Dr. Blaxall's report upon the long continued prevalence of diphtheria in the urban sanitary district of Taunton, and on the sanitary condition of the town / [F.H. Blaxall].

  • Blaxall, F. H.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Blaxall's report upon the long continued prevalence of diphtheria in the urban sanitary district of Taunton, and on the sanitary condition of the town / [F.H. Blaxall]. Source: Wellcome Collection.

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    6 It will be seen by reference to the above :— (1.) That the newly invaded families increased from 2 in October 1881 to 10 in March 1882. That in the three following months of April, May, and June they stood at 8, 8, and 9 respectively, but rose to 14 in July, reaching the maximum of 19 in September, then decreasing to 13 and 12 in October and November, and to 3 in December. (2.) Of the 127 primary attacks, 44, or more than one third, occurred in adults, while of the remainder, 51 were children attending one or other of the schools, and 32 children non-school goers. (3.) Females were the chief sufferers, to the extent of more than two thirds of the total cases amongst adults and school children. (4.) Multiple cases occurred in 46 families, varying from 2 to 6 cases in a family. (5.) The mortality has been high, about one in every four attacks proving fatal, and the deaths, it should be noted, were confined to children under 15 years of age. The deaths did not all take place at Taunton, one occurring at Torquay, two at Ply¬ mouth, one at Dulverton, and four at the sanitary hospital outside the limits of the borough. But inasmuch as in these cases the disease was contracted at Taunton, the deaths are included in the above table. I heard of one instance in which a girl of about 15 had recovered from the acute symp¬ toms of diphtheria, and was, sent to Torquay for change of air. Subsequently general paralysis supervened, and in a few days she died. Other interesting particulars came to light in connexion with this epidemic, such as examples of family predisposition to contract the disease, with attendant fatal results ; and in these cases the sufferers had been more or less subject to sore throat, and some of them had had diphtheria before. Further, four deaths here shown as due to diphtheria call for special comment. (a.) Three children in one family died within three weeks of each other. The first death, that of an infant 10 months old, was registered as due to bronchitis and convulsions, the second to inflam¬ mation of vagina and gangrene, the third to diphtheria. In this last case the boy had com¬ plained of sore throat before the other two children were taken ill. In the second case the vulva was covered with a white membrane, accompanied by great oedema, and followed by gan¬ grene. No doubt this was a case of diphtheria manifesting local symptoms in a less usual part of the body. Under the circumstances 1 have regarded all three deaths as due to diphtheria, and included them accordingly in the above table. (b.) In another family two children, the one an infant and the other a little girl, aged six years, died within 11 days of each other. The infant’s death is registered as due to bronchitis, and the second case to ulcerated throat; but the medical man who attended these children in¬ cluded them in the cases of diphtheria he gave me, and from the history and particulars of the cases I learned from the mother I have no doubt they were so. (These cases will herein¬ after be referred to as illustrative of disease spread by personal intercommunication.) I visited the 127 infected houses, as well as numerous other houses in which measles, scarlatina, or typhoid fever had been present, and others again that had escaped such invasions. Diphtheria was still present in the town, and typical cases came under my own observation, as well as numerous instances of diphtheritic paralysis amongst convalescents, affecting vision, voice, and motor power. As regards the manner of spread :— Inquiry into the various channels by which disease is not infrequently disseminated went to show:— (1.) As to the water supply:—Of the 127 infected families, 91 obtained their drink¬ ing water from the town supply, 30 from wells, and 6 from both sources. Now, seeing that some 2,700 families get the town water, the proportion of those attacked (90) is inconsiderable, being little over 3 per cent. So, again, as regards the wells, about 1,000 families are depeudent upon this source, and 30 or 3 per cent, only suffered. Thus the disease was pretty equally distributed amongst the consumers of water of both sources. More¬ over, where several families obtained their drinking water from one and the same well, it not infrequently happened that one individual only of the number was attacked. Hence there appears no reason for suspecting the water supply of either source to have been directly implicated in the spread of the disease. (2.) As to milk :—This was obtained from different dairies, whilst a few of the infected families did not take milk. (3.) As to sewer air :—Many of the infected houses were undoubtedly exposed to the escape of sewer air into them, but this was equally as much the case with houses exempt from disease, while a notable number of the infected