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Puerperal Fever.—There were six cases notified, and one not
notified, with four deaths. It is difficult in such cases to find out the
exact source of the blood poisoning which occurs, but in one instance it
was found that the basement of the house occupied by the patient had
been flooded with sewage from an obstruction in the drain; and in
another a relative was suffering from a septic wound at the time.
Enteric or Typhoid Fever.—132 cases were notified, with
22 deaths, but there were four cases not notified, and three of the cases
notified were subsequently found not to be typhoid fever.
There was also a fatal case of continued fever, which was probably
typhoid. Assuming this to be so, there were 134 cases altogether, with
23 deaths, as compared with 102 and 20 deaths in 1901. Thus, although
the cases were more numerous, the case mortality was less (17.l per cent. compared with 19per cent.6 per cent). Table XIV. shows that these were
distributed all over the City, but that there was a special incidence on
the Strand Ward. Over the whole City the cases were in the proportion
of 7.1 per 10,000 inhabitants, but in the Strand it waper cent.s equal to 37per cent.0 per
10,000, in Conduit Ward 10.1, in St. Johnper cent.s 9.0, and in Victoria 8.3;
the following Wards were below the City, Covent Garden 7.0, St.
Margaret 6.5, St. Anne 6T, Pall Mall 4per cent.6, Charing Cross 4.0, Grosvenor
and the Hamlet 2.6, Kuiglitsbridge St. George 2per cent.5, Eegent and Great
Marlborough 1.0. 39 of the 134 cases were undoubtedly contracted
outside the City, and I have been informed of one case which occurred
in the Isle of Wight which was probably contracted in the City.
In many cases it is very difficult to discover the manner in which
the disease was contracted. This is due to several reasons, such as the
long period between the inception of infection and the appearance of
symptoms, and the removal of patients to Metropolitan Asylums Board
hospitals, so that information cannot be obtained from them. I have
gone over the list of cases, and so far as possible I have divided them
into classes. In fifty-two instances no sufficient cause was discoverable,
twenty-three cases probably contracted the disease from other cases,
seven of these were nurses and seven soldiers. Many soldiers returned
from South Africa convalescent from this disease, and it is quite possible
that some of them brought back infection with them.
In ten houses (eleven patients) serious drainage defects were
discovered; five of these were public-houses.
Shellfish.—Thirty persons are believed to have contracted
the disease from eating shellfish; twenty-two of these were persons
in the Strand and Covent Garden Wards who had been to
Southend and to Southwick, at one or other of which places they had
eaten cockles or mussels from sources known to have been sewage
polluted. A further report on this is given below. One other had eaten