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The more important outbreaks of scarlatina in the year occurred in St. Pancras and
Hampstead.
The report of the medical officer of health of St. Pancras contains an account of an outbreak
of scarlatina in that district and the adjoining district of Hornsey, beginning in the latter part of the
month of October among the customers of a milk vendor in Highgate. This milk vendor received
his milk from three sources: from his own cows, from Finsbury-park, and from a farm at Hendon. Of
the customers supplied solely from his own cows none were attacked, the incidence of the disease
being upon the consumers of milk from the other sources. The milk from Finsbury-park and Hendon
was distributed in three rounds. The customers on two of these rounds received Hendon milk in the
morning and Finsbury-park milk in the afternoon, the customers on the third round received Hendon
milk both morning and afternoon. The customers on the first two rounds numbered 191, of whom 8,
or 4.2 per cent., were attacked; the customers on the third round numbered 100, of whom 20, or 20 per
cent., were attacked.
Dr. Sykes ascertained at an early stage that some of the Hendon farm milk had been distributed
locally in Hendon by two milk vendors, among whose customers three cases of scarlet fever had occurred,
and further, one of the milkmen on the Hendon farm was found on October 21st to be suffering from
scarlatina. On proceeding to the farm at Hendon, Dr. Sykes learnt that " the county veterinary
inspector had been over to the farm, and had ordered five cows with sore teats and inflammatory
symptoms to be isolated, and the milk from these cows to be stopped from sale." Dr. Sykes had
early cautioned the Highgate vendor against the supply of milk from the Hendon farm, and orders
were subsequently made by the sanitary authority of St. Pancras under section 71 of the Public Health
(London) Act, upon the milk vendor in Highgate and the farmer at Hendon, requiring them not to
supply within the district of St. Pancras any milk from the dairy and farm referred to, until the
withdrawal of such orders by the sanitary authority.
A special prevalence of scarlatina in the neighbourhood of Mill-lane, Hampstead, was investigated
by the medical officer of health, who reported that the disease " appeared to be greatly
disseminated by the agency of the schools in the district." The medical officer of health of Islington
comments on the diminution of scarlet fever shortly after the closing of schools for the August holiday,
and subsequent increase when the schools re-opened in September.
Many of the annual reports of the medical officers of health refer to the insufficiency of accommodation
in the hospitals of the Metropolitan Asylums Board. Such references are found in the reports
of the medical officers of Kensington, Fulham, Marylebone, Hampstead, Islington, Hackney, St. Pancras,
Strand, St. Luke, Shoreditch, and Battersea. The medical officer of health of Fulham expresses
the opinion that at times of insufficiency of hospital accommodation the selection of cases for removal
to hospital should be in the hands of the medical officer of health of each district. The medical officer
of health of Islington addressed a letter to the Metropolitan Asylums Board, recommending the
adoption of this course, but the Managers felt themselves unable to accede to this request. In Marylebone,
the sanitary authority itself opened a temporary hospital to meet the demands for removal of
cases which could not obtain admission into the hospitals of the Metropolitan Asylums Board. This
hospital consisted in the first instance of two houses in Marylebone-road, which were placed, free of
cost, at the disposal of the vestry by Lord Portman. Three other houses were afterwards added,
accommodation being provided for 105 persons. Into this hospital 280 cases of scarlatina and 9 of
diphtheria were admitted during the year.
Diphtheria
The number of cases* of diphtheria notified in London in the year 1893 was 13,712, and the
number of deaths belonging to London 3,197. The number of cases notified in 1892 was 8,368, and
the number of deaths registered 1,859. The number of cases had therefore increased 64 per cent., and
the deaths 72 per cent. In 1893 the death rate per 1,000 of population was '74, and the case rate 3 2.

Compared with the diphtheria death rates of other large English towns, having a population of
more than 200,000 persons, the London death rate shows a marked excess. It was in fact more than
double the death rate of any of these towns, except West Ham. It was ten times as great as the death
rate of Nottingham, and six times as great as the death rate of Liverpool. If the mean death rate of
London from diphtheria in the ten years 1883-92, be compared with that of the other towns, it is found
to be higher than that of any town except Salford.
* Cases include membranous croup. † The Infectious Diseases Notification Act only came into force in 1889.
‡ See footnote (†), page 6.