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paratyphoid B) gave a history of having recently eaten oysters, but not from suspicious sources.
Besides these, in addition to the one case (typhoid) which was secondary to a previous case in
the same family, and the 6 cases (typhoid) in two families (see below), there were 11 cases (5
typhoid, 4 paratyphoid B, one paratyphoid A and one no bacteriological information) in which
no likely source of infection was traced. [Of these one (paratyphoid B) had drunk shallow well
water in the country two days before the onset of the illness, and one (typhoid) had been eating
every day for months boiled fish and watercress and other salads.] No part of the borough was
specially affected, the cases being widely scattered.
The history of the two larger family outbreaks was as follows:—
1. Three notified cases in a middle-class family in Cumberland Terrace, N.W.1 (with
other possible cases not notified).
(In this statement the children are denoted by the letters B or G according to sex and
their age in years.)
B. (12) had a short feverish illness from about 13th May, Widal reaction negative for typhoid
and paratyphoid A and B on 20th May and 30th June (Lister Institute). This case was not notified
as enteric.
B. (8) fell ill with feverishness a week later. Recovered early in June after being in bed for
three weeks, and relapsed towards the end of that month, the disease simulating appendicitis, when
he was again in bed for three weeks. Widal reaction negative for typhoid and paratyphoid A and B
on 20th May (Lister Institute), and on 25th June positive for B. typhosus 1 in 200, B. enteritidis
Gaertner 1 in 50 (slightly), and Y type of dysentery bacillus 1 in 25, and negative for paratyphoid
A and B and the Flexner and Shiga type of dysentery bacillus (Dr. J. G. Greenfield).
Notified as enteric on 27th June.
Housemaid (25) entered the family's service on 3rd May. She had diarrhœa and sickness for a
few days from about 17th May. Widal reaction negative for typhoid and paratyphoid A and B
on 30th June (Lister Institute). Not notified.
Daily man-servant (slept at his own home in Islington) had diarrhoea and sickness for five days
from about 1st June. Widal reaction on 30th June positive for B. typhosus 1 in 100 and definite
traces 1 in 200, negative for paratyphoid A and B (Lister Institute). Notified in Islington as enteric
fever.
G. (16) after being indisposed for about three weeks was found on 24th June to have a temperature
of 103° and was in bed for four weeks from that date. Widal reaction negative for typhoid
and paratyphoid A and B on 30th June (Lister Institute). Notified as enteric on 26th June.
The father (46) became ill on June 25th; the illness was serious and he was in bed for six
weeks. Widal reaction negative on 30th June for typhoid and paratyphoid A and B (Lister
Institute). Notified as enteric on 26th June.
In investigating the cause of this series of cases attention was directed to the cook (E. H.) who
was in the family's service from 22nd April to about the end of May. She had been previously
in service with a family in Hampstead from 21st January to 22nd April, and from 5th April to
3rd May Mr. , her employer, was ill in bed with an illness characterised by headache, high
temperature and loss of appetite, and diagnosed as influenza. The doctors in charge of that case
stated that they did not consider that there was any doubt about the diagnosis of influenza, and no
bacteriological tests were made either during the illness or subsequently. The cook was reported
to be of dirty habits, and her Hampstead employer stated that "she thought she suffered from
some intestinal trouble." She was believed to be a naturalised British subject of Austrian birth.
Efforts to trace her subsequent movements were unsuccessful. It may also be recorded that the
housemaid referred to above came from the country and that her husband had died about six months
before her entering the family's service on 3rd May from dysentery contracted in India. A resident
nursery governess left the family on the same day as the cook. E. H., having been with them for
rather more than two months. There was no special history in connection with her, and her subsequent
movements were unknown. The family were at the seaside from 8th June to 20th June
but the series of cases began before that time.
The household consisted of the above-mentioned persons only, including a cook who took the
place of E. H. on 2nd June, and about whom there was no suspicious history. Enquiries revealed
no other facts bearing upon the causation of the outbreak of illness. None of the cases were fatal.
(10495) G 2