Mr. Spear's report to the Local Government Board on the continued prevalence of diphtheria in the Aylesbury urban sanitary district.

  • Spear, John.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Mr. Spear's report to the Local Government Board on the continued prevalence of diphtheria in the Aylesbury urban sanitary district. Source: Wellcome Collection.

    4/18 (page 4)
    Importa tion. As to the influence of schools ; age and sex dis¬ tribution , exposure to infection, either from developed diphtheria or from mere “ sore-throat,” could be obtained. It is somewhat remarkable too, if personal infection were the all-important factor in the disease extension, that its effect should have been so moderate in individual household invasions. Of these, the attacks were single in 52 cases, or 57 per cent, of the total number, and in 23 of the remaining 39, the disease extended to two inmates only of the infected dwelling; an experience the more significant since, as a rule, little precaution as regards isolation, &c., was observed. The sequence of cases in houses where multiple attacks occur affords evidence probably of comparatively little value in an examination of this kind where the disease in question is diphtheria; the incubative and pro¬ dromal stage being so very variable and the former often of such short duration. So far as it goes in this case, the evidence is consistent with the view that personal infection was accountable for the occurrence of the great majority of secondary cases. In 16 households a second attack occurred within a week of the first; in only two could there be said to be no appre¬ ciable interval between first and second seizures. On the other hand, in several instances the interval was prolonged—from three to ten months in eight cases—so as to constitute what may be called recurring outbreaks. To this point I will again refer. In no case during the last epidemic did I find reason to conclude that the infection had been imported from other districts. On the other hand, there was evidence of its transmission from the town into the Aylesbury Rural District in three instances, and a probability of such transmission in two others.* The age and sex distribution in the 157 cases that occurred between April 1887 and May 1888 is shown in the subjoined table. Of initial attacks in families, 66 per cent, were amongst children of school age, 4 to 14; of secondary cases, 56 per cent, belonged to that age. Some slight prepon¬ derance of the disease was observed upon the female sex. Table III. Epidemic, 1887-88. I Sex. Total. Under 1 1-4. 4-8. 8-12. 12-16. 16-25. 25-40. 40-60. Initial attacks in fa- I'M. 42 ~ i 4 14 13 4 5 1 1 milies. 49 — 7 19 10 3 3 5 2 f M. 29 1 4 8 6 5 2 2 1 Subsequent attacks - u 37 1 7 10 8 4 2 4 1 * In three cases referred to the circumstances are of some interest. At Weedon, a child, aged 5, sickened on October 4th, and died on October the 8th, of what is stated to have been well-marked diphtheria. She had not been away from the village for some time, but a brother went daily to the British School at Aylesbury. He suffered just before, and at the time of his sister’s illness, from a “ had cold,” with foetid nasal discharge, but although confined to the house for a few days, received no medical attention, nor were any paralytic symptoms afterwards observed. Cases of diphtheria had occurred in two neighbouring cottages in March 1886, spreading apparently then from an imported case, but there had been no appearance of the disease in the village during the 18 months’ interval. There had, however, been a few well marked cases of scarlatina (the diagnosis being verified by subsequent desquamation, dropsy, &c.). At Dinton, a village in which I found sewage nuisances deplorably prevalent, sore-throat of the kind I have described had been general during the close of 1887. In January 1888, what is described as distinct diphtheria appeared in one family, the first sufferer being a young man, whose occupation took him almost daily into Aylesbury. Ho spread of the disease took place beyond his house ; but from the evidence we now possess of the influence, at the least in predisposing a population to epidemic diphtheria, of prevailing “ sore-throat,” it cannot be doubted that the little village of Dinton had a very narrow escape from a serious disaster. At Oving, a girl, aged 14, sickened with diphtheria on November the 13th, 1887, and died on the 24th; her brother was seized on that day, and died on the 30th. The medical man in charge of the cases after performing tracheotomy was likewise attacked. No other cases of diphtheria were known of in the neighbourhood. The first sufferer had for some time only been away from home once and then to a tea-party held on the 8th of November in the Corn Exchange, Aylesbury ; i.e., five davs before definite symptoms of infection were observed.