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from a visit to Warsaw, where, in all probability, he was infected. In the latter
case the source of the infection was not ascertained as there was no history of the
patient's having travelled or having been in contact with the disease. Dr. J. A. H.
Brincker was called in consultation to see this case, and agreed with the diagnosisof
typhus fever. Both patients recovered.
Typhoid Fever.
There were 264 cases of typhoid fever notified in London in 1922, as compared
with 329 in 1921 and 387 in 1920. The deaths numbered 45 as against 60 in 1921
and 48 in 1920. Of the total cases notified only 141 were admitted to hospitals of the
Metropolitan Asylums Board; the corresponding number in the year 1921 was
193. Of the 141 cases admitted in 1922, 65 were found not to be cases of typhoid
fever.
In 14 instances more than 1 case was notified from the same house, as compared
with 19 instances in 1921. The multiple house invasions in 1922 included 1 with
6 cases, 1 with 5 cases, 2 with 4, and 2 with 3 cases. The group of 6 cases was notified
from a house in Fulham, and the group of 5 from a house in Wandsworth; 2 groups
of 4 were from houses in Kensington and Stepney; the 2 groups of 3 from houses
in Stepney and Woolwich respectively. As regards the group of 6 cases, the Kensington
group of 4 cases and the Woolwich group of 3 cases, no source of infection
was traced. The group of 5 cases in Wandsworth formed part of a strictly localised
prevalence affecting persons living in houses in two streets only, and it was apparently
due to food infection. Milk at first seemed at fault, but enquiry led to the exclusion
of milk infection. There remained, however, the suspicion that fried fish was incriminated.
In the group of 4 cases in Stepney the dates of onset were from 25th October
to 19th November, food origin was suspected, but no shellfish or fried fish had been
consumed, and any plaice eaten was cooked at home. In the group of 3 cases in
Stepney the dates of onset ranged from 10th March to 11th May.
Dr. Howell, Medical Officer of Health of Hammersmith, reported upon a small
prevalence of typhoid fever in June and July; six of the sufferers in Hammersmith
were on Epsom Downs on Derby day and drank, while on or near the race course,
either" home-made lemonade," or water. It was subsequently ascertained by Dr.
Howell from Dr. Williamson of Epsom, that a similar history of drinking lemonade
or water at Epsom was elicited in two cases of typhoid fever, one from Leatherhead,
and one in Sutton, and an Acton case and a Lambeth case with like histories were
also forthcoming. The group of patients from Hammersmith included a young
man (by trade a seller of fried fish) and 2 boys, his friends ; they did not go to Epsom
to sell fried fish, but for the races.
Cockles from Ramsgate are mentioned as a possible source of typhoid fever
in 2 instances in 1922 (1 in Poplar and 1 inDeptford). The medical officer of health
of Ramsgate in his Report for 1922 states that of 3 cases of typhoid in Ramsgate
in the year, 2 had a history of consumption of cockles, the evidence in 1 case being
very definite. The cockles were unsterilized and had been taken from a source known
to be polluted.
In 42 cases, out of the total number notified, in which bacteriological confirmation
of diagnosis is forthcoming, the presence of B. Typhosus is recorded in 10 instances;
12 are returned as "Paratyphoid" ; while 5 are described as Paratyphoid A and
15 as Paratyphoid B. In 181 out of the total number of cases, in which information
as to a possible source of infection is given, reference is made to shellfish in 15, to
fried fish in 8, to other fish in 10, in 6 to watercress, and in 33 to other food (including
lemonade in 8 cases, bad water 5 cases, and ice cream in 8 cases). In 25 cases contact
with previous cases is mentioned. Nine patients contracted the disease in the country
and 19 abroad. Seven nurses were among the sufferers. Forty-seven of the 181
cases were held not to be cases of typhoid fever.