User:Dumelow/1906-1918 East Suffolk plague outbreaks

Latimer Cottages: 51.9969, 1.1570 Charity Farm Cottages: 51.9833, 1.2503 Warren Lane Cottages: 51.9732, 1.2333 Hospital, HMS Ganges 51.9562, 1.2718

p540: In 1910 an oubreak occured at Latimer Cottages, a terraced residence between Freston and Holbrook, in East Suffolk. A 9-year-old girl fell ill with a cough, pneumonia, diarhorea and vomiting on 13 September. She died on 16 September. All had the same symptoms. Their local GP Carey had visited the sick and after the husband and neighbour fell ill considered pnseumonic plague as a diagnosis. Blood samples from the pair were confirmed as containing plaque bacili by laboratory testing at Ipswich and Cambridge. The last two patients were buried on the day of their deaths, the service being carried out in the open air and all attendees had their clothes disinfected. No post mortems were carried out. All who had contact with the victims were isolated at Tattingstone WOrkhouse and the district medical officer notified the local government board of the diagnoses. Because of the speed of the outbreak it was not possible to determine the cause.

p541: Pneumonic plague occurs when the plague bacili infect the liungs, rather than the lymph sustem and is significantly more deadly, with a mortality approaching 100% (compared to around 70% for untreated bubonic plague). Rats are the usual reservoir in outbreaks but it ca be carried by more than 200 mammals. Suffolk outbreaks thought ot be releated to the Nosopsyllus fasciatus flea which lives on rats. A rat caught near Freston died and, along with a hare shot near the village, were found to be infected when tested on 12 Ocotber. Further rats in the district were also found to be infected as well as a ferret in Woodbridge and a cat in Stutton. Leaflets were distributed advising the public not to pick up dead rats and local farmers were encouraged to cull rats. Cases of pneumonic plague at Shotley 1906-7, HMS GAnges 1911 and Enwarton in 1918; bubonic plague Trimley St Maritn 1909-10. Teh local government board appointed rat catches and arranged for free distribution of rat poison. Four nursess were immunised with Haffkine's anti-plague vaccine to treat any further victims.

p542: Surveys were carried out in November and December-January from the mouth of the River Orwell through Orfordness, Woodbridge, Boulge, Claydon, Ipswich and Copdock. Captured 568 brown rats of which 17 were found to be infected with the plague. 584 fleas were recovered, the stomaches of three from the ifnected rats were tested and two found positive for plague. 40 rabbits were caught and of these 2 of which carried the Nospsyllus fasciatus flea and 2 were positive for plague. A more intensive survey of 22 urban districts, 15 rural districts and 301 parishes on 14 January found no positive plague cases. Plague is more widely transmitted in early autumn adn another survey was carried out from July to October. Of 15,332 rats dissected 35 were found to be infected by plague. In 1912 250,000 rats wdre killed and tested but no cases were found. In 1913 rat cases were found in two parishes in the SHotley Peninsula and one in Woodbridge district. In 1914 no cases were found and the outbreak of teh FIrst World War ended survey work. The plague was found to be widespread in East Suffolk and the Eastern part of Essex in the pre-war period. In 1906-07 a large number of rats on the Woolverstone Park estate died and a similar occurence happened ay Freston House in Autumn 1910. These rats were reportedly well nourished, ruling out cases of Danysz and Liverpool viruses (varients of Salmonella). Shotley oubteak affected two families at Charity Farm Cottages and Brickhill Terrace Cottages between Shotley and Chelmondiston between 9 December 1906 and 6 January 1907/ Eight wer infected and only one, a young man, recovered. They were attended by Dr Carey, the same GP as at Latimer cottages, cause of death was certified as pneumonia but was considered to be a probable pneumonic plague case after the 1910 cases. Trimley St Martin outbreak 19 December 1909 to January 1910. Affected tow adutls and their five children. House was infested with fleas, three recovered. All bar one reported enlarged glands in the neck, axilla or groin. After the Latimer COtages case this was determined to be a bubonic plague outbreak. On 19 Ocotber 1911 a sailor at HMS Ganges reported a heacache and leg pain adn was determined to be suffering from a 104F temperature. He reported the symptoms afer having cut himself whilst cleaning a rabbit he had shot about a mile from Latimer Cottages, Freston.

p543: Developed severe pnuomia and was diagnosed with pneumonic plague. Recovered after 12 weeks but had suffered from Anterior uveitis and rendered almost completely blind. No reported cases until 1918 when a womna at Erwarton fell ill on 8 June with pneumonia and died the following dat. A female visitor fellill on 16 June and was visited by Dr Careu who suspected pneumonic plague. This was confirmed by an army surgeon. Second victim died on 19 June. Again all their personal contacts were traced and isolated at Tattingstone Workhouse, their clothes and bedding were burnt. No evidence of plague in Suffolk before 1906 and, other than isolated cases at ports, no other infections in the british Isles betwene 1906 and 1918. The local government inspector Dr Bulstrode suggested the most obvious route was by shiopping on the Orwell and Stour. This principally imported manure from London, in which no cases were reported, and grain from the Black Sea and the AMericas, where plaque was reported. It is possible that infected rats came assure during unloading at Butterman's Bay befor eonward transit to Ipswich. Another possibility was from fleas carried in grain or their sacks, as they can survive withour a host for up to six months. Teh Suffolk outbreaks were unusual in having cases of pneumonic plague transmitted direcgtly from person to person. The outbreak is considered unique in Western Europe in this period. Dr Carey praised for his diagnoses of plaque when there had been no outrbeaks in Britain for 250 years. Not known why the outbreak ended or if plague continues to infect rats in the Sjotley Penisnula.

https://journals.sagepub.com/doi/pdf/10.1177/014107680009301014

p63: Apart from an isolated case at a Porton laboratory in 1962 was the last outbreak of plague in England. Outbreak began in the Chapman family residence, centre of the three terraces. Mr Chapman was a farmworker and lived with his wife and four step children. Nine year old Annie Goodall was first to fall ill, had not been away from home for nine days prior. Dr Carey saw her on 14 September but had no physical symptoms apart from a fever of 105. That night she became delrious and the next day was found by Carey to have bronchial breathing in one lung. Died 16 September and buried on 20. Mother taken ill on 21st September with headache and nausea and the next day Carey recorded a temperature of 105, rapid breathing and crepitations in both lungs, that night she suffered diarrhoea and vomiting. The next day Carey thought she was dying and requested a second opinion by Dr Herbert Brown, a physician from Ipswich. By the time Brown arrived at mid-day she was dead. Brown collected some sputum but it only tested positive for pseumococci and gram-negative diplobacilli.

p65: 26 September Mr CHapman and a neighbour, Mrs Parker of Turkey Farm, who had nursed Mrs Chapman, both gell ill. Carey requested Brown attend but he was unable to and sent Dr Lewellyn Heath, who had conducted the testing on Mrs Chapman's sputum; Heath took a sample of blood from Chapman on 27 September. Brown attended on 28 September with Carey and the district medical officer, Dr. H.P. Sleigh. Brown took another blood sample from CHpaman and a sample of fluid from Mrs Parker's lungs. Both had high temperatires, Chapman had scattered rales in the base of both lungs and Parker had pneumonic consolidation. Both died on 29 September. Heath wrote to Sleigh on 30 September to advise that he had, the previous day, isolated plague bacteria from the sample he had taken on the 27th and on the 30th had confirmed this finding, Pasteuella pestis in both samples taken by Brown. HEath advised brown and went to Professor Sims Woodhead at Cambridge, thinking it best to "have a big name at the back of me" for such a radical diagnosis. At 5.41pm Heath telegraphed Sleigh to state that Woodhead confirmed his diagnosis and to request that all contactsbne isolated. In the meantime Brown has met Sleigh at 2pm to warn him of the probable diagnosis. The workhouse isolation quarters had to be made ready, as they were not usually occupied, and contacts could not be moved until the following day 1 October. That same day Sleigh notified the Local Government Board. Chapman and Parker were buried on 30 September. Local GOvernment Board inspector Dr Timbrell Bulstrode visited Samford on 4 October and arranged the Board's bacteriological adviser Dr Klein to receive the samples from Woodhead for confirmation testing. Klein failed to replicate the results.

p66-67: After confirming the outbreak Bulstrode dfocussesd on culling rats and investigating potential earlier outbreaks. Charity Farm 1906-07 first patient was 53-year-old Mrs CHurch who developed pnumonia 9 December and died three days later. Her daughter 24-year-old Mrs Radcliffe, who nursed her but lived in a detached cottage, developed the disease on 17 December and died on 19 December. Another daughter, 19-year-old Miss E. Church, fell ill on 20 December and recovered. 46-year-old Mrs Goodchild had nursed both duaghters, she lived 0.5 miles away at Brickhill Terrace. Goodchild contracted the disease on 24 December and died two days later. Her son H. Goodchild displayed symptoms from 27 December but later recovered. Her 56-year-old husband, Mr Goochild displated symptoms on 28 December and died 2 Janaury. Another son 7-year-old R. Goodchild contracted the disease on 30 Decmebr and died 4 January. Mrs Goodchild's mother, Mrs. Woods, came from Saxmundham to help, contracted the disease on 3 January and died 6 January. Carey attended on all the patients. Teh cottages lay close to the River Orwell.

p67: At Trimley Dr. Gart had first considered poisoning as a cause due to the suden onset of the illness. 46-year-old Mrs Rouse displayed symtpons on 19 December and died on 22 December; 14-year-old daughter C. Rouse symtpons on 26 December and died 5 January; 9-year-old symptoms 8 January and died 10 January; 50-year-old husband Mr Rouse symtpoms 9 January and recovered; 12-year-old son W. Rouse sympyoms 15 January and died 17 January; 6-year-old son John Rouse symtpoms 18 January and recovered; 18-year-olddaughter Honora Rouse symptoms 20 January and recovered.

p67: HMS Ganges case was W.E. Buck contracted 10 October 1911 and recovered, estimated age 20. Erwarton cases were 52-year-old Mrs Bugg symtpoms 8 June 1918, died 13 June 1918 and 42-year-old Mrs Garrod symptoms 16 June, died 19 June.

p68: Mr Rouse's swelling in the groin was incised but no pus was found. John Rouse was discharged on 9 March. Bulstrode also considered antoher case near Trimley. Honora ROuse had visited her brother at Barham hospital on 16 Janaury but her horse had an acciednt on the way home and she was taken in y the Foster family in Nacton, remained there until 22 January when taken to hospital. 3 February 7-year-old Hylda Foster was taken ill with abdominal pain and was admitted to hosspital the following day, where she died. Teh surgeon considered her disease similar to the ROuses but the post-motrtem found acute peritonitis, given this and the 12 day delay between contact and osnet of symptoms makes plague unlikely. Bulstrode persuaded the local authorities that the destruction of rats awas key to controlling the outbreak. Ipswich Borough COuncil and Samford Rural District COuncil formed a joint committee that appointe rat catchers and eventually authroised the free distribution of rat poison. East Sffolk had never had a County Medical Officer until this time and Heath was appointed on 1 November in n acting capacity., Heath asked the district medial officers to survey their districts for rats and to cull them, also enlisted local doctors to help and the police to compil reports on rat mortality. Heath alerted the public by notices and immunized the four nurses. 10 November the Local Government Board ordered (under the Public Health Act 1875) all local authorities to destrouy rats and report cases of rat plague. Bulstrode led the rat suveys assisted by the Local Government Board Inspecorate and testing by the Lister Institute in borrowed laboratories in Ipswich. H.T. Bulstrode died suddenly, aged 52, on 21 July 1911. L:ocal tradition stated that he died of plague, but there is no evidence fo this.

p69: The July-October survey used rats caught by rat catchers and collected together by teh police who forwarded them to a lab at Ipswich. If a rat tested positive then it was taken as evidence that a parish was affected and no further rats form that location were tested. Sailor Buck admitrted toi sick quarters at teh Royal Naval Barracks in SHotley 10 October 1911. General malaise, temp 104, headache and pain in the back and legs. Small cut to left index finger and painful lump in axilla. Cut occurred 7 Ocotber while cleaning a rabbit. On 13 October suffered a haemoptysis, lump incised 15 October but no pus foud. Afterwards developed severe pneumonia. His sputum suggested the plague and he was afterwards isolated.

p70: Samples from Buck's eye found no pus. Treated with oxygen, strycnhine, brandy and autogenous vaccine. Plague diagnosis was confirmed by the LGB. Suffered a high fever for 12 weeks, absesses in the neck (treated by incision), an empyema (which was aspirated) and albuminuria. Declared free of infection 14 January 1912, but left disabled by blindness. Mrs Bugg lived at Warren Lane Cottages, Erwarton, about a mile from SHotley barracks. Suaffered a chill on 8 June 1918 and retired to bed, died 13 June after pneumonia. Mile from the RIvers Stour and Orwell.Bugg was visited by her neighbour Mrs Garrod, she fell ill 16 June and was seen by Carey on 18 June who recorded a temperature of 102F, rapid pulse and breathing and spitting of blood. Carey diagnosed lobar pneumonia but was suspiciou sit was another plague case. He invited Captain Cade, bacteriologist of the army's Eastern COmmand, to examine the sputum and he confirmed plague. Garrod died 19 June. Following the survey of July-October 1911 more rat catchers were employed and the public rewarded at the rate of two pence per rat tail brought in. Care was taken to minimise refuse left on the streets. ALmost 250,000 rats in East Suffolk were killed in 1912. A laboratory was set up in the county, which later became part of the Public Health Laborartory Service. In 1913 seven infected ferrets found in Woodbridge district. 1914 saw four rats and a rabbit. Although the war prevented the LGB from investigating the outbreak further the military requested teh county council continue examinations of rats. After checking 9,691 rats with no psoitive cases the laboratory was closed.

p71: Shipping ports of San Francisco, San Nicolas, Valparaiso, Rosario and Alexandria brought grain to the Orwell, all suffered outbreaks of plague between 1907 and 1911. Plague from China had reached Glasgow in 1900 and led the LGB to declare it a notifiable disease. Notes on how the Galsgow cases were dealt with were sent to Sleigh when he notified the Samford cases The Suffolk outbreak was categorised as a sylvatic (or wild rodent) plague. The disease was largely confined to the wild rodents of the are ana donly occasionally affected indiviudals, such outbreaks tend to be pneumonic rather than bubonic. The finding sof epizootic disease in the rats had led to fears of more oubreaks.

p72: Of all the cases only four were confirmed bacteriologically, Mr CHapman, Mrs. Parker, Buck and Mrs Garrod. Shotley and Trimley outbreaks were highly infectious with a short iincubation period and high mortality. Plague was endemic in England from the 14th to 17th centuries. The Suffolk cases were only detected due to the opening of a bacteriiological laboratory at Ipswich Hospital in 1910. The earlier cases had been missed. Teh conditions in rural Suffolk at this time had not changed much sinc eteh 17th century, fresh water, food and sewage services were local and travel to cities such as Ipswich was rare. Some have posited that the repalcement of the black rat by the brown rat in England led to the demise of the plague outbreaks in the 17th century but the Suffolk cases showed that plague can spread via brown rats. It may be that outbreaks on a similar pattern could have occurred undetected in England over the preceding centuries.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/5E5C121F07307A7D8C467B82D662903C/S0025727300015143a.pdf/div-class-title-the-last-epidemic-of-plague-in-england-suffolk-1906-1918-div.pdf

https://www.nature.com/articles/088056a0

https://www.researchgate.net/publication/47543401_A_plague_on_five_of_your_houses_-_Statistical_re-assessment_of_three_pneumonic_plague_outbreaks_that_occurred_in_Suffolk_England_between_1906_and_1918