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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    Dr. Thorne Thorne’s Report to the Local Government Board on an Epidemic of Diphtheria at Llanrhaiadr. Edward C. Seaton, M.D., Medical Department, . March 30,1878. The Local Government Board having been informed that diphtheria was epidemic in the parish of Llanrhaiadr, I received instructions to inquire into the circumstances under which the disease was prevailing, and I now beg to report as follows :— Llanrhaiadr is a parish in the rural sanitary district of Ruthin, in Denbighshire. Spreading from the low-lying parts of the Yale of Clwyd up to and amongst the mountainous hills which bound the vale on the west, it covers in all 16,976 acres, and it had in 1871 a population of 1,700. The most populous part of the parish is the village of Llanrhaiadr, which consists of two hamlets, Pentre and Llan, lying about half a mile apart. They are both on the main road from Ruthin to Denbigh, and are mainly situated on the low-lying land of the Yale of Clwyd, immediately at the foot of the hills. According to information supplied to me by Mr. H. Davies, Inspector of Nuisances, Pentre and its vicinity contains 104, and Llan 66 inhabitants. These two hamlets were the principal seats of the epidemic, and to its prevalence in them I propose in the first instance to refer. General History of the Outbreak. 1st. At Pentre.—The first clear case of diphtheria occurred at Pentre ; it is referred to as Case No. 1 in the appended list of cases, the patient being a child two years and nine months old. The child sickened on August 12th, 1877, sudden prostration soon followed by dyspnoea being amongst the earlier symptoms ; the breath also soon became foetid, and when the child was seen on August 14th by Dr. W. D. Jones, of Ruthin, the entire fauces were covered with a “ thick mass, of grey deposit.” The child rapidly sank, and died on August 15th. As the result of often repeated inquiries as to the prior movements of this child, nothing could be ascertained which seemed in any way to connect its diphtheria with any prior case. The child was under the charge of its grandmother, with whom it lived, and I was confidently assured that the last time it left Pentre was when it went, one month prior to its illness, with its grandmother to Ruthin, where no sickness in any way resembling diphtheria is known to have occurred. In the next case, No. 2, which commenced on August 14th, there was a possibility, if not a strong probability, of communication with the house in which Case No. 1 occurred. Cases Nos. 3 and 4 occurred in the same house as No. 1, on August 17th and 19th, and in the case of No. 5 there was admittedly free communication with that house. Indeed, as far as the cases in and about Pentre are concerned, no interest attaches to the question of origin after Case No. 1, for there were then ample means for its diffusion. In all 16 cases, three of which were fatal, occurred in Pentre from August 12th to the end of October. This number includes one case of a second attack in the same patient. The first attack, (Case No. 11,) commenced on October 5th, and though a mild one, was marked by distinct diphtheritic deposit; it was apparently followed by complete recovery ; the second attack, (Case No. 15,) commenced on October 27th ; it was one of some severity, and when I saw the patient there was a considerable amount of grey deposit on both tonsils and the uvula. But some of the cases referred to would not have been looked upon as true diphtheria had it not been for the circumstances under which they occurred. Thus Cases Nos. 5 and 6 were, so far as general symptoms and throat appearance are concerned, cases in which simple sore throat was associated with the existence on the tonsils of one or two yellowish grey patches, and in Case No. 7 nothing beyond what is generally seen in “ simple tonsillitis ” could at any time be discovered. But the specific character of these and similar cases was clearly marked; not only did they occur synchronously with, or follow upon, well-marked cases of diphtheria in the same house, but they were a source of infection to others. C. 936. Wt. 15061. A