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5
Typhus
fever.
One case was notified during the year in Stepney, that of a woman iet. 50, originally notified to
be suffering from typhoid fever.
Typhoid
fever.
During 1917 (52 weeks) there were 446 cases of typhoid fever in London as compared with 461
cases in 1916. The number reported in each quarter of the year, except the third, showed decrease
upon the corresponding quarter of 1916, and the slight increase in the third quarter is probably merely
the reflection of the slightly increased incidence of diarrhoea and enteritis in 1917. On the other hand,
the deaths, which in 1916 numbered 75, increased in 1917 to 101, the increase being mainly in the second
(8) and third (15) quarters. An analysis of the age and sex incidence of deaths shows that the increase
occurs chiefly in the age group 20—45 years and among females.
The number of cases in which particulars were obtained by borough medical officers of health
as to possible sources of infection was 183. Fish, shellfish, etc., are mentioned in 51 instances; 16 cases
were those of soldiers or sailors; in 27 cases the disease was said to have been contracted outside London;
42 were ascribed to contact infection (this number included 9 nurses—there were 3 groups of 2 each
and 3 single cases; one of the last-named was almost certainly an oyster case); 5 cases were attributed
to river bathing and 1 to a fall into four feet of sewage water; 3 to drainage; 5 to drinking water
and 3 to "air raids."
In the latter months of the year suspicion was thrown upon oysters as the source of certain
cases of typhoid fever, and in some eleven or twelve London cases there is considerable probability that
polluted oysters obtained from one particular locality were implicated. Attention was first directed
to oysters as the possible source of recent cases by a letter received on the 26th November from a county
medical officer regarding a case occurring after a visit to London where oysters were consumed at a
certain restaurant. The restaurant in question being situated in Westminster, the letter was forwarded
to Dr. Allan and as a result of Dr. Allan's inquiries in connection with this and earlier cases in which
oysters came into question, the Fishmongers' Company caused samples of oysters from a certain locality
to be submitted to Dr. Klein, who reported them to be not clean. Investigations made by the Company's
inspector revealed the fact that some consignments from the source in question had not been
relaid for the proper period for cleansing, but had been consigned directly from a polluted source. The
circumstances were investigated and confirmed by Dr. McEwen, of the Local Government Board, who
succeeded in tracing a number of cases in addition to those occurring in London to oysters from this
particular source and took the necessary steps to prevent further mischief.
A series of cases has been recently noted in two of the London county asylums, and in the
provinces two outbreaks of some severity in asylums have occurred. In none of these cases can it be
ascertained that oysters were implicated.
Plague.
No cases of plague occurred in the administrative county during the year, but on two occasions
vessels arrived in the Port of London from the East with cases of plague on board. In one case (the
S.S. Sardinia), five of the crew were suffering from the disease when the boat arrived on 2nd May, whilst
two had been buried at sea ; the patients were removed to Denton Hospital, together with a suspect
case, and three of them subsequently died. On the second occasion ten cases of plague were reported
on the S.S. Matiana. All necessary precautions were taken by the Port of London Authority.
Anthrax.
Six cases of human anthrax occurred in London during 1917, of which two proved fatal. In
each instance the patient was engaged in handling skins or hides, which doubtless were the means of
conveying the infection.
Outbreak of
illness of a
dysenteric
nature.
A localised outbreak of severe illness associated with dysenteric symptoms occurred in Chelsea.
During the period 4th August to 2nd October, 28 cases were reported, the majority occurring in a
circumscribed area comprising six adjoining streets in a poor part of the borough contiguous to the
river. The outbreak was investigated by Dr. Palgrave in consultation with Dr. Louis Parkes, the
Medical Officer of Health, and Dr. McNalty of the Local Government Board. It was shown that in the
fatal cases the disease had a very rapid course, about five or six days, and post-mortem examinations
revealed extensive intestinal ulceration and swelling of the mesenteric glands. The bacteriology of
the disease was not conclusively cleared up. Of the 28 cases noted during the period specified, 8 died.
Young children were mostly affected, although several cases occurrcd among older children and young
adults. Ten of the cases occurred in one household. Enquiries into the food and water supply, sanitary
arrangements, etc., did not throw any light on the origin of the cases. It was ascertained that a soldier
who had recently suffered from dysentery stayed at the house of one of the families attacked, and it
is now considered that the whole outbreak originated from this soldier.
A similar outbreak was reported about the same time in Islington, where seven cases occurred in
two adjoining houses in the same street. A discharged soldier was living in the house occupied by the
family originally infected. Within two weeks of the soldier's appearance two adults in the house
contracted an acute form of diarrhoea resembling dysentery in certain features. About a week later
two children in the family developed a similar condition. They were removed to Great Ormond-street
Hospital, where they subsequently died- Post-mortem examinations showed all the appearances of
dysentery. In the next house three cases of a like nature occurrcd about the same period.
In addition, 12 other deaths in different parts of London were registered as being due to dysentery,
but only in two instances were the patients known to have been in closc relationship with soldiers, and
none of the soldiers in question were known to have suffered from dysentery. It is important, however,
in view of the extensive epidemics of this disease recently reported in the Central Empires and in Eastern
Europe, that vigilance should be exercised with a view to preventing outbreaks occurring in this country
through the medium of military cases.
Malaria.
On the 1st August, 1917, intimation was received that a number of Australian munition workers
had arrived at Plymouth on board two vessels, the Ulysses and Banalla and that a number of them had