39
REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY
APPENDIX No. IV.
REPORT ON THE INVESTIGATION INTO THE OUTBREAK OF TYPHOID
FEVER AT ST. GEORGE'S HOMES, KAITI
BY
MAJOR J. A. C RUICKSHANK, I . M.S., Assistant Director.
I arrived at Kaiti on June 22nd to investigate the cause of cases of enteric fever which
had occurred in the St. George's Home there. I was accompanied by Assistant Surgeon
S. Ramakrishnan. There had been two cases among the boys one of whom had died and a post
mortem examination revealed that the cause was enteric fever though unfortunately no attempt
was made to isolate the causative organism. I also found a doubtful case in hospital. I
established a laboratory in a room in the Principal's house on June 23rd.
These are the following possibilities as to the causation of the cases:—
(1) W ater-supply—The source of the water-supply drains the Ootacamund-Kallar road
and also the ghat road and so is liable to contamination. The result of the water analysis show
that it is a bad supply and should not be used without purification. There had been heavy
rain some three weeks before my arrival when the water became muddy and the Principal
told me there was a good deal of sickness, vomiting and diarrhœa among the children. I
examined the water and also the water from the old military source which has been acquired
for a new supply. The reports on the water have been sent separately through the usual
channel. The filtration is now efficient and in addition the water is being efficiently chlori
- n a t e d . I t w a s b e i n g b o i l e d b e f o r e d r i n k i n g a t t h e t i m e o f m y v i s i t .
(2) These two boys are said to have bathed in a dirty tank near Kateri within the
incubation period of enteric fever.
(3) It is possible that there is a carrier in the Home. All the cooking is done by
House mothers, the children helping in the distribution of food. No servants are employed.
I commenced an investigation into this point, but as I was transferred to more urgent work
after three days, I was unable to reach any conclusion.
(4) The general sanitation of the Home apart from the sewage disposal is indifferent,
but is now being attended to. There were many flies the kitchen, etc., were not fly proof.
There were still many workmen about and there was no latrine accommodation for them.
(5) I was given to understand that the children are sometimes able to buy sweets, etc.,
outside, and that the bigger boys are able to wander about the hills. The cases may have
been due to infected food obtained on one of these occasions.
The blood of all the boys in the Home was examined and in three there was some slight
evidence of their having had enteric or having been inoculated. As above stated I was
unable to proceed with the investigation, but if more cased occur, it might be worth while to
examine these boys for carriers.
I inspected the catchment area of the old military water-supply, which has been
acquired for the Homes. I consider it to be a good source, free from habitations and cultiva-
tion. The barbed wire requires repair, the stream ought to be trained, and the cement tank
at the point where the source is piped needs cleaning and repair.
The result of the bacteriological examination is not as good as it might be and the
chemical examination reveals an excess of organic matter mainly vegetable in origin. I
think this analysis would be improved by a general clean up and proper policing of the area,
for, at the time of my inspection, there were stray cattle and also some men working at the
wood. The analysis of the present supply in July last year revealed a most unsatisfactory
state of affairs and the source was condemned. The present analysis of the military supply
is definitely superior to that and the fairly satisfactory state of the present supply may be
largely due to absence of rain.
From a general examination of the area, I am of opinion that the proposed military
supply is much superior and much less liable to dangerous pollution to which the other
stream is, from its situation, subject.