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Included in the above table are the cases which were not certified as
enteric fever and also three cases which were not notified until the current
year, but which were taken ill in November and December, 1909.
It will be noted that the numbers were steady, month by month, until
June, 1908. From June to November, 1908, they varied somewhat, but were
markedly increased. The maximum was reached in November, but the cases
were numerous in January, 1909, after which they rapidly decreased. The
figures do not suggest the explosive character of an outbreak due to any common
cause, such as water or milk or other common vehicle of infection.
To sum up the results of the investigations made with respect to the
prevalence of enteric fever in Shoreditch during the past two years: the majority
of the cases were connectable with previous cases in the Borough. With few
exceptions, such as those who contracted the disease in the execution of their
duty in connection with the sick, the cases were practically confined to very
poor people in the Borough. Their habits and the conditions generally under
which they dwelt were such as to favour contamination of food in the household,
and in all probability such infected food was usually the vehicle for the transference
of infection from person to person in the same house. The close
relationship which existed in several instances between families resident in
different houses favoured the transference of infection from house to house.
The presence of unrecognised cases, especially in infants and children, materially
assisted in the dissemination of infection, and in this respect it is also
to be noted that in the majority of the cases which were eventually certified
very appreciable periods of time, amounting in some instances to three weeks
or a month, elapsed before the cases were isolated. There was no evidence
that defective drains or sanitary arrangements played any conspicuous part
in favouring the prevalence of the disease, nor as the result of the enquiries
made was there any reasons for suspecting contamination of any common food
supply. Nothing was obtained to indicate that milk, shellfish, fried fish, ice
cream or water were concerned in the prevalence of the disease.
The cases of enteric fever certified in the Metropolis numbered 1,049, as
compared with 1,350 in 1908, 1,390 in 1907, and 1,608 in 190G. The attackrate
was 0.2 per 1,000 population. The deaths numbered 146, as compared
with 225 in 1908, the death-rate being 0.03 per 1,000 inhabitants.
ERYSIPELAS.
The cases certified as erysipelas numbered 143 as compared with 124 in
1908, 133 in 1907, 144 in 1906, 138 in 1905, 183 in 1904, 147 in 1903, and
172 in 1902. The deaths numbered 16 as compared with 5 in 1908, 6 in