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72
Enteric Fever.
1'our cases of enteric fever were notified during the year; none died.
the facts relating1 to the cases are as follows: —
Case No. 1. The patient was a professional man, aged 63 years, residing in a good class
flat. He first became ill about the middle of April and was notified as suffering from Enteric
Fever on the 7tli May. The Widal test gave a negative result. No definite source of
infection could be ascertained but it was stated that the patient caught cold whilst playing
golf a few days before the first symptoms of the illness and subsequently he developed
symptoms resembling those of influenza, and these were followed by gastric trouble.
Case No. 2. This patient was a male, aged 22, residing in a good class residential
house. The Widal test gave a positive result. The patient became ill about the third
week in November. He was reported to have had a high temperature for two or three days,
a month prior to his illness, again two weeks later, and again two days before the
definite symptoms of Enteric Fever developed. This patient had partaken of shell-fish,
oysters in the early part of November but other members of the family also partook of
oysters from the same batch at the same time and suffered no illness. Communications,
however, were sent to the large Stores from which the oysters were obtained and after
enquiries the Secretary of the Company intimated that they had sold a very large number
of oysters since the beginning of the season but no complaint of any description had been
received in connection therewith. It would, therefore, seem difficult to associate this case
of Enteric Fever with the consumption of these shell-fisli.
Cases Nos. 3 and 4. These patients were nurses, aged 29 and 20 years respectively,
working in a hospital in the Borough and were notified, one on the 7th and the other on the
14th of December. Both gave a Positive reaction to the Widal test. On enquiry
iT. was ascertained that both patients had worked in the same ward during
the month prior to their illness. An examination was therefore made of all
the patients in the ward concerned and it was found that one patient, a child of 5½ years,
gave a positive reaction to the Widal test. Her serum agglutinated the Oxford Standard
B. typhosus in dilutions 1-25, 1-50, 1-125 and 1-250—the reaction to Oxford Para B. and Para
C. were completely negative. On five consecutive examinations of her stools no B. typhosus
were found, her urine remained negative also, and there were no clinical symptoms of
Enteric Fever. This patient had been admitted to hospital on the 11th November with acute
appendicitis and the Resident Medical Officer of the hospital stated that there were no
symptoms of typhoid while she was a patient in the hospital, the reaction being tested only
because of the other cases which had occurred in the ward. Further, this child did not
appear to have shown any signs of ill-health until November, when the symptoms of
acute appendicitis began. The home address of this patient was outside the County of
London and information '.especting the matter was sent to the Medical Officer of Health of
the district in which the child resided. Tn reply, information was received that a brother
of this child had been admitted to an isolation hospital in October suffering from Enteric
Fever. This boy was discharged from hospital on November 28th. Prior to his discharge
examination of his excreta for the presence of typhoid and paratyphoid organisms gave a
negative result.
A further case a-sociated with this small outbreak was notified on January 20th, 1928,
the patient being a nurse wha had been working in the same ward from the early part of
December until she was taken ill about the 1st January. Enteric Fever, however, was not
definitely diagnosed until two weeks later.
In addition to the foregoing, two other cases occurred among in-patients in hospitals in
the Borough, the home address of one patient being in another London Borough and that of
the other outside the County of London. In both these instances the onset of the illness
commenced before admission to hospital so that the disease was in both instances contracted
before the patients came into this Borough.
322 cases were notified in London with 27 deaths.