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59
of the country where presumably he had contracted the infection. The
first of the locally contracted cases was a woman of 50 who fell ill with
paratyphoid B fever in the middle of February, and who died a month
later. The source of the infection was not detected in this case nor in
the next, a girl of 18 who lived in another part of the district and who fell
ill also with para. B infection early in May. There were, though, no more
notifications until July when within a few days of each other three
notifications were received. All three patients were children Living in
different parts of the district who had apparently no contact with each
other, nor was any food consumed by them of the type which might convey
infection obtained from the same source. As these three cases
coming together might have been part of a larger number, all general
medical practitioners in the district were written to. In the next few
days a number of patients were removed to hospital suffering from signs or
symptoms suggestive of enteric infection, but in none was the diagnosis
confirmed. At the end of the month another child was admitted
to hospital, the onset of her illness being at the beginning of the
month.
In most years, about half-a-dozen cases of enteric infection are
recognised amongst those living in the district. Diagnosis in many cases
is not easy, and it might be that there are some milder cases unrecognised,
more especially if the illness is not sufficiently severe for the patient's
medical attendant to be summoned. When these three cases were
recognised early in July, the question was whether they were the only
cases in the district or whether they were the only ones recognised out
of a larger number. In an attempt to discover whether or not there was
any hidden infection in the district, Moore's swabs were put down at
four points in the sewer system, being sited so that they lay in the course
of the drainage from all parts of the districts. After being down for
48 hours the swabs were taken to the Colindale Laboratory for examination.
It had been intended if typhoid organisms had been found on any
of the swabs, that other swabs would have been put down further up the
sewers with a view to tracing back as far as possible the source of the
infection. As it happened, no typhoid organism was recovered from any
of the swabs. It is proposed to repeat the trial once a month for six
months.
The only other person in the district who it was known was infected
with typhoid organisms was a boy who went in the summer with a number
of fellow pupils to France. Some days after their return to their homes in
different parts of the country, some were found to be suffering from
paratyphoid fever. Information was received from the Ministry of Health
that four members of the party lived in this district. Enquiries brought
to light the fact that two of these had, after returning home, developed
gastro-intestinal symptoms, the other two remaining free from symptoms.
One of those who had this upset had gone as a member of a party of
Scouts to a camp in the Isle of Wight, being due to return home on the
day after the information was obtained. Examination of clinical
material from these four pupils showed that one was excreting paratyphoid
organisms; he was the one who had had gastro-intestinal symptoms and
can be presumed to have suffered from a mild attack of paratyphoid