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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    epidemic the mortality rate was equal to 6-3 per 1,000 of this population, whereas in the remaining streets the corresponding ratio was 23. A. summary such as this, however, scarcely serves to show the full parity of experience. To appreciate this the mortality of the several streets during the two epidemics (its variations and repetitions), given in the tabular state¬ ment above, as well as the notes contained in the last column, must be studied. I have already discussed the influence that may be attributed to schools in the later distribution of the disease, and have given my reasons for regarding such explanation as incomplete. As to class, all descriptions of houses, from the Manor house downwards, have been involved during the two epidemics. The families of four of the members of the Local Board have been attacked, two of them twice, by the disease. The trading classes generally have suffered severely; a private boarding school for the sons of gentlemen was in July 1886 permanently broken up owing to repeated outbreaks of diphtheria. The house, a large one, standing in its own grounds, was in a much infected locality. The next step in evidence as to localisation of the disease would naturally concern its recurrence in individual houses, and then its appearance in houses immediately adjoining those infected during the earlier epidemic. My infor¬ mation on this head is naturally incomplete (the absence of a complete list of cases during the earlier epidemic, combined with the lapse of time, removals, &c., could hardly fail to result in this) but even as it stands it affords some positive testimony. Nine houses invaded during 1885-86 were again, in the outbreak of 1887-88, the seat of disease. In other words, estimating the number of infected houses in the first outbreak at 80,* even at this high computation their inmates suffered during the recent epidemic more by 60 per cent, than the rest of the inhabitants of infected streets, or to somewhat more than twice the extent of their fellow townspeople generally. Again, during the progress of the last epidemic, the disease made its appearance twice, by two apparently separate and distinct invasions, in eight houses; the interval between the first and second ranging from three to 10 months. (In three cases, three to four months; in three, four to five months ; in one, six months ; and in one, 10 months.) Before the second appearance of the disease the house had in each case been apparently free from infection for some weeks at least. In 10 cases the disease was found to have made its appearance next door to houses invaded during 1885-86. In two of these cases, however, the disease had meanwhile re-appeared in the house next door (the one invaded in the earlier year); the interval between the second invasion of the one house and the first of the other being, in the two cases, five days and four months respectively. In considering the question of the recurrence of the disease in the same households, the possibility of family or individual predisposition has to be borne in mind. I can only say that I found no evidence to justify such an explanation. Except for the fact of recurrence, there was no evidence of greater disposition to spread in families in which two invasions occurred ; and, as to individual susceptibility, in only one case did the disease start definitely a second time in the person of a previous sufferer. In the case, again, of second appearances of the disease in a family during the same preva¬ lence, the possibility of the occurrence of chronic attacks with prolonged infectiousness, or of mild inconspicuous attacks bridging the interval, has to be considered. The histories I have obtained lead me to believe that chronic cases, or cases attended by relapse so as to cover a long period of time, and at last perhaps proving fatal, may occur; but in the instances of “recru¬ descence ” I have given, such explanation was, I think, sufficiently excluded. I will give the history of one such instance. In Northern Road (a small private street of 23 houses, in which five cases of diphtheria and two deaths had occurred in the epidemic of 1885-86) two children of one family fell ill during the first week of May 1887. They were both attending the British School, but only one case of diphtheria, and that a month earlier, had up to that time occurred amongst their school fellows ; indeed, these cases in Northern Road are mentioned on page 3 as amongst the earliest. The children recovered, and on June 6th were both attending school again. On September 23rd another child of the family, not attending school, was attacked by diphtheria. I could hear of no exposure to infection since her sisters’illness, nor could I learn on careful inquiry of any other case in this street during the interval of some four months that had elapsed. A fortnight later a young child of another family in the row sickened, and died after five days’ illness. The house first invaded was apparently free from infection once more, and the school children were again attending school, when, about November the 8th, the baby, aged 18 months, sickened ; another child, aged 4, not attending school, was seized on the 12th and died on the 23rd. A child belonging to another family in the road, a pupil at the British School, fell ill on the 21st of the month. The house where these recurring outbreaks occurred is, it may be remarked, damp, and, owing to drainage defects, exposed to sewage effluvia; the street itself is unmade, sloppy, and neglected. * Dr. G-resswell gives 37 as the number of infected dwellings from the commencement of the first epidemic to February 21st, 1886, by which time six-tenths of the mortality had occurred ; so that it is probable that the above estimate is considerably too high. U 55283. B Recurrence in the same house. Appearance (after long interval) in adjoining houses.