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14
1.° There is a prima facie case made out in favour of the affirmative, by the facts
mentioned in the former section. Infectious diseases habitually spread in
families they invade. Out of 47 families in which fatal diphtheria occurred,
there were only 15 in which the other members all remained healthy. Of
course it may be argued in opposition that all the members of a family are
equally exposed to the operation of local causes of disease.
2.° As a rule, it spread in the house3 it invaded, chiefly among those members of
the several families who were most closely in communication.
3.° In no case, where separation from the sick person has been effected early in the
disease, have I noticed that it has spread to the separated individuals. In one
case where communication had been allowed for 3 days before separation, a
child was seized with diphtheria on the 6th day from removal from home.
4.° The following special cases may be mentioned of communication from one
house to another, viz.:—
On May 1st and 2nd, Jane, aged 10 years, was on a visit to a cousin,
who on the 2nd manifested decided symptoms of diphtheria, but recovered;
another person in the house, a servant, subsequently dying of the disease. On
the 3rd having returned home to Islington, Jane was attacked with diphtheria,
and died in 7 days. Her mother, and her sister aged 14 years, were
both taken ill on the 11th. In each of these instances there was sloughing of
the tissues, and the mother expectorated a complete cast of windpipe. Both
died. Other members of the family had slight sore throat.
On September 18th, George, aged 2 years, was attacked with what was
believed to be diphtheria. There was much swelling behind and below the
angles of the jaw, with loss of voice and great fætor of the breath. He died
on the 24th. His brother Edward, aged 9 months, was attacked on the
22nd, i. e., on the 4th day of George's illness. The exudation was present,
there was much swelling of the throat with fætor of the breath, and bloody
discharge from the nose. He died on the 24th also. Beside other members
of the family, and other persons in the house, who had been in communication
with these children and consequently suffered from sore throat, the child's
grand-mother had sore throat on the 24th, 25th, and 26th. She laid out the
children, and on the 24th returned to her own home, at another part of the
parish. A child who lived with her, aged 16 months, cousin of those who died,
was seized with diphtheritic sore throat and fever on the 29th, and died on
October 19 th.
In the middle of June a boy brought home diphtheria from school and shortly after
his recovery a sister, aged 2 years, was attacked with the disease, in a marked form,
and died in 11 days. Almost every other member of the family suffered either from
diphtheria or some other form of sore throat.
A little girl, aged 6 years, went to a day school where a case of diphtheria occurred;
she was attacked with the disease in a characteristic form and died in 22 days. Her
father and mother both suffered from a slight attack of sore throat. Another child in
the family, who was kept apart from her, and subsequently sent out of the house,
escaped.
In view, therefore, of those facts alone which I have ascertained in your own
district, I may well repeat the admonition in No. 14 of my Monthly Reports, and
impress upon all in whose families this disease may appear, the importance of at once
interdicting any but the most necessary intercourse with the sick individual, and
especially any communication with the younger persons in the house.