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Information with regard to the suspected source of infection was supplied on the returns kindly
furnished by borough medical officers, in 380 instances. This information threw suspicion upon food
(fish, shell-fish, etc.) in 143 instances; 55 cases were soldiers or sailors, 5 were Belgian refugees ; in 43
cases the disease was said to have been contracted outside London, 57 were ascribed to contact infection
(this number included 6 nurses), 4 were ascribed to river bathing, 8 to drains and bad smells, 1 to water,
27 to milk, 5 are said to have had typhoid before, and 74 were found not to be cases of typhoid
fever. In all these instances the grounds upon which the suspicion as to origin were based must be
regarded as only having some degree of probability, far removed in many instances from certainty.
For example, the food and milk cases were not definitely determined to be due to the ascribed causes.
Again, the cases in nurses do not number, having regard to the size of the nurse population in London,
more than might be expected to occur as a mere matter of chance, and it must not, therefore, be assumed
that the nurses were infected by reason of any special risk due to their occupation.
Since the beginning of the present century, the prevalence of typhoid fever in London has been
low, and especially so during the last ten or eleven years. The marked autumnal prevalence manifested
year by year steadily diminished in extent during the first half of the series of 15 years in question,
and since 1908 the autumnal rise is only clearly apparent in two years. The first year of the series of
15, in which there is a marked failure of development of the usual autumnal prevalence was 1907, the
autumnal excess being then smaller than in any previous year back to the introduction of notification.
In 1908, the autumnal rise was again well developed, but in 1909 it was even more noticeably
undeveloped than in 1907 ; it again appears in 1910 and 1911, and then almost entirely disappears in
1912,1913, 1914 and 1915.
An examination of the incidence of typhoid fever in other towns of England and Wales during
the six years of low prevalence 1909-15 reveals correspondences in some of the years, in the movement
of typhoid prevalence in the autumn months, with the movement observed in London; but these
correspondences are in no instance very close, and even when a town agrees with London for three or
four years, it may differ from it in the other years. These differences point to the operation of local
causes, superimposed upon the general causes of the prevalence at large. The extension of the comparison
to still smaller areas is open to objection, because, in addition to the fact that quite a small
and merely local outbreak may suffice to disturb the figures for a whole district, there is also greater
liability to error owing to the smallness of the figures in question. With these reservations in mind,
however, it is deserving of note that in cases where a noticeable departure from the England and Wales
standard is observable in a particular town, the feature is frequently reflected in the figures relating
to adjacent towns. Neither Southampton nor Portsmouth reproduce the England and Wales type
during the years 1911-15, yet they show similarity to one another, and the same remark applies to
Salford, Manchester and Liverpool; on the other hand, the approximation to the general England
and Wales and London type is observable in a number of towns, including certain east coast towns, for
example, Grimsby, Hull, and also some of the midland towns.
The decreased incidence of typhoid fever since the commencement of the present century is, by
no means confined to England and Wales. It appears to be common generally speaking to most
European countries. If the deaths in these countries during 1906-10 be compared with those in 1901—5,
it will be found that there is a decrease of from 20 to 40 per cent., except in the case of Hungary (decrease
2 per cent.) and in Rumania, where there is an increase of GO to 70 per cent., but where changes in the
extent of registration of causes of deaths may, at any rate, in part account for the figures.
The Public Health (Shellfish) Regulations, 1915, prohibit the sale of shellfish likely to cause danger
to health and provide for the closing of shellfish layings where the evidence justifies such action.
The deaths among civilians at all ages from diarrhoea and enteritis in the administrative county
of London during 1915 numbered 3,098, as compared with 3,624 in 1914. Of the total deaths, 2,126
occurred during the first year of life, and 430 during the second year.
Zymotic enteritis was notifiable in Woolwich in 1915, and for part of the year in Poplar and
Greenwich.
Puerperal fever.
The deaths in the administrative county of London during 1915 attributed to puerperal fever
numbered 132, as compared with 195 in 1914. There were 276 cases of puerperal fever notified in 1915
(52 weeks) as compared with 393 in 1914.
During the year 1915 two midwives had four cases each, of which two, both in the practice of
one midwife proved fatal: two midwives had three cases each, in one instance all three were fatal and
in the other instance the three patients recovered: one midwife had two cases, both of which were
fatal, one had two cases, of which one had a fatal termination, and five midwives had two cases each,
all of which recovered. In no instance was blame attributed to the midwife concerned.
Phthisis.
Among the civilian population the deaths numbered 6,875, and this gives a death-rate of l.60
per 1,000 living. There is little doubt that this death-rate is not strictly comparable with that of 1.43
for 1914, when the population was of normal age- distribution. Recruitment for the war reduced
the proportion of healthy males aged 19-40, leaving in the civil population all who were rejected for
phthisis; and the effect is that a rate calculated on the civil population is overstated, when judged
in comparison with 1914.
Diarrhœa and
Enteritis