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13
A rash does not always appear, but when it does it is usually from the
sixth to the twelfth day. It consists of rose-pink spots, circular, slightly
raised above the surface, generally on the abdomen and chest. They vary
in number from half a dozen to 20 or 30.
Diarrhoea is one of the characteristic symptoms, but is variable in
duration and severity; but sometimes there is constipation throughout.
The stools are of the colour of yellow ochre and are of a peculiarly offensive
odour. The spleen generally is enlarged.
There are few diseases more variable than Typhoid Fever. As a rule
it lasts about three weeks, but sometimes it may last much longer.
Enteric fever generally occurs in the autumn, but an outbreak occurred in
Mile End during the months of February and March, which I was able to
trace to the local milk supply, the milkman being a carrier. 12 cases
occurred in February, 0 being children under 12 years of age, and 9 in March.
All the patients drank milk. One of the patients was a nurse at the Mile
End Hospital. As all the patients (with the exception of the nurse) had
milk from the same dairy, I went to the dairyman's premises and examined
each member of the family. All denied that they had been ill during the
previous few months.
The first difficulty that I met with, was that the father and son carried
on a separate and distinct business at the address. That is, they bought
their milk from a different wholesale firm, kept their receptacles apart, and
each washed his own cans, &c., in the same building, and yet, customers of
each, contracted Typhoid Fever. The son is married and lives away from
the business premises. I called at his house and examined his wife and
two children. One boy, aged looked pale and ill, and I was informed
that he had been an in-patient at the Mile End Hospital from January 11th
to February 3rd.
I took a sample of his blood and submitted it to the Bacteriologist for
a Widal test. I then went to the Mile End Hospital and saw Dr. Wilson,
the Medical Superintendent. We inspected the boy's chart and history
sheets, and his symptoms during the time he was an in-patient were certainly
not inconsistent with those of Typhoid Fever. In fact, the District Medical
Officer had called attention in his notes to a red spot which he had queried
before he was admitted. On making enquiries I found that the Nurse who
had contracted the Enteric Fever was engaged in a ward continuous to the
one in which the boy was a patient, and the Medical Superintendent stated