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farther argument, that if the water-supply was the cause of the
typhoid cases in the district, we should expect the disease to be
more widespread. For the water-supply is common to the entire
population.
From the distribution of the cases there is some evidence to
suppose that the actual causes are not common to the whole parish
and do not continually operate. From a careful investigation of
the cases brought to my notice from April 1900 up to the end of
the year, I have formed the opinion that direct personal infection
and infection through food are the two common channels for the
propagation of Enteric Fever in this District. There, is a disposition
among medical men and others, to regard Enteric Fever as
" only slightly infectious, if indeed it is infectious at all.'' The
disease is looked upon almost solely as a water-borne disease, and
certain experiences in outbreaks in this country, in South Africa, and
elsewhere, lend support to this view. London Districts, where the
water supply is excellent in quality and yet where Enteric Fever
prevails, appear to me to furnish indisputable evidence that,
there are other agencies commonly at work besides water. I think
in this District there is ample evidence, that direct contact with
the person or belongings, of either a known or unrecognised case
of Typhoid Fever, is one of the greatest factors in the spread of the
disease.*
* In support of this contention I may cite the following cases:—
1. Nelly Harp, aged 10. }
2. Minnie How, aged 14.}
3. Annie N., aged 18.}
were all notified as suffering from Enteric Fever between
October 20th and 22nd. They had each been
ill for some days previously. They were members of
three different families, but they were mutual friends and attended the same
Sunday School. It is possible they contracted the disease at this school, as
various complaints were made as to the defective drainage during the
autumn, and in particular on one Sunday, when they were all present, at the
end of September. In two of the cases there was further evidence to show
that the drainage of the two homes was not above criticism. Minute
investigation in all three cases revealed no other likely source of infection.
4. Rose C., aged 9, was notified on November 3rd She was a friend of Minnie
How, and went to the same Sunday School, She associated intimately with
one or other of the three previous cases during the incubation period of
their attacks.
5. Florrie H., aged 8, was ill during the first part of November and was nursed at
home The case was not notified as Enteric at the time and no doctor was
called in. The symptoms were those of Enteric. Florrie H. was a "great
friend " of Rose C., and played with her up to the time of the latter's
notification. She also attended the same Sunday School as the previous
cases, spending her playtime with Rose C. Florrie H, was nursed at home