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74
Modes of Spread.
The organisms of the disease are contained in the excretions of
persons who are suffering, or have suffered, from the disease. It
has been estimated that one person in every thousand of the population
is a "carrier," and that 25 per cent. of all chronic carriers
have had the disease in such a mild form that it has never been
suspected or diagnosed.
The disease is generally spread by some article of food or
drink which has become infected by the excretions of a patient or
carrier, although it may also be conveyed by flies, infected clothing
or bedding, dust, etc.
Polluted water may cause enteric fever either directly or by
way of infection of milk utensils ; and enteric organisms may be
recovered from sewage effluents even after the most modern methods
of treatment.
In spite of the evidence of the efficiency of pasteurisation in
controlling the Epping and Bournemouth outbreaks, much of the
milk sold in this and other areas is still unpasteurised.
Such foodstuffs as celery, watercress, ice-cream, shell-fish,
fried fish and bread have been the cause of widespread epidemics.
Control.
It will be evident that, as in the case of other infectious diseases,
the possibilities of infection are enormous. The relative immunity
from typhoid fever which the community enjoys is the result of
unceasing vigilance on the part of the public health service ; and
the present Croydon epidemic should serve as a reminder of the
danger which efficient health administration has served to obscure.
In spite of the great increase in our knowledge of the bacteriology
and causation of enteric fever, reliance should be placed first
and foremost on the well-tried sanitary measures which prevent
pollution of water, food and soil. Every effort should be made to
ensure that food is not prepared by persons whose hands have not
been thoroughly cleansed before they commence work.