THERE WERE 34 outbreaks of water-borne disease recorded in the UK between 1937 and 1986, comprising over I I 794 cases and at least six deaths.A total of 21 outbreaks were due to public water supplies, 11 of thcni contaminated at source; in eight of these 11 the water was unchlorinated or defectively chlorinated. None of the six' reported deaths was due t o contamination of public supplies at source. About 1 000 cases of gastro-intestinal illness were caused by consumption ofafoods, particularly milk and canned nicats, that had been contaminated by polluted water during processing. Shellfish harvested from pollutcd cstuarics gave rise to increasing numbers of outbreaks of viral gastroenteritis and hepatitis A. The recreational use of water was associated with about 400 serious infections and probably many minor illnesses. Sonie hospital infections may have hecn derived from the potable water supply. A total of 14 outbreaks of legionnaires' disease and eight of humidifier fever were associated with water in buildings.Thc future control of water-borne and waterassociated disease demands not only continued vigilance in the water industry but closer collaboration between public health doctors and water engineers and scientists.

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A milk-borne outbreak of Salm. heidelberg infection due to unpasteurized milk from tuberculin-tested cows is described. There were 77 cases and 46 symptomless excreters of the organism. There were no deaths. The infection was traced to a cow with a symptomless salmonella mastitis and the origin of the organism was thought to be contaminated animal feeding stuffs.We are indebted to Dr Joan Taylor, Colindale, for the identification of the salmonella serotypes; to Dr H. R. Cayton, Bristol, for assistance in the examination of animal feeding stuffs; to Dr E. N. Davey, Gloucester, for permission to include his results of milk examinations; and to the following public health inspectors who assisted in the field investigation—Mr A. Furniss, Mr G. Baillie and Mr M. V. Smith, Cirencester Urban District; Mr H. Wheeler and Mr R. Hayward, Cirencester Rural District; Mr P. Hayter, Bristol; and Mr D. S. Smith, Trowbridge.

In England and Wales between 1951 and 1980 233

A 54-year-old Jamaican employed as a grinding machine operator developed pulmonary anthrax and died within two days. In the eight days before his illness he had been grinding sterilized bone charcoal delivered in second-hand sacks, some of which had been used to import the raw bone before its sterilization. Bacillus anthracis was isolated from four out of six sacks examined and is considered to have been the source of the infection.

Sickle-cellBDisease-Konotey-Ahulu and Ringelhann I SH~cBARLI~sI~oNRBr 612 8 March 196 Sickle-cell Dises-Knty-hl and R~~in5gelhanIn MEDICAL JOURNAL Lehmann (1962) from Accra, while Went and MacIver (1958) described it from the West Indies. The differential diagnosis of adult sickle-cell disease reported " SS " is given in Table V. Clinically some cases of sickle-cell F-thalassaemia may be difficult to differentiate from SFhighgene cases, but the simple Kleihauer and Betke staining technique (Lehmann and Huntsman, 1966) will distinguish between the two by their foetal haemoglobin distribution in the red cells. In F-thalassaemia the distribution of Hb F in the individual red cells is quite heterogeneous, while in Fhighgeue it is relatively uniform. We have found this test useful in Accra, where the level of Hb F may be more than 10% in sickle-cell anaemia or sickle-cell .thalassaemia. The contribution that adult sickle-cell disease patients make towards the persistence of the S gene in the population is greater than is usually realized. It is no mere conjecture when we state that here in Ghana this contribution will soon outstrip that supposed to be made by balanced polymorphism through falciparum malaria. Widespread haemoglobin genotyping starting from schools and subsequent genetic counselling of young adults ought to be pursued relentlessly (Konotey-Ahulu, 1968) if the morbidity and mortality caused by sickle-cell disease are to be appreciably reduced on the African Continent.

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