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outbreak. No other local vendor supplied more than a very small number of houses. B's
business was a considerable one, and his premises were situated not far from the centre of the
area affected, so that it might be anticipated that a considerable percentage of persons attacked
would be supplied with milk by him. B was the occupier of cowshed premises, with accommodation
for 16 cows, and his milk was obtained almost exclusively from his own cows. The
wholesale supplies of all the local vendors were made the subject of inquiry; the facts have
now no special interest; in the early days of the outbreak it had been noted as remarkable that
four of these local vendors Messrs. A, D, G, and I—were obtaining milk from the company
supplying the vendor in Kensal Town, in connection with whose business the question of the
relation of milk supply and enteric fever was at the time being carefully investigated.*
Use of swimming baths.—In the early days of the outbreak importance was attached to the
fact that a number of the sufferers had been in the habit of visiting a twopenny swimming bath
in connection with some public baths situated a little to the north of the affected area. It was
from the first obvious that considerable difficulty must be experienced in endeavouring to connect
the use of a swimming bath, situated as this one was, with the outbreak of enteric fever, inasmuch
as the bath was quite outside the locality invaded by the disease, and while it was largely used
by residents in that locality, was also unquestionably used by many other persons, all of whom
had escaped infection. The number of those attacked who had attended these baths led, however,
to careful inquiry being made into the matter. On October 5th Dr. Waldo and I obtained, by
the courtesy of the superintendent of the baths, full particulars concerning them.
Most of the sufferers from enteric fever who made use of the twopenny swimming bath
were school children, and it was found to be the practice for parties of such children to be taken
to the baths for the purpose of being taught to swim.
During the week ending August 25th 1,296 males used the twopenny swimming bath, and
67 boys, scholars at various schools, were also taken there. Thirty females and 42 girl scholars
used the bath in that week.
In the week ending September 1st the numbers were 792 males and 615 boy scholars; 18
females and 285 girl scholars.
In the week ending September 8th, the corresponding numbers were 906 males and 727 boy
scholars; 19 females and 248 girl scholars.
Most of the swimmers (other than boy and girl scholars) were said to be under thirty years
of age, so that prima facie the bath hypothesis afforded some promise of fitting in with thepeculiar
age incidence of the enteric fever, but, on the other hand, it appeared difficult to understand
how it was that, whereas the scholars were only about half the total number of swimmers,
the cases of enteric fever, in which a history of attendance at the baths was given, were, for the
most part, confined to them. Again, the cases of enteric fever among scholars had principally
affected those attendin g two particular schools, and there were some dozen schools sending scholars
to the swimming baths; thus scholars attending the rest of these schools had almost entirely
escaped.
The facts were fully ascertained as regards use of the baths by scholars, and they may be
summarised as follows—
On Mondays boys from schools A, B, C and D attended the baths.
On Tuesdays boys from schools B, E and F attended the baths.
On Wednesday girls from schools A, C, D, F, G, I, J, L, M and two other institutions
attended the baths.
On Thursdays boys from schools G, H, F and I attended the baths.
On Fridays boys from schools C, H, J, K, L and M attended the baths.
All these children used the same swimming bath. This bath was cleansed and scrubbed on
the following dates—August 14th, 16th, 18th, 21st, 25th and 28th; September 1st, 4th and 8th.
The particulars as to attendance of individual sufferers at the baths are given in the
appended notes, in which these particular baths are referred to as the " X" baths.
Limiting consideration to the cases numbered 6 to 110 (i.e., to the cases occurring
at the time of special prevalence) particulars as to attendance at the baths in question were
ascertained in 83 instances. In 52 of these the patient never attended at the particular
baths, and in some of the 31 instances in which such attendance was made, it is noted as having
occurred some weeks before the onset of illness; again, in one or two cases it was the " first-class
bath," and not the twopenny swimming bath which was visited. Most of the cases occurring
among scholars who attended the baths were cases of boys and girls going to the school J (the
girls from this school attended the baths on Wednesdays, the boys on Fridays). A few boys
attending the school B, who attended on Mondays and Tuesdays, were also attacked. Girls from
this school are not taken to the baths. These two schools, it may be noted, are the schools
attended by the majority of children living on the area, but school J accommodates more children
from the area than school B does. Lists of children who attended the baths on particular days
were obtained by Dr. Waldo; they corroborate the particulars as to bath attendance obtained
from the patients themselves.
It was at first thought to be conceivable that infection of the water in the bath occurring,
say, after the bath was cleansed on August 28th (Tuesday), might have led to infection of boys
*The local vendor B on very rare occasions, " when he ran short," obtained a gallon extra, but could not
specify whence such extra supply would be derived. He was sure he had not had any extra milk for about a
month before the commencement of the outbreak. B's manager subsequently confirmed this last statement,
and enumerated the sources from which extra milk had been obtained in the past summer; these sources did
not include the company supplying milk in Kensal Town, and the manager on being asked said no milk had
been obtained from that company. It may be noted that even supposing B to have received a gallon of
milk from this company, the proportion of sufferers supplied with milk derived from the large company would
still, under these circumstances, be less than half the total number of persons attacked.
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