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The cases of typhus which have actually occurred show that much watchfulness will be required
to prevent this disease becoming prevalent in London, and certainly an ability to recognise this maladyis
imperatively needed. The statements made above suffice to show that typhus may readily occur
without recognition, corroborating the report which I presented to the Council in the preceding year,
1891. In that report I had to tell of typhus in Holborn, the nature of the disease not being recognised
until several persons had been attacked and death in some instances had resulted, infection being
communicated to a second family in the house invaded, and to a house in the Strand where a member
of the first family infected worked and where two cases occurred, one ending in death. Five cases had
also occurred in one family in Poplar, the nature of the disease not being recognised until one of the
later of these cases had been admitted into one of the hospitals of the Metropolitan Asylums Board.
Altogether as many as 24 cases of typhus in London became known, in which the disease was
not at first recognised, during that year.
Enteric Fever.
The cases of enteric fever notified in London during the year 189'2 numbered 2,469, and 424
deaths were attributed to this cause, giving a death rate of *1 per 1.000 of population.

The only special outbreak to which reference is made in the reports of the medical officers of
health is contained in the report for Greenwich. Mr. Hartt thus writes: "Twenty-seven of the
cases occurred in a school (where no expense had been spared to render the house everything
that could be desired from a sanitary point of view) amongst boys of the age of 13 years, and
all were taken ill about the same time in September, 1892. Thirty-three per cent. of the boys
escaped the infection. After a long and patient investigation, which necessitated a thorough
examination of the whole of the drainage system and water supply (in which I was greatly assisted by
your sanitary inspector, Mr. Wilson), it was thought that the source was due to some material which
had been taken into the stomach and caused irritation of the alimentary canal. I am happy to state
that all the cases recovered."
The incidence of mortality from this disease on the London sanitary districts in 1885-92 is
shown on the accompanying chart (X.), and the mortality during this period, as well as the number of
cases notified in 1892. are shown on the followins table —