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38
FEVER.
Eighty cases of enteric fever were notified, compared with 107, 104, and 97, in the three
preceding years. The deaths were 19 (two above the corrected decennial average); 18 in the Town
sub-district and 1 in Brompton. Eleven of the deaths took place in hospitals, to which 47 cases
were removed. The deaths from this cause in the three preceeding years were 23, 16, and 11,
respectively. In fourteen of the cases there was ground for suspicion that the illness had been
caused by the eating of shell-fish—oysters in twelve of the cases.
The deaths in London, as a whole, were 585, and considerably below the corrected decennial
average (657). The notifications were 3,412 (3,195 in, 1901): the admissions to hospitals 1806
(compared with 1,835, 2,074, and 1,480. in the three preceding years); and at the close of the year
there remained 210 cases under treatment, against 406, 403, and 195, at the corresponding period
of the three preceding years.
No case of typhus fever occurred in the Borough during the year, and there was no death
from this cause in the Metropolis; but four cases were notified.
No deaths occurred in the Borough from simple continued fever; four cases were notified.
The deaths and notifications in London, as a whole, were 5 and 48.
DIARRHŒA.
Diarrhœa was the cause of 78 deaths, compared with 101, 105, and 115, in the three
preceding years: 74 in the Town sub-district and four in Brompton; the corrected decennial
average being 101. Of these deaths, 61 occurred in the sixteen weeks July 13—November 1: viz.,
10,22,19, and 10, in the successive four-weekly periods; 71 of the deaths were of children under five
years of age, including 58 under one year.
The deaths in London, as a whole, were 2,504, and 1,253 below the corrected decennial
average (3,757): 2,292 of the deaths were of children under five years of age, including 1,934 of
infants under one year old. This low death-rate was due to the cold and wet summer weather.
The mean temperature in 1902 (48º8 Fahr.) was 1°5 below the average; the total sunshine in
hours, 1,236; the highest proportion in the preceding ten years having been 1,708 hours in 1899, in
which year the mean temperature was 50º6 Fahr.
There being much uncertainty as to the actual number of deaths from true infantile epidemic
diarrhœa, owing to loose certification of death in cases in which laxity of the bowels was present
during the fatal illness, the Registrar-General issued to medical practitioners, last year, a memorandum
on the subject, as follows:—
"The Royal College of Physicians of London, in response to an earnest appeal for its
authoritative guidance concerning the certificates of death from diarrhœa, has now expressed
an opinion which, if loyally adopted by medical men throughout the country in granting certificates
of death, will greatly improve the national records of mortality from this disease.
The following is an extract from the proceedings of the College, dated January 25th, 1900: —
'The Royal College of Physicians is convinced, after careful inquiry:—(a) That
various unauthorised and misleading terms, such as "gastro-enteritis" "muco-enteritis,"
"gastric-catarrh," etc., are now commonly employed to designate the disease officially
known as "epidemic diarrhœa," whereby its specific character is in danger of being
ignored, and great confusion ensues; (b) that the present confusion of terms renders it
impossible to determine accurately either the prevalence of the disease in special places
and at special times, the extent to which it influences the public health, or the effects
produced by sanitary measures; (c) that there is a widespread objection on the part of
medical practitioners to the employment of the term "diarrhœa" in certifying the cause
of death, probably because the term is generally held by the public to imply a mild disease,
insufficient by itself to cause death.
'The College, therefore, has sought to discover, as an alternative for the authorised
term (epidemic diarrhœa), some other name, which, whilst equally accurate, should convey
to the public the idea of a more serious affection. But the College regards it as essential
that the idea of specificity, intended to be conveyed by the term "epidemic," should
be retained.
'As the result of much deliberation, the College has agreed to authorise the use of
the term "epidemic enteritis" (or, if preferred by the practitioner, "zymotic enteritis"),
as a synonym for epidemic diarrhœa. The College has further decided to urge upon
practitioners the entire disuse, in medical certificates of death, of such terms as "gastroenteritis,"
" muco-enteritis," or " gastric catarrh," as synonyms of epidemic diarrhœa.'