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together in their rooms accompanied by their children, and are not
deterred from this by a sick person being present; but all the cases
except one were removed to hospital as soon after notification as
possible, and the vacated rooms, with clothes and bedding, etc., disinfected.
The course of the outbreak seems to connect the cases with
some other circumstance than those previously examined. The first
of these cases was notified on the 4th of April, the last on the 23rd
of July. Every one of the children affected had played on the abovementioned
vacant land during this period. Children at this age are
very fond of playing by digging, &c., with dirt and thus soiling their
hands and clothes. If the dirt happens to be specifically polluted,
it is not difficult to imagine how the children might be affected.
The final proof of the cause of this outbreak, namely, the bacteriological
examination of the polluted soil, is wanting; but there are
strong grounds for believing that polluted soil occupies a very
prominent place in the occurrences of so-called sporadic cases of
enteric fever.
How the soil of the vacant land could have become specifically
polluted is not difficult to suggest. During the stay of the itinerant
shows frequenting the place w.c. accommodation is not provided on
the ground; and the excreta of some of the rougher employes may
have been disposed of with the manure from the animals. Probably,
at some time, one or other of the employes was suffering from a mild
attack of enteric fever. Indeed, the ground had been used for many
years by travelling circuses and menageries, and polluted by
organic matter, animal and vegetable.
Briefly, the reasons for believing polluted soil to be the exciting
cause of these cases are :
1. The age of the patients (3 to 10 years).
2. The habit of playing on the ground.
3. Gradual progress of the outbreak.
4. The polluted condition of the soil with organic matter.
5. No other common cause to be suggested.