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40.
Paratyphoid Fever.
An outbreak of paratyphoid fever (B) occurred in
London, Surrey, Middlesex', Kent and Hertfordshire
during the month of July.
In London the outbreak was most acute in Kensington,
Fulham and Wandsworth and cases also occurred in
most of the other Metropolitan Boroughs.
General Features of Paratyphoid Fever.
Paratyphoid Fever resembles typhoid (or enteric)
fever but is a much milder condition than typhoid and
complications and after effects are infrequent.
The illness usually commences with headache and
pains in the body and limbs with rise of temperature,
especially in the evenings. Bleeding from the nose is
frequently one of the initial symptoms. In some cases
there is a rash which appears about a week after the
commencement of the illness and consists of tiny red
spots usually few in number situated on the abdomen and
lower part of the chest. Diarrhoea is sometimes present
but is more often absent. The fever and other acute
symptoms generally subside in about ten to fourteen days
when convalescence is established. Paratyphoid bacilli
are present in the stools and sometimes also in the urine,
both during the acute stage of the illness and during
convalescence. Great care is therefore necessary on the
part of those in attendance on these cases in disposing of
the patients' discharges in order to avoid contamination
of the hands, as nurses sometimes contract the disease.
Although the infection may be spread in this way
directly from the patient to another person, paratyphoid
and typhoid fevers are usually contracted indirectly by
the agency of drinking-water contaminated by infected
sewage or by the consumption of infected articles of
food. Shellfish, especially oysters grown in beds fouled
by sewage derived from patients, are often sources of
infection. Watercress contaminated by infected sewage
may also be responsible for outbreaks.