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12
Diphtheria.—This disease has been very prevalent in Shoreditch, and in
London generally during the year, and has claimed many victims. To describe
it briefly, diptheria is a specific infectious disease, which is characterised by
the presence of what is known as "false membranes" in the throat, nose
and elsewhere, and by constitutional symptoms, which are more or less severe.
The intensity of the local mischief is, however, by no means, always in proportion
to the severity of the constitutional symptoms. It is always to be met
with in large cities, in fact, it may be said to be endemic in them, but at times,
as during the present year, becomes very prevalent. This increasing prevalence
in large towns and cities has been now observed for some years past, and
this, notwithstanding the great improvements which have been made in
sanitation during recent years. The popular impression is that diphtheria is
mainly caused by effluvia from faulty drains. That there is a relation between
this disease and defective drains, there is no doubt, but it has not yet been
satisfactorily determined. It has been suggested that where the drainage is
faulty, there is produced a weakened condition of the throat, which affords the
germ of diphtheria an opportunity of growing and producing the disease.
When once a case has arisen, however, I do not think too much stress can be
laid upon the fact that it is extremely infectious, especially amongst children,
who are, by far, the most frequent sufferers from this complaint. At least 80
per cent of deaths from this disease occur amongst children below 10 years of
age. Amongst adults, those who are in attendance on the sick, are most liable
to suffer from it, particularly mothers, nurses and medical men.
The poison which produces this disease shews great tenacity and clings to
clothing, bedding, and the room in which the patient has been confined for a
considerable period.
In Shoreditch, during the year 1893, there were notified as diphtheria 513
cases of throat illness. Of these, 149 or 29.0 per cent. terminated fatally.
Under the age of five years, 181 cases occurred with a mortality of 111 or 61.3
per cent. Of the remaining 332 cases, 38 or 11.4 per cent. died. On referring
to Table II, it will be seen that all the deaths, with the exception of four, were
amongst children below the age of 15 years.

*Case Mortality = the percentage of attacks terminating fatally.