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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.
School Influence. In 1870 the Elementary Education Act
was passed for the establishment of School Boards and Elementary
Schools.
Now, whereas during the decade 1861-70, the number of
deaths from Diphtheria decreased annually, during that of 1871-80
they increased annually.
Sir Thome Thorne lias so fully and so carefully entered
into this subject of "School Influence," that his conclusion that
increased school attendance has had a material influence in
increasing the spread of Diphtheria is irresistible.
Although I am of opinion that "School Influence" has been
a potent cause in the spread of Diphtheria, I cannot charge
"School Influence" with being the sole cause of the great
increase that has occurred since the year 1893. I would rather
surest that the great increase is primarily due to one of those
peculiar waves that come over us in the form of an epidemic, the
cause of which is unknown at the present time. I have no doubt