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Louses, three cases in each of two houses, four cases in one house, and five cases in one house, the
number of houses having only one case each being 45. He found reasons for attributing multiple
cases in houses to " direct transference from patient to patient through neglect of all precautions."
A number of cases were found to occur in houses the drainage of which was faulty. Of 76 cases
reported 15 were imported from outside the district.
Chelsea—Of the total cases notified the infection of the disease was probably acquired outside
the district in 9 instances. The medical officer of health comments on the fact that " out of 14
cases notified in Kensal-town from the 1st October to the end of the year, 9 were of children under
12 years of age, this extreme incidence on children being somewhat unusual."
St. George, Hanover-square—The medical officer of health publishes a table showing the
number of cases of enteric fever in August, September, and October, and in November and December
in each of the years 1891-8, and showing, except in 1897, a higher monthly average in the latter
period, and he writes: " It will be seen from the table that this has been the case in every year,
except 1897, and I have already pointed out in previous reports that this excess of enteric fever in
November and December is coincident with the increase of organic matter in the drinking water
due to the flooded state of the river."
Westminster—Of 45 cases occurring in the district eight were cases in the Guards' Hospital,
soldiers serving in the late Soudan campaign. " In one case the origin was distinctly traced to the
patient having eaten some infected oysters, and in another to contaminated cocoanut water having
been consumed."
Hampstead—The medical officer of health writes: "There is always an increase of notifications
from this disease after the termination of the summer holidays, accounted for in a great
measure by the movement of all classes of people at this period of the year. In one or two instances
there was evidence of the spread of the disease from one individual to another in the same house,
occasioned, in all probability, by carelessness in nursing, or by partaking of food which has been
previously tasted by the invalid, or kept in the same room."
Hackney—Of the total cases notified 15 were introduced into Hackney after the
summer holidays. A group of 10 cases occurred in Tyssen-street and Tyssen-place between
the 4th March and the 22nd July. The sufferers were children, three boys and
seven girls, whose ages ranged from 3 to 10 years. The circumstances of these
cases were carefully investigated by the medical officer of health. The milk came
from different sources, and the schools attended were different. Dr. Warry writes "I
cannot altogether exclude personal infection of one patient to another, as the class of people living
in the affected locality are much in the habit of associating together in their rooms, accompanied
by their children, and are not deterred from this by a sick person being present; but all the cases
except one were removed to hospital as soon after notification as possible, and the vacated rooms,
with clothes and bedding, &c., disinfected." The one condition he found common to all the
children was that they played together on vacant land occupied during the first nine weeks of the
year by a circus and menagerie. From this land 15 cartloads of manure had been subsequently
removed, " most of it being the manure of carnivorous beasts of the show, besides the carcases of
several dead animals, and a large quantity of putrid meat." After full consideration of all the
circumstances of these cases, Dr. Warry regards the playing of the children on this polluted land
as the probable cause of their infection.
Strand—Of nine cases notified two were of persons who had just returned from the country.
In two instances the disease is believed to have been acquired through eating shell fish. One was a
hospital attendant, one worked at a rag store, and another as a scavenger.
Holborn—Of nine cases notified one was of a person who contracted disease while out of
town. In another case the cause may have been the consumption of infected oysters.
Shoreditch—So far as could be ascertained no cases were attributable to the consumption of.
oysters, milk, or ice cream. The medical officer of health gives an interesting account of the
spread of the disease in a family from one person to another, six persons being attacked. The
disease was probably introduced by a young man who spent the day with this family in the countiy,
taking his meals with them. This man subsequently died from enteric fever, and five members of
the family were attacked in succession. Nearly 70 per cent, of the cases notified in Shoreditch were
removed to hospital.
Bethnal-f/reen—Of the total cases notified, five occurred in families inhabiting ingle-room
tenements, and in three instances the premises were overcrowded. In one case a magistrate's orJer
was obtained for the removal to hospital of a patient occupying a house of two rooms, one of
which was used for the sale of articles of food. Two-thirds of the cases were removed to hospital.
St. Olave—Of five cases notified one contracted disease outside the district, and one was
probably due to the consumption of infected oysters. As two cases were regarded as doubtful,
" examinations were made for the Widal reaction which was obtained in both cases.
Lambeth—"Nine cases were introduced into Lambeth from outside, and in no single instance
could a satisfactory causal relationship be made out between a typhoid attack and a previous
ingestion of infected shell fish. In three instance the disease was conveyed from person to
person during nursing."
Battersea—Of 94 cases notified, 59 were removed to hospital and 35 treated at home. The
mortality of the former was 13 per cent., and of the latter 20 per cent.
Wandsworth (Wandsworth)—Of 51 cases notified 27 cases were removed to hospital, where
two died, 24 cases were treated at home, with four deaths. In three of the cases there was reason
to believe that the disease had been contracted from eating oysters, and in other three from the
drinking of water from the river Wandle. Four cases had only come to the district a few days
before the disease was diagnosed.
Greenwich (Greenwich)—The medical officer of health states that the majority of cases were
those of children. " In the case of children, many of them had partaken of ice creams, and it was