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keep indoors until absolutely compelled to do so; thus many struggle on at their work in
the early and distinctive stages of Influenza and do not consult a medical man until
these have passed oft, and Bronchitis or Inflammation of the Lungs has resulted. If
death occurs, then it is certified as due to the latter cause. It might thus lead to the
impression that this disease did not affect the Eastern Districts of the Metropolis so
much as the Western or suburban ones.
Notification of Infectious Diseases.—During the year 1891, 862 certificates
were received, as compared with 1,158 in the previous twelve months.

In London the Notifications per 1,000 inhabitants varied from 3.2 at Woolwich to
10 at Clerkenwell, giving an average over all of 8.5. Shoreditch shows a rate of 6 9,
which is exactly the average of the parishes in the Eastern Division, the lowest of these
being Whitechapel, 5.2; the highest Poplar and Betlnal Green, 9.2 each.
232 of the cases reported in 1891 were treated in Hospitals; 129 of the total cases
proved fatal. In 138 premises where infectious diseases occurred, works other than
cleansing of walls and ceilings were carried out to remedy sanitary defects discovered by
Inspector Lear.
Diphtheria, (including Membranous Croup), affected 237 persons as compared
with 207 in the previous year. The death-rate was 0.52 (including croup, 0 68) per
1,000 of population, as compared with 0.32 (including croup, 0.41) for London. The
presence of an outbreak of this disease in Islington caused an increase in the number of
cases in that part of the parish bordering on Islington.
Scarlet Fever produced 369 cases instead of 639, with a death-rate 0 0.13);
London being 0.14. This decrease corresponds with that noticed throughout the
country generally.