Dr. W. Ogle's report to the Local Government Board on the prevalence of diphtheria in the rural sanitary district of Barnstaple.

  • Ogle, W.
Date:
1879
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Licence: Public Domain Mark

Credit: Dr. W. Ogle's report to the Local Government Board on the prevalence of diphtheria in the rural sanitary district of Barnstaple. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    J26S life-long acquaintance -with tlie place, that some 14 years ago cases of diphtheria had occurred in one of the same cottages (B) as have suffered on the present occasion; but from that time there was no history of any further outbreak. Neither had there been, so far as I could ascertain, any diphtheria of late in the immediately surrounding neighbourhood. Two cases, both fatal, had, it is true, occurred in the Barnstaple Rural District in the quarter preceding this outbreak; but these were in a cottage at Eastcombe, in Atherington parish, not only three or four miles away from Cobbaton, but separated from it by the valley of the Taw, and practically as remote as had it been in some distant county. I have reason to believe that there had also been some non-fatal cases of diphtheria in the Urban District of Barnstaple. This town is also remote from Cobbaton, being more than six miles away. Still the relations between a market town and the rural parts for miles around are, of course, such as not to exclude the possibility of the transference of disease germs from one to the other. I failed, however, to trace any such transference in this case. I may add that the children who were attacked in the outbreak at Cobbaton had not been away from home, so that either the infection must have been brought to that place in some untraced way, or have been developed in the place itself. In the first week of October, two girls living in a cottage at Cobbaton were attacked by sore throat, swelling at the angle of the jaw, and vomiting. Their illness was slight, for neither was a medical man called in, nor were the girls kept from school more than two days, those days being, as I found from the school register, October 7th and 8th ; after which time they regularly attended school to the end of the month. Later on in October a third child fell ill in this cottage, and died on October 21st. This child was attended by a medical man, who assures me that the “ convulsions ” to which the death was attributed were certainly not connected with diphtheria. As regards, however, the earlier and unattended cases, the evidence seemed to me strongly to favour the opinion that they were in fact mild cases of genuine diphtheria, and I believe that all the cases that occurred afterwards are to be traced back with much probability to these. On October 15th, a boy in a cottage at a considerable distance from the last-mentioned was attacked by undoubted diphtheria ; for though his sore throat was not severe enough for medical assistance to be sought, yet it was followed (as later medical observations proved) by albuminuria and nasal utterance, well-known sequelae of diphtheria. Moreover, all the other occupants of this cottage, five in number, were shortly afterwards attacked by the same disease, and one of them died. The boy first attacked in this family attended school up to and including October 14tli, and a sister who fell ill later on attended school up to and including October 23rd. In the third week of October three more cottages were attacked, and of the persons who fell ill, five in number, four died. The exact date on which each cottage was attacked it was impossible to ascertain with perfect certainty ; for medical help was not called in at once, and cottagers themselves are not of retentive memory in regard to exact dates. The Jirst case, however, of illness in each cottage was a school-child, and consequently an examination of the school register, showing when attendance ceased, enables me to fix with tolerable precision the date of attack. One family now sought medical advice (October 24th), and a few days later the Medical Officer of Health also visited the place and advised that certain nuisances should be removed, and that the school should be closed. The Sanitary Authority directed that this should be done, but already, before their letter arrived, the school had “ closed itself,” the children in attendance having dwindled down gradually until, out of an average of 43, one single child presented itself to the schoolmistress on the morning of November 1st. This was accounted for partly by the alarm which had now sprung up con- cerning the diphtheria and partly by the fact that there were at this same time cases of measles in several cottages, and in one, if not in more, cases of mumps. A few days after the closure of the school another cottage was attacked by diphtheria. The single case—a fatal one—that occurred in this cottage was that of a girl who had attended school for the last time on October 28th, and who in the interval had, as I was assured by the mother, been carefully kept