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57
ENTERIC FEVER.
Five notifications of enteric fever were received during the
year, in only two of which, however, was the diagnosis confirmed.
One was a case of paratyphoid B infection in a child, diagnosed a
few days after admission to a local convalescent home. The
other patient was a boy who for two weeks preceding the onset
had been away in a camp outside the district.
DYSENTERY.
In November a child was notified as suffering from dysentery,
infection being due to the Sonne organism. From the last week
in November to the end of the year a further 11 cases were notified,
most of them demonstrating the presence of the Sonne organism
in the faeces and probably all of them being due to this cause.
This incidence of infection was part of a widespread prevalence
of this disease not confined to this country but which had, since
the middle of 1937, been present in a number of continental countries.
In this country the incidence in the earlier part of the year was
not excessive, but from some time in July a number of districts
had been affected, some very heavily. In London from the
middle of September the incidence steadily rose and the disease
became so widespread that for two weeks in December 25 out of
the 29 Metropolitan Boroughs were affected; and in December
many of the districts lying to the north of London were affected
to varying degrees. Although in one town it was suspected that
the source of infection was milk taken from one farm and subsequent
to pasteurization of this supply the outbreak ceased, in
most districts there was no factor common to all afflicted members
of the population. The absence of any such common factor, the
extent of the prevalence of the disease and the failure by rigid
aseptic precautions to prevent the spread of infection in a ward
to which the disease had been introduced suggests the possibility
of its being air-borne. In hog cholera, a disease due to a filterable
virus, B. suipestifer is constantly found as a secondary invader.
The explosive character of this outbreak of dysentery resembles
that due to a virus infection, so possibly the Sonne organism is a
secondary invader in this disease.
In five of the households members other than the primary
case were affected. In almost all cases the illness was mild in
character, recovery following in a few days.
UNDULANT FEVER.
One case of undulant fever was reported in a man who was
admitted to hospital on August 9th with a history of illness dating
from July 19th. The only time he consumed milk outside this
district was in late June and in early July.