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21
ENTERIC FEVER.
During the year 17 persons were notified as suffering from enteric
fever, one proving to be typhoid fever and the remainder cases of paratyphoid
B infection. In addition to these there was the case of a patient
who died in October of bronchial pneumonia and on whose certificate
reference was made to paratyphoid B infection but about whom no
particulars could be obtained.
The single case of typhoid infection was that of a man of 33 whose
illness dated from August 9th.
The remaining cases were all of para B infection. In the case of
two, namely, a girl of eleven, who came to this district on April 7th anc'
who fell ill on the 13th of that month, and a boy of nine who came to the
district on the 4th September and who fell ill on the 8th, the infection
was almost certainly contracted in another area.
The following are the particulars of the remaining cases : (1) Two
adult women living in the same house fell ill, one on May 23rd, the other
two days later. One of these patients died on July 3rd. (2) A girl of
five, onset of illness, June 6th. (3) A boy of ten who fell ill on June 9th,
but whose illness was not diagnosed until July 3rd. (4) A girl of eleven,
onset of illness June 23rd, and diagnosed as paratyphoid infection on
July 3rd. (5) Female adult of 49, onset of illness June 22nd, diagnosis
made July 19th. (6) A girl of 21 fell ill on June 28th, being diagnosed
on July 27th. A number of cases had occurred amongst her colleagues
at work in London. (7) A boy of 17, onset of illness July 8th, case
diagnosed July 19th. (8) A male of 20 who fell ill on August 30th and
was notified on September 8th. He worked in and took many meals in
London. (9) An infant of seven months, though notified as a case, was,
at the time of notification, really a carrier. There had been, some weeks
previously, in the institution in which the baby had been for some time,
acase of paratyphoid infection. (10) A female of 20, onset 7th September,
notified 14th October. She had several meals at the canteen at her
factory, which was not in this area. (11) A boy of 2, and his mother,
whose illness dated some ten days after that of the infant, fell ill in
October. (12) A girl of 8, onset of illness October 2nd, notified October
18th.
No connecting links could be found in these cases except, of course,
those which occurred in the same household, in one instance it appearing
probable that there was a simultaneous infection, in the other familial
infection. In some instances the patient was in the habit of having
meals out. In one case it seems probable, in view of the occurrence of
cases amongst co-workers, that the infection was contracted by food
consumed there. In most instances, however, there could be obtained
no history of food having been consumed elsewhere than at home.
There was no common milk supply. Some patients had partaken of
preparations which presumably contained synthetic cream, a product
which has been thought to have been responsible for some outbreaks,
but the remainder gave no such history. Investigations, of course,
are not easy in a disease with such a long incubation period and one,
moreover, in which the clinical condition of the patient is such that a