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It is obvious that certain allowances have to be made in
interpreting these figures. Thus the houses tested during house-tohouse
inspections are a selected group, as it is not our custom to test
the drains during house-to-house inspection unless the property is
very old, or there is some reason to suspect defect. In spite of this
it is clear that the sanitary condition of the houses in Croydon is
such that the defects found cannot be regarded as sufficient cause
for isolated cases of enteric fever. I believe that this holds true in
all districts where the sanitary arrangements are on modern lines.
Naturally, it is quite otherwise in towns where conservancy systems
are still found, or where gross defects of one kind and another offer
opportunities for infected sewage to contaminate water and food.
As stated in former years, I am of opinion that the residual
amount of enteric fever that still persists in the borough is, in all
probability, to be ascribed to personal infection from missed cases
and other direct human sources.
Considerable attention has recently been paid to this aspect of
the question, and especially to what are known as " carrier " cases
of enteric fever. By this is meant persons not obviously suffering
from enteric fever, but nevertheless carrying the germs of the disease
in their system, and under favourable circumstances capable of
infecting others. In the majority of instances, these " carriers " are
persons who have previously suffered from the disease, but have not
been able to free themselves from infection. Several instances of
this were under observation at the Borough Hospital in 1908. Thus
two of the patients admitted to the Borough from the Urban District
of Penge on July 4th and August 8th, were duly discharged on
August 18th and October 6th. At the time of discharge they
appeared quite convalescent, and the urine free from infection.