Dr. S. Monckton Copeman's report to the Local Government Board on the sanitary condition of Lakenheath, in the Mildenhall Rural District, with special reference to the recurrence there of diphtheria during a series of years.

  • Copeman, S. Monckton (Sydney Arthur Monckton), 1862-
Date:
[1893?]
Catalogue details

Licence: Public Domain Mark

Credit: Dr. S. Monckton Copeman's report to the Local Government Board on the sanitary condition of Lakenheath, in the Mildenhall Rural District, with special reference to the recurrence there of diphtheria during a series of years. 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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    18 One reason for introducing the above table and ciiarts is, that I desire Lhat it Causation of should at once be made apparent, as it will be from the most cursory study of the Diarrhoea, charts, that, while the general fact of temperature influence on the amount of -^^ Ballard diarrhoeal mortality, especially in the summer season, cannot be disputed, air- ' temperature will not account for everything ; for if it did we should not find such discrepancies in amounts of mortality in years which were alike in the mean temperature of their third quarter. It must be evident that other factors are operative. What these factors are it is one of the objects of this inquiry to discover. During the early years of registration there was necessarily much less reliance than now to be placed upon the statements made as to the cause of death, since the custom of medical certification has become more universal; so that probably the figures given for the earliest years must be taken with some allowances for incompleteness. II. Synonyms of Diarrhgea. The most frequently used term is diarrhoea. This term designates a complex Synonyms, malady by the name of its leading symptom. Other terms, however, are in use. Choleraic diarrhoea, English cholera, Cholera nostras, Inf atitile cholera, are terms used sometimes to designate very severe cases which in one way or another appear to the persons using these terms to assimilate to true cholera. Often such terms as enteritis, muco-enteritis, and gastro-enteritis are employed, the person using them desiring to signify that he recognises in the illness an inflammatory condition of the digestive mucous tract. When bloody stools or tenesmus occur the disease is often designated dysentery or dysenteric diarrhoea. There is obviously a good deal of fancy in the selection of any particular term as it is met with in public records, the terms diarrhoea, dysentery, dysenteric diarrhoea, cholera, and choleraic diarrhoea being those most commonly used in the diarrhoeal epidemic seasons, both in the case of infants and older persons; at other seasons the other terms are found to be more used, but still the term diarrhoea predominates. Moreover, the term cholera or choleraic diarrhoea is applied less frequently to the severe malady of infants than when a similarly severe case occurs in older persons. I may be permitted to add that I have satisfied myself as regards public records of classified mortality, that though all deaths certified in every one of the above ways be included with diarrhoea, nevertheless many other deaths directly due to that disease may remain omitted from their proper class. This is especially true of the deaths which are registered during the epidemic season; but the remark applies almost solely to infants. The hurry of extensive medical practice, especially in large and manufacturing towns, results I fear in a good deal of hurried, incomplete, and unscientific certification of the cause of death in infants ; so that many dia.rrhoeal deaths during the epidemic season get registered under the terms atrophy, marasmus, want of breast milk, &c., which are sometimes antecedent conditions determining the fatal issue; or under the terms convulsions, hydrocephalus (meaning mostly, I presume, the hydrencepha- loid disease of some writers), vomiting, &c., which, like diarrhoea, are elements in the condition of the patient met with at some period, often the final period, of the malady. But for my purpose the error is of little consequence, since it is of general occurrence in all parts of the kingdom, and so can affect only to a trifling extent any comparisons instituted between diff'erent places or the same place in diff'erent years. Nor, the error being thus recognised, does it detract from the extreme value and usefulness to the investigation of the mortality records of the General Register Office. III. Pathology of Diarrhcea. This has, with the assistance of Dr. Klein, whose services as a pathologist have been Pathology, invited by the Board in aid of this inquiry, been studied upon such bodies of infants dead of the malady as were available for the purpose. The opportunities were fewer than could have been wished for, but the uniformity of the morbid conditions discovered makes up to some extent for this deficiency. In the bodies examined there were marked pathological changes not only in the intestines, but in all the viscera, and not alone in the viscera of protracted cases, but in those of infants the total duration of whose illness had not exceeded 12 or 14 hours. For the most part the intestines were empty, or only contained a little Alimentary yellow fcecal matter, or a little opalescent mucoid fluid, or the surface was coated canal.