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37
dry and brown, slight diarrhoea before he was seen by the doctor,
no abdominal tenderness and no enlargement of the spleen was
noted. The symptoms and signs were generally indefinite.
The case was eventually notified as continued fever on the 11th
February and the patient died on the 3rd March. The house in
which the patient resided was occupied by two families, but no
other person in the house showed signs of illness. From the history
of this case, it would appear to be doubtful that it was one of enteric
fever—nor was there a far as could be ascertained any connection
between this case and the subsequent cases of enteric fever notified.
On the 9th March, the patient Leslie C., aged 11 years, was
notified and was removed to Hospital on the same day. He was
one of a family of 7 children, four other members of which were subsequently
attacked. Every possible source of infection was investigated,
but with very slender evidence resulting. The mother
of the patient Leslie, the first case attacked, stated that the boy had
been in the habit of playing with a child named C., who was one of
the persons attacked in the previous outbreak in the autumn of
1909. On trying to find this child it was ascertained that she had
left the district, so there was no opportunity of following up this
clue. It is possible that this girl may have been still a "carrier"
case, and so infected Leslie C. The subsequent cases were, there
was every reason to believe, the result of infection by personal contact
with Leslie C., and this view is strongly supported by the cases
of Emily L., a domestic servant employed in this family, and George
E. a playmate of Leslie C. who lived in the same street, and who
had been frequently visiting him when the boy Leslie was first taken
ill and before the nature of his illness was recognised.
The outbreak, which was confined to the L. family and to one
case in another family, that of George E., is of interest having regard
to the previous outbreak in 1909 in the same street and which was
of a much more serious and fatal character. This street is situate in
one of the poorest quarters of the Borough and is mainly inhabited
by persons earning a precarious livelihood. From the time the
first case was notified every precaution was taken to prevent the
spread of infection, and with satisfactory results, as with the exception
of the boy George E. and excluding the doubtful case of George
G. previously referred to, not another case occurred in the street or
neighbourhood.
Two other local outbreaks involving several members of the
same family occurred. The subsequent cases being due to the
nature of illness of the first case not having been recognised in time.
In one case two persons were thus subsequently infected and in
the other 4. In the latter case a mother and 2 of her children were
removed to hospital within 3 or 4 days of each other with typhoid