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In a number of instances the fact is mentioned that the persons who were attacked had,
within the incubation period of the disease, eaten ice-creams or watercress. In Hackney
two localised outbreaks of the disease were attributed by Dr. Warry to the eating of watercress.
The first of these, which comprised 48 notified cases, occurred within a period of eight weeks, from
the second week in June to the week ending the 25th July, in an area bounded by a circle of
one-third mile radius, the centre of the circle being situated in the Clarence-road, opposite Pembury-grove;
the second outbreak of 62 notified cases occurred in a period from the first week in
August to the week ending the 29th August, in an area bounded by a circle of half-mile radius, of
which the centre was situated near Orchard-street, adjoining Well-street. Inquiry as to the
food supply of the population in these areas enabled Dr. Warry to exclude as possible sources of
infection all articles of food usually thought of in connection with such outbreaks, except
watercress. He found, however, that during the first period watercress eaters suffered 4.6 times
as much as those who did not eat watercress, during the second period more than twice as much,
and during the whole epidemic over three times as much.
Dr. Warry submitted for bacteriological examination a number of specimens of watercress
purchased in Hackney, the source of some of which were known, and also water from beds at
West Ham, which he had reason for thinking were the source of watercress which had been supplied
in the areas of enteric fever incidence. All these samples were found to contain organisms
of the intestinal type.
This report was communicated to the Public Health Committee of the County Council.
The Committee, as far back as 1900, had their attention directed to the pollution of watercress beds
in London, and they now decided that inquiry should be made concerning watercress beds outside
the county.
Dr. Wellesley Harris also submitted, for bacteriological examination by Dr. Klein, samples
of water from the River Pool, which receives the effluent from the Croydon Sewage Farm. Dr.
Klein found that the watercress grown at Southend-lane and supplied by the River Pool was
sewage polluted. Dr. Harris states that it is proposed to construct additional filter beds to improve
the quality of the Croydon effluent.
The only cases of enteric fever attributed to milk during the year occurred at Eltham.
There were three such cases, the patients, with some few others at Mottingham, receiving their
milk from a farm in that village. The outbreak was investigated on behalf of the inhabitants of
the locality by Professor Simpson who, Dr. Davies, the medical officer of Woolwich, reports, was of
opinion that " the polluted condition of a small water-course running through a field in which the
cows of the suspected farm were turned out offers sufficient explanation of the infectiousness of the
milk.
In several annual reports account is given of the communication of infection from person
to person, and Dr. Bryett gives the particulars of cases occurring in Shoreditch among persons
who had been hop-picking in Kent, where infection was first received, and the disease subsequently
communicated from one person to another.
The use of the Widal test for the diagnosis of enteric fever is mentioned in the annual
reports relating to 17 districts. In these districts 566 such examinations were made, the result
being positive in 31.6 per cent.
Enteric fever—Age and sex distribution.
The following table shows the cases, deaths, case-rates, death-rates, and fatality of enteric
fever at the several ages and for each sex in London during the year 1903. The case-rate and
death-rate at "all ages" was greater among males than among females, but the fatality was
greater among females. In the age groups adopted for the purposes of this table the greatest
incidence of attack was upon males aged 15-20 and upon females aged 10-15. The greatest
incidence of death was upon males aged 20-25 and upon females aged 35-45. The fatality was
greatest among males aged 55 and upwards and among females aged 35-45.

1 See footnote (1), page 25.