Mr. John Spear's report to the Local Government Board upon a re-inspection of the registration sub-district of Dartford, and upon the continued prevalence in the district of diphtheria / [John Spear].

  • Spear, John.
Date:
[1884]
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Licence: Public Domain Mark

Credit: Mr. John Spear's report to the Local Government Board upon a re-inspection of the registration sub-district of Dartford, and upon the continued prevalence in the district of diphtheria / [John Spear]. Source: Wellcome Collection.

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    Mr. John Spear’s Report to the Local Government Board upon a Re-inspection of the Registration Sub-District of Dartford, and upon the continued Prevalence in the District of - theria. George Buchanan, Medical Department, July 15, 1834. In this registration area are comprised the Urban Sanitary Distric Cartel The^gTealer' part of the Rural Sanitary District, of Dartford. It was inspected on behalf of the Local Government Board in the latter part of 1882, on account of the then prevalence of diphtheria and enteric fever; and in the rural division, on account of diphtheria prevalence, an inspection on behalf of the Board was likewise carried out in 1879. The official abstracts of the reports presented on these occasions are as follow :— Rural Sanitary District. Inspection of 1879 :—“Fatal outbreak of diphtheria in Swanscombe parish, “ where the conditions of water supply, drainage, and excrement disposal were generally most defective. “ Sanitary circumstances of the entire rural district also found to be in many respects similar to those of “ Swanscombe, and sanitary administration very imperfect in many essential respects.” Inspection oj 1882:—“ Localised and recurring outbreaks of diphtheria. Initial cases appearing in houses “ where gross sanitary defects existed, and in spots where diphtheria had previously been observed ; “ disease then apparently spreading through schools. Parts of this district rapidly extending, yet no “ byelaws. Houses being built without any regard to sanitary requirements. Very little inspection for sanitary “ purposes.” Dartford Urban Sanitary District, Inspection of 1882:—“Prevalence of enteric fever, localised to “ low-lying portion of town, during 1881 and part of 1882. In parts invaded, sub-soil water stands often “ three or four feet only from the surface; and into this water-level wells and cesspools are sunk indifferently. “At time of fever outbreak sewers were being constructed, pumping operations to lower sub-soil water being “ needed. Wells and cesspools were often pumped dry. Wells, on again receiving water soakage, of course t£ much polluted. Forty per cent, of houses in this low-lying district supplied from local wells, remainder from Kent Company’s mains (everywhere available) ; in former, over 80 per cent, of fever attacks occurred. In addition to defects of water supply, cesspool and other nuisances very common in the district.” In March 1884, owing to the continued prevalence of diphtheria, and in the absence of any precise information of proper sanitary action on the part of the two authori¬ ties, the Board again directed a medical inspection. The enteric fever prevalence in the urban district, the subject of previous report, was found to have ceased ; but, on the other hand, diphtheria had become more general and fatal; and the urban district, which had previously escaped this disease, was now implicated. A table giving the vital statistics of the Registration Sub-district as a whole will be found appended, but it will be necessary in this descriptive portion of the report to deal with the two sanitary divisions separately. The Urban District. The prevalence of diphtheria in the urban district is, so far as recent times are con¬ cerned, a new experience. During the 15 years, 1868-1882, I find oniy four deaths registered under this name ; although from “ croup,” a name under which true diphtheria doubtless often passes, there were registered, it is to be noted in this con¬ nection, in the same period, 26 deaths. In February 1883 an isolated fatal case of diphtheria occurred in Great Queen Street, and in April there were two cases, with one death, in a family living in the High Street. In November and December several cases occurred, eight deaths (including one from “ diphtheritic croup ”) being registered in these two months and the first three days of 1884. It seems almost impossible now to estimate the number of cases. The Medical Officer of Health, who would probably have heard of recognised attacks, knew of only nine families invaded during the year; or seven during the last two months. In these, some 14 attacks occurred. The death register, however, records an unusual number of deaths from “croup” and “laryngitis” during the year in question, and, as to milder cases, several of a suspicious character were heard of. The appearance of scarlatina at the close of the year presented a further difficulty in this connexion. Two deaths were then registered as from “ suppressed scarlatina, paralysis,” a descrip¬ tion which strongly suggests diphtheria; and in another instance the first death in a family was ascribed to scarlatina, the second, three weeks later, to diphtheria. The following table will further illustrate these coincidences:— u 1^902. 200.-7/84. Wt. 3614. E. & S. %