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
Catalogue details

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.

    12/64 page 10
    to the contamination of one section only of the public waltr service. That the outbreak was one of a waterborne char- acter leaves no opportunity for question if the data be looked to, and that one portion of the service was implicated is also amply demonstrated by the figures which Dr. Wheaton, of ti e Local Government Board, is able to adduce in favour of this thesis. Of the circumstances leading to contamination of the particular water I shall have to speak in other connec- tion, suffice it here that the contamination was fully made out and that we have now merely to consider the part played by the means of distribution of the water. Looking to the interest attaching to this outbreak I have introduced a reduced plan of the district affected from Dr. Wheaton’s report, with a view of leading to a better under- standing of the bearing of the levels of the epidemic area to the outbreak. The portion of the plan shaded most deeply constitutes the “epidemic area,” and lies at the lowest levels. The imolicited ( ‘ Outwcods ”) water ran in the pipe terminat- ing at the Greek cross at the junction of South Street and Station Street. During the time of chief epidemic manifes- tation of the disease this water was nightly turned into the mains by being joined to the remaining pipe in the Coleshill Koad, the o’.her “ town ” water service being nightly turned Kough Llan of thk Town of A'lntiitTONF showing ams Main Streets and Water Mains otf on account of fear of water famine if it were allowed to be constantly flowing to the distributing mains. In these cir- cumstances and in view of tne large amount of water used by the residents of this portion of the town, there would be almost no water in the mains when the implicated “Out- woods” water was turned into the pipes each evening. Now the levels of the district are such that this “Out- woods ” water oh admission to the mains would flow flrst of all to the district north of the Greek cross, namely, down Station Street, under the railway to a dead end at the foot of the canal bridge at Watling Street and along the northern half of Long Street back to Coleshill Street and thence to its original starting place. The levels respectively of the Ather- stone mains and of the source of the Outwoods water were such that little if any of the water thus admitted from Out- woods could, having regard to the pressure, reaeh the dis- trict south of Coleshill Street. In respect of these two dis- tricts thus natur.ally formed for purposes of water di.-tribuLion Dr. Wheaton says that the difference of level between the dead ends of the two was seven feet. “ Water could therefore circulate round the northern loop when the pressure would not suffice to enable it to circulate round the southern loop If the whole system of mains were supposed to be completely emptied, and a small body of water then turned at low pres-'ure into the main leading from the reservoir, the water would fill the whole of the northern loop, including the long main ending in a ‘ dead end,’ before any of it would pass into the southern loop.” The local surveyor was of opinion that the pressure was never such as to carry the Outwoods water into the mains in the south- western portion of the district. The locality, being inhabited by people who in the nature of their occupation had to rise early, was one in which they would, in drawing off water at an early hour, be more likely to draw off the Outwoods water than persons residing in other parts of the town. And in addition, as in some way perhaps showing cause for undue prevalence of typhoid in tliis locality, the residents had the fountain at the Greek cross to whitdi to resort for this same Outwoods water. The season during which this water was nightly turned into the mains was but a short one, but while it lasted no less than 93 per cent, of the numerous cases aiif-ing occurred within this epidemic area; in the next four weeks as many as 83 per cent, so occurred. There was a special incidence on adult males. The evidence here given seems to me to be pretty conclusive of the potency for harm, within the special area of epidemicity, of the contents of the low lying water mains, whilst the configuration of the ground saved the closely adjacent streets from sharing the same fate. But yet another factor in the continuance of the fever in this same northern low-lying section of the town has to be considered. It is that the specific poison having been admitted to the mains may have become multiplied in the long pipe ending in a “dead end” at the canal bridge. At a point where the dip of the pipe takes it under the railway the depression is such that the accumulated water is peihaps never wholly drawn off, the germ of the disea-e increasing in the stagnant water, to be distributed every time the water newly admitted into the main came in contact with the stagnating contents, constant mixing of the waters at this point leading to contaminatie n equally constant. Here, inde ed, we learn that the water from the main was entirely disused on account of its having a nasty taste, so that any direct evidence as to this theory cannot be found. But it is a feasible one. It is easily to be conceived that when water was rapidly drawn from the mains, some of the stagnant water from this depression could be in this way drawn into the loop supply- ing the epidemic area and consumed there. That the cir- cumstances of this most interesting occurrence of typhoid fever at Atherstone afford indication of a special danger attaching to low lying localities at the perip'.ery of a water source, w'hen sptcifically contaminated water is distribuUd thereto, admits to my mind of no doubt. The incidence of fever on low-lying streets thus circumstanced both in this case and that of West Worthing and West Tarring having been so ably described by Ih's. Wheaton and Thomson, should lead sanitaiy officers, when incidence of a like nature comes within their ken, to ascertain whether water may not be concerned as a medium of cause and spread, and whether the local conditioi.s are such as to have led either to gravitation, with chance of subsequent stagna- tion, of infective material to the lower levels of the distribut- ing mains, or to the gravitation of water already possessed of in'ective quality to the low level terminal pipes, and to these alone. The matter will arise in the next heading treated.
    digitised image 1
    digitised image 2
    digitised image 3