Dr. R. Bruce Low's report to the local government board on an outbreak of enteric fever at Helmsley, in the Helmsley rural district, North Riding of Yorkshire.

  • Low, Robert Bruce, 1846-1922.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Dr. R. Bruce Low's report to the local government board on an outbreak of enteric fever at Helmsley, in the Helmsley rural district, North Riding of Yorkshire. 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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    sent Dr. Porter nine notifications of cases in Helmsley, five of them being certified as suffering from “ relapsing fever,” three from “ remittent fever,” and one from “ remittent or relapsing fever.” From this time till the 1st of September cases were notified nearly every day. In addition, no fewer than eight persons who had been residing in Helmsley during the first week of August or earlier, were found to have developed the disease during that month in places some distance away to which they had removed. The 43 cases comprised in the Helmsley outbreak were limited to 27 households, 22 of them being invaded during August, and only five during September. A plurality of cases of fever occurred in eight houses ; in 19 there were only single cases met with. The following Table III. gives the age and sex in each instance. Table III., Showing Cases of Enteric Fever in Helmsley and Deaths therefrom, distributed in Age Periods. Age Periods. Cases. Deaths. Males. Females. Total. Males. Females. Total. Under 1 year . _ __ 1 to 5 years - - 2 6 8 — 1 1 5 to 15 years - 10 5 15 — — — 15 to 25 years - - 3 3 6 2 3 5 25 to 60 years 2 12 14 1 1 2 60 years and upwards — — — — — 17 26 43* 3 5 8 The greater incidence of the fever upon adult females is no doubt accounted for by the fact that some of them acquired the disease while nursing other sick persons in the family. One case occurred in a trained nurse who was in attendance on a family attacked by the fever. A few (three or more) of the Helmsley cases were not, for one reason or another, officially notified. In reference to the question of disputed diagnosis, already mentioned, I visited a number of convalescent cases, and from the sufferers themselves or from their parents, I obtained an account of the symptoms observed in each instance. From the statements made to me, it would appear that some of the earlier cases did not run altogether a typical course. Some of them had constipation throughout the attack, a fact which was locally considered at first as discounting a diagnosis of true enteric or typhoid fever. Added to this, the cases among children had a shorter duration than is usual in typical enteric fever; some of them were regarded as having been ill only 10 to 14 days. This, agaiu, was looked upon at the time as throwing doubt on a diagnosis of true enteric fever. Some cases were described as having had fever, constipation, flushing of the face, and occasionally a little delirium ; it was said that in these instances no “spots ” were seen, and no abdominal symptoms noted. But side by side with these mild, irregular, or anomalous cases, or occurring more usually as secondary cases in households already invaded, were other attacks presenting a number of symptoms typical of enteric fever, though in some cases constipation persisted throughout the illness. In some of the originally milder cases occurring in young adults, there was a serious return of the fever, with severe abdominal symptoms of an aggravated character, following a premature indulgence in solid food, or. as in one instance, following the use of purgative medicine administered by a well-intentioned though misguided relative. In these cases violent diarrhoea supervened, with haemorrhage from the bowels : and several of the patients died with symptoms pointing to perforation of the bowel. I also visited a few of the secondary cases which were acutely ill at the time of my inquiry, and I had no doubt in my own mind as to the * Including eight persons who were attacked during August subsequently to their removal from Helmsley.