Mr. R.D.R. Sweeting's report to the Local Government Board on the prevalence of diphtheria and enteric fever in the Tottenham urban sanitary district / [R.D.R. Sweeting].

  • Sweeting, R. Deane.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Mr. R.D.R. Sweeting's report to the Local Government Board on the prevalence of diphtheria and enteric fever in the Tottenham urban sanitary district / [R.D.R. Sweeting]. Source: Wellcome Collection.

    3/8 (page 3)
    Here again, over 80 per cent, of fatal throat-illness registered otherwise than as Diphtheria, took place between the ages one and ten years, so that, on classing together Diphtheria deaths and deaths from other throat maladies, it appears that 87 per cent, of the total mortality from throat diseases of all kinds was incident upon the age-period 1-10 years. Prom consideration respecting the 33 deaths from throat-illness above referred to, I came to the conclusion that they were in essence of a diphtheritic character; hence, if they are added to the 48 undoubted Diphtheria deaths, the mortality-rate from this disease during 1884 becomes 1 • 1 instead of * 6. Similarly, in other years the rate of Diphtheria mortality would doubtless be raised if deaths under the headings referred to were brought into account. In 1885, to the end of April, 17 Diphtheria deaths have been registered in Tottenham. They occurred in 11 houses; all were under ten years of age and 13 of them under five years. In addition, 8 deaths were, registered from “ Croup” and “ Cynanche,” at ages ranging from seven months to nine years. The 29 “ Fever ” deaths which took place in 1884 all appear to have been cases of Enteric Fever. They occurred in 25 separate houses. Four of them, however, took place in the Training Hospital, of which two were cases from other districts, so that the corrected number is 27, and the corrected rate for 1884, *3 per 1,000. In point of time, these 27 fever deaths took place monthly, as follows :— January - 2 February - 2 March 5 April - - 2 June - - 1 J uly - 3 August - 1 October - 1 November - 3 December - 7 Also up to April 9th, 1885, 7 deaths from Enteric Fever have occurred in 7 houses. All the deaths in both years were over fifteen years of age. Upon commencing my inquiry at Tottenham into the conditions of this serious prevalence of Enteric Fever and Diphtheria, I found my investigation hampered by the circumstance that the Sanitary Authority possessed no Inspector of Nuisances; the old one had left, and the newly appointed one had not yet taken office. The Chairman of the Local Board was, however, good enough, at the suggestion of the Medical Officer of Health, to arrange that the services of Mr. Poulson, the late Nuisance Inspector, should be placed at my disposal for a couple of days. Another circumstance which was adverse to the completeness of my inquiry in Tottenham was the migratory character of the population, and the consequent difficulty in tracing cases which had left. Having regard to these difficulties, I did not attempt to obtain from the 32 medical practitioners who reside in the Tottenham Urban District, complete lists of cases of Diphtheria and Enteric Fever, but set to work to visit all the localities (and as many houses as possible) in which fatal Diphtheria and Enteric Fever had occurred since December 31st, 1883, as well as a few other localities and houses where non-fatal cases of the above diseases were reported as having- prevailed. As a general result of investigation of this kind I found that fatal Diphtheria and Enteric Fever had been pretty uniformly distributed over the whole district, no part of it seeming to have suffered or to have escaped disproportionately to the rest; and therefore, the unwholesome hygienic conditions of the places visited may be looked upon as affording a fair criterion of the sanitary short-comings of the district. The chief insanitary conditions thus found associated with fatal Diphtheria and Enteric Fever in 1884 are taken in the following order:— (I.) Sewer Ventilation and Flushing.—Ventilation of sewers is irregularly provided throughout the District, and is in many parts very inadequate. Further, the road orifices of the ventilators are not uncommonly blocked up with mud and detritus. No automatic provision for flushing exists. Such flushing as is done is by charging certain flushing chambers with water conveyed to them in water-carts ; but even this is not carried out regularly. Neglect of systematic flushing of the sewers in Tottenham becomes the