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140 ON THE SANITARY CONDITION OF
The great increase in the cases of notified diseases,
from 88 in 1891 to 186 in 1892 and 286 in 1893, is due
to the epidemic of scarlet fever which so extensively
prevailed throughout London in these two years. The
total notifications received were at the rate of 11.3 per
1,000 of the population, against 3.4 and 7.3 in the two
previous years respectively. Throughout the Metropolis
the average rate was 16T per 1,000 for 1893,
being 9.2 above the 1891 rate and 5.3 above the 1892
rate. 184, or 64 per cent., of the Strand cases were
removed to fever hospitals, as shown in detail in
Table II. (Form B). The amount paid for certificates
notifying the existence of infectious disease was
£26. 15s.
Smallpox.—2,930 cases were notified as Smallpox
in the Metropolis in 1893, and 30 of these related to the
Strand District; (but 1 case proved to be chicken-pox).
The bulk of the cases occurred in March and April.
Five of the cases were in persons ascertained to be
unvaccinated, and one died. The Ambulance Committee
of the Asylums Board report on the outbreak
as follows:—
"The introduction to and dissemination of Small"pox
within the Metropolis during the early part of
"the year were mainly due to persons of the vagrant
"class who entered London from places in the pro"vinces
where the disease was prevalent.
"Principally through the medium of these persons
"the disease was later on spread amongst the settled
"population of London.
"As a result, many of the Casual Wards, Salvation
"Army and other Shelters, and Common Lodging