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The cases certified as diphtheria in London numbered 6,783, as compared
with 7,840 in 1908 and 8,585 in 1907, the attack rates being 1.4, 1.6, and
1.8 per 1,000 population respectively. The deaths in London numbered 605,
as compared with 724 in 1908 and 781 in 1907, the death rate being 0.12, 0.15,
and 0.16 per 1,000 population respectively. The figures show that in Shoreditch
during 1909 diphtheria was slightly more prevalent, and that the mortality was
a little higher than in the Metropolis as a whole.
ENTERIC OR TYPHOID FEVER.
The cases certified during 1909 numbered 49, of which 5 were subsequently
not regarded as enteric fever by the Metropolitan Asylums Board Authorities,
and there was also one other, a fatal case, which was in all probability not one of
enteric fever.

A marked reduction in the number of cases certified as compared with the
number for 1908 is noticeable. The majority of the cases occurred during the
first four months of the year. They were certified at the rate of 0.4 per 1,000
population as compared with 0.8 in 1908, 0.3 in 1907, 0.3 in 1906, 0.3 in 1905,
0.4 in 1905, and 0.8 in 1903. The deaths during the year numbered 6, the deathrate
being 0.05 per 1,000 inhabitants as compared with 0.09 in 1908, 0.05 in
1907, 0.03 in 1906, 0.01 in 1905, 0.07 in 1904, 0.11 in 1903, 0.20 in 1902,
0.08 in 1901, and 0.11 in 1900. The enteric fever death rate for 1909 was therefore
below the average for the previous nine years.
The case-mortality was at the rate of 12.2 per cent. of the cases certified, or,
deducting the cases not regarded as having been enteric fever, the mortality
was 11.6 per cent. The case-mortality for 1908, 1907, and 1906 were 10.9, 17.6,
and 10 per cent. respectively.