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A certificate was received on November 7th relating to a child aged 7,
living in St. George-the-Martyr, Southwark, but the medical man attending the case
subsequently cancelled his notification, and returned the case as one of typhoid.
The annual report of the medical officer of health of Islington contains reference
to a case of typhus occurring in November. The patient was a paperhanger living in
the Langdon-road, Islington, who in the first instance was certified to be suffering
from enteric fever. He was removed to the Great Northern Hospital, where he died, the
death being attributed to typhus. The source of infection was unknown.
December.—A case in Shoreditch, notified on December 2nd as typhus, subsequently proved
to be one of typhoid fever.
It will be seen that after excluding all the cases in which the later development
of the malady led to the diagnosis of typhus fever being rejected, there remain ten
cases. Three of these cases were admitted to hospitals of the Metropolitan Asylums
Board, and the diagnosis of typhus fever was there confirmed, one was removed to the
Great Northern Hospital. The remaining six cases were not removed to hospital.
Diagram XV. shows the death rate in each year since 1868, in relation to the mean of the whole
period 1869-93.
Enteric Fever.
The cases of enteric fever notified in the County of London during the year 1893 numbered
3,681, and the deaths belonging to London 677, or increases of some 50 per cent. upon the numbers
of the preceding year.
Diagram XVI. shows the death rate of each year in relation to the mean death rate of the period
1869-93.

London has therefore not only suffered more heavily from enteric fever, but it is noteworthy
that in each of the years 1892 and 1893 the cases have been attended by a higher fatality than in the
preceding year.
The following table shows the case mortality, case rate, and death rate from this disease at various
ages during 1893. It will be seen that the incidence of attack and of death was greater on males than
on females, but the fatality (case mortality) of females was greater than that of males.

* The Infectious DiseaEes Notification Act only came into force in 1889.
† See footnote (†) page 6. § See footnote (*), page 26.