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The death rate of London was 18.5, the lowest on record,
while the death rate in the "Outer Ring" of suburban
districts, with a population of considerably over a million, did
not exceed 15 0 per 1,000 against 15.9 the previous year.
The death rate in the twenty-eight great towns, with
an aggregate population of over nine millions, was 19.2,
ranging between 16.1 in Brighton, and 26.1 in Manchester.
Although in this district the mortality from diphtheria
was not as great as in the year 1880, the increase of deaths
from that complaint is a most important matter, more especially
as during 1888 the disease was not confined to any
particular suburb, but was more or less epidemic over the
whole Metropolitan area.

On enquiry as to the cause of the disease, it was in many
cases directly traceable to defective household sanitary arrangements.
In others no solution was arrived at.
I am strongly of opinion that milk is often the cause
of this ailment, and that it is quite as likely to occur from
milk supplied from first-rate dairies and where the cows
receive every possible care and attention, as it is from a dairy