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The chief precautions to be taken, are in my opinion: (1) early
notification, to be attained, in part, by means of bacteriological
examination of the blood, which facility may now be obtained free
at the Town Hall, by any medical man in Finsbury; (2) strict
and early isolation of the patient; (3) thorough disinfection of all
belongings of the patient; (4) during the treatment of the patient,
by her mother and sister Ellen. She slept with her mother till November
24th, and after that slept with her sister Annie.
6. Mrs H. aged 45, was notified as suffering from Enteric on November 28th.
She was the mother of Florrie, and had helped to nurse her during her illness,
and slept in the same bed with her till November 24th, when Mrs. H.
became ill and went to sleep with her daughter Lottie. During the daytime
Mrs H. was out to work and Ellen nursed Florrie.
7. Elien H., aged 22, took ill a day or two after the mother, and was notified on
November 28th. She had felt ill for some days but struggled on with her
work. Her attack proved a very severe one, and she died in hospital on
December 15th.
8. Henry G., aged 21, living in another district of London, was engaged to be
married to one of Mrs. H's daughters. He spent his evenings very frequently
at Mrs. H's house in Clerkenwell and was a general favourite in the family.
During Florrie's illness he nursed her and would sit on her bed and amuse
the child "almost every evening." He was very kind to her and they were
great friends. On December 1st he sickened, with what afterwards proved
to be Enteric. He was nursed at home.
9. Clara H., aged 18, sister of Ellen H., was notified on December 14th as suffering
from Enteric. She had helped to nurse both her mother and Ellen
previously to her removal to hospital, and was ill at least two weeks before
notification.
10. Lottie H., aged 20, sister of the above, was notified on December 14th. She
had slept with her mother and nursed her and Ellen previously to their
removal to hospital. She was ill for seven days before notification.
11. Annie H., aged 13, sister of the above, became ill on December 13th and
was notified with Enteric on December 14th, and removed with the other
two sisters to hospital. She had assisted in nursing the previous cases and
had slept in the same bed with Clara and Lottie about ten days before.
Here there are eleven cases all closely connected with each other, and in all
probability springing from one of the first three patients. The most thorough
and careful investigation has revealed no other likely source of infection
beyond personal contact, or direct infection from soiled linen, bed clothes, etc.
Moreover there is this instructive fact—from the commencement of the illness in
the family (in which six cases occurred one after the other) up to November
26th there was no disinfection of excreta, linen, etc., but from that date
onwards thorough disinfection was carried out.
In five other cases in the district the only traceable source was the eating
of oysters and other shell-fish procured in each case from one particular stall
in a certain street. Many of these shell-fish sold in Clerkenwell are collected on
the coast of Scotland and Ireland and some come from Holland and Belgium.
When they reach the London market they are stored in heaps at Billingsgate,
and shovelled up as required for various retail customers. In the case of street
stalls in particular, shell-fish also run additional risks of contamination and
uncleanliness. Street markets and stalls for the sale of food are as a rule to be
strongly deprecated from a public health point of view.
C