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The marked increase of late years in the number of deaths due to
Diphtheria, especially in towns, in spite of the great improvements in
sanitation which have taken place, has attracted great attention, but
has as yet received no satisfactory explanation. The belief once
entertained, that Diphtheria was essentially a "filth" disease, has been
of late largely modified, and though there can be but little doubt that
insanitary conditions must at least predispose to the disease, it is
probable that direct infection plays the chief part in spreading
it. Attention has been drawn, notably by Dr. Thome, to the
increase of Diphtheria coincident with the extension of primary
education, and he, in common with others, regards the aggregation of
children at school as the most constant of the conditions under which
ordinary Diphtheria arises out of the prevalence of indefinite sore
throats, which so generally precede and accompany its outburst. No
special school influence could be traced in the cases occurring here
during the year, as among children attending school there were 99
cases with 23 deaths and 90 cases with 39 deaths among children not
attending school; the incidence of the disease, taking into account the
relative number of the two classes, being greater on the latter, and in
only five of the cases occurring among those not attending school was
the disease apparently contracted from another child in the same house
who had been attending school.