View report page

13
somewhat serious aspect, I addressed a circular letter to about one
hundred medical men practising in the central and southern parts
of the parish, requesting to be informed, Whether they had had any
cases of Typhoid fever under their care within the previous six
weeks; and asking particulars of any such cases, the probable
origin of them, especially with reference to the existence of sanitary
defects or a polluted water supply: I also asked to be informed
of the source from which families, where sickness had occurred,
obtained their daily supply of milk? To this circular I
had about fifty replies, verbal or written, and a few new cases were
thus discovered, raising the total number, between the middle of
November and the end of January, 1878, to some thirty cases.
Sixteen of the cases had this feature in common, that the families
in which they occurred had their milk from one of the largest
and best known dairies in the parish. The first of these cases was
recognized on the 18th November, and the last case on or about
the 16th December.* The 16 cases occurred in thirteen well-to-do
families in as many houses and in nine streets. Ten of the sufferers
were above 15 years of age, and six were children ranging in age
from two years to eleven. Six were female domestic servants. The
total number of persons in the several households was 161 — adults
113, children 48. Six of the persons attacked drank milk freely :
most of the others in the usual quantity—i.e., a little—in two or three
instances a very little, with tea, &c. Eight died—four at home and
four in hospitals. The weekly number of cases was 2, 3, 6 and 5=16 :
six males and ten females, †
The circumstance that the sufferers had presumably partaken
of milk obtained from one dairy naturally engaged my attention
in the first instance and satisfied me of the prima facie reasonableness
of the suspicion that had been so freely expressed regarding
milk as the fons et origo maii. There was nothing novel in this
suspicion, for milk has again and again been proved to be the
medium in which the infective agency of typhoid fever had been
conveyed. Milk has the power of absorbing the poison germs
when stored in the vicinity of the sick or when exposed to the infected
emanations from foul drains; but usually the poison has
been introduced into the milk by the addition to it of specifically
polluted water, i.e., water contaminated by the infective discharges
from the bowels of the sick.
It follows that in the investigation of outbreaks of typhoid fever,
enquiry should be specially directed to the discovery of any source
of polluted air or water : attention therefore was first given to the
*Thirteen of the remaining cases were posterior in origin to December 16th.
None of them had partaken of milk from the suspected dairy, and they do not call
for any special notice.
†For particulars of a somewhat important (17th) case that did not come to light
till after the enquiry had been completed, vide page 19.