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18
children are allowed to mix with others, and this is one
means of the disease spreading.
In July, September, and October, the hospital accommodation
of the Metropoliton Asylums Board was insufficient to
take all the cases requiring removal, and a number of
patients had to wait day after day without proper isolation
at their homes. This has occurred on many previous
occasions. I am aware that it is a difficult matter to
prepare for prospective epidemics, but at the same time, as the
deficiency in accommodation has occurred year after year, it is
to be hoped that adequate measures will be taken in the near
future to prevent a repetition of what has been felt by some
to be a serious slur on the administration of the Board.
Diphtheria.
In spite of all the improvements that have been carried out
in the way of sanitation in London, this disease continues to
increase. In 1895 there were 11,426 cases, and in 1897 13,192
cases, but whilst the numbers have increased, the mortality
has decreased. In 1895, for London, the case mortality was
20*0 per cent., and in 1897 this was reduced to 16*9 per cent.
This has been largely due to more effective isolation and more
skilful treatment. The antitoxin treatment is now largely
adopted both by the medical men in the Isolation Hospitals and
also in private practice, with the most beneficial results. In
this district the number of cases notified during the past year
was 445, as against 537 in the year 1896, whilst the case
mortality per cent, has fallen from 14*5 in 1896, to 13*9 in
1897. There is no doubt that school attendance bears a
singular relation to the spread of this disease, as it has been
many times observed during the past few years that as soon as
the school holidays begin, the disease declines until the schools
resume work, when it again increases. In all the cases that
were notified to us measures were taken to prevent any children
in the infected premises attending school, until the patient
had recovered, or had been removed to a hospital, and
also in all cases where possible disinfection of the premises
was carried out by the officers of the Vestry. In