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017 per 1,000 living, and in the preceding year the rate was only
0.18—rates far lower than those previously recorded. "The great
decline in the mortality from this disease in 1885 and 1886," we
are told by the Registrar-General, "was not peculiar to London,
but was shared by the whole of England and Wales, but not in an
equal degree; for the London rate was again below that of the rest of
the country as has very commonly been the case in late
years." The suggestion that the "comparative immunity of
London from scarlet lever may not impossibly be due to the greater
amount of provision it enjoys for isolation by means of public
hospitals, and the increasing use made of such means of isolation,
finds further support in the increased proportion borne by the
hospital deaths to the total mortality." This proportion has risen
from 7 per cent. in 1878 to 22'7 in 1886. The decline in scarlet
fever mortality in 1885-86 was due partly to a "diminished prevalence
of the disease, and partly to the disease having assumed
a milder form," a conclusion inferred from the "diminution of
the case-mortality in the hospitals," which, 111 per 1,000 in
1880, fell in 1885-86 to 81 and 84 respectively, a fall of 21 per
cent.; the death rate from it having fallen by 78 per cent. It has
been mentioned that the admissions of scarlet fever cases during
the month of October (305) were higher than in any month
during the past seven years, having been most nearly approached
in September, 1882, in which month the number of admissions was
250. As a consequence, the Managers, at their meeting on
November 20th, authorised the Ambulance Committee to make,
if necessary, additional accommodation for fever patients by the
re-opening of either of the hospitals then closed, or by such other
means as they might deem expedient; but the necessity did not
arise.
SCARLET FEVER DISSEMINATED BY MILK OF
DISEASED COWS.
In my last Annual Report, I stated that scarlet fever had
recently acquired a new interest for sanitarians as the result of