Infective Hepatitis: The History of an Outbreak in the Lavant Valley

Hepatitis had been present for some time in several places in the coastal-area of Sussex to the west of Arundel when the first case was repprted from the village of West Dean.This village lies some four miles to the north of Chichester, where the valley of the River Lavant enters the Downs, accompanied by the London road.At Singleton, a mile further on, the river leaves the road and turns to the east to the villages of Charlton and East Dean, which lie in a secluded hollow, and have little communication with the outer world other than by the main road.This lie of the land made the investigation of an epidemic much easier than would otherwise have been the case, and also showed the essential unity of what might have been regarded as sporadic cases of disease.Had there not been separate villages, visited by a single doctor, but separate streets in a large town visited by several, there would probably have been no more comment than on the curious fact that two or three cases of catarrhal jaundice should appear about the same time.Cases in West and East Dean About the middle of July, 1939, Betty Swift, a housemaid employed at the local sanatorium, suffered from an attack of hepatitis with jaundice.A fortnight after the beginning of the illness she went to her home in West Dean.None of the six other girls with whom she had lived till then was infected, nor were any of her relatives at home.Her history was discovered only when her brother developed the disease from an unknown source three months later.He worked at Charlton Saw Mills and had visited Chichester, but knew of no case of jaundice in either place.Case 1.-Bill Swift, aged 19, was taken ill gradually about September 20 with an ache in the middle of his epigastrium.He stayed in bed on the 23rd, but on the next two days got up and went out, and on the 26th returned to work.But he had to give up and go home to bed.He felt very ill, was irritable and a little drowsy, and vomited repeatedly.The next day his urine was dark, and on the 30th he began to turn yellow all over.After a fortnight in bed he returned to work, and was later troubled only by itching.Among the other workers at the saw mills was Gerald Sparrow, who lived in the village of Cocking, some six miles away.He had not visited any of the known sites of jaundice, nor had there been any cases in his neighbourhood.What was even more curious was that the two worked in different parts of the saw mills, and had not, so far as they knew, had any meeting at all.Yet 34 days after Swift's last appearance in his neighbourhood Sparrow was taken ill.Case 2.-Gerald Sparrow, aged 18.The onset of illness was sudden at dinner-time, and later in the day his urine was the colour of beer.For the next three days he felt sick, sweated, and had a pain like a stomach-ache across his upper abdomen.On the second day he turned yellow: but hp never took to bed, and after three days at home he went back to work and no more was heard of the disease in connexion with him.