View report page

30
Annual Report of the London County Council, 1913.
Eight cases of typhus or suspected typhus were reported during the year. Six of these cases
(1 to 6) form one group and all occurred in one four-roomed house situated in the Borough of Stepney.
The following is a history of the cases :—
Case No. 1.—J. F. W., aged 30, a street vendor of vinegar, was taken ill on Sunday, 11th March,
about mid-day. He was attended at home and on 25th March, when he was admitted to the Mile
End Infirmary, his temperature was 102.5 deg. and rales and rhonchi were heard in both lungs. There
was no sign of disease in the abdomen. His bowels were quite regular and there was no diarrhoea.
On 27th March the right lower lobe of the lung was solid. On 3rd April his chest was quite clear. He
was discharged on 15th April. The diagnosis made was one of pneumonia.
Case No. 2.—A. M. W., aged 21, wife of No. (1), was taken ill on 5th April. On 9th April she
was admitted to the Mile End Infirmary. On admission her temperature was 102*6 deg. She had
a rash on her right arm with scattered spots elsewhere. There were no signs of disease in her lungs,
heart or abdomen. The tongue was furred and the urine albuminous. On 12th April she was dull
mentally, her legs were drawn up and she vomited after taking milk ; after this date she improved. She
was discharged from the infirmary about the end of May. Her temperature chart is very suggestive of
enteric fever. In the opinion of the medical attendant she suffered from enteric fever, but the case
has not been notified as the medical superintendent of the infirmary did not so regard it.
Case No. 3.—On 11th April, J. B., aged 47, the father of No. (2), a painter, was taken ill and
he was admitted to the Mile End Infirmary on 16th April. On admission his temperature was 103 deg.
and he complained of pains all over his stomach, but there was no vomiting. He had flea bites on his
legs. His blood was examined and gave a negative Widal reaction on 17th April, but was positive
on 24th April. There was no tenderness or rigidity over the abdomen and the spleen was not palpably
enlarged. He became gradually worse and on 27th April the pulse was very weak and he became
delirious. He died on 29th April and on the same day the case was notified by the medical superintendent
of the infirmary.
Case No. 4.—F. M. B., aged 7, was taken ill on 4th May and notified to be suffering from enteric
fever on 7th May. She was removed to the South Eastern Fever Hospital on the same day. She
was notified to be suffering from typhus fever on 19th May.
Case No. 5.—M. B., aged 17, was notified on 16th May to be suffering from typhoid fever. She
had been removed to the fever hospital late the previous evening—14th May—having been notified
as enteric fever. She had been ill since 11th May. On 17th May she was reported as suffering from
typhus fever and not enteric fever.
Case No. 6.—K. B., visitor to the house, fell ill about 11th May. Admitted to Metropolitan
Hospital on 19th May. Removed to Eastern Hospital on 27th May. The case was diagnosed as typhus
on 28th May.
The source of infection in this group of cases could not be traced, and even now there appears
to be doubt as to whether the illness at this house.was typhoid fever or typhus fever, so great was the
difficulty which was experienced in determining whether the individual cases were, clinically speaking,
cases of typhus or typhoid fever. In all probability the disease from which the patients suffered was
really one and the same in all instances, and that being so, great interest must be attached to the considerable
divergence of view as to the diagnosis.
There were two other cases, one in Bermondsey and one in Southwark, neither of which had
any connection with the Stepney cases. They were as follows :—
Case No. 7.—A. S., aged 39, a labourer. The patient had been ill since 11th August and before
that date he had diarrhoea. There was a rash on the 14th and he was certified as suffering from enteric
fever. He was subsequently notified as suffering from typhus and removed to the Eastern Fever
Hospital on 21st August. On 25th August the temperature was down, there was a purplish rash on
the legs (suspicious of typhus) and arms, while the trunk was more or less clear.
Case No. 8.—H. L., aged 20, a tin solderer. The. onset was sudden on 11th May. On the 21st
vomiting and shivering occurred, and a rash on the arms developed on the 23rd. The patient was
admitted to the South Eastern Hospital on the 24th. By next day the rash had become universal
except on the forehead and circumoral region. There ensued violent delirium and convulsions ; the
eyes were suffused ; the tongue was furred and dry ; fauces normal; some cough ; respirations 44 ;
pulse 140 ; temperature 103 deg. ; rhonchi in lungs. The following day the patient was a little better ;
mind clear ; tongue moist; slight deafness. Diagnosed as typhus.
Typhoid Fever.
The number of cases of typhoid fever notified in the Administrative County of London during
1913 (53 weeks) .was 758, compared with 704 in the year 1912 (52 weeks). The deaths from
this disease numbered 114 in 1913 (53 weeks), compared with 117 in 1912 (52 weeks).