MILK-BORNE DIARRHCEA 225 



ing 146 patients, and there was evidence on this occasion also that 

 the medium of infection had been milk. On 5th August 1898, a 

 third outbreak affecting 84 patients and 2 nurses took place at the 

 same hospital, the vehicle of infection in this instance being some 

 rice pudding made with milk, also said to contain an organism 

 similar or identical with the B. enteritidis sjoorogenes. There can be 

 no doubt that milk was the agent of infection in each of these three 

 outbreaks. It was in these outbreaks that the £. enteritidis sporogenes 

 of Klein was isolated and held to be the specific organism. Dr Klein 

 has produced evidence in behalf of this bacillus being the true cause 

 of epidemic diarrhoea.* 



Other similar outbreaks are on record traceable to contaminated 

 milk. Nor is the evidence on this subject derived only from epidemics. 

 Newsholme has shown that of the fatal cases of diarrhoea in children 

 only 9 '4 per cent, occur in children which have been breast-fed.-f 

 In Finsbury 20 per cent., in Kensington 35 per cent., and in Croydon 

 12 per cent., were breast-fed. From such figures it is evident that 

 most of the deaths of infants from diarrhoea occur in children who 

 have been hand-fed. This fact is now widely accepted. In one of his 

 official reports | Dr Hope, of Liverpool, states that " the method of 

 feeding plays a most important part in the causation of diarrhoea : 

 when artificial feeding becomes necessary, the most scrupulous 

 attention should be paid to feeding-bottles." Careless feeding, in 

 conjunction with a warm, dry summer, invariably results in a high 

 death-rate from this cause. These two causes interact upon each 

 other. A warm temperature is a favourable temperature for the 

 growth of the poisonous micro-organism; a dry season affords 

 ample opportunity for its conveyance through the air. Unclean 

 feeding-bottles are obviously an admirable nidus for these injurious 

 bacteria, for in such a resting-place the three main conditions 

 necessary for bacterial life are well fulfilled, viz., heat, moisture, and 

 pabulum. The heat is supplied by the warm temperature, the 

 moisture and food by the dregs of milk left in the bottle ; and the 

 dry air of summer assists in transit. It becomes clear that diarrhoea 

 is, in part at all events, due to polluted milk, polluted by dust or 

 flies, directly or indirectly, at the farm or in the home. 



Del^pine has urged that milk is infected at the farm or in transit, 

 as many of the milks which he examined and proved to be virulent 

 had not been exposed to any influence attributable to a consumer's 

 home, but were in fact infective before they reached the consumer. | 



* Reports of Medical Officer of Local Qovermnmt Board, 1895-96, 1896-97, 1897-98, 

 1898-99. 



t Report on Health of Brighton, 1902, p. 50. 

 X Report of Health of Liverpool, 1899, p. H. 

 § Jour, of Hygiene, 1903, p. 86. 



P 



