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17
years. In 1849 there were 14,137 deaths (cholera and diarrhoea together accounted
for 26 per cent. of deaths from all causes in that year). In 1854 there were 10,738
cholera deaths. There is no evidence that the cases of cholera which occurred after
the termination of the 1866 epidemic were attributable to the public water supply.
The last case was notified in 1911 and the cases which occurred between 1866 and that
date were probably due to minor outbreaks from ship-borne cases conveyed by means
other than the public water supply.
Enteric fever was conquered less rapidly but the reduction in incidence has been
no less dramatic. In 1869 the Registrar-General distinguished enteric fever as a
cause of death, although the distinction was, of course, on clinical grounds, since the
specific organism was not discovered bacteriologically until 1880.
The death rate for enteric fever in London in 1870 was 0.62 per 1,000. By 1889
when the London County Council was instituted, the rate had fallen to 0.12 per 1,000.
Later figures are:—
1891-95 0.13 1926-30 0.008
1896-1900 0.14 1931-35 0.005
1901-05 0.084 1936.40 0.004
1906-10 0.045 1941-45 0.003
1911-15 0.028 1946 0.002
1916-20 0.016 1947 3 deaths
1921-25 0.011 1948 1 death
A rising standard of personal cleanliness has also played an important part in
this saving of lives. But for continual vigilance enteric fever might easily return as
an important cause of death, and as has been illustrated by minor outbreaks in
recent years, the public cannot afford to relax their efforts to maintain high standards
of personal hygiene, and of care in the production and handling of food.
I am indebted to the Water Examiner, Colonel E. F. W. Mackenzie, for much
of the above information.
There were 719 cases of erysipelas in 1948, giving an attack-rate of 0.215 per
1,000 compared with 0.224 in 1947. The incidence of this disease has been declining
continuously since 1941. There were 3 deaths in 1948 (0.0009 per 1,000 living).
Erysipelas
There were 78 deaths (0.023 per thousand) from influenza during the year ; 1948
was an exceptionally light year for respiratory mortality generally. During recent
years the deaths have been:—
Year Influenza deaths
1940 569
1941 397
1942 198
1943 726
1944 206
1945 171
1946 371
1947 284
194.8 78
Influenza
There has so far been no major outbreak of influenza since 1937.
Measles became notifiable in London in 1938. For control purposes the results
were immediate, but, before any records of epidemiological value could be accumulated,
the normal biennial rhythm of attack was disturbed by the evacuation movements of
1939 and subsequent war years. It will be seen from Table 11 that periodical
epidemic outbreaks have occurred, but there is not yet any evidence that conditions
have been stable sufficiently long to restore the biennial wave.
Cases have been less frequent in recent years than before the war. This is partly
a consequence of the reduction in the child population but there is evidence also of
a significant fall in the overall incidence of the disease. A special study* has reached
the conclusion that whereas before the war about 80 per cent, of children had a
* Breen, G. E. and Benjamin, B.—• (Lancet, 1949 ii. 620).
Measles