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The absence of evidence that the public supplies have been concerned in giving rise to typhoid
fever in London, does not mean more than that they have not conspicuously done so. Avery small temporary
increase of the number of typhoid cases in the area of a water company might be all that would result
from the supply of slightly infected water, and this result might not affect the number of deaths so as
to excite attention. The demonstration of any relation between such increase of cases and a water
supply would be a work of extreme difficulty even if it were possible, and in view of the administrative
arrangements of London in the past, it is quite conceivable this event might have occurred unnoticed.
On the other hand it must be equally stated that no evidence is forthcoming that this has happened.
A point well deserving of observation is the diminishing London typhoid fever death rate. To
assume that this is due to improvements in the water supplies (whether due to better treatment
of the sewage of towns above the intakes or to the operations of the water companies) would
necessitate acceptance of the view that water had in the past caused this disease in the London population.
It may be due to the general improvement in the sanitary condition of the metropolis, and it is
quite conceivable that change in the nature of the virus may have played some part in a diminution
which has been generally shared by the country as a whole.
Experience of the value of natural processes of purification of rivers and of filtration must be
sought out of London, and trustworthy knowledge can only be arrived at as the result of prolonged
observation. There was one case in which the question was raised whether a river of considerable
volume, after flowing some distance subsequent to receiving pollution, had given rise to epidemic prevalence
of enteric fever among the consumers of the water. This case was that of the river Tees, which,
according to the report of Dr. Barry, a medical inspector of the Local Government Board, had distributed
through the mains of certain water companies, enteric fever among the tenants of these companies. So
much importance attaches to the lessons to be learnt from the behaviour of typhoid fever in the Tees
valley that it is necessary to make special reference to this report.
The Royal Commission thus discussed the subject—
" In 1890 a serious outbreak of enteric fever occurred in the Tees valley, and was attributed by
Dr. Barry, the medical inspector, in a report published in the supplement to the twentieth annual report
of the Local Government Board, 1890-91, to the consumption of water taken from the Tees, and
delivered after filtration by the Darlington Corporation and Stockton and Middlesbrough Water Board.
" This view he further upheld in a later and fuller report, which will appear in the supplement
to the twenty-first annual report of the Local Government Board, in continuation of the report of the
medical officer for 1891, and of which we were favoured with advance copies; and in this final report
he extended his inquiries to a second outbreak in the year 1891, and assigned to this also an origin in
the Tees water supply.
" The conclusion at which Dr. Barry arrived in regard to the 1890 outbreak, to which we have
more specially directed our attention, appears to have been mainly based on the following propositions—
" (a) That the fever was so vastly more prevalent in the districts supplied with Tees
water than in the districts supplied from other sources, that it may be said to have been
practically confined to them.
" (b) That the attacks were spread over all the districts supplied with Tees water with
very great, though not of course with mathematically perfect, uniformity, and that the several
districts were attacked simultaneously.
" (c) That water supply apart, there was no other difference of any importance between
the Tees-drinking and the other districts.
" (d) That there was an accumulation of filth upon the banks of the Tees at places above
the intake, and notably at Barnard Castle, and that a flood, which happened on August 13th,
1890, must necessarilly have washed this filth into the river; and that the time when the
outbreak declared itself, after allowing for the incubation period, tallied with the view that the
outbreak was caused by this pollution."
" This series of propositions doubtless constitutes a formidable indictment against the water
supply. They are, however, one and all traversed by Mr. Wilson, the representative of the Stockton
and Middlesborough Water Board, and the chief objections that can be made to them severally may be
stated as follows—
" As regards the proposition lettered (a) it is admitted, speaking generally, that the fever was
much more prevalent in the Tees-drinking than in the surrounding districts ; but it is said that the
difference in this respect between the two was very much smaller than represented by the inspector,
inasmuch as notification of cases was compulsory in the former, with the exception of one sanitary
district out of ten, while it was voluntary in the latter, with the exception of seven sanitary districts out
of twenty-two; and that in consequence of this the number of cases was largely overstated in the
Tees-drinking districts, and largely understated in the other districts ; and in support of this, appeal
is made to the respective case-mortalities, as deduced from the inspector's own tables.
" To the proposition lettered (b) it is answered that not only did numerous villages or hamlets
that were supplied with Tees water altogether escape, but that, in districts which were attacked, the
attacks were not spread with uniformity over the area, but occurred, either exclusively or preferentially,
in certain parts, and that this distribution coincided with marked difference in the sewerage arrangements,
which were so faulty that previous outbreaks of fever had been attributed to them by official
inspectors, and the probability of further outbreaks asserted.
" To the proposition lettered (c) it is answered that he water supply does not constitute the
only important difference between the two sets of districts ; that the Tees-drinking districts are almost
exclusively urban, and the other districts almost exclusively rural; and that, if the 32 sanitary districts
dealt with in Dr. Barry's report he divided into urban and rural without regard to their water supply,
it is found that the reported fever cases were four or five times as numerous in the urban as in the
rural group ; and that the conditions of urban life, with its common sewerage and its closer aggregation