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was operative about the third week of August, and was possibly
operative for some days, including the 23rd of August, as on this day
one of the sufferers, who had been away in Kent for 3 months, returned
to her home. She was taken ill on the 30th August, so that the incubation
period in her case could not have been longer than 7 days. Four
of these primary cases were members of the same family, the remaining
13 cases occurring in separate houses in the affected locality. Most of
the patients were young people under 20 years of age, two were between
the ages of 20 and 30, and two were over 30.
Dr. J. Hamer, Assistant Medical Officer of Health to the County
of London, co-operated in an endeavour to trace the source of infection
of this outbreak, but nothing definite was ascertainable. Suspicion at
one time attached to the milk supply, as a large proportion of the cases
had in all probability derived their milk from a particular dairy
company. Inasmuch, however, as this dairy company is in a very large
way of business, and supplies the trade very largely in this and other
parts of London, the fact of the majority of the patients taking milk
from this particular source, is merely another way of stating that the
majority of the residents in the district do the same. Inquiry was
made as to the possibility of infected water, infected shell-fish, fruit,
ice-creams, and temperance drinks, having played any part in the origin
of the outbreak, but without result.
The last of the primary cases was taken ill about the end of the
second week in September. Other cases followed, but they were
secondary to the first cases; although the interval elapsing between the
onset of the last primary and the commencement of the first secondary
case was probably not more than a few days. The secondary cases
appear to be 17 in number. This number includes seven persons in one
family (father, mother, and 5 children), the five children being infected,
and becoming ill at dates varying between the 21st September and
the 10th October, from a sister, who was one of the primary cases
(date of onset, the 29th August). This girl's case was not diagnosed
by the medical man attending her, but she was treated for
"influenza and diarrhœa" in her own home amongst her numerous
relatives; and it was not until the 26th September, that she was
removed to hospital. Tho father and mother were the last to succumb
to the infection on tho 17th and 20th of October, and the house being
then emptied of its occupants was thoroughly overhauled, cleansed,
and disinfected, This occurrence illustrates the infectiveness of enteric
fever, when cases of the disease are treated at homo in the houses of the
poor, and there is an absence of all precautions to prevent the spread of
infection.
Of the remaining 10 secondary cases, 7 were probably attributable
to visits to some of the primary cases, after the latter were taken ill,
but before removal to hospital. Three of these cases occurred in ono
family, after visiting a brother in a neighbouring house, who was ono
of the primary cases.