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68
The fact that the cases occurred on consecutive dates points
to a case-to-case infection. The first case of Diarrhoea occurred
on August 28th, and the other cases occurred at intervals up to
September 9th. There was no Diarrhaea amongst the nurses before
the end of August and the illness started amongst them during the
first week in September. It was impossible to fix the exact date
of onset in the nurses, but the exact dates could be fixed in the
children, as charts were kept recording the temperatures, state
of the bowels, etc., and from the dates given in a preceding page
it will be observed that the cases occurred, not at the same time,
but at varying intervals following each other. It is no objection
to the evidence of communicability that all the members of the
household were not attacked. In the early stages, no significance
was attached to the occurrence of successive cases, but later the
probability of communicability was appreciated and precautions
were taken. As soon as these precautions were taken the
outbreak ceased, although the conditions favourable to Diarrhoea
continued for some time. In London the deaths from Diarrhoea
did not appreciably drop until the middle of October, and the
temperature was comparatively high for a month later. Last
summer up to the week ending August 23rd, the temperature in
London was below the average; for the week ending August 30th,
it was below 2.3° below the average, and for the weeks ending
September 6th and 13th, the temperature was only 0.5° and 0.4°
respectively, below the average. For the week ending September
20th, it was 2.2° below the average, but for the week ending
September 27th, it was 4.8° above the average.
It is only fair to state that some authorities believe that
Diarrhoea is not an infectious disease.
At the Children's Hospital, Vincent Square, no precautions,
as in the case of infectious disease, are taken. No attempt at
isolation is made. The infants lie side by side in their cots—the
case of severe atrophy next to the case of epidemic Diarrhoea—
and they are attended by the same nurses, who minister to all their
requirements, and yet there is no case-to-case infection.