HH62/1/AYR/49

Transcription

[Page] 48

[impossible] to get anything like exact numbers of the cases which occurred,
except those that terminated fatally. The epidemic of 1886 and
1887 is evidently a continuation of the same one, which began in
November of the former year, in which 4 deaths occurred, followed
by 1 death in January, 2 in February, and 1 (outside the village) in
March the following year. Dr Reid, of Mauchline, thinks that
there were about 30 cases, at least, in all at the time. The ages and
sex of the 15 deaths in the village and the 4 in the landward part
we note below.

AGES AND SEX OF 19 FATAL CASES OF DIPHTHERIA IN THE PARISH
OF MAUCHLINE.

[Table inserted]

It will be seen that the majority was three years of age, and
that 12, at least, out of the 19 were under school age.
Leaving the country deaths out of consideration in the mean-
time, we find that of the 15 deaths in the village, 2 occurred in each
of three families, while the remaining 9 cases took place in different
families. As to the localities, they seemed to have been distributed
all over the village. It was impossible for me to get reliable
information in connection with any communication between the
infected houses. But it is highly probable that a good deal of the
infection may have disseminated by carelessness in this respect,
as a case which came under my own observation in Mauchline
recently was undoubtedly transmitted from one house to the other in
this way.
As to the cause or causes of diphtheria in Mauchline. By
causes I mean the predisposing factors or influences which favour its
development, as the essential cause of diphtheria is a micro-organism,
which can be isolated and cultivated artificially. There is nothing
in the geological formation - the red sandstone of Permian age -
upon which Mauchline stands that would favour any theory as to
diphtheria; nor in the rainfall, which, in Mauchline, last year was
moderate (39.65 inches), being under the average for the whole
county. Then the public water supply cannot have any relation to
it, as it is a wholesome, though hard, water. It may be stated that
several wells are still in use, and some of these I have found
polluted, but I do not think the water supply had any connection
with the outbreaks of diphtheria. When we come to the drainage,
however, we find that it is most defective. I hold that Mauchline
would have been healthier if there had been no drains of any kind,
for defective underground drains are worse than useless. Although
there is nothing in the geological strata to be suspected, the clayey

[Page] 49

soil which overlies the latter at Mauchline would require careful
draining, and with inefficient drains and soakage from filthy
ashpits, privies, &c., the soil has become, in a measure, sewage-
logged, thus forming probably a suitable nidus for the bacillus of
diphtheria, which may remain in this soil alive and quiescent for a
certain time, and under favourable conditions, such as temperature,
&c., break out into an epidemic. The prevalence of enteric fever in
Mauchline within the last few years, to a certain extent strengthens
the drainage theory in regard to diphtheria there.
I may state that, as far as I could investigate, there was no attempt
at anything like systematic isolation of the cases and disinfection of the
houses, although in some houses this would no doubt be done. By
far the greater number of the cases were under school age, and there
is no evidence that the school influence had as much to do with the
spread of diphtheria here as is frequently the case in other places.
There appeared to have been a number of more or less mild "sore
throats" in Mauchline about the same time as the diphtheria
outbreaks.
As to the other diseases in the Kilmarnock District, there is
nothing requiring special notice. There is no doubt, however, that
a considerable amount of the disease in the district can, with sani-
tary measures, be prevented.
The statistics which we now for the first time possess, in con-
nection with the landward parishes of the district, afford us valuable
data for the sanitary work of the future.