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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.
The subject of continuing the supervision of those who had
been suffering from enteric fever, but who had apparently recovered
from the disease, has been already mentioned.
During 1909 there were 12 specimens of urine and faeces
taken from those who at the time of leaving hospital were still
passing typhoid bacilli in their dejecta although quite well in all
other respects. The investigation is now amplified to include all
persons discharged from the Metropolitan Asylums Board Hospitals.
There are some of these who apparently try in every way, even
at some personal inconvenience, to co-operate with this investigation,
but with the majority it seems impossible to arouse them into a
of the duty they owe to themselves and their neighbours in
aiding anything which may throw a light on the disease, and this
among those where deaths had occurred.
Perhaps if one tried to collect the specimens garbed as a
policeman fear and ignorance might achieve what an appeal to
reason cannot.
In each notification of enteric fever careful enquiries were made,
not only as regards suspected articles of food, but also as to whether
the persons attacked had been in association with any one who had
suffered from this disease. There were 12 more notifications
than in 1908 and 3 fewer deaths, only 4 having been recorded.
In the words of Osler, it is "everywhere an index of the sanitary
intelligence of a community."
There were 1,038 notifications received under the new Order
which came into force on June 1st, 1909, which renders it obligatory
for Poor Law Medical Officers to notify to the local Medical Officer
of Health all cases of consumption which they are called on to
treat, and the Relieving Officers have also to report cases of which
they may become acquainted with, and any subsequent removal of
such person.
It must not, however, be assumed that the notifications received
represent actual cases, for by careful sifting we have come down to
509 persons concerned; even now it is quite possible that some
duplicate notifications have slipped through. Duplicate notifications
occurred in 164 instances, triplicate in 228, and more than this in
regard to 56 patients.