Dr. Blaxall's report to the local government board on an epidemic of scarlatina in the urban sanitary district of new and old Swindon, and on the sanitary condition of those towns.

  • Blaxall, F. H.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Blaxall's report to the local government board on an epidemic of scarlatina in the urban sanitary district of new and old Swindon, and on the sanitary condition of those towns. 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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    -c lO 3 the disease had appeared in every street. I visited each of the 106 and made inquiry with reference specially to the first attacks in families. It appears that the disease was almost entirely confined to children, and so far as I could ascertain there was nothing to attach suspicion to any other mode of dissemination than intercom] 'unication between the infected and healthy. And although direct personal communication of this kind could only in a few instances be established as a fact, yet there was such abundant evidence of unrestricted commingling in schools and elsewhere of healthy children with children coming from infected houses, if not themselves infected, and children partially convalescent from the disease, as to point strongly to the disease having been chiefly spread by this manner. As illustrative of direct personal communication I would cite the following cases:— A girl went to her situation on a Tuesday as nurse-maid in a family that had recently had scarlatina; on the following Sunday she returned to her home feeling unwell, and on the Monday manifested marked symptoms of the disease. Five cases followed in this house. In another instance a child went to visit its grandmother, who was living next door to a family just recovering from scarlatina; the child came in contact with one or other of the infected family, went home and in five or six days developed the disease. Again, a little boy went in and out of an infected house, one child lying dead of scarlatina, and a second child ill with it; in due course the boy himself was attacked. With regard to the schools. To determine precisely the part these played in the dissemination of the disease would necessitate accurate knowledge of the families that suffered, the number of children, school-goers or others, resident in the district, together with the number of each such class attacked, data which I do not possess. But that the schools were implicated, and this to a considerable extent, may be inferred from the fact that of the 106 primary cases, 74 were children attending one or other of the day-schools up to the date of their being taken ill, and five or six were children attending Sunday schools until similarly attacked. Again, evidence was forthcoming of children from infected houses continuing to frequent school as usual until, being themselves attacked, they were compelled to absent themselves; and inasmuch as the dwellings did not admit of the infected being effectually separated from the healthy even where such separation was attempted (as I am told was occasionally the case), it is obvious that children coming from infected houses might be, though not them- selves attacked, a source of danger to others with whom they came in contact. It is highly probable that in this way the disease was communicated to healthy children and conveyed by them to hitherto uninfected localities, as for example, Gooch Street, Mill Street, and Villett Street, where the first attacks originated in children in attendance at one or other of the schools. Moreover, some of the mothers told me that their children on being attacked had spoken of having sat next to children at school who were suffering from sore-throat or whose skin was peeling: this latter condition indicating that children had either continued to attend school during their illness or had been allowed to return to school while in an infective condition. Further, as tending to implicate the schools, critical examination of the dates of attack amongst school children went to show that the interval between the occurrence of many of the cases corresponded very closely with the usual incubation period of scarlatina, namely, from three to six or seven days, thereby suggesting connexion of the cases one with another. Further, the fact of certain of the cases occurring simultaneously, a child in attendance at school being the first member of the family to be attacked, in the case of a number of families residing in different streets, would seem to point to the school as the centre of infection. For example, at Drill Hall School, 10 cases occurred between the 29th of August and the 19th of September, the dates being as follows :—August 29th, September 2nd, 4th, 6th (two cases), 10th, 12th, 17th, and 19th. All these were primary cases, i.e., first cases in a house, with the exception of the two on the 4th and 12th September. At College Street School there were 13 attacks (all primary) from September the 15th to October 29th; namely, September 15th, 22nd, 23rd, October 1st, 8th, 14th, 15th, 17th (three cases), 19th, 22nd, and 29th. A 2 New Swindon.