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During the year 135 of the children completed the course of inoculations and 81 of
these were tested and found immune. At the end of the year 83 cases were still
under treatment or were awaiting the final Schick test.
Diphtheria Carriers.—Two persistent carriers were referred by the County
Medical Officer of Health to the Carrier Clinic for treatment of school children at
the Hospital for Sick Children, Great Ormond Street. Four notified cases admitted
to infectious disease hospitals were subsequently diagnosed as carriers.
TYPHOID
After a long period of relative immunity in the borough an outbreak of typhoid
fever occurred in the autumn of 1938. In the late afternoon of November 9th
information of three cases of typhoid fever was telephoned to the department with
a statement that two relatives of the patients were at home with similar symptoms.
Inquiries at the patients' homes were put in hand forthwith and the Ministry of
Health and the London County Council were notified that evening. Subsequently
the Public Health Department was continually in touch with Medical Officers of
the Ministry, and was greatly assisted by the advice and co-operation of Dr. Norman
Smith. Medical practitioners in the borough and surrounding Medical Officers
of Health were informed of the position on Thursday, November 10th, and one
or two doctors who made enquiries were told that if they wished to vaccinate contacts
against typhoid fever the cost would probably be paid by the Borough Council.
Serum was not considered advisable. Medical practitioners were further informed
as to the position on the following Tuesday, and a meeting was called for the
Wednesday afternoon to discuss further means of mutual co-operation. Here,
with the authority of the Public Health Committee, which had had a special meeting
on November 15th, it was agreed to have available for contacts and other suitable
persons a scheme for anti-typhoid vaccination to be run on similar lines to the
British Medical Association's diphtheria immunization scheme. Detailed enquiries
suggested almost from the beginning a common source of infection through foodstuffs,
and events which subsequently occurred served to strengthen this belief. In all,
eleven patients were vaccinated.
It is to be borne in mind that typhoid fever is spread by infected food or drink.
The source of infection here was the handling of a variety of foodstuffs by an individual
who was later found to have been suffering at the time from a mild form of the
disease, of which he was quite unaware. As soon as this was learned steps were
taken to protect the public and it is clear that these were effective and that the
original source of the infection was removed on November 11th. It is rarely possible
in these outbreaks to be absolutely certain of the original cause of the infection,
but in the present outbreak it seems very probable that the cause was as detailed
above. The individual probably contracted his infection outside the borough
and was suffering from the disease for some weeks before he had the relapse which