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"for thorough disinfection of clothing and person to be carried out, and the ordinary precautions
as to cleanliness taken." The medical officer of health of St. Pancras states that upon receipt of
a certificate inquiry is made at the house as to the circumstances and any possible source of infection
; sanitary inspection of the premises is made and the drains tested; the question of the
degree of isolation requisite is left to the medical attendant and nurse; and upon recovery, or removal,
disinfection of the bedding and clothing by steam is enforced.
Inquiry made by the medical officer of health of Paddington into the circumstances of the
five cases of puerperal fever in that district showed that "in four the labour was more or less
complicated, requiring the attendance of more than one medical practitioner; that there were
different practitioners, midwives, and nurses in each case; that three of the patients resided in
basement rooms; and that the condition of the houses was described as 'clean,' or 'very clean,' in
four out of five, the state of the fifth house not being specified. The sanitary condition, i.e., as
regards drains, &c., was found to be excellent in one case, bad in a second, and very bad in the
remaining three. The nurse in one case was an amateur, a friend acting through goodwill. She
had never assisted at a confinement before, and her appearance when seen (qua dirt) was such that
it is to be hoped that she will never act as nurse to a puerperal woman again. One case occurred
next to a house the drain of which had been opened for examination two days prior to the confinement,
and was not properly covered in when that event came off."
In Fulham each of the eight cases of puerperal fever was attended by a separate practitioner
and nurse.
Influenza, Bronchitis, and Pneumonia.
The deaths attributed to influenza, which in 1897 numbered 671, rose to 1,283 in 1898, the
corrected annual average for the preceding ten years being 1,138. The deaths attributed to
bronchitis and to pneumonia were, however, below the corrected annual average of the preceding
ten vears.

The following table is of interest as showing the rapidity with which influenza may increase
from small to epidemic proportions, and the fact that the mortality from the disease has usually
attained its maximum in the late autumn or winter months.

Phthisis.
The deaths from phthisis in the Administrative County of London during 1898 numbered
7,762.
* The deaths occurring in the 53rd week of the years 1890 and 1896 are excluded from these figures.
1 Eee footnote (2), page 3.