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At the end of the year there was an outbreak of sonnei dysentery in the children and staff of a Council day
nursery which necessitated a number of exclusions until the infection subsided. Sporadic cases of flexner
dysentery were also notified at various times. A chronic infection of amoebic dysentery was discovered in a
young man who had worked among refugees in India. This is not surprising in view of the conditions which he
experienced; but it is probable that it will begin to appear more frequently among returning tourists as
holidays in the tropics become more popular.
Rubella
As stated in the 1971 Annual Report, the Haringey Council decided that year to revoke its earlier decision not
to vaccinate girls aged 11 to 13 years against this disease. Owing to shortage of staff it was not possible to begin
that autumn but the programme was undertaken in 1972 and completed by the middle of the year, mainly by
using senior medical staff to give the injections. As this disease in mothers can cause congenital malformations
in their unborn babies this should be a useful investment for the future. Later in the year vaccination was also
offered to women of childbearing age employed by the Council and a small number availed themselves of it. A
total of 2,524 individuals were vaccinated during the year.
Enteric Fever
A carrier of typhoid, who had infected several others and had been a source of anxiety during the previous year,
eventually agreed to have an operation for removal of the gallbladder. Specimens since then have shown no
evidence of the organism, so it would appear that the focus of the disease has been eradicated.
Only two incidents of enteric infection occurred in 1972, though they involved a considerable amount of
investigation. Both originated on the continent of Europe.
The first began with the admission of a young woman to hospital suffering from a fever of three weeks
duration. A diagnosis of typhoid was made and subsequently confirmed bacteriologically. She had been
nursing a young baby who then was found to be a symptomless excreter of the same organism. The child, too,
was admitted to hospital. The mother responded well to treatment and all trace of her infection disappeared.
Unfortunately, the baby, although well, continued to excrete the germ and had to remain in hospital after the
mother was discharged. When it became apparent that this might persist for some time, discussions were held with
the parents regarding possible alterations to their house to reduce the chance of further spread should the child
still be positive on coming home. These presented great difficulties and, even if they had been carried out, an
element of risk would have remained. Fortunately, the baby's infection cleared up after four months in
hospital and no further action was needed.
Enquiries as to the cause of this infection centred on a visit of some friends from southern Italy just over a
fortnight before the mother became ill. They had brought with them a local delicacy, a kind of shellfish, bought
in Taranto on the same day as their flight to England. These were eaten that evening in the traditional manner—
raw with lemon juice.
There was, therefore, a strong presumption that these uncooked shellfish were infected with typhoid but it was
impossible for us to investigate further as the shells had long since been thrown away. The Department of Health
was then contacted to ask if co-operation with the Italian authorities could be arranged. We were reminded that
enteric was not internationally notifiable and told that they themselves had not yet succeeded in getting a number
of southern European countries, including future Common Market partners, to appreciate the seriousness with
which we regarded this infection. It would, therefore, be a waste of time to try to communicate with them.
Further enquiries were therefore reluctantly abandoned, but another case occurred a few months later which
reopened the question and stimulated us to independent action. A man became very seriously ill five days after
returning from a holiday in Juan-les-Pins on the French Mediterranean coast, and was found to have typhoid
fever. Fortunately, he responded well to treatment and was able to give a very detailed history. He felt that he
might have caught the infection while bathing in the sea and was able to give a detailed description of the
surroundings of the part of the beach he used. He also named various restaurants in the town which he had
visited. The possibility of infection from sea water heavily contaminated with sewage is not yet established but
is becoming more and more likely as marine pollution increases, especially in enclosed waters like the Mediterranean.
But although he described drains entering the sea in the locality of this beach we felt that the cause
was more likely to be food.
Another reason for anxiety emerged when it was learnt that there were three French families with children
staying in the same block of holiday flats, and that two young children, one from Rouen the other from
Evreux, had had attacks of diarrhoea at about the time when he may have become infected with typhoid. A
brief attack of diarrhoea sometimes occurs a day or two after infection by typhoid. In young children, this is
rarely followed by the development of the full blown disease, but as we know from our own experience, they
can become symptomless carriers.
The Medical Officer of Health of Alpes Maritimes, informed us that the drains at the beach which had been
mentioned were for rainwater only and that it would not be possible to identify the source of the infection as
the number of cases of typhoid notified in the area was very low and tended to be isolated. Reassuring replies
were also received from Rouen and Evreux.
It would appear, therefore, that although the cause of this particular incident could not be identified, there are at
any rate the beginnings of co-operation between ourselves and public health authorities in Europe, which we hope
will develop extensively in the years to come.
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