Bagthorpe Isolation Hospital

“Heathfield Hospital”

Infectious Diseases

Mortality figures reflect the dominant role infectious disease played in destroying life in these early years. In the Medical Officers of Health’s Annual Report for 1882 the following deaths were recorded.

                                                 437 Tuberculosis (12)                       75 Whooping cough (nil)

                                                 282 Scarlet Fever (nil)                       65 Typhoid (nil)

                                                 257 Diarrhoea (mainly infants) (13)    50 Smallpox (nil)

                                                 136 Measles (nil)                               19 Diphtheria (nil)

Compared with 1972 (shown in brackets), these figures hardly begin to indicate the suffering imposed by these diseases but certainly reflect the progress made.

Notification of infectious diseases by medical practitioners was formalised in 1882 by a local Act and at that time there was a great deal of resistance to this measure on the part of a large number of doctors. But the Medical Officer of Health firmly pursued this objective and by obtaining this information expanded the preventive services with striking results. Smallpox and scarlet fever were the first to be tackled but the list was gradually enlarged.

Notifications enabled an outbreak of diphtheria to be traced to a milkman in 1886, an outbreak of smallpox to the arrival of a family of music hall artistes in 1888 and to a barber in 1902. In 1886 measles was noted to be a disease, which became epidemic in Nottingham ‘about every two years’, a conclusion drawn without resorting to modern analytical methods and based solely on mortality data. Many epidemics were noted in these years and invariably they occurred in the poorer and crowded parts of the city.

Among the advances that had been made in the control of infectious diseases was the introduction of immunisation procedures. The first occurred at the turn of the 18th Century with Edward Jenner’s promotion of inoculation of cowpox vaccination. By the 1870’s, vaccination was carried on by both public and private vaccinators and had become compulsory for infants. It was to remain so until 1946. Parents could apply for a ‘certificate of conscientious objection’ against vaccination and before 1873 a strong anti-vaccination lobby existed, backed by influential and wealthy persons. It inspired strong condemnation from the Medical Officer of Health for Nottingham. In answer to the contention that smallpox was no longer a problem and that strict isolation could contain the disease, Dr. Philip Boobbyer replied in 1896 that ‘the fact remains unalterably true that there is as much difference, so far as liability to smallpox is concerned, between a properly vaccinated and an unvaccinated community as there is, withy regard to explosiveness, between wet and dry gunpowder.

In 1904 a suit was brought against Nottingham Corporation by the Attorney General acting on behalf of a group of residents near the site of Bulwell Smallpox Hospital. They claimed they were in danger of infection and that the hospital was a serious nuisance. The evidence concerned the question of whether smallpox was aerial-spread or transmitted only by contact. The case failed and the hospital remained a monument to the victory of enlightenment over bigotry.

In 1901 a Municipal Laboratory was established and a bacteriologist appointed, progress, which was of great value in ascertaining the cause of fevers and particularly in its early days, in the identification of diphtheria. Supplies of anti-diphtheria serum were distributed at the Health Department from 1903 and contributed to a lowering of its high mortality. At the turn of the 19th Century over 500 cases of diphtheria were being notified annually. A note in the medical Officer of Health’s Annual Report for 1913, despite the availability of free serum ‘a very large number of cases among the poor are still allowed to pursue their course without serum treatment.’ At that time doctors were admonished by the Medical Officer of Health for not using this facility.

In 1933 Dr. Cyril Banks, the then Medical Officer of Health, noted that ‘children can be protected from it (diphtheria) by a simple process of immunisation, and full information is readily available, but I have not considered it desirable to start a campaign towards general immunisation against diphtheria in a community which has shown itself unwilling to avail itself of vaccination against smallpox.’ Perhaps his stern pessimism about public co-operation was well founded. It was only mitigated finally by the response to the diphtheria immunisation campaign launched in 1940 when nearly 30,000 children were immunised in two years.

In 1912, Dr. Boobbyer had commented on the effects of pertussis on small children. ‘This disease (whooping cough) gave rise to relatively little trouble in Nottingham during 1911. The deaths from it numbered only 39.’ Once again we can gauge the progress achieved later by such early comments. It was to be another 40 years or more before this infant killer would be brought under control

The influenza outbreak of 1918-19 was the worst epidemic of this period and part of a worldwide pandemic. In Nottingham influenza began in late October 1918 and continued to the end of March 1919 by which time over 1,500 persons had died. It was the young who were mostly affected, half the deaths being in the 20 to 55 age group and the rest in infancy and childhood.

Venereal disease came into prominence in the 20th century and grew as a public health problem as other infections waned and facilities for treatment developed. In 1943 the Medical Officer of Health deplored ‘the new sex morality’ and the fact that ‘the glamour and freedom of sex has been over-stressed during the past 40 years.’ This criticism has an up to date ring about it.

Modern time for infectious disease control began with the inception of the National Health Service. Since its inception epidemic diseases have dwindled and vaccines of many kinds have appeared and have been incorporated in mass programmes. With the further advent of antibiotics bacteria have lost predominance. Diseases caused by viruses appear now in the ascendancy, largely due, one suspect’s, to advanced virological technology.

Whooping cough vaccine was combined with diphtheria in 1954. In the same year B.G.C. was introduced to 13 year olds. Tetanus toxoid made up the triple vaccine in 1960. The introduction of live attenuated oral poliomyelitis vaccine in 1962, after the brief period of using injections of killed virus, has virtually eliminated that disease. Measles and rubella vaccine were used in the community from 1968 and 1970 respectively.

But with the solution of old problems, new ones hold the centre of the stage and secondary problems come to the fore. Worldwide influenza pandemics occurred in 1957 and 1969-70 with local epidemics in Nottingham despite the appearance of a vaccine. Infective hepatitis, made notifiable in 1968, appears to be on the increase since the first outbreak occurred in 1954 involving about 100 school children. Psittacosis has demanded more attention in recent months.

In recent years the steady immigration of people from tropical countries into Britain has drawn attention to cases of ‘exotic’disease. Typhoid, malaria, hookworm, tapeworm, roundworm, and whipworm infestations, and trachoma have all been noted in recent years. There are present day epidemiological problems for the Medical Officer of Health.

The vast slum clearance programme and general improvement in housing conditions since 1930, together with the enforcement of food hygiene regulations, have also made a considerable contribution towards the reduction of infectious disease.

Bagthorpe Isilation Hospital