Last updated: Sun 12 Oct 2014

Typhoid in Nunney

Our village gained an ‘unenviable notoriety’ after an outbreak of typhoid in Nunney in 1872.

dippingplace

View of the historic dipping place in Nunney around 1900. Steps lead down to stones in the river.
(glass negative, collection Visit Nunney)

The story of the Nunney epidemic of 1872 reads like a Victorian detective novel.

Nunney was in many ways an accident waiting to happen – although it was by no means unique in this respect. Arnold Taylor, inspector of the Local Government Board, reported in 1871 that he had dealt with a complaint by the Guardians of the Frome Poor Law Union against the Nunney vestry, the predecessor of Nunney Parish Council. The vestry was accused of defaulting on its responsibility to provide proper main drainage and water supply in the village.

“There is the greatest need in this place for better drainage and water supply, especially for the latter,” Taylor wrote. “But unfortunately a special drainage district has been formed of so restricted an area and of such limited value in respect to rateable property that I fear proper sanitary improvements cannot be attained except at a most burdensome cost to the owners and occupiers in the district.”

“I wish to direct special attention to this matter; without any reference to the central authority, a vestry may at present carve the parish into as many special drainage districts as it pleases. Once formed the boundaries – however objectionable – cannot be annulled, unless within three months of such formation an appeal to this department be presented by twenty or more inhabitants.”

“Ratepayers in country parishes have seldom much knowledge or experience of the working of the Sanitary Acts. It is not till improvements come to be talked about and their cost discussed – which does not generally take place within the prescribed three months after formation of the district – that it is discovered how ignorantly or artfully the boundaries of the special drainage district have been settled,” Taylor noted.

Taylor wrote his report shortly in August 1871 – a year before the epidemic of typhoid in Nunney.

The Medical Times and Gazette

The Medical Times and Gazette

Unsanitary conditions

On 4 January 1873 the leading medical journal The Medical Times and Gazette published a case study by Dr. Edward Ballard. The article Dr. Ballard’s report upon an outbreak of enteric fever at the village of Nunney, in the union of Frome, Somersetshire was based on his report to the Local Government Board.

In the report, described by the editor as ‘exceedingly valuable and interesting’, Ballard described how between June and October 1872 76 people contracted typhoid in Nunney and nearby Holwell out of a total population of 832 people. Three people died.

College_of_Physicians_edited

A meeting of the College of Physicians in the early 19th Century

Admitted a member of the Royal College of Physicians and Fellow of the Royal Society, Ballard (1820-1897) was a physician who served as the Medical Officer for Health at the Medical Department of the Privy Council (later Local Government Board).

In this position Dr. Ballard wrote numerous reports on the unsanitary conditions in which the masses of Victorian England lived. He co-authored Elements of Materia Medica and Therapeutics, published in 1845, the first medical textbook on what is now known as clinical pharmacology.

Poor personal hygiene

Typhoid MaryTyphoid – or ‘enteric fever’ as it was called in 1872 – is a common worldwide bacterial disease that has caused devastating pandemics for centuries. Symptoms usually develop 1–3 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhoea, rose-coloured spots on the chest, and enlarged spleen and liver.

A typhoid patient can return to full health but remain a carrier of the disease. Such healthy carriers should not be allowed to prepare food. The most notorious carrier of typhoid fever — but by no means the most destructive — was Mary Mallon, also known as Typhoid Mary.

In 1907, she became the first American carrier to be identified and traced. She was a cook in New York. She is closely associated with fifty-three cases and three deaths.

Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.

Bad air

Queen_Victoria_and_Prince_Albert_1861

Prince Albert and Queen Victoria in 1861, the year in which he died of typhoid.

The disease did not only affect the poor and uneducated. Prince Albert died of typhoid in December 1861. Outbreaks of the disease were most intense around 1860 to 1880 and epidemiological investigation played an important part in identifying patterns.

Throughout the 19th century, the medical community was divided on the explanation for disease proliferation. On one side were the contagionists, believing disease was passed through physical contact, while others believed disease was present in the air in the form of miasma – or ‘bad air’ -, and thus could proliferate without physical contact.

Many Victorian physicians were convinced that the disease was spread through poor personal hygiene and a lack of adequate sanitation. However, the question was whether typhoid could develop independently or was only spread by infected patients.

The Nunney case study became famous because Dr. Ballard concluded that decomposing sewage in the Nunney Brook did not spontaneously cause typhoid, but that it took contamination by a typhoid patient to spread the disease.

An estimated 16–33 million cases of typhoid fever still occur every year. It is most common in children and young adults between 5 and 19 years old. In 2010 about 190,000 people died of the disease, up from 137,000 in 1990.

Nunney Brook

The hamlet of Holwell near Nunney

The hamlet of Holwell near Nunney

On 13 September 1872 a local doctor formally reported the death of a 14-year-old girl in Nunney as a result of “fever from the effects of cow disease”. He added that nearly 40 others were suffering similar symptoms in the village.

Dr. Ballard visited Nunney to study the outbreak of the disease. In his report he wrote: “There are no main sewers in any part of the village. The excrement of the population is collected in cesspools, and the rest of the sewage, consisting of slops of all kinds, is either thrown directly into the brook or runs into it, at various places along the stream, from old drains proceeding from several dwellings.”

To make matters worse, Ballard noted, “The brook also receives all the surface drainage from the farmyards, stable-yards, back premises of dwellings, and from the roads, and in rainy season a large quantity of all kinds of filth is washed into the brook.”

He concluded that the fever in Nunney was enteric – affecting the gut. There were no other outbreaks of typhoid in the area around Nunney.

Ballard therefore concluded that the disease must have been brought into the village from further afield by a visitor. He identified the source as Sydney Nicholas from Old Ford, five miles away on the other side of Frome.

Ballard observed that during his visit human excrement infected with typhoid was finding its way into the Nunney Brook at “the very last house in the village up the stream”. “There were two cottages under one roof,” he wrote. “The one was occupied by the family of Nicholas, the other by the family of Garrett. They are small cottages, standing a few feet from the steep bank of the gorge at the bottom of which runs the Nunney Brook.”

“At the rear of the Nicholas’ cottage, and adjoining it, is a privy with a cesspool for the use of the two families. The cesspool is distant about 15 yards from the edge of the descent of the gorge, here about 30 or 40 feet deep.”

Sydney Nicholas, 24, was visiting his brother Thomas and at first infected his host, his brother’s children and his neighbours’ children. Their excrement and urine found their way into the Nunney Brook, most likely because heavy rain had washed excrement from the cesspool into the brook.

Dipping place

Nunney c1900

Sydney Nicholas was first seen by a medical officer on 15 June. The neighbours fell ill a month later – a normal incubation period for typhoid.

There was then another interval of about a month before the first cases were diagnosed in Nunney itself. The typhoid outbreak spread in the village because the villagers were drinking the contaminated water half a mile downstream.

On 6 August two families living next to each other immediately below the bridge (Beehive Cottage and Kingfisher Cottage in Church Street) fell ill. Both families, the Hilliers and the Whitakers, used water from the Nunney Brook for all domestic purposes.

“It is worthy of notice,” Ballard wrote, “that only a very few yards higher up than these houses, and just on the other side of the bridge above them, a large drain bringing sewage from several houses on the north side of the stream, pours sewage into the brook.”

The next cases that occurred were in a house next to Kingfisher Cottage and in two houses opposite on Church Street. All used water collected from the dipping place next to Kingfisher Cottage.

Nunney residents had been drinking water from the Nunney Brook for centuries. Water was collected at the dipping place behind Kingfisher Cottage on Church Street, close to the bridge. Despite the fact that the Nunney Brook was pretty much an open sewer until the 20th century, there had been no major outbreaks of typhoid in the village in the past 28 years.

“With very few exceptions the water used for all purposes throughout the village is taken directly from the brook, at holes or ‘dipping places’ provided for the purpose. Bad as the water is, is is almost universally drunk either cold, made into tea, or brewed into beer, or mixed with spirits,” Ballard wrote. “Some of the dipping places I saw were immediately adjoining the outfall of filthy drains, and in one instance close to the wall of a cesspool.”

The Nunney Brook was not significantly worse polluted than in previous years. The focus of Ballard’s enquiry therefore became what different circumstances had triggered the major typhoid outbreak this time.

Heavy rainfall

Typhoid-Fever-Discovered-By-Pierre-Fidele-Bretonneau

Typhoid fever is a critical infection caused by bacteria named as Salmonella typhi. It was discovered by French medical doctor Pierre-Fidele Bretonneau in 1819.

Writing about the epidemic of typhoid in Nunney in the British Medical Journal in 1880, Dr. Ballard wrote: “It turned out on inquiry that, in the month of June, a man ill with fever had come from a distance and had taken up his residence in a cottage on the summit of the gorge above the village, and that his evacuations had been deposited on an ash-heap at the very edge of the gorge.”

“On July 6th, a heavy rainfall, capable of washing down some of this excremental matter into the brook below, occurred, and it was the first such rainfall that happened after it is certain that the excrement was so deposited.”

“On July 20th, a singing-master at Frome, who had taken a meal in the village on the 10th (four days after the heavy rain), was attacked with fever. But for a knowledge of the history of this man’s proceedings, and of what had happened on the gorge, his case might easily have been taken to have been one of de novo origin.” (de novo in this context means independent, unrelated or spontaneous)

“In the meantime, other people had been attacked with fever in the cottage on the gorge, and their evacuations had been similarly dealt with. On July 25th, a thunderstorm occurred, which must certainly have carried more of the specific matter into the brook, and probably much more than previous more gentle rains.”

“Twelve days thereafter, the first burst of fever occurred in the village below, in five families who drew their water from the brook at nearly the same spot. Before the epidemic was over, there had been seventy-six cases of the disease in a population of about eight hundred persons.”

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