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other diseases. 41
yield to the usual remedies. Fever supervened, the temperature rising in some cases as high
as 102° and lasting for various periods up to a week. There were no indications of any
pulmonary lesions, no splenic enlargement, and no delirium. Some of the older patients had
attacks of grave syncope, and, with the exception already mentioned, convalescence was slow,
but all the patients recovered.
At the outset enquiries were directed to determine which of the foods taken by the
household had been the cause of the outbreak. The time of the commencement of the cases
and the fact that none of the male residents had been attacked, gave rise to a suspicion that
the infected food—if there had been any—had formed part of the mid-day meal on the 10th,
at which only one male guest had been present. Careful inquiries, however, failed to elicit
any evidence of any one food having been taken by the patients, and not by those who
escaped. Still, in view of the known capriciousness with which an infected food will affect
certain only of those partaking of it, it was thought desirable to push the enquiries into the
origin of all the food stuffs supplied to the house on the 9th and 10th. Such inquiries proved
quite abortive, and while they were in progress a preliminary report was received from the
Lister Institute giving the results of the bacteriological examination of the specimens of faeces
forwarded to the Institute on the 14th.* Briefly it may be stated that the causal organism
was found to be one of the paratyphoid bacilli (B. paratyphoid "B.") a comparatively rare
organism in this country, and one not previously recorded as causing gastro-enteritic attacks
simulating "food poisoning."
The source whence that organism came could not be determined, but some suspicion was
aroused of one of the servants (who had recently taken a situation in the house) being a
" carrier." She was not included among the persons reported to have been ill during the outbreak,
but her blood gave the " clumping reaction " with a culture from the bacilli isolated
from the faeces of the patients.
Further interest attaches to the outbreak owing to the occurrence of cases of exactly the
same character in persons residing in out-lying districts, viz. :—Willesden, Hampstead, and
Lambeth, who either visited the house or were visited by residents in the house at the date of
the outbreak or immediately after. Altogether eight cases in out-lying districts were
reported, such specimens as were obtained from the patients giving the same results as did
those from the patients in the originating household. Further particulars of these cases will
be found in the communication in the Journal o] Hygiene already referred to.
OTHER DISEASES.
The remaining diseases selected for special tabulation (Table 31) can be dealt with in a
very few words.
Influenza.—The mortality was 0'20 last year, and compares favourably with that of the
previous year (0.47) and with the quinquennial mean rate (0.34). The mortality was lower
in all the Wards of the Borough last year, that of Church Ward (0.28) showing the smallest
reduction from the mean rate (0.31).
Respiratory Diseases.—Although both measles and whooping cough were unduly prevalent
last year, the mortality from bronchitis and the "pneumonias," fell from 2.44 in 1909 to 2.03
last year, the latter rate being 0.21 less than the mean rate. Of the rates recorded in the
* A full account of the bacteriological work in connection with this outbreak was published in the Journal of
Hygiene, vol. xi., Pt. I., p. 24—issue of April, 1911.