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tember 14th, two on September 15 th, one on September 16th,
three on September 17 th, one on September 19th, four on September
20th, five on September 21st, two on September 22nd,
three on September 25th, and one each on September 26th, 27th,
28th, and 30th respectively; whilst during October there have
been nine more cases notified.
Each house has been visited by me personally, and as a result
of investigation, it has been found that intervals varying from
days to weeks have elapsed between the cases sickening and being
notified, and during those intervals infected centres have exis-ted
in the area, which is a crowded one, and one in which there is
considerable daily; and hourly inter-communication between persons
and families living in different houses. In 3 cases the
interval was three to four weeks; in 3 cases two to three weeks;
in 19 cases one to two weeks ; and in 17 cases one to seven days.
A further means of inter-communication (and a most important
one, as it has been proved since) is in connection with the mangling
of clothes. It is found that many of the people living in this
area (as elsewhere) after washing their clothes take them to some
neighbour or neighbours who possess a mangling machine, to have
them mangled or wrung, and the present outbreak shows pretty
conclusively that such mangles may be the means of spreading a
particular disease like typhoid fever, which is infectious and contagious
by reason of the germs that are voided in large numbers
from patients whilst suffering from the disease, and even during
convalescence, through the bowels and the kidneys. Stains on
bedding, underclothing, etc., would be especially dangerous, and
if such stained and infected clothes or bedding were taken from
an infected house or houses and mixed with non-infected clothes
and bedding from other houses, it is readily understood how the
disease might be propagated from person to person, and from
house to house. Such has apparently been the mode of spread
in the present outbreak, as by working out the dates of sickening
of the infected persons, it is found that the different cases fit one
into another like a Chinese puzzle.
Another important factor in the outbreak is the difficulty in
diagnosing exactly typhoid fever in its early stages.