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Puerperal Pyrexia
Any rise in temperature of 2° of any duration within 2 weeks of
childbirth or miscarriage is notifiable under the Puerperal Pyrexia
Regulations, 1951. It includes all febrile conditions, whatever the cause,
whether related to childbirth or not. Past experience has shown that
most such notifications are to be expected from the large maternity
hospital units established within the district which cater for the obstetric
needs of a large part of Metropolitan Surrey. The majority of these
cases are mothers who are not resident in Carshalton, and hence the
calculation of the incidence rate of puerperal pyrexia based on each
thousand of Carshalton births, gives an entirely misleading indication
as to the risk of this type of pyrexia in the local population.
A total of 270 notifications was received, all from maternity
hospital units. Seventy-four were residents of Carshalton. One hundred
and sixty-six were first confinements. There were no deaths.
Food Poisoning
Twelve cases of food poisoning were reported. Seven of these were
single cases, 6 of them being S. Typhimurium infections and one S. Bovis
morbificans. As is usual in these isolated cases, it was not possible to
identify the vehicle of infection. Investigation into the domestic contacts
of one patient revealed that the other two members of the family were
excreting the offending organism but had not been ill.
The remaining 5 cases were also due to infection by S. Typhimurium
and occurred in two groups of 2 and 3. It was found that the family
which provided the two cases kept 3 ducks and a drake as well as hens
and, since duck eggs are known to be a not uncommon source of this type
of infection, attention was focussed on the ducks. Five eggs were secured
from this small flock over a period of 8 days, and two of them were
found, on bacteriological investigation, to be heavily infected with
S. Typhimurium. Thereupon, the four birds were removed to the Ministry
of Agriculture and Fisheries' veterinary laboratory at Weybridge for
further investigation. There, one duck was found to give a positive
blood reaction to this salmonella and to be excreting the organism.
Tests on the other two ducks and the drake were entirely negative, as
were those on 40 eggs laid by these two ducks, whereas S. Typhimurium
was isolated from the shell of one egg laid by the first-mentioned duck.
On post-mortem examination, S. Typhimurium was recovered from the
ovary and other organs of the duck which gave the positive tests when
alive, but the autopsy on the other three birds was negative. Although
on a much smaller scale, this is the second outbreak of S. Typhimurium
food poisoning which has occurred locally from a domestic flock of ducks,
the previous one being in 1949, when 28 members of a boarding school
and religious community were the victims of this infection found to be
present in the majority of a flock of 32 ducks.
The group of 3 cases were patients in the maternity block of a
local hospital. Two were newborn breast-fed babies, 1 day and 4 days
old respectively, in different wards, the dates of onset being separated
by (i days. The third was a baby of six months, which arose a few days
later in the ward to which the first two babies had been transferred.
The origin of this infection could not be ascertained. There was obviously
no gross contamination of a food commodity and the fact that spread
among so many mothers and babies was kept to such very narrow limits
was doubtless due to the high standard of nursing technique. All three
babies recovered.
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