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London County Council
Public Health Department,
Spring Gardens, S.W.
8th March, 1894.
Preliminary Memorandum by the Medical Officer on the increase of Diphtheria in
London.
(Ordered by the Public Health and Housing Committee to be printed.)
Before making any recommendation to the Committee as to the course to be adopted for the
purpose of enquiring into the circumstances of the present prevalence of diphtheria in London.
I think it well to submit for the Committee's consideration a memorandum on some points in the
behaviour of the disease which are indicated by a study of the statistics now available.
There is no mention of diphtheria in the statistics of the Registrar General until the year 1855.
Before that year deaths registered as due to diphtheria were included with the deaths registered as
due to scarlatina. In the London tables the deaths from these two diseases were not separated until
1859, although later tables supply the figures for the period 1855-60. The separate classification of the
two diseases in 1859 was probably due to the notable prevalence of diphtheria in that year.
Diagrams I. and II. show for England and Wales and for London respectively, for each year since
1859, the excess and defect of diphtheria mortality above and below the mean diphtheria death rate of the
whole period. Diphtheria and croup are especially likely to be confused with each other, and therefore
while the continuous line gives the mortality registered as due to diphtheria the dotted line indicates
the mortality from croup and diphtheria combined.
Diagram I. shows that since the excessive mortality of diphtheria which characterised the period
1859-65, the deaths from this disease in England and Wales have been almost altogether below the
average. There has been, however, some increase during the later years. When croup and diphtheria
are combined the result is much the same, except that the mortality during the later years has been
below the mean instead of above it.
Diagram II. shows that since the prevalence of diphtheria in 1861-63 the mortality from
diphtheria in London has been below the mean until 1883; since that year, however, it has remained
above the average, especially in 1892 and in 1893.* When croup and diphtheria are combined much
the same result is obtained, except that the excessive prevalence in 1893 as compared with the excess
in 1861-3 is less marked. The dotted line (croup and diphtheria) affords, I believe, a much better
basis than the continuous line for comparing recent with early diphtheria.
I have prepared Table I. in order to show the relative prevalence of the disease in the large
towns of England and Wales during a series of years.

*I desire to acknowledge the courtesy of the Registrar General in supplying me, before their publication,
with the London statistics relating to diphtheria for the year 1892, and in affording me the opportunity for
obtaining the facts as to 1893.
f Those Towns for which no death rate is given for the period 1872.81 were not included in the list of great
towns for which statistics are given in the annual summaries of the Registrar General until after the census
of 1881.
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