KWWSVGRLRUJ6 3XEOLVKHGRQOLQHEDPEULGJH8QLYHUVLW3UHVV DavidVanZwanenberg648 ID: 938452
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THELASTEPIDEMICOFPLAGUEINENGLAND?SUFFOLK1906-1918byDAVIDVANZWANENBERGAPARTfromasinglecaseofplaguecontractedinalaboratoryatPortonin1962thelastEnglishoutbreakofplagueoccurredinSuffolk.Therewereseveralofficialreportspublishedsoonafterandtherehavebeenanumberofshortaccountsbasedonthesereports.Thisaccountoftheepidemicwascompiledwiththeaidofcontemporarysourcessuchasnewspapers,letters,minutesofcommitteesandcoroner'sdepositions,togetherwithinformationfromoneofthesurvivors,fromseveralnearrelativesofthevictims,aswellasfromofficialreports.Inparticulartheauthorwasfortunateindiscoveringacollectionofletters,telegramsandotherdocumentsbelongingtothelateDr.H.P.Sleigh,whowasMedicalOfficerofHealthoftheRuralDistrictofSamfordatthetime.THEDIAGNOSISOFPLAGUEFivemilessouthofIpswich,abouthalfwaybetweenthevillagesofFrestonandHolbrookliesasmallgroupofcottagescalledLatimerCottages(seeMapandPhotograph).Atthetimethatplaguewasfirstdiagnosedthisbuildingwasdividedintothreehomes.Inthemiddlecottagelivedafarmworker,Mr.Chapman,hiswifeandfourofhiswife'schildrenofaformermarriage.OnTuesday,13September1910,thethirdofthesechildren,AnnieGoodall,agednine,wastakenill.Shehadnotbeenawayfromhomesince4September.Followingaboutofvomitingsheranahightemperature.ShewasseenbyDr.Careyonthefollowingdaywhenhertemperaturewas105°F,butapartfromhergeneraltoxaemiahecoulddetectnophysicalsigns.Shebecamedeliriousduringthatnightandbythefollowingmorningwasdrowsy.Dr.Careythenfoundbronchialbreathingatthebaseofonelung.Hercoughbecamemoresevereandshedevelopeddiarrhoeaandvomiting.Shediedon16Septemberandwasburiedon20September.Thedayafterthefuneral(21st)hermotherwastakenill.Sheroseasusualbutlatercomplainedofheadacheandnausea.ThenextdayshewasseenbyDr.Carey,whofoundhertemperaturetobe105°F,herrespirationsrapid,andcrepitationsatthebaseofbothlungs.Duringthatnightshesufferedwithdiarrhoeaandvomiting.Thefollowingday(23rd)Dr.Careyfoundhertobedying.HeinvitedDr.HerbertBrown,aphysicianinIpswich,tovisitthepatient.Dr.Brownarrivedatnoonbutthepatienthadalreadydied.Dr.Browncollectedsomebrownishsputumwhichhetooktothelocalbacteriologist,Dr.LlewellynHeath.Onlypneumococciandgram-negativediplobacilliweregrownfromthisspecimen.63 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V DavidVanZwanenberg648*104MiGo*g4;I..la K W W S V G R L R U J
6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V TheLastEpidemicofPlagueinEngland?Suffolk1906-1918Threedayslater(26September)Mr.Chapman,thehusbandofthelastpatientandMrs.ParkeranearneighbourfromTurkeyFarm,whohadnursedMrs.Chapman,bothfellill.ThenextdayDr.CareyagainrequestedDr.Browntovisit.AsDr.BrownwasunabletogohimselfheaskedDr.Heathtogoinstead.Dr.HeathtookabloodsamplefromMr.Chapman'sear.Onthe28thDr.BrownvisitedthepatientsinconsultationwithDr.CareyandDr.H.P.Sleigh,theMedicalOfficerofHealthofthedistrict.Dr.BrowncollectedasyringefulofbloodfromMr.Chapman'sbasilicveinandalsoobtainedsomebloodstainedfluidbypuncturingMrs.Parker'spneumoniclung.FromthesetwospecimensDr.HeathgrewbacilliwhichheidentifiedasPasteurellapestis.Boththeselasttwopatientshadhightemperaturesandsignsinthelungs,Mr.ChapmanhavingscatteredralesoverbothbasesandMrs.Parkerhavingpneumonicconsolidation.BothpatientsremainedrationaluntilafewminutesbeforedeathonThursday,29September.InalettertoDr.Sleighon30SeptemberDr.HeathstatedthathehadfirstisolatedplaguebacilliontheeveningofThursday,29September,inthespecimenofbloodthathehadcollectedonthe27th.Heconfirmedthisfindingonthe30thinthespeci-menstakenbyDr.Brownonthe28th.HeimmediatelyinformedDr.BrownofthediagnosisthenjourneyedtoCambridgetoseeProfessorSimsWoodhead.Hewroteintheletter'Ithoughtitbettertohaveabignameatthebackofmeifnecessary'.At5.41p.m.Dr.HeathwiredtoDr.Sleigh,'ProfessorWoodheadagreeswithmydiagnosis.Isolateallcontacts-writing-LlewellynHeath'.InthemeantimeDr.BrownhadmetDr.Sleighat2p.m.andwarnedhimoftheprobablediagnosis.TheisolationaccommodationwasattheWorkhouseinTattingstoneandonlyopenedwhenrequired.Thecontactscouldnotbemovedintothisuntilthefollowingday(1October).Itwasonthisday,also,thatDr.SleighnotifiedthediagnosistotheLocalGovemmentBoard.Thetwopatientshadbothbeenburiedon30September.Thevicarconductedthewholeserviceintheopenairandallthoseattendingthefuneralhadtheirclothesdisinfected.OnMonday,3October,theLocalGovernmentBoardInspector,Dr.TimbrellBulstrode,wiredtoDr.Sleighthathewouldvisitonthefollowingday.ItisnotclearwhatDr.BulstrodedidonthisvisittoSamford,exceptthathearrangedforthebacteriologicalspecimenswhichhadbeentakentoProfessorSimsWoodheadtobesubmittedtotheBoard'sownBacteriologicalAdviser,Dr.Klein,oftheListerInstitute.OnSaturday,8October,thePrincipalMedicalOfficeroftheLocalGovern-mentBoar
dwiredtoDr.Sleigh'Dr.Klein'sexaminationofmaterialfromProfessorWoodhead'sLaboratoryisentirelynegativeforpestis.Letterfollows.'Dr.Newsholme'sletterconfirmingthisfindinggivestheimpressionthattheepisodewasnowover.Hislastparagraphreads'MayItakethisopportunityofcongratulatingyouonthepromptitudewithwhichyoudealtwiththisunfortunateoutbreak?'*Dr.Bulstrodewroteon9OctoberalsoconfirmingDr.Klein'sresults.HeannouncedthathewouldbereturningtoSuffolk.Healsoacknowledgedreceiptofaratthat*Dr.Sleighmusthavecomplainedaboutthisletterandthequeryattheendofit;becausethereisahandwrittenletterfromDr.Newsholme'DearSir,Yourletteriswrittenunderatotalmis-apprehension.Mystatementwasintendedasacomplimentforgoodworkandclearlycanmeannothingelse.ThedemandsofEnglishCompositionrequiredthe?.'65 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V DavidVanZwanenberghadbeencaughtnearFrestonandhaddiedaftercapture.ThisrathadbeenforwardedtoDr.Klein.On12OctoberthisratandaharewhichhadbeenshotnearFrestonwerebothfoundbyDr.KleintobeinfectedwithPasteurellapestis.TwelvedayshadelapsedbetweentheoriginaldiagnosisandtheconfirmationofplaguebytheLocalGovern-mentBoard.Shortlyafterotherrodentsfromthatparishandsurroundingareaswerefoundtobeinfected.ItwassoonreportedthataninfectedharehadbeenfoundatMistleyinNorthEssex,andaratatEdwardstoneinWestSuffolk.tTherewerealsoreportsofaninfectedferretinWoodbridgeandacatdyingofplagueinStutton.TheSamfordRuralDistrictCouncilheardon20Octoberthatthediseasehadcomefromrats.Theyagreedtothedistributionofhandbillsadvisingpeopletoavoidtouchingdeadrats,rabbitsorhares.Itwasalsodecidedtopersuadefarmerstotryandkillallrats,providedthattheCouncilitselfdidnotpayforthepoison.Dr.BulstrodereturnedtoSuffolkassoonasthediseasewasconfirmedandcon-centratedhisattentionontwoaspectsoftheproblem.Hesoughtevidenceofpossibleearliercasesofplagueinhumanbeingsandheorganisedschemesforratdestruction.PREVIOUSCASESOFPLAGUEDr.Bulstrodefoundevidenceoftwopreviousoutbreaksofinfectiousdiseasewhich,afterinvestigation,heacceptedasbeingplague.ThefirstoftheseoutbreakshadoccurredinDecember1906andJanuary1907.AfewmilesfromLatimerCottagesneartheRiverOrwellliesCharityFarmwithitsattendantcottages.Thereisnocontemporaryaccountofthisoutbreak,althoughthereisanotethatitwasdiscussedatameetingoftheSamfordRuralDistrictCouncil.Theearliestpublis
hedaccountisintheEastAnglianDailyTimesof6October1910.ThefirstpatientwasaMrs.Church,wholivedinCharityFarmCottages;shedevelopedpneumoniaon9Decemberanddiedthreedayslater.Shewasnursedbyherdaughter,Mrs.Radcliffe,wholivedinadetachedcottagenearthefarm.Thisdaughterdevelopedthediseaseon17Decemberanddiedonthe19th.Anotherdaughterfellillon20Decemberbutfinallyrecovered.TheselasttwopatientswerenursedbyMrs.Goodchild,wholivedinBrickhouseTerrace,arowofcottagesabouthalfamileaway.Mrs.Goodchild,herhusbandandhertwosonsthendevelopedthediseaseinsuccession.Mrs.Goodchild'smother,Mrs.Woods,camefromSaxmundhamtonurseherson-in-lawandtwograndsons.Shewasthelasttocontractthediseaseanddiedon6January.ThesequenceofeventsisgivenintheTable.Allthedeathswereregisteredasbeingduetoacutepneumonia.Dr.CareywholaterattendedthepatientsatLatimerCottages,wasinattendanceonallthesepatients.CharityFarmCottagescommandagoodviewofButterman'sBayintheRiverOrwell.TheotheroutbreakinvestigatedandacceptedasplaguebyDr.Bulstrodepresentedasadifferentclinicalpicture.ThishadoccurredtothenorthoftheRiverOrwell,nearitsmouth,intheparishofTrimley.InasmallandovercrowdedcottagesevenmembersoftheRousefamilyhadbeentakenillduringDecember1909andJanuarytThismayhavebeenanerror.ItwasreportedinthelocalpaperandistheonlyreportoftheinfectiongettingintoWestSuffolk.66 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V rigureiLatimerCottages,Freston,wherePlaguewasfirstdiagnosedin1910.Figure2WarrenLaneCottages,Erwarton,wherethelasttwocasesofPlagueoccurredin1918.Thephotographillustratestheisolationofthecottages. K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V TheLastEpidemicofPlagueinEngland?Suffolk1906-1918TABLEOFHUMANCASESOFPLAGUEINSUFFOLKAgeSexYearDateofDateofBubonicoronsetdeathPneumonicLocationMrs.ChurchMrs.RadcliffeMissE.ChurchMrs.GoodchildMr.GoodchildMr.H.GoodchildMr.R.GoodchildMrs.WoodsMrs.RouseMissC.RouseMissA.RouseMr.RouseMr.W.RouseMr.J.RouseMissH.RouseMissA.GoodallMrs.ChapmanMr.ChapmanMrs.ParkerW.E.Buck53F190624F190619F190646F190656M1906?M19067M190666F190746F190914F19099F191050M191012M19106M191018F19109F191040F191057M191043F1910Dec.17Dec.20Dec.24Dec.28Dec.27Dec.30Jan.3Dec.19Dec.26Jan.8Jan.9Jan.15Jan.18Jan.
20Sept.12Sept.21Sept.26Sept.26Dec.12PDec.19PRecoveredPDec.26PJan.2PRecoveredPJan.4PJan.6PDec.22BJan.5BJan.10BRecoveredBJan.17BRecoveredBRecoveredBSept.16Sept.23Sept.29Sept.29CharityFarmCottages,ShotleyBrickhillTerraceCottages,ShotleyLowerStreet,Trimleypi,PP*,Pt...PLatimerCottages,Freston....PTurkeyFarm,Freston20?M1911Oct.10RecoveredBNavalBarracks,ShotleyMrs.Bugg52F1918June8June13Mrs.Garrod42F1918June16June19PWarrenLaneCottages,ErwartonP,...O,9,1910.TheillnesshadbeensosuddenanddramaticthatDr.Harthadwonderedifthepatientscouldhavebeenpoisoned.Asaresultaninquestwasheldononeofthepatients.Oneofthethreesurvivors,HonoraRouse,agedeighteen,madeastatementwhichgivesanexcellentcontemporaryaccount.IamasinglewomanandsincelastsummerhavebeenlivingwithmyparentsatLowerStreet,TrimleySt.Martin.Therewasmyfatherandmother,myselfandtwosisters,CarrieandAlice,andtwoboys,WillieandJohn.OnSundayDecember19thmymotherhadaheadachewhensheawoke.Shegotupabout10o'clockandwassick.ShehadsicknessanddiarrhoeaandgotworseandonWednesday22ndshewenttobedabout4.30p.m.-Iwentupstairswithherandhelpedherintobed.Iwentdownstairsandatabout5p.m.Iwentupagainandfoundshewasdead....OnSunday*mysisterCarrieturnedupill,andsheandWilliewerebothfullofsores,andCarriehadaknotonherneck.Mymotherhadaknotonherneckwhileshewasill.Dr.Hartwassentforon2ndJanuary,hecameandattendedtoherandshediedon5thJanuary.Shewasburiedonthe8thJanuaryandonthisdayAlicefellill.Shewasillinthesamewayastheothers,andhadaknotandshediedonthe10thJanuary.Myfatheralsofellillonthe8thJanuary.Hewassickandhaddiarrhoealiketheothersbuthadaknotswelluponhisthigh.HewasremovedtoIpswichHospitalonthe10thJanuary.Onthe11thJanuarymytwobrothers,WillieandJohn,weretakentoBarhamWorkhouse.OntheSundayfollowingIheardthatWilliewasillandIwenttoBarhamandsawhim.Hehadthesamesymptomsastheothersandhadaknotonhisneck.Hediedonthe17thJanuary-Onthe22ndJanuaryIfellillandwenttothehospitalandremainedtheretillthe3rdFebruary.Iwasillinthesamewayastheothersandhadspotsonmylegsandalsoaknotinsidemythighandmyfaceandarmswereswollen.MybrotherJohnwasalsotakentothehospitalandisstillthere(5thFebruary).*InthedepositiontheCoronerhaswrittenJanuaryandanindecipherabledate-butthiswaspresumablyanerrorasthedategivenforCarriesillnessinDr.Bulstrode'sreportwas28DecemberandthishasrecentlybeenconfirmedinalettertotheauthorfromMrs.HonoraHubbard,n6eRouse.67EName K W W S V G R L R U J 6 3
X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V DavidVanZwanenbergMr.Rousehadhisswellinginthegroinincisedbutnopuswasfound.JohnRousewasadmittedtoHospitalon18Februarywithheadacheanddrowsiness.Herecoveredandwasdischargedon9March.HonoraRouse'sswellinginthegroinapparentlydischargedspontaneously.MissHonoraRouse,nowMrs.Hubbard,isstillaliveandsoisheryoungerbrotherJohn.Dr.BulstrodeinvestigatedanotherpossiblecasenearTrimleyandaccepteditwithsomedoubts.HonoraRousehadvisitedhersickbrotheratBarhamon16January.OnherwayhomeherhorsemetwithanaccidentandshewastakeninbytheFosterfamilyinNacton.Shestayedthereuntil22Januarywhenshewastakenillandremovedtohospital.On3February,HyldaFoster,agedseven,complainedofsevereabdominalpain.By5Februarythechildwasseverelyillandonthefollowingdayshewasadmittedtohospitalforanexploratorylaparotomy.ManyswollenabdominalglandswerediscoveredatthisoperationandthisfindingconvincedthesurgeonthatthediseasewassimilartothatoftheRousefamily.Thepost-mortemreportshowedthechildhadanacuteperitonitiswithanabscessinthepouchofDouglas.Thisfact,takentogetherwiththeperiodoftwelvedaysbetweenthecontactwithHonoraRouseandtheonsetofsymptoms,makesthediagnosisofplagueunlikely.Itseemsmorelikelythatthechildhadanacutedysenterywithaperforation.ACTIONAGAINSTRATS1910-1911Dr.Bulstrodepersuadedlocalauthoritiesthatitwasessentialtodestroyratsandtoavoidleavinggarbagethatmightsupplyfoodforrats.AJointCommitteewasformedbytheIpswichCountyBoroughandSamfordR.D.Committeesforthesepurposes.Rat-catcherswereappointedandeventuallySamfordCommitteeagreedtothedistributionoffreeratpoison.EastSuffolkhadneverhadaCountyMedicalOfficerofHealth.AstheresultoftheplaguetheCouncildecidedtoappointDr.LlewellynHeath,thebacteriologist,toactinthiscapacitytemporarilyfrom1November1910.Dr.HeathrequestedallDistrictMedicalOfficersofHealthtosurveytheirareasforratsandtodestroythem.Hewrotetoalldoctorsintheareaenlistingtheiraid.Herequestedthepolicetoreportonmortalityamongstrats.Hedistributedwarningnoticestothepublicandarrangedforfournursestobeimmunizedagainstplagueforworkanywhereinthecounty.On10NovembertheLocalGovernmentBoardissuedanorderunderthePublicHealthAct1875makingitobligatoryforLocalAuthoritiestoreportallcasesofratplagueandtodestroyrats.EarlyinDecemberinfectedratswerefoundtobelimitedtoSamfordandWoodbridgeDistricts.Thishadtobeconfirmedbyasystematicsurvey.Thissurveywasstartedon14January1911.Dr.Bulstrode*a
ssistedbyDrs.FletcherandReece,oftheLocalGovernmentBoardInspectorate,arrangedthedestructionandcollectionofratswhileDrs.PetrieandMacalisteroftheListerInstituteexaminedtheratsinaLaboratoryloanedbyDr.Pringle,theIpswichMedicalOfficerofHealth.Theyexamined6,071ratsfrom22urbandistrictsand301parishes.Theyfailedtofindanyevidenceofplague.*Dr.H.T.Buistrodediedsuddenlyon21July1911,agedfifty-two.HewasburiedatWhersteadinSuffolk,wheretherectorwashisfather-in-law.ThereisatraditioninSuffolkthathediedoftheplaguebutithasnofoundationinfact.68 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V TheLastEpidemicofPlagueinEngland?Suffolk1906-1918Inthemeantimeworkwasdoneontheidentificationofratfleas.Drs.MartinandRowland,whohadbothbeenwiththePlagueCommissioninIndia,spenttwoperiodsinSuffolk,8Novemberto22November,and27Decemberforaperiodofsixdays.From568ratstheyrecovered584fleas.324wereCeratophyllusfasciatusand259wereCtenophthalmusagyrtes-onlytheformerbitesmanreadily.Thenumberofman-bitingfleasperratwasconsiderablylessthanhadbeenfoundinareaswithbubonicplagueinIndia.Duringthisworkseventeenoftheratsexaminedforfleaswerefoundtobeinfectedwithplague.AfurtherthreeinfectedratswerefoundatHollesleyinDecember,togetherwithtwooutoffortyrabbits.Onlytwoman-bitingfleaswerefoundontheserabbits.NoblackratswerefoundintheruraldistrictsofSuffolkduringthisperiodalthoughonesuchratwasfoundinIpswich.Althoughthisfirstsurveyforinfectedratshadbeenunsuccessfulafurthersystematichuntforratswasconsideredadvisable.Julywaschosenasthestartingmonthasratplagueoutbreakstendtoexpandtoepizooticsearlyintheautumn.TheLocalGovernmentBoardorderedthesurveyfromJulytoOctober.Rat-catcherswereemployedthroughouttheareaandthepoliceagreedtoactasagentsforthecollecting,labellingandforwardingofratstoalaboratoryinIpswich.AllratsweredissectedbyDrs.G.H.MacalisterandR.St.JohnBrooks.Iftherewasdiseaseoftheliver,spleenorothertissuesthematerialwasforwardedtotheBoard'slaboratoryfordiagnosis.Drs.A.EastwoodandF.GriffithdidthebacteriologywithDr.Kleinactingasconsultant.Assoonasacaseofratplaguewasdiagnosednofurtherdeadratswerecollectedfromtheparishconcerned.Thediscoveryofoneinfectedpocketwasacceptedasevidencethatthewholeparishwasinvolved.Investigationswereextendedtosur-roundingparishesuntilthelimitoftheinfectedareawasdefined.15,332ratsweredissected,35ratswe
refoundtobeplagueinfectedin27differentareas(shownonthemap).Theopportunitywastakentoexaminetheratfleasagain.ProfessorC.StricklandandG.MerrimanofCambridgeUniversitydidthiswork.Theyfoundanaverageoffourfleasperrat(variation0.6to6.5).Fifteenspeciesoffleaweredis-coveredbutonlytwooftheseoccurredinanynumbers.1,986Cerotophyllusfasciatuswerefound(60percent)and1,257Ctenophthalmusagyrtes(38percent).Therewasadeclineinthenumberoffleasinthecoolerweather.LATERCASESOFPLAGUEOn10October1911,asthesurveyforinfectedratswasending,asailorwasadmittedtothesickquartersoftheRoyalNavalBarracksatSbotley.HehadneverbeenabroadandhadspentthepastyearatShotley.Hehadgeneralmalaise,temperatureof104°F,headacheandpainsinthebackandlegs.Hehadasmallcutontheleftindexfingerandapainfullumpintheaxilla.Thiscuthadoccurredon7Octoberwhilehewascleaningarabbit.HehadcaughttherabbitontheIpswichRoadlessthanamilefromtheLatimerCottages,Freston.Hisconditionwasunchangeduntil13Octoberwhenhehadahaemoptysis.Theaxillarylumphadincreasedandonthe15thitwasincisedbutnopuswasfound.Hethendevelopedaseverepneumonia.Examinationofthesputumsuggestedthediagnosisofplagueandthepatientwasisolateduntilthediagnosiscouldbeconfirmed.Thepatientdevelopedseverebilateral69 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V DavidVanZwanenbergiritis.Paracentesisoftherighteyefailedtofindpus.Hisgeneralconditiondeterioratedandhewastreatedwithoxygen,strychnine,brandyandanautogenousvaccine.ThediagnosiswasconfirmedbyOfficersoftheLocalGovernmentBoard.Fortwelveweeksthepatientranahighremittentfever.Duringthisperiodhedevelopedabscessesintheneckwhichwereincised,anempyema,whichwasaspirated,andalbuminuria.Thissailorwasfinallydeclaredfreeofinfectionon14January1912.Hehadsurvivedtheplaguebut'wasinanextremelyhelplesscondition,partlyowingtothefactthathemadenoefforttocompetewiththehandicapofpracticallycompleteblindness'.Althoughheneverregainedhissighthelivedtoreachtheageofseventy-six.Therewerenofurthercasesofplagueforthenextsevenyears.Thentwofurthercasesoccurred.AMrs.Buggwhowaslivinginasemi-detachedcottageinWarrenLaneCottages,Erwarton,aboutamilefromShotleybarracks,didherbakingasusualonSaturdaymorning,8June1918.Intheafternoonshedevelopedachillandretiredtobed.ShedevelopedapneumoniaanddiedonthefollowingThursday.Thecottagesareatleastaquarterofamilefromtheroadandfurth
erthanthatfromthenearesthouse.TheyareaboutonemilefromboththeRiverStourandtheRiverOrwell(seemap).Mrs.BuggwasvisitedbyMrs.Garrod,hernext-doorneighbour.Mrs.GarrodbecameillonSunday16June.Afterteashefeltfaint,andonthefollowingdaywasdecidedlyill.ShewasseenbyDr.CareyontheTuesdaywhenhertemperaturewas102°F,herpulseandrespirationrapidandshewasspittingblood.Dr.Careydiagnosedlobarpneumoniabuthehadattendedtheearliercasesofplagueandwassuspiciousthatthismightbeanothercase.AccordinglyheinvitedCaptainCade,R.A.M.C.,thebacteriologisttotheEasternCommandtovisitandtoexaminethesputum.Thediagnosisofplaguewasconfirmed.Thepatientdiedon19June1918.OnceagainthecontactsofthetwopatientswereremovedtoTattingstoneWorkhousewhilealltheirclothingandbedclotheswereburnt.TherewerenofurthercasesofplagueinSuffolk.ACTIONAGAINSRATS1912ANDLATRTheevidencehadshownthatparishesonbothsidesoftheRiverOrwellharbouredratsinfectedwithBacilluspestis.Inthesedistrictsmeasuresweretakenforthedestructionofrats.Professionalrat-catcherswereemployed,andotherpersonsbring-ingindeadratswerepaidtwopenceatail.Allrefusewascarefullyremovedorburnt.During1912nearlyaquarterofamillionratswerekilledintherelevantareaandnocaseofplagueinfectionwasdiscovered.ApermanentbacteriologicallaboratorywasbuilttoservetheCountyofEastSuffolk.ItcontinuedtodotheCountyworkuntilitbecamepartofthePublicHealthLaboratoryService.In1913twoparishesintheSamfordDistrictandoneintheWoodbridgeareawerefoundtoharbourinfectedrats.FerretswerefoundtobeinfectedintheWood-bridgeDistrict(sevencases).Therewerefivefurthercasesofinfectedanimalsin1914(fourratsandonerabbit).TheoutbreakofwarpreventedfurtherinvestigationsbytheLocalGovernmentBoard.InresponsetothewishesoftheMilitaryAuthoritiestheCountyCouncilopenedaspeciallaboratoryfortheexaminationofrats.Afterexamining9,691rats70 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V TheLastEpidemicofPlagueinEngland?Suffolk1906-1918withnegativeresultsthelaboratorywasclosed.Itwasthenlefttodoctorstosendspecimenstothelaboratoryofanypersonssufferingwithacutepulmonarydisease.Inthiswaythelasttwocasesofhumanplaguewerediagnosedin1918.Noinfectedratswerediscoveredafter1914.SOURCEOFINFECTIONDr.Bulstrodeinvestigatedtwotheories.HeconsideredthatthemostlikelysourcewasinfectedratscomingashorefromgrainshipsintheRiverOrwell.Manysuchshipsusedtoanchori
nButterman'sBayintheriveraboutoneandahalfmilesfromLatimerCottagesandonlyhalfamilefromCharityFarm.During1910,631,585quartersofgrainwereimportedviatheRiverOrwell.ShipsarrivedfromSanFrancisco,SanNicolas,Valparaiso,RosarioandAlexandria.Ineachoftheseportstherewerecasesofplagueintheperiod1907-1911.TheothertheoryinvestigatedwasthattheplaguehadcomeonthebargesthatcamefromLondonRiver.GrainandvegetablesgrowninSamfordwereshippedbybargetoLondonandhorsemanurewasbroughtbackfromthestablesandstreetsoftheMetropolis.*Dr.BulstrodecouldfindnoevidencetosupportthistheoryasnocaseofplaguewasfoundamongstratsintheLondonarea.COMMENTThethirdpandemicofplaguehadspreadfromChinatoHongKongin1894andfromtheretomanypartsoftheworld.PlaguehadreachedGlasgowin1900.AsaresulttheLocalGovernmentBoardhadmadethediseasenotifiable.Dr.W.H.Power,theprincipalmedicalofficeratthetimehadwrittenanexcellentmemorandumonthesubject.AcopyofthismemorandumandtheBoard'sregulationsweresenttoDr.SleighwhenhenotifiedtheSamfordcasesin1910.TheplagueinruralSuffolk,however,hadnotbehavedlikethesevereepidemicsofthepastastheauthoritiesfeared,butwaslikethetypethatexistsinmanyremoteareasoftheworld.Thistypehasbeencalledsylvaticorwildrodentplague.Thediseaseisenzooticamongsttheprevailingwildrodentsoftheareaandonlyocca-sionallyinfectshumanbeings.WhenitdoesinfectmanittendstoaffectindividualsorsinglehouseholdsandaccordingtoHirstittendstobepneumonicratherthanbubonic.TheLocalGovernmentBoardhadobviouslyfoundithardtobelievethatfourcasesofacutepneumoniainaremoteruralcottagesomemilesfromthenearestportcouldbetheplague.WhenthefindingsofthelocalbacteriologistwerenotconfirmedbyDr.Kleintheymusthavedoubtedtheoriginaldiagnosis.Dr.Newsholme'simmediatereactionasshownbyhislettertoDr.Sleighwasthattheincidentwasofnorealconcern.Thefindingoftheepizooticamongsttheratshadraisedfearsofsevereepidemicsandinthenextfewyearsgreateffortshadbeenmadetoexterminatetherats.Itwasnotuntil1918thattheMedicalOfficerofHealthofEastSuffolkhadcometorealizethetrueepidemiologywhenhewarnedhiscommitteethattherewasthepossibilityofoccasionallocalizedoutbreaksofplagueinhumanbeings.Ofthetwenty-threepossiblecasesofhumanplagueinSuffolkonlyfourwere*ThistheoryisstillquotedinSuffolkasbeingresponsiblefortheplague.71 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V DavidVanZwanenbergconfirmed
bacteriologically(Mr.ChapmanandMrs.ParkeratFreston;thesailoratShotley,andMrs.GarrodatErwarton).TherecanbelittledoubtthattheothertwocasesatLatimerCottagesandMrs.BuggatErwartonalsohadthedisease.TheoutbreaksatShotleyandTrimleyhadbothbeencharacterizedasbeinghighlyinfectiouswithashortincubationperiodandahighmortality.ThediseasepatternwaspneumonicatShotleyandlargelyglandularatTrimleybutbothepisodesseementirelycompatiblewiththediagnosisofplague.ThepossibleexceptionisthecaseofHyldaFosterwheretheevidenceseemstopointtoanacutegastro-enteritiswithperforationasthecauseofdeath.ThequestionarisesfromahistoricalviewpointwhetherthisoutbreakofplaguewassimplyauniqueandcuriousepisodeorwhetheritwasademonstrationofhowplaguebehavesinruralEngland.FromthefourteenthcenturytotheseventeenthcenturyplaguewasendemicinEnglandanditsrecurringepidemicscanbetracedinthetownsinburialregistersandbillsofmortality.ItwouldbeimpossibleforthehistoriantodetectplagueinruralareasifithadbehavedasitdidinSamfordfrom1906-1918.ItwasonlytheopeningofabacteriologicallaboratoryattheIpswichHospitalearlyin1910thatallowedthistwentieth-centuryepidemictobediagnosed.Thetwosmalloutbreaksthathadoccurredbeforethattimewerenotdiagnosedbycon-temporarymeans.Althoughthediagnosisseemsreasonablenow,thereisnowayofconfirmingit.CircumstancesinruralSuffolkintheearlyyearsofthiscenturyhadnotalteredmuchfromtheseventeenthcentury.LatimerCottagesweresuppliedwithwellandpondwater,candlesandabucketprivy.TraveltoIpswichwasonfootorbythetwice-weeklycarrier'scart.Foodwasboughtlocally.Onlyclothingandhouseholdgoodshadtobefetchedfromthelocaltown.Thefarmcottagesbeingofbrickmayhavebeenofsounderconstructionthanthoseofearliercenturies.Adoubtfuldifferenceconcernstheruralratpopulation.Inanattempttoexplainthedisappearanceofplagueinthelateseventeenthcenturyhistorianshavecitedthereplacementoftheblackratbythebrownratasapossiblecause.However,thebrownratisjustascapableofcontractingandspreadingtheplagueastheblackrat,andintheSuffolkepidemicalltheratsinfectedwithplaguewereinfactofthebrownvariety.Rabbits,hares,ferrets,dogsandcatswerealsoinvolvedtoaslightextent.Inwildrodentplague,whichoccursinmanypartsoftheworld,theactualspeciesofwildrodentdoesnotseemtomatter,theepidemiologyofthediseaseseemstofollowthesamepattern(Hirst).Itissuggested,therefore,thatthiscuriousepidemicinSuffolkmaybethemodelforplagueinruralEnglandduringpastcenturies.ACKNOWLEDGEMIENTSIamindebtedto:Dr.J.G.Sleighforunearthingan
dlendingmehisfather'spersonalpapers;Dr.K.Harding,MedicalOfficerofHealth,andMr.R.Blenkinsopp,ClerktoSamfordRuralDistrictCouncilandtheirstaff;Mr.G.EwartEvansforhisinterestandadvice;Dr.S.T.Gray,MedicalOfficerofHealthforEastSuffolkCounty;Mr.D.Charman,ArchivisttoEastSuffolkCounty;Mrs.I.Hewitt,LibrarianofIpswichMedicalLibrary;ActingLibrarian,DepartmentofHealthandSocialServices;SurgeonCaptainR.S.McdonaldforfindingtheaccountoftheplagueattheNavalBarracks;theEditorandMr.F.TonkinsonoftheEastAnglianDailyTinesforpublishinganarticlerequestinginformationabouttheplague;allthosewhowrotetomewithinformation;thelateDr.P.H.Martin,whofirstinterestedmeinthissubject;mywifefortakingthephotographs;andmysecretary,Mrs.M.0.Bear.72 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V TheLastEpidemicofPlagueinEngland?Suffolk1906-1918SOURCESBROwN,H.B.,'TherecentplaguecasesinSuffolk',Brit.med.J.,1910,4,1490.BROWNE,R.J.H.,'AcaseofplagueatShotley',appendixtoHealthintheRoyalNavyfor1911,1912.Coroner'sDepositions,inquestonHyldaFoster,1910.EastSuffolkCountyArchives.Coroner'sDepositions,inquestonMrs.Garrod,1918.EastSuffolkCountyArchives.EastAnglianDailyTimes,1910:October5,6,7,11,15,21,24,25,26,27,28,29,31;November1,2,3,4,5,6,9,12,14,15,16,17,18,19,22,24,25;(GeneralElectionthenintervened)December23,31;1911:November1,3,6,21;1918:June27,29.GALE,A.H.,EpidemicDiseases,PelicanBooks,1959,pp.39-41.HURST,L.F.,TheConquestofPlague:aStudyoftheEvolutionofEpidemiology,Oxford,ClarendonPress,1953.MARTN,P.H.,lecturenotesandpersonalcommunication(thelateDr.P.H.MartinwasconsultantBacteriologist,P.H.L.S.,Ipswich).Personalcommunicationsfrom:Mrs.S.Bailey,whosebrother,W.E.Buck,wasthesailorwhosurvivedtheplagueatShotley.G.BakerwhosefamilyoccupiedLatimerCottagesaftertheoutbreakandwholivesatTurkeyFarm,Holbrook.E.J.Booty,anofficerintheTownClerk'sDepartment,Ipswich,1909-10.G.Brooke,whoseaunt,MissM.Blyth,nursedtheplaguecasesatFreston.H.Dickson,whowasservingattheNavalBarracksatShotleyin1911.Mrs.E.Godward(n6eGoodall),sisteroftheoriginalcaseatFrestonandahouseholdcontact.Mrs.H.Hubbard(n6eRouse),asurvivoroftheTrimleyoutbreak.Mrs.V.LewisandMrs.E.Webb,childrenofMrs.BuggwhodiedatWarrenLaneCottages,Edwarton.Mr.E.ParkerandMrs.Lummis,childrenofMrs.ParkerwhodiedatTurkeyFarm.Mrs.M.V.Simpson,wholivedinFrestonin1910andwenttoschoolwithAnnieGoo
dall.PRINGLE,A.,'TheoutbreakofratplagueinSuffolk',Publ.Hlth,Lond.,1911,24,no.4,126.ReportstotheLocalGovernmentBoardonPublicHealthandMedicalSubjects,NewSeriesno.52,1911.BULSrRODE,H.T.,'ReportonsuspectedpneumonicandbubonicplagueinEastSuffolkandontheprevalenceofplagueinrodentsinSuffolkandEssex'.*MRnN,C.J.,andRowLAmn,S.,'ObservationsonratplagueinEastSuffolk,NovemberandDecember1910'.PjmuE,G.F.,andMACALISTER,G.H.,'ReportonexaminationofratscollectedinSuffolkandEssex,16Januaryto14February1911'.**EsAsrwowD,A.,andGRIuFrrH,F.,'ReporttotheLocalGovernmentBoardonanenquiryintoratplagueinEastAngliaduringtheperiodJulytoOctober1911'.AppendixA:'Reportuponthepost-mortemexaminationofratsatIpswich',byG.H.MacalisterandR.St.JohnBrooks.AppendixB:'ObservationsonBritishratfleasJulytoOctober1911'.'ReportonratfleasinSuffolkandNorthEssex',byC.Strick-landandG.Merriman.t'ReportoftheCountyMedicalOfficerofHealthforEastSuffolkuponstepstakenbytheCountyCouncilandtheUrbanandRuralDistrictCouncilsinregardtotheoutbreakofratplagueupto31December1910',byLI.Heath.RousE,H.,StatementattheinquestonW.Rouse.Coroner'sDepositions,1910.EastSuffolkCountyArchives.ThesesectionswerealsopublishedintheFortiethAnnualReportoftheLocalGovernmentBoard1910-1911,SupplementcontainingtheReportoftheMedicalOfficer,AppendixA,No.3.ItalsocontainedashortextractofDr.Heath'sreport.**Thispaperwaspublishedseparately,J.Hgy.,1914,14,no.3,245.tThisreportwaspublishedseparatelyinIpswichin1911,byS.&W.J.King.73 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3 U H V V DavidVanZwanenbergSamfordRuralDistrictCouncil:MinutesofCommitteesheldin1911,1912,and1918.SamfordDistrictOffices,LondonRoad,Ipswich.SamfordRuralDistrict:RegisterofDeaths,1906,1909,and1910.SamfordDistrictOffices,LondonRoad,Ipswich.SLEoH,H.P.,'Fourcasesofpneumonicplague',Brit.med.J.,1910,ii,1489.SLEGH,H.P.,personallettersanddocuments,includinglettersandtelegramsfromLocalGovernmentBoard,andcorrespondencewiththeChairmanofSamfordRuralDistrictCouncil.STEWART,G.I.T.,MedicalOfficerofHealthforEastSuffolk,Reportsfortheyears1911,1912,1913,andasurveycoveringthewaryears,publishedin1923.SuffolkMercuryandChronicle,4November1910.74 K W W S V G R L R U J 6 3 X E O L V K H G R Q O L Q H E \ & D P E U L G J H 8 Q L Y H U V L W \ 3