Reports and papers on cholera in England in 1893 / with an introduction by the Medical Officer of the Local Government Board.

Great Britain. Local Government Board

Date:: 1894

Credit: Reports and papers on cholera in England in 1893 / with an introduction by the Medical Officer of the Local Government Board. Source: Wellcome Collection.

355/372 page 231

$Thk Malady obsekveo at tiik Wobkuousk not limited to App^c. THAT Institution. On an Outbreak C I n 1 n • . T -1 , f. f> • -1 of Diarr)ia;al boon alter the commencement of my inquiry, I liearu of cases or similar iiiness at type to those in the Workhouse as having occurred in Mill Lane, Deptlbrd. 1 was, however, unable to obtain any evidence, which I could regard as Oct. 1893; by conclusive, that cases had arisen there prior to October 4th. the date on Dr. Bulstrodf. which the first case Avas heard of in the Workhouse. At a later stage in my investigations I was, by the kindness of Dr. Roberts, Medical Officer of Health for Deptfbrd, enabled to obtain information of two deaths in adults which had resulted from diarrhoea and vomiting in his district. In one of the cases the history and all the symptoms bore an exact resemblance to the worst cases of the Greenwich outbreak. But although I spent a considerable time in endeavouring to trace out any connexion between them and the Workhouse, I was unable to do so; moreover, Dr. Roberts informed me that he had made careful inquiriijs at the houses of persons who had received, or who were stated to have received, visitors from the Workhouse, but he had been unable to ascertain the existence of any cases in such houses. With respect, however, to Greenwich, my inquiries were more suc- cessful. At first it appeared that no cases had occurred outside the Workhouse, but subsequently, owing to information which came to my knowledge, partly by the kindness of Mr. Jordan, master of the Work- house, I was led to suspect that the existence outside the Workhouse, of a disease similar to that which prevailed inside, had been by no means rare. In my inquiries in this direction, as also in others, I have to acknowledge the very material aid afforded me by Dr. Hartt, Medical OfBcer of Health for Greenwich. He Avas good enough to send a circular letter to all the medical practitioners in his district, asking to what extent diarrhroa and sickness, especially amongst adults, had been prevalent in their practices for £orae time antecedent antl during the outbreak at the Workhouse. By the courtesy of these gentlemen, I Avas able to obtain information of a most valuable kind, which established the fact that there had been prior to and simultaneously Avith the outbreak in the Workhouse several cases of an exactly similar description in some parts of GreenAvich, more especially in that part where the Workhouse is situated. 'lhe earliest cases of Avhich I was able to obtain information were two Avhich occurred not far from the Workhouse, ou September 28th—i.e., a week before the Institution was invaded and f-ubsequcntly to that date there occurreii in the practice of some of tile meilical practitioners in Greenwich over twenty cases of a similar character- Two of these cases were those of medical men in attendance npon patients suffering fi'oni similar attacks, and the description Avhich they •.vcre good enough to gi\'e me of their seizures (which Avere inexplicable u])on any thesis of water or food ingestion) corresponde 1 precisely Avith the typical attacks occurring in the Workhouse. There Avere not amongst those attacked Avith symptoms of this sort outside the Workhouse any deatlis, but it did not appear that in Greenwich outside tlie Work- house any persons of an advanced age iiad suffered from the illness. From all the facts here adduced, I conclude that, in all probability, the disease Avhich spread so Avidely amongst the inmates of the GreeuAA'ich Workhouse was introduced into tliat institution from Avithout. By Avhat person or by what agency it was so introducetl, I was unable to ascertain. Having once been introduced, it may haa-c spread, so at least the balance of evidence Avould seem to indicate, rather by means of personal infection and infected dejecta, and the like, than by the agency of any common vehicle such as Avater oi' food.$