Dr. R. J. Reece's report to the local government board on the epidemic of enteric fever in the city of Lincoln, 1904-5.

  • Reece, Richard J.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Dr. R. J. Reece's report to the local government board on the epidemic of enteric fever in the city of Lincoln, 1904-5. 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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    Milk. In this instance, the investigations made with a view to ascertaining whether milk had been the vehicle of transmission of the fever, lent no support to such a thesis. It was found that the first 48 cases of the disease derived their milk-supply from no fewer than 32 different sources ; and, throughout the whole course of the epidemic, the facts ascertained in relation with this question failed to suggest that milk played a part as a distributor of the infection, whether in Lincoln, Bracebridge, or New Boultham. Sewerage and Drainage. As has been stated, one system of sewers serves Lincoln, New Boultham, and the great majority of houses in the Bracebridge Urban District ; and the conditions of house drainage are much the same in each. Here then there is an agency, common to the three invaded areas, which is presumed to be a possible means of distributing the infection of enteric fever. But if the fever had in this instance spread by such channel, there would, it may reasonably be contended, have occurred very special incidence of the disease on houses to the interiors of which sewer-air could, by reason of defective sanitary fittings, gain access. In each of the first 25 houses invaded, however, the interior was efficiently disconnected* from the house drains, nor, moreover, could sewer-air have gained access to the interior of 21 of these houses by means of defective soil pipes, inasmuch as they were not provided with indoor waterclosets. Indeed, out of a total of 834 invaded houses, in regard of which information of this sort is available, only 73 had indoor waterclosets. Again, had sewers played an important part in causation of the epidemic, it is to be anticipated that there would have occurred special incidence of the fever in relation with a particular sewer or line of sewers, more especially in the early stages of the outbreak. But, as matter of fact, no such special incidence was observed. The first 25 cases occurred at spots widely apart and in every quarter of the City of Lincoln ; while the subsequent progress of the epidemic was characterised by like behaviour throughout all the three areas involved. Nor was any special incidence of the fever noted in relation with dead-ends of sewers ; nor on the higher parts of the invaded areas, which are maintained by some to be particularly liable to invasion by disease transmitted by sewers. There wras, indeed, greater incidence of the fever on the low-lying Park and Wit-ham wards of the City of Lincoln than on other wards of the City, as will be seen on reference to Table VII. (p. 9). For, wdiereas the percentage of houses invaded by the fever in Lincoln as a whole was 6*3, the percentage of such invasion was 9'34 in the Park ward and 7'47 in the Witham ward ; wdiile the percentage invasions in the Minster and Carholme wards wrere but 4-63 and 5'52 respectively. It is in these low-lying- wards that difficulty was experienced, by reason of the nature of the ground, in laying satisfactory sewers when the present sewerage system of Lincoln was installed (see Appendix II., p. 33) ; and it may be contended that the sewerage conditions in these wards stood in some degree of causative relation 'with the greater amount of fever experienced there than in other parts of the City. On the other hand, it is to be borne in mind that these two tvards are inhabited mainly by the working-class, which usually comprises a disproportionate number of persons at ages most susceptible to enteric fever, and which lives under the conditions rendering the individual more prone to contract enteric fever than is the case with the well-to-do class. As appears in Table V. (p. 8), eight of the 31 cases of fever known to have occurred in the Branston Rural District did not reside in New Boultham, and accordingly did not occupy houses draining to the sewerage system common to the three invaded areas. Twro’}' of these cases occurred in the Bracebridge Lunatic Asylum. With one exception, all these eight persons had been frequent * The house drainage of the office where “ E.W.,” the second notified case, worked daily were, however, defective. See p. 7. t One of these cases is certified as having died from acute phthisis. The circumstances, however, seem to point to this person having suffered from enteric fever also.