Mr. W. H. Power's report to the local government board on diphtheria at Hern Hill, in the Faversham rural sanitary district ; on the sanitary state of that district ; and on administration by the rural sanitary district.

Power, W. H.

Date:: 1880

Credit: Mr. W. H. Power's report to the local government board on diphtheria at Hern Hill, in the Faversham rural sanitary district ; on the sanitary state of that district ; and on administration by the rural sanitary district. 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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$4. As regards Local and Personal Conditions in-cdisposing to Diphtheria.—{a, h.) The disease in its epidemic extension was not fonnd to show any constant preference for spots characterised by any particular features of elevation, airiness, dampness, or otlier- wise ; nor for foul overcrowded unventilated hovels as compared witli more wholesome dwellings. There were two striking instances (at Raunds and Chipping) of diphtheria apparently taking rise in houses where the atmosphere was tainted with faical emana- tions, but more often there was nothing offensive to be found in the houses first invaded. (4) c. It was not noticed that the houses visited by diphtheria w^ere those which had previously suffered from other disease. (4) d. There was no conspicuous or disproportionate exemption of families in com- fortable circumstances as compared with those in a lower condition of life. (4) e. Though I cannot furnish any precise analysis of the ages of those attacked, it was observed generally in these epidemics (as has often been observed before) that infants and adults, as a rule, escaped, or were only very slightly affected, while children from 2 to 12 years were especially liable to this disease. To the above-mentioned general rule of exemption of infants and adults there were several exceptions. {See Bosmere, § 7 ; Clitheroe, § 6; Beddgelert, § 3; Haver- fordwest, § 2.) In some of the districts visited, I could not help noticing that the families affected were mostly fair-haired ; but as I cannot state the relative proportion of dark and fair complexions existing in the population of the district, the observation is of no value. In many of the families attacked there was something of a phlegmatic habit, or a history of phthisis, or of proneness to throat affections; but examples to the opposite effect were about equally numerous, where it was noted that the family history was good and the children robust. 5. As regards the Gonimunicability of Diphtheria.—(«.) It rarely hap]Dened that in a family of several children, all equally exposed to the risk of infection, only one was affected. [See Carnarvon, sec. 2.) {b.) The usual experience was that, where diphtheria was once introduced into a family, all or most of the children were attacked, some, per- haps, simultaneously, or at intervals of one or two days or a week, the parents at the same time often sufferiim from more or less severe sore throat. O (5) d. The variety of circumstances under which diphtheria appears to spread by means of personal communication, was illustrated in several of these outbreaks. First and most frequently operative was the circumstance of dwelling togethi3r under the same roof, and next, sitting together in the seme school. Probably the disease is often disseminated in a similar way at church and chapel (as observed liy I)r. W. Ogle at Llanddausaint in Anglesea), but of this I have no certain instance to record. Diphtheria may be caught in occasional visits to the bedroom or dwelling of a diphtheria patient (Festiniog, § 3) ; or, perhaps, in making purchases at a shop where the shopwoman is ill with diphtheritic sore throat. (Festiniog, § 3. Clitheroe, § 7). Diphtheria may bo conveyed from one locality to another by a person who has con- tracted diphtheritic sore throat at the one place afterwards visiting a susceptible family at the other. (Builth, § 7. Pembroke, § 7). Diphtheria may be conveyed to a new locality by a person who has been in contact with a diphtheria patient, but has not himself contracted the disease. A striking instance of this occurred in the Beddgelert outbreak, (Festiniog, § § 4, 7),where a girl, who was in service at a house infected with diphtheria, though not suffering herself, appears to have conveyed the infection to her mother’s house, 6 miles distant. This fact gives proof of a most perilous facility, under some conditions, of transport and dissemination of the diphtheria poison. Not only does the poison adhere to the person or clothes of the patient himself, but it can attach itself also to the person or clothes of an occasional attendant in such force as to survive the dissipating and diluting and destroying action of the air during a journey 5f several miles, and display its infectious property in the community to which it is thus newly introduced. Seeing how greatly the chances of spread, and the difficulties of tracing it, are increased by this power of mediate communication, it may be asked whether this is not sufficient to explain the untraceable and apparently unaccountable origin of many outbreaks which at first seem to admit of no explanation but that of de novo or spontaneous origination. To what extent this is true cannot at present be affirmed. As regards indirect modes of conveyance of the infection, bearing in mind Mr. Power’s investigation of an epidemic of diphtheria, in North London, in which there seemed reason to regard the spread of the disease as connected with a certain milk supply, I made enquiry on this point in each district that I visited, but in every case the facts were negative of the theory that milk was the vehicle of infection.$