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Enteric fever.— Age and Sex Distribution.
The following table shows the notified cases, deaths, case-rates, death-rates, and fatality of enteric
fever at the several ages and for each sex in London during the year 1905. The case-rate at " all ages "
was greater among males than among females ; the death-rate was equal in both sexes, but the fatality
was much higher among females at " all ages." In the age-groups adopted for the purposes of this table
the greatest incidence of attack was upon males aged 10-15, and upon females aged 5-10. The greatest
incidence of death was upon males aged 35-45, and upon females aged 20-25 and aged 35-45. The
fatality was greatest both among males and females aged 55 and upwards.

The decline in the enteric fever case.rate and death-rate, which has been manifested for a
number of years, has been maintained in 1905. With this decline the proportion of cases in London
due to infection received in other parts of the country or on the Continent becomes more conspicuous.
Cases which occurred in London during 1905 were frequently attributed as in previous years to infection
derived from an antecedent case or to some article of food which is commonly thought of as being
responsible for the conveyance of infection. In no instance, however, were any of the cases attributed
to infected milk supply.
Instances in which infection was believed to have been received from an antecedent case are
mentioned in the reports relating to the following districts. Paddington—A girl contracted enteric
fever in Teignmouth, probably from eating shell-fish. This girl's illness was followed by that of another
child in the house, the girl's nurse, her aunt, her mother, and subsequently six other persons in the
same house. Hackney—Ten groups of cases occurred in which a primary case in a house gave rise to
others. The primary case was followed by one case in three instances, by two cases in four instances,
by three cases in one instance, by four cases in one instance, and by eight cases in one instance.
Shoreditch—Infection from an antecedent case is said to have occurred in a few instances.
Southwark—The illness of a man was followed by that of his wife and four children ; one of these
children visited two other families in the street, among each of which a case subsequently occurred.
In nine cases in this district the infection was probably due to an antecedent case. A similar source
of infection was found in six cases in Battersea, and in thirteen cases in Wandsworth. One group of
seven cases occurred in Wandsworth, the first of which was a boy whose own illness was thought to
be probably due to eating shell-fish, inasmuch as he was the companion of costermongers who sold
mussels and winkles; the disease subsequently spread to the others.
In a number of reports shell-fish or fish is stated to have been eaten within a period before the
attack which suggested that it might have been the source of infection. Thus, in Paddington, of 46 cases
oysters had been eaten in four, periwinkles in two, and mussels in one case. In Kensington, of 49
cases shell-fish came under suspicion in a few cases, oysters having been eaten in two cases. In
Westminster, of 37 cases, it is stated than seven persons may have received infection through articles
of food; in one instance cockles had been eaten shortly before the attack. In Hampstead, of 17 cases,
in one case cockles had been eaten. In Finsbury, of 42 cases, in six the illness was thought by the friends
of the patients to have been caused by eating shell-fish. In Shoreditch, where 36 cases occurred, shellfish
and fried fish were stated to have been eaten in a few cases. In Bethnal Green, where 61 cases
occurred, 22 of the patients were stated to have been in the habit of eating fried fish, and six had recently
eaten shell-fish. In Poplar, of 70 cases, 10 were attributed to the eating of shell-fish. In Southwark,
of 74 cases, mussels had been eaten in nine and cockles in four cases. In Bermondsey, of 42 cases, in
1. See footnote (2) page 34.
11476 F 2