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Table No. 3 gives the number of cases notified under age
groups.
Smallpox
There were 57 referrals for supervision of possible smallpox
contacts who had arrived in this country from locally
infected or declared endemic smallpox areas and who were
reported to be proceeding to addresses in Hounslow. All
these were visited and kept under surveillance for the
required period.
Cholera
Anyone entering the country without a valid cholera
vaccination certificate must be kept under surveillance for
5 days from the date of leaving an infected area.
Information regarding these people is telephoned or
telegrammed to the department from the Port Health
Authorities. By the end of the year 127 such notifications
were received. All these were visited and kept under
surveillance for the required period.
Whooping cough
There were 36 cases notified compared with 30 in 1970 and
11 in 1969. Of these 2 were under the age of one year.
Vaccination records show that 6 of the 24 notified cases
under the age of six years had been immunised in infancy.
and further stated that until an acceptance rate of at least
90% of susceptible children had been achieved, measles
would not be eliminated.
Doctors and health visitors were asked to make a
concerted effort to improve the acceptance rate for measles
vaccination to prevent the recurrence of epidemic measles
and to avoid a build-up of susceptible older children.
Dysentery
There were 14 cases compared with 7 cases in 1970.
Typhoid fever
There were 4 cases notified, two were members of the same
family who had visited relatives in Pakistan, the third was a
girl aged 14 who had recently arrived from India. The
fourth case was a forty-three year old lady who was
admitted to hospital with an undiagnosed illness of three
weeks duration. She developed a breast abscess from which
Salmonella typhi was isolated although faecal specimens
remained negative. Routine epidemiological investigation
revealed that her landlady, who was of Estonian origin was
a carrier of the disease and two phage types of Salmonella
typhi were isolated from her, an untypable \/\ strain and
also a type A. The landlady subsequently had a
cholecystectomy and Salmonella typhi was found in the
gall stone. Repeated specimens over a six month period
following cholecystectomy have all been negative.
An original paper on the events relating to this case and
three previous cases associated with the same typhoid
carrier by Dr. D. A. McSwiggan, consultant microbiologist
at the Central Middlesex Hospital and Dr. Megan E.
Wilkinson, deputy medical officer of health, is reprinted
below by courtesy of Community Medicine vol. 128,
147-8, 1972.
Four cases of typhoid fever associated with a chronic
carrier.
We describe here events relating to four cases of typhoid
fever where an association with the same typhoid carrier
took some time to become apparent.
History
In August 1969 Miss B, a 65-year-old woman, returned from
a short holiday in this country to find her elderly landlady
(Mrs. K) suffering from severe diarrhoea and vomiting.
Miss B looked after the landlady for a week until arrangements
could be made for the latter to be cared for in the
home of a niece. Shortly after this, Miss B developed
diarrhoea and vomiting and became progressively worse
over the next 7 days, when she was admitted to a hospital
for infectious diseases.
A clinical diagnosis of enteric fever was rapidly
confirmed by isolation of Salmonella typhi from both the
blood and stools of Miss B.
It seemed highly probable that her elderly landlady was
also suffering from typhoid fever, and as the address to
which she had been taken was not known, hospitals in the
area were warned of the circumstances. This proved
worthwhile, as the landlady was admitted to one of these
15

The 410 cases notified in 1971 were the lowest
recorded, 54% of the notifications were of children under 5
years of age and 42% were in the 5 - 9 years age group.
The Chief Medical Officer in his circular dated November
1971 drew the attention of all medical officers of health to
the constant need to maintain and improve high levels of
measles vaccination within susceptible child populations