanding of the importance of clean utensils for food, the 

 covering over of food to protect from dust and flies, and personal habits of cleanliness ; 

 (4) Inhibition of fly life." 



In a later paper'* he states that there is no one specific micro-organism of diarrhoea and 

 that he is not convinced that breast-fed infants are really liable to epidemic diarrhoea. 

 Thus, amongst 138 deaths of infants under one year of age, there were 68 deaths from 

 diarrhoea in hand-fed infants and not a single death from diarrhoea amongst the 28 who had 

 been entirely breast-fed. 



Hewlett- agrees on most points with Nash, admits with him that there is no specific 

 micro-organism, but again states that the B. dysenteriie is the causative organism in a large 

 proportion of the cases, other organisms, such as B. coli, Proteous vulqaris, Streptococci, 

 B. pyocyaueus, and perhaps others, being operative in the remainder. He thinks that 

 infection of the food takes place mainly in the homes. 



GrifiQth'''* notes that bacteria of the lactic acid-producing group clearly exert an 

 inhibitive influence upon some of the milk bacilli which are specially dangerous to infants, 

 and concludes that this explains the value of milk purposely soured by adding the lactic acid 

 bacillus — for instance, buttermilk, which is useful in diarrhoea. He thinks that heat also 

 plays a part in infantile diarrhoea by its depressant action on the nervous and vaso-motor 

 systems and by its interference with the digestive processes. 



Sandilands'' considered epidemic diarrhoea in its relation to the bacterial content of food 

 and dealt with cow's milk and food other than natural cow's milk, especially Nestle's milk. 

 He quotes Hope, Eustace Smith and Cautley to the effect that living bacteria are found in 

 condensed milk, that such milk rapidly breeds bacteria even when still apparently fresh, and 

 becomes unfit for the child's consumption, and that tins of condensed milk once opened are 

 liable to decompose rapidly, especially in hot weather. His general conclusions are as 

 follows : — 



1. lu proportion to the number of consumers, Nestle's milk containing comparatively tew bacteria is 

 more frequently associated with diarrhoea than cow's milk in which the number of bacteria is phenomenally high. 



2. In certain seasons cow's milk may be exposed to temperatures which favour a high bacterial count 

 and yet not become a fi-equent source of diarrhcea. 



3. The numbers of bacteria in preserved and natural cow's milk have no direct influence on the 

 incidence of diarrhcea. 



4. The groat majority of cases of diarrhoea arc due to the consumption of food which has been infected 

 iu the district in which the cases have occurred. 



5. The infective matter thug conveyed to food is generally the excrement of some person suffering from 

 diarrhcea. 



6. The life history of house-flies and the facility with which they can convey the fsecal excrement of 

 infected infants to food of the healthy suggest that the seasonal incidence of diarrhoea coincides with and 

 results from the seasonal prevalence of flies. 



Newsholme's views'' coincide in large measure with those already detailed. He states 

 that breast-fed infants have only one-tenth of the average proclivity of infants to fatal 

 diarrhoea, and suggests that possibly toxic products of bacterial action may be operative both 

 in fresh and condensed milk infection, and that the latter may be derived from the farm and 

 not the domestic in all cases. Most of the evidence, however, is against this supposition. 

 The whole question of the causation of infantile diarrhoea is yearly becoming of greater 

 importance in Khartoum and other towns in the Northern Sudan, for while the native 

 breast-fed child is not likely to be a sufferer, the infants of the lower class Europeans of 

 various nationalities may and do fall victims to the disease. In the summer of 1907 there 

 were a considerable number of cases of infantile diarrhoea in Khartoum. While these cases 

 were doubtless due largely to contamination of milk, I have no doubt that improper feeding 



1 Nash, J. T. C. (May, 1906), Practitioner. 



- Hewlett, R. T. (August, 1905), " The Etiology of Epidemic Diarrhoea." Journal of Preventive Medicine, 

 p. 496, Vol. XIII. 



» Griffith, J. P. C. (July 15th, 1906). Therapeutic Gazette. 



* Sandilands, J. E. (January, 1906), "Epidemic Diarrhcea and the Bacterial Content of Pood." Journal of 

 Hygiene, p. 77, Vol. VI. 



" Newsholme, A. (April, 1906), "Domestic Infection inEelation to Epidemic Diarrhcea." Journal of Hygiene, 

 p. 139, Vol. VI. 



• Article not consulted in the original. 



