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This steady growth of Diphtheria is a most serious matter, and
demands the closest investigation. Many sanitarians have given it most
anxious consideration, and many reasons accounting for the increase
have been adduced, one being that the malady is better diagnosed, and
that consequently sore throats, which had been referred to other species
of disease, are now classed under their correct heading, and are accordingly
entered in the returns as Diphtheria. This solution is not, to my
mind, nearly sufficient, for it will not by any means explain the great
increase, especially in London, of the disease.
Diphtheria is a disease that, to a large extent, has been spread,
like other diseases, by the ordinary means of infection, such as personal
contact, fomities, and infected milk.
There are, however, other means by which it is propagated, and
these are school influences, defective sanitary fittings, and damp. In
my opinion these are the three great factors in its causation. I have
convinced myself that this is so by an examination into the circumstances
of 1,300 cases that were reported in Islington under the
Notification Act, from December 1892 to the present date. These
are no new theories; they have been discussed in the medical press
time after time, and therefore I do not intend to continue to discuss
them here; but I would say one or two words respecting the possibility
of contracting Diphtheria from sewer air, admitted into houses through
defective drains and other sanitary fittings. The possibility of the
disease being contracted in this manner has been altogether denied
by some writers. In the light, however, of personal investigation, I have
no hesitation in saying that even they would be convinced if they
could see the records I have collected. In case after case I find a