Mr. Spear's report to the Local Government Board on the continued prevalence of diphtheria in the Aylesbury urban sanitary district.

  • Spear, John.
Date:
1888
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Licence: Public Domain Mark

Credit: Mr. Spear's report to the Local Government Board on the continued prevalence of diphtheria in the Aylesbury urban sanitary district. Source: Wellcome Collection.

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    Prevalence of “ Sore- throat.” it was as high as 3*2. My own inquiry then has been concerned with a long standing and increasing prevalence of the disease. This prevalence has not, however, been continuous, and the seasonal incidence of the disease has been marked. The epidemic of 1885-86, the first part of which was reported upon by Dr. Gresswell, commenced in October and lasted until the end of the following March, after which the disease extended but slowly until June. From the 15th of July until the following April (1887) no death from diphtheria was registered, and so far as I can ascertain non-fatal cases occurred in only three widely separated houses* The fact of this intermission may at least be affirmed as regards recognised diphtheria. As to the possibility of mild and hidden cases maintaining a continuous chain of infection, it is certainly true that “ simple sore-throat ” had prevailed throughout the winter of 1886-1887 ; catarrhal rhinitis, like¬ wise, with some offensive discharge, has been spoken of to me as common during this period. But as to the diphtheritic nature of the catarrhal affections that were thus interposed, the absence throughout a long series of cases of the distinctive appearances of diphtheria, the freedom from fatality and from characteristic sequelse, must be allowed weight. On the other hand, when diphtheria prevalence was again established, although that of “ simple sore-throat ” had then diminished, several cases of illness occurred not distinguishable, it is said, from the apparently simple affection, except for characteristic sequelse ; and here and there unequivocal cases of diph¬ theria were associated, apparently causally, with attacks that from a clinical standpoint alone would be considered non-specific. The possibility, suggested by Dr. Thorne, of potential and gradually developing specificity attaching to an apparently benign disease has likewise to be considered; and as to this the importance of negative testimony, such as that above referred to, deducible from long continued absence of fatality, &c., is certainly discounted on finding that, as regards unequivocal diphtheria, virulence is a quality subject to seasonal variation. In the epidemic of 1887-88 in Aylesbury, the maximum fatality was observed only after a prevalence of some months of the recognised disease. From April to the 20th of November (nearly eight months) 86 cases and 10 deaths occurred; then, during the next eight days there were 10 deaths, all amongst recent cases. From the 20th November to the end of the year there were 45 cases and 17 fatalities. The medical gentlemen of Aylesbury favoured me with clinical accounts of the sore-throat spoken of as prevalent. In recdgnisablfe features the affection does not appear to differ from that of an erythematous or follicular tonsillitis. The small white or yellowish specks on the swollen and hyperasmic mucous membrane of one or both tonsils, common to that affection, never it is said, assumed the appearance of the thick continuous membrane of developed diphtheria, and dis¬ appeared after one or two days’ duiation; slight follicular erosions of the tonsils were frequently seen. The lymphatic glands were often enlarged and tender ; and for a day or two constitutional disturbance was present. Albuminuria, in the few cases in which it was looked for was never observed. General debility of some duration frequently followed these attacks, but distinct paralyses were absent. Children and young adults were attacked in largest proportion and occasionally, it is said, several members of a family suffered simultaneously, or more often in rapid succession Dr. Eagles, who tells me he has seen perhaps 200 of these cases speaks of them as generally multiple, and is convinced of their infectiousness. Dr. Hilliard likewise holds this view. Dr. Gresswell reported the first case of the epidemic of 1885-86 to have occurred in October in the person of a child (Flory R.), living in Church Row St. Mary s Square. No evidence of recent exposure to infection was discovered but it was noted that a servant maid had in the month of February Eecognised previous returned to her home in the same row after an attack of diphtheria • Diphtheria- that the Sirl *suffered from a “ relapse,” so as to be invalided until June’ one of 1885- and that cases of sore-throat occurred in her family subsequently to her 86. return in February. The first recognised case in the epidemic of 1887-88 occurred in this same row of six cottages, two doors from the R’s. The sufferer, aged 3^ years, had attended the British Infant School for one week, but, from choice simply it is said, not from any ill-health had one ol 1887- discontinued such attendance on March 4th, a full month before her seizure She was attacked on April ike 5th and died on the 11th. A baby-brother* * Of these solitary outbreaks, one of which occurred in August and two in fWnW t „ m m • no satisfactory explanation. In one case, however, the disease had prevailed in the sarn^bou^m months before : in another, the first sufferer had, it was stated passed tbrnno-b same house 10 previously while living elsewhere. In two of the three housefthe d sea e Sn Zrtelf 18 Ml‘ during the progress of the 1887-88 epidemic. 6 agam made lts appearance 22502705846