Dr. S. Monckton Copeman's report to the Local Government Board on an outbreak of epidemic skin disease in the Enfield workhouse of the Edmonton union / [S. Monckton Copeman].

  • Sydney Copeman
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Dr. S. Monckton Copeman's report to the Local Government Board on an outbreak of epidemic skin disease in the Enfield workhouse of the Edmonton union / [S. Monckton Copeman]. Source: Wellcome Collection.

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    regions, and gradually extended thence over the limbs and trunk. In yet a few other cases the disease made its first appearance on the soles of the feet. In the further progress of the cases the same distinction was noticeable between a “ moist ” and “dry” variety as had been witnessed in previous outbreaks of the malady. In a large proportion of the cases the rash was followed after a longer or shorter period by copious desquamation. Unfor¬ tunately, however, no clinical notes or temperature charts had been kept, so that it was impossible to say in any instance whether the onset of the disease had been accompanied by pyrexia or other special symptoms. (Janie of the Outbreak. As in my former investigations, I made inquiries into the circumstances, not only of the persons who had suffered attack by the disease but also of those other persons living in the house who had not become attacked, in order to find out if possible the cause or causes which had brought about the epidemic. With one or two exceptions, all the persons attacked were of advanced age, and sufferers also from chronic disease of one kind or another. The disease had attacked a number of these persons in the first instance almost concurrently, although they were at that time distributed over several different sick wards. Of these, the female wards are in direct communication with the main building, while the male sick wards, on the other hand, are isolated from it. There is thus, ordinarily speaking, no communication between these two sets of wards, excepting that the nurses on duty in either block necessarily meet, from time to time, in their mess-room or in the surgery. As in former outbreaks in other Poor-law infirmaries, I was able to eliminate irritation of the skin due to soap, to coarse body clothing, and to newly-dyed and unwashed bedding from having had concern with the outbreak. As far as I was able to learn, there existed no possibility of infection having been brought personally to the patients from outside the institution. The sanitary surroundings of the patients, too, were very similar in all the different wards. Only when the question of diet came to be considered did there appear a basis whereon distinction could be made between the circumstances of those who had suffered attack and those who had escaped the disease. On going carefully into this subject, it appeared that of the various articles of food and drink contained in the dietaries of the various inmates of the institution, only two were in common use among all the persons who had suffered attack, namely milk and bread. The bread, baked on the premises, and believed to be of good quality, had been, however, supplied equally to all the inmates of the institution, whereas the milk had been (with the exception of the small amount supplied in tea) only served to the patients in the various sick wards. It is true that two cases of the disease occurred among the more or less able-bodied inmates of the house proper, into whose diet milk does not enter; but, on fuller and detailed inquiry, it was found in each instance that these particular persons had been consuming a certain amount of milk. One, a man named H——, who had been employed each day to carry the supply of milk to the female side of the building, had not only received some from the nurse each day for his trouble, but had, he confessed, from time, to time abstracted a still further portion. The other case, a woman named B-, who had been on No. 2 dietary,* had also, I found, been receiving a special allowance of milk to the extent of one pint a day. With the exception of these two, no case occurred from first to last among those persons living in any part of the workhouse other than the sick wards. On inquiry of the master, I learned that in April, when the epidemic commenced, the contractors for the milk supply were Messrs. A-, the same firm which had been supplying the other Poor-law institutions on which I have reported in connexion with former outbreaks of a similar character. I further learnt that the contract with this firm dated from the previous quarter-day. Their milk had, however, actually been supplied to the workhouse since March 31st only, previous to which date milk had been * See Appendix.
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