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142 ON THE SANITARY CONDITION OF
the year. Some difficulty was experienced in obtaining
admission into hospitals at this period from the
accommodation at the disposal of the Asylums Board
being fully occupied; but as shown on Table II., the
Strand fared better than many districts in this respect,
as 64 per cent. of its cases were removed, and it will
be noted that the removals were proportionately greater
from the poorer parts of the district. But although
removal was obtained eventually, it was, in a number
of cases of scarlet fever and diphtheria, not effected
with sufficient rapidity to prevent the infection spreading
to other members of the family or household, and
in crowded neighbourhoods this is an important point.
The deaths in the whole of London from scarlet fever
were at the rate of 4.2 per cent. of the cases notified,
and in the Strand District 13 per cent. (St. Anne 9 per
cent., St. Mary 18 per cent., St. Clement 17 per cent.)
Diphtheria and Membranous Croup.—79 cases
of this disease were notified, 53 were removed to
hospital, and 21 died, being 26 per 100 cases notified,
against 23 per cent. for the metropolis.
The great increase in London of this disease during
the last few years, and its marked fatality, make it
one of most serious importance, requiring careful
investigation. The knowledge we at present possess is
in many respects defective, and this, added to the
difficulty of recognising the disease in the early stages,
and in mild cases, must tend to promote its spread
from person to person. For undoubtedly it is chiefly in
this way that it is distributed either directly from the
poison exhaled in breathing by persons or animals, or
indirectly by the contamination of milk either by the