Waterborne typhoid : a historic summary of local outbreaks in Great Britain and Ireland, 1858-1893 (with a tabular analysis of 205 epidemics) : a report prepared for the Parliamentary Bills Committee of the British Medical Association / by Ernest Hart.
- Ernest Abraham Hart
- Date:
- 1897
Licence: Public Domain Mark
Credit: Waterborne typhoid : a historic summary of local outbreaks in Great Britain and Ireland, 1858-1893 (with a tabular analysis of 205 epidemics) : a report prepared for the Parliamentary Bills Committee of the British Medical Association / by Ernest Hart. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![St. Lu?:p, Middlesex {County of London).—T>v. Yarrow, in )iis annual report for 1893, relates the circumstances attend- ing the occurrence of cases of typhoid fever in relation to the use of well water. The well in question has, some 20 feet distant, three waterclosets, a large urinal, and, nearer still, another watercloset, the only convenience for 67 persons in an adjacent works. The well serves a total of 84 persons. Professor Stokes was of opinion, after an analysis, that the water was polluted hy surface drainage. Five cases in all arose in persons drinking of the water of the well, and having apparently no condition in common save drinking water ; 4 of the patients were employed in the works just referred to. There would seem to be several wells in this parish, in situa- tions not by any means such as to lend security to consumers of their contents. The foregoing, then, are samples of the outbreaks which find no place in my appended summary. Not that I throw any doubt on the contention in the cases of these occurrences that they had casual relation with polluted water. But only that I have regard to the fact that the relationship has not seemed to have been made out with the same amount of convincing force as in other cases. It will, however, have served a useful purpose to have here reviewed the general outlines of reports illustrating the class of outbreaks which are excluded. Tabulated Summary. The outbreaks included in the appended summary tables number no fewer than 206, ranging from the year 1863 to the end of 1893. The outbreaks are very unevenly distiibuted in point of time, differing years showing vastly different num- bers of separate epidemics caused by polluted waters. I have already stated that I have taken the year 1858 as my period of commencement, but there is no evidence of any outbreak thenceforward that I have come across in which water was the means by wliich typhoid was originated earlier than the year 1863 This is not to be understood as conveying my im- t>ression that no such occurrences happened ; far from it; hut only that they have not come within my cogt)isance. An analysis of the tables shows that in the 18 years 1871-76, 1879-84, and 1888-93, there occurred no fewer than i65 outbreaks out of the total noted ; 69 in the first period, 58 in tliesecond, and 39 in the third period. In these 18 years, then, 80 per cent, of the total number happened, the percentages in the respective subperiods being 33, 28, and 19 respectively. The entire period covered by the tables is 31 years. I have already explained my reason for drawing an arbitrary line at 1858, which has in reality become 1863, and with a view of illustrating the care taken to settle the then too little thought of rnalterof theoriginof the spread of diseases by the medium of ])olluted water I here give two instances prior to that year in which, without doubt, drinking water played the leading jiart. .The first I quote from the late Dr. Murchison’s work on Continued Fevers: “ Uichmond Terrace, Clifton, was a crescent composed of 34 houses. In 1847 the inhabitants of 13 of these houses drew their drinking water from a well at one end of the crescent. The remaining houses were supplied with water from another source. At the end of September it became evident, from the state and smell of the water from the pump, that it was tainted with sewage. Early in October ‘ intestinal fever’ broke out nearly at once in all the 13 houses in which the tainted water had been drunk, but did not make its appearance in any of the other houses. In almost every one of the 13 houses 2 or 3 persons were laid up, and in some a much larger number. The houses in wliich the fever broke out were far apart in the terrace, and there was little or no intercoui>e bcffween their inmates. The water from the well was the sole connecting link.” The second has reference to an outbreak reported by Dr. (now Sir Anthony) Home for the Privy Council Office, some years after its occurrence. The outbreak took place at Whit- wick, in Leicestershire, in 1856, and occasioned 13 deaths. Only one street was invaded, all the residents drinking the water from one well which, on being opened, gave evidence, by a layer of soapsuds on the top, of leakage from an adjacent drain. The people were found to be literally “drinking .(ever;” and we are told that “the use of this water beiig fc'iiRrdicted, the fever disappeared.” Consideration of Tabulated Outbreaks. In proceeding to treat of the several different, and indeed numerous, methods by which water has become the source and cause of spread of typhoid fever, it will be best to deal with typical instances of these methods. To this end the outbreaks are grouped under various headings, accord- ing as they were related to one or another class of cause. It may not be unwise to begin with a class all too common in rural districts, namely polluted wells. The outbreaks due to these death-dealing iniquities are neither few nor far be- tween. Here are some typical examples. Wellborne Outbreaks. Shallow Wells near Dicellinys.—A most clear case of water- borne typhoid was that of Page Green, Tottenham (No. 4), the water supply being, for some 30 houses, from shallow wells, sunk in a porous gravelly soil ; the water in one well smelling distinctly of carbolic acid which had been poured down a yard sink. At Winterton (No. 7), the shallow wells were situate in the midst of all kinds of abominations, privies, ashpits, cesspools, and wells being in close proxi- mity. “It is hardly possible,” says Dr. Thorne Thorne, “ to conceive conditions more favourable for its spread”—speak- ing of typhoid—“ than those existing at Winterton.”. One can scarcely imagine a worse case than that of Stamford in 1868 (No. 10), where wells were sunk in a strata honey- combed with cesspools; “a subsoil in which the ordure of generations had been carefully stored up beneath the dwelling houses.” A long continued outbreak was clearly traced to the consumption of tlie polluted contents of these filth traps. Perhaps one of the most glaring instances of persistent refusal to deal with a crying evil is that of the Eotherham Corporation in the matter of the Wellgate spring, situate as it is in the midst of the population of the borough. As long ago as 1863 the report of the Medical Officer to the Privy Council drew attention to the sp’ing. In 1872 (No. 51) Dr. Ballard had to report an outbreak of typhoid in which this same spring played a part in disseminating the disease; whilst Dr. Theodore Thompson’s report to the Local Govern- ment Board on an outbreak in the autumn of 1892 (No. 190) has called very special attention to this well. The water had been the subject of several analyses from 1886 to 1892. Every one gave indication of serious contamination; one at least pointed to “ pollution by urine, cesspool drainage, or similar impurity,” and this of a spring “in the centre of the borough,” a town of 40,000 inhabitants. Towards the close of 1893 Dr. Klein made bacteriological examination of a sample of water from tliis well, and found the bacillus coli in abundance, as also a bacillus morphologically and culturally difficult to differentiate from the typhoid bacillus. Dr. Klein considered the spring open to excremental pollu- tion ; and the Corporation issued a warning that the water sliould be boiled before use. But what a pitiable spectacle does this case afford of local administration ? Of the remain- ing sources of supply to Rotherham we shall have occasioa to speak later. In the case of Worthing in 1886 (No. 124), we have an instance of a polluted well preftrred to a public supply actually laid on to the house, and that house, more- over, a dairyman’s premises. That the water became speci- fically contaminated by the discharges of a typhoid patient there can be little doubt. The excreta were thrown down the drains of a house from which soakage was finding its way to the well. Dr. Ballard paints a miserable picture of rural life in Newlyn in 1880 (No. 118), where the conditions as to excre- ment disposal and removal were disgraceful. On openiirg up the town well he found the level of the water therein and in the adjacent drain to be identical, whilst it was obvious that a free interchange of their contents had been for some time going on. Dr. W. Brown, the health officer of Stapleton, mentions an interesting instance of well closure, the first in his district. He connected 9 cases of typhoid with use of the water, and Mr. Stoddart, the analyst, found in the water and succeeded in separating organisms which behaved almost precisely like the typhoid bacillus, though they were not typically morphological of that bacillus. Dr. Harrison, the health officer of the Lincoln rural district, in his annual re-](https://iiif.wellcomecollection.org/image/b22339954_0010.jp2/full/800%2C/0/default.jpg)
