THE PROPAGATION OP ENTERIC FEVER. Another
striking illustration
has occurred of the fact that may go on for years, perhaps for a generation, drinking water contaminated with sewage, and yet almost escape suffering from typhoid till, the specific poison of this horrible disease being imported, the disease spreads, and the hitherto unsuspecting inhabitants have demonstrated to them the extent to which they have been swallowing fa>cal matter in their drinka
community
ing
Avater.
lately been an outbreak of typhoid in the village in the Union of Frome, Somersetshire, unlike anyhas been seen by medical men who can answer for the medical history of the village for twenty-eight years. Now and again there may have been isolated cases of typhoid, but nothing like the recent outbreak. Nunney has a population of 832. living in 199 houses. It appears that 76 persons got typhoid between June loth and October 26th. Of the 76 cases, 57 occurred in 21 houses, in numbers from two to sis in a house. The remaining 19 cases were solitary ones. There has
of
Nunney, thing which
The interest of the outbreak is, first, in the origin of it, and, secondly, in the mode of its extension. These have been made out by Dr. Ballard with a care and minuteness for which he has already a reputation in regard to typhoid investigations. To fully appreciate the significance of the circumstances, the report must be read in full; but the principal facts are too plain and too practical to be unrecorded by us. The first case, fortunately a very typical one, came from a distant place named Old Ford, and was seen by Mr. Marsh on the loth of June. The patient's named was Sidney Nicholas, and he occupied the very last house in the village up the stream, to which we shall presently refer. On the 29th of June his brother sickened. In August two other cases occurred in this same cottage. In the adjoining cottage three members of the family sickened in the week ending July 13th. An interval of a month elapsed without fresh cases; when, in the weeks ending August 10th and 17th, eleven persons, members of five families, all taking their water from nearly the same spot of the brook which passes through Nunney. and which is so placed as to receive much of the human excrement of Nunney and villages about?viz., "Western-town, "Wanstrow, Holwell (with its twenty-five cottages without privies), and Tenterden, at which last part the first cases occurred, and which brook was the principal source of water for drinking and other domestic purposes to the villagers. Another interval of a fortnight occurred, and the disease spread in other directions. The chief points of Dr. Ballard's investigation are these?first, that the disease was imported; secondly, that there were but three cases in which it was doubtful whether the water from the brook had been drunk, one of these cases being that of a coachman, who said he had nothing to drink in the " village but an occasional glass of beer at the George Inn," both the master and mistress of which had died of the fever; thirdly, that with two exceptions, one of which is doubtful, no fever occurred in families entirely supplied with water from other sources than the brook ; fourthly, that there were at least two instances of persons at some distance taking the fever after visiting Nunney, who had drunk nothing at Nunney but tea, or tea and cider; lastly, as we have already said, that a community may go on drinking water containing excrement for twenty-eight years without being attacked with typhoid, showing that mere faecal matter will not give the disease unless it be charged with the typhoid poison. This has long been a moot point, but there is a steadily increasing weight of testimony in favour of the view so long ably enforced by Dr. William Budd, that the typhoid poison is something specific and not existent in ordinary sewage. The moral of such cases as Nunney is clear, that a town or a village which allows its water-supply to be contaminated with
84,
THE INDIAN MEDICAL GAZETTE.
sewage has all the conditions necessary for an explosion of and only needs the arrival of a case arid a few favourable circumstances to have an extensive and disastrous epidemic. ?The Lancet.
typhoid,
(Maech 1,
1875.
striking illustration
has occurred of the fact that may go on for years, perhaps for a generation, drinking water contaminated with sewage, and yet almost escape suffering from typhoid till, the specific poison of this horrible disease being imported, the disease spreads, and the hitherto unsuspecting inhabitants have demonstrated to them the extent to which they have been swallowing fa>cal matter in their drinka
community
ing
Avater.
lately been an outbreak of typhoid in the village in the Union of Frome, Somersetshire, unlike anyhas been seen by medical men who can answer for the medical history of the village for twenty-eight years. Now and again there may have been isolated cases of typhoid, but nothing like the recent outbreak. Nunney has a population of 832. living in 199 houses. It appears that 76 persons got typhoid between June loth and October 26th. Of the 76 cases, 57 occurred in 21 houses, in numbers from two to sis in a house. The remaining 19 cases were solitary ones. There has
of
Nunney, thing which
The interest of the outbreak is, first, in the origin of it, and, secondly, in the mode of its extension. These have been made out by Dr. Ballard with a care and minuteness for which he has already a reputation in regard to typhoid investigations. To fully appreciate the significance of the circumstances, the report must be read in full; but the principal facts are too plain and too practical to be unrecorded by us. The first case, fortunately a very typical one, came from a distant place named Old Ford, and was seen by Mr. Marsh on the loth of June. The patient's named was Sidney Nicholas, and he occupied the very last house in the village up the stream, to which we shall presently refer. On the 29th of June his brother sickened. In August two other cases occurred in this same cottage. In the adjoining cottage three members of the family sickened in the week ending July 13th. An interval of a month elapsed without fresh cases; when, in the weeks ending August 10th and 17th, eleven persons, members of five families, all taking their water from nearly the same spot of the brook which passes through Nunney. and which is so placed as to receive much of the human excrement of Nunney and villages about?viz., "Western-town, "Wanstrow, Holwell (with its twenty-five cottages without privies), and Tenterden, at which last part the first cases occurred, and which brook was the principal source of water for drinking and other domestic purposes to the villagers. Another interval of a fortnight occurred, and the disease spread in other directions. The chief points of Dr. Ballard's investigation are these?first, that the disease was imported; secondly, that there were but three cases in which it was doubtful whether the water from the brook had been drunk, one of these cases being that of a coachman, who said he had nothing to drink in the " village but an occasional glass of beer at the George Inn," both the master and mistress of which had died of the fever; thirdly, that with two exceptions, one of which is doubtful, no fever occurred in families entirely supplied with water from other sources than the brook ; fourthly, that there were at least two instances of persons at some distance taking the fever after visiting Nunney, who had drunk nothing at Nunney but tea, or tea and cider; lastly, as we have already said, that a community may go on drinking water containing excrement for twenty-eight years without being attacked with typhoid, showing that mere faecal matter will not give the disease unless it be charged with the typhoid poison. This has long been a moot point, but there is a steadily increasing weight of testimony in favour of the view so long ably enforced by Dr. William Budd, that the typhoid poison is something specific and not existent in ordinary sewage. The moral of such cases as Nunney is clear, that a town or a village which allows its water-supply to be contaminated with
84,
THE INDIAN MEDICAL GAZETTE.
sewage has all the conditions necessary for an explosion of and only needs the arrival of a case arid a few favourable circumstances to have an extensive and disastrous epidemic. ?The Lancet.
typhoid,
(Maech 1,
1875.
