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14 SANITARY CHRONICLES, 1894.
TYPHOID FEVER, 1894.
Typhoid fever was far more prevalent throughout the
Metropolis in 1894 than usual. As regards St. Marylebone,
the number of cases of typhoid fever notified in 1890 were
72 ; in 1891, 61 ; in 1892, 70 ; in 1893, 93; and in 1894, 141.
27 of the 141 cases did not however arise in the parish,
but were imported from elsewhere ; 17 of the imported cases
being derived from other Metropolitan districts; 6 obtained
their infection in the provinces; and the remainder from
abroad—1 from Paris, 1 from New York, 1 from Yarmouth,
and 1 from Buenos Ayres. Hygiene is no longer a matter
of local concern. The rapidity with which persons can now
travel from one part of the Globe to another, makes all
infectious maladies more or less of international importance.
A number of the imported cases came into the district
to be treated at the several excellent surgical and medical
homes which have been established; the treatment of
typhoid in a nursing home under skilled supervision constitutes
in no way a public danger, and there is no instance
on record of the disease spreading in such institutions save
to those in actual contact with the patient.
The theories current with regard to the causation of
typhoid may be briefly referred to : in the first instance, it
is supposed to be produced by a minute organism, one of
the many microscopic rod-shaped bacteria; this organism
in a majority of cases is in some way swallowed, and in the
minority of cases breathed. It may be taken as proved
that by far the most frequent cause is drinking contaminated
water; next in order comes contaminated food; and
lastly, it may be produced by the inhalation of bad air containing
the specific bacterium.
With regard to water, notwithstanding the report of
the Royal Commission, one can scarcely deny the possibility
for water derived from the Thames to be occasionally inefficiently
filtered, and for the specific organism to be
distributed with the water supply; if the contaminating
matter is small in amount and widely diffused through a
large body of water, most persons would escape infection,
but some, either from constitutional or temporary causes,
might be in such a state of health as to be readily receptive.