View report page

31
free of charge to the practitioners attending. The materials for swabbing
are supplied by the Council, and reports are in the first instance telephoned
or telegraphed to the doctor concerned, and written reports follow. The
number of throat swabs examined by the Council's bacteriologist during
each year since 1923 was :—
1923. 1924. 1925. 1926. 1927.
281 556 674 679 595
Enteric Fever.—There were 24 cases of typhoid and paratyphoid
which came to the knowledge of the department during 1927. Of these
18 were notified as paratyphoid and 6 were typhoid. There was a history
of fish having been consumed in 2 cases, ice-cream in 3 cases, 1 case
came from abroad, and in 18 cases there was no history ascertainable.
There was 1 death. The death-rate of this disease for England and
Wales was 0.01, and for Westminster .007. The case rate for England
and Wales was 0.09 and for Westminster 0.17.
Paratyphoid.—One case was of the A variety, a form usually found
in Southern Europe, and 17 were of the B. type. Eight of the latter
group occurred in the fourth week of October in a residential institution,
and the following account of the small outbreak may be of interest:—
The first case, R. H., a student aged 20, was notified on 20th October, after a positive
Widal reaction, and removed to St. George's Hospital. He had been ill since 12th October,
the onset being characteristic of a chill with headache. He had diarrhoea on 13th and 14th
and his temperature rose to 103° F. The course of his illness subsequently was moderately
severe. A similar history was given by H. H., another student, aged 18, whose onset was
also on 12th October. He gave a positive Widal on 21st October, and was likewise
removed to St. George's Hospital, where his illness was also somewhat severe.
On receipt of these notifications I visited the institution as there seemed the likelihood
of further cases arising. Two other students, W. T. (18) and C. A. (20), were in bed
believed to be suffering from colds, but not entirely free from suspicion. Both exhibited
Bome rose spots and were sufficiently definite cases, in my opinion, to be removed. The
clinical diagnosis was subsequently confirmed by Widal in Westminster Hospital, to
which they were removed that day. Both were mild cases throughout their illness, and
the onset in each was the 12th October, as in the case of R. H. and H. H.
On the 26th October, S. S., student, aged 19, who had slight colic and diarrhoea, with
temperature of 99° F., was also diagnosed and removed to Westminster Hospital, the Widal
again proving positive. C. S. (20), student, became bilious, with headache and temperature
100° F., on 23rd October. He was removed to an M.A.B. hospital on 27th October,
where his case was bacteriologically confirmed. Two sisters, E. S. (14) and M. S. (18),
maids on the domestic staff, developed symptoms as above described on 27th and 28th
October respectively. They were removed to an M.A.B. hospital, and although E. S. was
the more pronounced case clinically, only M. S. gave a positive Widal. The eight cases
were all young adults between tho ages of 14 and 20 ; all but the first two were subsequently
treated in the M.A.B. hospitals and all recovered.
Owing to the vague and slight symptoms in all except the first two, it was somewhat
difficult to fix tho onset. There is, however, a resident nurse on the staff, to whom anyone
feeling even slightly ill reports as a matter of routine, and has temperature taken. Thus,