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31
Tyjphoid Fever.
There were 331 cases notified as typhoid fever in London in 1923, as compared
with 264 in 1922, 328 in 1921 and 387 in 1920. The deaths numbered 42 as against
45 in 1922, 60 in 1921 and 48 in 1920. Of the cases admitted to the Metropolitan
Asylums Board hospitals, the diagnosis of typhoid fever was not confirmed in
60.9 per cent. The proportion of unconfirmed cases has shown increase in late
years ; it was about one-fourth at the commencement of the present century In
1909 the proportion rose for the first time above one-third (37.9 per cent.). In 1912 and
the subsequent years it has generally exceeded 40 per cent, and in 1922 was 45.8
per cent. The years 1909, 1912 and onwards were marked (as noted in these reports)
by definite absence of any autumnal prevalence of typhoid fever. They were,
moreover, years in which the total number of deaths from typhoid fever, after
declining from the higher level of the nineties of the last century, fell still further
and dropped below .03 per 1,000 living. In other words since the death rate from
"typhoid fever" in London has fallen down to or below .03 per 1,000 living the
difficulty as regards diagnosis appears to have become intensified, so that out of some 50
to 100 deaths registered in each of the recent years a considerable percentage (ranging
around 50 per cent.) may be presumed not to have really been cases of the disease.
In 17 instances two or more than two cases were notified from one house as
compared with 14 instances in 1922 and 19 in 1921. There was a group of 5 cases
one of which was subsequently decided not to be typhoid ; another group of 5 cases,
3 of these were not London residents and had recently come from Paris ; a group
of 4 hospital nurses; a group of 3 members of the staff at another hospital; two
groups consisting of 2 cases in a particular house and one in a neighbouring house,
a nurse and a patient at a hospital; an instance in which two cases in a sister and
a nurse at a hospital were associated with some dozen other persons admitted to the
hospital or living in the neighbourhood; and 9 other cases.
In at least three of the above groups the infection appears to have been contracted
outside London. In two instances fish or cockles, and in one oysters came under
suspicion. In the case of the group of a dozen or more cases, including a nurse and
a sister at a hospital, and occurring from January.April, 1923, enquiries were made
by the borough medical officer, by the house physician at the hospital, and by Dr.
Brincker, but it was not found possible finally to decide as to the causation of the
outbreak.
Special enquiry was made in 1923 as to the bacteriological diagnosis made,
if any, and replies were forthcoming in 253 cases ; the presence of B. typhosus was
recorded in 93 instances ; 27 were returned as paratyphoid ; 2 as paratyphoid A.;
42 as paratyphoid B. ; 11 as paratyphoid A. and B. ; 35 as typhoid not otherwise
described and 57 were returned as not typhoid fever. Information as to probable
origin of the disease is given in 173 instances ; in 34 it was believed to have been
contracted outside London ; in 59 instances fish or shellfish were held to have been
at fault; other foods were suspected in 34 instances: 17 nurses were among the
sufferers ; in 9 of these B. typhosus was found, 4 were reported as suffering from
paratyphoid B.
In the Annual Report for 1922 (vol. III., pp. 19.32), a review of typhoid fever
in London during the last 32 years was given and reference was especially made
to the part played in the causation of the disease by immature ungutted plaice.
At the top of p. 31 reference is made to suggested restrictions as to the marketing
of immature fish which were put forward in July 1921 by the Plaice Sub.Committee
of the International Council on Fisheries in the North Sea. These suggested restrictions
were intended to prevent immature plaice being brought to this country from
certain inshore areas (including an area near the mouth of the Elbe) from which,
prior to 1909, supplies were from time to time derived. A few years before the
war the sale of these immature plaice in London practically ceased and it was not
resumed immediately upon the close of the war. During the closing months ol
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