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26
The last case in which there was reason for suspecting connection with
previous cases in the Borough was case 38 in the foregoing list. It will be noticed
that this patient although ailing from the end of May was not certified until
July 1st. Five cases only were certified during the latter half of the year.
There was no reason for believing that these were associated with previous
cases in Shoreditch. With regard to cases.39 and 40 information was received
that there had been cases of enteric fever in the neighbourhood where the
boys were residing at Banwell whilst staying there on a holiday. Case No. 2,
that of the disinfecting officer may be noted. There had been no illness
suggestive of enteric fever in the house in which he resided nor in the immediate
neighbourhood. He had for months been handling bedding and textile
articles from cases of enteric fever, and there is little doubt that he contracted
the disease whilst following his occupation. It may be mentioned that he
was in the habit of chewing tobacco whilst at work. It is possible that he
may have infected some of the tobacco whilst putting it into his mouth.
With regard to the cases at 69, Granville Buildings, the probability is
that J. F. C. was the source of infection in the dwelling (see note to case 5).
No history was obtained to throw light on the source of infection in his case.
It may be mentioned, however, that the family before moving to No. 69,
Granville Buildings, resided in the neighbourhood where a number of cases
of enteric fever occurred, and it is not improbable that the mother had friends
and acquaintances in some of the infected families. It is possible that the
child may have received infection whilst with its mother shopping in the
neighbourhood where these infected families were.
With respect to the cases at 71, Wilmer Gardens, it may be noted that
from November 10th, 1908, until January 28, 1909, when the first case was
certified, a period extending over eleven weeks, there was in all probability
the infection of enteric fever in the house. There have been other instances
also in connection with this series of cases, in which long periods have elapsed
before the nature of the illness has been recognised, notably the cases at
No. 2, Nancy Street, and 30, Ware Street (cases 7 and 70 Annual Report for
1908). It may be mentioned too that in other series of cases which have
been investigated in Shoreditch during the past 12 years similar instances
have been observed. They indicate the facility with which enteric fever may
escape recognition, and the consequent danger of infection to the other inmates
of the infected household and the friends and relatives of the infected family.
Attention may be directed to the probable dates of invasion and the dates
of notification. There is practically in all the cases a considerable interval
between the date the patient becomes unwell and the date of removal to
hospital. This interval is rarely less than 10 days, and frequently amounts to
three weeks or a month, or sometimes even longer. Occasionally it has been