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EPIDEMIC OF DYSENTERY.
On November 24th, 1937, the existence of an outbreak of a definite type of enteritis was
brought to the notice of the Health Department.
A circular letter was immediately sent to all the general practitioners in the district
requesting them to give what information they could concerning any case of diarrhoea they were
treating or had treated during the previous two or three weeks. The response to this was
immediate, and all cases notified were visited and complete investigation of the cause and subsequent
course of the illness carried out.
Examination of the faeces and blood proved the enteritis to be a form of dysentery caused
by the bacillus dysenteriae Sonne.
Practical difficulties experienced.
Unfortunately from the statistical point of view, the epidemic was past its peak before
the notification of cases commenced so that several difficulties attended any attempt to produce an
accurate survey.
In the first place it was impossible to attempt to trace the original source of the infection.
The supplies of milk and water, as being the agents most likely to account for such a wide
spread epidemic, were both investigated. Most of the milk comes from outside the district so
it was not thought necessary, in view of the mildness and the late stage of the outbreak, to
incur the expense entailed in pursuing the enquiry further. Water supplies were taken from
parts of the Borough where the concentration of cases was thickest. In every instance the water
was found to be of the highest hygienic purity and completely free from any dysentery organisms.
Another difficulty was provided by the fact that many cases must have been missed
where, owing to the mildness of the symptoms, no medical aid was sought. This must have
occurred chiefly among the women and children as the adult males found it impossible to carry
on with their work while the diarrhoea lasted. To obviate this, as far as possible, a close
watch was kept at the various clinics and enquiry was made at the schools regarding any absenteeism
due to diarrhoea.
Samples of blood and faeces were taken wherever possible and here again difficulty was
experienced. In the first place few cases were seen early enough for bacteriological examination
of the faeces to be of much importance as, after the 4th day, isolation of the causative organisms
provided great difficulty in some cases. Where no information was gained from an examination
of the faeces a sample of blood was taken for the purpose of demonstrating the presence of the
specific agglutinins which are usually present from 7-21 days after the onset of the disease.
By this time the patient was usually quite well and, therefore, apt to resent giving his blood for
what were really purely experimental purposes. Also mothers were in the same position regarding
blood being taken from their children and only in one case was a sample taken from a child
under 14 years of age. Actually it is pleasing to record that, in the main, excellent co-operation
and help were afforded by everyone concerned.
Features of the outbreak.
1. Clinical Symptoms.
The manifestations presented were very varied in their intensity and ranged from slight
intestinal irritation, with the passage of 3 or 4 motions, through increasing grades of severity
to a much more severe type. The majority of cases were of the mild type and the following
was the average history given.
The first complaint was of abdominal discomfort with the almost immediate onset of
diarrhoea, about 6 to 8 times during the first 24 hours. The motions were very fluid and offensive
and, in some cases, green in colour. On the 2nd day the diarrhoea was rather worse, about 10
motions being passed and these contained mucus, and, in a few cases, small quantities of blood.
From the 3rd day the diarroea gradually lessened and, by the 4th or 5th, had ceased altogether,
the patient by this time feeling practically normal. The temperature in the majority was practically
normal throughout. In a few cases it was subnormal for the first two days.
In severe cases the initial symptoms were of a much more pronounced nature. The onset
was acute with severe colicy pain followed by the frequent passage of very fluid foetid motions
which, in some cases, contained blood from the first. Nausea was usually extreme but there
was seldom any vomiting. The temperature was raised in most cases during the first two days
and sometimes reached as high as 104°F., especially in children.
Another feature which was most commonly seen in children was the early onset of collapse
in quite a number of cases. This compared with the intense colic of the adult.
These acute symptoms lasted as a rule for about 36—48 hours and, during this time,
the diarrhoea was very severe, the motions in some cases being over 20 daily and containing mucus
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