The Diphtheria outbreak at Foxearth School of 1897, and the 'prolonged cesspit'

I came across this interesting document from 1897, that related a sad occurrence of Diphtheria at Foxearth school, and the resulting deaths of two children. The origin of quite a lot of disease and death came from outside the parish. Although the infamous Foxearth Culvert came in for its share of blame, it would seem that a visit to London was the ultimate cause of the tragedy.  These reports of the medical officer are interesting because they give a lot of information of the rather desperate living conditions of local people. So often one reads of disease caused by the very poor habitation, and lack of clean water supply. The death rate was a lot worse than the average in England at the time. 

BELCHAMP RURAL DISTRICT,

In the Administrative County of Essex.

Annual Report of the Medical Officer of Health, for 1897.

(Pursuant to the regulations of the Local Government Board,)

Population 1881, 6200; 1891, 5722. Number of Parishes 16. Acreage 26545.

Person per acre 0.46.

RATEABLE VALUE £25,891

Geological formation, chalk, covered on the higher ground with Boulder Clay, and in the valleys with brick earth, sand or gravel.    Superficially with alluvium.

Births. There were 120 births registered during the year equivalent to a birth-rate of 20.9 per 1000 of the population.   The births and birth-rates in this district during the past seven years were ; —

	1891	1892	1893	1894.	1895.	1896	1897
Births	131	137	127	127	115	113	120
Birth-rate	22.8	23.9	22.1	22.1	20.0	19.7	20.9

Diphtheria.   An outbreak of eleven cases of this disease, two of which proved fatal, occurred in the parish of Foxearth, during the autumn.   It was evident that the infection started from the school, as the three cases first affected were children attending there. For some times enquiries failed to account for its origin, but afterwards I found that a girl who had been for a long visit to London had a severe attack of diphtheria when there, she was removed to hospital, and after six weeks was discharged convalescent and came back to Foxearth.   When she returned to school she was still suffering from a nasal discharge, which I have no doubt was still infected with the diphtheria bacilli, as a few days afterwards three children became infected. One of these a boy slept with an elder brother, the latter took the disease in a virulent form and died. Until this case occurred there was no suspicion of the mischief that was brewing. The school was closed for a week and disinfected and cleansed. But other cases occurring brought to light the origin of the infection, the girl was excluded and the school disinfected again.    At the same time attention was called to the insanitary condition of a main sewer in the village and the offensive smells arising therefrom, as a possible cause of aggravating the disease and of originating some of the diphtheritic sore throats.   This matter will be alluded to further on.

Deaths. The number of deaths from all causes registered in the district was 91 to which 9 deaths belonging to the district occurring in the Workhouse and St. Leonard's Hospital, Sudbury, have to be added, making the total deaths 100 equivalent to a death-rate of 17.4 per 1000 of the population. The deaths and death-rates during the past seven years were : —

	1891	1892.	1893.	1894.	1895.	1896.	1897
Deaths registered	93	88	106	82	70	85	91
Deaths belonging to the District	97	104	112	88	78	92	100
Death Rate	16.9	18.1	19.5	15.3	13.6	16.0	17.4

Infant Mortality. The deaths among infants under one year of age were 11, being equivalent to the proportion of 91.6 deaths to a 1000 births. In 1896 the proportion was 194. The proportion throughout all England for 1897 was 156.

The seven principal Zymotic Diseases caused 8 deaths, equal to a death rate of 1.2 per 1000 of the population.

The deaths arose from Diptheria 2. Typhoid Fever 1. Whooping Cough 5. The mean death-rate due to zymotic diseases during the past six years was 1.0 per 1000

Deaths from all other causes belonging to the district wore 92 in number or 15.9 per 1000. The following diseases contributed to the general mortality. Phthisis 8. Bronchitis and Pneumonia 16. Heart Disease 7. Cancer 7. Injuries 4.

The death-rate from Consumption in this district during the past year was 1.3 per 1000 of the population as against a mean of 1.2 during the previous six years.

The Infectious Diseases (Notification) Act came into operation on 1st February, 1890. Since then the following cases have been notified per 1000 of Population.

	Smallpox.	Scarlet Fever.	Diptheria and Croup..	Typhoid Feve cases.	Puerperal Fever.	Erysipelas	Total	Per thousand Population.
1890	0	29	6	1	0	5	41	7.1
1891	0	38	0	1	0	1	40	7.0
] 892	0	92	2	1	0	6	101	17.6
1898	0	43	47	0	0	11	101	17.6
1894	0	18	4	0	0	8	35	5.2
1895	0	20	1	0	0	4	25	4.3
1896	0	54	8	4	1	7	74	12.9
1897	0	i2	11	5	0	4	23	4'0

The following are particulars of the occurrence of zymotic diseases during the year in this district.

Scarlet Fever At the close of the preceding year several cases of this disease had occurred and were recovering when a fresh case appeared in the parish of Middleton evidently infected from a previous case close by. A second ease occurred in the parish of Alphamstone, a servant girl came home ill from Sudbury and developed the disease.

These two cases were the only ones in the district during the year, both recovered. The usual precautious were successfully taken to prevent any spread of the disease.

Diphtheria.  An outbreak of eleven cases of this disease, two of which proved fatal, occurred in the parish of Foxearth, during the autumn.   It was evident that the infection started from the school, as the three cases first affected were children attending there. For some times enquiries failed to account for its origin, but afterwards I found that a girl who had been for a long visit to London had a severe attack of diphtheria when there, she was removed to hospital, and after six weeks was discharged convalescent and came back to Foxearth.   When she returned to school she was still suffering from a nasal discharge, which I have no doubt was still infected with the diphtheria bacilli, as a few days afterwards three children became infected. One of these, a boy, slept with an elder brother, the latter took the disease in a virulent form and died. Until this case occurred there was no suspicion of the mischief that was brewing.   The school was closed for a week and disinfected and cleansed. But other cases occurring brought to light the origin of the infection, the girl was excluded and the school disinfected again.    At the same time attention was called to the insanitary condition of a main sewer in the village and the offensive smells arising therefrom, as a possible cause of aggravating the disease and of originating some of the diphtheritic sore throats.   This matter will be alluded to further on.

Typhoid Fever. Five cases of this disease occurred. The first case was in the parish of Borley, a farmer in delicate health returned ill from a visit to Lowestoft, typhoid fever developed and proved fatal. No insanitary conditions exists in his house or premises. The other four cases took place in the parish of Pentlow, in two families, both used the same water from a well in a farm yard, analysis of the water showed that it was contaminated with sewage matter, evidently derived from farm yard liquid percolating into the well. At the same time the typhoid germs had very likely another origin, as the first case who took ill, was a young man who a fortnight before had taken a day's excursion to Southend where he had eaten freely of cockles, a very probable source of typhoid. The two families intermixed, and in spite of directions, the neglect of absolute cleanliness may have given rise to the three cases which followed. The well, however, was closed, and water was obtained from a spring near the houses. Of the other infectious diseases not notifiable, whooping cough was the only one that was prevalent during the year, occurring in the parishes of Walter Belchamp, Bulmer, and Gestingthorpe, fortunately in the summer months or the mortality would have been greater than it was. Five children died, four of whom were infants under one year of age.

Water Supply.   At Chapel-hill, Walter Belchamp, where 12 cottages were reported last year as without water and notices had been served on the owners, a supply is now obtained from a disused well close to the chapel, this well has been cleaned out and a temporary pump put into it.

A well in Bures Hamlet got out of order through defects in the pump, the owners attention was called to this and a new pump was put into the well.

At Foxearth the water in a public pump entirely failed probably owing to the dry summer and autumn, and the people at this part of the village had resort to a stream of water which flows in a ditch by the side of the village, which water was unfit for drinking purposes, though useful for washing and slop purposes.   This was remedied by Mr. Ward, allowing and making access to the water from a deep well at his brewery, and notice boards were put up at three dipping places along the stream, that the water here was not to be used for drinking.

The water from a well in lower end Henny supplying six cottages, was found on analysis to be impure, notice was served on the owner who had the well cleaned out, the water was much improved, though not perfect yet.

A well in Pentlow parish was closed being contaminated with farm yard sewage, and typhoid fever existing in two cottages using it.

Ten analyses of drinking water were made during the year. In most parishes there are outlying cottages depending on pond or ditch water, in which nothing can be done except keeping these surface collections as free from contamination as possible.

Sewerage. The privy and cesspit system is in general use. As most cottagers have garden or allotment ground the cesspit contents are naturally disposed of. No new privies were constructed, five which were in a dilapidated condition were repaired

Owing to the outbreak of diphtheria in the parish of Foxearth and complaints of smells from gullies connected with the village sewer, a sub-committee of the District Council had the sewer opened in four places for examination. It was found to be a brick culvert 467 yards long, 2 feet deep, and 2 1/2 feet broad with nearly flat bottom and little fall, two or three inches of offensive sewerage matter covered the bottom. This prolonged cesspit was originally constructed of these dimensions in order to convey the storm water from the land above the village, and thus to sweep out the sewerage matter and keep the culvert clean. But for nearly two years sufficient storm water has been absent owing to the dry weather. While the sewerage which is derived from house slops and cask washings from the brewery has been accumulating. The brewery sends about 5,000 gallons of water through the culvert in 24 hours which is at the rate of 3 gallons in a minute, thus trickling through, it does more harm than good. The obvious remedy is to tank the brewery water for 48 hours and then let it flush the culvert.

This and the turning of a former water course into the culvert are under consideration. In the meantime quantities of chloride of lime have been thrown into the culvert.

The outflow from the Foxearth sewer, passes into a ditch running for more than a mile through the parish of Liston, this ditch is always foul and the cause of much complaint. If the Foxearth culvert was kept clean this ditch would soon cease to be offensive.

Houses Seven houses were reported as unfit for human habitation. Two in Henny, and two in Walter Belchamp have been put into habitable repair; two in Bulmer and one in Gestingthorpe have been closed.

Four cases of overcrowding were reported, and notices were served on the owners of the overcrowded cottages to abate this nuisance. One was remedied by reducing the number of the family. The other three cases still exist, but will be abated.   Two new houses were erected during the year.

Sanitary Inspection. Systematic as well as special inspection have been made in every parish in the district during the year. Many improvements  have been effected in the condition of cottage premises, such as the prevention and removal of offensive accumulations, the emptying and cleansing of cesspools, ashpits, and pig styes.

The following is the report of the Sanitary Inspector :—

Number of cottnges inspected	430
Number of notices served	16
Number of Nuisances abated	28
Number of houses reported as unfit for human habitation	7
Number of houses placed in habitable repair	4
Number of houses disinfected .	15
Number of bake-houses inspected	9
Number of slaughter-houses inspected	1

J. S. ROBINSON,

Sanitary Inspector.

There are no factories in the District. The only offensive trade is a small knackers yard in Walter Bolchamp

One Special Report was made relating to Diphtheria in Foxearth.

J. SINCLAIR HOLDEN, M.D.,

Medical Officer of Health.