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33
Annual Report of the Medical Officer of Health.—1896.
on joists separated by a few inches from the underlying soil, and there is no provision
for ground ventilation. The general dampness of foundations is shown by discolouration
of white-wash and peeling off of paper especially in cupboards. The back yards
and forecourts are many of them unpaved, while others are imperfectly paved with
concrete. In many of them fowls, pigeons, and rabbits are kept. At the backs of
that side of the street which includes numbers 37 to 49 runs a strip of vacant ground
some 3 feet wide and 95 feet long which, until recently was a general dumping ground
for rubbish often of an offensive nature. The dust-bins are situated in the backyards;
all of them are made of wood and many are without covers.
General Sanitary Conclusions.—From a sanitary point of view the environment
of dwellers in Cornbury Street can in no sense be regarded as satisfactory. The
fundamental defect is the drainage system which is so constructed as to permeate the
soil, to poison the air—both outside and inside the dwellings—and to risk the pollution
of the water-supply. The connection between this undesirable state of affairs and the
outbreak which forms the subject of the present inquiry will be subsequently alluded
to.
History of the Outbreak.—On the 14th of July a girl, aged five, of 41, Cornbury
Street, was notified to be suffering from diphtheria. Owing to a skin affection she
had not attended school for six months previously. She was supplied with milk from
a dairy situated in Oornbury Street. The medical man in attendance was unable to
trace the source of the infection. He was inclined, however, quoting his own words
"to believe in contagion from school, or perhaps from some case in the neighbourhood
but not in the street." This girl died in the upper front room, which was fumigated
with sulphur and all clothes and bedding disinfected.
On the 1st August another child, a girl aged one year ten months, died in the
upper front room from what was certified as diarrhoea. On the 5th August, another
child a boy aged six, was notified. He was treated in the lower front room where he
died, and the mother was left childless. From various sources, including that of the
doctor, I gather that the neighbours flocked into the house, both when the children
were lying ill and on the occasion of the funerals. On the same date another case, a
baby of 2½ years, was notified at number 21, eleven houses off on the same side of the
street. The mother of this child had, just previous to its attack, been cleaning up at
number 41. It seems reasonable to suppose that cases number 2 and 3 contracted the
disease from the original case. Had any other common source of infection been at
work it is tolerably certain that more cases would have occurred in the street. On
the 17th August, a young man of 20, a lodger, was notified from number 41, the house
where the outbreak began. It is more than suggestive that this young man occupied
the lower front room in which case number two was nursed and died. The contents
of the room had been carried away and disinfected, and the room fumigated with
sulphur. The conduct of this young man, as reported to me from various quarters,
shows the recklessness with which some sections of the public treat the risks of
spreading the infection of diphtheria. It is hardly necessary to enter into a detailed
history of the rest of the outbreak. Suffice it to say that eight fresh cases were notified
at intervals of from two to eleven days up to the 16th of September. After a break
of a fortnight, another case was reported, and nine days later the last of the fourteen
cases occurred. Three of these cases were at number 41, three at 37, two at number
36, and the rest were scattered about on both sides of the street.
Dealing next with common general condition we find :—
(a) School.-There is no reason for attributing this strictly limited and local
outbreak to the influence of any particular school or schools. Had any institution
in the neighbourhood been the active source of contagion it is obvious that
many more cases would have been reported in the neighbourhood.
(b) Milk.—The supply was obtained from various sources, notably from a dairy