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6
allowing for the proportionate decrease in all London, give a
lower number, and I have therefore taken the mean between
these and that of the progressive rate of increase.
As we have had an unusually large mortality from
diarrhoea, and an epidemic of scarlet fever, this low death-rate
is very satisfactory. The deaths from scarlet fever have been
much below the average of the preceding ten years, as they
were only 55 against the decennial mean of 83. This result
has arisen chiefly from the extreme mildness of the disease, as more
cases were reported to me this year than in 1886 or in 1882;
the two last years when it was epidemic. In 1882, when I
received reports of 287 infected houses, the number of deaths was
144, and 118 in 1881 ; whilst in 1886 there were 283 infected
houses reported and 70 deaths, against 293 infected houses in
1887, and only 55 deaths. An examination of the death returns
showed that there were comparatively few complications, such
as kidney disease, in 1886 and 1887 as compared with former
epidemics. The number of cases in a house amongst those who
had not been previously attacked, so far as I could learn, was
not less than in former epidemics, so that there did not appear
to be any relation between the diminished mortality and the
intensity of infectiveness. In my last report I discussed at some
length the important question of the influence of the hospital in
the spread of the disease in this district, and arrived at the conclusion
that the evidence up to that time showed that, unlike smallpox,
there was not such an aggregation of cases in the vicinity
of the hospital as to lead to the belief that the disease was
spread from it by aerial infection, and that, therefore if the
hospital had exerted any injurious effect, it must have been by
personal rather than by aerial infection. I have this year
followed out the same plan of ascertaining the precise locality
of each infected house, and showing it on a map, plotting down
only one case for each house, with results somewhat intermadiate
between those obtained by the discussion of the cases
in the years 1832 and those of 1886.