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79
The following record will serve to show the importance of the
"carrier":—On 20th October, 1923, I received a notification of enteric
fever occurring in a child, E.H., 6 years, living at P. Street. The
child was removed to the South-Eastern Hospital. The last date on
which he attended school was 9th October. He was taken ill on the
9th and the doctor was called in on the 10th, in view of his feverish
condition. The nature of the illness became manifest on the 18th, the
diagnosis being confirmed by a Widal test. 1 visited the house and
made an appointment to meet all the members of the three families
living there next day (Sunday). The three families were closely
related, comprising thirteen people, living in seven rooms, of which
four were bedrooms. Three brothers were the heads of the three
families.
Taking the patient's family first; this consisted of E.G.H., 35
years, who shares a bed with his son, the patient E.H. The father,
E.G.H., is an engine driver on the London, Brighton Railway and
has lived for five years at P. Street. His health history was good
with no recollection of any transient febrile disorder such as might have
been a mild typhoid attack. He said that the patient, his son, had had
headache, pains in the abdomen, sickness and vomiting. The father
had had diarrhoea for one day himself. A sample of the father's faeces
was taken for a bacteriological examination, but proved negative The
second family consisted of J.H.H. (brother of E.G.H. above) his wife
F.H., his sister T.H., and five children, namely C.H., male, 13 years,
T.A.H., female, 9 years, L.H., male 8 years, E.H., female, 5 years
and B.H., female, 4 years. The health history of the family was as
follows:—The father, J.H.H., had pleurisy and pneumonia in
December, 1921 and was six weeks in bed. His physical signs ware
slow in clearing up and the family doctor sent him to the Tuberculosis
Dispensary for co-operative observation. His chest cleared up and
since then his health has been satisfactory. In the past, one has come
across cases in which an attack of pneumonia has been a complication
of a true typhoid infection, so it was felt advisable that samples of his
dejecta should be examined lest he should be a typhoid carrier.
Mrs. J.H.H. had a goitre for which she was receiving medical treatment.
The sister, T.H. had suffered from anaemia and constipation.
The child C.H., aged 13 years, though seemingly in perfect health, had
diarrhoea on the 14th and 15th. His blood serum gave a negative
Widal. The fæces were negative, no B. Typhosus being isolated.