Diphtheria and Membranous Croup.—This disease was very
prevalent during the year, 738 cases of diphtheria and 25 of
membranous croup being notified. This is an increase of 191 over
the number for 1896. The attack-rate for the year is 3.5 per 1,000.
The number of deaths was 265, giving a mortality rate of 1.1 per
1,000 persons living in the Parish, against .50 per 1,000 for all London.
The chart shows the disease to have been present during the
whole year, with a marked increase during the latter half of the
year. This increase I was unable to associate with any particular
agency. It was not confined to any particular part of the district,
although the attack-rate has varied in the different wards. Schools
have not appeared to be conspicuous in causing a spread of this
disease, neither has milk been an agency to call for comment. There
seems the best grounds for belief that the disease has been spread
by personal infection, and in many of the secondary cases we have
been able, fairly well, to localise the source of infection; but the
majority of the primary cases appear to baffle our efforts to trace
them to their source. The connection of this disease with defective
house drainage I have dealt with in another part of this report.
Diphtheria and Anti-toxin Treatment.—The serum treatment
of diphtheria has now been on trial at the Metropolitan Asylums
Board's Hospitals during three years, and the general results have
been reported upon for the years 1895-1896. The conclusions
arrived at from the experience of those two years by the Board
1. A great reduction in the mortality of cases brought
under treatment on the first three days of illness.
2. The lowering of the combined general mortality to a
point below that of any former year.
3. The still more remarkable reduction in the mortality
of the laryngeal cases.
4. The uniform improvement in the results of tracheotomy
at each separate hospital.