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99
In order to limit the spread of infection, every case notified was
visited by the Sanitary Inspector. Faecal specimens were taken
from all cases and contacts in the household. Any found bacteriologically
positive were notified to their private doctors who arranged
for appropriate treatment. This Department was responsible for
the collection and examination of subsequent specimens. Treatment
was continued until two consecutive specimens were negative
bacteriologically.
Positive cases involved in food handling or working with preschoolchildren,
nursery and schoolchildren, were excluded until
rendered negative.
Four drugs were used in the treatment of cases and contacts
according to the severity of the illness and the individual preference
of the physicians :
(1) Succinyl sulphathiazole (sulphasuxidine).
(2) Sulphaguanidine.
(3) Phthalyl sulphathiazole.
(4) Chloromycetin (chloramphenicol).
It was found that cases not responding to the sulphonamide
drugs cleared quickly with Chloromycetin, which seems to have a
rapid and effective action. It seems also that cases treated with
this antibiotic are less liable to subsequent relapse. In refractory
cases it was found useful, in the absence of Chloromycetin, to treat
with one of the sulphonamides and follow it immediately with
another similar preparation. Sulphaguanidine followed by
sulphasuxidine was very useful in rendering specimens negative
and another good combination was sulphasuxidine followed by
phthalyl sulphathiazole.
A striking feature of the outbreak was the high proportion of
a family found to be positive carriers where a case had occurred. In
some instances all members of a family were found to be harbouring
the organism and it seems that search for and treatment of carriers
is of the utmost importance in dealing with any outbreak. This
form of Dysentery would appear to be spread by individuals carrying
and excreting the organisms. There is evidence that such persons
may be infective for very long periods. One individual known to
us was positive for four months.
Despite diligent investigation, in no case could we establish
infected food as the primary causative agent. I am certain that
our efforts to find and treat positive excreters limited the incidence
considerably.