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185
OUTBREAK OF EPIDEMIC CATARRHAL
JAUNDICE.
An outbreak of epidemic catarrhal jaundice occurred
during the last three months of 1914 and January of this
year. 1915. Details of 40 cases have been obtained, the great
majority of these relating to children attending the elementary
schools, as it is much easier to get information concerning
these. It is known, however, that many other cases occurred
during the same period, and that in quite a number of instances
adults were affected. Epidemics of catarrhal jaundice
are not very frequent, although it is not very uncommon for
several children of a family to fall ill of this disease at the
same time.
The aetiology of the disease is obscure. There is no
evidence that it is spread by any particular food, etc., and the
infectivity does not appear to be very marked judging from
the number of instances where more than one case occurred
in a household.
Although, as will appear below, some schools were much
more affected than others, considerable trouble was taken
to ascertain whether any connection could be traced to any
common food or milk supply, but this appears to be directly
or definitely negatived, and this line of enquiry led to no
result.
It must be assumed that the cause is a specific organism,
and it has been suggested that this may possibly gain access
to the body through the pharynx, and it has been stated that
preliminary pharyngitis may occur. In one case only was this
symptom sufficiently well marked to be complained of, but I
know of several other cases which occurred at this time where
children convalescent from scarlet fever or diphtheria had
fallen ill with jaundice.
Symptoms.—The preliminary symptoms vary somewhat.
Vomiting at the commencement was very common: of the 40
cases, 30 were taken ill with this symptom, and this was
usually accompanied by severe headache. Diarrhœa was