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35
Average number of cases of Typhoid Fever notified per year in
WpcfminQfor in:-
1890-99 (10 years) 112
1900-1909 (10 years) 48
1910-14 (5 years) 33
1915-19 (5 years) 17
(10 years) = 26.
1920-24 (5 years) 13
The figures in the period 1910-19 included a number of infected
refugees arriving in Westminster in 1914-15, otherwise the average would
have been lower.
To various causes has the general decline of Typhoid Fever been
ascribed, such as improvements in water supply, house drainage and
sewage disposal, greater control in the supply of oysters and other shellfish
milk, ice creams, the introduction of deep sea fishing by steam trawlers,
so that fish are not taken from polluted shallow water, the recognition
that certain persons may be " carriers " of infection. Probably all the
above have contributed their share and to the above list should be added
the greater number of patients removed to hospitals for treatment and,
especially during the war period the introduction of protective inoculation.
Measles..Every second year Measles assumes epidemic forms.
Thus in 1921 only 26 cases were known, in 1922, there were 591 and in
1923, 131 cases were noted. An increase in the last quarter of 1923 was
remarked upon in my last Report and the suggestion was made that it
was an early beginning of the 1924 outbreak and indicated more extensive
and serious epidemic. This unfortunately proved correct, for 882 cases
were recorded of which 852 occurred in the first four and a half months
of the year, half of the cases being in the month of March. The outbreak
was practically over by the end of April. In the third quarter of the
year, 21 cases were recorded and 9 in the last.
Information as to the cases is derived from the head masters and
mistresses of schools, hospitals, medical practitioners and from the
Metropolitan Asylums Board. These numbered 816, but on visiting, the
Health Visitors found that 16 children were not suffering from Measles,
but they discovered 82 other cases and possibly there were more cases
in families above the standard usually visited.

The rise and fall of the outbreak is shown below, week by week, from
which it will be seen that it attained its height about the middle of March,
after which it declined.