Dr. Thorne Thorne's report to the local government board on the general sanitary circumstances and administration of the rural sanitary district of Dartford, and on an outbreak of diphtheria in the parish of Swanscombe.

  • Thorne, R. Thorne (Richard Thorne), Sir, 1841-1899.
Date:
1879
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Licence: Public Domain Mark

Credit: Dr. Thorne Thorne's report to the local government board on the general sanitary circumstances and administration of the rural sanitary district of Dartford, and on an outbreak of diphtheria in the parish of Swanscombe. 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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    the jaw were greatly enlarged, the fauces were covered with a characteristic membrane, and the child died within about 24 hours of the visit referred to. Another member of the family, George I , aged 6 years, was taken ill with diphtheria on August 1st. and he died on August 5th, having doubtless contracted the disease from his sister. Repeated inquiries have entirely failed to show that Sarah I had, prior to her attack, come into contact with any other person suffering from sore throat in any form. The child, in common with most of the children in this district, attended a school at- Galley Hill, but no throat sickness is known to have prevailed amongst the scholars. The water-supply to the house did not appear to be subject to pollution, and the only milk used in the house was “ condensed milk.” So-called “ common sore throat ” had however, previously prevailed in the family, one member of which had so severe an attack of “ ulcerated throat” in 1878 as to need medical attendance. Enteric fever also prevailed in the house about 15 months prior to the outbreak of diphtheria. The second house referred to is at Galley Hill, about half a mile from where the family I lived ; and in July last it was occupied by a family named E , and consisting of the two parents and of five children all between the ages of 3 years and 14 years. The house is a new one, and its sanitary arrangements, though not faultless, were far superior to those of the majority of houses in Swanscombe, and afforded no clue whatever to the illness which followed. On the 29th of July a medical prac- titioner was called to the house to see Rosina E , a girl of 10 years of age. She was found to be suffering from well-marked diphtheria, characterised by some enlarge- ment of the glands below the jaw, and the presence of membrane on the fauces. Her illness was ascertained to have commenced either on July 26th or 27th. She died on August the 27th from pneumonia which supervened during convalescence. Three other children in this house sickened of the same disease, viz., Kate E , aged 5 years, on July 29th ; Alfred E -, aged 14 years, apparently, on July 30th ; and Harry E , aged 6 years, on July 31st. The boy named Alfred died on August 29th. With the exception of the first case in this house all the others were probably due to direct infection, and as regards the first attack, the only history which could be obtained bearing upon the disease was, that although the child Rosina, had, owing to severe headache, to which she had long been subject, not been to school for about eight days before she sickened, yet there was a considerable intimacy between her family and that of the I family, the children belonging to each being frequently together. Indeed there can be little doubt but that Rosina had opportunities of meeting Sarah I , whose attack has already been considered, and who is admitted to have been walking about during the early stages of her illness. With a disease like diphtheria, having probably at times a period of incubation which may be limited to hours, and with the uncertainty which exists as to the precise date when the first symptoms commenced in the two children Sarah I and Rosina E , it seems quite possible that the latter child may have had opportunity of con- tracting the disease from the former, and in this connexion it should be stated that the medical practitioner who attended both the children had from the first a strong conviction that the first symptoms which had been recognised in the case of Sarah I were quite one day in advance of those of Rosina E . Thus far we have dealt with six cases occurring in two families. Another attack deserves attention in connexion with the early history of the outbreak. It is that of an infant between 2 years and 3 years of age, named Jessie I d, who was attacked with diphtheria on August 2nd. The attack in this case appeared slight at first, but, a relapse occurring, it died on August 22nd. The house in which this child lived is also a new one, and its sanitary arrangements could not be found, apart from one point to be hereafter mentioned, to have had any bearing upon the disease. In point of situa- tion it is not far from that where the family E lived, yet, owing to the child’s tender years, there does not seem much probability that it had come into contact with the sick of either of the families previously referred to. Under these circumstances inquiry was made as to any previous throat illness in the same house. The family consisted, at the date of the outbreak, of the parents and three children, the other two children being respectively 10 years and 6 years of age. At first all previous sore throat was denied; but on being pressed, the mother, Mrs. I d, who had previously not thought the matter worth mentioning, informed me that, owing to the subsoil water get- ting in to the house the basement became flooded and she had on July 26th or 27th baled the water out. She suffered at the time from “ a chill,” which was followed, as far as can be recollected, on the next day, by a sore throat, which lasted until August the 2nd, when her child sickened. If this woman’s “ sore throat ” was the infecting cause of her child’s diphtheria, then it must also be considered in connexion with the