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62
necessity for awareness of statements given on enquiry and for not
coming to a too early conclusion as to the source of infection.
The history is as follows:—
The patient was 48 years of age and dangerously ill. Illness
began on 28th January. 1953. A Consultant was called in on
8th February and diagnosed Typhoid, which he later confirmed by
blood culture and stool on 9th February. Detailed Public Health
enquiries began on the 9th February. These proved that the patient
had been resident in the premises since 1938. Except for a weekend
in Oxfordshire in 1940. she had not left the district at any time,
nor had she taken meals or food otherwise than that provided on
the premises. There had been no illness in the premises, either
among the eighteen residents or among the four resident and seven
non-resident staff. There had been no changes in staff or in the
residents during the previous six months. The water supply was
that of the Metropolitan Water Board; the premises were on main
drainage except for the lodge which was on cesspool drainage.
There had been no case of Typhoid in the district for the past five
years, nor any case of Typhoid recorded as related to the premises.
All residents and staff declared that they had never suffered from
an enteric fever. The kitchen hygiene was good, but there was no
provision for handwashing immediately available to the kitchen
staff. No vegetables had recently been supplied from the garden
of the premises which took some of the effluent from cesspool. It
was apparent from the information and investigations that the
infection was within the premises. We therefore first concentrated
on the food handlers. Stool outfits were left for all staff and all
residents, and it is of special interest to record that it was later
found that the proprietor and his wife were the only ones who
were unable to submit specimens.
At these early stages of investigations, the water supply was
examined. Moore's sewer swabs were laid in the effluent from the
lodge cesspool—all of which proved negative to Typhoid. One of
the first results of the pathological specimens to be returned on
12th February was a positive stool from a part-time dishwasher,
who attended for two hours each evening. Her blood reaction
indicated a carrier state, the Vi-agglutination being positive in 1/10
and her Widal negative. The conclusion reached was that here was
the source of infection. The history of this young married woman
was that she had been perfectly well during the past six months
and had had no illness except about two and a half years ago
when she had an attack of Dysentery. She had been employed in
her job on a part-time basis for a few hours each evening since
October. 1952. Her husband had served in the Middle East before
her marriage two and a half years ago. Repeated stools and bloods
taken from him and the child all proved negative. His blood
reaction was as follows:—