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have stated that eleven fell by lysis, I do not mean it to be inferred that it was gradual and
prolonged, like that of enteric. It was usually short as stated above, and began about the 14th
and 15th day. The chart shows the temperature in such a case.
In the cases in which it was prolonged beyond this, it was due to complications. That the
cases were infectious admits of no doubt, but the disease was exceedingly capricious in the victims
it selected for attack. Several cases occurred within two or three weeks from the removal of a
previous case in the family ; but the danger of infection does not appear to have been very great
to casual visitors, or even to many of those whose contact with the patient is very close. It was
rare for the nurse in attendance upon the patient previous to removal to be attacked. Of the
two families which suffered most, in one the father, and in the other the mother escaped, though
both were in very close attendance. No doubt had the disease gained a firmer footing at first,
and occurred at the beginning of the winter instead of towards the end, the virulence of the poison
would have become exalted, especially if the usual predisposing conditions of over-crowding and
poverty existed in the neighbourhood attacked.
Prevention.
The usual methods were adopted to stamp out the outbreak, viz., isolation in hospital,
disinfection, and keeping contacts under observation. This latter was done in the case of three
families, several members of which were attacked, by keeping them in quarantine during the
period of incubation in the Council's shelters. The advantage of this is shown by a reference to
the table, which shows that four cases occurred in these dwellings. Under ordinary circumstances
the last case would have occurred here also, but the existence of this contact was
unknown until he became a victim of typhus.
Another preventive method which I took was the closing of St. Joseph's Schools, Paradise
Street. This was done on April 20th, for a period of fourteen days, which brought it up to the
Easter Holidays. The reasons given to the Council for this action were as follows: —
1. With the exception of the first two cases in the Borough, the earliest discoverable
case, viz., No. 3, occurred among children attending that school and was unrecognised,
and a number of other cases are apparently connected with this.
2. Several of the families where adults have been attacked have had children
attending this school, and in two cases at least there has been a previous history in the
family of some indefinite form of illness, which may have been an unrecognised attack
of typhus.
3. Judging from the mild form which the disease takes among children, I am
inclined to think that some unrecognised case or cases have been infecting the school,
and it is therefore advisable to have it closed for a period to prevent the spread of the
disease.
That this action was justified, appears from the fact that no fresh cases occurred among
the children in the neighbourhood, and the outbreak very speedily came to an end. This
outbreak was instructive, inasmuch as it showed how typhus may be kept up by mild,
unrecognised cases among children, analogous to "masked "or latent scarlet fever; and also
that the origin of the first case was as obscure and difficult to trace as when Murchison
propounded his theory that it arose de novo.
Failing the " masked " or " latent typhus " theory, the only other feasible suggestion is
that the poison is harboured for long periods in old second-hand clothes which find their way
from certain endemic centres to London, and —given favourable soil—start the disease.