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The eastern anil central groups of districts had the highest enteric fever death rate during
the year 1901, viz., 0"14 per 1,000 living, and the southern group of districts the lowest (0-10).
Among the several metropolitan boroughs the death rate was highest in Holborn (0-20) and lowest
in Kensington and St. Marylebone (0 06). The enteric fever death rates in London in the four
quarters of the year 1901 were as follows—First quarter, 012; second quarter, 0*06; third
quarter, 014 ; and fourth quarter, 013 per 1,000 living.
Information as to the possible causes of enteric fever is contained in a number of the
reports of the medical officers of health. Dr. Reginald Dudfield in an analysis of the cases
occurring in Paddington states that 92 cases were reported, of which 21 contracted the disease
outside the borough, in 2 infection was contracted while nursing cases of this disease, and in
G there was error in diagnosis. Among the remaining G3, 12 persons habitually had meals
beyond the borough, 4 admitted having eaten oysters, 5 admitted having eaten mussels or cockles,
or both, an'd 5 had had ice-creams. In one street he found cases in three houses adjacent to
each other, and in another in two houses, but with considerable intervals between the dates of
attack. Dr. T. Orme Dudfield gives account of eight cases occurring in three houses in Kensington.
The inmates of two of the houses were related to each other, and one of these houses was frequently
visited by the inmate of the third house (situated in another street), who was himself attacked.
Mr. -Jackson writes that there was an especial prevalence of the disease in Fulham during the last
week of July and the first three weeks of August, 43 cases being notified in that period. He
adds—
" Careful inquiries were made into the cases, especially as to the possibility of the infection having
been connected with the food supply, but no explanation was forthcoming of the outbreak, which occurred
before the usual autumnal increase of the disease was established. The localised prevalence of the disease
was, of course, strongly against the supposition that it could have been connected with the water
supply, but it may be mentioned that Drs. Crookes and Dewar reported that between the 6th and 15th
July, which was about the period when the bulk of the cases were infected, the disease being in many
instances not notified until a week or two after the commencement of the illness, nearly the whole
of the filtered water of the different companies derived from the Thames and Lea showed an excessive
number of microbes per cubic centimetre, far above the variations permissible as showing the difference
between good and bad filtration."

1 See footnote ('). page 9.