Mr Netten Radcliffe's report to the Local Government Board on the sanitary condition of Gravesend, Kent.

  • Radcliffe, J. Netten.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Mr Netten Radcliffe's report to the Local Government Board on the sanitary condition of Gravesend, Kent. 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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    66 year (1877) have been no less than 74.* I have endeavoured to obtain some account of the actual number of cases of scarlet fever which have occurred in this formidable outbreak, and from returns with which various medical gentlemen practising in Gravesend have courteously forwarded me, I learn that the number under their treatment from the 1st January 1876 to the end of June 1877 has been 369, by far the greater proportion occurring in the last quarter of 1876 and first and second quarters of 1877. Gravesend has no public means of dealing effectually with the first beginning of an infectious disease, such as scarlet-fever, nor of limiting with any certainty its after* spread. Whether the recent great prevalence of the disease was determined by development of the malad}7 beyond the proportions in which it commonly exists in the borough, or by its importation anew from neighbouring localities where it had previously become actively diffusive, cannot be said. Gravesend had at the time of the outbreak the infection within itself, while at the same time it was freely exposed to infection from without. The essential fact to be had in mind with respect to the dissemination of this disease is that this is effected by the com- munication of infection from the sick to the well, either directly or through the agency of clothing or other matters which may have been exposed to the infection. Overcrowding and even certain other insanitary conditions of a sort to be presently described, may facilitate the spread of the infection, but fewer infectious diseases are less dependent than scarlet fever on incidental aids of this kind for promoting their diffusion. There are but two means which afford any certain security against the spread of the disease, namely prompt isolation of the sick, and the effectual disinfection of articles which having been exposed to infection may harbour the infection. Now Gravesend has no means of isolating infectious sick, not even such sick as would come under the operation of section 124 of the Public Health Act, 1875. Hence during the whole of the recent prevalence of scarlet fever it has not been practicable for the Local Authority to isolate a single individual where such isolation was necessary for the safety of the community and could not be had within the patient’s home. Hospital provision used for the isolation of early cases of infectious diseases, it must be remembered, is the provision of all others most likely to prevent an epidemic, and this equally whether the early cases of the epidemic were indigenous or imported. Evidence has been sub- mitted to me which has led me to the conclusion that had there been hospital accommoda- tion for the infectious sick in Gravesend it might have been possible either to arrest wholly the progress of the outbreak at the beginning, or if this could not have been achieved, at least to prevent fully one third, if not one half, of the sickness, and probably also, to the same extent, loss of life from the disease. Not only has Gravesend no hospital, but it has also no public means of disinfecting clothing and bedding by heat—the only mode of disinfection v* hich meets properly the exigencies as to disinfection of infectious diseases such as scarlet-fever or small-pox. The Local Authority makes use, it is true, of chemical disinfectants, and it has the excellent plan of destroying by fire, and paying the cost of, beds and bedding which may have been exposed to infection, when its Medical Officer of Health recommends. But such destruction can only meet to a very limited extent the necessity of the case, unless it be made to include all materials (bed-linen, clothing, curtains, &c.) which are liable to receive infection, when the expensiveness of the procedure could hardly be justified, other less costly means being available. Then Gravesend has no mortuary, and the dead from infectious disease are apt to become dangerous sources of infection while the corpse remains unburied within an inhabited house.f The number of cases of enteric fever returned to me as having occurred in Gravesend during recent months (the fever being habitually present) was no less than 106. Almost the whole of these cases occurred during the 11 months following July 1876. The Medical Officer of Health, Dr. Gramshaw, has expressed a doubt whether a few cases of comparatively slight febrile disturbanee, but of several days’ duration, included * Gravesend :—Deaths from Scarlet-fever. 1871. 1872. 1873 1st quarter 2nd quarter 3rd quarter 4th quarter 1st quarter 2nd quarter 3rd quarter 4th quarter 1st quarter 1873. 1874. 1875. 2nd quarter 3rd quarter 4th quarter 1st quarter 2nd quarter 3rd quarter 4th quarter 1st quarter 2nd quarter 1 1 2 7 15 2 2 1875. 3rd quarter 4th quarter 1876. 1st quarter 2nd quarter 3rd quarter 4th quarter 1877 1st quarter 2nd quarter ICl - - ^IIVA. t^uax l/Vl - td ICl - Twice in the course of this inquiry has small-pox been introduced into Gravesend, and the grave mm want, of means of isolation in furred. The second case died, and here hardly less i f Twice in the course of this inquiry has small-pox its extension from want of means of isolation incurred, incurred from the corpse.