INFECTIOUS DISEASES IN PEMBROKESHIRE IN THE NINETEENTH CENTURY
By Ray Jones
In the nineteenth century, the people of Pembrokeshire, like those else where, lived under the permanent shadow of disease and death. Although there is a good deal of information on these conditions, it is impossible to record, classify and quantify every disease nineteenth century inhabitants may have suffered. Most ailments will have gone unrecorded and any consideration of nineteenth century disease is constrained by lack of diagnostic accuracy and the fact that national recording of diseases did not begin until the establishment of the Registrar General’s office in 1837. Further, the registration of births and deaths was not made compulsory until 1874 and there was no requirement to list some important diseases for many years, in some cases not until the twentieth century.
Most feared were the infectious or contagious diseases (now know as communicable diseases) , especially cholera, typhus, typhoid, (both called ‘fever’,) influenza , diphtheria, scarlet fever and tuberculosis also known as the ‘white plague ‘ or phthisis. Smallpox was also endemic for much of the century. These diseases were feared because of their epidemic and endemic status; onset was often sudden, spread rapid and cause unknown. Morbidity and mortality were high. It was believed that diseases were caused by poisonous gases (miasma) from piles of filth, or by a particle (contagium) arising spontaneously which carried the ‘poison’ of the disease. It was also thought disease was a punishment for the ungodly and early in the century, that disease s were caused by spells cast by witches (maleficium). There was no concept of public health and it was generally thought that the State should not interfere with the ‘sanctity of the domestic hearth and the decent seclusion of private life .. .’1 It was regarded as intolerable that the Government should meddle with ‘ individual liberty , personal dignity and social propriety” and this included the health of the populace . Public health measures ‘did not form a plank in any ministry’s platform and neither political party had developed a comprehensive ethic, or philosophy of public health.’ 2 However, this attitude began to change when it was realised that cholera was advancing across Europe and it was inevitable it would reach Britain. There were four major epidemics of cholera in Britain in the nineteenth century and it is generally agreed that the cholera epidemics were the greatest stimulus to the improvement of public health and limiting infectious diseases in the nineteenth century. This was despite the fact that notwithstanding its severity, death rates from cholera were fewer than death rates from the other infectious diseases. This emphasis, it is believed, was because cholera tended to attack all social classes whereas the other diseases tended principally to attack the poor or labouring classes. The detailed effects of cholera in Pembroke shire will be considered elsewhere.3 This paper will focus on the other diseases listed above.
Typhus was one of the major killing disease of the nineteenth century 4 although it was not clearly distinguishable from typhoid fever (often called enteric fever) until about 1866 (‘fever’ was also used, at that time, as a generic term for a number of pyrexial diseases, as early symptoms were similar). The disease is caused by a bacterium Ricke1sia prowazekkii; the bacteria live in infected humans and are transmitted from person to person by the human body louse Pediculus humanis. Undernutrition, close confinement and unsanitary conditions are predisposing causes. These are thought to be the reasons the disease rarely affected the upper classes.5 There were eight major epidemics of typhus in the UK in the nineteenth century with Swansea, Merthyr Tydfil and Neath being the towns most effected in Wales.
Cases of typhus were supposed to be reported to the Registrar General’s office but it was not separately reported from typhoid until 1869. However, although typhoid can be fatal, most people recover and it is thus likely that the data before 1869 will only slightly over-estimate typhus deaths.
Chadwick considered that typhus was ‘the constant accompaniment to life in the courts, closes and wynds [and] an unerring index of destitution’ 6 and it caused a death rate of 14 per 1,000 living in the UK in 1846. 7 Although it is known deaths from typhus declined in the latter part of the nineteenth century, it is nevertheless surprising that there is little mention of typhus in the Pembrokeshire Medical Officer of Health (MoH) reports perused. Perhaps it was not reported because such a report would have drawn attention to poor living conditions, highlighting the deprived state of the dwellings and the need to spend money on improvements. It is also possible, that as typhus tended principally to attack the poor, they did not seek medical attention and thus there is no record. Some death rates for typhus in Wales and Pembrokeshire are shown in Table One.
|1837||693||47||Annual Report of Registr ar General Vol. 3
|1840||‘over 900’||106||G. Penrhyn Jones.
‘ Y Teiffwys yng Nghymr u’
Cyf. 3 (1959) ,
Tenby Museum SE/24/4/5
op. c it.
|1884||2||Tenby Museum SE /24/4/5
G. Penrhyn Jones
Archive Office Annual Report: Sanitary Ins pector H ‘west Rural 189 15
Table One: Deaths from Typhus in Wales and Pembrokeshire. (Blank S pace = No Data).
Typhoid, also known as enteric fever, is an infection of the intestinal system caused by bacteria of the Salmonella genus . It is transmitted by food or drinking water contaminated by the faeces of infected people or carriers. Recovery is natural but the disease can be fatal. T he re we re scattered cases of typhoid in Pembrokeshire throughout the century but most quantitative information comes from the last quarter. Some details are shown in Table Two. Haverfordwest, with a population of about 6,500 at this time, was badly affected and there is evidence that some data reported from the town council to central government shows fewer cases and deaths than actually occurred as indicated by local MO Hs reports to the local authority. This may have been an effort to show that Haverfordwest was not badly affected – towns were often anxious not to let it be known that there were infectious diseases in their area.
Following the 1880 outbreak in Haverfordwest, the Local Government Board called for a report on the prevalence of typhoid in the Borough. The report severely criticised the sanitary state of the town and its water supply and required the Sanitary Authority to ‘diligently exercise … the powers they possess [for the prevention of infectious disease] under the Public Health Act of 1875 … 8 The 1884 outbreak in Broad Haven, in which 48 residents of the population of 271 population were afflicted, was thought to be due to contamination of the village well. The village squire then kindly allowed the villagers to use the water from his private well. Unfortunately, this was found to be more contaminated than the village well!
The term influenza was not used in Great Britain until 1743. Some believe that ‘ague’ may have referred to influenza while others say ague described ‘malarial fever.’ Influenza is caused by a virus or viruses and is transmitted from person to person by aerosols in the breath. There was no requirement lo re port the disease until 1881 and it was not separately recorded by the Registrar General until 1891. However, it is known that there were seven e pide mics in the UK in the nineteenth century, the worst being in 1847 whe n deaths increased by 83% in children, doubled in adults and increased two and a half times in old age. Total deaths were about five times greater than deaths from cholera in 1849. 9
Influenza would have been particularly difficult to diagnose accurately and relatively little attention is paid to it in the Pembrokeshire MoH reports surveyed. Mention is made of a ‘recent epidemic’ in Fishguard in 1890 10 and the same report quotes a further outbreak, with no deaths, in December of 1890. A further case is reported 11 in 1891 and there were four deaths in 1895, all in Fishguard. 12 Of more significance is 93 deaths from influenza – a serious epidemic – in the Haverfordwest District of Haverfordwest Rural Sanitary Authority in 1891 13 falling to four deaths in 1896. 14 St. David’s had an ‘influenza epidemic in early 1890 ‘ 15 without deaths but two deaths were recorded in 1889.16 In 1892, the disease was described as ‘prevalent’ in St. David’s with two persons dying.17 Haverfordwest Urban Sanitary Authority had one death from influe nza in 1890,18 one in 1896, five in 1897 , four in 1898 19 and seven in 1899. 20 Five people died from influenza in Tenby in 1895. 21
Smallpox, so called to distinguish it from the Great Pox (syphilis), is also a virus disease and has a high mortality rate. There are three forms of smallpox, two being comparatively minor, with the virus Variola major being the cause of the true virulent disease. An attack with one form can protect against infection with the other forms. Accurate figure s for the incidence of smallpox are only availab1e since 1884 when notification became compulsory but the disease has been known since ancient times . There were at least six epidemics in the eighteenth century with at least three in Haverfordwe st, in 1722, 1729 and 1731- 1732. 22 Over 200 people had the disease in Haverfordwest in 1722 with 52 deaths. 23 There were at least five epidemics in the UK in the nineteenth century with smallpox being responsib1e for about 11% of recorded deaths in the 1837-1840 out break.24 From about 1840, deaths declined with the last major outbreak being in Gloucester in the 1890s. 25
The first mention of smallpox in Pembrokeshire in the nineteenth century that could be traced, was in the Prison Surgeon’s Journal or 1831 – 23. 26 ‘ The patient was given treatment – ‘white bread and milk ‘ together with ‘… a little extra fire for every evening, and a small quantity or brandy daily for three days’ plus one extra blanket. 1838 saw ‘ virulent smallpox’ in Narberth 27and in 1857 there was an outbreak in Pembroke Dock, said lo have been brought in by a ‘swarthy tinker [who had] arrived overnight from Swansea.’ 27 The dockyard was closed and eight people died.28 One case of smallpox occurred in Milford Haven in 1872, but no further cases were reported from there until 1892 when there were two further cases.29 There was a plan to have a smallpox hospital at Milford but the inhabitants would not allow it because it would mean that suspected cases would have to travel through the town and fatal cases transported to the cemetery!
In 1887 there were three fatal cases, one each at Llanglydwen, Stepaside and East Williamston, all in the Narberth area. These were all attributed to the use of impure water. Nothing further occurred until a ‘suspected’ case at Narberth workhouse in 1890. 30 was reported this being the last mention of smallpox in that area that could be traced.
In 1882 a MOH Report to Pembroke Rural Sanitary Authority 31 described a case at Carew, said to be in a man from Pembroke Dock who had contracted the disease there. The Report added there had been an outbreak at Pembroke Dock and ‘… [smallpox] was on the increase not decrease.’ No evidence to substantiate this claim could be traced. One fatal case at Tenby, in 1872, was described, this being the only mention in Tenby MoH Reports.32 There was no further mention of smallpox in the documents studied until 1884, when Haverfordwest Rural Sanitary Authority received a report from their MOH33 saying there had been no deaths from smallpox in the district. A similar Report of 1891 again reported no deaths from smallpox.34 However, in 1892, the MOH of the Haverfordwest Urban Authority wrote of smallpox where ‘each outbreak had been brought in by the migratory population – Haverfordwest is constantly in danger of importing [infectious] disease … [and] there is a tendency to conceal cases.’ 35 He went on that there had been one case in an adjoining town (probably Pembroke Dock) and a ‘serious epidemic’ there in the last quarter. This is the last mention of smallpox in the local documents perused.
The incidence of smallpox was in decline in the last part of the century and this was one of the very few diseases contained by medical advances of that time. This was due to vaccination, the injection of the virus of cowpox into the skin; this gives protection against the virus of smallpox . and hence the disease. Also used was variolation, the injection of pus from a smallpox lesion, which usually gave a mild infection and thus immunity. However it occasionally gave severe or fatal attacks and the recipient was always highly contagious.
It is generally believed that smallpox vaccination was introduced by Jenner, but more recently the work of Jesty has been given more prominence. 36 Benjamin Jesty, a Dorset farmer used a stocking needle to inoculate pus from cowpox lesions into the arm of his wife and sons in 1774, 22 years before Jenner inoculated eight year old James Phipps. Variolation was introduced to Britain in 1717, when Lady Anne Wortly Montague, the wife of the Ambassador to Turkey and their two children were inoculated. However, there is evidence that variolation was used in Pembrokeshire at an earlier date. Letters dated 23 and 28 September 1722 in Philosophical Transactions from Perrot Williams MD, a physician at Haverfordwest stated ‘[variolation] has been practised since time immemorial in this part of Wales ‘ and that it was a ‘ very ancient custom.’ And there is a record of a woman from Milford Haven selling the pus from three smallpox pustules for one shilling for use in variolation before 1717.
It is believed variolation was successfully used to prevent the spread of the disease and reduce death rates in the several seventeenth and eighteenth century outbreaks and ‘a substantial proportion of the poor were immunized .’37 However, there was strong opposition to its use, partly because of side effects and partly because it was thought illogical to deliberately infect people. With the success of vaccination, variolation was banned and vaccination made compulsory. Pembrokeshire did well in this programme with 86% of babies vaccinated by 1890. 38
Of all the diseases that attacked and killed the population in the nineteenth century, tuberculosis (TB), also known as consumption, phthisis and the ‘White Plague’ was probably the worst, perhaps accounting for one-third of all the deaths in this period, more than cholera and smallpox put together.39 It is caused by a bacterium, Mycobacterium tuberculosis, conclusively shown by Robert Koch to be the cause of tuberculosis in 1886 – ‘ the final nail in the coffin of the miasmatists.40 Tuberculosis is principally a respiratory disease but the organism can attack every organ in the body including bones and glands, particularly the neck glands, this latter being known as scrofula and also King’s Disease or King’s Evil because it was believed it could be cured by the touch of the King of England or France. This was introduced in the days of Edward the Confessor (1003-1066) and lasted until it was stopped by George I (1714-1727) because he thought it was ‘ too catholic.’ Indeed there was a ritual for the ceremony in the Book of Common Prayer as late as 1633 and it is recorded Charles II touched 92,107 people. There is no record of how many were cured.
Tuberculosis was not a fully notifiable disease until 1912 but it was tabulated in Registrar General’s Reports in the nineteenth century. Deaths from tuber culosis were reported intermittently and for Pembrokeshire, no significant information could be traced until the last quarter of the century. This is shown in Table Three. However, because of relatively poor diagnostic tech niques and the ability of tuberculosis to mimic other diseases, especially in its early stages, such data should be treated with care. By 1898, when there were 20 deaths from tuberculosis in Haverfordwest, it was reported ‘it is thought that 20% of all milk cows in England and Wales carry tuber culosis.’ 41
Scarlatina or scarlet fever, these names being used interchangeably, is primarily a disease of children with 95% of cases being under the age of 1042 although it can also attack adults. It has been named and identified since 1749 although the exact cause was not established untill899. It was listed with fever and typhus in the Registrar General’s Report of 1838 and with diphtheria until 1860. Thus, earlier epidemics cannot be separately distinguished. Scarlatina can be caused by a number of bacteria now col lectively known as Group A streptococci and is transmitted by aerosols or direct contact. Initially there is a sore throat and headache with fever, vomiting and swollen neck glands but the bacteria can rapidly enter the blood stream causing septicaemia (blood poisoning).
The first record of the disease in Pembrokeshire traced, was in 1818-1819 when there was an ‘outbreak’ in Haverfordwest gaol.43 The gaoler requested six extra sheets and six extra mattresses so that the sick could be kept in one room and this was agreed. Little further was reported until several decades later when there were several severe outbreaks throughout the county. Some details of these are given in Table Four. As well as the data sampled above there were several reports of other outbreaks but without quantitative information although the reports noted cases occurred or were confined to one district.
Attempts were made to isolate sufferers and there were complaints about the lack of an isolation hospital. Houses and clothes were disinfected and an advice leaflet was printed. It was believed that not all cases were being reported and it was decided to prosecute infringements and in 1895, Joseph Challender of St. Thomas Green, Haverfordwest, was brought before magistrates for ‘default in notifying the existence of Scarlet Fever in his house and allowing his child to be exposed to the Public after notice was given by the Medical Officer of Health to isolate the boy.’ 44 In 1872 Tenby school s were closed for 16 weeks and Haverfordwest Urban schools were closed for 12 weeks in 1891. Also in 1891, schools were closed in Mathry, Hayscastle and Brawdy, cases isolated and houses disinfected ‘as far as possible’ (Report’s italics).45 The 1896 outbreak in Haverfordwest Rural district were ‘spread throughout the year and district’ ; it was decided not to close the schools but the inhabitants of Keeston parish were banned from attendance for two years. However despite the outbreak, Pembrokeshire did not do so badly – the death rate from scarlatina in Haverfordwest for the period 1881-1890 was 1.67 per 1,000 living compared with 2.58 for the whole of England and Wales for the period 1848-1872.
Diphtheria is also caused by a bacterium Corynebacterium diptheriae there is sore throat, heart failure and septicaemia with a membrane grow ing across the trachea(windpipe) often to the point of asphyxiation. The disease has also been called ‘croup,’ ‘putrid sore throat,’ malignant sore throat’ and ‘ throat fever.’46 As with scarlatina, most of the information in the county comes from the latter part of the century and some details are given in Table Five. There were also deaths in 1877, 1878 and 1879 in Tenby.47
Unlike MoH reports on most other diseases, additional comments were often made on the incidence of diphtheria, for example, ‘ houses and family filthy’ 51, ‘ diphtheria has been hanging about the Western Cleddy [sic] and its branches for years’ 52 ‘all cases aged 1½ -18 years ,’53 ‘all in one family of eight’ 54 and ‘ in people assembled at marriage festival.’55 As with scarlatina, several schools were closed, for varying periods, up to one month and following the 1888 outbreak in Llandisssilio/Clunderwen, a ‘Local Report’ was made to the Local Government Board. There were critical comments on the state of the villages but no cause for the outbreak could be found. 56
In the nineteenth century, the diseases described were endemic in Pembrokeshire, as they were among poor people in all parts of the UK. The bulk of the populace lived short, brutal lives in constant fear of the killer diseases described in this paper. The not untypical life of a labouring class family in the middle of the nineteenth century, surrounded by disease may be summarised by reference to the Merriman family of Begelly.57 Nearly all the family are thought to have died of tuberculosis.
John Merriman married Eliza Richards on August 15, 1844. They had ten children between 1845 and 1865.
Their first born Thomas born 1846 died in 1862 aged 17. The second son William born 1849 survived.
Baby born 1853 died of diarrhoea 1854 aged 11months.
George born 1860 died 1863 aged 3.
John born 1863 survived.
Mother Eliza died 1865. Eliza died 1867
Maria born 1851 died 1868 aged 17.
Thomas born 1865, died 1869 aged 4.
Jane born 1864 died 1872 aged 18.
Emma born 1859 died 1872 aged 13.
‘There was no medical attendant for all but one of the dead’.
The tragedy of this family truly encapsulates the effects of infectious diseases in Pembrokeshire in the nineteenth century. The marvel is that anyone survived to provide the heritage of good health enjoyed by so many today.
- Anthony S. Wohl, Endan gered Lives: Public Health in Victorian Britain (London, 198 3), 3 2 .
- Klaus -John Dodds, ‘Much Ado about Nothing? Cholera , Local Politics and Health in Nineteenth Century Reading ‘ , The Local Historian, Vo l 2 1.4 ( 19 9 1 ), 168-176.
- T. Jones , ‘ Cholera in Pembrokeshire in the Nineteenth Ce ntury’ , Journal of the Pembrokeshire Historical Society, No. 20 (20 11 ). Forthcoming.
- Patrick Murray , Medical Microbiology (London, 1990), 128- 129.
- Pickstone, ‘ Death, Dirt and Fever Epidemics : Rewriting the History of British “Public Health” 1780 – 1850 ‘ , in T. Ranger and P. S la c k (eds.), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge, 199 2), 130.
- Edwin Chadwick , Report on the Sanitary Conditions of the Labouring Population of Great Britain, 1842 (ed.), M. W. Flinn (Edinburgh, 1965), 8-9.
- Ibid., 10.
- Pembrokeshire Record Office. Dr. Parsons’ Report to the Local Government Board on the Prevalence of Typhoid Fever in the Boro ug h of Haverfordwes April, 1881. HAR/HE/1/13.
- Creighton, o p. cit., 215-219.
- Pemb R.O. Clerk of the Peace . General Correspondence. PQ/ C/1/91.
- Pemb R.O. MOH Report Fishguard District. 1891. HAR/HE/ 1 /6
- Ibid., 1895. HAR/HE/1/7.
- Pembs. R.O. MOH Report Haverfordwest District. 1892 HAR/HE/1/10. 14.
- Ibid., 1896. HAR/HE/1/12.
- Ibid., MOH Report. St David’s District 1890. HAR/HE/1/2.
- Ibid., Clerk of Peace. General Correspondence. PQ/C/1/90.
- Ibid., MOH Report. St David’s District. 1891. HAR/HE/1/20.
- Ibid., Minutes, Corporation of Haverfordwest acting as Urban Sanitary Authority. 1880-90. HAM/SE/1/6.
- Ibid., 1891-1895. HAM/SE/1/6.
- Ibid., 1899-1908. HAM/SE/1/17.
- Ibid., Report of Tenby MOH 1895. TEM/HE/1/1.
- F. Cartwright, A Social History of Medicine (London, 1977) , 91.
- G. Penrhyn Jones, ‘Y Frech Wen yng Nghymru’ , YTraethodydd, Cyf. 3 (1959), 171-181.
- J. R. Smith, The Speckled Monster (Chelmsford, 1987), 14.
- Roy Porter, The Greatest fit to Mankind (London, 1999), 650-651.
- Pembs. R.O. Records of the Court of Sessions of the County of Pemb roke. Surgeon’s Journal 7. 1820-1835. PQ/AG/72.
- Ibid., Haverfordwest Board of Guardians Minute Books. SPU/HA/1/2/F62.
- Vernon Scott, Pembrokeshire Life (June 1997), I
- Pembs. R.O. Milford Port Sanitary Authority Minute Book. 1874-1926 D/MPH/1/1.
- Pembs. R.O. Minutes Narberth Rural Sanitary Authority. NAR/SE/ 1/2.
- Pembs. R.O. Minute Book Pembroke Union Rural Sanitary Authority I 881- 1900. PER/SE/1/4.
- Tenby Museum. MOH Report to Tenby Board of Health, SE?24/4/5; see also TEM/SE Box
- Pembs. R.O. MOH Report. Haverfordwest Rural Sanitary Authority 1884. HAR/HE/ 1/9.
- Ibid., HAR/HE/1/10.
- Pembs. R.O. Minutes of the Corporation of Haverfordwest Acting as Urban Sanitary Authority. 1891-95. HAM/SE/l/6.
- See for example, Patrick J. Pead, Vaccination Rediscovered: New Light in the Dawn of Man’s Quest for Immunity (London, 2006).
- J. R. Smith , The Speckled Monster, 13.
- Pembs. R.O. HAM/SE/1/6.
- F. B. Smith, The Retreat of Tuberculosis I850-1950 (Lo ndo n, 1988), I.
- Galina Crawford, ‘A Short History of Bacteriology’, Biomedical Scientist, 3 (2005) ,
- Pembs. R.O. HAM/SE/1/16.
- Anthony S. Wohl, op cit., 279.
- Pembs. R.O. Surgeons Journal (No. 7). I 820-1835. PQ/AG/72
- Pembrokeshire Herald and General Advertiser, July 24, 1892.
- Anthony S. Wohl, op cit., 131.
- Tenby Museum. MOH Report to Tenby Sanitary Authority (1884) SE/24/4/5.
- Urban and Rural Social Conditions in Industrial Britain. Reports to the Local Government Board 1869-1902. Series Two (Brighton, 1979), Report No. 402. (1888) (Microfiche).
- Idem., Report No. 602. (1899).
- Idem., Report No. 642 (1901).
- Pembs. R.O. HAR/HE/1/14.
- Idem., HAR/HE/1/19.
- See note 48.
- Pembs. R.O. HAR/HE/1/7.
- Idem., HAR/HE/I 1.
- See note 48.
- Data slightly modified from: B. W. Richards, ‘The Merriman Family of Begelly’, Dyfed Family History Society, Vol. 4 ( 1992), 153-154. (Some diagnoses are slightly conjectural).