Dr. Thorne Thorne's report to the local government board on an extensive outbreak of enteric fever, affecting especially Red Hill, in the urban sanitary district of Reigate, and Caterham in the rural sanitary district of Godstone.

  • Thorne, Richard Thorne.
Date:
1879
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Licence: Public Domain Mark

Credit: Dr. Thorne Thorne's report to the local government board on an extensive outbreak of enteric fever, affecting especially Red Hill, in the urban sanitary district of Reigate, and Caterham in the rural sanitary district of Godstone. 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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    Dr. Thorne Thorne’s Report to the Local Government Board on an Extensive Epidemic of Enteric Fever, affecting especially Red Hill, in the Urban Sanitary District of Reigate, and Caterham in the Rural Sanitary District of Godstone. George Buchanan, Assistant Medical Officer, 7th April, 1879. On February the 4th last the Local Government Board received a communication from Dr. II. C. Hilliard, of Caterham, to the effect that within the previous 10 days 25 cases of enteric fever had come under his notice in that place. The outbreak was explained to have been sudden in its occurrence, and, as the result of some inquiry which he had made, Dr. Hilliard stated his belief that the disease had been conveyed by means of the water supplied by the Caterham Waterworks Company. Under these circumstances I, on the same day, received instructions to make immediate inquiry into the causes of the outbreak. This inquiry was commenced on February 5tli, and it was continued at intervals until early in the following month. On reaching Caterham I found that the other medical practitioners in the place had also been called in to a considerable number of cases of the same disease. The first person attacked had sickened on January 19th; a second attack occurred on January 20th, two more on the 23rd, three on the 24th, and from then up to February 2nd, to which date information was at first limited, fresh attacks in fresh houses had occurred day by day, the total number of houses affected being 35, and the total number of sick being 47. The daily number of attacks which came under medical treatment had varied from one on January 19th, 20th, and 30th to ten on February 1st. This group of 47 cases, included as they were within a fortnight, was at once made the subject of inquiry. Caterham is situated in the rural sanitary district of Godstone, and it has a popula- tion of about 5,800. One part of it, which will in this Report be called Lower Caterham, occupies a position near to the southern extremity or head of the Caterham Valley, a valley bounded by chalk hills, extending north and south for a distance of about 5 miles, and opening out at Caterham Junction about half way between Caterham and Croydon. The houses in Lower Caterham consist mainly of superior villa residences, many of which have been built within recent years. The other part, or Upper Caterham, lies at a higher altitude at the southern end of the range which bounds the valley on the west. Here also are a number of villas, the old village of Caterham, one of the asylums belonging to the Metropolitan District Asylums Board, and the barracks of H.M.’s Foot Guards. The cases of enteric fever above referred to, and which had occurred in the fortnight ending February 2nd, were spread over a very wide area, some in Upper, some in Lower Caterham, extending to the extreme outskirts of those places. The houses attacked belonged to no special class, both rich and poor having suffered. It was at once apparent that the disease could not have been conveyed to the affected houses bjr means of any general system of sewers common to the district, for by far the majority of the houses were found to drain into separate cesspools excavated into the chalk; some of these cesspools, as also the house drains, being efficiently ventilated, others having no such ventilation. Some of the houses affected had no artificial means of drainage, the liquid refuse being thrown on to gardens adjoining them. There was also no possibility that there had been any common cause of infection in connexion with the prevailing means of excrement disposal, because there was nothing in common with regard to such disposal. Most of the houses in which the disease had appeared were provided with waterclosets, a considerable number of which were apparently well trapped and ventilated. Others had closets which were fitted with a trap and pan and emptied into cesspools, and though these closets were at times a source of nuisance owing to the absence of any flushing apparatus, yet they were all situated out of doors. Others again were provided with common privies and a few with earth-closets. The possibility of infection having been communicated by means of a milk-supply was next inquired into, and it was ascertained that 33 of the houses affected received their milk from at least five different and completely independent dairies, and that, at the remaining two, private cows were kept. It was also evident that personal infection could not in any way have led to the outbreak. Further, there was no history of any recent prevalence of enteric fever in Caterham. It was stated that the locality for some years past had been remarkably free from the L 905. Wt. 2077. E. & S.