Mr. W. H. Power's report to the local government board on diphtheria at the hospital for sick children, Great Ormond Street.

  • Power, W. H.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: Mr. W. H. Power's report to the local government board on diphtheria at the hospital for sick children, Great Ormond Street. 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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    (a.) Water.—As regards quality of the water supplied to the hospital, no suspicion attaches to it as delivered by the New River Company’s mains; but in the circumstances of water storage in hospital there may have been opportunity for its contamination. The drinking-water cisterns, which are, as has been said, situated in the space beneath the roof of the central block, are uncovered cisterns, and water in them is therefore liable to contamination by dust or other material suspended in air in this neighbourhood. Whether or not the particular dust from the houses in Powis Place penetrated the space beneath the roof of the hospital which is occupied by these cisterns, I am not able to say ; but it is certain that dust of some sort is to be found there in abundance. It should be noted that these cisterns have no kind of communi- cation with the drains of the hospital, their waste pipes being conducted outside on to the roof of the building, and there ended over open lead channels.' On the whole it is unlikely that the water supply of the hospital has been concerned in the production of disease. (b.) Milk.—Milk in some form or other was an element of diet of all patients. In addition most patients consumed as a drink, at some period of the day or night, milk or milk-and-water. The milk supplied to and used in the wards for drinking purposes was unboiled milk. All patients that were attacked during the outbreak drank milk, or milk-and-water, at one or other of their meals to within a short period of their seizure. But numerous other children habitually consumed milk under similar circumstances without suffering from infectious illness. Probably therefore the milk supply of the hospital, if infective at all, was at no time uniformly infective. At the date of the outbreak the quantity of milk received daily at the hospital (in two or more deliveries) averaged 80 quarts, and all of this milk was obtained from one retail milk business in the neighbourhood of the hospital. Investigation respecting the methods of storage of milk in the hospital dairy, and the routine of its distribution to and in the wards, seemed to show that a compara- tively small quantity of milk might be received and retained in the dairy, and subsequently be distributed in supplementary fashion, to particular patients, without at any time becoming mixed with other milk, or entering into the total milk service of a ward. If, therefore, a portion only of the total daily milk supply to the hospital had on occasions been (or had afterwards become) infective, such portion might have got distributed among the wards in some such way as would explain the phenomena of the outbreak. Further, the method of delivery of milk from the dairyman to the hospital seemed not inconsistent with exceptional supply to the institution of a small quantity of milk differing as regards source from the bulk of the day’s delivery. It may on occasion have permitted delivery of a large quantity of milk from one or more churns, and a much smaller quantity from another vessel. But there was no suggestion that the milk, or any portion of it, delivered at the hospital by the dairyman differed in any way from that distributed by him in the operations of his somewhat extensive business in the neighbourhood, where, as has been said, no unusual prevalence of diphtheria was heard of. In short, the total evidence, though failing to exclude milk as an agent in the outbreak, did not support suspicion of it to an extent justifying detailed inquiry into the operations of this dairyman’s milk business; the less so since experience has shown that investigation of this sort has sufficed before now to seriously damage the milk business inquired about. Nor was I disturbed in this judgment by the fact that the Great Ormond Yard case above mentioned chances to have been in a child among the customers of the dairy in question. Thus I find it needful to bring this report to an end, without having arrived at any definite answer to the question how diphtheria was produced in the Hospital for Sick Children. In some particulars the constructive details of the hospital will probably be considered by the Committee as requiring further critical observation, with a view to getting assurance that all the carefully devised arrangements are doing their work efficiently and safely. I should wish to add, that had a satisfactory outcome to this investigation been for me attainable. Dr. Abercrombie’s able assistance would have gone far to secure it. W. H. PQWER. 2nd June 1880.