Mr. Spear's report to the Local Government Board upon the prevalence of diphtheria in the Fareham registration district, and upon the occurrence therein of enteric fever.

  • Spear, John.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Mr. Spear's report to the Local Government Board upon the prevalence of diphtheria in the Fareham registration district, and upon the occurrence therein of enteric fever. Source: Wellcome Collection.

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    Typhoid fever at the County Asylum. footing. The medical officer of health is not under the Board’s Order and makes no annual report. The mortality returns are, in fact, not supplied to him, so that it is difficult to see how he is effectually to study the distribution and cause of disease. The authority possess no hospital for dealing with infectious diseases, but have on one or two occasions been allowed the use of the Rural Sanitary Authority’s building. In the County Lunatic Asylum, which although remotely situated is within the limits of the urban district, certain outbreaks of lyphoid fever have occurred under circumstances deserving of notice. The subject in its various relations has been reported upon by Dr. Worthington, the medical super¬ intendent, and by Mr. Rogers Field, C.E., and Dr. Dupre, amongst others, who were specially retained by the committee of management for the purpose. Dr. Worthington records the following cases as having occurred during recent years:— Years. 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 Cases of Typhoid J 3 — 2 — 2 — 3 3 9 14 4 — 75 The cases have been widely distributed in the institution—male and female patients, officers, and servants being amongst the sufferers. Notable periodicity in the occurrence of the disease in the several years has, however, been observed. All the cases have occurred during the last seven months of the year; then their more particular distribution has been as follows : — June. July. Aug. Sept. Oct. Nov. Dec. 2 60 29 9 7 6 2 There has been great and hitherto quite unexplained variation in the fatality of the disease in the outbreaks of different years. In 1885 the fatality amongst those attacked was equal to 57 per cent., in 1888 to only 5-3 per cent. It will be remembered that 1885 was the year in which the disease was epidemic in the town of Fareham. As to any immediate cause, however, there appears to be no possible connexion between these two experiences. The asylum is complete in itself, and isolated as regards sewerage, water supply, &c. When Mr. Rogers Field made his examination in January 1886 he found that, although various alterations had been made, the drainage of the building was exceedingly defective. Reason also was found for concluding that the water supply of the institution was contaminated; and a series of •analyses conducted by Dr. Dupre strongly supported this view. The drainage of the institution was remodelled at a cost of upwards of 4,000h, the work being completed in the course of 1887. Nevertheless the disease showed a greater prevalence in 1888 than it had ever done before, although the type was then comparatively mild. The asylum stands upon a thick bed of gravel overlying the chalk forma¬ tion, and water is obtained from a deep well in the asylum grounds. Mr. Rogers Field reported (January 1886) that many of the drains of the institution were leaky, and that “two of the worst of these were within a “ few yards of the well.” Moreover, he found by various observations that the movement of the underground water in this locality naturally tends from the direction of an adjoining cemetery and of plots of ground upon which the sewage of the asylum is discharged, towards the well; and that con¬ tinuous or even ordinary pumping of the well will influence the level of the underground water beyond the distance at which these possible sources of pollution stand. The committee of management are now endeavouring to devise some other means of water supply. JOHN SPEAR.