Dr. Theodore Thomson's report to the Local Government Board on an outbreak of enteric fever in the urban district of Bicester.

  • Thomson, Theodore.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Theodore Thomson's report to the Local Government Board on an outbreak of enteric fever in the urban district of Bicester. Source: Wellcome Collection.

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    enteric fever in the Bicester Urban District was 3 * 3 per thousand persons living; and the fatality of the disease during the same period was, if sus¬ picious cases be not reckoned as enteric fever, 18 per cent, of persons attacked. The outbreak therefore was, in regard of the small population involved, a serious one. This outbreak of enteric fever did not extend over the whole of Bicester ; it was, in fact, almost entirely restricted to the northern part of the town, as may be seen by reference to the appended map. With five exceptions all the invaded houses lay tolerably near together towards the extremity of one of the limbs of the Y which the town of Bicester forms ; and, indeed, of these five exceptions three were houses which, although not situated within the area of chief invasion, were nevertheless at no great distance therefrom. Accord¬ ingly, in search for the cause of the outbreak, only possible fever-agencies restricted in their operation to the quarter of the town mainly affected by the disease could be accepted as satisfactorily accounting for its occurrence. In this respect possible causes of fever such as sewerage conditions, general sanitary circumstances, and milk supply were alike found to fail. As regards sewerage conditions, there did not appear reason to regard them as more faulty in the area chiefly invaded by fever than in other parts of Bicester entirely free from the disease : indeed, the sewers in St. John Street and Field Street, in both of which streets several houses were invaded by the fever, are among the few sewers in Bicester in which attempt at ventilation has been made. Further, the houses in the main area of invasion drain to two sewers passing, as shown on the map, in different directions, and having- no connection the one with the other, until they reach the main sewer in Chapel Street, a considerable distance from the area in question. The general sanitary circumstances of invaded houses were, for the most part, unsatisfactory in one or another respect. Defective drainage arrange¬ ments were found in not a few ; in some, excreta were disposed of in offensive vault privies; while the houses themselves were not always satisfactory as regards proper access of light and air and freedom from conditions of dilapi¬ dation and dampness. Amongst this variety of defective circumstances there were, however, none that could be regarded as accounting for the distribu¬ tion of the fever ; indeed the previously noted localisation of the disease was far from being accompanied by a corresponding limitation of these unhealthy conditions to the part of Bicester in question. Inquiry as regards milk supply of the 30 invaded houses elicited the information that these had been supplied by one or other of four different vendors. The following list shows the number of invaded houses supplied by each of these four persons, and aiso the total number of houses ordinarily supplied by them :— A supplied 21 invaded houses; total houses supplied in Bicester daily about 180 a 39 V 59 3 33 53 39 33 ou c 39 7 53 3 39 33 33 55 130 D 33 2 33 3 •3 33 33 33 10 It will be observed that the total number of invaded houses supplied by A, B, C, and D is in excess of 30, this being due to some of these houses taking milk from more than one of these vendors. There was a relatively larger incidence of fever on the customers of A and B than on those of C which may be referred to the fact, ascertained by inquiries made in the chief area of invasion, that A and B supply a relatively greater number of families in the northern or chiefly invaded end of the town. Furthermore, the fact that the disease was almost entirely limited to this end of the town, while all these milk vendors supply other parts of Bicester, is in itself sufficient to exclude milk from suspicion of having been the vehicle by which the fever was disseminated. When, however, inquiry was made concerning conditions of water supply, a series of facts came to light which were found to be consistent with water having been the agent whereby, in this instance, enteric fever had been spread. Comprehension of these facts will be facilitated by the following list, which shows week by week, during the period of chief prevalence of the