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are concerned, the position of Woolwich is decidedly
satisfactory. It is quite true that it is a serious matter
to have a large amount of non-fatal preventable disease
which causes suffering, inconvenience, and expense;
but, on the whole, notifications have been less since
1900 than in the previous ten years. In the four years
1901-4, there was a very marked diminution. The last
three years, however, have again shown a rise, but this
rise did not reach nearly the high-water mark which
was attained by both these diseases in the previous
decade. As I have already pointed out, deaths are
a much more reliable measure of serious illness than are
notifications. It must be remembered that only a
certain proportion of the cases of infectious disease
which occur are notified, and this proportion varies from
different causes. The poor cannot afford to call in
medical advice, and among them a large proportion of
cases of infectious disease are never detected. This
was even more the case in past years than it is now.
Although the number of notifications of Diphtheria has
been larger in the past three years than for some five
years before, I have little doubt that the actual number
of cases of Diphtheria has been no greater. Many cases
are now discovered by bacteriology and notified, which
could not have been discovered before bacteriology was
used for this purpose. The more active the sanitary
administration of a borough, the larger the number of
mild, infectious cases discovered, and hence the number
of notifications increased. Probably one reason why
Woolwich has more notifications but fewer deaths from
Scarlet Fever and Diphtheria than the rest of London,
is that more mild cases of these diseases are detected
and notified. Another reason is that owing to the
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