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It will be seen that, in view of the limited medical staff and hospital accommodation locally available and the distance from the laboratory facilities of all kinds and from the main administrative centre in Christchurch, the control of an epidemic of any size in this township poses problems of considerable magnitude. PART lI.—THE OUTBREAK The first case in this outbreak was notified to the Department of Health on the 10th October. The date of onset of this case was most probably the 22nd September, some eighteen days earlier. Some six days later, on 16th October, the local doctor informed the Department at Christchurch that he was attending several patients whom he suspected to have typhoid fever, 2of which were clinically positive. In 1 case only had laboratory confirmation of the diagnosis been obtained. Officers of the Department visited Kaikoura the following day, and on the 17th and 18th October carried out a preliminary inquiry. Some 13 patients in all were interrogated. It became evident from the inquiries made that most of these persons had become ill and had therefore presumably been infected within a few days of each other. The local doctor took samples of blood from several of these patients —these were brought back to Christchurch for examination. With one exception the homes involved were provided with a watercarriage sewerage system. Flies were conspicuously absent and it was difficult to see how the infection, if, indeed, it were typhoid, could be accounted for except by the consumption of some common article of food or drink. The detailed histories taken definitely eliminated all such articles except water and milk. All the affected households received high-pressure water from the town supply; all except one bought their milk from the town milk-vendor. The family in which this exception occurred had their own cow, and this patient subsequently proved not to be a typhoid case. None of the patients appeared to be seriously ill. The majority were children and some of them were kept in bed only with difficulty. Generally they were sitting up in bed and reading or playing with their toys. The only constant symptoms were headache and feeling off colour. All had shown a raised temperature at some time or other. The most striking feature noted about the children was a slightly flushed face and a general impression of tenseness and alertness. Inquiries were made into the water and milk supply and samples of blood, faeces, and urine taken from possible carriers. The results of the specimens submitted to the laboratory on 19th October, 1947 r were not available until the afternoon of the 22nd October, when four positive cultures from the clots of the blood sent in for a Widal examination were reported. The nature of the outbreak was now established and the following immediate action taken (1) The Medical Superintendent of the North Canterbury Hospital Board was notified that preparation should be made for hospitalization of all cases immediately. The medical officer in charge of the Kaikoura Hospital was similarly notified. (2) A statement was made to the local press (which has a wide circulation in the Kaikoura district) informing Kaikoura residents that an epidemic of typhoid fever had broken out and advising them of the steps they should take for their own protection. (3) The bus company which maintains the service between Christchurch and Nelson were notified, and requested to advise their passengers of the occurrence of the outbreak. It was suggested that they confine their meals in Kaikoura, until advised to the contrary, to hot cooked foods only. The manageress of the Railway refreshment-rooms had earlier been advised to boil all milk used.

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