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hand, it sometimes happens that true diphtheria is not
recognised in the primary stage: the nature of the disease
does not become known until paralysis supervenes. Cases
of croup, again, are sometimes described as diphtheria, and
vice versa. Diphtheria, it may be added, does not often show
a disposition to become epidemic, or even endemic, in the
metropolis. Occasionally, however, when the disease occurs
as a result of insanitary conditions, it will spread in the
family : thus, for instance, there were five cases in a family
living in rooms over a stable at Ruston Mews, Notting Hill,
the first case being due to defective drainage, and the following
cases to infection. The first case was concealed and
fatal: its existence became known upon the registration of
death only, and it was found impossible to persuade the
parents to let the other children—for all the sufferers were
children under fourteen—be removed to the parish infirmary.
The Asylums Board, it may be mentioned, do not treat
diphtheria in their hospitals.
Fever.—The deaths from the three diseases grouped as
"fever," were 35, viz., 28 in the Town sub-district, and 12
in Brompton; the decennial average, corrected for increase
of population, being 36.3.
Typhus. Two deaths from this highly infectious disease
were registered, viz., that of a manufacturer of parquet
flooring, aged 54, at Lancaster Road, after five days illness,
and that of a school girl, aged 12, at St. Ervan's Road,
Notting Hill. I was unable to obtain any definite information
as to origin in the first case: the circumstances of the
second case were peculiar, and strongly suggestive of error
in diagnosis. The deceased was a daughter of an upholsterer,
being a "half-time" pupil at Buckingham Terrace Board
School, and lived in service at Hammersmith. She was
sent home unwell November 1, and next day was taken to a
private "Dispensary." She was subsequently attended at
home by the "Dispensary" doctor till she died, on the 7th,
having been visited five times in as many days. The doctor,