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20
(1.) Annie S., aged 22, working at a wholesale stationer's in Whitechapel,
was ill from the beginning of September, took to her bed about
September 14th and was certified to have typhoid fever on September
28th, and removed to hospital.
(2.) Edith S., aged 6, was ailing from the beginning of October and was
certified to have enteric fever and removed to hospital on October 24th.
(3.) Robert S., aged 50, father of the above patients, was taken ill about
October 17th and certified and removed to hospital on October 26th.
The wife of Robert S. looked after case (1) during her illness and also after the
other two cases. She also attended to her household duties and prepared food for the
family. There were several other children besides the patients in the family. The
probability is that case (1) infected case (2) and case (2) passed the infection on to case
(3). It is possible, however, that cases (2) and (3) were infected through the medium
of food prepared by the mother whilst she was nursing the first case.
One of the chief reasons why the disease spreads in the manner illustrated by the
series of cases given above, lies in the fact that the primary cases are frequently not
recognised to be enteric fever until a considerable period has elapsed, often amounting
to three or four weeks from the beginning of the illness. The infectious nature of the
malady is not realized, and no precautions are consequently taken. Granting that
there is no superabundance of room space in the dwelling, and that the means for
efficient nursing at home are inadequate which is likely to be the rule in a working
class district like Shoreditch, it can hardly be held surprising that secondary cases
occur, for even in hospitals where cases are treated under the very best of conditions
nurses and doctors sometimes take the disease. Other conditions which are
favourable to the spread of infection are unskilled nursing and want of cleanliness,
and there is always great risk when a person engaged in attending to a patient suffering
from enteric fever is in the habit of preparing food for other people. In a large proportion
of the cases of enteric fever certified in Shoreditch no reliable information throwing
light upon the source of the disease is obtainable. It is therefore impossible to form
anything like an accurate estimate as to how far personal infection plays a part in the
propagation of the disease. It may, however, be mentioned that of some 730 cases
of enteric fever occurring in Shoreditch during the six years, 1898-1903, in 78 or 12
percent. there were good grounds for believing that infection was more or less directly
conveyed from or taken from previous cases within the Borough.
In consequence of a communication from the Medical Officer of Health for the
City of London in the early part of the year my attention was directed to army
blankets which were being sold to persons in the Borough. An outbreak of enteric fever
occurred on board the training ship "Cornwall," in connection with which blankets
sent back from South Africa were suspected of conveying infection. It appears that a
large quantity of these blankets had been disposed of by certain firms in London to
persons in various parts of the country and some of them found their way into
Shoreditch. All the blankets which could be discovered at the time in the Borough were