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Islington.—Nine cases occurred in the Islington Workhouse schools, which was attributed by
the medical officer of health to the use by the boys, as a urinal, of a water-safe tray placed under a
water-tap. The tray had formerly been connected with the drain by a pipe some 25 feet long, and
had subsequently been sealed at the junction. The pipe was thus charged with urine, to the emanations
from which the disease was attributed. It is supposed that a boy who was suffering from enteric
fever used this water-safe tray and so infected the urine in the pipe.
Stoke Newington.—Of 38 cases "four were doubtless imported and five were ascribed by the
sufferers to the eating of oysters."
Hackney.—"Of the 203 cases no less than 14 appear to have been contracted outside the
district, and only one case seemed to be associated with oyster-eating; but this latter may have been
a coincidence only."
Strand.—"At least six of the cases (18) appear to have arisen from eating uncooked shellfish,
five of them at a seaside resort. Two cases were tramps recently arrived in the district. No cases
appeared to be connected with the Maidstone epidemic."
Holborn.—"Of the 25 cases notified as typhoid fever seven were probably not contracted in the
district, five of these seven having been contracted when out of London." Three of the seven cases
were probably due to the eating of oysters.
Shoreditch.—"In one instance it is possible that infection may have been conveyed through
eating a portion of a pear which had been handled by a patient who was suffering from enteric fever.
In two cases in which it is probable that the disease was contracted outside the parish it was thought
that some oysters which had been consumed might have been the cause, but the evidence as to this
was not conclusive."
St. George-in-the-East.—Reference is made to a coffee house having sanitary defects "to which
could be traced four cases of this disease." No case was traced to the Maidstone outbreak.
Limehouse.—One case was due to infection received at Maidstone.
Poplar (North district).—Reference is made to the risk of enteric fever caused by the existence
of a watercress bed in Bow. The water was found to be largely polluted with sewage. The owner
gave an undertaking to the medical officer of health, in writing, to abolish the bed.
Newington.—"In no case could the disease be in any way connected with the Maidstone
epidemic, and in only two cases could the disease be said to be due, with almost certainty, to oysters."
St. Olave.—One case was a nurse who had been in attendance on a person suffering from enteric
fever in Guy's Hospital. Four cases were probably not contracted in the district, one of which was
apparently caused by the consumption of infected oysters while at Southend.
Wandsworth parish.—Two cases were definitely traced to the eating of oysters at Clacton.
Another was attributed to the eating of oysters in a restaurant in the City. One case had come from
Maidstone on the 18th September, and subsequently died, and a fifth had been working for five weeks
previous to the onset at the Croydon sewage works.
Lambeth.—A few of the cases were traced to Maidstone and also to other parts of the kingdom.
Lee (Eltham).—One case was attributable to the Maidstone outbreak.
Plumstead.—In one instance the patient had eaten whelks eight days before his attack.
In November, 1897, I made inquiry as to the number of cases of enteric fever notified in
London which were traceable to a severe outbreak of the disease at Maidstone, due to a polluted
water supply. Information concerning thirty cases thus contracted was communicated to me.
Enteric fever—Age and sex distribution.
In 1897 it will be seen from the following table that males had a greater attack and death rate
from this disease than females, and this greater incidence on males is manifested at each age-period,
except 5-10, when the incidence of death was greater on females, and at age 0-5, when the incidence
of mortality was equal. The case mortality of males at all ages was greater than that of females, this
being due to the higher case mortality of males above ten years of age.

* See footnote page 31.