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1921 and in 1922 reports were received that this particular kind of fish was again
being sold in London. During August and September last a considerable amount of
Danish and Dutch caught fish (the major proportion consisting of plaice) was sold
at Billingsgate ; some of the Danish fish was condemned as unfit for food.
In the weeks ending Sept. 15th, Oct. 13th, Oct. 20th, and Nov. 3rd, the number
of notifications of typhoid fever in London either reached or exceeded ten, a number
only equalled on four occasions and not exceeded on any occasion by the average
figure for the preceding five years. There was thus an approach to the development
of a slight autumnal rise, a feature which had been absent for some years past.
The facts were brought to the notice of the Medical Officer of Health of the City
and an opportunity was taken of conferring with him on the question. After
November 3rd there was a slight fall, though in the week ending December 15th,
eleven notifications were again forthcoming ; in the last week of the year the number
fell to three.
The following review of the behaviour of typhoid fever in the mental hospitals
of London during the last 30 years is of interest in connection with the general
problem of London typhoid prevalence. In the annual report for 1920 a diagram
was exhibited showing prevalence of typhoid fever and dysentery in the London
mental hospitals from 1914.1920. The records have recently been further examined
as far back as 1890. Water, though often suspected in the early years, seems now
in the light of later knowledge to be free from blame. At one hospital (A in the
diagram on p. 30 of the 1920 report) typhoid fever has only been reported in four
instances since 1890, a remarkably low incidence of the disease ; dysentery on the
other hand has been not uncommon in the institution. In B., since the opening
in 1898, a few cases of typhoid have occurred in most of the years. In 1912, 21
cases, 6 of which affected female staff, occurred. During the years 1914.1920
typhoid fever was confined to the female side of the institution. In C. (already
open in 1890) there was but little typhoid until the outbreaks of 1915, 1916, 1917
and 1918 appeared. In 1919 and 1920, 18 cases occurred, all of them (the whole
of the patients and staff having been inoculated) in inoculated persons. Dysentery
has been uncommon in this hospital. In D, there has been much dysentery, and
typhoid fever has been reported in several years, notably in 1914, 1917 and 1918
and 1921. In E. several cases of typhoid occurred from 1896.1904 and some 19
members of the female staff were affected during those years. Between 1914 and 1920
typhoid was limited to the female side of the institution. Dysentery was of rather
common occurrence. In F. typhoid has from time to time occurred from 1875
onwards, and there were 4 cases in 1894, several in 1897 and 1898, and six female
attendants were attacked between 1897 and 1899. A few cases developed between
1914 and 1920. Dysentery was prevalent between 1914 and 1918. In G. (opened
in 1907) typhoid occurred each year from 1908 onwards, 11 patients and 3 female
attendants in 1912; 4 patients and 1 female attendant in 1913; 16 patients in 1914;
and 10 patients and 4 female attendants in 1915 ; a further group of nearly 20
cases in 1919. Dysentery was prevalent in 1917 and 1918. In the last three years
the total number of cases notified from the mental hospitals has been 41 in 1921,
37 in 1922 and 19 in 1923. The general impression obtained from a review
(covering this period of 30 years) of typhoid fever in the mental hospitals, is that
it is difficult to differentiate with certainty in many cases between " dysentery "
and " typhoid fever." Often prevalences of the one disease seem to coincide with
prevalences of the other, in other hospitals or in another section of the same hospital.
Female staff have suffered more than males, and the fact that they live in the
institutions (to a much greater extent than the males) explains this, whether it be
assumed that the infection is conveyed by food or by direct case to case infection
from patients. The prevalences of 1917 and 1918, whether of " typhoid fever "
or of " dysentery," were clearly associated with war conditions, and probably the
shortage of food supplies in those years played some part. typhoid fever in the mental hospitals,