William Budd and the spread of typhoid

North Tawton in Devon had some 1,100 to 1,200 people, few drains, a privy over a pit for each cluster of cottages and dungheaps by the doors. By William Budd's inquiry it had seen no severe outbreak of fever in fifteen years, and only a single case in nearly ten. Budd was born there in 1811 and came back after his Edinburgh MD in 1838 to help in his father's practice. On 11 July 1839 a first case of typhoid appeared in a poor, crowded house. By the beginning of November more than 80 villagers had had the fever under his care. He kept records, and the first thing he noticed was that once the fever entered a family it went through the household.

Budd settled in Bristol in 1842. In the autumn of 1847 fever broke out at Richmond Terrace in Clifton, a horseshoe of 34 houses. Thirteen of them drew drinking water from a pump, and in late September the water was found to be tainted by sewage leaking into the well. Early in October typhoid appeared in all 13 houses almost at once. Neighbouring families on other water stayed well.

On 15 November 1856 the Lancet described an outbreak at the Clergy Orphan School in St John's Wood, London, where 19 pupils fell ill within 36 hours. The drains had been repaired during the holidays, and the report held that the simultaneous cases ruled out contagion. Budd replied on 6 December. The disease was intestinal fever, he wrote; it was essentially contagious, and the most virulent part of its poison was in the diarrhoeal discharges. Once thrown into privies these saturated the drains, and the poison could reach the healthy by seeping into a well, by escaping from faulty sewers into the air, or through badly trapped privies. He had taught this for years at the Bristol Medical School. Further papers followed in the Lancet and the British Medical Journal until 1860.

The rival view, then widely held, was that typhoid arose from decaying sewage whether or not any earlier case existed; Charles Murchison's textbook called it pythogenic fever, fever born of putrescence. Budd's book Typhoid Fever, printed in 1873, answered with North Tawton's long freedom from fever amid its privies. It advised putting a strong solution of chloride of zinc in the patient's chamber pot before use, so that the discharges would lose their power to infect. Budd died at Clevedon on 9 January 1880.