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107
Erysipelas.—Four cases were notified compared with 6 last
year and 5 for 1954. One case received hospital treatment.
Zymotic Enteritis or Epidemic Diarrhoea (Children under
5 years of age).—Originally 18 cases were notified but this figure was
modified and 17 were eventually recorded as confirmed compared
with 7 for the previous year.
Three cases were admitted to hospital but there were no deaths.
Sonne Dysentery.—This disease is usually characterised by
diarrhoea, fever and, to a lesser extent, vomiting. Although
modern methods of treatment are effective and usually fairly rapid,
nevertheless the disease has become a serious nuisance and difficult
to control. It is normally mild but in infants and young children it
can produce serious illness and debility, especially if the patients are
already slightly below normal health. In adults it is an irksome
inconvenience and, if they work in the food trade, it can cause
economic hardship.
Notifications of this illness are increasing and have increased
alarmingly since the war, e.g. in 1940, 2,860 cases of Dysentery were
notified in England and Wales and in 1954 there were 31,833.
Undoubtedly these figures represent only a fraction of the true incidence,
because in Greenwich we have found many cases with symptoms
too mild to seek serious medical attention, and yet these
untreated cases can become a potent source of spread. Since the
war the incidence in Greenwich has paralleled national experience ;
e.g., in 1946 notifications totalled 8 and in 1954 70.
The problem is to decide whether this type of Sonne Dysentery
which is now so prevalent is of exactly the same type as previously
existed. Some workers believe that new strains of Sonne organisms
of increased infectivity and antigenically indistinguishable from the
old organism were imported into the country during the war. On
the other hand this " new " Dysentery may be a true variant of the
old strains—laboratories are apparently unable to help us in this
matter.
The difficulties of preventing outbreaks or controlling them
when they occur have been magnified by the lack of knowledge of
the precise methods of spread of the illness. Some years ago it was
confidently assumed that the spread was predominantly by food
and drink, and that, indeed, may have been true. Recently, however,
it has been suggested that this method is no longer of primary
importance and that case-to-case contact is the method of choice.
It is significant in support of change of method of spread from food
to direct contact that the most vulnerable groups in respect of food