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18
enteric ever.
ENTERIC FEVER*
Forty (40) notifications of this disease were received last year, the highest number since
1905, when 46 cases were reported. In each of the years 1906 and 1907, 35 cases were notified,
in 1908, 32, and in 1909,29 , no corrections being made for errors of diagnosis. The morbidity
rate was 0.26 per 1,000 persons last year, or 0.03 above the mean rate for the five preceding
years (Table 4). The local rate for the year was exceeded by that of Westminster only,
which was 0.29 (Table 7). In comparison with the preceding year more cases were reported
last year in all the Wards of the Borough, except Queen's Park and Lancaster Gate, East
(Table 6). I he cases notified in each quarter of last year, except the first, were in excess of
the averages (Table 12).
The total of 40 notified cases included 7 of erroneous diagnosis, equal to 17.5 percent., as
compared with 17.2 per cent. in 1909, and an average of 14.7 during the five years 1905-09.
Of the remaining 33 cases, imported infection was noted in 11 instances. The consumption
of shellfish was believed to be the causal factor in the following instances:-—Oysters, 4 cases
(including 2 imported); cockles, and cockles and whelks, one case each. Three patients were
in the habit of taking some of their meals out of the Borough, but nothing could be
learned pointing to the consumption of any foodstuff suspected of being infected.
Three groups of cases presented features of special interest, one owing to the causation
of the disease (the consumption of shellfish), and the others to the evidence of the personal
spread of infection.
I.-A family named N- -, came to Paddington from Portsmouth on March 31st of last year. On May
11th, E.N. (m. æt 7) was reported ill with enteric fever. The date of the onset of the disease could not be
definitely ascertained, but it appeared practically certain, from the history which was obtained—bearing in
mind the lengthy incubation of the disease- that the boy was infected whilst at Portsmouth.
On May 22nd, E.N. (m. æt 8), brother of the above patient, was taken ill with abdominal symptoms. He
had appeared to be in usual health until some 3 or 4 days previously. His illness was not thought to be
serious, but he died suddenly during the night of the 22nd. An inquest was ordered, and at the post mortem
examination all the evidences of enteric fever (of some duration) were found, including perforation of the
bowel, and enlargement of the spleen. The bacillus typhosus was afterwards isolated from the latter organ.
On May 25th, J. N. (f. æt 12), sister of the above, was reported ill with the same disease, which was reputed
to date from the 23rd of that month, but more probably from the 12th or 13th. She was removed to hospital
and made a good recovery, as also did the younger E. N.
Enquiries were addressed to the Medical Officer of Health of Portsmouth, who reported that it was known
there that the N. children frequently collected and ate raw cockles from Langstone Harbour. He added, "the
cockles from certain parts of Langstone are not fit to eat, and are undoubtedly polluted with sewage."
Subsequently, in reply to a request for specimens of the cockles, he wrote: "The cockles from various neigh"bourhoods
round about have already been examined bacteriologically, and found grossly polluted, as indeed
" it is difficult to imagine how anything else could be the case."
II. On September 19th (Mrs.) S. A. (f. æt 22) was reported ill with enteric fever, her illness having
apparently, commenced on the 11th. She was removed to isolation on the 19th, having been nursed between
the 11th and 19th by Mrs. J. M., a relative living in the same street, who took Mrs. S. A.'s child to her home.
On November 3rd C. M. (m. æt 5) was reported to have the disease, which commenced about the 26th of
the previous month, and on November 5th J. M. (f. æt6) was also reported with the disease, her attack dating
from the 29th of the previous month. Finally, Mrs. J. M. was taken ill about 6th November, and removed to
hospital on the 14th. Mrs. S. A.'s child was not affected.
III. J. McD. (m. æt 3) was taken ill with symptoms which were not thought to be those of enteric fever,
on October 23rd. He was nursed at home until November 7th, when he was removed to hospital, and 14 days
later his case was reported as one of that disease. Whilst J. McD. was seriously ill, his mother (B. McD.)
visited him daily at the hospital. She was taken ill on December 2nd, and kept her bed from the 7th, her case
being diagnosed as one of enteric fever on the 8th, on which day she was removed to hospital. On the 8th
another child (B. McD., f. set 2) was taken ill. She was admitted to hospital on the 9th, and her case was
reported on the 23rd.
* For statistical purposes " continued fever " it deemed to be the same as enteric, any special cases notified
under the former name being referred to in the text. No case was reported as continued fever either in 1909 or 1910.