Mr. Spear's report to the Local Government Board upon an outbreak of enteric fever in the Pemberton urban sanitary district, Lancashire / [John Spear].

  • Spear, John.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Mr. Spear's report to the Local Government Board upon an outbreak of enteric fever in the Pemberton urban sanitary district, Lancashire / [John Spear]. Source: Wellcome Collection.

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    It so happens that a graveyard stands on the northern or higher side of Graveyard. Lamberhead Green, just below the principally infected localities. It is drained at a depth of nine feet into the Pemberton main sewer. The method in which interments are reported to be carried out appears objectionable. According to my information, unsealed coffins are still deposited in vaults; and, as to ordinary graves, since the prescribed interval between each is only 2\ feet, it occasionally happens that in digging one the coffins in another are exposed. The defects of sewerage and of methods of excrement disposal above described may, perhaps, in a season favourable to the development of the typhoid poison, and in localities that have suffered previously from time to time from typhoid fever, be held to account for some degree of prevalence of that disease amongst the general population; but the sudden and practically simultaneous occurrence of many cases amongst the children of Lamberhead Green evidently requires further explanation. I will proceed now to examine more closely the history of those cases. Of the 29 initial sufferers under 16 years of age during the first 16 days of the epidemic prevalence at Lamberhead Green, 11 (aged from 13 to 16) were engaged in various household or industrial occupations, and did not attend school. Of the school children, no very great incidence upon the pupils of either school was observed, and the schools were, moreover, closed for three weeks, for the summer holidays, on July 18th ; that is to say, four days before the date suggested by the evidence as the one upon which infection operated. It does not appear, then, that school attendance could have exerted any influence. I have had occasion, in several outbreaks of typhoid fever, to suspect that bathing in sewage-polluted waters may, in isolated instances, have led to infection; but in this case such an explanation could not, it was found, apply in any material degree. It will be observed that girls suffered even more than boys. The supply of milk in no way corresponded with the distribution of infection. Of 25 initial sufferers at Lamberhead Green two were stated to have used no milk, and amongst the others the supply was obtained from eleven different sources. Other Food Supply.—Inquiries in this direction met with purely negative results except as regards the following exceedingly suspicious circumstance. On July 22nd—the day on which it has been suggested special mischief befell the youthful population of Lamberhead Green—the village fair was held, and, with very few exceptions, the early sufferers had, I found, indulged themselves either in ice-cream, pease-pudding, or ginger-beer (and often all three), sold at the fair booths. As to the ice-cream, all I learned was that three dealers, coming from Wigan, it was believed, provided it, and that in Wigan no unusual prevalence of typhoid fever was at the time experienced. Of the pease-pudding and ginger-beer, a quantity of that sold had, I found, been made in a dirty, ill-ventilated room, in which a boy lay ill of fever. This was the case that appears in Table I. as occurring in Lamberhead Green in the week ending July 13th. It was one characterized by much diarrhoea during the early stages of the attack. The process of making the “ pease-pudding ” and ginger-beer was described to me; where the boy lay he could have stretched out his hand and touched the vessels in which these articles were being prepared; they stood, moreover, the whole night in a scullery adjoining, and ventilated from, the sick chamber. Several of the affected children were able to tell me not only what they had at the fair, but at what stall they obtained it, and while positive statements were forthcoming in the case of 14 of the earlier sufferers that they had partaken of the things prepared in this fever chamber, there was reason to believe that the same held good as regards nine others. In fact, it seemed not unlikely that all the chi Id-sufferers at the time of the epidemic outburst had been exposed to this possible danger. The marked incidence of the epidemic disease upon the children inhabiting the north side of the village (already referred to) is difficult at first sight to satisfactorily explain within the limitations of this hypothesis, and, in fact, seemed to me at first destructive of it. It has to be noted, however, that the family making and selling the suspected articles of food and drink lived A 3 Considera¬ tions respect¬ ing influence of ordinary sanitary conditions. Schools Bathing. Milk. Other food supply. The fail- booths.