William Budd and the 1839 North Tawton Typhoid Outbreak
Transcriptions and notes by Caroline <tilburycm <AT> netscape.net>
William Budd, M.D., F.R.S. was born in 1811 in North Tawton, and died on 9 January 1880 in Clevedon, Somerset. He published "Typhoid Fever, its Nature, Mode of Spreading, and Prevention" (London, Longmans, Green & Co.) in 1873, based on his several previous publications (1857-1860); the book was dedicated to William BUDD's earlier mentor, Sir T. WATSON, Bart., M.D., F.R.S. It provides a vivid description of living conditions for a country labourer's family, and the additional misery caused by illness, and is followed by a detailed account of daily life in North Tawton, the outbreak of typhoid there in 1839, and its spread.
William was the son of Samuel BUDD, surgeon of North Tawton, and his wife Catherine [WREFORD]. Of nine children, eight were boys; of those I have been able to trace so far most were medical doctors (although the probable ninth, Francis Nonus BUDD, was a barrister), and William mentions the assistance of his brothers during the outbreak. Other researchers cite a paper by Samuel BUDD concerning typhoid, but I have not as yet found this publication, and do not know if it was by Samuel BUDD snr. or jnr. William's brother George also rose to eminence in the field of medical research
Note: My web page on the Budd Family of Physicians also contains a detailed draft of the Budd Family Tree.
For the London area (20 Unions & Parishes), William BUDD quotes:
13,972 claims for relief from destitution due to fever attacks
1,281 of which were fatal
5,634 = total number of fever deaths for the metropolis.
Later statistics for fever mortality (England, including typhus) were given as:
5-yr. period pre-1866: >20,000 p.a.
1865-1871: >18,000 p.a. on average
Deaths from (7 principal) other infectious diseases, 4Q:
The Registrar General's remarks of 1871:
"Although the remarkably low death rate in town districts, last quarter, may be due to the somewhat unusual meteorological conditions which prevailed, [very heavy, cleansing, rain] it may be safe to assume that a portion of the improvement in their health is permanent, and is the result of the general awakening to the importance of sanitary measures which has been so conspicuous in the last few years."
BUDD's portrayal of the living conditions and human misery witnessed:
"There are few things which concern the people of this country more deeply than to know the exact truth touching the mode in which this fatal fever is disseminated amongst them. Every year, on an average - take the United Kingdom through - some fifteen thousand or more of their number perish prematurely by it: a population equal to that of a considerable city every year swept into the grave by a single, and, as I hope to show, a perfectly preventable plague.
As nine or ten recover for every one who dies, one hundred and forty thousand persons, or more, must every year pass through its protracted miseries. The real amount of suffering involved in this is, however, but feebly represented by these bald figures.
No one can know what they really imply who has not had experience of this fever in his own home. The dreary and painful night-watches - the great length of the period over which the anxiety is extended - the long suspense between hope and fear, and the large number of the cases in which hope is disappointed and the worst fear is at last realised, make up a sum of distress that is scarcely to be found in the history of any other acute disorder. Even in the highest class of society, the introduction of this fever into the household is an event that generally long stands prominently out in the record of family afflictions. But if this be true of the mansions of the rich, who have every means of alleviation which wealth can command, how much more true must it be of the cottages of the poor, who have scant provision even for the necessaries of life, and none for its great emergencies! Here, when Fever once enters, WANT soon follows, and CONTAGION is not slow to add its peculiar bitterness to the trial.
As the disease is, by far, most fatal to persons in middle life, the mother or father, or both, are often the first to succumb, and the young survivors being left without support, their home is broken up and their destitution becomes complete.
How often have I seen in past days, in the single narrow chamber of the day labourer's cottage, the father in the coffin, the mother in the sick bed in muttering delirium, and nothing to relieve the desolation of the children but the devotion of some poor neighbour who in too many cases paid the penalty of her kindness in becoming, herself, the victim of the same disorder!"
William BUDD's attitude as an observer:
"In its ordinary course, human life has few such consummations of misery as this.
It is impossible to contemplate events such as these, merely as objects of science. It is, indeed, a fundamental axiom in scientific investigation that our emotions should be rigidly excluded from it. But, although, by the nature of things they cannot help in the solution of a problem, they may, at least, be suffered to give a spur to inquiry. Where the interests concerned are the sacred interests of life and death, this is their proper function, and that in a degree of which none of the common alternatives that hang upon human duty can give any adequate measure. It were well with us all if they were more often allowed to have their true weight with the conscience.
Having been by accident thrown much in the way of this fever, I have long felt that it is impossible to bear a part in the calamities of which it is the source, without becoming possessed with a burning desire to devote the best powers of the mind to the discovery of means by which such calamities may be prevented.
From the fact, already referred to, of its being so much more deadly to grown-up persons, this disease has a relation to pauperism which is almost peculiar to itself."
Other and earlier medical practitioners' theories were in conflict with William BUDD's, and rejected the idea of contagion (chiefly propagated by the typhoid excreta), e.g.:
'an illusive hypothesis'
Manual on the Practice of Medicine; Dr. Tanner; 6th edition
'Observed facts and the few experiments which have been made tend, however, to disprove these views.' [of the contagion of typhoid]
'Much doubt prevails whether enteric (typhoid) fever be infectious or not, and the question really turns upon the existence of a distinct, specific poison. Positive proof that it may be conveyed from one person to another is wanting, and certainly the majority of people affected with the disease derive it, upon the clearest evidence, from one and the same source. Those in attendance upon persons suffering from enteric fever do sometimes fall ill of the disease, but the source of the disease may be present in any house.'
Physician's Vade Mecum; Hooper; editors: Drs. Guy & Harley
As part of his discussion of the causes of such attitudes, William BUDD relates the following:
"It is obvious that the formation of just opinions on the question how diseases spread may depend less on personal ability than on the opportunities for its determination which may fall to the lot of the observer. ... rural districts, where the population is thin, and the lines of intercourse are few and always easily traced, offer opportunities ... which are not to be met with in the crowded haunts of large towns.
This is one of the cases, in which medical men practising in the country have ... advantages which are denied to their metropolitan brethren, ....
In the early part of my professional life, while engaged in country practice in Devonshire, outbreaks of typhoid fever continually fell under my eye, amid conditions singularly favourable to the study of its origin ...."
"Of these outbreaks the most memorable occurred in the village of North Tawton, where I then lived.
Having been born and brought up in the village, I was personally acquainted with every inhabitant of it; and being, as a medical practitioner, in almost exclusive possession of the field, nearly every one who fell ill, not only in the village itself, but over a large area around it, came immediately under my care.
... At the date of the outbreak in question, the people of the place numbered some eleven or twelve hundred souls.
Of these, a small minority, consisting chiefly of women and children, worked in a serge factory. The rest were employed in agricultural pursuits.
The spot on which this community dwelt is richly endowed with all the natural conditions of health. Built on a dry soil, in the midst of an open and well drained country, and occupying the side of a hill sloping gently to the north-west, this village had long been justly noted in that part of Devon for the rare healthiness of its site.
... it had for many years enjoyed an almost entire immunity from the fever to which it was so soon to pay so large a tribute.
... there were in the economy of the place, and in the habits of the people, many things which, according to modem views, are hard to reconcile with such a fact. In the first place, there was no general system of sewers. A few houses, occupied by the more opulent, were provided with covered drains, but all these might be counted on the fingers.
In the cottages of the men who earned their bread with their hands, and who formed the great bulk of the inhabitants, there was nothing to separate from the open air the offensive matters which collect around human habitations. Each cottage, or group of three or four cottages, had its common privy, to which a simple excavation in the ground served as cesspool. Besides this, it was a part of the economy of all who worked in the fields ... to keep a pig, one of whose functions was to furnish manure for the little plot of potatoes which fed man and pig alike. Thus, often, hard by the cottage door there was not only an open privy, but a dungheap also.
Nevertheless, these conditions existed for many years without leading to any of the results which it is the fashion to ascribe to them. Much there was ... offensive to the nose, but fever there was none. It could not be said that the atmospheric conditions necessary to fever were wanting, because while this village remained exempt, many neighbouring villages suffered severely from the pest. It could not be said that there were no subjects, for these, as the sequel proved, but too much abounded.
Meanwhile privies, pigstyes and dungheaps continued, year after year, to exhale ill odours, without any specific effect on the public health.
Many generations of swine innocently yielded up their lives, but no fever of this or any other sort could be laid to their charge. I ascertained by an inquiry conducted with the most scrupulous care that for fifteen years there had been no severe outbreak of the disorder, and that for nearly ten there had been but a single case.
For the development of this fever a more specific element was needed than either the swine, the dungheaps, or the privies were, in the common course of things, able to furnish.
In the course of time ... this element was added, and it was then found that the conditions which had been without power to generate fever, had but too great power in promoting its spread when once the germ of fever had been introduced."
"On the 11th July 1839, a first case of typhoid fever occurred in a poor and crowded dwelling. Before the beginning of November, in the same year, more than eighty of the inhabitants had suffered from it under my care.
I kept an accurate record of all the principal events which marked this terrible outbreak; and it is to certain of these events, in their bearing on the mode in which this fatal disorder spreads, that I now wish to draw attention."
In Chapter II, BUDD describes in detail the progress of the 1839 fever.
"... after the disorder had become rife in North Tawton [it showed a] strong tendency, when ... introduced into a family, to spread through the household.
... in the family of Ann N__, a young woman who was taken ill in the second week in July, ... the first case, the mother, a brother, and a sister .. were one after another laid up with the same fever; the father, who had already had the disease in former years, and the young infant, being the only inmates spared.
In another house, four out of six persons [died]; in another three, and so on. ... before the disease finally died away, there were few houses in which, having once appeared, it did not further extend itself to one or more members of the family.
This ... was, in itself, sufficient to lead to a strong presumption of the contagious nature of the disorder.
But while these events were occurring in the village itself, there were others happening at a distance, which converted this presumption into a certainty.
During the prevalence of the fever in North Tawton, ... three persons left the place after they had become infected. ... all three communicated the disease to one or more of the persons by whom they were surrounded in the new neighbourhood in which they fell ill.
Two of these three persons were sawyers by trade, who had hired themselves for a few weeks to a timber merchant living in the village. While these men remained in North Tawton, they lodged in a court with a single and a common privy, and next door to a house in which the fever was. In the course of time both these men sickened ... and on the ... first decided symptoms, both returned to their own homes, in the parish of Morchard, about seven miles off.
The first was a married man, with two children. He left North Tawton on August 9, being already too ill to work. Two days after reaching Morchard he took to his bed, and at the end of five weeks he died.
Ten days after his death his two children were laid up with the same fever, and had it severely; the widow escaped.
The other sawyer was a single man and an aged couple who lived with him were the only other inmates of the house.
Like his comrade, he was driven from North Tawton by indisposition, which rendered him unable to follow his employment, and cut off his means of support. He began to droop on July 26, but did not leave for Morchard until August 2. On the 3rd he finally took to his bed. His attack was severe, but, after a long struggle, he recovered.
When this man was at his worst, a friend ... was called upon to assist in raising him in bed. While thus employed, the friend was quite overpowered by the smell from the sick man's body. He felt very unwell from that time .... On the tenth day from ... this event, he was seized with a violent shiver, which was immediately followed by an attack of typhoid fever of long duration.
Before he became convalescent, two of his children got the same fever, as well as a brother, who lived at some distance, but who had repeatedly visited him during his illness.
The houses occupied by these four men lay some way apart, and, [except under] their roofs, there was no fever at the time in that part of the country.
Was this series of events ... the result of chance or the work of contagion?
If any rational person should entertain doubts as to the true answer ..., the history of the next case may ... resolve them.
The subject who was the means of propagating the disorder ... was a widow named Lee, residing in North Tawton. She began to droop on August 20. On the following day, not knowing what was impending, she went to visit her brother, a farmer who occupied a large farm in the hamlet of Chaffcombe, about seven miles off.
On the 23rd she was laid up. On the 24th I was sent for ... and found her in bed in the first stage of fever. In ... her case, which ... was very prolonged, she exhibited ... all the most characteristic marks of the disorder.
(... nose-bleeding, spontaneous and obstinate diarrhoea, tympanitis, dry tongue, low delirium, and other typhoid symptoms, together with - towards the end of the second week - the now well-known eruption of rose-coloured spots.)
After ... several weeks under my care at Chaffcombe, she slowly recovered.
... the fever had become ... so rife at North Tawton, that, while I was attending Mrs. Lee, I had ... seventeen persons under my care in the village ....
A few days after she had become convalescent, her sister-in-law (Mrs. Snell), who had nursed her, fell ill of the same fever. Her case was very severe, and, after a protracted struggle, terminated fatally on November 4.
The husband (Mr. Snell), who had spent the chief part of his time in his wife's sick room, and had sat up many nights by her, in great anxiety and distress, was the next sufferer. He begin to droop in the last week of October, but was not finally laid up until the day of his wife's death. After having lain for some time in a very precarious state, he recovered.
... three weeks ... from the date of the seizure - one of the farm apprentices was attacked in the same way.
Then followed a lad employed as day labourer on the farm; and then Miss S__, who had come to take charge of the house after the death of Mrs. Snell.
Next in order came another apprentice; and again, as a last group, a servant man, a servant girl, and another young person (a daughter of Mrs. Lee), who, until she was laid up, had acted the part of nurse.
As far as external conditions went, the sanitary state of the homestead which had become the seat of this terrible scourge differed in nothing from what it had been for many years before, during which the household had continued to enjoy perfect health.
The only new incident in its history was the arrival of Mrs. Lee from the infected village, seven miles off, with the fever upon her.
... many other such homesteads lay near to this one, ... far worse off in respect of these same conditions, but in which no fever of this or any other kind existed.
There was no single case ... within miles of the place, or nearer than North Tawton, whence the taint had been imported.
The outbreak ... did not ... end here.
In order to lighten the burden of so heavy a sick list, the servant girl ... was sent to her own home (a small cottage in the hamlet of Loosebeare, about four miles away) as soon as the first symptoms of illness appeared. Here she lay ill for several weeks under my care.
Before she had recovered, her father, a farm labourer of the name of Gibbings, was likewise seized, and narrowly escaped with life.
A farmer, named Kelland, who lived across the road, and who visited this man several times during his illness, was the next to take the disorder.
His case was, in turn, followed by others under the same roof; and the fever, spreading from this to other houses, became the focus of a little epidemic, which gradually extended to the whole hamlet.
Scattered over the country side there were some twenty or thirty other hamlets ... which in all things were the precise counterparts of this. Two or three farmyards and a few labourers' cottages clustered round them, made up ... each ... little community. In each .. were the usual manure-yard and the inevitable pigsty; ... the same primitive accommodation for human needs. The same sun shone upon all alike, through month after month of the same fine, dry, autumnal weather. From the soil of all, human and other exuviae exhaled into the air the same putrescent compounds, in about equal abundance. In some ... these compounds ... were much more rife.
And yet, while at Loosebeare a large proportion of the inhabitants were lying prostrate with fever, in not one of the twenty or thirty exactly similar places was there a single case.
To explain a contrast so signal there was but one fact to appeal to - the arrival from Chaffcombe, where the fever was already raging, of Mary Gibbings with the disease actually upon her. Before that event, in spite of manure heaps, pig-styes, and the like, Loosebeare, too, was free from the malady.
The diseased intestine of the infected girl had continued to deposit its morbid excreta upon the soil for a fortnight or more before the fever began to spread, and the first cases that succeeded to hers sprang up immediately around her person.
The Chaffcombe tragedy ... had yet another episode. One of the boys already mentioned ... was the means of widely disseminating the fever in quite another direction. This boy, who was employed as day labourer on the farm, lived, when at home, in one of a pair of cottages standing by the roadside, about midway between Bow and North Tawton. The cottage in question was occupied by the boy's mother; the cottage next door by the husband and family of one of her married daughters.
Of the ten persons who, one after another, contracted fever at Chaffcombe, this boy, Oliver Lang, was the fifth in order of attack. Like Gibbings, he was sent home to his friends as soon as he fell ill; and he took to his bed in the last week of December. I attended him for a long time at his mother's house, and his case was very severe.
Before he had become fully convalescent, his mother, who had nursed him, sickened; and while she yet lay ill, his sister took the fever. In the last-named subject the course of the disease was unusually rapid, terminating fatally as early as the ninth day. On January 24 she had a severe shiver, on the 26th she was unable to leave her bed and on February 2 she died.
The next to be attacked were two children of the family next door, every member of which ended by being laid up with the disorder.
Another married daughter (a sister of Oliver Lang), who had come from a distance to take care of her sick relatives, being at length infected, became, on her return home, the means of propagating the fever in yet another quarter.
It is only important to add that, with one exception, all the cases included in the last narrative were either under my own care, or under that of one of my brothers, who was associated with me in their treatment, and that I kept, as I have already stated, an accurate record of them at the time of their occurrence, with the express view of illustrating the mode of propagation of this particular species of fever."
William BUDD's publication continues with other examples of the spread of the fever, and the conclusions he drew.
The complete text may be read here: http://www.deltaomega.org/documents/typhoid.pdf
In Bristol, 1866, William BUDD demonstrated that limiting the contamination of a town's water supply could stop a cholera epidemic (from 'www.answers.com')
John SNOW was a contemporary of William BUDD; read about his detective work and determination of the causes of cholera (also water-borne); the Broad Street pump outbreak; maps of London in 1827, 1859 & 1889; London water in 1856.
The site relates that William BUDD had stated - in an 1849 pamphlet - his belief that cholera was water-borne; this hypothesis, also arrived at by SNOW, was demonstrated true by the latter's careful observation and experiment based on his conviction. SNOW's work was acknowledged almost immediately after his death. BUDD's biography was not published until 1936.
Superb university website offering items for all levels of interest: John Snow
Lead was used in cider presses but at the outset its connection with the colic it produced was not understood, then rejected (partly for economic reasons); it became known as Devonshire colic. As the use of lead was phased out in the 19th century, so the colic disappeared. In 1885 Frederick WILLCOCKS, speaking at a meeting of the Devonshire Association, recalled Dr. Christian Budd (of North Tawton):
"in the early part of his career some forty years ago ... occasionally saw cases of lead colic produced by drinking cider made in a lead press."
Such presses had since entirely disappeared and Dr Budd had:
"... not for many years seen any case of lead poisoning produced by cider. ... believes that there is no more wholesome drink than pure cider ..."
Note: Caroline's own web page on the Budd Family of Physicians also contains a detailed draft of the Budd Family Tree.