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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 1831-90.
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
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 904, 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 England and Wales; in the last decade, when
sanitary measures outside London had also improved, the ratios for England
and for London fell so as to approach each other.
Turning to diphtheria on the other hand, in both England and London the
mortality was less in the second decennium than in the first, but in the last
decennium it was greater than in the second, and in London had increased to
a higher ratio even than in the first. Comparing London to England, in
the first decennium the ratio of mortality was about 5 per cent lower than in
England, in the second was about equal, and in the third it was about 60 per
cent. higher.
Dr. Longstaff, in his paper on "the Geographical Distribution of Diphtheria
in England and Wales," in the extra supplement to the Report of the Medical
Officer of the Local Government Board for 1887, found the death-rates from
diphtheria per million of population, according to density to be as follows:—
Districts according to density of population. 1855-60. 1861-70. 1871-80.
Dense Districts 123 163 114
Medium „ 182 164 125
Sparse „ 248 223 132
The noticeable feature in these figures is that a progressive diminution in
the mortality from diphtheria appears to have been taking place in rural
districts, being most marked in the mostly sparsely inhabited.
Dr. Thorne Thorne, Medical Officer of the Local Government Board, in his
work upon diphtheria published in 1891, showed in tabular form (Table No. IX.)
that since 1871, whereas the annual death-rates from all causes, from the seven
principal zymotic diseases, and'from enteric fever, have been steadily falling in
England and Wales, in the large towns, and in London, the annual death-rates
from diphtheria have been rising slightly in England and Wales, more
markedly in the large towns, and most markedly iu London.