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Report of the County Medical Officer—General. 35
The death-rate in each year since 1868 in relation to' the mean death-rate of the entire period
1869-1912 is shown in diagram (Q).
During the year 3 cases of typhus fever were notified as having occurred in London, one each in
Finsbury, Shoreditch, and Bermondsey. All the patients died. Accounts of the cases are given in the
respective annual reports of the medical officers of health and are here summarised.
Typhus
suspected
cases.
Finsbury.—A married woman, aged 39 years, who worked as a laundress ironer in a Holloway
laundry, suffered from an illness which was notified as typhoid fever. After her admission to hospital,
in May, she was suspected to be suffering from typhus, a suspicion which was confirmed by a postmortem
examination. She died thirteen days after the symptoms of disease were first observed.
The source of her illness could not be traced, and no further cases occurred in the borough.
Shoreditch.—A commercial traveller out of employment, aged 50 years, began to be ill on 14th October.
His illness was marked by a severe shivering fit. He was admitted to the Shoreditch Infirmary
on 16th October, was delirious on the 17th, a rash appeared on the 18th, he became unconscious
and had a series of fits and convulsions and died the following day. His temperature was continuously
between 104 and 105 degrees Fahrenheit. The eruption, which resembled that of measles, was distributed
generally over the trunk and limbs, and was to be seen on the face. The Medical Officer of Health states
that a physician of great experience in typhus fever who saw the body shortly after death, was of opinion
that the disease was not typhus, and suggested that the eruption was to be associated with convulsions
sometimes met with in persons with kidney disease. Marked evidence of chronic kidney disease was
found at the post mortem examination, but it was also noticcd that the eruption was distinctly petechial
in character and persisted after death. The patient's wife and two children were kept under observation
at the borough council shelter, but no further cases occurred and the source of infection could not be
traced.
Bermondsey.—This case, that of a lighterman notified on October 5th, was seen by Dr. Brown, the
medical officer of health on October 3rd. The rash was fairly typical of typhus, and the man seemed
very ill. His mental condition was clear. He earned good wages, had a very good home, and there
was a total absence of the usual concomitants of the disease, namely, poverty, dirt, and overcrowding.
He was removed to the South-Western Hospital, where he died. Dr. Brown states that it is difficult to be
absolutely certain whether the case was a genuine one, but arguing by the process of exclusion it was
impossible to come to any other diagnosis.
Enteric Fecer.
The number of cases of enteric fever notified in the Administrative County of London during
1912 (52 weeks) was 704, compared with 1,022 in the year 1911 (52 weeks). The deaths from
this disease numbered 117 in 1912 (52 weeks), compared with 144 in 1911 (52 weeks).

Enteric fever
death-rates
and caserates,
London.
The death-rate in each year since 1868 in relation to the mean death-rate of the period 1869-1912
is shown in diagram (R).
The notified cases in each week of 1912 may be compared with the average weekly notifications
of the period 1890-1912 on reference to diagram (S).
The monthly case-rate and case-mortality in each of the years 1891-1912 in relation to the
mean of the whole period is shown in diagram (T).
Enteric
fever.
During the year 1912 there appeared a very important report, on Typhoid Fever in South West
Germany, giving the results obtained in the campaign against this disease instituted 9 years previously
by Robert Koch. The report is profoundly interesting, for the point of view is one which differs
Comparison
of experience
obtained in
South-west
Germany,
with that of
this country.
(a) See footnote («), page 26. (b) See footnote (c), page 4.
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