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and blood. From the 3rd to the 6th day the diarrhoea lessened and had usually ceased by the
7th to the 10th day.
Some rather unusual features occurred in the case of a boy aged 11 years which it may
be of interest to describe. His illness commenced with a feeling of complete collapse at 12 noon
on the 20th November, skin being clammy and face cyanosed. He experienced extreme nausea
but did not vomit, nor did he complain of abdominal pain. At 4 p.m. his temperature rose to
104°F. and at 8 p.m. diarrhoea commenced. This was very soon blood stained and contained
mucus. Nineteen motions were passed during the night and he complained of the gradual onset
of headache and pains in the neck. These symptoms continued during the following day and
he further complained of photophobia and, for an hour in the morning, was unable to bear the
weight of the bedclothes anywhere near him. The diarrhoea continued, about 20 motions being
passed, all blood stained and containing mucus. His temperature was 100°F. Next day the
diarrhoea lessened and he felt much better. His nausea left him and his temperature was almost
normal. He continued to have 3 to 4 blood stained motions for the next three days and after
the 6th day the diarrhoea ceased altogether. By this time he looked, and felt, rather washed
out, but went on to make an uninterrupted recovery.
2. Treatment.
The treatment was more or less symptomatic and consisted of the elimination of the toxic
process by means of a fluid diet and salines and the administration of bowel sedatives. Milk
was contra-indicated in any form and, in the more severe type of case, caused aggravation of
the abdominal distress.
3. Sanitary action.
Little action was necessary on the part of the Health Department as adequate trea ment
of the disease and advice regarding disinfection of the excreta, etc., was carried out by the local
practitioners. In no case was it found to be advisable to recommend the removal of any patient
to hospital for observation or treatment.
4. Epidemiological features.
An epidemic of Sonne dysentery of the magnitude of this affecting the London and Home
Counties area has hitherto been unknown in this Country, although small outbreaks have been
recorded, from time to time. The disease has been much more prevalent in the United States
and Scandinavia and while investigating cases of dysentery in Norway in 1919, Thytta stated
that it was probably much more prevalent than statistics showed owing to cases not being subjected
to bacteriological investigation on account of the mildness of the symptoms.
While it is assumed that the spread is due to the passing on of the infection from a
patient or convalescent to a contact, it is reasonable to think that, owing to the rapidity with
which the disease has spread over such a wide area, some other factor is concerned in the transmission
at the beginning of the epidemic at least. Various possibilities have been suggested
such as an air borne infection, transmission by flies etc., while the most original seeks to trace
a connection between the spread of the disease and the changing habits of seagulls.
It was not possible to determine the incubation period with any degree of accuracy.
Taking those cases among which a history of contact appeared certain the average time between
such contact and the onset of the first symptoms was 1—3 days. In three different families,
however, a much longer period than this seemed to be quite definite and one of them appears
to be worthy of note. In this particular household four persons were involved, the mother, her
two children and the children's nurse. The source of the infection was known, as the mother
developed the characteristic symptoms some hours after partaking of a meal at a London Cafe.
Nine days later her children both became ill and eleven days after this the nurse who attended
them followed suit.
The average time of the longer incubation periods was about eight days.
As stated previously few cases were seen early enough for bacteriological examination to
be really effective and reliance had to be placed chiefly on an accurate record of the history and
clinical symptoms.
Diagnosis was confirmed by bacteriological or serological examination in 38% of cases
only.
AGE AND SEX DISTRIBUTION OF CASES.
Age.
Male.
Female.
69 cases were investigated and of these 53 were
notified by private practitioners, 6 referred for
examination from the various M. & C.W. Centres
and 10 followed up after school enquiry.
Under 1 year
2
2
1— 5 „
8
7
5—10 „
9
7
10—15 „
5
3
15—20 „
2
1
20—40 „
2
10
40—60 „
3
5
Over 60 „
2
1
48