Robert Howard’s history of typhus

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Howard, R. (1844) A history of the typhus of Heptonstall-Slack, which prevailed as an endemic during the winter of 1843-4 ; accompanied by remarks on the sanatory state of that village. Published by William Garforth, Hebden Bridge, England. 83p.

This book provides a detailed account of an outbreak of typhus in a small village community located near Hebden Bridge in West Yorkshire

Dr Robert Howard describes the diet, housing and social place of handloom weavers. He also describes the provision of water supply and outlines the poor sanitary measures and contamination of water with faecal matter. He recommends steps to improve housing conditions which he considered to be a “repository of filth and source of pernicious exhalation”. His research is note-worthy but less well known and influential than William Farr’s theory that “atmospheric impurities” or the “miasma” were responsible for disease such as cholera or John Snow’s subsequently accepted idea that ingestion through drinking polluted water was the actual mode of transmission.

Howard recognises the disease risk arising from contamination of water with faecal matter but tends to side with Farr in suggesting smell is the key factor. Although the miasma theory was eventually shown by Snow and others to be incorrect it provided scientific evidence for campaigners like Edwin Chadwick to successfully argue the case for Government investment in improved sanitation and clean drinking water provision.

“All smell is, if it be intense, immediate acute disease” Chadwick (1846)

Here are some excerpts from Robert Howard’s paper describing conditions in Heptonstall-Slack:

“At its origin this is capital water, but along its passage it becomes, to a certain extent, loaded with vegetable matter, and in the summer and autumn, is converted into a nursery of loathsome animal life, which, aided by solar heat, is highly injurious to its quality.”

“They [the sewers] now unite in front these habitations, and the commingled filth and detritus then pass through a sewer under one of these dwellings – the flags of the floor being its only covering –and the effluvia which permeates the seams is occasionally suffocative to the inmates. In the next house…three cases of fever occurred, and in the next but one, four cases….”

“The next that will be pointed out is a covered sewer, the opening of which is in the porch of a farmhouse. It had no proper outlet at its termination in the field behind the house and not having been opened for 20 years the stench emitted from its large aperture in the porch as extremely noisome. Six individuals in this house were attacked by the typhus, and, horrible to relate, three died.”

“…The sewer was opened, and the exhalations from it well-nigh overwhelmed the bystanders, as a powerfully depressant producing nausea, vertigo and sickness.”

Symptoms reported by Howard include:
◦ “Mental excitement”
◦ “arms and legs drawn up so as to form acute angles”
◦ “mouth and teeth mottled brown”
◦ “….in several cases a cough occurred….and, in one or two cases, attended by spitting of blood”
◦ “The respiration was accelerated”
◦ “in many cases diarrhoea commenced 2-3 days after the commencement of fever”
◦ “In certain cases the patient was passing 8-10 evacuations in one night”

In retrospect it is probable that Robert Howard was observing an outbreak of typhoid fever rather than typhus. Typhoid means “resembling typhus” and occurs through ingestion of food or water contaminated with the faeces of an infected person. Typhus, however, is a parasitic bacterium spread to humans from lice or sometimes rats – a mode of transmission first discovered in 1928 by Charles Nicolle for which he won the Nobel Prize.

Nevertheless Howard accurately identified risks to health from poor sanitation and made recommendations that were many years ahead of their time:

“I will conclude this chapter by expressing the opinion, that if an Act of Parliament was obtained, obliging the owners of property to make certain alterations in these cottages and other buildings now in existence, and confirm to certain instructions in all future erections in regard to their architecture and the construction of sink-stones, sewers, cess-pools and the removal of the contents of the two…then typhus fever be as effectually extinguished as small-pox is by vaccination.”

Read a detailed extract from Robert Howard’s paper.

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