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that this lowered mortality must, in a measure, be due
to the admission, of late years, of a greater proportion of
mild cases. In olden times the tendency was to keep (and
conceal) such cases at home. Concealment, since the Notification
Act came into operation (October, 1889), cannot have
been largely practised; and a great many mild cases have,
as a result of notification, been removed to hospital. In
1887, when the disease was last epidemic, the deaths were
1443. In only four of the 28 years, between 1859 (when
scarlet fever and diphtheria were first differentiated by
the Registrar-General), and 1886, inclusive, viz., in 1872,
1873, 1885, and 1886, were the deaths so few as in 1887.
In these four years the deaths were 918, 645, 722 and 690,
respectively. In six of the years the deaths ranged between
1430 and 1902 annually; in ten of the years the deaths were
between 2000 and 3000; in five of the years between 3000 and
4000; in one year between 5000 and 6000, and in one year
(1870, when the population was a million less than in 1891)
upwards of 6000; numbers in comparison with which the 6072
deaths that occurred in the six years 1887-92 seem few
indeed The moderate total for 1892, viz., 1174 deaths, being,
as before stated, 60 below the corrected average, probably
represents, in proportion to cases notified, the lowest rate of
mortality on record, viz., 4.2 per cent.
The year did not pass without furnishing illustrations of
probable modes of spread of the disease. Two may be
cited:—
A child, aged 10 years, was taken ill on or about May 27th. She
with her mother and an adult sister, occupied a single room. Mother and
sister worked at two laundries. A doctor was called to see the child
May 31st, but he did not notify the illness. On June 4th another doctor
was called in, and he notified the case, but neither removed the child to
hospital, nor referred to the circumstances above set out. The facts came
to light on visitation of the case, on Monday, June 6th, upon receipt of
the notification. I wrote to the certifying doctor stating the facts, and
advising removal, but had no answer. I wrote to the mother and to the
laundresses intimating that the attendance of the mother and the sister