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36
The monthly case-rate and case mortality in each of the years 1891-1904 in relation to the mean
of the whole period is shown in diagram XVI.

It will be seen from the foregoing table that among the several sanitary areas the enteric
fever death-rate was, in the period 1901-3 highest in Poplar (0.14), and lowest in Kensington, Chelsea
and Greenwich (0.07); in 1904, Hackney and Bermondsey had the highest death-rate (0.12), the City
of London, where no death was recorded, the lowest. The death-rates from enteric fever in London
in each of the four quarters of the year 1904 were as follows: first quarter, 0 05; second quarter, 0.04;
third quarter, 0 07; and fourth quarter 0.09 per 1,000 persons living.
The decline in the case-rate, death-rate, and fatality of enteric fever has been maintained, but
some London districts suffer practically twice as much as others. This may in part be due to difference
in the food supply, but in all probabilty it is especially dependent upon other conditions of life, and
especially the habits of the population which give opportunity for the disease to be spread from one
person to another. Thus it will be observed that districts which are especially occupied by poor persons
suffer more than districts inhabited by persons better circumstanced. Efforts to secure greater reduction
in the prevalence of this disease should therefore especially be directed to the discovery of persons suffering
from this disease in so slight a degree that their illness escapes recognition and notification, but who may
nevertheless be infective. When regard is had for the long period of time during which the bacillus of
enteric fever often remains in the urine of a person who has been attacked by enteric fever, the frequency
of the opportunity for infection can be appreciated.
The annual reports contain numerous references to the spread of enteric fever by infection
conveyed from one person to another. Dr. Brown gives the particulars of nine cases of this disease
which occurred in one house in Bermondsey, eight of which were directly or indirectly infected by the
first case, a man, the cause of whose own attack was unknown. In another house in this district three
cases of undoubted enteric fever occurred, and other cases of less defined disease, but which was
probably enteric fever, the disease being communicated by personal infection. Enquiry by
Dr. Newman in Finsbury enabled him to attribute the source of infection to antecedent cases in ten
instances. In Shoreditch, Dr. Bryett found four such cases. In Wandsworth, Dr. Caldwell Smith
attributed the origin of eight cases to this cause, and Dr. Davies found three such cases in Woolwich.
Again, Dr. Sykes gives account of the occurrence of a number of cases of enteric fever, occurring during
1 See footnote (1), page 7.