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27
In six instances, viz., cases 2, 3, 20, 24, 29, and 34, in the foregoing summary,
infection was undoubtedly taken from previous cases within the Borough. One of
the patients, it will be noticed, was a nurse, who was nursing a case of enteric fever.
With respect to cases 29 and 34, the probable sequence was that the father infected
the child, who, in its turn, passed the infection on to the mother. In a few cases there
were reasons for believing that the patients contracted the disea.se elsewhere than in
Shoreditch, and it is highly probable that several others did also. In most of the
cases nothing definite was ascertained to throw light upon the source of infection.
Shellfish and fried fish were mentioned as having been eaten by a few of the patients,
and in one case attention was directed to strawberries, but whether they were in any
way instrumental in causing the disease it was impossible to say. The fact that in
one case (No. 21) the patient swallowed a fly may be noted. It was mentioned by the
patient herself, who attached some importance to it, and it may possibly have been
the means of infecting her.
The period elapsing between the time the patient was noticed to be ailing and
the date of certification as to the case being one of enteric fever, was in one case
as short as five days, and in another as long as 33 days. The average for the 30
cases of enteric fever (excluding those not of that disease) was 17 days, and this is
about the usual time that elapses before a case of enteric fever is notified. The
disease is ordinarily recognised about the end of the second or the beginning of the
third week of illness. Where cases come under the notiice of medical men as soon as a
deviation from health is observed and can be kept under close observation, as happens
sometimes in hospitals, the nature of the illness may be recognised quite early. In
ordinary circumstances, however, the ailing patient goes about his usual avocation until
the gradually increasing debility forces him to seek medical advice, and oftentimes
it happens that the doctor is not called in until two or three weeks or more from the
beginning of the illness. All the time such a patient is going about—it is unnecessary to
dwell upon it—he is a source of danger, a danger all the greater because unsuspected.
The majority of the houses in which the cases occurred were found to be in a
satisfactory or fairly satisfactory sanitary condition, that is, no sanitary defects or only
those of a minor character were ascertained to exist. It is not to be concluded from
this that enteric fever is more likely to occur in a house in good sanitary condition,
for the majority of the houses in the Borough would be found on inspection to be in a
satisfactory or fairly satisfactory sanitary condition. It is highly probable that multiple
cases are more likely to be met with in insanitary houses, especially in those which
are dirty and overcrowded, and where the people are poor and without proper means
for nursing the patients. In such instances the risks of personal infection are greatly
increased, but multiple cases occur even where the sanitary condition of the dwelling is
exceptionally good, a great deal in connection with the occurrence of these cases depending
upon the habits of the people.