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organism responsible for much of the illness. From the history which
could be obtained—not an easy matter and perhaps not too reliable in
view of the very extensive changes which had taken place in the staffing
of the nursery—it seems that the nursery had probably for a long time
had a smouldering infection or infections as numbers of children had
suffered over a period of months from minor alimentary and febrile
disturbances.
The source of the typhoid organisms is considered to be the mother
of one of the children in the nursery. She was on the staff of a convalescent
home outside the district. On investigation she was found to
be excreting typhoid organisms of the same phage type as those found
in the sufferers at the nursery. Her child was admitted to the nursery
on the 19th August. She was alleged to have arrived in this country
from Germany the previous day. The opportunity was there for spreading
infection as she visited the nursery each week, bringing food which was
consumed not only by her own child. She gave no history of recent
illness, so it is improbable that she was herself infected at the nursery.
The laboratory results of examinations of blood specimens were described
as being compatible with temporary or chronic excretion of typhoid
organisms. It is strange if she was the origin of the trouble that she
neither infected her own child nor, it appears, anyone at the convalescent
home at which she was working. Another member of the staff came
under suspicion, more especially as she with her child came to the nursery
on the 16th August, having only a short time before arrived in this
country. Both she and her infant, however, were considered to be recent
infections both because of the clinical signs of their illness and because
of the altered titre of their blood serum.
Complications in the investigation arose because of the difficulty
in obtaining the organisms for purposes of identification. In some
cases positive results of the examination of the stools were obtained only
after a series of four or five negative findings. The same thing happened
when the time came for the patients to be freed from isolation, a positive
result coming up after a series of as many as six negative findings.
The interval between the penultimate and the last case is of interest.
The penultimate positive case was removed to hospital on the 2nd
October. The last case found to be positive after admission to hospital
was admitted on the 27th October. This long period suggested the
possibility of there being some inanimate undiscovered infection still
present in the home, a long period of incubation dating from infection
by one of the patients previously removed to hospital or the presence
of an intermittent carrier state amongst one or more of those at the
nursery. No further cases occurred to give a clue to the reason.
The home was closed, any children there who had not been admitted
to hospital being allowed to proceed to other places on the many
laboratory investigations failing to show that any of those at the nursery
were excreters of the infectious organism. As far as possible those
admitted to the hospital were discharged to their new homes without
returning to the nursery.
This was the first experience in this district of the facilities available
by the staff of the Public Health Laboratory at Colindale, and it
is a pleasure to acknowledge appreciation of the services so freely given.