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18
Much infected excrementitious matter must have passed into the
main sewer between November 18th and December 16th (and
cases had certainly occurred in the course of it not long before):
it is not difficult to conceive, therefore, that the air circulating in
it, and through its affluents, had become specifically poisoned, and
that the gases escaping into houses where sanitary defects existed ;
or becoming, in some cases, absorbed by the water in cisterns, may
have caused the mischief. Insanitary conditions, it is well known,
lower the health of those exposed to them and prepare the system
to succumb readily to zymotic poisons. Such insanitary conditions
existed in many of the houses, and the persons most exposed
to them- not the chief milk drinkers, but the servants who
inhabit basements were, as a class, the most numerous victims.
The theory here put forward would help us to explain the high
rate of mortality in our sixteen cases—a fatality which, as before
observed, militates against the milk theory. It is consistent,
moreover, with the results of the investigation of similar outbreaks
in small towns, where the conditions were less complex, and the
conclusions arrived at were of a more demonstrable character,
and it is supported by certain inferences that may be fairly
drawn from the facts of the cases:—
For example, there was a case in each of two adjoining houses,
the second case beginning thirteen days after the first. The milk in
the second family was not obtained from the suspected dairy, and
the illness was attributed to a sanitary defect similar to that which
existed in the first house.
In another street there were cases in adjoining houses—an
interval of thirteen days separating them. The families had milk
from the same suspected dairy: but in both houses there were
similar sanitary defects.
The same relations in respect to the situation of houses, and
the commencement of cases, existed in a third instance: and
in two others, in two streets, there was a similar state of
things, though the houses were not so close together, but the
milk in all these instances was obtained from the suspected dairy.
This is the suspicious feature in the cases : but the essential facts
to which I would allude are, (1) that in all the cases above
glanced at sewer gas was found to have free entrance into the
houses: and (2) that an interval of many days separated the cases,
in respect of time, both in contiguous and detached houses in
the same streets. Excluding secondary cases in the same houses,
we have only 13 cases to deal with, and the points alluded to are
applicable to eight of them.
Had the outbreak depended on milk I cannot but
think the cases would have been more numerous, and that
there would have been large groups of cases occurring almost
simultaneously : whereas, though there were many children in some