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HYGIENE IN PALESTINE
470 0.5-3-0 millicuries per millilitre. Chemical analysis is furnished with each shipment. Material will meet the
containing
following specifications : Concentration....
pH
......
Total solids.... Non-volatile matter.. P (inert) ....
CI
Fa Ni
......
A1 } 1
Greater than 0-5 mC./ml. 7-9 Less than 10 mg./ml. Less than5 mg./ml.
Approximately 0-025 mg. /mC. added.
(Carrier-free material is available if desired.) Less than5 mg./ml.
low that
"
"
"
Content so is formed at
pH
no
precipitate
7-9
Iodine 131 Beta radiation 0-6 MeV. Gamma Half-life 8-0 days. radiation 0-367, 0-080, and probably also 0-65 MeV. (10-15%). Carrier-free, in neutral or weakly basic solution containing 0-3-2-0 millicuries per millilitre. Chemical analysis is furnished with each shipment. Material will meet the following
specifications : Coneentration.... Greater than 0-3 mC./ml. ...... 7-9 pH Total solids.... Less than 1 mg./ml. we inactive.... 0-1 mg./ml. Te active.... Less than I X 10-4mC./ml.
The Council will not accept responsibility for the accuracy of the statement as to radioactive content which will accompany each sample, or for the freedom of the sample from toxicity. The cost of the materials will depend on various factors, including the demand, but is unlikely in the first instance to be less than 1per millicurie for J131 or 10s. per millicurie for P32. While every effort must be made to utilise these therapeutic developments and possibilities to the full, there can be little doubt that, from the long-term point of view, the treatment of cancer and allied diseases is most likely to be advanced by the encouragement of tracer investigations, using both radioactive and nonradioactive isotopes. Materials for this purpose are also obtainable from the Council, and at present, in view of the small quantities involved, no charge is being made. The need for extreme caution in the clinical use of radioThe active isotopic tracers cannot be over-emphasised. safety of non-radioactive tracers should recommend their use in clinical investigations. DANGERS AND LIMITATIONS OF RADIOACTIVE ISOTOPE THERAPY
dangers inherent in radioactive isotope therapy becoming recognised, especially in the case of radiophosphorus administered internally as inorganic phosphate. The most serious of these are possible injury to the reproductive organs, genetic damage, the induction of leukaemias and the hastening of the appearance of leuksemic conditions, and the production of malignant tumours. The leuksemogenesis and carcinogenesis, including induction of sarcoma of bone, are likely to be delayed effects, with a long latent period of possibly five years and probably often longer. Accordingly, in the present state of knowledge, it is usually unwise to employ radiophosphorus in the treatment of patients of either sex in the reproductive period of life or in patients where the expectation of life exceeds five years. In general, it must be concluded that therapeutic trials of radioactive isotopes should be limited to cancer and allied diseases, and polycythaemia vera. With rare exceptions, radioactive isotope therapy should not be used in non-malignant conditions. Further, the opinion has been expressed that, in the present state of knowledge, radioactive isotopes should in no case be used in Certain
are
the treatment of children suffering from non-malignant diseases. Despite these limitations, there is an important field for investigation in the therapeutic applications of radioactive isotopes. At first, it will be necessary to develop techniques and to confirm and extend the results of the American workers, while profiting from their experience. Subsequently, it seems likely that the development of selectively concentrated organic compounds containing radioactive isotopes may be a promising line of investigation. Probably there will be an immediate though rather limited field for the use of external applicators containing sources of beta rays. Experience with artificial gammaray sources, such as radiocobalt (cobalt 60), in radiotherapy is at present very restricted but this is a matter for experimental development when adequate regular supplies become available. All correspondence should be addressed to the Secretary, Advisory Panel on the Allocation of Radioactive Isotopes for
Clinical
Research, Medical Research Council, 38, Old Queen Street, London, S.W.I.
Public Health HYGIENE IN PALESTINE
ERIC HARDY F.Z.S. UNDER the British mandate, Palestine’s sanitation and
public health improved considerably from what they had been during the Turkish occupation. Scientific control of the mosquito-breeding places greatly reduced the amount of malaria-infested land, and the destruction of the packs of pariah dogs which had haunted the gates of the cities at sundown since Biblical times removed this dangerous source of rabies. In more recent years the Jewish settlements, with their technical advisers at the University of Jerusalem and elsewhere, developed parts of Lake Huleh, Jebel Usdum, and the plain of Jezreel which had previously been undeveloped malarious swamps. All this useful work is threatened by the disturbance of the civil war and the lack of scientific supervision of many of the native parts of the countryside. The malaria position at the end of the mandate was roughly that the malaria risk was high in the Jordan Valley from the Syrian border to the south of the Dead Sea, chiefly on the Transjordan side. It was also very high in marshy parts of the coastal plain near the Wadi Sukreir, the Wadi Rubin, and the Tantura area, in the Wadi Faria near Nablus, and’ south of Faluja. Near Jericho, Tiberias, and Safad it was high from September to December but otherwise moderate ; but there was little risk around Jerusalem, Hebron, and Lydda. In 1940, Krikorian and Bedrechi listed 9 species in their Atlas of the Anopheles Mosquitoes of Palestine, published by the department of public health in Jerusalem, and a strict and wide control of mosquitoes in the villages was supervised in the later years of the mandate by Dr. J. MacQueen, the director of medical services, and Dr. W. K. Bigger, the A.D.M.s., with trained Jewish and Arab personnel, and also assistance from officers of the R.A.M.C. Together with Jewish scientists, a malaria research hut was maintained in the notorious Huleh region where the intensity of malaria in the Arab villages was very high, the splenic index being 80-100 %, with an extremely high death-rate among children under 10 years, so that the natural increase of the population there was negligible. Lieut.-Colonel R. St. John Lyburn, R.A.M.C., describesan experiment in the mass spraying of the Huleh villages, made with Dr. Bigger’s supervision in January, 1946, primarily to control malaria and flyborne dysentery, another widespread insect-borne trouble of Palestine which is likely to increase, since the native Arab practises little personal sanitation. The three commonest rural malaria-carrying mosquitoes in Palestine are the palaearctic Anopheles sergenti, A. superpictus, and A. saccharovi (elutus), the last-named, 1. Bulletin
of the Jerusalem Naturalists’ Club,
no. 14.
471 the largest anopheline in the country, breeding in swamps and stagnant water like Huleh. Many adult mosquitoes were found resting in the dark interiors of cattle byres and papyrus living-huts in the villages. The water is too cold for them to breed at Huleh (in the north) at that time of year, but the mosquitoes emerge to lay their eggs in the warmer weather of April. The malaria season lasts from then to December, when the mosquitoes become torpid again and are then more easily accessible for spraying. Owing to the war-time development of the Palestine Potash Company’s plant at the Dead Sea outbreaks of malaria were traced to the fresh-water swamps on the north-western shores of the Dead Sea at Ein Fashka, and these were controlled by cutting down the vast thickets of phragmites and arundo reeds and admitting light to the cleared channels of fast water from this wellknown spring. Towards the end of the mandate D.D.T. had largely replaced the Paris Green hitherto used in breeding waters. In October, 1942, a malaria survey of the Wadi el Arabah-the Arabah of the Bible, an arid desert over 100 miles long between the Dead Sea and the Red Seawas made by Major Lumsden, during the active breeding season of the mosquitoes. He found both in the Ghor and the Wadi Arabah A. superpictus, the Ethiopian A. d’thali, A. sergenti, and A. multicolor. In February, 1946, an expedition of the Jerusalem Naturalists’ Club to the Wadi el Arabah remained a fortnight there, when the mosquitoes were studied by Major F. Jacousiel, R.A.M.C. It was found2 that even in this warm subtropical area mosquito breeding is at a very low ebb in February. A few scanty specimens of A. sergenti and A. multicolor were found, adult specimens of the first-named sheltering in a cave near the spring of Ein Arus in the Ghor. Larvae of both species were collected in swamps in that neighbourhood, which is close to the south shore of the Dead Sea, and at Ein Weba, a small oasis in the heart of the Arabah desert. Of the culicine mosquitoes, the expedition found the large larvae of Theobaldia longiareolata in sweet water at almost every spring and marsh visited in the Ghor and the Arabah, and a few larvae of Culex pipiens were collected in the springs near Ein Beida. The latter species, with C. laticinctus, are the common urban culicine mosquitoes of Palestine, tolerating the very dirty water of ancient stone cisterns, Roman caves, tanks and native wells, and they are abundant concrete in native village houses. Uranotcenta unguiculata, Taeniorhynchus buxtoni, Ochlerotatus caspius, and O. detritus breed in the marshy parts of the country, and 0. marice in saline water in holes by the sea. Culex perexiguus and C. tritceniorhynchus prefer cleaner water, but are common. Other insect-pests, like small sand-flies (Phlebotomus) and house-flies (]}Iusca), are probably as numerous as they naturally can be, and are less likely than the mosquitoes to be affected by the lack of scientific -
of faeces have been sent for examination from 20 residents of these dwellings. The ’one food factor common to all cases is the consumption of water from this stream and it is almost certain that this is the source of the outbreak. A vigorous press campaign locally has been prosecuted to ensure that all possible cases are brought to light. It is anticipated that a few more cases will be detected, but the main outbreak seems to have passed. In Shropshire On Sept. 5 a night-sister at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, complained of severe headache and was feverish; she had felt unwell the previous day. On Sept. 6 another night-sister and the assistant matron reported with the same symptoms. Next day there were 5 more cases, in a third night-sister, 2 day-sisters, and 2 maids. On the 8th and 9th positive Widal reactions were reported -in 9 further members of the nursing and domestic staff, and in 2 children in separate wards who had been feverish since Sept. 5 ana C. Six nurses who went on leave on Sept. 3-and 4 have been reported as cases. Up to the night of Sept. 11 there were 24 cases among the nursing and domestic staff and 4 patients, and a further 3 cases have been confirmed among the outside domestic staff who had been sent home ill. The signs and symptoms in all cases have been severe headache, temperature generally from 103 to 105 °F at night and 100-101°F in the morning, injected conjunctivae in most cases, -and constipation. There have been no preliminary gastro-intestinal symptoms. diagnosis was influenza, but on Sept. 7, The original owing to the continued fever, Dr. Aylmer Lewis took a sample of blood for Widal reaction from a patient who had not had T.A.B. inoculations at any time and on the 9th this was reported as showing a titre of 1/125 for S. paratyphi-A and of 1/25 for S. typhi. Later samples showed a titre of 1/1000 for S. typhi;cultures of blood and faeces have so far been negative. The milk-supply has been investigated, samples of blood and urine and rectal swabs having been taken from all milk handlers at the farms supplying the hospital and from all the kitchen staff ; samples of water are also being examined, and so far the distribution of cases and other factors suggest that the water-supply is the most likely source of infection. The population at risk in the hospital is about 400 patients, 170 nurses, 50 indoor domestic staff, 80 outdoor domestic staff, and 12 medical and clerical staff.
Paratyphoid
at
a
Girls’ Camp
A party of 42 members of the Oldbury (Worcestershire) branch of the Girls Life Brigade were camping in a small church hall in Pevensey Bay, Sussex, from Aug. 16 to 30, and since returning home many of them have developed paratyphoid fever. By Sept. 10 there were 19 suspected or confirmed cases in hospital. The church hall had main water and drainage, but with 6 adults and 36 girls in it supervision. the conditions must have been rather cramped and the lavatory accommodation and cooking facilities were in close proximity. Information was obtained from the Two Outbreaks of Typhoid Fever local food office as to the main sources from which this party obtained their foodstuffs, and these were On Clydeside investigated, but nothing suspicious has been revealed. A sharp outbreak has occurred in the Greenock; One of the party, who had been doing the cooking, Port Glasgow, and Gourock areas of Clydeside. By was taken ill with diarrhoea and vomiting about Aug. 22 5 29. The 3 totalled first cases the cases Sept. diagnosed and had to be suspended from cooking duties. She was were in holiday-makers in Gourock who had crossed the Firth of Clyde to Kilcreggan, a favourite place for removed to hospital for investigation, but by Sept. 11 had not been proved that this was a case of paratyphoid picnic parties, and there had drunk water (unboiled) it fever. However, a small boy, aged 8, who had also been from a stream. The next batch of cases came from in the camp ill with diarrhoea, vomiting, and pyrexia members of a Church organisation, about 700 of whom on Aug. 22 was proved to have a paratyphoid B infection. went on an excursion to the same resort. Large numbers It is understood that this boy had been isolated in the are known to have drank unboiled water from the stream church hall, but under the existing conditions the and 24 cases have so far been notified. The remaining isolation could not have been fully effective. 2 cases are Greenock youths who were camping at It seems probable, therefore, that this boy was the Kilcreggan. All cases are due to Salinonella typhi. So source of infection in the other cases. As to the origin far the organism has not been discovered in the stream ; of his infection it is unlikely that he contracted it in three samples taken have revealed 24 types of bowel Bay, since there have been no other cases there, organism but no typhoid organisms. It is known that Pevensey it seems probable that he was infected before his drainage from a few dwellings reaches the stream above and arrival on Aug. 16. the point from which the water was taken, and samples No secondary cases have arisen in Pevensey Bay up to Sept. 13. 2. Ibid, no. 20.
containing
following specifications : Concentration....
pH
......
Total solids.... Non-volatile matter.. P (inert) ....
CI
Fa Ni
......
A1 } 1
Greater than 0-5 mC./ml. 7-9 Less than 10 mg./ml. Less than5 mg./ml.
Approximately 0-025 mg. /mC. added.
(Carrier-free material is available if desired.) Less than5 mg./ml.
low that
"
"
"
Content so is formed at
pH
no
precipitate
7-9
Iodine 131 Beta radiation 0-6 MeV. Gamma Half-life 8-0 days. radiation 0-367, 0-080, and probably also 0-65 MeV. (10-15%). Carrier-free, in neutral or weakly basic solution containing 0-3-2-0 millicuries per millilitre. Chemical analysis is furnished with each shipment. Material will meet the following
specifications : Coneentration.... Greater than 0-3 mC./ml. ...... 7-9 pH Total solids.... Less than 1 mg./ml. we inactive.... 0-1 mg./ml. Te active.... Less than I X 10-4mC./ml.
The Council will not accept responsibility for the accuracy of the statement as to radioactive content which will accompany each sample, or for the freedom of the sample from toxicity. The cost of the materials will depend on various factors, including the demand, but is unlikely in the first instance to be less than 1per millicurie for J131 or 10s. per millicurie for P32. While every effort must be made to utilise these therapeutic developments and possibilities to the full, there can be little doubt that, from the long-term point of view, the treatment of cancer and allied diseases is most likely to be advanced by the encouragement of tracer investigations, using both radioactive and nonradioactive isotopes. Materials for this purpose are also obtainable from the Council, and at present, in view of the small quantities involved, no charge is being made. The need for extreme caution in the clinical use of radioThe active isotopic tracers cannot be over-emphasised. safety of non-radioactive tracers should recommend their use in clinical investigations. DANGERS AND LIMITATIONS OF RADIOACTIVE ISOTOPE THERAPY
dangers inherent in radioactive isotope therapy becoming recognised, especially in the case of radiophosphorus administered internally as inorganic phosphate. The most serious of these are possible injury to the reproductive organs, genetic damage, the induction of leukaemias and the hastening of the appearance of leuksemic conditions, and the production of malignant tumours. The leuksemogenesis and carcinogenesis, including induction of sarcoma of bone, are likely to be delayed effects, with a long latent period of possibly five years and probably often longer. Accordingly, in the present state of knowledge, it is usually unwise to employ radiophosphorus in the treatment of patients of either sex in the reproductive period of life or in patients where the expectation of life exceeds five years. In general, it must be concluded that therapeutic trials of radioactive isotopes should be limited to cancer and allied diseases, and polycythaemia vera. With rare exceptions, radioactive isotope therapy should not be used in non-malignant conditions. Further, the opinion has been expressed that, in the present state of knowledge, radioactive isotopes should in no case be used in Certain
are
the treatment of children suffering from non-malignant diseases. Despite these limitations, there is an important field for investigation in the therapeutic applications of radioactive isotopes. At first, it will be necessary to develop techniques and to confirm and extend the results of the American workers, while profiting from their experience. Subsequently, it seems likely that the development of selectively concentrated organic compounds containing radioactive isotopes may be a promising line of investigation. Probably there will be an immediate though rather limited field for the use of external applicators containing sources of beta rays. Experience with artificial gammaray sources, such as radiocobalt (cobalt 60), in radiotherapy is at present very restricted but this is a matter for experimental development when adequate regular supplies become available. All correspondence should be addressed to the Secretary, Advisory Panel on the Allocation of Radioactive Isotopes for
Clinical
Research, Medical Research Council, 38, Old Queen Street, London, S.W.I.
Public Health HYGIENE IN PALESTINE
ERIC HARDY F.Z.S. UNDER the British mandate, Palestine’s sanitation and
public health improved considerably from what they had been during the Turkish occupation. Scientific control of the mosquito-breeding places greatly reduced the amount of malaria-infested land, and the destruction of the packs of pariah dogs which had haunted the gates of the cities at sundown since Biblical times removed this dangerous source of rabies. In more recent years the Jewish settlements, with their technical advisers at the University of Jerusalem and elsewhere, developed parts of Lake Huleh, Jebel Usdum, and the plain of Jezreel which had previously been undeveloped malarious swamps. All this useful work is threatened by the disturbance of the civil war and the lack of scientific supervision of many of the native parts of the countryside. The malaria position at the end of the mandate was roughly that the malaria risk was high in the Jordan Valley from the Syrian border to the south of the Dead Sea, chiefly on the Transjordan side. It was also very high in marshy parts of the coastal plain near the Wadi Sukreir, the Wadi Rubin, and the Tantura area, in the Wadi Faria near Nablus, and’ south of Faluja. Near Jericho, Tiberias, and Safad it was high from September to December but otherwise moderate ; but there was little risk around Jerusalem, Hebron, and Lydda. In 1940, Krikorian and Bedrechi listed 9 species in their Atlas of the Anopheles Mosquitoes of Palestine, published by the department of public health in Jerusalem, and a strict and wide control of mosquitoes in the villages was supervised in the later years of the mandate by Dr. J. MacQueen, the director of medical services, and Dr. W. K. Bigger, the A.D.M.s., with trained Jewish and Arab personnel, and also assistance from officers of the R.A.M.C. Together with Jewish scientists, a malaria research hut was maintained in the notorious Huleh region where the intensity of malaria in the Arab villages was very high, the splenic index being 80-100 %, with an extremely high death-rate among children under 10 years, so that the natural increase of the population there was negligible. Lieut.-Colonel R. St. John Lyburn, R.A.M.C., describesan experiment in the mass spraying of the Huleh villages, made with Dr. Bigger’s supervision in January, 1946, primarily to control malaria and flyborne dysentery, another widespread insect-borne trouble of Palestine which is likely to increase, since the native Arab practises little personal sanitation. The three commonest rural malaria-carrying mosquitoes in Palestine are the palaearctic Anopheles sergenti, A. superpictus, and A. saccharovi (elutus), the last-named, 1. Bulletin
of the Jerusalem Naturalists’ Club,
no. 14.
471 the largest anopheline in the country, breeding in swamps and stagnant water like Huleh. Many adult mosquitoes were found resting in the dark interiors of cattle byres and papyrus living-huts in the villages. The water is too cold for them to breed at Huleh (in the north) at that time of year, but the mosquitoes emerge to lay their eggs in the warmer weather of April. The malaria season lasts from then to December, when the mosquitoes become torpid again and are then more easily accessible for spraying. Owing to the war-time development of the Palestine Potash Company’s plant at the Dead Sea outbreaks of malaria were traced to the fresh-water swamps on the north-western shores of the Dead Sea at Ein Fashka, and these were controlled by cutting down the vast thickets of phragmites and arundo reeds and admitting light to the cleared channels of fast water from this wellknown spring. Towards the end of the mandate D.D.T. had largely replaced the Paris Green hitherto used in breeding waters. In October, 1942, a malaria survey of the Wadi el Arabah-the Arabah of the Bible, an arid desert over 100 miles long between the Dead Sea and the Red Seawas made by Major Lumsden, during the active breeding season of the mosquitoes. He found both in the Ghor and the Wadi Arabah A. superpictus, the Ethiopian A. d’thali, A. sergenti, and A. multicolor. In February, 1946, an expedition of the Jerusalem Naturalists’ Club to the Wadi el Arabah remained a fortnight there, when the mosquitoes were studied by Major F. Jacousiel, R.A.M.C. It was found2 that even in this warm subtropical area mosquito breeding is at a very low ebb in February. A few scanty specimens of A. sergenti and A. multicolor were found, adult specimens of the first-named sheltering in a cave near the spring of Ein Arus in the Ghor. Larvae of both species were collected in swamps in that neighbourhood, which is close to the south shore of the Dead Sea, and at Ein Weba, a small oasis in the heart of the Arabah desert. Of the culicine mosquitoes, the expedition found the large larvae of Theobaldia longiareolata in sweet water at almost every spring and marsh visited in the Ghor and the Arabah, and a few larvae of Culex pipiens were collected in the springs near Ein Beida. The latter species, with C. laticinctus, are the common urban culicine mosquitoes of Palestine, tolerating the very dirty water of ancient stone cisterns, Roman caves, tanks and native wells, and they are abundant concrete in native village houses. Uranotcenta unguiculata, Taeniorhynchus buxtoni, Ochlerotatus caspius, and O. detritus breed in the marshy parts of the country, and 0. marice in saline water in holes by the sea. Culex perexiguus and C. tritceniorhynchus prefer cleaner water, but are common. Other insect-pests, like small sand-flies (Phlebotomus) and house-flies (]}Iusca), are probably as numerous as they naturally can be, and are less likely than the mosquitoes to be affected by the lack of scientific -
of faeces have been sent for examination from 20 residents of these dwellings. The ’one food factor common to all cases is the consumption of water from this stream and it is almost certain that this is the source of the outbreak. A vigorous press campaign locally has been prosecuted to ensure that all possible cases are brought to light. It is anticipated that a few more cases will be detected, but the main outbreak seems to have passed. In Shropshire On Sept. 5 a night-sister at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, complained of severe headache and was feverish; she had felt unwell the previous day. On Sept. 6 another night-sister and the assistant matron reported with the same symptoms. Next day there were 5 more cases, in a third night-sister, 2 day-sisters, and 2 maids. On the 8th and 9th positive Widal reactions were reported -in 9 further members of the nursing and domestic staff, and in 2 children in separate wards who had been feverish since Sept. 5 ana C. Six nurses who went on leave on Sept. 3-and 4 have been reported as cases. Up to the night of Sept. 11 there were 24 cases among the nursing and domestic staff and 4 patients, and a further 3 cases have been confirmed among the outside domestic staff who had been sent home ill. The signs and symptoms in all cases have been severe headache, temperature generally from 103 to 105 °F at night and 100-101°F in the morning, injected conjunctivae in most cases, -and constipation. There have been no preliminary gastro-intestinal symptoms. diagnosis was influenza, but on Sept. 7, The original owing to the continued fever, Dr. Aylmer Lewis took a sample of blood for Widal reaction from a patient who had not had T.A.B. inoculations at any time and on the 9th this was reported as showing a titre of 1/125 for S. paratyphi-A and of 1/25 for S. typhi. Later samples showed a titre of 1/1000 for S. typhi;cultures of blood and faeces have so far been negative. The milk-supply has been investigated, samples of blood and urine and rectal swabs having been taken from all milk handlers at the farms supplying the hospital and from all the kitchen staff ; samples of water are also being examined, and so far the distribution of cases and other factors suggest that the water-supply is the most likely source of infection. The population at risk in the hospital is about 400 patients, 170 nurses, 50 indoor domestic staff, 80 outdoor domestic staff, and 12 medical and clerical staff.
Paratyphoid
at
a
Girls’ Camp
A party of 42 members of the Oldbury (Worcestershire) branch of the Girls Life Brigade were camping in a small church hall in Pevensey Bay, Sussex, from Aug. 16 to 30, and since returning home many of them have developed paratyphoid fever. By Sept. 10 there were 19 suspected or confirmed cases in hospital. The church hall had main water and drainage, but with 6 adults and 36 girls in it supervision. the conditions must have been rather cramped and the lavatory accommodation and cooking facilities were in close proximity. Information was obtained from the Two Outbreaks of Typhoid Fever local food office as to the main sources from which this party obtained their foodstuffs, and these were On Clydeside investigated, but nothing suspicious has been revealed. A sharp outbreak has occurred in the Greenock; One of the party, who had been doing the cooking, Port Glasgow, and Gourock areas of Clydeside. By was taken ill with diarrhoea and vomiting about Aug. 22 5 29. The 3 totalled first cases the cases Sept. diagnosed and had to be suspended from cooking duties. She was were in holiday-makers in Gourock who had crossed the Firth of Clyde to Kilcreggan, a favourite place for removed to hospital for investigation, but by Sept. 11 had not been proved that this was a case of paratyphoid picnic parties, and there had drunk water (unboiled) it fever. However, a small boy, aged 8, who had also been from a stream. The next batch of cases came from in the camp ill with diarrhoea, vomiting, and pyrexia members of a Church organisation, about 700 of whom on Aug. 22 was proved to have a paratyphoid B infection. went on an excursion to the same resort. Large numbers It is understood that this boy had been isolated in the are known to have drank unboiled water from the stream church hall, but under the existing conditions the and 24 cases have so far been notified. The remaining isolation could not have been fully effective. 2 cases are Greenock youths who were camping at It seems probable, therefore, that this boy was the Kilcreggan. All cases are due to Salinonella typhi. So source of infection in the other cases. As to the origin far the organism has not been discovered in the stream ; of his infection it is unlikely that he contracted it in three samples taken have revealed 24 types of bowel Bay, since there have been no other cases there, organism but no typhoid organisms. It is known that Pevensey it seems probable that he was infected before his drainage from a few dwellings reaches the stream above and arrival on Aug. 16. the point from which the water was taken, and samples No secondary cases have arisen in Pevensey Bay up to Sept. 13. 2. Ibid, no. 20.