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15
necessary, since to close a school is to admit that it has been allowed to be:ome
generally infected to a dangerous extent. It would not be justifiable to close a
large school for a few cases of measles, yet they may be the forerunners of a
general outbreak.
The death-rate of measles is variously estimated from 1 or 2 per cent, to 10
or 20 per cent., according to the virulence of the epidemic. Taking 10 per cent.,
or 1 in 10, as the average in this instance, then the 206 deaths represent over 2,000
cases, probably the number occurring during the epidemic would be about onehalf
of these, as the remainder would be spread over the rest of the year.
SCARLATINA.
This disease caused 56 deaths, or 4 less than the previous year, and 38 less
than the average of the previous ten years. The good effect of the Metropolitan
Asylums Board's Hospitals is seen at a glance by comparing the annual numbers
in Table 5. Notification of this disease will still further reduce the mortality by
preventing the exposure of convalescents still infected, whom the medical attendant
has ceased to visit or advise; this, together with neglect of disinfection, being the
most fertile method of its propagation.
TYPHUS.
It is now five years since a death from this disease has been registered in St
Pancras.
WHOOPING COUGH.
From this disease there were 142 deaths against 199 in the previous year, and
an average of 181 in the ten previous years.
DIPHTHERIA.
This is another disease which shows a decided increase in mortality. The
number of deaths was 72, against 59 for 1887, and 46 for the decennium. Not
only in St. Pancras, but throughout the metropolis, this disease shows a gradual
and decided increase. It is interesting to observe in Table 8, B and C, that the
mortality is lowest in the lowest and southern districts, and increases gradually
towards the northern or highest districts This peculiar affinity of diphtheria for
the higher-lying districts has frequently been observed, and has been attributed
to the currents of sewer air in sewered towns, but the same phenomenon has been
observed in rural districts without sewers. Diphtheria has been assumed to be
due to some low form of growth. The growth is evidently averse to the water or
swamp of valleys, although, like most low forms of type inimical to man,
requiring a certain amount of moisture, and this it can find equally well in the
midden upon high ground, as it can in the crown of high-lying sewers with
considerable gradients, which rarely run as full as those lying in low or level
ground. The conditions are not dissimilar, and certainly do not justify but tend to
contradict the assertion that sewers do not propagate Diphtheria, in support of
which we have also the characteristic sewer-gas throat. It is possible that the
continuous crown of the network of London sewers may, in a measure, assist the
ramification and growth of Diphtheria.