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52
The origin of the illness of Mrs. S. (case 1) is unknown;
the spread of the disease from person to person in the remaining
cases (2 to 12) is clear enough. It was due in part, I
believe, to direct infection. Enteric fever is not a highly
infectious disease, like typhus for example; but when it
spreads from the sick person to the nurse or other person,
it is usually owing to the want of cleanliness, and through the
agency of the excreta, contaminating hands, etc., or getting
into food. I had communications with the doctors in attendance
on the sufferers, who attributed the spread to this cause,
and to general neglect of necessary precautions, and disregard
of the directions given by them. Dr. M., who attended cases
1 and 2, said "Mrs. S.'s illness looked like typhoid," and he
said he meant to report it, "but the diarrhoea stopped." He
subsequently added that he did not at the first look upon the
case as one of typhoid, but knowing what had happened
since," he thought "it may have been. Of course," he continued,
" if the wife's case was one of typhoid, the husband
might quite well have contracted the disease from her, for
although he was warning them all the time, they slept in the
same bed. The family were not cleanly, and probably drank
out of the same dishes, although he warned them against all
this." Dr. E., who attended cases 3, 4, 5, 6, 9 and 12, stated
that his view with respect to the spread of the disease amongst
the children was, that the people, being poor and cramped for
room, the parents, moreover, "being uninstructed as to the
danger, allowed the bed clothes to get soiled with the
excreta, which, having dried and become pulverised, contaminated
their food." Dr. C., who attended case 8, and
knew of the other cases, attributed the spread of infection to
"overcrowding and general carelessness in cleansing and
disinfecting contaminated articles." Dr. G.'s patient, Louisa
R— (case 10), had partaken of food left by her daughter
Amy (case 7), using the same dishes and utensils. The two