View report page

STUDENTS AND VISITORS
Student Public Health Inspectors.
Six Student Public Health Inspectors are employed by the Port Health Authority and all made
satisfactory progress. Two of them completed the four year course and were successful in their
examination for the Diploma of Public Health Inspector. Both obtained appointments within the
Corporation, one as a Port Inspector and the other as a Public Health Inspector in the City.
During the year training was given to students from other Local Authorities, thirty-five of
them having received instruction for three or more days in Port Health work.
Visitors
In response to requests from Government Departments, Local Authorities and Institutions of
health education, a considerable number of doctors and public health inspectors have received
instruction in Port Health organisations and practices, sometimes in groups and sometimes as
individuals. Overseas visitors came from CYPRUS, GHANA, INDIA, IRAN, ISRAEL, JAPAN,
MALTA, NIGERIA and POLAND.
PAPERS
The following Papers were read by the Medical Officer of Health at Conferences held during
the year:—
1. Health Congress of the Royal Society of Health. — 27th April, 1965.
TYPHOID FEVER : PAST AND PRESENT
THE EVALUATION OF RISKS OF INFECTION ARISING FROM FOOD,
WITH SPECIAL REFERENCE TO CANNED FOOD AND TYPHOID FEVER.
By W.G. SWANN, B.SC., M.D., D.OBST.R.C.O.G., D.P.A., D.P.H.
Medical Officer of Health, Port and City of London
An attempt at an evaluation of the risks of infection is bound to be at the best an inaccurate
approximation. In the nature of things it can only be a commonsense sort of assessment and not
an objective scientific appraisal. "The deficiency of available vital statistics with respect to
both completeness and accuracy is well known1." Any medical officer of health is aware that the
notification of infectious diseases is incomplete, and this in particular in relation to bacterial
food infections. Notifications of typhoid fever, however, are likely to be more complete, owing to
the fact that generally the illness is so severe as to require medical care and special investigation
in hospital. But this is not necessarily so. In the South Shields outbreak in 1963, a boy
had been ill for a fortnight with pyrexial illness associated with abdominal discomfort before he
was admitted to hospital and found to be suffering from typhoid fever. Similarly the second case
had an indefinite history of onset and had been ill for twelve days before the diagnosis of typhoid
was made. Only when general practitioners and hospitals had been asked to keep a strict lookout
were several other cases found. In the Harlow outbreak in 1963, there was the same insidious
onset of the outbreak with considerable delay before the first cases were diagnosed, but some
cases were definitely infected by a large dose of virulent organisms as the incubation period
was as short as six days. Even more so, the evidence in the Aberdeen outbreak points in some
instances to an incubational period as short as four days with a mass of virulent contamination
of the ihfected food. But in the above-mentioned outbreaks most of the typhoid cases were eventually
discovered and notified.
In relation to some other food-borne infections it is otherwise. Many individual mild cases as
well as outbreaks of bacteriological food poisoning doubtless are never notified. The illness may
be so slight as not to require medical attention, and even then it may not be sufficiently severe
to be adequately investigated bacteriologically in order that the aetiological agent can be detected.
Many cases are treated in their own homes without such investigations. In fact milder
38