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2. BACILLARY DYSENTERY
We were fortunate in having no wide-spread outbreaks of dysentery in the schools this year,
due probably to the relatively mild weather in December. Experience over the past few years has
shown that when the playground lavatories (usually the only ones available to the children) freeze
up dysentery outbreaks frequently follow in infants' schools and, to a lesser extent, in the junior
schools. The causative germ Shigella sonne inhabits the bowel of the infected child causing
diarrhoea but it can survive for surprisingly long periods on W.C. chain pulls, seats, door handles
and even on a bar of soap. Hence provision is made during an out-break for children to immerse
their hands in disinfectant after washing in the normal way. Individual paper towels, of course,
are used and the lavatories repeatedly disinfected by the school keeper. A complication of this
relatively mild condition is the need to exclude from work other members of the family if they are
employed in the preparation or sale of food.
3. ENTERIC FEVER (TYPHOID AND PARA-TYPHOIDS)
One confirmed case occurred in the borough, a lady recently returned from a holiday in
Majorca. Follow-up of her contacts was complicated by the fact that the day her illness became
apparent she was one of a coach party visiting a Church Fete in the country where temporary
earth-pit latrines were the only available conveniences.
Another case, clinically typical but not confirmed bacteriologically, occurred in a young
lady immediately following her return from a holiday in Tangiers. Her parents kept a confectionery
and tobacco shop, and we banned the sale of ice cream and of all unwrapped sweets until the
whole family had been cleared.
During the late summer much work was involved in surveillance of residents exposed to
infection from outbreaks in Spain, Blackpool and Barnet. A single case at a holiday camp at
Bognor Regis produced no less than 40 Waltham Forest contacts. Specimens, to exclude latent
infection, had to be taken from all contacts and contributed significantly to the total of 763
examined during the year.
Health Education, principally by H.Vs and P.H.Is (who also administer the Food Hygiene
Regulations) is doing much to raise standards and reduce the risk of epidemics but the danger
continues and it is noteworthy that over the past five years the annual incidence of enteric fevers
in England and Wales has risen from 331 cases in 1960 to 970 in 1965.
During the year there also occurred 24 cases of gastro-enteritis due to related germs, e.g.
salmonella typhimurium which causes typhoid fever in rodents but usually only acute gastroenteritis
in man. It is very highly infectious and one of the most common sources of severe food
poisoning.
4. TUBERCULOSIS
During the year 111 new cases of tuberculosis were notified, 101 of them from the Chest
Clinic at Whipps Cross Hospital, where 21 per cent occurred in immigrants and three quarters of
these in Pakistanis. There has been little change during the past few years 102 new cases being
notified last year, and 122 in 1963. Deaths from tuberculosis totalled 12, compared with 17 and
14 for the combined boroughs for 1964 and 1963 respectively.
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