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16
Without imputing any blame to the Board for this want of
accommodation, I am of opinion that the inability to remove all
cases led to an increase in their number in this district. It
may be said that I am reversing the actual facts, and that the
failure of the Board was really due to the excess of cases. But
the prevalence of scarlatina does so much depend upon the ability to
isolate quickly the earlier cases, that a difficulty in accomplishing
this must necessarily lead to an extension of the disease. That the
increase did take place when the Board felt the pressure may be seen
by a glance at the chart. In addition, I would put forward the
following table of the number of applications made to the Board
for the removal of each case,
showing that there was considerable
delay in the removal of a large number of patients.
No of Applications
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Cases removed after
above number of applications
97
93
28
14
9
9
9
1
3
3
2
_
1
3
1
Further evidence in this direction is furnished by the fact that
several secondary cases occurred in homes where there had been
great delay in the removal of the primary cases.
Diphtheria and, Membranous Croup. During the year there were
554 cases of Diphtheria, and 18 of Membranous Croup notified in
the district. These give an attack rate of nearly 2.7 per 1000 for
the year. The deaths numbered 143, making the death-rate *67 per
1000 living persons. For the year 1895 the attack-rate was 2.2 and
the mortality rate *36 per 1000. So that in 1896 not only was the
number of cases larger, but the mortality nearly double that of the
previous year. This increase of the mortality depends no doubt on
the type of the disease, which varies in different epidemics as that
of other infectious fevers.
There is no doubt that for some years diphtheria has been
ncreasing in London, and we in Hackney have shared in the general
increase. As to the cause of the increase very little can be said
with any degree of certainty. At one time the disease was almost
confined to rural district, but of late years it has increased in towns