Understanding disease as a driver of sewerage complexes
Health Board Minutes.
Source: 102-28 (formerly RG 35-1-2-28) Halifax, NS Board of Health 1841-1940 records 1848-1941.
Note that although the inclusive dates for the series are 1848-1941, this is not a continuous record. This may mean that I ‘use what I have’ with respect to illustration, from the closest possible dates to my case study. It remains entirely plausible that I make my evolutionary argument from human-health to environmental health.
LIST OF CASES OF INFECTIOUS DISEASES 1895-1912.
Record provides time of year (month) name of infected individual, disease, date of investigation by the health board and school, if applicable. Records are available prior to 1895, but are not specifically available for the years 1890-1894. It, therefore, might be an idea to look at the early records in order to statistically ‘fill in’ in the missing 5 years with respect to the most prevalent conditions, etc., etc.
Deaths in 1895 area predominately as a result of scarlet fever and Diphtheria, which are clearly be understood as infectious diseases. Homes affected by disease were “placarded” by the Board of Health making clear the quarantine in a given household and as a warning to avoid the impacted residences.
The prevalence of scarlet fever and Diphtheria continued into 1896, with the first incident of typhoid fever, frequently a waterborne disease, appearing in on the 9th and 12th of October 1896, typhoid was again reported on Grafton Street on 2 February, 1897, and again on 10 December, 1897 at Charles Street. Throughout 1896 and 1897, scarlet fever and diphtheria remain the dominant diseases, with respect to the prevalence of diphtheria during this time it is understandable that the City Council, and the Board of Health, in particular, were concerned about the spread of disease, and would have also been looking to determine the cause of its spread.
As the Council Minutes illustrate on at least one occasion, it was the common belief that diphtheria was a waterborne illness, or at least that it was a result of uncleanliness. The predominant understanding of the time, promoted by sanitary theory, that disease, including diphtheria was caused by contact with human waste, and unsanitary conditions generally, an evolution from the idea of miasmas (bad smells) causing illness, resulted in citizens agitating for improved sanitary conditions in their respective neighbours on their street, etc.
Typhoid reported 4 March 1898, Heath Street
Diphtheria continues prevalent throughout 1898, find out more about this disease, with respect to its determination as waterborne condition, (epidemiological history, particularly in a North American context, although it is very likely a disease that arrived in the area with the European migrants.)
12 November 1898, Typhoid Upper Water Street. Map out the occurrences of these disease outbreaks.
Diphtheria and Scarlet fever continue as the major infectious outbreaks throughout 1899, they were the only two infectious diseases reported during that year. There were no reported cases of typhoid, or other waterborne complaint. Note that it might be an idea to determine, if possible, from Health Board Minutes, which conditions required reporting to the Health Board. If this is not specifically available, consider health boards in general in other Canadian cities, in Great Britain and the United States, as illustrative of the types of diseases which typically required reporting.
Typhoid reappears on 16 February 1900, on Albert Street.
n.b. How is scarlet fever contracted (likely a droplet infection).
Small pox first appears in the record, 23 September 1901.
What can be seen from a survey of infectious diseases between 1895 and 1900 is that the prevalence of diphtheria and the belief that its occurrence and spread was as a result of contact with water and/or contaminated water was the cause of this disease was a driving force behind the ‘plea for a drain.’ The actual occurrence of waterborne disease is low, so perception and understanding on the part of medical professionals, as well as concern and fear on the part of the general population is a significant public health factor in this incidence.
From the first occurrence of smallpox in the fall of 1901, its occurrence increases throughout that fall.
In the early part of 1902, diphtheria appears to make ‘come-back.’
In the early part of 1902, incidence of scarlet fever appears in decline, with an increase in the incidence of smallpox.
Throughout the middle of 1902 (June) diphtheria appears as the dominant condition. Mortality in the cases of diphtheria generally appears approximately 40% (check this against the average death toll in these cases, and increase the simple random sample size to 100 cases, if possible.
Also recall that last week I noted that I thought I should map the cases of diphtheria. (Can I use mapping software for this?)
Diphtheria continues as the dominant condition throughout the later half of 1902, into the early months of 1903. Diphtheria appears as the primary reportable disease throughout 1903 with periodic incidents of scarlet fever, fever which appears with greater prevalence in the later part of the year. (As noted above, I should probably consider the vectors of transmission of each disease which I consider, including the epidemiological history and the beliefs concerning the transmission of given conditions. As my secondary reading has already begun to illustrate, the ‘sanitary movement’ as began in Great Britain held much sway in over the understanding of diseases and the control of their transmission. The ideas of miasmas, or ‘malaria’ (in its broader sense) seem to have persisted, particularly amongst those who espoused the sanitary theory) into the early 20th century, these ideas remained persistent, even as the medical community turned their attention away from sanitation to focus on the newly discovered causes of disease.
Diphtheria remains prevalent throughout 1904, with particularly high occurrence in the fall of that year. Note that there appear no reported cases of typhoid or cholera, which are in fact, waterborne conditions. It might prove useful to go through the minute books of the late 19th century to decipher whether these conditions appeared at this time and what was concluded about them if they did occur. Nb. Are there any records of particular epidemics in Halifax/Dartmouth?
25 April 1905, report of whooping cough
01 May 1905 first appearance of tuberculosis
Throughout 1905, “puerile tuberculosis” appears as the dominant medical condition being reported to health officials. It is possible, however, that the appearance of a ‘new disease’ would warrant its more frequent report than a condition that is endemic in the community. (What about the community’s ability to recognize given conditions?)
8 November 1905 typhoid was reported at 331 Campbell Road. TB, diphtheria and scarlet fever are the dominant conditions throughout 1905.
1906 saw a reappearance of the incidence of diphtheria, and scarlet fever, with a marked decline in the number of reported cases of TB, which might point to its decline, or its passage as a ‘new’ condition which is less dramatic in its symptoms than scarlet fever or diphtheria. December 1906 saw resurgence in scarlet fever.
Early 1907 records illustrates a continued occurrence of the three most commonly reported conditions in the area, namely scarlet fever, diphtheria, and TB. Small pox appears again in mid 1907, and again becomes the prevalent condition.
1908 The early part of the year illustrates a mixture of the most common conditions, scarlet fever, diphtheria, and small pox. Note that it might be worthwhile to determine exactly what numbers entail an ‘epidemic’ that was worthy of note, as occurred in GB when John Snow ordered the handle of a particular well pump removed, thereby stemming an epidemic of cholera that was impacting a given neighbourhood. High incidence of small pox fall 1908. (Being the only reported condition September to December.)
1909 High incidence of diphtheria first half 1909. Mixture of the above recorded diseases beginning in the spring of that year.
1910 n.b. perhaps investigate the degree to which the sanitation movement was seen as solution to all communicable diseases, rather than merely waterborne disease. Snow, in particular, made the connection between cholera and polluted water, find out when the idea of polluted water became an issues (likely arising from the miasmic theory, and being associated with ‘malaria’ and the subsequent draining of swamps, etc. Throughout the first half of 1910, scarlet fever is the most commonly reported condition. There appears in 1910, a disease recorded by what appears to be cou or com, if it com, it is likely consumption, as it appears in earlier years, it does not appear to be a notation for cholera, which would be of particular interest in my research.
END NOTES List of cases of infectious diseases, excerpt from 1895-1912. (1895-1910).
