Dr. R. Deane Sweeting's report to the Local Government Board on the sanitary circumstances and administration of the Ramsey Urban District, with special reference to the prevalence of scarlatina.

  • Sweeting, R. Deane.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Dr. R. Deane Sweeting's report to the Local Government Board on the sanitary circumstances and administration of the Ramsey Urban District, with special reference to the prevalence of scarlatina. Source: Wellcome Collection.

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    annum, with 7 deaths, must he regarded as constituting an excep- tionally severe epidemic at the present day. These 128 cases appeared to be about equally divided between the town proper and the outlying fen localities. So that, for purposes of appraising the conditions of spread of the disease, these may be considered as practically one and the same place. • The total 128 cases occurred in 74 families, of which 44 con- tributed single cases. The remaining 30 families furnished 84 cases, as follows :— 2 families had 5 cases each 5 •5 4 ,, ,, Q O ^ 5? ^ 35 53 1 ^ 9 33 53 ^ 33 33 So that about two-thirds of the total cases belonged to families where more than one was attacked. This gives the key to the explanation of the persistent prevalenc.e of scarlatina in Ramsey, viz. :—sustained personal infection and the absence of hospital isolation. I am able fully to endorse Dr. Wdkinson’s conclusions inhis 1908 report as to the incompleteness and the futility of the home isolation that has been attempted in the district. It has utterly failed to arrest the prevalence of scarlatina. I could adduce many similar detailed instances to those given by Dr. Wilkinson. Suffice it to say that 1 found children with peeling hands and ear discharges mixing with others, and no precautions worth the name taken to hinder the spread of infection. During my inspection, indeed, subsequent attacks were taking place in families, where previous sufferers were supposed to be under isolation. And, generally, the occurrence of dropping cases in families, at intervals of a few days or a week or so, showed that personal infectivity was still rampant. Attempted home isolation has, too, led to over- crowding in small cottages, since one bedroom has been commonly reserved for the first sufferer, leading to the rest of the family being crowded together in the other bedrooms. Not only has scarlatina in Ramsey been more fatal so far in 1909 than in 1908 and 1907, but it has shown exceptionally high fatality in ages between 15 and 30. It is also noteworthy that, in three of the four fatal cases in this age-period, there were pronounced cerebral symptoms with suppression of rash. This appears to indicate that scarlatina is becoming more malignant iu Ramsey, and approaching a type of greater virulence for adolescents and adults. As for the influence of schools in spreading the disease, I have no reason to dispute Dr. Wilkinson’s conclusions that in 1908 the “ association of children in the schools, especially the Council Schools, has contributed very largely to tl'.e continuation of the disease,” though I did not find that in 1909 these town schools had been largely instrumental in spreading scarlatina. But I found distinct evidence that the Council School at St. Mary’s (outside the town) had been actively concerned in disseminating the disease this year. Thus, first sufferers in families were nearly always attending this school prior to attack, and those who escaped were usually those who did not attend this school. On the recommendation of the medical officer of health, it was closed on July 28th until the end of the summer holidays. It remained closed at my visit.