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Presumed sources of infection.—In 5 cases there was
reason to believe that the patients had probably contracted enteric
fever by eating fouled shell fish or watercress. Seven patients were
infected, directly or indirectly, by one or other members of the same
family. The circumstances were as follows: The mother of a family
was notified to have enteric fever in November, 1913, and was removed
to hospital. The family and the other occupaints of the house
were kept under observation. The children were being kept at home.
The father was out of work. In a few weeks one of the younger
children, five years old, was found to have occasional diarrhœa.
The significance of this was pointed out to the father, and he was
asked to have the child medically examined by his own doctor or
by the medical officer of health. The father declined to assent.
Later it was agreed that the child should be examined by a doctor,
and the fee was paid iri advance by the Public Health Department.
However, at the last minute, the father again refused his consent.
Meantime all the children were being kept indoors at home,
so that it was felt that there was no safe and sure ground for
legal intervention in the absence of positive knowledge. The
suspected child got very slowly worse, and was eventually notified
to have enteric fever in January, 1914. During the succeeding
fortnight, the father and five other children were also notified.
With the exception of the baby one year old, the whole family
contracted enteric fever—eight cases in all.
All cases of typhoid fever on their discharge from hospital are
visited and examined. A leaflet of instruction is left with them
and specal attention is directed to its more important clauses,
which are orally explained at some length. The faeoes and urine
are examined baeteriologically only in those patients discharged
for home where there is some evidence or suspicion which points
to their acting as typhoid carriers.
Diagnosis. -Specimens of blood from suspected cases of
typhoid fever are examined free of charge for medical men by the
Public Health Department. The examinations are conducted at
the Bacteriological Laboratory of the Middlesex Hospital. In
1914 eight specimens of blood were received—three gave a positive
Widal reaction, the rest were negative.