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The results of inquiry into the source of infection are stated in about half of the annual reports.
Dr. Caldwell Smith gives account of the occurrence in Wandsworth of nine cases in the early part of the
year, due to infection from a milk supply derived from Wiltshire, and supplied by a Wandsworth dairyman
to the invaded houses. Other five cases among persons supplied from the same source occurred
in Barnes. Dr. Caldwell Smith's inquiries elicited the fact that a case of enteric fever had occurred
on the farm from which the milk was derived, and he urges the need for notice of cases occurring on
dairy farms to be sent to the medical officer of health of the district in which the milk consumers are
resident.
Some of the reports give information as to the number of cases in which articles of food, usually
coming under suspicion as a cause, have been consumed at a time which would suggest that they may
have been operative in the cases in question. In summary it may be stated that in ten districts in which
276 cases of enteric fever occurred, mussels had been consumed in 12 instances, oysters in 10 instances,
periwinkles in 2 instances, cockles in 1 instance, shell-fish unspecified in 11 instances, and ice-cream
in 1 instance. Both mussels and watercress had been consumed in one instance and "fish" is mentioned
in two instances. Dr. Alexander records that three cases occurred in one family in Poplar
and two in another, in both of which a hearty meal of mussels had been eaten.
In a number of instances infection derived from an antecedent case is mentioned as explanation
of the attack. Dr. Stevens' report, relating to Camberwell, contains the following paragraphs illustrative
of such cases:—
Two outbreaks of enteric fever which occurrcd in two distinct localities in Dulwich, and apparently unconnected
one with the other, are remarkable in the way of showing how this disease, while not, to use a popular term,
catching, may under certain conditions be passed on from one person to another. In the first outbreak, a child
was attacked by some obscure form of illness, and was nursed by her mother, who, a few weeks later, started
to be ill. When she became incapable of looking after the first patient, a daughter returned from service to take
charge of affairs, and she too was attacked, and down to February of this year, cases kept on cropping up at this house
With the gradual disablement of the members of the household, a married daughter came to the rescue, her husband
meanwhile staying at home. The daughter escaped the disease, but the husband was attacked, and that fatally.
Careful questioning brought out the fact that he had occasionally taken his meals at the infected house, so that there
was little doubt about the origin of infection. The food, milk and water supply were all reviewed, but nothing
could be found in any way likely to suggest that they were at fault.
The second set of cases occurred only a short distance away from the first, but were apparently unconnected
with it. The cases occurred in two adjoining houses occupied by two sisters, each of them married and having a family
Here again no question of food arose ; but the policy of exclusion led to the same conclusion as in the first series:
for there was a lengthy and undiagnosed illness of one man followed by attack of other members of the same family.
Proportion of cases erroneously certified.
Cases certified to be those of enteric fever admitted into the hospitals of the Metropolitan
Asylums Board, but in which the diagnosis was not subsequently confirmed, constituted the following
percentage of total cases admitted in successive years:—