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entirely to this circumstance. The disease appears to have been propagated
by infection or contagion from one patient to another. I am not prepared to
say what occasioned the extreme virulence of the earliest case. The occurrenoe
illustrates the immense importance of removing the healthy from the sick when
such diseases as Scarlet Fever arise in a family. It is better to send away the
healthy from the sick than the sick from the healthy, wherever this is practicable;
but if from the circumstances of the family this is impossible, the patient may
be removed to the Fever Hospital, either by paying a guinea, or in case of
poverty at the expense of the Parish.
"WORKHOUSE.
The mortality has amounted to 18, which is a low number, especially for this
season of the year. Of this number 13 were of persons above the age of 10.
In the workhouse there have been 126 cases of Influenza under treatment,
besides 46 cases of Bronchitis, Pleurisy, or Pneumonia. There have been under
the care of all the Parochial Medical Officers no fewer than 372 cases of
Bronchitis, Pneumonia, Pleurisy, and Influenza.
The building is now very full; the average number during the month has
been 1,571. The average number in the sick wards has been 314, in the
separation wards 116, and in the lunatic wards 118.
Diarrhoea Returns.—At the beginning of the summer a series of questions
relating to Diarrhoea were drawn up, and copies of them placed in the hands of
each District Medical Officer, in order to obtain some definite information as to
the external conditions under which the cases of that disease which came under
their treatment occurred, and to get some clue to the most frequent determining
causes of Diarrhoea amongst the poor.
The questions referred to the sex, age, occupation, and residence, of the patient,
also to the room he occupied, his habits in respect to alcoholic drink, the drainage
of the house, the state of crowding, the usual diet of the patient, and that
which immediately preceded the attack. There were also questions relating to
the amount of water drunk immediately before the attack, and the quantity of
water usually drunk by the patient.
Answers have been obtained to these questions in 374 oases, so far as it was
possible to give the required information; and subjoined is a summary of some
of the more interesting results obtained from a careful analysis of them. Of
the whole number 150 were under five years of age, and 50 above 60 years.
Of all those above 12, there were 144 females and only 63 males. This fact is
a very interesting one, showing that amongst adult females who spend much
time in the house, there was more than twice as much Diarrhoea as amongst
adult males who are much more engaged in the open air. It is young children
and women who are most exposed to the continued effects of bad drainage, overcrowded
and ill-ventilated rooms. Amongst children the number of each sex
was as might be expected nearly equal. Forty-two of the patients lived in
underground rooms, 81 lived in houses known to be very badly drained. Fifty
in rooms much overcrowded, and fifty others in rooms rather crowded. Nine
were known to be habitual drunkards, and many more drank very freely.
Twenty-two are known to have taken foul water just before the attack; and
39 drank just before their illness more water than they usually took. In 21
cases the Diarrhoea could be traced to errors in diet. Twenty-two appeared to
depend in part on extreme poverty of diet. These facts are very interesting,
confirming as they do the oft repeated observation that very many of the prevalent
diseases depend on causes which admit readily of removal.
I have the honour to remain, Gentlemen,
Your obedient Servant,
21, upper Gower Street. THOMAS HILLIER, M.D., L.R.C.P.