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from the disease before it was recognised to be diphtheria. In 78 other cases, although
the patients themselves were not attending school, children, members of the same
families as the patients or dwelling in the same houses, were attending school at the
time the patients were taken ill. In 12 instances there were histories of throat
illness in the bouses invaded and in 17 cases there was clear evidence as to infection
from previous cases. In 103 of the cases the houses in which the patients resided
were found to be in a satisfactory sanitary condition, and in the remaining 80 insanitary
conditions of major or minor importance were met with. In 35 of the latter
the conditions of the houses was distinctly unsatisfactory, the houses being in many
instances dirty, and defects were found in connection with the drains.
The cases of diphtheria certified in London during 1902 numbered 10,542, and
the attack-rate was 2.8 per 1,000 population; the deaths numbered 1,159 and the deathrate
was 0.25 per 1,000 inhabitants.
ENTERIC OR TYPHOID FEVER.
The cases certified as enteric or typhoid fever numbered 149, which is
considerably above the average for the previous 12 years. Thirteen of the cases were
found after being under observation at the fever hospitals not to be suffering as certified.

The cases were most numerous in the Shoreditch South Registration Sub-District,
being at the rate of 2.5 per 1,000 inhabitants, as compared with 0 9 in Hoxton New
Town, 1.0 in Hoxton Old Town, and l.l in Haggerston. Eight only of the cases were
of persons under five years of age, and three of these were not regarded as enteric
fever by the hospital authorities. In addition to the cases certified as enteric fever,
there were three cases of continued fever notified. Twenty-three of the cases of
enteric fever, and one of continued fever, terminated fatally. The death-rate due to
the disease was 0.20 per 1,000 as compared with 0.08 in 1901, 0.11 in 1900, 0.2 in
1899, 0.14 in 1898, 0.15 in 1897, 0.14 in 1896, and 0.17 in 1895. Deducting the
thirteen cases not regarded as enteric fever at the fever hospitals, the attacks proved
fatal in 17.2 per cent. of the cases, as compared with 11.3 in 1901, 12.7 in 1900,
16.1 in 1899, 18.6 in 1898, 17.7 in 1897, 15.7 in 1896, 21.2 in 1895, 14.1 in 1894, and
15.8 in 1893.