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extremely doubtful. The presence in the population of a large
number of individuals unprotected by vaccination, will, I am
afraid, lead to a rise in the smallpox mortality.
Measles, including both intra-parochial and extra-parochial
leaths were 61, giving a measles death-rate of 0.92 per thousand
as against 0.68 per thousand for London as a whole. The presence
of measles epidemics seem to be a normal condition of the
district, at any rate, for the past three years, we appear never to
have been free from the disease. During 1898 we had an
epidemic at one time in the North, and again in the South and
Central districts. Perhaps, with a large juvenile population,
this is not to be wondered at, but the cost to infant life is
extremely great, and probably calls for greater efforts to deal with
the disease.
Scarlet fever caused no deaths in the district, but 13 occurred
amongst the patients treated in external hospitals. This gives a
death rate of 0.19 per thousand, that for London as a whole
being only 0.13 per thousand. As has been noticed in recent
years the mortality continues very low.
Diphtheria caused during the year 10 deaths in the district,
and 26 deaths also occurred among the cases removed for treatment,
making a total of 36, and giving a death-rate of 0.54 per
thousand. It is gratifying to be able to report a decided improvement
upon the mortality of last year, which was 0.7 per
thousand, Clerkenwell holding the unenviable position of having,
with the exception of Woolwich, the highest diphtheria deathrate
amongst the London Districts. Its position is now altered
from 2nd to 9th of the highest districts. Much good has resulted
from the energetic measures taken last year. Recognizing that
Clerkenwell was peculiar in having a large number of houses
which, originally built for one family, were now inhabited by
several, and as a consequence are ill-adapted for home nursing of
diphtheria, a special effort was made to have cases removed for
treatment, and the number of cases treated at home in unsuitable