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of typhoid fever at Whitehaven. It was exemplified, too, very strikingly in the
first recorded fish-outbreak—that of 1900.
Conclusion.—The various facts elucidated in this Bethnal Green prevalence
point very suggestively to small plaice or dabs as the source of infection; prior
to 1906 these fish were widely implicated on several occasions in London ; this
cause, however, practically ceased to operate in 1909 and (with an exception in
1911) remained conspicuous by absence until after the war.
The very slight rise of typhoid fever prevalence in September, 1923, and the
striking increase manifested in September and October, 192-1, taken in conjunction
with the facts which have been set out in detail, suggest that this source of danger
is not entirely removed, and make it desirable that a close watch should be kept
upon London typhoid prevalence in this connection.
Throughout the outbreak I was in communication from time to time with
members of the medical staff of the Ministry, and Drs. Brincker, Forbes and Chaikin
on my behalf have conferred with the medical officers of the City and of Bethnal
Green. I am indebted to all of them for advice and help. So far there has been
no evidence of recrudescence of the mischief in question, at any rate since the early
days of October last year.
Report of the Bacteriological Laboratory.
During the past year bacteriological and microscopical examinations reached
a total of 6,875, mainly represented by investigations in connection with diphtheria
and ringworm. This shows an increase in the amount of material submitted as
compared with the year 1923, caused by nearly 1,000 more throat and nose cultures,
and over 20 more cerebro-spinal fluids examined. This work involved the preparation
by the laboratory staff of between five and six thousand tubes and plates of various
media for bacteriological cultivation.
I. Diphtheria investigations.—In spite of the lower general incidence of
diphtheria among school children during 1924 (3,696 cases as compared with 3,985
in 1923, as mentioned elsewhere), the disease has been focused in certain localised
areas and has called for more frequent and extensive investigations for carriers in
particular schools, including the Army school (known as Newport Market), Bushy
Park Camp School and the Industrial School at Mayford near Woking, and resulting
in a total of 3,973 children swabbed, or 973 more than in 1923.
Of this total, 314, or 7.9 per cent., yielded positive results for the presence of
morphological diphtheria bacilli in throat or nose; in 294, or 7.4 per cent.,
suspicious organisms were present; and 3,365, or 84.7 per cent., proved negative.
The virulence tests carried out gratuitously by the Wellcome Research Laboratories
during 1921 and 1922 proved of great value in securing the early re-admission
of non-virulent carriers, who would otherwise have been excluded until found
bacteriologically free from diphtheria bacilli.
II. Ringworm and fames.—2,694 specimens of hairs were examined with positive
results in 1,222, or 45.3 per cent.; represented by 992, or 36.8 per cent., cases of
small spore fungus, 197, or 7.3 per cent., large spore fungus, and 17, or .63 per cent.,
of favus. In 16 the type of fungus was unclassified.
III. Conjunctivitis and ophthalmia neonatorum.—Smears from the eye discharges
of 45 infants were examined. The presence of the gonococcus was recognised in
5, or 11 per cent.
IV. Histological sections were made and examined from 42 specimens of brain,
fiver, spleen and thyroid, from post-mortem material of cases of encephalitis and
acute ex-ophthalmic goitre.
V. Miscellaneous material sent for examination included:
(1) Urine, 6 specimens for chemical analysis as well as microscopical and
bacteriological examination.
(2) Sputum, 6 specimens ; tubercle bacilli were found in two.