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Turning to St. Marylebone, no death from diphtheria has occurred during the past 8 years, and no
case lias been notified in the last 3 years. In 1928 there were 177 cases and 12 deaths. In that year
diphtheria immunisation was started in the Borough—12 years before the nation-wide campaign was
launched—and from 1943 onwards resulted in the immunisation of 78 per cent, of St. Marylebone
children aged 1—5 and 72 per cent, of those in the 5—15 age-group. These percentages were above
the minimum which the Ministry of Health considered necessary for the immunising campaign against
the disease to achieve its full effect.
The situation is now being reached—a situation scarcely dreamed of in 1940—when the eradication
of diphtheria as an indigenous disease in this country can be foreseen as a real possibility within the
next few years, providing there is no slackening in the immunisation efforts that have been so
dramatically successful in the past 10 years.
Suspected Poliomyelitis.—During the summer an outbreak of suspected poliomyelitis occurred amongst
the nursing staff of a large general hospital in the Borough, the total number of cases and suspects
reaching 19. Ultimately the question of diagnosis was reviewed and the opinion expressed that
probably the disease was not poliomyelitis but an obscure virus infection. Treatment was first carried
out at the hospital but early in September patients were transferred to a fever hospital as this course
was urged in order to lessen the possibility of cross-infection arising. The Medical Officer of Health
visited the general hospital frequently and maintained a close liaison with the Ministry of Health,
whose specialist medical officers attended several conferences at the hospital with the medical staff
in connection with investigations into the outbreak.
Sonne Dysentery.—A small committee of officers in the Public Health Service was set up under the
aegis of the London County Council to carry out an investigation into sonne dysentery in London.
It was felt that useful information on the effect of environment on the spread of infection could be
derived from an analysis of all notified cases, and the Department gladly arranged to co-operate in
the enquiry by providing details of the circumstances of all St. Marylebone patients.
Food Poisoning Outbreaks.—Details of cases of food poisoning notified during the year are given
below in the form required by the Ministry of Health :—
(a) Number of outbreaks.—One of seven cases and nine single unrelated cases.
(b) Deaths.—None.
(c) Organisms or other agents responsible, with number of outbreaks attributable to each.
Salmonella typhi-murium.—One outbreak of seven cases and three single unrelated cases.
Not ascertainable.—Six single cases.
(id) Foods involved, with number of outbreaks associated with each food.—In no case was it possible
definitely to identify a particular foodstuff as being the source of infection.
Thirty-two visits were paid by one of the women sanitary inspectors in connection with these cases.
The outbreak affecting seven persons occurred in April in two wards of a general hospital in the
Borough. In the stools of one of the patients a food poisoning organism (salmonella typhi-murium)
was isolated. Further investigation showed that six other patients, together with a night nurse and a
ward maid, had suffered from diarrhoea or vomiting or both since the 4th April. The ward maid
reported sick on the 4th April, having, unknown to the medical staff, suffered from diarrhoea for a
fortnight previously. It was considered possible that she might have been the source of infection
but subsequent tests proved negative. Precautionary measures were immediately taken and these
included closing the two wards to new admissions for a week, boiling of all ward crockery, barrier-nursing
of all patients suffering from diarrhoea or vomiting, and bacteriological examination of faecal specimens
from all such patients and from the entire nursing and kitchen staff involved. Food in the ward
kitchens was suspended from use until proved bacteriologically innocent. Except in the case of the
one patient referred to, the whole of the tests were negative to a specific organism. As the night nurse
and the ward maid had been on leave prior to the 9th April, and one patient had been transferred to
another hospital on that date, the medical officers of health of the areas in which the homes of the staff
and the hospital were situated were informed of the outbreak. All the patients recovered, and
no further cases were reported. It is possible that a symptomless carrier amongst the patients or staff
may have been responsible for the outbreak, a full report of which was submitted to the Ministry of
Health.
Though no formal notifications of food poisoning or suspected food poisoning were received, it was
learned that on the 1st July 40—50 members of the staff of a local telephone exchange had complained
of feeling ill the previous evening and during the night, and had suffered from diarrhoea in varying