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121
sufficiently slight that he goes about his ordinary business, so spreading
the disease. It would be helpful if the practice could be cultivated of a
child being revaccinated as routine on his entry to school and again just
before he leaves.
Patients suffering from smallpox are admitted to special hospitals.
For many years those from Middlesex have been admitted to one of the
London County Hospital special hospitals. Under to-day's arrangements
patients are admitted to Joyce Green Hospital (Superintendent
Dr. Mitman, Dartford 3231). The Ministry of Health has set up up a
panel of consultants who will visit patients suspected to be suffering
from smallpox. The one nearest to this district is Dr. W. Gunn, Royal
Free Hospital, Hampstead, Primrose 7671. The patients are removed
by an ambulance of the London County Council. The service of the
ambulance is obtained by approach being made to the Middlesex County
Council Ambulance Service.
MALARIA
Although at one time endemic in large areas in this country, to-day
malaria is endemic only in limited localities. Most of the cases notified
are those who are suffering from a relapse of an infection acquired abroad.
The two cases notified this year are such instances.
ENTERIC FEVER
Each year a small number of cases of enteric infection amongst
those living in this district are received. Very rarely the disease is
typhoid fever; the vast majority of the cases, though, are of paratyphoid
fever, the organism nearly always being the para B type. Although
clinically similar, though typically the paratyphoid infection is of a
milder character than typhoid, epidemologically the diseases are very
different in that typhoid fever infection is almost always associated at
some stage with contamination of water, while paratyphoid infections
are more commonly food borne.
In an attempt to discover whether there is any hidden infection in
the district, in 1951 Moore's swabs were put down at points in the sewer
system. 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 to the source
of infection. No results were obtained though, because organisms
right be recovered on the swabs in the smaller sewers and yet not be
found on those in the larger sewers to which these led.
Two patients were notified to be suffering from paratyphoid
infection. They were two sisters who fell ill within a few days of each
other. The laboratory work on the organisms which were recovered
was carried out at the Colindale Laboratory. An enquiry into the distribution
of organisms of the same phage type of which the laboratory
had knowledge led to the discovery that two members of two families in
districts adjoining this were infected with the same organism. Enquiries
of the local cases pointed to the consumption of a preparation from a
local bakery as the source of infection. Enquiries at the households of
these other patients disclosed that those affected had consumed