Modern Statistics of Infantile Diarrhoea.

The first six months of registration of the causes of death in England and Wales, July-December, 1837, brought to light the following highest mortalities from diarrhoea, which are mostly in manufacturing towns, and especially in those of Lancashire and Yorkshire:

1837

Deaths by Diarrhoea

		3rd qr.	4th qr.
{	Manchester	164	47
	Salford	26	15
	Chorlton	63	14
{	Liverpool	142	49
{	West Derby	53	15
	Leeds	52	37
	Nottingham	43	4
	(besides dysentery	25	2)
	Dudley	45	52
	Wolverhampton	37	32
	Bolton	40	27
	Newcastle	35	25
	Sheffield	30	23
	Stockport	28	23
	Preston	21	20
	Wakefield	22	10
	Cockermouth	12	14

The returns were incomplete at first; and, for London, the figures of only three parishes are given:

	3rd qr.	4th qr.
Shoreditch	73	15
Greenwich	43	19
Kensington	35	13

Apart from the imperfect machinery of registration in the first years, the figures of mortality by infantile diarrhoea are incorrect owing to many such deaths having been certified as from “convulsions,” according to the old tradition of the Parish Clerks’ bills. Doubtless this goes on still to a considerable extent; but it will appear from the following comparative table for London that it masked the real amount of infantile diarrhoea to a much greater extent at the beginning of registration than afterwards.

London Mortalities from the beginning of Registration.

Years	Diarrhoea	Dysentery	Cholera	Gastritis and Enteritis	Convulsions
1838	393	105	15	881	3419
1839	376	79	36	843	2961
1840	452	70	60	977	2983
1841	465	78	28	957	2778
1842	704	151	118	996	2773
1843	834	271	85	874	2701
1844	705	125	65	818	2736
1845	841	99	43	707	2395
1846	2152	156	228	648	2086
1847	1976	—	—	—	2258

There is a progressive decline under “convulsions” and a progressive increase under diarrhoea. The year 1846 was undoubtedly marked by an unusual amount of choleraic disease; but the high level of the diarrhoeal deaths was maintained from that year, so that it is probable that some radical change had been made in the mode of entry. The nearly equal proportion of deaths from diarrhoea and from convulsions in London has continued since that time to the present, the former falling mostly in the third quarter of the year, the latter not unequally on all the quarters.

In all England and Wales during the first five and a half years of registration the deaths from diarrhoea were few compared with the numbers relative to population in later periods:

England and Wales
Years	1837 (6 mo.)	1838	1839	1840	1841	1842
Deaths from Diarrhoea	2755	2482	2562	3469	3240	5241

There is a break in the annual tabulations of the returns for four years from 1843 to 1846; when they are resumed in 1847, the diarrhoeal death-rate per million living is found to have apparently risen to an enormous height, at which it remained somewhat steady for a whole generation.

Annual average Mortalities per million living from Diarrhoea (and Dysentery).

England and Wales		London
1838-42	254	1838-40	274
1847-50	900	1841-50	782
1851-60	918	1851-60	1030
1861-70	968	1861-70	1040
1871-80	917	1871-80	949
1881-90	662	1881-90	749

From year to year the mortality has fluctuated enormously, as in the following list, the rise or fall depending for the most part on the kind of summer: e.g. that of 1893 was hot, and had an excessive mortality from infantile diarrhoea.

1866		18266
1867		20813
1868		30929
1869		20775
1870		26126
1871		24937
1872		23034
1873		22514
1874		21888
1875		24729
1876		22417
1877		15282
1878		25103
1879		11463
1880		30185
1881		14536
1882		17185
1883		15983
1884		26412
1885		13398
1886		24748
1887		20242
1888		12839
1889		18434
1890		17429
1891		13962
1892		15336
1893		28755

These large annual totals stand almost wholly for deaths of infants, according to the following table of rates per million living at the respective ages:

Mortality from Diarrhoeal diseases per million living at the age-periods.

	All ages	0-5	5-10
1851-60	1080	5263	229
1861-70	1076	5985	160
1871-80	935	5728	69

Three-fourths of the deaths are of infants in their first year. The middle period of life is comparatively free from this cause of death, but at fifty-five the ratio begins to rise again, and at seventy-five and upwards is almost as high, among the comparatively small number living in extreme age, as it was in infancy. Male infants die of it in excess of females, according to a very general rule of sex mortality. It is also according to rule that the ratio of female deaths approximates to that of males in middle life and old age.

The deaths from infantile diarrhoea fall in great excess upon the towns, and most of all upon the manufacturing towns and certain seaports. London, which almost certainly had a great pre-eminence in the 18th century in the matter of infantile deaths by summer diarrhoea, has lost it to a number of provincial towns, of which the following is a list in the order of the percentage ratios of their diarrhoeal death-rate per 1000 living under five years to their death-rates from all causes under five years (Decennial Period, 1871-80):

Percentages of Diarrhoeal death-rate in the death-rates from all causes under five years.

	Yarmouth	19·4
	Leicester	19·2
	Preston	16
	Worcester	16
{	Sculcoates	16
{	Hull	14
	Northampton	15
	Coventry	15
	Goole	14
	Leeds	13·7
	Birmingham	13·5
	Manchester	13
	Salford	13
	Norwich	13
	Wigan	12·7
	Hartlepool	12·5
	Nottingham	12·4
	Sheffield	12
	Hunslet	12
	Bolton	11·6
	Holbeck	11·6
	Stoke-on-Trent	11·3
	Stockport	11·2
	Liverpool	11
	Blackburn	10
	London, St Giles’s	10
	London, Whitechapel	9·6

The reasons for placing the towns in the above order will be found in the Table that follows, the significance of which will be pointed out after some other matters have been disposed of. Meanwhile it may be said that all these have diarrhoeal death-rates under five years greatly in excess of all England and of all London.

Table of English Towns with highest death-rates from Infantile Diarrhoea.

		Death-rate from all causes under five per 1000 living at the age-period	Death-rate from diarrhoea under five per 1000 living at the age-period	Deaths of infants under one to 1000 births	Birth-rate per 1000	Death-rate per 1000
	Liverpool	119·29	14·13	217	35·08	33·57
	Manchester
	(1871-73 incl. Prestwick)	103·82	18·84	207	38·97	31·46
	Manchester (1874-80)	103·52	11·23	190	40·78	32·16
	Preston	97·85	15·61	212	37·86	28·05
	Salford	95·96	12·44	184	42·39	27·65
	London, Whitechapel	95·83	19·24	181	36·42	33·03
	Holbeck	94·00	10·93	196	42·63	26·64
	London, St Giles’s	92·69	9·42	176	34·05	23·42
	Leicester	92·52	17·81	214	41·44	24·46
	Sheffield	91·22	10·96	183	42·50	27·41
	Blackburn	90·33	9·02	191	39·30	25·29
	Hunslet	88·35	10·75	192	44·52	25·49
	Leeds	87·47	12·02	188	39·33	26·04
	Wigan	87·28	11·13	172	45·70	25·77
	Stoke-on-Trent	86·76	9·91	189	43·29	25·80
	Birmingham	86·10	11·78	179	39·89	25·82
	Stockport	80·33	9·05	182	35·79	24·73
	Nottingham	79·30	9·86	184	32·58	22·55
	Bolton	78·54	9·13	167	39·20	24·34
	Yarmouth	75·37	14·38	199	32·45	22·94
	Hartlepool	75·26	9·43	166	43·36	22·49
{	Hull	77·89	11·02	178	37·88	24·52
{	Sculcoates	71·53	11·64	170	39·46	21·66
	Norwich	72·29	9·78	188	32·86	23·32
	Northampton	71·41	10·85	173	37·48	22·65
	Worcester	68·24	11·10	176	32·00	22·13
	Coventry	68·09	10·06	164	35·17	21·59
	Goole	64·58	9·20	166	36·47	21·39

The deaths by infantile diarrhoea have a seasonal rise more marked than that of any other malady. In the curves formed by Buchan and Mitchell of the rise and fall of the deaths by various diseases in London throughout the year, that of diarrhoea was the sharpest, rising to a high peak in the third quarter of the year (July-Sept.). “Speaking generally,” says Dr Ogle, “it appears from the returns of mortality in London that the diarrhoeal mortality becomes high when the mean weekly temperature rises to about 63°F.[1402]” The season is practically the same throughout the British Isles. But in warmer countries, such as the more southern of the United States of America, infantile diarrhoea is “the April and May disease.” It is not the fatalities only, but the cases as a whole, that fall decidedly upon the third quarter of the year[1403].