View report page

42
The only accounts of the occurrence of groups of cases in which a common cause was suspected
are contained in the reports of the medical officers of health of Fulham, Chelsea and Battersea.
The accounts in the Fulham and Chelsea reports refer to the same outbreak, involving two persons
resident in Fulham and five persons resident in Chelsea—the latter including all the persons resident in a
house in Chelsea, except the male head of the family, who escaped. Six of these persons were related and
were frequently together, and the infection may have been received on the 5th May, an occasion when
they all dined together. The seventh case was the servant in the Chelsea house. Suspicion attached
to the consumption of watercress, which, on the 5th May, was eaten by all except the servant, who
had, however, prepared it for table. The source of the watercress could not be discovered.
The account in the Battersea report relates to three groups of cases. The first group consisted
of nine persons, each living in a separate house, and all attacked between the 28th July and 17th
August. The source of infection could not be discovered. The second of these groups included
five persons living in the same house. The first, who was an eater of fried fish, was attacked the
beginning of February, and was removed to hospital. In the beginning of April his wife and child
and a child living in the top of the house were notified to be suffering from the disease, and three weeks
later the mother of this latter child was also notified, the first case having been in the hospital the
whole time. The third group, comprising four persons, occurred in one house. A child living in the
upper part of a house was certified on the 23rd September to be suffering from enteric fever. He was
looked after by a family living in the lower part of the house, and on the 4th October the mother and
two children of this family were certified to be suffering from this disease. Dr. Lennane suggests that
a faulty drain may have been the cause of the second of these groups, and that in the case of the third
of these groups the first case may have infected the others.
In other reports a proportion of the cases is attributed to infection from person to person.
The difficulty of determining the extent to which infection from person to person maintains enteric fever
in London is, however, considerable, as the widely different intervals of time which may elapse between
the date of infection and the date when the symptoms of the disease are sufficiently conspicuous to lead
to notification may easily obscure the existence of a cause such as an infected food supply, common
to all the cases of a group
In a number of the reports the consumption of some particular article of food, some
two weeks or so before the illness begins, is mentioned as a possible cause. Altogether, of 513
cases of enteric fever occurring in districts the reports for which give the necessary information,
the number of cases regarded as possibly due to the following articles of food was
—mussels, 16 cases ; oysters, 14 ; periwinkles, 6 ; cockles, 4 ; whelks, 1 ; crabs, 1 ; shellfish, unspecified,
31 ; fried fish, 14 ; watercress, 6 ; ice cream, 6. The number of cases associated with shellfish equals
14 per cent, of the total cases occurring in these districts, and the total number of cases associated
with articles of food of all descriptions equals 19 per cent. of all the cases.
Infection in the laboratory (Hampstead) is mentioned as the cause of one attack and immersion
in the Thames (Fulham) as another. A number of years ago Dr. Hartt, the then medical officer
of health of Greenwich, found reason for attributing several attacks of enteric fever in that district to
bathing in the Thames.
The Widal test is frequently employed for the diagnosis of enteric fever in London, and in
many districts sanitary authorities give opportunities for this test to be used at the public charge.
Some of the reports show the number of examinations thus made, from which it appears that out
of 393 cases a positive result was obtained in 127 instances, or 33 per cent.
Diarrhœa.
The deaths in the Administrative County of London during 1907 (52 weeks) attributed to
epidemic diarrhoea and infective enteritis numbered 780, while 763 deaths were attributed to
diarrhoea and dysentery. The corresponding figures for 1906 were 2,872 and 1,635 respectively.
The age-distribution of the deaths in 1907 was as follows:—

No accurate comparison can be made of the deaths from epidemic diarrhoea for a long series
of years in London, diagram XIX, however, shows the death-rate from cholera, dysentery, and diarrhoea
combined, in relation to the mean death-rate of the period 1841-1907 in each year since 1840, and it
is thus seen that the death-rate of 1907 is the lowest since 1841, a result to which the low temperature
which prevailed in the summer must be regarded as largely contributory.
The following table shows that the London diarrhoea death-rate was in the decennium 18971906
lower than the death-rate of any of the undermentioned large English towns, except Bristol,
1 See footnote (1), page 38.