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73
In the Greenwich District most of the cases were confined
to young children of school age. Some years ago this disease
used to be confined to the eastern part of the Parish, especially
in the Marsh district, but this year it has visited every part. I
believe that, owing to the highly infectious character of this
disease, it is largely spread in Schools.
Sir Thome Thome (Medical Officer to the Local Government
Board), in his Milroy Lectures on Diphtheria in 1891,
showed that since 1871, whereas the annual Death Rates from all
causes from the seven principal Zymotic diseases, and from
Enteric Fever, have been steadily falling in England and Wales,
in large towns, and in London, the annual Death Rates from
Diphtheria have been rising, slightly in England and Wales,
more markedly in the large towns, and most markedly in London.
Whilst the mortality of Diphtheria is still steadily rising,
that of Enteric Fever is equally steadily falling pari passu with
improved sanitation, and the mortality of Scarlet Fever is
also falling pari passu with increased Hospital isolation; so that
whereas the improvement of sanitation markedly decreases the
mortality of Enteric Fever, it appears to have no effect on
Diphtheria.
To what cause may this increase of Diphtheria be due ?
Many have been suggested.
1. School influence.
2. Sewer ventilation and unsanitary conditions.
3. Alteration in classification (particularly with regard to
Membranous Croup), now being classified with Diphtheria.
4 Connection with other throat affections.