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29
enteric fever. Two of these children who were ailing for about a month
were undoubtedly in contact with other children in the neighbouring houses
whilst they were ill, for they were not confined to bed and used to sit on the
front door steps. It may be mentioned that our enquiries were hampered,
especially during the early stages of the prevalence, by reticence on the part
of the patient's friends as to the information they were willing to give about
the cases.
In a number of instances poverty, with its attendant evils, a lack of proper
attention to domestic cleanliness, and want of sufficient accommodation in the
dwellings, undoubtedly helped to spread infection in households. There is,
however, always some risk of secondary cases, even when patients are treated
under the best of conditions. In connection with these cases this is exemplified
by the fact that a nursing sister in one hospital, a nurse in another, and
two nurses and a maid in the Shoreditch Infirmary, in which institution some
of the patients were treated contracted the disease. Moreover it may be
mentioned that one of the disinfecting officers of the Borough also took the
disease and unfortunately died. If persons trained in nursing, who are aware
of the risks of infection, who are dealing with patients under the best conditions
possible nevertheless do acquire enteric fever from their patients, how much
more liable to take infection are those who have to look after cases in the
homes of the poor, where proper accommodation is lacking, where
the conditions as to ventilation and cleanliness are most unfavourable, where
there is ignorance as to nursing, and a want of knowledge as to the patient
suffering from an infectious complaint ? There can be no doubt as to the
answer. In connection with this it is to be noted that cases of enteric fever
are not usually certified much under a fortnight from the commencement of
the illness. It is highly probable that infection is frequently spread during
this period.
It may be mentioned with regard to the results of Widal's test that
in several of the cases, negative results were obtained where clinically the cases
were clearly enteric fever. On the other hand, in one or two instances in which
the illness was not marked, instantaneous positive results were obtained. Cases
23 and 24 on the list may be instanced : the former was typically enteric
fever but Widal was negative ; in the latter case there were no signs of the
disease beyond slight continued pyrexia, the patient being bright and cheerful,
yet Widal's test was positive at once. Case 48 may also be referred to. The
patient in this case was ill from the end of July until the end of October;
there was a relapse but the temperature was never very high. Widal's tests
were made on September 9th, 14th and 21st, with negative results; on
October 4th a positive result was obtained but only in high concentrations
of serum. A further test made on November 17th, when the patient was
convalescent, gave a positive result. A daughter of this patient, who was