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11
The conclusions that I have therefore come to are:—
(1) That a slight diminution is taking place in the death rate from throat
diseases taken as a whole; and
(2) That the great rise in the mortality from diphtheria corresponds with
a great fall in that from other throat diseases.
As to the former, it may be due to diminished prevalence, or to greater
vigilance, or to better treatment. Parents, guardians, teachers, nurses,
medical men and the public generally are more alive to the danger of throat
diseases than formerly. As to the latter, many causes are possibly at work,
and a few words may be devoted to each.
1.—The effect of the Infectious Disease Notification Act.—This Act came
into force in the Metropolis at the end of October. 1889, and has tended to
more care and attention being bestowed, not only upon diphtheria, but upon
all infectious diseases. On referring to Diagram II. it will be noticed that
the great rises in the diphtheria mortality curve of the last decennium took
place from 1881 to 1883, and from 1887 to 1889, antecedent to the introduction
of compulsory notification, and that the persistent and gradually progressive
fall in the mortality curve of other throat diseases commenced in
1883, seven years previous to the introduction of compulsory notification into
the Metropolis. Furthermore, during the past decennium there has not been
any rises in the mortality from other notifiable diseases comparable to that of
diphtheria. It will be observed also that my conclusions are not based upon
notifications but upon deaths, that the fatal—not the benign—forms of
disease are in question.
2.—The effect of the Reception of Cases into the Hospitals of the Metropolitan
Asylums Board—It will be unnecessary to discuss here the effect of the Board's
hospitals upon diphtheria raised in the interesting Paper of Mr. R. D. R.
Sweeting upon Post-Scarlatinal Diphtheria in the Transactions of the
Epidemiological Society, 1892-3, nor the etiology of the various forms of
diphtheritic throat affections treated so fully and with such exactitude by Dr.
Klein in the supplementary Reports of the Local Government Board, seeing that
it has already been shown by figures from the Asylums Board's own reports that
the mortality of diphtheria cases admitted diminished in each succeeding year.
It may be that the admission of cases to hospital may have had some slight
indirect effect in directing more care and attention to sore throats, but the
upward tendency of diphtheria commenced prior to this date, and therefore
this effect would be only part of the generally increasing attention already
being paid to the disease.
3.—The effect of Sanitary Legislation generally.—This must also be taken
into account, for the Public Health Act, 1875, came into force during the very
decennium when compulsory education came into force, and the effect of the
Act was to stimulate the recognition and prevention of infectious diseases in
England, especially in large towns. Compare the dates in the earlier tables of
this Report. This stimulus, doubtless, extended to the Metropolis, and, in
conjunction with additional sanitary legislation, directed closer attention to
infectious diseases in London also.