15 



also because this matter looks like again becoming one of 

 public importance. 



Enteric Fever and its Incidence. 



It is instructive to notice the very remarkable way in which 

 the mortality from enteric fever has diminished during the 

 period of modern public health administration. The following 

 figures have been extracted from the Report of the Registrar- 

 General for 1919, and the decrease is most obvious : — 



Death Rate, per Million Persons living in England and Wales, 

 from Enteric Fever during the last 80 years. 

 1,053 1891-1895... 



1838-1842 

 1847-1850 

 1851-1855 

 1856-1860 

 1861-1865 

 1866-1870 

 1871-1875 

 1876-1880 

 1881-1885 

 1886-1890 



174 

 175 

 113 



70 

 47 

 30 

 28 

 26 

 16 



It is to be noted that the statistics from 1838 to 1870 

 include enteric fever, typhus fever and pyrexia, these diseases 

 not being distinguished in the above data for the period in 

 question. There can be little doubt that the contribution 

 made by the two latter causes was considerable during the 

 first half of the nineteenth century. The conditions due to 

 the rapid development of the modern factory system, the 

 overcrowding and insanitary housmg of that period, unemploy- 

 ment and general malnutrition among much of the artisan 

 and labouring classes during the " hungry forties " — these 

 were, no doubt, responsible for the " destitution disease," which 

 we now know typhus to be. About 1870, however, enteric 

 fever became distinguished, and it alone appears in the table 

 for the years subsequent to that date. During the latter half 

 of the nineteenth century typhus fever practically disappeared 



