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sufficiently admitted, and the three special outbreaks investigated
in connection with Lambeth—fortunately, small
outbreaks, on account of the severe and prompt measures
taken—will rank as important evidence in shewing that
the disease is apt to spread from person to person oftener
than is generally supposed—the fœces and urine of patients
being sources of infection, well-proved by bacteriological
methods. The natural corollary to the above statement is
the importance of strict isolation of all cases (preferably in
hospital), whilst the absolute necessity of diagnosing the
disease as early as possible, must come to be more and
more realised. Bacteriological examination of the blood of
suspected persons is a ready means at hand for assisting
medical practitioners in their diagnosis of doubtful Typhoid
cases, and such examination (offered gratuitously in Lambeth)
is much appreciated, and coming to be more and more
used (81 blood samples having been examined during the
last year). 25 cases were introduced into Lambeth from
outside, and in 6 cases there appears to have been a causal
relationship between the attacks and the previous ingestion
(within the incubation period) of infected shellfish, in
three cases oysters, in two cases mussels, and in one
case cockles, being the suspected medium. 35 cases were
due to personal contact, other likely sources being excluded.
CONTINUED AND TYPHUS FEVERS.
During 1899, 7 cases were notified in Lambeth, but
no deaths were registered, from Continued Fever, as compared
with 69 cases notified and 1 death registered (i.e.,
1.5% uncorrected case mortality) in London.
One case of Typhus was notified in Lambeth, but in all
probability this was a case of Typhoid fever. 14 cases
were notified in London, and 3 deaths registered, from
Typhus during 1899, giving a case mortality of 21.4%
(uncorrected).*
*One case of Relapsing fever was notified in London during 1899.