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the largest of these comprises the coalfield counties of Northumberland, Durham,
Lancashire, Yorkshire, Staffordshire, Derbyshire and Nottinghamshire, and overflows
southwards into Leicestershire, Rutlandshire and Northamptonshire ; thus
already, even fifty years ago, there is the suggestion that this area's influence extends
southwards on the way towards London. The second area includes the South Wales
coalfield. The third area (Hants with the Isle of Wight) and the fourth (Devon and
Cornwall) are areas with no coal, but the former, for three succeeding decades, and
the latter, for at least two succeeding decades, maintained a level of typhoid prevalence
considerably higher than their neighbours. Considering, in the first instance,
these third and fourth areas, their typhoid history differs materially from that of the
first and second areas, in the decades 1871.80 to 1901.10, and, indeed, is such as to
make it quite clear, in the light of the official reports, that the endemicity of the
disease in these third and fourth areas, in the decades in question, must be attributed
to shellfish. Turning back again now to the first and second coalfield areas, here, too,
shellfish may be in part accountable, but it is probable that even in South Wales
there was some superadded cause, and question arises as to whether this area suffered
in the same way as the northern area, for it is almost certain that a superadded cause
must have operated in that area and that its activities extended towards London
if not even further southward. It remains to note, in fact (as regards this decade
1871.80), that from the black deep of the northern coalfield and industrial area, with
a typhoid death.rate of over 300 per million, there stretches over England and Wales
a shallower surrounding sea of counties with a typhoid death.rate of from 200.299
per million, leaving only three outstanding islands with a rate of less than 200 per
million—these islands are constituted by the counties of Herefordshire, Sussex and
Dorset. Varying the simile, some point within the northern coalfield area may be
looked upon as a focus of added mischief (over and above that attributed to shellfish)
in this decade. This influence as it radiates southward clearly loses its strength when
it has stretched as far to the west or south as Herefordshire, Dorset and Sussex. The
added cause thus seems to operate from the north and east, southwards and
westwards.
In the decade 1881.90, the deep black areas have become much less dark; three
of them have advanced one step (from over 300 to over 200 per million);
the fourth, comprising Devon and Cornwall, has advanced two steps (to less than
200 per million). The large northern coalfield area now, moreover, stretches out
over Cheshire and Worcestershire, but has lost Westmoreland, Derby and also its
three most southerly counties—Northamptonshire, Leicestershire and Rutland.
The strength of the influences proceeding, from the focus in the north and east,
southwards and westwards is seen still to weaken, as in the preceding decade, on
reaching Herefordshire and Dorsetshire ; Sussex has, however, not kept its relative
pride of place, but the corresponding position to that which Sussex formerly occupied
is now assumed by Bedfordshire. A considerable part of the general improvement
manifested throughout the country in this decade is unquestionably due to increasing
accuracy of diagnosis—meningitis, appendicitis, pneumonia and the like tending,
as time goes on, more and more to be differentiated from typhoid fever. Allowing
for all this, comparison can still be made between one part of the country and
another as regards typhoid incidence.
In the decade 1891.1900 the disturbance emanating from the north and east
might be held to take origin in Yorkshire ; North and South Wales in this
decade both exhibit the same rate (between 100 and 200 per million). The Herefordshire
island stands out with a rate of less than 50 per million; the Dorsetshire island
has protruded northwards and greatly extended north.eastward through Wilts and
Gloucester, Oxfordshire and Berks, and then Buckinghamshire, to join Bedfordshire,
to which the adjoining county of Huntingdonshire is now added.
In the decade 1901.10, there is some improvement in the northern area, which
is not, however, marked in Durham and Lincolnshire ; Westmoreland, however, has