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In addition to the cases mentioned in the above table the following specimens were examined
in the laboratory :—
(i) Blood examinations.
17 specimens were examined by serum agglutination tests in connection with the occurrence
of para-typhoid fever at Bedford College, Regent's Park. Also blood cell counts were made in
three cases of influenza and neurosis.
(ii) Examination of faeces.
14 specimens of stools were examined in connection with the occurrence of dysentery at
an Industrial School.
(iii) 90 eye specimens submitted by the Council's inspectors of midwives were examined in
suspected ophthalmia neonatorum cases, of which 21 showed the presence of gonococcus.
(iv) 9 specimens of sputum were examined, three of which showed the presence of tubercle bacilli.
(v) 5,811 swabs were examined for Diphtheria bacilli and 3,239 hair specimens were tested for
the presence of Ringworm ( see report of the School Medical Officer).
In one instance the assistance of one of the consulting staff (Dr. Forbes) was requested
in a suspected case of leprosy. The case, however, proved to be one of leucoderma.
In last year's report reference was made to Mr. F. W. Twort's demonstration of " watery looking
areas " on agar, by the cultivation upon it of glycerinated calf lymph ; these areas he thought, " might
represent a condition, or disease of a micrococcus," or be due to an enzyme secreted by the micrococci,
and leading to their destruction. This ultra-microscopic virus, he said, may be " an enzyme with power
of growth." So, in 1891-2, when at work " On the conditions determining insusceptibility," I obtained
a glycerinated pancreatic extract capable of producing watery looking areas upon a gelatine medium, with
" no development of scum, of turbidity, or of flocculent material, such as is usually associated with the
growth of bacteria." (Supplement to 21st Ann. Rep. of Loc. Gov. Board). The whirligig of time has
brought the ultra-visible virus, almost undreamt of 30 years ago, into the common light of day, and
phenomena such as those just noticed are now being regarded as worthy of further study. F. d'Herelle
as stated in last year's report, has succeeded in growing an invisible organism (it seems at first sight a
contradiction in terms), a " bacteriophage," as he calls it, which attacks Shiga's dysentery bacillus. He
claims that, inasmuch as the power of " lysing " cultures of Shiga bacilli can be transmitted, by inoculation
with very minute quantities of infecting material, from tube to tube, such transmission generation
after generation must be due to a living agent endowed with powers of reproduction. Thereupon, M.
Kabeshima objects that the bacteriophage is not a living virus but a " ferment " (See Medical Science,
Vol. II., No. 2). The further discussion of this question is referred to in Medical Science , Vol. IV., No. 1,
where abstracts from papers from ComptesRendusdes Seances de la Societe de Biologie(Tome LXXXIII,
1920, No. 29, etc.) appear. F. d'Herelle (Seance du 23 Octobre) deals with M. Kabeshima's criticisms,
adducing strong evidence in favour of the view that his " principe bacteriophage " multiplies in vitro
and, hence, that it is " necessairement un etre autonome " : he adds, " le principe bacteriophage ne
peut etre qu'un etre qui jouit de la propriete de se reproduire aux depens de la substance des Bacteries
qu'il dissout." D'Herelle refers to J. Bablet's demonstration of the facts that the bacteriophage does
not develop in sterile bouillon, nor in the presence of certain antiseptics, and that it loses its activity after
long exposure to glycerine : Bablet concludes that it is " un etre vivant." Meantime, J. Dumas finds
the bacteriophage not only in material from the intestines of dysenteric convalescents, but in the healthy
intestine of guinea pigs, in water and in air; Salimbeni points out that phenomena like those described by
d'Herelle are known in connection with the myxomycetes, and he considers some stage in the history of a
pleomorphic organism is in question; J. Bordet and M. Ciuca claim that a transmissible bacterial
autolysin is the agency concerned, and that here is to be found the explanation of variations being transmitted
to descendants ; Wollman points out that Bordet's views recall Darwin's doctrine of pangenesis ;
Wollman, moreover, has carried out experiments to determine whether the bacteriophage will pass
through a collodium membrane. These observations clearly possess an importance far greater than any
concern they may have with the life history of Shiga's bacillus. They open up a path through the as
yet unexplored country of the ultravisible viruses.
Study of
ultra-viaible
viruses.
Typhoid Fever.
During 1920 there were 387 cases of typhoid and paratyphoid fever notified in London, as
compared with 342 in 1919 and 357 in 1918. The deaths numbered 48, as against 63 in 1919. The cases
in 1920 included 48 of paratyphoid fever, and among these a group of 20 cases affecting students and
others at a ladies college is included. The cases notified among males between the ages of 20 and 45
increased by 17 (from 55 in 1919 to 72 in 1920); while among females there was an inciease at these
ages, from 97 in 1919 to 122 in 1920. There was, therefore, for both sexes, at ages 20—45, an increase of
42 ; at all ether ages there was an increase of 3 cases. Nearly half the increase at ages 20—45 is attributable
to the paratyphoid outbreak above referred to. In addition to this considerable group of cases,
there were three sets of three cases in households in Wandsworth, Lambeth and Deptford, and ten double
cases in various parts of London.
In 209 cases particulars were obtained by borough medical officers of health as to the possible
sources of infection. Fish, shell-fish, are mentioned in 74 instances ; in 39 cases the disease is said to have
been contracted outside London ; eight nurses were attacked ; one illness was ascribed to river bathing,
one to "drainage," and 5 to drinking water Twenty-two of tue cases, concerning which information
was supplied proved not to be cases of typhoid fever. In 1918 two groups, one of 8 and one of 7 cases
notified as paratyphoid fever, occurred just about the time of commencement of the summer influenza
prevalence. In 1919 no considerable group of cases of paratyphoid was notified ; and in 1920 the only