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The above figures refer simply to the number of deaths
in the years referred to respectively.
Chart II., which includes the number of notifications
per 100,000 and the relation of the fatality to the average,
though somewhat complicated, will be found well worth study.
It happens, curiously enough, that in the first and last of the
series, viz., 1892 and 1903, we have the two points at
which the notifications were less numerous than at any other.
In 1892 the notifications were 312 upon a population of
238,788, with 85 deaths, or a case mortality of 35 per cent.
In 1903 the number of notifications was 367, with 36 deaths,
or a case mortality of 9.8. Allowing for the difference of
population, the numbers 312 and 367 are fairly equal, so that
we are confronted with the fact that by some means or other
the mortality from diphtheria in 1892 was, roughly speaking,
four times what it is found to have been in 1903.
Two changes only have occurred in the interim, viz.,
the provision of means for early diagnosis and a similar
provision for effectual treatment. It seems, therefore, not
unreasonable to conclude that these factors have been the
determining ones in bringing about this highly satisfactory
result.
In the case of scarlatina, whilst we find that the
epidemics are both less frequent and less severe than was
formerly the case, the mortality still tends to rise above the
average and to vary in its fatality in different epidemics; nor
do we find any evidence of the fact which is very remarkably
shown in the case of diphtheria, especially in the epidemics of
1896 and 1899, that while the number of notifications increased
considerably, the case-mortality was, in the first year, but
little in excess of the average, and in the second, very decidedly
below it.
Chart III. shows directly the number of deaths from
scarlatina and diphtheria respectively for the twelve years, the
average in each case being indicated by a dotted line, and in
this case the points referred to in the preceding paragraph and
especially the steady and continuous fall in the fatality of
diphtheria, as compared with that of scarlatina, are still more
strongly marked.
I desire to add in concluding this part of my report, that
in my opinion, neither the provision of anti-toxin, nor the