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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    270 first case, and in three of the cottages the only case, was a child from this school. Moreover, throughout the entire month of October there were children in constant attendance at the school, who, though apparently in good health, were yet, there is good reason to believe, capable of communicating the infection; for this power of transmitting infection attaches to persons after apparent recovery for a period which, though indefinite, is certainly much over a month. Again, the view that the school was the effective agency in the dissemination is strongly corroborated by the fact that, with the closure of the school, the outbreak almost at once came to an end. Two objections may be made to this view. Firstly, the case of the girl in cottage F, whose illness did not occur till after she had ceased attendance for a period, according to the mother’s account, of no less than 11 days ; but, as already said, a cottager’s memory as to exact dates is unreliable, and, more- over, though 11 days is, doubtless, beyond the usual period of incubation, yet that period is not ascertained with such certainty that one can reject 11 days as an impossibility. Nor must it be forgotten that an attack of diphtheria comes on occasionally in so insidious a manner that it may pass for several days unobserved. The second objection is, that though there were children from 23 families at the school, only 6 families suffered. Thinking that possibly some explana- tion of this might be found in the details of the school arrangements, I took the trouble to ascertain what places on the school-benches had been habitually occupied by the several children. I found that the schoolgirl who fell ill in cottage D sat next to one of the two girls from cottage A, who probably, as I think, introduced the infection. I found also that a child who sat next to the other of these two girls had suffered from slight sore throat, but so slight and uncertain in character, that the case is not included in the above table ; but with these exceptions, the distribution of seats in the school did not appear to explain the matter. The small number of cottages attacked is, I think, attributable in great measure to the lucky coincidence that there were measles about in the district, and that many children were kept away on this account. It is, moreover, a matter of common observation that when a number of persons are equally, so far as can be seen, exposed to some cause of contagion, some of them yield at once, while others resist for varying periods of time. The closure of the school alone in all probability prevented a much larger proportion than 6 families out of 23 being attacked. The number of deaths in proportion to the number of cases was very large. The Medical Officer of Health attributes this in great part to “ bad nursing.” I notice, also, that in a recent small outbreak of typhoid fever that occurred in another parish of this division of the Barnstaple Rural District, every one of the cases was fatal, and that here also the high mortality was attributed by the Medical Officer of Health to “ bad nursing.” Good nursing is hardly to be expected from cottagers, who have neither the requisite experience, space, time, nor appliances. At present there is no hospital provision whatsoever in the Barnstaple Rural District, except such as may exist in the workhouse. In the face of such statements as those made by the Medical Officer of Health, as to the results of bad nursing in the district, it must be evident that assist- ance to the poor could take no better form than providing them with nurses during sickness, as has been done in certain places by subscription. A hospital for the isolation and proper treatment of the sick is also much wanted in the district, and might be made to serve for town and rural district together. Perhaps the nursing arrangements of the hospital might in some useful way be associated with the arrangements to which I have above referred as desirable for the needs of the poor at home. May 17th, 1879. W. OGLE.