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19
Of the cases certified in Shoreditch, 77.7 per cent. were removed to hospital for
treatment.
Enteric fever was more prevalent in Shoreditch this year than in any year since
1890, as the following figures show:—

An increased prevalence of enteric fever is, however, not confined to Shoreditch,
but is observable in the figures relating to the Metropolis, some 4,460 casses of enteric
fever being certified, as compared with 3,032 in 1898. The attack-rate in the
Metropolis was 0.97 per 1,000, as compared with 0.67 in 1898, and the death rate was
0.18, as compared with 0.12 per thousand estimated population in 1898. In Shoreditch
the disease was especially prevalent during the months of October, November, and
December. It is during these months that the disease is usually most prevalent, but
in 1899 the number of cases certified was considerably above the average for the
preceding six years. During the months of October, November, and December, 1893,
there were 24 cases; in this period in 1894 there were 37 cases, in 1895 there were
42, in 1896 24, in 1897 36, and in 1898 44, the average being 34. During th se
months in 1899 there were 79 cases, or 45 above the average for the corresponding
periods during the previous six years. No less than 48 cases occurred during the
period October 31st to December 4th, inclusive. These cases were scattered about in
the parish, and except in a few instances there was no apparent connection between
them. Enquiries as to the milk supply threw no light upon the causation. In several
instances infection appeared to have been conveyed from a previous case to other
persons living in the same house.
In last year's Annual Report a series of cases was stated with a view to showing
the danger which exists of enteric fever spreading amongst members of a family when
there is a lack of proper precautions. During the year under consideration several
inquiries have been made in instances where more than one case has occurred in the
same house. In most of the houses in question, insanitary conditions of more or less
gravity were found, nevertheless the histories of the cases afford grounds for believing
that the first case which occurred was the source of infection in the cases which
subsequently occurred in the house. It is not difficult to surmise how, under certain
circumstances, the infection of enteric fever may be spread amongst the members of a
household. Take the case of a family consisting of the parents and three or four
children occupying a dwelling of two or three rooms; one of the members become
unwell, and gradually gets so ill that medical advice is at length sought, and the
patient is pronounced to be suffering from enteric fever; the patient has probably been
ill for a week, a fortnight or longer suffering from the disease before the dangerous