Report by the Medical Officer on the prevalence of diphtheria in London and elsewhere : and its alleged connection with the elementary schools.

  • Smith, William Robert.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Report by the Medical Officer on the prevalence of diphtheria in London and elsewhere : and its alleged connection with the elementary schools. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    7 r ^7 To the Most Honorable The Marquis of LONDONDERRY, K.G., Chairman, and the Members of The School Board for London. In response to the direction contained in your resolution of the 24th January, 189-5 :— That the Medical Officer be requested to report generally on the prevalence of Diphtheria in London and elsewhere, and its alleged connection with th(i Elementary- Schools, and further to advise what, if any, steps the Board should take in the matter, I have made enquiry into the subject matter thereof and beg to report as follows:— Diphtheria is an acute specific disease of an infectious and contagious nature, manifesting itself generall}^, by symptoms of fever and weakness, and locally, by inflammation of the mucous membranes—particularly those of the throat and larynx—such inflammation being accompanied by a peculiar fibrinous exudation followed by abrasion and ulceration of the surface, with subsequent symptoms of paralysis, which paralysis may either be confined to the muscles of the palate or extend to those of the eye, the limbs, etc. The disease appears to have been known in the earliest ages, for the writings of Hippocrates, Galen, Celsus and others indicate that it was recognised by them. In England, in 1389, there was an epidemic of sore throat which carried off a large number of children, and in the district of the Rhine in 1517, there is recorded a prevalence of an unknown disease, in which the patients' tongues and throats were covered with a white fungoid growth. From this time the disease seems to have visited Spain, Portugal and Italy; in 1736 it was very prevalent in England and America, and during the years 1745-50 it not only again occurred in Portugal and Italy, but for the first time appeared in France and Holland, and again in England, especially in Cornwall and notably at Liskeard. In 1752 it was epidemic in Switzerland, Germany, and America, and later in Portugal, the north of France, Holland, Germany, America, and England. Towards the close of the 18th century there was, except in France, a marked remission which lasted for the first half of the present century when the disease again appeared on a more extended scale, but during the remission sporadic cases occurred in Great Britain; in 1840 there was an epidemic in Havei-fordwest and in 1855 one at Launceston. In 1821 a work was published by Bretonneau which gave a fuller account of this disease than had been published by any other authority, and in which many lessons are recorded drawn from his experience of an epidemic in Tours in 1818-21. It was this observer who gave the disease the name of Diphtheric, in allusion to its special power of forming membranes. In illustration of the persistency of the disease in France, and the possibility of the transport of the virus by human agency, it may be noted that in the Crimea the French troops suffered much from Diphtheria. According to Hirsch, a new era of prevalence of the disease began about 1857 in Europe and North America ; and in England the mortality was very great in 1858-59. From this brief outline of its history, there would appear to be no doubt that the disease has been known for many centuries, and, further, that one decided remission occurred, which was however followed by a sudden outbreak over a very greatly extended area. In England the Registrar General has only separately abstracted Diphtheria deaths since the year 1855 ; up to that time the few deattis occurring were registered under the head of Scarlet Fever. The following Table gives the death-rates per million from Diphtheria in England and Wales since 1855, and in London since 1859.