Mr. Spear's report to the Local Government Board upon recent prevalence of diphtheria and "croup" in the Stalybridge urban sanitary district, and upon the general sanitary circumstances of the district / [John Spear].

  • Spear, John.
Date:
[1890]
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Licence: Public Domain Mark

Credit: Mr. Spear's report to the Local Government Board upon recent prevalence of diphtheria and "croup" in the Stalybridge urban sanitary district, and upon the general sanitary circumstances of the district / [John Spear]. Source: Wellcome Collection.

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    regarded as diphtheritic, and I learned that the mother had suffered similarly Qj^ty three houses where a fatal attack or fatal attacks occurred, either of diphtheria or “ croup 55 or laryngitis, did I find that other members of the family had suffered from nm-fatal sore throat. The disease was undoubtedly very fatal, and with few exceptions death occurred within three or four days of seizure, or at least of the occurrence of any noticeable symptoms. There can belittle doubt that many of the so-called cases of “croup” were cases of true diphtheria. The history of the household invasion, alone, was in several cases strongly suggestive of this. Thus : ' In one family, within a week, two children died from “ croup,” and another from “tracheitis” (so certified). [One medical man who saw the last- named case assures me that it was without doubt a case of diphtheria, and certified it as such to the authority. A fourth death in the family three weeks later is not without suspicion ; it was certified as due to “ broncho¬ pneumonia.”] In a second family, two children died within two days of each other, of what was certified as “ croup.” In a third, within a month, one child died of what was certified as “ croup,” and another from what was certified as “laryngitis.” In a fourth two children died within a week of each other from “ croup,” and another a week later from “ pyrexia, irritation of the brain.” In a fifth, three children died within a week ; the deaths in two cases being ascribed to “ laryngitis, tracheitis,” in the other to “ malformation.” As to age, 32 fatal cases may be thus classified :—Under one year, one ; one to two, four; two to four, 16 ; four to eight, nine; eight to ten, two. I could not trace the various family outbreaks of diphtheria to any common source, nor, in the great majority of cases, was any chain of infection discover¬ able. So far as I could find, the earliest family invasion of the series occurred in November 1888, when, in the course of a week, two children of a family living in Kenworthy Street died from what was certified as “ croup.” I could not discover that these children had been exposed to any risk of direct infection; although it has to be noted that in the neighbouring districts of Saddleworth Rural and Upper Mill Urban diphtheria was then, and in Upper Mill had been for some time, prevalent.* The next known case was in Grosvenor Street (the same locality), and the child, who was certified like¬ wise to have died from “croup,” had been a playfellow of the previously deceased children, and had visited their house. Subsequently, the monthly list of family invasions (from diphtheria, “ croup,” and “ laryngitis ”) was as follows:—January, one; February, two; March, five; April, three; May, one; August, two ; September, one ; October, five ; November, one ; Decem¬ ber, two; January (1890), one; February, three. I did not find much evidence of the extension of infection through the attendance of children at school. Three of the October cases were amongst children attending one school; on the other hand, of the total number of initial sufferers, eleven were amongst non-attendants. There was no significant community of milk supply. As to locality, the disease was widely distributed throughout the town, although certain quarters suffered more than others. In a large proportion of the cases it was noticed that the infected houses were exposed, through direct connexions with the sewers, to the entrance of drain and sewer air. To this matter I will again refer. Sanitarv Condition of the District. Seioerage and Drainage.—The district is sewered chiefly by pipe sewers, but partly by brick and stone channels all emptying by many different outlets into the river as it passes through the town. Some years ago, owing, it is said, to the entire absence of ventilation of the sewers, two men working in one of them lost their lives; and since then they have been ventilated at various points by open man-holes, while the authority have likerwise favoured the plan— one that is open to grave objection—of connecting with the sewers rain-water * It should also be mentioned that sewer air was found blowing into the house through an internal gully connexion, a defect that remained unremedied at the time of my visit many months later.