154 MILK AND THE PUBLIC HEALTH chap. 



years. "While the death-rate has been steadily declining, the 

 infant mortality rate, until within the past few years, has not 

 shared in this decline. In spite of immense sanitary and 

 social improvements, children under twelve months old were, 

 up to a few years ago, dying as extensively as they did 

 seventy to eighty years ago. The infantile mortality rate is 

 still very high in spite of the recent decline. For example, 

 during 1908 one -fifth of the total deaths at all ages in 

 England and Wales occurred in infants in their first year 

 of life. 



As is well known, this infant mortality rate varies greatly 

 in different areas, being, for example, very high in mining 

 counties like Durham and Glamorgan, and low in essentially 

 rural counties like Somerset, Wiltshire, and Dorset. 



We have to consider sickness as well as deaths. As 

 Newsholme remarks : 



It is fair to assume, in accordance with general experience, that 

 the amount of sickness varies approximately with the number of 

 deaths ; and there can be no reasonable doubt that in the counties 

 having a high infant death-rate there is (apart from migration) 

 more sickness and a lower standard of health in youth and in adult 

 life than in counties in which the toll of infant mortality is less. 



One of the most important of the factors contributing to 

 infantile mortality is the ravages of epidemic diarrhoea, a 

 disease intimately related to an impure food supply. 



Epidemic diarrhoea is an acute infective disease which 

 occurs almost entirely (certainly always in its epidemic form) 

 in the summer, and which mainly affects children under two 

 years of age. Certain epidemiological features are universally 

 recognized, the chief being that it is a disease of the later 

 summer months, that it only occurs to any extent when there 

 is or has been immediately antecedently a high temperature, 

 that it is in the main an urban disease, and that it is more 

 prevalent in dry than in wet seasons. The disease is allied 

 to food-poisoning outbreaks in that it is an infection, often an 

 intoxication, of the gastro-intestinal tract. 



The infection is clearly conveyed by food, and is un- 

 doubtedly bacterial in nature, although at present no one 

 organism can be accepted as its cause. As regards causation, 

 its relationship to hand- feeding is an outstanding one, as 



