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Local government board inquiries
Aug,t, ls99~ LocaI Government Board Inquiries
731
LOCAL GOVERNMENT BOARD INQUIRIES. D I P H T H E R I A OUTBREAKS.
Tunbridge Wells.--During the year 1898 the occurrence of a number of cases of diphtheria in Tunbridge Wells led the Local Government Board to send Dr. G. S. Buchanan to investigate the matter. H i s report (dated March 9th, 1899) reveals a state of affairs not at all creditable to a town which sets itself up as a health resort. I t appears, however, that the Town Council are beginning to realize the need for improvement all round. I t is extraordinary how many places desiring to attract the public are so careless of their own interests as to allow insanitary conditions to exist which may one day lead to an epidemic, with the result that long years elapse before their reputation is reestablished. Dr. Buchanan complains that the administration had been conspicuously lax in matters of import to the public health. Even now the sewerage is faulty, water-closets are without flushing apparatus, and drains irregularly laid and leaky. Dwellings are rarely crowded upon area, but overcrowding of persons in dwellings appears go be not uncommon. On much of the cottage property there are no gardens, and the unpaved yards are frequently kept in such a condition as to cause nuisance. Diphtheria prevalence, as judged by the death-rate, has been for many years greater in the county of Kent than in England and Wales. In Tunbridge Wells itself the rate approximates to that of the rest of the country, but it must be recollected that the proportion of persons at the most susceptible age is only 98, as compared with 122 for England and Wales. The outbreak of 1898 occurred chiefly in the north-eastern part of the town in the East Ward. The principal factor in the spread of the disease was undoubtedly exposure to personal infection. At least a third of the notified cases occurred in dwellings from which a case of diphtheria had previously and recently been notified. The schools, of course, played an important part in this distribution of infection. There is no doubt that patients were not seldom treated at home under conditions which rendered isolation almost impossible, and apparently unrecognised cases of diphtheria were not uncommon. Very few cases were treated in hospital. From January 1st to the end of September, when Dr. Buchanan made his inquiry, 251 cases had been notified in 167 houses, with 30 deaths. In addition to the defects of sewerage, house.draining, and other sanitary shortcomings, it is thought that the disturbance of foul soil, which took place in the neighbourhood of a large number of dwellings in the East Ward, contributed indirectly to the epidemic by rendering persons more liable to contract diphtheria on exposure to infection. If, as has been alleged, part of the East Ward (including one of the schools) has been built on " made soil," another predisposing factor was present. Longton and Fenton Epidemic.--Diphtheria having been prevalent for a number of years in these two urban districts of the Stoke-onTrent Registration District, Dr. W. W. E. Fletcher has made a report
732
Local Government Board Inquiries
E~,ub~oso,at,,
on the subject. H e deals very fully with all the circumstances, showing the importance of the personal element in disseminating this disease. and the part played by school attendance, the report being furnished with charts showing the effects of school closure on the course of the epidemic. Here, as at Tunbridge Wells, the prevalence of the disease seems largely due to a failure to appreciate what is known of the natural history of the disease, or, rather, of the organism which produces it. Personal infection, if one is to judge by the methods pursued, seems to be frequently ignored, with the result that isolation is carried out in a perfunctory manner or not at all. The fact that the diphtheria organism may exist in the throat without causing distinctive symptoms seems to have been forgotten, and its persistence for long periods evidently not regarded, with the result that insufficient measures were taken by the authorities in dealing with an outbreak at the beginning. Both in Longton and Fenton Dr. Fletcher attributes the prevalence of the disease to the influence of personal infection, especially in connection with the schools. In Fenton, though the number of eases notified was not so large, the mortality was much higher than in Longton. This, too, although the sanitary conditions were better in the former than in the latter place. I t does not appear that the disease was of a more severe type in Fenton than in Longton, and Dr. Fletcher does not consider it safe to draw any definite inference as to the cause of this difference, bus there is a strong suggestion that it was due to the extensive use of antitoxin in Longton.
Christchurch, South Hants--Sanitary Condition.--The water-supply and sewerage of the borough of Christchurch (population 4,432) has for some time been in an unsatisfactory condition: several inquiries have been made by officers of the Local Government Board, and the Town Council do not appear to have appreciated the points which have been repeatedly brought under their notice by the Medical Officer of Health. The proximity of the town to Bournemouth, and its tendency to extend into Christchurch, are additional reasons for the authorities taking prompt steps to remove the causes of complaint. Dr. :F. St. George 5'Iivart, reporting thereon, says that much of the small cottage property is in bad condition, being dilapidated and damp. Even comparatively new buildings are not constructed so that the rain runs away from them. The public wells are exposed to great risk of pollution by soakage of foul water, and the private wells appear to be even more unsatisfactory. A water company exists, but it takes its water from the Avon, which is freely polluted by drainage. Further, pig-keeping on a large scale prevails close to the river, about a quarter of a mile above the company's intake. Everything depends upon the sufficient and efficient filtration of the water before its delivery to consumers. A description of the method of filtration, storage, etc., accomanies the report. The inspector recommends that immediate attention e given to the questions of water-supply, sewerage and drainage, and excrement disposal.
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731
LOCAL GOVERNMENT BOARD INQUIRIES. D I P H T H E R I A OUTBREAKS.
Tunbridge Wells.--During the year 1898 the occurrence of a number of cases of diphtheria in Tunbridge Wells led the Local Government Board to send Dr. G. S. Buchanan to investigate the matter. H i s report (dated March 9th, 1899) reveals a state of affairs not at all creditable to a town which sets itself up as a health resort. I t appears, however, that the Town Council are beginning to realize the need for improvement all round. I t is extraordinary how many places desiring to attract the public are so careless of their own interests as to allow insanitary conditions to exist which may one day lead to an epidemic, with the result that long years elapse before their reputation is reestablished. Dr. Buchanan complains that the administration had been conspicuously lax in matters of import to the public health. Even now the sewerage is faulty, water-closets are without flushing apparatus, and drains irregularly laid and leaky. Dwellings are rarely crowded upon area, but overcrowding of persons in dwellings appears go be not uncommon. On much of the cottage property there are no gardens, and the unpaved yards are frequently kept in such a condition as to cause nuisance. Diphtheria prevalence, as judged by the death-rate, has been for many years greater in the county of Kent than in England and Wales. In Tunbridge Wells itself the rate approximates to that of the rest of the country, but it must be recollected that the proportion of persons at the most susceptible age is only 98, as compared with 122 for England and Wales. The outbreak of 1898 occurred chiefly in the north-eastern part of the town in the East Ward. The principal factor in the spread of the disease was undoubtedly exposure to personal infection. At least a third of the notified cases occurred in dwellings from which a case of diphtheria had previously and recently been notified. The schools, of course, played an important part in this distribution of infection. There is no doubt that patients were not seldom treated at home under conditions which rendered isolation almost impossible, and apparently unrecognised cases of diphtheria were not uncommon. Very few cases were treated in hospital. From January 1st to the end of September, when Dr. Buchanan made his inquiry, 251 cases had been notified in 167 houses, with 30 deaths. In addition to the defects of sewerage, house.draining, and other sanitary shortcomings, it is thought that the disturbance of foul soil, which took place in the neighbourhood of a large number of dwellings in the East Ward, contributed indirectly to the epidemic by rendering persons more liable to contract diphtheria on exposure to infection. If, as has been alleged, part of the East Ward (including one of the schools) has been built on " made soil," another predisposing factor was present. Longton and Fenton Epidemic.--Diphtheria having been prevalent for a number of years in these two urban districts of the Stoke-onTrent Registration District, Dr. W. W. E. Fletcher has made a report
732
Local Government Board Inquiries
E~,ub~oso,at,,
on the subject. H e deals very fully with all the circumstances, showing the importance of the personal element in disseminating this disease. and the part played by school attendance, the report being furnished with charts showing the effects of school closure on the course of the epidemic. Here, as at Tunbridge Wells, the prevalence of the disease seems largely due to a failure to appreciate what is known of the natural history of the disease, or, rather, of the organism which produces it. Personal infection, if one is to judge by the methods pursued, seems to be frequently ignored, with the result that isolation is carried out in a perfunctory manner or not at all. The fact that the diphtheria organism may exist in the throat without causing distinctive symptoms seems to have been forgotten, and its persistence for long periods evidently not regarded, with the result that insufficient measures were taken by the authorities in dealing with an outbreak at the beginning. Both in Longton and Fenton Dr. Fletcher attributes the prevalence of the disease to the influence of personal infection, especially in connection with the schools. In Fenton, though the number of eases notified was not so large, the mortality was much higher than in Longton. This, too, although the sanitary conditions were better in the former than in the latter place. I t does not appear that the disease was of a more severe type in Fenton than in Longton, and Dr. Fletcher does not consider it safe to draw any definite inference as to the cause of this difference, bus there is a strong suggestion that it was due to the extensive use of antitoxin in Longton.
Christchurch, South Hants--Sanitary Condition.--The water-supply and sewerage of the borough of Christchurch (population 4,432) has for some time been in an unsatisfactory condition: several inquiries have been made by officers of the Local Government Board, and the Town Council do not appear to have appreciated the points which have been repeatedly brought under their notice by the Medical Officer of Health. The proximity of the town to Bournemouth, and its tendency to extend into Christchurch, are additional reasons for the authorities taking prompt steps to remove the causes of complaint. Dr. :F. St. George 5'Iivart, reporting thereon, says that much of the small cottage property is in bad condition, being dilapidated and damp. Even comparatively new buildings are not constructed so that the rain runs away from them. The public wells are exposed to great risk of pollution by soakage of foul water, and the private wells appear to be even more unsatisfactory. A water company exists, but it takes its water from the Avon, which is freely polluted by drainage. Further, pig-keeping on a large scale prevails close to the river, about a quarter of a mile above the company's intake. Everything depends upon the sufficient and efficient filtration of the water before its delivery to consumers. A description of the method of filtration, storage, etc., accomanies the report. The inspector recommends that immediate attention e given to the questions of water-supply, sewerage and drainage, and excrement disposal.
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