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Caldwell Smith reports, in only 2 cases could oysters be said to have been the cause, while in 11
instances the disease was contracted outside of the borough, in 2 instances in Paris. In Greenwich,
Dr. Annis states, "ice-cream was alleged to have been the infecting agent in one or two
of the cases, but no definite proof of this point was obtainable, although a knowledge of the conditions
under which this delicacy is prepared always allows quite legitimate grounds for suspicion,
if no more." Dr. Sidney Davies states that 8 of the 68 notifications of enteric fever in Woolwich
were not actual cases of the disease. Of the actual cases, 4 were due to infection from previous
cases, 13 had partaken of shellfish within four weeks of the commencement of the illness, 4 of
celery or watercress, and 3 of ice-creams. One was attributed to working on a blocked drainage
manhole, and in one case a wife contracted the disease several months after her husband had it.
Dr. Davies discusses the occurrence of 11 cases at Eltham which occurred in July, August, September
and October. Of a series of 9 cases, the first was a milk carrier, but none of the later cases
received milk from this source. Of the remaining 8, 6 had their milk from one dairy, the milk of
which was widely distributed. The cases were, however, on one round, and the man who served this
round had been in good health. A man who served another round was a friend of the milk
carrier, the first of the series. He was of unclean habits, and was dismissed for this reason,
and there was a cessation of cases shortly after his dismissal. Dr. Davies states, "it is possible
that this man may have had some dealings with milk cans belonging to the affected round, but
the fact remains that no cases occurred on his own round." Other food supplies could be
excluded as possible sources of infection.
Bacteriological examination of blood serum.
The annual reports in several instances show that the blood of persons suspected to be
suffering from enteric fever was examined for the "Widal reaction"; thus, in Paddington, the
reaction was obtained in 22 out of 37 cases, in Fulham in 33 out of 44 cases. In Westminster, of
10 cases examined, the reaction was strong in 5 and feeble in 1. In St. Pancras, of 92 cases
examined the reaction was obtained in 47. In Islington, 112 specimens were examined, and the
reaction obtained with 66. In Stoke Newington the reaction was obtained with 2 out of 6 specimens.
In Hackney, blood from 9 cases was sent to the Jenner Institute for examination. In
Finsbury, in 23 cases blood was examined, in 17 of which there were positive results. In Shoreditch
the blood was examined in 9 instances, in 4 the results were positive. In Poplar, the
blood was examined in 52 instances, the reaction being obtained in 28. In Lambeth, 98 samples
of blood were examined, the reaction being obtained in 50. In Wandsworth, the blood was
examined in 7 cases, in 3 the result being positive. In Deptford, arrangements have been made
for the examination of blood from doubtful cases of enteric fever. In Woolwich, an examination
was made in 27 cases, and in 15 a positive result obtained.
Enteric fever—Age and sex distribution.
The following table shows the cases, deaths, case rates, death rates and fatality of enteric
fever during the year 1901 in London. The case rate at "all ages" was greater among males
than among females, as were also the death rate and fatality. In the age groups adopted for
the purposes of this table the greatest incidence of attack was upon males aged 15-20 and females
aged 10-15. The greatest incidence of death was upon males aged 20-25 and females aged 10-15.
The fatality was greatest among males aged 55 and upwards and females aged 45-55.

* See footnote (*), page 33.