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42
"(3) The Caretaker, Coroner's Court, Horseferry Road, S.W., at any
hour.
"When a supply has been obtained a receipt must be given by the
medical practitioner in order that it may be forwarded to the City
Council, who will otherwise not hold themselves responsible for payment."
Bacteriological Examination.—Advantage was taken by medical men
of the means provided by the City Council to have the diagnosis of
their cases assisted by bacteriological examination of swabbings from
the nose or throat in 184 instances.
In 13 instances I had a bacteriological examination made of the
throats of the members of families in which a case had occurred, or
when children were excluded from school in consequence, and no medical
man was in attendance; the bacillus was present in one of them.
In one instance examination was made on account of other cases
occurring subsequent to the first patient's return from hospital—it
proved negative.
Typhoid Fever.—The number of cases notified, both in London and
Westminster, show an increase over 1909. Of the 48 persons notified
in the City, 1 was eventually declared not to be so suffering.
This disease was proportionately most prevalent in Holborn, Finsbury,
Shoreditch, Bethnal Green, Stepney, Poplar, and Bermondsey.
According to a report issued by Dr. Hamer to the County Council, it is
possible that some of the attacks may be due to the consumption of
small plaice or dabs. These small fish frequent the more shallow
waters, which are those which would be more liable to pollution.
The Local Government Board has also issued a report by Dr.
Ledingham, dealing with the subject of the enteric fever carrier. The
carrier is a person, usually a woman, who, although in good health,
carries the infectious material in the body and excretes the bacillus
typhosus in fæces or urine. The excretion of the bacillus may continue,
persistently or at intervals, during many months or years. The carrier
state is not necessarily the result of a previous attack of enteric fever,
or at least of any illness which can be traced or is known to the carrier.
Fnteric fever patients, however, may continue after convalescence to
excrete the bacillus, sometimes for a period less than three months
("temporary carrier") and sometimes for much longer periods ("chronic
carriers"), and it is naturally among persons who have been attacked
by enteric fever that most carriers have been detected. The average
carrier does not appear to be a serious danger, but some have been
proved capable of causing outbreaks wherever they go. Surveillance
seems necessary in the case of carriers of proved infective ability,
especially where food preparation is concerned.