Dr. Page's report to the Local Government Board on the circumstances of recent prevalence of scarlatina and enteric fever at Spennymoor, County of Durham.

  • Page, David, M.D.
Date:
1889
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Licence: Public Domain Mark

Credit: Dr. Page's report to the Local Government Board on the circumstances of recent prevalence of scarlatina and enteric fever at Spennymoor, County of Durham. Source: Wellcome Collection.

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    Scarlatina. once be stopped within their district. The Spennymoor Sanitary Authority thereupon communicated with the farmer, who suspended the sale next morning, but resumed it in the evening and again on the following morning, on both of which occasions it was seized in course of delivery by Mr. Coldwell and destroyed pursuant to a Justice’s order. At the outset of my inquiry I found it necessary to ascertain, as com¬ pletely as possible, the whole amount of fever prevalence in Spennymoor, Dr. O’Hanlon labouring under the disadvantage of not having had reported to him cases of infectious illness occurring outside his own practice. Dr. Anderson, the only other medical practitioner resident in Spennymoor, was o-ood enough to furnish me with complete lists of cases occurring in his practice over a considerable period. And I received similar information as to cases occurring in Tudhoe Grange, a part of the town extending into the adjacent Durham Rural Sanitary District, from Dr. Blackett, Medical Officer of Health. In all there were thus heard of 45 families attacked by scarlatina in which there had occurred 83 cases with 15 deaths, and 19 families attacked by enteric fever in which 25 cases with 5 deaths had occurred in the 22 weeks, July 1st—December 1st, 1888. In searching for the causes accountable for this prevalence of scarlatina and enteric fever, I have made minute inquiry into the individual circumstances of the several invaded families, the results of which will be considered under the respective diseases. It is a notorious fact that scarlatina is seldom if ever wholly absent from this district in common with other colliery districts of the county of Durham. It figures habitually as a cause of mortality in the annual returns. The disease was fatally prevalent in 1881, when it caused .16 deaths, and again orevalent, but with small mortality, in 1884. Returns of sickness placed at my disposal show that scarlatina has been lingering in and about Spenny¬ moor since 1885 until October last, when, becoming active, it may be said to have reached its maximum prevalence by the end of that month. The out¬ break would appear to have ended somewhat abruptly, but since the close of my inquiry I have been informed of several later occurrences of the disease. In Tudhoe Grange a like behaviour of scarlatina has been observed pari passu with that in the Urban Sanitary District of Spennymoor. The table on next page shows the number of households invaded week by week from July to November in both localities, later or secondary cases in families, i.e., cases not occurring within a week of first seizures in tho same family and for which personal infection was accountable, being dis¬ tinguished from the latter.’ The households attacked have been dispersed over the town and belonged, with one or two exceptions, to the labouring class. The 15 deaths were, save that of a youth of 18, all of children between 3 and 12 years of age. Three of the deaths were not medically certified. Meanwhile, in mid-August, at the suspected dairy farm, three younger children were attacked one after another with scarlatina, the first to be attacked being a child of two and half years not at school, and in whose case no exposure to infection could be ascertained. The children were isolated under medical supervision during illness and desquamation until their complete recovery at the end of September. In the course of inquiry numerous households afforded evidence as to the operation of personal infection, more particularly by the association of healthy children with others ill or convalescent from the disease. Instances, too,, were met with of the return to school of children within a fortnight, and even a week, of attack, and in no less than 26, or 58 per cent, of the invaded house¬ holds, those first attacked were children who had been attending the elemen¬ tary schools up to the date of attack. But although I have a strong suspicion that two of these schools, the National and the Board Schools, played a prominent part as centres of infection, implication of school attendance may be more apparent than real in view of the abundant opportunities of infection elsewhere than at school. Disinfectants had been, I found, freely dispensed by the sanitary officers in all known cases, but the construction of the majority of the dwellings and the habits of the inmates are such as to render * The farmer was, on December 17, summoned before the Justices at Bishop Auckland Petty Sessions, on informations under sections 116 and 117 of the Public Health Act, 1875, and Article 9 of the Dairies, Cowsheds, and Milkshops Order, 1885, and fined 51. including all costs.