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22
ciable scale to the civilian population of London.* Milk cannot be appealed to as a
cause of the dechne, for milk outbreaks, though sedulously searched for in London,
have been very rarely recorded there. Ice-cream, watercress, etc., stand in like
case. The problem in London has in fact been practically narrowed down to
examination of the parts played by fish and shell-fish, and to this problem some
further attention may therefore be directed.
(2) The most striking fact evident on examination of the accompanying
diagram, apart from the general dechne in the last 20 years and the disappearance
of the autumnal rise, is the almost complete removal of the disease from its formerly
favoured haunts. All these phenomena are, generally speaking, apparent on a glance
at the diagram ; which also shows the comparative freedom from attack even in the
earlier series of years of such boroughs as Lewisham and Woolwich and the heavy
incidence upon St. Pancras, Islington, Stepney, Poplar and other boroughs. In
order to assist, however, in exhibiting these time and space relationships, a table
has been prepared, which sets out the larger local prevalences of typhoid fever
during the years in question, and also gives particulars as to some of the smaller
prevalences. The following summary may be made of the data shown in the diagram
and table, or discussed in special reports on typhoid fever which have from time
to time been made to the Council.
(a) The main burden fell in the past, up to the year 1909 and still just appreciably
in 1910 and 1911 upon the 37th-48th weeks of the year and upon people living in
certain poor areas. The time incidence can be traced in the diagram on pages 20-21.
for proof of the incidence on the poor areas, appeal must be made to an analysis
in 1903 of cases notified during the years 1896-1903 and associated with 24 specially
delimited areas occupied by poor persons.")" In the 24 areas there lived some 130,000
persons. To these 24 areas, in the light of experience of subsequent years (up to,
say, 1911), 11 other areas with some 60,000 persons may be added, making a total
of 35 areas with 190,000 persons especially exposed to attack.
The cases of typhoid fever notified in the year 1900, during the 9th, 10th and
11th four-weekly periods (37th-48th weeks) of the accompanying diagram, constitute
about 37 per cent. of the total number of cases notified in London as a whole during
those 9th, 10th and 11th periods. Now the 190,000 persons belonging to the 35 poor
areas almost all live in streets of houses belonging to sections C and D of Charles
Booth's scheme of classification. As was noticed in 1911 (see Annual Report,
Medical Officer of Health, 1911) experience has shown that in London the food
outbreaks of the last 25 or 30 years have not implicated, as a rule, the well-to-do
populations (classes E, F, G and H), or the persons of the very lowest classes A and B,
but have attacked those living in Charles Booth's light blue and purple streets, in
fact persons of the class inhabiting the above specified 35 areas. These speciallyaffected
classes C and D include in all upwards of 900,000 persons, or about onefifth
of the total London population.
* It is true that during the war large numbers of soldiers were inoculated, but the rest of the
population (uninoculated) has enjoyed a like, indeed during the war years an even greater, immunity
from attack by the disease.
†The 24 areas described in the Report for 1903 (Appendix I, p. 7), include areas in the following
localities. In each instance the approximate population of the affected area is indicated:—
i. Southwark 25,000
ii. Lambeth 5,000
iii. Kensal Town, Chelsea 5,000
iv. Newington, Southwark 4,000
v. Holborn 6,000
vi. Newington, Southwark 3,000
vii. St. Pancras 10,000
viii. Starch Green, Hammersmith 4,000
ix. Battersea 8,000
x. Clapham, Wandsworth 5,000
xi. Lisson Grove, Marylebone 4,000
xii. Somers Town, St. Pancras 6,000
xiii. Garratt-lane, Wandsworth 3,000
xiv. Hackney Wick, Hackney 4,000
xv. Poplar 4,000
xvi. Miilwall, Poplar 3,000
xvii. Cubitt Town, Popla 8,000
xviii. Rotherhithe, Bermondsey 4,000
xix. Bermondsey 4,000
xx. Wentworth-street, Stepney 5,000
xxi. Stepney 4,000
xxii. Bethnal Green (i.) 5,000
xxiii. Bethnal Green (ii.) 4,000
xxiv. Bethnal Green (iii.) 4,000
132,000
(See continuation of footnote on page 23.)