Dr. R. Bruce Low's report to the local government board on an outbreak of enteric fever at Helmsley, in the Helmsley rural district, North Riding of Yorkshire.
- Low, Robert Bruce, 1846-1922
- Date:
- 1896
Licence: Public Domain Mark
Credit: Dr. R. Bruce Low's report to the local government board on an outbreak of enteric fever at Helmsley, in the Helmsley rural district, North Riding of Yorkshire. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![nature of their ailment. It deserves mention that in about a third of the adult cases one of the first symptoms complained of by the patient was acute pain in the neck followed by stiffness, which gradually disappeared with the development of the graver symptoms of the fever. Some other cases were complicated by sore throat. The same pain and stiffness in the neck was observed in some of the enteric fever cases at Nunnington during September. Although the earlier cases departed somewhat from the usual type, and notwithstanding that some of them, from various causes, had relapses or remissions, in none could the illness be properly described either as “relapsing” or as “remittent” fever, in the sense that these terms are now generally understood ; the former is a famine fever a]id the latter a disease of malarial origin. In three households, where fever, under the above designations, had been notified, five secondary cases, occurring chiefly among persons who had nursed the primary cases, were subsequently notified as “ typhoid fever.” In a particular house from which two notifications were received on the same day, one person was referred to as suffering from “ relapsing fever,” the other from “remittent fever” ; while 11 days later a third case in the same household was notified as “ typhoid fever.” The terms used in the notification of these earlier erases must be regarded as misleading to those immediately responsible for taking measures to prevent the spread of the infection. Later in the course of the epidemic, doubts as to the nature of the prevailing illness seem to have altogether disappeared, and all cases came to be notified as suffering from “enteric” or “ typhoid” fever. [During the outbreak a charge was brought against the medical man who had certified cases under the above-mentioned misleading names, that he had been attending fever patients for some time previous to notifying them ; that he had neglected to notify to the District Council the cases forthwith as required by law. No reliable evidence in support of such charge was, however, forthcoming, and it may be dismissed from further consideration here.] The Origin oe the Outbreak. On niv arrival in Helmsley I made a careful inquiry as to the origin of the outbreak. It will be remembered that the report of Dr. Porter, the Medical Officer of Health, inculpated a particular milk service as having been concerned in the diffusion of the disease. Two other theories were also advanced locally ; one of these attributed the epidemic to a temporary con- tamination of the public water supply, while the other alleged that the absence of proper sewerage in the High Street, along with neglected scavenging of midden privies and other insanitary conditions, had conduced to propagate infection which had been introduced from without. A brief reference to each of these three hypotheses is necessary, and for convenience I take them in the following order :—- (1.) The influence of insanitary conditions, including deficient sewerage. (2.) The alleged pollution of the public water supply. (3.) The asserted contamination of a particular milk service. (1.) The Influence of Insanitary Conditions existing in Helmsley, including the present Sewerage and Drainage.—In a report which I prepared for the Board in 1893 “ on an outbreak of enteric fever in certain villages situated on the Diver Bye,” I gave some details as to the sewerage of Helmsley, and noted that untreated sewage was discharged by this town into that river. The facts briefly recapitulated are as follows;— The town, roughly speaking, has sewers provided for two-thirds of its population; with two outfalls, one direct into the Boro’ Beck close to its confluence with the Bye, the second into a tank on the banks of the Rye with overflow into the stream. The tank has not been properly attended to, and might as well have never been constructed for any useful purpose that it serves at present. The remainder of the town, which is unsewered, com- prises the High Street, Church Street, and Castlegate, practically one long, wide, straight street, through which flows the Boro’ Beck (see Map). Near the top of the High Street stands the workhouse, with five waterclosets A 3](https://iiif.wellcomecollection.org/image/b24398263_0007.jp2/full/800%2C/0/default.jpg)
