Dr. G.S. Buchanan's report to the Local Government Board upon epidemic diphtheria in the borough of Tunbridge Wells / [G.S. Buchanan].

  • Buchanan, George Seaton, Sir, 1869-1936.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Dr. G.S. Buchanan's report to the Local Government Board upon epidemic diphtheria in the borough of Tunbridge Wells / [G.S. Buchanan]. Source: Wellcome Collection.

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    On inquiry as to the situation of the invaded houses, both throughout the epidemic and during the February outbreak, I ascertained that in each instance there had been an altogether exceptional incidence of diphtheria upon dwellings in the north-eastern part of the town. These dwellings were situate within an area roughly half a mile square, comprising about a quarter of the populous part of Tunbridge Wells, and a large proportion of the smaller dwellings of the place. Except that it includes “ Shatters Wood,” the boundaries of this area correspond very nearly to those of the East Ward of the borough, and it may accordingly be termed the East Ward area. From a series of “ spot-maps ” prepared for me by the Inspector of Nuisances, I ascer¬ tained that during six weeks prior to February 9th, a total of seven houses had been notified as invaded by diphtheria, of which six were in East Ward area ; and that 42 out of 47 additional dwellings notified as invaded between February 10th and March 15th were within the same area. From the middle of March onwards to September, East Ward area continued to suffer in excess of the rest of the borough. The spot-maps gave me particulars of 93 houses newly attacked by diphtheria between March 16th and August 22nd, and of these, 68 were within, and 25 outside the East Ward area. It seemed necessary therefore, to inquire more particularly for conditions which through¬ out the epidemic had conduced to infection within the East Ward area, and which had particularly operated within this area during the period of outbreak. First as to the operation of infection from person to person. At no time throughout the epidemic, I learnt, had inquiries been made with a view to referring each newly notified case of diphtheria to infection from some antecedently occurring case or cases. Indications were not wanting, however, that in this instance, as commonly in other diphtheria outbreaks, the principal factor in the spread of the disease had been exposure to personal infection. Thus there had been numerous instances in which members of an invaded household had suffered diphtheria one or more weeks after the first occurrence of the disease in their dwelling ; at least a third of the 251 notified cases had occurred in dwellings from which a case of diphtheria had been previously and recently notified. That members of an infected household had in some cases communicated infection to members of neighbouring households was suggested by several instances in which every one of a group of adjoining dwellings possessing a yard or garden used as a common playground by children became invaded in the course of the epidemic. With reference to particular opportunities of personal infection which might have afforded explanation of the outbreak of February, 1 learnt that with six exceptions, all the 78 persons notified as attacked by diphtheria between February 3rd and March 9th were children at ages between 3 and 15. Apart from question of school attendance, no considerable number of these children had, so far as I could ascertain, been brought together during the period ; their dwellings were not confined to a few particular streets, but were scattered all over the East Ward area. As to school attendance, the facts were as follows :—There are two public elementary schools which between them serve the East Ward area, and derive almost all their scholars from this area. These schools, named St. Barnabas and St. James respectively, are situate in the centre of East Ward. In each instance they are of recent construction. St. Barnabas school is designed to accommodate 743 scholars, and St. James’ school 516. Each school has girls’, boys’, and infants’ department, and a distinct playground. But the boundaries of the two schools are separated merely by the breadth of the Camden Road ; children attending one school, I was informed, habitually play with children of the other just outside the school premises or on the way to and from school ; while in a large number of households certain of the children attend St. Barnabas’ while others attend St. James’. It was thus hardly to be expected that if diphtheria had been spread in this area by inter¬ course of school children, the disease would have manifested itself among children of one school and not among children of the other.