View report page

44
the circumstances of her "recrudescence of fever" on September 19th at Slough, suggest, however,
a more probable hypothesis than this.
At the Convalescent Home the first five cases sickened between September 17th and 26th. These
cases might not unnaturally have been grouped with that of A. F. herself, who had a "recrudescence of
fever" when at the Home on September 19th, and with that of M. S., who had a "recrudescence of
fever" on September 24th at the Home, but who was readmitted to the institution (to the surgical
ward already referred to) on the following day. The dates of onset of this group of seven cases are
distinctly suggestive of some food infection, and if A. F. had enteric fever at all it is quite possible that this
so-called " recrudescence of fever " really constituted her original attack. The one piece of evidence concerning
A. F.'s relation to enteric fever (apart from the information gleaned in October from her friends)
was the discovery, on October 5th, that her serum gave a positive Widal reaction, and this phenomenon
might, of course, not unnaturally find explanation in occurrence of an attack of enteric fever commencing
on September 19th, when A. F. was in the Convalescent Home. A food infection hypothesis of the seven
children in the Home, as opposed to the hypothesis of the infection of six of them by A. F., finds, moreover,
support in the fact that none of the children originally attacked at the Home were in the same
ward as A. F., though two patients in the Home attacked later (September 30th and Octobcr 14th)
were in that ward.
The curious inter-relationships of the patients and nurse attacked in the surgical ward at
Paddington Green Children's Hospital are, as noted already, suggestive of personal infection, but
there remains the fact that while these inter-relationships fit in with the view that A. F. when in
that ward was an unrecognised source of mischief, this theory does not accord so well with the
subsequent occurrence of A. F.'s "recrudescence of fever" at the Home on September 19th, or with
the almost simultaneous (September 24th) attack of the child M. S., then at the Home, and only
subsequently sent to occupy the ward occupied by A. F. at the hospital in Paddington.
The circumstances of these cases are well deserving of study, but they cannot be held to conclusively
establish the infectivity of the child A. F. from July 31st to October 2nd.
Diarrhœa.
The deaths in the Administrative County of London attributed to epidemic diarrhoea and
infective enteritis during 1906 (52 weeks) numbered 2,872, while 1,635 deaths were attributed to
diarrhoea and dysentery. The figures for 1905 were 2,125 and 1,285 respectively.
The age-distribution of these deaths was as follows:—

No accurate comparison of the deaths from epidemic diarrhoea for a long series of years in London
can be made; diagram XIX., however, shows the death-rate from cholera, dysentery, and diarrhœa
combined, in relation to the mean death-rate of the period 1841-1903 in each year since 1840.
The following table shows that the London diarrhoea death-rate was in the decennium 1896-1905
lower than the death-rate of any of the undermentioned large English towns except Bristol, Bradford and
Newcastle-on-Tyne, and in 1903 was lower than that of any except Bristol and Bradford.

1 See footnote (1) page 8.