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13
enteric fever.

Institutional Treatment.—Of the 13 notified cases 8 received institutional treatment,
including one case removed to a nursing home. The cases so treated formed 61.5 per cent. of
the notifications, a proportion in marked contrast with the records for the preceding two years,
viz., 90 per cent. in 1919 and 84.2 per cent. in 1920.
Fatality, Mortality.—There was one death among the cases notified, equivalent to a fatality
of 11T per cent. of the verified cases, the fatalities observed during 1919 and 1920 being both
zero. In addition to the death here referred to there was a second—at a lunatic asylum—but
the case was not notified. The Index Number (see Table IXa.) shows a marked fall below
the average.
Source of Infection.—In one case there was a history of the consumption of oysters, but
enquiry as to possible contamination proved that the supply was a "clean" one. Two patients
were nurses at a nursing home and had been nursing an enteric patient admitted from an
outlying district. One of the nurses died. A third nurse at the same home was notified for
the same disease, but the diagnosis was not confirmed at the hospital. After the report of the
last case, the entire staff was inoculated against enteric fever.
Erysipelas.
General Prevalence.—Last year 83 cases (36 males; 47 females) were notified, 2 more
than in 1920 and 7 more than in 1919, The annual averages for the quinquennia 1909-13 and
1914-18 were 90 and 101.
Institutional Treatment.—Nineteen (19) cases received institutional treatment (mostly in the
Infirmary) or 22.8 per cent. of the total, as compared with 34"5 per cent. in 1920 and 27.6
in 1919.
Secondary Attacks.—Two patients (one of each sex) were reported for this disease during
the year, but it is doubtful whether the woman really had two attacks or whether the second
notification was a duplicate only. The man (aged 23) had his first attack in June and was
treated at home. The second attack came on in August when he was admitted to the
Infirmary. Two men of the same family were attacked during the year, the first in June and
the other in October. Both cases were facial and were treated at home.
Fatality, Mortality.—There were 6 deaths among the reported cases, 4 in the Infirmary
and 2 at home. The fatality was at the rate of 7.2 per cent. as compared with 6.9 in 1919 and
3.8 in 1920. The Index Number (see Table IXa) shows a slight increase above the average.
Puerperal Fever.
General Prevalence.—Last year 16 cases were notified, one more than the totals recorded
in each of the years 1919 and 1920. The totals for each of the years since 1918 are higher
than those for any of the years 1911-18 (See Table V.) Last year.s total was equivalent to a
rate of 6.03 per 1,000 births registered within the Borough. That rate compares unfavourably
with the average rates for the two quinquennia 1909-13 and 1914-18, which were 2.67 and 3-02
respectively. The rates for 1919 and 1920 were 7.44 and 471, averaging 5.77 for the two years.
Those figures furnish some evidence of what has been adverted to in the two last Reports, viz,
the tendency to increased risks attaching to child-bearing.
The numbers of cases reported from the different Wards (see below) show strange
differences from year to year, but two features deserve comment. The first is the apparent
diminution in frequency of puerperal fever in Church Ward during the last three years, and
the appearance of the disease in Lancaster Gate, West, Ward.