Bolton Enteric Epidemic – An Unparalleled Emergency.

December 1921

Mexborough & Swinton Times – Saturday 17 December 1921

The Bolton Epidemic

Medical Officer’s Review.

History of the Outbreak.

An Unparalleled Emergency.

Dr. Morris, the Medical Officer of Health to the Bolton-on-Dearne District Council has issued a full report on the disastrous epidemic enteric fever which has been raging in the district. The report. which was read at the meeting the Bolton Council on Tuesday evening, gives the following information:

In July of this year, enteric fever appeared simultaneously in this district and in several neighbouring districts, a common source of infection being indicated. Cases in the Council’s district occurred at Bolton, Goldthorpe and Highgate Contact cases arising from the primary cases had, by Oct 26th, brought the total of notified cases in that district to 52, which were distributed as follows: Bolton 22, also 23 and Highgate 7. From September 25 to October 27 the only case notified from Bolton was recently removed from Highgate, having been infected there.

On October 27 a case of enteric lever was notified from High street, Bolton, and on the following day two further cases were notified from Wath road, Bolton. These cases were regarded as contact eases coming from the first epidemic. On October 29, three cases were notified from Highgate. On October 31, thirteen cases, were notified, distributed as follows: Bolton 9. Goldthorpe 1. Highgate 3. Rapid investigation of these cases at once led at once to the conclusion that an epidemic from a new source had arisen in Bolton. This conclusion unhappily proved correct. The new epidemic rapidly assuming calamitous proportions, and has taxed the energies and resources of the departments for six weeks.

During that period, cases were notified as follows: Bolton 250, Goldthorpe 9 and Highgate 19. Two of the Goldthorpe, eases were infected at Bolton, and I have received intimation from Leeds, Sheffield and Halifax that in each town one case infected at Bolton has been notified.

Cases attributable to the present outbreak, then, total 255 at present. Twenty-five deaths have occurred, five at home, and the remainder in hospitals. Before proceeding to discuss the preventive adopted, I must first point out the extraordinary nature of the outbreak. When, on Oct. 31, ihe first batch of notifications was handed into, the Medical Officer not less than 150 residents in Bolton were already suffering from the disease, and not less than 80 others had been infected, and were later to develop it. That is to say, no power could then prevent the occurrence of the huge total of 230 cases of enteric fever in Bolton. The success of the measures adopted must be viewed in the plight of this fact.

Preventative Measures.

The preventive measures adopted in deal-: with the outbreak consisted of elimination of the source of infection, the isolation of sufferers, the destruction of infection, the care of the sick and the securing, of prompt notification. With regard to the first, a rapid investigation of the cases notified on the morning of Oct. 31, led at once to suspicion of the contamination of the Town Pump, in High Street Bolton. Before noon, a notice was posted on the pump warning all users to boil the water before use for drinking and other purposes. A sample of the water had been despatched for chemical analysis and arrangements made for the collection of a sample for bacteriological examination. Investigation of cases on successive days amply confirmed the suspicions on the pump, and on Nov. 7 the bacteriologist reported that his examination indicated contamination by human faecal matter. The handle of the pump was afterwards removed to preclude further use of the water. In the meantime other pumps had been posted with notices and later, by arrangement with the owners, the handles of the pumps accessible to the general public were removed. Householders having pumps on enclosed premises were warned against permitting indiscriminate, use alter the closing of the Town Pump.

Hospital Arrangements

On October 27, 23 beds were available for enteric lever in the district’s joint hospital at lath Wood. During the first epidemic arrangements had been made for the treatment of enteric patients from this district at the Conisborough Hospital and the arrangement is still in force. Twenty beds were evadable here. On Nov. the accommodation in these two hospital was exhausted.

Arrangements were made in the meantime for the admission of 13 case to the Brealey Hill hospital, and this took place on November 5. November 9 by another arrangement, 19 cases were sent to Rawmarsh isolation Hospital. At a conference on local authorities and the County authority at Wakefield, on November 10 the following arrangements were made:

The Lund Wood hospital of the Barnsley corporation to be fitted up and staff to receive 40 patients; scarlet fever patients at Wath Wood and Conisborough hospital to be removed, releasing 38 beds for enteric cases; the conversion of the Bolton Infants School into an emergency hospital to take 42 patients.

On November 14 the first patients were sent to Lund Wood, and on the same day more beds were available at Wath Wood hospital.

The following day the school hospital received its first batch of patients. On the 18th further accommodation at the Conisborough Hospital became available, and on the 23rd arrangements were made for 24 beds at the Rotherham Isolation Hospital. Necessary delay in the completion all these arrangements, and especially difficulties in staffing, made the accumulation of cases in the homes inevitable.

On November 11 no less than 80 notified cases were still at home, and not until December 3 was it possible to remove to hospital all the cases which ought to have been removed. Though the policy pursued throughout has been that of isolation of all cases, it had to be recognised early that a number of case would have to be treated at home. The selection of cases for removal was carried out with this fact in mind. In the negotiations of the additional hospital accommodation and expedient conversion of the school, the services of the County Medical Officer and staff were most invaluable. The loyalty with which the various local authority placed their hospital resources at the disposal of this district is most commendable. The following statement shows the case and admitted, debts, and discharges at the various hospitals:

Hospital Admitted Died Discharged Remaining
Wath Wood 67 9 26 32
Conisbrough 41 4 7 30
Brierley Hill 16 3 4 9
Rawmarsh 19 1 18
Bolton School 43 2 41
Lund Wood 40 1 1 38
Rotherham 24 1 23
Totals 250 20 39 191

 

Destruction of Infection.

With regard to scavenging, very many of the in the affected area still have midden-privies of most objectionable types. Routine cleansing of these privies is carried out monthly. After the occurrence of infectious disease in a particular house, it is the practice to cleanse and disinfect the privyimmediately after the removal of the case. Early recognition of the size of the problem presented by the new epidemic led to change in the procedure. The whole of old Bolton was regarded an infected area and on the night of November 1 the clearance and disinfection of the whole of the midden–privies was commenced. Cleansing and disinfection was then undertaken weekly. The privies have been cleaned by night, and the following morning the surroundings have been thoroughly disinfected with corrosive sublimate solution. All drains and gullies likely to have received infectious material have been regularly cleansed and disinfected by the Department’s staff. After removal, death, or recovery patients, the sick rooms and their contents base been disinfected by fumigation with formulin or sulphur. As far as possible, the bedding and clothing has been removed to The Wath Wood Hospital and passed through the steam disinfector. It has been possible, however, to deal with only a portion of the bedding in this manner and tor the remainder reliance has had to be placed on fumigation at home.

By arrangement with the County Medical Officer, six County health visitors were drafted into the district at the time when the accumulation of cases was greatest. There first task was in rendering assistance in homes where, for various reason, proper attention could not be given to the sick, and then visiting other homes and giving advice. On Nov. 4 a letter was addressed to local practitioners requesting notification of all metes of suspicious sickness. After the removal to hospital of the necessitous eases, the services of three of the County health visitors were retained for the purpose of house-to-house visitation in the infected area. The object of these visits was to encourage the calling in of medical advice in all cases of sickness in the area, the spreading of information, and bringing to light of any overlooked eases.

The Present Situation.

Diving the last twelve days only nine cases have been notified, and since December 9 there have been no notifications. Since December 2 the Wath Wood Hospital has ‘been able to receive all eases notified. There remain at home at the present time only 23 patients. 10 of these are cases the diagnosis of which is doubtful, and all blood tests taken have given negative results. Thirteen are cases left at home to give preference to cases the removal of which was more urgent. These cases are well isolated, and are now so near, to recovery that it is not considered necessary to remove them to hospital. Thirty nine patients have been discharged front hospital and further discharge may be anticipated at an early date. Hospital accommodation is now available in excess of probable future needs.

The Bolton Hospital was placed in my charge. Forty-three patients have been treated and a large proportion of these have been cases of severe type, whose removal to more distant hospitals would have been impossible. Two deaths have occurred, one’ being that of a patient whose condition was hopeless on admission and who died the same night. The progress of the rest has been very satisfactory. Three patients only are now considered to be in a dangerous condition. There have been 255 cases of enteric fever, which were attributable to the epidemic arising from the pollution of the town pump. Of these cases 230 were inevitable when the outbreak was first recognised. Up to the present only 25 secondary cases have arisen. If the epidemic can now held without undue increase of this number significant success made may he claimed for the efforts nude to deal with a situation probably without parallel in this country on the part of the medical practitioners, so as to secure that no case of the disease goes recognised and becomes the centre of further infection.

For this purpose, free use should be made of the blood test in all cases in which the symptoms or associations are suspicious. I wish to place on record my appreciation of the excellent, work cheerfully performed by the nurses, Mason’s hand health visitors. I should also like to commend to the notice of the Council the valuable work done by the members of the Emergency Committee appointed by you to deal with the epidemic.

Since the completion of this report, five further cases of enteric fever have been notified— fourth from Highgate, and one from Bolton.