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41
carriers of either typhoid or paratyphoid bacilli. Should such a result prove to
be of common occurrence, it is obvious that the discovery of a healthy bacillus
carrier (upon examination of, say, one or two dozen dairy employees) must be
regarded merely as a result to be expected just as a matter of chance, and one to
which no special significance, from the point of view of causation of typhoid, can
be ascribed.
Autumnal
incidence of
typhoid
fever.
These considerations have led to further examination of the question of seasonal A
incidence of typhoid fever, in London and in the country generally, during recent
years, and a chart showing the records for the last three years is exhibited on p. 35.
This chart and an earlier one (p. 21 of the Annual Report of the Medical Officer
for 1922) show the almost entire absence of any autumnal prevalence of typhoid
fever in London between 1911 and 1924. In the latter year, the autumnal increase
(in cases notified) was due to an outbreak of typhoid fever in Bethnal Green during
September, October and November (see Annual Report of the Medical Officer of
Health, 1924, p. 35). In 1925, there was again an increase in the prevalence of
typhoid in London in the latter half of the year, and in this case, the increase
resulted from three separate prevalences, one (of paratyphoid) centred in Croydon
involving in all 75 cases, of which 30 occurred within the County of London in the
extreme south of Lambeth and Lewisham; the second (also of paratyphoid) occurred
in the Lee Green area of Lewisham, where some 17 cases occurred at irregular intervals
over a period of two months; and the third was a sharp localised typhoid fever
prevalence in Streatham in October, the number of cases of illness reported being 32.
The first of these outbreaks was reported upon by Dr. II. P. Newsholme, medical
officer of health of Croydon, who ascribed it to various articles of food (supplied by
a firm of confectioners) which were held to have been infected by a man whose blood
agglutinated the Bacillus paratyphosus B; the second outbreak was of altogether
obscure origin; the third was one of true typhoid fever and was believed to be
due to milk infected by a carrier of the Bacillus typhosus.
The autumnal prevalences of typhoid have been more marked in England
and Wales in the last three years than in London (Chart p. 35). There was a welldefined
autumnal increase in 1923 and 1925. In 1924 a remarkable departure
from the normal seasonal incidence was observed, for while the autumnal rise is
apparent, there is imposed upon the normal contour of seasonal incidence a
considerable prevalence in the months of May, June and July, the number of cases
in the latter part of June and early July being so great as to exceed the height of
the autumnal prevalence in October. Analysis of the figures shows that the abnormal
early summer prevalences were mainly attributable to outbreaks in three localities,
namely in the West Riding of Yorkshire in May, and in Luton and in Dover in June
and July; but even when allowance is made for these localised outbreaks, the
incidence in these three months remains considerably above the normal for this
time of year. Some of the prevalences outside London, as in the county itself, were
outbreaks of typhoid, some of paratyphoid fever; in a few of them the possibility
of a diagnosis of gastro-intestinal influenza was considered, but was held to be ruled
out on discovery of a bacillus carrier.
Reference has been made from time to time in these reports to the sale in London
of small ungutted plaice derived from the "fish nurseries " of the so-called A3 area,
i.e., that part of the shallows of the North Sea which adjoins the German and Danish
coasts. In the annual report for 1922 (pp. 24-29) and in last year's report (p. 34),
the efforts, made by the fish trade some twenty or more years ago, to obtain legislation
protecting the plaice fisheries of the North Sea from injury, were alluded to and
attention was called to the then recently published "Report on Sea Fisheries,
1919-23" of the Ministry of Agriculture and Fisheries (pp. 67-73). The outcome
of its findings was to emphasise the need of taking steps to protect the " small
plaice nursery grounds." The Plaice Fisheries Sub-Committee had recommended