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On May 6th another probationer felt unwell, vomiting the following day and looking jaundiced
on May 10th and 11th. On May 9th, two other probationers felt unwell, one of them vomiting,
and both subsequently becoming jaundiced. A fourth nurse who felt unwell on May 9th became
jaundiced on May 14th. Rises of temperature were either absent or of slight degree and no hæmorrhagic
lesions in the skin occurred.
These nurses all shared the same bedroom, the room being partially sub-divided into cubicles
by curtains. No dietetic or other common aetiological factor could be discovered except (1) contact
with the first case and (2) a common bedroom and common work-place.
A further case occurred in a cleaner who worked half-days at the Nursery. She felt ill and
had abdominal pain on May 15th, this continuing on May 16th and 17th. Her urine was very dark,
but nothing abnormal was discovered on examination. She still showed definite icterus on May 20th.
Her daughter, aged 14 months, vomited twice on May 20th but on examination on May 25th
showed nothing significant.
A medical officer from the Ministry of Health kindly assisted in the investigation of the outbreak
and various examinations of throat swabs and specimens of urine and faeces were made, nothing
significant being discovered.
The Nursery was closed to children for a week and on being re-opened, careful clinical observation
was kept on all the children, their urine also being examined for bile salts and bile pigment.
One child, aged 9 months was discovered towards the end of May to have a transient glycosuria.
His mother, who attended the Nursery night and morning to bring and fetch him, felt unwell on
May 24th, vomited on May 26th and subsequently for some days suffered from nausea and flatulence.
She noticed that her motion was clay coloured and her urine dark on May 26th, continuing so for a
few days. Recovery, as in the case of the nurses, was uneventful.
No further cases occurred in the children and the marked susceptibility of adults in this outbreak
is curious.
One further, apparently independent, outbreak was discovered. Mrs. L., aged 31 years, was
in Fulham Hospital with phlebitis from July, 1936, to January 16th, 1937. She vomited about a
week after returning home and one week later was jaundiced, the condition persisting about three
weeks. Her son, John, aged 13 years, felt sick towards the end of February (no vomiting) and then
became jaundiced. He was away from school three weeks with this condition. Ann, aged three years,
was feverish and restless, feeling sick also on May 27th, having appeared listless for two or three days.
She showed no definite icterus but bile salts were present in the urine.
No contact of any kind could be discovered between this family and the Day Nursery and its
staff or children.
It will be noted that this outbreak was unaccompanied either by deaths or complications.
NON-NOTIFIABLE INFECTIOUS DISEASES
During 1937 the Woman Sanitary Inspector paid visits to cases of non-notifiable infectious
diseases as follows:—
Chicken pox 50
Whooping Cough 30
Mumps 60
Suspicious cases (sore throats, spots, etc.) 80
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