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diagnosis was frequently made only very belatedly after the onset of
the first signs or symptoms. Although, in point of fact, the illness in
one of the patients was sufficiently serious to cause a fatal issue, in the
majority the attacks, clinically, were of the mildest. It seems most
probable, therefore, that there must have been many other cases in
which the clinical condition was just that much milder to prevent the
condition being recognised at all as a paratyphoid infection.
There are many factors which would tend to lead to an increase in
food infections. The mere fact that paratyphoid fever has, of recent
years, been on the increase is of itself one factor making for further
increase as a certain proportion of patients may continue to act as carriers.
With the absorption of unskilled labour, particularly of persons not
hygienically educated, into factories dealing immediately or remotely
with food products, the risk is increased. Deficient lighting, arising from
the imposition of black-out conditions favours contamination. Shortage
of skilled labour operating plants to process food stuffs, or inability to
obtain or repair or replace damaged parts of plants, may increase the
output of potentially infective food. At ordinary times the sanitary
conditions at some premises where food is handled are not of the best.
To-day many who have had little previous experience are handling
food, so adding to the risks of dissemination of food-borne infections.
The matter is of sufficient importance to justify in at least the larger
food factories the appointment of a welfare supervisor.
The salvage of products exposed to the heat of a fire in a burning
warehouse or to the rusting effects of the water with consequential sale
possibly at reduced prices of these goods, with the small amount of
supervision which it seemed at one time it was proving possible to devote
to it, must have led to a substantial increase in the consumption of food
stuffs not entirely sound. Rationing of food stuffs too must undoubtedly
lead to a consumption of articles which at other times the discriminating
housewife would reject. Difficulties of purchase, coupled with the
rationing will tend, too, to result in much in the household larder being
kept for longer periods than usual.
The course of the illness in most patients was not severe. It is of
interest that two patients presented symptoms of an acute abdomen
for which they were admitted to hospital and operated on.
Four of the patients were treated at home, six were removed to
isolation hospitals, while the remainder were treated at general hospitals,
in many cases the diagnosis having been made at the hospital.
DYSENTERY.
Twelve cases of dysentery were notified during the year, the diagnosis
being subsequently withdrawn in two. With the single exception
of an adult male, a sailor home on leave, in whom the infection was due
to the Flexner organism, the illness was due to Sonne infection. Six of
those so affected were child in-patients at one of the local hospitals,
in whose cases it seemed the infection was contracted in the hospital. One
patient was a nurse in an institution outside this area whose illness was
diagnosed while she was home here on leave and who was thought to
have contracted the illness at her place of work. The other two cases