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was removed to the South-Eastern Fever Hospital on a certificate that he was suffering from enteric
fever, but whose disease was there recognised to be typhus. In 1898 only two cases were known to
have occurred in these districts, both of them in St. George-the-Martyr. The first of these was a
woman who had assisted in the nursing of a family suffering from typhus in Kensington, the other a
brushmaker, the first of a series of cases of which account has already been given. In 1899 occurred
the series of cases mentioned above.
The frequent recurrence of cases of typhus in this part of London is therefore noteworthy,
and the history of the cases which have come to light shows how readily the disease is overlooked.
London has for many years been comparatively free from this disease, but this fact does not
negative the possibility that under favourable conditions it might again become prevalent. It is
therefore very important that medical men, having under their observation cases of ill-defined fever
in these districts, should have in their minds the possibility that their patients are suffering from
typhus.
There is much probability that the disease has been maintained, in the group of districts
especially referred to, by the occurrence of unrecognised cases. In typhus, as in other diseases, the
severity of attack may differ very greatly, and may in children not be indicated by more than mere
poorliness, the nature of their malady only being recognised by its concurrence with well-recognised
cases of typhus. The notable reduction in the prevalence of typhus during recent years is in all
probability largely due to natural causes which have not only reduced the actual numbar of cases
occurring, but have also reduced the virulence of the disease. There is therefore no improbability in
the hypothesis that the disease has been maintained in these districts by persons suffering from so
mild a form of typhus that it is impossible to recognise the malady, the cases coming to light being a
few of the total number who are suffering from more severe attacks. If natural causes may reduce
severity of disease, they may also increase it, and in that event there is no certainty that there will
not eventually be much greater prevalence of typhus than has been experienced in late years. The
amount of such prevalence will then largely depend upon the extent to which the population is well
housed and well fed.
Enteric Fever.
The number of cases of enteric fever notified in the Administrative County of London
during 1899 (52 weeks) was 4,467, compared with 3,031 in 1898; the number of deaths from this
disease belonging to the administrative county was 759, compared with 554 in 1898.
The rates per 1,000 living in 1899 and preceding periods are as follows—

The death rate in each year since 1868 in relation, to the mean death rate of the period
1869-99 is shown in diagram XIV.
In the distribution of enteric fever mortality throughout the year the central and eastern
groups of districts were above, and the western, northern and southern groups below the average
of London. Of the several districts the City had the highest death rate (0.43) and St. Saviour
the lowest (0'04). During the first quarter of the year the central group of districts had the
highest and the southern group the lowest rate of mortality; during the second quarter the
central group again had the highest death rate and the northern group the lowest; during the
third quarter the eastern group of districts had the highest death rate and the central group the
lowest; and during the fourth quarter the eastern group again had the highest death rate and
the western group the lowest ; in this quarter the death rate in each of the groups of districts
was considerably in excess of the average for the year.
* The Infections Diseaf s (Notification) Act only came into force in 1889.
1 See footnote ('), page 3.