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43
This group of cases in the same family tells its own tale by the dates in the
columns, "Beginning of Illness," "Date of Notification" and "Date of
Removal." The father Robert was first attacked, and as the mother was
unable to nurse him on account of pregnancy and lying in, the daughter Lily
nursed him, and when Lily fell ill Nina nursed her. This is a very clear
illustration of the spread of typhoid fever by personal infection from one
member of a family to another consecutively, five cases over a period of five
months. The father, who died a few days after removal to hospital, gave a
history of having eaten oysters a fortnight before falling ill. The family
occupied a dwelling of three rooms.
Infcctivity and Size of Dwelling.—In January, 1903, Dr. Chalmers, the
Medical Officer of Health, presented to the Committee on Health, a Report, to
which was appended an account of an Inquiry by Dr. Dittmann, as to the
incidence of enteric fever in the Eastern District of Glasgow from 1897—
1901. This inquiry elicited the fact that a relationship existed between the
occurrence of secondary cases of enteric fever in the same family and the size
of the dwelling. The dwellings were divided into 1, 2, 3, and 4 or more room
dwellings. The first indication was that secondary cases occurred more
frequently in the larger dwellings. The figures revealed in the second place
that as the dwelling increased in size the intervals between the primary and
secondary sickenings increased; enteric fever declares itself slowly, but as
soon as diagnosed and notified all cases were removed to hospital from one
room dwellings, and nearly all from two room dwellings, while patients were
frequently nursed at home in dwellings of three or more rooms. In the third
place the figures showed that the percentage of secondary cases in dwellings
of one room was 6.2, of two rooms 7.9, of three rooms 8.3, and of four or more
rooms 6.5, due, doubtless, to the possibility of isolation becoming greater as
the dwelling increases in size, to the proportionately longer retention of cases
at home, and to the ultimate breakdown of the rigid precautions in a
proportion of the cases nursed at home.
Typhoid and Bedding.— During the second quarter of the year a
communication was received from the Local Government Board stating that
they had received information in connection with an outbreak of enteric fever
on board the training ship "Cornwall," that a large quantity of old army
blankets lately received in this country from South Africa had been disposed
of by certain London firms to persons in various parts, and that bacteriological
examination of some of these blankets had shewn that many of them which
were dirty and stained were probably specifically infected. Careful inquiries
were made at all the places where the blankets had been delivered in St.
Pancras. All the blankets were removed and disinfected and returned, and
no spread of infection was traced to them.
Watercress and Typhoid Fever.—It is now well established that shellfish
that has been polluted by sewage may be the means of communicating enteric
fever to consumers, and especially raw and scalded, and even partly cooked
shellfish. The Medical Officer of Health of Hackney in an enquiry into the
prevalence of enteric fever in that Borough during the summer of 1903 found
grounds for the possibility of sewage polluted watercress acting as a carrier of
the disease, and the Local Government Board was requested to enquire into
this possibility.