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a low one, namely, 2.8 per 10,000 of population. There were no cases
notified in the first quarter of the year, 7 were notified in the second
quarter, 4 in the third quarter, and 10 in the fourth. In North Chelsea
14 cases were notified, and in South Chelsea 7. Two cases ended
fatally.
Of the 21 cases notified, one was stated by the Medical Superintendent
of the M,A.B. hospital to which the patient was removed, not
to be a case of enteric fever, but of basal meningitis, which subsequently
proved fatal. Of the remaining 20 cases, in 4 the infection was in all
probability contracted outside the Borough of Chelsea, one of these
cases being probably due to the consumption of infected oysters at
Marseilles. There were, therefore, 16 cases of enteric fever in the
Borough, which can be regarded as having contracted the disease in
Chelsea.
Specimens of the blood of 3 patients were sent to the Lister
Institute for investigation as to the Widal reaction, and in two cases
positive results were obtained. The average duration of stay in hospital
of 8 cases, of which the records are to hand, was 31 days, the corresponding
figure for 1906 being 47 days.
In May, 5 cases of enteric fever were notified in a single day
amongst a family living in the King's-road. All the occupants of the
house were attacked with the exception of the male head of the family.
In addition a married daughter of the family and her husband, residing
in Fulham, were simultaneously attacked, they having been constant
visitors at their parents' house in Chelsea. The circumstances of the
outbreak pointed to the family having been infected through the medium
of some food or drink (not water or milk, as there were no other cases
brought to light either before or after the King's-road cases). Suspicion
attached to some watercress that was partaken of by all the affected
persons at a Sunday meal (8 days before the onset of symptoms in the
first person attacked), with the exception of the servant, who had however,
prepared it for table. If the watercress was in reality the infecting
agent, the incubation periods in the 5 cases would be as follows:—
8 days (1), 9 days (2), 10 days (1), 12 days (1). It is to be noted that
the longer incubation period of 12 days was seen in the mother of the
family, the 4 shorter periods of 10 days and under characterising the
attacks in the younger members of the family, aged 13 to 20 years. It
was subsequently ascertained that the watercress was bought at Covent
Garden Market, but it was impossible to trace the beds from which the
cress was derived, as the supply of this vegetable to the market from
the different localities is very irregular, depending on the ripening of
the beds and their readiness for cutting, and no records appear to be
kept by the market salesmen of the consignees and the dates of delivery
of their goods.
Case Mortality.—The following Table shows the case mortality,
or percentage of deaths to notifications of scarlet fever, diphtheria
(including membranous croup), and enteric fever, in Chelsea and in
London, in each of the 18 years 1890-1907:—
c 2