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Report of Medical Officer of Health.] 21

Many of the "imported cases" were patients who came to the district ill with the disease.
Of the 30 "remaining cases," histories of the consumption of oysters, whelks, &c., were obtained
in 11, and of ice-creams in 2. Of the 17 patients not included in these figures, 3 were in the habit
of taking meals in other parts of the Metropolis, 1 did so occasionally, and another, a guard on
the G.W.R., probably had meals in various parts of the country.
The 30 "remaining cases" may also be arranged according to the water company
supplying their homes. Nineteen resided in houses supplied by the Grand Junction Water Works
Company, and 11 by the West Middlesex. The ratios of supplies of the two companies is
something like 55 by the West Middlesex Company to every 100 by the Grand Junction, and the
ratio of the cases in houses supplied by the respective companies, 58 to 100—a difference which
may be purely accidental.
Mention has been made in former Reports of the direct communicability of infection from the
patient to those in contact with him. This danger is not generally recognized. Three times
during the past year did such direct spread come to the knowledge of the Department, in one
case from the husband to the wife, in the second from a child to the (domestic) nurse, and in
the third at a boarding house to a second inhabitant. A fourth instance was also reported in the
person of a nurse at St. Mary's Hospital, who was in charge of a patient ill with enteric fever.
At 13 of the 30 houses where the 30 "remaining cases" resided, the sanitary arrangements
(drains, closets, &c.) were found to be in good order; at 10 the arrangements were radically bad ;
at 3 the general arrangements were good, but defects were found; and at 1 they were good, but
the drain was choked.* The water supply for dietetic purposes was taken direct off the main at
houses; from cisterns at 19 houses; and could be obtained either off the main or from
cisterns at 2 houses. Two of the cisterns (the only source of supply) were found to be dirty, and
1 was in direct communication with the water closet.
Of the 54 cases in North Paddington, 42 were removed to hospital or nursing homes for
treatment, and of the 5 in South Paddington, 3. The percentages removed from their homes
during the last five years are indicated below:—
1900. 1899. 1898. 1897. 1896.
Paddington 76.1 77.5 60.0 51.1 58.0
St. Mary 77.7 72.8 77.6 50.0 59.0
St. John 60.0 64.7 46.1 54.5 55.5

It is difficult to say what may be the value of the notifications of this disease. Strictly
interpreted, "erysipelas" is a septic infection of a wound, but the bulk of the cases are of a very
* Note.—Three houses are not included in this list, 1 because the patient had not recovered at the time of
writing ; 1 because it was a new house just occupied; and the third as it had previously been reported upon.