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(4.)
an enquiry as to the cause of the outbreak, and visited Sutton on July 19th. On this
and subsequent dates I accompanied Dr. Monckton Copeman to the Belmont Asylum
and assisted him as far as possible in making the necessary investigations.
Our enquiries failed to associate the infection with the milk, food, or water
supply, or with defective sewerage and drainage, and regarding the final conclusion
arrived at as to the source of the epidemic I may quote the following extracts taken
from Dr. Monckton Copeman's elaborate report to the Local Government Board :—
"There can, I think, be little doubt that personal infection has been the chief, if
not the only factor responsible for the introduction and subsequent spread of enteric
fever at the Belmont Asylum. Reference to such a possibility indeed occurs in the
report of Dr. Bower, presented by him to the Sutton Urban District Council under
date June 7th, 1906, as also in the third of a series of interim reports to the Belmont
Asylum Sub-Committee written by Dr. Sherlock during the progress of the outbreak.
In the absence of a knowledge of facts which has accumulated since the respective
dates of these reports, both Dr. Bower and Dr. Sherlock expressed the opinion that
there did not seem to be sufficient grounds for ascribing the outbreak to personal
infection ; both laying stress on the point that the most recently admitted, though
not the earliest to be attacked by the disease, of the (then) affected patients had been
received into the Belmont Asylum more than three months previously, while the hist
arrival at the Asylum from Darenth, where in 1904 there is known to have been a
small outbreak of enteric fever, had been admitted on February 23rd, 1906."
" Under these circumstances, and in view of the facts detailed above, tending to
eliminate all the more generally accepted methods of infection it cannot, I think, be
regarded as other than a reasonable hypothesis that enteric fever was originally
introduced into the Belmont asylum in the person of one or more patients,
transferred originally from Darenth or Tooting Bec Asylums, who were in reality
suffering from the disease, although, in the absence of marked symptons, the fact
passed unrecognized at the time.
" Admitting the probability of infection having been introduced in the manner
suggested, the further spread of the disease from patient to patient will find sufficient
explanation in their continued propinquity by day and by night, especially when the
filthy personal habits of the inmates are taken into consideration The special
incidence of the disease in certain wards may perhaps be regarded as consequent in
the first instance on infection of a plurality of patients in these particular wards
during the period preceding recognition of the true nature of the disease."
Amongst the facts referred to by Dr. Monckton Copeman as having accumulated
after the earlier reports were that after the deaths of several of the patients at the
Asylum who had succumbed to other distinct causes, such as Pneumonia and
Phthisis, post-mortem examination revealed the presence of healed typhoid ulcers in
the intestine, no symptoms of the latter disease having been previously manifested.
The difficulty in tracing the origin of the outbreak was materially increased
by the unusual type of the disease, which in all but probably 5 or 6 cases was
unaccompanied by any of the usual distinctive diarrhoeal symptoms, but associated
with constipation.
Whooping Cough.- This disease was somewhat prevalent, both in the earlier
part and also in the later months of the year. Eight deaths were attributed
thereto.
♦
Measles.—No deaths occurred from Measles, although the disease was
prevalent in some districts during December.
Diarrh3 during the previous year. Sixteen of these occurred during the hot weather in
August and September. Bandbills were distributed throughout the district calling