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32
from an attack of " cholera " which lasted two months. From
the description of the symptoms it seemed to me not improbable
that the past attack of " cholera " might really have been enteric
fever. This however must remain an open question though it
is the only clue that could be obtained.
Group 5.—Mrs. "S."' aged 31 failed with enteric fever on
the 28th September and was removed to the Infirmary on
October 13th. Louisa "S." aged n failed on the 6th October
and was removed to the Infirmary on October 13th where she
and her mother remained until November 21st when they were
sent home. Some difficulty was experienced in tracing the
family but it was subsequently found that another child
Alfred " S." aged 7 had failed with an undetected attack of
enteric fever on September 7th. He was taken into hospital on
the 26th October. The fourth case George " S." aged 4 was
removed to hospital on November 2nd and the father " A. S."
aged 37 was admitted to hospital on December 12th having
probably been ill since November 28th. In all probability the
2nd, 3rd, and 4th cases were directly infected by the first. This
would not however account for the 5th case as the interval was
too long. It should however be noted that Mrs. " S." and
Louisa " S." had been discharged from the Infirmary about
a week before the onset of the 5th case. It was therefore arranged
to have the excreta of these two patients examined and
Dr. Ledingham isolated the enteric fever bacillus from the
excreta of the younger patient. In all probability therefore we
had an instance of infection from a convalescent patient. The
evidence was not however quite conclusive as the last patient
suffered from a chronic disease which rendered it difficult to fix
with accuracy the date on which he failed with enteric and his
attack may really have been anterior to the return of his child
(Louisa S.) from the Infirmary.
The part played by "carrier" cases in the dissemination of
enteric fever is doubtless larger than most of us have teen led to
believe. The problem has not however been studied in sufficient
detail to allow of our modifying our administrative procedures to
meet these recent epidemiological and bacteriological discoveries.
At the moment it is difficult to suggest any method of dealing with
" carrier " cases beyond enforcement of the strictest possible personal
hygiene, but one may hope that the investigation that is now
being made by Dr. Ledingham and others will result in the discovery
of a method whereby these patients may be freed from infection.
PUERPERAL FEVER was notified on 10 occasions, in eight of
which a doctor was present at the confinement, including one in
which the diagnosis of puerperal fever was subsequently considered
doubtful.