With the general recognition of the causal relation between impure water supplies and typhoid fever came the rapid provision of public supplies, on which, as already seen, large public expenditure was incurred; and to this fact is owing, in the main, the rapid reduction in typhoid mortality shown in the following statement:

Population of EnglandNo. of Deaths
and Walesfrom Typhoid
Yearin MillionsFever
187122⅘12,709
1881266,688
1891295,200
190132⅗5,172
191136⅕2,430
191733⅗ (civilian)977

The number of cases notified in England and Wales

in 1911 was 13,852
in 1917 was 4,601

There was, it will be noted, a period of apparent cessation of decline in the typhoid mortality between 1891 and 1901, followed by a striking decline between 1901 and the present time. The late decline was due in large measure to the discovery of the relation between contaminated shell-fish and enteric fever, and, probably to a less extent, to the realisation of the importance of the small minority of cases of this disease, who continue after their recovery to spread infection. At the present time typhoid fever promises to become as rare in England as typhus fever or malaria; and with increased care in the protection of food, as well as of water supplies, and with the universal hospital treatment of the sick and observation of their bacterial condition on discharge, this anticipation bids fair to be realised.

Typhus Fever

The history of typhus is similar to that of typhoid fever; and when Murchison in 1858 asserted its spontaneous generation under conditions of overcrowding and bad ventilation—

Its great predisposing cause is destitution; while the exciting cause or specific poison is generated by overcrowding of human beings with deficient ventilation—

he was expressing the considered conclusion of his period.

Typhus Fever was not differentiated from enteric fever in the Registrar-General’s returns prior to 1869, but the course of events in later periods can be seen in the following statement: