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
Catalogue details

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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    93 attack in the family E , for she admits haying held free communication with that family, although it is uncertain how far her more recent visits had preceded the attack of Rosina E . That they followed it is certain, and this leaves it further open to doubt whether Mrs. I d, without herself having any infectious sore-throat, could have been the means of conveying infection from the E s to her own child. The other two children in the house escaped. The circumstances narrated will suffice to show that at the period when this inquiry was commenced, the only available information had not that precise and accurate character which is essential to the elucidation of the causes of an epidemic. Especially did it fall short, so far as concerns the dates of the earliest recognised attacks, of the data necessary for the formation of an opinion as to the immediate origin of a disease, the etiology of which is at present involved in so much obscurity. It is, however, certain, that the houses first attacked had nothing in common as regards water supply, drainage, or milk supply. The influence of school attendance was inquired into, both with regard to the early history and the spread of the disease. As regards its early history, it was found that only one of the children who were first attacked in the three families above referred to was at the time attending school, and although as regards some of the later attacks, attendance at school may doubtless have favoured the spread of the disease by means of direct infection, yet even this influence was limited, because about a week after the disease commenced the school was closed. Notwithstanding this, however, there was subsequently such free communication between children coming both from infected houses, and from houses as yet healthy, as to render useless any attempt to ascertain whether any other influence beyond direct infection from person to person was at work as regards the cases that followed. But with regard to the first attacks, the occurrence in several families attacked with diphtheria of previous attacks of “ sore throat ” led to an inquiry whether the disease had not, either as sporadic diphtheria, or in an unrecognized, and perhaps in a modified form, been prevalent either in Swanscombe or the neighbourhood before the commencement of the epidemic. Any general prevalence of “ sore throat ” was not ascertained to have existed, and had it prevailed such, I am informed, is the reluctance of many of the inhabitants to seek medical attendance, even in cases of grave sickness, that it is not likely it would have come under medical observation. In the first week of July, however, a child aged 3 years residing at Galley Hill, was attacked with a disease which, in the absence of any suspicion as to the prevalence of diphtheria, was considered to be “ croup,” and the child dying, it was so registered. The medical practitioner in attendance did not observe any deposit on the fauces or any glandular enlargement, but the attack appears to have been associated with distinct febrile disturbance. No com- munication is, however, known to have taken place between any member of this family and either of the families in which diphtheria subsequently occurred. Again, in February last a death from diphtheria in a child 5 years of age was registered as having occurred at Galley Hill, and another took place in the same locality in September 1878. Besides which, in the first quarter of the present year, diphtheria was prevalent in the adjoining parish of Northfleet, four deaths being registered as due to this cause. Between Northfleet and Swanscombe there is admittedly very free com- munication, many people from the latter place going regularly to Northfleet to do their shopping. In short, there is very little doubt that cases of genuine diphtheria had been prevalent in and about Swanscombe prior to July last. And further, there are strong grounds for believing that the cases which were believed to have constituted the commencement of the epidemic had, at varying intervals, been preceded by other cases of “ sore-throat.” The incidence of the disease on one more house is noteworthy, both on account of the sanitary circumstances with which it wrns found to be associated, and which it may be useful to record for the purposes of the sanitary administration of the district, and because it wras found in common with several other cases to have been preceded by so-called “ sore-throat ” attacks in the same house. The case in question occurred in one of a modern row of houses erected for the working classes, and having a somewhat attractive exterior. The child Phoebe S , aged 3 years, was attacked on August 20th, and her case terminated fatally. She lived with her parents and an infant 10 months old on the first floor of the house in question, another family, Sp , occupying the basement and the upper story. The house has an open space at the back in which are situated a well and a cesspool. The well is sunk into the chalk to a depth of about 80 feet, the cesspool is also dug out in the chalk and is believed to be about 40 feet deep, the two being about 40 feet or 50 feet apart. Owing to the child’s extreme youth the mother was able to express herself as confident