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9
enteric fever.
ENTERIC FEVER.
(Including Continued Fever.*)
Owing to the small number of cases reported in recent years, and the frequency of mistakes in
diagnosis, the prevalence of this disease requires to be considered from a different aspect to that
adopted in the case of diseases such as diphtheria and scarlet fever. Moreover, since the beginning
of the war three clinical entities have been differentiated among attacks which used to be called
"enteric fever." While the clinical symptoms may differ but slightly three separate causal organisms
can be identified, viz., the bacilli known as "Paratyphoid A," "Paratyphoid B" and the "bacillus
typhosus (Eberth)."
During 1922,8 cases were notified as "enteric fever"—under which designation all three forms
are notified—compared with 13 in 1921, and 19 in 1920. Two of the cases were "para" varieties.
For the three years, 1920.22, the cases numbered 40 (males 10, females 30), whereas during 1910-12
the total was 92 (males 39, females 53). The ratio of cases among males to those among females
was 1 : 1.4 during the earlier period and 1 : 3 during the later. The morbidity rate in 1922 was 0.05
per 1,000 persons, that for 1920.22, 0.09, and that for 1910.12, 0.21. The morbidity rate for males
during 1920.22 was 75 percent. less than that during 1910.12, the rate for females showing a fall of
43 per cent. only.
There have been striking changes in the sex age distribution of the notified cases. At ages 0.5
6 cases were reported during 1910-12 (5 males and 1 female), but during 1920-22 not a single case.
At ages 5-15 there were 17 cases (8 males, 9 females) in the earlier period, and in the later 3 only (all
the cases in males occurring in 1920 and 1921). At ages 15-25 the cases during 1910-12 numbered
19 (males 8, females 11), and during 1920-22, 13 (males 3—during 1920 and 1921—females 10), and
at ages 25 and upwards during 1910-12, 50 cases (males 18, females 32), during 1920.22 24 (males 4,
females 20).
For the first time since 1912 no case was found to have been erroneously diagnosed, the average
percentage of errors during 1919.21 being 22.4. During the years 1910.12 the errors averaged 19.5
per cent., and during 1920.22, 17.5.
Last year only one death, of a female, was certified as due to this disease, to which cause no deat h
of males has been assigned for the past three years. The deaths during 1910-12 numbered 10 (males
7, females 3), and those during 1920.22, 3 (all females). The mortalty rates (all ages) for the two
periods are : Males 0.04 per 1,000 and nil; females 0.01 in both. The fatality rates (per 100 cases)
for each sex show the following changes: Males, 1910.12, 18; 1920.22, 0; females, 5.6 and 10.
All the deaths took place between the ages of 5 and 45, the only sex.age groups showing increases
during 1920.22 being those of females at ages 15.25 and 25 and over.
Of the 8 cases reported last year 6 were imported (including that of the only male, a " para "
case) and one imported case was traced to the eating of shell fish. Bacteriological tests were used
in 7 instances, positive results being obtainnd in 6. Six (6) cases (75 per cent.) were treated in institutions,
the average percentage for the three preceding years being 78.6.
PUERPERAL FEVER.
Last year 8 cases were notified, compared with 16 in 1921 and 15 in 1920. The annual average
for 1920.22 was 13, and that for 1910.12, 9, showing an increase of 44 . in the later period,
Calculating the morbidity rate on the corrected number of births, the rate for 1922 was 2.92 per 1,000.
and that for 1921, 5.59.
During 1910.12 the mean morbidity rate in the Borough as a whole was 3.00 per 1,000 births,
the rates recorded in the individual Wards ranging from zero (Lancaster Gate, East) to 5.60 (Maida
Vale). During 1920.22 the rate for the Borough was 4.33—an increase of 44 per cent.—the Ward
rates varying from 1.76 (Hyde Park) to 11.90 (Lancaster Gate, East). The rates recorded in the
later period were lower in Maida Vale (by 37 per cent.), and in Hyde Park (by 11 per cent.), and higher
in the other Wards, the increases ranging from 358 per cent.—Queen's Park, 1910.12, 1.68 per 1,000 ;
1920-22, 7.70—to 8 per cent.—Westbourne, 1910-12, 4.99; 1920.22,5.40. The changes in the rates
for the Lancaster Gate Wards can be shown only by combination. During 1910-12 the combined
rate was 2.86, and during 1920.22, 11.15—an increase of 319 per cent. It should, however, be noted
that the rates are in every instance based on very small numbers and that, in consequence, no great
significance attaches to the changes.
The seasonal distribution shows dissimilarity when the two periods are compared, approaching
that recorded in the case of scarlet fever. During the first half.years of 1910.12, 52 . of the
cases were notified, and during the second 48. In the period 1920.22, the proportions were 41 and
* The last case of continued fever was reported in 1915.