SUMMER DIARRHCEA I49 



CHAPTER XIV 



EPIDEMIC OR SUMMER DIARRHCEA 



Epidemic or summer diarrhcea is a term applied to an 

 affection marked by a somewhat definite group of symptoms, in 

 which vomiting, copious diarrhcea, rice-watery and green stools, 

 and finally convulsions play a conspicuous part. From the studies 

 of a large number of histories Ballard (1889) concluded that he 

 was dealing with a definite disease, and observers since his time 

 have been of the same opinion. Yet no doubt enteric fever and 

 other diseases of infants are often mistaken for it. " Whether 

 summer diarrhcea is produced by a definite micro-organism or is 

 an illness conditioned by several allied bacilli, it is a clinical entity 

 possessing a very definite course, and as such is susceptible of 

 study" (Niven, 1910, p. 133). It is a disease, which occasions 

 great mortality among infants under five years of age, but also 

 produces symptoms, though of a less marked character in older 

 persons. Between infancy and old age the fatality is so slight, 

 that its widespread distribution escapes attention. " As a rule 

 the sufferer is able to go out to the closet, a fact which may 

 prove of considerable significance." 



It is doubtful whether many people realize the full extent of 

 the ravages of the disease. In the United States, and in Great 

 Britain, and in many European countries the general death rate 

 is largely dependent on the infant mortality, a very large pro- 

 portion of which is due to epidemic diarrhoea. In the registration 

 area, for example, of the United States 189,865 children under 

 five years of age died in 1908, and of these 52,213 died of epidemic 

 diarrhcea (Howard, 1911, p. 157). 



From time to time various hypotheses, which need not be 

 summarized, have been put forward connecting the disease with 

 emanations from the soil, atmospheric conditions, etc. It is 

 now generally admitted that the disease is infectious, but up to 

 the present the infective agent has not been identified with 



