883PUBLIC HEALTH.-VITAL STATISTICS.

The Senior Censor (Sir WILLIAM ALLCHIN) then deliveredto him the insignia of office. The PRESIDENT gave his faithto the College and thanked the Fellows for the honour theyhad conferred upon him.The PRESIDENT then dissolved the Comitia.

Public Bealth.REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF

THE LOCAL GOVERNMENT BOARD.

On the R6peated Occurrence of Enteric Fever at Jennet Hilland 8tanft..rd D-trtgley ’m the Ratral Distr’Íct of Bradfield, byDr. R. W. JOHNSTONE.—This report gives a conciseaccount of the circumstances in which a small groupof houses in the rural district of Bradfield has sus-

tained a remarkably high rate of attack by enteric feverfor many years past, and it forms an important contribu-tion to the literature of research into carrier cases.

The special incidence of enteric fever at Jennet Hill wasbrought to the notice of the Local Government Board by thedistrict council in 1908, and Dr. Johnstone made his firstlocal inquiry early in 1909. Jennet Hill is a collection of

cottages, hardly of sufficient importance to call a hamlet,midway between Reading and Newbury. It consists of a rowof ten dwellings, known as Lailey’s-row, lying in a cul-de-sac off a high road, and nine other dwellings near by. A caseof enteric fever occurred in Clay Cross village, about a quarterof a mile south of Jennet Hill, in 1893. but no other casesoccurred in the neighbourhood until 1896, when four in-habitants of Jennet Hill were attacked. After that datecases of enteric fever have occurred in Jennet Hill in

. each of the following years : 1897, 1898, 1899, 1900, 1902,1904, and 1907, a total of 16 attacks being notified. Tothese must be added 11 other cases among persons livingelsewhere who had been at Jennet Hill before theirattack, and in all probability contracted infection there.The population of Jennet Hill is not more than 80

persons. During the period 1893-1907 inclusive only 36cases of enteric fever were notified from the rural districtoutside the vicinity of Jennet Hill, with a populationof about 15,000. The years in which cases occurred inJennet Hill did not correspond with those in which the

majority of cases occurred in the rest of the rural district,and it is noteworthy that when the cases between 1893 and1907 were grouped according to the month of attack, thosein Jennet Hill showed very little seasonal variation, while inthe remainder of the district the usual October maximumwas apparent. Dr. Johnstone was naturally unable, on

account of the lapse of time, to deal fully with the questionof possible infection by way of articles of food or drink

brought into the neighbourhood from contaminated sources.But, as he points out, in an agricultural neighbourhoodof this kind there is little variety of ordinary diet, andhis inquiries tended to negative the suggestion that somespecial food or drink-mineral water, shell-fish, &c.-likelyto convey enteric fever infection had been habitually con-sumed, and to an exceptional extent, by the Jennet Hillinhabitants. The conditions of water-supply and of excre-ment disposal were of a kind which might be expected tofacilitate the spread of infection. A dip-hole by the road-side, fed by a spring and unprotected from surface washings,formed the water-supply between 1893 and 1903, when thepresent supply, a tube well into the chalk, was provided.There was, however, an interval in 1897, when the dip-holewas closed, and a shallow well, which the parish councilhad caused to be made close by, was resorted to instead.Certain of the cases in Jennet Hill occurred during thisinterval and others have occurred since 1903. Excrementfrom pail closets is disposed of in the gardens andfields near the houses. The closets of invaded houseshave been systematically disinfected, but not until afterthe removal or recovery of the patient. Thus while soilor water pollution may have contributed in any givenyear to local spread of infection, they do not appear of them-selves to afford an adequate explanation of the continuedoccurrence of cases year by year which has been above

1 Reports to the Local Government Board on Public Health andMedical Subjects. New Series, No. 22. London Wyman and Sons,Fetter-lane; Edinburgh: Oliver and Boyd; Dublin: E. Ponsonby.Price 4d.

described. Dr. Johnstone adopted this view after his first

inquiries and concluded that a probable explanation of themain circumstances would be found in the existence of oneor more carrier cases among the inhabitants, especiallyof certain suspected houses in Lailey’s-row. This suppositionwas verified by the history of the place in 1909, as ascertainedby Dr. Johnstone at a further inquiry. On March 27th, 1909,a boy living at 8, Lailey’s-row sickened with enteric fever.He had come to Jennet Hill with his family in the previousautumn ; he had not been away from home except to a

neighbouring school, and he had not been exposed to anyknown source of infection. Another case suspected to beenteric fever occurred at 9, Lailey’s-row in May. A mother,aged 27 years, and her daughter, aged 4 years, went to

stay at 8, Lailey’s-row on Feb. 25th, 1909, and returned totheir home in Newbury rural district on March 15th. Themother had then been ailing for a week and her illness wasultimately diagnosed as enteric fever. The daughtersickened about March 17th with the same disease. Thesecases, together with the results of Dr. Johnstone’s previousinquiry, facilitated attempts to obtain specimens of blood,fasces, and urine of the inhabitants of Jennet Hill for

examination, but this was not an easy matter. Theinhabitants, Dr. Johnstone remarks, I became suspicious ofour motives. Some pleaded outraged modesty, others hadreligious scruples, and argument and persuasion only madethem more obstinate." Eventually, with much pressure andsome pecuniary inducement, samples of fasces and urine wereobtained from 19 persons, 15 of whom resided in Lailey’s-row.They were examined by Dr. J. C. G. Ledingham at the ListerInstitute. Six of the blood samples gave a positive reaction withthe agglutination test. The bacillus typhosus was not recoveredfrom any of the samples of urine, but four of the samples offasces contained bacillus typhosus in large quantities. Intwo of these four cases Dr. Johnstone was not satisfied thatthe fasces had been those of the persons from whom theywere stated to have been obtained. But in regard to theother two, A and D, no doubt arose, and each of these

persons may therefore be regarded as a potential cariiercase. The woman A had no history of enteric fever or ofany illness bearing suspicious resemblance to enteric fever,although other members of her household were alleged tohave had the disease in 1892. In 1893 she was living atClay Hill, and in that year her next-door neighbour wasattacked by enteric fever. Immediately afterwards Aremoved to 9, Lailey’s-row at Jennet Hill, where she hasbeen since. It is from 1896 onwards that the succession ofcases in Lailey’s-row has occurred. But in view of the

history of other cases which have been investigated, the occur-rence of this interval could not be said to negative thehypothesis that A had been from time to time a carrier ofinfection since her arrival at Jennet Hill. The second case,D, is that of a married woman who came to Lailey’s-row inSeptember, 1903. Here also it is remarkable that she had no

history of having suffered from enteric fever or anythingresembling it. One case occurred in her family in 1906. In1908 she moved to a village three miles away, and two casesof enteric fever have since occurred in connexion with thehouse which she then occupied. The conveyance ofinfective material from the carrier to the victims is

usually effected directly, as a result of personal contact,or indirectly by means of food or other articles con-

taminated by him. In the present instance inquiriesdirected to ascertain the degree of intimacy betweenthe inhabitants of Jennet Hill were singularly negativein their results : -the inhabitants " never frequentedeach other’s houses, never borrowed or lent cookingor eating utensils, never had fruit or vegetables fromeach other’s gardens, never smoked each other’s pipes,and never shook hands with each other." Dr. Johnstoneadds, however, that having seen some of the inhabitants intheir neighbours’ houses, he was not disposed to placegreat reliance on the answers he received. The nioditsoperandi of the agencies which transmitted infection fromthe carrier cases remains a matter of conjecture.

VITAL STATISTICS.VITAL STATISTICS OF LONDON DURING FEBRUARY, 1910.

In the accompanying table will be found summarisedcomplete statistics relating to sickness and mortality in theCity of London and in each of the metropolitan borougb"-With regard to the notified cases of infectious diseases, it