Murchison pointed out that there had been previous isolated cases of typhoid in Nunney in 1867, 1870 and February 1872. These had not resulted in a pandemic. He therefore concluded that although there were patients in the village who provided an active source of infection on these previous occasions, the favourable circumstances that had caused the major outbreak in September 1872 had previously not been present.
There was more mystery. Mr Marsh was a surgeon who attended most of the cases of typhoid in Nunney. He told Murchison that there had been no other known cases of the disease in Old Ford in the summer of 1872, apart from Sydney Nicholas – the man who was believed to have brought the disease to Nunney.
Dr Murchison also discovered that Sydney Nicholas had visited Nunney on two previous occasions, three weeks and one week before he fell ill. During the first of these visits he had attended a meeting of his club in the house where the worst and largest number of typhoid cases subsequently occurred.
Murchison therefore concluded that it was more likely that Nicholas had contracted the disease during this particular visit to Nunney, rather than in Old Ford.
“It follows that the origin of the epidemic admits of a very different interpretation from that which was first apparent, and that it is not, as was imagined, a crucial proof of the necessity of a specific faecal ferment for the production of enteric fever.”
Murchison also pointed out that even if the overriding medical opinion now was that Ballard was right in saying that typhoid was introduced into communities by other carriers rather than the result of unhygienic conditions, certain conditions – such as temperature and stagnant water – were likely to create more favourable conditions for an outbreak of the disease.
He concluded that typhoid may be spread through decomposing faeces contaminating air or drinking water – although he disagreed with Ballard that this necessarily had to be the excrement of a patient. More likely, according to Murchison, it was due to a specific poison, “possibly a bacillus, though this cannot be considered as proved”.
Whether they believed that typhoid was caused by bad smells or infection by other patients, scientists agreed that better sanitation and hygiene were key to combating the disease.
“It has been contended that the disease may be stamped out by recognising the fact that, when the disease is due to germs derived from a diseased intestine, these germs [may be destroyed] with chemical reagents, such as chloride of zinc and carbolic acid,” Dr Murchison wrote.
Sanitation and hygiene
Ballard was right though. The official advice from the World Health Organization and other leading medical bodies today is that sanitation and hygiene are the critical measures that can be taken to prevent typhoid.
Typhoid can only spread in environments where human faeces or urine are able to come into contact with food or drinking water. Vaccines are available and antibiotics are also effective.
The epidemic of typhoid in Nunney had been one of the key moments in defining the cause of this dreadful disease.
However, the spread of water-borne diseases spread by drinking water from the Nunney Brook did not stop after Parliament took action to improve conditions.
“There were four deaths from diphtheria in the Nunney district, all in the same family, the disease appearing again and again, in spite of every preventive measure,” according to a report in the British Medical Journal in 1886. “Mr. Parsons (the local medical officer for Nunney) attributes the origin of the mischief to “unventilated drainage, for though the water was impure, yet it had been used in common with other dwellings in which no disease appeared, whereas the sewage of the farm-premises had been recently rearranged.” We know, of course, what Mr. Parsons means; but a more accurate use of the words which we have italicised would have been an advantage.”
Worse was to come, with a cholera epidemic in Nunney in 1893.
Cause of death in Nunney 1871 – 1911
Another Great Stink?
Today we take for granted that raw sewage should no longer go straight into our rivers. However, London’s Mayor Boris Johnson says his city is lapsing back to the Great Stink of 1858. The city’s Victorian sewerage system, built by Sir Joseph Bazalgette for a city of 2.5 million people, cannot handle the present population of 8 million.
Every time the skies add in just two millimetres – less than a tenth of an inch–of rain, the ‘Bazalgette Interceptors’ break open and raw sewage pours into the river.
Johnson writes: “In one of the crimes for which we are truly all guilty, society is now discharging an awful 50 million tons of raw sewage into the river in London alone, and unless we are bold in our plans, that figure will rise to 70 million tons in 10 years.”
“When Bazalgette designed his interceptors, in response to the Great Stink of 1858, he assumed that they would only kick into action in emergencies – truly torrential downpours of a kind that happen once or twice a year. Now it happens 50 times a year, basically once a week.”
Sanitation and healthcare may have improved since 1872, but it seems that the reality of British rivers as open sewers is still closer than we think…