Dr. Thorne Thorne's report to the local government board on an epidemic of diphtheria at Llanhaiadr.

  • Thorne, R. Thorne (Richard Thorne), Sir, 1841-1899.
Date:
1878
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Licence: Public Domain Mark

Credit: Dr. Thorne Thorne's report to the local government board on an epidemic of diphtheria at Llanhaiadr. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    their banks, as they frequently do on heavy rainfall, the accumulated sewage mingles with the flood waters spread over the valley. It is to this circumstance, as also to the large amount of decomposing vegetation in the valley, that must in all probability be attributed the offensiveness which at times characterises the valley during and subsequent to periods of flood, and which I am informed is at times specially noticeable during the night. Ci rcumstances associated with the spread of the Disease. Infection unquestionably played a large part in the spread of the diphtheria. To some extent it is believed to have operated in connexion with school attendance. But the disease broke out at a time when the village school was closed, and though the school reopened on the 9th of September, it was again closed on the 9th of October at the suggestion of the Medical Officer of Health; circumstances which, taken together with irregularity of attendance owing to the prevalence of the disease, prevented any definite information being obtained on this point. Age also appears largely to have influenced the spread of the disease. The total number of persons residing in the village at the commencement of the epidemic is stated to have been 180. Only five of these appear to have been under 3 years of age; of these two suffered from diphtheria; 52 were found to be from 3 years to 15 years old, and of these as many as 23 or 44-2 per cent, were attacked; and of the remaining 123 persons, all over 15 years of age, only three were attacked, and two of these were only 16 years of age. After the description already given as to site, soil, and dampness in speaking of the origin of the disease, it is only necessary to add that the conditions of dampness existing in the Vale at the commencement of the outbreak were to a great extent maintained during the course of the epidemic, and that the rainfall in September and October, viz., 3'38 in. and 3’09 in., respectively sufficed to maintain a certain amount of flood during the whole of those months. With regard also to this question of dampness I would further note that a large proportion of the persons attacked with diphtheria in Llanrhaiadr lived in very damp dwellings, the dampness being almost invariably due to the houses being partly built into the surrounding rising ground, and the floors, as a rule slabs of slate, being laid immediately upon the soil beneath. In several marked instances the wetness about the houses was added to by the soakage from undrained piggeries and from privy-pits. In the outlying portions of the parish of Llanrhaiadr and in the adjoining parish of Llanynys several cases of well-marked diphtheria were also met with. The occurrence of most of these could be explained as the result of personal infection, but this was not so in all the cases. The circumstances of two of these exceptional instances are of interest. The first of these cases occurred in an isolated house in the parish of Llanrhaiadr, occupying an elevated position in the Vale of Clwyd on a small table-land stated to consist of drift gravel overlying new red sandstone. The foundations of the house are particularly dry, and beyond the existence of a glazed pipe drain, in dangerous proximity to a somewhat deep well, and of certain defects in a partially ventilated system of. house drains, the establishment seemed to be free from any ordinary sanitary defects. The household consisted of 14 adults and of five children, varying in age from 1 year to 12 years. On Sunday, September 23rd, five adults, and two children aged 2 years and 11 years, drove to Llanrhaiadr Church, and on the 27th the child aged 11 years, Case D, complained of sore throat. This being, however, a very common ailment with her, the complaint was all but disregarded. On the 30th, however, serious symptoms set in, and the case rapidly became one of great severity; the entire fauces were covered with a thick and characteristic exudation, and the recovery was a pro- tracted one. This child was strictly isolated on and after September 30tli, and no other member of the family was attacked. Every possible source of infection in this case was most carefully investigated by Dr. Tumour, of Denbigh, at the date of the illness, and a few weeks later by myself, and it appears evident that the family had no relations with any of the earlier cases scattered about the district, and that if it was in any way due to an antecedent case, the disease can only have been contracted during the visit to Llanrhaiadr on September 23rd. The child’s movements on that day are, however, for special reasons, distinctly remembered by several members of her family, and I am positively assured that it is quite impossible that she can have come into contact with any of the villagers in any other way than by being seated with them in the same church, and even there she occupied a separate pew belonging to the family. In point of time the attack in this case might be related to this visit to Llanrhaiadr ; but if the