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(III.) DIPHTHERIA.
The increase of diphtheria during the last few
years in London and many of the larger towns is very
remarkable and disquieting, and all the more so that this
increase in the towns has gone along with a subsidence in
the country districts where formerly it prevailed largely.
That diphtheria is highly infectious there is no doubt.
There is also no doubt that it depends on a specific organism
which as a rule attacks the throat and in the first instance
grows there. Further, there can be no reasonable doubt that,
like typhoid fever, it spreads largely by indirect contagion;
but by what means this indirect contagion is conveyed is
even now a matter of great doubt. It is generally attributed
to imperfect drainage and the emanations from sewers; but
as Dr. Thorne Thorne shows in his valuable lectures,
embodying the information collected over many years by
his inspectors (all able men), there is no clear evidence that
it is connected with drains : and it is particularly noteworthy
in this respect that its increase in London has taken
place pari passu with the improvement of drainage. Moreover
it occurs relatively as frequently among the well-to-do
as among the poor. I have already mentioned that according
to my estimate the deaths in Camberwell due to this
disease were 118 this year against 85 in 1892. This is a
large increase. But the Registrar-General makes it 130;
doubtless by including in his computation cases I had good
reason to regard as not being truly diphtheritic. It is
important to note that while he attributes 130 deaths to
Camberwell, he attributes 184 to Lambeth, 167 to Battersea,
and 147 to Greenwich —parishes immediately adjoining our
own. These statements are of serious omen, for they lead