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52
year it was 23.5 per cent. The reduction in the rate of
mortality from the rates prevailing in 1888-89 is too great to
be accounted for on the assumption of diminished malignancy
in the type of the disease, and was more probably due to the
inclusion among the home-treated adult cases notified, of a
considerable number of cases of non-specific throat disease.
It is to be remembered, however, that in 1888, and during
the greater part of 1889, diphtheria was not notified, so
that non-fatal cases to a considerable number may have
occurred without my knowledge.
Diphtheria in London.—The deaths from diphtheria
in London in 1893 were 3,265; 1,984 above the corrected
decennial average and 0 76 per 1000 of the population:
they were also 1,380 more than in 1892, a year characterised
by the then highest death-rate on record from this
disease. The quarterly numbers of deaths in 1893 were
639, 677, 860, and 1,089. The Registrar-General, referr
ing to the increased mortality from this disease in recent
years, states that a part of it, but only a small part,
may be attributed, with much probability, to a number of
deaths which would formerly have been referred to croup
being now ascribed to diphtheria ; for, concurrently with the
increase under diphtheria, there has been a constant diminution
in the number of deaths from croup. If, however, the deaths
from diphtheria and croup be taken together, they amounted
in 1893, to 3,482, while the average number in the preceding
decennium, corrected for increase of population, did not
exceed 1861. Diphtheria, which was formerly mainly a
rural disease, shows an ever-increasing tendency to become an
urban disease. Fortunately, the hospitals of the Asylums
Board are available for the reception of sufferers from it,
but the accommodation is at present quite inadequate to the
demand.
The following table sets out some particulars with regard
to diphtheria in Kensington, in 1893,