Scotland—Deaths from the Continued Fevers since the beginning of Registration.

Year
1855 2419}
}
}
}
}
}		Inclusive of typhus, relapsing, enteric and other continued fevers.
1856 2363
1857 3087
1858 2790
1859 2436
1860 2344
1861 2579
1862 3021
1863 3441
1864 4804[402]
Typhus Enteric Relapsing Simple
continued		 Infantile
Remittent		 Cerebro-Spinal
1865 3272 1048 62 839 164 —
1866 2172 1404 34 249 159 —
1867 1745 1378 40 105 119 —
1868 1561 1404 45 100 132 —
1869 2059 1335 29 121 157 —
1870 1460 1207 205 151 141 —
1871 1129 1234 411 108 124 —
1872 795 1223 115 103 118 —
1873 628 1495 31 192 117 —
1874 726 1455 27 104 80 —
1875 615 1625 17 98 85 —
1876 471 1448 18 65 88 —
1877 265 1427 5 164 — —
1878 263 1477 2 147 — —
1879 210 1013 5 133 — —
1880 170 1338 4 155 — —
1881 229 1004 0 115 — —
1882 180 1204 2 90 — —
1883 152 998 1 71 — 7
1884 138 1050 2 63 — 9
1885 111 889 1 58 — 8
1886 80 755 2 62 — 10
1887 126 835 7 65 — 4
1888 102 665 6 58 — 6
1889 69 795 1 45 — 2
1890 77 777 — 30 — 3
1891 107 799 4 23 — 6

Circumstances of Enteric Fever.

The circumstances of typhus and relapsing fevers need no general stating after what has been said of particular epidemics in England and Scotland, or remains to be said, for the most distinctive instances of all, in the chapter on fevers in Ireland. There has been so little typhus in the country at large since the disease began to be registered apart in the mortality returns, in 1869, that hardly anything can be inferred except the fact of its disappearance. It is significant, however, that Sunderland, one of the two great towns which have kept typhus longest and in largest measure (Liverpool being the other) is distinguished for the overcrowding of its dwelling-houses (7·24 persons to a house in the Census of 1881, 7·00 in the Census of 1891).

But the circumstances of enteric fever are not only not so obvious as those of typhus in the historical way; they are also more complex and disputable. One fact in the natural history of enteric fever has been made clear in the chronology, namely, its greater frequency after a severe drought. It was in the autumn of 1826, after the driest and hottest summer of the century, that cases of fever with ulceration of the bowel were first described and figured in London. It was in the autumn of 1846, after the next very dry and hot summer, that cases of the same fever again became unusually common in many parts of England and Scotland. The same sequence has been remarked on more recent occasions and in various countries. It is explained by taking into account some other facts in the natural history of enteric fever. In nearly all countries in our latitudes, autumn is its principal season, and autumn is the season when the level of the water in the soil, or in the wells, is lowest. Virchow states the law of enteric fever in the following simple and concrete way: “We [in Berlin] have a certain number of cases of typhoid at all times. The number increases when the sub-soil water falls, and decreases when it rises. Every year, at the time of the lowest level of the sub-soil water, we have a small epidemic.” A sharp rise above the mean level of the year, from the first week of September to the end of October, has been well shown for London from the admissions to the hospitals of the Metropolitan Asylums Board, 1875-1884. The curve has an equally sharp descent, passing below the mean line of the year in the second week of December[403]. There are indications that it is the partial filling of the pores of the sub-soil with water, after they have long been occupied with air only, that makes the virus of typhoid active, or, in other words, that the rains of late summer and autumn are the occasion of the seasonal increase of the infection.

Yet it is not the changes in the ground-water by themselves, just as it is not rainfall and temperature by themselves, that make enteric fever to prevail. The soil in which those vicissitudes of drought and saturation are potent for evil must be one that is befouled with animal organic matters, more especially with excremental matters. For that and other reasons (such as the geological formation), enteric fever shows, in its more steady or endemic prevalence from year to year or from decade to decade, certain marked preferences of locality. Since 1869, when the deaths from it began to be registered apart, it has been much more common, per head of the population, in the quick-growing manufacturing and mining towns than in any other parts of England and Wales, the districts with highest enteric death-rates being the mining region of the East Coast from the mouth of the Tees to somewhat north of the Tyne, the mining region of Glamorgan, certain manufacturing towns of Lancashire and the West Riding of Yorkshire, and some districts in the valley of the Trent in Staffordshire and Nottinghamshire. The following Table shows, by comparison with all England and Wales and with London, the excessive death-rates from enteric fever in the registration divisions which head the list:

Highest mortalities from Enteric Fever in Registration Divisions of England and Wales[404].

Decennium 1871-80Decennium
1881-90
Annual
death-rate,
all causes,
per 1000
living		Annual
death-rate,
Enteric,
per 1000
living		Enteric
Deaths
in 10
years		Deaths,
Enteric
in 10
years
England and Wales21·270·327842153509
London22·370·2485367497
Durham co.23·770·5645252590
South Wales21·090·4537152550
W. Riding, Yorks.23·240·4591665170
N. Riding, Yorks.19·680·441259896
Nottinghamshire21·230·4317071263
Lancashire25·170·39123889874