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fit to receive all such patients as cannot be attended at home without
endangering the health of others living either in the same house or in the
immediate locality.
The following memorandum on relapsing fever, which has been issued by
the Medical Officer of the Local Government Board, is of such importance at
the present time as to justify me in adding it to this report.
"MEMORANDUM ON RELAPSING FEVER. 1873.
"RELAPSING fever, which in 1868-71, after many years absence, seriously
affected the metropolis and other places in England, is now again threatening the
country: cases of the disease having recently been seen in certain districts of South
London and of Manchester.
For the purposes of Local Authorities, responsible for taking precautions against
this disease and its consequences, the chief practical points to be borne in view are
the following.
1. Relapsing fever is in a very high degree communicable from sick to healthy.
The greatest personal predisposition to the disease is given by states of poverty and
privation; so much so that the disease is often known by the name of famine-fever.
The more confined the atmosphere in which sick and healthy are together, the more
certain is the disease to be communicated.
2. Relapsing fever is eminently a disease which cannot safely be treated in the
houses of the poor; for in them, crowded and ill-ventilated as they generally are, and
with inmates often insufficiently nourished, there must be every likelihood that the
infection will spread. It is essential that, under such circumstances, the sick should at
once be removed from amid the healthy. Ample hospital-accommodation is therefore
an indispensable condition for limiting the extension of the disease.
3. Where relapsing fever has attacked, and when all its acute symptoms are past,
the sufferers remain for a while extremely weak, requiring that food and restoratives
should be liberally supplied them; in default of which, the feebleness left by the disease
may often be of indefinite duration. This is the more important, because, where
relapsing fever becomes epidemic, typhus often accompanies or follows it; and persons
whom the relapsing fever has weakened not infrequently fall victims to typhus.
4. At present, (as in all times when epidemic disease is prevalent or threatening)
it is particularly important that powers conferred by the Nuisances Removal and other
Sanitary Acts should be well exercised by those in whom they are vested. Very
detailed district-inspection is most necessary. Everything practicable should be done,
especially in all poorer parts of each district, to promote cleanliness of and about
dwellings. The washing and lime-whiting of uncleanly premises, especially of such as
are densely occupied, should be pressed with all practicable dispatch. It is essential
that overcrowding should, as far as possible, be prevented, and proper ventilation be
enforced; and in these respects common lodging-houses, and houses which are sublet
in several small holdings, will require particular attention. Great vigilance must be
used with a view to the discovery of first cases of relapsing fever in such houses; and
frequent inquiry should be made as to the sorts of illness prevailing among the poor.
The attention of Authorities is invited to the powers conferred on them by various
sections of the Sanitary Act of 1866, with reference to infectious disease; especially to
the powers conferred for purposes of disinfection, and for the conveyance of sick persons,
and for the separation of the sick from the healthy.
5. Relapsing fever, as described in medical text-books, has the following characters.
The patient becomes suddenly ill with shiverings, headache, heat of skin, prostration,
and generally vomiting. To these symptoms are usually added more or less yellowness
of skin, and severe general pains resembling those of rheumatism. After from five to
seven days, the symptoms abruptly cease. For a week the patient feels well, and has
his ordinary appetite, his natural temperature. and a pulse often even slower than in
health. On or about the fourteenth day from the commencement of the original attack,
relapse takes place, with a sudden paroxysm of fever similar to the first. The duration
of the stage of relapse is commonly three days. Second, or even several, relapses
sometimes occur; and as above stated, convalescence is usually protracted."
From the inquiries which I have made, I am glad to learn that ample
provision will be made in this District for the reception and treatment of
patients who may be attacked with relapsing fever.
I have the honor to be, Gentlemen,
Your most obedient Servant,
JOHN LIDDLE.
15, Great Alie Street.