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I'lagua and cholera.
April) who had been in contact with typhus fever and were proceeding to London, was forwarded by the
Medical Officer of Health of Southampton; the names and addresses were communicated to the medical
officers of health concerned. No developments arose.
No cases of plague or cholera occurred in London during 1919. Three vessels on which cases of
plague had occurred arrived in the Port of London during the course of the year, and the names and
addresses of the passengers and crew were reported to the medical officers of health of the districts to
which they proceeded. Communications were also received from the Medical Officer of Health of
Liverpool reporting the existence of plague rats on board vessels arriving at Liverpool from abroad,
and notifying for observation the names and addresses of passengers proceeding to London. An outbreak
of bubonic plague on board one of the first three ships, the S.S. Nagoya, is specially Doteworthy. The ship
came from Yokohama and arrived in the Port about the end of October. The first patient was attacked
on the 21st October and died at sea two days later. When the vessel was boarded at Gravesend 7 fresh
cases were discovered and were removed to the Port Sanitary Authority's Hospital at Denton. The
diagnosis of plague was bacteriologically confirmed by the Ministry of Health. Disinfection of the
vessel and other necessary precautions were taken, and no further developments occurred.
Plague and
cholera.
Anthrax.
During 1919, 11 cases of anthrax were notified in London, 3 of which proved fatal. An
additional fatal case was reported in a worker for a firm of horsehair dealers in Finsbury, but as the
deceased man lived in Edmonton the case is not included in the figures for the administrative county.
Of the total number of cases reported 7 were directly attributable to the patients' employment—viz.,
the handling of imported skins, hides, hair or bristles, 4 were attributed to infection from shaving-brushes,
and in the remaining case the patient, who subsequently died, was engaged in handling sacks, containing
meat, at a dog biscuit factory; no definite source of infection could be traced in this case.
As regards shaving-brushes, it will be recalled that a similar outbreak occurred in 1915 (a description
of which appeared in my annual report for that year) when it was found that mixed hairs of
Chinese origin were being imported and manufactured in this country into shaving-brushes, which were
discovered in a large number of instances to be infected with anthrax. The brushes, which were
responsible for cases of anthrax in London, as well as in the provinces, during 1919, were manufactured
in Japan, and those imported into this country were covered by a certificate issued by the Japanese
Government to the effect that they had been properly disinfected. The first case in which suspicion
fell upon a shaving-brush as being the source of infection occurred in the Borough of Hammersmith at
the end of October. The patient had recently bought a new shaving-brush, and this was submitted to
a bacteriological test at West London Hospital where anthrax spores were definitely identified. The
brushes in possession of the retailer were confiscated. Investigations were made at once as to the source
from which the brush was derived, and the wholesale supply was traced to the City of London.
Dr. Howarth, Medical Officer of the City, made the fullest enquiry and ascertained that there were
on the market large numbers of shaving-brushes of the kind found to be infected, and he discovered that
they had been imported in large numbers from Japan five or six months previously. The distribution
of the majority of these brushes, which were subsequently found to be of various types, was closely
followed up and large numbers were recovered from the retailers, returned to the wholesale firms
concerned, and their further sale prohibited. It was discovered, however, that many of them had
already been sold to individual purchasers, whilst large stocks had been exported to Belgium, Spain,
India and other places abroad; the respective Governments of these countries were accordingly informed
of the facts by the Ministry of Health. Several of the various types of brush imported were bacteriologically
examined and found to be infected; of one type alone eight out of eleven which were examined
were found to contain living anthrax spores. The Ministry of Health communicated with all wholesale
firms in the City of London and Shoreditch, who were likely to have received suspected consignments,
drawing attention to the desirability of having the consignments of brushes from Japan bacteriologically
tested. A general caveat was issued in the Press by the Ministry of Health warning the public against
the use of cheap shaving-brushes of Japanese origin, and setting out the method of disinfecting any
doubtful brush. Jtepresentations were also made to the Japanese Government through the Embassy
in London, and it was eventually considered necessary to prohibit altogether the importation of shavingbrushes
from Japan by Order in Council under the Anthrax Prevention Act, 1919. Concurrently with
the case which occurred in Hammersmith it was reported that a man living in Plumstead had contracted
anthrax, and that he had bought a new shaving-brush. It was not possible to secure the brush in
question, but enquiries elicited the fact that the patient had obtained the same from a local stallholder,
who in turn had received his supply from a manufacturing firm of chemists in Notting Hill Gate. A
companion brush was secured and found to be infected. The type was known as the"Woodstring Shaver,"
and was of English manufacture; the distribution was traced back through a period of two years to
the original holder of the stock, and a veto was placed upon the further sale of unsold brushes. Following
upon the two cases referred to above a man living in Westminster was admitted to the infirmary on the
16th November with a pustule on the cheek. He was found to be suffering from anthrax, and he died
half an hour after admission. The man was a bank clerk in temporary employment and little was known
of his habits. Although no possible source of infection other than a shaving-brush could be discovered
the bacillus anthracis could not be recovered from the brush in his possession.
Another case of anthrax in which a shaving-brush was suspected as being the origin of infection,
was notified on the 16th December in the person of a demobilised officer who was staying at the Carlton
Hotel. He first noticed a lump on his cheek on the 11th December, and he was subsequently removed
to a nursing home where the pustule was excised. Bacteriological examination confirmed the diagnosis
of anthrax. Upon enquiry it was ascertained that the patient bought a shaving-brush in a bazaar in
India just before proceeding home for demobilisation, and he used it for the first and only time two
days before the onset of illness. Attempts to isolate the bacillus anthracis from the brush, however,
were unsuccessful.
Anthrax.