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means of ambulance steamers the patients are conveyed down
the river to Long Reach, where the hospital ships are
moored. This floating hospital has accommodation for 400
patients, and four miles inland there is a large convalescent
hospital capable of holding 800 patients. One inconvenience
in connection with this arrangement has been brought under
my notice by which, in cases of doubtful or mistaken
diagnoses, patients are mixed up with genuine small-pox
cases at the Wharf pending the decision of Board's officer,
who appears to be the sole arbiter of what is, or is not, a
case of small-pox.
Diphtheria.—The deaths from diphtheria were in excess for
the whole of London, the rate for 1893 being again the
highest yet recorded from this disease. The total number of
cases notified during the year in this Parish was 158 against
136 for lb92 ; and of these, 60 were sent into hospitals.
Including Membranous Croup (2), the total deaths of
parishioners from this cause was 38 — being in the
proportion to 0.51 per 1000 living against 0.76 for
the whole of London. The death-rate from this cause
was higher in all the neighbouring parishes than in
Hampstead. To have reached the average of London
our deaths should have been over 50—the number, indeed,
returned for Lewisham, a parish almost identical in population
with Hampstead. The danger of an upward flow of
sewer air as a factor in the production of diphtheria has, at
times, received undue importance, for there would be little
difficulty in showing that in the crowded populations of the
low lying parishes this disease was both more frequent and
more fatal. I append a list of the fatal cases, with the
address of the houses from which the patients came, by which
it will be seen that the cases were pretty generally scattered