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vaccinated. In the same year 2,855 babies were born. In the hope that
if facilities for the vaccination of children against smallpox were offered
to those attending infant welfare centres in the same way as they can be
immunised against diphtheria, a greater proportion might be treated,
the Middlesex County Council sought the approval of the Minister of
Health to such arrangements being made. The approval was given
towards the end of the year.
ENTERIC FEVER
In January, a child of five fell ill with para. B. infection of unknown
origin. In April a child of 12, an in-patient of a local hospital, was
recognised to be suffering from paratyphoid fever which she must have
contracted before being admitted to the hospital. In June a boy of five
was admitted to the isolation hospital with an indefinite illness; paratyphoid
B organisms were later recovered from the stools. In October
a mother and her boy of two who for some weeks had an intestinal disturbance,
were admitted to hospital and were diagnosed to be suffering
from a para. B infection.
Apart from the last two cases there was no connection between these
patients. They fell ill at different times and they lived in different parts
of the district. This is the usual history of the infection as seen in this
district, namely, some half dozen cases almost invariably para. B infection,
spread over the year, occurring in different parts of the district and
having apparently no connection one with another.
In an attempt to discover whether the small number of cases recognised
each year is the entire infection of the district, or whether they
represent merely that proportion of those infected in whom the illness is
recognised, in 1950 some Moore's swabs were put down at four points in
the sewer system. It had been intended, had the organisms been found,
that further swabs should be inserted further up the system in the hope
of tracing back to the origin. In point of fact, none was found to be
positive. It was decided to continue the investigation for some months,
putting swabs down at intervals of a month if the findings were negative,
but tracing back immediately if organisms were found. Unfortunately,
the trials were not successful. Organisms were recovered from swabs in
the main sewer, but could not then be found in any of the branch lines.
On the other hand, on another occasion, organisms were recovered from
the swab in a branch line, but none were recovered from the swab put
down in the main sewer at the same time. It would seem then that there
can be no assurance that a Moore's swab placed in the sewer system
dealing with such volumes of sewage as flow in the sewers in this district
will pick up organisms which are possibly being excreted intermittently.
The position might be different if a patient nursed at home were excreting
large number of organisms regularly. This trial then did nothing to give
an answer to the question of whether these few cases which are detected
each year, are the whole or only part of the infection in the district.