Dr. Airy's report to the Local Government Board on an outbreak of diphtheria at Great Dunmow / [Hubert Airy].

  • Airy, Hubert, 1838-1903.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Airy's report to the Local Government Board on an outbreak of diphtheria at Great Dunmow / [Hubert Airy]. Source: Wellcome Collection.

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    Referring, again, to the list of cases appended to this Report, it is noteworthy that in seven of the ten invaded families in Great Dunmow the first person attacked was a boy attending the National School. One of them, however, was in the infants’ class. In only two (H. and R.) the first attacked was a girl, and one of these two (H.) was a girl who was every day employed in sweeping the floors of the schoolrooms (the boys’ room as well as the girls’), in which duty she would be liable to inhale some of the dust her sweeping would raise. This may justifiably be called an exception con¬ firmatory of the rule which connects the spread of the infection with something appertaining to the boys’ schoolroom. In the other case (R.) 1 did not find any such exceptional circumstances, but it was a case that occurred near the end of the outbreak when the possible sources of infection were numerous. Again, out of the seven boys four were in the fourth class, one in the second, one in the first, and one in the infants’ class. The fourth class is numerically the largest, ' with 35 boys, the third class has 23, the second class has 23, the first class has 24. The boys’ classes, I to 4, are arranged in that order, from east to west, in the boys’ schoolroom. Class 4 is at the west end of the room, nearest to a large window which overlooks the back yard containing the boys’ waterclosets. Probably but little importance is to be attached to this relation, for it can hardly be supposed that the air which entered by that window could be retained by the nearest group of children. It would circulate through the room in various currents and eddies, and probably, in the first instance, pass clear over the heads of those just under the window. None of the boys in the next class (3) were attacked. I would rather attach importance to the fact that the boy in whom the disease first appeared on January 22 (in family A.) was a member of the fourth class, and regard it as most probable that the infection spread to other boys of the same class by per¬ sonal communication. In this way probably the disease was caught by No. 4 (attacked February 4), and by Nos. 11 and 12 (attacked February 17 and 18), though here the clue is complicated by the fact that the mother of Nos. 11 and 12 had recently (February 3) helped at the house of B., laying out the dead body of No. 3. (No. 3 was in the second class, but may have been in contact with No. 1 out of school hours, or may have been poisoned by sewer air in the closets.) The next case in class 4 was No. 31 (family P.), who was taken ill on April 27. Thus for more than two months that class was free from the infection. But in the mean¬ time it had been smouldering on in the families C. and G., passing from one family to the other, probably in the act of drinking from the same mug, till it appeared (April 16) in the family K., in the person of a boy who was in the first class at the National School. Whether he had been in contact with a previous case or owed his infection to the closets is uncertain. The disease spread to three other children in this family. Possibly one or another of these gave it to a little boy in the infants’ class (No. 27, family 0.), who was taken ill on April 24. The infection rapidly spread to his brothers and sisters. The elder brother (No. 28) was in the fourth class, and was attacked on May 1 ; but four days earlier another boy in this class (No. 31, family P. above mentioned), who, it was afterwards remembered, had complained of a bad smell from the breath of No. 27, was taken ill. From him the disease spread to his two sisters (who attended a private school), and then to the father and trained nurse. The three children died. The father was removed to an infectious hospital at the union workhouse, where he was nursed by the mother and the trained nurse. The mother has since been attacked. This apparently ends the outbreak in Great Dun¬ mow, which, I think, gives plain indication of having been caused by sewer air escaping in the boys’ closets, and of having been spread chiefly by close personal contact, especially among scholars in class 4, and among children of the same family. Besides the chain of infection in Great Dunmow there were, as has been mentioned above, cases in some of the neighbouring parishes. In Little Dunmow, to the east, the disease appeared early in February in a family (D.) residing about half a mile from B. and C. on the same road. There is a probability that there had been com¬ munication between the families B. and D., though the children of the latter went to another school. About the same time, at Great Canfield, to the south-west of Dunmow, a boy (No. 10) was attacked with diphtheria and died on February 12. This case could not be shown to have any connexion with the outbreak in Dunmow. Two deaths occurred (Nos. 16 and 38) on April 9 and May 12, both registered as diphtheria in Felstead parish, about four miles to the east of Dunmow, among children attending one of the Felstead and Rayne board schools. From what I could learn of the symptoms presented by these children, it seems by no means certain that their B 8044. A 2 Diphtheria in parishes around Great Duu- movv.