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because there is an interval of about three and a half months between the
two cases ; but recent researches have demonstrated the possibility of the
typhoid bacillus living months in suitable soil, so that the probability is that
Ernest H. or Mrs. O. introduced the disease into 9, Windsor Road, where it
remained latent during the winter months until the spring, when the next
case was attacked.
The next case notified was Charles S., of No. 2, Windsor Road, on the
29th March, 1894. This patient was a cousin of the last two patients, and
there was a close daily intercourse between them. The next to be notified
from the same disease was A. M., a daughter of the above-named Mrs. O.,
and cousin to the last patient. There is evidence that during the early stage
of the disease the children were constantly together. This patient was removed
to Hospital on the 11th April. The last to be taken ill was Ernest S., the
notification arriving on the 1st May. This patient was sister to Charles S.,
notified on the 29th March, and both slept in the same room. She was also
a cousin of A. M., notified on the 9th April, the two being constantly together.
The association in the last three cases was so close as to leave no doubt in my
own mind that the disease was transferred from one to the others by direct
contagion.
In estimating the value of the above evidence the habits of this class of
people must be taken into consideration. It is quite usual for the excreta of
Typhoid Fever patients nursed at home to be left an indefinite time in the
sick-room : also those attending on the sick person do not recognize the
absolute necessity for ablutions after each attendance on the patient. It has
been no doubt the innocent neglect of these precautions which is responsible
for most of the above cases.
The remarks I have made as to the influence of the closed house in
Windsor Road on the production of Typhoid Fever in Prince Edward's Road,
apply also to the cases occurring this year in Windsor Road.
Conclusions.—1. The origin of some of the first cases could not be
found out at the time of notification or subsequently; but the secondary
cases at 14 and 68, Prince Edward's Road, and 12 and 9, Windsor Road, as
stated above, I believe to have been contracted from the first cases.
2. Whilst I do not consider the closed houses to be instrumental in the
spread of Typhoid Fever, I think they ought either to be put in good
condition or demolished. (Having been closed under the Public Health—
London—Act, 1891, it is not possible to obtain a demolition order under
that Act.)
Note 1. Of course after the notification or recovery of each case, the
rooms were fumigated, and the bedding was disinfected by dry heat we had
not then the present steam apparatus.
Note 2. The reason why some of the cases were not removed to
hospital, was that the Asylum Board's Hospital accommodation was exhausted
at this time, and cases could only be admitted as vacant beds arose.
I remain, Gentlemen,
Yours obediently,
J. KING WARRY, M.D., D.P.H.,
June 22nd, 1894
Acting Medical Officer of Health for Hackney.