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in 1915 were 327, as compared with 319 in 1914. The decrease in prevalence in London as a whole is
shared by each of the metropolitan boroughs with the noteworthy exceptions of Shoreditch and Bethnal
Green, where the cases notified increased from 424 to 556 and 654 to 786 respectively.
The civilian cases of diphtheria (including membranous croup) notified in the administrative
county of London in 1915 (52 weeks), numbered 9,094, as compared with 9,118 in 1914. The number
of civilian deaths was 704 in 1915, compared with 713 in 1914.
The prevalence of diphtheria in London as a whole appears generally to rise and fall with that
of scarlet fever, but the rule does not hold for each individual borough. In 27 out of the 29 metropolitan
boroughs the scarlet fever cases notified in 1915 showed marked decline as compared with 1914, but in
the case of diphtheria only 16 showed decrease. This difference is associated with greater tendency
to persistence in particular areas of diphtheria as compared with scarlet fever.
The deaths from whooping-cough in the administrative county of London during the year 1915
numbered 1,158 as compared with 921 in 1914. Whooping-cough was a notifiable disease in Holborn,
Lambeth, and Greenwich during the year 1915.
Typhus fever, typhoid fever, diarrhœa and enteritis.
A small outbreak of typhus fever occurred in the Borough of Stepney in the early spring. There
were four notified cases, and two other associated cases of illness, which, though not at first diagnosed
as typhus fever, came to be regarded in the light of subsequent events with suspicion.
On 1st February, Mrs. L., aged 46, engaged in sorting clean rags and tailors' cuttings, was taken
ill with " pains about the body" and high temperature. On further examination it was found that she
was suffering from lobar pneumonia of both bases, accompanied by foul smelling expectoration. She
gradually recovered, and was discharged from the infirmary on 5th March.
On 20th February, J. C. (male, aged 39, son of E. C., below) returned to London, and visited his
wife, Mrs. L., in the infirmary. From the 25th to 28th February he slept at No. 69, C—street, the
residence of his mother (E. C.) and sister (F. C.). On 1st March, J. C. was seen by the district medical
officer, who recommended his removal to the infirmary suffering from " catarrh and influenza." On
admission to the infirmary, he was found to be suffering from pneumonia of both bases. On the
following day be became delirious; his condition became progressively worse, and he developed
pneumococcal meningitis. On the fourth day he became comatose, and died on 5th March. His body
was taken home to 69, C—street, and was seen by the mother and sister and other friends.
On 20th March, J. C.'s sister (F. C.) (female, aged 19) was removed to the South-Eastern Fever
Hospital, notified to be suffering from enteric fever. On 22nd March, the medical superintendent of
the hospital notified the case as one of typhus fever.
On the same day E. C. (female, aged 58), the mother of F. C., was removed to the South-Eastern
Hospital, where she also was notified to be suffering from typhus fever. Both patients had ben ill
since 18th or 19th March. E. C. died on the 29th March, and F. C. was discharged from hospital cured
on 1st May.
On 26th March, Mrs. S., aged 56, a friend of E. C., was taken ill with pains in the head and body,
and was seen by a doctor on 28th March. On admission to the infirmary, she had a temperature of
103 deg., pulse 116, and respirations 26. On 8th April, it was reported that she became slightly delirious
and her body was covered with a blotchy morbilliform rash, but the face was quite free. The rash
was stated to be definitely petechial. Dr. D. L. Thomas, the Medical Officer of Health of Stepney was
called in to consult with the Medical Superintendent, and they both agreed that the case was one of
typhus fever. The patient was removed to the Eastern Fever Hospital, and died there on 21st April.
In view of the fact that Mrs. S. was a frequent visitor at 69, C—street, and was known to have called
there when J. C.'s body was brought from the infirmary on 5th March,and most probably also visited E.G.
and F. C. when they fell ill on the 18th or 19th March, there appears to be little room for doubt that
Mrs. S. died of typhus fever ; the opinion was strengthened by the occurrence of a further case of
typhus fever affecting the husband of Mrs. S. (Case VI.)
J. S. (male, aged 58) was taken to the infirmary on 1st May supposed to be suffering from
pueumonia. His body was dirty, and it was only after bathing that a " dusky measley " rash was
found about the shoulders, forearms, and thighs, especially on the inner sides, and slightly about the
trunk. It was not the rash of measles and was similar to that of his late wife. He became worse,
and died on 3rd May. A post mortem examination was made, and the conclusion arrived at that the
case was one of typhus fever.
In spite of the fact that two of the patients (cases I. and II.) were not recognised as cases of
typhus fever, and that doubts were entertained in case V., considering these persons were all related
or definitely associated with one another, and assuming that the diagnosis of typhus fever in cases 111.
and IV. was correct, there are strong grounds for regarding five, if not six, of the cases as typhus
fever. There is little doubt that J. C. was an unrecognised case and infected E. C. and F. C., his
mother and sister, but whether his wife, Mrs. L., was an unrecognised case and he derived his infection
from th:s source, or whether he himself introduced the disease it was impossible to determine.
The number of cases of typhoid fever among civilians notified in the year 1915 (607) is considerably
lower than the corresponding figure for the year 1914 (779). The deaths numbered 120
—civilians, 104. From enquiries made it appears that less than twenty deaths from typhoid fever
occurred among the military population in London in 1915, and from this fact it may reasonably
be inferred that if the whole of the military cases had been notified the total number of cases in London
in 1915 would still be substantially below that of the preceding year.
Diphtheria.
Whoopingcough.
Typhus fever.
Case I.
(Suspicious)
Case II.
(Suspicious).
Case III.
Case IV.
Case V.
Case VI.
Typhoid
fever.