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1588, whereas the decennial average, after correction for growth
of population, was only 932. In about half of the Metropolitan
Sanitary Areas the deaths have gone up at least 50 per cent. since
1887; in many of them they have been doubled, and in some
cases more than trebled in that short period. The mortality was
above the decennial average throughout the entire year, having
only fallen in two weeks to the average level, but its main excess
was in the four months from the middle of June to the middle of
October. The Registrar-General further remarks that it is
probable that some part of the increase under diphtheria may be
due to a diminution under the heading "Croup." But this can be
only a partial explanation of the rise which was far greater than
the falling off under croup. For the deaths from diphtheria and
croup together amounted to 2068 in 1889, while the decennial
average, after due correction for increase of population, would
have been only 1647.
HOSPITAL ACCOMMODATION FOR DIPHTHERIA.
I stated, in my Report for 1887, that the Managers of the
Metropolitan Asylums District were willing to admit sufferers
from diphtheria into their hospitals, but that the Local Government
Board, acting upon a medical opinion that this disease does not
fall within the category of "Fever," as that term is used in the
Metropolitan Poor Act, 1867, deemed it desirable that if cases of
diphtheria were to be admitted there should be express legislation
for the purpose. Happily the necessary legislation was effected
last year by The Poor Law Act, 1889, the third section of which
enables the Local Government Board to issue an order authorising
the Managers to receive diphtheria cases at their hospitals. So
urgent was the need, that the Local Government Board informed
the Managers in October, 1888, that if they determined "to admit
such cases, the Board, with the view of removing any difficulty
with the Auditor, would be prepared, on application from the
Managers, to sanction any expenditure incurred in the treatment
of such cases, which, in the opinion of the Auditor, was not open
to question otherwise" than on the ground that, as they had been