Mr. W. H. Power's report to the local government board on diphtheria at Hern Hill, in the Faversham rural sanitary district ; on the sanitary state of that district ; and on administration by the rural sanitary district.

  • Power, W. H.
Date:
1880
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Licence: Public Domain Mark

Credit: Mr. W. H. Power's report to the local government board on diphtheria at Hern Hill, in the Faversham rural sanitary district ; on the sanitary state of that district ; and on administration by the rural sanitary district. 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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    three previously mentioned in the Jarmans’ family, made the five deaths reported to Registrar-General. Eigdit other non-fatal cases occurred in four families that had children attending the Llandewyrcwm school. Altogether, in connexion with this school, 15 children and one adult were attacked, in six families. Five of the 16 children died. In each of the six families the child first attacked was attending the school; except in one case where the infection, if derived from the school, was probably con- veyed by an elder child who was attending the school, but was not taken ill. The school was not closed until the 8th of December. 4. The school building stands on the northern slope of the hill near its foot. It is rather damp and cold. The privies, with cesspit in common, are placed in rear, not far from, the building. Above the school is a cow pasture, the surface drainage of which, in wet weather, runs in a little stream near the school. The water is certainly polluted by the droppings of cattle. The children often drink of it. The school mistress, however, believes the streamlet was not flowing at the time when diphtheria broke out. In this, as in most country schools, it is usual for those children who reside at some distance to bring their dinners with them, pi basket or bag, and stay at the school during the dinner hour. For drink, they bring a bottle of milk or tea. The bottles get broken, and then, for punishment, they are sent without any beverage. At these times, and indeed at all times, the children readily resort to the nearest runnel of water, with no thought of previous sewage contamination. A wholesome water supply at village schools is much to be desired. 5. Minute enquiry failed to discover any clue to the origin of this outbreak. No previous case of diphtheria had been known to have occurred in the Builth registration district since 1877, and then in a distant parish. There was no knowledge of any pre- cedent or concurrent disease among animals, though more recently the sheep in Wales and the west of England have suffered extensively from liver-fluke. There was nothing exceptionally un wholesome in the site or surroundings of the Jarmans’ cottage. None of the family had recently visited, nor had they received visitors from, any other district. No parcels of clothing, or bedding, or furniture had recently been brought to the house. No stranger was remembered to have called. Indeed the remoteness of the cottage from any public road makes it exceedingly improbable that any tramp or way- farer would ever find his way thither. The children Avent nowhere but to school. It is just possible that there may have been a previous unrecognised case of contagious sore throat at the school. The parents went to market at the town of Builth. The mother went there every day. There was a large fair at Builth on October 2nd. It is possible that the infection may have been brought into Builth by some stranger attending the fair fromja distajice, and may subse- quently have been conveyed by the mother to her OAvn home. But evidence of any such importation of the disease is wholly wanting. 6. There was one fact in this outbreak which appears at first sight highly significant. Nearly half of the children (about 20 out of 45) who attended the Llandewyrcwm school, came from a corner of the parish, comprising southern outskirts of the town of Builth. Among these Builth children there was not a single case of sore throat, while among children Avho came from lonely cottages and farmhouses on the hill side, eight were attacked, or five if we reckon only the first attack in each family. Had the numbers been much smaller, we might have attributed this disparity to chance. On the other hand they require to be larger, to put chance wholly out of the question. In school, the children, whether from the town or the country, Avere all exposed to the same conditions. They Avere mixed together in one room. The different classes that Avere formed (according to the “standard” to which each child belonged), contained toAvn children and country children alike. Many of both sections stayed at the school diiring the dinner-hour. On leaving school they would all pass the rivulet of surface- drainage at the foot of the pasture, and then emerging into a steep lane, the town children would turn doAvn the lane, and the country children would turn up. This difference of direction on leaving school, and the difference in the situation of their homes, appear to be the sole conditions to which we can look for an explanation of the result. The first case having occurred in a child belonging to the country section, who, Avhen out of school, Avas longer in company with other country children than with those from the town, there was slightly greater probability that subsequent attacks would occur among country children, but hardly in such disproportion as to account for the complete immunity of the town scholars. If diphtheria were caused by a malarious miasm, haunting certain cold clayey uplands, as ague haunts the banks of the Thames towards its mouth, we might suppose that the Builth children escaped,