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9
As compared with the previous year the total of returns
is much less, but with that exception it is higher than any
former year. The excess seems to be due to the scarlatina
cases and to the abnormal amount of typhoid. This latter
has been much in evidence the last few years throughout
the country, and the notifications the last four years, 1, 3,
5, 12, are suggestively progressive, the more so that during
the seventeen years from 1877 to 1893 inclusive, the total
deaths were only twelve. The number of typhoid cases
treated in this country, but contracted abroad must be
enormous, and the risk in travelling is no small one.
Owing to the long period of incubation—often three weeks
—and the gradual feeling of malaise, travellers warned by
their increasing indisposition have often time to return
home before being laid up, and in this way, besides numerous
cases from continental towns comparatively near by,
I have had others from as far as "Vienna and Chicago.
Now that we are becoming aware of the extended duration
of infectivity in diphtheria, and have also increasing evidence
of the numerous hitherto unsuspected sources of
infection of typhoid, especially abroad, the incidence of
disease as shown by notifications of these and other zymotic
diseases cannot, without a lot of correcting be taken as
more than a refex of the health, for the time being, of a
more or less small aggregation of residents, and not nessarily
idicative of the healthiness or otherwise of the
locality itself, especially if the population is a migratory
one, or where as in districts like this, it contains a large
proportion who leave their homes yearly or oftener. In this
respect, indeed, the value of notifications is somewhat on
a par with that of a death-rate, and as the latter is more
often than not taken by the generality of the public to
indicate by itself the superior healthiness of one place over
another, it is necessary to be on one's guard and to point
out, that while by itself this is in the main a simple and
accurate measure of the comparative prevalence of diseases
as between places, it is apt to be misleading as regards
healthiness when there is a wide difference in the character