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Scarlatina was once more singularly absent as an epidemic from
our district, 25 deaths only being referable to this disease during the
year.
The next lowest number was 29 in the previous year, the highest
having been 465 in 1870.
During the last five years the deaths have been gradually
declining from 142 in 1882 to 95, 57, 29 and 25 in 1886, whilst in the
corresponding years the deaths from Diphtheria have been successively
54, 70, 114, 138 and 54.
The distinction between Scarlatina and Diphtheria was either
unrecognised or unacknowledged before the year 1859, when for the
first time the deaths from these diseases were separately registered.
At that time, from the result of the observations made by my
predecessor, Dr. Ballard, and by others in connection with the cases
of Diphtheria which occurred both in 1858 and 1859, there were no
doubt excellent reasons for making a distinction in the classification
of these diseases, and the necessity for this may still be fairly admitted
to exist.
The careful diagnosis, however, of the first investigators in respect
to this disease, who noted and stamped its specific characteristics
as distinguished from Scarlatina, has been gradually much widened
if not altogether departed from, with the curious but apparent
result that in the course of years the proportional fatality of Scarlatina
and Diphtheria has altogether changed, for whereas in the first year,
1859, and for two decenniads afterwards, the deaths from Scarlatina
were, with slight variations, several times in excess of those attributable
to Diphtheria, the proportional relationship (more especially since the
death of the Princess Alice) has been constantly diminishing until it
is now altogether reversed, and the deaths from Diphtheria in London
generally exceeded those referred to Scarlet Fever during the years
1885 and 1886, whilst in Islington the deaths from Diphtheria in 1884
and 1886 were twice as many as from Scarlatina and in 1885 they
were very nearly five times as numerous.
With these facts in view, the following Table, having reference to