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36
children of the A. family had played with those of Kate M. One
of the children of the A. family removed to the Workhouse was
said to have been ill from about the end of August, and his statement
was subsequently confirmed by the mother. It is probable,
therefore, that the disease may have been contracted from the
M. family in the first instance.
The last case notified was that of George A., of 47, L-
Street, on the 27th October. He occupied, with his family of
ten persons, the lower part of No. 47, the upper rooms being
occupied by a married couple without children. Not a single
case of illness of a suspicious nature occurred amongst the other
occupants of this house, and there appeared to be no connection
either direct or indirect between any of the other cases in the
same street. It is, therefore, probable that his case may have
been only a coincidence.
The history of the outbreak appears to point to the disease
having been spread by personal contact or by so-called "carrier"
cases. It is clear that the disease started at No. 16, and that
probably George S. was the first case infected. How he mayhave
contracted the disease it was impossible to ascertain. The
subsequent spread of the disease to the family living in the lower
rooms of the same house, and the intercourse that existed between
the other persons attached appears to furnish a strong case in
favour of the personal contact theory as the cause of the spread
of the disease. The probable presence of an unrecognised
"carrier " case must be remembered.
The drains in each of the houses invaded were tested and
found not to be defective. Cleansing and disinfection of rooms,
clothing and bedding was carried out in every case. The measures
taken proved successful in preventing a further spread of infection
after the nature of disease was brought to light.
Forty-four samples of blood were submitted for bacteriological
examination for the Widal reaction for typhoid, and in 12 (i.e., 27
per cent.) a positive result was obtained.
At the suggestion of the Local Government Board, arrangements
were made for the bacteriological examination of specimens
of the stools and urine of persons discharged from fever hospitals
after typhoid fever in connection with an investigation into the
question of "carrier" cases—that is, cases of persons capable of
conveying infection to others though not themselves suffering from
clinical manifestation of the disease but in whose blood or excretions
the typhoid germ is found on bacteriological examination to
be present, as a cause of the spread of infection in typhoid fever.
Samples were obtained in several cases and forwarded to the
laboratories for bacteriological examination.