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Typhoid and Paratyphoid Fever.
The incidence and mortality rates of typhoid fever have
decreased considerably since the beginning of the present
century. This improvement is due to the great advance in
sanitation. Cases occur occasionally and are usually due to
carriers. The detection of carriers of this disease is a recognised
procedure in the investigation of all cases notified. On receiving
a positive report from the bacteriologist, the carriers are excluded
from employment as food handlers until negative cultures of
faeces and urine are obtained.
In the investigation of the source of infection of any individual
case phage typing has been proved to be most useful.
The value of preventive inoculation against typhoid fever is
well known. In civilian practice it is reserved for persons
subject to unusual exposure to infection by reason of occupation
or travel and family contacts of carriers, (see graph page 44.)
Pneumonia.
The only forms of pneumonia which are notifiable are
Acute Primary and Acute Influenzal. The downward trend of
the death rates of pneumonia is due to the discovery of the
sulphonamides and antibiotics. The notifications of these types
of pneumonia during the years 1921-51 are shown in the
graph on page 45.
Dysentery.
The term dysentery is loosely applied to all forms of diarrhoea
in which the stools contain mucous and blood. There are two
known types of dysentery—bacillary and amoebic. The parasite
which causes amoebic dysentery has a world-wide distribution,
but fortunately, few cases are to be found in temperate regions
such as England.
The incidence of bacillary dysentery has increased considerably
in recent years. The majority of the notifications of
dysentery is due to infections with the Sonne species of the genus
Shigella. There is reason to believe that the number of actual
cases which occur every year is greatly in excess of the notifications.
Sonne dysentery is mainly a disease of children and often
occurs in close communities such as schools or day nurseries.
Clinically the disease is mild in type and deaths few in number.
It is believed that the spread of this disease is due to temporary
excretors rather than chronic carriers. Infection is spread
mainly by direct and indirect contact.