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19
ENTERIC FEVER.
the five-year average (0.24). The numbers of cases and the morbidity rates recorded during the
six years are appended :—
1906. 1907. 1908. 1909. 1910. 1911.
Cases 35 35 32 29 40 38
Morbidity 0.24 0.24 0.22 0.20 0.28 0.26
How the local rates compare with those for London and the districts circumjacent to the
Borough can be seen from Table G. The favourable position of the Metropolis in comparison
with the other parts of England is clearly shown by the following rates (per 1,000 persons)
extracted from the Report on Notification Statistics already referred to:—
England 0.38
England, less London 0.39
Aggregate of County Boroughs, less London 0.43
London 0.23
The local figures for last year which have been given so far represent reported cases, among
which there were 11 "errors,"* equal to 28 9 per cent, of the total, the average for the preceding
five years being 169—a considerable difference. The proportions of "errors" noted last year
ranged from zero in Hyde Park Ward to 50 percent, in Queen's Park, Westbourne, and Lancaster
Gate, East, Wards. Eleven (11) of the remaining 26 cases were thought to have been due to
infection acquired outside the Borough, and among the other 15 cases 2 occurred in persons
working at fried fish shops and 2 others were due to earlier cases in their households. The
Widal reaction was applied for the purpose of diagnosis in 15 instances, 14 with positive results
(2 of the cases being, however, subsequently pronounced to be suffering from diseases other
than enteric fever, viz., tuberculosis and gastric ulcer), and one with a negative—the case, certified
as enteric fever on the symptoms before removal to hospital, ultimately proving to be one of
scpticzemia. In one other case, in which a positive reaction was obtained, the diagnosis of
enteric fever remained a matter of doubt.
In two families secondary cases occurred. In the one the second patient (a mother)
sickened some six weeks after her child had been removed to the Infirmary. She had
visited the child almost daily. In the other instance the first patient (f., æt. 25) sickened
(approximately) on June 29th, and was admitted to the Infirmary on July Pith. She died on
July 26th. Her husband was taken ill about July 14th, and admitted to the Infirmary on
August 3rd. In both cases a positive Widal reaction was obtained.
Of the 38 reported cases, 32 were removed to institutions for treatment, the proportion
of removed to total cases being 84.2 per cent., 8.2 above the average (76.0 per cent.). (See
Table 14.) The numbers of cases removed from the individual Wards were too small to
make it worth while to give the proportions. The figures themselves are given in Table 13.
There were G deaths among the reported cases (all in institutions),one of them being an "error."
The total fatality was 18.5 per cent. (Table 14), or 52 in excess of the average. The
fatality among institutional cases last year was 20.8 per cent., more than double the average
(9.7 per cent.).
The numbers of deaths and mortality from enteric fever during the past six years is given
below. Last year's rate (0-03) was equal to the average for the five preceding years.
1906. 1907. 1908. 1909. 1910. 1911.
Deaths 8 5 4 3 4 5
Mortality 0.05 0.03 0.02 0.02 0.02 0.03
The mortality rates for the circumjacent districts are to be found in Table 10.
*The morbidity rate, after exclusion of " errors," was 018 per 1,000, the corresponding average for 1906-10
being 0.19.