Dr. Blaxall's report upon the long continued prevalence of diphtheria in the urban sanitary district of Taunton, and on the sanitary condition of the town / [F.H. Blaxall].

  • Blaxall, F. H.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Blaxall's report upon the long continued prevalence of diphtheria in the urban sanitary district of Taunton, and on the sanitary condition of the town / [F.H. Blaxall]. Source: Wellcome Collection.

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    houses were not exposed to this danger, either the drain-inlets and closets being well removed from the dwellings, or the houses, as was the case in a few instances, not being included in the drainage system at all. Further, the attacks did not exhibit the simultaneous character indicative of common exposure to such an infection. The only instance that primd facie suggested sewer air as the probable agent was met with at the Convent. Here was a school of 56 girls, holding, it is said, little or no communication with the external world. The sleeping accommodation consisted of three dormitories, 18 girls sleeping in one, and 19 in each of the two others. In dormitories 1 and 3 the wash-basins had discharge pipes leading direct into the drain, thereby affording a channel for the escape of the sewer air into the room ; this faulty connexion did not exist in No. 2 dormitory, but it opened into No. 1 dormitory, and so, to a certain extent, shared in the danger, while sink and bath pipes situated on the same floor were in direct communication with the drain. Of the 56 children 12 were attacked, namely, four in each dormitory. The dates of attack could not be ascertained, but it is clear they extended over a month or six weeks, while a fortnight elapsed between the first case and those that followed. Now had the outbreak been due to sewer air, to the evil effects of which all in the school were more or less exposed, simultaneous attacks would have been anticipated. There was no evidence to show how the disease was introduced into the school, but, inasmuch as measles on a previous occasion made its appearance there, diphtheria may have been conveyed by some unsuspected channel, and, once introduced, spread amongst the other children. [I should state that at the time of my visit the connexion between the wash-basins and drains had been severed, but not so as regards the pipes from baths and sinks.] Thus water, milk, and sewer air may alike be excluded from having exercised any direct influence on the spread of the disease; in short, careful inquiry into the condi¬ tions and circumstances under which the people lived failed to reveal anything that could be accepted as offering a satisfactory solution to the question, except personal intercommunication between the infected and healthy. And here there was good ground for suspicion, abundant evidence being forthcoming at every stage of the inquiry that intercommunication of this kind obtained to a very great extent. Personal inter¬ course took place freely between infected and healthy families, servants going to and fro between infected and healthy houses ; females and children continuing to attend factories and schools while in an infective condition, or going there from infected dwellings, and so forth. In illustration of the foregoing, the following examples may be cited:— (1.) Mrs. P. went to a kindergarten school, taking with her her little girl; while waiting outside the school one of the pupils ran out and kissed the child. On the following day Mr. W. Liddon was called in to see this pupil, when he found her suffering from diphtheria. Two days afterwards he was called in to see Mrs. P.’s child, and found her also suffering from diphtheria. Upon making inquiry as to where the child had been the mother mentioned the incident of the visit to the kindergarten school and the little pupil’s kiss, when Mr. Liddon at once saw the connexion between the two cases ; but for the circumstance that they both came under treatment of the same medical man the probability is the origin of this second case would have escaped detection. (2.) A gardener residing in Pearce’s Court was attacked on February 15th, subsequently diphtheria appeared in the adjoining house, free intercommunication existing between the two families. Here an infant was attacked and died on March 5th ; a second child, a boy, continued to go to school as usual till March 8th, when he also was taken ill and died. These deaths were registered as due to bronchitis and sore throat, as already stated on page 5. (3.) A servant residing in North Terrace, who was in the habit of being sent to another house in the same row to inquire for sufferers from diphtheria, w'as herself attacked, when she was sent to her own home in the country, where she conveyed the infection to her sister. (4.) A girl in service with a family in the Avenue was sent back to the “servants’ home” suffering from sore throat, when it appeared that several members of the family she had left were also suffering from sore throat of an indefinite character. Two days after the girl’s return to the “ home ” she mani¬ fested symptoms of diphtheria, and was sent to the hospital. At an interval of another two days a second case occurred in the “home” in one of the inmates who had been in contact with the first sufferer. She was also sent to the hospital. There had been no diphtheria in the “ home ” prior to the girl’s return there from the family in the Avenue. (5.) A little child residing in Fore Street was attacked with diphtheria contracted, it would seem, through the circumstance of his nurse when out walking with him having joined another nurse and child, the latter of whom was convalescing from diphtheria. (6.) One of a family of s:x children was attacked with diphtheria and sent to hospital; on being discharged from there he was taken to Minehead for a week or two, and then returned to his own home. His voice and vision were much affected, and there was a free and offensive discharge from his nose. Shortly afterwards a second child and a servant were attacked, and were sent to the sanitary hospital, where the child subsequently died. The mother and the rest of the family then went to Plymouth, and within a few days of arrival there four other children were successively attacked, two cases proving fatal. Thus all six children suffered ; three died. (7.) Mr. H.’s family (consisting of husband, wife, five children, and servant) was invaded on Novem¬ ber 11 th, when diphtheria appeared in one of the little girls. The case terminated fatally on the 22nd,