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septic diseases.
Thirty-two (32) patients received institutional treatment, including 7 whose illness had
been wrongly diagnosed. The cases removed formed 80.2 per cent. of the total reported, as
compared with 72.4 in 1909, and 72.8 in the five years 1905-09. There were 4 fatal cases,
three at the patients' homes, and one in hospital; the total fatalitv being equal to 12.1 per
cent., as compared with an average of 15.2. The fatality among patients kept at home was
37.5 per cent. 8.5 per cent. above the average, and more than nine times the fatality observed
during the year among patients removed to hospital (Table 14).
The nett mortality was at the rate of 0.03 per 1,000 persons, equal to the mean rate for
the quinquennium 1905-09. In Willesden alone was last year's rate (0.01) below that recorded
in the Borough (Table 10).
Carrier Cases.—Recovery from an attack of enteric fever does not always secure a
complete elimination of the bacillus typhosus from the patient's system, and he may continue
to excrete that organism for an almost indefinite period either continuously or spasmodically.
Such persons are designated "typhoid carriers," a term which cannot be justified by scientific
etymology, but has apparently attained a firm footing in medical terminology. Such persons
may present no indication of abnormal health, and the excretion of the bacillus may be quite
unknown until the occurrence of cases of the disease among persons with whom they are
brought into contact leads to a systematic bacteriological examination of the fæces and urine.
Horton-Smith was the first to draw attention to this possible factor in the spread of the
disease, in his Gulstonian Lectures of 1900, but the German profession first took the matter
up seriously. The first bacteriological station devoted to the search for "carriers" was
opened in 1903 at Trier. In this country several small outbreaks have been traced to
"carriers" within the past two years.
At the close of 1909 the Local Government Board made arrangements for the faeces and
urine of patients discharged during 1910 from the Hospitals of the Metropolitan Asylums
Board to be systematically examined bacteriologically. Six specimens of each kind were to
be obtained from each patient, the first, one month after discharge from hospital, and the
remainder at intervals of one month. Only five patients were discharged during the year to
the Borough, one so late in the year that the investigation was not completed at the end of
the year. In none of the other four instances could the full number of specimens be obtained,
refusals being given to applications for the second, third and fourth specimens (one case each)
while the fourth patient left the district just before the fifth specimen was due, and could not
be traced. The specimens received and forwarded to the Lister Institute numbered 22 in
all, 11 of each kind. The results of the bacteriological examinations were uniformly negative.
SEPTIC DISEASES.
Under this head attention will be directed to puerperal fever and erysipelas, diseases
which are notified, and to the group of "other septic diseases " which are known only through
the registration of death.
Puerperal Fever.—Nine cases were reported last year, three times as many as in the
previous year, and the largest number since 1906, when 12 cases were reported. The
morbidity rate was 0.05 per 1,000 persons last year, as compared with a mean rate of 0.04
(Table 4). Last year's rate, according to the figures in the Registrar-General's Reports,
was 0.06 (Table 7) which rate was exceeded by that of Willesden (0.07) only.
If reference be made to Table 12 it will be seen that the increase in prevalence
occurred in the second half of the year, and was confined to Westbourne and Church