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26
Diphtheria.—In May I made a Special Report to the Health Committee
" Upon the causes of the increase of mortality from Diphtheria in London,"
which was printed and duly forwarded to your Vestry, and the principal points
of this Report I will summarise.
Comparing scarlet fever, diphtheria, and enteric fever in the three previous
decennia, the following are the results as recorded in Tables 18 & 19 of the
Registrar-General's last Annual Report.

* Includes also Typhus and Simple Continued Fever.
It will be observed that the scarlet fever mortality per million for London
fell from 1133 in the first to 600 in the second decennium, and in the 47th
report (1884) of the Registrar-General, it is suggested that the greater fall in
London than in England and Wales may have been due to the provision of
greater isolation and hospital accommodation. This would appear to be
corroborated by the fact that in the next decennium more isolation hospitals
having been provided in the larger towns, the fall in the mortality in England
and Wales was greater even than in London, and the two ratios per million
were almost equal in 1881-90.
The mortality from enteric fever fell in London from 244 per million in the
decennium 1871-80 to 189) per million in the last decennium, and in England
from 326 to 198 per million, due to improved sanitation. Comparing London
with England, exactly the same order of fall in mortality is observed as in the
case of scarlet fever. In the decennium 1861-70, enteric fever was embraced
under the head of Fevers, which included also typhus and simple fever ; at
this period the combined mortality from the three diseases in London was
higher than in all England and Wales, the former being 901, and the latter
886. The effect of sanitation first became apparent in London when the
mortality from enteric fever, taken alone, in the next decade fell below that in