The smallpox outbreak

The smallpox outbreak of 1893

One of the most dreaded afflictions of past times was smallpox (variola major), an acute and highly contagious viral infection which has now been practically eradicated throughout the world and is extremely rare in the industrialised countries. A less serious form of the disease (variola minor) is still found in some parts of Africa but all the signs are that it, too, will soon be wiped out. It has disappeared from Britain and elsewhere because of a widespread programme of vaccination and so few can understand the fear that it once engendered. The very mention of the name in years past was enough to frighten most people for although few knew much about its effects, it was generally accepted to be fatal.

Nevertheless, there were occasional outbreaks over the years in which patients suffered the tell-tale symptoms of the infection including back aches, digestive disorders, fever, vomiting and the appearance of numerous pocks or pustules, skin eruptions that left pitted scars if the patient survived. The cause of the disease has never been determined exactly but low standards of nutrition and a general uncleanliness predispose to infection and every case can be traced to a previous one. It was because the illness was gradually becoming rare that few family doctors were able to diagnose the signs and symptoms correctly and commonly confused them with chicken pox, a situation that occurred during the Bourne smallpox outbreak in the late 19th century.

At this time, there was a great deal of ignorance about the illness and in particularly, whether vaccination was a suitable precaution against infection. This was evident from a debate held by the Bourne Mutual Improvement Society only four years before the outbreak and reported by the Stamford Mercury on Friday 1st March 1889:

On Friday, one of the most interesting debates of the session was opened by Mr A Wall and Mr J B Roberts on the subject of "Compulsory Vaccination". The Rev J Ratcliffe presided. Mr Wall and Mr Roberts both maintained that vaccination was inefficacious for the prevention of smallpox and injurious to the system of those subjected to the operation. Mr Davies maintained that smallpox was not traceable to imperfect sanitation but was directly contagious. He believed vaccination with due care in the selection of the lymph to be a valuable if not an infallible preventative. Mr Harrison and Mr Bertolle believed that greater attention to cleanliness would prove more efficacious in exterminating the disease. Mr Davies maintained that the immunity of nurses in smallpox hospitals was proof of the protective influence of vaccination. The chairman gave instances under his personal observation tending to prove the efficacy of vaccination.

A public debate by lay people on a medical subject of this nature would be unthinkable today but this was the climate of public opinion at the time of the Bourne smallpox outbreak which ocurred in February 1893 when the Midland and Great Northern Railway Company were building a track through the Bourne area to link it with the main line to the Midlands and the North at Little Bytham. The disease broke out initially among Irish navvies employed on the work in the Castle Bytham and Thurlby areas and as some of them were living at a common lodging house in South Street, the infection soon spread to the town, notably to several inmates of the workhouse in St Peter's Road.

There was some doubt in the mind of the workhouse medical officer whether those who had been taken ill had smallpox or chicken pox and in a state of near panic, the Board of Guardians who ran the institution telegraphed the Local Government Board in London to "urgently send an inspector to verify the diagnoses", owing to the prevalence of smallpox at Castle Bytham and Thurlby, and to inform the board by telegraph of the time of the inspector's arrival at Bourne. Their reply refused the request and a letter that subsequently followed read: "If the medical officer to the Board of Guardians and the town's Medical Officer of Health [they were in fact, the same person] are unequal to verify these cases, it simply means that they are unfit for their posts. This board has no army of inspectors from which they can comply with requests like this."

By this time, the number of smallpox cases was increasing but medical facilities to treat them were totally inadequate. The Bourne Fever Hospital had been set up in 1885 when the Rural Sanitary Authority had purchased two empty cottages in Manor Lane for the purpose and the conversion work was carried out by a local builder, Mr Thomas Hinson, at a cost of £60, providing basic accommodation with ten beds in two wards for dealing with patients who needed to be isolated because they were suffering from an infectious disease. In addition, because of the current smallpox outbreak, a makeshift hospital had been opened by the railway authorities at Castle Bytham. This was little more than a primitive building, situated to the south of the railway line and cemetery, that became known locally as the Small Pox Hut and is recorded on maps of the period as the Fever Hospital, being used for those navvies who had contracted the disease. But there was no room for further patients and all that could be done locally was to isolate and disinfect the cases.

On February 25th, the medical officer wrote to the Board of Guardians saying: "The cases of sickness in the Bourne workhouse are chicken pox and not smallpox and I cannot account for the disease except through tramps coming in and as far as I can ascertain there is not, up to the present time, a single case of smallpox or chicken pox in Bourne town. As regards the Bourne Fever Hospital, I have repeatedly pointed out its defects, to wit: water supply, none; drainage, inefficient; ventilation, imperfect; arrangements for lighting, cooking and bathing, inefficient; no apparatus for disinfection of clothes; no store room; no ambulance; no water closet; no mortuary. In my opinion, a temporary hospital should immediately be constructed. Otherwise, if infectious diseases are promiscuously congregated together, the death rate will be considerably increased."

But on March 9th, the public vaccinator for the Rippingale district, Dr John Galletly (senior), wrote: "Smallpox is breaking out in the district" and as the number of victims increased, they were sent to the fever hospital in Manor Lane. By now, they needed full time care and so the Nurses' Institute at Hull was contacted and one of their staff, Nurse Maud Beesley, volunteered to come to Bourne and look after the smallpox sufferers.

At last, on April 27th, the Local Government Board agreed to send an inspector and in his subsequent report, he stated that the workhouse medical officer had told him that there had been two cases of smallpox at the workhouse but that he had persistently described them as chicken pox and purposely concealed their true nature, presumably to avoid panic or because he could not distinguish between the two. It is impossible to know how many died. There is a record of the vicar, the Rev Hugh Mansfield, complaining that one victim was buried without benefit of clergy and that if only he had been told, he would willingly have officiated. No Register of Deaths for the workhouse from that time has been found although other documents relating to the outbreak that did survive have been likened to "a correspondence that reads like something from the Crimean War".

There was obviously a cover up, official or otherwise, to abate public alarm and it is not therefore known how many people died but by mid-summer, the outbreak had been brought under control and Nurse Beesley returned to her previous duties in Hull. On 23rd June 1893, the Stamford Mercury reported that the town of Bourne had acknowledged "her cheerful and invaluable service in nursing some of the smallpox sufferers single-handed" and the Medical Officer of Health, Dr James Watson Burdwood, presented her with a travelling bag together with a purse of money and an illuminated address. The fever hospital continued in use until Bourne Hospital, with its own isolation wards, opened in 1915 when the two cottages were sold and they are still in use as private homes.

Smallpox had been endemic throughout Europe since the 9th century until the development of a vaccine by Edward Jenner in about 1800 but remained so in Asia where a particularly virulent form of the disease entailed a fatality rate of 30% but a campaign by the World Health Organisation from 1967 resulted in a virtual eradication by 1980. Vaccination is no longer compulsory in this country but it is a sensible precaution, particularly for those who are contemplating travelling abroad and is still required for entry into many countries.

AN EARLIER CASE OF SMALLPOX

There were other cases of smallpox and the public and medical officers were constantly vigilant, although not all were reported as was this one in the Stamford Mercury of Friday 22nd December 1871:

A case of smallpox having occurred on the North Road, Bourne, some apprehension was entertained lest it should spread but it is satisfactory to remark that through the careful arrangements of Mr Charles Eldred, in whose house the disease appeared, it has not gone beyond his own home. It is an imported case from one of the manufacturing towns of Lancashire by his daughter who had come to his house on a short visit and fell ill of the malady immediately on arriving here. Four other branches of Mr Eldred's family have been attacked with the same complaint but under the skilful treatment of Dr James Watson Burdwood, the whole of the patients are fast recovering and it is hoped there is no further ground for fear of its spreading to other householders. [It is suggested by a correspondent that Bourne, with its first class and abundant supply of water and the sanitary improvements lately affected, is, notwithstanding this outbreak, in a perfectly healthy state.]

Note: Mr Charles Eldred was a brick and tile manufacturer who lived at North Lodge, North Road, and Dr James Watson Burdwood was the Medical Officer of Health and Vaccination Officer for Bourne.