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The account for all London was—Notifications 13,791. Cases
5 years and under, 5414: 6 to 15 years, 4042; over 16 years, 4335.
It is worthy of note that an analysis of all the cases shews that the
incidence of the disease at different periods of life was almost the
same in Bow as in all London, and still nearer that of the district
which is our antipodes—Kensington.
In the face of these figures there can be hardly any doubt as to
the existence of the epidemic. Possibly many cases of sore throat,
due to the infection of diphtheria, have not been notified, and I
consider it to be probable that many cases of non-infectious throat
have been notified as diphtheria. In the early stages and the aborted
conditions no medical man can venture positively to negative the
diagnosis of diphtheria. One case which came under my notice was
as follows:—A child had the characteristic membrane, and 3 days
after the mother complained of sore throat; an examination of the
throat showed nothing characteristic, no cause could be discovered
in the house for the attack: was it not very probable that the mother
contracted her sore throat from the child ? and had anyone seen the
mother's throat without knowing of the child's illness, what guide was
there in the case to point to its cause? Medical men may justly be
divided into two bodies—the one never notifies "diphtheria" without
the case is typical and complete, and the other does not wait for
developments.
If we consider that the intention of the Legislature in the Public
Health Act (London) 1891, and previously in the Notification of
Infectious Diseases Act, was to enable Sanitary Authorities to obtain
the earliest and surest information of the presence of infectious
disease, and give them an opportunity of searching for insanitary
conditions, we shall conclude that it is to the latter class of medical
men that the best thanks of the community are due. There are more
infectious throats than the diphtheritic, and it has long been recognised
that insanitary conditions frequently cause sore throats. An alteration
in the schedule of diseases, adding to it "Infectious sore throat" or
even simple "sore throat" would remove the conscientious scruples entertained
by some medical men on the score of notifying "diphtheria."