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20
DIPHTHERIA (INCLUDING MEMBRANOUS CROUP).
The cases certified numbered 177, but of these, 55, or 31 per cent. were not
regarded as cases of diphtheria at the hospitals of the Metropolitan Asylums Board,
the diagnosis of the Board's medical officers being in 42 instances tonsillitis, in 7 scarlet
fever, 3 Vincent's angina, 1 stomatitis, 1 laryngitis, and in 1 measles. To those who
are not familiar with the difficulties attending the diagnosis of cases of diphtheria it
might seem somewhat extraordinary that in such a large number of the cases removed
to hospital as diphtheria there should be difference of opinion as to the nature of the
disease. The explanation is that there are several affections of the throat which upon
examination at the bedside of the patient may appear to be diphtheria, and the true
nature of the disease only becomes manifest after careful and oftentimes prolonged
observation combined with the help of the bacteriologist. It would obviously be dangerous
to keep patients for this purpose in the homes of the poor, where isolation is
impossible and the medical attendants in the vast majority of cases base their diagnosis
upon the results of inspection of their patients' throats, and in more than two out
of three they are correct as to the disease being diphtheria.
The cases certified as diphtheria in 1904 numbered 183, including 47 which
were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board.
Deducting the cases not regarded as diphtheria, the cases were distinctly less numerous
in 1905.

The cases are grouped according to ages in Table III. (Appendix).
Slightly over 93 per cent. of the cases certified were removed to hospital as compared
with 94 per cent. in 1904, 88 in 1903, 84 in 1902, 83 in 1901, 86 in 1900, 80
in 1899, 77 in 1898, 67 in 1897, and 65 in 1896.