Jaundice
An illness which was not so usual became an epidemic in the village in 1925 with a fatality. This illness was generally called jaundice at the time although from the following writing they believed it may have been Weil’s disease. Some children from every family in the village succumbed to it. There was a great deal of testing of all the water sources and also childrens sweets. Did they check the canal I wonder, the children were taken down there to learn to swim!!
B Pittam 2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2524456/pdf/brmedj08283-0021.pdf
Page 108
EPIDEMIC CATARRHAL JAUNDICE
An outbreak of epidemic catarrhal jaundice involving over 200 persons overtook a number of places in the Midland and Eastern Counties of England during the winter of 1925. A report just issued by the Ministry, of Health states that the disease first showed itself early in September, 1925, at the village of Yardley Gobion, and appeared thereafter in succession in isolated foci, separated from one another by ten miles or more and- apparently unassociated. The county borough of Peterborough alone excepted, all these foci were villages. All the Midland villages are described as infested with rats in varying degree. In Kings Cliffe a block of cottages where a patient lived was said to be overrun. There was no evidence of rat prevalence in affected houses in Peterborough. Of 100 cases investigated, 14 only were found to have occurred in adults. In Yardley Gobion, Ringstead,and Raunds children alone suffered. In the village of Kings Cliffe, on the other hand, 8 out of 9 patients were adults. A clinical survey of the patients who recovered indicates that vomiting was a constant feature, its severity and frequency being out of all proportion to the general mildness of the attack. All cases except the mildest complained of epigastric pain coincident with the vomiting. Generalized pain in bones and muscles attended the onset of some attacks. The intensity and duration of the jaundice varied. In mild cases it was fugitive and intermittent, showing in the conjunctivae only. In other cases it was more pronounced and distributed over the body, though more marked on the face, chest, and neck. Its tint was golden or orange rather than sallow or muddy, and was produced by the mingling of the jaundice yellow with the red colour of the blood, in which there was no appreciable anaemia. An urticarial rash of one day’s duration was observed in one case. During the jaundice the urine was deeply coloured with bile pigments, and assumed a smoky brownish hue; urates were abundant and albumin present, often in considerable quantity; the reaction was usually acid, and in 8 of 20 cases examined acetone was demonstrated in the urine. Most cases had initial constipation with pasty stools. Later, owing to excessive flow of bile into the intestine, the stools became dark and more fluid. The liver in a few cases was slightly enlarged and palpable. The temperature was seldom more than 100 or 101. Some cases were afebrile. A child of 11 who died was severely ill from the outset, with constant vomiting, severe abdominal pain, jaundice, and delirium; pulse 100, but no pyrexia. The liver extended for two inches below the costal margin. A dark-coloured stool was suggestive of haemorrhage. Death took place by sudden collapse after nine days’ illness. At post-mortem examination the brain, lungs, heart, stomach, intestines, spleen, and kidney appeared to be normal. There was a little pus in the crypts of the right tonsil. The liver was large, soft, and yellow, and on section pale and fatty in aspect. Microscopically the liver cells were distended with fat, especially round the periphery of the lobules. The portal canals were packed with a small round-celled infiltration. Actual necrosis could not be made out. The liver condition in this fatal case, and the discovery of leptospira in the urine of a girl of 9 who, though not closely related to the outbreak under discussion, was suffering from typical epidemic catarrhal jaundice, suggested the thought that this series associated through a common causative agent with infective jaundice or spirochaetosis icterohaemorrhagica, also known as Weil’s disease, a malady which made its appearance in Scotland in 1923, as described in a report of the Medical Research Council, reviewed in the JOURNAL two months ago. A careful series of tests was carried out with post-mortem material, urine, and blood of patients, and water from water supplies; microscopically by use of the dark field or silver-impregnated sections, experimentally by inoculation into guinea-pigs and by testing the bloodserum of convalescent cases for agglutinative and protective power against a strain of leptospira; but all attempts to demonstrate the presence of Lectospire icterohaenorrhagiae or trace it inferentially by serological methods proved unsuccessful. It is notorious, however, that leptospira is difficult to find, that it may appear in blood or urine for a few hour’s only, and that the protective power of convalescent serums against stock leptospirae is uncertain, so that the question cannot be regarded as closed, and further inquiry will doubtless throw light on this hitherto baffling problem.
I A Ministry of Health. Reports on Public Health and Medical Subjects.
No. 42. H.M. Stationery Office, or through any bookseller. Price 9d. net
[ TEmBRiMS! M MEDICAL JOURNAL
JULY 16, :1927
Ministry of Health Reports on Public Health and Medical Subjects. 42 Catarrhal Jaundice by Morgan & Brown 1927
EPIDEMIC CATARRHAL JAUNDICE
An outbreak of epidemic catarrhal jaundice involving over 200 persons overtook a number of places in the Midland and Eastern Counties of England during the winter of 1925. A report just issued by the Ministry, of Health states that the disease first showed itself early in September, 1925, at the village of Yardley Gobion, and appeared thereafter in succession in isolated foci, separated from one another by ten miles or more and- apparently unassociated. The county borough of Peterborough alone excepted, all these. foci were villages. All the Midland villages are described as infested with rats in varying degree. In Kings Cliffe a block of cottages where a patient lived was said to be overrun. There was no evidence of rat prevalence in affected houses in Peterborough. Of 100 cases investigated, 14 only were found to have occurred in adults. In Yardley Gobion, Ringstead,and Raunds children alone suffer adults. A clinical survey of the patients who recovered indicates that vomiting was a constant feature, its severity and frequency being out of all proportion to the general mildness of the attack. All cases except the mildest complained of epigastric pain coincident with the vomiting. Generalized pain in bones and muscles attended the onset of some attacks. The intensity and duration of the jaundice varied. In mild cases it was fugitive and intermittent, showing in the conjunctivae only. In other cases it was more pronounced and distributed over the body, though more marked on the face, chest, and neck. Its tint was golden or orange rather than sallow or muddy, and was produced by the mingling of the jaundice yellow with the red colour of the blood, in which there was no appreciable anaemia. An urticarial rash of one day’s duration was observed in one case. During the jaundice the urine was deeply coloured with bile pigments, and assumed a smoky brownish hue; urates were abundant and albumin present, often in considerable quantity; the reaction was usually acid, and in 8 of 20 cases examined acetone was demonstrated in the urine. Most cases had initial constipation with pasty stools. Later, owing to excessive flow of bile into the intestine, the stools became dark and more fluid. The liver in a few cases was slightly enlarged and palpable. The temperature was seldom more than 100 or 101. Some cases were afebrile. A child of 11 who died was severely ill from the outset, with constant vomiting, severe abdominal pain, jaundice, and delirium; pulse 100 , but no pyrexia. The liver extended for two inches below the costal margin. A dark-coloured stool was suggestive of haemorrhage. Death took place by sudden collapse after nine days’ illness. At post-mortem examination the brain, lungs, heart, stomach, intestines, spleen, and kidney appeared to be normal. There was a little pus in the crypts of the right tonsil. The liver was large, soft, and yellow, and on section pale and fatty in aspect. Microscopically the liver cells were distended with fat, especially round the periphery of the lobules. The portal canals were packed with a small round–celled infiltration. Actual necrosis could not be made out. The liver condition in this fatal case, and the discovery of leptospira in the urine of a girl of 9 who, though not closely related to the outbreak under discussion, was suffering from typical epidemic catarrhal jaundice, suggested the thought that this series of cases might be a form of spiroclhaetosis, and therefore associated through a common causative agent with infective jaundice or spirochaetosis icterohaemorrhagica, also known as Weil’s disease, a malady which made its appearance in Scotland in 1923, as described in a report of the Medical Research Council, reviewed in the JOURNAL two months ago. A careful series of tests was carried out with post-mortem material, urine, and blood of patients, and water from water supplies; microscopically by use of the dark field or silver-impregnated sections, experimentally by inoculation into guinea-pigs and by testing the blood serum of convalescent cases for agglutinative and protective power against a strain of leptospira; but all attempts to demonstrate the presence of Lectospire icterohaenorrhagiae or trace it inferentially by serological methods proved unsuccessful. It is notorious, however, that leptospira is difficult to find, that it may appear in blood or urine for a few hour’s only, and that the protective power of convalescent serums against stock leptospirae is uncertain, so that the question cannot be regarded as closed, and further inquiry will doubtless throw light on this hitherto baffling problem.
From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2524456/pdf/brmedj08283-0021.pdf
Page 108
The girl who died was Iris May Swain of Yardley Gobion who was buried November 23rd 1925 aged 11 at Yardley Gobion, St Leonards church. BP