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].