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In this table the progressive increase of mortality attributed to diphtheria,
and the equally progressive decrease of mortality due to other throat
diseases in London, are distinctly shown, the inverse ratio in the progression
being so well marked and corresponding so closely that the total of the two
classes of diseases shows no progressive variation, until the means of the
two quinquennia are compared, and then it appears that the mortality from
all throat diseases taken together decreased, a result for which the increase
in diphtheria mortality had scarcely prepared us.
The conclusions that I therefore came to were:—
(1) That a slight diminution had taken place in the death-rate from throat
diseases taken as a whole; and
(2) That the great rise in the mortality from diphtheria corresponded with
a great fall in that from other throat diseases.
As to the former, it may have been due to diminished prevalence, or to
greater vigilance, or to better treatment. Parents, guardians, teachers,
nurses, medical men, and the public generally are more alive to the danger
of throat diseases than formerly. As to the latter, many causes are possibly
at work, and a few words may be devoted to each.
1.—The. effect of the Infectious Disease Notification Act.— This Act came
into force in the Metropolis at the end of October, 1889, and has tended to
more care and attention being bestowed, not only upon diphtheria. but upon
all infectious diseases. On referring to the last table it will be noticed that
the great rises in the diphtheria mortality of the last decennium took
place from 1881 to 1883, and from 1887 to 1889, antecedent to the introduction
of compulsory notification, and that the persistent and gradually progressive
fall in the mortality of other throat diseases commenced in 1883,
seven years previous to the introduction of compulsory notification into
the Metropolis. Furthermore, during the past decennium there have not been
any rises in the mortality from other notifiable diseases comparable to that of