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average, little more than half what it was a few years ago. It is
true that sixteen cases of typhoid fever were notified during 1909.
All but three of these, however, were due to the conveyance of the
specific virus from outside the district.
The circumstances of this outbreak call for narration and
comment.
On February 9th, I received from Dr. G. Hovenden intimation
that a child in Barnes was, in his opinion, suffering from typhoid
fever.
On February 10th the case was removed to a London hospital,
where the diagnosis made by Dr. Hovenden was contradicted, a
fact of which I did not become aware until some weeks later, when
the authorities finally corroborated the perfectly accurate diagnosis
originally made. Within the next two or three days, two cases of
children suffering from intestinal disturbance occurred in my own
practice, and, as enquiry established a possible common factor for
the three, I was enabled to make a diagnosis of typhoid fever with
some confidence. On February 14th, I saw a fourth case, a child
of eighteen months, and in this instance the common factor was
also present.
Enquiries and activity had, however, already been set on foot,
and a purveyor of milk, whose premises were outside this district,
agreed to sterilize all milk sold by him.
Dr. Caldwell Smith, the Medical Officer of Health for
Wandsworth, was communicated with, and he satisfied himself that
there was no fault to be found with either the condition of the
purveyor's premises or the health of his employees.
In the meantime a circular had been sent to the practitioners
in this district, with the result that in the course of a few days
seven cases more were discovered in Barnes. Dr. Smith also
became aware of four cases in Wandsworth. Enquiries as to the