Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
1. That the epidemic was due to infection of the water supply is borne out by the following points:
(a) The explosive character of the outbreak as shown in Graph II which is characterised by a rapid rise to peak at the end of third week followed by a sharp fall and a gradual tailing off to the end of the epidemic.
(b) The widespread distribution of cases (see Map), no area supplied by water from the city having escaped.
(c) The rapid decline which followed the adoption of appropriate measures to deal with the water supply.
2. 255 persons in the city area (including the 12 military cases) were definitely affected (equivalent to a rate of 3·1 per 1000 of the population). As shown by the rise in the death-rate for the rural area it is apparent that a far greater number of persons were actually attacked.
3. The outbreak had its origin in a defective manhole in the Mental Hospital grounds whereby the sewage overflowed into a rubble drain and infected the water supply. This defect had existed for twenty-five years, and an epidemic in the hospital fifteen years previously established the reservoir from which infection was disseminated through the city.
4. The spread of typhoid was favoured by unsatisfactory arrangements for the filtration of the water supply. This is borne out by the endemic character of the disease prior to the installation of an effective filtration plant.
5. The institution of this plant was followed by an immediate reduction in the incidence of the disease until, as at the present time, water-borne typhoid has been practically eliminated.
6. The value of such a plant combined with chlorination and bacteriological examination has been shown.
