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enteric fever
17
On October 2nd, M.S., f., aetat. 6, a patient in the hospital, was reported to have the
same disease.
History.—M.S. was admitted to the Institution with a psoas abscess on June 2nd; was transferred to
the Convalescent Home on July 30th ; had a recrudescence of fever on September 24th, and was re-admitted
to the Institution on 25th, idem ; placed in isolation on October 1st, and died on 6th.
Investigations were commenced at the Institution on the same day (October 2nd), when
it was ascertained that four other cases had occurred among the patients, two being then
at the Institution and two at the Convalescent Home. Suspicion fell almost at once on
the case of a child A. F., not then reported as having the disease.
History.—A. F., f., aetat. 3, admitted August 21st, for pneumonia. Transferred to Convalescent Home
5th September; recrudescence of fever 19th, idem ; and re-admitted 20th, idem.
Between August 21st and September 1st, A. F. was in the Surgical Ward, being
transferred to the Medical on the latter date.
Steps were taken to trace back the history of this child's case prior to August 21st. It
was ascertained that she was admitted from Willesden, where she had been living with her
foster-mother (Mrs. B.). A. F.s mother died in Canning Town on June 20th of last year ;
on July 31st. A. F. and her brother S. F. were brought to Paddington and there handed over to
the care of Mrs. B. Although a doctor had certified at that date that the children were in
good health, Mrs. B. stated (on October 3rd) that A. F. was ailing from the day she
received her. A doctor who saw A. F. in W illesden suspected the presence of a " fever."
A. F. was taken to the Out-patient Department on August 14th and 21st, being found to
be so ill (with pneumonia) on the latter day that she was at once admitted as an
in-patient.
On enquiry being made of the Medical Ofucer of Health of West Ham as to the cause
of death of the mother of A. F., the following account was received:—
Mrs. F. was a strong robust woman, aged 22 years, who appeared to have lived a regular life. She is
reported to have been fond of shell-fish, and frequently bought fried fish for supper ; she is supposed to have
bought some cockles about the end of May, and she is known to have partaken of some on the 4th or 5th of
June, which were brought from Southend. Soon after the latter date she was attacked with diarrhoea, and
became increasingly worse, but continued to carry out her domestic duties. Vomiting supervened, and on
the 16th June she went to Poplar Hospital, and from there to the London Hospital, from both of which
institutions she received medicine for diarrhoea. With great difficulty she returned home, went to bed, and
was so ill that on Sunday the 17th a private practitioner was called in, who attended her until her death on
June 20th. Sickness and diarrhoea of a very foul character were constant from the time she went to bed.
S.-St. (where the deceased resided) is one of an isolated group of streets separated from the West of the
Borough by a railway line, in which group there had been no case of enteric fever for many months; but at
another part of my District I had a sudden outbreak of cases of this disease, a large number of which
appeared to be associated with the eating of cockles, purchased on the 26th May from a shop in a main
thoroughfare, which would on occasions possibly be used by Mrs. F.
The whole history of her case is highly suggestive that the pneumonia and heart failure (the certified
causes of death) from which she died were complications of an ambulatory form of enteric fever.
This information tended to confirm the suspicion that A. F.'s case was really one of enteric
fever, a suspicion which was converted to a certainty by the Widal test on 5th October.
It was concluded that the child was capable of spreading infection from July 31st, or
thereabouts, until October 2nd, when full precautions were put into operation. During
that period she had been in Willesden, at the Institution and its Convalescent Home, and
had, there was good reason to believe, infected at least 25 persons, directly or indirectly.
I he cases fall into three groups, as set out below.
In Willesden—
At 24 Q.-Rd. (where Mrs. B. resided) —
W. B., m., aetat. 13 ; sickened 14th August; died 8th September. Widal reaction.