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The death rate of 1861-70 is materially affected by the deaths occurring towards the
close of the severe epidemic which took place in the latter part of the previous decade,
when the disease was not as generally recognised as at the present time. During the next
decade a lower mortality prevailed, but in the latter part of that decade the mortality began
to increase, and with slight fluctuations has increased until the year under consideration. The
mortality from diphtheria in each year of the period 1859-92 in relation to the mean mortality
of that period will be seen by reference to diagram VIII., which shows in a similar manner the
mortality from croup and diphtheria combined in corresponding years. The rates of mortality
from diphtheria in the two decades 1861—70 and 1871.80 corresponded closely with those of England
and Wales, but while that of London in 1881-90 was 26 per 1,000 of population, the rate of England
and Wales was 16, and in 1891 the London rate was double that of England and Wales. Dr.
Longstaff has pointed out that the incidence of diphtheria mortality upon densely inhabited districts
in England as compared with sparsely inhabited districts, has become relatively greater in more
recent times. I find also that with the more recent increase of diphtheria in London there is a change
in the age incidence of mortality from the disease, children at the ages 3 to 10 years suffering more
heavily in the decade 1871-80 than before. This change is observable also in the England and Wales
figures. Inasmuch as I am at present examining for the Public Health Committee in more detail these
circumstances, I refrain from discussing them further for the purposes of this report. It is probable
that some of the apparent increase of diphtheria is a question of nomenclature, and the close
connection existing between diphtheria and croup will be appreciated by reference to diagram VIII.
The medical officer of health of Whitechapel says: "with regard to diphtheria, I have before shown that
since that disease appeared more frequently, a corresponding reduction in the cases of croup became
evident." The medical officer of St. Luke says that: "I have in previous reports referred to the fact
that in proportion as the number of deaths registered from diphtheria increase those from croup
decrease."
Diphtheria.
In 1892, 8,368 cases of diphtheria were notified to the medical officers of health, and 1,859 deaths
attributed to this disease were registered. This number is in excess of that of any year since 1859
when deaths from this disease were separately classified by the Registrar-General in the London returns.