Continued-fever Deaths in England and Wales, 1869-91.
| Year | Typhus | Simple or Ill-defined | Enteric | |||
| 1869 | 4281 | 5310 | 8659 | |||
| 1870 | 3297 | 5254 | 8731 | |||
| 1871 | 2754 | 4248 | 8461 | |||
| 1872 | 1864 | 3352 | 8741 | |||
| 1873 | 1638 | 3081 | 8793 | |||
| 1874 | 1762 | 3089 | 8861 | |||
| 1875 | 1499 | 2599 | 8913 | |||
| 1876 | 1192 | 1974 | 7550 | |||
| 1877 | 1104 | 1923 | 6879 | |||
| 1878 | 906 | 1776 | 7652 | |||
| 1879 | 533 | 1472 | 5860 | |||
| 1880 | 530 | 1490 | 6710 | |||
| 1881 | 552 | 1159 | 5529 | |||
| 1882 | 940 | 1016 | 6036 | |||
| 1883 | 877 | 963 | 6068 | |||
| 1884 | 328 | 768 | 6380 | |||
| 1885 | 318 | 662 | 4765 | |||
| 1886 | 245 | 505 | 5061 | |||
| 1887 | 211 | 502 | 5165 | |||
| 1888 | 168 | 436 | 4848 | |||
| 1889 | 140 | 413 | 4971 | |||
| 1890 | 160 | 361 | 6146 | |||
| 1891 | 148 | 325 | 5075 |
Continued-fever Deaths in London, 1869-91.
| Year | Typhus | Simple or Ill-defined | Enteric | |||
| 1869 | 716 | 615 | 1069 | |||
| 1870 | 472 | 570 | 976 | |||
| 1871 | 384 | 436 | 871 | |||
| 1872 | 174 | 322 | 867 | |||
| 1873 | 277 | 325 | 968 | |||
| 1874 | 312 | 337 | 879 | |||
| 1875 | 128 | 272 | 817 | |||
| 1876 | 159 | 202 | 769 | |||
| 1877 | 157 | 194 | 901 | |||
| 1878 | 151 | 197 | 1033 | |||
| 1879 | 71 | 160 | 849 | |||
| 1880 | 74 | 134 | 702 | |||
| 1881 | 92 | 134 | 971 | |||
| 1882 | 53 | 95 | 975 | |||
| 1883 | 55 | 102 | 963 | |||
| 1884 | 32 | 75 | 925 | |||
| 1885 | 28 | 78 | 597 | |||
| 1886 | 13 | 73 | 618 | |||
| 1887 | 19 | 44 | 612 | |||
| 1888 | 9 | 35 | 694 | |||
| 1889 | 16 | 42 | 538 | |||
| 1890 | 10 | 35 | 604 | |||
| 1891 | 11 | 44 | 557 |
Such being the proportions of typhus and enteric fever since 1869, when the separation was made, it remains to ask what share each of them may have had in the total of “typhus,” or of continued fever generally, in the years before the two forms were distinguished in the annual registration reports. Of course, they were distinguished by many of the profession long before that; so that there are means of forming a judgment. At the London Fever Hospital, enteric fever and typhus were distinguished after 1849. If the admissions of each kind of fever to that hospital be assumed to have been proportionate to the prevalence of each in London from year to year, we should get in the following table a means of estimating which of the two forms of continued fever furnished most of the deaths in all London, as given in the first column:
| Deaths in London from both fevers | Admissions to London Fever Hospital | |||||
| Year | Typhus | Typhoid | ||||
| 1838 | 4078 | — | — | |||
| 1839 | 1819 | — | — | |||
| 1840 | 1262 | — | — | |||
| 1841 | 1151 | — | — | |||
| 1842 | 1184 | — | — | |||
| 1843 | 2094 | — | — | |||
| 1844 | 1721 | — | — | |||
| 1845 | 1324 | — | — | |||
| 1846 | 1838 | — | — | |||
| 1847 | 3297 | — | — | |||
| 1848 | 3685 | — | — | |||
| 1849 | 2564 | 155 | 138 | |||
| 1850 | 2032 | 130 | 137 | |||
| 1851 | 2374 | 68 | 234 | |||
| 1852 | 2183 | 204 | 140 | |||
| 1853 | 2617 | 408 | 212 | |||
| 1854 | 2816 | 337 | 228 | |||
| 1855 | 2410 | 342 | 217 | |||
| 1856 | 2717 | 1062 | 149 | |||
| 1857 | 2195 | 274 | 214 | |||
| 1858 | 1919 | 15 | 180 | |||
| 1859 | 1840 | 48 | 176 | |||
| 1860 | 1476 | 25 | 95 | |||
| 1861 | 1848 | 86 | 161 | |||
| 1862 | 3673 | 1827 | 220 | |||
| 1863 | 2871 | 1309 | 174 | |||
| 1864 | 3782 | 2493 | 253 | |||
| 1865 | 3217 | 1950 | 523 | |||
| 1866 | 2688 | 1760 | 582 | |||
| 1867 | 2184 | 1396 | 380 | |||
| 1868 | 2468 | 1964 | 459 | |||
From this it will appear that every great annual rise in the London deaths from “fever,” since the last great typhus epidemic of 1847-48, has corresponded to a greatly increased admission, not of enteric cases, but of typhus cases into the London Fever Hospital. On the other hand, enteric fever has been at a somewhat steady or endemic level for a good many years. Even at that level it would have had a small share of the whole fever-mortality in the old London; in modern London, especially in its residential quarters, its rate has probably been higher than in former times; while in recent years, owing to the absolute decline of typhus, it has been by far the most common continued fever. If the conditions were the same in London as in Edinburgh, it was the very creation of residential streets and new quarters of the town that called forth typhoid fever; while the more the town was remodelled, the more were the fomites of typhus destroyed. Thus it seems probable that the same progress in well-being among all classes, which has gradually brought typhus down almost to extinction (or apparently so for the present), has been attended with an increase of typhoid, an increase which has happily fallen within the last few years from its highest point.
The disappearance, during the last twenty years, of typhus and relapsing fevers from the observation of all but a few medical practitioners in England, Scotland and Ireland, is one of the most certain and most striking facts in our epidemiology. Most of the recent English cases have occurred in Lancashire, especially in Liverpool, and in Sunderland, Gateshead, Newcastle and other shipping places of the north. In the decennial period 1871-80 the death-rate from typhus, per 1000 living, was 0·58 in Liverpool and 0·33 in Sunderland, rates which were about the same as those from enteric fevers. The rates in 1881-83 were also high in the same group of towns. As to other industrial centres, including the coal-districts of Cumberland, Wales and Scotland, it is probable that a good deal of typhus passes under the name of “typhoid,” the change in medical fashion having outrun somewhat the real change in the relative prevalence of each fever[401]. In Scotland the disease is still heard of from time to time in Glasgow, Edinburgh, Leith, Dundee, Aberdeen, Inverness and Thurso. In London the recent immunity from it is remarkable, but intelligible. First, the populace is better housed: we have got rid of the window-tax, rebuilt the houses in regular streets opening upon wide thoroughfares, pulled down most of the back-to-back houses, dispersed the working population over square miles of suburbs easily accessible from the heart of the town by tramways and railways, perfected the sewerage and the water-supply. These great structural changes are so far an earnest that typhus cannot come back in the old way. Secondly, food has been for a long time cheap and wages good. During the remarkable lull in typhus from 1803 to 1816, Bateman pointed out that the unwholesome state of the dwellings of the working class remained the same as before, but that money was flowing freely among all classes (thanks to the special war-expenditure). Under free trade, the same abundance of the necessaries of life has been secured in another way. Typhus, it need hardly be said, is an indigenous or autochthonous infection; the conditions of its engendering are never very far off. In a small and remote island off the coast of Skye, which I happened to know in its pleasing aspects from having landed upon it during a summer vacation, typhus fever was reported by the newspapers a few months after to have broken out in the hamlet of twenty or thirty families, the winter storms having prevented the fishers from leaving their cottages or any stranger from approaching the island. In a sparsely populated parish of the east coast of Scotland, two cases of genuine typhus (one of them fatal), and two only, have occurred, to medical knowledge, within the last ten years, each in a very poor cottage in a different part of the parish and in a different season. So long as our cheap supplies of food, fuel and clothing are uninterrupted, there is small chance of typhus or relapsing fever. But the population of England being now twice as great as the home-grown corn can feed, a return of those fevers on the great scale is not out of the question in the event of the foreign food-supply being interfered with, or the necessaries of life becoming permanently dearer from any other cause.
The following Table of the fever-deaths in Scotland since the beginning of Registration does not distinguish enteric from typhus, relapsing and simple continued during the first ten years of the period; but it is probable, from all that is known non-statistically or by hospital figures only, as to the history of enteric fever in Scotland, that it made the smaller part of the generic total of fever-deaths so long as typhus and relapsing fevers were common.